1.Overarching goals & objectives of projectImprove access to prevention and care services for sex workers (SW) and men who have sex with men (MSM) by providing a minimum package of prevention services to 38115 SW and 12705 and care services to 2382 SW and 1191 MSMReinforce the capacity of 12 local clinics and 3 community associations.Establish a system for monitoring and evaluation that contributes to the dissemination of lessons learned.Reinforce the coordination of prevention and care activities for SW and MSM.

2.Strategy to become more cost-efficientIMPACT-CI activities are based on mobilizing and strengthening HVP at the grassroots. Training sessions by coaching and supervision will continue to be conducted on site by Focal Points from Health District. This will increase regular support on the ground at a lower cost as compared to traveling frequently to the sites or bringing groups to Abidjan.

3.Strategies to transition activities to national/local structuresIMPACT-CI will coordinate closely with PNPEC, PLS-PHV, and continue to transfer competences to the Implementing partners, and to the District for M&E activities..

4.Overall M&E strategy to ensure high-quality monitoring and evaluation of your project.Quality monitoring will be conducted at local level by local supervisors (M&E person of the implementing partners, and the Focal Point from the Health district).

Vehicles: 2 vehicles;No new request made

IMPACTs interventions will continue to be implemented by 15 Implementing Partners in 12 health districts that are Abengourou, San-Pedro, Gagnoa, Guiglo, Daloa, Man, Yamoussoukro, Bouaké, Bondoukou, Marcory, Yopougon Est, Abobo Est. Planned interventions included into the "Care and Support axis of PSN 2011-2015.Activities target MSM and CSW (men and women) from to the following age stratification: Below 18 years, 18-24 years and over 25 years. Community care and support include: positive living, psychological support, nutritional status assessment, legal and social support, home based care, treatment literacy and support to adherence, trauma reduction, and psychological support targeting Peer Educators for burn out symptoms management. These services will be delivered by peer educators at home, in clinical centers, in 2 mobile clinics.Clinical care and support include STI screening and Management, prophylaxis and treatment of opportunistic infections, monitoring health status of HIV positive MARPs. This year IMPACT-CI will focus on strengthening the quality of current clinical services provided, through a stronger involvement of community agents in strategic decisions and activities and the sensitization of health professionals. IMPACT-CI will build the capacity of the health professionals on HVP health specificities. In Abidjan and San Pedro, IMPACT-CI will increase coverage of care and support service through bringing a minimal package of testing, screening and care on specific sites in their mobile clinics.In order to improve the quality of services, IMPACT-CI will reinforce the feedback system to disseminate the results of supervisions among implementing partners. Focal Points will provide local monitoring of implementation of the recommendations issued after supervision. A satisfaction questionnaire will be administered to clients quarterly to gather the opinions of the MARPs on services delivered. These opinions will be taken into account in the activity implementation in order to guide services delivery, to increase demand and client retention.All MARPS tested HIV positive through the mobile strategy will be referred preferably to IMPACT-CI clinical centers. Still, no pressure of any sort will be exercised on patients and peer educators who will prioritize HVP comfort and effective access to health services in the health system over all. IMPACT-CI will carefully monitor referral data and produce regular mappings of patients most common trajectories toward testing, care and support. A map of the most successful service delivery outlets will be produced and orient further support of clinical services, as well as capacity building efforts. Progressively the most efficient centers in the national health system will be involved to MARPs care and support services to ensure long term sustainability.IMPACT-CI care and support strategy will also focus on hygiene and nutrition for MARPs. These themes will be discussed both with clinical and community partners through direct coaching and provision of minimum hygiene packages for HIV positive MARPS, as well as standard BMI equipment and nutrition counseling at clinical centers.IMPACT-CI will build the capacity of MARPs, peer educators in CBOs, following the priorities describes here under, and expressed needs through coaching. A particular effort will aim at strengthening self support services through treatment literacy, home based care and positive living techniques.

?IMPACT-CI targets MARPs (Sex workers and regular clients, MSM and their partners). A study run by FHI in Une 2007-2009 among sex workers at specialized clinical centers showed 27% prevalence in this population, ranging from 11% in Gagnoa to 44% in San Pedro. Data on MSM prevalence are still incomplete, but a few partial studies show an exceptionally high prevalence (up to 50%, Vuylsteke, 2010).?Testing and Counseling leads to care and support, treatment. IMPACT-CI, through CBOs and clinical NGOs will continue to offer counseling and testing services while improving their quality and scale. Two approaches will be favored: a community led mobile strategy (strategie avancee) whereby peer educators will provide rapid test on community sites. A stable strategy (strategie fixe) in clinical centers. 2 clinical centers will also provide mobile testing and counseling services in their mobile clinics, in collaboration with peer educators. Both strategies will make use of Ditermine, Bioline and Statpak in conformity with national guidelines. People tested positive at clinical centers level will find care, support and treatment services locally. Those tested in the community sites will be referred to health centers in IMPACT-CI network for follow up.?In COP12, a total of 10 164 PS and MSM should be tested.?All MARPs tested positive that are not yet eligible for HIV treatment will receive follow up (care and support) from implementing partners. They will be invited to participate in community led activities by the peer educators responsible for testing and counseling. Those tested at the clinic will be referred to CBOs for community friendly follow up.?All VCT peer educators trained by PNPEC according to national guidelines will benefit from reinforced training and supervision through coaching at district level and periodic supervision by Heartland Alliance team. The aim of IMPACT-CI is to create and stabilize a solid team of peer VCT agents who will provide quality services at the door step while ensuring confidentiality, to favor a trusting relationship with those who are ready for testing.?One of IMPACT-CI objectives is to strengthen the quality of the link between community led activities and clinical services. In order to do so, IMPACT-CI will put the client at the center of its intervention model, giving HVP individuals the agency to express their needs and preferences. IMPACT-CI will learn from clients demand and advices through quality assessment at service level, best practice reports and mapping of actual trajectories of MARPs seeking testing and counseling. This will be key to an uptake of the demand for testing and care at clinical sites as well as in the community.?All data on counseling and testing will be validated on a quarterly basis by Heartland Alliance Monitoring and Evaluation team in collaboration with implementing partners, PEPFER and Health Districts.?Capacity of the 27 VCT peer educators who were trained in CDIP will be reinforced to strengthen the quality of services. This capacity building will be conducted on each site with expertise from human resource available in the health district. A solid team of at least 3 VCT peers will be stabilized in each of the 3 CBOs and 3 to 5 community core groups in clinics through higher incentives.Retro-CI lab will continue to ensure the control of lab test quality. All wastes will be taken care of by the clinics

IMPACTs Interventions will cover 15 sites in 12 health districts that are Abengourou, San-Pedro, Gagnoa, Guiglo, Daloa, Man, Yamoussoukro, Bouaké, Bondoukou, Marcory, Yopougon Est, Abobo Est. IMPACT-CI is implementing in urban and suburban areas of cities listed above.Activities targeting MSM and CSW (men and women) according to the following age stratification: Below 18 years, 18-24 years and Over 25 yearsInterventions are conducted as part of the implementation of National Strategic Plan 2011-2015 in relation to the situation of HVP populations within the HIV context. These interventions are identified by the Government of Côte dIvoire and incorporated into the "Prevention" axis (PSN 2011-2015). Activities are as follows:Promote the correct use of condoms targeting CSW and MSM across the sub-partnersPromote of HIV counseling and testing targeting CSW and MSM across the sub-partnersProvide support for operational coordination of the management of the national responseProvide support to the production, management and use of strategic information all the level the Health pyramidProvide support for mobilization, management and optimum utilization of financial resources

The intervention strategy is to provide the minimum package of services to the target populations at each intervention site (one stop shopping). To that end, IMPACT-CI shall ensure that the 15 partners offer a minimum package of services needed by CSW and MSM.

In order to improve the quality of services, IMPACT-CI will conduct quality supervision and assessment missions and disseminate the results of supervisions to the implementing partners. The Focal Point in regions provides local monitoring of implementation of the recommendations. A satisfaction questionnaire will be administered to clients quarterly out of the clinic. OBCs and community core groups will document the best practices encountered and obstacles to qualitative services quarterly. This will guide services delivery, and will contribute to increase demand and client retention.

IMPACT-CI will document behavioral changes in its program environment through focus groups in the CSW and MSM community sectors, mapping existing networks, community dynamics, representations, identities and practices, and program beneficiaries trajectories towards seeking VCT and care. IMPACT-CI will also research gender issues within CSW and MSM communities and their impact on the quality and efficiency of prevention, care and support strategies and tools.

Workshops will be organized by health districts and will involve implementing partners, and other services available in the area. Those workshops may also involve the implementing partners from different health districts. During these meetings, experiences and good practices will be shared, as well as specific expertise when needed.