Despite important gains in health and development in Uganda, gaps in HIV and AIDS services persist in many settings. Poor communities along Uganda's major transport corridors, including border towns, are particularly underserved with prevention, care, support and treatment services. Morbidity and mortality rates tend to be relatively high in these communities, where HIV prevalence is often significantly higher than national estimates. The combination of poverty, concentration of transient workers, preponderance of multiple concurrent partnerships (MCP), heavy alcohol consumption, widespread sexual and gender-based violence (SGBV), and poor access to health services create an environment of elevated risk. These communities remain, in effect, incubators of HIV, driving HIV transmission in areas well beyond their geographic location.

The Roads to a Healthy Future (ROADS II) Projecta five-year Leader With Associate award managed by Family Health International and funded by the U.S. Agency for International Development (USAID)extends HIV prevention, care and support services to most-at-risk populations in these underserved, often remote communities. The project currently works in four Ugandan corridor communities, Busia, Katuna, Koboko and Malaba, with plans to establish an additional site in FY 2010 (pending available funding) based on team assessments to be conducted in September 2009.

Like ROADS I, ROADS II utilizes the cluster community organizing model, which maximizes program reach by expanding participation and collective action of small, sustainable, indigenous volunteer groups with similar focus and interests. Through 11 clusters, ROADS is building the capacity of 65 such groups in Uganda with a combined membership of more than 10,767. Project partners implement HIV and AIDS prevention, care and support programming of their own design, and are introducing such wrap-around programming as community-based alcohol counseling and interventions to address SGBV (based on Busia and Malaba innovations).

In addition to skills-building in these areas, ROADS II strengthens skills in monitoring and evaluation, program and financial management, leadership, conflict resolution and governance. To raise the visibility of clusters and signal availability of quality services, including those provided through private drug shops and pharmacies, ROADS II continues to socially market the SafeTStop concept, which uses consistent but adapted strategies, branding and materials across countries.

Target populations: 1) PLHIV (all ages); 2) family members of PLHIV (all ages); 3) PLHIV caregivers (15+). Promoting gender equity and male involvement cut across all ROAD II program elements.

Program description: With COP FY 2010 funds (programming year 2011), ROADS II/Uganda will expand HBHC in existing SafeTStop sites (Busia, Katuna, Koboko, Malaba, and another TBD in FY 2010), plus at least one additional site to be established in FY 2011 if funds are available. ROADS II will reach 3,330 eligible adults and children with a minimum of one care service (Next Generation Indicator C1.1.D). The basis for programming will be existing ROADS mapping, assessments and evaluations plus new participatory assessments to be conducted in FY 2010. ROADS II/Uganda will link with a range of partners in the outreach and bi-directional referral system, including CBOs, FBOs, NGOs, government and private businesses, to ensure PLHIV and their families can access all needed services, including FP/RH, malaria, MCH and TB.

With the MOH, ROADS II will ensure that sufficient numbers of community and para-social health workers are trained in comprehensive HIV management with skills to address palliative and terminal care at the household level. Services of HBHC workers will include prevention for positives, including distribution of condoms and demonstration of correct use. ROADS II will provide appropriate home-based care kits including gloves, cotton wool, disinfectant, and basic medicines to enable them perform their work; ROADS II will also provide PLHIV a Basic Care Package including a water vessel, CTX prophylaxis (prescribed and received), long-lasting insecticide-treated net, water purification tablets, liniment, pain medication, condoms, filter cloth, multi-vitamins, de-wormers, disinfectants, cotton wool, gloves, etc. ROADS II will utilize a non-monetary incentive package that includes a bicycle, identifying clothing, and such professional development opportunities as advanced training, exchange visits and references.

ROADS II will provide counseling and spiritual care by training community volunteers as psychosocial support counselors. The PSS counselors will be selected from the existing HBHC workers that have already undergone training on all other aspects of care. The PSS counselors, some of whom are trained in child counseling, will be given further training in trauma identification and counseling, especially for children, and thus be able to provide emotional and spiritual counseling. The PSS counselors will hold sessions with their clients on a regular basis at household level to help them deal with bereavement, and provide end-of-life care to the client and family when needed. They will also assist them to cope with issues around stigma and discrimination, counsel them on positive living, and offer spiritual support.

ROADS II will work with PLHIV "clusters" at each site to enhance LifeWorks Partnership Trust economic strengthening strategies for PLHIV, their family members and caregivers. This will build on food-security strategies introduce by ROADS II/Uganda in FY 2010. Through a demonstration farm in Busia (to be established in FY 2010), ROADS II will ensure PLHIV and dependents have access to nutritious food. Food/nutrition support will be targeted to stage of disease, particularly for those on antiretroviral therapy. PLHIV and family members who receive support will also be provided skills in modern agricultural techniques that they can use at home. All PLHIV in the program will have the opportunity to participate in support groups in their area, focusing on positive living. Social support services will also include shelter, protection, and access to health services.

ROADS II will continue upgrading pharmacy/drug shop providers' skills in palliative care, including counseling on OIs and ART, including adherence. The project will integrate alcohol counseling and treatment options for PLHIV, particularly ART patients, linking alcohol counseling groups with public health facilities.

Recognizing the importance of proper monitoring and evaluation, ROADS II will engage the HBHC workers at the lowest level of care (household) to provide weekly reports to their supervisors. Monthly assessments of PLHIV by health workers will be essential to ensure care received by clients is indeed what they need. Healthy facility staff will meet quarterly with HBHC workers to discuss progress and address barriers to effective care at the household level. Cluster and ROADS II Site Coordinators will compile the data collected weekly to produce a monthly report that will inform on progress and provide information on how to improve current programming. ROADS II will also conduct quarterly program reviews to assess the effectiveness of the program, particularly the outreach and bi-direction referral system. Annual evaluations will be conducted to assess the impact of the program.

The main oversight structures at the site level are the Cluster Steering Committees, which include representatives from all groups belonging to respective clusters. Steering committee members communicate routinely with the ROADS Site Coordinators and meet formally once per month. At the monthly meetings, the Committees and Site Coordinators review monthly data reports against targets, ensure activities are on track and focused on agreed target audiences, identify programming impediments, and resolve issues in a timely manner. The Site Coordinators report directly to the Kampala-based Country Manager, who has overall responsibility for achieving country program targets, ensuring ongoing quality assurance/quality improvement, and managing the day-to-day relationship with USAID/Uganda, in liaison with the ROADS II management team in Nairobi. The Country Manager will visit each site at least once per quarter to ensure all project activities are on track, and will convene in-country quarterly staff/partner meetings with Site Coordinators and implementing partners. ROADS II will strengthen the technical skills of our local partners and site staff, drawing on our strategic partners for technical assistance in support.

The ROADS II/Uganda M&E system is based on national monitoring and evaluation (M&E) requirements and responds to the needs of the Government of Uganda, PEPFAR, USAID/Uganda and ROADS II. The project will continue to strengthen its M&E system building on existing systems to guide participatory, coordinated and efficient collection, analysis, use and provision of information to track achievement of project objectives and inform decision-making at all levels. This will include the Kampala-based M&E Officer, who will continue to strengthen the capacity of the clusters to collect, manage, report and utilize data. The system will use targeted and special evaluations to establish the project's contribution to selected outcomes, to monitor quality and performance, and measure program results and contribution to achievement of outcomes. Using realistic methodologies and through collation and analysis of service statistics, an estimation of key socio-demographic indicators at project sites will be made to provide important denominator information. Documentation of changes over time will be conducted for comparison with the baseline assessment data to establish the project's contribution to any observed changes at community and individual targets populations. This will include use of inexpensive and quick evaluations using appropriate methodologies to measure its contribution to the target population's quality of life at the household and individual levels. These assessments will provide answers to the questions about the extent to which the project resulted in behavior change at the individual, family, and community levels as well as answers to the contribution support for those infected and affected by HIV/AIDS. A Quality Assurance and Quality Improvement strategy will be implemented to ensure high quality of services provided. The monitoring system will include routine data collection and a tracking system with standardized recording and reporting protocols for all types of services rendered. FHI will periodically conduct Data Quality Assessments (DQA) to ensure quality of the data and strengthen the M&E system.

Target populations: 1) orphans and vulnerable children (<18); 2) OVC caregivers (15+). Promoting gender equity and male involvement, including prevention of sexual and gender-based violence, cut across all ROADS II programming.

Program description: With COP FY 2010 funds (programming year 2011), ROADS II/Uganda will expand OVC programming in existing two SafeTStop sites (Busia and Katuna) and potentially other sites if funding is available. ROADS II will reach 1,650 eligible OVC with three or more OVC core program areas beyond psychosocial/spiritual support (Next Generation Indicator C5.0.D.); to achieve this result, ROADS II will train 220 caregivers in comprehensive HIV management (NGI C5.0.D). ROADS II programming will address four of the five priority areas for OVC: community support and coordination; family household strengthening; improving quality service delivery; and increased data development and use for strategic planning. Services will be linked closely through a strong referral network including health facilities and CBO, FBO, NGO and private sector partners.

ROADS II will continue working with the Ministry of Gender, Labor and Social Welfare, CBOs, FBOs, NGOs and the private sector to meet the daily needs of OVC. The platform for delivering services will continue to be the cluster model, which has successfully brought together community-based partners in a coordinated response, with joint capacity building, to care for vulnerable children. The focus of OVC programming will be at the family/household level. All services will be provided within the national OVC policy framework.

A major challenge has been enumerating OVC in target communities. ROADS II has conducted OVC censuses in Busia and Katuna to guide programming. ROADS II will conduct additional child-focused needs assessments to identify where and how services will be provided, including shelter and care-giving, health care per the national OVC policy, education and/or vocational training, food and/or other nutrition services, protection and legal aid services, psychological/ social/spiritual services, and economic strengthening. ROADS II will continue to work with the private sector through public-private partnerships. In FY 2010, ROADS will continue programming for orphan-headed households, recognizing their unique vulnerability and needs. To address the long-term needs of orphan-headed households, ROADS' LifeWorks Partnership Trust will conduct job training and job creation, and develop other economic opportunities for OVC caregivers. The project will also continue supporting HIV risk-reduction and care strategies specifically for OVC who are heads of households, linking them with sexual prevention messaging, HVCT, and STI diagnosis and treatment. ROADS will also facilitate care in cases of rape and sexual assault. ROADS II will introduce programming specifically to address the needs of OVC caregivers by providing counseling, education/training in nutrition and parenting, medical and social services; access to economic strengthening through agriculture and other business development; and community-sharing of child support.

The main oversight structures at the site level are the Cluster Steering Committees, which include representatives from all groups belonging to respective clusters. Steering committee members communicate routinely with the ROADS Site Coordinators and meet formally once per month. At the monthly meetings, the Committees and Site Coordinators review monthly data reports against targets, ensure activities are on track and focused on agreed target audiences, identify programming impediments, and resolve issues in a timely manner. The Site Coordinators report directly to the Kampala-based Country Manager, who has overall responsibility for achieving country program targets, ensuring ongoing quality assurance/quality improvement, and managing the day-to-day relationship with USAID/Uganda, in liaison with the ROADS II management team in Nairobi. The Country Manager will visit each site at least once per quarter to ensure all project activities are on track, and will convene in-country quarterly staff/partner meetings with Site Coordinators and implementing partners. ROADS II will strengthen the technical skills of our local partners and site staff, drawing on our strategic partners for technical assistance in support.

The ROADS II/Uganda M&E system is based on national monitoring and evaluation (M&E) requirements and responds to the needs of the Government of Uganda, PEPFAR, USAID/Uganda and ROADS II. The project will continue to strengthen its M&E system building on existing systems to guide participatory, coordinated and efficient collection, analysis, use and provision of information to track achievement of project objectives and inform decision-making at all levels. This will include the Kampala-based M&E Officer, who will continue to strengthen the capacity of the clusters to collect, manage, report and utilize data. The system will use targeted and special evaluations to establish the project's contribution to selected outcomes, to monitor quality and performance, and measure program results and contribution to achievement of outcomes. Using realistic methodologies and through collation and analysis of service statistics, an estimation of key socio-demographic indicators at project sites will be made to provide important denominator information. Documentation of changes over time will be conducted for comparison with the baseline assessment data to establish the project's contribution to any observed changes at community and individual targets populations. This will include use of inexpensive and quick evaluations using appropriate methodologies to measure its contribution to the target population's quality of life at the household and individual levels. These assessments will provide answers to the questions about the extent to which the project resulted in behavior change at the individual, family, and community levels as well as answers to the contribution support for those infected and affected by HIV/AIDS. A Quality Assurance and Quality Improvement strategy will be implemented to ensure high quality of services provided. The monitoring system will include routine data collection and a tracking system with standardized recording and reporting protocols for all types of services rendered. FHI will periodically conduct Data Quality Assessments (DQA) to ensure quality of the data and strengthen the M&E system.

Target populations: 1) family members of PLHIV; 2) males and females (15+) involved in multiple concurrent sexual partnerships; 3) females and males (15+ years) engaged in commercial and transactional sex, including those working in bars, guest houses and other local hotspots, as well as community members who do not self identify as a sex worker; 4) mobile workers (18+ years) including truck drivers, driver assistants, traders (e.g., fish mongers in Busia), and businesspeople; 5) out-of-school youth (15+ years) including money changers, boda boda riders, loaders, etc.; 6) sexually active in-school youth (15+) where they are not being reached by another program; 7) 1) males and females (15+ years) in stable relationships; 8) members of faith-based groups (10+ years); and 9) OVC (15+). Promoting gender equity and male involvement, including prevention of sexual and gender-based violence, cut across all ROAD II program elements.

Program description: With COP FY 2010 funds (programming year 2011), ROADS II/Uganda will expand HVCT in existing SafeTStop sites (Busia, Katuna, Koboko, Malaba, and another TBD in FY 2010), plus at least one additional site to be established in FY 2011 if funds are available. ROADS II will support 40 outlets (staff, supervision, supplies and equipment, infrastructure upgrading) to provide counseling, testing and results for 8,860 individuals (Next Generation Indicators P11.0.D and P11.1.D., respectively). To achieve these results ROADS II will provide pre-service HVCT training for 35 individualscounselors, counselor supervisors, lab techniciansand in-service training in the same categories for another 100. (HVCT volunteers do not work on a full-time basis, as they balance volunteering with livelihood.) The basis for programming will be existing ROADS mapping, assessments and evaluations plus new participatory assessments to be conducted in FY 2010.We will follow Uganda's national HVCT algorithm in all sites. Special focus will continue to be on counseling discordant couples including positive prevention, identifying and counseling clients with hazardous drinking behavior, and promoting and referring for family planning. ROADS will continue promoting testing to all family members where the index patient is found to be positive. Testing all family members will be the entry point for referral to the full menu of health services, including child survival, family planning/reproductive health, malaria prevention and treatment, PMTCT, TB and pediatric care and treatment. In FY 2010 ROADS will support fixed outreach outlets in program sites with hours and locations appropriate for key target audiences, including couples, mobile workers and their sexual partners. Sites will include the SafeTStop Recreation and HIV Resource Centers, which serve as alcohol-free recreation sites and a venue for a range of HIV services. Beyond client-initiated HVCT, ROADS II/Uganda will work with local health facilities to strengthen provider-initiated testing and counseling (PITC). Importantly, ROADS II will organize meetings between HTC staff, health providers and community caregivers to ensure HTC clients and family members are referred to and from services. ROADS II will conduct quarterly evaluations of the referral system to ensure the linkages are functioning efficiently and effectively. As a wrap-around to HTC, the project will address gender barriers to uptake of HTC at health facilities, fixed outreach sites or the home, safe disclosure of results and training of HTC counselors to identify and refer clients who may be suffering from alcohol abuse.

Community-based mobilization complemented by targeted local radio will be the cornerstone of our HVCT promotion strategy. Community "clusters" will be supported through funding and training to encourage peers in their immediate social networks to present for HVCT. Promotional channels will include peer education, interactive drama, community campaigns and special events. Clusters will be linked in a strong referral system with district health teams, local government, the private sector and the faith-based community.

ROADS II will provide ongoing QA/QI to HVCT sites, including periodic site visits, to existing and new HVCT sites. Linking with the MOH, counselor supervisors will be trained to monitor quality of services provided by each site. Quarterly meetings of all counselor supervisors will ensure that the same standard of services is provided in all sites. The Kampala-based Technical Officer in liaison with local MOH will mentor the counselor supervisors. QA/QI under ROADS will be applied to monitor and improve services in all HVCT sites. Exit interviews, monthly summary sheets and counselor self-assessment checklists will be used to ensure high-quality services. Every six months counselors will be involved in a quality assurance cycle. For quality control of HIV testing, dry blood spots will continue to be collected for every tenth client. These will be sent to a reference laboratory for validation of results given to clients. Lab supervisors will be trained to ensure quality of testing.

The main oversight structures at the site level are the Cluster Steering Committees, which include representatives from all groups belonging to respective clusters. Steering committee members communicate routinely with the ROADS Site Coordinators and meet formally once per month. At the monthly meetings, the Committees and Site Coordinators review monthly data reports against targets, ensure activities are on track and focused on agreed target audiences, identify programming impediments, and resolve issues in a timely manner. The Site Coordinators report directly to the Kampala-based Country Manager, who has overall responsibility for achieving country program targets, ensuring ongoing quality assurance/quality improvement, and managing the day-to-day relationship with USAID/Uganda, in liaison with the ROADS II management team in Nairobi. The Country Manager will visit each site at least once per quarter to ensure all project activities are on track, and will convene in-country quarterly staff/partner meetings with Site Coordinators and implementing partners. ROADS II will strengthen the technical skills of our local partners and site staff, drawing on our strategic partners for technical assistance in support.

The ROADS II/Uganda M&E system is based on national monitoring and evaluation (M&E) requirements and responds to the needs of the Government of Uganda, PEPFAR, USAID/Uganda and ROAD II. The project will continue to strengthen its M&E system building on existing systems to guide participatory, coordinated and efficient collection, analysis, use and provision of information to track achievement of project objectives and inform decision-making at all levels. This will include the Kampala-based M&E Officer, who will continue to strengthen the capacity of the clusters to collect, manage, report and utilize data. The system will use targeted and special evaluations to establish the project's contribution to selected outcomes, to monitor quality and performance, and measure program results and contribution to achievement of outcomes. Using realistic methodologies and through collation and analysis of service statistics, an estimation of key socio-demographic indicators at project sites will be made to provide important denominator information. Documentation of changes over time will be conducted for comparison with the baseline assessment data to establish the project's contribution to any observed changes at community and individual targets populations. This will include use of inexpensive and quick evaluations using appropriate methodologies to measure its contribution to the target population's quality of life at the household and individual levels. These assessments will provide answers to the questions about the extent to which the project resulted in behavior change at the individual, family, and community levels as well as answers to the contribution support for those infected and affected by HIV/AIDS. A Quality Assurance and Quality Improvement strategy will be implemented to ensure high quality of services provided. The monitoring system will include routine data collection and a tracking system with standardized recording and reporting protocols for all types of services rendered. FHI will periodically conduct Data Quality Assessments (DQA) to ensure quality of the data and strengthen the M&E system.

Target populations: 1) males and females (15+ years) in stable relationships; 2) members of faith-based groups (10+ years); and 3) OVC (10+ years). Promoting gender equity and male involvement, including prevention of sexual and gender-based violence, cut across all ROAD II program elements.

Program description: With COP FY 2010 funds (programming year 2011), ROADS II/Uganda will expand HVAB programming in existing SafeTStop sites (Busia, Katuna, Koboko, Malaba, and another TBD in FY 2010), plus at least one additional site to be established in FY 2011 if funds are available. ROADS II will reach 44,000 individuals under Next Generation Indicator (NGI) P8.2.D. To achieve this target, ROADS II will provide pre-service training for 1,130 community health and para-social workers (NGI H2.2.D), and in-service training for an additional 1,350, using standardized materials (individuals are trained in HVAB and HVOP simultaneously). The basis for programming will be existing ROADS mapping, assessments and evaluations plus new participatory assessments to be conducted in FY 2010. Community-based interventions will continue to be the cornerstone of our strategic communication strategy in program sites. Community "clusters" will be supported through funding and training to implement evidence-based community outreach interventions that utilize simple, robust, participatory approaches to provide HVAB messages. Approaches will include twice-weekly peer education, weekly interactive drama, monthly special events, and community-developed branding and messaging. Clusters will be linked in a strong referral system with district health teams, local government, the private sector and the faith-based community.

In all community outreach, ROADS II will promote routine interaction among trusted individuals, which our experience shows is more effective than infrequent information-exchanges with strangers in their communities. ROADS II will continue to strengthen and expand an immediate social network (ISN) approach to maximize the quality and frequency of interaction among trusted individuals, be they transport workers or community residents. Under this approach we broaden "peer" to include not only people in an educator's age cohort, but also those older or younger with whom s/he has a trusted relationship (e.g., family members, neighbors, customers, health workers and faith leaders). This approach is highly responsive to the reality of residents in ROADS II/Uganda sites, where most residents are faced with the choice between volunteering and making ends meet. Through these networks, peer educators will promote risk-reduction behaviors and HIV services, with a major focus on faithfulness, partner reduction and HVCT. Our experience with this model indicates peer educators identify up to 150 people in their immediate social networks. They enumerate them during training, which forms the basis of a simplified M&E tool to track interactions and expand the networks.

ROADS II will strengthen peer education and community outreach to examine barriers to abstinence and being faithful to target audiences, including truck drivers, who spend much of their lives away from home. ROADS II will also help youth and OVC to develop more positive, safe sexual behaviors and norms (including secondary abstinence for youth). Where they are not reached by other programs, ROADS II will expand programming into schools, particularly focusing on creating positive gender norms through extra-curricular programming such as creating positive self-images through art and other forms of expression, healthy attitudes, and safe behaviors. ROADS II will continue to link prevention activities with such HIV-related services as HVCT (MOH, fixed outreach), PMTCT, ART and pediatric AIDS, including those supported by other USG partners. We will also refer clients for other district health services, such as family planning/reproductive health, malaria, MCH and TB. ROADS II will work with transport workers to create opportunities to strengthen family ties while the men are on the road (e.g., through email linkages at resource centers) and to provide alcohol-free programming and venues (e.g., adult learning activities, men's discussion groups, and sports activities linked to the SafeTStop Recreation and HIV Resource Centers) to provide safer alternatives. ROADS II will continue working with the faith-based community and youth groups to promote HVAB, including partner reduction for truck drivers, community men and women, and sexually active youth. The project will reinforce HVAB prevention programming for military personnel near Koboko, particularly at sites where they congregate off base. Finally, ROADS II will expand dissemination of the MP4 device with HVAB content for use by drivers on the road and discussion groups where they stop.

The main oversight structures at the site level are the Cluster Steering Committees, which include representatives from all groups belonging to respective clusters. Steering committee members communicate routinely with the ROADS Site Coordinators and meet formally once per month. At the monthly meetings, the Committees and Site Coordinators review monthly data reports against targets, ensure activities are on track and focused on agreed target audiences, identify programming impediments, and resolve issues in a timely manner. The Site Coordinators report directly to the Kampala-based Country Manager, who has overall responsibility for achieving country program targets, ensuring ongoing quality assurance/quality improvement, and managing the day-to-day relationship with USAID/Uganda, in liaison with the ROADS II management team in Nairobi. The Country Manager will visit each site at least once per quarter to ensure all project activities are on track, and will convene in-country quarterly staff/partner meetings with Site Coordinators and implementing partners. ROADS II will strengthen the technical skills of our local partners and site staff, drawing on our strategic partners for technical assistance in support.

The ROADS II/Uganda M&E system is based on national monitoring and evaluation (M&E) requirements and responds to the needs of the Government of Uganda, PEPFAR, USAID/The project will continue to strengthen its M&E system building on existing systems to guide participatory, coordinated and efficient collection, analysis, use and provision of information to track achievement of project objectives and inform decision-making at all levels. This will include the Kampala-based M&E Officer, who will continue to strengthen the capacity of the clusters to collect, manage, report and utilize data. The system will use targeted and special evaluations to establish the project's contribution to selected outcomes, to monitor quality and performance, and measure program results and contribution to achievement of outcomes. Using realistic methodologies and through collation and analysis of service statistics, an estimation of key socio-demographic indicators at project sites will be made to provide important denominator information. Documentation of changes over time will be conducted for comparison with the baseline assessment data to establish the project's contribution to any observed changes at community and individual targets populations. This will include use of inexpensive and quick evaluations using appropriate methodologies to measure its contribution to the target population's quality of life at the household and individual levels. These assessments will provide answers to the questions about the extent to which the project resulted in behavior change at the individual, family, and community levels as well as answers to the contribution support for those infected and affected by HIV/AIDS. A Quality Assurance and Quality Improvement strategy will be implemented to ensure high quality of services provided. The monitoring system will include routine data collection and a tracking system with standardized recording and reporting protocols for all types of services rendered. FHI will periodically conduct Data Quality Assessments (DQA) to ensure quality of the data and strengthen the M&E system.

Target populations: 1) males and females (15+) involved in multiple concurrent sexual partnerships; 2) females and males (15+ years) engaged in commercial and transactional sex, including those working in bars, guest houses and other local hotspots, as well as community members who do not self identify as a sex worker; 3) mobile workers (18+ years) including truck drivers, driver assistants, traders (e.g., fish mongers in Busia), and businesspeople; 4) couples in union (15+ years) who lack skills to introduce condoms into their relationships; 5) out-of-school youth (15+ years) including money changers, boda boda riders, loaders, etc.; 6) sexually active in-school youth (15+) where they are not being reached by another program; 7) PLHIV (15+ years) for positive prevention; 8) chronically underemployed male and female youth (15+); 7) widows (18+ years) and OVC (15+ years) heading households; and 9) individuals abusing alcohol and other substances (15-49 years) as well as local brewers. Promoting gender equity and male involvement, including prevention of sexual and gender-based violence, cuts across all ROAD II program elements. Based on our experience programming for MARPs, ROADS II/Uganda will explore opportunities to share technical expertise with other USG-funded programs targeting, potentially organizing a Technical Working Group to facilitate exchange of lessons learned and promising/best practices.

Program description: With COP FY 2010 funds (programming year 2011), ROADS II/Uganda will expand HVOP programming in existing SafeTStop sites (Busia, Katuna, Koboko, Malaba, and another TBD in FY 2010), plus at least one additional site to be established in FY 2011 if funds are available. ROADS II will reach 88,000 individuals under Next Generation Indicator (NGI) P8.1.D. and 27,500 individuals under NGI P8.3.D. To achieve these targets, ROADS II will provide pre-service training for 1,130 community health and para-social workers (NGI H2.2.D), and in-service training for an additional 1,350, using standardized materials (individuals are trained in HVOP and HVAB simultaneously). In addition, ROADS II will establish 350 targeted condom service outlets in SafeTStop communities (NGI 8.4.D), focusing on easy access for MARPs. The basis for programming will be existing ROADS mapping, assessments and evaluations plus new participatory assessments to be conducted in FY 2010. Community-based interventions will continue to be the cornerstone of our strategic communication strategy in program sites. Community "clusters" will be supported through funding and training to implement evidence-based community outreach interventions that utilize simple, robust, participatory approaches to provide HVOP messages. Approaches will include twice-weekly peer education, weekly interactive drama, monthly special events, and community-developed branding and messaging. Clusters will be linked in a strong referral system with district health teams, local government, the private sector and the faith-based community.

In all community outreach, ROADS II will promote routine interaction among trusted individuals, which our experience shows is more effective than infrequent information-exchanges with strangers in their communities. ROADS II will continue to strengthen and expand an immediate social network (ISN) approach to maximize the quality and frequency of interaction among trusted individuals, be they transport workers or community residents. Under this approach we broaden "peer" to include not only people in an educator's age cohort, but also those older or younger with whom s/he has a trusted relationship (e.g., family members, neighbors, customers, health workers and faith leaders). This approach is highly responsive to the reality of residents in ROADS II/Uganda sites, where most residents are faced with the choice between volunteering and making ends meet. Through these networks, peer educators will promote risk-reduction behaviors and HIV services, with a major focus on correct and consistent condom use, partner reduction and HVCT. Our experience with this model indicates peer educators identify up to 150 people in their immediate social networks. They enumerate them during training, which forms the basis of a simplified M&E tool to track interactions and expand the networks.

The SafeTStop Recreation and HIV Resource Centers in Busia, Katuna, Koboko and Malaba, with integrated Wellness Centres (primary health services), will continue to be the focus of programming for MARPs, providing mobile workers (Ugandan and non-Ugandan), their sexual partners and other vulnerable community members with HVCT, STI treatment and other services at convenient hours; HIV peer education; condom distribution; adult education on life and job skills; psychosocial and spiritual services; men's discussion groups on male social norms; and internet services to help truckers stay in contact with family members while away from home. Focusing on MARPs, ROADS II will continue to distribute an innovative MP4 audio device with prevention content for use by drivers on the road and discussion groups where they stop. ROADS II will continue to link prevention activities with such HIV-related services as STI diagnosis and treatment, HVCT (MOH, fixed outreach), PMTCT, ART and pediatric AIDS, including those supported by other USG partners. We will also refer clients for other district health services, such as family planning/ reproductive health, malaria, MCH and TB. ROADS II will mobilize the private sector, especially brothel/bar/guest house owners, and promote joint action to reduce risk for bargirls and patrons. To enhance the community education effort, local pharmacists/drug shop providers will receive expanded training in managing STIs, condom promotion and referral for HVCT.

Based on lessons learned around the region, ROADS II will continue its programming to address root causes of HIV risk, including gender norms that perpetuate SGBV, abuse of alcohol and other substances, and economic inequity. (Though economic strengthening is listed under palliative care and OVC under the Next Generation indicators, we see a role for this in sexual prevention as well given the need for alternatives to high-risk survival strategies.) Alcohol programming will be based on the cost-effective community alcohol counseling methodology developed by ROADS clusters in Busia, Kenya and launched in Uganda in FY 2009. Additional community Alcohol/GBV Task Teams will be established by ROADS clusters. These will refer survivors to health facilities for post-rape services, including post-exposure prophylaxis. The project will continue expanding food/nutrition support to reduce reliance on high-risk survival strategies, building on a promising community food-banking strategies and kitchen gardening techniques established in other ROADS sites.

The main oversight structures at the site level are the Cluster Steering Committees, which include representatives from all groups belonging to respective clusters. Steering committee members communicate routinely with the ROADS Site Coordinators and meet formally once per month. At the monthly meetings, the Committees and Site Coordinators review monthly data reports against targets, ensure activities are on track and focused on agreed target audiences, identify programming impediments, and resolve issues in a timely manner. The Site Coordinators report directly to the Kampala-based Country Manager, who has overall responsibility for achieving country program targets, ensuring ongoing quality assurance/quality improvement, and managing the day-to-day relationship with USAID/Uganda, in liaison with the ROADS II management team in Nairobi. The Country Manager will visit each site at least once per quarter to ensure all project activities are on track, and will convene in-country quarterly staff/partner meetings with Site Coordinators and implementing partners. ROADS II will strengthen the technical skills of our local partners and site staff, drawing on our strategic partners for technical assistance in support.

The ROADS II/Uganda M&E system is based on national monitoring and evaluation (M&E) requirements and responds to the needs of the Government of Uganda, PEPFAR, USAID/Uganda and ROADS II. The project will continue to strengthen its M&E system building on existing systems to guide participatory, coordinated and efficient collection, analysis, use and provision of information to track achievement of project objectives and inform decision-making at all levels. This will include the Kampala-based M&E Officer, who will continue to strengthen the capacity of the clusters to collect, manage, report and utilize data. The system will use targeted and special evaluations to establish the project's contribution to selected outcomes, to monitor quality and performance, and measure program results and contribution to achievement of outcomes. Using realistic methodologies and through collation and analysis of service statistics, an estimation of key socio-demographic indicators at project sites will be made to provide important denominator information. Documentation of changes over time will be conducted for comparison with the baseline assessment data to establish the project's contribution to any observed changes at community and individual targets populations. This will include use of inexpensive and quick evaluations using appropriate methodologies to measure its contribution to the target population's quality of life at the household and individual levels. These assessments will provide answers to the questions about the extent to which the project resulted in behavior change at the individual, family, and community levels as well as answers to the contribution support for those infected and affected by HIV/AIDS. A Quality Assurance and Quality Improvement strategy will be implemented to ensure high quality of services provided. The monitoring system will include routine data collection and a tracking system with standardized recording and reporting protocols for all types of services rendered. FHI will periodically conduct Data Quality Assessments (DQA) to ensure quality of the data and strengthen the M&E system.