High Risk Corridor Initiative (HIV Prevention)

This is a continuing activity from FY06. This is a comprehensive ABC activity. This activity relates to activities in OP, CT and PC. In addition, Save the Children USA will collaborate with the AIDS Resource Center(10388,10606,10422), IOCC/Orthodox Church, (10512,10513,10511) PACT/Muslim Development Agency(10520), Abt Associates/Private Sector Program, OSSA/Mobile Counseling and Testing (10538)(Abt),10547 (HAPCO) TBD(10404) /Targeted Condom Promotion and Family Health International/MARPS in Amhara and ROADS project (10597).

High Risk Corridor Initiative Summary: Ethiopia's High Risk Corridor Initiative (HRCI), an HIV prevention and care intervention started in 2003, follows a busy transportation corridor originating in Addis Ababa until the border with Djibouti. Along the corridor 24 peri-urban and urban areas have HRCI-installed AIDS Information Centers and additional HIV prevention outreach activities to transport workers, commercial sex workers and in/out of school youth. Several services are offered including ABC education and STI/PMTCT/VCT referral. HRCI also has CT and Palliative Care (including wrap-arounds) elements to provide most at risk populations with HIV services and wrap-arounds in underserved areas. Approaches include information dissemination, active community conversations, group discussions, peer education and interactive drama. In addition, informative meetings with hotel and bar owners are conducted.

The target groups under this activity include: in/out of school youth; transportation workers and bar/hotel based commercial sex workers.

HIV prevalence information from recent ANC and EDHS surveys indicate that urban Oromia and Afar are critical areas to enhance HIV prevention efforts. Oromia's HIV prevalence using the ANC 2005 survey is 2.3% (urban 8.0% and rural 1.3%) and 2.2% using the EDHS 2005 survey. Several towns along the corridor are hubs for transportation, trucking and commerce.

COP06 Summary: In FY05 APR, 26,339 clients were provided with AB counseling services at AIDS Information Centers and in school programs targeting girls. In FY06 SAPR, 54,933 clients were provided with AB counseling services and in school programs targeting girls. 12,000 clients were provided with A-only messages.

COP07 Proposed Activities:

In FY07, the High Risk Corridor Initiative will maintain existing services along 24 towns of the Addis Ababa - Djibouti corridor and expand to provide HIV prevention services in towns along two additional transportation corridors: Debre Berhan - Kombolcha - Dessie - Weldiya - Mekelle - Adigrat; and Modjo - Shashemena - Awassa - Dilla.

Under the AB component, HRCI will build or strengthen existing partnerships with local school parent-teacher associations and predominant faith-based organizations to facilitate skills-training programs for parents to better communicate with their children about sexual behavior. HIV prevention education, discussion forums for both sexes, and young female support groups will be integrated into this informal training program. This activity strongly supports the Government of Ethiopia's Social Mobilization strategy. Utilizing Ethiopia's Youth Action Kit, HRCI sub partners will support local schools in AB programming by increasing the capacity of teachers and administrators, HIV/AIDS focal persons and in-school youth leaders to promote life skills, risk perception and abstinence programs in public and private schools for adolescents and youth age 14-19. Youths engaging in sexual intercourse will be referred to AIDS Information Centers or into at-risk youth activities for condom programming/wrap- around services to reduce the probability of HIV infection.

Furthermore, outreach B programming to males residing or transiting in the community will be implemented. Utilization of pre-existing materials will be maximized. Harmonization with the ROADS project's messages along the Addis - Djibouti corridor will occur. HRCI will work closely with the USG to develop broader community-level networks that leverage HIV prevention, care and treatment partners implementing activities in the same urban area.

High Risk Corridor Initiative (HIV Prevention)

This comprehensive ABC activity continues from FY06. It relates to activities in OP, CT and PC. Save the Children USA will collaborate with the AIDS Resource Center,10428, AB 10592, OP 10388 Treatment 10606, IOCC/Orthodox Church (AB) 10512 (pall) 10513, 10511 (OVC), PACT/Muslim Development Agency, Abt Associates/Private Sector Program, OSSA/Mobile Counseling and Testing, TBD/Targeted Condom Promotion and Family Health International/AB 10594, OP 10641 , 10404 MARPS in Amhara and ROADS project.

Ethiopia's High Risk Corridor Initiative, an HIV prevention and care intervention started in 2003, follows a transportation corridor between Addis Ababa and the Djibouti border. Along this corridor, 24 peri-urban and urban areas have HRCI installed AIDS Information Centers and additional HIV prevention outreach activities to transport workers, commercial sex workers and in/out of school youth. Several services are offered including ABC education, STI, PMTCT and CT referral. The Initiative also has CT and Palliative Care (including wraparounds) elements to provide most at risk populations with HIV services in underserved areas. Save the Children USA has worked with World Food Program to wraparound food baskets for their palliative care clients. Approaches include information dissemination, community conversations, group discussion, peer education and interactive drama. Informal meetings with high risk individuals such as hotel/bar owners, truck drivers, sex workers are also part of the initiative.

The target groups of this activity include: in/out of school youth; transportation workers and bar/hotel based commercial sex workers.

HIV prevalence information from recent ANC and EDHS surveys indicate that urban Oromia and Afar are areas critically in need of HIV prevention efforts. Oromia's HIV prevalence using the ANC 2005 survey is 2.3% (urban 8% and rural 1.3%) and 2.2% using the EDHS 2005 survey. Several towns along the corridor are hubs for transportation, trucking and commerce.

In FY05, 25,320 clients were served with OP counseling services at AIDS Information Centers. At SAPR06, 45,737 were provided with other prevention based counseling services. Beneficiaries included transport workers, bar and hotel-based commercial sex workers and out-of-school youth. HRCI is expanding and intensifying activities for most at risk populations (MARP) year by year.

HRCI has initiated several AIDS Information Centers and is currently transitioning ownership to local HIV/AIDS committees and Anti-AIDS Clubs. AIDS Information Centers are run by counselors whose services draw MARP. AIDS Information Centers are also platforms for outreach activities to transportation workers, bar and hotel-based commercial sex workers and out of school youth. Commercial sex workers and out of school youth participate in interpersonal peer sessions that emphasize ABC, harm reduction and risk perception. These meetings ensure commercial sex workers and out of school youth of a venue to obtain accurate information where they are challenged to participate in HIV prevention outreach and recruit additional individuals hard to reach individuals.

In FY07, the High Risk Corridor Initiative will maintain existing services along 24 towns of the Addis Ababa - Djibouti corridor and increase HIV prevention services in towns along two additional transportation corridors:

Debre Berhan - Kombolcha - Dessie - Weldiya - Mekelle - Adigrat Modjo - Shashemena - Awassa - Dilla

AIDS Information Centers will be transitioned to communities at risk for self management. They will continue to receive technical assistance and financial support from Save the Children USA. Counselors will be stationed in urban centers and secondary towns to provide information on correct consistent condom use and directly distribute condoms to most at risk populations; they will discuss HIV transmission and ABC prevention, provide information regarding available local community and facility-based HIV/AIDS services; and conduct outreach activities to hard to reach groups such as transportation workers, out of school youth and commercial sex workers. Counselors visit high risk settings (bars, hotels

etc, where MARP congregate) to distribute HIV prevention information including condoms. AIDS Information Centers and outreach services have supported the highly transient at risk trucking and commercial sex worker populations as they move along the corridor for economic reasons.

HIV other prevention activities include: (1) Collaborate with RHB/HIV Prevention and Control Offices to support provide other prevention services in surrounding areas (STI prevention, condoms to MARPS); (2) Transition information centers to communities and support them in partnership with local organizations; (3) Recruit and train counselors and outreach volunteers to target at risk populations; (4) Conduct interpersonal communications/peer education with youth, commercial sex workers and transport workers. MARP peer leaders will recruit hard to reach groups for prevention participation; (5) Intensify interactive drama and magnet theatre for hard to reach out of school youth; (6) Integrate substance and alcohol abuse into HIV prevention materials and life skills; (7) Make condoms and HIV prevention, care and treatment information accessible to most at risk populations in high risk settings via counseling and outreach activities in locations where truckers, commercial sex workers and out of school youth congregate; (8) Track condom availability in surrounding areas; (9) Collaborate with other USG partners to stimulate demand for mobile HIV CT services; (10) Refer to community and facility-based services including anti-AIDS clubs, support groups and community/home-based and clinical care treatment services.

High Risk Corridor Initiative (HRCI)

This is a continuing activity from FY04 -FY06. As of June 06, the partner received 100% of FY06 funds and is on track in achieving targets and work plan. Funding was increased based on the achievements to date.

This activity is linked to the HRCI CT (5719); HRCI AB (5601); HRCI OP (5599), WFP Food and Nutrition support and Promotion Positive Living and Self-Reliance for PLWHA (5774),Care and Support Contract-Palliative Care (5616), and ART Service Expansion at Health Center Level, PMTCT/Health Centers and Communities (5586). In FY06, SCUSA implemented community-based care and support programs in 22 communities to improve the well-being of PLWHA and to mitigate the effect of AIDS within families and the community. HIV-related palliative care was provided to 986 individuals. Moreover, 912 chronically sick PLWHA, 2,654 HIV/AIDS orphans and 53 PMTCT clients were linked to WFP food support in four major urban areas.

In FY07, HRCI will expand provision of home and community-based palliative care services along the Addis-Djbouti high risk corridor to reach a total of 24 communities, including Kulubi and Chelenko. The high risk corridor includes Afar, Oromiya, Dire Dawa and Somali Regions. SCUSA activities include training and support to care givers, spiritual counseling, promoting positive living, establishing support groups, identifying and referring for OI, STI, and TB treatment, and linking with WFP food support in four large urban areas.

SCUSA will provide the following palliative and preventive care services: medical and nursing care; pain management; treatment of skin conditions; diarrhea and oral problems; identification and referral for OI including TB screening based on symptoms, adherence to ART or OI treatment and prophylaxis; education on hygiene and safe water; and referral of household contacts for VCT and nutrition counseling. SCUSA will work with local community and faith-based organizations to deploy, train and supervise volunteer HBC providers.

In partnership with IOCC, SCUSA will provide spiritual, social and psychological care services. Refresher training will be given to spiritual leaders to deal with emotional and psychosocial issues of both infected and affected people. HRCI will also strengthen community-based support groups, community mobilization and leadership development of PLWHA to reduce stigma and strengthen affected households and communities.

SCUSA will train care givers in order to provide ongoing prevention messages for PLWHA in HBC settings to help them maintain safe sexual practices using abstinence, being faithful and correct consistent condom use (ABC). Condoms will be readily provided for those who choose to use them.

To reduce the morbidity and mortality caused by diarrhea, HRCI will educate PLWHA and their families on safe water and personal hygiene, including education on the use of chemicals for home water treatment.

In addition to existing food support in four large urban settings, HRCI will support training of HBC volunteers to assess the nutrition state of their PLWHA clientele and to refer them to health facilities when necessary. Needy patients will be linked to existing food support mechanisms. HRCI will work through CBO and other partners to mobilize internal and external (WFP, FAO, Food for Peace, etc.) resources to provide community-based nutrition services, (e.g. community meals, daily vitamin supplements, community gardens and food vouchers).

HRCI home-based care activities will be strongly linked to health centers and hospitals. For ART services, the HRCI will work closely with Columbia University, ITECH and health center level ART partners as well as other relevant PEPFAR and non-PEPFAR partners to strengthen referral systems through the use of standard procedures and regular meetings with health facility based HIV/AIDS committees.

In FY07, in Afar, Oromiya, and Somali regions, and the Dire Dawa Administrative Council along the corridors, HRCI will promote ART adherence and compliance as well as ANC attendance. The home-based care volunteers will receive basic training on ART referrals

and adherence counseling.

HRCI will continue to leverage local resources from 24 local HIV/AIDS Committees to assess the needs of and map available services for persons and families affected by HIV/AIDS. Through this approach, HRCI has strengthened the program context for wrap-around services and policies. This has resulted in community networks that are more user-friendly and confidential, able to mobilize resources, and able to coordinate community-based care and support services. SCUSA will continue to work with these local partners to conduct ongoing resource mapping along the high risk corridor.

HRCI will also continue to honor long-serving HIV/AIDS Committee members. This activity will also continue its capacity-building efforts, including training on resource mobilization, leadership, and simple accounting procedures. HRCI will support restructuring or election of new members, and revising by-laws as part of the Community Action Cycle. Kebele committees are encouraged to provide more representative involvement in community planning and to replace non-functioning members.

HRCI will also strengthen management and supervision of community-based palliative care services through sub-grant processes by building the capacity of indigenous FBO and CBO.

The High Risk Corridor Initiative (HRCI)

This activity is linked to the Mobile and Private Sector Counseling and Testing Services (5718); Community-level counseling and testing service support in Ethiopia; Care and Support Contract Palliative Care (5616), Care and Support Contract counseling and testing (5654), and ART Service Expansion at Health Center Level.

This is a continuing activity from FY06. As of June 06, the partner received 100% of FY06 funds and is on track according to the original targets/work. Funding was increased based on the achievements from FY05 and partially from FY06.

Since 2005, this activity has been establishing and supporting VCT service in 17 government health facilities along the Addis-Djibouti corridor and one free-standing VCT service. To date, over 35,000 people were able to access the VCT service in HRCI supported VCT sites.

In FY07, this activity will strengthen and institutionalize supervision, data management, procurement and inventory, referral to other HIV/AIDS prevention, care and treatment services in facilities and communities. It will also support the introduction and practice of confidentiality and regular quality control and assurance for HCT through woreda-based supportive supervision and linkages with regional or private laboratories. This activity will support implementation of outreach VCT to market places, information centers, health posts and public gatherings along the Addis-Djibouti transport corridor. It will continue support provision of consistent quality HCT services in 16 public health facilities and one stand alone center along the corridor. At the facility level, VCT support will include introduction of provider initiated counseling and testing services within clinical care settings, such as TB clinic, STI and ANC.

In order to expand the VCT services, community- and outreach-based counseling and testing will be initialized in three major towns and three workplaces. This activity will train and deploy 12 counselors and six assistants to conduct community based and outreach counseling services. The six assistants will be selected from PLWHA associations. Assistants will help in community mobilization, registration, and facilitation of referral linkages to community and facility based prevention, care and treatment services.

This activity will also train home-based care volunteers on counseling skills in order to provide ongoing counseling services to capitalize on positive living for PLWHA. Information center counselors in 22 towns will also be trained and provided with necessary tools and guidance to be able to provide pre-test counseling and referrals for clients seeking prevention services at the information centers.

In FY07, this activity will build the capacity of "Community HIV/AIDS Committees" to institutionalize Partnership Defined Quality (PDQ) processes in at least nine communities along the Corridor. These committees will have the capacity to monitor and address any barriers to VCT services and issues related to beneficiary satisfaction and how stigma and discrimination is experienced by PLWHA in the community.