This is a continuation activity from FY08 and FY09 after US-based universities have partnered with the Family Guidance Association of Ethiopia (FGAE) to initiate PMTCT, HCT and STI activities in their existing reproductive health (RH) service outlets. In COP 2010 these activities will continue and expand but under a new TBD mechanism. This mechanism will help to facilitate graduation of local sub-partners to prime partners that are capable of carrying out the activities by their own. Furthermore, it will contribute towards ensuring sustainability while reaching high-risk populations at the same time.

Because of very low ANC coverage, Ethiopia has the lowest PMTCT uptake of all the PEPFAR countries in Africa. The PMTCT program in the NGO health sector has been initiated to contribute to the overall effort of improving the uptake of ANC, labor and delivery, in addition to PMTCT services in the country. The project has the objective of expanding PMTCT in FGAE health facilities, as these facilities are located in urban settings where the HIV prevalence is highest in Ethiopia. In FY08 and FY09, JHPIEGO has supported the FGAE to integrate PMTCT into existing RH services.

A recent survey in Ethiopia has shown that STIs are common among MARPs, who tend to seek STI treatment from drug vendors, traditional healers, and open marketplaces. Services provided in these facilities are inferior in terms of provider knowledge, condom promotion, demonstration, and supply, as well as linkage to HIV/AIDS services, including VCT, care/ART, PMTCT, and education. Therefore, confidential, user-friendly clinics for MARPs are essential for providing them with comprehensive prevention, care, and treatment services for STIs and HIV. Urban settings have a high concentration of commercial sex workers (CSWs) in Ethiopia.

The FGAE is a local NGO established in 1966 advocating for the promotion of RH rights and in improving access to RH services. At present, the association runs a network of 18 comprehensive RH clinics, 28 multi-service youth centers, and 850 community-based and 250 outreach service delivery outlets. Starting from early 2002, FGAE has managed to make significant contributions in HIV prevention by integrating VCT, PICT, PMTCT, STI services and community home based care.

The PMTCT services that have started in FY08 continued to expand in FY09 to reach 22 FGAE clinics under a different mechanism, with JHU/TSEHAI as the prime partner and JHPIEGO as a sub-partner because the cooperative agreement with JHPIEGO had expired. In FY09, FGAE expanded HCT services to 39 sites. In FY09 US-based universities partnered with FGAE to establish six confidential STI clinics for CSWs in Addis Ababa, Eastern Oromyia and other major urban centers in Ethiopia.

In COP 2010, the PMTCT activity will be strengthened in 22 FGAE clinics and HCT services will be initiated in 23 FGAE youth centers. The activities include:

1. Training of FGAE staff working at health clinics, community-based and outreach services.

2. Assist and facilitate implementation of the revised PMTCT guidelines

3. Ensure regular supply of PMTCT commodities including test kits and ARV drugs

4. Establish 2 additional labor and delivery services at 2 sites

5. Establish Mother Support Groups (MSG) at 5 sites

6. Support initiatives to expand PMTCT services in the private/NGO sector

7. Regular mentoring and supportive supervision.

In COP 2010, the HCT activities will continue to be expanded and strengthened at 40 sites. The activities include:

1. Training of FGAE trainers in VCT, Couple HCT, and PICT

2. Training providers in PITC and training VCT counselors (including community counselors) and FGAE counselors in Couple HCT and burnout management

3. Supporting VCT, Couple HCT and PITC services at all sites

4. Train and support volunteers to perform CT outreach activities, including provision of HCT in the community

5. Document HCT best practices

6. Procure test kits and medical supplies, if these cannot be leveraged from sources funded through the Global Fund for AIDS, Malaria, and Tuberculosis

7. Support FGAE to provide outreach CT programs at the market place and during community mobilization

In COP 2010, the Confidential STI Clinics will expand to 12 sites in other major urban towns in Ethiopia. The following major activities will be undertaken to realize the project objectives:

1. Identification of clinic sites and implementing partners for the confidential MARPs clinics.

2. STI diagnosis and treatment, including drug provision for MARPs,

3. Condom promotion and provision,

4. Establishment of peer-support groups, STI education

5. Counseling and referral linkages to VCT, ART and PMTCT

6. Communications skill training will be provided to clinic staff to improve service delivery and to make user-friendly.

7. Support renovation of the confidential clinics

8. Promotion of clinics emphasizing their low cost/free services, confidentiality, and quality of service (including hospitality)

This activity was previously funded through a cooperative agreement with Jhpiego. That agreement is expiring and is being re-announced for competitive bid.

The Family Guidance Association of Ethiopia (FGAE) is a local NGO delivering sexual and reproductive health services in an integrated fashion. Services family planning, cervical cancer diagnosis, care for rape victims, management of sexually transmitted infections (STI), and HIV services (e.g., VCT, condom promotion and distribution, treatment of opportunistic infections). FGAE's programs and services cover many parts of the country through branches in regions, sites in workplaces, youth centers, and outreach and marketplace activities.

In FY 09 through PEPFAR/Jhpiego support, FGAE expanded HCT sites to 39 and the number of people tested reached more than 35,000 in the last half year (SAPR 09). Through this support FGAE will strengthen VCT and introduce PITC services in 40 clinics and youth centers. Outreach workers will be trained to provide education and referral for HCT services. Sample collection through finger prick will be used in all sites.

For FY10, the FGAE activities will continue to expand current activities, including:

1) Training of FGAE trainers in VCT, CHCT, and PICT;

2) Training providers in PITC and training VCT counselors (including community counselors) and FGAE counselors in CHCT and burnout management;

3) Supporting VCT, CHCT and PITC services at all sites;

4) Training and supporting volunteers to perform CT outreach activities, including provision of HCT in the community;

5) Document HCT best practices;

6) Procure test kits and medical supplies, if unable to be leveraged from sources funded through the Global Fund for AIDS, Malaria, and Tuberculosis;

7) Support FGAE to provide outreach CT programs at marketplaces and during community mobilization.

This is a continuation activity that is being re-competed in COP10. In FY09, US-based universities partnered with Family Guidance Association of Ethiopia (FGAE) to establish confidential STI clinics in Addis Ababa and other major urban centers. The objectives of this activity are to establish comprehensive services for MARPS including STI, and to link with other services like mobile counseling and testing, ART, PMTCT, and prevention education.

STIs are common among MARPs, which include commercial sex workers (CSWs) and their clients, long-distance truck drivers, vulnerable women, substance abusers, street people, migrant workers, and bar owners. Due to stigma and lack of accessible and affordable health services, MARPs with STIs tend to seek treatment from drug vendors, traditional healers, and marketplaces. The services provided in these venues are inferior in terms of provider knowledge; condom promotion and supply; linkages to HIV/AIDS services; and prevention education. Confidential clinics are essential to reach MARPS and provide them with comprehensive services.

In FY09, six confidential STI clinics were established in FGAE clinics in Addis Ababa and Eastern Oromia Region which provide comprehensive STI/HIV services, reproductive health and post-exposure prophylaxis services for MARPs, CSWs and rape survivors. Previous efforts have established FGAE's links to HCT and ART services and have improved confidential clinical STI/HIV/RH services.

In FY10, this activity will expand to several other major urban towns. To ensure sustainable programs, this activity will ideally be transferred to local institutions with capacity to assume the activity. FGAE's university partners will help develop a transition plan.

The major activities of this project are to:

1) Identify MARP clinic sites and implementing partners.

2) Provide STI diagnosis and treatment.

3) Promote and provide condoms.

4) Establish peer-support groups and STI education.

5) Counsel and refer clients to VCT, ART and PMTCT.

6) Provide communications skills training to staff to improve service delivery and user-friendliness.

7) Support renovation of confidential clinics,

8) Promote clinics, emphasizing their low cost/free quality services, confidentiality, and hospitality.

This is a continuing activity. In COP08, JHPIEGO supported expansion of PMTCT services to FGAE clinics throughout Ethiopia. In COP09, JHU/TSEHAI further expanded PMTCT services to 22 FGAE clinics through JHPIEGO. To date, 10 FGAE clinics have been able to offer HTC services to all ANC clients. JHPIEGO and FGAE are negotiating with the officials from Regional Health Bureaus to make ARVs available to HIV-positive pregnant women. Currently, this group is being referred to nearby health facilities because of an ARV shortage at FGAE clinics.

JHPIEGO has trained FGAE staff on the new PMTCT guidelines and efforts are also underway to renovate and equip two labor and delivery clinics at Hawassa and Harrar. JHPIEGO has also established referral networks to link HIV-positive women to ARV services in all regions.

In COP2010, this activity will continue with a TBD prime partner, selected on a competitive basis. To ensure sustainability, the sub partner (FGAE) is also being encouraged to compete for the award on its own.

In COP, the partner will:

Strengthen ongoing PMTCT activities in FGAE clinics.

Expand to 18 additional FGAE clinics, bringing the total number of sites to 40.

Continue supporting established L&D services.

Ensure the availability of ARVs at all FGAE clinics.

Undertake extensive community level PMTCT awareness campaigns in all catchment areas through outreach and CBRHAs.

Establish and support Mothers Support Groups at five FGAE sites.

Undertake minor renovations to improve service quality.

Strengthen the integration of PMTCT into routine FGAE activities

Ensure the organized and integrated implementation of the four-pronged approach to PMTCT.

Support the implementation of quality improvement models.

Improve the PMTCT M&E system and documentation of best practices for FGAE clinics.

Boost counseling on infant feeding options.

Conduct training on PMTCT/ART/infant feeding.

Design and implement family-based approaches to improve male involvement in PMTCT.

Ensure that the necessary job aids, IEC materials, PMTCT testing and counseling tools are available in FGAE clinics that provide PMTCT services.