This project will further strengthen sustainable prevention, care and support activities and linkages to services reaching the most at-risk and vulnerable populations along the transport corridor. We do not envision ROADS as a large stand-alone project. It is a gap-filler and will need to closely integrate its activities into PEPFAR activities already on the ground. The project will established a Safe-T-Stops resource center in various sites that provides prevention services to the truckers and vulnerable populations (such as FSW and women engaged in transactional sex) and works within the community to promote services at the Health Center (including counseling and testing) and provide prevention programming and outreach at high-risk venues through community events and through peer education.

The following are key tenets of the projects strategic approach:

1) Focused Interventions: This project will be a focused set of gender and HIV prevention sensitive interventions targeting specific clearly defined problems to be resolved within a 3-year timeframe;

2) Evidence-based strategies: This project will adapt an innovative mix of strategies and risk-reduction approaches that are based on current epidemiological and programmatic evidence, to target priority audiences with simultaneous behavioral social normative and structural interventions that respond to local realities;

3) Coordination with other USG-funded partners: Within targeted provinces, this program will work in close coordination with other USG implementing partners focused on supporting province-level capacity and governance, economic growth, health, HIV/AIDs, social protection, peace and security, to ensure USG funded programming is having the maximum possible impact.

HIV prevention with PLHIV integrated into routine care will be a core component of a comprehensive and integrated HIV prevention, care, and treatment strategy.The key elements of a strong care and support program are interventions that lead to: a) Early identification of HIV-infected persons, linkage, and retention in care. Most HIV-infected persons enter HIV treatment and care programs with advanced disease. There is a need to identify persons earlier in their illness and to create effective linkage and retention mechanisms to maximize the benefits of HIV treatment and care;b) Reduction in HIV-related morbidity and mortality. Because of proven effectiveness and cost-effectiveness for reducing mortality, provision of cotrimoxazole to PLHIV support groups (CTX) prophylaxis and TB identification and treatment are very high priority interventions. Other services (prevention of malaria, WASH, food and nutrition, and others) that can reduce early morbidity or mortality outcomes will be implemented, depending on funding; c) Improved quality of life. The provision of appropriate psychological, social, and spiritual support are important elements in improving the quality of life for HIV-infected persons and family members and other contacts affected by HIV disease and d) Reduction in transmission of HIV infection from HIV-infected to uninfected persons. PwP programming, integrated into HIV care services, is critical for reducing the risk of ongoing HIV transmission. PwP activities include short term and ongoing behavioral counseling to reduce high-risk behaviors, distribution of condoms, attention to risks imposed by alcoholism and use of other drugs, and screening and treatment of sexually transmitted infections. Each of the above elements will be supported within a framework of key cross cutting considerations, including sensitivity to gender-specific issues, linkage of facility-based and community/home-based services, equitable distribution of services across geographic areas and populations; sustainable improvement in health care systems; improvement in the quality of programs, and appropriate monitoring and evaluation.

A specific focus of the strategic communication strategy including training) to promote abstinence, including delay of sexual activity or secondary abstinence, fidelity, reducing multiple partners and concurrent partners, and related social and community norms that influence these behaviors. Activities will address programming for both adolescents and adult, with a particular focus on HCT as an entry point. Part of bridging community to care will be involving health providers in developing and refining educational content and approaches. Encouraging involvement of providers and training them on HIV stigma and discrimination will help cement community trust of health facilities that are often viewed with mistrust. In this context, the project will partner with local health facilities in developing and adapting materials for PLHIV and the general public to enhance client-provider interaction on all services. It will be essential to involve facility, government and community opinion leaders as spokespersons in local radio, newspapers and public events. Working with health care providers on interpersonal communication skills to minimize stigma within the care setting is critical. Comprehensive HIV prevention package of best-practice interventions and SGBV awareness, with a focus on the high prevalence areas along transport corridor and other critical hot spots are provided to MARPs and vulnerable populations.

ROADS DRC will work closely with PNLS, health zone management teams, health facilities, community-based organizations and other development partners to strengthen HTC services in Kawama and Sakania in Katanga Province, and in Kisangani and Bunia in Orientale Province. With a strong focus on continuous quality assurance/quality improvement, the services will be offered through health zone facilities (15) and the four SafeTStop Resource Centers. The project will support PNLS and PNMLS to ensure national HTC guidelines are adhered to in target health zones. In coordination with PNLS, ROADS DRC will train health workers to offer HTC services that are friendly to key and other vulnerable populations and expand provider-initiated testing and counseling (PITC), highlighting confidentiality as a key element of quality services.The goal is to develop multiple HTC portals accessible and convenient for target populations in an enabling environment. A key focus will be strengthening the coordination role of PNLS in HIV service delivery. Key activities will include:

--Strengthening PNLS capacity at the provincial and health zone levels to plan, expand and sustain HTC for key and other vulnerable populations, in accordance with the Strategic Plan in the Fight against HIV 2011-2015, provincial HIV and AIDS plans and national HTC guidelines;

--Ensuring strong referral linkages between HTC and other community- and facility-based services, including PMTCT, ART, TB, FP/RH, GBV and other services;

-- Provide HTC services in SafeTStop Resouce Centers at convenient hours;

-- Expand HTC services to PLHIV family members in a family-centered approach;

-- Provide ongoing training, technical assistance and support in existing and new sites, with a focus on new modalities for HTC provision;

-- Strengthen HTC mobilization through community clusters and linkages with other development partners;

-- Engage PNLS and PNMLS in advocacy to permit home HTC, which has not yet been integrated into the national policy;

-- Support training and counselor supervision for practicing counselors reaching key and other vulnerable populations

Comprehensive HIV prevention package of best-practice interventions and SGBV awareness, with a focus on the high prevalence areas along transport corridor and other critical hot spots are provided to MARPs and vulnerable populations, specifically targeting HIV preventative efforts among MARPs (MSM, SWs, and SW clients) and vulnerable populations such as alcohol and other drug-using populations, mobile populations, and persons engaged in transactional sex. Additionally, the program will cover activities that target condom and other prevention other than abstinence and be faithful programs for the general population.

These will be the mechanisms to significantly increase the coverage and intensity of messages promoting consistent condom use and HCT, for example, and to directly provide relevant community based prevention services. This strategic thinking needs to be guided by the local epidemiology of the HIV epidemic, including consideration of populations at elevated risk, the drivers of that risk, and geographic areas of high transmission. Once identified, these populations should be reached with interventions that include the core components of evidence-based interventions. Comprehensive, accessible, acceptable, sustainable, high-quality, user-friendly HIV prevention, treatment, care and support services will be scaled up and adapted to different local contexts. Even where services are theoretically available, sex workers face substantial obstacles to accessing HIV prevention, treatment care and support, particularly where sex work is criminalized. Ensuring that sex workers and their clients have meaningful access to essential services demand sconcerted action to overcome structural factors that limit access. Stigma and discrimination will be effectively addressed through engagement of civil society and policymakers

ROADS DRC will work with PNLS, PNMLS and health zone management teams to support ART services in the four target health zones. The health facilities will include some of those identified for strengthening of PMTCT and HTC to foster integration, cross-referral and comprehensive care and treatment. Activities will include limited refurbishment, provision of basic equipment, and provider training. ARVs will be sourced through the USG and Global Fund procurement systems. ART services will be linked closely with other health facility units (TB, FP/RH, etc.) as well as community-based services such as HBHC to ensure cross-referral and minimize loss to follow up. Through a case management system, individuals who test positive for HIV will be enrolled in care and treatment at participating health facilities, and tracked along the continuum of lifelong treatment and care. A key focus will be strengthening the coordination role of PNLS in HIV service delivery. In COP FY 2013, ROADS DRC will support enrollment of approximately 100 individuals on ART, with PMTCT as the entry point; all HIV+ pregnant women identified through PMTCT services (estimated 250) will be referred for TB screening. ROADS DRC will utilize program monitoring data, linked with service statistics, to evaluate outcomes and the efficacy of program stategies addressing the needs of key and other vulnerable populations.