PEPFAR's annual planning process is done either at the country (COP) or regional level (ROP).
PEPFAR's programs are implemented through implementing partners who apply for funding based on PEPFAR's published Requests for Applications.
Since 2010, PEPFAR COPs have grouped implementing partners according to an organizational type. We have retroactively applied these classifications to earlier years in the database as well.
Also called "Strategic Areas", these are general areas of HIV programming. Each program area has several corresponding budget codes.
Specific areas of HIV programming. Budget Codes are the lowest level of spending data available.
Expenditure Program Areas track general areas of PEPFAR expenditure.
Expenditure Sub-Program Areas track more specific PEPFAR expenditures.
Object classes provide highly specific ways that implementing partners are spending PEPFAR funds on programming.
Cross-cutting attributions are areas of PEPFAR programming that contribute across several program areas. They contain limited indicative information related to aspects such as human resources, health infrastructure, or key populations programming. However, they represent only a small proportion of the total funds that PEPFAR allocates through the COP process. Additionally, they have changed significantly over the years. As such, analysis and interpretation of these data should be approached carefully. Learn more
Beneficiary Expenditure data identify how PEPFAR programming is targeted at reaching different populations.
Sub-Beneficiary Expenditure data highlight more specific populations targeted for HIV prevention and treatment interventions.
PEPFAR sets targets using the Monitoring, Evaluation, and Reporting (MER) System - documentation for which can be found on PEPFAR's website at https://www.pepfar.gov/reports/guidance/. As with most data on this website, the targets here have been extracted from the COP documents. Targets are for the fiscal year following each COP year, such that selecting 2016 will access targets for FY2017. This feature is currently experimental and should be used for exploratory purposes only at present.
Years of mechanism: 2007 2008 2009
PEPFAR targets populations most at risk for HIV acquisition and transmission in order to affect
HIV transmission dynamics and provide care to those most in need. In Cote d'Ivoire, with its prolonged
political and military crisis, the USG team targeted uniformed services and their sexual partners for special
attention.
In 2005, PSI and its partners (AIMAS, Caritas, Espoir FANCI, and JHPIEGO) were funded to implement a
PEPFAR project to expand HIV prevention, counseling and HIV testing, and care interventions targeting the
uniformed services, ex-combatants, and their partners in Cote d'Ivoire. The project seeks to address
negative gender and sexual violence norms promote sexual risk reduction, especially emphasizing partner
reduction and condom use; and promote uptake of HIV testing and STI and HIV care and treatment
services, including secondary prevention for HIV-positive persons and within HIV-discordant couples. This
strategy includes prevention interventions targeting child soldiers that are adapted to their age, sexual
experience, and context, which are conducted in collaboration with UNICEF.
With FY05-FY07 PEPFAR funds, PSI coordinated with the Ministry of Defense, former rebel forces, other
partners (UNFPA and UNICEF), and the national disarmament, demobilization, and reinsertion program
(DDR) to conduct a national needs assessment. With these data, the project initially identified 40
intervention sites with FY05-FY06 funds. With FY07 funds, PSI identified 10 additional sites to bring the
total to 50 intervention sites (25 in the northern zone formerly controlled by the Forces Nouvelles, 25 in the
southern zone) as well as 14 Centers for Transit and Orientation (CTO) for child soldiers.
With FY05-07 funds, PSI sub-partner Caritas took the lead in implementing the project's "AB" interventions,
working closely with the Ministry of AIDS (MLS) as well as national and international technical partners
(JHU/CCP, UNICEF, UNFPA, ONUCI, NCDDR). They developed curricula and behavior change
communication (BCC) tools for child soldiers and children otherwise associated with the military. They also
defined a baseline package for selected CTO sites and trained 20 trainers/supervisors, 104 community
animators among local NGOs members, and 920 peer educators among adult soldiers. The focal point of
each military (northern and southern) visited PSI's military project in Togo during FY07 to share best
practices and lessons learned
With FY08 funding, PSI is continuing a sustained communication campaign that promotes sexual risk
reduction, including abstinence and the promotion of sexual health among children and partner reduction for
adults. Gender, stigma reduction, and counseling and testing (CT) promotion are themes integrated into the
campaign, which had reached 334,391 individuals from October 2005 through March 2008 and is expected
to reach 349,661 individuals by March 2009. Interpersonal communication activities based on participatory
approaches are being conducted through peer education and are reinforced by mass communication at
military sites using mobile video units. All communications materials are developed and validated with the
involvement of the government (ministries of Defense, Internal Security, Health, AIDS, Education, and
Family and Social Affairs, among others) as well as international organizations (UNFPA, ONUCI, PNDDR,
CDC) and key implementing partners (JHU/CCP, FHI, REPMASCI, ARSIP, COSCI, RIP+, Care
International, ANS-CI).
With the country in the process of reunifying and a national disarmament, demobilization, and reinsertion
program under way for both child and adult soldiers and rebel forces, UNICEF has closed its CTOs and the
project has adapted its target group from child soldiers to children of uniformed personnel. Additionally,
since April 2008 certain PSI intervention sites have ceased to exist due to demobilization activities.
Currently there are 45 project intervention sites. The project works with all the major uniformed services -
the national military (FANCI), the rebel forces (FAFN), the gendarmes, the police, the customs service, and
Water and Forest officials.
With FY09 funds, the project will build upon previous project activities to expand prevention interventions in
existing project sites, adding some sites for specific interventions as explained below. Key activities
promoting HIV prevention through AB methods will include:
For children - ages 8-14:
- Identification of children of uniformed personnel
- Collaboration with uniformed personnel spouses' associations/NGOs to conduct AB activities among
identified children. This will include providing training and technical support to associations of military wives
to assist them with carrying out awareness and behavior change activities promoting AB as well as other
prevention methods as appropriate. The goal of this activity is to empower and encourage mothers (and in
turn their partners) to engage in HIV/AIDS prevention activities with their children within the context of
military families. This activity will be expanded from 12 sites to 32 (20 new) sites, with additional sites for
each uniformed service.
- Training of trainers in the life skills approach for members of the military wives associations
- Training of members of these associations/NGOs as community-based educators to deliver AB messages
to children and to enable parents/guardians to communicate with children about expectations and values.
- Training of youth leaders to deliver AB messages
- Training of peer educators selected from the Military Prep Technical School of Bingerville
- Behavior change communication activities focused on abstinence and delay of sexual debut, delivered by
peers and influential elders and including recreational and cultural activities
- Activities focused on young girls, such as training women as peer educators who can lead activities that
promote exchanges among young girls about their specific vulnerabilities and issues.
For older and sexually experienced children, adult uniformed personnel, and their partners, key activities
with FY09 funding will include:
- Promoting HIV prevention through partner reduction, mutual fidelity, knowledge of one's serostatus,
condom use, and positive gender norms, using a variety of approaches based in part on results of PSI's
formative research study (Tracking Results Continously, or TRaC). Issues involving social norms and
beliefs will be addressed using mass media tools (posters, flyers, radio spots, etc.) designed to shift
Activity Narrative: perceptions and attitudes on issues such as fidelity, discrimination against people living with HIV/AIDS
(PLWHA), and sexual violence and coercion. These tools will be augmented by efforts to involve key
community leaders and influential members of the target groups. These approaches will be complemented
by interpersonal communication activities (IPC) designed to address individual attitudes and behaviors,
thereby enhancing risk perception, self-efficacy, and other key behavioral determinants. These IPC
activities will be conducted by peer educators.
- Training of additional peer educators among uniformed personnel to increase coverage of peer education
activities to deliver effective HIV prevention messages to the target population. Training will cover the full
range of issues related to HIV/AIDS prevention, including an important module on how peer educators can
address gender issues, including rape and sexual coercion. The Men as Partners approach may be
adapted to involve men more in accepting responsibility for HIV-positive family members as well as
personal responsibility in relationships.
- Dissemination of a TV spot on fidelity developed in FY08.
- Promotion of "positive prevention" among PLWHA., including assisting PLWHA to protect
their sexual health, avoid newly acquiring STIs, delay progression of the disease, and avoid transmission of
HIV to others. This will be achieved via self-help groups that will promote couples testing, the adoption of
healthy behaviors, and HIV status disclosure.
- Support for HIV-negative people to maintain their HIV-negative status, to be tested regularly, to bring their
partners to be tested, and to act as community leaders.
In addition, PSI will:
- Continue regular internal and quarterly external supervisions, with standards-of-performance tools. To
further motivate project partners, periodic awards and recognition will be given to sites delivering high-
quality services. Quality will be determined by supervisors using standardized evaluation forms.
- Continue to coordinate activities, including peer education, trainings, and referral systems, with national
and local authorities. For instance, coordination with the Ministry of AIDS (MLS) will occur through various
activities including the pilot committee (presided over by the MLS and integrating PEPFAR partners and
technical organizations (UNAIDS, UNFPA). At the local level selected project supervisors will participate in
MLS local committees (CTAIL). MLS also provides trainers for peer education trainings and is regular
solicited for feedback when new communication materials are developed.
- Support its three-level coordination system: a site supervisor responsible for planning and coordination at
the site level; the Liaison Bureau, which is the operational implementation unit for the program and
coordinates among all uniformed forces and among interventions; and the MLS-led pilot committee.
- Perform a TRaC survey to monitor prevention activities and measure project impact and behavior change
over time.
- Work to improve retention of peer educators by developing recognition mechanisms and identifying
opportunities for greater involvement in program activities.
- Work to ensure that peer education activities are sustainable. PSI has transferred regular supervision of
peer educators to trained uniformed personnel and the Liaison Office and has stopped paying transport
fees, placing peer educators on a completely volunteer footing. Members of the Military Wives Association
(AEMCI) have also been trained as trainers.
PSI will continue to implement an M&E plan to ensure service quality based on national and USG
requirements and will report to the USG strategic information team quarterly program results and ad hoc
requested program data. To help build and strengthen a unified national M&E system, PSI will participate in
quarterly SI meetings and will implement decisions taken during these meetings.
Sustainability is a priority of the PSI program and has been a key component in strategy development and
activity implementation. One strategy has been to build the capacity of each of the branches of uniformed
personnel, through the creation of a Liaison Office, to provide more direct oversight and supervision of peer
education activities. This allows HIV-related activities to become better integrated into day-to-day activities
of uniformed personnel rather than being viewed as "extra" work. Similarly, a Coordination Office will be set
up with representatives from the Ministry of Transport and the National Transporters Union for all
interventions targeting truckers. Organizational and technical capacity building of local NGOs is provided to
help them better support PLWHA and educate their communities. PSI will organize program planning and
management trainings to build capacity of relevant stakeholders to continue program implementation. PSI
also plans to work with relevant ministries to integrate HIV education into the curricula at training schools for
the uniformed services.
Another strategy to support sustainability is to routinely include members of target groups in the
implementation of project activities. For instance, target group representatives are trained to deliver and
even supervise services (prevention, CT, care and support) so that activities can continue after the project
ends. Military health structures are equipped and personnel are trained to integrate STI care and support
services, CT, and palliative care, with enhanced referral systems.
New/Continuing Activity: Continuing Activity
Continuing Activity: 15153
Continued Associated Activity Information
Activity Activity ID USG Agency Prime Partner Mechanism Mechanism ID Mechanism Planned Funds
System ID System ID
15153 4582.08 HHS/Centers for Population 7062 5313.08 PSI CI $600,000
Disease Control & Services Uniformed
Prevention International services VCT
Promotion
10307 4582.07 HHS/Centers for Population 5313 5313.07 PSI CI $350,000
4582 4582.06 HHS/Centers for Population 3537 3537.06 Rapid expansion $200,000
Disease Control & Services uniformed
Prevention International services
Emphasis Areas
Gender
* Addressing male norms and behaviors
* Increasing gender equity in HIV/AIDS programs
* Reducing violence and coercion
Military Populations
Workplace Programs
Human Capacity Development
Estimated amount of funding that is planned for Human Capacity Development $100,000
Public Health Evaluation
Food and Nutrition: Policy, Tools, and Service Delivery
Food and Nutrition: Commodities
Economic Strengthening
Education
Water
Table 3.3.02:
PSI expanded sexual-prevention interventions targeting mobile and other high-risk populations along major
trucking routes, including frontier towns, building on the successful regional PSAMAO project funded
through USAID and complementing the World Bank-funded coastal Corridor project.
Though still recovering from political and economic instability, Cote d'Ivoire is a transport and trade hub of
the West African region, characterized by high mobility of people. To mitigate the spread of HIV associated
with highly mobile populations, cross-border interventions targeting core and bridge groups and populations
along the main migratory routes have been identified as national and regional priorities.
PSAMAO (Prevention du SIDA sur les Axes Migratoires de l'Afrique de l'Ouest et du Centre), started with
USAID funding and expanded into 17 countries, is a best-practice program designed to encourage the
adoption of safe and responsible sexual behaviors among truckers, sex workers, customs and uniformed
officials, and other high-risk and mobile populations. The program includes behavior change communication
(BCC), social marketing of condoms, treatment for sexually transmitted infections (STI), and HIV counseling
and testing (CT) promotion and referrals.
Studies conducted by the PSAMAO regional project showed that from March 2005 to November 2006, the
consistent use of condoms rose from 44% to 53% among commercial sex workers and from 36% to 77%
(with occasional clients) among truckers. The surveys also showed that use of condoms during last sexual
encounter among both commercial sex workers and truckers increased significantly with exposure to
PSAMAO activities, regardless of the type of partner (regular, occasional, or commercial) outside of an
established partnership. However, studies have also indicated that condom use is inconsistent among truck
drivers and sex workers in the region, suggesting a need for consistent program intervention. Cote d'Ivoire's
2006-2010 National Strategic Plan identified prostitution, non-systematic use of condoms, migration, and
mobility of people as important determinants of the nation's HIV epidemic.
PSI received USAID funding through the SFPS and WARP projects from October 2003 to September 2006
to implement the PSAMAO regional project in Côte d'Ivoire. Two local NGOs, Croix Rouge de Cote d'Ivoire
(targeting truck drivers) and SidAlerte Cote d'Ivoire (targeting sex workers), benefited from capacity building
to carry out activities at eight sites identified by the project: two in Abidjan and one each in Bouaké,
Korhogo, Ouangolodougou, Pogo, Man, and Danané. Within these organizations, two focal points, 14
ground supervisors, and 28 community-based educators were trained in BCC based on a participatory
approach. As of November 2006, an estimated 1,075 commercial sex workers and 1,702 truckers each
month were being reached with communications activities across the eight sites. More than 87% of
commercial sex workers and truckers at these sites said that they had been exposed PSAMAO
communications activities. Along with exposure to BCC activities, these populations were also referred to
institutions providing CT and STI services. PSI's HIV project targeting the uniformed services also ensured
access to affordable condoms in and around PSAMAO sites. Through this USAID funded PSAMAO
program, two health centers in Abidjan also participated in a training program on STI syndrome
management and were provided with STI syndromic treatment kits.
Given the end of USAID funding, PSAMAO activities were incorporated into PEPFAR funded activities
starting with FY07 funds. With FY07 and FY08 PEPFAR funds, PSI is extending these interventions to new
sites on the border and in the interior of the country, for a total of 22 intervention sites. Target populations
include truckers, sex workers, customs and uniformed officials, and "migrant" populations. More than sixty
members from the National Transport Union and local Red Cross were trained as peer educators.
With FY09 funding, PSI will continue to implement the range of PSAMAO BCC interventions by community-
based educators, including gender-based training focusing on sexual violence, alcohol, vulnerability, and
condom negotiation, and will expand these activities to customs and other officials (formal and informal) in
14 border crossing zones.
Specific activities that will be undertaken with FY09 funding include:
- Ensuring continued implementation of the project's communications activities by community educators and
supervisors, targeting sex workers and their partners (including transactional sex workers such as
waitresses, bartenders, and vendors). Peer and community educators will conduct
interpersonal communications activities (IPC) as well as mass media events at bus stations, at border
crossing points, in bars and restaurants, and in other areas where the target populations congregate, as
well as within identifiable brothels and hotels used for transactional sex. IPC and mass media activities will
be complemented by the distribution of flyers and posters in high-traffic areas.
- Training additional community education agents in BCC to increase coverage in the existing 22 project
sites. The education agents and supervisors will be selected among Transportation Union members to
promote sustainability of education activities. Selection will be based on identified criteria.
- Training commercial sex worker peer educators in BCC in seven project sites. This training will be done in
consultation with FHI. Training modules validated at the national level will be used.
- Delivering the project's BCC messages via IPC activities and public demonstrations using the project's
mobile video unit in all existing 22 PSAMAO project sites.
- Producing and installing billboards with education messages on PSAMAO transportation routes. PSI
collaborates with relevant partners in the production of all education/communication materials.
- Ensuring the continued availability and re-supply of condoms at all condom access points created in
conjunction with the condom social marketing project implemented by AIMAS.
- Supervising and reinforcing diagnosis and care for STIs at 14 fixed sites identified in FY07, as well as the
extension of STI services to all 22 project sites in collaboration with the Ministry of Health and in
coordination with relevant implementing partners.
- Supervising and reinforcing Croix Rouge, already sub-contracted to implement PSAMAO activities across
various project sites.
The relevant district and regional health departments (DD and DR) will play an important role in identifying
project intervention sites within their geographic regions, as well as being involved in monthly and quarterly
Activity Narrative: project planning activities. PSI's site supervisors will participate in the decentralized health committee
meetings held by the DD and DR and will also invite DD and DR representatives to participate in regular
supervisory activities. PSI will also share with the DD and DR all results from activity implementation and
surveys conducted in their respective geographic areas.
The project will promote sustainability by creating a Liaison Office based on lessons learned and best
practices from the Uniformed Personnel Liaison Office. Members will include Croix Rouge, the Ministry of
Transport, and the National Transport Union. PSI will also seek to participate in relevant coordination
forums at local, regional, and national levels, complementing activities of PEPFAR and other partners.
Commodities (condoms, STI kits) will be procured through existing distribution channels, in coordination
with national authorities.
A network of condom sales points has been set up around program sites, and linkages have been created
with the traditional national distribution network through private wholesalers to ensure continued product
availability for the target population.
Continuing Activity: 15154
15154 11056.08 HHS/Centers for Population 7062 5313.08 PSI CI $225,000
Estimated amount of funding that is planned for Human Capacity Development $80,000
Table 3.3.03:
PEPFAR targets populations most at risk of HIV transmission in order to affect HIV transmission dynamics
and provide care to those in greatest need. In Cote d'Ivoire, which experienced a prolonged political and
military crisis, the USG team has targeted uniformed services and their sexual partners for special attention.
From 2002 until recent months, the country saw active mobilization and deployment of various uniformed
services (national army, gendarmes, and police) as well as rebel forces. Increased mobility with separation
from spouses, economic disparities with the surrounding population, and crisis-related shifts in perceptions
likely contributed to heightened sexual risk behaviors among these populations. Access to information, HIV
counseling and testing (CT), and health care has been limited for uniformed services on active deployment.
In 2005, PSI and its partners (AIMAS, CARITAS, Espoir FANCI, and JHPIEGO) applied successfully for
PEPFAR funding to expand HIV prevention, CT, and care interventions targeting the uniformed services
(including child soldiers) and their partners in Cote d'Ivoire. Increased access to and uptake of combined
HIV prevention and CT interventions in these populations is intended to lead to safer sexual behaviors,
including abstinence, fidelity, and, for populations engaged in high-risk behaviors, correct and consistent
condom use, as well as increased use of HIV care, treatment, and support services through a strong referral
network to complementary services.
In the program area of Condoms and Other Prevention, PSI's activities are designed to increase correct and
consistent condom use among those engaged in high-risk behaviors as part of a comprehensive ABC
prevention strategy; to reduce high-risk behavior and stigma; and to improve perception of personal risk,
including the negative effects of alcohol consumption on HIV-infection risk and anti-retroviral therapy (ART)
adherence. Activities at 45 project sites throughout the country target all six major uniformed services - the
national military (FANCI), the rebel forces (FAFN), the gendarmes, the police, the customs service, and
Water and Forest officials - and include training of peer educators to promote HIV prevention, counseling of
other prevention methods, dissemination of prevention methods via mass media and group events,
diagnosis and treatment of sexually transmitted infections (STIs), and condom sales in high-risk areas.
PSI collaborates with and provides support to the National Security and Defense Forces, Ministry of Health,
and other government agencies, including helping to develop and implement training and communications
materials for peer educators. PSI's implementing partner AIMAS is responsible for creating condom sales
points in high-risk areas and ensuring condom promotion and accessibility to high-risk target groups, while
JHPIEGO has trained and supervised providers for the diagnosis and treatment of STIs. Espoir FANCI, an
NGO of military PLWHA, works to reduce stigma through testimonials and peer education. PSI and its
partners work to link activities with other HIV prevention, care and treatment, and social services.
Project activities complement and build on other PEPFAR-funded efforts, including prevention, care, and
treatment activities by various ministries (AIDS, Health, Education, Social Affairs), ANADER (in rural areas),
Care International (in underserved northern and western areas), Alliance CI, and EGPAF. Activities are
coordinated with the Ministry of Defense. All communication materials are developed and validated with the
involvement of the government as well as international organizations (UNFPA, ONUCI, PNDDR, PEPFAR)
and key implementing partners (JHU/CCP, FHI, REPMASCI, ARSIP, COSCI, RIP+, Care, ANADER, and
Alliance CI). PSI also collaborates with Care, Alliance, EGPAF, ACONDA, and other partners to ensure a
continuum of care for those testing HIV-positive.
With FY09 funding, the project will continue and reinforce current activities, Specific activities, which are
expected to reach at least 17,925 people with Other Prevention outreach and to train at least 360 people
between April 2009 and March 2010, will include:
- Behavior change communication via interpersonal communication (IPC) techniques as well as mass
media promoting HIV prevention. Issues involving social norms and beliefs will be addressed using a
combination of mass media tools (posters, flyers, radio spots, etc.) designed to shift perceptions and
attitudes on issues such as fidelity, discrimination against PLWHA, and sexual violence and coercion.
These tools will be augmented by efforts to involve key community leaders and influential members of the
target groups. These approaches will be complemented by IPC activities designed to address individual
attitudes and behaviors, thereby enhancing risk perception, self-efficacy, and other key behavioral
determinants. IPC activities will include small-group sessions led by a peer educator and touching on key
issues such as risk perception, partner reduction, correct condom use, stigma, the negative effects of drug
and alcohol use in relation to HIV, and the promotion of CT. Peer educators will use a variety of interactive
strategies, such as games, role-plays, and discussions of educational films, to achieve sustained behavior
change among the target group. These IPC activities will be conducted by peer educators and community-
based educators.
- Training of additional peer educators charged with conducting communications activities promoting correct
and consistent condom use and other means of HIV/AIDS prevention. Training will cover the full range of
issues related to HIV/AIDS prevention, with an important module on how peer educators can address
gender issues, including issues of rape and sexual coercion.
- Training of peer educators in the "Men as Partners" approach at six pilot sites (one per uniformed service).
Based on lessons learned in 2009, this approach can be scaled up to other project sites. PSI will train BCC
trainers among the unformed personnel, who will then train peer educator supervisors and peer educators
in pilot sites. PSI will also consult with EngenderHealth to ensure that best practices in this approach are
included.
- Management and re-supply of 1,500 condom sales points created during previous years of the project.
- Distribution of 500,000 male condoms during IPC sessions, group events, and CT sessions, with
demonstrations of correct condom use.
- Updating and dissemination of a map of functional condom sales points.
- Distribution of male condoms to new recruits and to uniformed personnel departing on peacekeeping
Activity Narrative: Missions.
- Adaptation and validation of STI and HIV/AIDS training modules in military schools/uniformed services
academies.
- Training of 60 health professionals in syndromic STI care and treatment.
- Diffusion of TV spots produced in previous years on the promotion of correct and consistent condom use,
couples CT, and stigma reduction.
- Promotion of "positive prevention" among PLWHA. These activities, conducted by men and women
selected in consultation with Espoir FANCI and/or the national PLWHA network RIP+, will include assisting
people with HIV/AIDS to protect their sexual health, avoid newly acquiring STIs, delay the progression of
the disease, and avoid transmitting HIV to others. This will be achieved via self-help groups that will
promote couples CT, the adoption of healthy and safe behaviors, and safe disclosure of one's sero-status to
partners and family members.
- Support for people testing HIV-negative to maintain their HIV-negative status, to get tested regularly, to
bring their partners for testing, and get involved in promoting CT.
The impact of BCC activities will be evaluated via PSI's TRaC (Tracking Results Continuously) surveys.
These
surveys are used to identify key behavioral determinants for specific behaviors (such as consistent condom
use or partner reduction), measure exposure to project activities, and follow the evolution of the adoption
and retention of the desired behaviors over time. Having received approval of the study protocol in
FY07, PSI conducted a baseline study at the beginning of 2008, with a follow-up TRaC planned with FY09
funding.
Sustainability is a major priority of the Population Services International (PSI) program and has been a key
component to strategy development and activity implementation. One of PSI's primary priorities has been
building the capacity of each of the branches of uniform personnel (Military- FANCI, Gendarmes, Forces
Armees Forces Nouvelles (FAFN), Police, Customs, and Water & Forests) through the creation of a Liaison
Office to provide more direct oversight and supervision of peer education activities. Therefore, HIV related
activities become better integrated into day to day activities of uniformed personnel rather than being
viewed as an "extra" work. Organizational and technical capacity building of local non-government
organizations (NGOs) such as the Military Wives Association (AEMCI) is also provided so that these
organizations can better educate their communities. Furthermore, PSI plans to work with related Ministries
to integrate HIV education into uniformed schools' curricula so that HIV information is provided from the
moment an individual enters uniformed service.
Additionally, a network of condom sales points has been set up around all program sites, and linkages have
been created with the traditional national distribution network through private wholesalers to ensure
continued product availability for the target population.
Continuing Activity: 15155
15155 10049.08 HHS/Centers for Population 7062 5313.08 PSI CI $325,000
In 2005, PSI and its partners (AIMAS, CARITAS, Espoir FANCI, and JHPIEGO) were awarded PEPFAR
funding to expand HIV prevention, CT, and care interventions targeting the uniformed services (including
child soldiers) and their partners in Cote d'Ivoire. Increased access to and uptake of combined HIV
prevention and CT interventions in these populations is intended to lead to safer sexual behaviors, including
abstinence, fidelity, and, for populations engaged in high-risk behaviors, correct and consistent condom
use, as well as increased use of HIV care, treatment, and support services through a strong referral network
to complementary services.
In the program area of Adult Care and Support, the project aims to provide comprehensive care, including
health care, psychosocial support, and appropriate referrals, for people living with HIV/AIDS (PLWHA).
Linkages with HIV prevention, CT, ART, and OVC services are emphasized. Activities are guided by the
new national
palliative-care policy and guidelines and the 2006-2010 National HIV/AIDS Strategic Plan and Palliative
Care Strategic Plan.
Identifying individuals in need of HIV care and support is part of a community-based strategy that begins
with HIV education and CT. Peer educators raise HIV/AIDS awareness among the target population,
addressing issues such as fidelity, condom use, discrimination against PLWHA, and sexual violence and
coercion. Peer educators stress the importance of knowing one's sero-status, and people interested in
being tested are referred to CT services. The CT counselor records the names of those testing positive and
puts them in touch with a community-based educator trained in providing psychosocial support. The client's
children are referred for health-care services, if needed, and other services for OVC. The project uses
national referral procedures to refer all HIV-positive clients to care and treatment services. The counter-
referral is addressed back to the site counselors.
FY06 activities included needs assessments and selection of 40 intervention sites for adult soldiers (20
military camps in the North and 20 in the South) and 14 transit and orientation centers (CTO) for child
soldiers. With FY07 funds, PSI, in collaboration with the Ministry of Defense, expended to 10 additional sites
for adult soldiers. In line with a national disarmament, demobilization, and reinsertion program for child and
adult soldiers and rebel forces, CTOs were closed, and the project's child target group shifted from child
soldiers to children of uniformed personnel.) In addition, certain project intervention sites ceased to exist
due to demobilization efforts. Thus since April 2008, project intervention sites total 45. Resource trainers
from RIP+ (a national network of PLWHA organizations) have conducted training of trainers for members of
Espoir FANCI, an NGO of military members living with HIV, in psychosocial support based on peer
counseling. These trainers, in turn, train other members of Espoir FANCI, who act as counselors providing
psychosocial support and assistance with referrals to available treatment and care services.
Since Espoir FANCI does not have access to all sites in the South or to sites in the North, additional local
NGOs have been identified to deliver community-based care and support services. Counselors at all project
sites provide support to PLWHA through home and workplace visits, encourage treatment literacy and
observance, organize support groups with military authorities, conduct awareness activities to reduce
stigma and discrimination, and strengthen networking with other PLWHA organizations. Counselors are also
trained to refer PLWHA to appropriate health and other services and to update the mapping of palliative-
care units, treatment centers, and OVC care units.
In addition to psychosocial support and referral services, the project provides PLWHA with "positive-living"
kits containing insecticide-treated nets, a potable water system, oral rehydration salt, condoms, and a
positive-living guide. Counselors promote HIV prevention for PLWHA through use of the kit, such as
teaching correct and consistent condom use.
The project encourages systematic testing of PLWHA partners and families. This is done beginning with the
post-test counseling session and within the project's self-help groups. Anyone testing HIV-positive is
administered a screening questionnaire for TB, and anyone suspected of having TB is referred to the
nearest TB center or health facility.
Project activities complement and build on other PEPFAR-funded efforts, including development of a
palliative
-care policy and guidelines for clinic- and home-based care as part of a continuum of care as well as
prevention, care, and treatment activities by ministries (AIDS, Health, Education, Social Affairs), ANADER
(in rural areas), Care International (in northern and western areas), Alliance CI, and EGPAF. Activities are
coordinated with the Ministry of Defense.
With FY07 funds, the project expanded activities (prevention communication, CT, care and support) to other
uniformed services (police, customs, and forest rangers). This expansion involved meeting with the
leadership of these services to present the strategies and, identify appropriate intervention sites and
individuals to be trained as peer counselors and educators.
More than of 550 care clients have been identified, and by March 2009, PSI plans to reinforce its care and
support strategy by training health-care providers to provide comprehensive care and referral, including
"positive living" kits. By September 2009, the project expects to provide care and support services for at
total of 2,100 PLWHA and to train at total of 160 people to provide care and support services since project
Activity Narrative: inception.
FY09 funding is requested to continue and reinforce the project's care and support activities, including:
1. Training trainers in HIV care and support (both community and health center approaches)
2. Supervising partner NGOs implementing care and support care activities.
3. Constituting and distributing an additional 718 care kits so as to reach a total of 2,100 PLWHA since
project inception.
4. Renewing contracts for delivery of care kits by local NGOs that have proven themselves capable of
implementing this activity. The project will continue to identify and train additional NGOs to ensure proper
coverage of all project sites.
5. Referring PLWHA to health centers for additional care and treatment as needed.
6. Supervising counselors providing CT and care activities
In 2009, it is expected that the country will continue to move toward full political reconciliation. As the
process of disarmament, demobilization, and reinsertion of military forces progresses, PSI will work with the
Ministry of Defense to identify and locate all military personnel trained as part of the PSI-PEPFAR program
so as to capitalize on their skills to continue implementation of HIV/AIDS/STI activities. Similarly, PSI will
continue to involve military hierarchy in monthly planning of activities, as well as in external supervisory
activities. In addition, PSI's site supervisors will participate in meetings of the decentralized health
committees organized by the district and regional health departments.
Continuing Activity: 16776
16776 5036.08 HHS/Centers for Population 7062 5313.08 PSI CI $120,000
10055 5036.07 HHS/Centers for Population 5313 5313.07 PSI CI $100,000
5036 5036.06 HHS/Centers for Population 3537 3537.06 Rapid expansion $100,000
Estimated amount of funding that is planned for Human Capacity Development $40,000
Table 3.3.08:
Despite significant interest in CT among the armed and security forces, uptake remains low. In a 2004 PSI
survey among the Army of Cote d'Ivoire, 82% of respondents stated that they intended to get tested for HIV,
yet fewer than 30% had done so. The main reason cited for not seeking a test was a lack of medications to
treat HIV/AIDS (66%).
To improve CT uptake among the target population, PSI is pursuing a dual strategy involving integrated
fixed CT services and mobile CT services. In FY06-07, the project started with integrated CT services at
three military health structures (reinforcing the existing CT center at the Military Hospital of Abidjan and
integrating new CT services in Daloa and Korhogo) and established two mobile CT units. With the addition
of eight fixed sites and one mobile unit for a total of 11 fixed sites and three mobile units, 37,000 military
personnel, police officers, customs agents, water and forest agents, and their partners will have received
CT services by March 2009.
A mapping exercise by region is being completed to define referral facilities, which will help PSI-supported
sites refer PLWHA to needed services (ART, PMTCT, psychological and nutritional management, OVC)
within their geographic region.
At all project sites, CT services are part of a continuum of care that includes providing
clients with information on HIV prevention during pre- and post-test counseling (including issues such as
partner reduction, correct and consistent condom use, and avoiding risk factors such as excessive alcohol)
as well as providing referral to care, treatment, and support for those testing HIV-positive. All providers are
trained to encourage the testing of clients' partners, to provide CT services to couples, and to assist sero-
discordant couples in managing their status and avoiding sero-conversion.
With FY09 funding, activities will be informed by key lessons learned and sustainability strategies identified
in previous years, including the importance of thoroughly training community counselors and peer
educators; of conducting regular supervision of these counselors and educators to ensure quality service
delivery; of repeated exposure to health messages, particularly in small-group or individual settings, to
achieve behavior change; of communication and coordination with partners at the local, regional, and
national levels; and of finding ways to motivate community and peer educators.
Funding in FY09 will allow the project to reinforce activities begun in FY07 within the structure of the police,
customs, and water and forest departments and to move toward a more community-based testing strategy.
With the expected adoption of a simpler national algorithm allowing rapid tests with blood drawn from a
finger prick, PSI proposes to train the project's peer educators/counselors to conduct HIV testing at their
sites. This strategy will allow for the rapid scale-up of CT activities and ensure permanent CT services at
each program site, as opposed to having to wait for the periodic arrival of the mobile testing unit and
accompanying laboratory technician. This strategy will also help in promoting HIV testing among couples.
Key interventions planned with FY09 funding include:
1- Continuation of CT activities via integrated sites as well as community-based CT at all 45 sites previously
served by the mobile testing unit (down from 50 sites because of demobilization at some sites), resulting in
the testing of 18,500 people between April 2009 and March 2010. Within the project's 11 integrated sites,
CT will be proposed to all individuals coming to the health facility, making CT a routine, integrated element
of health-care services ("opt-out" approach).
2- Continuation of promotional activities surrounding CT, with an emphasis on couples counseling.
Promotional activities will include using mass media to raise awareness of the benefits and availability of
CT, as well as interpersonal communication by peer educators and counselors.
3- Training of 286 counselors (151 health care workers and three lay counselors at each of 45 Operation
Haute Program (OHP) sites) by national trainers to integrate CT service delivery with an opt-out approach in
all uniformed health facilities and to increase the number of peer counselors who will be able to conduct CT
functions at their respective sites, thus eliminating dependence on the arrival of the mobile testing units.
Counselors and lab technicians will be trained in counseling and finger-prick testing based on the new
algorithm. Lab technicians currently doing HIV testing via blood draws will play a role in training and
supervising the community-based CT agents in applying the new algorithm. A module addressing couples
counseling will be included in trainings.
4- Supervision of community-based and health center-based CT activities. The project's three mobile CT
units will visit project sites on a regular basis to ensure quality services. This will be complemented by the
work of 20 supervisors drawn from the ranks of the military health service and trained in FY08, to be chosen
in geographically representative areas so as to be able to provide regular supervision.
5- Quality control of testing procedures in collaboration with the National HIV/AIDS Care and Treatment
Program (PNPEC) via CDC/Projet Retro-CI and regional technical representatives for laboratory quality
Activity Narrative: assurance
6- To ensure proper and efficient referral processes, PSI will participate in updating the national directory of
services for PLWHA and in revising the mapping of all treatment and care facilities. Psychosocial care and
support for those testing HIV-positive will be provided by members of Espoir FANCI (an NGO of military
PLWHA) and NGOs that are part of RIP+ (national network of PLWHA organizations). These NGOs will
provide self-help groups at project sites. PSI will also rely on existing referral systems at the national level
and among other PEPFAR implementing partners. Other possible activities include ensuring that health
care professionals at project sites are trained in palliative care and organizing regular coordination meetings
with relevant actors at the local level. At sites that don't offer all services, this information will be shared with
national authorities, PEPFAR, and other stakeholders to discuss possible opportunities to expand service
offerings...
PSI will continue to involve the military hierarchy in the monthly planning of activities in their areas, as well
as in supervision activities three times a year. PSI's site supervisors will participate in meetings of the
decentralized health committees organized by the district and regional health departments, and all research
data and program results will be shared with these institutions.
Continuing Activity: 15156
15156 4580.08 HHS/Centers for Population 7062 5313.08 PSI CI $450,000
10064 4580.07 HHS/Centers for Population 5313 5313.07 PSI CI $450,000
4580 4580.06 HHS/Centers for Population 3537 3537.06 Rapid expansion $300,000
Table 3.3.14:
