Overview of guidance/frameworks

1. Overview of guidance/frameworks SAG PF OGAC Prevention Draft Guidance

2. SAG Priorities Epidemiologically/demographically focused targeted -KYE/KYR Scale up combination prevention strategies that are evidence based and have been shown to have an impact including biomedical, behavioral and structural interventions Promote SAG and community ownership and leadership for prevention Focus on social and structural drivers and behavior change using a multi-sectoral response to address HIV

3. SAG Priorities System strengthening (information use, program planning design and implementation, policy, standards, skills transfer Mainstreaming prevention across sectors and within systems Strengthen coordination across government sectors and among levels

4. SAG Priorities Roll out PHC strategy: a framework for a comprehensive, integrated community-based prevention program Implementation of DBE prevention strategy: an evidence-based framework to reduce vulnerability among youth in school Strengthen community response – community outreach, community mobilization, and reinforce sustainable integrated response at community level

5. Partnership FrameworkGoal 1 Prevent new HIV and TB Infections comprehensive, multi-sectoral, integrated and epidemiologic focus • Expand coverage of combination interventions that address the drivers • Reduce vulnerability to HIV and TB infection • Increase the number of persons who know their HIV and TB status and link them to appropriate services

6. OGAC Guidance • HIV Plan must align with locally specific epidemiology and the host government • Assure coverage and reach of prevention among priority populations • Assure that interventions address populations and communities so that the level of investment matches the level of risk

7. OGAC Guidance Country Prevention Plan must • Use a continuum of response model • Enhance coordination between prevention, care, and treatment • Identify/implement the optimal combination of prevention, care, and treatment activities to maximally reduce new infections • Assure that the most effective biomedical, behavioral and community/structural interventions are prioritized

8. OGAC prevention guidance Programs must: • Work with local government to track and reassess the epidemiology, in order to fashion an optimal prevention response based on best available and most recent data; • Emphasize proven/ effective approaches and targeting interventions to populations with high incidence rates; • Engage communities to assure effective quality coverage with a combination of prevention interventions and services; • Increase emphasis on supporting and evaluating innovative and promising prevention methods.

9. Ogac guidance Country plans will focus on: KYE/KYR/KYC/KYC • Prioritization of populations and geographic areas • Coverage of targeted population • Understand and address the social, structural and political contexts • Effectiveness and cost-effectiveness of the intervention • Quality assurance, monitoring, and evaluation mechanisms • Interaction, combination and targeting of interventions

10. Conceptual Framework Programs to Address Behavior The importance of behavior extends beyond specific behavioral interventions. It shapes the context for all prevention programs and should be a part of all other interventions, including biomedical – e.g. media and community-based activities to increase awareness, create demand, and support prevention interventions Priority Interventions Treatment coverage • HIV testing and Counseling • Routine Opt out in clinical settings • Testing in non-clinical settings Critical Enablers e.g. Programs addressing GBV; STI diagnosis and treatment; efforts to change existing structures, policies, and regulations that are barriers Innovation/ Evaluation e.g. Stand-alone programs to address risk reduction, Economic strengthening Core Interventions PMTCT VMMCCondoms Comprehensive packages for MARPs PwP PEP Foundational Blood Safety Universal Precautions School-based and non school based programs for youth

11. Key Themes Support SAG leadershipand capacity in evidence-informed decision-making for effective prevention programming and resource allocation Support community led response to improve the quality, effectiveness, and coverage of an optimal combination of prevention interventions that address the biomedical, behavioral and structural drivers of the epidemic Improve effectiveness of targeted prevention programs to reduce vulnerability to HIV and TB infection Use a continuum of response model, reinforce linkages and referrals among prevention, treatment, care, RH and TB services Strengthen key systems that deliver Prevention services Assure gender responsive interventions promote positive gender norms

12. PEPFAR/SA Prevention Principles Aligned with and supporting the SAG National Strategic plan and priorities Epidemiologically targeted (with a focus on areas of highest estimated incidence with populations at greatest risk of infection) Evidence informed – or based on promising practice Address the key drivers of the epidemic Strengthen systems and use existing structures Have the greatest potential for population-level impact on HIV incidence