I. Introduction

Salesian Missions in partnership with Salesians of Don Bosco in Nigeria is being implementing the CDC funded -Life Choices Voluntary Counseling and Testing Project as of July 2009.The Life Choices Nigeria VCCT Project aims to increase the number of people that know their HIV status. The project will achieve this by increasing access to VCT services, by counseling and testing 7,500 youth and adults in five years and by improving quality of service delivery in the already existent VCT set-ups on a yearly basis. This project is being implemented in Akure -Don Bosco Health Center in Ondo State within a period of five years. The project will also work toward decreasing fear and stigma of HIV/AIDS at grass-roots level which will increase the willingness of people to be tested. The project will use part of the experienced staff from Salesian Akure Health Center as well as has newly employed new staff that will bring new expertise to the team. The project will also use the vast network systems built previously by the Salesian Health Center. In the end of the project cycle sustainability will be ensured by continuing these services with funding from alternative sources in order to continue serving the local community needs.

II. Project Objectives and Strategy The capacity and resources of Life Choices-Nigeria will enable the rapid integration of VCCT services into the current program and health center activities, since VCCT referrals have already been a part of the program. In COP10, however, the Life Choices will expand access for most-at-risk population by making services more readily available through mobile VCT services, and follow-up through support groups, further education, and/or treatment referrals.

REDACTED. .In COP10 the following objectives are expected to met :

Objectives 1: Expanded facility based VCT services and one Mobile VCT services; Objective 2: Test 1,500 youth & Adults for HIV; Objective 3. Refer 1,500 clients to care, treatment and prevention interventions; Objective 4: Organize 5 VCT sensitization workshops with community.

In order to build the capacity of Life Choices-Nigeria to carry out mobile VCCT services, Salesian Missions will provide assistance with activities covering procurement, technical expertise transfer, recruitment and training to service providers and other clinic staff, and best practices material adaptations.

Approach to increasing access to mobile VCT services: Life Choices-Nigeria will expand access to VCT services by: (a) integrating VCT into th; (b) offer health centering high schools and churches in the Ondo State with access to mobile VCT services; (c) improving the quality of youth friendly VCT services at existing VCT sites through training and mentoring of service providers and other clinic staff; (c) increase community mobilization within schools and churches via peer educators, educators, parents and community leaders; and (e) offering psychological support and counseling for onward care and support services to clients diagnosed HIV positive. Life Choices- Nigeria will also build the capacity of the local providers and clinic staff to provide quality youth-friendly VCCT services, including pre-test and post-test counseling of HIV+ and HIV- clients (this is b). Furthermore, the partnering organizations plan to use existing national VCCT and other treatment, care, and support guidelines for training and capacity building in the Ondo State.

In COP09 Salesian Missions Life Choices-Nigeria project supported HIV counseling and testing (HCT) at 1 site in Akure. In COP10, Salesian Missions will continue to support activities focusing on youth and adults in Akure. In COP10, Life Choices will continue to provide targeted HIV counseling and testing services in Don Bosco Health center. At least 1,500 youth and adults will receive counseling & testing and receive their results. Therefore, Salesian Missions Life Choices-Nigeria will expand access to VCT services by: (a) integrating VCT services; (b) offering high schools and churches in the Ondo State with access to mobile VCT services; (c) improving the quality of youth friendly VCT services at existing VCT sites through training and mentoring of service providers and other clinic staff; (c) increase community mobilization within schools and churches via peer educators, educators, parents and community leaders; and (e) offering psychological support and counseling for onward care and support services to clients diagnosed HIV positive. Life Choices- Nigeria will also build the capacity of the local providers and clinic staff to provide quality youth-friendly VCCT services, including pre-test and post-test counseling of HIV+ and HIV- clients (this is b).

Human Capacity Development In COP10 Salesian Missions Life Choices-Nigeria will train 5 new clinic staff . In addition 10 clinic staff will get a refresher training on couple counseling and lab quality assurance. The project will continue to work to promote the following key tenets of quality management through capacity-building activities: understanding of client's needs and expectations; measurement and monitoring of results and outcomes. Life Choices-Nigeria will establish streamlined, interactive approaches for assessing, monitoring, learning and improving management of organizational performance, resources, policies and personnel. In addition, Life Choices-Nigeria will strengthen capacity of local service providers and clinic staff to develop strategies for improving the continuum for care for PLWHA and to ensure that health care facilities become more youth friendly in the delivery of their services.

Community Linkages and Communication Life Choices-Nigeria will promote a behavior change framework that will be grounded in an understanding of an individual context cultural, political, economic, etc and that individual risk behavior is influenced by a variety of factors, or determinants that may be classified into categories such as opportunity, ability, and motivation. Therefore, program interventions have to be designed to influence these factors in ways that are appropriate to each context. Synergies will also be looked at to strengthen the referral system for special-risk groups and maximizing access to and the quality of VCCT, or prevention or care services (opportunity/availability/access) while simultaneously conducting strategic behavior change communication interventions could motivate people to 1) access the services, 2) demand more (and better) services and 3) change or maintain their behavior. Furthermore, the project will organize 5 VCT sensitization workshops with the community. This strategy is based on the concept that people do not change with information, but change when others around them change, and the fact that peer education is supported by behavior theories, the program also provides community mobilizations activities geared towards the youth, parents/caregivers, teachers and community members. The aim of this program is to motivate the community and increase their knowledge and skills and to create an environment that is conductive to healthy behavior practices.

Contributions to Overall Program Area: This activity will contribute to the overall COP10 maintenance plans by providing access to HCT services to at least 1,500 youth and adults who will receive their test results. HIV positive clients will be referred for access to care and treatment, including ART when needed. Fifteen individuals, including health care providers and laboratory staff at facility and community levels, will be trained and retrained to provide services.

Populations being targeted The project aims to provide youth friendly volunteer counseling and testing to youth and young couples 15-24+ years as well as adults and discordant couples.

Emphasis Areas Emphasis areas include awareness and mobilization campaigns, youth friendly services, referral and Support of HIV+ clients and counselor and health care staff training. During COP10 Life Choices-Nigeria will organize awareness and mobilization campaigns prior to the implementation of mobile VCCT visit. These campaigns will incorporate culturally and age-appropriate HIV/AIDS prevention communication. The project will also place an emphasis on youth friendly service delivery. All youth will receive strong messages about the benefits of abstaining, to be faithful to one negative partner and information about the consistent use as well as the limitations of condoms. All youth will be referred to prevention, care and treatment programs. Youth who are diagnosed as HIV positive will be monitored closely to ensure their psychosocial well-being and follow-up to ensure they receive proper care and treatment. The project will also build on its current referral networks for HIV CT clients. Project counselors and health professionals will be trained to refer HIV+ additional prevention, care and treatment programs. The project will also engage in a full range of capacity building activities focused on organizational management, resources, and monitoring and evaluation. Training will be crucial for developing capacity of local HIV VCCT, prevention and care organizations, regardless of which particular area is being strengthened or which capacity building technique is being implemented. Life Choices will utilize and adapt existing tools for capacity building of civil society organizations. The adaptation of tool will focus on appropriateness for us in the improvement collaborative approach and the technical accuracy of HIV related information to ensure that staff is equipped with the most up-to-date HIV related information, and the critical role of referral for diagnostic and clinical services, particularly for those at high risk.

This activity will contribute to the overall COP10 maintenance plans by providing access to HCT services to at least 1,500 youth and adults who will receive their test results. HIV positive clients will be referred for access to care and treatment, including ART when needed. Fifteen individuals, including health care providers and laboratory staff at facility and community levels, will be trained and retrained to provide services.

Populations being targeted The project aims to provide youth friendly volunteer counseling and testing to youth and young couples 15-24+ years as well as adults and discordant couples. Emphasis Areas Emphasis areas include awareness and mobilization campaigns, youth friendly services, referral and Support of HIV+ clients and counselor and health care staff training. During COP10 Life Choices-Nigeria will organize awareness and mobilization campaigns prior to the implementation of mobile VCCT visit. These campaigns will incorporate culturally and age-appropriate HIV/AIDS prevention communication. The project will also place an emphasis on youth friendly service delivery. All youth will receive strong messages about the benefits of abstaining, to be faithful to one negative partner and information about the consistent use as well as the limitations of condoms. All youth will be referred to prevention, care and treatment programs. Youth who are diagnosed as HIV positive will be monitored closely to ensure their psychosocial well-being and follow-up to ensure they receive proper care and treatment. The project will also build on its current referral networks for HIV CT clients. Project counselors and health professionals will be trained to refer HIV+ additional prevention, care and treatment programs. The project will also engage in a full range of capacity building activities focused on organizational management, resources, and monitoring and evaluation. Training will be crucial for developing capacity of local HIV VCCT, prevention and care organizations, regardless of which particular area is being strengthened or which capacity building technique is being implemented. Life Choices will utilize and adapt existing tools for capacity building of civil society organizations. The adaptation of tool will focus on appropriateness for us in the improvement collaborative approach and the technical accuracy of HIV related information to ensure that staff is equipped with the most up-to-date HIV related information, and the critical role of referral for diagnostic and clinical services, particularly for those at high risk.