Eswatini’s achievement in 2020 of the UNAIDS 95-95-95 fast-track targets for HIV epidemic control (HEC) is remarkable, but inequalities in HIV risk and response remain. While both facility-based health programs and community-based services have been instrumental in tackling HIV and TB, sustaining HIV and TB control requires a stronger focus on comprehensive, person-centered community-based services, targeting the subpopulations most at risk of HIV, TB and GBV, building on existing successes and local structures. Georgetown University (GU), through its Center for Global Health Practice and Impact, and its partners, Pact Inc, Swaziland Network of Young Positives (SNYP+), Compassionate Swaziland, Cabrini Ministries and the Ministry of Health (MOH) Rural Health Motivator (RHM) program, submit this application in response to CDC-RFA-GH22-2222 “Comprehensive Community-based Programming to Maintain HIV Epidemic Control in Eswatini under the President’s Emergency Plan for AIDS Relief”(PEPFAR).Through the project entitled BLOSSOM – Building Local Organizations and Structures to Overcome HIV/TB/GBV and Maintain Epidemic Control, we will support Eswatini in maintaining HEC and achieving TB epidemic control in Manzini and Lubombo regions, by: 1) establishing or extending resilient, differentiated and sustainable community-based services for prevention, diagnosis, treatment and care of HIV and TB, especially for the most vulnerable and hard-to-reach populations across the cascade, in ways that both serve their needs, 2) building an interface between health facilities and the community to ensure seamless service access and delivery, 3) building the capacity of community- and faith-based organizations to implement and monitor programs that can be used to address emerging public health threats, and 4) supporting the community systems strengthening initiatives of the Ministry of Health, particularly with the government community health volunteer program (Rural
Health Motivators [RHM] program) to deliver integrated services including HIV & TB. BLOSSOM will build on the successes of the SCORE program to consolidate gains & overcome remaining gaps to achieve sustained HIV & TB epidemic control and reduce GBV throughout Lubombo and Manzini regions. BLOSSOM will enhance programmatic reach & depth by leveraging GU’s experience delivering comprehensive, high-quality, facility-based HIV services, data science for precision service delivery linked to quality improvement, and human-centered design expertise; along with Pact’s expertise in delivering community-based services to orphans & vulnerable children, adolescent girls and young women, implementing Determined, Resilient, Empowered, AIDS-free, Mentored and Safe (DREAMS) interventions, and building organizational capacity. Leveraging GU’s demonstrated capacity to engage with the government and the MOH, we will support community health systems strengthening through the RHM program and local community-based organizations. Our approach will be bolstered by six cross-cutting principles: 1) Person-centered services informed by human-centered design; 2) Evidence-informed precision programming; 3) Community-facility integrated care network; 4) Continual quality improvement integrated with community-led monitoring; 5) Capacity- and resilience-building of local organizations; 6) Design anchored within MOH strategies. Our established presence and existing relationships in facilities and communities will enable rapid startup, and our complementary technical and organizational competencies will be applied to ensure a seamless service continuum between health facilities and the community, using expert facility-to-community teams, establishing bi-directional referral systems, and improving coverage and use of electronic record-keeping in the community. Our comprehensive, person-centered, community-based services linked to facilities approach will fill the existing gaps lea
ding to sustained HEC and TB control.