The HAPP is a three-year program which contributes to reducing new HIV infections in MARPs by: (1) Increasing adoption of HIV-preventive behaviors through production and dissemination of prevention messages as well as condom, counseling and testing (CT) promotion; (2) Improving the quality of HIV/AIDS prevention services via the creation/strengthening of MARP-friendly CT services, capacity building for rights-based community outreach.The HAPP covers 5 sites; the Center, Littoral, East, and North West regions of Cameroon. CSWs and MSMs are primary targets, and clients of CSWs are secondary targets.It prioritizes country ownership and sustainability by strengthening capacities of health facilities and five community-based organizations (CBO) to provide MARP-friendly services; setting up of a referral system; the integration of this service delivery model into the supervisory chain of the MOH in order to facilitate transition to the host Government. HAPP also collaborates with the Global Fund Principal Recipient (PR), CAMNAFAW, to harmonize approaches and help integration of HAPP interventions within the Global Fund program.The HAPP Performance Monitoring and Evaluation Plan (PMEP) is well-aligned with the national M&E plan. USAIDs data quality assessment carried out September 2011, concludes that HAPP data collection tools and data management systems are suitable for data management for the PMEP. HAPP shares data with USAID and NACC on best practices.The HAPP has acquired two vehicles to support monitoring and supervision; and one vehicle to serve as a mobile HCT unit for the Yaoundé site. HAPP will solicit support for a second mobile HCT for Douala, while five motorcycles will be allocated to local CBO partners.

Global Fund / Programmatic Engagement Questions

1. Is the Prime Partner of this mechanism also a Global Fund principal or sub-recipient, and/or does this mechanism support Global Fund grant implementation? Yes2. Is this partner also a Global Fund principal or sub-recipient? Sub Recipient3. What activities does this partner undertake to support global fund implementation or governance?

Budget Code Recipient(s) of Support Approximate Budget Brief Description of ActivitiesHBHC PLHIV 1439057 Treatment adherence support, search for patients on ARV lost to follow up, home-based care and supportHVOP MSM and CSW 110484 Prevention information and education for MSM and CSW in KribiMTCT Women of childbearing age and their male partners 792725 Community moblisation for PMTCT

HAPPs HTC activities (which target 5,684 MARPs) will provide an opportunity to identify and link HIV-infected persons to care and support programs provided within four community drop-in centres in Douala, Yaounde, Bamenda, and Bertoua these centres are located in areas easily accessible to clients with measures taken to ensure the safety and security of personnel and clients. At least 792 PLWHA will receive 1 clinical service, while 291 PLWHA will receive at least one minimum care package.HAPPs HBHC activities are well-aligned and harmonized with priorities within the National HIV/AIDS Strategic Plan 2011-2015 which focus on improving access to adult care and support by strengthening the capacity of community and health systems to build a sustainable referral network. Psychosocial counsellors and social workers working out of these drop-in centres will provide a range of services to MARPs including risk evaluation and mitigation planning, positive living and coping skills, mediation, adherence support, positive prevention, and couples counselling along with to referrals to partner health facilities (for STI management), ART programs and other services. Doctors, nurses, psychologists, and jurists will volunteer some hours to carry out medical consultations, counselling, legal advice, and other support within drop-in centres. Weekly group meetings will be held in each centre on various themes identified by clients. In addition, material assistance will be provided to extremely vulnerable clients including food packages, disease prevention kits, water treatment units, mosquito nets, and basic hygiene products. Small grants will be used to strengthen groups representing PLHIV and reduce stigma through community-level testimonials and exchange visits.

HAPP has planned a series of capacity-building measures to ensure country ownership and sustainability. HAPPs supervision plan includes regular visits to sub-prime partner, partner CBOs and health centres, with accompanying tools for the monitoring of project implementation in the field

Key SI activities include:- (1) In FY 2012, the HAPP will identify key questions for operational research to better understand the MARP context in Cameroon. A first look at the IBBS findings seem to indicate the existence of sexual networks within the MSM community as well as a degree of social stratification based on gender roles that may foster the further marginalization of certain sub-groups within the community. Among CSW, it is necessary to dig deeper to better understand the driving factors behind the prostitution of young girls and to find models for dealing with violence inflicted on CSW by law enforcement (rape, extortion, battery, etc.) so that the program can achieve greater impact beyond the delivery of HIV/AIDS prevention information and services.(2) Final evaluation: This will involve measurement of the attainment of performance and outcome indicators as well as an assessment of the beneficiary satisfaction with respect to project implementation and service delivery.

While there is some tolerance for CSWs, MSMs face generalized stigma and discrimination, which affect their abilities to access critical services especially within the public health system. The National HIV/AIDS Strategic Plan 2011-2015 identifies CSWs and MSM among key drivers of the pandemic. HTC coverage in Cameroon is low in 2006-2009, only 13.6% of a target 13.2 million people accessed HTC services and received their test results. 64.1% of CSWs know their HIV status, while 18.1% have never done an HIV test.HVCT activities make up 23% of the HAPP FY 2012 budget. HVCT activities will ensure that at least 65% of total MARPs reached through HVOP activities (4206 women, and 1478 men) access HTC services and receive their test results. Personnel from seven partner health facilities will carry out HIV tests, using the national algorithm, within four community drop-in centers and through referrals (1,684 MSM and CSW). One mobile HTC units will be deployed at three special events and seven mass campaigns targeting at least 3,500 community members. CBO partners will also organize small-group events to facilitate access for at least 500 members. An emphasis is placed on strengthening referrals to other services. HAPP's community drop-in centers will provide a safe space for MSM, CSW, and clients to access HIV prevention services, HIV pre- and post-test counselling, adherence support, positive living and couples counselling, stigma reduction, psychosocial support, material assistance and referrals to other services, including ART. The community drop-in centres will partner with health clinics to do STI testing and treatment.Trainings will target 21 counselors, 4 social workers, 25 health workers, and 15 project personnel on effective delivery of HVCT services to MSMs and CSWs. The HAPP will also strengthen the capacity of an MSM CBO in Douala to provide HTC services in line with the national algorithm by training lab technicians, equipment upgrade, and purchasing reagents for confirmation tests. Finally, trainings will also be provided to 105 sub-grantee personnel and health workers on M&E including data collection, quality assurance, and reporting.

Cameroons CSW population is estimated at 18,000 (CSW Mapping, 2008) with HIV prevalence at 36.8% (NACC, 2009). Theres limited information on MSM although, HAPP's 2011 IBBS preliminary results estimate 38% prevalence. STIs are frequent among MARPs, with 17.5% syphilis prevalence in CSWs (NACC, 2009). National condom coverage is estimated at 31%, with 60% of CSWs and 43.7% of MSM reporting systematic condom use.FY 12 HVOP activities will reach 8,744 MARPs (6,122 CSW; 1,049 MSM; 1,573 clients of CSW). Biomedical interventions will include regular supply of condoms and single dose lubricants provided through 600 distribution points vendors will be trained in social marketing of HIV prevention products and services. The HAPP will distribute 1,2 million male, 200,000 female condoms and 60,000 lubricants for CSWs; 800,000 male, 100,000 female condoms, and 300,000 lubricants for MSMs; 400,000 male, 100,000 female condoms, and 50,000 lubricants for CSWs clients. In line with national policy, condoms will be sold at $0.05 per male condom and $0.21 per female condom. 60,000 male and 50,000 female condoms are also provided to peer educators for use during demonstration sessions. The HAPP will train personnel of partner health centers on the syndromic management of STIs and provide a stock of STI medications to health centers for the treatment of 720 cases (360 CSWs; 144 MSM; and 216 other).Behavioral interventions will seek to increase protective behaviors through dissemination of appropriate prevention messages. The HAPP will use adapted behavior change communications (BCC) materials and mobile technology (SMS) to disseminate appropriate prevention messages. 50 (38 CSW and 12 MSM) previously trained and new peer educators will provide HIV/STI prevention and safe sex education outreach using interpersonal communications techniques. Prevention education will also be offered through 4 community drop-in centers.HAPP has planned a series of capacity-building measures to ensure country ownership and sustainability. HAPPs supervision plan includes regular visits to sub-prime partner, partner CBOs and health centers, with accompanying tools for the monitoring of project implementation in the field