This activity specifically links with activity #7667, #8723, #7770 in OP, and with #8657 CT, #7715 in OVC, and #7716 in Palliative Care. This activity will also collaborate with and support CT and ARV service partners in Iringa and Mbeya Regions.

Regional mapping and HIV prevalence statistics support the need to more effectively target most-at-risk populations (MARPs), especially along high-prevalence transport corridors. The overall goal of the multi-sectoral Transport Corridor Initiative (TCI), branded SafeTStop, is to stem HIV transmission and mitigate impact in vulnerable communities along transport routes in East and Central Africa. In addition to high HIV prevalence, many of these communities are severely underserved by HIV services. To date the Regional Outreach Addressing AIDS through Development Strategies (ROADS) Project has launched SafeTStop in Kenya, Uganda, Rwanda and Djibouti. Activities will commence in Tanzania in September 2006.

In April/May 2006, ROADS participated in a consultative process with the Government of Tanzania, USAID and other partners to identify sites for SafeTStop programming. ROADS met with the National AIDS Control Programme (NACP), the Tanzania AIDS Commission (TACAIDS), USAID, T-MARC, AMREF, JSI, DOD, and many local stakeholders including the AIDS Business Council of Tanzania and the Tanzania Drivers Association. Four sites were identified for assessment based on their strategic location, high HIV prevalence and gaps in services: Tunduma (Mbeya Region), Makambako (Iringa Region), Isaka (Shinyanga Region) and Singida (Singida Region). In June 2006 ROADS dispatched teams, including representatives from T-MARC, ABCT and the Tanzania Drivers Association, to each of these sites to conduct a rapid assessment process. Findings were shared with the GOT and other partners at a national stakeholders meeting in June, 2006. With FY06 funding, ROADS is focusing activities on Tunduma and Makambako; programming in Isaka and Singida has been deferred due to budgetary constraints.

HIV prevalence estimates in these two sites are significantly higher than the national average: 13.5 percent in Mbeya Region, with prevalence spiking to 20 percent or higher in Tunduma and surrounding towns; 13.4 percent in Iringa Region, spiking to 23.6 percent in Njombe District, location of Makambako. These communities, range from 20,000 (Makambako) to 40,000 people (Tunduma) not including the sizable mobile populations that spend time. In Tunduma, truck drivers regularly spend up to a month waiting to clear customs and cross into Zambia. The combination of poverty, high concentration of transient workers, high HIV prevalence, hazardous sexual networking, lack of recreational facilities, and lack of HIV services create an environment in which HIV spreads rapidly. Tunduma and Makambako are important targets for HIV programming in their own right; they are also bridges of infection to the rest of the country.

HIV services in Tunduma and, to a lesser extent, in Makambako are underdeveloped. Other prevention programming is ad hoc and generally does not reach the most critical populations (such as commercial sex workers and truck drivers) who are typically low users of available government health services. Limited programming that exists does not address critical drivers of the HIV epidemic in these communities, including poverty, underemployment, idleness and the absence of recreation beyond drinking. The result is a high level of hazardous alcohol consumption in the community and alarming levels of gender-based exploitation and violence against women, young girls and boys. Pharmacists/drug shop providers who play an important role in providing health services to these populations have had little or no training in HIV and AIDS.

With FY06 funds, ROADS is in the process of establishing a facility near the bars to serve as a community outreach center for truck drivers, sex workers, other high-risk women and youth providing HIV and AIDS education, counseling and support services. It will provide an alcohol-free alternative recreational site for transient populations and the host community. The facility will offer adult education on life and job skills and link patrons with spiritual services. With FY06 funds (including USAID/East Africa funds), the outreach center will begin providing on-site CT services as well as referral to pharmacies/drug shops for STI and other health needs. Working with community and religious leaders, ROADS will support community action to address alcohol use and gender-based violence against women and youth as a key HIV prevention strategy.

With FY07 funding, ROADS will strengthen work initiated with FY06 funds to reach MARPs

in Makambako and Tunduma. ROADS will integrate with existing services, where possible, as a priority. This will include linking other prevention activities with such services as CT (this service is particularly weak in Tunduma), ART and PMTCT (related services are only available at significant distance from the planned sites), and existing efforts to promote and distribute condoms. ROADS will link and, where feasible, strengthen these services through SafeTStop community branding, to mobilize the community around HIV prevention, care, treatment and mitigation services.

In Makambako ROADS will focus on mobilizing the private sector, especially bar and guest house owners, and promote joint action to reduce risk for bargirls and patrons. This will include continued work with T-MARC for a consistent supply of condoms and peer education among sex workers and other at-risk women. Local pharmacists/drug shop providers will receive refresher training in management of sexually transmitted infections, condom promotion and referral for CT. ROADS will strengthen linkages with local health facilities, including pharmacy/drug shop providers to promote expanded CT and other services for truck drivers, sex workers, other low-income women and out-of-school youth. Linking with PharmAccess and the TBD Uniformed Services Project, ROADS will also build on work initiated in Makambako with FY06 funding to reinforce prevention programming for military personnel, particularly at sites where they congregate off base. With FY07 funds, ROADS will strengthen community-outreach to address key issues of alcohol use and gender-based violence. ROADS will link with the four existing CT services and the USG/T care and treatment partner for Iringa Region.

With FY07 funds, ROADS will strengthen a similar community outreach model in Tunduma, mobilizing the private sector (bar and guest house owners, liquor club members and pharmacy/drug shop providers) and local community-based organizations to expand programming, including condom promotion and distribution, for MARPs.

With plus up funds, ROADS will establish a third SafeTStop site at the Port of Dar es Salaam, focusing on other prevention and referral for C&T, STI and HIV care and support. This SafeTStop will differ slightly from the other two stops along the corridor in that there is no inherent community surrounding the port. However, the vulnerabilities of the individuals who do reside, work and forage nearby are heightened and make the port area one of extreme vulnerability. For this reason the targets will be set somewhat lower for community outreach.

ROADS will establish a SafeTStop leadership board comprising representatives from these entities to finalize design of the resource center and mobilize the resources and skills needed to ensure its successful implementation. Companies will be encouraged to provide shipping containers and other materials to establish the facility; ROADS will link with their workplace programs to enlist staff to run special events and programs on a rotating basis. ROADS will hire two individuals to serve as resource center staff to coordinate programming from the companies and community services.

This activity relates specifically to activities funded under Other Prevention (#7717), Counseling and Testing (#8657) Home-based Care(#8706) and Orphans and Vulnerable Children (#7715).

The activity has several components under the multisectoral Transport Corridor Initiative, targeting most-at-risk populations (MARPS). Regional mapping and HIV prevalence statistics support the need to more effectively target MARPs, especially along high-prevalence transport corridors. The overall goal of the multi-sectoral Regional Outreach Addressing AIDS through Development Strategies (ROADS) Project, branded SafeTStop, is to stem HIV transmission and mitigate impact in vulnerable communities along transport routes in East and Central Africa. In addition to high HIV prevalence, many of these communities are severely under-served by HIV services. To date, ROADS has launched SafeTStop in Kenya, Uganda, Rwanda, and Djibouti. Activities commenced in Tanzania in late 2006, but the substantive work in Tanzania will commence in FY 2007.

In June 2006, ROADS dispatched teams to Tunduma (Mbeya Region) and Makambako (Iringa Region) to assess the impact of HIV and AIDS, identify gaps in HIV services, and propose programming to address weaknesses using the SafeTStop model. This comprehensive model includes classic prevention, care and treatment programming, as well as essential wrap-around programming (HIV and alcohol, gender-based violence, food security, economic empowerment) to reduce vulnerability to HIV and barriers to care- and treatment-seeking. The sites were identified by NACP, TACAIDS, USAID, ROADS and other partners, recognizing their strategic location, high HIV prevalence, and gaps in critical services.

In the two sites, HIV prevalence estimates are significantly higher than the national average: 13.5 percent in Mbeya Region, with prevalence spiking to 20 percent or higher in Tunduma, Mlolo and Vwawa; 13.4 in Iringa Region, spiking to 23.6 percent in Njombe District, location of Makambako. These communities, ranging from 20,000 (Makambako) to 40,000 people (Tunduma), not including the mobile populations that spend considerable time there, are sizable. The combination of poverty, high concentration of transient workers, high HIV prevalence, hazardous sexual networking, lack of recreational facilities, and lack of HIV services create an environment in which HIV spreads rapidly, and that generates large numbers of orphans and vulnerable children (OVC).

In both sites, the care infrastructure for people living with HIV and AIDS (PLWHA) is extremely weak. People who test positive for HIV at Tunduma Health Centre (THC) find it difficult to reach the Care and Treatment Clinic (CTC) at Vwawa Hospital, the district's only anti-retroviral therapy (ART) site 30 kilometers inland. Shortage of trained home-based care (HBC) providers has compounded the lack of access. As of June 2006, only 16 people were receiving home-based care through the THC, with others receiving ad hoc support from one community-based organizations (CBO) and a few faith-based organizations (FBOs). There is no integration of services or a package of services that PLWHA can expect. Pharmacists/drug shop providers in Tunduma have had practically no training in HIV and AIDS, according to a June survey, and there is only one formal PLWHA support group.

In Makambako, people who test HIV-positive at one of the community's four C&T sites must travel 25 kilometers to Ilembula Mission Hospital or 60 kilometers to Njombe District Hospital (NDH) for ART services. Due to distance and inadequate staffing, follow up of these patients is weak. Non-existence of HBC in Makambako further inhibits follow up, while also inhibiting timely treatment of OIs, referral for clinical services, food/nutritional support, PMTCT, psychosocial support and other services.

ROADS can play an important role in getting basic HBC services to these communities until such time that other established HBC providers reach these remote areas.

With FY07 funds, care activities in Tunduma will build on the interventions launched in FY06. The project will expand and strengthen home-based care through FBOs and ABC Group, the lone CBO offering HIV support services in the community. The funding will train families and caregivers in basic palliative care, including hygiene, monitoring ART adherence, identifying and treating simple OIs, referral for clinical services and psychosocial support. With local health officials and PLWHA, funding will be used to devise

strategies to address the barriers to ART services. The project also will strengthen pharmacy-based HIV counseling, support, and referral. Finally, funding will target the development of alcohol support options for ART patients, linking closely with the THC and FBOs.

In Makambako, the focus with COP07 funds will be on strengthening pharmacy-based HIV counseling, support, and referral. These outlets are an untapped resource in an underserved community. As in Tunduma, funding will go toward addressing hazardous consumption of alcohol as a barrier to treatment adherence and efficacy. The activity will also address the transportation barriers facing PLWHA who need to reach CTCs for ART services.

The activity will strengthen referrals in these two regions, one working with Department of Defense and the other working with Deloitte's Tunajali (We Care) HBC activity.

This activity relates specifically to activities funded under Other Prevention (#7717), Care (#7718), and Peace Corps OVC (#7850). As an OVC partner, this activity will link with the PACT coordinating implementing partner group network for OVC (#7783) and the FHI OVC data management system (#7715).

Regional mapping and HIV prevalence statistics support the need to more effectively target most-at-risk populations (MARPs), especially along high-prevalence transport corridors. The overall goal of the multi-sectoral Transport Corridor Initiative, branded SafeTStop, is to stem HIV transmission and mitigate impact in vulnerable communities along transport routes in East and Central Africa. In addition to high HIV prevalence, many of these communities, particularly in outlying areas, are severely underserved by HIV services. To date, the Regional Outreach Addressing AIDS through Development Strategies (ROADS) Project has launched SafeTStops in Kenya, Uganda, Rwanda and Djibouti. Activities began in Tanzania at the end of FY06.

With FY07 funding, ROADS Transport Corridor Initiative will establish programming for orphan-headed households, recognizing their unique vulnerability and needs. This will build on activities initiated with FY06 funding to mobilize the community around OVC issues and enumerate orphan-headed households. The targeted areas for FY07 are the towns of Makambako and Tunduma, where OVC networks are weak. ROADS utilizes a comprehensive model that includes classic prevention, care and treatment programming, as well as essential wrap-around programming (HIV and alcohol, gender-based violence, food security, economic empowerment) to reduce vulnerability to HIV and barriers to care- and treatment-seeking.

The project will work with existing child-welfare organizations, FBOs, local officials and, importantly, the private sector/business community to meet the daily needs of OVC. One strategy will be to work with farmers and traders to develop community food banks. In addition, the ROADS Transport Corridor Initiative will go beyond daily sustenance of OVC, attempting to secure the longer-term viability of orphan-headed households. This will entail job training, job creation and other economic opportunities for OVC breadwinners through the ROADS LifeWorks Initiative, which already has Global Development Alliances in place with General Motors and Unilever. The project will also develop HIV risk-reduction and care strategies specifically for OVC breadwinners, linking them with C&T, sexually transmitted infection (STI) services, food/nutritional support, psychosocial support and emergency care in cases of rape and sexual assault. The activity expects to reach 870 OVC.

The sites of Makambako and Tunduma were identified by NACP, TACAIDS, USAID, ROADS and other partners, recognizing their strategic location, high HIV prevalence, and gaps in critical services. In the two sites, HIV prevalence estimates are significantly higher than the national average: 13.5% in Mbeya Region, with prevalence spiking to 20 percent or higher in Tunduma; and 13.4% in Iringa Region, spiking to 23.6 percent in Njombe District, location of Makambako. These communities, ranging from 20,000 (Makambako) to 40,000 people (Tunduma), not including the mobile populations that spend considerable time there, are sizable. The combination of poverty, high concentration of transient workers, high HIV prevalence, hazardous sexual networking, lack of recreational facilities, and lack of HIV services create an environment in which HIV spreads rapidly, and that generates large numbers of orphans and vulnerable children (OVC).

In Makambako and Tunduma, there are small-scale community-based activities to meet the basic needs of OVC. In Makambako, the two main organizations supporting OVC are Chasawaya and Save the Nation Foundation. Combined, these organizations care for approximately 50 orphans. This indicates a major gap, given that there are an estimated 2,500 OVC in Njombe District and approximately 1,400 in Makambako. In Tunduma, the faith-based organizations (FBOs) Taqwa and Holy Family Health Centre support about 60 OVC. As of June 2006, ward officials were still registering OVC in Tunduma to gauge the scope of this challenge. Given the heavy disease burden in the community, the number of OVC likely exceeds that found in Makambako. According to key informant interviews, a significant proportion of young sex workers in Tunduma and Makambako, referred to as "Twiga Stars," are orphans from other parts of Tanzania and neighborhing high-prevalence countries who have migrated to work in the sex trade. They are among the most vulnerable young people in these sites, often victim to beatings and sexual

assault.

During the course of the year, the ROADS Transport Corridor Initiative will share their experiences and lessons learned with the National Partners Implementing Group, and will link with the Deloitte/FHI Palliative Care and OVC Initiative in Iringa (Njombe), CRS Njombe Diocese, and HJFMRI in Mbeya (Tunduma) to ensure that OVC are identified, enumerated, and receive comprehensive services.

This activity relates specifically to activities funded under Other Prevention #7717, as well as Care #7716 and Orphans and Vulnerable Children #7715.

Regional mapping and HIV prevalence statistics support the need to more effectively target most-at-risk populations (MARPs), especially along high-prevalence transport corridors. The overall goal of the multi-sectoral Transport Corridor Initiative, branded SafeTStop, is to stem HIV transmission and mitigate impact in vulnerable communities along transport routes in East and Central Africa. In addition to high HIV prevalence, many of these communities, particularly in outlying areas, are severely underserved by HIV services. To date the Regional Outreach Addressing AIDS through Development Strategies (ROADS) Project has launched SafeTStop in Kenya, Uganda, Rwanda and Djibouti. Activities will commence in Tanzania in FY 2007.

In June 2006, ROADS dispatched teams to Tunduma (Mbeya Region), Makambako (Iringa Region), Isaka (Singida Region) and Singida (Singida Region) to assess the impact of HIV and AIDS, identify gaps in HIV services, and propose programming to address weaknesses using the SafeTStop model. This comprehensive model includes classic prevention, care and treatment programming, as well as essential wrap-around programming (HIV and alcohol, gender-based violence, food security, economic empowerment) to reduce vulnerability to HIV and barriers to care- and treatment-seeking. The sites were identified by NACP, TACAIDS, USAID, ROADS and other partners, recognizing their strategic location, high HIV prevalence and gaps in critical services. ROADS is focusing activities on Tunduma and Makambako, along the TanZam Highway. Programming in Isaka and Singida has been deferred due to budgetary constraints.

In the two sites, HIV prevalence estimates are significantly higher than the national average: 13.5 percent in Mbeya Region, with prevalence spiking to 20 percent or higher in Tunduma, Mlolo and Vwawa; 13.4 in Iringa Region, spiking to 23.6 percent in Njombe District, location of Makambako. These communities, ranging from 20,000 (Makambako) to 40,000 people (Tunduma)?not including the mobile populations that spend time there? are sizable. In Tunduma, truck drivers regularly spend up to a month waiting to clear customs and cross into Zambia. The combination of poverty, high concentration of transient workers, high HIV prevalence, hazardous sexual networking, lack of recreational facilities, and lack of HIV services create an environment in which HIV spreads rapidly. Tunduma and Makambako are important targets for HIV programming in their own right; they are also bridges of infection to the rest of the country.

ROADS will focus C&T activities in Tunduma, where demand for C&T will overwhelm current capacity based on ROADS community mobilization activities to be launched with FY 06 funds. At present there is only one C&T site in the community, at Tunduma Health Centre. With one C&T room and two trained nurse counselors, who offer C&T as part of their broader responsibilities, the center has the capacity to test six people per day. Since January 2005 the center has referred only 34 people to Vwawa Hospital, the district's sole antiretroviral therapy (ART) site 30 kilometers inland. Staff at the center attempt to promote C&T in the community, but due to overwork their efforts are limited. As a result, services are not well-known or understood in the community, particularly among truck drivers, commercial sex workers and other transient groups. The Tunduma Dispensary, located along the highway leading to town, refers clients to the health center for C&T, while faith-based organizations refer couples prior to marriage. The District Medical Office hopes to expand C&T in Tunduma, though as yet there are no firm plans to do so. Walter Reed/DOD plans to extend C&T services through a community-based organization working on HIV and AIDS in Tunduma, though proposed funding for this site is quite low. ROADS will train private health providers to introduce C&T, including off-hour services, at a SafeTStop resource center to be established near the bars in FY 2007. The project will also explore expanding C&T services through private pharmacies. Training will include counseling skills to identify and counsel C&T clients with hazardous drinking behavior. ROADS will coordinate with the DMO and Walter Reed/DOD to ensure maximize coverage in this highly underserved community. In Makambako, ROADS will focus C&T activities on increasing referral to the four existing C&T sites. In both sites, C&T services will benefit from and work in concert with community mobilization efforts to address stigma, discrimination and gender-based violence, major constraints to accessing C&T services. In both sites, the project will strengthen referral of C&T clients for family planning.