DRAFT PD_CAYFHE Eswatini.pdf

Strengthening Services for Children, Adolescents, Youth and Families in the HIV Epidemic (CAYFHE) in Eswatini Activity

This funding opportunity is authorized under the Foreign Assistance Act (FAA) of 1961, as amended. The resulting award will be subject to 2 CFR 200 – Uniform Administrative Requirements, Cost Principles, and Audit Requirements for Federal Awards, and USAID’s supplement, 2 CFR 700, as well as the additional requirements found in Section F.

A. BACKGROUND

A.1 EPIDEMIOLOGIC CONTEXT:

Through political commitments, intensified national efforts on treatment and prevention, reduction of stigma and discrimination, and equitable access to services for all, the Kingdom of Eswatini, hereafter referred to as Eswatini, has made significant strides in the HIV response. The availability and use of antiretroviral therapy has increased, and conversely, the life expectancy at birth has increased from 44.2 years in 2004 to 57.7 years in 2019 (World Health Organization). Eswatini is among the first countries to achieve the 95-95-95 global targets as a result of the substantial progress made in the HIV response.

(Swaziland HIV Incidence Measurement Survey - SHIMS)

Despite the progress above, challenges remain with new infections, awareness of HIV status and uptake of treatment particularly among the youth. According to the third Swaziland HIV Incidence Measurement Survey (SHIMS 3), Eswatini has an estimated HIV annual incidence of 0.62% among adults aged 15 and older, resulting in around 4,000 new cases per year. The incidence is higher among adults aged 15-49, with 1.49%, and seven times higher among women. Disparities in HIV testing, ART uptake, and viral suppression in lagging populations may be the primary driver of new infections. The mother-to-child transmission rate in 2022 was 1.2%, despite 12.7% of exposed neonates not having a documented final outcome. The SHIMS 3 report further reported a national HIV prevalence of 24.8% (~185,000 adults living with HIV), which was higher among women aged 15 years and older (30.4%) compared to their male counterparts in the same age group (18.7%). Additionally, the national viral load suppression (VLS) prevalence was 88.6% among HIV-positive adults regardless of their knowledge of HIV status or use of antiretroviral therapy (ART).

Around 6, 646 children under 15 are living with HIV with only 84% on ART. For children on ART, 95% have a suppressed viral load which compares favorably with other countries in Southern Africa, but lags behind viral suppression for adults in the Kingdom. Despite the fact that antiretroviral therapy has enabled a significant number of People Living with HIV (PLHIV) to maintain their health and support their families, the repercussions of the epidemic's previous high mortality rate persist; approximately 20% of children between the ages of 0 and 17 are orphaned. The impact of HIV has disrupted and destabilized families and communal support systems, which has been exacerbated by and contributes to pervasive poverty.

The most recent Multiple Indicator Cluster Survey (MICS) for Eswatini shows that only a third of children live with both biological parents, and economic insecurity has increased further in recent years due to climate-related shocks, including severe drought, and the effects of COVID-19 on the economy, leaving households ill equipped to care for OVC. While the Ministry of Education and Training (MoET)’s introduction of free primary education has boosted primary school enrollment and completion, less than 30% of children attend early childhood development (ECD) programming, and there is a significant drop-off at the secondary level, especially in urban areas and among girls, with teenage pregnancy as a key reason for girls dropping out of school.

While gender-based violence (GBV) and Violence Against Children (VAC) affect both males and females, adolescent girls and young women (AGYW) are particularly vulnerable, with one in four experiencing some form of sexual violence by 18 years of age and 48% women reporting to have experienced some form of sexual violence in their lifetime (VACS, 2022). Youth unemployment (46.2%) and a lack of access to opportunities lead to a variety of risks (Eswatini National Youth Policy 2022-2025) . Economic and societal factors promote transactional and intergenerational sex, putting AGYW and youth at even greater risk of HIV infection.

A.2 GOVERNMENT OF THE KINGDOM OF ESWATINI (GKoE) RESPONSE

The Government of the Kingdom of Eswatini (GKoE) has committed to addressing HIV by focusing on high-impact interventions, targeting the most vulnerable and those at higher risk of HIV acquisition. The multi-sector National Emergency Response Council on HIV and AIDS (NERCHA) coordinates the implementation of the national strategies for achievement of epidemic control as outlined in the National HIV Prevention Policy (2012) and the National Strategic Framework for HIV and AIDS (NSF). The NSF 2023 – 2027 comprises a set of evidence-informed strategies focused on building resilient and sustainable health systems with a clear focus on community systems strengthening and a well-coordinated multi-sector response. It outlines five strategic priorities, each with focus areas and recommendations, aimed at addressing emerging gaps in access to prevention, care, treatment, and support services for all PLHIV, with a renewed emphasis on comprehensive combination precision prevention strategies and continuity of care for key and vulnerable population groups. Furthermore, the country is implementing person-centered precision prevention to achieve optimal outcomes and reduce HIV incidence. The NSF advocates for co-creation of intensive prevention packages for populations with high HIV incidence, including key populations and adolescent girls, boys, women, and men in few communities. The NSF emphasizes equitable approaches, removing gender and human rights barriers, and promoting social enablers for equal service uptake across diverse populations. Lastly, the NSF prioritizes resilience and sustainability, including sustainable health financing, to maintain long-term response effectiveness. It emphasizes strengthening health systems through integration, efficiency, and technological innovation, and empowering communities, especially during pandemics and emergencies, to foster community-led interventions and enhance resilience.

A.3 PEPFAR SUPPORT TO THE GKoE RESPONSE

The overarching goal of the PEPFAR/Eswatini (PEPFAR/E) investments is to support the GKoE to achieve and sustain epidemic control, provide high-quality client-centered HIV services to PLHIV, and continue to rapidly reduce the number of new infections. PEPFAR Eswatini is aligning its strategy with the GKoE's National Strategic Framework, focusing on prioritizing certain populations to address HIV as a public health threat. The PEPFAR/Eswatini Country Operational Plan 2023 (COP23) aims to address the HIV epidemic by focusing on service delivery support, accelerating the sustainability of the National HIV response, and strengthening health systems. Key priorities include high-impact combination prevention interventions;

scaling up Pre-Exposure Prophylaxis for adolescent girls and young women (AGYW) and key populations;

pivoting in HIV testing strategies for children, AGYW, and men aged 25-34; as well as client-centered services to close early ART initiation and treatment continuity gaps.

Eswatini has been implementing PEPFAR’s global Determined, Resilient, Empowered, AIDS-free, Mentored and Safe (DREAMS) initiative which was launched in 2014 to reduce risk and foster resilience among AGYW.

DREAMS consists of a core set of layered evidence-based interventions to address HIV risk knowledge and behaviors including uptake of clinical Sexual Reproductive Health (SRH) and HIV services. DREAMS is implemented in 15 countries and focuses on vulnerable AGYW (10-24 years) in communities with high incidence and high burden of HIV who are at an increased risk of acquiring HIV due to various demographic, geographic, behavioral, and structural reasons. In 2023, PEPFAR released the DREAMS NextGen programming guidance which is poised to sustain the gains made in reducing new HIV infections. DREAMS NextGen is the next phase of DREAMS, which will adopt a more nuanced approach that is tailored to the current context of each country. PEPFAR Eswatini also has a well-established OVC program which aims to improve child well-being by mitigating the impact of AIDS, reducing their risk of HIV acquisition, and increasing their resilience to thrive in households affected by the disease. The comprehensive OVC program strengthens the family’s capacity to meet children’s basic needs for shelter, nutrition, health, education and protection. The program targets children with known risks, especially children and adolescents living with HIV and AIDS (C/ALHIV) to ensure that they receive family and home-based support to bolster treatment outcomes.

The PEPFAR Eswatini DREAMS/OVC program is currently being implemented by four (4) organizations covering 36 Tinkhundla across the four regions of Eswatini. These organizations include World Vision, Young Heroes, Cabrini Ministries and Georgetown University. The Luke Commission (TLC) provides community based mobile clinical services through DREAMS on Wheels whilst EGPAF and Georgetown University provide clinical services at facility level. Furthermore, since FY23, Young Heroes has led the implementation of above-site activities such as collaborating with the Ministry of Education and Training (MoET) to strengthen HIV and GBV/VAC prevention in schools, as well as the Deputy Prime Minister's Office (DPMO) to improve GBV response coordination and monitor the social protection strategic plan. In addition to PEPFAR funding, the Global Fund makes significant contributions to the HIV response, with the National Emergency Response Council on HIV/AIDS (NERCHA) and the Coordinating Assembly of Non- Governmental Organizations (CANGO) serving as primary recipients. PEPFAR and the Global Fund assessed current AGYW initiatives and regional footprints and agreed on the need to unify service packages nationally through GKoE coordination.

B. THE ACTIVITY GOAL, OBJECTIVES, RESULTS & EXPECTED OUTCOMES:

This Strengthening Services for Children, Adolescents, Youth and Families in the HIV Epidemic in Eswatini Activity, hereinafter referred to as the Activity will build upon the successes of current efforts, leveraging key learning and evidence-based approaches to accelerate progress toward epidemic control at this critical point in Eswatini’s fight against HIV. It is a follow-on to the DREAMS and OVC activities currently being implemented by World Vision Eswatini, in the Shiselweni and Lubombo regions. The Activity will include a combination of evidence-based and high-impact service delivery interventions for HIV prevention and social protection targeting children, adolescents, youth and their families in the HIV epidemic; local partner capacity strengthening, and regional level social service system strengthening for long-term sustainability. For increased sustainability, implementation approaches are expected to shift significantly during the lifespan of this Activity from current PEPFFAR OVC and DREAMS programming towards improved integration with GoKE and civil society cadres and programs. Below is the results framework for this activity:

The Activity will consist of two key objectives as follows:

● Objective 1: Improve targeted prevention services for children, adolescents and youth to counter HIV risks

● Objective 2: Improve access to health and social protection services for children, adolescents, youth and their families

Objective 1: Improve targeted prevention services for children, adolescents and youth to counter HIV risks

As Eswatini reaches epidemic control, OVC and DREAMS programming must evolve to focus on the remaining unserved OVC and AGYW. Under this objective, program participants will be reached with the relevant services through appropriate community and institutional platforms, comprising individual level and group interventions tailored to the needs, vulnerabilities, risks and aspirations of every program participant. It is anticipated that the Recipient will implement innovative approaches to identify and enroll most at-risk children, adolescents and youth (AGYW, Adolescent Boys and Young Men, OVC and C/ALHIV).

Engagement with older and out-of-school program participants will need to be responsive to contextual factors such as high mobility, poverty levels, and difficulty in participating in activities over an extended period of time. The Recipient will be expected to design innovative and sustainable interventions for delivering evidence based HIV prevention sessions, improving service seeking behaviors among program participants, and actively linking them to comprehensive youth friendly health services. The Recipient will be expected to establish strong collaboration with health facilities, advocate for youth friendly and stigma free HIV prevention services, and track and document completion of referrals. Furthermore, the Recipient will be required to collaborate closely with other or current Implementing Partners to arrange the deployment and scheduling of the mobile DREAMS on Wheels clinical services, which are intended to offer Sexual Reproductive Health (SRH) and HIV services to program participants, with a particular emphasis on those who reside in remote areas (hard-to-reach). For program participants residing closer to public health facilities, the applicant will be required to ensure active linkage of participants to these health facilities and implement a robust system to ensure successful linkage of referred participants to the needed health services.

Under Objective 1 there are four (4) Intermediate Results (IRs).. Illustrative activities for each IR are listed under the IRs. Applicants must propose appropriate and feasible strategies and activities to achieve the results for this area in line with GKoE, PEPFAR and USAID priorities.

● IR 1.1: Increased identification of at risk children, adolescents and youth

○ Enrollment approaches/identification strategies (proposed innovative ideas for finding and enrolling AGYW at high risk of acquiring HIV)

○ Focused targeting and risk-stratification of children, adolescents and youth per the different enrollment criteria

● IR 1.2: Strengthened identification, retention & viral suppression of C/ALHIV

○ Effective strategies for referral and linkages with health care facilities

○ Innovative strategies to support adherence for C/ALHIV especially those transitioning into adulthood and those whose parents are not adhering to their treatment.

● IR 1.3: Improved adoption of positive norms & behaviors for SRH, HIV prevention & of other health services for vulnerable adolescents, youth & sexual partners

○ Modified safe spaces approach to improve retention

○ Hybrid models for delivering HIV prevention sessions

○ Innovative demand creation strategies for the uptake of SRH, HIV prevention and other services in mobile and health facilities.

○ Innovative solutions to partner with health facilities and clinical IPs to promote youth friendly services

● IR 1:4: Socio-economic strengthening for adolescents and youth

○ Strategies for sustained economic strengthening interventions for adolescents and youth which may include business start up, savings groups and others

○ Strategies to strengthen economic prospects of adolescents and youth.

○ Temporary cash grants, support for emergencies (nutrition support and others)

Illustrative outcome indicators for this objective may include:

● Number of OVC linked to HIV testing, care and treatment, and support to remain virally suppressed.

● Number of AGYW accessing HIV prevention services

● Number of vulnerable youth receiving business start up support or participating in savings groups

Objective 2: Improve access to health and social protection services for children, adolescents, youth and their families

Interventions for this objective should be designed to mitigate the socio-economic vulnerability of most at-risk program participants to the impacts of HIV. Interventions for OVC should be family- and community-centered and designed to keep children healthy, safe, stable, and schooled, utilizing case management as a foundation. Case management is the process of identifying vulnerable children and caregivers, assessing their needs and resources, working with the family and the child to plan actions and accessing services, monitoring both the completion of actions and receipt of services, and progress towards achievement of objectives and graduation benchmarks. A robust case management and referral process must support the continuum of care, integrating and leveraging other existing community-based programs and community-based health workers (e.g. Rural Health Motivators) to ensure that program participants are successfully linked to appropriate services. This Activity will also expand AGYW access to market-oriented vocational skills training, internships and mentorships, and ensure the tools and resources needed for financial independence and HIV prevention reach the young women who need it most. Recognizing the crucial role of the community leadership in addressing harmful gender norms, this Activity is expected to implement evidence-based gender norms change and GBV prevention interventions at community level. Responding to the findings of the Violence Against Children Study (VACS) and supporting the implementation of the National Strategy to End Violence is also a key priority for this Activity.

Below is a list of IRs for this objective including the illustrative activities thereof. Applicants must propose appropriate and feasible strategies and activities to achieve the results for this area aligned with GKoE, PEPFAR and USAID priorities.

● IR 2.1: Increased capacity/ability of high schools to deliver life skills education

○ Support career guidance teachers to facilitate life skills education sessions

○ Innovative strategies to motivate/hold schools accountable to deliver life skills education

● IR 2.2: Improved access to & progression, attainment/completion of secondary/high school education for vulnerable children and adolescents

○ Identifying vulnerable and at-risk AGYW, with special attention to out-of-school adolescent girls and boys, AGYW at risk of or engaging in transactional sex, pregnant and breastfeeding AGYW, and AGYW with disabilities

○ Tracking of enrolment and progression at primary school and transition from primary to secondary/high school

○ Provision of school fees, block grants, education subsidies

○ Strategies to address period poverty (menstrual health and hygiene)

○ Strategies to ensure progression and completion of secondary/high school (study clubs, tutor,etc.)

● IR 2.3: Strengthened community engagement and commitment to prevent new infections & address harmful gender norms

○ Deliver evidence-based contextual interventions engaging community-based leaders for creating an enabling environment for AGYW addressing harmful gender norms and practices

○ Create awareness, knowledge, and skills among children, adolescents, youth and caregivers on recognizing VAC and GBV and how to seek support

○ Strategies to strengthen community engagement and improve societal norms and behavior

● IR 2.4: Strengthened prevention & timely response to violence against children, adolescents & youth

○ Deliver evidence-based curriculum sessions on HIV and violence prevention education for

AGYW

○ Deliver evidence-based approaches/curricula for HIV and GBV prevention for ABYM (10- 24yrs)

○ Provide training on first line support best practices of “Listen, Inquire, Validate, Enhance Safety, Support” (LIVES) and Violence Against Children (VAC) for all frontline workers (community cadre, project staff) who interact with OVC or AGYW program participants

○ Develop strategies for supporting the mental health of GBV/VAC service providers and first-line responders.

○ Collaborate with post-violence service providers to ensure effective case management of cases of VAC and GBV among program participants, including social workers, One Stop Centers, police, and court officials

○ Provide information and psychosocial support to child survivors of VAC and their caregivers for legal proceedings against alleged perpetrators of abuse

○ Expand evidence-based models for positive parenting

○ Case management for access to post-violence care and justice for survivors

● IR 2.5: Enhanced family resources & skills to support the growth & development of vulnerable children

○ Strategies for sustained economic strengthening interventions for caregivers which may include savings groups and others

○ Temporary cash grants, support for family emergencies (nutrition support and others)

Illustrative outcome indicators for this objective may include:

● Number of high schools providing life skills education

● Number of vulnerable out of school youth re-enrolled into school

● Number of community leaders reached with evidence based GBV prevention interventions

● Number of survivors accessing post violence care

● Number of service providers trained on LIVES

C. GEOGRAPHIC FOCUS

The geographic focus for this activity is the Shiselweni and Lubombo regions of Eswatini. Geographic coverage will be assessed on an annual basis considering available resources, program achievements, updated epidemiological data, GoKE priorities, and alignment with other donor investments. For the DREAMS components, PEPFAR aims to achieve saturation, defined as 75% of eligible age groups having completed the DREAMS primary package and any needed secondary services. In districts that have achieved saturation, DREAMS services should continue to be provided targeting the most vulnerable AGYW. It is projected that all of the current DREAMS sites in these regions will be fully saturated by the end of FY25, however, it is expected that active and visible DREAMS presence is maintained in these sites.

This activity is therefore expected to maintain the core DREAMS package of interventions by age group, targeting smaller numbers of AGYW and appropriately targeting to reach the most vulnerable AGYW, including those who “age-in” to DREAMS and “age-up” between DREAMS age bands in saturated sites.

Core DREAMS implementation should be focused on the current Tinkhundla. In the remaining sub-national units (SNUs),this activity will use a hyper targeted approach to identify high risk AGYW through health facilities and other high risk entry points to identify and deliver an adapted DREAMS service package as part of Enabling DREAMS. The OVC program will operate in focus Tinkhundla targeting all children with known HIV risks. In addition, it will serve C/ALHIV across all Tinkhundla in the two regions.

D. TARGET POPULATION

The Implementation of the activity should focus on the beneficiary populations listed below in their respective geographic areas prioritizing those with multiple risk factors. It should be noted that these categories of populations frequently overlap. Adolescent girls aged 10-17 in the OVC program who meet DREAMS vulnerability and risk criteria should be encouraged to enroll also in the DREAMS program, and adolescent girls in the DREAMS program meeting core vulnerability criteria of the OVC program should be referred for OVC enrolment.

a. Vulnerable children aged 0-17 with known risks, including, but not limited to:

● Children and adolescents living with HIV

● Children with perinatal HIV exposure

● Children of parents living with HIV, especially those who are not virally suppressed or at risk of interruption in treatment

● Children who are orphaned due to HIV

● Children who have experienced sexual and other abuse

● Children of female sex workers

● Adolescent girls who are pregnant or are mothers

● Children in child-headed households

● Children with disabilities

b. Girls and boys aged 10-14 years in high-prevalence areas (sexual violence and HIV prevention)

c. AGYW 10-29 years old at high risk of HIV and/or violence (see Table 1 below)

d. Adolescent boys and young men, Table 1: AGYW at risk of HIV and/or violence

AG 10-14 AG 15-19 YW 20-29

● Ever had sex

● History of pregnancy

● Experience of sexual violence

● Experience of physical or emotional violence in the last year

● Alcohol or substance abuse

● Out of school

● Orphanhood

● Living with disability

● Ever had sex

● Pregnant, breastfeeding/parenting

● Multiple sexual partners

● History of pregnancy

● STI (diagnosed or treated)

● No or irregular condom use

● Transactional sex (including staying in a relationship for material or financial support)

● Experience of sexual violence (lifetime)

● Alcohol or other substance misuse

● Out of school

● Orphanhood

● Living with a disability

● Multiple sexual partners

● STI (diagnosed or treated)

● No or irregular condom use

● Transactional sex (including staying in a relationship for material or financial support)

● Experience of sexual violence (lifetime)

● Alcohol or other substance misuse

● Living with a disability

E. IMPLEMENTATION MODALITIES

E.1 DREAMS

The global fight against HIV and AIDS is at a critical point, and it is essential to transition from an emergency response to a sustained response. This includes sustaining the gains made by maintaining millions of people with PLHIV on life-saving treatment and viral suppression, closing equity gaps, and advancing the sustainability agenda. The DREAMS and OVC programs have made a strong impact in reaching thousands of OVC and AGYW with evidence-based interventions in the country. The DREAMS core package is an evidence-based and informed, age-appropriate, comprehensive package of biomedical, behavioral, and structural interventions across multiple sectors shown to mitigate the risk factors that may lead to HIV infection. The DREAMS core package, illustrated in Figure 2, layers interventions that address individual, community, and structural factors that increase AGYW’s HIV risk, including gender inequality, gender-based violence, and limited access to education and economic opportunities. The DREAMS core package is modified to target different levels of vulnerabilities with priority interventions from the core package.

Figure 2: Eswatini DREAMS Layering Table

In COP 23 PEPFAR introduced the DREAMS NextGen Program which is poised to sustain the gains made in reducing new HIV infections. DREAMS NextGen is the next phase of DREAMS that will take a more nuanced approach that is responsive to the current context within each country. DREAMS NextGen puts increased emphasis on these enabling environment activities within Core DREAMS sub- national units (SNUs) and allows for implementation at a regional and/or national level. The vision for DREAMS NextGen includes two complementary implementation pathways as illustrated in Figure 3 below.

This activity will build upon these successes and lessons learned to propose the next generation of prevention programming for AGYW and youth in Eswatini.

Figure 3: DREAMS NextGen Program Implementation

E.2 OVC

The OVC Comprehensive Programming Track ensures the delivery of comprehensive services that mitigate the impact of HIV on children by reducing vulnerability, contributing to prevention goals, and increasing access to and retention in treatment. The implementation of core activities should ensure that children are healthy (improving access to health/HIV services); safe (improving child protection and prevention of GBV);

stable (improving household economic security and linkage to social protection); and schooled (improving school retention and progression and early care childhood development). This program component strengthens the HIV care continuum among children, adolescents, and caregivers. The Recipient must describe a plan for systematic assessment of HIV risk and linkage to care and treatment. OVC comprehensive programming leads to household graduation, which is defined and assessed using outcome-oriented graduation benchmarks across all four domains (healthy, safe, stable, and schooled).

The OVC prevention programming track targets a broader group of 10–14-year-olds in a less intensive manner by providing them with education on prevention of HIV and sexual violence. Success is defined only in terms of completing an approved curriculum for primary prevention of HIV and sexual violence.

The following core programming considerations should be embedded into the technical approach:

● Capacity building of local organizations

● Identification of the most vulnerable children, adolescent girls, boys and young women and men

● Sustainability

● Meaningful engagement of youth

● Innovative approaches

● Inclusivity of underrepresented groups

● Gender equality

● Child safeguarding

F. ADDITIONAL TECHNICAL CONSIDERATIONS

F.1 COLLABORATING, LEARNING & ADAPTING (CLA):

USAID’s CLA approach aims to improve our development effectiveness in a more systematic and intentional way by encouraging strategic collaboration, continuous learning, and adaptive management throughout all our activities and programming. Successful applicants should incorporate these important principles throughout their design, development, and implementation. Integrating CLA into this program will help to ensure that interventions are coordinated with others, grounded in a strong evidence base, and iteratively adapted to remain relevant throughout implementation.

F.2 GENDER CONSIDERATIONS

Children and youth face gender barriers that impede their access to education, health services, and economic opportunities. These barriers ultimately make this group more vulnerable to HIV infection and contribute to their inability to obtain treatment. Economic and social disparities leave young women and girls especially susceptible to GBV, domestic violence, discontinuation of medical care and treatment, and sexual exploitation. For USAID, gender equality and women’s empowerment are vital to achieve sustainable development and positive health outcomes. The USAID Gender Equality and Female Empowerment Policy advances equality between women and men, boys, and girls, and empowers women and girls to participate fully in and benefit from development activities, through the integration of gender in the entire Activity implementation cycle from design and implementation to monitoring and evaluation.

Interventions and technical assistance supported through this Activity will implement a program model that addresses structural barriers fueled by gender inequities that impede access to and uptake of HIV and TB service delivery in order to reduce gender disparities in the access of HIV and TB diagnosis, treatment, and prevention services. The Activity will use evidence-based interventions informed by gender analyses that explore the underlying reasons for gender-based differences throughout the entire patient pathway.

The Activity will integrate gender transformative and trauma-informed approaches throughout the program that promote early care seeking behavior, and access to HIV and TB services equitably between men and women. The Activity will integrate age-appropriate GBV case identification, first-line support, and clinical and non-clinical care into HIV service delivery platforms aligned with PEPFAR and WHO Guidance.

Furthermore, interventions will also uphold the right of all individuals - men, women, and transgender people to quality HIV and TB services. The Monitoring, Evaluation and Learning (MEL) plan for the Activity should include clearly defined indicators and targets to support measurement of performance specific to gender considerations.

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https://www.usaid.gov/sites/default/files/documents/1865/GenderEqualityPolicy_0.pdf