This activity relates to activities in Condoms and Other Prevention (#9944), Basic Health Care and Support (#9945), CT (#9943), OVC (#9938), and Other Policy (#9946).

This activity contributes to building an indigenous, sustainable response to the HIV epidemic through the rapid expansion of culturally appropriate HIV/AIDS prevention and care interventions that target underserved populations in northern and western Côte d'Ivoire, where health-care services have been severely disrupted since civil conflict split the country in 2002.

CARE used FY04 EP funds to develop HIV prevention activities in those regions in partnership with five NGO/CBO/FBOs and won funding for the current project in September 2005. As lead implementer of Global Fund- and EP-supported prevention and care activities in northern and western CI, CARE works to ensure coherence in programming and delivery of services in the main target areas of Bouaké, Korhogo, and Man. From each of these central sites, CARE is gradually scaling up activities to three satellite sites. The project complements and builds on other EP-funded efforts, including Ministry of the Fight Against AIDS (MLS), JHU-CCP, and ARSIP (network of religious leaders) activities to develop effective BCC materials and mobilize faith communities and Ministry of Education (MEN) and Ministry of Family and Social Affairs activities to support youth and OVC, including out-of-school youth.

With FY07 funds, CARE will continue to provide sub-grants to organizations that conduct prevention activities focusing on abstinence and fidelity, including CARITAS, REMSCI (network of Islamic leaders), and ARSIP, as well as a minimum of three other local NGOs (one per zone). CARE will work through regional HIV/AIDS coordination networks, whose responsibilities for the last two project years will include action plan and budget development and accounting for funds and achievements. CARE will hire a grants manager based in the North who can provide TA and training to both the networks and grant recipients.

CARE will support selected local CBO/FBO partners in the use of socio-cultural analysis results from FY06 to identify and respond to local gender and cultural factors that perpetuate the spread of HIV, including stigma and gender-based violence. Local partners will be supported, with the help of JHU/CCP, in applying existing and newly developed culturally appropriate BCC curricula, materials, and strategies, including the Sports for Life approach, that deliver abstinence, faithfulness, partner-reduction, stigma-reduction, positive-prevention, and gender-based violence-prevention messages targeting youth (including out-of-school youth), women and girls, illiterate populations, discordant couples, and other particularly vulnerable groups.

Working mainly in the emphasis areas of IEC and local organizational capacity development, and on the key legislative issues of gender, stigma/discrimination, and wraparounds, prevention activities are expected to reach at least 400,000 people during the 4.5-year project and 124,000 (total prevention, AB plus Condoms and Other Prevention) during FY 07. Activities for AB prevention in FY 06 targeted 40,000 people and in FY07 will aim to reach 60,000 people (20,000 per region), including 35,000 in schools (5,000 ages 10-14) and 25,000 in community settings.

AB prevention interventions envisioned with FY 07 funds include implementing targeted and coordinated BCC campaigns mediated by influential figures, religious and traditional leaders, teachers, and peers designed to a) delay sexual debut among youth, b) decrease inter-generational sex, sexual coercion, and gender-based violence, c) decrease multiple sexual partnerships, and d) promote mutual fidelity with knowledge of one's own and one's partner's serostatus. Small-group communication methods (theater, participatory peer education, videos, traditional events, etc.) in the community, schools, sporting fields, mosques, and churches will be reinforced by radio messages in local languages.

CARE will also continue to work on putting into place pilot savings and loan activities. These will be complemented by pilot income-generating activities for targeted sub-populations, including young out-of-school girls, to address a root cause of HIV vulnerability and reduce early sexual debut resulting from the need for income through transactional sex. Given the "feminization" of HIV in Cote d'Ivoire (AIDS Indicator Survey, 2005) and increasing poverty in the North as a result of the politico-military crisis, this is a

crucial element of CARE's prevention strategy.

Using FY07 funds and beginning the scale-up of activities to satellite sites around Bouake, Korhogo , and Man, the project will:

1. Work with the MEN to implement the use of national BCC education curriculum and supporting materials in schools, including MEN life-skills materials that deliver age-appropriate abstinence messages to younger children, abstinence-and-fidelity messages to older children, and educational messages to all children about gender inequity, prevention of gender-based violence, and the role of alcohol and other drugs in HIV transmission. 2. Provide training to 60 school health providers on delivering age-appropriate "AB" information to young people age 10-14 and "ABC" information to young people above age 14 and on identifying, counseling, and referring young victims of gender-based violence to health-care providers. 3. Provide refresher training to an existing pool of 60 peer educators to promote HIV/AIDS prevention through abstinence and faithfulness messages and add a module on identifying, counseling, and referring young victims of gender-based violence to health-care providers. 4. Work with UNFPA and UNICEF to train 10 health-care providers in each zone on the correct treatment and care of young victims of rape, incest, and other forms of gender-based violence. 5. Help ARSIP extend its network to the North and provide training to 30 religious leaders per zone, representing Catholic, Islamic, Protestant, and Buddhist faiths, in promoting HIV/AIDS prevention to their congregations. 6. Implement BCC community-based campaigns to promote AB messages, with an emphasis on HIV counseling and testing for couples who do not know their HIV status. Special emphasis will be placed on identifying, disallowing, and strengthening community response against stigmatization, discrimination, and gender-based violence, including female genital mutilation, child sexual abuse and other practices that place young girls at particular risk for HIV/AIDS. CARE will work with JHU/CCP, UNFPA, ANADER, and Alliance CI to develop, disseminate, use, and evaluate appropriate messages and materials to support community sensitization efforts aimed at out-of-school youth, women, and other particularly vulnerable groups. 7. Develop prevention messages in local languages for local radio with AB messages and education messages about sexual violence against youth (especially girls). CARE will work with JHU/CCP and UNFPA to develop appropriate materials and messages and collaborate with REPMASCI (network of journalists and artists), ANADER, and Alliance CI to ensure dissemination of these messages. 8. Support at least 200 young girls and women with pilot income-generating and savings-and-loan activities. CARE will continue to adapt and follow the project M&E plan developed in FY06 based on national and EP targets. Population Council will begin the progressive transfer of M&E skills and responsibilities to local partners in 2007.

To support sustainability, CARE incorporates flexibility into its partnerships with local NGOs so as to avoid dependency and encourage autonomy. An accent is placed on training and supportive supervision so that necessary technical and management skills are imparted to partner staff.

This activity complements CARE activities in AB (#9941), Other Prevention (#9944), Basic Health Care (#9945), CT (#9943), OVC (#9938), and Other Policy (#9946).

CARE and sub-partners Caritas, JHPIEGO, and Population Council began this EP-funded project in September 2005. The project seeks to build an indigenous, sustainable response to the HIV epidemic through the rapid expansion of innovative, culturally appropriate HIV/AIDS prevention and care interventions that target underserved populations in the northern and western regions of Côte d'Ivoire, where health care has been disrupted by the country's extended crisis.

CARE initiated operations in northern CI in 2003 under the Rail-Link Project. A 2004 GFATM grant allowed CARE to launch an emergency HIV prevention program in 24 areas under the control of the New Forces. A second two-year project was approved by the GFATM in FY06.

As lead implementer of Global Fund- and EP-supported prevention activities in the regions, CARE will work to ensure coherence in programming and delivery of HIV prevention and care services targeting youth, transactional sex workers, transport-industry users and service providers, and PLWHA in the main target areas of Bouaké, Korhogo, and Man, as well as activities with migrants who pass through the North on their way to Abidjan. CARE is scaling up prevention activities to at least three satellite sites per central site.

With FY07 funds, CARE will disburse at least nine sub-grants promoting sexual risk reduction targeting high-risk populations. A grants manager based in the North will be hired to provide TA and training to grant recipients. The project will support regional HIV coordination networks and will complement and build on other EP-funded efforts, including Ministry of the Fight Against AIDS and JHU-CCP activities to develop effective BCC approaches and mobilize faith communities and opinion leaders, as well as prevention and care interventions targeting commercial sex workers, truckers, discordant couples, and "prevention for positives" by RIP+, PSI, FHI, and others.

Other Prevention interventions envisioned with FY07 funds include targeted BCC campaigns mediated by influential figures, religious and traditional leaders, and peers designed to increase the correct and consistent use of condoms among high-risk sub-populations, to increase CT uptake by individuals and couples, and to prevent gender-based violence as part of a comprehensive ABCD+ approach. Use of methods of proximity (theater, participatory peer education, video programs, traditional events, Sports for Life, etc.) in the community, schools, sporting fields, mosques, and churches will be reinforced by radio messages in local languages. Interventions will aim to reduce HIV-related stigma and gender inequity and will address issues such as cross-generational sex, male social norms related to multiple sex partners, and the role of alcohol and other drugs in HIV transmission..CARE will collaborate with JHU/CCP, REPMASCI (network of journalists and artists), ANADER, and Alliance CI to ensure the development, dissemination, and use of appropriate BCC materials and messages targeting youth (including out-of-school youth), women, illiterate populations, discordant couples, and other particularly vulnerable groups.

The project will use an innovative peer-educators model developed in FY06 to educate high-risk groups (transactional sex workers, migrant workers, truckers, PVVIH and their partners, youth) about condom use and reducing risky sexual behaviors, promote access to CT and HIV/AIDS care and treatment, and facilitate disclosure. Peer educators will hold repeated small-group sessions and encourage members to form their own groups, in an expanding "tree" of small-group meetings. Peer educators will be provided with communication materials and incentive items with pre-printed messages. The project will draw on the expertise of RIP+ (network of organizations of persons living with HIV/AIDS) and tools such as PSI/AIMAS films sharing "positive living" stories. At least one subgrant per region (3) will target transactional sex workers and draw on the technical expertise of Clinique de Confiance (CdC) and the FHI-led PAPO project, including practical training at the CdC site.

Expanded funding will allow a larger number of peer educators and the creation of a "prevention for positives" cadre of expert trainers in each intervention site to provide consolidated CT for family members of HIV-infected persons, ongoing counseling for

PLWHA and sero-discordant couples, advice on dealing with disclosure, integrating positive prevention into treatment and care, and addressing HIV-related gender-based violence. These trainers will work with CT centers and care and treatment organizations to integrate positive prevention into regular services. They will also assist in creating and operating support groups for PLWHA and their families. Support groups will be encouraged to work with local PLWHA networks and media partners such as AIMAS to create local-language radio shows and short films that share "positive living" stories to reduce stigma and facilitate prevention for positives.

CARE will pilot savings-and-loan and income-generating activities for targeted sub-populations, including transactional sex workers and women. CARE will coordinate with PSI on IGAs with ex-combatants in the North, focusing on women, as disarmament and reintegration activities continue.

Working in the emphasis areas of IEC, community mobilization, and local organizational capacity development, and on the key legislative issues of gender, stigma/discrimination, and wraparounds, prevention activities are expected to reach at least 400,000 people during the 4.5-year project and 124,000 (total prevention, including AB) during FY07. Activities for Other Prevention in FY06 targeted 40,000 people and in FY07 will aim to reach 84,000 people and train 185 people in Other Prevention.

Using FY07 funds, the project will:

1. Provide training to 80 peer educators and refresher training to an existing pool of 60 peer educators to promote HIV/AIDS prevention through ABCD+ messages, adding a module for sensitizing populations about gender-based violence as well as identifying, counseling, and referring young victims of gender-based violence to health-care providers. 2. Work with RIP+ (a new NPI recipient) to train an expert cadre of 15 PLWHA trainers in each site. 3. Support the application of national BCC education curriculum and supporting materials for the promotion of ABCD+ prevention messages in collaboration with the Ministry of Education and JHU-CCP, for in- and out-of-school youth. 4. Implement community-based BBC campaigns. With CCP support and in coordination with ANADER and Alliance CI, Care will develop and implement plans for distribution, use, and evaluation of new and appropriate BCC materials for particularly vulnerable groups. 5. Develop ABCD+ prevention messages in local languages for local radio and produce culturally and linguistically tailored radio programs and films to deliver prevention messages through mass campaigns. 6. Create one mobile "sensitization caravan" equipped with audio-visual equipment to reach satellite and rural sites with prevention messages. 7. Pilot income-generating and savings-and-loan training with at least 200 members of targeted vulnerable groups. 8. With CCP support, implement an ABCD+ prevention campaign with migrants who pass through the North on their way to Abidjan.

CARE will adapt and follow the project M&E plan based on national and EP requirements and tools and contribute to an integrated national M&E system.

This activity complements CARE activities in AB (#9941), Condoms and Other Prevention (#9944), CT (#9943), OVC (#9938), and Other/Policy & Systems (#9946).

This project, awarded EP funding in September 2005, contributes to building an indigenous, sustainable response to the HIV epidemic through the rapid expansion of culturally appropriate HIV/AIDS prevention and care interventions that target underserved populations in northern and western Côte d'Ivoire, where health-care services have been severely disrupted since the civil conflict split the country in 2002.

CARE received a 2004 grant from the GFATM to support an emergency HIV prevention program in 24 areas controlled by the Forces Nouvelles, in partnership with PSI and AIMAS. A second two-year phase was recently approved by the CCM and GFATM for FY06 and FY07. CARE used FY04 EP funds to develop PLWHA/OVC community-care projects in partnership with five NGO/CBO/FBOs. As lead implementer of Global Fund- and EP-supported PC activities in northern and western CI, CARE works to ensure coherence in programming and delivery of services in the main target areas of Bouaké, Korhogo, and Man. CARE is gradually scaling up PC activities to three satellite sites in each central site.

Planned PC activities will draw on baseline assessments conducted with FY05 funds. They will complement and build on other EP-funded efforts, including Ministry of Health and FHI development of palliative-care policy and guidelines for clinic- and home-based care as part of a continuum of care, as well as prevention, care (including OVC), and treatment activities by other ministries (AIDS, Education, Social Affairs), PSI, HIV/AIDS Alliance, and EGPAF. District health management teams will be involved in planning and supervision to maximize capacity-building and coordination with the MOH, and regional HIV/AIDS networks will be reinforced.

CARE's palliative-care strategy is to ensure linkages among care, HIV and TB treatment, CT, HIV prevention, and other services, such that anyone identified as HIV+ will have immediate access to the needed spectrum of diagnostic and treatment services and avoid "loss" of clients due to lack of effective follow-up systems. Palliative-care services are provided at the community level by local NGO/CBO/FBOs and at local health centers by health-care workers. CARE will support health centers (NGO and public) with assessment (of CT and OI/ART quality), training, medicines, and other materials.

The project will continue to support 12 FBO/NGO/CBOs selected in 2006 and will select three more organizations for capacity building. TOT methods were emphasized in FY06 so that partner FBO/NGO/CBOs can train community-care groups, religious leaders, clinic staff, and counselors in FY07, with quality assurance by JHPIEGO. The project will mobilize communities around the use of CT, ART, and STI services and will ensure the availability of these services at 15 health sites (two per hub in Man, Bouake, and Korhogo, plus three satellites per hub).

Given the high costs of PC training and service delivery, especially for home-based care in remote areas, and based on its experience in FY05-06, CARE believes it is necessary to seek a significant increase in PC funding to ensure quality of care.

Expanded FY07 funding will also allow the rehabilitation, equipping, and operation of a pilot "maison de passage" in Bouake that will assist PLWHA in accessing care and treatment by offering a place of refuge and psychosocial support for those who are traveling to town for follow-up visits or support-group meetings or seeking respite from stigmatization and discrimination. Local partners have noted that clients and their families are sometimes "lost from view" because of the difficulties of traveling into town for support-group meetings and follow-up visits. A previous transit facility, highly successful before the 2002 conflict, was also appreciated by those experiencing isolation or discrimination, providing a reprieve and time for a social worker to visit and counsel family or community caregivers, eventually facilitating the client's return home.

The "maison de passage," expected to benefit 300 PLWHA and their families per year, will be managed by a local partner and will include a live-in non-clinical care provider, a clinical care provider, and at least 15 beds. Visitors will generally be allowed to stay for up to two nights and will be asked but not required to pay at least 500 CFA ($1) per day to support the costs of running the house. In special cases where family and community care are not

available, the maison de passage may serve as a hospice.

Working mainly in the emphasis areas of development of network/linkages/referral systems and local organizational capacity development, and on the key legislative issues of stigma/discrimination and wraparounds, FY07-funded PC activities will support 16 PC service outlets, train 87 people to provide PC services, and provide PC services to 4,800 people (including, with some overlap, comprehensive home-based care for 1,500 PLWHA; OI services and basic care and support with links to treatment for 3,000 HIV patients; and STI treatment for 3,000 people).

Activities with FY07 funds will include:

1.Training of 60 NGO/CBO/FBO health workers in home-based care for PLWHA, including the diagnosis and treatment of OIs, monitoring of ART, provision of psychosocial and spiritual support for patients and family members, pain alleviation, and provision of a preventive-care package that includes counseling for prevention of positives, cotrimoxazole, safe-water products, and ITNs. Trainers trained by JHPIEGO in 2006 will undertake these trainings. 2.Training of 27 health personnel at nine rural health centers in the diagnosis and treatment of OIs, palliative care, and monitoring of ART, and linking through a referral system to accredited ART sites. 3.Follow-up and supervision of 81 health personnel and 120 trainers trained in FY05-06 with EP support. 4.Sub-grants to local NGOs to continue with home-care visits to PLWHA. 5.Support to religious partner organizations for the provision of spiritual counseling and support to PLWHA and their families. 6.Provision of medicines for OI treatment to NGOs, rural health centers, and outpatient hospitals, along with support for the tracking and ordering of stocks. 7.At least two workshops to facilitate the sharing and replicating of best practices for community-based PC with ACONDA, the national care and treatment program, FHI, Alliance, and other partners. 8.Provision of wraparound nutritional support in partnership with WFP, complemented by nutrition education for and by food distributors and care providers. 9.Pilot village savings-and-loan and income-generating activities to promote self-sufficiency for PLWHA and their families.

The project will continue to adapt and follow the project M&E plan based on national and EP targets. Population Council will use data collection approaches that allow the measurement of service quality and client satisfaction and willl begin the progressive transfer of M&E skills and responsibilities to local partners in 2007.

To build sustainability, CARE incorporates some flexibility into its partnerships with local NGOs so as to avoid dependency and encourage autonomy. A strong accent is placed on training, training of trainers, and supportive supervision so that necessary technical and management skills are imparted to local partner staff, who will be able to support other organizations in the future. CARE is also emphasizing the development of project-writing and financial-management skills so that partners can apply directly for and manage funding in the near future. Institutional capacity is being supported through infrastructure rehabilitation and equipment purchases.

This activity complements CARE activities in AB (#9941), Condoms and Other Prevention (#9944), Basic Health Care and Support (#9945), CT (#9943), and Other/Policy & Systems (#9946).

CARE and partners Caritas, JHPIEGO, and Population Council successfully competed for an EP award in September 2005. The project contributes to building an indigenous, sustainable response to the HIV epidemic through the rapid expansion of culturally appropriate HIV/AIDS prevention and care interventions that target underserved populations in northern and western Côte d'Ivoire, where health-care services have been severely disrupted since civil conflict split the country in 2002.

CARE used FY04 EP funds to develop PLWHA/OVC community-care projects in partnership with five NGO/CBO/FBOs, including Caritas. With its faith-based extension network and links to eight health reference centers, Caritas is well-positioned to initiate prevention and care activities. As lead implementer of Global Fund- and EP-supported OVC activities in northern and western CI, CARE works to ensure coherence in programming and delivery of services in the main target areas of Bouaké, Korhogo, and Man. CARE is gradually scaling up OVC activities to three satellite sites from each of the central sites.

OVC activities in 2007 will draw on baseline assessments, including participative assessments with OVCs, conducted in FY06. CARE's program will complement and build on other EP-funded efforts, including Ministry of Education (MEN), Ministry of the Fight Against AIDS (MLS), HIV/AIDS Alliance, ANADER, and Hope Worldwide activities in support of youth and OVC. The project will operate in consultation with the National OVC Program and the national OVC committee (CEROS-EV) and will work through the regional HIV/AIDS networks. District health management teams will be involved in supervision to maximize capacity-building and coordination with the Ministry of Health.

At least four sub-grants will be disbursed in Year 2 for OVC activities. CARE will hire a grants manager who can provide TA and training to the networks and grant recipients.

OVC will be identified using a holistic approach. This involves ensuring that OVC services are linked through a referral system with CT, treatment, and care services (including PMTCT and TB) that will actively identify HIV-infected or -affected children. Local social, educational, and judicial services will identify OVC using a tool developed by the National OVC Program in conjunction with FHI. CARE envisions adapting this tool so that the needs of OVC can be stratified and prioritized based on the initial analysis conducted with each child.

Follow-up at household level will continually assess the needs of children and address the special needs of certain groups, including HIV-positive children and their families, children of HIV-positive parents, adolescent girls, and orphans requiring grief support. Support will include psychological support and monitoring, access to school and legal assistance (e.g. birth certificates), and support packages (school kits, exam fees, basic health supplies) for OVC and other children in their host families.

CARE will support poverty-reduction and economic-support activities for building self-sufficiency among OVC, including pilot income-generating and savings-and-loan activities for child-headed households and host families of OVC, as well as for out-of-school vulnerable children.

A cadre of trainers, including CARE field staff, is being trained by JHPIEGO in FY06, using the national OVC care and treatment guidelines. In FY 07 these trainers will provide follow-up technical support to assist local partners in effectively providing the minimum package of care to identified OVC and host families.

CARE will continue to work with WFP to provide wraparound programming for OVC and host families identified as needing nutritional support. CARE will use FY07 funding to provide training to food-distribution teams, caregivers, and other care providers on the basic elements of nutrition education and the nutritional needs of OVC and PLWHA.

With expanded FY07 funding, the project will improve and expand prevention services for childhood illnesses, including TB, malaria, recurrent respiratory infections, and persistent

diarrhea, among HIV-infected and -affected children. Beginning by identifying existing prevention and treatment services, the project will develop a "response tree" that partners will use to either provide a service or refer a child for appropriate care. The following will be ensured for all identified HIV-positive and HIV-exposed children: immunization coverage, diagnosis and referral of TB cases when available, insecticide-treated bednets, and safe-water products and hygiene-promotion kits.

Given weakened health-care services and absent outreach services, this approach will require supporting NGO caregivers (and health centers when possible) with training on the diagnosis and treatment of childhood illnesses among HIV-positive and HIV-exposed children, vaccine administration, TB screening, and malaria and diarrhea prevention and simple treatment. Where NGOs and health centers lack the capacity to provide treatment services, the project will aim to develop referral systems with other EP-funded partners and regional service sites. The linking of OVC to routine immunization and other programs could include putting into place a system to link medical records for HIV-exposed and HIV-infected children with records at local health centers that track childhood immunizations.

Working in the emphasis area of development of network/linkages/referral systems and on the key legislative issues of stigma/discrimination and wraparounds, FY07 activities will provide OVC services to at least 3,000 children and train at least 120 caregivers in OVC care.

Activities to be carried out with FY07 funds include:

1. Provide training for NGO and other service providers and caregivers to reinforce their capacity to diagnose HIV infection in children according to national guidelines. 2. Support and reinforce the referral system linking OVC, CT, prevention, and treatment organizations. 3. Provide core technical capacity-building training and supervision to partner NGOs/CBOs on the care and treatment of OVC. 4. Provide care and support services to 2,500 OVC and host families. 5. Provide refresher training to 60 social workers and community counselors in the provision of care and support services to OVC and their host families, with emphasis on quality psychosocial support and using a "family approach." 6. Provide training on nutrition-education methods and nutritional needs of PLWHA to food-distribution teams and care providers. 7. Provide training of trainers for 60 social workers and community counselors on the provision of childhood-illness prevention services to OVC and their host families. 8. Buy drugs and commodities needed to implement programs to prevent pneumonia, TB, malaria, and diarrheal disease in HIV-exposed and HIV-infected children according to national guidelines. 9. Conduct regular visits to local partners to ensure the implementation of the project-specific M&E plan based on national and USG requirements and tools.

To build sustainability, CARE incorporates some flexibility into its partnerships with local NGOs so as to avoid dependency and encourage autonomy. A strong accent is placed on training, training of trainers, and supportive supervision so that technical and management skills are imparted to local partner staff, who will be able to support other organizations. CARE also emphasizes the development of project-writing and financial-management skills so that partners can apply directly for and manage funding in the near future. Care will expand its services and sites to reach 2,000 more OVC and train 40 more caregivers with plus up funds.

This activity complements CARE activities in AB (#9941), Condoms and Other Prevention (#9944), Basic Health Care and Support (#9945), OVC (#9938), and Other/Policy & Systems (#9946).

This project, awarded EP funding in September 2005, contributes to building an indigenous, sustainable response to the HIV epidemic through the rapid expansion of culturally appropriate HIV/AIDS prevention and care interventions that target underserved populations in northern and western Côte d'Ivoire, where health-care services have been severely disrupted since the civil conflict split the country in 2002.

CARE received a 2004 grant from the GFATM to support an emergency HIV prevention program in 24 areas controlled by the Forces Nouvelles, in partnership with PSI and AIMAS. A second two-year phase was recently approved by the CCM and GFATM for FY06 and FY07. CARE used FY04 EP funds to develop PLWHA/OVC community-care projects in partnership with five NGO/CBO/FBOs. As lead implementer of Global Fund- and EP-supported activities in northern and western CI, CARE works to ensure coherence in programming and delivery of services in the main target areas of Bouaké, Korhogo, and Man. CARE is gradually scaling up project activities to three satellite sites in each central site, in coordination with local district health teams.

With GFATM funding, integrated CT services have been established at health centers in Man, Bouaké, Korhogo, and Odienné. EP-funded partners EGPAF and ACONDA are integrating CT and HIV/TB services at health facilities; HIV/AIDS Alliance is supporting local authorities to establish sustainable community CT centers; PSI and FHI are providing CT and other services to the uniformed services, truckers, and sex workers; and ANADER is increasing awareness and access among rural populations. Planned FY07 activities will complement and build on CARE's GFATM activities and those of other EP partners to achieve geographic and service-delivery coverage in the North and West while helping to establish a referral network linking CT promotion and service delivery to HIV prevention, care, and treatment services.

FY07 CT activities will draw on baseline assessments, including those conducted with FY05 funds and the MOH/PSI-supported evaluation of CT services in 2005. The project will continue to ensure the provision of quality CT services at six health sites (two per hub in Man, Bouake, and Korhogo) and add five new CT sites by providing sub-grants and technical assistance to local partners who provide direct services, including pre- and post-test counseling, couples counseling (discordant and accordant), family counseling, and referral services. A sub-grant/support-services manager will be hired.

Quality will be assured through supervisory visits and training by JHPIEGO and CARE field staff for the 35 counselors trained in FY05 and the 30 people selected for a training of trainers in counseling in FY06. Quality assurance for HIV tests will be provided by the RETRO-CI laboratory in collaboration with PNPEC and local health authorities.

CARE will use the two principal approaches available on the national front: stand-alone community-based CT centers offering targeted CT services (including youth-, couples-, and men-friendly services) and the integrated model with CT services systematically offered within standard health-care settings (such as in PMTCT, TB, STI, and HIV care and treatment services at local hospitals). The project will reinforce or create linkages with other partners such as EGPAF, Global Fund, and Clinton Foundation and will work to integrate CT into the existing minimum package of health-care services while emphasizing the need for STI, TB, and prenatal care.

CARE will prioritize the promotion of CT service utilization and serostatus knowledge as well as the follow-up of seropositive clients. The project will work to reach out to more rural communities to ensure that prevention and treatment services are available to whole families and that counselors are trained in using "the family approach." With expanded FY07 funding, CARE will develop an innovative approach for ensuring that community counselors identify and visit people newly diagnosed as HIV-positive to dramatically reduce the percentage of clients "lost from view."

CARE will work closely with RIP+ (network of people living with HIV) to organize post-test peer-support groups. Group members will be encouraged to disclose their status, conduct

anti-stigmatization activities, share insights on PWLHA-specific issues, and create new support groups.

CARE will also encourage partners to create "twinning" relationships with organizations conducting similar work in other countries, such as Rwanda or Uganda. At least two international trips will allow key project staff and partner representatives to learn from successful community-based CT approaches, such as house-to-house testing, mobile service provision, and the linking of CT with care and prevention services at one site.

To address the lack of qualified laboratory technicians in the North, CARE will advocate a policy change to allow young technicians to use their "bridge year" (between schooling and integration into the public health-care system) to gain experience in the CT labs in the North. A second innovation for which CARE will advocate is the training of health personnel (such as nurses and matrons) to conduct HIV counseling and rapid testing services.

Working mainly in the emphasis areas of local organizational capacity development and infrastructure, and on the key legislative issues of stigma/discrimination and wraparounds, FY07-funded CT activities will train 90 people in CT provision and provide CT services for 10,000 people. Activities will include: 1. Provide sub-grants and technical assistance to local institutions/NGOs to reinforce six existing CT sites and add five new CT sites. 2. Reinforce training of 60 social workers and community counselors in community mobilization for the promotion of CT uptake. 3. Reinforce training of 60 health personnel and community counselors to provide counseling and psychosocial services, with a focus on couples and family counseling. 4. Provide TA and supplies to support 10,000 on-site HIV tests. 5. Provide pre- and post-test counseling to 10,000 persons tested, with psychosocial support for those who test positive. 6. Train 30 additional health personnel, community counselors, nurses, and matrons in the provision of quality CT services. 7. Work with regional HIV/AIDS networks to conduct 36 mobilization activities promoting the use of CT services, especially for families, couples, and groups. 8. Establish mobile teams for at least three CT centers, to expand service coverage to rural health centers in target areas. 9. Provide a sub-grant to RIP+ to train NGOs to organize post-test peer-support groups 10. Establish quality-assurance systems for HIV testing with national reference lab. 11. Ensure the continued implementation of project-specific M&E activities within an integrated national M&E system.

To build sustainability, CARE incorporates some flexibility into its partnerships with local NGOs so as to avoid dependency and encourage autonomy. A strong accent is placed on training, training of trainers, and supportive supervision so that necessary technical and management skills are imparted to local partner staff, who will be able to support other organizations in the future. CARE is also emphasizing the development of project-writing and financial-management skills so that partners can apply directly for and manage funding in the near future. Institutional capacity is being supported through infrastructure rehabilitation and equipment purchases.

This activity complements CARE activities in AB (#9941), Condoms and Other Prevention (#9944), Basic Health Care and Support (#9945), CT (#9943), and OVC (#9938).

CARE International successfully competed for an EP award in September 2005. Its project contributes to building an indigenous, sustainable response to the HIV epidemic through the rapid expansion of culturally appropriate HIV/AIDS prevention and care interventions in northern and western Côte d'Ivoire. CARE also received a 2004 grant, renewed in 2006, from the Global Fund to support its emergency HIV-prevention program in 24 areas controlled by the Forces Nouvelles.

With both EP and Global Fund support, CARE is leading the largest HIV/AIDS projects in the North and West with local NGO/CBO/FBOs as implementing partners. CARE provides sub-grants and technical/administrative assistance to build local capacity for sustainable prevention and care services. CARE is also working to build networks at the district or local levels and to encourage organizations to develop their complementary comparative advantages, contributing to the provision of a continuum of services.

In FY07, CARE will provide support to local partners through institutional capacity building in project management, financial management, and administration and will provide training and support in the development and implementation of policy/advocacy initiatives.

One of CARE's capacity-building strategies is to facilitate participation by local NGO/CBO/FBOs in the USG's New Partner Initiative. The NPI, designed to seek out new EP partners with important skills and/or infrastructure but little experience with USG funding, is an opportunity for indigenous organizations to build management and financial capacity and translate their local organizational capital into effective HIV prevention and care services. This opportunity is particularly critical for Cote d'Ivoire, where an extended political and military crisis has disrupted health and education services (including HIV prevention and care) in the North and West, leaving local NGOs, CBOs, and FBOs to play an increasingly important role in the fight against HIV/AIDS.

To enhance its sub-granting and capacity-building activities (including NPI applications), CARE in FY07 will hire a senior sub-grant/institutional capacity support manager. To enhance its advocacy activities, CARE will hire a policy/advocacy adviser.

1. Senior Sub-Grant/Institutional Capacity Support Manager

This senior manager will assist with sub-grant supervision and overall project management, including assistance to local partners in obtaining and managing NPI funding. The manager will provide training and oversight to CARE field staff on the management of sub-grants, focusing on the regular review and update of partner-project management documents and tools as well as financial tracking documents. The purpose is to help midlevel CARE field staff to provide quality technical assistance to partners in terms of planning, organizing, and coordinating activities. The manager will also providing training for other capacity-building activities, particularly leadership, vision, and administrative systems development.

The manager will develop and share the process that will be used to evaluate partner progress and improvements in all areas of "institutional capacity" and will work with the M&E staff to ensure that appropriate tracking tools are in place to accomplish this. CARE will organize a workshop, and will invite the participation of other EP-funded partners who administer sub-grants, to synthesize and harmonize approaches used to evaluate project proposals, measure institutional capacity, and evaluate progress.

Support tailored to partner needs regarding the NPI will include: ? Identifying any indigenous organizations working in the same geographic area (whether an existing sub-partner or not) that was invited to submit a full NPI application - Familiarize CARE staff and potential NPI applicants with NPI requirements - Provide technical assistance to potential NPI applicants in conceptualizing and developing a project - Provide technical assistance to at least three NPI applicants with accepted concept papers in the November 2006 round in developing individual projects, planning and

budgeting activities, and writing and submitting full application proposals - Assist potential NPI applicants, especially HIV/AIDS, PLWHA, and confessional networks of CBO/FBOs, in developing concept papers for NPI opportunities in 2007

This activity focuses mainly on the emphasis areas of local organizational capacity building and community mobilization/participation. Technical assistance and training will use best practices, CDC and government standards and guidelines, and approved modules and curricula, when available. Manuals developed and tested by CARE Rwanda for this purpose will also be adapted and used.

2. Policy/Advocacy Technical Adviser

The adviser's primary function will be the identification of key problems affecting target populations that can be addressed with policy changes or by ensuring policy implementation. This will require identifying areas and topics where policy advocacy is needed at the national, regional, or local level.

The policy/advocacy adviser will work with CARE staff and at least 20 local partners to review, analyze, and propose measures and messages that can be implemented and integrated into an advocacy plan that can be used at the national level. The adviser will help partners build their capacity to develop and undertake HIV-related advocacy efforts on the local level as well. Advocacy issues, plans, and strategies will be determined through a consultative process involving all partner organizations and CARE, in conformance with project objectives, EP priorities, and national and local partner realities.

Issues to be explored may include: - Regularizing and standardizing treatment approaches, particularly for home-based care and OVC activities - Enforcing laws that protect and promote human rights, especially for women, girls, and PLWHA - Enforcing laws that disallow and punish rape, sexual abuse, incest, and other forms of gender-based violence, as well as discrimination against PLWHA - Ensuring that the principle of non-discrimination is applied in all contexts where PLWHA are receiving services - Ensuring that children's rights are being protected and working to ensure non-discriminatory treatment of OVC - Advocating for the rights of girls and women who are infected or affected by HIV (inheritance rights, prevention of gender-based violence, excision prevention, etc.) - Advocating for policy change to enable assistant caregivers and other health-care personnel to administer rapid HIV tests - Advocating to allow lab technicians to spend their "bridge year" (between schooling and integration into the public health-care sector) working in the North, as a way to gain training and relieve the human-resource shortage for CT services - Advocating for the inclusion of CT services into the regular package of prevention services offered during standard consultations in public health structures

Working mainly in the emphasis area of policy and guidelines and local organizational capacity development and on the key legislative issue of governance, these FY07 activities will provide 20 local organizations with technical assistance for HIV-related policy development and institutional capacity building and train at least 60 people in HIV-related policy development and institutional capacity building.

District health management teams will be involved in trainings, as well as planning and supervision, to maximize capacity-building and coordination with the MOH. Progress toward the achievement of key EP and CARE indicators will be monitored for quality and quantity.