This is a continuing activity from the FY 2007 supplemental and receives HVAB, HVOP and HVCT funding. This comprehensive prevention activity, addressing high risk populations along four major transportation corridors in Ethiopia, is planned as a follow-on program to the previous High Risk Corridor Initiative implemented by Save the Children USA.

Towns along the following transportation corridors will be targeted: Addis Ababa Djibouti (specifically Dukim, Adama, Metehara, Awash, Mille and Loggia); Addis Ababa Adigrat (specifically Kombolcha, Dessie, Weldiya); Addis Ababa Gondar, Debre Markos, Bahir Dar, Gondar; Modjo Dilla (specifically Shashemene, Yirgalem, Dilla and Awassa). Additional towns will be identified by the implementing partner in coordination with the USG to maximize HIV prevention activities in key towns.

Target populations include various subpopulations of adult men and women residing in and transiting through urban areas. Adult men (specifically transportation workers, men with disposable income, and migrant populations) appear to be engaged in high levels of informal transactional sex. Older adolescent girls and women, with specific emphasis on those aged 20+, who engage in transactional sex, will be recipients of ABC interventions and services to reduce their risk of becoming infected with HIV. Tailored HIV prevention programs will be established to reach adult women engaging in transactional sex in high-risk settings and in offsite areas. Structured peer promotion by at-risk population groups will be utilized to increase access to these groups. Population specific support groups will be utilized to encourage greater interaction and uptake of available HIV prevention and care services, including treatment.

The activity will expand structured HIV prevention activities in key towns along three additional transportation corridors to ensure at risk populations receive interpersonal and interactive HIV prevention counseling, condom distribution, and voluntary counseling and testing services. The activity will utilize structured implementation approaches to facilitate and sustain the adoption of prevention behaviors. It will link activities to clear behavior change objectives related to mutual faithfulness, partner reduction, and other prevention methods.

Lessons from the High Risk Corridor Initiative and the East African Regional Transportation Corridor Initiative will be incorporated into the design and implementation of this activity. The implementing partner will gather existing formative assessments on high risk behaviors, substance abuse, transactional and cross-generational sex for further analysis. Additional low-cost formative assessments will be completed by the implementing partner in collaboration with other USG implementing partners to better understand the target population's needs and the factors that expose them to a HIV risk.

The new activity will aim to build on successes and draw from USG interagency programming experiences in alcohol and substance abuse, targeted condom promotion, gender-based violence, and the Male Norms Initiative to address at risk populations in specific geographical areas where such populations congregate. Structured interpersonal and interactive behavioral change interventions will be strengthened. Inherent in the design of the activity will be strong referral to HIV/AIDS and TB services offered by public and private health facilities, mobile voluntary counseling and testing services, and community-based care programs within program implementation areas.

The main approaches in the program, BCC and peer education, have built-in cost effectiveness. The incremental cost of training and material production will gradually reduce as the program reaches more people over time. In many settings, the act of combining HIV prevention services is a cost effective way of reducing new infections over time; this should apply to this program also.

The activity will blend sub-partnering and direct implementation to address USG priorities. The implementing partner will engage in civil society local technical capacity building in key towns where available. The activity will place an emphasis on gender, specifically addressing male norms, including multiple partnerships, coercive sex, alcohol use and condom use. We also anticipate that the partner will leverage both USG and non-USG resources to increase at-risk women's access to productive income and services. Additionally this program will be subject to mid-term and end-term external evaluations.

As part of the strategic objectives aimed at preventing new HIV infections among at risk populations, COP 2010 activities strengthen linkages to care and support services in towns and commercial hotspots along or linked with major transportation corridors.

In COP 2010, eight training for new CHBC groups will be conducted for 50 trainees. Each training is expected to last 14 days. Twelve training sessions will be organized for 80 nurse supervisors. Twenty spiritual counselors will also be trained to complement the service provision. Monthly supervision meetings will be held to improve the service efficiency. Peer support groups (PLWHAPLWHAA) will be established or strengthened. Seventy-six referral systems will be in place and in use. Tear-away forms coming back through tracking system, and able to generate data on completed referrals and counter referral. The 36 town based referral advocacy meetings will be followed by a referral directories with a list of the health network members as well as the local NGOs and their partners to facilitate two-way referrals from the NGOs/communities to health facilities and vice versa. 17,949 individuals will be provided with HIV-related palliative care through 96 service outlets. It is home/patient and family-centered care that optimizes the quality of life of adults and children living with HIV through the care and support services.

TransACTION ensures the quality of the care and support program by providing refresher training to CHBC. PLWHAPLWHAA associations and other community-based organizations will receive capacity building support and will be involved in addressing MARPs through the comprehensive care and support package.

TransACTION will expand access for HIV and STI services (both static and mobile) through a network of private providers (private for profit, NGO clinics, and pharmacies) in 36 new towns along the South-East, South, South-West and West corridors. Mechanisms such as community mobilization (supported by mini and mass media), structured peer education focusing on at risk mobile populations and safety stops will increase demand for services to serve 120,000 MARPs. Finger prick algorithm will be used to avoid the need for cold chain and address the mobile population in a more effective and economic manner. One hundred and fifty professional, semi professionals or lay persons will be trained in PICT, STI syndromic management and couples testing to complement demand generated from comprehensive prevention education. TransACTION will address the needs of discordant couples and model effective approaches to couples HCT. MARP-friendly events or market places with HCT services will also be organized. To measure client satisfaction and monitor quality at mobile and static sites, supportive supervision, mystery client and exit interviews using national guidelines and an agreed upon strategy will be conducted. The program will support community awareness activities such as coffee ceremonies, drama and community meetings to address identified service barriers and gender and social norms. TransACTION reflects partner commitment to MARP-friendly services and the meaningful engagement of MARPs beneficiaries throughout the program cycle, including in the participatory Partnership Defined Quality.

The program will support provider training, utilizing participatory learning exercises, discussion, practical examples and role plays. The program will utilize existing HIV/AIDS job aids and develop additional aids as needed. As part of a continuum of care services, TransACTION will refer beneficiaries for HIV prevention services through peer educators and establish a referral to link clients to organizations and facilities providing HIV/AIDS-related services. Referral directories will include a list of the health network members and local NGOs and their partners to facilitate two-way referrals from NGOs/communities and health facilities.

TransACTION reaches MARPs populations concentrated along the transport corridors. Though TransACTION is focusing on MARPs, addressing them will require active engagement at the community and household levels. TransACTION trains a cadre of peer educators, selected with pre-determined criteria, on comprehensive HIV prevention topics. In this effort, they will target families, discordant couples and individuals who are not yet sexually active, but potentially at risk. Ideally the project trains one peer educator for one-to-one counseling and/or at the household level. The education sessions use peer interpersonal communication to teach positive behaviors, including abstinence and being faithful. TransACTION may organize events addressing the families of MARPs and aimed at reducing stigma. Mentorship support and supportive supervision will be conducted regularly to ensure and reinforce quality and consistency of AB messages. The quality of peer education and communication skills will be assessed using jointly agreed upon criteria which may include exit interviews, supervisory checklists, a self-assessment tool, content knowledge, use of participatory teaching methods, and standardization of delivery. A consultative process will be undertaken to define key evaluation questions, and to finalize the outcome evaluation agenda. A quantitative behavioral assessment will take into account other planned studies that may be occurring as part of national surveillance and AIDS control activities such as BSS and HIV surveillance.

In 2010, 19,500 most at risk individuals located in the 36 towns along the South-East, South, South-West and West corridors are being counseled and educated about risk reduction through peer educators and health care providers. The peer education sessions will depend on the size of the total population but will cover a two-five day TOT. Twenty rounds of peer educators and counselor trainings will be organized for 350 participants.

In COP 2010, TransACTION will reach 33,852 MARPs, CSWs, long distance truck drivers and mobile daily laborers. It will expand access to key combined preventive information and services among MARPs, reaching 36 new towns located in the West, North West and South West transportation corridors of the country.

MARPs will be reached by interventions that meet at least the minimum standards of service. Correct and consistent use of condom messages combined with STI treatment and HCT services and economic strengthening will be used. With PSI and DKT, 250 condom service outlets will distribute 228,000 condoms.

76 safety stops will be linked with health facilities for referral and will be used as hubs for outreach, providing information materials and condoms for MARPs. Each safety stop will have four peer educators linked to it. TransACTION will create a multi-channel campaign linking radio, peer education, service providers, and community mobilization, all reinforcing the themes of risk reduction and further spread of HIV.

TransACTION will provide HIV counseling and testing (HCT), referral and linkage to ART and other HIV/AIDS-related services among MARPs and their families. MARPs will have an enabling environment by expanding the alternative for sources of MARPs friendly clinical care service for HCT and STI treatment. Economic support will be provided for 2,400 beneficiaries through income generating activities (IGAs) for vulnerable groups and MARPs. Activities involve the formation of savings groups and addressing the skills development of selected IGA operators (240 beneficiaries) to improve the quality of their products and services through providing support for market-based vocational/apprenticeship training programs.

TransACTION will develop and support networks of private health facilities in the targeted geographic areas to provide quality STI management and HIV HCT services. Private providers that are included in the proposed health network will include both commercial and NGO providers. Technical capacity will be improved in 60 health facilities to provide MARP-friendly services; 444 health workers will be trained in provision of MARP-friendly HCT and STI treatment.