This is a continuing activity. Columbia University (CU ICAP) supports comprehensive HIV services to decrease new HIV infections, expand ART services and provide care and support to PLHIV and their families. CU ICAP supports activities in Oromia, Harari and Somali Regional States, and the Dire-Dawa City Administration. It covers all hospitals and health centers providing HIV/AIDS services in these regions, including urban and rural populations, pastoralist and mobile populations. All but Somali Region have started direct agreements with the USG through PEPFAR to facilitate transition in partnership with CU ICAP. CU ICAP's focus under COP2012 is to integrate PMTCT services with MNCH services and provide HIV, HTC, ART and care and support services; integrate TB/HIV services; provide comprehensive HIV-related laboratory services and support the health management information system; implement a quality improvement system; increase human resources capacity, especially new medical doctors and emergency surgical officers; and build FMOH/RHB capacity to support delivery of standardized HIV services. As part of the 2012 USG PEPFAR interagency reconfiguration in Ethiopia, ICAP will assume new responsibility for at least 186 health centers in Oromia Region in addition to 39 hospitals, accounting for ~24% of PEPFAR-supported ART patients in Ethiopia. Given this expansion, CU ICAP may require an additional 30 purchased/leased vehicles with a unit cost of ~$45,000. The CU ICAP program supports the goals of the GOE's National Strategic Plan II (SPMII) as well as the GOE and USG HIV/AIDS Partnership Framework and Global Health Initiative. CU ICAP has a system in place for routine performance monitoring and reporting.

In FY2010 and 2011, CU ICAP has supported health facilities to develop community resource mapping matrices which could assist referrals of PLHIVs from health facilities to the community based organization (CBO) for various care and support services. Under COP2012, CU ICAP will continue its support in updating the community based resource mapping matrix and encourages CBOs involvement in MDT as well as catchment area meetings in order to enhance the referral linkages. It also strengthens the capacity of case managers and adherence supporters interaction with the CBOs as well as with the HSEP in order to enhance the tracing of LTFU PLHIVs who are in chronic care. In order to improve retention of PLHIVs in care, CU ICAP continues supporting nutrition assessments, counseling and support services at ART and PMTCT units in collaboration with USAID partners working in the area. It also ensures the availability, distribution, proper training, utilization, and monitoring of the adult preventive care package in all facilities. CU ICAP will also provide TA and in-service training on improved WASH behavior and practice for different cadres of health care workers using the training material adopted by AIDSTAR-One.

IEC/BCC materials will be developed and translated to local languages to bring about an evidence-based behavior change and reinforce the simple doable actions of WASH. They will work on mental health service integration in some facilities in partnership with JHU-TSEHAI. CU ICAP strengthens site level mentorship and supervision on CPT, considers CPT as one of the quality improvement indicators and will assess healthcare providers compliance with the national CPT guideline. It strengthens pain assessment and management with pharmacologic and non-pharmacologic interventions to ease distressing pain and symptoms of PLHIVs in all CU ICAP supported facilities. CU ICAP will also develop a pain management monitoring tool and will work closely with PFSA to ensure the supply of pain medicines including oral morphine. CU ICAP will promote the Prevention with Positive/Positive Health and Dignity Prevention (PwP/PHDP) activities in all of its supported facilities and will scale up FP integration into ART units. Throughout CU ICAP's program, linkages with community support services will be created and/or further enhanced. Where applicable, gender issues will be integrated into activities, particularly prevention of gender violence and coercion. Refer to indicators and targets for magnitude and impact of CU ICAP's program.

In FY2011, CU ICAP continued to provide a full-time TB/HIV integration expert assigned to FMOH/FHAPCO. CU ICAP also assisted the national TB program review, TB treatment regimen shift in supported areas, worked with Jimma and Haramaya Universities to build their capacity, and supported MOH, HHS/CDC, and EHNRI initiatives to establish TB culture facilities at the regions.

Under COP2012, CU ICAP will continue to build the capacity of RHBs and local universities for smooth transition of TB/HIV programs to the RHBs per the transition plan. In collaboration with the RHBs, CU ICAP will continue to support 69+194 sites in 4 regions to provide integrated TB/HIV and MDR TB services. Specific activities include:

Support routine TB screening in HIV patients and integrate TB screening to ANC, PMTCT and pediatric clinics.Strengthen PITC to test all TB patients and suspects for HIV and link HIV co-infected TB patients with HIV care and treatment services.Strengthen family based approaches and contact investigations.Improve pediatric TB diagnosis for HIV exposed and infected children.Scale up IPT uptake to HIV positives.Provide CPT to all TB/HIV co-infected patientsImprove M&E of TB/HIV programs and collaborate with EHNRI in TB/HIV surveillance.Develop and share provider support tools for TB/HIV management.Collaborate with EHNRI and regional labs to introduce improved TB diagnostic services including bleach concentration, fluorescent microscopy and other technologies as appropriate.Support FMOH to roll out the training of physicians on chest X ray reading.Support minor renovations of TB clinics, waiting areas and isolation wards to minimize nosocomial transmission.Implement basic administrative and environmental TB IC measures, and provide supplies.Undertake evaluations to assess impact of IPT and other TB/HIV interventions on morbidity and mortality among HIV patients in care.Support MDR-TB treatment scale up at supported regions.Support community TB care at Dire Dawa, Harar and Somali regions and pilot community level sputum sample transportation.Support the expansion of TB DOTS.Improve access to PWP services at the TB clinics.

CU ICAP led the establishment and rollout of the national pediatric care and support program. In FY 2010, they supported pediatric care and support services at 69 facilities. These services and activities included the initial site-level assessment, training of the multidisciplinary teams, clinical mentoring, data collection and reporting, renovations and supportive supervision. Under COP2012, CU ICAP will support the pediatric services across hospitals and health centers in its entire operational zone including an additional 120 health centers in Oromia. Key activities will include:National / regional level support for the development of guidelines, training curricula and standard operating procedures.Strengthen EID service delivery as well as the intra-facility linkages required to test and identify HIV positive children.Ensure all HIV exposed and infected children/adolescents receive caring and consistent psychosocial support services including HIV status disclosure, adherence counseling and bereavement care.Provide on-site implementation assistance, including staff support, implementation of referral systems, and support monthly pediatric HIV/AIDS team meetings.Provide training in pediatric care and pediatric preventive care package support.Provide clinical mentoring and supervision to realize a multidisciplinary approach for care of HIV exposed and infected children and improve quality of care.Develop and distributing pediatric provider job aids and patient education materials related to pediatric care and support.Integrate child survival interventions such as - immunization, safe water and hygiene, micronutrient supplement, growth monitoring, and improved infant and young child feeding.Support nutrition assessments and counseling as a routine clinical activity and coordinating with USG and other partners for provision of food products.Promote interventions to ensure provision of appropriate pain management for infants and children.Link families with community resources after discharge.Coordinate with other partners to supporting safe water interventions like point of use water treatment by disinfectant and general personal and environmental hygiene.

CU ICAP provides integrated laboratory service support to 75 health centers and hospitals and 3 regional laboratories. The support included on-site and off-site trainings, site level mentorship and coaching, minor renovation and procurement of small laboratory equipment/accessories, and support of the WHO/AFRO laboratory accreditation.

Under COP2012, CU ICAP will continue providing lab support to the same sites and will expand to an additional 189 health center laboratories in Oromia region. CU ICAP will provide embedded mentorship with the goal of implementing the 12 quality essentials and ultimately attaining accreditation. CU ICAP will work to ensure strong referral linkages, improved inventory systems, preventive maintenance, and troubleshooting of equipment failures. ICAP will improve the laboratory physical infrastructure through minor renovations, procurement of laboratory equipment and safety materials to support the WHO-AFRO accreditation effort. CU ICAP will provide technical support for participating tier-level laboratories and points of testing in EQA programs. CU ICAP will also support the establishment of a regional laboratory in Somali region.

CU ICAP will continue to support three regional laboratories in Oromia, Somali and Harari regions to strengthen the capacity of the regional laboratories to lead their own programs and to address sustainability. The regional laboratories will be supported to manage regional EQA effectively and WHO-AFRO accreditation effort through training, equipment provision and mentorship. A regional quality assurance scheme will be utilized to develop a laboratory improvement plan and to obtain timely feedback. CU ICAP will support establishment of clinical bacteriology diagnostic capacity at selected hospitals. Emphasis will be given for implementation of strengthening laboratory management towards accreditation (SLMTA) for laboratories enrolled in WHO/AFRO accreditation scheme. CU ICAP will support the implementation of LIS at selected sites in collaboration with other stakeholders. Technical assistance will continue for early infant diagnosis, viral load testing, TB culture, microbiology laboratory services and monitoring and evaluation of laboratory programs.

This activity will strengthen the national HMIS and optimize the use of routine data for service and program improvements. Under COP2012, CU ICAP site-level M&E support will be maintained in 80 facilities and expanded into health centers in Oromia region to support data quality and maximize data use for continuous quality improvement. CU ICAP will:

Fully document information on pre-ART, ART, TB/HIV, PMTCT, VCT, and PICT clients.Establish regular data quality assessment and feedback mechanisms.Build capacity of site staff in data analysis and data use to improve service delivery.Facilitate annual review and planning meeting for facilities to share experiences.Strengthen sites with trained data clerks and provide M&E tools.Facilitate the implementation of HMIS in new health facilities by renovating and furnishing space and providing technical support in data archiving, retrieving, and report aggregation.Collaborate with Tulane University to facilitate the trainings of ICAPs regional mentors/M&E officers so that they can mentor facility staffs on HMIS.

CU ICAP will also maintain its M&E support to 80 existing sites and new expansion sites of 194 health centers while collaborating with partners to scale up HMIS implementation and fully integrate HIV information in the national HMIS and EMR systems. In line with the government plan, CU ICAP will support sites to assess and address gaps in space, furniture, equipment and training to implement HMIS and EMR systems. It will also prospectively collect, archive, retrieve, compile and report data for all HIV-related services using HMIS forms.

This is an ongoing activity and is linked with PEPFAR/Es support for HRH activities. In recognition of the HRH deficiencies in Ethiopia, CU ICAP will be addressing health workforce challenges by providing technical assistance (TA) to and strengthening institutional capacity of medical institutions to deliver quality pre-service medical education.

In FY2011, as part of scaling up of the pre-service medical education, CU ICAP provided technical, material and financial support to Jimma and Haramaya University medical schools to deliver quality medical education and teaching materials and equipment.CU ICAP also provided the installation and operational support for a video-conferencing facility at Jimma University.

Under COP2012, CU ICAP will build institutional capacity of the existing Adama, Jimma and Haramaya Universities including the new medical institutions namely Ambo, Meda-walabu, Wolega and Dire-Dawa Universities by providing technical, material and financial support for infrastructure development, procurement of teaching materials and toolkits, and establishing a mini-medical library in affiliated hospitals. CU ICAP will also continue its support in faculty development, cases development for problem based learning, ICT support, e-resources, and simulation production. CU ICAP will support an Integrated Emergency Surgery and Obstetrics (IESO) training at Adama, Jimma and Haramaya University postgraduate programs.

CU ICAP will provide ongoing TA to the medical schools of Jimma and Haramaya Universities to deliver quality pre-service medical education. Moreover, it will provide TA to these universities to establish training units and deliver HIV-related in-service trainings in their catchment area. In addition, CU ICAP will build the capacity of Oromia, Dire Dawa, and Harari RHBs to effectively plan, implement, coordinate, monitor, and evaluate their HIV/AIDS programs.

The mission of the FMOH is the provision of safe and adequate blood and blood products to all patients who require blood transfusion as part of their treatment. The target of the FMoH is to collect 120,000 units per annum from voluntary blood donors, test all the blood in a quality assured manner in the regional blood banks and preposition stocks of blood for use at the health facilities. CU ICAP will provide technical support to blood banks and health facilities in four regions (Oromiya, Harari, Somali and Dire Dawa) in the implementation blood safety program: 1. Strengthening of the clinical interface through training of clinicians and nurses on appropriate clinical use of blood as well its safe administration to patients; also, support the establishment of hospital transfusion committees in the regions of Oromiya, Dire Dawa, Harari and Somalia 2. Support creation of linkages between blood banks and the hospitals in the respective areas of responsibility including transportation of blood and blood products, supplies as well maintenance of blood inventory at the hospitals 3. CU ICAP will support the strengthening of data collection both from the blood banks and the regional blood banks and develop a comprehensive monitoring and evaluation plan as well as support reporting of blood bank activities to the RHB and the FMOoH. 4. With the support and collaboration of WHO, conduct mentorship of 10 blood banks in the regions 5. Improve the collection of blood through mobile collection teams. CU ICAP will support the activities of the mobile collection teams in the regional blood through target setting and development of collection plans 6. Support blood donor education and mobilization through effective engagement with local radio stations, print media, and training of communication experts, blood donor mobilisers and blood bank staff.

CU ICAP has been working in collaboration with FMOH in health facilities of Oromia, Harari, Dire-Dawa and Somali regional state in capacity building and IP commodity supply. In FY 2011, CU ICAP provided TOT training to health care workers and conducted a need-based assessment for IP training to cascade it to new CU ICAP supported facilities. Thus, IP training was given to 160 healthcare workers. IP commodities were procured and distributed including disposable IP materials and PEP service was provided in all supported facilities. Regular mentorship was conducted to strengthen the capacity of IP committees at all supported facilities to decrease the transmission of HIV. In FY 2012, CU ICAP will support a sustainable supply of IP/injection safety materials. They will focus on integrating injection safety and waste management into HIV and OPD/IPD services and work with medical service directorates at all levels to promote country ownership and sustainability. CU ICAP will also provide ISS and mentorship to health facilities in Oromia, Harari, Somali and Dire Dawa regions. In order to build capacity, healthcare workers will be trained on IP/injection safety. To strengthen program implementation, continuous clinical mentorship and supportive supervision will be provided to health institutions through their IP/Injection safety committees. CU ICAP will continue to collaborate with GOs and NGOs working on IP to harmonize and minimize duplication of activities and build national consensus with TWGs. Quality improvement activities will be designed and conducted in collaboration with TWG at FMOH, RHBs and facility level. To measure the program effectiveness, CU ICAP will conduct an assessment to measure behavioral change practices brought by IP/Injection safety training and share best practices. The organization will work to fill the gaps with continuous performance monitoring and evidence based decision making using IP committees at all health facilities. Throughout CU ICAP's program, linkages with community support services will be created and/or further enhanced. Where applicable, gender issues will be integrated into activities, particularly prevention of gender violence and coercion. Refer to indicators and targets for magnitude and impact of CU ICAP's program.

The primary goal of CU ICAP support in the area of prevention is to strengthen STI/HIV prevention activities within CU ICAP's operational area. The target population is STI patients at CU-ICAP-supported health facilities. Under COP2012, CU ICAP activities that focuses on "abstinence and / be faithful" include:Educate STI patients about the importance of secondary abstinence to reduce the risk of HIV/STI transmission.Promote fidelity among STI patients to reduce the risk of HIV/STI transmission.Educate STI patients on reducing multiple and concurrence partners to prevent sexual transmission of HIV/STIs.STI/HIV prevention information, education and behavior change and communication material will be adapted and used to educate STI patients at facility level.Mini media and AIDS resource at the health facilities will be supported to deliver continuous messages about STI/HIV/RH. Throughout CU ICAP's program, linkages with community support services will be created and/or further enhanced. Where applicable, gender issues will be integrated into activities, particularly prevention of gender violence and coercion. Refer to indicators and targets for magnitude and impact of CU ICAP's program.

In FY 2011, CU ICAP supported HIV testing and counseling (HTC) services in 80 facilities in 4 regions (Oromia, Somali, Dire Dawa and Harari). CU ICAP trained more than 400 service providers and supported HTC services for more than 600,000 clients.

In FY 2012, CU ICAP will support client and provider initiated HTC services in the existing 80 facilities and in an additional 194 health centers (previously under the support of MSH) in Oromia. Intensive support will be provided to the newly added health centers in human resources development and material support to deliver quality HTC service. TA assistance will be provided to these facilities to offer HTC services for high risk and vulnerable groups through both fixed and outreach approaches.CU ICAP will focus on identifying more HIV positives and discordant couples with both clinical and outreach programs. It will conduct intensive promotion using peer educators and healthcare providers to encourage PLHIV already enrolled in care and treatment to refer their partners and family members for HIV testing. Nearly 90 percent of the tested HIV positives from these facilities will be linked to care and treatment services. The program has established a feedback mechanism to ensure all referred clients reach and receive the service.

In CU ICAP supported facilities, children will be offered HIV testing in both out and in patient departments. In collaboration with partners, CU ICAP will ensure availability of HTC supplies and test kits and equipment. CU ICAP will contribute to the development of policy and guidelines, standards for HCT services, training aids, and provision of seminars, onsite trainings, case presentations and updates to health providers. CU ICAP will also support partners to strengthen HTC service delivery and program management by implementing supportive supervision, analysis of standard of care (SOC) and use of monthly, quarterly, bi-annual and annual reports. Throughout CU ICAP's program, linkages with community support services will be created and/or further enhanced. Where applicable, gender issues will be integrated into activities, particularly prevention of gender violence and coercion. Refer to indicators and targets for magnitude and impact of CU ICAP's program.

Since FY 2007, CU ICAP supported the implementation of facility based STI activities in 65 sites in Oromia, Harari, Dire-Dawa and Somali Regions. The support included: training healthcare providers on syndromic management of STI and the provision of materials/supplies, and mentoring site level staff. CU ICAP was also providing TA to health facilities, RHBs and local universities implementing STI related activities; coordination with RHBs to facilitate integration of STI related activities with HIV care and treatment, ANC, FP and other services. This included strengthening referral linkages between health facilities and CBOs, FBOs and PLHIV associations. In FY 2010 CU ICAP expanded the number of their operational sites to 78. They also support local universities and colleges to maximize local ownership and sustainability of the program. In FY 2011 CU ICAP partnered with FGAE to establish free standing confidential STI clinics in Adama. In FY 2012, CU ICAP will: Provide on-site TA and support to improve STI diagnosis and treatment. Organize and conduct training, supportive supervisions and clinical mentorship on STIs. In collaboration with RHBs and responsible partners avail adequate supplies of STI medications. Strengthen provider-initiated testing and counseling (PITC) service for STI clients coming to the facility. Provide education on STI risk reduction, HIV screening, and treatment for all patients. Promote and provide condoms to all patients with special focus on MARPs. Integrate STI services in to ANC and PMTCT services to ensure education of women regarding STI prevention. Develop and strengthen linkages to CBOs that promote risk reduction and HIV/STI prevention and early/complete treatment. Support targeted STI prevention, diagnosis, and treatment services to MARPs, including commercial sex workers. Build the capacity of health care providers in diagnosing, treating and screening STIs. Strengthen STI data recording and reporting systems at all levels. Transition the CSW clinic in Adama to FGAE. Throughout CU ICAP's program, linkages with community support services will be created and/or further enhanced. Where applicable, gender issues will be integrated into activities, particularly prevention of gender violence and coercion. Refer to indicators and targets for magnitude and impact of CU ICAP's program. JHU will expand facility-based STI activity implementation to186 sites, which primarily includes support for training of health care providers on STI Syndromic Case management in ART clinics .

In FY2011 CU ICAP supported PMTCT services in 79 health facilities. In FY 2012, ICAP will expand PMTCT services to public hospitals and health centers in Dire Adwa, Oromia, Somali and Harari regions. This will include 186 facilities which are CU/ICAP supported ART sites. Another USG partner, Intrahealth, will cover non ART sites and ART sites which are run by RHB without PEPFAR support. .CU ICAP will support the FMOH and PEPFAR/E PMTCT acceleration plan to improve uptake and quality of PMTCT services.

CU ICAP will:

Support PMTCT services at public hospitals and health centers and expand outreach for PMTCT services focusing on high prevalence and hotspot areas in Dire Dawa, Oromia, Somali and Harari regions.Support the FMOH in revising the national PMTCT guidelines, training packages and implementation manual to adapt the new 2010 WHO PMTCT guidelines.Support rolling out the revised national PMTCT guidelines at health facilities.Implement quality improvement approaches to increase retention of HIV positive mothers and HEIs in care, and expand the role of case managers and Mother Support Groups (MSGs) and strengthen referral linkages.Support the FMOH/RHBs to introduce a monitoring system for PMTCT program along the PMTCT cascade.Support training on safe pregnancy/FP counseling and promote integration of FP/HIV services.Scale up couples counseling and partner testing, facilitate male friendly services, and establish monitoring system.Expand counseling, PWP and treatment services for discordant couples.Expand MSGs to 10 more sites and establish linkage with Income Generating Activity (IGA).Expand integrated Maternal, Newborn and Child Health (MNCH)/ART/PMTCT services.Enhance postnatal follow-up of HIV-infected mothers and HIV-exposed infants.Strengthen and expand Essential Newborn Care (ENC) services.Minor renovations, refurbishments, and repair of ANC, labor and delivery rooms, and maternity wards.Provide 80% of supported facilities with e-mobile phones and airtime cards to facilitate inter-facility communication including consultation requests for transport, referrals, lab test results and client tracing.Set the research/evaluation agenda with the GOE and support PMTCT program evaluation.Provide comprehensive PMTCT services to pregnant women with known HIV status and ARV prophylaxis and treatment to HIV+ women. Throughout CU ICAP's program, linkages with community support services will be created and/or further enhanced. Where applicable, gender issues will be integrated into activities, particularly prevention of gender violence and coercion. Refer to indicators and targets for magnitude and impact of CU ICAP's program.

CU ICAP provides technical support for ART services for PLHIV as part of comprehensive HIV care and treatment. Under COP2012, CU ICAP will expand the number of ART sites to include all 186 ART health centers in Oromia Region. CU ICAP will continue to build capacity and carrying out minor renovations, refurbishments, and maintenance of the ART providing health facilities and provide in-service training for ART providers , which includes basic and refresher training programs for all ART providers.At CU-ICAP ART sites, regular on-site supervision is conducted and intensive clinical and system mentoring is provided. CU-ICAP has implemented a quality improvement program and conducts a regular Standard of Care (SOC) assessment to improve the quality of care and treatment service delivery at the sites. It also works to strengthen the ART Multi Disciplinary Teams at the ART sites.The partner implements a comprehensive care and treatment package, using a family centered approach. Screening for TB, prophylaxis with IPT and cotrimoxazole, and preventive care package are provided to ART patients. It provides support to strengthen the clinical and laboratory monitoring of ART patients. It partners with NEP+ in the Case Management program. ICAP is working to build the capacity of NEP + for a sustainable transition and ownership of the case management program at national level. CU ICAP also works in building the capacity of the RHBs to ensure sustainability and ownership of the program. Three of the four RHBs in its operational area are now HHS/CDC PEPFAR/E prime partners. CU ICAP has developed a transition plan and will continue to work in building the capacity of the RHBs and incrementally transition specific activities in the coming years.CU ICAP has an established monitoring and evaluation system to capture performance and clinical outcome data. It supports the national Health Management Information System (HMIS). CU-ICAP will collaborate with other USG partners (e.g. Intrahealth, Health TB) working at the community level to avoid duplication of effort and optimize delivery of services to PLHIV.

In FY2010, CU ICAP supported the FMOH in developing national policies, protocols, and guidelines on pediatric HIV. CU ICAP supported the full-spectrum of pediatric HIV prevention, care, and treatment services at 69 facilities and is currently on track to meet FY2011 targets.

Under COP2012, CU ICAP will expand pediatric care and treatment services to all health facilities that are providing adult ART and PMTCT services and support an additional 120 health centers in Oromia. At the national level, CU ICAP will continue to support the FMOH to update national policies and guidelines, develop a national capacity-building plan, update pediatric monitoring and evaluation into the existing HMIS, and support performance evaluations to inform the program.

CU ICAP will continue its partnership with the Ethiopian Pediatric Society to provide training on pediatric HIV/AIDS care and treatment and organize national pediatric HIV conferences and annual CMEs. CU ICAP will support radio and TV campaigns, use IEC/BCC materials in local languages to enhance public awareness of pediatric HIV care and treatment services. At the regional level, CU ICAP will work with RHBs to build their capacity to effectively design and implement pediatric HIV/AIDS programs. They will continue to build the capacity of the two regional universities to provide technical assistance, supportive supervision and mentoring to RHBs. At the facility level, CU ICAP will continue to provide technical support with an emphasis on integrating pediatric HIV with child survival interventions, family-centered HIV care and treatment and strengthening appropriate retention mechanisms. Emphasis will also be placed on increased pediatric ART service uptake at all sites through improved entry points for children. CU ICAP will expand its experience in assessing and improving quality of service to all supported facilities and shares experience with other PEPFAR/E implementing programs. On-site assistance will be provided to improve medical records keeping, referral linkages, and patient follow-up. ART training will be provided in collaboration with local universities based on national guidelines. Throughout CU ICAP's program, linkages with community support services will be created and/or further enhanced. Where applicable, gender issues will be integrated into activities, particularly prevention of gender violence and coercion. Refer to indicators and targets for magnitude and impact of CU ICAP's program.