With EP support since 2004, JHPIEGO continues to provide technical and logistic assistance to build human capacity in support of quality HIV service delivery in Côte d'Ivoire. Major achievements have included development and validation of PMTCT, VCT and HIV treatment comprehensive training materials drawing on national and international materials and adapted to the Côte d'Ivoire context.

With FY06 funds, and in close collaboration with the MOH, WHO and EP implementing partners, JHPIEGO is in the process of: (1) introducing HIV content into preservice education at 5 national training institutions requiring an institution specific integration plan; (2) building local capacity in competency-based training by conducting an advanced training skills (ATS) course for 20 advanced trainers; (3) implementing a MOH based Training Information Monitoring System; (4) improving quality of PMTCT/CT services at 20 sites through a standards-based participatory management and recognition (SBM-R) approach; and (5) providing a senior-level consultant in HIV related planning and coordination to the Ministry of Health.

Under the first of these objectives (introducing HIV content into preservice curricula), JHPIEGO has implemented or is implementing in FY06 the following activities, consistent with its approach to preservice strengthening: - Development and validation of PMTCT, CT and Care and Treatment curricula which can be applied in inservice and preservice settings (completed) - Workshops with the schools to determine in which part of the student curriculum the PMTCT, CT and Care and Treatment content will be inserted (completed) - Training of faculty in PMTCT, CT and care and treatment content and in teaching skills (ongoing) - Follow-up visits of the trained faculty and the schools to determine if the content is indeed being taught and if appropriate teaching methods are being used, and also to trouble-shoot any issues with the schools as they integrate the learning packages into the student curricula (scheduled for FY06) - Strengthening sites where students received their clinical training. Please note that in FY06 the SBM-R sites to be selected will to the extent possible be preservice clinical training sites. (scheduled for FY06)

In the last year of the current CDC University Technical Assistance Projects award, JHPIEGO plans to focus on the completion of the integration of the HIV curricula at key preservice institutions, including institutional capacity building, with development of advanced and master trainer skills to promote ongoing curricula revisions and improved use of adult learning techniques. These efforts are expected to have a substantial downstream benefit, with all medical, nursing and paramedical students graduating with the skills to immediately support HIV service delivery. Substantial other benefits due to the importance of academic leaders as opinion and policy leaders in their fields are also anticipated. A particular focus will include the decentralized institutions such as INFAS Korhogo and Bouake.

While this section focuses on PMTCT, there are complementary activities in treatment services as well as other prevention. Cross-cutting activities of effective teaching skills training, site strengthening and followup supervision, are split between PMTCT and Treatment but contribute to both components.

Other activities have been successfully integrated or will be expanded with support from other EP partners, demonstrating JHPIEGO's commitment to sustainability and transfer of competence. For example, the Training Information Monitoring System will continue to be reinforced through its use by key EP public and NGO partners and its inclusion in the new MOH award focusing on decentralized HIV services. Utilizing supervision based upon performance standards and participatory methods, promotion of service quality will be transitioned and expanded through the MOH project, coupled with their TA partner (Abt Associates), and EP implementing partners EGPAF and ACONDA. Abt Associates will also engage a senior consultant to the MOH to support expanded planning and coordination.

With FY07 funds, JHPIEGO will continue the process of integrating the PMTCT training modules into preservice education at three national training institutions (Faculty of Medicine, Institut National de Formation des Agents de Santé or INFAS, and Institut National de Formation Social or INFS), to ensure full integration of the PMTCT curricula for

the 2007 academic year, beginning in July 2007, through the following activities:

1. Train a critical mass of staff to integrate PMTCT (and other CT and treatment) modules into overall curricula (60 to add to the 40 already trained for a total of 100) in accordance with the integration plan for each of the three (Faculty of Medicine, INFAS, INFS) institutions through Effective Teaching Skills training, to expand the pool of senior PMTCT trainers (from 20 trained in FY06 to 40 total). Recently translated and implemented in francophone Africa, the Effective Teaching Skills course emphasizes the transfer of key teaching skills including training needs assessment, design and update of curricula and courses, skills and competency development, clinical practice management, and skills assessment and monitoring. Designed especially for preservice faculty and clinical preceptors, this course combines the critical skills from the Clinical Training Skills, Advanced Training Skills, and Instructional Design courses, providing a cost-effective intervention for strengthening preservice institutions. Staff from the institutions outside Abidjan (e.g. INFAS Korhogo and Bouake will be specifically targeted to build decentralized capacity). 2. As noted earlier, clinical training sites will be selected based upon their use by identified preservice institutions. In 07, JHPIEGO will advocate with the EP partners who take over SBM-R to ensure that the preservice clinical training sites continue to be improved. 3. JHPIEGO will follow up on the faculty as they teach PMTCT content in the schools' curricula. Based on findings, JHPIEGO will trouble-shoot issues with the schools as they integrate the learning packages into the student curricula. 4. JHPIEGO will seek to capitalize upon existing meetings held by the schools to advocate that they carry out regular curricula review and updates. 5. To address any gaps in faculty and preceptor knowledge, PMTCT Technical Updates will be conducted for appropriate institution teaching staff. 6. To promote sharing of experiences between institutions and the MOH, the inter-institution coordination committee will continue to be supported throughout the preservice strengthening efforts.

This activity complements CCP activities in Other Prevention (#10299), Other Policy (#10080), and ARV Services (#10072).

CCP will improve the quality, targeting, and reach of BCC interventions promoting delay of sexual debut, fidelity, partner reduction, and sexual-risk reduction while addressing cross-cutting issues of gender and stigma and promoting HIV testing uptake. Given the dramatic feminization of the HIV epidemic, its continued spread into rural areas, and the ongoing military-political crisis, girls and women, HIV+ persons, discordant couples, out-of-school youth, rural populations, and other high-risk and vulnerable populations are included as specific target groups.

Building on previous research and BCC campaigns, CCP will continue to transfer capacity and provide technical support and tools to EP implementing partners by developing, disseminating, and evaluating use of BCC tools that enable diverse communities to engage in dialogue about HIV risk, behavior, and social norms to achieve behavior change. In the area of "A" and "B" prevention, FY07 programming focuses on HIV prevention among the target groups and includes an expanded response through faith-based communities, the "Sports for Life" initiative targeting schoolchildren and youth, and multipronged complementary BCC activities, with a TV/radio soap opera and materials for peer-to-peer education and other methods of proximity.

Adapting elements of effective programs in Africa, Asia, and Latin America, CCP's programming aims at changing sociocultural norms, especially gender norms, to reduce vulnerability to HIV.

1. HIV Prevention Targeting Women and Youth

Community-outreach activities in collaboration with EP implementing partners will reach at least 60,000 people with AB prevention messages, including at least 20,000 people with A-only messages, and train 150 trainers/facilitators to promote AB prevention.

a. Youth: CCP has conducted quantitative and qualitative research exploring the motivations underlying youth high-risk sexual behaviors. Results informed the design of a multimedia youth campaign targeting gender and social norms. Campaign materials include new print and audiovisual materials promoting safer sexual behavior. Implementing partners include PLWH/A CBOs, FBOs, village HIV/AIDS committees, and school-based health clubs.

In FY07, CCP will assess the first phase of the BCC youth prevention campaign through the development and use of a scale measuring youth perceptions of gender and social norms related to risk behaviors favoring HIV infection. CCP will also roll out the second phase targeting the most vulnerable (including ex-combatants and rural youth) with new materials: a radio serial drama, four profile videos (see "Other Prevention"), two TV spots, leaflets, and posters. The campaign will be conducted in collaboration with the Ministry of the Fight Against AIDS (MLS), MEN, REPMASCI (a network of journalists and artists), ANADER, CARE, Alliance, and other EP partners. The campaign will be monitored by two youth associations supervised by CCP. CCP will supply materials to key EP partners, will approve and oversee partner-specific dissemination plans, and will monitor use and results.

b. Prevention within faith-based and traditional communities: CCP will expand its work to help faith communities to address issues related to gender norms, stigma, HIV risk, and false cures for people living with HIV/AIDS, with women and rural populations as target populations. Building on FY06 efforts promoting face-to-face encounters between young people and religious leaders, activities (home visits, counseling, and conferences for youth associations) will be designed to help religious and traditional leaders provide messages that correct erroneous information, motivate behavior change, and encourage uptake of HIV testing and other services. The BCC prevention campaign will also address stigma and promote social inclusion of PLWHA, including discordant couples. This campaign will reach 50,000 people with AB messages. Partners will include an interfaith network of religious leaders (ARSIP), REPMASCI, RIP+ (network of PLWHA), ANADER, and Hope Worldwide. Training costs for participants will be supported by EP implementing partners.

2. Sports for Life In FY06, CCP launched a Sports for Life (SFL) intervention to capitalize on soccer's enormous popularity and potential to bridge differences within a conflict setting. Building on similar work in other African settings, soccer has been shown to be an effective BCC entry point to disseminate HIV-prevention and life-skills-building messages to youth.

After laying the groundwork in FY06 (training of trainers, materials development), CCP in FY07 will: - Equip, train and deploy 48 more SFL peer-educators and community-outreach teams. - Produce promotional items and leaflets to reach 30,000 youth. - Design and implement a competition, including a tournament and health-festival calendar, to connect SFL teams with common goals and build local interest. - Leverage private-sector funding to support program scale-up (see Other Policy). - Scale up work with the MEN to integrate SFL modules in the life-skills school curriculum. - Collaborate with other EP partners such as CARE, ANADER, and Hope WW, to integrate SPL into their prevention activities.

3. BCC Educational Entertainment: TV/Radio Soap Opera Complementing SFL, CCP will provide a sub-grant to Common Ground Productions to contribute to the production of a 26-part TV and radio soap opera about a fictionalized CI national soccer team. Drawing on the expertise of REPMASCI and RIP+, the dramatic series will address issues such as high-risk sexual behaviors, personal responsibility, gender norms, CT, and positive living to deliver effective BCC messages, including AB prevention, along with peace-promoting messages of tolerance and respect. Common Ground has produced similar programs in Nigeria and South Africa and has leveraged resources from private and other donors. It will draw on Ivorian writing, acting, and producing talent. The audience is estimated at 1 million people.

4. BCC Capacity Building CCP works to build the capacity of local public and NGO partners to develop, implement, and evaluate strategic health-communication interventions that mitigate HIV incidence. In FY06, CCP established links with various partners (REPMASCI, GT/CCC, Alliance, CARE, ANADER, and ARSIP) to help them conduct prevention and care activities with high-quality BCC programming. In FY07, CCP will expand its technical support to EP partners, including development and dissemination of BCC tools relevant to the sociocultural context and review, adaptation, and improvement of messages and interventions most appropriate to the setting.

Many EP partners are in need of high-quality BCC messages, printed materials, and audiovisual supports aimed at youth. In FY07, CCP will serve this need by conducting a participatory quarterly review of the content and quality of BCC interventions (BCC materials, curriculum and manuals, messages).

To promote sustainability of BCC activities, CCP will maintain a repertory of national BCC experts to provide technical assistance to key EP partners. In FY07, CCP plans to provide two training-of-trainers sessions for 53 people based on the new HIV/AIDS BCC curriculum for community workers, targeting partners such as MEN, ANADER, and CARE. The BCC skills monitoring tool developed in 2006 will be administered to training recipients to assess and fine-tune their acquired skills. CCP's Strategic Leadership and Management training course will also be provided to 30 qualified BCC practitioners from partner organizations (GT/CCC, ANADER, REPMASCI, NGOs, religious leaders, teachers, and other stakeholders).

This activity complements JHU/CCP activities in AB (#10295), Other/Policy & Systems (#10080 ), and ARV Services (#10072).

This activity will contribute to HIV prevention by improving the quality, targeting, and reach of BCC promoting correct and consistent condom use and other behavior change, within a comprehensive ABC approach, for at-risk youth, women and girls, people living with HIV/AIDS, discordant couples, and other particularly vulnerable groups throughout Cote d'Ivoire while addressing cross-cutting issues of gender and stigma. Given the feminization of the HIV epidemic, its continued spread into rural areas, and the ongoing military-political crisis, women and rural and other particularly at-risk populations will be included as target groups. Building on FY06 research and BCC campaigns, this activity expands JHU/CCP's work in transferring capacity and providing technical support to PEPFAR key implementing partners through development, implementation, training, and evaluation of BCC tools that enable program partners and diverse communities to engage in effective, productive dialogue about HIV risk, behavior, and social norms to achieve behavior change. In the program area of Condoms and Other Prevention, FY07 programming focuses on multimedia initiatives (including a TV/radio soap opera) and support to the network of media professionals fighting AIDS (REPMASCI), and on BCC capacity-building among program partners through development and provision of materials and assistance in their use, dissemination, and evaluation.

Within one of the most severe HIV epidemics in West Africa (4.7% HIV-positive among ages 15-49), Ivorian youth are particularly at risk because of their lack of knowledge and their risky behaviors. The country's extended political, military, economic, and social crisis has increased susceptibility to HIV/AIDS and other STIs among the military and combatants (including young militia members), girls and women who engage in intergenerational or transactional sex, and other groups.

Adapting elements of effective, innovative programs in sub-Saharan Africa, Asia, and Latin America, CCP's programming aims at changing behavioral norms to reduce vulnerability to HIV. In FY 06, JHU/CCP conducted quantitative and qualitative research exploring the motivations underlying youth high-risk sexual behaviors at the individual, socio-economic and cultural levels. Results informed the design of an innovative multimedia youth behavior-change campaign targeting gender and social norms. Campaign materials included new print and audio-visual materials promoting abstinence, delay of sexual debut, fidelity to one partner, reduction in the number of sexual partners, and use of condoms among vulnerable populations.

CCP also launched a Sports for Life intervention to capitalize on soccer's enormous popularity (see Cote d'Ivoire's World Cup appearance) and potential, in a conflict and post-conflict environment, to bridge long-standing gaps within and between communities.

With an expanded focus on girls and women, rural populations, PLWHA, discordant couples, and religious and traditional communities, FY07-funded activities will include HIV prevention messages that promote uptake of HIV testing, positive prevention for PLWH/A including discordant couples and social inclusion of people affected and infected by HIV. Materials will address issues of HIV stigma and male social norms related to multiple/concurrent sexual partners, with video and other materials aimed at youth providing a focus on girls, cross-generational sex, and the role of alcohol and other drugs in HIV transmission. Working in the emphasis areas of IEC, community mobilization/participation, and training, and in the key legislative areas of gender and stigma/discrimination, these activities will reach 40,000 people with messages promoting prevention through other behavior change beyond abstinence and fidelity and will train 200 people to promote prevention through other behavior change beyond abstinence and fidelity. Activities will include:

1.CCP will develop and supply BCC materials to ANADER, Care International, Alliance CI, the national HIV care program (PNPEC), the Ministry of AIDS, REPMASCI, RIP+ (network of PLWHA), and other key EP partners and will approve and oversee the partner-specific dissemination plans and monitor results. Training costs will be supported by implementing partners.

2. CCP will develop a series of video profiles of real young men (some in uniform), their

parents, older men, and young women to highlight how some have been able to break out of socio-cultural norms, take control of their lives, and protect themselves and their loved ones from HIV. Specific actions to be highlighted include getting tested for HIV; using condoms with older partners (in cases of transactional sex) and regular partners if their status is unknown; showing love and respect for one's partner; refusing to use force and seeking peaceful solutions to domestic problems; being open with a casual partner about concerns regarding STI infection; not abusing one's position as a teacher to have sex with students, etc. With orientation and a discussion guide, the profiles will be used in community discussion groups and congregations.

3. CCP will collaborate with PSI and CARE International to produce two video profiles of young men in uniform. CCP will provide technical assistance to PSI and Espoir FANCI, an NGO for HIV-positive members of the uniformed services, to conduct a message-design and materials-development workshop to harmonize key messages targeting this audience.

4. Building on the success of an FY06 contest to develop stories for books (Ecrire Pour Vivre) addressing issues such as OVCs, living with AIDS and going to school, tolerance toward PLWHA, abstinence, and prevention through condom use, CCP will produce numerous copies of a collection of 10 stories to be distributed through the Ministry of National Education's health clubs and other structures where school-age children can access them. A second edition of the contest will be launched in 2007.

5. Along with MLS, MEN, and CARE International, CCP will organize an HIV counseling and testing awareness-raising youth caravan using role models such as artists or Miss Cote d'Ivoire 2006 to encourage young people to get tested.

6. Sports for Life: Like other entertainment education, soccer can be used as an effective BCC approach to disseminate HIV-prevention messages. By using the excitement of soccer to involve youth and young adults in HIV/AIDS prevention, health promotion, and life-skills-building activities, CCP aims to increase awareness, change behaviors, and build healthier communities. After laying the groundwork in FY06 (training of trainers, materials development), CCP in FY07 will organize more training sessions and mobilize additional soccer teams for older peer educators (15-25 years) and community outreach teams, using an updated SFL curriculum that includes messages on condom use, safe sex, and fidelity to one sexual partner.

7. Building further on public interest in soccer, CCP will provide a sub-grant to Common Ground Productions for the production and broadcasting of a 26-part TV and radio soap opera about a fictionalized CI national soccer team. Drawing on the expertise of REPMASCI, RIP+ (network of PLWHA), and other EP partners, the dramatic series will address issues such as high-risk sexual behaviors, personal responsibility,cross-generational sex, gender norms, CT, and positive living to deliver effective BCC messages aimed at ABC prevention, along with peace-promoting messages about tolerance, respect, etc. Common Ground, which has produced similar programming in Nigeria, South Africa, and elsewhere, will leverage resources from other public and private donors and draw on Ivorian writing, acting, and producing talent. This series are expected to reach 1,000,000 persons.

This activity complements activities in AB (#10307), Condoms and Other Prevention (#10049), CT (#10064), and Palliative Care (#10055).

As part of the Project "Increasing Access to, and Uptake of, HIV Prevention and Care Service including Confidential Voluntary Counseling and Testing (CT) Among the Uniformed Services, ex-Combatants and their Partners in the Republic of Cote d'Ivoire" led by PSI, JHPIEGO has drawn on its EP funded training and quality improvement portfolio to provide technical assistance to CBO/FBO implementing partners.

To date, JHPIEGO's assistance has been provided under the rubric of a sub-contract from PSI. However, for reasons of cost-and administrative-effectiveness, activities in FY07 are proposed to be financed directly from CDC to JHPIEGO, under the UTAP award. Nevertheless, the activities must continue to be integral to the scope of work (SOW) under the PSI-led project. Based on the SOW negotiated with PSI, JHPIEGO has so far carried out activities under this project that include: (1) Recruitment and provision of an STI Expert; (2) Participation in needs assessment of 27 sites to look at training needs; (3) Updating STI curriculum and printing copies; and (4) Training 52 providers in STI treatment. PSI is conducting VCT activities that complement the JHPIEGO SOW. With the FY07 allocation made directly to JHPIEGO, our work will nevertheless be coordinated within PSI's broader project mandate, and may grow to include a broader and more holistic approach that more clearly integrates counseling and testing (CT) with the STI capacity building that JHPIEGO has been addressing. Discussions will be undertaken with CDC and PSI to redefine roles, within the programs' objectives, and the comparative competencies of PSI and JHPIEGO. At this time it is expected that the JHPIEGO FY07 program will include, but not necessarily be limited to, undertaking training of trainers in STIs, followed by a training in STIs of service providers that will be conducted by the trainers who were trained in the previous activity. In keeping with JHPIEGO established practice, the emphasis will be on ensuring that capacity development occurs, and this will in fact be demonstrated through significant use of previously established local training capacity. JHPIEGO will then also provide additional technical assistance to all trained project staff through supervisory visits, thus assuring that the trained providers effectively provide STI services. An evaluation will be conducted during each supervisory visit, to review the quality of the training methods used as well as the correctness of the technical information provided. In addition, discussions will be held during the visit with those being observed, and written recommendations will be provided to both the trained trainers as well as PSI. Again, as is usual under the capacity building approaches utilized by JHPIEGO, we will ensure that supervisory skills are built, by including staff and trained trainers from the Ministries of Health and Defence in the teams conducting these visits. These may include JHPIEGO/PNPEC CT trainers. During the supervisory visits to trained health care workers and other care providers the technical knowledge retained by the participants, as well as the application of correct procedures and standards presented in trainings, will be assessed. Every effort will be made to observe the participant in the action of providing STI services in order to better assess capacities and skills.

The evaluations will be combined with verbal exchanges with the participant, during which immediate feedback will be given. A written report with recommendations will be provided to both the participant and PSI.

Overall PSI's military program scope includes the following: • Number of sites involved in military program: 40 • Number of supervision visits anticipated: 4 quarterly supervision visits by site • Type of site: Military • Target audience: Soldiers and their partners

In addition to training the previously mentioned 52 STI treatment providers, JHPIEGO's current scope of work in STI capacity building will include the following targets: • Needs assessments for STI case management at an additional 10 project sites; • Training of an additional 20 military trainers for STI case management; • Training of 2 military medical service providers in STI case management To the extent possible, JHPIEGO will work with CDC and PSI to link the activities

implemented under this scope of work with our broader preservice education and other capacity development work, as well as STI work in other parts of the country. JHPIEGO may therefore explore greater utilization of CT competencies and innovations, as well as promoting more sustainable capacity development through standards-based management and recognition approaches.

This activity relates to activities in Condoms and Other Prevention (#10299, 10304), ARV Services (#10071, 10302). and to CARE International activities in AB (#9941), Condoms and Other Prevention (#9944), Basic Health Care and Support (#9945), CT (#9943), OVC (#9938), and Other/Policy & Systems (#9946).

As part of the Project CARA, "Access to Prevention, care and treatment of HIV/AIDS in underserved regions of North and West Cote d'Ivoire (CARA).", lead by CARE International, JHPIEGO has drawn on it's EP funded training and quality improvement portfolio to provide technical assistance to CBO/FBO implementing partners.

Although to date this assistance has been provided under a subaward from CARE, for reasons of cost-and administrative-effectiveness, activities in FY07 are proposed to be implemented under the UTAP award.

To date, JHPIEGO has carried out training activities under CARA that included: participation in needs assessments and advocacy, organizing two training workshops in STI management for 40 persons, one training workshop for 20 people in VCT, and two training workshops in opportunistic infection management for 40 people. Activities planned with FY06 funds include: Four trainings of trainers in HIV counseling and testing, palliative care, and care of orphans and vulnerable children.

With FY 07 funds, JHPIEGO will work with CARE to conduct a training needs assessment, to identify priority training needs, reviewing existing gaps or weaknesses among staff and partners. This will be conducted during the first 2 months of FY 2007. This needs assessment will take into consideration any document needs of local implementing partners, identifying national standards and policies documents, treatment protocols, or other items that are required by each organization to ensure that appropriate reference materials are available.

On the basis of this assessment, JHPIEGO will lead a workshop to validate the findings from the assessment, and to decide upon a training action plan that will be developed, proposed, and validated, with dates, with all local and institutional partners. This will allow CARE, JHPIEGO and consortium partners, to plan trainings through the life of Project CARA including in 2007. Training of at least 40 persons will be planned with FY07 CARA funds and JHPIEGO TA following this assessment.

JHPIEGO will then also provide additional technical assistance to all trained project staff through supervisory visits. The major focus will be on VCT but other domains will also be included. These visits will vary in content, depending upon the type of training received by participants. When a participant has been trained as a trainer, efforts to coordinate with CARE in order to observe trainings being led by a newly "trained" trainer, will be made. An evaluation will be conducted during this visit, reviewing the quality of the training methods used as well as the correctness of the technical information provided. A discussion will be held during the visit, and written recommendations will be provided to both the trained trainer, as well as CARE within 2 weeks after the visit.

Supervisory visits to trained health care workers, and other care providers will also be conducted in coordination with local CARA staff and/or the district health team, during which the technical knowledge retained by the participant, as well as the application of correct procedures and standards presented in trainings held in 2006, will be assessed. Transfer of competence of supervision skills to local staff will also be developed through this process. Every effort will be made to observe the participant in the action of providing assistance in the domain for which s/he was trained (example counseling clients), in order to better assess capacities and skills.

The evaluation will be combined with verbal exchanges with the participant, during which immediate feedback will be given. A written report with recommendations will be provided to both the participant, and CARE, within 2 weeks after the visit.

JHPIEGO will continue to participate in the consortium management group (CMG) made of all partners involved in the implementation of the CARA project. This will involve attendance at each of the monthly meetings, as well as the quarterly coordination meetings in the field.

In FY07, JHU/CCP will expand its behavior-change communication for HIV prevention with a focus on girls and women, rural populations, PLWHA, discordant couples, and religious and traditional communities. FY07-funded activities will include HIV-prevention messages that promote uptake of HIV testing; positive prevention for PLWHA, including discordant couples; and social inclusion of people affected and infected by HIV. Along with the ministries for AIDS and Education and CARE International, CCP will organize a caravan to raise awareness of HIV counseling and testing among youth, using role models such as artists and/or Miss Cote d'Ivoire 2006 to encourage young people to get tested.

With the approval of plus-up funds, JHU/CCP will increase its efforts to promote HIV testing by working in direct collaboration with the MLS to support a national HIV counseling and testing campaign to promote a national testing weekend, with a particular emphasis on religious venues (i.e. churches and mosques) as testing sites. The MLS and JHU/CCP will coordinate with community-based EP partners (Alliance, CARE, PSI, ANADER, HOPE Worldwide, RIP+, etc.) as well as facility-based partners (ACONDA and EGPAF) to increase visibility of HIV testing throughout the country.

Target Populations: Adults Family planning clients Infants International counterpart organizations People living with HIV/AIDS Pregnant women Local government bodies Children and youth (non-OVC) Host country government workers Public health care workers

Table 3.3.09:

This activity relates to activities in Condoms and Other Prevention (#10299, 10304) and ARV Services (#10071, 10302).

With EP support since 2004, JHPIEGO continues to provide technical and logistic assistance to build human capacity in support of quality HIV service delivery in Côte d'Ivoire. Major achievements have included development and validation of PMTCT, CT and HIV treatment comprehensive training materials drawing on national and international materials and adapted to the Côte d'Ivoire context.

With FY06 funds, and in close collaboration with the MOH, WHO and EP implementing partners, JHPIEGO is in the process of: (1) introducing HIV content into preservice education at 5 national training institutions requiring an institution specific integration plan; (2) building local capacity in competency-based training by conducting an advanced training skills (ATS) course for 20 advanced trainers; (3) implementing a MOH based Training Information Monitoring System; (4) improving quality of PMTCT/CT services at 20 sites through a standards-based participatory management and recognition (SBM-R) approach; and (5) providing a senior-level consultant in HIV related planning and coordination to the Ministry of Health.

Under the first of these objectives (introducing HIV content into preservice curricula), JHPIEGO has implemented or is implementing in FY06 the following activities, consistent with its approach to preservice strengthening: - Development and validation of PMTCT, CT and Care and Treatment curricula which can be applied in inservice and preservice settings (completed) - Workshops with the schools to determine in which part of the student curriculum the PMTCT, CT and Care and Treatment content will be inserted (completed) - Training of faculty in PMTCT, CT and care and treatment content and in teaching skills (ongoing) - Follow-up visits of the trained faculty and the schools to determine if the content is indeed being taught and if appropriate teaching methods are being used, and also to trouble-shoot any issues with the schools as they integrate the learning packages into the student curricula (scheduled for FY06) - Strengthening sites where students received their clinical training. Please note that in FY06 the SBM-R sites to be selected will to the extent possible be preservice clinical training sites. (scheduled for FY06)

In the last year of the current CDC University Technical Assistance Projects award, JHPIEGO plans to focus on the completion of the integration of the HIV curricula at key preservice institutions, including institutional capacity building, with development of advanced and master trainer skills to promote ongoing curricula revisions and improved use of adult learning techniques. These efforts are expected to have a substantial downstream benefit, with all medical, nursing and paramedical students graduating with the skills to immediately support HIV service delivery. Substantial other benefits due to the importance of academic leaders as opinion and policy leaders in their fields are also anticipated. A particular focus will include the decentralized institutions such as INFAS Korhogo and Bouake.

While this section focuses on Treatment Services, there are complementary activities in PMTCT (ID number XX) as well as other prevention (ID number XX). Crosscutting activities of effective teaching skills training, site strengthening and followup supervision, are split between Treatment and PMTCT but contribute to both components.

Other activities have been successfully integrated or will be expanded with support from other EP partners, demonstrating JHPIEGO's commitment to sustainability and transfer of competence. For example, the Training Information Monitoring System will continue to be reinforced through its use by key EP public and NGO partners and its inclusion in the new MOH award focusing on decentralized HIV services. Utilizing supervision based upon performance standards and participatory methods, promotion of service quality will be transitioned and expanded through the MOH project, coupled with their TA partner (Abt Associates), and EP implementing partners EGPAF and ACONDA. Abt Associates will also engage a senior consultant to the MOH to support expanded planning and coordination.

With FY07 funds, JHPIEGO will continue the process of integrating the Treatment training

modules into preservice education at three national training institutions (Faculty of Medicine, Institut National de Formation des Agents de Santé or INFAS, and Institut National de Formation Social or INFS), to ensure full integration of the Treatment curricula for the 2007 academic year, beginning in July 2007, through the following activities:

1. Train a critical mass of staff to integrate Treatment (and other CT and PMTCT) modules into overall curricula (60 to add to the 40 already trained for a total of 100) in accordance with the integration plan for each of the three (Faculty of Medicine, INFAS, INFS) institutions through Effective Teaching Skills training, to expand the pool of senior Treatment trainers (from 20 trained in FY06 to 40 total). Recently translated and implemented in francophone Africa, the Effective Teaching Skills course emphasizes the transfer of key teaching skills including training needs assessment, design and update of curricula and courses, skills and competency development, clinical practice management, and skills assessment and monitoring. Designed especially for preservice faculty and clinical preceptors, this course combines the critical skills from the Clinical Training Skills, Advanced Training Skills, and Instructional Design courses, providing a cost-effective intervention for strengthening preservice institutions. Staff from the institutions outside Abidjan (e.g. INFAS Korhogo and Bouake will be specifically targeted to build decentralized capacity).

2. As noted earlier, clinical training sites will be selected based upon their use by identified preservice institutions. In 07, JHPIEGO will advocate with the EP partners who take over SBM-R to ensure that the preservice clinical training sites continue to be improved.

3. JHPIEGO will follow up on the faculty as they teach Treatment content in the schools' curricula. Based on findings, JHPIEGO will trouble-shoot issues with the schools as they integrate the learning packages into the student curricula.

4. JHPIEGO will seek to capitalize upon existing meetings held by the schools to advocate that they carry out regular curricula review and updates.

5. To address any gaps in faculty and preceptor knowledge, ART Technical Updates will be conducted for appropriate institution teaching staff.

6. To promote sharing of experiences between institutions and the MOH, the inter-institution coordination committee will continue to be supported throughout the preservice strengthening efforts.

This activity complements JHU/CCP activities in AB (#10295), Condoms and Other Prevention (#10299), and Other/Policy & Systems (#10080).

This activity is designed to improve communication and counseling skills of clinic-based health service providers and community counselors in support of effectively provided and used HIV treatment and care.

A literature review by HCP in 2005 found important gaps limiting the communication required to support effective and high-quality ARV treatment, including low-quality patient/provider materials and poor access to them; a lack of training in interpersonal communication and counseling (IPC/C), particularly with regard to ART adherence; a need to include treatment counseling in hotline services; inadequate client feedback on the quality of care; and a lack of self-management/client-empowerment materials.

In 2006, CCP conducted a needs assessment on ART information, ART-adherence information, and IPC/C for PLWHA and their caregivers in Cote d'Ivoire. Interviews with ART service providers, PLWHA and their caregivers, and institutions responsible for care and support of families living with HIV/AIDS revealed a great need for information, for improved interpersonal communication skills, and for tools for both service providers and PLWHA and their families.

In FY06, CCP facilitated the development of a strategic communication framework for HIV treatment and care and support, in collaboration with the Ministry of Health and the national HIV/AIDS care and treatment program (PNPEC), RIP+ (a network of PLWHA), HIV/AIDS Alliance, EGPAF, and other EP partners. A behavior change communication (BCC) strategy document was developed in which key priority areas were identified and various strategic approaches were proposed. Priority areas for communication about HIV treatment and care and support include ARV treatment, PMTCT, counseling and testing, PLWHA psychosocial and nutritional care, OVC services, and opportunistic infections and TB. The strategic framework was validated by PNPEC and other national and international partners involved in HIV treatment and care and support in Côte d'Ivoire. New BCC messages and materials were subsequently developed to promote HIV treatment and care and support services among key target audiences, including women of childbearing age, PLWHA, youth, and the general public.

Building on this body of work, CCP in FY07 will collaborate with MOH/PNPEC and EP implementing partners FHI, EGPAF, ACONDA-VS, Alliance CI, and JHPIEGO to develop and implement communication interventions aimed at building demand for quality HIV services and improving HIV care services through better interpersonal communication and counseling at clinic and community levels. Activities will support and promote quality improvement of HIV-care services in order to sustain increased use of those services.

Working mainly in the emphasis areas of training, quality assurance and supportive supervision, and IEC, activities will provide training for 150 health-service providers (plus 2,000 indirect) and reach 20,000 PLWHA with treatment-literacy promotion (for adherence to ARV, positive living, and secondary prevention). Specific FY07 activities will include:

• Putting in place a quality-improvement and accreditation program for key HIV treatment, care and support services (ART, PMTCT, CT), in collaboration with MOH/PNPEC, JHPIEGO, and EGPAF. This program will address quality of services in clinics and in the community while linking both in decision-making and in a continuum of care. Elements of this program will include: - A qualitative assessment to obtain communities' and service providers' perceptions of quality of care: What brings them satisfaction in community and clinic-based care? What would encourage them to use and continue using services? - Improved interpersonal communication and counseling skills of clinic-based and community counselors. In collaboration with EP partners PNPEC, RIP+, FHI, EGPAF, ACONDA, CARE International, PSI, Hope Worldwide, and others, CCP will develop a curriculum and conduct a minimum of three training-of-trainers sessions for 90 health service providers and community counselors in the areas of ART, PMTCT, CT, and care for PWLHA. - Tools to help health service providers and community counselors to improve their performance. Such tools will include job aids (service-delivery algorithms, checklists, flip

charts) and client-communication materials (pamphlets, cards). - Support and burn-out prevention for health service providers and community counselors through a community radio diary initiative that allows them to talk about their day-to-day work. This will also be an opportunity to promote providers and their services, recognize their hard work, give them satisfaction in their work, and encourage them to maintain quality services. - Documentation of improved quality at sites through a quarterly supervision and certification process that will be recognized by authorities and promoted through mass media the following year.

• Improve community counselors' interpersonal communication skills in support of ART adherence by assessing the performance quality of the 48 community counselors trained in 2006. Assessments will look at their effectiveness in increasing awareness of available services, improving ART adherence, and increasing referrals of PWLHA. Periodic program assessments will involve supervision and appropriate action to maintain quality. Two refresher training sessions for 60 counselors will be conducted.

This activity complements JHU/CCP activities in AB (#10295), Condoms and Other Prevention (#10299), and ARV Services (#10072).

This activity is designed to mobilize private-sector involvement in a sports-based HIV-prevention and life-skills program for youth. It is part of broader Emergency Plan efforts to facilitate public-private partnerships to strengthen the national response to HIV/AIDS.

The intervention, Sports for Life, is an innovative and proven prevention intervention aimed at promoting AB-oriented HIV-prevention messages to youth through soccer. In 2006, Cote d'Ivoire qualified for the first time for the FIFA World Cup Finals, the world's largest and most prestigious sporting event. The USG and JHU/CCP viewed this as an opportunity to help unite a country torn by internal dissension and to support positive social and behavior change through its young people. Sports for Life is a behavior-change and life-skills program designed to use the appeal of soccer to attract young people, ages 10 and up, and their communities to participate in health and life-skills activities. The program will be complemented by a 26-part TV and radio soap opera about a fictionalized CI national soccer team, to be produced by Common Ground Productions through a CCP sub-grant, that will address issues such as high-risk sexual behaviors, personal responsibility, gender norms, CT, and positive living as well as peace-promoting messages about tolerance and respect.

Sports for Life is well-designed to attract corporate interest, and the probability of broad financial support is high. Soccer is a proven public-relations vehicle (the telecommunications company Orange is the corporate sponsor of Cote d'Ivoire's national soccer team), and the variety of activities and publications involved in Sports for Life offer many opportunities for positive public-relations impacts for corporate sponsors. Sports for Life is geared to build up to the 2010 World Cup in South Africa and is marshalling strong support from local and international soccer teams and organizations, including FIFA.

CCP is leading implementation and FY07 expansion of Sports for Life. As described in its AB narrative, CCP in FY06 laid the groundwork for the program (training of trainers, materials development) and in FY07 will train and mobilize 24 more peer-educator and community-outreach teams, produce promotional items to reach about 20,000 young people, design and implement a competitive structure within the Sports for Life program, and begin work with the Ministry of Education to integrate some modules of the Sports for Life curriculum in its school-based life-skills program.

CCP's work to mobilize private-sector involvement in the program will focus on the EP-supported Business Coalition for HIV/AIDS. The members of this coalition - including ILO, Shell, BMS, Coca-Cola, and Unilever - are the logical first targets for a pitch by Sports for Life. CCP will seek to leverage EP funding with private-sector support in a number of ways involving both cash and in-kind contributions. In-kind support could include office space, communications, publicity, promotional materials, and team supplies (e.g. equipment and uniforms). Corporate and service-club sponsorships at the national, district, and local levels are expected to build public interest and sustainability.

This effort is a logical continuation and reinforcement of EP support for building public-private response through a new policy forum led by the Ministry of Civil Servants and Labor. With technical assistance from FHI (CI and regional AWARE) and GTZ, the Labor Sector Tripartite Committee (LSTC) will work to define and implement strategies to promote public-private partnerships, HIV-in-the-workplace programs, and economic incentives that promote greater private-sector investment in, and long-term sustainability of, HIV-related interventions and services. The EP also continues to contribute to the policy dialogue with the Ministry of Economy and Finance for the development of public-private sector initiatives to contribute to sustainability of expanded HIV prevention, care, and treatment services. The USG's key objective is to open a dialogue between private companies and the EP about opportunities for partnership and to share examples of best practices of HIV/AIDS workplace and youth-focused initiatives among private companies.

This initiative will work mainly in the emphasis areas of IEC/BCC, linkages with other sectors and initiatives, and community mobilization/participation, and in the key legislative

area of public-private partnerships.

The USG is contributing to a new policy forum led by the Ministry of Economy and Finance's HIV committee to define and implement strategies to promote public-private sector partnerships, HIV-in-the-workplace programs, and economic incentives to stimulate greater private-sector investment in, and long-term sustainability of, HIV-related interventions and services. This work represents a logical continuation and reinforcement of activities supported by multiple committees, donors, and partners, including PEPFAR (USAID and CDC/HHS), GTZ, ILO, Shell, BMS, Coca-Cola, and Unilever, with technical assistance from FHI (CI and regional AWARE) and GTZ. The USG continues to contribute to the policy dialogue with the Ministry of Economy and Finance for the development of public-private sector initiatives to contribute to sustainability of expanded HIV prevention, care, and treatment services.

To develop a sustainable approach to creating and building HIV/AIDS public-private partnerships between the USG (and partners) and the private sector in Cote d'Ivoire, JHU/CCP will develop a concept paper from the USG/CI to USAID for a Global Development Alliance (GDA) APS grant. The USG is prepared to provide funding to match the GDA contribution.

Despite a major increase in HIV related funding from the USG and Global Fund overall donor presence and contributions remain inadequate and wrap-around funds are extremely limited. HIV/AIDS sector plans (2004-2007) have been developed in at least 13 sectors integrating policy and legal reforms to address stigma, discrimination and remote service delivery, but, with delays in the World Bank/MAP, they remain largely un-funded.

Decentralization is progressing with more decision-making ability at the district and local HIV/AIDS action committee levels. Non-state forums, such as networks of NGOs, PLWH/A, journalists and artists, and faith communities, have contributed to coordination and advocacy, but they are generally young organizations and require substantial institutional capacity building.

The USG is contributing to a new policy forum lead by the Ministry of Economy and Finance's HIV committee to define and implement strategies to promote public -private sector partnerships, HIV in the workplace programs and economic incentives which promote greater private sector investment in, and long term sustainability of, HIV related interventions and services. This work represents a logical continuation and reinforcement of, activities supported by multiple committees, donors and partners including PEPFAR (USAID and CDC/HHS), GTZ, ILO, Shell, BMS, Coca Cola, Unilever and others with technical assistance from FHI (CI and regional AWARE) and GTZ. The USG continues to contribute to the policy dialogue with Ministry of Economy and Finance for the development of public-private sector initiatives to contribute to sustainability of expanded HIV prevention, care and treatment services.

The USG/CI requests the Technical Assistance of the Public-Private Partnership (PPP) Working Group to achieve the following goals:

To develop a sustainable approach to creating and building HIV/AIDS public-private sector partnerships between the USG (and partners) and the private sector in Cote d'Ivoire.

Specific Objectives:

1. Technical Assistance from the PPP to assess the current PEPFAR/CI private sector programs in country and propose recommendations which can be incorporated into new strategy. 2. Technical Assistance from the PPP working group to develop a Private-Public Sector strategy for 2007 and 2008 for PEPFAR (USG) Cote d'Ivoire. 3. Based on the developed strategy; technical assistance to prepare a concept paper from the USG/CI to USAID for Global Development Alliance (GDA) APS grant. The USG is prepared to provide seed funding to match GDA contribution