The purpose of this new program is to increase access to HIV services and reduce transmission among bridge and most-at-risk populations (MARPs), along transport corridors and "hot spot" venues, by promoting a package of interventions and preventive services tailored to their lifestyle and risk situation. Transient lifestyles often encourage a preponderance of multiple concurrent partnerships (MCP), heavy alcohol consumption, widespread sexual and gender-based violence (SGBV) all of which create an environment of elevated risk for HIV acquisition and transmission. Populations include mobile populations, such as truckers, miners and other migrant workers who engage in risky behavior, commercial, transactional or casual sex, and place their regular partners at increased risk as well; female sex workers (FSWs) and their partners, and girls and young women who engage in risky sex primarily for economic purposes. Communities at elevated risk, such as in mining towns or transit points along transport corridors and other hotspots also constitute key foci for this project. As needed, geographic

mapping and prioritization exercises will be undertaken to provide the basis for planning programmatic interventions. Programmatic emphases and resources will be allocated among population groups and localities based on analysis of existing and additional data, including formative research to better understand risk behavior patterns and design appropriate interventions. The project will benefit from experience gained under ROADS I along transport corridors in neighboring African countries to expand appropriate prevention and communication approaches most likely to be effective in promoting HIV prevention among MARPS and the communities they live in and interact with. Risk reduction interventions will also address alcohol abuse and gender based violence.

The project will also expand and increase the uptake of non-traditional HIV CT targeted to hard-to-reach populations, and strengthen the linkages of CT to other HIV and health services. Emphasis will be given to innovative approaches for expanding the availability of and the demand for CT among populations who may not have access to services at mainstream clinics.

In line with priorities of the Partnership Framework, this activity will strengthen capacity of government, civil society and the private sector to deliver comprehensive HIV services for high-risk populations and to create an enabling environment for service expansion. The project will help strengthen government coordination and multisectoral programming for MARPs, and will train local nongovernmental organizations (NGO) and community-based organizations (CBO) in advocacy, resource mobilization, and service delivery for the targeted populations.

Under this activity, USG encourages the provision of sub-agreements to local organizations, especially those which include representation by the targeted groups and populations, and developing agreements with private enterprises along transport corridors and hot spots. All approaches and activities will be carried out in collaboration with the national, provincial and district directorates and the MOH, Ministries of Labor, Transportation, the NAC and relevant Technical Working Groups, thus reinforcing the Partnership Framework's goal of strengthening the multisectoral response.

Interventions will take place in the following provinces: Maputo City, Maputo, Gaza, Manica, Sofala, Zambezia, Tete, and Niassa. Activities will target busy transport corridors and hotspot venues and will be purposefully intensified in the highest prevalence provinces of Gaza, Maputo and Maputo city. The program will include interventions in Beira where other USG partners and donors are working. The program stresses coordination with existing HIV prevention programs eg for FSWs, and complementarity with USG prevention efforts targeting other MARP groups, to ensure the widest possible coverage of different populations at increased HIV risk. In addition, collaboration will be fostered with USG partners and service providers in CT, care and support services, and others engaged in outreach to high-risk populations. Economic opportunities for high risk populations, especially women and young girls, will be

explored to reduce their exposure to risky sex.

This new award will have specific and quantifiable performance measures, indicators and targets to help document, monitor and evaluate the program's performance and achievements in extending HIV prevention and CT services to targeted MARPS along the transport corridors. Performance will also be evaluated based on the completion of specific tasks as outlined in the agreement, adherence to the work plan, and regularly submitted reports. Activities will utilize findings and recommendations from planned USG MARP size estimation studies, mapping exercises and assessments.

Reduced HIV transmission among MARP and bridge populations in communities and venues with high levels of risk behavior will be achieved by increasing the use of commodities, services, and adoption of safer behaviors. Efforts will expand and increase uptake at non-traditional CT sites that target mobile

and hard to reach populations and strengthen linkages to other HIV and health services. To ensure availability of a comprehensive package of prevention services for MARPs and bridge populations, the project will develop, test and scale-up innovative models for creating demand and increase uptake of CT. These models will emphasize post-test prevention counseling and establish strong STI referral systems, TB screening, HIV care, ART, and other critical HIV and health services. The technical approach will incorporate strategies that promote gender equity and address gender norms and expectations that can be detrimental and increase vulnerability to HIV infection for both men and women.

Implementation will be national in scope with interventions focused selectively on high-risk areas, particularly major transportation corridors, communities with high prevalence and high density of MARP/bridge populations, and venues with high levels of risky sexual behavior, including such communities in the highest prevalence provinces of Maputo City, Maputo Province and Gaza.

Capacity building is crucial for scale-up of interventions targeting MARPs. NGO/CBOs provide local ownership, essential for long-term sustainability. The private sector will be strongly encouraged to play its role and PPPs will be explored. Advocacy with government to create an enabling policy environment in which to effectively reach these populations and to ensure appropriate government leadership and coordination of programming for MARPs.

An M&E plan will be developed and will include process, output, outcome and impact components. Routine data quality assessments, process, and outcome evaluations will be carried out to design effective strategies for targeting CT services to reaching MARPs and the communities they interact with.

The implementing partner will design a comprehensive prevention program tailored for different categories of MARPs, and will develop approaches to discourage practices such as transactional sex, and multiple concurrent partnerships, which are particulalry common among mobile populations. The partner will also design and implement a surveillance system at designated STI night clinics established for FSW. This surveillance system will be implemented in order to provide much needed qualitative and quantitative information around specific MARPs groups in a clinical setting. Such data collection is considered a critical SI activity in that data around MARP populations in these settings has been a traditionally difficult data set to collect. As part of the need to move towards more evidence-based intervention programs, more quantitative and qualitative information around specific MARP groups is critical in the scaling-up of MARP evidence based interventions and programs. In addition, it is expected

that this surveillance activity will begin to assist both the MOH and the NAC in developing more comprehensive datasets around MARPs. Such surveillance should also provide information about the effectiveness of MARPs oriented activities and interventions supported by the USG.

The partner will be responsible for implementing the surveillance system at selected night clinics and the training of relevant clinic staff in the maintenance and effective use of the system. In addition, the partner will ensure that all required surveillance indicators and quality assurance activities related to the surveillance are implemented. The partner will also be responsible for providing ongoing reports based on this surveillance to USG and to the MOH.

This program focuses on high risk activity among long distance truckers, migrants, miners, other mobile populations, and FSW who live and work along the busy transport corridors and hotspot venues along the way. Interventions will be tailored to the needs and lifestyles of these most at risk populations and will increase access to, and coverage by, a comprehensive package that may include the following services and supportive interventions:

1) Targeted promotion and distribution of condoms and lubricants in close collaboration with the CSM efforts; 2) Risk reduction activities and counseling, including alcohol abuse 3) Peer education and outreach; 4) HIV counseling and testing, especially mobile and home-based services; 5) Sexually transmitted infections (STI) screening and treatment, as part of comprehensive HIV prevention and care; 6) Linkages to HIV care, treatment and PMTCT; 7) Post-exposure prophylaxis (PEP), especially for female sex workers (FSW); 8) Drop-in centers and night clinics, especially for FSW; 9) Sustainable/Alternative livelihood interventions, especially for FSW and vulnerable girls; 10) Reduction of stigma and discrimination; 11) Linkages to health services including RH/FP, PHC, psycho-social and legal support; 12) Screening for and reduction of SGBV

Capacity building at all levels is crucial for scale-up of interventions targeting MARPs. This activity will strengthen capacity of government, civil society and the private sector to deliver this comprehensive

package of HIV services for high-risk populations and to create an enabling environment for service expansion. Advocacy with government leaders is needed to create the enabling policy environment in which to effectively reach these populations, and to ensure appropriate government leadership and coordination of programming for MARPs. NGOs and CBOs can also provide local ownership essential for long-term sustainability. The private sector has a role to play in condom marketing and in supporting prevention among its workforce and leveraging of public private partnerships, which will be strongly encouraged.