The DRC Integrated HIV/AIDS Project (ProVIC) aims at reducing the incidence and prevalence of HIV and mitigate its impact on people living with HIV/AIDS (PLWHA) and their families. This objective will be achieved by: improving HIV/AIDS prevention, care and treatment services in 40 Champion Communities located in the 5 provinces of project (Bas Congo, Katanga, Kinshasa, Sud Kivu, and Orientale); increasing community involvement in health issues and services through sustainable community-based approaches; increasing the capacity of government and local civil-society partners and thereby empowering new local organizations and communities to plan, manage, and deliver quality HIV/AIDS services. ProVIC intends to work with and through grantees, and in collaboration with national government programs and other USG partners to ensure the achievement of its three intermediate results (IR): 1) HIV counseling, testing and prevention expanded and improves in target areas; 2) are, support, and treatment for PLWHA and (OVC) improved in target areas; and 3) health systems supported and strengthened in target zones. The project is closely working with government counterparts and the Champion Communities to ensure ongoing capacitation and effective transfer of skills, knowledge and best practices.

Since Year 2, three approaches have been introduced to work with adult PLWHA in the community: the positive living; the positive prevention strategy; and the palliative care strategy. The target populations are adolescents, adults and their families living in and around champion communities. Year 3 will continue these approaches, framed within an overarching strategy to build both resilience and capacity in the community increasing the number of people in target groups reached. Self-help groups (SHG), introduced in year 2, will be developed and strengthened and most importantly linked into the champion communities and health services in their community. The SHG will use a problem solving approach to look at common issues and use the forum to discuss and address these issues. The care givers will make regular visits to SHGs to identify those who need specific support and will make home care visits providing psychological, social, spiritual support and/or palliative care. They will also follow up on missing PLWHA, sick persons, families facing death, family facing stigma/discrimination, etc. PLWHA will be referred to SHG from other components of ProVIC project (HTC, PMCTC and medical or community structures) and they will be referred from SHG to community health facilities to address malnutrition and other OI, to NGO specialized in protection of vulnerable people to address legal issues. PLWHA will be linked to microfinance institutions in their area to get money for IGA to ensure their autonomy. Through the strategy above, the project responds to 2 and 3 priorities actions area of National strategic Plan against HIV/Aids and PEPFAR guidelines.To ensure the quality of services, the project will create a format for keeping individual social and medical records. The Care and Support Specialist will train the nutritionist and care givers or social workers on how to complete these forms and also train the grantees on how to analyze the forms. They in turn will train the facilitators and members of the group on how to maintain the form and how to review them on a regular basis so that health and social needs are monitored and needs are referred, with the end result of improving overall wellbeing.

The ProVIC strategy is family focused, offering both comprehensive and coordinated care that addresses the needs of adults and children in a family. It meets the health and social care needs of OVCs, either directly or indirectly through strategic partnerships and/or referrals to other service providers. The project links care and support work for OVC with care and support with the families in which they are situated because its in the families where decisions are made concerning a child's welfare.

The project focuses on children between 0 and 17 year old distributed in different groups (0-1, 2-5, 6-14, 15-17 years). Focus is on girls and boys living in and around champion communities. The main activities are centered on childrens welfare by providing health referral, food and nutritional support, access to school or training OVC in social entrepreneurship to get them autonomous, addressing child protection issues and OVCs phase-out plan.The child to child approach is the main strategy for addressing the care and support needs of OVC. This approach, rooted in health communication, encourages children to play an active and central role in their own development. It is based on the belief that children can be actively involved in their communities and in solving community problems. it involves children in activities that interest, challenge and empower them with the aim of achieving positive change on three levels: 1) Communal impact on families and positive changes in health attitudes and behaviors; 2) personal impact on children involved and strengthening of friendships; and 3) increased respect for childrens ideas and abilities.

The success of this project is the creation of child to child group witch help children to find solutions of their own problems to improve families and communitys welfare. However, the biggest challenge was to ensure a quality service delivered. The project is planning new improvements. For example in OVC schooling, the project will progressively move from paying school fees and kits to one time block grant investment to ensure sustainability. At the same time, grantees will be trained on strategies to help communities become more autonomous.

In year 2, ProVIC provided prophylactic cotromoxazole to 95% of targeted PLHWAs. In 2012,The project will ensure that 100% of PLWHAs are consistently provided with prophylactic cotrimoxazole either by the project or a local health provider, the project will work closely the care givers/facilitators and SHGs through the grantees to ensure there is well stocked supply chain of contrimoxazole to meet the gaps. The project will encourage grantees to work with SHGs to identify which health centres are not providing cotrimoxazole and encourage them to lobby for it to be provided. The importance of cotrimoxazole will be raised with the SHG by the facilitators trained in the key messages on prevention.

"ProVIC Health Systems Strengthening is designed to address all issues related to the poor quality of service delivery. Support is provided at the national level to refine policies, norms and directives, and activities are rolled out at the provincial level to reinforce providers competency and address some key issues such retention of human resource in their setting, incentive.

In regards to the DRCs highly international aid dependent system and the low financial contribution in the health sector, capacity building faces many challenges which undermine effectiveness of interventions. Planned activities intend to address these challenges by increasing the competency of services providers, others actors, and also strengthening the system in the provision of the needed resources. ProVIC will work to build sustainability by empowering the community to take over all activities aimed at their wellbeing.

All program intervention areas are concerned with improving the quality of beneficiarys life as a final goal of the program. Activities are driven by program results and limited by the available resources. Integrated services are delivered through the partnership with others actors. Services providers will be trained in PMTCT, HCT, sensitization, laboratory, bio medical waste management, care & support to PLWA, and OVCNGOs partners will be trained in the organizational development for a greater impact of community interventions.

Collaboration with others partners is a key issue for success. Activities are implemented closely in collaboration with its government counterpart, and achievements are designed according to the national HIV strategic plan. The government provides trainers, and USG partners provide any others needed resources to organize workshops, trainings. Support to the joint supervision and coordination meetings improves the quality of service delivery, and allows for needs based intervention adjustments.

"The project will use evidence based AB interventions for specific target groups that include young women and men aged 10-14, and 15-24 for abstinence and the couples for being faithful interventions.

The project, via NGOss, will establish collaboration mechanisms with selected schools in the target areas to identify leaders among students, developing and reinforcing their skills based sexuality, knowledge, fidelity practices and norms for mutual respect and open sexual communication. « Champion Youth Club or student associations will be developed and be used to increase AB behaviors among these specific groups. The members of champion youth club teach themselves to stop the spread of HIV/AIDS. Each leader of the club will receive a kit that contains: HIV visual aids, flyers, pamphlets, any other items.

For young men and women not attending school and street kids, the project will collaborate with NGOs, churches and other community associations involved in care, support and treatment for OVC in project sites. The project will reinforce the capacity of these NGOs/Churches/community associations to identify emerging leaders among young men and women not attending school and street kids, sharpening their skills based sexuality, improve their knowledge about HIV and responsible sexual behaviors and promote fidelity practices, mutual respect and open sexual communication. These young leaders will provide education and information among this specific group; a mobilization kit based on the activities above will be given to each young leader.

With regards to couples, the project via NGOs will collaborate with selected Churches involved in providing programs and services to couples to promote mutual fidelity and respect, open sexual communication, to discourage multiple partnership, sexual violence, provide information and knowledge on HIV-AIDS. The project will reinforce the capacity of these organizations by providing them with materials, training modules and skills needed to achieve the stated activities.

The project expects to reach 129,000 peoples with interventions focused on abstinence and being faithful.

Three types of HCT services are implemented in ProVIC sites: mobile HCT service, Community based HCT and the provider initiated counseling & testing (PICT)

Adapted equipments (tents) were acquired to run the mobile HCT services for outreach to deliver testing services for MARPS in their setting.Peer educators are trained to sensitize their peers to adhere to the services. Innovative strategy for instance running the service tonight to reach CSW, MSM is succefully used in different sites. In the community based HCT, sensitization is done within the champion communitys sites, this service is mainly addressed to the Champion Community in order to promote testing & counseling. Community workers refer the clients to the needed services in health or community facilities.

In fact, the PICT strategy, services providers are trained to initiate the counseling & testing at any contact with the clients and their families during the out-patient or any consultation in the health facility. As needed, referrals are usually used between the PICT and other services within the hospital or communitys based serviceIn order to reduce barrier for access to services, Champion community approach offers an opportunity to reinforce the link between the community and the health facility. The patient seeking behavior is addressed through the identification of available services. In order to ensure the quality of testing services, the facilities perform an internal quality control of sample monthly, and the national laboratory ensures a quarterly randomized control of samples.

Target PopulationNumber to be reached by each intervention componentActivityCSW 14,400 sensitizationMSM 1440 sensitizationTRUCKERS 21,600 sensitizationFISHERMAN 18,000 sensitizationMINERS 16,560 sensitizationGENERAL POPULATION 516,000 sensitization

The project will use a series of interventions based on current evidence-based sexual prevention strategies to reach the general population and specific target group that include MARPs (CSW, MSM, Truckers, Fishermen, Miners and other uniformed services), women and men aged 15-24, 25-34, 35-44 and more than 45. The program strategy is focused on targeting high-risk population through the champion community approach. This will be done by reaching 516,000 people and 72,000 MARPS in 40 traditional communities through 4 ProVIC regions of intervention (Kinshasa, Matadi, Lubumbashi, and Bukavu).Each Champion Community has at least 40,000 people .Communities are aware of vulnerable populations and their specific locations. These sites include youth hang-outs, police stations, truck stops, hotels, bars or informal meeting place for commercial sex workers. As such, local communities are key to bringing the problem to light and dealing with it. Through effective communications, open dialogue and interpersonal outreach; community members will encourage people to reject unhealthy behaviors and seek testing, counseling and or care and support.In our work with the communities, we facilitate the development of community objectives and actions that target MARPs. In this way the community becomes responsible for its MARPs, Community volunteers are identified and recruited among all specific groups during the champion community process to provide education and information and to raise awareness and knowledge about the importance of prevention. Those volunteers are used as local resources and community liaisons to promote services. Each community volunteers receives a kit that contains: HIV visuals aids, flyers, pamphlets, any other items required for their activities. Peer educators training for the communitys volunteers is conducted based on the PNLS modules.

ProVIC PMTCT team will implement peer to peer sites in Kinshasa and Katanga. The existing ProVIC sites will serve as central sites to reinforce capacities of peripherals sites in terms of PMTCT. Also, we will organize a tailored TOT for the mentors across the targeted two provinces in 2012 and three others provinces in 2013. The pool of trained trainers and providers will help to scale up PMTCT activities across 5 provinces. In addition, in 2012, we will implement PMTCT activities in 6 news PTMTCT sites in Kisangani. The central sites will become the center of a mentorship and training network for the satellite sites, with providers from the central sites visiting the satellite sites to initiate clients on ART and provide guidance and supportive supervision to PMTCT providers at the satellite sites. The providers from the 6 news PMTCT sites will be trained during the Integrated HIV training. ProVIC PMTCT team will ensure the supplies and commodities provisions in those sites as well as PMTCT implementation. Based on the PMTCT cost estimation in DRC context, ProVIC found that the unit cost for PMTCT is ebtwen US$ 102- US$ 150. Given limited resources but striving to maximize impact and results, ProVIC plans to employ a decentralized approach to PMTCT service provision. At the national level:In 2012, ProVIC PMTCT team will participate and reinforce the National PMTCT technical group. During this period, the National Technical group will be focused on the Elimination plan development and global fund R11 proposal development, which is focused in PMTCT.Best practices: In 2012, ProVIC PMTCT team will supervise an international expert who will help to develop a plan to implement quality improvement strategies at ProVIC PMTCT sites. Keys ProVIC technical staff will be trained on the QI approach. QI model will be rolled out to all ProVIC PMTCT sites. We will ensure that the medical wastes are well managed in all the PMTCT sites. . ProVIC PMTCT team will continue working together with Community mobilization team to reinforce the integration of PMTCT targets into the Community Champion model, leading to increased uptake of PMTCT services and male involvement.