Goal: To improve access by vulnerable populations to quality HIV prevention and care services in 4 states and 10 counties. Target groups are perceived to be at higher risk of HIV infection. Objectives: To reduce HIV/AIDS transmission among the general population and key target groups through improved BCC strategies; To improve the quality of life of PLHIV and their families by expanding access to and promoting community and home based care services and by linking them closely with other non-HIV related services; To expand and promote the utilization of quality counseling and testing services; to build capacity in South Sudan for HIV policy development and implementation and to build systems to provide for sustainability of activities. Cost efficiency strategy: SHAP supports the national efforts to decentralize services to the lower levels; integrate services, strengthen referrals and encourage provider initiative counseling and testing (PICT). Transition strategy: SHAP will continue to strengthen health systems through continued capacity building at the government and community level. Staff will work with providers and managers at all levels of the health system to build their capacity to plan, manage and monitor. Monitoring and Evaluation: SHAP will continue to build capacity at all levels to better understand the HIV epidemic and its drivers, by strengthening GoSS and community partners to collect, use, and disseminate quality data to support evidence based decision making for policy-making, programming and program strengthening. In this COP year, increased emphasis will be placed on following up on use of registers and data collection tools for data collection and analysis, thereby improving the M&E system for better aggregation of data at the country level.

SHAP has been working with the County AIDS Commission (CAC) in strengthening M&E systems and promoting the utilization of information. In previous years, Data Use and M&E trainings were organized for CAC staff. SHAP will continue to provide technical support until the end of the program. Under this COP, SHAP will work on capacitating CAC in the areas of monitoring and reporting of program results.

Monitoring program results: Using information obtained from previous Health System Strengthening (HSS) M&E assessments, conducted by SHAP, the project will continue to strengthen the M&E systems of select government departments and promote the adoption of the systems by others.

Illustrative Activities: If necessary, review and refine existing monitoring tools, developed by SHAP, to address evolving needs and issues of the select departments. Sensitize local level structures on any changes in reporting tools including the CACs, Boma health committees, County Health Departments and Sate M&E Officers. Organize refresher training on how to use the data collection tools developed by government and SHAP to government partners. Organize refresher training on how to use the data collection tools developed by government and SHAP to sub-grantees. Provide regular (quarterly) on site monitoring visit and mentor Data Officers. Provide technical support to these government departments to share their experiences to other counties and states. Conduct quarterly DQA, jointly with the government staff, to insure the quality of the reports received from sub-grantees and field staff.

Reporting results: Due to current capacity gaps, the health sector information management system is not fully developed. In some instances, more emphasis is given to data collection than analysis and utilization.

In the last two years, SHAP has taken the initiative to now analyze the data collected by facilities supported by the program. The major objective of analyzing this data was to advocate for its use by government departments. SHAP will continue to advocate for data analysis and use by providing feedback to facilities, supporting analyses, and promoting guidelines for data analysis and use. The feedback sessions serve the purposes of: 1) building capacity to use data for decision-making, 2) ensuring that the data is used to measure progress, and 3) examining barriers to achieving expected results.

The flow of information from county to state to national levels is hampered by weak infrastructure, communication and logistical systems. Under this COP SHAP will conduct random spot checks to identify problems and help resolve data flow challenges, by creating a virtual communication forum.

In this COP year, SHAP will continue to strengthen and support the data management system at community level by on site mentoring and by providing support supervision to sub-grantees.

Illustrative activities: Continue to conduct annual quality of life surveys to measures project activities effect on improving the life of PLHIV. Collaborate with GoSS and other stakeholders in surveys/studies and continue to participate in the M&E TWG. Take part in national level studies/research/surveys initiated by government and/or other stakeholders. Dissemination of best practices in community and facility based data management. FHI will also conduct behaviorial qualitative studies in its project areas.

The SHAP program will implement HIV and AIDS sexual prevention Abstinence / be faithful (AB) prevention activities to reach youth in and out of school peer education and Behavior change communication strategies, and through trained school based peer educators.

Ongoing peer education sessions and BCC interventions will equip youth with skills to cope with peer pressure and help them develop positive norms and values to make appropriate and safe choices in relationships. In addition, the activities will integrate messages to address prevention with positives; comprehensive condom promotion; correct and consistent use of condoms; and correct condom disposal and distribution. SHAP will also continue to address issues on quality of life, effects of drugs and substance abuse, and gender based violence among young people. The activities engender to increase gender equity in HIV and AIDs activities and services through integrating and mainstreaming gender related issues in the training of peer educators, peer education and behavior change communication activities.

SHAP will work with Ministry of Education and other partners to reach out to young people with abstinence only messages through the life skills program in lower primary classes.

SHAP Abstinence and Be Faithful Program activities will link the target population to other prevention services especially for the sexually active youth and also encourage all to know their status by linking to counseling and testing services and treatment for those eligible for ART.

The geographic coverage for this intervention includes schools in and around big towns, city and transport corridors; which are associated to hot spots and high behavior groups such as CSWs, truckers and other vulnerable populations. The hot spots are where key populations at higher-risk have located their activities. SHAP will continue to support the MOH to disseminate best practices in PE, targeting the various sub-groups such as, Youth in schools, Youth out of schools, and MARPs.

The BCC for AB will be linked to HCT, STI, condom distribution and family planning for youth above 15 years of age. There will be outreach activities targeting secondary and tertiary schools within the areas of implementation.

The Southern Sudan AIDS Strategic Framework 2008 outlined the policy for HIV and AIDS implementation and the response to the Declaration of Commitments. The Framework underlined HIV counseling and testing as one of the six thematic areas of responding to the epidemic by partners.

SHAP will begin the process of transitioning the management of HCT services and support of the HCT counselors to the Government in all project sites. In order to facilitate the smooth transition, SHAP, in consultation with the government, will develop an effective transition plan that will be used to monitor and document handover of services. This will be a phased out approach, starting with the stronger sites, ending with the weaker ones. This transition will involve joint supervision of sites, mentoring, and on the job training. Special attention will focus on assisting the government to better use HCT site data for decision making. SHAPs role will mainly be to ensure that all sites continue to use HCT protocols and standard guidelines, and to provide feedback to the government to ensure improved quality of services.

In this COP year SHAP will assist the government to increase PITC services, and to intensify CT services in sites where there are more HIV positive clients. A greater emphasis on PITC will minimize missed opportunity for HIV testing and improve access to care and treatment. Provision of couple counseling, Youth Friendly HIV services, and mobile CT will continue to improve access to HCT. To further improve access for MARPs, mobile outreach teams will conduct CT services in special locations like brothels, Boda Boda (motor bikes used for transport) parks and other work place settings. SHAP will continue to collaborate with strategic partners and sub-grantees to promote the culture of the need to know ones sero-status through community mobilization.

SHAP will continue to ensure quality services through Quality Assurance and Quality Improvement activities at all HCT sites. This will be done through the use of checklists, job aids, and the provision of supportive supervision.

Illustrative Activities:

Increased access for HCT: Continue provision of HCT in the already existing sites, Renovations of health facilities at: 4 sites in WES; 1 in Greater Yei; 2 in WBG; and 1 in EES, Work with CBOs in mobilization for increased uptake of HCT, Monitoring and supporting PITC in all Health facilities supported by SHAP, Updating existing referral systems and tools, including directories, Supportive supervision for MOH staff to continue to provide services, Workplace HCT, Youth Friendly HIV Services (YFS): Strengthen TWG on YFS, Refresher training focusing on YFS, Integrate YFS in Health Facilities providing HCT and FP, Document experiences in providing YFS, Mobile and Outreach HCT, Documentation of successes and challenges of providing Mobile HCT, Participate in special events including WAD celebrations; Couple HIV counseling and Testing CHCT: Promote couple counseling through the use of IEC materials, Awareness creation on CHTC, Conducting routine checks on quality of CHCT services; Capacity Building: Counselor Supervision, Refresher PITC training, Lab Supervision Support, Mentorship; Quality Assurance and Quality Improvement: Reinforce the use of QA/QI guidelines and practices; systematically administer questionnaires to monitor Quality of PITC services. Analyze and develop improvement strategies, Quarterly mentorship for all HCT providers

In this COP year, SHAP will consolidate Other Sexual Prevention activities through peer education, BCC, community outreaches and continue with condom distribution through established outlets. These interventions will build on HIV and AIDS OP implemented under the previous COP in the four states of Central Equatoria, Eastern Equatoria, Western Equatoria and Western Bar El Gazal. The activities will focus on reaching the Most at Risk Populations in formal and informal settings. These interventions will continue to be implemented by the sub-grantees in all the four states.

The sub-grantees will also continue to target the general population to increase their knowledge and awareness on the risks associated with unsafe sexual practices, including cultural norms and behaviors that would expose them to HIV infection.

SHAP Strategic partners will continue to provide assistance and capacity building to partner organizations to implement other sexual prevention programs. The program will link with and provide referrals to existing networks of HIV/AIDS counseling and testing, home-based care, and ART programs in the program areas.

SHAP will integrate prevention messages into models of care and support for PLHIV. In addition SHAP will integrate messages to address quality of life, effects of drugs and substance abuse, and gender based violence. The interventions will also continue to promote gender equity in HIV and AIDs services delivery and access through the promotion of safe sexual norms among men, increased negotiation skills of condom use among females, and increased involvement of women in other HIV and AIDS prevention.