This is a new award / mechanism with limited eligibility for award. The purpose of the program is to strengthen the capacity of the Federal HIV/AIDS Prevention and Control Office of Ethiopia (FHAPCO) to coordinate, monitor and evaluate the multi-sectoral HIV/AIDS response in Ethiopia. This program will support improved FHAPCO coordination with Regional HAPCOs and Regional Health Bureaus (RHBs) as well as key implementing partners. National information systems will be strengthened, as well as FHAPCO and regional capacities for monitoring and evaluation of health facilities, activities and outcomes including those related to HIV/AIDS prevention, control and care and treatment activities. FHAPCO will coordinate with other national agencies and entities for building monitoring and evaluation capacities. The FHAPCO is a GOE entity responsible for multi-sectoral coordination, monitoring and evaluation, and resource mobilization for the GOEs national HIV/AIDS program. The proposed program is aligned with the goals of the GOE and USG HIV/AIDS Partnership Framework and Global Health Initiative. The TBD partner will have in place a system to routinely monitor and regularly report on program performance.

Under COP2012, two specific HVSI activities will be implemented by the TBD partner monitoring and evaluation and conduct evaluations. Specifically, the TBD partner will:

Continue to pilot the community health information system (CIS).

Conduct routine analysis of CIS data and report and disseminate CIS findings at community, regional and national levels.

Conduct training to build skills for M&E at the regional level.

Provide IT support to enable more efficient collection, analysis and use of monitoring data at the regional level.

Expand and improve quality of routine monitoring activities at federal and regional levels.

Establish evaluation coordination working group under the auspices of Federal HAPCO.

Prepare terms of reference for evaluations of the GOE community conversation HIV prevention program and care and support activities.

Select organization to conduct evaluation(s) from interested local universities, based on competitive criteria.

Prepare a standard operating procedure for future evaluations.

Host and lead meetings around research or monitoring findings, disseminate results more formally and broadly, and support the translation of research findings into GOE national policy.

FHAPCOs capacity to coordinate activities and foster stronger communication within and between federal and regional HAPCOs and multisectoral institutions has been limited. The GOEs new HIV prevention policy mandates that MARPs or MARPS-related task forces and/or technical working groups are required to have regular coordination meetings with federal and regional HAPCOs, civil society groups, implementing partners and risk group representatives. Therefore, a key area needing coordination is the targeted prevention activities for most at risk populations (MARPS) and vulnerable groups. Currently, these coordination efforts are led by USG implementing partners. Under COP2012, the proposed program will broaden and intensify FHAPCOs coordination role, specifically as it relates to MARPs-related prevention efforts. Activities to be undertaken by the TBD partner include:

Conduct biannual Joint Review Meetings (JRM) for federal and Regional HAPCOs within Ethiopia with key partners.

Conduct biannual joint site supervision visits (JISS) with HAPCO and implementing partners.

Conduct quarterly meetings with Regional HAPCO and RHB representatives.

Form and conduct regular meetings at the regional level on focus activities (e.g. MARPs technical working groups) including HAPCO and regional implementing partners.

Provide regular feedback and information sharing across sectors at both the federal and regional HAPCOs on policy implementation, programming successes and failures, and best practices.

Reinforce messaging though regular dissemination of policy documents, best practices and evaluation findings.

Publish relevant reports in print and electronic form and distributed at meetings, international conferences, and via AIDS Resource Centers and websites.

Mobilize resources from donors.

HIV testing and counseling (HTC) services are now available in all regions of Ethiopia. Services are targeted to both general and most-at-risk populations (MARPS). Even though, HIV testing numbers have reached new highs (nearly 12 million tested in FY 2012), HIV positive rates of those tested have fallen to barely 1% and MARPs have some difficulty to access the HCT service. Linkage and retention in services remain a major challenge particularly for testing outside health facilities.

Therefore FHAPCO will:

1) Develop targeted communication strategies to encourage appropriate access and uptake of HCT services according to population segment, risk exposure and recommended frequency of repeat testing.

2) Develop and provide targeted communication materials using various media.

3) Conduct the Annual National HCT day and coordination of World AIDS Day (WAD) in Addis Ababa and in each of the regions of Ethiopia.

4) Monitor and evaluate the national HCT program including innovative pilot strategies.

5) Oversee HCT data management and information use.

6) Mobilize community wide events and targeted HCT intervention to address gaps in HCT coverage.

FHAPCO may use funds to coordinate efforts of various local and international stakeholders to develop materials and extend services for all population segments while prioritizing those most likely to benefit from HCT and subsequent linkage to services. FHAPCO may also use funds to mobilize and implement targeted HCT campaigns more efficiently in terms of reaching HIV-infected individuals and their partners. The plan will be monitored and feedback solicited from stakeholders and partners to improve quality. FHAPCO will utilize networks and relations with FMOH, the regional HIV prevention efforts, and partner to ensure HCT services are delivered to all according to anticipated benefits for prevention. FHAPCO will strengthen its monitoring and evaluation system to better respond to the GOE and USG new generation indicators.

The GOE recognizes the need for innovative evidence-based prevention approaches to address the heterogeneous nature of the Ethiopia HIV epidemic. Under COP2012, the TBD partner will develop new prevention interventions in support of the GOE's national HIV prevention efforts. Specifically, the TBD partner will:

Conduct targeted rapid assessments (IRARE) of priority areas for prevention interventions.

Develop, pilot and evaluate new HIV prevention interventions or improvements/adaptations to existing ones (such as innovative ways to promote male circumcision and couple testing).

Develop, pilot and evaluate new secondary prevention interventions or adaptations to existing interventions in support of care and support goals including PLHIV, OVC, and vulnerable women (such as linking HIV infected clients identified in communities with clinical care).

Publish and disseminate outcomes of evaluation activities within Ethiopia and at appropriate international fora.

An outcomes evaluation of HIV care and treatment services of patients initiated on treatment between 2005 and 2010 was conducted in 2011 by a consortium of local universities in collaboration with the Federal HIV/AIDS Prevention and Coordination Office (HAPCO). Overall, the study demonstrated encouraging findings regarding retention in care and impact of treatment on immune function. However, the study also identified sources for concern; despite having thousands of patients on ART for more than four years with less than optimal means of assessing drug adherence, less than 2% of all ART patients were on a second line treatment regimen, suggesting that treatment failure is being under-diagnosed. As treatment programs become mature, the durability of treatment effectiveness comes into question, especially if in earlier years there has been inadequate attention paid to detecting early treatment failure. In addition, gaps in the quality of services may occur as treatment sites expand to 250 new hospitals that are currently being built or planned, and as new treatment protocols including PMTCT Option B+ and the change in treatment threshold to CD4 350 are being rolled out. For these reasons it is imperative that program vigilance be maintained at a high level. CDC will fund a follow-on impact evaluation study to be conducted in FY2014, which will document trends in impact compared to 2011 (Eg, has impact been sustained? Is there evidence of enhanced or diminished retention and survival compared to 2011?) and will also serve as an assessment of programmatic gaps that exist in order for PEPFAR partners and the GOE to address going forward. The USG was unable to engage in the planning and design of the 2011 study. By having a much larger engagement in designing the 2014 protocol, USG will collaborate closely with HAPCO, increasing its capacity to manage complex program evaluations, as it is mandated to do by Parliament, while addressing some of the limitations identified in the design of the earlier study. HAPCO has welcomed this opportunity. In addition, the results will serve as a baseline performance measure against which subsequent measures of performance can be compared as site level support is transitioned from PEPFAR implementing partners to the Regional Health Bureaus. Findings will inform GoEs future planning of clinical services. HAPCO will implement the study through sub granting to an appropriate local institution with technical assistance to be provided by CDC-HQ.