This is a continuing activity. HIV prevalence among the Ethiopian Federal Police Commission (FPC) population is declining (ANC surveillance in police hospital 24.8% in 2005, 10.7% in 2007, and 3.7% in 2009), suggesting that prevention interventions targeting this high-risk population are working. During the next two years, the FPC will target HIV peer education to more than 30,000 federal police aged 20-49 years and their family members, particularly those living in Addis Ababa and Dire Dawa. The FPC's program is based on a peer education approach referred to as the Modeling and Reinforcement to Combat HIV/AIDS (MARCH). Its goal is to avert HIV infection among the police force by increasing correct/consistence condom use, fidelity and abstinence, and use of key HIV services (e.g. HCT and ART), as well as improving the police forces ability to discuss sexual risks and HIV/AIDS related stigma. The program is fully-owned by the FPC and integrated into their routine command structure. The formation of a FPC HIV/AIDS advisory board has led to greater ownership of the program and stronger leadership on behalf of the FPC, which will enable its sustainability in the long-term. The FPC program follows the GOE guidance on the implementation of a minimum package of prevention services for uniformed services and supports the goals of the GOE's National Strategic Plan (SPMII). In addition, the activity falls under the combination prevention framework of the USG HIV prevention portfolio and is aligned with the goals of the GOE and USG HIV/AIDS Partnership Framework and Global Health Initiative. Currently a formal evaluation of MARCH approach is underway. Evaluation findings will be used to further guide and target the FPC HIV/AIDS interventions during the next two years.

The FPC will recruit or assign a care and support focal person who will oversee the implementation of adult care and support related activities and take over the activities being supported by UCSD. In COP 2013, FPC will undertake the following activities:

Provide nutritional assessment and counseling services, and provide nutritional support to those malnourished PLHIV in collaboration with partners working on nutritional support.

Intensify prescription of co-trimoxazole prophylactic therapy (CPT) to eligible PLHIV: consider CPT as one of the quality monitoring indicators and review its performance regularly.

Strengthen pain assessment and management services for PLHIV and improve their access to pain medication including morphine.

Strengthen the civil-police alliance so as to intensify the two-way referrals and linkages among police health facilities and communities based care and support services. This will also provide updated care and support service directories to supported health facilities.

Strengthen Cervical Cancer Prevention (CCP) service at the Police Hospital.

Coordinate and oversee the scaling up of the integration of mental health services into chronic care units in FPC hospitals.

Ensure availability, distribution, and utilization of Basic Preventive Care package (BPCP) in the FPC, and train health professionals on BPCP.

Strengthen PwP prevention messages and services in the FPC.

In COP 2013, FPC will strengthen its capacity to support and monitor TB/HIV program and service integration at defense facilities in a sustainable manner through training and integrated mentorship activities and ensuring quality of TB/HIV care.

In COP 2013, FPC will:

Develop costed strategic plan for the TB/HIV program support as part of the comprehensive HIV/AIDS program plan.

Strengthen TB and HIV control program coordination and integration at central and lower level health care structures.

Undertake assessment of the TB and TB/HIV program to identify key program gaps and focus areas for the regional TB control programs.

Strengthen TB program management and human resource capacity at program level through training of TB and TB/HIV control program staff.

Undertake regular supportive supervision and review meetings to monitor the TB/HIV programs.

Organize a pool of core trainer teams for comprehensive TB-Leprosy, TB/HIV and MDR-TB training at central program level.

Organize TOTs and in-service trainings on comprehensive TB, TB/HIV TOTs in collaboration with local universities, police hospitals and partners.

Organize mentorship teams composed of program management, health facility, local universities and partner staff; undertake mentorship on comprehensive TB and TB/HIV control program to defense health facilities in collaboration with partners.

Undertake TB, TB/HIV related program evaluations.

Strengthen TB diagnostic services and EQA in collaboration with EHNRI, regional laboratories and partners.

Strengthen patient referral network across TB/HIV delivery sites in the police health system.

Print and distribute TB/HIV guidance and job aids.

Support TB and TB/HIV Advocacy Communication and Social Mobilization (ACSM) activities.

In COP 2013, FPC will build its managerial and technical capacity to manage the pediatric care and treatment program in preparation to fully transition the support by 2015. FPC will collaborate with UCSD to take over certain site level activities in the implementation of the pediatric care and support services. In COP 2013, key activities by FPC will include:

Participation in the development of guidelines and training materials at national level,

Training of the multidisciplinary team on palliative care and the preventive care package for children.

Facilitate site-level clinical mentoring, enhancement of data collection and reporting, and supportive supervision to pediatric care and support services.

Improve the skills of staff at the facilities through training in collaboration with Defense University.

Work to ensure provision of nutritional assessment and counseling services for HIV exposed/infected children and infants, and supply job aids.

Ensure provision of micronutrients and nutrition supplementation.

Support sites to perform early infant diagnosis.

Promote prophylaxis and treatment for opportunistic infections in accordance with national guidelines.

Use of pCTX for HIV-positive children, and for HIV-exposed infants especially at those sites not yet providing ART.

Provide screening and isoniazid prophylaxis (IPT) which will be promoted and provided for HIV-positive children.

Strengthen referral and linkages with community based support groups for adherence counseling and psychosocial support.

Ensure a regular supply of drugs for OI and pain management, malaria prevention and de-worming, and work to sensitize the community on PC care through preparation and distribution of IEC/BCC on pediatric care and support materials targeting children.

The overall aim of this PEPFAR support is to enable the different levels of the Federal Police Force of Ethiopia to effectively monitor the performance and quality of HIV/AIDS/TB/STI services and programs under its management.

In COP 2013, the Federal Police will establish and implement strong routine monitoring systems that will enable it to track the implementation of prevention, care and treatment activities effectively. The Federal Police will work with UCSD to adapt, print and distribute M&E tools that are in line with the national HMIS, including patient registers, charts, data-capturing and reporting formats.

COP 2013 support will also be used to recruit, train and deploy M&E officers for the Federal Police

National HIV/AIDS/TB/STI Program Coordinating Office, as well as for data entry clerks/Health Information Technicians (HITs) for health facilities that implement programs. Furthermore, the Federal Police HIV/AIDS Program Coordination Office, and similar intermediate health offices and health facilities under the Federal Police, will be able to routinely capture, generate, analyze, report, and utilize PEPFAR supported HIV/AIDS/TB/STI program data in a timely manner. Different levels of health/HIV/AIDS programs of the Federal Police will also be supported to plan and conduct timely and regular supportive supervision visits and organize meetings to review the performance and quality of their programs and services, based upon data generated from the system.

Medical Injection/Infection Prevention (IP) procedures are important components for providing quality health care services and to prevent the transmission of HIV and other diseases. Since 2009, UCSD has been implementing various activities in Federal Police health facilities, which includes technical support through training, provision of basic IP/personal safety equipment, ISS and clinical mentoring, along with other activities.

In COP 2013, some of the IP and patient safety activities will be transitioned to the Federal Police in order to build IP management capacity through training, printing and distribution of IPPS guidelines, integrating injection safety and waste management practices into all OPD/IPDs in the facilities, and procuring and distributing standard IP commodities.

Accordingly, the Federal Police will closely work with the Health Unit and Disease Prevention and Control department of the Federal Police, and the IP committee in all health facilities to build capacity through mentoring of clinical staff and waste handlers, ISS, and providing IP support materials. This support will include assistance with planning for cost effective, appropriate, and environmentally friendly waste management techniques at the facility level. The health facilities will continue to work on ventilation of TB wards and complete the MDR/XDR TB prevention activities. A continuous quality improvement assessment on the injection safety activities will be conducted to identify and close gaps in close collaboration with the IP committees at health facilities and national TWGs.

The FPC will target peer education interventions to FPC members aged 20-49 years and their family members to increase correct and consistence condom use, fidelity and abstinence, and use of key HIV services. In addition, interventions will improve the police forces ability to discuss sexual risks and HIV/AIDS related stigma. As appropriate, interventions will link FPC service members with HIV/AIDS services including condom access, HIV testing and counseling, sexually transmitted infection management, prevention from mother to child transmission, antiretroviral therapy and care and support. Approximately 3,500 peer group trainers will lead peer group discussions every two weeks. With an average of 10 persons per group, the program aims to reach 35,000 people each year. Small group discussions will provide opportunities for participants to practice HIV prevention skills and understand positive health-seeking behaviors. Thematic discussion topics will include addressing multiple concurrent sexual partnerships, social and community norms, and stigma and discrimination. Peer leader training and information, education and communication material and behavior change and communication material will be adapted specifically for the FPC uniformed service members. FPC "anti-AIDS" clubs will supplement the peer group activities by organizing dramas and sporting events, World AIDS Day activities, and other outlets for peer groups to meet. For monitoring purposes, the FPC will provide routine progress reports on the number of peer groups that meet and the discussions that have taken place, as well as the number of participants. In addition, the number of participants attending other types of HIV prevention reinforcing activities will be included in the report. The FPC will conduct site visits to assess peer group discussions for regularity, group and member participation, and to identify major challenges that arise during the discussions. Documentation of best practices and sharing of lessons learned with the FPC leadership, the GOE and other key stakeholders will be an integral and on-going activity throughout implementation.

In collaboration with UCSD, the FPC has been implementing HCT activities for the past couple of years. HCT activities in COP 2013 will focus on building the managerial and technical capacity of the Federal Police to make a full transition and take over the HCT activities currently being implemented by UCSD. FPC will build its capacity to implement and coordinate the HCT related activities. In COP 2013, the Federal Police will:

Provide PITC for all clients accessing services at Federal Police health facilities.

Provide HTC for Police and their spouses.

Establish routine annual testing services, promoting couples counseling for regular partners of Federal Police members, and referrals to counseling and care services.

Promote and provide couples testing for police and their regular partners.

The FPC will target peer education interventions to FPC members aged 20-49 years and their family members to increase correct and consistence condom use, fidelity and abstinence, and use of key HIV services. In addition, interventions will improve the police forces ability to discuss sexual risks and HIV/AIDS related stigma. As appropriate, interventions will link FPC service members with HIV/AIDS services including condom access, HIV testing and counseling, sexually transmitted infection management, prevention from mother to child transmission, antiretroviral therapy and care and support. Approximately 3,500 peer group trainers will lead peer group discussions every two weeks. With an average of 10 persons per group, the program aims to reach 35,000 people each year. Small group discussions will provide opportunities for participants to practice HIV prevention skills and understand positive health-seeking behaviors. Thematic discussion topics will include addressing multiple concurrent sexual partnerships, social and community norms, and stigma and discrimination. Peer leader training and information, education and communication material and behavior change and communication material will be adapted specifically for the FPC uniformed service members. FPC "anti-AIDS" clubs will supplement the peer group activities by organizing dramas and sporting events, World AIDS Day activities, and other outlets for peer groups to meet. For monitoring purposes, the FPC will provide routine progress reports on the number of peer groups that meet and the discussions that have taken place, as well as the number of participants. In addition, the number of participants attending other types of HIV prevention reinforcing activities will be included in the report. The FPC will conduct site visits to assess peer group discussions for regularity, group and member participation, and to identify major challenges that arise during the discussions. Documentation of best practices and sharing of lessons learned with the FPC leadership, the GOE and other key stakeholders will be an integral and on-going activity throughout implementation.

In COP2013, the FPC will work with the respective CDC/PEPFAR international implementing partner to build its capacity, and will transition PMTCT activities incrementally to strengthen local ownership and ensure sustainability of the program. It will enhance capacity of the regional Police Commission Health Offices to support transitioning of PMTCT services effectively.

In COP 2013, FPC will:

Support transitioning of PMTCT services to the FPC health facilities.

Support rolling out of Option B+ through training and mentoring of health care providers at facilities providing PMTCT services.

Conduct site supportive supervision, use site level performance data and implement quality improvement approaches to improve retention of HIV positive mother and HEIs in care services.

Strengthen case managers and MSGs to improve retention of HIV+ women and family members in care and treatment services.

Support implementation of the updated PMTCT monitoring system in line with Option B+.

Support training on safe pregnancy and FP counseling, and promote integration of FP and HIV services.

Support integration of TB screening with PMTCT programs.

Scale-up couple counseling and partner testing, facilitate male friendly services, and establish monitoring system related to these services.

Provide minor renovation, refurbishment, and repair of ANC, labor and delivery rooms, and maternity wards.

Improve referral system to ensure continuum of PMTCT care.

The FPC uses different regional police commissions such as Addis Ababa Police Commission and Dire Dawa Police Commission to disseminate HIV/AIDS information to policemen and other people in the community. FPC also has different clinics and hospitals throughout the country. UCSD has been providing technical support for HIV/AIDS services in these health facilities. ve. Thus far, UCSD has supported 24 health facilities (8 federal and 16 regional). To ensure sustainability of the program, transitioning these health facility-based programs to the FPC is essential. FPC built its capacity through its prior CoAg with CDC and is well acquainted with the processes and procedures of administering a PEPFAR funded program. With additional funding from the HTXS program area, the FPC will strengthen its capacity and take over the technical assistance for ART services currently being provided by UCSD within the Federal Polices health system. The FPC will continue to build the capacity of regional police commissions, police health facilities, and its own head office program management office. The partner will ensure the continuity of HRH development, referral linkages, mentoring and supervision, adherence, patient monitoring, as well as program monitoring and evaluation. The FPC will recruit competent staff that can provide mentoring and supervision to health facilities providing ART services. The partner will also use hospital-based staff to provide mentoring activities. Furthermore, the partner will provide refresher and in-service training to staff engaged in ART related activities. To ensure referral linkages, FPC will support health facilities to organize and conduct regular MDT meetings. Case managers will also be provided with technical and financial support to address adherence and lost to follow up cases. Health care providers will be provided with support to regularly monitor patients using CD4 counts, other tests, and clinical staging. To improve progress of the program overtime, regular monitoring and evaluation will be conducted using PEPFAR indicators.

In COP 2013, FPC will build its managerial and technical capacity to manage the pediatric care and treatment program in preparation to fully transition the support by 2015. Moreover, FPC will gain experience by working with UCSD to:

Provide technical support to national and regional working groups in the area of guideline development, training curricula and other job aids.

Improve pediatric case-finding and referral to care and treatment services with strong linkages with PMTCT, and strengthen implementation of PITC at under-5 clinics, pediatric inpatients, TB clinics and EPI clinics.

Ensure the implementation of family-focused care and family testing in all sites,

Provide trainings for health workers on comprehensive pediatric HIV care/ART in collaboration with the Defense University.

Promote advocacy to improve the attitude among health professionals as well as creating awareness in the community on the importance and benefit of pediatric ART services.

Improve the quality of service (growth monitoring, TB screening, CPT, determination of infection status) provided for HIV exposed infants in the follow up clinics with on-the- job refresher training and regular mentorship as well as through the provision of job aids to all the facilities.

Focus on regular site level support through clinical mentoring, on-the-job refresher trainings and supportive supervision.

Assess and improve quality of service for pediatric care and treatment through a standardized QI approach.

Work to establish and strengthen strategies to integrate pediatric HIV services with MNCH and other child survival program interventions.

Identify potential challenges in implementing the programme related to the unique situations in the FPC and provide solutions.