This program is a result of a public-private partnership between USAID and Projecto Carvão de Moatize Consortium composed of Vale, Odbrecht and Camargo Correia companies and aims to reduce the occurrence of sexually transmitted infections, including HIV, among Most-at-Risk (MARPs) Populations in Tete Province, specifically in the Municipalities of Moatize and Tete. Its specific objective is To improve access to quality sexual and reproductive health and rights services for female sex workers and their clients. Because of the core role that commercial sex workers and their clients play in the spread of HIV and STIs, it is expected that these infections will also be reduced in the community at large. The two key concepts of the program are to apply a combination HIV prevention approach and to address reproductive health in a comprehensive and holistic way through clinical and community based services. The clinics serve as a drop-in center for all people who feel that they are at risk for HIV and other RH problems and provide a comprehensive package of basic RH services. The facility-based services are complemented by community outreach activities, including peer education among CSWs and clients, workplace-based education at companies with important CSW client populations. Special attention will be given to efficiently reaching occasional CSWs and also regular partners of CSW, and to factors that are known to be important deterrents of consistent condom use, such as excessive intake of alcohol or other substances. One vehicle has been purchased/leased under this mechanism from the start of the mechanism through COP FY2011. New Vehicles in COP FY 2012 =0 Total vehicles for the life of this mechanisms = 1 47,430) for delivery of MARP prevention services in Tete.

ICRH will receive HVCT funds for the first time through COP 12 to provide voluntary CT services through night clinics as part of the comprehensive package for MARPs (however, for the purposes of S/APR, results will be captured as community-based MARPs CT). Allotting new funds to this existing partner falls within the PEPFAR Mozambique CT strategy of ATS-C expansion for most-at-risk groups. ICRH has experience implementing MARPs- focused CT through past projects funded by other donors and will implement counseling and testing, promotion and supervision. The night clinics are located in Moatize and Tete city in Tete province, a transport corridor that has seen an immense expansion of private and bilateral mining concessions and subsequent internal migration in the last four years. ICRHs HIV prevention program targets mine workers, their partners and families, commercial sex workers, truckers, and individuals living in these corridor communities. HIV prevalence is 8% among women 15-49 years ;5.7% among men. 33% of women reported having had a test in the last 12 months compared with only 10% of men. Coverage of HIV testing among TB cases is 99% in Tete. ICRH will promote awareness of the availability of CT services and its benefits among MARPs and bridge populations; encourage opinion leaders, public and private health providers and policy makers to publicly endorse CT as an essential service; address stigma, denial and discrimination (a key barrier to CT uptake) and encourage sustainable behavioral after a person has visited a CT site. Linkages with other prevention (e.g. male circumcision), care and treatment services will also be prioritized. Care, support and treatment services will be through CHASS SMTs (Tete lead clinical partner) case manager and community activista system. ICRH will use the national referral documentation system to track and monitor HIV+ clients are received at appropriate services. ICRH is expected to participate and support the NIH biannual EQA panels, and to utilize standardized quality management tools for CT. ICRH may opt to utilize the JHPIEGO model of peer supervision or consider implementation of client exit interviews and provider self-reflection tools for monitoring and improving counseling quality. Planned HVCT trainings include but are not exclusive to: quality assurance and control, counseling and message delivery in non-judgmental ways, supply planning and forecasting, campaign coordination, linkages/continuum of care, gender and gender-based violence (especially that due to disclosure) and treatment as prevention. There are zero targets for this activity as ICRHs COP 12 HVCT funds ($40,000) are not expected until the very end of FY12. Once funds arrive and services begin, ICRH will train personnel in using the new national data collection tools.

The program will continue to support implementation of a comprehensive package of services for MARPs, mainly CSWs and their clients including truck drivers and other high-risk groups along the Tete - Moatize corridor through promotion and provision of quality integrated health services and humanized care for these populations. Interventions will build on existing approaches of information and services delivered through peer education and night clinics and will explore innovative ways to improve outreach to MARPs groups. Strategies will include mobile brigades; extending hours in existing health centers; working with lodge and bar owners to improve condom availability and communication materials tailored for CSWs. The program will also work with lodge and bar owners to promote social responsibility and a code of conduct to discourage unsafe sex and cross-generation sex.

The package of services will be substantially broadened and include:

Information, education and communication (IEC) on sexuality, HIV, STI, contraception and other HR issues;

Condoms (both male and female) will be made easily available at the clinic in sufficient quantities and free of charge;

The clinics will provide prompt care for syndromes of reproductive tract infections such as vaginal and urethral discharge, genital ulcers and warts, inguinal and scrotal swellings and lower abdominal pain.

Pre-ART monitoring of HIV infection and referral for ART or treatment of opportunistic infections, including tuberculosis (TB) will follow the referral system already established between hospitals and health centers in Tete City and Moatize;

All available, reversible, contraceptive methods will be offered at the clinic, following the national guidelines. Emphasis will be put on dual protection and on contraception in the context of living with HIV. Clients preferring permanent methods will be appropriately referred;

Women victims of violence will receive appropriate psychological support by trained counselors. In the case of rape, medical care including post-exposure prophylaxis of HIV will be offered according to the national guidelines;

Clinics will provide counseling and referrals to the MC Services;

ICRH is negotiating with the provincial health directorate (DPS) to include the night clinics as official MOH sites for cervical cancer screening, and use them as key services in the planned roll-out of cervical cancer screening program in Tete province.

The night clinics will strengthen linkages to other health services, including assisting nearby treatment sites for patient follow-up and proper referral for primarily health care, family planning, psychosocial support and legal advice. Alcohol consumption/misuse and linkages with GBV and Risk Behaviors will also be addressed within the program through community enforcement by creating and support community watch dog groups to enforce laws on serving alcohol to minors, traditional alcohol consumption, monitoring operation policies and proximity of bars and truck stops to schools in focus provinces.

Performance monitoring is based on the principles of action research. Information gathered during the course of the project will be immediately translated into action to improve sexual and reproductive health and rights services for MARP.