NASTAD became a PEPFAR partner in 2001 when it began to establish its long-term relationships with federal and regional HAPCOs. Initially, NASTAD developed and delivered training in community planning and proposal development to assist regions to help woredas to access EMSAP (pooled) funds. In 2004, NASTAD redefined its community planning training model to assist communities to mobilize for support of ART treatment adherence. NASTAD's work coincided with national strategic planning efforts in Ethiopia, and in 2006, NASTAD began to work with federal HAPCO to integrate its training modules into National Social Mobilization (NSM) trainings. NASTAD has since expanded its work in support of NSM by placing staff in three regional HAPCOs to support planning, referral, and coordination efforts through integrating ART treatment adherence modules into Community Conversation (CC) facilitator training and providing one-on-one follow up for CC staff in selected zones in five regions of the country. In addition, NASTAD began a twinning program, establishing relationships between Amhara and Michigan, SNNPR and Maryland, Oromia and Minnesota, and Dire Dawa and San Diego. As a result, TOT for quality management of CC has been developed and delivered for regional and woreda CC training staff, a collaborative nutrition support program for PLWAs has been established in Oromia, and replication of an evidence-based prevention intervention known as SISTAs is occurring among MARPs in Amhara.

Goals:

1. Strengthen capacity of national and local public sector staff to plan, manage and evaluate and coordinate public sector prevention, care and treatment programs

2. Build organizational capacity of the public sector to support the delivery of national and local HIV programs

3. Create sustainability in national and local programs

4. Capture community-based information from non-health sector in Dire Dawa and Addis Ababa.

Objective 1. Enhance the capacity of zonal and woreda health bureau/HAPCO staffs to manage, coordinate and implement the NSM Strategy, particularly the CC intervention

Objective 2. Integrate adherence promotion into ongoing CC training, planning and implementation.

Objective 3. Enhance existing CC activities in SNNPR to retain individuals in care, both prior to and during ART treatment.

Objective 4. Build technical and organizational capacity of national and regional government agencies to coordinate and sustain comprehensive HIV prevention strategies.

Objective 5: Promote behavior change and demand for prevention servicesamong MARPs in selected zones/kebeles in Dire Dawa, Oromia, Amhara, and SNNPR. Objective 6: Support collection and reporting of community level (non-health) program data.

Target Populations

Federal level HIV/AIDS agencies

Regional and Zonal HAPCO staff and woreda health department staff in Oromia, Addis Ababa, Dire Dawa, SNNPR, and Amhara

CC members

MARPs in Amhara, SNNPR, Oromia and Dire Dawa, including pregnant women

PLWHAs

Cross cutting programs

NASTAD will strengthen and support HR within regional and zonal HAPCOs and woreda health offices, support of the nutrition collaborative in Oromia, and address gender and gender-based violence through the dissemination of the SISTAs intervention in Amhara. SISTAs is an evidence-based intervention implemented in partnership with the Michigan state health department which empowers women with negotiating skills around sexual behavior.

Implementation Strategy

NASTAD has a central office in Addis Ababa for programmatic and operational coordination. NASTAD has placed regional coordinators in all five target regional HAPCOs who are responsible for delivery of all activities at the zonal and woreda level in each region. NASTAD also draws upon US state health department twinning partners who, as professional counterparts and peers to RHB/RHAPCO directors, can provide peer-to-peer support, technical and content expertise. Together, these staff and TA providers aim to implement increasingly cost-efficient and sustainable activities by transferring technical and programmatic skills, guidelines and processes to local public health staff, including

- Strategies, tools and guidelines to support planning, referrals and coordination

- TOT manuals and delivery of training to woreda staff

- One-on-one follow up support and mentorship to woreda staff responsible for managing kebele level CC activities

- Sponsorship of CC refresher trainings and review meetings

- Training and support of CC group members to promote community awareness of loss to care issues and provide support to PLWHAs to retain them in the care system.

- Tools and systems for the collection and utilization of community-level data

Monitoring and Evaluation Plan

NASTAD has developed a comprehensive M&E framework that identifies performance indicators and data collection sources and methodologies. For activities described, NASTAD will establish systems to collect unduplicated numbers of participants, and will rely on pre/post surveys of training participants, and interviews with participating regional, zonal and woreda staff to monitor targets and measure positive changes in performance indicators.

This activity has expanded its scope and requires streamlined COP 10 submission. NASTAD currently is in the process of strengthening and expanding community planning for its ART adherence program in three target regions and has started conducting review meetings in the focal zones to share lessons learned and to build future activities based on experiences gained thus far.

In 2010, NASTAD is planning to expand its community planning for community ART adherence activity to additional zones of the three target regions and also include Dire Dawa and Addis Ababa as target areas to implement this activity. In addition, NASTAD proposes to pilot an innovative, community based prevention of lost-to-follow-up services program in SNNPR, based both on the request of the region and on recent rapid assessments performed by NASTAD in the region.

The pilot program will have the following objectives:

Objective 1: To integrate the promotion of ART adherence into ongoing Community Conversation training, planning and implementation activities in five regions.

Objective 2: To enhance existing Community Conversation activities in SNNPR to retain HIV-positive individuals in care, both prior to and during ART treatment.

NASTAD will develop this adherence program to enhance its existing work in support of the national Community Conversations intervention, and using strategies consistent with Ethiopian national adherence guidelines.

This intervention is based upon a model of community engagement and empowerment in which an educated kebele helps to assumes responsibility for its members. Evaluation of this intervention will be two fold: (1) Baseline and follow-up surveys of the general community within a kebele will measure changes in knowledge, attitudes and other parameters before and after the intervention; (2) Adherence to medical visits and default rates at the clinic level will compare those from kebeles where this intervention is and is not implemented. The partner being within PEPFAR will play its part in Global Health Initiative (GHI).

With this new activity, NASTAD will support collection, reporting, and integration of community level (non-health) HIV program data into a community-based information system (CBIS) in Addis Ababa and Dire Dawa.

In FY09, NASTAD developed a framework to monitor and evaluate its programs, and by collaborating with Regional Health Bureaus and HIV/AIDS Prevention and Control Offices (RHBs/RHAPCOs), collects and analyzes data from woredas, community conversations sessions, and other community-based settings. Findings are disseminated to all HIV organizations, particularly at community level. Recognizing that NASTAD is committed to and experienced in collection of community-based data relevant to HIV programs, Dire Dawa RHAPCO, through its twinning partnership with San Diego, requested technical assistance for the development of tools, systems, training, and support for the collection and integration of community-level data into a CBIS system.

NASTAD is planning in COP10 to design and pilot a CBIS to capture HIV program data from the non-health sector of the community. Linking with the Federal HAPCO, and with the objective of strengthening national information systems, the CBIS will be piloted in Dire Dawa and Addis Ababa. These two sites are where NASTAD is currently engaged in community-based activities, including supporting Community Conversations and mainstreaming.

In COP10, NASTAD will: i) Establish a technical working group (TWG) of stakeholders, including representatives from RBOH/HAPCO, zonal and woreda health departments, and the community; ii) Assess existing CBIS and with the TWG classify and standardize community-based indicators, data sources, and data collection tools and methods; iii) Provide capacity building support for the training of community providers and other stakeholders in the collection, management, use, and dissemination of community-level data. NASTAD will assign a senior CBIS advisor to closely work with the Dire Dawa and Addis Ababa HBs/HAPCOs and will also deploy technical advisors from the San Diego HIV Department.

This activity has had a significant budget increase and expansion of scope. Community capacity enhancement through Community Conversation (CC) is a core strategy of Ethiopia's Social Mobilization Strategy. Since 2007, NASTAD has buildt the capacity of RHB/HAPCO staff to manage CC. In FY 2008, NASTAD placed regional coordinators within the regional HAPCO offices of Amhara, Oromia and SNNPR to deliver technical assistance for i) regional planning, coordination, and referral ii) delivery of CC program management training in three target zones to woreda managers, and iii) for one-on-one follow up assistance, supervision , and mentorship to these managers. NASTAD has also supported HAPCO in the implementation of Social mobilization strategy.

In COP 2010, NASTAD will increase support to four zones in each of the three identified regions of Oromia, Amara and SNNPR, and to four zones/kebeles in Dire Dawa and Addis Ababa.

Objective 1. To enhance the capacity of regional, zonal and woreda health bureau/HAPCO staff in five regions of Ethiopia to manage and coordinate implementation of the National Social Mobilization Strategy, particularly CC.

i) Provide one refresher training on CC program management per zone per region (20 TOTs);

ii) Provide ongoing TA to RHB/HAPCO, zonal and woreda staff through site visits and joint supportive supervision and feedback

iii) Sponsor quarterly zonal level CC review meetings and/or CC refresher trainings (100 meetings);

iv) Technically and financially support regional HAPCOs for monitoring, documentation and dissemination of CC best practices

v) Provide logistic and technical support to US state health department twinning partners to:

Develop protocols to improve referral linkages between community, community health center, and hospital at the zonal level

Develop comprehensive HIV planning toolkit and provide training and technical support to selected zones for development, implementation and monitoring of annual HIV plans

Support HAPCOs to coordinate partners

Support implementation of activities identified in specific twinning work-plans: in Amhara, adaptation, TOT and dissemination of U.S. community level evidence-based HIV prevention intervention SISTAS for MARPs of female students and commercial sex workers; in Oromia, development of community collaborative for sustainable nutrition support program for PLWAs; in Dire Dawa development of M&E data base and data collection protocols to improve CC and community based reporting. Other activities will be implemented as identified by twinning partners.