This activity relates to COH II programming in HVCT and HVOP.

The Corridors of Hope II (COH II) is a contract under Research Triangle Institute (RTI) that follows on from

the original Corridors of Hope Cross Border Initiative (COH). COH II both continues the activities of COH

and expands the program to ensure a more comprehensive and balanced prevention program. COH II has

three basic objectives focusing on other prevention, AB activities, and CT services. These three program

areas fit together and are integrated as a cohesive prevention approach in seven of the most high

prevalence border and high transit locations in Zambia.

Based on the Zambia specific HIV/AIDS epidemiological data, findings of the Priorities

for Local AIDS Control Efforts (PLACE) study and the Sexual Behavior Study/AIDS Indicator Survey (AIS),

other behavioral and biological data, and lessons learned from the original COH, COH II will continue to

focus on sexual networks in high risk locations; address the vulnerability of youth and provide contextually

appropriate intervention alternatives; address the relationships between gender disparities, sexual violence,

and alcohol use/abuse and HIV transmission; ensure integrated AB, CT and Other Prevention services; and

facilitate linkages to other program areas such as treatment and care. To accomplish this, COH II will

continue to work closely with communities, local leaders, and existing governmental structures such as

district health management teams (DHMTs) and the district AIDS task forces (DATFs). COH II will continue

to coordinate and collaborate with USG partners and other donors to eliminate redundancy and ensure

services are comprehensive. COH II will also continue to have a strong focus on sustainability through

ongoing capacity building of three national non-governmental organization (NGO) partners and, through

them, of other local partners, including faith-based organizations (FBOs), community-based organizations

(CBOs) and other NGOs, to provide comprehensive prevention services.

COH II will focus on providing AB services for the larger communities living in the high HIV prevalence

transit and border locations. Seven sites will continue to be covered: 1. Livingstone, 2. Kazungula, 3.

Chipata, 4. Kapiri Mposhi, 5. Nakonde, 6. Solwezi, and 7. Siavonga (Chirundu). In addition, COH II will

continue to provide mobile services to reach targeted groups who do not have easy access to the static

sites. These sites represent populations that have the highest HIV prevalence and number of people living

with HIV/AIDS (PLWHAs) in the country. These communities are characterized by highly mobile

populations, including sex workers, truckers, traders, customs officials and other uniformed personnel, in

addition to the permanent community members, in particular adolescents and youth, who are most

vulnerable to HIV transmission by virtue of their residence in these high risk locations. COH II anticipates

reaching 200,000 persons in these areas with AB interventions, of which 50,000 will be adolescents and

youth for abstinence only activities. To reach these individuals, COH II will use the cadre of 750 trained

outreach workers, on average 107 per site, to implement AB prevention activities and programs.

COH II will continue to ensure a continuum of prevention interventions that reach not only the most at risk

populations (MARPs) but also the wider community and will significantly increase AB activities in these very

high prevalent locations. In particular, this program will continue to address the influence of gender norms

and practices on sexual behavior, multiple and concurrent partnerships, how perceptions of masculinity and

femininity affect sexual behavior and HIV/AIDS service seeking, sexual violence, early debut of sex among

females and males, influence of alcohol abuse on sexual behavior, and the common practice of

transactional and inter-generational sex.

COH II through community-based programs will continue to use the participatory research methods

developed in years 1 and 2 to identify determinants of the HIV/AIDS transmission among corridor

communities, engage the community fully in selecting and implementing appropriate interventions to

promote abstinence and faithfulness, leverage resources, and link to education and economic activities.

COH II will continue to focus on sustainability by building the capacity of communities, and local religious,

traditional and civic leadership to ignite social and behavioral change, engage them in programming, and

increase program ownership. Through its three national NGO partners, COH II will subcontract with local

organizations to implement AB and other prevention activities specifically focused on eliminating

transactional and intergenerational sex, increasing abstinence/secondary abstinence and preventing early

sexual debut, changing gender norms that lead to high risk sex, preventing sexual violence, reducing

alcohol intake, promoting faithfulness and reducing multiple and concurrent sexual partnerships. To

promote abstinence and prevent transactional and intergenerational sex and sexual violence, local partners

will work with adolescents aged 10-14 and youth 15-24 along with their parents and guardians to instill

healthy social norms and values early on and encourage parent-child communication and protection.

COH II's mandate is to increase the sustainability of these programs and thereby work with local

subcontractors and other selected local organizations to build their capacity to conduct participatory

planning, implement effective programs addressing AB, and increase linkages to other services such as

most at risk prevention programs, counseling and testing services and treatment services. COH II will

continue to provide technical assistance to strengthen all facets of the local implementing partners by

helping to improve their technical approaches, financial management systems, human resource

management, strategic planning capabilities, networking capabilities, monitoring and evaluation (M&E) and

quality assurance and commodity/equipment logistics management. In conjunction with its local

subcontractors, COH II will continually update the previously-developed timeline for the phase-out of

technical assistance (exit strategy) and implement the graduation plan, developed in year 2, that identified

the technical and capacity building needs of each local partner. COH II will continue to work in close

collaboration with other USG and other donor funded projects working in the specified locations, and will

continue to network and link to economic development programs, education and vocational training

programs, police sexual violence prevention programs, and Ministry of Health (MOH) HIV/AIDS services.

COH II will continue to collaborate in planning sessions to support and eliminate redundancy with the work

of the other USG partners, the National HIV/AIDS/STI/TB Council (NAC) and other donors.

COH II will harmonize its HIV prevention strategies and activities with the National HIV/AIDS Strategic

Framework 2006-2010 as well as with the current National Communication Strategy produced in 2005.

COH II will actively participate in the planning processes and campaigns of the DHMTs and DATFs in those

districts where the project operates as well as in the planning and campaign activities of the NAC.

COH II will conduct a final evaluation to determine the impact of the A and AB activities and identify lessons

Activity Narrative: learned. The results of this evaluation will be disseminated widely to inform similar ongoing activities. All

FY 2008 targets will be reached by September 30, 2009.

The Corridors of Hope II (COH II) is a contract under Research Triangle Institute (RTI) that follows on from

the original Corridors of Hope Cross Border Initiative (COH). COH II both continues the activities of COH

and expands the program to ensure a more comprehensive and balanced prevention program. COH II has

three basic objectives focusing on other prevention, AB activities, and CT services. These three program

areas fit together and are integrated as a cohesive prevention program.

In FY 2005 and FY 2006, the original COH trained 50 outreach workers and 188 high risk women, such as

queen mothers and sex workers, as peer educators; reached over 500,000 men and women with other

prevention behavior change messages through interpersonal counseling and group discussions. The

project also provided technical support to 33 trucking companies for HIV prevention and workplace

programming. COH had over 900 condom outlets that were socially marketing condoms to high risk groups,

including sex workers and their clients.

COH II started in FY 2007. Based on Zambia-specific HIV/AIDS epidemiological data, findings of the

Priorities for Local AIDS Control Efforts (PLACE) study and the Zambia Sexual Behavior Study, other

behavioral and biological data, and lessons learned from COH services, COH II focuses on reducing sexual

networks, providing sexually active youth with contextually appropriate intervention alternatives, addressing

gender disparities, sexual violence, and transactional sex, providing services and activities for CT, AB, and

other prevention, and facilitating linkages to other program areas such as care and treatment. To

accomplish this, COH II implements a range of appropriate outreach services in bars, clubs, truckstops, and

other key gathering places. COH II will continue to have a strong focus on sustainability through building

the capacity of three national non-governmental organization (NGO) partners and, through them, of other

local partners, including faith-based organizations (FBOs), community-based organizations (CBOs), and

other NGOs, to provide other prevention services.

In FY 2008, COH II will continue to reduce HIV/AIDS transmission among most at risk populations (MARPs)

and most vulnerable populations within seven border and high transit corridor areas: 1. Livingstone, 2.

Kazungula, 3. Chipata, 4. Kapiri Mposhi, 5. Nakonde, 6. Solwezi, and 7. Siavonga (Chirundu). In addition,

COH II will continue to provide mobile services to reach targeted groups who do not have easy access to

the static sites. The services to be provided at both static and mobile sites will include treatment for

sexually transmitted infections, counseling and testing for HIV, and delivery of prevention messages for

behavior change through one-on-one and group discussions. These locations represent populations that

have the highest HIV prevalence and number of people living with HIV/AIDS (PLWHAs) in the country.

These communities are characterized by highly mobile populations, including sex workers, truckers, traders,

customs officials and other uniformed personnel, in addition to the permanent community members, in

particular adolescents and youth, who are most vulnerable to HIV transmission by virtue of their residence

in these high risk locations. It is anticipated that 200,000 persons will be reached with other prevention

services and community outreach activities and 50 targeted condom service outlets will be established. To

reach these individuals, COH II will work through the 750 individuals the project trained in years 1 and 2 in

inter-personal behavior change communication for partner reduction and correct and consistent condom

use. COH II will continue to expand the current scope of HIV/AIDS other prevention activities along the

corridor areas beyond the limited targeting of sex workers and long distance truck drivers and their partners

to include border on-site services and condom social marketing. COH II will continue to target women and

men engaged in transactional sex and intergenerational sex, sexually active youth, individuals involved in

concurrent and multiple sexual partnerships, HIV+ persons, discordant couples, victims of gender-based

sexual violence, migrant workers, cross-border traders, border uniformed personnel, customs agents, and

money changers.

COH II activities will continue to include individual and community risk assessments, interpersonal

counseling for behavior change, with an emphasis on partner reduction, condom promotion and distribution

for consistent and correct use, HIV counseling and testing services, management of sexually transmitted

infections (STI), referrals for post-exposure prophylaxis (PEP) for victims of sexual violence, referrals for

medical care and treatment, and links to economic and education programs. COH II will continue to provide

interpersonal counseling to address the social and behavioral sexual norms that lead to HIV transmission.

COH II will strengthen services and counseling services related to sexual violence, multiple and concurrent

partnerships, drug and alcohol abuse, and transactional sex. COH II will use an integrated approach to

ensure women's legal rights. COH II will continue a specific focus on providing appropriate services

targeted at sexually active 15 - 24 year olds. Condom promotion and distribution will continue to be

targeted at spots frequented by MARPs. COH II will continue to work with law enforcement and health

facilities to ensure PEP provision and counseling for victims of sexual violence.

COH II will continue to address the issue of HIV and alcohol at COH II sites. It is a well known fact that

excessive alcohol use not only increases vulnerability to risky sexual behaviors and impairs efficacy of HIV

medications, reduces compliance to treatment and generally contributes to poorer HIV treatment outcomes.

COH II will develop key messages in collaboration with SHARe, the National HIV/AIDS/STI/TB Council

(NAC), district AIDS task forces (DATFs), and the Health Communication Partnership Zambia (HCP). COH

II will use interpersonal counseling and communications tools, mass media spots for local television and

radio, pamphlets, and posters to raise awareness on the ill effects of alcohol abuse on HIV transmission.

The project will support trained outreach workers, local partners, and district health management team

(DHMT) staff to give out specific information on alcohol and its close association with HIV/AIDS

transmission and the health of PLWHAs.

COH II will harmonize its HIV prevention strategies and activities with the National HIV/AIDS Strategic

Framework 2006-2010 as well as with the current National Communication Strategy produced in 2005.

COH II will take an active role in the planning processes and prevention campaigns of the NAC and of

DHMTs and DATFs in the districts where the project operates.

COH II's mandate is to sustain other prevention services and activities beyond the project period. COH II

will continue to work with subcontracted national NGO partners and other selected local organizations to

build their capacities to conduct participatory research, implement effective programs addressing MARPs,

and provide comprehensive prevention services such as CT, STI diagnosis and treatment, and link to other

services including PEP, antiretroviral therapy (ART), prevention of mother-to-child transmission (PMTCT),

and palliative care. DHMTs will continue to provide periodic quality assurance supervision for project STI

diagnosis and treatment activities. COH II through technical assistance will continue to strengthen local

Activity Narrative: implementing partners by helping to improve their technical approaches, financial management systems,

human resource management, strategic planning capabilities, networking capabilities, monitoring and

evaluation (M&E), quality assurance, and commodity/equipment logistics management. COH II will

continue the strong focus on support for program managers, health care providers, counselors, and peer

educators in inter-personal behavior change communication for partner reduction and correct and

consistent condom use. Health care providers and lab technicians will continue to use their training

provided in years 1 and 2 in STI management using national guidelines and others trained by COH II earlier

will link with those providing PEP counseling for victims of sexual violence. In conjunction with its NGO

partners, COH II will implement the timeline developed in years 1 and 2 for the phase-out of technical

assistance and implement the full graduation plan that identifies the technical and capacity building needs of

each local partner leading up to graduation. COH II will work in close collaboration with other USG and

other donor funded projects working in the COH II locations, particularly HCP, PSI Social Marketing, CIDRZ,

ZPCT, CRS AIDSRelief, CHANGES 2, Equip II, and RAPIDS, and will network and collaborate with Ministry

of Health (MOH) HIV/AIDS services. COH II will collaborate with the Prevention of Sexual Transmission

Group and participate in the USG Other Prevention group to eliminate redundancy with the work of other

USG partners, NAC, and other donors.

COH II will conduct a targeted behavioral surveillance survey (BSS) focused on sex workers, truck drivers,

and youth to compare the results in relation to those at the end of COH I. Maintaining the same groups

from previous surveys will allow rigorous analysis of the results across the BSS's that have been carried

out. In year 3, COH II also will measure changes in behavior among the broader population served by the

project against baseline data gathered in year 2.

All FY 2008 targets will be reached by September 30, 2009.

The Corridors of Hope II (COH II) is a contract under Research Triangle Institute (RTI) that follows on from

the original Corridors of Hope Cross Border Initiative (COH). COH II both continues the activities of the

original project and expands the program to ensure a more comprehensive and balanced prevention

program. COH II has three basic objectives focusing on other prevention, AB activities, and CT integrated

with sexually transmitted infections (STI) services for a comprehensive approach to prevention.

Based on Zambia-specific HIV/AIDS epidemiological data, findings of the Priorities for Local AIDS Control

Efforts (PLACE) study, the Zambia Sexual Behavior Study, other behavioral and biological data, and

lessons learned from the original COH, services will continue to focus on sexual networks, addressing the

vulnerability of youth, address gender disparities, build local capacity to provide CT, AB, and other

prevention services, and facilitate linkages to other program areas such as prevention of mother-to-child

transmission (PMTCT), care, and antiretroviral therapy (ART). To accomplish this, COH II will continue to

work with communities and with existing governmental structures such as district health management teams

(DHMTs) and will continue to coordinate and collaborate with United States Government (USG) partners

and other donors to eliminate redundancy and ensure services are comprehensive. COH II will continue to

have a strong focus on sustainability through building the capacity of local organizations.

With the advent of PEPFAR, the original COH introduced HIV testing into their services at border and high

transit sites for the first time. By FY 2005 and 2006, COH had trained 20 HIV counselors and 20 health

care workers to provide CT services to high risk women and men and reached nearly 9,000 men and

women, including sex workers and their clients, with CT services. The test results were shocking with

prevalence rates from 50%-70% among female sex workers. These data reinforced the importance of

expanding CT services and linkages to care and treatment services in the new COH II project.

Building on the lessons learned and the experience of years 1 and 2 of COH II, the project will continue to

provide CT services in seven static facilities and mobile services in: 1. Livingstone, 2. Kazungula, 3.

Chipata, 4. Kapiri Mposhi, 5. Nakonde, 6. Solwezi, and 7. Siavonga (Chirundu). These locations represent

populations that have the highest HIV prevalence and number of people living with HIV/AIDS (PLWHAs) in

the country. These communities are characterized by highly mobile populations, including sex workers,

truckers, traders, customs officials and other uniformed personnel, in addition to the community members,

in particular adolescents and youth, who are most vulnerable to HIV transmission by virtue of their

residence in these high risk locations. In FY 2008, 20,000 individuals will access CT services and receive

their test results through COH II. COH II will continue to promote universal CT and community prevalence

findings will continue to be utilized to inform community members of the real risk of HIV transmission in their

area, to reduce denial, increase personal risk perception, ensure gender equity in service delivery, address

male behavior and norms in relation to accessing CT, and provide CT to victims of sexual/gender based

violence. COH II will continue to provide static and mobile community-based CT services. CT will be an

entry point to prevention, care, and treatment services and linkages for referrals will be strengthened. COH

II and their local partners will continue to work closely with communities to establish post-test clubs and

support activities.

COH II is leveraging local resources from the MOH and the DHMTs. The MOH will continue providing HIV

test kits for COH II static and mobile testing services and the DHMTs will continue to provide periodic quality

assurance supervision for project CT activities.

COH II's mandate is to increase the capacity of local partner organizations to provide and sustain a

continuum of prevention services. COH II will continue to build local capacity to conduct CT services,

integrate CT with AB and other prevention activities, and establish effective and comprehensive referral

networks that are easily accessible and acceptable to Most-at-Risk Populations. COH II will continue to

strengthen all facets of its three subcontracted national non-governmental organization (NGO) partners and

other local implementing partners by providing technical assistance and training to improve their technical

approaches, financial management systems, human resource management, strategic planning capabilities,

networking capabilities, M&E, quality assurance, and commodity/equipment logistics management. In

conjunction with its subcontracted local partners, COH II will implement the exit strategy developed in years

1 and 2 along with the graduation plan that identifies the technical and capacity building needs of each local

partner and the timeline for the phase-out of technical assistance leading up to their graduation.

Sustainability and comprehensiveness will be addressed by ensuring that all CT services will be linked to

existing health centers, hospitals, and community services such as PMTCT, prevention and clinical

management of HIV-related illnesses and opportunistic infections, ART, tuberculosis control, and

psychosocial support. COH II will continue to collaborate with the district AIDS task forces (DATFs) and the

DHMTs in planning sessions to support and eliminate redundancy and build a strong referral system to

existing local government and private sector HIV/AIDS services and other USG supported programs. All FY

2008 targets will be reached by September 30, 2009.