Since late 2005, the USG has funded Care International to extend access to HIV/AIDS prevention, care, and treatment services to underserved populations in the northern and western regions of Côte d'Ivoire, where health, education, and social services were severely damaged during the country's 2002-2008 politico-military crisis. Working through local community- and faith-based organizations (CBO/FBOs), Care activities have supported behavior change communication (reaching 93,723 people with AB and 172,672 people with Other Prevention outreach in FY 2009), HIV testing and counseling (20,650 in FY 2009), and care and support for people living with HIV/AIDS (6,571) and orphans and vulnerable children (11,155), with linkages to medical care and treatment, support groups, economic strengthening activities, and other services, in and around the hub cities of Bouake, Man, Duekoue, Korhogo, and Bondoukou. With a no-cost extension, Care's award will end in September 2010.

Results achieved and lessons learned suggest that a) working with local CBO/FBOs to extend HIV/AIDS prevention and care services to areas in crisis and post-crisis situations can produce impressive results and b) that future interventions must place even greater emphasis on building sustainability through transfer of capacity to the community level.

For the next five-year period, the USG team has launched a competitive FOA designed to expand on Care's work to engage and sustain community involvement and build local capacity to implement and monitor evidence-based, culturally appropriate, gender-sensitive HIV prevention and care interventions in the highest-density and highest-prevalence areas of the North and West (similar to Care's current intervention zones).

A TBD partner will be funded in the HVAB, HVOP, HVCT, HBHC, and HKID budget codes to provide subgrants and technical assistance to build the organizational and technical capacity of local CBO/FBOs and other civil-society members (e.g. traditional and religious leaders, teachers, women's and youth associations, etc.) in the North and West to deliver appropriate, innovative, high-quality:

- Behavior-change communication (BCC) interventions promoting HIV prevention, including use of PMTCT and HIV testing and counseling (TC) services and reduction of stigma, discrimination, and gender inequity

- Direct TC services and care and support services for people living with HIV/AIDS (PLWHA) and orphans and vulnerable children (OVC), with effective linkages to HIV treatment and other health and social services.

The TBD partner will progressively expand the organizational and management capacity and the quality and range of interventions of CBO/FBO implementing partners and demonstrate these achievements through measurable outcomes. Project-specific quantifiable milestones to measure indigenous capacity-building and progress toward sustainability will include increasing the number and improving the quality of locally organized and supported HIV/AIDS activities, as well as demonstrating quantifiable progress through the implementation of a sustainability plan and individual capacity-building plans. The partner will participate in relevant national technical, coordination, and quality-assurance committees and progressively reinforce the capacity of faith- and community-based organizations and village and district structures to promote quality, local ownership, accountability, and sustainability of activities.

The partner will work to link project interventions with existing HIV care and treatment and other social services in the area, including services supported by other PEPFAR-funded initiatives and by other donors (Global Fund, World Bank), and will promote coordination at all levels, including through bodies such as district, regional, and national HIV coordination committees and networks of PLWHA and faith-based organizations.

Monitoring and evaluation (M&E) of all interventions, including baseline and impact assessments, will be essential in measuring the success of these activities. Using participatory approaches, the partner will develop and implement a project-specific strategic information/M&E plan consistent with national policies and OGAC guidance that draws on available data and national tools and uses quantitative and qualitative methods. This plan will require the collection, analysis, and dissemination of data to ensure adequate baseline data and regular data reports to support targeted service delivery, program M&E, and appropriate information systems. This information will also serve to measure coverage and reach of mass media messaging and to analyze intervention effectiveness.

The partner will contribute to the key issues of gender equity, addressing male norms, and increasing women's access to income and productive resources by, among other things, using gender-sensitive materials and approaches in HIV prevention outreach; targeting girls and women as priority groups for HIV prevention, care and support, and economic strengthening activities; supporting the Families Matter parent-child communication program; and promoting HIV services (including PMTCT services) to women.

The TBD partner will provide subgrants and technical assistance to build the organizational and technical capacity of local CBO/FBOs and other civil-society members (e.g. traditional and religious leaders, teachers, women's and youth associations, etc.) in the North and West to deliver high-quality, culturally appropriate, gender-sensitive HIV prevention, care, and support services for people living with HIV/AIDS (PLWHA) and their families, with effective referrals to treatment and other services.

While details remain to be planned with the TBD partner and national stakeholders and targets will depend on the timing of the award and funds availability, activities in the technical area budget code of Adult Care and Support will focus on building capacity to provide:

- Strong referral networks, follow-up, and care and support for PLWHA and their families, including support for status disclosure, testing for their sexual partners and children, home-based palliative care, Prevention with Positives activities, support groups, and active, prominent roles for PLWHA in program planning and implementation.

- Use of situational analyses and validated, evidence-based approaches to develop appropriate economic strengthening and nutritional support for eligible PLWHA and OVC families, such as food-production income-generating activities, vocational training, savings and loan groups, etc.

- Provision of home-based care and support for PLWHA, including kits, psychosocial support, and referral to health centers, social services, and OVC care

Training of community counselors in psychosocial support and support group therapy for PLWHA and OVC

Training of religious leaders in psycho-spiritual support for PLWHA and HIV-affected people

Production and distribution of media materials (print materials such as posters brochures, and mass media outlets such as radio spots) with messages designed to reduce stigma and discrimination against PLWHA and OVC

The partner is expected to provide at least 5,000 PLWHA by September 2011 (7,500 by Year 5) with care, support, and PwP services and to ensure that these clients receive cotrimoxazole (at least 80% by Year 5), TB screening (100%), and ART adherence counseling (90%) and have access to bed nets and a safe water supply (75% by Year 5). At least 750 PLWHA are expected to receive food and/or nutrition services over five years, and all targeted health facilities are expected to have active PLWHA support groups. At least 1,000 community health care workers are expected to be trained in HIV care and support over five years.

The TBD partner will provide subgrants and technical assistance to build the organizational and technical capacity of local CBO/FBOs and other civil-society members (e.g. traditional and religious leaders, teachers, women's and youth associations, etc.) in the North and West to deliver high-quality, culturally appropriate, gender-sensitive HIV prevention, care, and support services for people living with and affected by HIV/AIDS and their families, including OVC.

While details remain to be planned with the TBD partner and national stakeholders and targets will depend on the timing of the award and funds availability, activities in the HKID budget code will focus on building capacity to:

Identify and assess the needs of OVC in accordance with PEPFAR guidance and national directives

Provide care and support for OVC as needed, including health care, educational, legal, and psychosocial support, follow-up, provision of HIV prevention education and items such as impregnated bed nets, nutrition assessment and counseling, food support (in collaboration with the World Food Program), TB screening, and hygiene education

Using situational analyses and validated, evidence-based approaches, provide appropriate economic strengthening and nutritional support for eligible PLWHA and OVC families, such as food-production income-generating activities, vocational training, savings and loan groups, etc.

At least 15,000 OVC are expected to benefit from care and support by Year 5, including 8,000 by September 2011.

The partner will collaborate with other PEPFAR and non-PEPFAR implementing partners and will work to strengthen government social centers using the platform approach for OVC support coordination and conduct supervision visits in conjunction with the National OVC Program (PNOEV). The partner will support training of social workers and community counselors in OVC identification, care, and support using a "family approach" and the Child Status Index, as well as in diagnosing HIV infection and other illnesses in children.

The TBD partner will provide subgrants and technical assistance to build the organizational and technical capacity of local CBO/FBOs and health care providers in the North and West to deliver high-quality HIV testing and counseling (TC) services, with effective referrals to care, treatment, OVC, and other services.

While details remain to be planned with the TBD partner and national stakeholders and targets will depend on the timing of the award and funds availability, activities in the HVCT budget code will focus on building capacity to provide TC services reaching at least 150,000 people over five years, including 12,000 by September 2011. Expanded uptake of confidential TC will emphasize promotion of routine testing at health-care facilities, in partnership with health-care providers, as well as follow-up (e.g. home-based) testing for sexual partners and children of people living with HIV/AIDS, and improved access to testing for other populations (e.g. through mobile testing).

The partner will work to support training of health workers and community counselors (at least 1,000 over five years) in the promotion and provision of TC using the new national testing algorithm and finger-prick technique; on-site coaching and supervision of community counselors and health workers providing TC services; referrals to care and treatment for patients testing positive and their families, including OVC; and mass-media and proximity campaigns promoting TC.

The partner will work with regional HIV/AIDS networks and prevention partners to conduct mobilization activities focusing on traditional leaders, traditional practitioners, and religious leaders to promote the use of TC services, especially for families, couples, and at-risk groups.

The TBD partner will provide subgrants and technical assistance to build the organizational and technical capacity of local CBO/FBOs and other civil-society members (e.g. traditional and religious leaders, teachers, women's and youth associations, etc.) in the North and West to deliver high-quality, culturally appropriate, gender-sensitive behavior-change communication (BCC) interventions using mass media (local radio) and proximity approaches to promote HIV prevention.

While details remain to be planned with the TBD partner and national stakeholders and targets will depend on the timing of the award and funds availability, activities to promote HIV prevention through abstinence and being faithful (AB) are likely to include targeted BCC campaigns involving religious and traditional leaders in the community as well as teachers and peer educators in and out of schools. Messages will be designed to encourage the delay of sexual debut among youth; promote mutual fidelity; decrease inter-generational and transactional sex, sexual coercion, gender-based violence, and HIV-related stigma and discrimination; decrease multiple sexual partnerships; and promote HIV testing and counseling (TC) and PMTCT service uptake. Small-group communication methods will take place in community settings, mosques and churches, and schools and will be reinforced by radio messages in local languages. Religious, community, and other leaders will use a family approach to prevention, making efforts will address issues with both parents and children.

The partner will identify and implement targeted BCC tools and strategies in collaboration with other PEPFAR partners, with priority target groups including girls, women, and out-of-school youth. Individual and small-group interventions focused on HIV prevention through AB are expected to reach at least 420,000 individuals over five years, including 75,000 by September 2011.

Promotion of PMTCT services will be a key element of HIV prevention messages; over five years, individual and small-group interventions are expected to reach at least 42,000 women with PMTCT messages, including referral of pregnant women to TC services with appropriate linkages and follow-up for those who test HIV-positive.

The partner is also expected to train 300 community counselors per year (1,500 over five years) in HIV prevention interventions; to collaborate with a national network of religious leaders (ARSIP) to strengthen religious leaders' capacities to address HIV/AIDS in their communities; to work with women's organizations to help women discuss AB-related issues with their children; and to identify, pilot, and evaluate other innovative, evidence-based HIV prevention activities involving HIV prevention and reproductive-health education, risk awareness, life skills, leadership development, and vulnerability reduction for at-risk subpopulations, including out-of-school youth, with a particular focus on girls. The partner will collaborate with the Ministry of Education to support the implementation of a life skills curriculum, which delivers age-appropriate abstinence messages to children and promotes healthy lifestyles; to identify and train community health workers to deliver BCC interventions using a family-based approach; to support the piloting, evaluation, and possible expansion of the Men as Partners project which aims to promote gender equality and encourage positive male involvement in HIV prevention; and to collaborate with CBO/FBOs to conduct training on gender sensitivity and implement campaigns against gender-based violence.

The TBD partner will provide subgrants and technical assistance to build the organizational and technical capacity of local CBO/FBOs and other civil-society members (e.g. traditional and religious leaders, teachers, women's and youth associations, etc.) in the North and West to deliver high-quality, culturally appropriate, gender-sensitive behavior-change communication (BCC) interventions using mass media (local radio) and proximity approaches to promote HIV prevention.

While details remain to be planned with the TBD partner and national stakeholders and targets will depend on the timing of the award and funds availability, activities to in the technical area budget code of Condoms and Other Prevention will promote risk awareness and risk reduction through correct and consistent condom use, in conjunction with abstinence and fidelity; reduction of inter-generational and transactional sex, sexual coercion, gender-based violence, and HIV-related stigma and discrimination; decreased multiple sexual partnerships; and promotion of HIV testing and counseling (TC) and PMTCT service uptake, with referral to appropriate care and support services. Approaches are likely to include targeted BCC campaigns involving religious and traditional leaders in the community as well as teachers and peer educators in and out of schools. Small-group communication methods will take place in community settings, mosques and churches, and schools and will be reinforced by local radio messages. Religious, community, and other leaders will use a family approach to prevention, making efforts will address issues with both parents and children.

The partner will support procurement and distribution (including social marketing) of male condoms to rural communities to accompany prevention messaging and encourage correct and consistent condom use, and will support development of a package of prevention activities targeting people living with HIV/AIDS, in collaboration with national and local PLWHA organizations.

Promotion of PMTCT services will be a key element of HIV prevention messages; over five years, individual and small-group interventions are expected to reach at least 54,850 women with PMTCT messages, including referral of pregnant women to TC services with appropriate linkages and follow-up for those who test HIV-positive.

The partner will identify and implement targeted BCC tools and strategies in collaboration with other PEPFAR partners, with priority target groups including sex workers, men who have sex with men, girls, women, and out-of-school youth. Individual and small-group interventions focused on HIV prevention through AB are expected to reach at least 420,000 individuals over five years, including 147,000 by September 2011.

The partner is expected to train 300 community counselors per year (1,500 over five years) in HIV prevention interventions; to work with women's organizations to help women discuss AB-related issues with their children; and to identify, pilot, and evaluate other innovative, evidence-based HIV prevention activities involving HIV prevention and reproductive-health education, risk awareness, life skills, leadership development, and vulnerability reduction for at-risk subpopulations. The partner will collaborate with the Ministry of Education to support the implementation of a life skills curriculum, which delivers age-appropriate abstinence messages to children and promotes healthy lifestyles; to identify and train community health workers to deliver BCC interventions using a family-based approach; to support the piloting, evaluation, and possible expansion of the Men as Partners project which aims to promote gender equality and encourage positive male involvement in HIV prevention; and to collaborate with CBO/FBOs to conduct training on gender sensitivity and implement campaigns against gender-based violence.