The International Rescue Committee projects overall goal is to build a sustainable, local response to the HIV epidemic, particularly among vulnerable populations in the central, northern, and western regions of Côte dIvoire. The specific objectives are to build the technical, organizational, and management capacity of local CBOs/FBOs to plan, deliver, evaluate, and sustain high-quality HIV prevention services. At the end of the five-year period of CARA II, the expected outcomes are that local partners will have:

1. Reached 480,000 individuals with evidence-based, preventive interventions

2. Reached 23,500 women aged 15-49 with PMTCT messages

3. Tested 28,100 people

4. Provided care and support to 3,000 PLWHA

5. Provided 2,000 OVC with care and support

6. Gained the capacity to lead similar projects on their own

To make the program more cost-effective, the IRC will: focus on a gradual handover of key activities to local partners; rely on IRC GBV and economic recovery development expertise; and develop non-cash-dependent ways to motivate peer educators and community advisors (CAs).

As IIRC transfers project activity ownership to local partners, it will monitor each partners progress. The IRC will collaborate with national and regional state actors, allowing the IRC to locally address programmatic constraints.

Key planned M&E activities include a baseline analysis at the beginning of COP 2012 for the new geographic areas, a mid-term review of the project, and two evaluation missions to assess intervention quality.

Vehicles:

Through COP11: 0

New requests in COP12: 2 ($80,000) for 2 subpartner organizations to carry out supervisory trips and attend meetings in the projects large geographic area.

Total planned vehicles for life of mechanism: 5

The IRC will continue to lead adult care and support activities to improve the quality of life for adults and children living with HIV, along with their families; and to minimize their suffering through clinical care, psychological, spiritual, social, and preventive services in implementing communities.

Through support to local partners, the IRC will develop a strategy that will connect patients to partners responsible for care and support, including HIV and TB care, PMTCT, and testing. This strategy will ensure that everyone identified as HIV+ through community partners can immediately have access to all diagnostic services.

To ensure quality services are available, the IRC and its partners will build on nationally-validated standards. The training sessions for Community Councilors will be made available through the national pool of trainers under the supervision of the National HIV/AIDS Care and Treatment Program (PNPEC). PLWHA will be provided with home care and support activities by trained community agents: these will be appropriate for the social and cultural context and will provide basic physical care, as well as psychological, social, and spiritual support.

The IRC will also refer the PLWHA to structures providing medical support for the intake of Cotrimoxazole. This project will assist PLWHA in adhering to treatment (ARV, cotrimoxazole, and others).

In addition, PLWHAs will be placed in support groups to promote positive prevention, fight against stigma and discrimination, share experiences, and promote Greater Involvement of People living with AIDS (GIPA). As a result, the implementing partners will have to involve PLWHAs at different levels of care and support. PLWHA will benefit from HIV/AIDS prevention activities focused on positive prevention and environmental hygiene, and the most vulnerable will receive hygiene and water purifying kits. Infected women will be directed to specialized services for gynecological screening and follow-up. The IRC will work with the PNPEC, the National Reproductive Health Program, and AIBEF to implement this activity.

Key actions for this component are:

Grant to two partners for care and support activities for PLWHAs, in accordance with national standards and guidelines

Support for organizations that provide care and support for PLWHAs (i.e., minor renovations to their premises and equipment)

Strengthening functioning networks for referral to organizations that conduct prevention activities (including GBV) and care and support to OVCs

Training of community counselors in care/support for PLWHAs, and violence and gender-based norms of masculinity related to HIV/AIDS

Establishment and/or strengthening of self-support groups

Support for the operation of a transit house

Evaluation of the economic activities of self-support groups in the previous year

Training/re-training partners for the development of economic activities for PLWHAs

Participation in development processes and validation, dissemination, and use of national reference documents

Collaboration with other institutions and programs for a synergy of effort (e.g., the National Program for the Fight against Malaria, the WFP)

Coaching and technical monitoring of self-help groups.

The main objective of OVC care and support activities is to improve childrens (aged 0-17) quality of life by providing age and need-appropriate services to those, and their families, who are affected, infected, or exposed to HIV/AIDS. The strategy will be based mainly on:

Child identification:

Organizations and partners in adult care, actors involved in OVCs care and support, other partners and the community center will collaborate taking steps to avoid double-counting. OVC identification will be done through screening centers, PLWHA associations, and care and support centers (hospital and non-hospital structures). Social centers will also be an essential point for identifying child violence victims.

The initial needs assessment:

This will estimate the contextually specific needs of each child. It will be done through the Child Status Index (CSI), a national reference tool validated for such evaluations.

Support:

Community-based support focus will be based on the initial assessment and include the following holistic and high-quality areas:

Services provided following national standards for most vulnerable OVC (economic, psychological, and social criteria), according to CSIs analysis and a rapid needs assessment of the family

Psychosocial that starts with identification and continues during home visits

Education (formal and technical). The IRC will work with the Ministry of Education and social centers to determine gaps involving children outside school systems.

Shelter and care, including appeals during special events (e.g., Day of the African Child) for foster homes for OVCs

Protection, including awareness sessions for children and their families on HIV/AIDS, GBV, and human rights using the "Family Matters" approach ) GBV survivors or victims of abuse will be directed towards care centers.

Individualized, locally-appropriate support to food security and nutrition, done with PNN in socio-educational sites

Health care through referrals to health centers

Economic strengthening of OVC families through IGAs. IRC will train the most vulnerable OVC families.

Parents and/or guardians of OVC through the Family Matters approach, where the IRC will work closely with the PN PE and social centers to scale up the program

Social centers through capacity building in identification, assistance and referral of child victims of violence.

Evaluation of services:

A progress evaluation will be done every six months with Child Status Index based on needs expressed at the beginning of the year.

The IRC will focus on the following:

Grants to partners to lead OVC care and support activities within national standards/guidelines

Advocacy support by the two partners and networks to promote protection and inclusion

Strengthen the functioning of OVC platforms through social centers

Train community counselors in community care and support for OVC, GBV, HIV/AIDS related issues

Support the scale up transition and improve the quality of services offered to OVCs and their families

Evaluate economic support activities developed for OVC, their families, and/or guardians

Train/re-train partners for development of economic activities for OVC, their families and/or guardians

Participate in the development processes and validation, dissemination, and use of national reference documents

Organize joint missions to supervise training with the national programs and technical partners involved in

The IRC will intervene in: Man, Séguéla, Duékoué, Yamoussoukro, Tiébissou, Toumodi, and Bouaké.

AB-focused activities will target women (especially aged 30-34); and youth aged 15-24 (especially those not in school and performing risky work). The IRC chose these groups based on site investigation data and the 2005 EIS, which states that the national HIV prevalence remains high (3.9% in 2009, UNAIDS source), that it increases with age among young women, and that women aged 30-34 have a high prevalence.

The intervention will also address the post-electoral crisisrelated increase in young girls and womens vulnerability.

The IRC will use locally-focused peer education to reach women aged 15-24. With the national pool of trainers support, target groups (up to 25 people each) will be trained. The IRC will evaluate participants before and after the meetings. Focused topics will be postponing sexual activity and secondary abstinence. The approach supports local norms denouncing cross-generational and transactional sex, rape, incest, and other forced sexual activity. The IRC will also use peer education to reach participants over 25. Training will focus on: GBV, HIV/AIDS transmission, multiple sexual partners, mutual faithfulness with uninfected partner(s) in long-term sexual partnerships; and joint counseling and testing.

This approach is done closely with the national programs for highly vulnerable populations and for reproductive health and AIBEF.

In addition to peer education, the IRC will use the "Family Matters" approach. This targets parents and guardians of children aged 9-12 and encourages positive parenting and effective communication between parents and children regarding sex and sexual risk reduction. It also helps parents to better express their values and expectations. .

AB prevention activities will be conducted in collaboration with the Ministry of Health and the Fight Against AIDS (MSLS) through the PLS-PH, HOPE CI (Family Matters approach), social centers for support to victims of violence, and public health centers (medical support to IST and victims of violence).

The IRC will use its GBV expertise for "AB" Prevention by: training the PEs to provide clear and precise information on GBV, referring identified cases to social centers and public health centers, and contributing to better national coordination of GBV interventions through participation in PHV technical working group meetings.

The IRC works with the regional entities of the Ministry of Health and AIDS and other donors and stakeholders in its intervention zones.

Key actions for this component are:

Give grants to four local partners to conduct prevention activities that conform to AB guidelines

Support community mobilization and the identification of peer educators

Develop or adapt messages to different target groups through mini-workshops

Produce and distribute awareness materials and activity supplies

Develop a communication plan for AB activities

Organize training sessions for PEs in abstinence education, presentation skills and GBV

Organize training sessions for facilitators on conducting quality AB prevention activities through the "Family Matters" approach

Provide technical assistance to local institutions and NGOs

Develop activities to increase women and girls affected by HIV/AIDS access to financial resources and means of production

Testing and counseling (TC)D activities will complement and strengthen the IRC activities of the last year and those of other partners. Special emphasis will be placed on HIV testing.

Quality testing and counseling will be provided on-site. Sub-grants will be awarded to local partners to provide consulting services using two approaches: activities in the permanent centers and mobile activities.

Mobilization for access to testing centers:

To promote HIV testing and counseling services, the IRC will work with all financial and social partner networks, in particular targeting community leaders and at-risk groups. The mobilization will be made within the community to encourage people, in particular the AB targeted groups, to get tested. Given the particular strategy developed in prevention, priority will be given to those groups targeted by PE outreach. Mobilization activities will normalize testing in the population.

Members of certain groups living with HIV will be encouraged to disclose their status, to undertake the fight against stigma, to participate in outreach activities against stigmatization, and to encourage people to be screened.

Counseling and screening activities:

These activities will be conducted in accordance with national guidelines in this area.

In the permanent centers: They will accommodate everyone who expresses the need for voluntary testing.

The mobile activities (outreach): They will be directed towards screening for couples, families, and particularly vulnerable groups using the current national algorithm. The use of rapid tests performed on blood samples from finger-pricks will be used. Results will be communicated as soon as possible to reduce the number of clients who do not receive their results.

Training/re-training service providers (consultants, technicians, mobilizers and receptionist):

Training of community advisors will be conducted through a national pool of trainers made available by the NPEC on the following topics: counseling techniques, screening at your fingertips, and the management of biomedical waste. Medical staff will conduct coaching and on-site training supervision to assure the quality of the services. Tools to be used will be those produced and validated by the national plan.

Monitoring and supervision activities:

The partner will be responsible for providing the services, under the continued support of the local IRC team. In addition, regular supervision and reinforcement will be done on site by the IRC with the National HIV/AIDS Care and Treatment Program and local health authorities.

The management of biomedical waste:

This will be done in collaboration with the health districts. To this end, discussions with partners and local health authorities (Departmental Directors and Regional Directors of Health) will ensure that waste generated during the screening activities is regularly taken away and transported to the departments or regions secure disposal facilities. In addition to this, an appeal will be conducted with local authorities (City Hall and the General Council) to assist with this collection.

Management of biomedical waste will be done in collaboration with the health districts. Waste collection will be routed through the screening center and safely transported to the center of destruction in the district. The victims of accidental exposure to blood will be directed to health centers to benefit from PEP kits provided by other partners.

As part of the implementation of COP 2012, the IRC will continue to support prevention activities that focus on condom promotion and other types of prevention through grants to four local partners.

These interventions will primarily target persons whose sexual behaviors place them at risk of HIV transmission or infection, and those susceptible to infection because of their vulnerability (especially boys and girls aged 15-24).

In addition, the IRC will target women aged over 25 through womens associations, Women Training Institutes (IFEF), small traders, and domestic workers.

Especially with youth, the IRC will use the approach developed in the program "African Transformation" by JHU/CCP to promote desired social and sexual behavior change in young people. This approach will be coupled with that of peer education, which uses behavior change communication (BCC). BCC activities will include the use of condoms when AB prevention does not apply; the importance of testing (including within couples); decreasing, intergenerational sex, sexual coercion, and GBV; and promoting the prevention of mother-to-child HIV transmission.

JHU/CCC will provide training in its African Transformation approach to addressing unhealthy gender and social norms. The national pool of trainers, under the supervision of the Ministry of Health and AIDS (MSLS), will provide training on the IEC/CCC. To maintain and ensure the quality of services, joint supervisory missions will be organized with members of the national pool and the regional structures of the MSLS.

In addition to joint supervision, the IRC will closely work with other MSLS decentralized structures, regional coordinators of the MSLS and other donors and stakeholders in the intervention zones.

For the implementation of this component, the following key actions will be taken into account:

Grants to four partners to conduct OP prevention activities according to national standards and guidelines

The implementation of a mapping of OP interventions for the project

Development and/or adaptation of messages to different target groups through mini-workshops

Production and distribution of awareness materials and activity supplies adapted to the different identified target groups

Development of a communications plan for the OP activities

Organization of training sessions and/or refreshers for 150 peer educators to enable them to conduct quality OP activities

Training EPs on GBV prevention, including the identification and referral of survivors to social centers for psychological support and to health centers for medical support

Participation in technical working group meetings on PLHWA to reinforce national response to GBV and gender issues

Organization of joint supervisory missions with the national program for highly vulnerable populations for coordination of prevention interventions

Technical assistance to local institutions and NGOs through regular supervision

Making functional and/or revitalizing 60 outlets for condom sales. AIMAS technical support will be requested for the identification of condom outlets, training of sellers in condom social marketing, stock management, and the preparation and implementation of a sustainable mechanism to cover costs related to the sale of condoms.