This is a continuing activity. The Organization for Social Services for AIDS (OSSA) is a pioneer indigenous not-for-profit organization that has been working on HIV/AIDS prevention and control interventions in most parts of Ethiopia since 1989. OSSA became a direct partner of HHS/CDC in 2010. The goal of OSSAs HIV/AIDS program is to prevent HIV infection and alleviate the impact of HIV/AIDS at the community-level through the implementation of mobile HIV counseling and testing (HTC) and provision of HIV/AIDS community care and support in eight regions of Ethiopia in both urban and rural communities. The OSSA program supports GOE efforts to expand health services nationally by filling gaps not yet met by public sector services. In accordance with USG PEPFAR program realignment, OSSA will shift emphasis to reaching discordant couples and family members from individuals who test HIV positive from CDC-supported facilities. This insures continuity of services, and fits neatly in OSSA's existing activities providing home-based support for ART patients. OSSA regularly conducts supportive supervision visits to each program site as well as has in place a system to routinely monitor and regularly report on program performance.

In prior years, OSSA successfully established 31 care and support community-based service outlets in 7 regions providing nutritional, psychological, social and spiritual support to PLHWAs. Under COP2012, OSSA will establish 19 new service outlets, reach 40,000 people with care and support services (of which 3,000 will receive food support) and continue to improve the quality of services at existing sites. All OSSA sites will be actively linked to referral systems with facility-based HIV/AIDS services. OSSA will distribute nutritional assessment equipment to each service outlet, carry out malnutrition screening and provide nutritional support and/or link clients to food programs, such as the World Food Program. OSSA will adopt the PwP/PHDP lay counselor training guidelines and develop PwP/PHDP community implementation guidelines in collaboration with the MOH and stakeholders. Regular and close follow-up by volunteer care providers and establishment of client support groups as well as close collaboration with case managers and adherence supporters at health facilities will enhance referral linkages and tracing of lost-to-follow-up PLHIVs. The performance and quality of care and support services will be monitored by trained nurse supervisors locally at each site and through periodic supportive supervision by senior program staff. A major focus will be on performance improvement by strengthening data management systems and developing uniform data capturing tools including registers, reporting templates, referral slips and key performance measurement indicators. All service outlets will review their performance measurement indicators on a regular basis to assess and compare achievements. In order to improve the referral linkages, OSSA will strengthen its network with health facilities and urban or rural health extension workers. It will participate actively in catchment area and multidisciplinary team meetings held by the regional health bureaus. To promote stronger working relationships with the public sector, MOUs will be developed with health facilities and the regional health bureaus to clearly delineate OSSAs role and contributions in providing community care and support services.

Under COP2012, OSSA will intensify targeting of HTC services to MARPs and increase couples testing with a goal of testing a total of 100,000 people in eight regions of Ethiopia. Mobile HTC services will be transitioned to index case testing. Index case HIV testing will be implemented in close collaboration with the facilities and PEPFAR and other partners. It will target facilities with high load HIV patients, who are residing in urban and peri-urban settings. HIV testing of partners or family members will be conducted at home when the index case voluntarily agrees for the service. OSSA counselors will support disclosure counseling for the index case to build the clients negotiation skill. OSSA will pilot a combined approach using both mobile and home-based testing and counseling at the same time to increase female and couple HIV testing. Linkage and referral with the health facilities will be strengthened, all clients found HIV positive through mobile services and index case testing will be referred to nearby health facilities and ensure client reached and received service through care and support service providers. Regular supportive supervision visits to each project site will also be conducted to monitor the performance of the project. In addition, linking activities and strengthening referral systems with HIV/AIDS facility-based services will be a focus. OSSA will follow-up with clients to ensure enrollment in appropriate HIV services and will play an active role in improving retention rates. OSSA will provide in-service training (both basic and refresher) for service providers, perform regular case conferences and counseling session observations, and conduct supportive supervision in partnership with regional HIV/AIDS Program Coordination Offices to improve and ensure quality of OSSA services. In addition, OSSA will work with regional laboratories to conduct external HIV testing quality control. To improve OSSA service delivery activities and inform future programming, OSSA will evaluate both mobile and home-based HTC approaches during FY2012.