TCE considers every individual essential in collectively turning the tide against HIV/AIDS, equipping them with the knowledge and tools to take control of the epidemic in their lives and the life of their communities. The model addresses both prevention and care, and is systematic, cost-efficient, comprehensive, and easily scaled up.
The TCE program seeks to mobilize behavior change throughout the general population and at-risk groups. It helps support orphans and vulnerable children and people living with HIV/AIDS, and reaches out to educators and school children. TCE focuses on supporting individual decision making, mainly with respect to abstinence and fidelity, prevention of mother-to-child transmission (PMTCT), access to home-based care, and voluntary counseling and testing services.
Key Intervention Areas
Community Mobilization to Create Demand for Services. HPP members work through locally employed and trained field officers and, in many countries, with volunteers (called “passionates”) or even peer educators (for reaching youth, young mothers, commercial sex workers, men who have sex with men). TCE encourages people who have been sexually active (or otherwise involuntarily exposed to HIV) to be tested and made aware of their status, and provides them with prevention messaging. The field officers assist the person at risk to create an individual risk reduction plan to reduce the chance of infection or re-infection while also combating stigma and resistance to testing.
Provision of HIV Testing Services (HTS). A number of HPP members have fine-tuned the highly effective index case testing methodology to systematically target sexual partners of HIV-positive clients in the hardest hit communities. The model includes a TCE field officer based in each health facility who manages the index cases, and community-based field officers who follow-up and provide counseling and testing to the clients’ sexual partners. The building of trust between the TCE field officer and the index client is critical, as the index client would ideally provide a list of his/her sexual contacts over the last 12 months, including their contact details. The index-case testing approach has yielded significant results and is now being scaled up in most HPP countries. In addition to index case testing, TCE also implements mobile testing, workplace testing, and twilight testing. People are tested and counseled, either as individuals or couples. Those testing positive are also screened for TB and risk of gender-based or domestic violence.
Linkage to Care and Treatment. Those who test HIV-positive are linked immediately to health facilities for treatment. Those who test negative but are at high risk are provided more information and referrals for biomedical prevention methods as appropriate. Such prevention methods include preexposure prophylaxis, post-exposure prophylaxis, voluntary medical male circumcision, and prevention of mother-to-child transmission. In most projects, HPP’s response is comprehensive, providing linkage to ART treatment and community groups, as well as access to nutrition, food security, and economic support groups for people living with HIV/AIDS.
Treatment Adherence. Individuals who are on ARTs are assisted to overcome obstacles to treatment. One key strategy is the formation of a Trio System of support. A trio consists of three people: the person on treatment and two supporters (often family members or friends). The model has been used by HPP members successfully across a number of countries in Sub-Saharan Africa for psychological support, easing open disclosure, reducing stigma, and instilling a sense of social acceptance. HPP has found this simple model to be especially effective during the first six vulnerable months of treatment initiation. After six months, or when the client is stable, field officers will help them transition into existing community ART adherence support groups who may be eligible for multi-month dispensary of ARTs, easing the adherence burden.
Viral Load Suppression. Individuals who have been on treatment and are stable are mobilized, through field officers or community volunteers, to go to health centers to measure their viral load every six months. Many TCE programs also include screening for gender-based violence and referrals to adequate services to affected women—this is a critical challenge that is also closely linked to bringing the epidemic under control, particularly for vulnerable adolescent girls and young women.
Field Officers and Local Passionates Joining Hands
Field officers are the backbone of the TCE program. They are recruited locally and undergo intensive training to learn how to engage individuals in open discussions about HIV/AIDS and sexual behaviors. They become skilled counselors, assisting individuals in developing personal risk reduction plans and guiding them to obtain testing or treatment. They walk or bicycle from house to house, village to village, mobilizing and counseling people one on one.
TCE also enlists local volunteers, called passionates, to support HIV infected and affected persons and families in the local community. They play a vital role in overcoming the stigma and discrimination surrounding HIV, and are often HIV positive themselves, thus setting examples by revealing their own status. Passionates lead the formation of "positive living clubs," which are support groups that engage in a wide variety of activities, from income generation projects to education and awareness building.