ROADS II is designed to reduce HIV transmission, improve care, and reduce the impact of HIV and AIDS along major transport corridors. The project achieves this goal by linking mobile populations and communities to prevention, care, treatment, and support services. In line with the GHI strategy, ROADS II recognizes the socio-cultural factors that place individuals at heightened risk for HIV infection and attempts to link households to economic strengthening opportunities that will create a stable and sustainable future.

ROADS ll utilizes a community organizational model, which enhances the programs reach through the collective action of community clusters of small, sustainable, indigenous groups. These clusters are focused on reaching most at-risk populations (MARPs) in their respective communities, which often include truck drivers, fishermen, construction workers, mobile populations, food vendors, women engaged in transactional and commercial/transational sex work, in and out of school youths and OVC and their families.

In an effort to enhance country ownership and strengthen the indigenous response to the epidemic, capacity building and the transition of responsibilities represent essential components of the ROADS II cluster model. ROADS II works closely with local government authorities as well as provides sub-contracts to several local organizations.

The ROADS II monitoring system includes routine data collection and a tracking system with standardized recording and reporting protocols for services rendered. The evaluation component includes special studies to measure qualitative and tangible results.

Given the expansive areas that site coordinators and FHI staff serve, motorcycles will be purchased as a cost effective alternative to 4WD vehicles.

ROADS II will continue implementing community and home-based care (HBC) activities in Kahama, Makambako, Mwanza, Dar es Salaam, and Tunduma while initiating similar activities in Chalinze and Ilula. These areas are identified hotspots and, as such, the project will support adult care and support services in these areas. Activities will include strengthening provision of palliative care to adults and children and provision of the basic HBC/PHDP care package (condoms, water purification, reagents, insecticide-treated bed nets). Target audiences will be adolescents, key populations, and male and female adults.

To strengthen provision of palliative care, HBC providers will conduct monthly meetings to share experiences and challenges, as well as quarterly joint supportive supervision to ensure quality provision of HBC services. In the new sites of Ilula and Chalinze, the project will work closely with local governments and international and local partners to ensure project activities are complementary rather than duplicative of existing programming. The HBC program and team will be fully linked with district health facility HBC supervisors and adherence workers, where applicable.

HBC providers will be trained on the integrated HBC package. The project will organize and conduct in-service training on the HBC/PHDP core package for community para-social and health workers. In addition, project-supported field officers from PLHIV clusters will be oriented on the national recording and reporting tools to effectively and accurately compile and submit high-quality reports. As part of its family-centered approach to care, HBC volunteers will identify and refer family members for HTC (or facilitate home testing) and other needed services.

As part of the micronutrient component, ROADS II will build skills in home food production for PLHIV and their dependents. Training in business and entrepreneurial skills with a focus on group savings will enhance the economic well-being of AIDS-affected households and caregivers. The project will also harness the reach and convenience provided by neighborhood pharmacies and drug shops, which are the first line of care for many community residents as well as truck drivers and their immediate networks. In between periodic trainings, HU/PACE will provide virtual coaching and mentoring to District MOH pharmaceutical care focal persons, clusters, and associations of local pharmacies and drug shop owners to continually strengthen this component.

For COP 2012, the project will integrate alcohol counseling and treatment options for PLHIV, particularly ART patients (see section on HVOP for additional information). Strengthening care for truck drivers will also be a particular area of emphasis through primary health care services (Wellness Centers) integrated into resource centers in Kahama, Dar es Salaam, Tunduma, and Mwanza sites. Recognizing the emotional and physical toll that HIV care and support can have on caregivers, ROADS II will implement programming specifically to address the needs of caregivers such as providing psychosocial support, education and training in nutrition, medical and social services, and access to economic strengthening through agriculture and other business development.

ROADS II will strengthen OVC programming at the three existing sites, Makambako, Dar es Salaam, and Tunduma, as well as initiate additional programming, as needed, in Ilula, Chalinze and Mwanza. As ROADS II expands into these areas, an emphasis will be placed on identifying opportunities for collaboration with partners already working in the area. ROADS II will adhere to recently released PEPFAR OVC guidance and will direct partner work plans on OVC/MVC programming for FY 2012, primarily focusing on building the capacity of governance structures and communities to lead OVC/MVC care and support to enhance sustainability of programs. The projects goals under this element are to improve access to safety nets for most vulnerable families.

ROADS II will work with and strengthen district and ward level social development and welfare units and local MVCC Committees in such areas as resource mobilization, collaboration among partners at site level, enhance community involvement in MVC/OVC care and support, and improve linkages with public private partnerships. Through local MVCC support, eligible OVC/MVCs will be provided with a minimum of one core care service, which includes food and nutrition support, shelter, protection, health care, education, economic strengthening, and psychosocial support. The project will provide technical assistance to the MVCCs to ensure evidenced-based OVC/MVC programming that truly benefits the target populations. The project will continually seek strategic collaborations and linkages with other program elements including prevention, care and support, treatment, and gender. Further partnerships with other USG/T initiatives, such as Feed the Future, and other actors, including UN agencies and Global Fund programs, will also be sought after. Technical assistance will be provided to local MVCCs and local leaders to advocate and secure additional funding for OVC/MVC programming. The project will also look for strategic opportunities to work with local and national level government to ensure full engagement as the various government levels increase their efforts by taking on more technical, fiscal, and monitoring oversight for OVC/MVC programming.

To address the long-term needs of orphan-headed households, ROADS II will conduct vocational training and economic strengthening for MVC/OVC breadwinners. The project will also continue supporting HIV risk-reduction and care strategies, specifically for OVC who are the breadwinners within the households, linking them with HVOP and HVAB messaging, HTC services, and STI diagnosis and treatment. The project will introduce programming specifically to address the needs of MVC/OVC caregivers by providing education and training in nutrition, parenting, medical, and social services; access to economic strengthening through agriculture and other business development; and community sharing of child support. Health-related wrap-around services supported by the project will include, but not limited to, family planning and reproductive health services.

Reporting skills for cluster staff and volunteers will be enhanced and strengthened by providing training of the National Plan of Action (NPA) and national Data Management System (DMS), which are harmonized with the ROADS II regional M&E system. In existing and new sites, OVC/MVC identification or re-identification, will be conducted, per government guidelines, to ensure an updated and accurate list of OVC/MVCs.

While ROADS II sexual prevention programming primarily focuses on reaching MARPs, the project continues to have activities that target the general population, youth, and MVC/OVCs. ROADS II will continue to build capacity of peer educators and community mobilizers from indigenous volunteer groups to convey partner reduction messages while linking clients to services such as HTC and STI treatment. The project intends on reaching 40,000 individuals in FY 2013 with AB messages.

Rapid assessments of key behavioral drivers of the epidemic will be conducted at all project sites. This will ensure that activities are appropriately tailored to the context in which HIV transmission takes place. MCA-T sites will also implement similar behavioral interventions.

For COP 2012, ROADS II will examine barriers to partner reduction among certain populations, particularly transient workers who are young adult men and women aged 18-30. The project will also help facilitate and encourage dialogue among youth and OVC on transforming harmful sexual norms. The MCA-T program will extend AB programming to construction workers and at-risk community members near construction sites, including in- and out-of-school women and girls. The project will establish and strengthen health clubs in primary and secondary schools along road construction projects, drawn from best practices in Tanzania and the region. Additionally, the project will conduct regular in-school and inter-school debates, essays, and drama competitions addressing HIV/AIDS, gender, alcohol abuse, and sexual and reproductive health issues.

Recognizing opportunities for synergies with other interventions, the project will link its clients with clinical services, such as HTC, ART and PMTCT, as well as promote other community-based interventions. The project will continue to link and strengthen these services through the SafeTStop model, which mobilizes the community around HIV prevention, care, treatment, and mitigation services as well as addresses gender norms, alcohol use, stigma, and discrimination. The project will continue working with faith-based community organizations and youth groups to promote AB messages, specifically partner reduction, community men and women, and sexually active youth, while linking them to the appropriate services.

ROADS II will continue to implement facility and community based HTC programming in project sites. HTC programming will be implemented at all sites, including Dar es Salaam, Chalinze, Ilula, Makambako, Tunduma, Kahama, and Mwanza. MCA-T sites will implement HTC in Tanga, Ruvuma, and Tunduma -Sumbawanga sites. By generating interest and an appreciation for HIV services, an increase demand for HTC services has been noted at upgraded facilities and during special events and outreach activities.

ROADS II has and will continue to refresh counselors on URT guidelines. These trainings will cover counseling skills to serve discordant couples, including appropriate pre-test information and post -test risk reduction counseling; identify and counsel clients on alcohol use and abuse; and discuss family planning and reproductive health options while linking to services based on sero-status.

ROADS II will actively promote testing to all family members where the index patient is found to be HIV-positive. Testing all family members will be the entry point to referrals to a full menu of health services, including child survival, family planning and reproductive health, malaria prevention and treatment, PMTCT, TB, and pediatric care and treatment.

For COP 2012, ROADS II will receive additional funds to support an increased number of HTC outlets in program sites with hours and locations appropriate for key populations, particularly truck drivers, construction workers, commercial sex workers and women and girls engaged in transactional sex. Sites will include HCT services in the SafeTStop Resource Centers, which serve as alcohol-free recreation sites as well as venues for a range of HIV and other health services. The MCA-T program will establish and implement strategic fixed outreach HTC sites at and near work places during special events and where construction workers frequent in the evening and weekend hours.

Additionally, the MCA-T program will offer HTC services after select monthly and bi-monthly HIV prevention sessions for construction workers. ROADS II will continue to work with community-based organizations to expand fixed outreach HTC during special events.

Importantly, the project will organize meetings between HTC staff, health providers, and community caregivers to ensure HTC clients and family members are referred to and from services. Clients who receive HTC services will receive relevant IEC materials. The project will also address gender barriers to uptake of HTC at health facilities, fixed outreach sites, and the home.

Through District DMO offices, quarterly joint supportive supervision will be conducted to ensure quality provision of HTC services.

Target Population / USD / Target Number / Type of InterventionTruck drivers / $91,750 / 18,350 / Peer educationCSW / $300,000 / 4,900 / Peer education, economic strengthening, mobile HTC servicesIn and out-of-school youth / $700,000 / 136,000 / Prevention education, economic strengtheningFood vendors / $56,000 / 11,000 / Prevention education, economic strengthening, mobile HTCBar maids/Guest attendants / $32,000 / 6,000 / Prevention education, mobile HTCFishing populations / $320,000 / 60,000 / Peer education, mobile HTCConstruction workers / $150,000 / 4,050 / Workplace programming

ROADS II will provide targeted interventions for key populations while working with local district officials, NACP, and TACAIDS at all levels to promote gains realized and sustainability. Peer educators and implementing partners will be trained to identify and reach key populations using strategic behavior change communication techniques and refer them to appropriate clinical services. A social mapping exercise will identify where key populations work, socialize, and live to determine what resources and health facilities are accessible to them.

ROADS II will continue focusing on high-risk behaviors, such as multiple concurrent partnerships, alcohol abuse, and unprotected sexual intercourse, while linking clients to relevant health services . The project will also encourage biomedical interventions, including VMMC and ART, as well as adherence to ART for those already HIV infected. ROADS II will provide technical and program support to CBOs, peer educators, and drama troupes to sensitize key populations on alcohol and drug abuse.

The MCA-T program will continue HIV prevention programming at the workplace, which includes monthly or bi-monthly HIV prevention sessions, workplace and community peer education training and outreach, and special events.

The project will use local media, mainly radio, to channel various HIV and AIDS messages, discuss health services, and promote targeted condom distribution at key populations -frequented locations, such as shops, bars, guesthouses, truck stops, and construction sites.