This is a continuing activity. The Family Guidance Association of Ethiopia (FGAE) is a local non-governmental organization providing integrated and comprehensive reproductive health services in Ethiopia. It delivers services to the needy, marginalized and high-risk population groups through 18 reproductive health clinics, 28 multi-service youth centers, 850 community-based sites and 250 outreach service delivery sites. Since 2000, FGAE has successfully integrated HIV/AIDS services into these sites, which includes HIV testing and counseling (HTC), prevention from mother to child transmission (PMTCT), and sexually transmitted infection (STI) management. The goals of the FGAE program are to continue to provide high quality health services to its target population, expand services into 45 FGAE sexually reproductive health clinics and youth centers and increase the targeting of these services to most-at-risk and vulnerable populations. The FGAE will continue to work in partnership with other USG implementing partners to maximize efficiencies and minimize duplication of effort. The FGAE program follows the GOE guidance on the implementation of a minimum package of prevention services for most-at-risk populations. The FGAE program supports the goals of the GOE's National Strategic Plan (SPMII) and is aligned with the goals of the GOE and USG HIV/AIDS Partnership Framework and Global Health Initiative. The FGAE has in place a comprehensive monitoring and evaluation system to routinely report and monitoring program performance.

Under COP2012, FGAE will enhance and strengthen HTC, specifically voluntary counseling and testing (VCT), and introduce Provider Initiated Testing and Counseling (PITC) services in 45 FGAE clinics and youth centers. Outreach workers will be trained to provide education and referral for HTC. Training of master trainers courses will be held aimed at improving individual and couple testing. Same hour HTC services will be initiated in all clinics and youth centers. Major emphasis will be given to partner/couple testing in all testing outlets. Those testing HIV positive will be linked to care and treatment services in public and private facilities. Family planning services will be offered to all HTC clients. FGAE plans to recruit more volunteers to promote HIV testing service, and influential leaders will be used to encourage and promote couples and families to get tested for HIV. FGAE will collaborate with government and nongovernmental partners to promote testing during National HIV Testing day and other campaigns. To ensure quality, direct observation of the HTC sessions will be conducted periodically by senior counselors, and case conference and client exit interviews will be conducted for the same purpose. By 2015, FGAE aims to have more than 550,000 individuals counseled and tested for HIV through their clinics and outreach sites, and 1,050 individuals trained in counseling and testing. Where applicable, prevention of gender-based violence and coercion will be integrated into FGAE activities. Refer to indicators and targets for magnitude and impact of the FGAE program.

STIs are common among MARPs, which include sex workers (SWs) 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. Under COP2012, the objective of the FGAE program is to provide comprehensive HIV and STI services to highly vulnerable women from low socioeconomic groups working in bars, petty trade or daily laborers. The service includes regular screening and treatment for STIs, referral to other services like HTC, ART, PMTCT, and prevention education.

Major activities will include:

Renovate and equip 50% the 44 FGAE clinics to be friendly to highly vulnerable women.

Provide regular STI screening diagnosis and treatment for 13,200 highly vulnerable women at the 44 FGAE clinics.

Promote and provide condoms for highly vulnerable women at the 44 FGAE clinics.

Link the highly vulnerable women to HTC, ART, PMTCT services and prevention education.

Transition free standing sex workers confidential clinics from US-based Universities to sole implementation by FGAE.

In prior years, JHPIEGO and JHU/TSEHAI technically supported FGAE service delivery activities. Since COP2010, FGAE has taken over the direct implementation of their activities as a prime partner. Currently, FGAE clinics offer HTC services to all ANC clients and ARV prophylaxis to HIV positive pregnant women. Labor and delivery services are at two FGAE PMTCT sites. FGAE is successfully linking their ART eligible patients to nearby health facilities. Under COP2012, FGAE will focus on the following - 22 FGAE health facilities provide ANC services linked with HIV testing and ARV for PMTCT; pregnant women will be tested for HIV; HIV positive pregnant women will receive ARVs to reduce risk of mother-to-child-transmission; health care workers will be trained in PMTCT; and PMTCT services will be delivered to pregnant women with known HIV status and ARV prophylaxis to HIV positive women per the national guidelines. Activities will include:

Strengthen ongoing PMTCT activities in FGAE clinics.

Support laboratory and diagnostic services and undertake minor renovations to improve service quality.

Support the MOH in revising national PMTCT guidelines, training packages and implementation manual to adapt the 2010 WHO PMTCT guidelines and support rolling out of these guidelines at FGAE sites.

Ensure the availability of ARVs and integration of PMTCT with RH services at all FGAE clinics.

Undertake extensive community-level PMTCT awareness campaigns in all catchment areas through outreach and community-based reproduction health associations.

Establish and support Mothers Support Groups at FGAE clinics

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

Support the MOH to introduce a monitoring system of PMTCT indicators along the PMTCT cascade and implementation of proven quality improvement models to increase retention in care.

Conduct training on PMTCT/ART/infant feeding and support infant feeding options.

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

Ensure that the necessary Job Aid, IEC materials, PMTCT testing and counseling tools are available in FGAE that provide PMTCT services. Where applicable, prevention of gender-based violence and coercion will be integrated into FGAE activities. Refer to indicators and targets for magnitude and impact of the FGAE program.

FGAE is a CDC treatment partner implementing PMTCT and HIV/AIDS prevention activities. FGAE has implemented different prongs of the PMTCT strategy including 3 and 4. This puts the partner having an exposure of HIV/AIDS treatment related activities. FGAE has 6 confidential sex workers clinics in different towns and plans to expand the service to two additional hot spot areas, which will bring the total number of sex worker clinics to 8. These clinics serve most at risk populations (MARPS), mainly commercial sex workers (CSWs) who are core HIV transmitters to the general population. The ultimate goal of FGAEs confidential clinics is to provide a comprehensive service package, including provision of ARTs for HIV positive commercial sex workers. Given this, FGAE can make a significant impact on the reduction of HIV transmission among commercial sex workers in the areas where they operate. The clinics have already started providing STI services and are working on initiation of ART services. Upgrading these clinics to provide ARV services will be an excellent opportunity to help control the HIV/AIDS epidemic among this high risk populationand those affected by the virus. Criteria for initiation of ART among CSWs are similar to the criteria for the general population.

Providing ART service at the FGAE confidential clinics requires strengthening HRH development, lab systems, referrals, linkages, adherence, mentoring, supervision, accreditation, monitoring and evaluation. In COP 2013, FGAE will build on its existing structure and system through building capacity at its head office and regional offices. The required number of staff needed for providing ART services at the confidential STI clinics will be recruited by FGAE and in-service training will be provided in collaboration with regional health bureaus (RHBs), local and US-based universities. An MDT committee will be established at each clinic to ensure intra-and inter-facility linkage. The required lab equipment, reagents and supplies will be procured for patient monitoring services. Case managers will be deployed in collaboration with RHBs and NEP+. Competent staff shall be recruited that can provide proper mentoring and supervision. Prior to starting ART services, FGAE will secure appropriate accreditation from FMHACA for its confidential clinics. To improve programperformance, FGAE will carry out regular monitoring and evaluation activities using PEPFAR indicators.