The Save the Children TransACTION Projects goal is to prevent new HIV infections among at risk populations and strengthen linkages to care. This program will continue to contribute to the PEPFAR prevention response under the PF and the GHI principles largely focused on promoting health and well-being among women and girls who are exposed to unwanted pregnancy, HIV, other STIs and violence risk factors. Local ownership and transitioning is promoted through mentoring and involving the GOE, local CSOs and associations formed by target groups such as the Association for Truckers. TransACTION will be implemented in 120 towns along the four major transportation corridors of Ethiopia: Addis Ababa-Djibouti, Addis Ababa-Adigrat, Addis Ababa-Gondar, and Modjo-Dilla. The target populations are adult men and women residing in and transiting through these urban areas, including transportation workers, sex workers, girls and women engaged in transactional sex, and other men with disposable income including migrant workers. Embracing a continuum of response approach, Trans ACTION promotes HIV prevention and sexual health promotion for at risk groups linked with stronger facility and community-based follow-up and support when these groups are found to be HIV positive. The program provides a combination of prevention services in a cost effective way by leveraging resources from other partners. The program will have both a mid-term and a final external evaluation to chart activity progress. The program estimates the purchase or lease of 3 vehicles to assist with activity implementation and monitoring. Though no COP12 funds are being requested for this project, the project will continue as described using pipeline funds.

It is expected that the mechanism shall receive funding in COP FY 2012. The Care and Support Services under this mechanism are primarily targeting HIV-positive sex workers and their clients, migrant workers, women engaged in transactional sex, and their families. The services will be provided directly at private health facilities at both the household and community level. All services will develop active linkages and follow up to public health facilities. This year, the program will cover 120 towns in 8 regions of Ethiopia. Addressing the PEPFAR strategic objectives to prevent new HIV infections among at-risk populations, TransACTION program activities will strengthen linkages to care and support services in towns and commercial hotspots along major transportation corridors. TransACTION will strengthen the linkages of HIV-positive individuals and their involvement in care and support services. To this end, TransACTION will deploy HIV-positive Case Managers in high-volume private facilities that provide free HIV testing. These care providers will mentor newly diagnosed and known HIV-positive MARPs to help them adhere to HIV/AIDS care and support services. The program will use prevention messaging combined with behavior change communications strategies to better inform this new community. HIV-positive individuals will receive home-based care, including spiritual and economic support, as well as referrals for food and other support services. TransACTION will ensure the quality of care and support by providing refresher trainings to community-based home care providers. The program will integrate regular mentoring and supportive supervision sessions to reinforce quality and consistency of services provided. People living with HIV associations and other community-based organizations will receive capacity building support and will be involved in addressing MARPs through the comprehensive care and support package.

TransACTION will reach most-at-risk populations (MARPs) and highly vulnerable populations concentrated along the major transportation corridors impacting 120 towns in 8 regions of Ethiopia. The TransACTION program will target at risk youth (aged 15-25), older men, and women engaged in transactional and commercial sex. The program will also actively engage individuals and groups at the community and household levels, including local leaders and police officers, to foster an enabling environment and adoption of social norms that promote healthy sexual behavior and practices. HVAB funds will primarily support a communication tool consisting of 15 activities designed to stimulate community dialogue on multiple concurrent partnerships, male-dominant norms, gender-based violence, stigma and discrimination against MARPs and vulnerable populations, and unhealthy sexual behaviors. The TransACTION program will select and train a cadre of peer educators to provide education on comprehensive HIV prevention topics. The project will specifically engage potential clients of sex workers as well as discourage transactional sex among youth. Stigma reduction activities might also be incorporated to engage families and communities where MARPs reside. The program will integrate mentoring and supportive supervision on a regular schedule to ensure and reinforce quality and consistency of comprehensive messages being communicated. The program will assess the quality of peer education and communication skills through exit interviews, supervisory checklists, self-assessment tools, content knowledge tests, and evaluation of standardization of delivery.

The TransACTION program targets most-at-risk populations (MARPs) and other highly vulnerable populations including sex workers and their clients, long distance truck drivers, migrant workers and other at-risk groups for HIV counseling and testing (HCT) services. The HIV prevalence among these groups widely varies with a range of 10-30%. The TransACTION program successfully tested 40,000 individuals from these groups in the last six months of FY 2011. The program consists of two main approaches in its implementation of HCT services. First, the HCT service is linked to intensive behavioral interventions, peer education and other prevention packages. Peer educators typically refer MARPs and other vulnerable populations to public, private and mobile outreach testing outlets. TransACTION may also incorporate some innovative approaches such as reimbursement vouchers for MARPs and vulnerable populations to access services as needed. Outreach activities supporting HCT services were organized in several different towns with the result of 31,915 MARPs and highly vulnerable accessing services.219 private health professionals and laboratory technicians were trained in various topics such as syndromic management for sexually-transmitted infections (STI) and provider-initiated counseling and testing (PICT), The second main approach to better facilitate access to HCT services involves the use of drop-in centers and STI screening and treatment facilities, where PICT is primarily employed. An estimated amount of >85% of the funding for HCT is budgeted for MARPs and highly vulnerable populations. TransACTION will use the national testing algorithm, which recommends serial testing with three tests (screening, confirmatory and tie breaker). The TransACTION program will provide HCT, referrals and linkages to anti-retroviral therapy and other HIV/AIDS services that all together form a supportive environment guaranteeing quality care and support for MARPs and their families. The program will assure data quality through an external review of data collected at each private facility and through data quality assessment examining data accuracy and reliability.

The TransACTION program will reach 55,000 most-at-risk populations (MARPs) and other highly vulnerable populations, such as female sex workers (FSW), long-distance truck drivers, female staff in food service establishments, and mobile daily laborers. In Ethiopia, women are highly involved in transactional or commercial sex, while men are largely mobile, engaging in multiple concurrent relationships (MCP). In 2009, the TransACTION program estimated that 30,000 FSWs were operating in the major towns where activities were being implemented. The program will expand access to critical combined prevention information and services for MARPs and will extend to 30 new towns in the western transportation corridors of Ethiopia. This expansion will increase program coverage by 50%, as compared with last year. Program activities will integrate such interventions as standardized behavior change communication tools and peer education guides. The behavioral interventions will engage all mobile target groups to participate in 8-10 weekly intensive sessions combined with reinforcement activities. Correct and consistent use of condom messages combined with counseling, testing and treatment services and economic strengthening will be promoted through TransACTION, along with a reduction in MCP and in transactional sex. The programs 250 condom service outlets will distribute 2 million condoms. More than 100 private and public facilities will provide testing and treatment services for HIV and sexually-transmitted infections and reproductive health services. Income-generating activities, such as savings groups and market-based vocational/apprenticeship training programs, will be developed to economically support 2,400 individuals with an emphasis on MARPs and other highly vulnerable groups. The program will integrate mentoring and supportive supervision on a regular schedule to ensure and reinforce quality and consistency of comprehensive messages being communicated. The program will assess the quality of peer education and communication skills through exit interviews, supervisory checklists, self-assessment tools, content knowledge tests, and evaluation of standardization of delivery.