Goal: Contribute to reduce the HIV/STI transmission and impact

Dual Objectives: (1) Strengthen HIV/AIDS/STI prevention and care among mobile and vulnerable target populations; (2) Strengthen the capacity of the Ivoirian uniformed personnel to expand quality HIV prevention and BCC.

To be more cost effective, PSI has incorporated it experience in an effort to support local ownership and build capacity. PSI is continuously developing tailored expertise, tools, and models to improve health programming while also building organizational strength. PSI vision will be achieved by integrating capacity building at all levels of implementation.

PSI has established trusting relationships and mutual respect with local organizations engaged in health and development work. The PSI teams success is rooted in its nuanced understanding of the countrys complexity and in the teams ability to leverage networks to bring about positive change.

To assure high quality M&E, PSI adheres to rigorous evidence-based decision making. PSI will train all stakeholders, to gather and share data using its system. PSI will continue to monitor the accuracy and quality of reporting. One 4x4 car is planned to be used with condom delivery and supervision, to replace AIMASs old one.

PSI will work with partners to strengthen care and support systems across project sites in Côte dIvoire through trainings, referrals, improvement of supply chains and communication materials. PSI will strengthen referrals to new and existing care and support sites, as well as follow up care for those who tested positive for HIV or STIs. To reduce stock outs of medications and consumables, PSI will work closely with SCMS to improve the procurement and supply chain system through use of improved Management Information System (MIS) tools, using mobile phones with text messaging capabilities. Field agents will use the mobile phones to store and send data about each Counseling and Testing Center and/or care site and materials, equipment and medicines needed to PSI. The real time data will ensure that sites have the materials they need.

The Care and Support activities will be conducted in the whole OHP (24 zones) and PSAMAO (26 sites) sites toward uniformed personnel, their family, transporters, migrants and sex workers. Activities will be done as Testing and Counseling fixed centers. The project will aim to increase the percentage of individuals of target populations who have sought at least one relevant care and/or support service (such as STI testing, STI treatment, ART, or support group).

Counselors at all project sites provide support to PLWHA through home and workplace/site 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. PSI CI will strengthen and expand the pool of health providers through trainings on comprehensive care support to PLWHA. Counselors are also trained to refer PLWHA and their partners to appropriate health and other services and to update the mapping of care & support units, treatment centers, and Orphan and Vulnerable Children (OVC) care units. PSI will provide added support to the national police, customs agents and Water and Forests agents, as recommended by different Ministries.

In addition to psychosocial support and referral services, the project will continue to provide PLWHA with positive living kits containing insecticide-treated nets, household water purifying tablets, oral rehydration salts, 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. When the kit contents run out, PLWHA will be able to find condoms and ORS distributed by PSI CI and AIMAS at local sales outlets. Water purifying tablets will soon be available to PLWHA and the public via the commercial sector in the northern region (partnership between (United Nation Children Fund (UNICEF) and PSI CI will distribute Aquatabs through the commercial sector). This effort will be associated by hygiene sensitization and the hand washing with soap promotion.

PSI CI will work with partners to strengthen care and support systems across project sites in Côte dIvoire through trainings, referrals, improvement of supply chains and communication materials. PSI CI will strengthen referrals to new and existing care and support sites, as well as follow up care for those who tested positive for HIV or STIs.

PSI-CI will engage the target population through a variety of IPC activities and small group discussions. Such activities will take place in targeted locations in communities, neighborhoods, and stations where people naturally get together to meet, talk, rest, eat, watch television or listen to the radio. PSI-CI will provide ongoing support and supervision to supervisors to hold planned and spontaneous discussions in support of abstinence and fidelity.

In each of the 32 sites located in these town (Abidjan, Aboisso, Bondoukou, Dimbokro, Daoukro, Yamoussoukro, Daloa, Gagnoa, San-Pedro, Soubré) children of uniformed personnel will be grouped together in 6 groups by taking into account parameters of age, sex and address. Groupings will be 10 to14 years and 15 to 24 years with separate group for girls and boys. This segmentation facilitates the discussions and offers an opportunity for the children to express themselves.

In total, 26 000 children of uniformed personnel will be sensitized on abstinence: 14 000 girls and 12 000 young boys, from 10 to 24 years old will be reached during Girl Club activities and young leaders Peer Education sessions. An accent will be put on discussion groups, movie viewing followed by debates, peer exchanges and educational games.

PSI CI will support the creation of new youth and girls clubs and organize regular group meetings for women and girls. PSI will train military spouses association to increase parent-child communication on abstinence and fidelity, to promote delayed sexual activity, primary and secondary abstinence and correct and consistent use of condom.

Communication supports, developed by PSI and validated by partners, will be duplicated and shared at all 32 sites. Messages on abstinence and delayed activity targeting children will be prioritized. For those who are sexually active, other means of prevention will be communicated.

The CCV will pursue these activities. To increase awareness of abstinence and fidelity behaviors, PSI-CI will organize several social mobilization events, integrated with CCT campaigns, debates, games, contests, theatrical troupes, dance and fairs; sporting events, competitions and game shows.

4 000 persons will be reached (3 000 wives and 500 couples) by IPC interventions on Be Faithful. 2 women by site in 25 sites will lead these activities in conjunction with the uniformed person peer Educators.

To insure the quality of the interventions, 30 to 45 minutes BCC sessions will be made by homogeneous groups of 25 persons at the most. A different theme will be approached every week by the peer educator. Once a group has discussed all of issues, the peer educator will pass to the next group. PSI CI will capitalize on market days to better reach communities and tap into partner AIMASs materials and grasp of cultural influences to reach target populations.

25 religious leaders will be trained to accompany the young people and the adults to provide a religious point aspect of the topics. 120 persons of the local hierarchies and 180 relatives will be trained to insure the promotion of activities in their respective sites. 50 women will be trained for the supervision of activities in the sites. 235 young people will be trained in communication techniques for abstinence promotion.

The Testing and Counseling activities will be conducted in the whole of OHP (24 zones) and PSAMAO (26 sites) sites toward uniformed personnel, their family transporters, migrants and sex workers.

Mobile Testing and counseling services are essential to reaching vulnerable mobile populations and tend to be more appealing for men. Furthermore, cost-per-client data from PSI indicate that mobile Testing and counseling services are more cost-effective than other fixed Testing and counseling sites. PSI program data and the participatory evaluations with target populations indicate that maintaining confidentiality and saving time are key reasons why men are more likely to seek HIV and STI testing through mobile services as well as through the private sector.

The Testing and Counseling services decided to combine approaches between fixed and mobile as an advanced strategy when the needs are identified or solicited during target groups special events. Using geographic information system mapping to overlay access, coverage, and prevalence data, mobile teams will identify gaps and plan their penetration into areas and hot spots where counseling and testing (CT) is needed. PSI-CI will open new sites in target zones, including exploring the feasibility of expanding testing fixed sites in transport stations through partners using rapid tests. Mapping will also facilitate linking clients to follow-up services (Treatment and care) and assist in mobilizing communication teams to generate demand for services.

PSI CI will conduct participatory needs assessments of new and existing HIV/AIDS/STI testing sites to assess needs for equipment, training, and staffing. PSI CI will also coordinate with Regional and District Health Departments to respond to identified needs and offer HIV/STI testing training to personnel with emphasis on serving target populations. Furthermore, PSI will participate in monthly coordination meetings through the Ministry of Health and Fight against AIDS and engage in regular support and supervision visits.

PSI CI will integrate mobile with special days events such as National Testing Day (JNCD), Aids Control National Week and World Aids Day (JMLS).

We will continue to reinforce the existing collaboration between integrated Testing centers and the care and support centers. A cartography of all interventions and organism implementers will be developed to find a way for the complementarily and will be made available to partners.

Training is the pillar of assuring quality of care with rapid testing using the serial algorithm according to the national guidelines. 125 Testing and Counseling service providers will be trained on testing. Regular refresher trainings will also be held to ensure skills are maintained and improved. 150 providers will receive refresher courses. During quarterly supervisory visits to all sites, PSI CI staff will evaluate sites and counselors against a checklist of international standards for CT services and put in place improvement plans where standards are not fully met. With other HIV testing implementing partners, PSI CI will explore the possibility of creating a standardized quality assurance logo for sites that meet quality standards.

The system effectiveness of referral and counter referral will be reinforced through a tools harmonization and putting in place a monitoring mechanism. Quarterly experiences sharing meeting with care management implementing partners will be organized.

For the OHP program, the target populations are: uniformed personnel, their partners and their sexually active age children. Truck drivers, sex workers and migrants constitute the target populations of PSAMAO program.

For both programs, the age brackets vary from 15 to 18 years and 19 to 25 years and more and are segregated by sex. OHP activities will take place in the camps of uniformed personnel (military, police, Waters and forests agents, gendarmerie and Customs agents). As for PSAMAO, activities will be localized in bus stations, big trucks parking, corridors and the agro industrial complexes.

In total 48,000 persons will be touched by the OHP program and 20,000 persons (among them 4,000 sex workers) for the program PSAMAO. These activities will be located in following town: Abidjan, Aboisso, Abengourou, Adzopé, Divo, Bondoukou, Bouna, Dimbokro, Daoukro, Yamoussoukro, Tiébissou, Bouaké, Korhogo, Boundiali, Ferké, Odienné, Séguéla, Bouaflé, Daloa, Gagnoa, San-Pedro, Soubré, Tabou, Man, Duékoué, Guiglo, Zuénoula.

Conducted in 2008 a PSIs TRaC survey indicated that over 60% universal personnel reported having sexual relationship(s) with one or more partners to whom they were not married. Of these, only 32% used condoms regularly and 36% during their last sexual encounter. Significant findings showed that men lacked the self-efficacy to resist risky sexual encounters or to insist upon condom use during such encounters;

The persons touched during the sessions of BCC, from tackled issues, are invited to go towards testing and counseling units for STI and HIV. The actors trained to the techniques of BCC are also trained on STI and HIV testing techniques. The actors will lead talks during post test clubs. The OHP and PSAMAO supervisors participate in the coordination meetings (local, departmental, regional and national level) organized by the technical ministries and the supervisory ministries.

Sessions of BCC from 30 to 45 minutes will be made by homogeneous group of 25 persons at most. A different theme will be approached every week by every peer educator. Once all the tackled issues treated, the educator passes to another group.

In addition, formatives supervisions will be led to estimate the quality of the data strengthen the capacities of the supervisors and make a coaching of the organizations of young people and women for the manners of the activities. These supervisions will also allow identifying domains requiring capacities building. Quarterly meetings of coordination involving all the partners will be organized to discuss the state of progress of the project and handle the met difficulties

To be able to make decisions or plan actions based on the evidence, PSI CI plans to make 1 TRaC study to insure the quality of the delivered services among commercial sex workers (CSW). A study MAP on the quality of availability of the condom will be also led (OHP and PSAMAO sites). For data quality assurance, a capacities building training is planned for implementation partners persons in charge of monitoring and evaluation. Tools of collection and communications will be provided to them, formatives supervisions will be scheduled and quarterly meetings will be organized for the data validation.The validated data will be regularly shared to the various actors and to their respective hierarchy. Also a workshop annual balance assessment will be organized to present the results of the activities led to all the actors operating in HIV field.