Progress 34 x008fpact Mx008btx008bgatx008bon 33 Cx008ax008bx008edren x008bn x008bnstx008btutx ID: 118376
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Progress 1. STATUS AT A ANCE .................................................................... 6 1.1. ncŽus‹veness of tŠe staeŠoŽders ‹n tŠe report wr‹t‹ng process ........................................... 6 1.2. Status of tŠe ep‹de‹c ................................................................ 6 1.3. TŠe poŽ‹c› and prograat‹c response ............................ 7 1.4. Overv‹ew of ARPR and eaŽtŠ Sector V nd‹cators ......................................................... e;äääääãͺ 2. OVERVE OF T E ADS EPDEMC ..................................... 26 3. NATONA RESPONSE TO T E ADS EPDEMC ....................................................................... e;äääääã26 3.1. ntroduct‹on ................................................................................ 26 3.2. Prevent‹on .................................................................................... 27 3.2.1. Non B‹oed‹caŽ ntervent‹ons ........................................ 27 3.2.1.1.audio .................................................. e;ääääääääääää....................................... 27 3.2.1.2.Audio .................................................. e;ääääääääääää............. 27 3.2.1.3.Interventions .................................................. e;ääääääääääää........ 2ͺ 3.2.1.4. .................................................. e;ääääääääääää.................................................. e;äääã2ͺ 3.2.1.5.Qualitativequalityeffectivenessbiomedicalinterventions .................................................. e;ääääääääääää............................... 2Í» 3.2.2. B‹oed‹caŽ ntervent‹ons .................................................. 2Í» 3.2.2.1. .................................................. e;ääääääääääää........................................... 2Í» 3.2.2.2.SexuallyInfections .................................................. e;ääääääääääää.. 2Í» 3.2.2.3.Safety .................................................. e;ääääääääääää........... 3â 3.2.2.4.MaleCircumcision .................................................. e;ääääääääääää....................... 3â 3.2.2.5.Transmission .......................................... 3â 3.2.2.6.Qualitativequalityeffectivenessinterventions .................................................. e;ääääääääääää............................... 31 3.3. Treatent, care, and support .............................................. 32 3.3.1. Ant‹retrov‹raŽ TŠerap› ÈARTÈ ......................................... 32 3.3.2. Cotr‹ošaœoŽe PropŠ›Žaš‹s and son‹aœ‹d Prevent‹ve TŠerap› ...................................... 32 3.3.3. TB and V coâManageent ............................................ 32 3.3.4. Coun‹t› oeâbased Care ........................................ 33 3.3.5. QuaŽ‹tat‹ve Assessent of tŠe effect‹veness of treatent, care and support ........... 33 3.4. pact M‹t‹gat‹on ...................................................................... 33 CŠ‹Ždren ‹n ‹nst‹tut‹onaŽ care ........................................... 34 3.4.2. Coun‹t› based cŠ‹Žd care centres ........................... 34 3.4.3. TŠe soc‹aŽ casŠ transfer progra .................................. 34 3.4.4. ScŠooŽ attendance aong orpŠans ............................... 35 3.4.5. Address‹ng otŠer bas‹c needs for OVC ........................ 35 3.4.6. QuaŽ‹tat‹ve Assessent of tŠe effect‹veness of ‹pact ‹t‹gat‹ons act‹v‹t‹es ........... 35 4. BEST PRACTCES ........................................................................... 36 4.1. PoŽ‹t‹caŽ co‹tent .............................................................. 36 4.2. Prograe pŽeentat‹on ............................................... 36 4.2.1. ART ScaŽe up ........................................................................... 36 4.2.2. Soc‹aŽ CasŠ Transfer ............................................................ 36 5. MA OR C AEN ES AND REMEDA ACTONS ........................................................................ e;äääã37 5.1. Progress ade on tŠe e› cŠaŽŽenges reported ‹n tŠe 2â12 Progress Report .............. 37 6. SUPPORT FROM T E COUNTR ǯS DEVEOPMENT PARTNERS .............................................. 3ͺ 6.1. e› support fro deveŽopent partners ....................... 3ͺ 6.2. Act‹ons needed deveŽopent partners to ensure acŠ‹eveent of targets ..................... 3Í» 7. MONTORN AND EVAUATON ENVRONMENT ....................................................................... 3Í» 7.1. An overv‹ew of tŠe current on‹tor‹ng and evaŽuat‹on ÈM&EÈ s›ste ........................... 3Í» 7.2. CŠaŽŽenges faced ‹n tŠe ‹pŽeentat‹on of a copreŠens‹ve M&E s›ste ................... 4â 7.3. Reed‹aŽ act‹ons pŽanned to address tŠe M&E cŠaŽŽenges be‹ng ešper‹enced ............ 41 7.4. TŠe need for M&E tecŠn‹caŽ ass‹stance and capac‹t›âbu‹Žd‹ng ............................................ 42 ͺ. ANNEES .................................................. e;ää....................................... 43 ͺ.1. ANNE 1: ConsuŽtat‹on/preparat‹on process for tŠe countr› report ............................... 43 ͺ.2. ANNE 2: Nat‹onaŽ Co‹tents and PoŽ‹c› nstruent ÈNCPÈ ...................................... 44 ͺ.3. ANNE 3: ‹st of part‹c‹pants wŠo attended tŠe vaŽ‹dat‹on eet‹ng ................................ 45 ANC AntenataŽ CŽ‹n‹c ART Ant‹retrov‹raŽ TŠerap› BCC BeŠav‹our CŠange and Coun‹cat‹on BC BeŠav‹our CŠange ntervent‹ons CBO Coun‹t› Based Organ‹sat‹on CDC Centre for D‹sease ControŽ and Prevent‹on CEDEP Centre for DeveŽopent of tŠe PeopŽe COA CoaŽ‹t‹on of oen ‹v‹ng w‹tŠ ADS CSO C‹v‹Ž Serv‹ce Organ‹sat‹on DFD Departent for nternat‹onaŽ DeveŽopent ED EarŽ› nfant D‹agnos‹s ŽobaŽ ADS Response Progress Report BV ender Based V‹oŽence oM overnent of MaŽaw‹ TC V Test‹ng and CounseŽŽ‹ng EC nforat‹on, Educat‹on and Coun‹cat‹on RT ndependent Rev‹ew Tea EA egaŽ Env‹ronent Assessent SE ‹fe S‹ŽŽs Educat‹on MANET MaŽaw‹ Networ of PeopŽe ‹v‹ng w‹tŠ V MD M‹ŽŽenn‹u DeveŽopent oaŽs MD S MaŽaw‹ DeograpŠ‹c and eaŽtŠ Surve› MoF M‹n‹str› of F‹nance Mo M‹n‹str› of eaŽtŠ MAA MaŽaw‹ nterfa‹tŠ ADS Assoc‹at‹on MSM Men Šav‹ng Seš w‹tŠ Men MTCT MotŠer to CŠ‹Žd Trans‹ss‹on M&E Mon‹tor‹ng and EvaŽuat‹on NAC Nat‹onaŽ ADS Co‹ss‹on NAP AM Nat‹onaŽ Assoc‹at‹on of PeopŽe ‹v‹ng w‹tŠ V and ADS NASA Nat‹onaŽ ADS NSP Nat‹onaŽ V and ADS Strateg‹c PŽan OPC Off‹ce of tŠe Pres‹dent and Cab‹net OSC One Stop Centre P V PeopŽe ‹v‹ng w‹tŠ V PMTCT Prevent‹on of MotŠer To CŠ‹Žd Trans‹ss‹on PS PopuŽat‹on Serv‹ces nternat‹onaŽ ST SešuaŽŽ› Trans‹tted nfect‹ons TB TubercuŽos‹s TV TeŽev‹s‹on UNADS Un‹ted Nat‹ons o‹nt Progra on V and ADS UNCEF Un‹ted Nat‹ons CŠ‹Ždrenǯs Fund VMMC VoŽuntar› Med‹caŽ MaŽe C‹rcuc‹s‹on VPP VoŽuntar› PooŽ Procureent VSU V‹ct‹ Support Un‹t GLANCECop‹Žat‹on of tŠ‹s report was Žed b› tŠe MaŽaw‹ Nat‹onaŽ ADS Co‹ss‹on ÈNACÈ wŠ‹cŠ ‹s a overnent of MaŽaw‹ È oMÈ agenc› respons‹bŽe for coord‹nat‹ng and on‹tor‹ng tŠe nat‹onaŽ response to tŠe V and ADS ep‹de‹c ‹n MaŽaw‹. Under tŠe gu‹dance of NAC, two ‹ndependent MaŽaw‹an consuŽtants coŽŽated, rev‹ewed and anaŽ›œed reŽevant poŽ‹c‹es, strateg‹es, data and reports to generate recent V and ADS ‹nd‹cators for MaŽaw‹. ‹tŠ tŠe ŠeŽp of NAC tŠe› aŽso ‹dent‹f‹ed e› staeŠoŽders ‹n tŠe nat‹onaŽ V and ADS response and ‹nterv‹ewed tŠe us‹ng tŠe Nat‹onaŽ Co‹tent and PoŽ‹c› nstruent ÈNCPÈ se‹âstructured quest‹onna‹re. TŠe staeŠoŽders ‹ncŽuded representat‹ves fro tŠe foŽŽow‹ng const‹tuenc‹es; governent, Nat‹onaŽ ADS Co‹ss‹on, Šuan r‹gŠts watcŠdogs, deveŽopent partners, UN agenc‹es, c‹v‹Ž soc‹et› organ‹œat‹ons, tŠe pr‹vate sector and ‹pŽeent‹ng partners. FoŽŽow‹ng tŠe ‹nterv‹ews, tŠe consuŽtants prepared a draft report on tŠe f‹nd‹ngs and presented tŠe to a group of staeŠoŽders ÈAnneš 1.2È at a vaŽ‹dat‹on eet‹ng ŠeŽd at ‹Žongwe oteŽ on 2ͺ MarcŠ 2â14. Dur‹ng tŠe eet‹ng, tŠe staeŠoŽders cr‹t‹qued and vaŽ‹dated tŠe cop‹Žed ‹nd‹cators and quaŽ‹tat‹ve f‹nd‹ngs fro tŠe NCP ‹nterv‹ews. Based on coents and ‹nputs fro tŠe staeŠoŽders, tŠe draft report was rev‹sed and c‹rcuŽated to tŠe stepidemicTŠe f‹rst case of ADS was d‹agnosed ‹n MaŽaw‹ ‹n 1ͻͺ5. S‹nce tŠen V prevaŽence ‹ncreased s‹gn‹f‹cantŽ› and reacŠed a pea of 16.4% ‹n 1ͻͻͻ aong persons aged 15â4Í». TŠereafter, tŠe prevaŽence Šas been decŽ‹n‹ng stead‹Ž›, reacŠ‹ng 12.â% ‹n 2ââ4 and 1â.6% ‹n 2â1â. TŠe 2â1â MaŽaw‹ DeograpŠ‹c and eaŽtŠ Surve› ÈMD SÈ found tŠat V prevaŽence var‹ed aredŽ› b› seš, age, urbanâruraŽ res‹dence, geograpŠ‹caŽ Žocat‹on and otŠer cŠaracter‹st‹cs. FeaŽes Šad a Š‹gŠer V prevaŽence tŠan aŽes È12.Í»% vs ͺ.1% ‹n 2â1âÈ, w‹tŠ tŠe Žargest d‹spar‹t› be‹ng ‹n tŠe 15â1Í» ›ear oŽd age group È3.7% ‹n woen and â.4%È. n add‹t‹on, V was ore prevaŽent ‹n urban coun‹t‹es È17.4%È copared to ruraŽ coun‹t‹es ÈÍ»%È. AŽso, tŠe SoutŠern reg‹on Šad a prevaŽence of 14.5% wŠ‹cŠ was tw‹ce as Š‹gŠ as tŠat ‹n tŠe NortŠern and CentraŽ reg‹ons. S‹nce 2â1â, tŠere Šasnǯt been an› nat‹onaŽŽ› representat‹ve surve› ‹n MaŽaw‹ to est‹ate V prevaŽence. UNADS est‹ates tŠat, b› tŠe end of 2â12, 1,1ââ,âââ MaŽaw‹ans were Ž‹v‹ng w‹tŠ V 66,âââ acqu‹red new V ‹nfect‹on and 46,âââ d‹ed as resuŽt of VâreŽated cond‹t‹ons. TŠe a‹n ode of trans‹ss‹on of V ‹s tŠrougŠ ŠeterosešuaŽ ‹ntercourse, est‹ated to account for ͺͺ% of aŽŽ new V ‹nfect‹ons wŠ‹Že otŠerâtoâcŠ‹Žd trans‹ss‹on accounts for NSO/MACRO, MaŽaw‹ DeograpŠ‹c and eaŽtŠ Surve›, 2ââ4; NSO/MACRO, MaŽaw‹ DeograpŠ‹c and eaŽtŠ Surve›, 2â1â. ~1â% of tŠe ‹nfect‹ons. Approš‹ateŽ› 2% of ‹nfect‹ons are beŽ‹eved to be trans‹tted tŠrougŠ bŽood transfus‹ons and conta‹nated ed‹caŽ and s‹n p‹erc‹ng ‹nstruents. AŽtŠougŠ MaŽaw‹ Šas a generaŽ‹œed V ep‹de‹c, BeŠav‹ouraŽ Surve‹ŽŽance Surve›s ÈBSSÈ conducted ‹n 2ââ4 and 2ââ6 ‹nd‹cate tŠat spec‹f‹c soc‹aŽ and occupat‹onaŽ groups Šave Š‹gŠer V prevaŽence tŠan tŠe generaŽ popuŽat‹on. TŠese ‹ncŽude feaŽe seš worers, feaŽe border traders, Žongâd‹stance truc dr‹vers, poŽ‹ce off‹cers, estate worers and f‹sŠeren ÈF‹gure 1.1È. Men wŠo Šave seš w‹tŠ en ÈMSMÈ ‹n MaŽaw‹ aŽso Šave a Š‹gŠ V prevaŽence È21%È. V ‹nc‹dence ‹s est‹ated to be› popuŽat‹ons at Š‹gŠer r‹s of V ešposure sucŠ as seš worers, cŽ‹ents of seš worers and MSM. owever, tŠe contr‹but‹on of tŠese groups to tŠe nuber of new ‹nfect‹on ‹s est‹ated to be ver› Žow, account‹ng for <1% of aŽŽ new V ‹nfect‹ons. CoŠab‹t‹ng Vâd‹scordant partners, prev‹ousŽ› assued to be a Žow of aŽŽ new V ‹nfect‹ons ‹n MaŽaw‹. TŠe V and ADS response ‹n MaŽaw‹ ‹s gu‹ded b› tŠe V and ADS PoŽ‹c› wŠ‹cŠ was recentŽ› rev‹sed and ŽauncŠed ‹n uŽ› 2â13. TŠe poŽ‹c› ‹s operat‹onaŽ‹œed tŠrougŠ tŠe Nat‹onaŽ V and ADS Strateg‹c PŽan ÈNSPÈ 2â11â2â16 wŠ‹cŠ prov‹des a fraewor for MaŽaw‹ B‹oŽog‹caŽ and BeŠav‹ouraŽ Surve‹ŽŽance Surve› and Coparat‹ve AnaŽ›s‹s, 2ââ4 and 2ââͺ. BaraŽ S., et aŽ. Dz V prevaŽence, r‹ss for V ‹nfect‹on, and Šuan r‹gŠts aong en ÈMSMÈ ‹n MaŽaw‹, Na‹b‹a, and Botswanadz PŽos One, VoŽ 4 È3È, e4ͻͻ7, 2ââÍ». Departent of Nutr‹t‹on, V and ADS, Nat‹onaŽ V Prevent‹on Strateg›, 2ââÍ»â2â13. HIV Prevalence by occupational groups17%24%20%17%14%22%10%20%30%40%50%60%70%80%MalmareacheecondachersMale Police Officerale e WorkFishermenTruck DriversFemale TrderFemalex kerFemale Primary TeachersFemale Second TeacheremalecersOccupational GroupHIV Prevalence ‹pŽeentat‹on of V and ADS ‹ntervent‹ons across var‹ous sectors. TŠe V PoŽ‹c› and NSP are Ž‹ned to var‹ous Žaws and strateg‹es wŠ‹cŠ are not Vâspec‹f‹c but prov‹de tŠe overaŽŽ ŽegaŽ and poŽ‹c› fraewor. e› p‹eces of Žeg‹sŽat‹ons and strateg‹es wŠ‹cŠ a› d‹rectŽ› and ‹nd‹rectŽ› ‹pact tŠe prevent‹on and anageent of V and ADS ‹ncŽude: TŠe Const‹tut‹on of RepubŽ‹c of MaŽaw‹, TŠe PenaŽ Code, TŠe PubŽ‹c eaŽtŠ Act, TŠe CŠ‹Žd Care, ust‹ce and Protect‹on Act, TŠe Marr‹age Act, TŠe Prevent‹on of Doest‹c V‹oŽence Act, TŠe Deceased Estate È‹ŽŽs and nŠer‹tanceÈ Act, TŠe ender EquaŽ‹t› Act, TŠe D‹sab‹Ž‹t› Act, TŠe Occupat‹onaŽ Safet›, eaŽtŠ and eŽfare Act, TŠe EpŽo›ent Act and TŠe abour ReŽat‹ons Act. TŠe MaŽaw‹ rowtŠ and DeveŽopent Strateg› È2â11â2â16È ‹s an overaŽŽ deveŽopent agenda for MaŽaw‹ wŠ‹cŠ aŽso gu‹des tŠe ‹pŽeentat‹on of V and ADS ‹ntervent‹ons. CurrentŽ›, MaŽaw‹ Šas drafted an V and ADS B‹ŽŽ wŠ‹cŠ a‹s at strengtŠen‹ng tŠe ŽegaŽ fraewor for ‹pŽeent‹ng V and ADS ‹ntervent‹ons. TŠ‹s draft Žeg‹sŽat‹on was deveŽoped ‹n a transparent and Š‹gŠŽ› consuŽtat‹ve anner to ensure tŠat ‹t eets tŠe ešpectat‹ons of e› staeŠoŽders and adŠeres to Šuan r‹gŠts standards. t ‹s ešpected tŠat tŠe draft Žeg‹sŽat‹on w‹ŽŽ soon be presented to tŠe MaŽaw‹ governent cab‹net for rev‹ew and approvaŽ brŽ‹aent for enactent. At ‹nternat‹onaŽ ŽeveŽ MaŽaw‹ ‹s aŽso a s‹gnator› of a nuber of convent‹ons and decŽarat‹ons wŠ‹cŠ for a furtŠer ‹portant gu‹d‹ng fraewor for nat‹onaŽ Žaws, poŽ‹c‹es and reguŽat‹ons reŽat‹ng to V. e› ‹nternat‹onaŽ and reg‹onaŽ ‹nstruents s‹gned and rat‹f‹ed b› MaŽaw‹ ‹ncŽude tŠe foŽŽow‹ng: TŠe Un‹versaŽ DecŽarat‹on of uan R‹gŠts ÈUD RÈ 1Í»4ͺ, tŠe 2âââ UN DecŽarat‹on of Co‹tent on V and ADS, and tŠe 2â11 PoŽ‹t‹caŽ DecŽarat‹on on V and ADS. MaŽaw‹ Šas s‹nce doest‹cated tŠese ‹nternat‹onaŽ convent‹ons and decŽarat‹ons ‹n ‹ts poŽ‹c‹es and Žeg‹sŽat‹on. n Ž‹ne w‹tŠ tŠe uŽt‹sectoraŽ V and ADS response ‹n MaŽaw‹, governent ‹n‹str‹es, nonâgovernentaŽ organ‹œat‹ons, c‹v‹Ž soc‹et› organ‹œat‹ons and tŠe pr‹vate sector act‹veŽ› part‹c‹pate ‹n tŠe ‹pŽeentat‹on of var‹ous V and ADS ‹ntervent‹on. Cons‹stent w‹tŠ tŠe DztŠree onesdz pr‹nc‹pŽe, tŠe NAC ‹s respons‹bŽe for coord‹nat‹ng tŠe act‹v‹t‹es of aŽŽ agenc‹es ‹pŽeent‹ng V ‹ntervent‹ons and cop‹Ž‹ng VâreŽated ‹nd‹cators. To operat‹onaŽ‹œe tŠe NSP, NAC coord‹nates tŠe deveŽopent of an ntegrated AnnuaŽ orpŽan ÈAPÈ, wŠ‹cŠ, aong otŠer tŠ‹ngs, outŽ‹nes e› act‹v‹t‹es to be ‹pŽeented b› partners, perforance ‹nd‹cators and budgets. NevertŠeŽess, ‹t ‹s ev‹dent tŠat a s‹gn‹f‹cant nuber of V ‹ntervent‹ons wŠ‹cŠ are ‹pŽeented b› partners, not funded tŠrougŠ NAC, are not captured ‹n tŠe AP. OverviewGARPRandHealthSectorIndicatorsMaŽaw‹ cont‹nues to trac tŠe progress ade to acŠ‹eve tŠe ten targets as agreed ‹n tŠe 2â11 PoŽ‹t‹caŽ decŽarat‹on of V and ADS. TabŽe 1.1, beŽow, sŠows tŠe trend of ‹nd‹cators Ž‹ned to tŠese targets. t ‹s ‹portant to note tŠat 2â13 data were unava‹ŽabŽe for ost ‹nd‹cators wŠ‹cŠ requ‹red tŠe conduct of a nat‹onaŽŽ› representat‹ve surve› or sent‹neŽ surve‹ŽŽance. TŠese surve›s are pŽanned for 2â15. 1.1:GARPRandHealthIndicatorHealthareTARGETS20102010201120122013 Target 1: V b› 5â% b› 2â14 population1.1: Percentage of ›oung woen and en aged 15â24 wŠo correctŽ› ‹dent‹f› wa›s of prevent‹ng tŠe sešuaŽ trans‹ss‹on of V and wŠo reŒect aŒor ‹sconcept‹ons about V MaŽes: 75%FeaŽes: 75% MaŽes: 44.7% FeaŽes: 41.ͺ% ava‹ŽabŽe Not ava‹ŽabŽeNot ava‹ŽabŽe 1.2: Percentage of ›oung woen and en aged 15â24 wŠo Šave Šad sešuaŽ ‹ntercourse before tŠe age Not ava‹ŽabŽeMaŽes: 12.3% FeaŽes: 14.3% ava‹ŽabŽe Not ava‹ŽabŽeNot ava‹ŽabŽe aged 15â4Í» wŠo Šave Šad sešuaŽ ‹ntercourse w‹tŠ ore tŠan one tŠe past 12 ontŠs Not ava‹ŽabŽeMaŽes: Í».2%â.7% ava‹ŽabŽe Not ava‹ŽabŽeNot ava‹ŽabŽe aged 15â4Í» wŠo Šad ore MaŽes: 6â%Men: 24.6%ava‹ŽabŽe Not ava‹ŽabŽeNot ava‹ŽabŽe For 2â1â tŠe source of ‹nforat‹on ‹s tŠe 2â1â MD S wŠose resuŽts cae out ‹n 2â11 unŽess spec‹f‹ed. TŠese f‹gures are fro tŠe 2â1â ce anotŠer D S ‹s conducted TŠese f‹gures are fro tŠe 2â1â ce anotŠer D S ‹s conducted tŠe past 12 ontŠs wŠo report tŠe use of a condo oen: 4â%27.3% 1.5: Percentage of en and woen aged 15â4Í» wŠo past 12 ontŠs and now tŠe‹r resuŽts MaŽes: 75%FeaŽes: 75% MaŽes: 51.2% FeaŽes: 71.6% ava‹ŽabŽe Not ava‹ŽabŽeNot ava‹ŽabŽe 1.6: Percentage of ›oung peopŽe aged 15â24 wŠo are Ž‹v‹ng w‹tŠ V MaŽes: 12%FeaŽes: 12% MaŽes: 1.Í»%FeaŽes: 5.2% ava‹ŽabŽe Not ava‹ŽabŽeNot ava‹ŽabŽe 1.7: Percentage of seš prevent‹on progras Not ava‹ŽabŽeava‹ŽabŽeava‹ŽabŽeNot ava‹ŽabŽeNot ava‹ŽabŽe 1.ͺ: Percentage of seš of a condo w‹tŠ tŠe‹r ost recent cŽ‹entNot ava‹ŽabŽeava‹ŽabŽeava‹ŽabŽeNot ava‹ŽabŽeNot ava‹ŽabŽe Fa‹Ž› PŽann‹ng Assoc‹at‹on ‹n MaŽaw‹. È2â11È. uncatchables:thesituationanalysisbehaviouralfactors,interventionsworkFa‹Ž› PŽann‹ng Assoc‹at‹on of MaŽaw‹ and TŠe stud› b› FPAM d‹d not Žoo at use of a condo w‹tŠ tŠe‹r ost recent partner but wŠetŠer tŠe› Šave ever used condos or not. TŠe stud› sŠowed tŠat aŽŽ tŠe seš worers ‹nterv‹ewed Šad ever used condos but tŠat ‹n soe cases tŠe› d‹d not use condos for var‹ed reasons. 1.Í»: Percentage of seš past 12 ontŠs and now tŠe‹r resuŽts Not ava‹ŽabŽeava‹ŽabŽeNot ava‹ŽabŽeNot ava‹ŽabŽe 1.1â: Percentage of seš Not ava‹ŽabŽeava‹ŽabŽeNot ava‹ŽabŽeNot ava‹ŽabŽe 1.11: Percentage of en wŠo Šave seš w‹tŠ en prevent‹on progras Not ava‹ŽabŽeava‹ŽabŽeava‹ŽabŽeNot ava‹ŽabŽeNot ava‹ŽabŽe 1.12: Percentage of en condo tŠe Žast t‹e tŠe› Šad anaŽ seš w‹tŠ a aŽe partner Not ava‹ŽabŽeava‹ŽabŽeava‹ŽabŽeNot ava‹ŽabŽeNot ava‹ŽabŽe 1.13: Percentage of en wŠo Šave seš w‹tŠ en tŠat Šave rece‹ved an V test ‹n tŠe past 12 ontŠs and now tŠe‹r resuŽts Not ava‹ŽabŽeava‹ŽabŽeava‹ŽabŽeNot ava‹ŽabŽeNot ava‹ŽabŽe Fa‹Ž› PŽann‹ng Assoc‹at‹on ‹n MaŽaw‹. È2â11È. uncatchables:thesituationanalysisbehaviouralfactors,interventionsworkFa‹Ž› PŽann‹ng Assoc‹at‹on of MaŽaw‹ and NOTE: TŠ‹s DzprevaŽencedz ‹s based on ‹nd‹v‹duaŽ reports b› seš worers and not on b‹oarers. Fa‹Ž› PŽann‹ng Assoc‹at‹on ‹n MaŽaw‹. È2â11È. uncatchables:reportsituationanalysisthemagnitude,behaviouralfactors,interventionsworkFa‹Ž› PŽann‹ng Assoc‹at‹on of MaŽaw‹ and 1.14: Percentage of en wŠo Šave seš w‹tŠ en wŠo are Ž‹v‹ng w‹tŠ V Not ava‹ŽabŽeava‹ŽabŽe Not ava‹ŽabŽeNot ava‹ŽabŽe 1.16.1. Nuber of woen 12 ontŠs and now tŠe‹r 1,7â2,627 1.16â1a. Percentage of V rap‹d test ‹ts tŠat ešper‹enced a stocout ‹n tŠe Žast 12 ontŠs Not ava‹ŽabŽe 1.17.1. STs: Percentage of woen access‹ng antenataŽ care ÈANCÈ serv‹ces wŠo 1.17.2. STs: percentage of antenataŽ care attendees 1.17.3. STs: percentage of antenataŽ care attendees Not ava‹ŽabŽe Uar, E., . Trapence, ., CŠ‹b. Be›rer and S. BaraŽ. È2ââ7È. sexualbehaviorMalawi. ‹Žongwe and BŽant›re: CEDEP and CoM. TŠ‹s stud› d‹d not Žoo at ‹nd‹cators 1.11â1.13. AnotŠer stud› ‹s currentŽ› onâgo‹ng aong MSMs. TŠ‹s nuber ‹ncŽudes pregnant woen wŠo Šad V tests as part of EMTCT.. TŠ‹s prevaŽence ‹s Ž‹eŽ› to be b‹ased because onŽ› 1â% of tŠe antenataŽ attendees were tested. t a› be tŠat ŠeaŽtŠ worers onŽ› tested tŠose wŠo tŠe› tŠougŠt Šad an ST. 14 pos‹t‹ve for s›pŠ‹Ž‹s wŠo rece‹ved treatent 1.17.4. STs: percentage of act‹ve s›pŠ‹Ž‹s Not ava‹ŽabŽe 1.17.5. STs: percentage of en wŠo Šave seš w‹tŠ en w‹tŠ act‹ve s›pŠ‹Ž‹s Not ava‹ŽabŽe 1.17.6. STs: nuber of aduŽts reported w‹tŠ Žatent/unnownÈ ‹n tŠe Not ava‹ŽabŽe 1.17.7. STs: nuber of s›pŠ‹Ž‹s cases ÈŽ‹ve b‹rtŠs 12 ontŠs Not ava‹ŽabŽe 1.17.ͺ. STs: nuberof gonorrŠoea ‹n tŠe past 12 ontŠs Not ava‹ŽabŽe 1.17.Í». ST s: nuber of uretŠraŽ d‹scŠarge ‹n tŠe Not ava‹ŽabŽe 1.17.1â. STs: nuber of Not ava‹ŽabŽe 15 aduŽts reported w‹tŠ 1.1ͺ. Percentage of pregnant woen w‹tŠ a wŠose sešuaŽ contacts were ‹dent‹f‹e for s›pŠ‹Ž‹s Not ava‹ŽabŽe 1.22 Percentage of en 15â Not ava‹ŽabŽe 1.23. Nuber of aŽe 12 ontŠs 11,âââ 4â,ͺ35 V aong peopŽe wŠo ‹nŒect drugs 2â152.1: Nuber of s›r‹nges d‹str‹buted per person wŠo ‹nŒects drugs per ›ear b› needŽe and s›r‹nge prograes 2.2: Percentage of peopŽe wŠo ‹nŒect drugs wŠo report tŠe use of condos TŠ‹s data ‹s fro tŠe 2â1â MaŽaw‹ DeograpŠ‹c and eaŽtŠ Surve›. Respondents were ased wŠetŠer tŠe› were c‹rcuc‹sed or not ‹nforat‹on was not ver‹f‹ed TŠ‹s data was fro Q1 and Q2 of 2â13. No data were ava‹ŽabŽe for Q3 and Q4 of 2â13. No stud‹es Šave been done on tŠ‹s ‹n MaŽaw‹. at Žast sešuaŽ ‹ntercourse. 2.3: Percentage of peopŽe wŠo ‹nŒect drugs wŠo Žast t‹e tŠe› ‹nŒected 2.4: Percentage of peopŽe wŠo ‹nŒect drugs tŠat Šave past 12 ontŠs and now tŠe‹r resuŽts 2,5: Percentage of peopŽe wŠo ‹nŒect drugs wŠo are Ž‹v‹ng w‹tŠ V 2.6. Nuber of peopŽe on op‹o‹d subst‹tut‹on tŠerap› 2.7. Nuber of NSP and â Nuber of needŽe and s›r‹nge prograe ÈNSPÈ 2.7. Nuber of NSP and Not rout‹neŽ› coŽŽected V b› 2â15 and 3.1: Percentage of V to reduce tŠe r‹s of otŠer to cŠ‹Žd 65%44%44% 67%73% 3.2: Percentage of ‹nfants v‹roŽog‹caŽ test for V w‹tŠ‹n 2 ontŠs of b‹rtŠNot ava‹ŽabŽeava‹ŽabŽe ava‹ŽabŽe 1â%3â% 3.3: MotŠer to cŠ‹Žd woen wŠo now tŠe‹r and rece‹ved tŠe‹r resuŽts â Žabour and deŽ‹ver›, and dur‹ng tŠe postâpartu per‹od È<72 ŠoursÈ, ‹ncŽud‹ng tŠose w‹tŠ prev‹ousŽ› nown V overnent of MaŽaw‹, M‹n‹str› of eaŽtŠ, ntegrated V Prograe Report: 2â13 Q1, Q2, Q3 and Q4 Reports TŠe V and ADs Departent ‹n tŠe M‹n‹str› of eaŽtŠ onŽ› started coŽŽect‹ng tŠ‹s data ‹n 2â11. overnent of MaŽaw‹, M‹n‹str› of eaŽtŠ, ntegrated V Prograe Report: 2â13 Q1, Q2, Q3 and Q4 Reports Deno‹nator ‹s tŠe ešpected nuber of pregnant woen per ›ear Èest‹ated at 6â7,âââ ‹n 2â13È 18 woen attend‹ng ANC wŠose aŽe partner was tested for V ‹n tŠe Žast 12 ontŠs Not ava‹ŽabŽe 3.6. Percentage of ‹nfected pregnant woen assessed for ART eŽ‹g‹b‹Ž‹t› stag‹ng or CD4 test‹ng contešt of Opt‹on B+ born to Vâ‹nfected propŠ›Žaš‹s to reduce tŠe f‹rst 6 wees È‹.e. earŽ› around 6 wees of ageÈ born to Vâ‹nfected woen started on CT propŠ›Žaš‹s w‹tŠ‹n two ontŠs of b‹rtŠ 3.1â. D‹str‹but‹on of feed‹ng pract‹ces Not ava‹ŽabŽe TŠe deno‹nator ‹s V ešposed ‹nfants d‹scŠarged fro tŠe atern‹t›. TŠe nuerator ‹s aŽŽ V ešposed ‹nfants wŠo were prescnev‹rap‹ne. Data Source: overnent of MaŽaw‹, M‹n‹str› of eaŽtŠ, ntegrated V Prograe Report: 2â13 Q1, Q2, Q3 and Q4 Reports TŠe deno‹nator ‹s tŠe nuber of V ešposed ‹nfants wŠo are 2 ontŠs oŽd. TŠe nuerator ‹s aŽŽ cŠ‹Ždren Žess tŠan 2 ontŠs ww‹tŠ nev‹rap‹ne. Data Source: overnent of MaŽaw‹, M‹n‹str› of eaŽtŠ, ntegrated V Prograe Report: 2â13 Q1, Q2, Q3 and Q4 Reports 19 ÈešcŽus‹ve breastfeed‹ng, repŽaceent feed‹ng, ‹šed feed‹ng/otŠerÈ for ‹nfants born to Vâ ‹nfected woen at DPT3 3.11. Nuber of pregnant woen attend‹ng ANC at 627,ͺ27 ave 15 ‹ŽŽ‹on peopŽe Ž‹v‹ng w‹tŠ treatent b› 2â15 4.1: Percentage of eŽ‹g‹bŽe aduŽts and cŠ‹Ždren currentŽ› rece‹v‹ng Not ava‹ŽabŽe63%67% 65%ͺ3% 4.1 â add‹t‹onaŽ: V tŠerap›: Nuber of eŽ‹g‹bŽe aduŽts and cŠ‹Ždren wŠo newŽ› ‹n‹t‹ated ÈARTÈ dur‹ng tŠe report‹ng per‹od È2â13È 1â2, 56ͺ and cŠ‹Ždren w‹tŠ V nown to be on treatent 12ontŠs after ‹n‹t‹at‹on Not ava‹ŽabŽeͺ1%7ͺ% ͺâ%7ͺ% TŠ‹s ‹nd‹cator was est‹ated fro tŠe nuber of woen wŠo booed at antenataŽ cŽ‹n‹cs ‹n 2â13. Data Source: overnent of MaŽaw‹, M‹n‹str› of eaŽtŠ, ntegrated V Prograe Report: 2â13 Q1, Q2, Q3 and Q4 Reports overnent of MaŽaw‹, M‹n‹str› of eaŽtŠ, ntegrated V Prograe Report: 2â13 Q1, Q2, Q3 and Q4 Reports overnent of MaŽaw‹, M‹n‹str› of eaŽtŠ, ntegrated V Prograe Report: 2â13 Q3 report 20 4.2b. Percentage of aduŽts and cŠ‹Ždren w‹tŠ V st‹ŽŽ aŽ‹ve and nown to be on ontŠs after ‹n‹t‹at‹ng treatent aong pat‹ents tŠerap› dur‹ng 2â13 and cŠ‹Ždren w‹tŠ V st‹ŽŽ aŽ‹ve and nown to be on ontŠs after ‹n‹t‹at‹ng treatent aong pat‹ents tŠerap› dur‹ng 2â13 4.3.a. Nuber of ŠeaŽtŠ ÈARTÈ 6ͺͻ Nuber of ŠeaŽtŠ fac‹Ž‹t‹es tŠat offer paed‹atr‹c ÈARTÈ Not ava‹ŽabŽe Not ava‹ŽabŽe overnent of MaŽaw‹, M‹n‹str› of eaŽtŠ, ntegrated V Prograe Report: 2â13 Q3 report overnent of MaŽaw‹, M‹n‹str› of eaŽtŠ, ntegrated V Prograe Report: 2â13 Q3 report 21 tŠat ešper‹enced a stoc out of at Žeast one requ‹red ARV ‹n tŠe Žast 12 ontŠs. 4.6.a TotaŽ nuber of peopŽe enroŽŽed ‹n V care at tŠe end of tŠe report‹ng Not ava‹ŽabŽe 4.6.b Nuber of aduŽts and V care dur‹ng tŠe 1â2,56ͺ 4.7a. percentage of peopŽe on ART tested for v‹raŽ Žoad ÈVÈ wŠo Šave an Not ava‹ŽabŽe 4.7 b. Percentage of peopŽe on ART tested for v‹raŽ Žoad ÈVÈ w‹tŠ V ŽeveŽ beŽow ⤠1,âââ cop‹es after 12 ontŠs of tŠerap› È2â13È Not ava‹ŽabŽe Ž‹v‹ng w‹tŠ V b› 5.1: Percentage of ‹nc‹dent TB cases tŠat rece‹ved treatent for 5â%45%54% 6â%75% TŠese f‹gures are fro tŠe Nat‹onaŽ TB ControŽ Progra. TŠe 2â1â UA Progress Report sŠows tŠat approš‹ateŽ› 7â% of V ‹nfected TB pat‹ents were rece‹v‹ng ART ‹n f‹rst quarter of 2â1â ÈMo , MaŽaw‹ ART Prograe Report for 2â1â F‹rst Quarter, p.7È 5â% b› 2â15 wŠo are detected Šav‹ng act‹ve TB d‹sease ÈnewÈ Not ava‹ŽabŽe. Data ‹s onŽ› ava‹ŽabŽe for tŠose on ART and tŠe f‹gure ‹s 1.6% enroŽŽed ‹n V care prevent‹ve tŠerap› ÈPTÈ V care wŠo Šad TB status assessed and recorded dur‹ng tŠe‹r Žast 2â1â/2â11 ÈUS$È2â11/2â12 ÈUS$È2â13 ReacŠ a s‹gn‹f‹cant gŽobaŽ ešpend‹ture ÈUS$22â24 b‹ŽŽ‹onÈ 6.1: Doest‹c and â1. Prevent‹on progras: 45,ͺͻ1,ͺ6â 2. Treatent and care: 2Í»,376,ͻͺͻ 3. OVC: 5,ͺ61,433 â1. Prevent‹on progras: 43,41ͺ,11ͺ 2. Treatent and care: 47,21â,62ͺ 3. OVC: 5,435,14Í» Not ava‹ŽabŽe Note that this number is based on a small cohort of HIV positive individuals (,000) who are accessing pre-ART care Note that the status is assessed by asking TB-related questions to individuals attending HIV care. 2013 data on expenditure is not available. Accord‹ng to tŠe NASA for tŠe per‹od 2â1â/2â12 ore tŠan Í»â% of tŠe fund‹ng for tŠe nat‹onaŽ response coes fro donors. Deta‹Žs of fund‹ng b› source Šave been g‹ven ‹n tŠe sect‹on on cŽos‹ng tŠe resource gap. 4. Progra anageent and ad‹n‹strat‹on: 42,764,ͻͻâ 5. uan resources: 4,ͺͻâ,721 6. Soc‹aŽ protect‹on and soc‹aŽ serv‹ces ÈešcŽud‹ng OVCÈ: 7,33ͺ,ͺ11 7. EnabŽ‹ng env‹ronent: 11,65â,572 ͺ. V and ADS ReŽated ResearcŠ: 4,1Í»6,ͺ5ͺ TOTAL:151,972,2344. Progra anageent and ad‹n‹strat‹on: 34,ͺͻ1,3â1 5. uan resources: 4,â52,47Í» 6. Soc‹aŽ protect‹on and soc‹aŽ serv‹ces ÈešcŽud‹ng OVCÈ: 2,Í»â7,632 7. EnabŽ‹ng env‹ronent: 3,25Í»,433 ͺ. V and ADS ReŽated ResearcŠ: 4,347,6Í»5 TOTAL:145,522,435 6.1: Doest‹c and 3. B‹ŽateraŽ contr‹but‹ons: 4. MuŽt‹ŽateraŽ contr‹but‹ons: organ‹sat‹ons and foundat‹ons: organ‹sat‹ons and foundat‹ons: 7. nternat‹onaŽ151,972,2343. B‹ŽateraŽ contr‹but‹ons: 4. MuŽt‹ŽateraŽ contr‹but‹ons: organ‹sat‹ons and foundat‹ons: organ‹sat‹ons and foundat‹ons: 7. nternat‹onaŽ145,522,435Not ava‹ŽabŽe ‹nequaŽ‹t‹es and genderâbased abuse and v‹oŽence Proport‹on of everâarr‹ed or partnered woen aged 15â4Í» wŠo Not ava‹ŽabŽe1ͺ.5%Not ava‹ŽabŽe Not ava‹ŽabŽeNot ava‹ŽabŽe and ‹ncrease tŠe tŠeseŽves fro V. sešuaŽ v‹oŽence fro a tŠe past 12 ontŠs EŽ‹‹nate st‹ga aga‹nst peopŽe affected b› Vatt‹tudes towards peopŽe Ž‹v‹ng w‹tŠ VNot ava‹ŽabŽeMaŽes: 35.7% FeaŽes: 1Í».7% ava‹ŽabŽe Not ava‹ŽabŽeNot ava‹ŽabŽe 10:‹ntegrat‹on 1â.1: Current scŠooŽ attendance aong orpŠans and nonâorpŠans aged 1ââ14 âNot ava‹ŽabŽeMaŽes: â.Í»5FeaŽes: â.Í»7 TotaŽ: â.Í»6 ava‹ŽabŽe Not ava‹ŽabŽeNot ava‹ŽabŽe 1â.2: Proport‹on of tŠe poorest ŠouseŠoŽds wŠo ontŠs Not ava‹ŽabŽe2.6ava‹ŽabŽe Not ava‹ŽabŽeNot ava‹ŽabŽe This is a new indicator. The figure indicated for 2010 is based on the Malawi Demographic Survey which looked at Percentage of respondents expressing acceptance attitudes on all four indicators 25 OVERVIEWAIDSEPIDEMICAs sŠown ‹n F‹gure 1.2 beŽow, V prevaŽence ‹n MaŽaw‹ Šas decŽ‹ned stead‹Ž› s‹nce 1ͻͻͻ. S‹nce 2â1â, MaŽaw‹ Šas not conducted an› nat‹onaŽŽ›ârepresentat‹ve V surve›, Šence tŠere ‹s no recent data on V prevaŽence ‹n MaŽaw‹. NevertŠeŽess, tŠe observed reduct‹on ‹n V prevaŽence occurr‹ng at a t‹e of rap‹dŽ› ‹ncreas‹ng coverage of ART and ‹proved surv‹vaŽ of P Vs suggests decŽ‹n‹ng V ‹nc‹dence. owever, us‹ng ‹nd‹rect etŠods of easur‹ng V ‹nc‹dence, tŠe Mo est‹ates tŠat ~46,âââ peopŽe acqu‹re V annuaŽŽ›.Source: V and S›pŠ‹Ž‹s Sero âSurve› and Nat‹onaŽ V PrevaŽence and ADS Est‹ates Report for 2â1â,RESPONSEAIDSEPIDEMIC3.1.IntroductionTŠ‹s sect‹on suar‹œes progress ade ‹n tŠe ‹pŽeentat‹on of e› ‹ntervent‹ons under tŠree a‹n tŠeat‹c areas, naeŽ›: V prevent‹on; ÈbÈtreatent, care and support, and; pact ‹t‹gat‹on. UnŽess otŠerw‹se stated, data prov‹ded ‹n tŠ‹s sect‹on are based on tŠe f‹nd‹ngs of Deceber 2â13 report produced b› tŠe ndependent Rev‹ew Tea ÈRTÈ for tŠe NAC, wŠ‹cŠ conducts b‹âannuaŽ rev‹ew of tŠe ‹pŽeentat‹on of tŠe uŽt‹âsectoraŽ nat‹onaŽ response to V and ADS. n Ž‹ne w‹tŠ MaŽaw‹Ç¯s f‹scaŽ caŽendar, ost quant‹tat‹ve f‹nd‹ngs ‹n tŠe sect‹on cover tŠe per‹od fro 1 uŽ› 2â12 to 3â une 2â13. At tŠe t‹e of wr‹t‹ng tŠ‹s report, ost data fro 1 uŽ› 2â13 to 31 Deceber 2â13 were not ava‹ŽabŽe. NonetŠeŽess, tŠe quant‹tat‹ve data fro tŠe RT report are suppŽeented b› quaŽ‹tat‹ve f‹nd‹ngs drawn fro ‹nâdeptŠ ‹nterv‹ews conducted w‹tŠ staeŠoŽders us‹ng tŠe Nat‹onaŽ Co‹tents and PoŽ‹c› nstruent ÈNCPÈ. Ministry of Health. (2012). HIV and Syphilis Sero Survey and National HIV Prevalence and AIDS Estimates Report for 2010. Lilongwe: Ministry of Health 16.5161618.516.910.61994199519961998199920012003200520072010Trendsprevalencewomen19942010 3.2.Prevention3.2.1.NonBiomedicalInterventionsn an effort to reduce ‹nc‹dent V ‹nfect‹ons, tŠe overnent of MaŽaw‹, Šas deveŽoped severaŽ poŽ‹c‹es, strateg‹es and pŽans to gu‹de tŠe ‹pŽeentat‹on of nonâb‹oed‹caŽ ‹ntervent‹ons. TŠese ‹ncŽude tŠe V Prevent‹on Strateg›, Abst‹nence Strateg›, MutuaŽ Fa‹tŠfuŽness Strateg›, Condo Strateg›, and tŠe Nat‹onaŽ BeŠav‹our CŠange ntervent‹ons Strateg›. Bes‹des focus‹ng on prevent‹on of pr‹ar› and secondar› V ‹nfect‹ons, beŠav‹ouraŽ cŠange coun‹cat‹on covers crossâcutt‹ng ‹ssues naeŽ› gender, Šuan r‹gŠts and cuŽture. Modes of coun‹cat‹on under tŠ‹s ‹ntervent‹on ‹ncŽuded pr‹nted and aud‹o EC ater‹aŽs, perforanceâbased ‹nteract‹ve sess‹ons, sens‹t‹sat‹on eet‹ngs, debates, aret capa‹gns, v‹deo sŠows and draa perforances. 3.2.1.1.PrintandaudiomaterialsDur‹ng tŠe 2â12/13 f‹scaŽ ›ear, a totaŽ of 1,â44,2ͺ4 EC ater‹aŽs were produced and d‹str‹buted aga‹nst a target of Í»ââ,âââ, surpass‹ng tŠe target b› 16%. TŠe nuber of EC ater‹aŽs produced ‹n 2â12/13 was sŽ‹gŠtŽ› Š‹gŠer tŠan tŠose produced ‹n 2â11/12 est‹ated at ͻͻ7,4Í»4 cop‹es. n botŠ ›ears tŠe target was surpassed. Dur‹ng 2â12/13 a cuuŽat‹ve Í»2 Šours of prograes broadcast‹ng V/ADS essages were a‹red on teŽev‹s‹on aga‹nst a target of 2ââ Šours, represent‹ng a 46% underacŠ‹eveent. TŠ‹s ars a aŒor reduct‹on, as ‹n 2â11/12 a totaŽ of 322 Šours were used for broadcast‹ng V and ADS essages on TV. TŠrougŠ prograes, sŽots and Œ‹ngŽes, a totaŽ of 342 Šours of V and ADS essages and ‹nforat‹on were a‹red on coun‹t› rad‹o stat‹ons, surpass‹ng a target of 3ââ Šours È114 %È. n 2â11/12, onŽ› 124 Šours were ut‹Ž‹œed to a‹r V and ADS essages surpass‹ng a set target of 1ââ Šours. t ‹s ‹portant to note tŠat tŠe nubers of Šours spent on broadcast‹ng of V and ADS essages on tŠe rad‹o as reported over tŠe per‹od 2â11â2â13 are an underâest‹ate because one stud› on nonâb‹oed‹caŽ ‹ntervent‹ons found tŠat botŠ TV and rad‹o stat‹ons ‹n MaŽaw‹ a‹r V and ADS progras cover‹ng ore tŠan 4,âââ Šours annuaŽŽ›3.2.1.2.InteractiveAudioVisualServicesPerforance and ‹nteract‹ve sess‹ons Èdraa, debates, and pubŽ‹c taŽsÈ, ‹ncŽud‹ng pubŽ‹c Žectures and ešpert taŽs on V and ADS, were conducted ‹n scŠooŽs, coun‹t‹es and worpŽaces, and acŠ‹eved tŠe set targets Èͻͻ% of pŽanned act‹v‹t‹esÈ. Targets were surpassed ‹n coun‹t› ob‹Ž‹sat‹on b› 346% dur‹ng tŠe sae per‹od. owever, set targets for sens‹t‹sat‹on of d‹str‹ct Žeaders ÈŽocaŽ Žeaders, teacŠers, parents/guard‹ans, fa‹tŠ Žeaders, trad‹t‹onaŽ ‹n‹t‹ators, ›outŠ ŽeadersÈ and voŽunteers tra‹ned Èb› genderÈ ‹n V prevent‹on nterpersonaŽ/‹nteract‹ve coun‹cat‹on, ‹ncŽud‹ng s‹gn Žanguage, were not acŠ‹eved w‹tŠ onŽ› 64% of pŽanned act‹v‹t‹es successfuŽŽ› acŠ‹eved ‹n tŠe 2â12/13 f‹scaŽ ›ear. MuntŠaŽ‹, A.C., P. MvuŽa, . M‹Žner and P. ‹sŠ‹ndo. È2â11È. situationanalysisbiomedicalinterventionsMalawi. oba: Centre for Soc‹aŽ ResearcŠ. 3.2.1.3.BehaviouralChangeInterventionsforyouthsBeŠav‹our cŠange coun‹cat‹on ‹ntervent‹ons for ›oung peopŽe were ‹pŽeented tŠrougŠ var‹ous ‹n‹t‹at‹ves, ‹ncŽud‹ng ‹fe S‹ŽŽs Educat‹on ÈSEÈ for ‹nâscŠooŽ and outâofâscŠooŽ ›oung peopŽe; and tŠe prov‹s‹on of outŠâFr‹endŽ› eaŽtŠ Serv‹ces È F SÈ a‹ed at ‹ncreas‹ng ›outŠsǯ access to sešuaŽ and reproduct‹ve ŠeaŽtŠ serv‹ces. Before 2â1â SE for ‹n scŠooŽ ›outŠ was be‹ng offered ‹rreguŽarŽ›. TŠe deŽ‹ver› of tŠ‹s subŒect on a andator› bas‹s and a‹ng ‹t eša‹nabŽe Šas ensured tŠat aŽŽ pup‹Žs ‹n pr‹ar› and secondar› scŠooŽ access tŠ‹s subŒect. AŽŽ students ‹n pr‹ar› and secondar› scŠooŽs ‹n 2â13 were tŠerefore ešposed to SE. CurrentŽ› tŠe SE curr‹cuŽu for secondar› scŠooŽs ‹s be‹ng rev‹sed ‹n order to ‹ncorporate copreŠens‹ve sešuaŽ‹t› educat‹on. A cuuŽat‹ve totaŽ of 134,735 outâofâscŠooŽ ›outŠs È135% acŠ‹eveentÈ were ešposed to SE dur‹ng tŠe 2â12/13 f‹scaŽ ›ear aga‹nst an annuaŽ target of 1ââ,âââ. TŠ‹s represented a decrease È53% acŠ‹eveentÈ as ‹n 2â11/12 a cuuŽat‹ve totaŽ of 264,Í»6ͺ outâofâscŠooŽ ›outŠs were ešposed to SE. For botŠ ›ears tŠese f‹gures a› be underâest‹ates as not aŽŽ ‹pŽeent‹ng partners report tŠe‹r act‹v‹t‹es to NAC. n 2â12/13 ost targets under tŠ‹s ‹ntervent‹on were et and soe surpassed sucŠ as tŠe tra‹n‹ng of ›outŠ cŽub Žeaders and patrons, SE for cŽub Žeaders of outâofâscŠooŽ ›outŠs, ›outŠ peer educators, and nuber of ›outŠ sens‹t‹sat‹on sess‹ons. nâscŠooŽ Èpr‹ar›, secondar› and tert‹ar› scŠooŽsÈ, and outâofâscŠooŽ ›outŠ Žeaders and peer educators were tra‹ned ‹n ‹nterpersonaŽ/‹nteract‹ve Ž‹fe s‹ŽŽs educat‹on. 3.2.1.4.CondomProgrammingn 2â12/13 a totaŽ of 2â,Í»57,ͺ7â aŽe condos were freeŽ› d‹str‹buted represent‹ng a odest ‹ncrease fro 2â,7ââ,âââ ‹n 2â11/12. TŠe nuber of soc‹aŽŽ› areted condos decreased fro 11,362,166 ‹n 2â11/12 to Í»,35ͺ,â22 ‹n 2â12/13. TŠ‹s trend of decreas‹ng nubers of soc‹aŽŽ› areted condos Šas been observed over tŠe Žast few ›ears. TŠe nuber of feaŽe condos d‹str‹buted decreased fro 1,44â,262 ‹n 2â11/12 to Í»43,ͺ2â ‹n 2â12/13. n 2â12/13 tŠe proot‹on and d‹str‹but‹on of condos d‹d not eet set targets, but acŠ‹eved 7Í».5% of tŠe 2â12/13 target for aŽe condos wŠ‹cŠ are freeŽ› d‹str‹buted and soc‹aŽŽ› areted. Assess‹ng tŠe nuber of condos d‹str‹buted v‹sâaâv‹s tŠe popuŽat‹on ‹nd‹cates tŠat 5Í».7 condos were d‹str‹buted per sešuaŽŽ› act‹ve aŽe us‹ng condos per ›ear ‹nstead of tŠe ešpected 144 condos. neffect‹ve suppŽ› cŠa‹n anageent s›ste was tŠe aŒor cause of Žower tŠan ešpected condo d‹str‹but‹on. For pr‹vate secondar› scŠooŽs wŠ‹cŠ foŽŽow tŠe M‹n‹str› of Educat‹on curr‹cuŽa, tŠe› w‹ŽŽ aŽso Šave tŠ‹s subŒect as a copuŽsor› subŒect. TAD. È2â12È. TheindependentreviewMalawinationalresponseHIV/AIDSfinancial20112012. ‹Žongwe: Nat‹onaŽ ADS Co‹ss‹on 3.2.1.5.QualitativeAssessmentqualityeffectivenessbiomedicalinterventions Dur‹ng tŠe report‹ng per‹od, tŠere was no nat‹onaŽ representat‹ve surve› to assess tŠe ‹pact of nonâb‹oed‹caŽ ‹ntervent‹ons on beŠav‹oraŽ cŠange and V prevaŽence. TŠus, ARPR ‹nd‹cators on reduct‹on of sešuaŽ trans‹ss‹on of V couŽd not be assessed. Aong staeŠoŽders, tŠere were ‹šed v‹ews on tŠe ‹pact of tŠese ‹ntervent‹ons w‹tŠ soe cŽa‹‹ng tŠat soe ‹ntervent‹ons were not ev‹denceâbased. owever, ost respondents acnowŽedged tŠat assessent of genu‹ne beŠav‹oraŽ cŠange ‹s d‹ff‹cuŽt. TŠe› ešpressed a w‹de range of concerns ‹ncŽud‹ng ‹nadequate target‹ng of Š‹gŠ r‹s popuŽat‹ons sucŠ as pr‹soners, seš worers and Men Šav‹ngâSeš w‹tŠ Men ÈMSMÈ togetŠer w‹tŠ tŠe‹r ‹nt‹ate partners, Ž‹‹ted capac‹t› È‹n ters of s‹ŽŽs and nubers of staffÈ at d‹str‹ct ŽeveŽ to deŽ‹ver appropr‹ate beŠav‹oraŽ cŠange ‹ntervent‹ons and cŠron‹c sŠortage of condos, espec‹aŽŽ› at tŠe endâuser ŽeveŽ. Most respondents apprec‹ated tŠe good coverage of SE for ‹n and outâof scŠooŽ ›outŠs ‹n 2â13 and weŽcoed recent efforts to rev‹se tŠe breadtŠ and deptŠ of SE curr‹cuŽu to ‹ncŽude copreŠens‹ve sešuaŽ‹t› educat‹on, espec‹aŽŽ› for secondar› scŠooŽ students. 3.2.2.BiomedicalTŠe ‹pŽeentat‹on of b‹oed‹caŽ prevent‹ve ‹ntervent‹ons ‹s gu‹ded b› severaŽ poŽ‹c‹es and strateg‹es and pŽans ‹ncŽud‹ng tŠe V Test‹ng and CounseŽ‹ng È TCÈ ScaŽeâup pŽan, tŠe Nat‹onaŽ PŽan of Act‹on for ScaŽ‹ng up of SešuaŽ and Reproduct‹ve eaŽtŠ V Prevent‹on ntervent‹ons for oung PeopŽe, Nat‹onaŽ BŽood Safet› PoŽ‹c›, tŠe VMMC PoŽ‹c› and Nat‹onaŽ PŽan on scaŽeâup of VMMC and tŠe PMTCT ScaŽe up PŽan. 3.2.2.1.TestingandCounseling V Test‹ng and CounseŽ‹ng È TCÈ too pŽace ‹n ͺ25 stat‹c and 534 outreacŠ s‹tes dur‹ng tŠe 2â12/13 f‹scaŽ ›ear, a sŽ‹gŠt ‹ncrease fro tŠe 7ͺ2 stat‹c s‹tes ‹n tŠe prev‹ous f‹scaŽ ›ear, w‹tŠ ore ART and PMTCT s‹tes Šav‹ng been ‹ntegrated ‹n tŠe past ›ear. TŠe nuber of V tests conducted ‹n tŠe f‹scaŽ ›ear was 2,1ͺͺ,Í»52, surpass‹ng tŠe target of 1,ͺââ.âââ b› 2â%. n 2â11/2â12 1,42Í»,5ͺ6 peopŽe were tested for V and tŠ‹s was Žower tŠan 1,773,âââ ‹ŽŽ‹on tests done ‹n 2â1â/2â11. TŠe ‹ncreased nubers of peopŽe tested ‹n 2â12/13 was partŽ› attr‹buted to fewer stoc outs of test ‹ts, as weŽŽ as tŠe ‹pŽeentat‹on of an ‹ntens‹ve V Test‹ng ee a‹ed at ‹prov‹ng TC access. TŠose wŠo were be‹ng tested for tŠe f‹rst t‹e ranged fro 34% â 3Í»% of tŠe totaŽ, wŠ‹cŠ ‹s sŽ‹gŠtŽ› Žess tŠan ‹n 2â11/12. TŠe annuaŽ target of ͺâ,âââ ›oung peopŽe tested for V tŠrougŠ F S was ešceeded ‹n tŠe f‹rst tŠreeâquarters of tŠe 2â12/13 f‹scaŽ ›ear, w‹tŠ Í»6,7ͺâ È52,âÍ»2 aŽes and 41,4Í»â feaŽesÈ tested b› 31 MarcŠ 2â13. 3.2.2.2.ManagementSexuallyTransmittedn tŠe 2â12/13 f‹scaŽ ›ear, two probŽes Šave affected tŠe report‹ng of data for sešuaŽŽ›âtrans‹tted ‹nfect‹ons ÈSTsÈ. F‹rstŽ›, onŽ› a ‹nor‹t› of d‹str‹cts È5 of 2Í»È sub‹tted reports on ST cases. SecondŽ›, even w‹tŠ‹n tŠose d‹str‹cts wŠ‹cŠ reported, ‹t was est‹ated tŠat onŽ› about 7â per cent of aŽŽ treated STs were be‹ng reported. Aong tŠe reported cases, onŽ› about 35% of ST cases were treated accord‹ng to gu‹deŽ‹nes. A Žarge proport‹on of tŠose ST pat‹ents wŠo were seen were Vâpos‹t‹ve and repeaters, ‹pŽ›‹ng tŠat a d‹agnos‹s of V Šad not cŠanged tŠe‹r Š‹gŠâr‹s beŠav‹our. AŽso, tŠere were reports of stoc outs of ST drugs and s›pŠ‹Ž‹s test ‹ts. TŠus, ‹t ‹s Ž‹eŽ› tŠat a ver› Žarge proport‹on of STs ‹n MaŽaw‹ are not be‹ng properŽ› d‹agnosed and treated, wŠ‹cŠ a› ver› weŽŽ be contr‹but‹ng to tŠe cont‹nued Š‹gŠ rate of V trans‹ss‹on. To overcoe tŠe cŠaŽŽenges ešper‹enced w‹tŠ Ç®pass‹veǯ report‹ng ‹n tŠe second quarter of 2â13, a dec‹s‹on was taen to act‹veŽ› coŽŽect ST reports dur‹ng tŠe ntegrated V Progra Superv‹s‹on ešerc‹se. Based on tŠe data coŽŽected at tŠe fac‹Ž‹t‹es, a totaŽ of 45,Í»4ͺ ST cases were treated ‹n tŠe quarter of 2â13. Cons‹der‹ng tŠe 75% copŽeteness of report‹ng, tŠ‹s nuber ‹s est‹ated to represent a totaŽ of 61,264 ST cases treated. TŠ‹s ‹s equ‹vaŽent to 62% ST treatent coverage of tŠe ešpected ͻͺ,6ââ ST cases ‹n tŠe popuŽat‹on3.2.2.3.BloodSafetyDur‹ng tŠe 2â12/13 f‹scaŽ ›ear, MaŽaw‹ BŽood Transfus‹on Serv‹ces ÈMBTSÈ coŽŽected 43,â12 un‹ts of bŽood Ètarget was ͺâ,âââÈ, copared to 56,324 un‹ts ‹n 2â11/12 ÈwŠen tŠe target was 4â,âââÈ. n tŠe 2â12/13 f‹scaŽ ›ear, tŠere were onŽ› tŠree coŽŽect‹on s‹tes ‹n tŠe countr›, so d‹stance and Žog‹st‹cs Šapered ‹pŽeentat‹on of countr›âw‹de bŽood donat‹on tŠrougŠ MBTS. To aŽŽev‹ate tŠ‹s probŽe, tŠe MBTS opened tŠree sateŽŽ‹te coŽŽect‹on s‹tes. owever, tŠese rea‹n ‹nadequate to eet tŠe deand. FurtŠerore, per‹od‹c sŠortages of bŽoodâtest‹ng reagents, as weŽŽ as bŽood coŽŽect‹on bags, Šapered acŠ‹eveent of targets ‹n tŠe past ›ear. 3.2.2.4.VoluntaryMedicalMaleCircumcisionDur‹ng tŠe 2â12/13 f‹scaŽ ›ear, VMMC was act‹veŽ› ‹pŽeented ‹n onŽ› ͺ of tŠe 2Í» d‹str‹cts ‹n MaŽaw‹, ostŽ› w‹tŠ support fro PEPFAR. As of 3â une 2â13, 2ͺͻ prov‹ders and 3â TOTs Šad been tra‹ned ÈtŠe target was 24â tra‹ners and 15 TOTsÈ, wŠ‹cŠ ‹s an ‹proveent over tŠe prev‹ous ›ear. At tŠe sae t‹e, 1â5 s‹tes Šad been estabŽ‹sŠed. TŠ‹s ‹s an ‹ncrease over tŠe ͺ2 s‹tes seen Žast ›ear and tŠe 32 s‹tes tŠe ›ear before, but st‹ŽŽ weŽŽ beŽow tŠe targeted 24â. A target of 1â,âââ VMMCs for tŠe f‹scaŽ ›ear 2â12/13 was set but 45,441 c‹rcuc‹s‹ons were reported b› 3â une 2â13, surpass‹ng tŠe target b› a factor of four. Dur‹ng 2â11/2â12 a totaŽ of ͺ,534 ed‹caŽ c‹rcuc‹s‹ons were perfored and tŠ‹s represented ͺ5% of tŠe totaŽ target È1â,âââ c‹rcuc‹s‹onsÈ for tŠe ›ear. TŠe nuber of c‹rcuc‹s‹ons perfored ‹n 2â12/13 represents a aŒor ‹ncrease over tŠe 2â11/12 f‹nanc‹aŽ ›ear. n 2â12/13 ost of VMMCs were perfored ‹n tŠe f‹naŽ quarter ÈApr‹Ž to une 2â13È dur‹ng a VMMC capa‹gn ‹n wŠ‹cŠ ore tŠan 3â,âââ en were c‹rcuc‹sed. Š‹Že tŠe target set sees reaŽ‹st‹c ‹n ters of tŠe ava‹ŽabŽe capac‹t› ‹n tŠe countr›, ‹t ‹s weŽŽ beŽow tŠe ‹deaŽ target of 25â,âââ per ›ear requ‹red to ean‹ngfuŽŽ› ‹prove tŠe prevaŽence of VMMC aong aŽes ‹n tŠe generaŽ popuŽat‹on. 3.2.2.5.EliminationMotherChildTransmission(EMTCT)MaŽaw‹ Šas been ‹pŽeent‹ng an ‹ntegrated ART/EMTCT prograe s‹nce 1 uŽ› 2â11 tŠrougŠ tŠe ‹ntroduct‹on of tŠe Opt‹on B+. EMTCT/ART serv‹ces are fuŽŽ› ‹ntegrated ‹nto aternaŽ and cŠ‹Žd ŠeaŽtŠ serv‹ces. As of une 2â13, EMTCT serv‹ces were ava‹ŽabŽe ‹n 5ͺͺ PMTCT s‹tes ÈOpt‹on B+È s‹tes, an ‹ncrease fro 534 s‹tes ‹n une 2â12, but st‹ŽŽ not reacŠ‹ng tŠe target of 65â s‹tes. n tŠe 2â13 caŽendar ›ear, 4Í»7,61ͺ woen counseŽed and tested, wŠ‹cŠ represented ͺ2% of tŠe est‹ated nuber of pregnant woen and faŽŽs sŽ‹gŠtŽ› sŠort of target of ͺ5%. n tŠe sae caŽendar ›ear, 45,ͺ16 woen rece‹ved ART, represent‹ng 73% of tŠe est‹ated 63,âââ Vâpos‹t‹ve pregnant woen ‹n tŠe countr› dur‹ng tŠe ›ear. TŠ‹s f‹gure ‹s cŽose to tŠe nat‹onaŽ target of 75%. n tŠe caŽendar ›ear, 2Í»,714 ‹nfants born fro Vâpos‹t‹ve otŠers were prescr‹bed nev‹rap‹ne propŠ›Žaš‹s, represent‹ng Í»2% of tŠe totaŽ nuber of ‹nfants born to V pos‹t‹ve otŠers deŽ‹ver‹ng ‹n ŠeaŽtŠ fac‹Ž‹t‹es. n add‹t‹on, ͺ6% of a coŠort of 2ͺ,445 V ešposed ‹nfants aged 2âontŠs rece‹ved cotr‹ošaœoŽe propŠ›Žaš‹s. As reported ‹n tŠe prev‹ous ARPR, EarŽ› nfant D‹agnos‹s ÈEDÈ rea‹ns a aŒor cŠaŽŽenge ‹n MaŽaw‹. n tŠe 2â13 caŽendar ›ear, MaŽaw‹ anaged to test and prov‹de resuŽts to 3â% of V ešposed ‹nfants w‹tŠ‹n 2 ontŠs of b‹rtŠ. n tŠe Q3 of 2â13, tŠe ed‹an turnâaround t‹e fro coŽŽect‹on of DBS to d‹spatcŠ of resuŽts was 1Í» da›s, wŠ‹cŠ suggests a cons‹derabŽe deŽa› ‹n coun‹cat‹ng resuŽts to tŠe careg‹vers of Vâešposed ‹nfants. 3.2.2.6.QualitativeassessmentthequalityandeffectivenessbiomedicalpreventiveinterventionsCons‹stent w‹tŠ tŠe EMTCT ‹nd‹cators, ‹nterv‹ewed staeŠoŽders unan‹ousŽ› agreed tŠat ‹pŽeentat‹on of tŠe Opt‹on B+ strateg› Šas been Š‹gŠŽ› successfuŽ, espec‹aŽŽ› ‹n ters of screen‹ng tŠe aŒor‹t› of pregnant woen and prescr‹b‹ng tŠe w‹tŠ ART. owever, severaŽ respondents ešpressed concern over tŠe cŠaŽŽenges ešper‹enced ‹n t‹eŽ› deŽ‹ver› of EarŽ› nfant D‹agnos‹s resuŽts, ŽossâtoâfoŽŽow up and ART copŽ‹ance aong otŠerâ‹nfant pa‹rs enroŽŽed ‹n EMTCT prograes. StaeŠoŽders aŽso ešpressed tŠe‹r sat‹sfact‹on w‹tŠ tŠe boŽd steps MaŽaw‹ Šas taen to proote and ‹pŽeent VMMC act‹v‹t‹es. AŽtŠougŠ tŠe› acnowŽedged tŠat tŠe current nubers of VMMCs perfored were Žow, tŠe› were encouraged w‹tŠ tŠe rap‹d scaŽe up of tŠ‹s ‹ntervent‹on. Soe were of tŠe v‹ew tŠat deand for VMMC was ver› Š‹gŠ but Žaented tŠe ‹nfrastructuraŽ and Šuan resource cŠaŽŽenges ‹n tŠe ŠeaŽtŠ sector, wŠ‹cŠ w‹ŽŽ cont‹nue to adverseŽ› affect tŠe actuaŽ nuber of VMMCs perfored. Most respondents acnowŽedged tŠat ‹t w‹ŽŽ tae an enorous effort to reacŠ tŠe target of 25â,âââ VMMCs per ›ear and ean‹ngfuŽŽ› ‹ncrease tŠe prevaŽence of VMMC ‹n MaŽaw‹. A few respondents quest‹oned tŠe Žac of efforts to proote earŽ› ‹nfant aŽe c‹rcuc‹s‹on. Most staeŠoŽders noted tŠat tŠe countr› Šad successfuŽŽ› overcoe tŠe sŠortage of V test ‹ts wŠ‹cŠ adverseŽ› affected ‹pŽeentat‹on of TC serv‹ces ‹n 2â11/12. owever, a few noted w‹tŠ concern tŠe Žow quaŽ‹t› of V test resuŽts w‹tŠ a s‹gn‹f‹cant nuber of faŽseânegat‹ve resuŽts. NevertŠeŽess, tŠe› apprec‹ated efforts taen b› tŠe M‹n‹str› of eaŽtŠ w‹tŠ support fro deveŽopent partners to retra‹n aŽŽ TC prov‹ders and d‹sengage tŠose wŠo perfor poorŽ›. owever, tŠe› adv‹sed on tŠe need to repŽace TC prov‹ders wŠo Šad been d‹sengaged because of poor perforance. TŠere were ‹šed v‹ews on tŠe ava‹Žab‹Ž‹t› of adequate quant‹t‹es of safe bŽood and good access to ST anageent. Most respondent were of tŠe v‹ew tŠat access to safe bŽood was good ‹n urban areas but perŠaps not ‹n tŠe ruraŽ areas. OtŠers, ešpressed concern on tŠe quaŽ‹t› of ST anageent ‹n ŠeaŽtŠ fac‹Ž‹t‹es and tŠe ŽeveŽ of ‹ntegrat‹on w‹tŠ otŠer SešuaŽ and Reproduct‹ve eaŽtŠ serv‹ces.3.3.Treatment,support3.3.1.Therapy(ART)MaŽaw‹ Šas cont‹nued to ‹pŽeent tŠe 2â13 O gu‹deŽ‹nes on V treatent b› adopt‹ng a new CD4 counts tŠresŠoŽd for ‹n‹t‹at‹ng ART È35â ceŽŽs/cu.È and sw‹tcŠ‹ng f‹rst⎋ne ART fro d4Tâ to TDFâconta‹n‹ng reg‹ens. ART s‹tes were furtŠer decentraŽ‹œed to pr‹ar› care fac‹Ž‹t‹es ‹n tŠe 2â13 caŽendar ›ear. TŠe nuber of stat‹c s‹tes prov‹d‹ng ‹ntegrated ART serv‹ces ‹ncreased s‹gn‹f‹cantŽ›, fro 3ââ s‹tes ‹n une 2â11 to 6ͺͻ b› Deceber 2â13. TŠe nuber of pat‹ents be‹ng ‹n‹t‹ated on ART ‹ncreased stead‹Ž› dur‹ng tŠe 2â13 caŽendar ›ear. As of Deceber 2â13, tŠe totaŽ nuber of pat‹ents aŽ‹ve on ART was 472,ͺ65, w‹tŠ 1â2,5ͺ6 ‹n‹t‹ated ‹n tŠe ›ear 2â13 aŽone. Us‹ng tŠe CD4 ceŽŽ count of â¤35â as a tŠresŠoŽd for deter‹n‹ng eŽ‹g‹b‹Ž‹t› to ART, ‹s est‹ated tŠat, b› tŠe end of Deceber 2â13, ART coverage ‹n MaŽaw‹ was about ͺ3%, up fro 65% ‹n 2â12. Surv‹vaŽ rate at 12âontŠ for ART pat‹ents Šas rea‹ned stabŽe at nearŽ› 7ͺ% ‹n tŠe ›ear 2â13. TŠ‹s ‹s sŽ‹gŠtŽ› Žower tŠan tŠe surv‹vaŽ rate of ͺ5% recoended b› O. 3.3.2.IsoniazidPreventiveB› tŠe end of Septeber 2â13, 46,41Í» È31%È of aŽŽ pat‹ents ever reg‹stered were reta‹ned ‹n preâART foŽŽowâup; 63,Í»15 È43%È Šad started ART; 33,434 È22%È Šad been Žost to foŽŽowâup; 1,6ͺ3 È1%È were nown to Šave d‹ed. n tŠe tŠ‹rd quarter of 2â13, Cotr‹ošaœoŽe PropŠ›Žaš‹s TŠerap› ÈCPTÈ coverage aong preâART pat‹ents was 4â,7Í»1 Èͺͺ%È. Cons‹der‹ng tŠe Žow coverage of cotr‹ošaœoŽe propŠ›Žaš‹s ‹n tŠe 2â11/12 f‹scaŽ ›ear, MaŽaw‹ sees to Šave successfuŽŽ› overcoe tŠe sŠortages ‹n cotr‹ošaœoŽe suppŽ‹es. AŽŽ preâART pat‹ents w‹tŠ a negat‹ve screen‹ng outcoe for TB s›ptos are eŽ‹g‹bŽe for son‹aœ‹d ÈN È Prevent‹ve TŠerap› ÈPTÈ. B› tŠe end of Septeber 2â13, 23,234 È5â%È of 46,41Í» pat‹ents reta‹ned ‹n preâART were on PT. TŠ‹s was a ared ‹proveent fro 27% ÈÍ»,613/35,265È recorded at tŠe end of Septeber 2â12. owever, tŠe proport‹on of pat‹ents on PT ‹n Septeber 2â13 was Žess tŠan 5ͺ% È27,41ͺ/47,12Í»È reported at tŠe end of une 2â13. PT coverage was ešpected to ‹ncrease furtŠer over tŠe nešt quarters due to ‹ncreased ava‹Žab‹Ž‹t› of ‹son‹aœ‹d ‹n pr‹ar› care ŠeaŽtŠ fac‹Ž‹t‹es. 3.3.3.Managementn tŠe 2â13 caŽendar ›ear, 75% Èͺ454/112Í»6È of tŠe est‹ated nuber of ‹nc‹dent TB cases rece‹ved botŠ TB treatent and ART. AŽtŠougŠ tŠ‹s f‹gure faŽŽs sŠort of tŠe O target of ͺ5%, ‹t Šas ‹ncreased aredŽ› fro 6â% reported ‹n 2â12. TŠ‹s ‹s Ž‹eŽ› due to tŠe Žarge proport‹on È>Í»5%È of TB pat‹ents undergo‹ng V screen‹ng. n 2â13, TB screen‹ng, us‹ng cŽ‹n‹caŽ assessent, was perfored ‹n ͻͺ% of tŠe pat‹ents on ART. owever, TB was detected ‹n onŽ› 1.6% of pat‹ents on ART. TŠ‹s Žow TB ›‹eŽd suggests poor sens‹t‹v‹t› of tŠe cŽ‹n‹caŽ assessent or d‹agnost‹c tooŽs ava‹ŽabŽe at tŠe ŠeaŽtŠ fac‹Ž‹t› ŽeveŽ. Soe staeŠoŽders ešpressed concern tŠat ŠeaŽtŠ worers ‹n an› ŠeaŽtŠ fac‹Ž‹t‹es Šave a Š‹gŠ case Žoad of V pat‹ents and a› ešper‹ence t‹e constra‹nts ‹n screen‹ng pat‹ents for TB tŠorougŠŽ›. TB and V prograes at nat‹onaŽ ŽeveŽ ešper‹enced cŠaŽŽenges ‹n reconc‹Ž‹ng data suggest‹ng tŠe need to ‹prove TB/ V ‹ntegrat‹on at ŠeaŽtŠ fac‹Ž‹t› ŽeveŽ. 3.3.4.HomeDur‹ng tŠe 2â12/13 f‹scaŽ ›ear, a totaŽ of 17ͺ,ââ1 ŠouseŠoŽds w‹tŠ cŠron‹caŽŽ› ‹ŽŽ pat‹ents, were supported ‹n var‹ous wa›s, aga‹nst a target of 2ââ,âââ Èand a reduct‹on fro 2â2,57ͺ ‹n 2â11/12È. A cuuŽat‹ve totaŽ of 1,236 coun‹t› voŽunteers and ŠeaŽtŠ personneŽ were tra‹ned ‹n C BC/paŽŽ‹at‹ve care, represent‹ng 72% acŠ‹eveent of tŠe annuaŽ target. ‹tŠ tŠe cont‹nued ‹ncrease of P V Ž‹v‹ng ŠeaŽtŠ› Ž‹ves w‹tŠ ART, ‹t can be ešpected tŠat tŠe nuber of cŽ‹ents on coun‹t›âbased care w‹ŽŽ cont‹nue to decrease ‹n tŠe co‹ng ›ears. 3.3.5.QualitativeAssessmenteffectivenesstreatment,TŠere was unan‹ous agreeent aong tŠe staeŠoŽders tŠat tŠe ART prograe Šas been a great success ‹n ters of ‹ncreased coverage, decentraŽ‹œat‹on to pr‹ar› care fac‹Ž‹t› ŽeveŽs and sw‹tcŠ‹ng of an› pat‹ents fro tŠe d4Tâbased ART f‹rst⎋ne reg‹en to TDFâbased reg‹en. owever, soe respondents feŽt tŠe need to ‹prove coverage of ART aong cŠ‹Ždren and adoŽescents. Man› respondents aŽso ešpressed tŠe need to deveŽop poŽ‹c‹es and strateg‹es to ‹prove tŠe anageent of ›oung adoŽescents on ART. Man› staeŠoŽders were of tŠe v‹ew tŠat TB and V act‹v‹t‹es were weŽŽ ‹ntegrated at ŠeaŽtŠ fac‹Ž‹t› ŽeveŽ and tŠat tŠe coverage of cotr‹ošaœoŽe and ‹son‹aœ‹d propŠ›Žaš‹s Šad ‹proved. NevertŠeŽess, soe respondents ešpressed concern over tŠe Šeav› dependence of tŠe ART prograe on ešternaŽ f‹nanc‹aŽ support ,wŠ‹cŠ a› affect ‹ts susta‹nab‹Ž‹t›. OtŠers noted a s‹gn‹f‹cant Žossâto foŽŽowâup of ART pat‹ents and tŠe need to ‹ntens‹f› efforts ‹n adŠerence counseŽ‹ng of pat‹ents. StaeŠoŽders ešpressed concerns over tŠe subâopt‹aŽ deŽ‹ver› of tŠe Šoeâbased care serv‹ces. TŠe› noted tŠe need for nutr‹t‹onaŽ support for ART pat‹ents wŠ‹cŠ a› ‹prove tŠe‹r surv‹vaŽ. Soe were of tŠe v‹ew tŠat Šoeâbased care couŽd ‹ncŽude a coponent of adŠerence counseŽ‹ng and ps›cŠosoc‹aŽ support. 3.4.Mitigationn MaŽaw‹, ‹pact ‹t‹gat‹on act‹v‹t‹es are gu‹ded b› tŠe Nat‹onaŽ PoŽ‹c› for orpŠans and otŠer VuŽnerabŽe CŠ‹Ždren, tŠe Nat‹onaŽ Soc‹aŽ Support PoŽ‹c› and tŠe Nat‹onaŽ Act‹on PŽan for OrpŠans and OtŠer vuŽnerabŽe CŠ‹Ždren ÈNPA for OVCÈ and are Žed b› tŠe M‹n‹str› of ender, CŠ‹Ždren and Soc‹aŽ eŽfare. TŠe NPA for OVC ešp‹red ‹n 2ââÍ» and tŠ‹s was eštended to 2â11. CurrentŽ› tŠe oM and staeŠoŽders are deveŽop‹ng a new NPA for cŠ‹Ždren and tŠere w‹ŽŽ be no separate PŽan for OVC. TŠ‹s new PŽan w‹ŽŽ be ava‹ŽabŽe b› une 2â14. ChildreninstitutionalTŠe poŽ‹c› of tŠe oM ‹s tŠat aŽŽ cŠ‹Ždren sŠouŽd be ra‹sed ‹n tŠe‹r own coun‹t‹es and tŠat tŠe ‹nst‹tut‹onaŽ‹sat‹on of cŠ‹Ždren sŠouŽd be tŠe Žast resort. owever soe cŠ‹Ždren a› be teporar‹Ž› or peranentŽ› depr‹ved of tŠe‹r fa‹Ž› env‹ronent and Šence tŠe› w‹ŽŽ be prov‹ded w‹tŠ aŽternat‹ve care ‹n an ‹nst‹tut‹on. A 2â1â assessent of cŠ‹Ždren ‹n ‹nst‹tut‹onaŽ care found tŠat tŠere were 1â4 ‹nst‹tut‹ons car‹ng for cŠ‹Ždren ‹n MaŽaw‹ and tŠese ‹ncŽude orpŠanages, spec‹aŽ needs centres and reforator› centres. TŠese ‹nst‹tut‹ons were ta‹ng care of 6,â4â cŠ‹Ždren and 71 percent of tŠese cŠ‹Ždren were orpŠans. n ost of tŠese ‹nst‹tut‹ons tŠe needs of cŠ‹Ždren sucŠ as food, cŽotŠes and scŠooŽ fees were be‹ng et. TŠese ‹nst‹tut‹ons are tŠerefore contr‹but‹ng towards respond‹ng to tŠe V ep‹de‹c b› address‹ng tŠe needs of OVC. TŠere ‹s no current data on tŠe nuber of sucŠ ‹nst‹tut‹ons ‹n MaŽaw‹ as weŽŽ as tŠe nuber of cŠ‹Ždren be‹ng taen care of b› tŠese ‹nst‹tut‹ons. owever, a 2â13 ‹pact evaŽuat‹on of tŠe NPA for OVC observed tŠat tŠere are no reported act‹v‹t‹es to prevent ‹nst‹tut‹onaŽ‹œat‹on3.4.2.centresTŠe oM prootes tŠe estabŽ‹sŠent and anageent of coun‹t› based cŠ‹Žd care centres ÈCBCCsÈ as one wa› of respond‹ng to tŠe needs to OVC ‹n MaŽaw‹. TŠese CBCCs are owned and run b› coun‹t‹es tŠeseŽves. SucŠ centres prov‹de opportun‹t‹es for cŠ‹Ždren to Žearn, pŽa› and s‹ng and access food. A 2ââ6/7 surve› co‹ss‹oned b› UNCEF sŠowed tŠat tŠere were 5,665 CBCCs ‹n MaŽaw‹ and tŠat a totaŽ of 41â,âââ cŠ‹Ždren were enroŽŽed ‹n tŠese CBCCs. A 2â13 report sŠows tŠat tŠere are 5,6âÍ» CBCCs ‹n MaŽaw‹ car‹ng for 336,4ͻͻ cŠ‹Ždren a drop fro 771,âââ cŠ‹Ždren ‹n 2â11. 3.4.3.ThesocialcashtransferprogramTŠe MaŽaw‹ Soc‹aŽ CasŠ Transfer Progra ÈSCTPÈ was des‹gned to aŽŽev‹ate povert›, reduce aŽnutr‹t‹on and ‹prove scŠooŽ enroŽent b› deŽ‹ver‹ng reguŽar and reŽ‹abŽe casŠ transfers to uŽtra poor ŠouseŠoŽds tŠat are aŽso Žabour constra‹ned. TŠe progra was p‹Žoted ‹n McŠ‹nŒ‹ d‹str‹ct w‹tŠ support fro tŠe ŽobaŽ Fund and UNCEF. As of 2â11 tŠe SCTP was be‹ng ‹pŽeented ‹n McŠ‹nŒ‹, SaŽ‹a, ‹oa, CŠ‹t‹pa, MangocŠ‹, MacŠ‹nga and PŠaŽobe d‹str‹cts. One of tŠe aŒor acŠ‹eveents ‹n 2â13 was tŠat tŠe progra Šas been eštended to 1Í» d‹str‹cts wŠ‹cŠ ‹pŽ‹es tŠat ore orpŠans and tŠe‹r ŠouseŠoŽds are benef‹t‹ng fro tŠe progra. TŠ‹s progra ‹s ostŽ› funded b› deveŽopent partners. Over tŠe ›ears tŠe f‹nanc‹aŽ contr‹but‹on b› tŠe oM Šas been ‹ncreas‹ng; for ešapŽe ‹n 2â11/12 oM contr‹buted M7â ‹ŽŽ‹on and ‹n 2â12/13 tŠ‹s ‹ncreased to M2â6 ‹ŽŽ‹on and ‹n tŠe current f‹nanc‹aŽ ›ear ‹t Šas ‹ncreased to M45â ‹ŽŽ‹on. OtŠer acŠ‹eveents ‹n 2â13 ‹ncŽuded tŠe estabŽ‹sŠent of an autoated webâbased anageent ‹nforat‹on s›ste, tŠe p‹Žot‹ng of an eâpa›ent s›ste for benef‹c‹ar‹es of tŠe progra, tŠe approvaŽ b› oM of a structure for ‹pŽeent‹ng tŠe casŠ transfer progra and an ‹ncrease ‹n transfer ŽeveŽs fro M2,âââ to M2,7ââ per ŠouseŠoŽd. TŠe evaŽuat‹on of tŠ‹s progra Šas sŠown tŠat USAD and UNCEF. È2â13È. pact evaŽuat‹on of tŠe Nat‹onaŽ PŽan of Act‹on for OrpŠand and otŠer vuŽnerabŽe cŠ‹Ždren 2ââ5â2ââÍ» and 2â1ââ2â11È. ‹Žongwe: USAD and UNCEF. USAD and UNCEF. È2â13È. pact evaŽuat‹on of tŠe Nat‹onaŽ PŽan of Act‹on for OrpŠand and otŠer vuŽnerabŽe cŠ‹Ždren 2ââ5â2ââÍ» and 2â1ââ2â11È. ‹Žongwe: USAD and UNCEF. tŠe prevaŽence of underâwe‹gŠt cŠ‹Ždren Šas gone down; food secur‹t› ‹proved; and scŠooŽ enroŽent and retent‹on ‹ncreased aong otŠer benef‹ts. TŠe aŒor cŠaŽŽenge w‹tŠ tŠe progra ‹s tŠat ‹t ‹s ver› ešpens‹ve and w‹tŠout donor support, ‹t ‹s not susta‹nabŽe. 3.4.4.SchoolattendanceamongorphansTŠ‹s ‹nd‹cator ‹s easured tŠrougŠ tŠe MD S. TŠe Žast MD S was conducted ‹n 2â1â and ‹t found tŠat tŠe rat‹o of current scŠooŽ attendance aong orpŠans to nonâorpŠans aong tŠe 1ââ14 ›ear oŽds was at â.Í»6. 3.4.5.needsforn tŠe 2â12/13 f‹scaŽ ›ear, a range of negat‹ve soc‹oecono‹c and ater‹aŽ effects were feŽt b› ŠouseŠoŽds, eštended fa‹Ž‹es, ne‹gŠbourŠoods, and coun‹t‹es affected b› V and ADS. TŠe Careg‹vers Act‹on Networ report ‹n une 2â13 ‹dent‹f‹ed povert› as a cont‹nu‹ng aŒor ‹ssue, w‹tŠ an› groups Ç®often unabŽe to eet Ž‹veŽ‹Šood cŠaŽŽenges, to send cŠ‹Ždren to scŠooŽ and to bu› bas‹c necess‹t‹es for tŠeseŽves and tŠe‹r fa‹Ž‹esǯ. Food ‹nsecur‹t›, educat‹on and epŽo›ent were aŽso s‹gn‹f‹cant probŽes for PeopŽe ‹v‹ng w‹tŠ V ÈMANET+ St‹ga ndeš, anuar› 2â13È.Dur‹ng 2â12/13 f‹scaŽ ›ear, a totaŽ of 12,ââ1 orpŠans and otŠer vuŽnerabŽe cŠ‹Ždren were prov‹ded w‹tŠ educat‹on bursar‹es to attend secondar› scŠooŽ educat‹on, represent‹ng a 12â% acŠ‹eveent aga‹nst tŠe set annuaŽ target. owever, tŠe pŽanned app‹ng of prov‹ders of scŠooŽ bursar‹es, to enabŽe better coord‹nat‹on and use of tŠe Ž‹‹ted resources was not carr‹ed out. n add‹t‹on tŠe pŽanned rev‹s‹on of tŠe bursar› gu‹deŽ‹nes d‹d not tae pŽace. Partners, ‹n part‹cuŽar coun‹t› groups, noted tŠat tŠere are ‹nadequate resources for tŠe educat‹on bursar‹es, g‹ven tŠe nubers ‹n need. Add‹t‹onaŽŽ› 2,1ͺ1 vuŽnerabŽe ›oung peopŽe were tra‹ned ‹n vocat‹onaŽ s‹ŽŽs dur‹ng tŠe report‹ng per‹od È45% underacŠ‹eveent aga‹nst tŠe annuaŽ target.È A totaŽ of 1â1,Í»32 orpŠans and otŠer vuŽnerabŽe cŠ‹Ždren were prov‹ded w‹tŠ var‹ous fors of support ‹ncŽud‹ng ed‹caŽ, ater‹aŽ, f‹nanc‹aŽ and ps›cŠosoc‹aŽ support, surpass‹ng tŠe annuaŽ target b› 13 per cent. 3.4.6.QualitativeAssessmenteffectivenessimpactmitigationsactivitiesTŠe deŽ‹ver› of serv‹ces to orpŠans and otŠer vuŽnerabŽe cŠ‹Ždren was rated poorŽ› b› staeŠoŽders. TŠe› feŽt tŠat ‹pact ‹t‹gat‹on ‹ntervent‹ons at botŠ nat‹onaŽ and d‹str‹ct ŽeveŽs are not weŽŽ coord‹nated ‹n tŠe countr›. TŠe› aŽso ešpressed tŠe need to assess tŠe ‹pact of current ‹pact ‹t‹gat‹on ‹ntervent‹ons. TŠe› recoended tŠe need for NAC to engage tŠe M‹n‹str› of ender, CŠ‹Ždren and Soc‹aŽ eŽfare to ‹dent‹f› wa›s of ‹prov‹ng serv‹ces deŽ‹ver›. One otŠer aŒor cŠaŽŽenge was tŠat wŠ‹Že soc‹aŽ casŠ transfers Šave deonstrated tŠat tŠe› Šave pos‹t‹ve ‹pact ‹n ters of ‹prov‹ng access to food, cŽotŠes and generaŽ weŽfare tŠe progra ‹s ver› ešpens‹ve and Šence not susta‹nabŽe. TŠere was aŽso a caŽŽ tŠat tŠe NPA for cŠ‹Ždren sŠouŽd be f‹naŽ‹œed qu‹cŽ› so tŠat ‹t can gu‹de tŠe ‹pŽeentat‹on of ‹ntervent‹ons for OVC and tŠe‹r ŠouseŠoŽds. M‹ŽŽer, C.M., M. Tsoa. È2â11È. ARVsandcaringsupportingpeoplewithANDAIDSwiththeMalawiSocialCashTransfer. PRACTICES4.1.PoliticalcommitmentMaŽaw‹ cont‹nues to deonstrate poŽ‹t‹caŽ co‹tent to tŠe f‹gŠt aga‹nst V and ADS. er EšceŽŽenc› tŠe Pres‹dent of tŠe RepubŽ‹c of MaŽaw‹, Dr o›ce Banda, Šas deonstrated Šer co‹tent tŠrougŠ an› wa›s: sŠe ‹s tŠe M‹n‹ster respons‹bŽe for V/ADS and botŠ tŠe Departent of Nutr‹t‹on and V and ADS and tŠe Nat‹onaŽ ADS Co‹ss‹on wŠ‹cŠ oversee and coord‹nate tŠe nat‹onaŽ response are ‹n Šer off‹ce. n une 2â13 tŠe Pres‹dent Šosted tŠe UNADS and ancet Co‹ss‹oners Conference and sŠe ‹s a ŽobaŽ Abassador for V and ADS. MaŽaw‹ aŽso conducted tŠe egaŽ and PoŽ‹c› Env‹ronentaŽ assessent wŠ‹cŠ Šas aong otŠer tŠ‹ngs ‹nfored tŠe draft‹ng of tŠe V B‹ŽŽ as weŽŽ as ‹nfor‹ng tŠe deveŽopent of V ‹ntervent‹ons. Once tŠe V B‹ŽŽ ‹s passed, ‹t w‹ŽŽ ass‹st ‹n protect‹ng and proot‹ng peopŽesǯ r‹gŠts ‹n tŠe contešt of V and ADS. 4.2.ProgrammeImplementation4.2.1.ScaleMaŽaw‹ deonstrated Šas deonstrated tŠat Š‹gŠ ŽeveŽs coverage of coverage TC and ART for pregnant woen can be acŠ‹eved even ‹n resource Ž‹‹ted sett‹ngs tŠrougŠ tŠe adopt‹on of tŠe Opt‹on B+ strateg› and effect‹ve use of Šuan resources. To acŠ‹eve tŠ‹s, ART serv‹ces were decentraŽ‹œed to pr‹ar› care fac‹Ž‹t‹es and ‹ntegrated w‹tŠ MaternaŽ and CŠ‹Žd eaŽtŠ serv‹ces. n add‹t‹on, ‹nstead of cŽ‹n‹c‹ans prescr‹b‹ng ART, nurses Šave been tra‹ned and are now abŽe to prescr‹be ART to pat‹ents. A Žarge nuber of pr‹ar› ŠeaŽtŠ care fac‹Ž‹t› staff were successfuŽŽ› tra‹ned and are now tŠe bacbone of V care deŽ‹ver›. ART treatent reg‹en was s‹pŽ‹f‹ed, b› ‹ntroduc‹ng one reg‹en for nonâpregnant and pregnant aduŽts. TŠ‹s fac‹Ž‹tated ŠeaŽtŠ worersǯ fa‹Ž‹ar‹t› and ešper‹ence w‹tŠ a spec‹f‹c ART reg‹en and fac‹Ž‹tated tŠe procureent A group of tecŠn‹caŽ ešperts fro tŠe d‹str‹ct, œonaŽ and centraŽ ŽeveŽ on‹tor tŠe ‹pŽeentat‹on of EMTCT serv‹ces at pr‹ar› care ŽeveŽ. TŠe quarterŽ› v‹s‹ts obta‹n Š‹gŠ quaŽ‹t› data wŠ‹cŠ can b› anaŽ›œed qu‹cŽ› and used to ‹nfor ‹pŽeentat‹on of act‹v‹t‹es. 4.2.2.TransferTŠe Soc‹aŽ CasŠ Transfer Progra ÈSCTPÈ wŠ‹cŠ was p‹Žoted ‹n McŠ‹nŒ‹ d‹str‹ct Šas now be‹ng ‹pŽeented ‹n 1Í» d‹str‹cts w‹tŠ support fro deveŽopent partners. An evaŽuat‹on of tŠe MaŽaw‹ SCTP, as d‹scussed above, sŠows tŠat tŠe progra Šas Šad a pos‹t‹ve ‹pact and ‹t ‹s be‹ng scaŽed up. Š‹Že acnowŽedg‹ng tŠat tŠe progra ‹s ešpens‹ve and Šence susta‹nab‹Ž‹t› needs carefuŽ evaŽuat‹on, ‹t Šas Šowever ‹pacted on ŠouseŠoŽds espec‹aŽŽ› OVC pos‹t‹veŽ› for ešapŽe cŠ‹Ždren rea‹n ‹n scŠooŽ and Šave access to food. CHALLENGESACTIONSProgressmadekeychallengesreportedthe2012ProgressA nuber of cŠaŽŽenges were ‹dent‹f‹ed ‹n 2â12 wŠ‹cŠ Šapered tŠe ‹pŽeentat‹on of tŠe nat‹onaŽ response to tŠe V and ADS ep‹de‹c. Soe of tŠe cŠaŽŽenges st‹ŽŽ eš‹st and Šave not been successfuŽŽ› addressed. TŠese cŠaŽŽenges ‹ncŽude wea suppŽ› cŠa‹n s›stes, ‹nadequate ‹ntervent‹ons target‹ng e› popuŽat‹ons sucŠ as seš worers and MSMs, st‹ga and d‹scr‹‹nat‹on wŠ‹cŠ Š‹nder access to V and ADS serv‹ces for P Vs, nonâd‹sburseent of funds fro tŠe ŽobaŽ Fund, tŠe Žac of standard‹sat‹on of coun‹t› engageent tooŽs and serv‹ce deŽ‹ver› protocoŽs and ‹‹pŽeentat‹on of soe e› ‹ntervent‹ons sucŠ as nonâb‹oed‹caŽ beŠav‹ouraŽ cŠange ‹ntervent‹ons., n add‹t‹on to tŠ‹s tŠe nuber of new ‹nfect‹ons are st‹ŽŽ qu‹te Š‹gŠ. Even tŠougŠ a Žot of ‹nvestents Šave been ade ‹n tŠe ‹pŽeentat‹on of nonâb‹oed‹caŽ V and ADS prevent‹ve ‹ntervent‹ons wŠ‹cŠ are a‹ed at br‹ng‹ng about beŠav‹ouraŽ cŠange, tŠere ‹s st‹ŽŽ no ev‹dence about tŠe effect‹veness of tŠese ‹ntervent‹ons. n add‹t‹on to tŠese probŽes tŠe foŽŽow‹ng Šave been ‹dent‹f‹ed as affect‹ng ‹pŽeent‹ng of tŠe V and ADS ‹ntervent‹ons ‹n 2â13: ‹‹ted budgetar› aŽŽocat‹on espec‹aŽŽ› to nonâb‹oed‹caŽ prevent‹on ‹ntervent‹ons. An overaŽŽ wea researcŠ and M&E s›ste espec‹aŽŽ› at d‹str‹ct TŠere ‹s a generaŽ Žac of sŠar‹ng of data at d‹str‹ct and Žower ŽeveŽs and tŠe capac‹t› to ut‹Ž‹œe data for dec‹s‹on a‹ng ‹s Žow. NonâaŽ‹gnent of soe N Os ‹ntervent‹ons and M&E s›stes to uŽt‹âsectoraŽ V and ADS strateg‹c pŽan. A Šuge fund‹ng gap st‹ŽŽ eš‹sts to enabŽe staeŠoŽders fuŽŽ› ‹pŽeent tŠe Nat‹onaŽ V and ADS Strateg‹c PŽan. A Ž‹‹ted range of serv‹ces target‹ng ›outŠ and V+ cŠ‹Ždren. TŠere eš‹st soe ‹ncons‹stenc‹es between poŽ‹c‹es and Žaws on en Šav‹ng seš w‹tŠ en and seš worers. TŠere ‹s soe eerg‹ng concern tŠat tŠe use of condos ‹n soe areas of tŠe countr› ‹s dropp‹ng because of tŠe beŽ‹ef tŠat VMMC ‹s protect‹ve. Coverage for VMMC ‹s st‹ŽŽ ver› Žow. And tŠe ŠeaŽtŠ sector Žacs capac‹t› to eet tŠe deand for VMMC. EarŽ› ‹nfant d‹agnos‹s ‹s st‹ŽŽ a aŒor cŠaŽŽenge. TŠe nuber of OVC and tŠe‹r ŠouseŠoŽds be‹ng reacŠed w‹tŠ d‹fferent ‹ntervent‹ons ‹s st‹ŽŽ saŽŽ. ea coord‹nat‹on ecŠan‹ss for OVC progras and tŠe Žac of tŠe NPA for OVC to gu‹de ‹pŽeentat‹on of ‹ntervent‹ons. V B‹ŽŽ ‹s ›et to be enacted. ‹‹ted capac‹t› of ‹pŽeent‹ng partners for beŠav‹ouraŽ cŠang‹ntervent‹ons. Susta‹nab‹Ž‹t› of tŠe soc‹aŽ casŠ transfer progra ‹s be‹ng quest‹oned. FROMTHECOUNTRYSDEVELOPMENTPARTNERSsupportdevelopmentpartnersn 2â13, deveŽopent partners contr‹buted over Í»â% of tŠe f‹nanc‹aŽ resources for tŠe ‹pŽeentat‹on of tŠe nat‹onaŽ response to tŠe V and ADS ep‹de‹c. TŠese ‹ncŽude tŠe ŽobaŽ Fund, PEPFAR, orŽd Ban, DFD, CDA, Norwa› and tŠe UN agenc‹es. Most of tŠe deveŽopent partners Šave aŽ‹gned tŠe‹r V and ADS act‹v‹t‹es to tŠe Nat‹onaŽ V and ADS Strateg‹c PŽan and tŠe› d‹rectŽ› support ‹ntervent‹ons as deta‹Žed ‹n tŠe NSP. DeveŽopent partners cont‹nue be‹ng ebers of tŠe MaŽaw‹ V and ADS PartnersŠ‹p Foru ÈMPFÈ and tŠe MaŽaw‹ ŽobaŽ Fund Coord‹nat‹ng Co‹ttee ÈM FCCÈ. TŠe MPF ‹s an adv‹sor› bod› to tŠe NAC Board support‹ng tŠe ŽeadersŠ‹p and coord‹nat‹on ecŠan‹ss of tŠe NAC and servesecŠan‹s tŠat ‹n‹‹œes wastefuŽ dupŽ‹cat‹on of efforts ‹n scaŽ‹ng up tŠe nat‹onaŽ response to V and ADS. TŠe M FCC ‹s a co‹ttee setâup to prov‹de overs‹gŠt and governance of ŽobaŽ Fund grants ‹n MaŽaw‹. TŠe› are aŽso ebers of tŠe V and ADS DeveŽopent roup È A DÈ wŠose obŒect‹ves are to Šaron‹se and coord‹nate deveŽopent partnersǯ support to tŠe ‹pŽeentat‹on of tŠe NSP and to aŽ‹gn deveŽopent partnersǯ support to tŠe ‹ntegrated annuaŽ wor pŽan. A nuber of TecŠn‹caŽ or‹ng roups Šave been fored as part of tŠe nat‹onaŽ response to tŠe V and ADS ep‹de‹c and deveŽopent partners are ebers of tŠese T s. n 2â12/2â13 deveŽopent partners a‹nŽ› prov‹ded tecŠn‹caŽ ass‹stance as weŽŽ as f‹nanc‹aŽ resources to tŠe Nat‹onaŽ ADS Co‹ss‹on, tŠe M FCC and tŠe ‹pŽeent‹ng partners ‹n MaŽaw‹. UN agenc‹es Šave supported tŠe nat‹onaŽ response b› support‹ng tŠe conduct of severaŽ stud‹es wŠ‹cŠ were a‹ed at generat‹ng ev‹dence to ‹nfor tŠe deveŽopent of ‹ntervent‹ons as weŽŽ as poŽ‹c‹es. For ešapŽe UNADS supported tŠe conduct of tŠe NASA ‹n 2â13, tŠe Dznow our Ep‹de‹c and Response and Modes of Trans‹ss‹ondz stud› and tŠe B‹oŽog‹caŽ and BeŠav‹ouraŽ Surve‹ŽŽance Surve› ÈBBSSÈ. OtŠer UN agenc‹es aŽso prov‹ded tecŠn‹caŽ ass‹stance ‹n suppŽ› cŠa‹n anageent for V cood‹t‹es, tŠe deveŽopent of tŠe Nat‹onaŽ V/ADS PoŽ‹c›, tŠe Capac‹t› DeveŽopent PŽan and tŠe rev‹ew of tŠe Nat‹onaŽ V/ADS Strateg‹c PŽan. UNADS aŽso prov‹ded tecŠn‹caŽ ass‹stance to support tŠe ‹nter‹ fund‹ng appŽ‹cat‹on tŠat MaŽaw‹ sub‹tted to tŠe ŽobaŽ Fund for fund‹ng. n 2â13 UNADS aŽso supported tŠe f‹rst ancet Co‹ss‹on Conference tŠat tooTŠe UN Šas aŽso been ‹nstruentaŽ ‹n tŠe prov‹s‹on of tecŠn‹caŽ ass‹stance ‹n tŠe rev‹ew of Žeg‹sŽat‹on, ‹ncŽud‹ng tŠe draft‹ng of tŠe V B‹ŽŽ, ešpŽor‹ng susta‹nabŽe f‹nanc‹ng ecŠan‹ss and Šas prov‹ded support ‹n tŠe deveŽopent of strateg‹c docuents. O ‹n part‹cuŽar prov‹ded tecŠn‹caŽ ass‹stance on tŠe new treatent gu‹deŽ‹nes and on TB/ V ‹ntegrat‹on wŠ‹Že UNCEF Šas been ‹nstruentaŽ ‹n address‹ng ED cŠaŽŽenges tŠat MaŽaw‹ ‹s ešper‹enc‹ng tŠrougŠ tra‹n‹ng and transportat‹on of sapŽes. UNFPA Šas aŽso been qu‹te ‹nstruentaŽ ‹n support‹ng wor w‹tŠ e› popuŽat‹ons sucŠ as seš worers, MSMs espec‹aŽŽ› focus‹ng on creat‹ng awareness about tŠe‹r r‹gŠts. MaŽaw‹ ‹s now ‹pŽeent‹ng VMMC as one of tŠe ‹ntervent‹ons for prevent‹ng V ‹nfect‹on. n 2â13, tŠ‹s ‹ntervent‹on was ostŽ› supported b› tŠe US overnent, tŠrougŠ PEPFAR. n add‹t‹on to tŠ‹s, tŠe US overnent ‹s aŽso support‹ng a TecŠn‹caŽ Ass‹stant ‹n nd M&E, as weŽŽ as BC ‹ntervent‹ons. developmentpartnersachievementn order to ensure tŠat MaŽaw‹ acŠ‹eves tŠe targets as set ‹n tŠe 2â11 PoŽ‹t‹caŽ DecŽarat‹on on V and ADS, deveŽopent partners w‹ŽŽ need to do tŠe foŽŽocont‹nue support‹ng tŠe NAC and ‹pŽeent‹ng partners and cŽose tŠe fund‹ng gap tŠat Šas been ‹dent‹f‹ed. cont‹nue support‹ng operat‹ons researcŠ ‹ncŽud‹ng surve‹ŽŽance ‹n order to ‹nfor progra‹ng and poŽ‹c› foruŽat‹on. ensure tŠat MaŽaw‹ overnent taes tŠe Žead ‹n dec‹d‹ng tŠe aŽŽocat‹on of f‹nanc‹aŽ resources for V and ADS, based on ŽocaŽ researcŠ ev‹dence ‹n Ž‹ne w‹tŠ tŠe Par‹s DecŽarat‹on, support ‹ntervent‹ons as def‹ned ‹n tŠe NSP and wn paraŽŽeŽ ‹pŽeent‹ng ecŠan‹ng cŠ‹Ždren and adoŽescents wsupport tŠe ‹ntroduct‹on and ‹pŽeentat‹on of effect‹ve ‹ntervent‹ons target‹ng e› popuŽat‹ons sucŠ as MSMs, seš worers and pr‹soners, wŠ‹Že apprec‹at‹ng tŠe need to adŠere to acceptabŽe deocrat‹c processes for cŠang‹ng tŠe ŽegaŽ env‹ronent. support tŠe bu‹Žd‹ng of tecŠn‹caŽ and anageent capac‹t› of MaŽaw‹an ‹nd‹v‹duaŽs, ‹nst‹tut‹ons and nonâgovernentaŽ organ‹œat‹on. MONITORINGANDoverviewthecurrentmonitoringevaluationsystemMaŽaw‹ subscr‹bes to tŠe DztŠree onesdz pr‹nc‹pŽe wŠ‹cŠ caŽŽs for one nat‹onaŽ strateg‹c pŽan, one nat‹onaŽ coord‹nat‹ng bod› and one nat‹onaŽ M&E s›ste. TŠe nat‹onaŽ M&E s›ste ‹s coord‹nated and anaged b› tŠe Nat‹onaŽ ADS Co‹ss‹on w‹tŠ overs‹gŠt fro tŠe Departent of V/ADS and Nutr‹t‹on ‹n tŠe Off‹ce of tŠe Pres‹dent and Cab‹net. TŠe Departent of PŽann‹ng, Mon‹tor‹ng, EvaŽuat‹on and ResearcŠ at tŠe Nat‹onaŽ ADS Co‹ss‹on ‹s respons‹bŽe for M&E act‹v‹t‹es ‹ncŽud‹ng tŠe product‹on of quarterŽ› and annuaŽ M&E reports. MaŽaw‹ Šas a Mon‹tor‹ng and EvaŽuat‹on PŽan for tŠe per‹od 2â12â2â16 and ‹s aŽ‹gned to tŠe Nat‹onaŽ V/ADS Strateg‹c PŽan 2â12â2â16. TŠe M&E pŽan prov‹des gu‹dance to aŽŽ V/ADS ‹pŽeent‹ng partners ‹n MaŽaw‹ on Šow tŠe› can report tŠe‹r M&E act‹v‹t‹es to tŠe Nat‹onaŽ ADS Co‹ss‹on. A Mon‹tor‹ng, EvaŽuat‹on and ResearcŠ T Šas been fored and ‹ts funct‹on ‹s to oversee V on‹tor‹ng and evaŽuat‹on ‹ssues w‹tŠ‹n tŠe nat‹onaŽ response and ‹t ‹s supposed to eet quarterŽ›. pŽeent‹ng partners for V and ADS ‹ntervent‹ons are supposed to report to tŠe ŽocaŽ counc‹Žs us‹ng tŠe ocaŽ AutŠor‹t› V and ADS Report‹ng S›ste ÈA ARSÈ wŠ‹cŠ coŽŽects botŠ b‹oed‹caŽ and nonâb‹oed‹caŽ data. TŠe ŽocaŽ counc‹Ž, ‹n turn, report to tŠe Nat‹onaŽ ADS Co‹ss‹on on a quarterŽ› bas‹s. Based on tŠese reports tŠe Co‹ss‹on cop‹Žes quarterŽ› and annuaŽ reports. Rout‹ne M&E data ‹s tŠerefore coŽŽected and reported to tŠe Co‹ss‹on. TŠe Mo aŽso ‹pŽeents tŠe MS wŠcoŽŽects rout‹ne data on V and ADS. TŠe Departent of V ‹n tŠe Mo Šas aŽso deveŽoped a paraŽŽeŽ s›ste wŠ‹cŠ ‹s be‹ng used for coŽŽect‹ng data on b‹oed‹caŽ ‹ntervent‹ons naeŽ› TC, PMTCT and ART on a quarterŽ› bas‹s. n add‹t‹on to tŠe rout‹ne M&E prograe data, tŠere are severaŽ popuŽat‹on based surve›s tŠat aŽso for part of tŠe nat‹onaŽ V and ADS M&E s›ste. TŠese surve›s, s‹nce tŠe› are conducted after ever› few ›ears, are used for trac‹ng botŠ tŠe outcoe and ‹pact ‹nd‹cators. SucŠ surve›s ‹ncŽude tŠe MaŽaw‹ DeograpŠ‹c and eaŽtŠ Surve›, tŠe uŽt‹pŽe ‹nd‹cators cŽuster surve›s ÈMCSÈ and tŠe B‹oŽog‹caŽ and BeŠav‹ouraŽ Surve‹ŽŽance Surve›s conducted b› tŠe Nat‹onaŽ Stat‹st‹caŽ Off‹ce; and tŠe V Sent‹neŽ Surve‹ŽŽance Surve›s conducted b› tŠe M‹n‹str› of eaŽtŠ. n add‹t‹on to tŠ‹s tŠere are aŽso soe geograpŠ‹caŽŽ› spec‹f‹c surve›s tŠat are carr‹ed out b› ‹pŽeent‹ng partners to ‹nforat‹on progra des‹gn. implementationsystemTŠe ‹pŽeentat‹on of tŠe M&E s›ste ‹n MaŽaw‹ Šas been decentraŽ‹sed and ŽocaŽ counc‹Žs are supposed to generate data and cop‹Že reports wŠ‹cŠ are sent to tŠe centraŽ ŽeveŽ. owever, one of tŠe aŒor cŠaŽŽenges be‹ng ešper‹enced at ŽocaŽ counc‹Ž ŽeveŽ ‹s tŠat tŠere ‹s cr‹t‹caŽ sŠortage of staff to effect‹veŽ› generate datof tŠe staff as weŽŽ Žac tŠe requ‹s‹te M&E s‹ŽŽs. D‹str‹ct ADS Coord‹nators ÈDACsÈ pŽa› an ‹portant roŽe ‹n ters of ob‹Ž‹s‹ng var‹ous sectors to sub‹t reports wŠ‹cŠ can subsequentŽ› be sent tŠe Nat‹onaŽ ADS Co‹ss‹on. Šere DACs are ava‹ŽabŽe copŽ‹ance w‹tŠ nat‹onaŽ V and ADS report‹ng requ‹reents are adŠered to. owever ‹n a nuber of d‹str‹cts ‹n MaŽaw‹ tŠese DACs are not ava‹ŽabŽe Šence affect‹ng report‹ng to tŠe Nat‹onaŽ ADS Co‹ss‹on. TŠe sŠortage of staff ‹s not onŽ› at ŽocaŽ counc‹Ž ŽeveŽ but aŽso ‹n tŠe Departent of PŽann‹ng, Mon‹tor‹ng, EvaŽuat‹on and ResearcŠ at tŠe Nat‹onaŽ ADS Co‹ss‹on: tŠere are supposed to be 5 off‹cers but for tŠe past 2 ›ears tŠere Šave been 3 operat‹ons of tŠe Departent. UNADS caŽŽs for one M&E s›ste. n MaŽaw‹, aŽtŠougŠ tŠere ‹s an M&E PŽan, tŠe cŠaŽŽenge ‹s tŠat tŠere are a nuber of ‹pŽeent‹ng partners botŠ at nat‹onaŽ as weŽŽ as ŽocaŽ counc‹Ž ŽeveŽ wŠose M7E s›ste Šas not been aŽ‹gned w‹tŠ tŠe nat‹onaŽ M&E s›ste be‹ng used b› tŠe Nat‹onaŽ ADS Co‹ss‹on. Soe partners are ‹pŽeent‹ng tŠe‹r own M&E s›ste and tŠ‹s ‹s espec‹aŽŽ› tŠe case ‹f tŠese partners are not be‹ng funded b› tŠe Nat‹onaŽ ADS Co‹ss‹on. TŠe ‹nterest for ost of tŠese organ‹sat‹ons wŠose M&E s›stes are not aŽ‹gned to tŠe nat‹onaŽ M&E s›ste ‹s to fuŽf‹Ž tŠe M&E requ‹reents of tŠe‹r fund‹ng agenc‹es. A s‹gn‹f‹cant proport‹on of tŠe staeŠoŽders do not report to tŠe Nat‹onaŽ ADS Co‹ss‹on and even wŠere tŠe› report tŠe reports are ‹ncopŽete and unt‹eŽ›. F‹nanc‹aŽ resources are requ‹red ‹n order to ‹pŽeent a copreŠens‹ve M&E s›ste. owever onŽ› about 5% of tŠe V progra budget ‹s for M&E ‹pŽeentat‹on. TŠe resources aŽŽocated to tŠe M&E pŽan w‹tŠ‹n tŠe Nat‹onaŽ ADS Co‹ss‹on ‹s ‹nadequate to effect‹veŽ› eet M&E resource requ‹reents. OtŠer ‹pŽeent‹ng partners aŽso fa‹Ž to report because of tŠe Žac of f‹nanc‹aŽ resources. astŽ› anotŠer cŠaŽŽenges affect‹ng tŠe M&E fraewor ‹n MaŽaw‹ ‹s tŠat tŠere ‹s Ž‹‹ted use of data espec‹aŽŽ› at ŽocaŽ ŽeveŽ for dec‹s‹on a‹ng. TŠe M&E pŽan outŽ‹nes a nuber of data sources for tŠe M&E s›ste sucŠ as tŠe MaŽaw‹ DeograpŠ‹c and eaŽtŠ Surve› and tŠe B‹oŽog‹caŽ and BeŠav‹ouraŽ Surve‹ŽŽance Surve›s. For soe of tŠese surve›s tŠe Nat‹onaŽ ADS Co‹ss‹on does not Šave tŠe powers to ensure tŠat tŠe› are done t‹eŽ› to ‹nfor tŠe nat‹onaŽ V and ADS cts tŠe overaŽŽ M&E s›ste as RemedialactionsplannedM&Eexperiencedn order to address tŠe sŠortage of staff at tŠe ŽocaŽ counc‹Ž ŽeveŽ, tŠe Nat‹onaŽ ADS Co‹ss‹on ‹s prov‹d‹ng f‹nanc‹aŽ resources for tŠe recru‹tent of DACs ‹n d‹str‹cts wŠere tŠese are not ava‹ŽabŽe. TŠe f‹ŽŽ‹ng of tŠese pos‹t‹ons at ŽocaŽ counc‹Ž ŽeveŽ w‹ŽŽ ensure tŠat DACs are ava‹ŽabŽe wŠo can wor w‹tŠ CBOs and otŠer ‹pŽeent‹ng partners to prov‹de data/reports for tŠe nat‹onaŽ response. ‹tŠ‹n tŠe Departent of PŽann‹ng, Mon‹tor‹ng, EvaŽuat‹on and ResearcŠ, wŠ‹Že awa‹t‹ng for tŠe f‹ŽŽ‹ng of tŠe 2 vacanc‹es, two ‹nterns w‹ŽŽ be recru‹ted to wor w‹tŠ‹n tŠe Departent. n order to address tŠe probŽe of nonâaŽ‹gnent to report‹ng s›stes, pŽans are be‹ng pursued for ‹pŽeent‹ng partners rece‹v‹ng fund‹ng outs‹de tŠe Nat‹onaŽ ADS Co‹ss‹on to s‹gn a Meorandu of Understand‹ng for tŠe to use tŠe M&E s›ste. TŠere Šave aŽso been attepts to prov‹de resources for tra‹n‹ng or or‹ent‹ng DACs, data entr› cŽers and M&E off‹cers on Šow to use tŠe A ARC. TŠ‹s ‹n‹t‹at‹ve w‹ŽŽ cont‹nue. n add‹t‹on to tŠese ‹ntervent‹ons tŠere ‹s a need for staeŠoŽders to advocate for ore funds be‹ng aŽŽocated to M&E at aŽŽ ŽeveŽs. astŽ› tŠere ‹s cont‹nued need for bu‹Žd‹ng capac‹t› of users ‹n ut‹Ž‹sat‹on of M&E and researcŠ data for poŽ‹c› and progra deveŽopent.needM&EtechnicalassistanceandbuildingTŠe Nat‹onaŽ ADS Co‹ss‹on sa›s tŠat ‹t needs tecŠn‹caŽ ass‹stance to address soe of tŠe M&E cŠaŽŽenges tŠat are be‹ng ešper‹enced. TŠe M&E s›ste Šas been decentraŽ‹œed and tŠe one at ŽocaŽ counc‹Ž ŽeveŽ ‹s not Ž‹ned to tŠe nat‹onaŽ ŽeveŽ s›ste. TŠese two sŠouŽd be Ž‹ned. TŠe Nat‹onaŽ ADS Co‹ss‹on ‹s tŠerefore Žoo‹ng for tecŠn‹caŽ ass‹stance ‹n ters of deveŽop‹ng a webâbased s›ste sucŠ tŠat once tŠe data ‹s entered at ŽocaŽ counc‹Ž ŽeveŽ tŠen ‹t sŠouŽd ‹ed‹ateŽ› be ava‹ŽabŽe and accessed at nat‹onaŽ ŽeveŽ. TŠe V and ADS sector ‹s aŽso cŠaracter‹œed b› paraŽŽeŽ M&E s›stes wŠ‹cŠ are not Ž‹ned. TŠere ‹s tŠerefore a need for tecŠn‹caŽ ass‹stance to ensure tŠat tŠese paraŽŽeŽ s›stes spea to eacŠ otŠer. ANNEXESANNEXConsultation/preparationprocesscountryreportProv‹ded separateŽ› ANNEXNationalCommitmentsandPolicyInstrumentProv‹ded separateŽ› ANNEXListthevalidationORGANISATIONDESIGNATION 1. Mac Ba‹n Mandaw‹re ONECOâ obaEšecut‹ve D‹rector 2. AureŽ‹e Andr‹aŽ‹son UNADSCMNA 3. Er‹ca N‹oŽ‹c UNADS R & ender 4. AŽeš SŠ‹eŽds C A V F‹nanc‹ng 5. TroubŽe CŠ‹oo UNADSSA 6. upŠre›s SŠuba UNFPANPOâ V 7. Dav‹e aŽoba NAC PMER ͺ. Marr‹a MangocŠ‹ DN A âOPCD A Í». Dr. Rosear› uwenda UNDP V PoŽ‹c› Adv‹sor 1â. Moses CŠ‹ow‹ NACM & E Off‹cer 11. ev‹ wanda NACM & E Off‹cer 12. engan‹ CŠ‹rwa V/ADS MO T/A Care & Treaten 13. Macenœ‹e CŠ‹guuŽa MaŽaw‹ PoŽ‹ceServ‹ce V & ADS 14. SaŽoe CŠ‹bwana MANET+PO, M & E 15. Brenda aangaPS MaŽaw‹ V Progra Manager 16. usao Mun›en›ebe M RCPr‹nc‹paŽ uan R‹gŠts Off‹cer 17. ›ness . Soo MBCACoun‹cat‹ons 1ͺ. AŽ‹ce CŠ‹Ženga DN AM & E Off‹cer 1Í». V‹ctor anŒe DN A V & ADS Off‹cer 2â. V‹ctor B‹ŽŽ› aa CEDEPResearcŠ Off‹cer