The Population Council in partnership with Project Concern International (PCI) is implementing a three year project called Community Mobilization for Preventive Action (COMPACT) to support the governments plan of reducing new HIV infection by 50% by 2015. The overall goal of COMPACT is to develop and determine the feasibility of community compacts as an innovative strategy to bring about behavior change that will ultimately lead to a reduction in HIV incidence. Broadly, community compacts are agreements between service providers and recipient communities that are intended to increase the effectiveness of services by promoting community ownership. It is being implemented in four communities: Chongwe and Chinyunyu in Chongwe district and Kawama and Kaniki in Ndola district.

In order to monitor and evaluate the impact of the project, COMPACT will conduct a sero and behavioral survey. The behavioral survey will monitor the results of the selected HIV interventions by assessing changes in the knowledge, attitudes, and practices regarding HIV in the four target communities. The sero survey will conduct an anonymous HIV test to determine the HIV status of the survey sample. The behavioral and sero surveys will happen concurrently among the same individuals and will be repeated every 12 months. In FY2012, COMPACT will conduct the baseline study to collect behavioral and sero-prevalence data that will be compared with data collected at midline (in 2012) and endline (in 2013) to determine behavioral changes and calculate HIV incidence.

COMPACT works closely with communities through signed community compacts on prevention interventions, including to orphans and vulnerable children (OVC). While other partners, such as STEPS OVC, are responsible for implementing care and support activities for OVC, COMPACT provides community mobilization for prevention actions in which OVC participate at the community level. In addition, COMPACT will be training communities and community groups that work directly with HIV prevention for OVC in the areas of addressing multiple and concurrent sexual partnership through safe love clubs, sexual and gender-based violence, protecting orphaned girls from HIV through the safe spaces program, reduction of alcohol abuse, and income generating activities for younger males. COMPACT will seek to enable vulnerable children to identify their own problems and meaningful solutions in HIV prevention. COMPACT will not target these trainings directly at OVC, but rather, target communities that have signed compacts that work directly with HIV prevention including for OVC at the community level. Prevention training will incorporate recommendations from the COMPACT sero-survey. OVC prevention efforts will begin at the earliest opportunity in the COMPACT community, in accordance with national guidelines. The counseling and testing efforts will also focus on OVC who range from early adolescence to 19 years of age, those who are already sexually active, or those who indicate they may soon become active.

COMPACT will collaborate with ZPI and STEPS OVC for OVC interventions that promote economic empowerment in communities where ZPI and STEPS OVC partners are working.

COMPACT aims to reach a total of 1,150 OVC. 1,000 of these will be those aged between 15 and above through various community mobilization interventions while 150 OVC will be adolescents aged between 12 and 19 years through the Safe Love club interventions.

COMPACT will conduct a sero-behavioral survey that will contribute to establishing the community level baseline for HIV incidence and measure changes in high risk sexual behavior. Currently there are no studies of HIV incidence in the general community in Zambia. The estimate of HIV incidence in the general population in Zambia that is being used for national strategic planning is provided by the UNAIDS Mode of Transmission (MOT) study that established that HIV incidence in the general population is 1.6% per 100 person years. This study will provide government and PEPFAR with an estimate of HIV incidence at community level in the general population.The study will be a longitudinal study aimed to track HIV-related behavior and incidence as the COMPACT intervention is implemented. It employs a repeated population-based survey methodology that will be conducted every 12 months among female and male members of households randomly selected at the time of the baseline in the intervention communities. HIV incidence will be monitored by testing individuals at baseline, midterm, and end term. The HIV testing will be anonymous; participants in the study will not be given their test results. Blood will be collected and tested at central labs. The aim will be to determine how many individuals who tested HIV negative in the first round are infected by the time of the second round of data collection, i.e., year 1 incidence, and how many individuals who were HIV negative in the second round are infected by the time of the third round, i.e., year 2 HIV incidences.

The study is powered to detect a reduction of HIV incidence by four tenths from 1.6% to 0.96%. Similarly it is powered to detect 1/5 unprotected sexual risk behavior. The baseline sample size required detecting a reduction in HIV incidence and sexual risk behavior is a total of 3,581individuals targeting equal number of men (1,790) and women (1,790).

Data collected in FY2012 will provide current HIV prevalence in the four communities and will be used to calculate HIV incidence after the second round of the study in FY2013. The information generated from this study will be made available to policy makers, planners and service providers for effective decision making in designing HIV prevention interventions.

COMPACT, through Safe Love clubs, Gender Action Groups, Safe Spaces, Alcohol committees, and income generating activities for young men, will raise awareness on and encourage access and utilization of HCT services. Although COMPACT will not provide HCT services directly, we will partner with Society for Family Health (SFH) and the District Health Management Teams (DHMT) to provide mobile and static HCT services in the community. The role of the COMPACT team will be to mobilize communities through various activities that will include small group discussions and public meetings to inform people on the benefits of accessing HCT. COMPACT has planned the following events at which HCT services will be provided by SFH and the DHMT;Compact signing and award ceremony events: these will be public events in which community members will be invited to participate. Compact signing ceremony will occur in the first quarter of FY2012 while award ceremonies, events at which communities receive a reward for achieving the benchmark, will happen at least once every quarter starting in the second quarter of FY2012. These events are intended to be high profile with high levels of community participation. SFH and DHMT will then provide HCT services to attendees.During the sero survey: While the sero-survey is anonymousparticipants will not receive test resultsparticipants who would like to know their HIV status will be referred to a mobile facility within the community.

In order to avoid double counting, SFH shall report the number of people who have been tested during such events to USAID. Therefore COMPACT has not provided targets for the number of people tested.

The project has targeted the general adult population above the age of 15 years and adolescent girls aged 12 to 19 years. Zambia has a generalized HIV epidemic and HIV prevalence is estimated at 14.3% in the adult age group. COMPACT includes a special focus on adolescent girls as they are more vulnerable to HIV infection compared to their male counterparts due to various socio-cultural and economic reasons. The interventions that will be implemented amongst these target populations are:a) Addressing multiple and concurrent sexual partnerships (MCPs) through Safe Love clubs: Safe Love Clubs will comprise both men and women. Members of the Safe Love clubs will be trained in sex and sexuality after which they will hold bi-monthly community discussions that will encourage partner reduction, increased condom use and promoting other safer sex practices.b) Overcoming sexual and gender based violence (SGBV) through Gender Action Groups: Working with community leaders and partner organizations such as A Safer Zambia (ASAZA), COMPACT will create and support community gender action groups. These groups will be trained in SGBV identification and management including counseling for survivors of SGBV. Gender action groups will carry out community sensitization activities through small group discussions and public meetings to raise awareness on the dangers of GBV.c) Protecting girls from HIV infection through the Safe Spaces Program. COMPACT will support the formation and implementation of Safe Spaces for adolescent girls aged 12 to 19 years. The core of the model is to enable girls meet weekly, to learn how to demand and enjoy their human rights, protect themselves from bodily harm, including sexual abuse and preventable diseases and learn financial and economic skills that will contribute to a more self reliant adulthood.d) Reduction of alcohol abuse: The four communities in which COMPACT is working will form a community alcohol control committee comprising community and government leaders who will work with their communities to develop a community alcohol use control policy that will be discussed and disseminated. The community committee will then work with others to ensure the enforcement of both community as well as national laws regulating alcohol.e) Income generating activities for younger men: COMPACT will support income generating activities for younger men aged between 15 and 24 years old. Through the income generating activities, COMPACT will increase awareness of HIV prevention services and encourage access to services such as male circumcision and condoms.