This activity complements FHI activities in OVC (#10060), CT (#10065), Palliative Care (#10056), and Other/Policy & Systems (#10078).

In FY06, FHI's Highly Vulnerable Populations project (PAPO-HV) supported the strengthening and expansion of sexual risk-reduction interventions as part of a comprehensive prevention, counseling and testing, and care package of services targeting transactional sex workers and their partners. The PAPO-HV program covered six communities: Abidjan/Biétry (implemented by NGO Espace Confiance), Abidjan/Yopougon (NGO Côte d'Ivoire Prospérité, CIP), and San Pedro, Méagui, Watté and Adjaméné (all NGO APROSAM). In FY06, three new sites were added: Soubré (NGO APROSAM), Gagnoa (NGO CIP), and Yamoussoukro (NGO ASAPSU).

With FY07 funds, FHI will build on these activities through technical support while continuing to provide sub-grants to NGO/CBOs. Technical and management support is provided by both international (FHI and ITM) and national organizations (Espace Confiance and ASAPSU), with progressive transfer of skills and leadership roles to national organizations. Technical support to implementing partners includes training for new service providers, provision and use of standard M&E tools, regular participatory reviews, and supportive supervision. Espace Confiance offers onsite practical training and coaching in a range of prevention, care, and ARV treatment services.

PAPO-HV has leveraged additional funding from the Belgian Development Cooperation (BC) for 2007. Approximately $85,000 USD will support the procurement and distribution of male and female condoms, lubricant gel, and the design and production of a training curriculum for community health workers. A technical adviser is also funded.

PAPO-HV will continue to collaborate with other EP partners through provision of complementary services, such as expanded service delivery with use of mobile units and comprehensive care and treatment services. At the regional level, PAPO-HV will collaborate with the AWARE-HIV project to improve regional coordination by integrating the Clinique de Confiance as a regional training center for prevention and care interventions that target sex workers. FHI will also work closely with USAID and the Contraceptives Procurement program to ensure steady condom supplies.

Specifically, in FY07 FHI will: 1. Continue technical support to the four NGOs that implement comprehensive risk-reduction and CT activities at nine service sites: Abidjan/Biétry (NGO Espace Confiance); Abidjan/Yopougon (NGO CIP); San Pedro, Soubré, Méagui, Watté and Adjaméné (all NGO APROSAM); Gagnoa (NGO CIP); and Yamoussoukro (NGO ASAPSU). 2. Continue to support sites for the implementation of health-education and preventive BCC activities for sex workers, according to pre-established criteria and in collaboration with the Ministry of the Fight Against AIDS (MLS), the Ministry of Health/National Program for Care and Treatment (PNPEC), and other partners. FHI will continue to support prevention activities through subgrantees identified in FY06. 3. Continue standardization of BCC for sex workers at existing sites through dissemination of standardized tools elaborated at the national level (national reference manual). 4. Continue to improve the mapping of sex-worker sites to obtain data for measuring the coverage of the interventions. 5. In collaboration with Alliance CI, provide technical assistance to strengthen outreach and service delivery, extend geographic coverage, and promote accessibility for sex workers in Abidjan (NGO Espace Confiance) and San Pedro (NGO APROSAM) through use of mobile units. 6. Improve coverage and quality of clinic-based and outreach prevention and CT-promotion activities conducted by peer health educators and community workers. Activities will address stigma and sexual violence by providing HVP-friendly services and staff with nonjudgmental attitudes and by conducting BCC activities with other HVP (partners, clients, bar owners). 7. Continue to strengthen the operational management of NGOs and existing associations through the strengthening of administrative and financial management, budgeting, leadership, monitoring and evaluation, and mobilization of resources. FHI will continue to support the elaboration of a quality-assurance system started in 2006 in collaboration with other partners (National Program for Care and Treatment, PSI, JHPIEGO, and RETRO-CI) evaluate the quality of services. The system will be part of the current

program-management system. FHI will train health staff and focal points for outreach activities in the use of these quality-assurance tools. Quality-evaluation activities will be performed periodically, in accordance with national guidelines, to improve the quality of BCC and other prevention services. FHI will also support the elaboration, review, and implementation of capacity-building plans for NGOs and networks and the revision of tools (elaborated in 2006) for the management and mobilization of funds. 8. Project PAPO-HV will continue to support the establishment of the Clinique de Confiance center of excellence for training and service delivery implemented by NGO Espace Confiance in collaboration with other EP partners (JHPIEGO, EGPAF, ANS-CI, RETRO-CI, and the regional AWARE project). This center will offer onsite training for health-care providers seeking to provide HIV/STI prevention and care services for sex workers, transgendered people, MSM, and other at-risk and/or marginalized populations. The center will be linked to networks of similar service-delivery centers at national and regional levels. 9. Support revision, after evaluation, of an extension plan of Project PAPO-HV. This plan was elaborated in 2006, in collaboration with all key partners, and includes geographical expansion of services into the zone controlled by the New Forces as well as an extension to occasional sex workers. Given comparative advantages, Project PAPO will provide technical expertise (predominantly through the Espace Confiance team) to expand geographic coverage and quality of services by assisting CBO/NGO/FBOs to implement effective risk-reduction services to meet the needs of sex workers and other highly vulnerable populations. Funding for service delivery, organizational-capacity development, and general oversight will be provided through ANS-CI (umbrella granting project) and/or CARE International (northern zone). At least four new sites should be established in 2007, including sites in the northern regions with support from CARE. 10. Promote coordination and technical exchange between implementing partners and key ministries and associations, including regional forums (such as IRIS San Pedro) and the national Sex Work and HIV/AIDS working group coordinated by MLS, with involvement of MOH (PNPEC) and CBO networks. 11. Conduct a baseline assessment of safe-sex indicators among sex workers visiting new service sites in FY07. 12. Support annual evaluation of a plan for sustainability of project activities. PAPO-HV is guided by a sustainability strategy aimed at reaching the goals of the project while preparing local partners to assume organizational and technical management functions and continue interventions at the end of the CDC/Belgian Cooperation funding period. 13. Support the participation of local partners at regional conferences in order to facilitate exchanges of lessons learned and promising practices.

With the plus-up funds, FHI will expand services to commercial sex workers in current sites and establish five new sites to reach an additional 15,000 CSW with a complete package of services. FHI will provide technical assistance to strengthen local capacity to offer a comprehensive package of prevention and care to sex workers and their partners. To provide technical assistance to its partners effectively, FHI will recruit new staff and purchase a car.

This activity complements FHI activities in Condoms and Other Prevention (#10050), OVC (#10060), CT (#10065), and Other/Policy & Systems (#10078).

Through the Highly Vulnerable Populations project (PAPO-HV), FHI and its partners have supported the strengthening and expansion of primary health services targeting sex workers and their partners in 2006 in 3 initial sites: Abidjan/Yopougon, operated by the NGO Côte d'Ivoire Prospérité (CIP); Abidjan/Biétry, operated by the NGO Espace Confiance; and San Pedro, operated by the NGO APROSAM. In 2006 FHI also supported the extension of primary health services in two new sites: Gagnoa (NGO CIP) and Yamoussoukro (NGO ASAPSU).

With COP07 funds, FHI will build on its ongoing programs by offering technical and financial support with subgrants to its project partners. FHI will continue to focus on strengthening local capacity to develop and manage primary health care programs for highly vulnerable populations. This technical assistance will include the strengthening of new service providers and the review of progress made by existing partners.

PAPO-HV will continue to receive co-funding from the Belgian Development Cooperation (BC) during 2007. This funding will support the procurement and distribution of primary health care drugs, including drugs for STI treatment (costing over USD $55,000); plus part of the salary of the technical advisor.

PAPO-HV will collaborate with other Emergency Plan partners such as Alliance CI to strengthen and assist NGOs in managing the mobile units for counseling and testing and primary health care delivery. PAPO-HV will also collaborate with EGPAF to train health care provides in ART at several service delivery sites. At regional level, PAPO-HV will collaborate with the regional AWARE-HIV project to improve regional coordination by integrating the "Clinique de Confiance" as a regional training center for prevention and care activities targeting sex workers.

Specifically, in FY07 FHI will:

1. Continue technical support to the four existing NGOs, who implement palliative care activities in five service sites. The care and support activities for people living with HIV/AIDS (PLWHA) include: screening and treatment for Sexually Transmitted Infections (STI), primary health care, prevention and treatment of opportunistic infections. In addition, FHI will continue to support HIV psycho-social support groups which were established in all sites to provide psychological and moral support, and adherence counseling. 2. Provide technical assistance in the implementation of the minimum package of palliative care for Highly Vulnerable People, in line with the technical support FHI is providing to the Ministry of Public Health/National Program for Care and Treatment (PNPEC) regarding palliative care. This package will be integrated in the existing minimum package of prevention and care for sex workers, which includes: behaviour change communication (BCC), counselling and testing, STI screening and treatment, primary health care, prevention and treatment of opportunistic infections, and access to antiretroviral therapy (ART). 3. Support the extension of services by introducing palliative care into the package of services offered to outpatients, including symptomatic pain relief, evaluation of social, psychological and spiritual needs of the patients, and the elaboration of a reference system based on a family-centered approach. Moreover, this extension of palliative care services will necessitate providing training for health care providers at the newly selected sites where the USG will be scaling up the IRIS-SP model, which was piloted in FY 06. 4. In collaboration with Alliance CI, FHI will provide technical assistance for the integration of mobile primary health care services in the package of care to CSW who are difficult to reach in Abidjan (NGO Espace Confiance) and in San Pedro (ONG APROSAM). 5. Continue to support two sites selected in FY 06 for the implementation of primary health care services for sex workers, according to pre-established criteria and in collaboration with the Ministry of AIDS, the Ministry of Public Health/National Program for Care and Treatment (PNPEC) and other partners. 6. Continue support to health care providers offering primary health care services to HIV infected HVP, including treatment of opportunistic infections and STI in all existing sites; 7. Continue supporting psychological and social support for HIV infected HVP in all existing

service centers sites; 8. Continue to strengthen the operational management of NGOs and existing associations through the strengthening of administrative and financial management, budgeting, leadership, Monitoring and Evaluation and mobilization of the resources. More specifically, FHI will continue to support the elaboration of a Quality Assurance System (QAS) which started in 2006, in collaboration with other partners (National Program for Care and Treatment, PSI, JHPIEGO and RETRO-CI), in order to better evaluate the quality of health care services. The QAS will be part of the current program management system. In 2007 FHI will train health staff and focal points Monitoring and Evaluation in the two new sites in the use of these QAS tools before providing these tools to them. Quality evaluation activities will be performed periodically in the five sites already existing according to national guidelines in order to improve quality of services. 9. Continue the support (started in 2006) to Espace Confiance, in collaboration with JHPIEGO, EGPAF, RETRO-CI and the regional AWARE project, to create a national and regional training center for health care providers working in settings dedicated to the prevention and care of STI/HIV among sex workers. More specifically, in 2007, promotion activities of the Clinique de Confiance will take place; national and regional key players and program managers will be approached to conduct a needs assessment and to draw participants' lists; finally Espace Confiance will train these participants according to a pre-established training plan; 10. Increase coordination among NGOs and associations by strengthening efforts and providing technical assistance to national government's working groups, particularly the Sex Work and HIV/AIDS working group within the Ministry of the fight against AIDS. 11. Conduct a baseline assessment of STIs among sex workers visiting new service sites in FY07; 12. Address stigma and sexual violence by providing HVP friendly services, staff with non judgmental attitudes and by conducting BCC activities with other HVP (partners, clients, bar owners). 13. Support revision, after evaluation, of an extension plan of the project PAPO-HV. This plan was elaborated in 2006, in collaboration with all key partners, and includes geographical extension to zones under control of the New Forces as well as extension of the target population to occasional sex workers. A revised plan will allow reorienting interventions, including primary health services for HIV infected people, and expanding them in the whole country; 14. Support annual evaluation of a plan for sustainability or project activities. PAPO-HV is guided since 2006 by a comprehensive sustainability strategy aiming at reaching the goals of the project while preparing the local partners to assume organisational and technical management gradually, over the life of the project. The annual evaluation of that plan (by all key partners) will contribute to measuring progress made and revision of the plan periodically, eventually aiming at continuing interventions at the end of the CDC/Belgian cooperation funding period. 15. Support the participation of local partners at regional conferences in order to facilitate exchanges of lessons learned and promising practices.

This activity complements FHI activities in Condoms and Other Prevention (#10050), CT (#10065), Palliative Care (#10056), and Other/Policy & Systems (#10078).

FHI is the primary technical-assistance partner for capacity building within the National OVC Program (PNOEV) of the Ministry of Family and Social Affairs (MFAS), the Ministry of the Fight Against AIDS (MLS), and all pilot OVC coordination committees. Its efforts continue to focus primarily on the San Pedro pilot and proposed replication of a network model of decentralized, integrated, and coordinated HIV/AIDS services (the IRIS-SP model) built around a community social center. The plus up funds will be used to provide continued technical assistance to the PNOEV and other partners as they significantly scale up the San Pedro district model for comprehensive continuum-of-care sevices in 4 new georgraphic zones in teh underserved North and West.

In FY06, FHI supported the development and implementation of national norms for OVC programs and the dissemination of the national policy calling for standardized quality services for children affected by HIV/AIDS. FHI also finalized training curricula on OVC care for social workers and caregivers.

FHI strengthened the decentralization process for OVC care and support by enhancing the referral system established in San Pedro. FHI began an evaluation of the social-center pilot (supported by the Emergency Plan (EP) since FY05), which is part of a departmental project that provides integrated comprehensive HIV services to HIV-infected persons. The center serves as a hub for a network of community-based services for the care and protection of OVC. The center also provides HIV-related health services to children, providing a continuum of care within the catchment area of San Pedro District Hospital (CHR de San Pedro). FHI provided support for the social center in collaboration with other technical partners (EGPAF, ANADER, Alliance CI, MLS, MFAS, and the Ministry of Education) to strengthen HIV/AIDS prevention, care, and treatment services.

FHI also contributed to a situation analysis on OVC programs at three sites and supported partners providing OVC care. FHI strengthened the national OVC M&E system through revision and validation of standardized data-collection tools and indicators.

In FY07, FHI will continue to strengthen the central and decentralized response to OVC in Côte d'Ivoire. To support replication of the IRIS model of decentralized, integrated, and coordinated interventions, FHI will add an M&E assistant, a financial assistant, a driver, and a vehicle.

Based on the results of the San Pedro district model evaluation (to be completed at the end of FY06 programs), FHI will work to improve integration of OVC activities into the continuum of care by: (a) continuing to document and diffuse the social-center model to new communities, (b) continuing to link all interventions in the IRIS-SP consolidated plan, (c) improving the accessibility of OVC palliative care through identification of and support for additional palliative-care sites, and (d) updating and diffusing the revised inventory of actors in the OVC area working in the San Pedro and Grand Bereby health districts.

In addition, FHI will contribute to strengthening the referral network for HIV/AIDS interventions by (a) continuing capacity building of local coordination bodies through training and logistics support, (b) reviewing and updating the departmental operational plan and the HIV/AIDS M&E plan, (c) revising and diffusing tools to ensure a well-functioning continuum of care, and (d) strengthening coordination and multisectoral collaboration by organizing periodic meetings of IRIS-SP partners in San Pedro and Abidjan.

Outside San Pedro, as part of the extension of the IRIS-SP model to other districts, FHI will collaborate with all partners (EP-funded and others) working in those districts to implement OVC activities. In the process to select districts to replicate the initiative, priority will be given to districts with an OVC collaboration platform (CEROS). FHI will support the implementation of the model by identifying districts according to the extension plan, which will comprise the following main steps: (a) situation analysis and mapping of STI/HIV/AIDS prevention and care activities in the new districts, (b) informing administrative and political authorities, community leaders, and stakeholders about the model, (c) strengthening the capacity of local coordination bodies, (d) developing and

revising HIV/AIDS departmental operational action plans, (e) developing M&E plans, (f) establishing referral/counter-referral networks to ensure a continuum of care, (g) organizing and coordinating meetings relevant to these activities, (h) documenting the process, and (i) providing monitoring, supervision, and routine evaluations. To ensure sustainability and appropriate scale-up of the IRIS-SP model, the FHI will provide support to the PNOEV as it attempts to mobilize involvement in the process by the World Bank, Global Fund, UNDP, UNICEF, and ILO.

FHI will continue to provide technical assistance to all organizations implementing activities for OVC and to encourage coordination with the PNOEV and Alliance CI, which provides a majority of capacity building through sub-grants to local indigenous NGOs/FBOs/CBOs to support OVC at the community level. Working mainly in the emphasis area of development of network/linkages/referral systems and on the key legislative issue of stigma/discrimination, FY07 activities will provide technical assistance and training in HIV-related policy development and/or institutional capacity building to 45 local organizations and at least 400 individuals. Specific activities to be implemented in FY07 include:

1. Evaluate and revise the plan to build the capacities of the PNOEV, the OVC technical working group (GTT/OEV), and the national OVC commission to: (a) develop, revise, and implement HIV/AIDS strategic and operational plans for OVC care and (b) provide technical assistance to MFAS/PNOEV for the implementation of national policies. 2. Support the decentralization of services by replicating the San Pedro social-center model in five other regions that have OVC collaboration platforms. FHI will disseminate information about costs and options for implementing the model. 3. Continue to support implementation and monitoring of minimum services standards by the end of FY07, in collaboration with the PNOEV; to support local implementing partners (volunteers, members of NGOs/CBOs/FBOs, etc.); and to improve integration of OVC-related issues in training curricula for social workers. An emphasis will be placed on continuous training on OVC care and support at the national training program (INFAS). 4. Continue to strengthen the legal aspects of OVC care and support by helping to establish a legal environment favorable to children and affected families and by ensuring basic legal protection through laws and protection measures for women and children. 5. Collaborate with the ministries in charge of HIV/AIDS (MLS, MOH, MFAS, MEN) and technical partners (UNICEF, Global Fund, CARE International, ANADER, WFP) to continually disseminate information on OVC programs in Cote d'Ivoire. FHI will collaborate with JSI/Measure and DPPSE/MLS to monitor and evaluate major OVC programs and share innovations and best practices. FHI will also provide assistance to the PNOEV to set up linkages among OVC partners to coordinate interventions and avoid duplication of services within geographic areas.

This activity complements FHI activities in Condoms and Other Prevention (#10050), OVC (#10060), Palliative Care (#10056), and Other/Policy & Systems (#10078).

Through the Highly Vulnerable Populations project (PAPO-HV), FHI and its partners have supported the strengthening and expansion of HIV counseling and testing (C&T) services targeting sex workers and their partners in 2006 in 3 initial sites: Abidjan/Yopougon operated by the NGO Côte d'Ivoire Prospérité (CIP), Abidjan/Biétry operated by the NGO Espace Confiance and San Pedro operated by the NGO APROSAM. In addition, FHI has supported during 2006, the extension of HIV counselling and testing services in two new sites: Gagnoa (NGO CIP) and Yamoussoukro (NGO ASAPSU). Voluntary counselling and testing is part of the minimal package offered to clients as outpatients at PAPO-HV centers. Rapid testing is done, and clients get their results the same day. However some clients prefer to come back for their result. To date, 1708 HVP have received C&T and have received their test results. At the end of COP2006, we expect 4000 HVP to be counselled and to have received their test results.

With COP07 funds, FHI will build on ongoing programs with technical and financial support while continuing to provide sub-grants to the 7 implementing NGOs. In FY07, FHI will expand PAPO-HV to two (2) new communities through strategically selected sub-partners. The technical support FHI will provide to new partners includes strengthening new service providers and reviewing progress and providing supportive supervision.

PAPO-HV leveraged additional funding for this program from the Belgian Development Cooperation (BC) for 2007. This funding supports the design and production of a training curriculum for community health workers for approximately USD $50,000; plus part of the salary for a technical advisor.

The Project PAPO-HV will collaborate with other EP partners such as Alliance National Côte d'Ivoire (ANCI) for the strengthening of NGOs and to assist NGOs in managing the mobile units for CT services. Mobile CT units will operate in a CT van (ANCI will provide the van in November 2006 to two NGOs: Espace Confiance and APROSAM). Mobile units are supposed to reach the hard-to-reach HVP in remote areas in Abidjan and San Pedro regions. PAPO-HV will collaborate with the regional AWARE-HIV project to improve regional coordination by integrating the "Clinique de Confiance" as a regional training center for prevention and care activities targeting sex workers.

Specifically, in FY07 FHI will: 1. Continue technical support to the four existing NGOs, that implement C&T activities in five existing services sites: Abidjan/Biétry (NGO Espace Confiance), Abidjan/Yopougon (NGO CIP), San Pedro (NGO APROSAM), Gagnoa (NGO CIP) and Yamoussoukro (NGO ASAPSU) and in two new sites which will be selected with COP06 funding (making a total of 7 sites).

2. Through a competitive mechanism, FHI will support two new sites to be selected in FY 07 for the implementation of C&T services for sex workers, according to pre-established criteria and in collaboration with the Ministry of the Fight Against AIDS (MLS), the Ministry of Public Health/National Program for Care and Treatment (PNPEC) and other partners. FHI will support C&T activities in the selected sites, through subgrants with two, newly identified NGOs

3. In collaboration with Alliance-CI, FHI will provide technical assistance for the integration of mobile C&T services in the package of services to SW who are difficult to reach in Abidjan (NGO Espace Confiance) and in San Pedro (ONG APROSAM). The aim is to expand geographical coverage of intervention and to improve access to services.

4. Strengthen support to promotion of C&T services for HVP during outreach activities in the field conducted by 110 peer health educators and community workers and during health education and prevention activities at 9 clinic sites..

5. Support 9 NGOs to adopt innovative C&T strategies for HVP, including couple, family and community counseling

6. Strengthen the internal and external referral system of PLWA to the appropriate

services including: care and support groups, ARV treatment and OVC services,

7. Continue standardization of C&T practices at existing sites through dissemination of standardized tools; which were elaborated at the national level, under the supervision of the PNPEC.

8. Continue to strengthen the operational management of 9 NGOs. and existing associations through strengthening administrative and financial management, budgeting, leadership, Monitoring and Evaluation and mobilization of the resources. More specifically, FHI will continue to support the elaboration of a Quality Assurance System (QAS) which started in 2006, in collaboration with other partners (National Program for Care and Treatment, PSI, JHPIEGO and RETRO-CI), in order to better evaluate the quality of health care services. The QAS will be part of the current program management system. In 2007 FHI will train health staff and Monitoring and Evaluation focal points in the two new sites to the use of these QAS tools before providing these tools to them. Quality evaluation activities will be performed periodically in the 5 existing sites according to national guidelines in order to improve quality of C&T services.

9. Continue the support (started in 2006) to Espace Confiance, in collaboration with JHPIEGO, EGPAF, RETRO-CI and the regional AWARE project, to create a national and regional training center for health care providers working in settings dedicated to the prevention and care of STI/HIV among sex workers. More specifically, in 2007, promotion activities of the Clinique de Confiance will take place; national and regional key players and program managers will be approached to conduct a needs assessment and to draw participants' lists; finally Espace Confiance will train these participants according to a pre-established training plan.

10. Increase coordination among NGOs and associations by strengthening efforts and provide technical assistance to national government's working groups, particularly the Sex Work and HIV/AIDS working group within the MLS.

11. Conduct a baseline assessment of HIV prevalence among a representative sample of 420 sex worker visiting new service sites in FY07.

12. Conduct an assessment of the HIV prevalence among 400 sex workers coming for the first time to the 9 different C&T service sites.

13. Address stigma and sexual violence by providing HVP friendly services, staff with non judgmental attitudes and by conducting BCC activities with 12,000 other HVP (partners, clients, bar owners).

14. Support revision, after evaluation, of an extension plan of the project PAPO-HV. This plan was elaborated in 2006, in collaboration with all key partners, and includes geographical extension to zones under control of the New Forces as well as extension of the target population to occasional sex workers. A revised plan will allow reorienting interventions, including primary health services for HIV infected people, and expanding them in the whole country.

15. Support annual evaluation of a plan for sustainability or project activities. PAPO-HV is guided since 2006 by a comprehensive sustainability strategy aiming at reaching the goals of the project, while also preparing local partners to gradually assume organisational and technical management. The annual evaluation of that plan (by all key partners) will help FHI monitor its progress.

16. Support the participation of local partners at regional conferences in order to facilitate exchanges of lessons learned and promising practices.