TITLE: Expanding HVAB in Makambako and Tunduma, TanZam Highway

Roads sites in Tanzania have been selected in collaboration with TACAIDS and NACP to bring services to

high prevalence areas that have been historically underserved and host a critical mass of truckers

overnight. AB activities in the sites have been underdeveloped and ad hoc, mostly operationalized through

faith-based organizations. ROADS has made progress in reaching MARPs (truckers, community men and

women, sexually active youth) with AB, though there is a need to scale-up AB programming.

ROADS is USAID's regional platform to address HIV along the transport corridors of East/Central Africa. It

is a comprehensive program focusing on the most underserved communities, extending prevention, and

care and support as appropriate to address gaps and add value to bilateral programs. With its network of

approximately 70 indigenous volunteer groups, including 20 FBOs, ROADS is well placed to extend AB

services.

ACCOMPLISHMENTS: During January-June 2007, ROADS established the Safe-T-Stop model in the two

sites, linking indigenous volunteer groups, businesses, and FBOs through common branding. ROADS

trained 300 peer educators and community mobilizers from indigenous volunteer group's community to

convey AB messages, reaching 14,330 people. AB prevention is disseminated to truck drivers, community

men and women, out-of-school youth, and OVC.

ROADS will strengthen peer education and community outreach to examine barriers to abstinence and

being faithful to MARPs (especially truck drivers who spend much of their lives away from home). ROADS

will also help youth and OVC to develop more positive, safe sexual behaviors and norms (including

secondary abstinence for youth) in Makambako and Tunduma, expanding programming to Isaka and

potentially the Port of Dar. ROADS will expand programming into primary 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 will continue

integrating with existing activities and services as a priority. This includes linking HVAB activities with such

services as counseling and testing (C&T) (ANGAZA sites in Makambako and Tunduma), ART, and PMTCT.

ROADS will continue to link and strengthen these services through the Safe-T-Stop model, which mobilizes

the community around HIV prevention, care, treatment, and mitigation services as well as addressing

gender norms, alcohol use, stigma, and discrimination that promote or lead to high-risk sexual behavior.

ROADS works 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 resource

centers) to provide safer alternatives. In Makambako, ROADS will continue working with the faith-based

community and youth groups to promote AB, including partner reduction for truck drivers, community men

and women, and sexually active youth. ROADS will link AB audiences with local health facilities, including

pharmacy/drug shop providers, to promote C&T and other services. The project will reinforce AB

prevention programming for military personnel, particularly at sites where they congregate off base.

ROADS will strengthen the referral system with the four existing C&T services and the USAID care and

treatment partner for Iringa Region (FHI). In Tunduma, ROADS will continue mobilizing indigenous

volunteer groups, particularly those linked with faith-based organizations, to expand HVAB programming for

MARPs. ROADS will continue using its strategically located Safe-T-Stop resource center as a center for

truck drivers, community men, women, and youth providing HIV and AIDS education around AB, counseling

and support services. This site is an alcohol-free alternative recreational site for transient populations and

Tunduma residents. Finally, ROADS will introduce an innovative MP4 device with HVAB content for use by

drivers on the road and discussion groups where they stop.

LINKAGES: As a regional program, ROADS integrates with and adds value to USAID bilateral programs.

This entails linking closely with USG and non-USG partners. In Tanzania, ROADS has linked with T-MARC

on HIV prevention and with FHI on care and treatment. In Tunduma, ROADS coordinates closely with

Walter Reed/DOD to ensure synergy in AB programming and to jointly fund selected activities. In

Makambako, ROADS has linked with the FHI care and treatment team (Njombe) to link AB audiences to

clinical and non-clinical services and build AB programming into its work with COTWU. In addition, the Safe

-T-Stop strategy is predicated on building local capacity. In Makambako and Tunduma, ROADS has linked

with 51 indigenous volunteer groups, strengthening and supporting their HVAB activities. ROADS also

liaises regularly with district leadership and health teams. District commissioners from Mbozi and Njombe

attended the official Safe-T-Stop launch in Tunduma in May 2007.

CHECK BOXES: For this activity, ROADS focuses on addressing male norms (partner reduction), human

capacity development, local organization capacity building, and strategic information. ROADS target

populations are children 5-9 (A for OVC), adolescents 10-24, adults, mobile populations (including military in

Makambako), and street youth. The project works on HVAB with discordant couples, PLHA, religious

leaders, and teachers.

ROADS M&E system will be fully integrated with the National Monitoring System. Qualitative and

quantitative data will be collected by the ROADS Site Coordinators in liaison with indigenous volunteer

groups reporting to districts and ROADS. Through case studies and success stories, the project will

document person-level impact. The project will conduct focus groups and in-depth interviews with

beneficiaries, community volunteers, and community leaders to gauge the quality and impact of AB

programming provided. Integration with the National Monitoring System will build M&E capacity of the

myriad community groups who report data through ROADS/Safe-T-Stop. Training of 100 peer

educators/community mobilizers will include training on the National Monitoring System.

SUSTAINAIBLITY: Almost all partners on the project are local entities that exist without external funding.

As a result, project activities are highly sustainable. Indigenous volunteer groups collaborating with the

project were established without outside assistance and will continue functioning over the long term. Local

businesses, market sellers, and farmers are also part of the fabric of community life and will be present over

the long term. It is critical to manage the roster of volunteers so that individual volunteers are not

overburdened and do not drop out of the program. ROADS has developed strategies to motivate volunteers

(non-monetary incentives, and planning implementation activities convenient to volunteers and their

immediate networks) to minimize attrition and enhance sustainability.

TITLE: Expanding OP in Makambako, Tunduma, Isaka, and possibly the Port of Dar

Other Prevention initiatives have been underdeveloped, although ROADS has made progress in reaching

most at risk population (MARPs) which include truck drivers, sex workers, and sexually active youth.

However, there is a need to scale up OP (condom promotion/distribution, peer education, community

mobilization), and wrap-around programming (food/nutrition, norm change surrounding alcohol abuse, and

GBV).

ROADS is USAID regional platform to address HIV along the transport corridors of East/Central Africa. It is

a comprehensive program focusing on the most underserved communities, extending prevention, and care

and support as appropriate to address gaps and add value to bilateral programs. With its network of

approximately 70 indigenous volunteer groups, ROADS is well placed to extend OP programming.

ACCOMPLISHMENTS: During January-June 2007, ROADS established the Safe-T-Stop model in the two

sites, linking indigenous volunteer groups, businesses, and FBOs through common branding. ROADS

trained 292 peer educators and community mobilizers from indigenous volunteer groups community to

convey HIV prevention messages including, but not limited to, AB. In the first quarter following initial

training, 390 people were reached. Other prevention messages and condoms are disseminated to MARPs

targeted by ROADS.

ACTIVITIES: ROADS will strengthen work initiated with FY 2007 funds to reach MARPs in Makambako and

Tunduma and expand programming to Isaka and potentially the Port of Dar. ROADS will continue to

coordinate and link with such services as C&T (ANGAZA sites in Makambako and Tunduma), ART,

PMTCT, and existing efforts to promote and distribute condoms, such as the collaboration with T-MARC in

the existing two sites). ROADS will continue to strengthen these services through the Safe-T-Stop model,

which mobilizes the community around HIV prevention, care, treatment, and mitigation services addressing

critical societal factors such as stigma, discrimination, and social norms around gender and alcohol

consumption.

ROADS will continue working with the private sector, especially bar and guest house owners, to reduce risk

for bargirls and patrons through condom distribution and peer education (focusing on an "immediate social

network" model). Pharmacy/drug shop providers will receive refresher training in managing STIs, condom

promotion, and referral for counseling and testing (C&T). ROADS will continue linking with local health

facilities, including pharmacies/drug shops, to promote expanded C&T and other services for truck drivers,

sex workers, other low-income women, and sexually active youth. ROADS will strengthen community-

outreach addressing alcohol use, gender-based violence (GBV), and prevention among discordant couples.

ROADS will collaborate closely with the four existing C&T services and the USAID C&T partner for Iringa

Region. In Tunduma, ROADS will continue mobilizing the private sector (bar and guesthouse owners,

liquor club members, and pharmacy/drug shop providers) and indigenous volunteer groups to expand

condom promotion and distribution. ROADS will continue using its strategically located Safe-T-Stop

resource centers to provide HIV/AIDS education, counseling, and support services for truck drivers, sex

workers, other high-risk women, and youth. These centers will also provide on-site C&T services, alcohol

counseling, and referral to pharmacy/drug shops for STI and other needs. These sites are alcohol-free

alternative recreational sites for transient populations and the host communities.

ROADS will collaborate with community and religious leaders in addition to local community services to:

address male norms that influence women's access to services; legal protection for women; post-rape

health; legal and law enforcement services; and economic strengthening for vulnerable women. With the

support of local businesses, ROADS will expand its community food-banking strategy, which identifies

sources of excess food and distributes it to AIDS-affected families. Additionally, jobs for low-income

women/older orphans will be created through ROADS' LifeWorks Partnership. ROADS will also introduce

an innovative MP4 device with HVOP content for use by drivers on the road and in discussion groups where

they stop.

LINKAGES: In 2007, ROADS linked with T-MARC to jointly launch regional programs such as Safe-T-Stop

and the VAA condom campaign. ROADS has integrated VAA branding in Safe-T-Stop branding and linked

T-MARC with bars/guest houses collaborating with the project. In Tunduma, ROADS coordinates closely

with DOD to ensure synergy in HVOP and to jointly fund selected activities. The project is also linked with

COTWU to reach transport workers. In Makambako, ROADS has linked with the FHI care and treatment

team (Njombe) to link HVOP audiences with clinical and non-clinical services. In addition, the Safe-T-Stop

strategy is predicated on building local capacity. In Makambako and Tunduma ROADS has linked with

approximately 70 indigenous volunteer groups, strengthening and supporting their prevention activities.

ROADS also liaises regularly with district leadership.

CHECK BOXES: ROADS focuses on gender norms, economic empowerment of women, strategies to

address GBV, human capacity development, local organization capacity building, strategic information,

economic strengthening, and food security. ROADS target populations are adolescents 15-24, adults,

mobile populations (including military in Makambako), non-injecting substance abusers (alcohol), people

who engage in commercial/transactional sex, and street youth. The project works on HVOP with the

business community, discordant couples, PLWHA, and religious leaders.

ROADS M&E system will be fully integrated with the National Monitoring System. Qualitative and

quantitative data will be collected by the ROADS site coordinators in collaboration with indigenous volunteer

groups reporting to districts and ROADS. Through case studies and success stories, the project will

document person-level impact. The project will conduct focus groups and in-depth interviews with

beneficiaries, community volunteers, and community leaders to gauge the quality and impact of OP

programming provided. Integrating with the National Monitoring System will build M&E capacity of the

myriad of community groups who report data through ROADS/Safe-T-Stop. Training of 150 peer

educators/community mobilizers will include training on the National Monitoring System.

SUSTAINAIBLITY: Almost all partners on the project are local entities that exist without external funding.

As a result, project activities are highly sustainable. Indigenous volunteer groups collaborating with the

project were established without outside assistance and will continue functioning over the long term. Local

businesses, market sellers, and farmers are also part of the fabric of community life and will be present over

Activity Narrative: the long term. It is critical to effectively manage the roster of volunteers so that individual volunteers are not

overburdened and do not drop out of the program. ROADS has developed strategies to motivate volunteers

(non-monetary incentives and implementing activities with people in their immediate social networks) to

minimize attrition and enhance sustainability.

TITLE: Regional Outreach Addressing AIDS through Development Strategies (ROADS) Project:

Expanding Care in Makambako and Tunduma, TANZAM Highway

NEED and COMPARATIVE ADVANTAGE: The port of Dar es Salaam is the largest in East Africa. Goods

entering Tanzania are trucked, via a network of highways, across the country and into neighboring

countries. The mobile populations that work on these highways and the communities through which they

pass are particularly vulnerable to HIV/AIDS. The towns of Tunduma (Mbeya) and Makambako (Iringa) in

Tanzania's Southern Highlands are located on the highway that connects Tanzania to Zambia. Mbeya

region, where Tunduma is located, has the highest HIV prevalence in Tanzania due in part to high rates of

substance abuse and risky sexual behaviors. When the Regional Outreach Addressing AIDS through

Development Strategies (ROADS) project began working in the two towns, the care infrastructure for people

living with HIV/AIDS (PLWHA) was weak. Antiretroviral (ART) services were inaccessible due to distance,

and PLWHA faced food insecurity, which interfered with treatment. The two facilities in Tunduma treated

some opportunistic infections (OI) but provided no HIV services beyond distributing educational materials.

There was a shortage of trained home-based care (HBC) providers. This project was designed to fill the

gap in services faced by PLWHA and their families in the two locations. With its large network of

indigenous volunteer groups, including faith-based organizations (FBOs), the ROADS project is well placed

to expand HBC and support.

ACCOMPLISHMENTS: ROADS has trained drug-dispensing outlet providers in Tunduma and Makambako

to enhance care, support, and referrals for PLWHA. ROADS partner, Howard University, has created a

baseline assessment tool to measure the impact of HIV training for drug shop operators, tested on select

drug stores. ROADS trained nearly 100 drug-dispensing outlet staff from Makambako and Tunduma in HIV

treatment, care, and support. ROADS also adapted a client encounter tool to evaluate the quality of

interventions provided and number of people reached. ROADS trained more than 30 individuals in home-

based care from ABC group, the lone community-based organization (CBO) offering HIV support services in

Tunduma.

ACTIVITIES: In FY 2008, ROADS will expand and strengthen HBC in Tunduma through FBOs and the ABC

group. ROADS will train additional families and caregivers in basic palliative care including hygiene, ART

adherence, identifying and treating simple OI, referral for clinical services, and various forms of support

(psychosocial, spiritual, social, and prevention) as well as preventive services, such as reproductive health

services. The project will take a family-centered approach to care, referring family members for counseling

and testing, and other needed services. ROADS will develop a basic care package for use by volunteers,

which will include condoms, cotimoxazole, safe water tablets, safe water vessels, and insecticide treated

nets. With local health officials and PLWHA, ROADS will devise strategies to address the transport barrier

to ART services in Mbeya . The project will continue to strengthen drug-dispensing outlets to provide HIV

counseling, support, and referral, recognizing the reach of these outlets and their role as first-line provider

for most at risk populations (MARPS). The project will also develop alcohol support options for ART

patients, linking closely with the Tunduma Health Centre and FBOs, as well as economic empowerment to

enhance self-sufficiency for HBC clients and caregivers. Finally, through a public private partnership (PPP)

initiative with commercial food producers in Tunduma, ROADS will develop a community food-banking

strategy to enhance food security of AIDS-affected households.

In Makambako, ROADS will focus care activities on strengthening drug-dispensing outlet-based HIV

counseling, support, and referral, recognizing these outlets as an untapped resource in an underserved

community. The project will also address the transport barriers facing PLWHA who cannot reach ART

services. ROADS will not address gaps in HBC in Makambako, recognizing that the PEPFAR treatment

partner (FHI/Tanzania) will address home- and facility-based care in Iringa region, including Makambako.

As in Tunduma, the project will also develop alcohol support options for ART patients to address treatment

adherence and efficacy, link with health facilities and FBOs, and enhance economic empowerment for HBC

clients and caregivers. In both sites, ROADS will seek to integrate family planning counseling into HIV care

and support services. Basic care kits will be purchased, or secured from the Medical Stores Department,

for both sites. FHI site coordinators will also work closely with the community clusters and health care staff

to strengthen the reporting and feedback mechanisms to ensure quality services are developed and

sustained.

In FY 2008, ROADS anticipates expanding to the port of Dar es Salaam and Isaka town, which both have a

high concentration of vulnerable mobile populations. All programs and expansion will be conducted in

compliance with government of Tanzania (GOT) programs in terms of training curricula, standards, and

guidelines.

LINKAGES: As a regional program, ROADS integrates with and adds value to USAID bilateral programs.

This entails linking closely with USG and non-USG partners. In Tanzania, ROADS has linked with FHI and

Walter Reed/DOD on care, support, and treatment in Njombe and Mbozi districts. In Makambako and

Tunduma, ROADS has linked with existing health services (Ilembula and Vwawa hospitals), referring

abstinence, faithfulness, and other prevention audiences for counseling and testing and higher-level

services. The ROADS strategy will build local capacity: in Makambako and Tunduma, ROADS has linked

with more than 50 indigenous volunteer groups, strengthening and supporting community-based HIV care

and support. ROADS also liaises regularly with district leadership, including district health management

teams.

CHECK BOXES: For this activity, ROADS focuses on human capacity development, local organization

capacity building, strategic information, and wraparound programs (family planning, malaria, economic

strengthening, and food security). Target audiences include children, adolescents, adults, mobile

populations, non-injecting drug users (alcohol), individuals involved in commercial/transactional sex, and

street youth. The project will work with the business community, discordant couples, PLWHA, and religious

leaders on care and support.

M&E: The activities of this project will fit into the overall ROADS M&E framework. Qualitative and

quantitative (service statistic) data will be collected by the ROADS site coordinators in collaboration with

indigenous volunteer groups and clinical care sites. The project will collect relevant quantitative data using

its reporting structure and integrate it into its existing database. Through case studies and success stories,

the project will document person-level impact. The project will conduct focus groups and in-depth

Activity Narrative: interviews with beneficiaries, community volunteers, and community leaders to assess the quality and

impact of care services provided. Supervisory support will be provided to local implementing partners as

part of the routine monitoring and review mechanism. Best practices and lessons learned will be monitored

to share with other implementing partners for the possibility of bringing them to scale. ROADS will

participate in the national monitoring program once it is operational, and provide data to contribute to the

national monitoring and planning, in addition, the data will be used for local planning, budgeting,

management, and decision making.

SUSTAINAIBLITY: Almost all partners on the project are local entities that exist without external funding.

As a result, project activities are highly sustainable. Indigenous volunteer groups partnering with the project

were established without outside assistance and will continue functioning over the long term. Local

businesses, market sellers, and farmers are also part of the fabric of community life and will be present over

the long term. It is critical to manage the roster of care volunteers so that individual volunteers are not

overburdened and do not drop out of the program. ROADS has developed strategies to motivate volunteers

(providing non-monetary incentives, planning so people implement activities within their immediate

networks) to minimize attrition and enhance sustainability.

TITLE: Expanding Support for Orphans and Vulnerable Children (OVC) in Makambako and Tunduma,

TANZAM Highway

Points along the Tanzania-Zambia highway are "hot spots" for transmission of HIV. In addition to high HIV

prevalence, many of these communities, particularly in outlying areas, are severely underserved by HIV

services. Two such sites, Makambako (Iringa Region) and Tunduma (Mbeya Region) have HIV prevalence

estimates significantly higher than the national average. Statistics show that prevalence is 13.4% in Iringa

Region, spiking to 23.6% in Njombe District (which includes Makambako), and 13.5% in Mbeya region, with

prevalence spiking to 20% or higher in the area around Tunduma. These communities, ranging from

20,000 (Makambako) to 40,000 people (Tunduma), not including the mobile populations that spend

considerable time there, are sizable. The combination of poverty, high concentration of transient workers,

high HIV prevalence, hazardous sexual networking, lack of recreational facilities, and lack of HIV services

create an environment, in which HIV spreads rapidly. This ultimately leads to large numbers of orphans and

vulnerable children (OVC). According to key informant interviews, a significant proportion of young sex

workers in Tunduma and Makambako, referred to as "Twiga Stars," are orphans from other parts of

Tanzania and neighboring high-prevalence countries who migrated to work in the sex trade. They are

among the most vulnerable young people in these sites, often victim to beatings and sexual assault. With

its large network of indigenous volunteer groups, including faith-based organizations (FBOs), the Regional

Outreach Addressing AIDS through Development Strategies (ROADS) Project is well placed to expand

OVC care and support.

ACCOMPLISHMENTS: The ROADS Project, led by Family Health International (FHI) began in May 2007.

The Makambako OVC cluster, organized through ROADS, has now conducted a six-day OVC census

establishing that in Makambako, there are 181 OVC aged less than 7 years, 1,753 OVC in primary schools

and 210 in secondary schools. The data also indicated that there are 149 out-of-school OVC and 29 street

children in Makambako. During the reporting period, 19 cluster members were involved in data collection

and analysis and the cluster conducted peer education reaching 185 people.

ACTIVITIES: In FY 2008, the project will continue work initiated in FY 2007 with existing child-welfare

organizations, faith-based organizations (FBOs), local officials and, importantly, the private sector/business

community to meet the daily needs of OVC. Child-focused needs assessments form the basis for

identifying services to be provided. All OVC, under both primary and secondary support, will receive

psychosocial support (PSS) in the form of counseling and/or training in life skills. Depending on results of

the identification process, which includes an OVC needs assessment prioritizing interventions, issues

regarding support for education, nutrition, basic health management and access/referral to health services,

shelter, and economic strengthening (linking to income generating activities including opportunities in

business management training) will be addressed. Wherever possible, ROADS will continue to work with

the private sector through public-private partnerships, based on the specific needs and possibilities in each

site. For example, ROADS expects to continue its work with farmers and traders in Tunduma to use

community food banks initiated with FY 2007 funding. With FY 2008 funding, ROADS will also continue

programming for orphan-headed households, recognizing their unique vulnerability and needs. To address

the longer-term needs of orphan-headed households, ROADS' LifeWorks partnership, which already has

Global Development Alliances in place with General Motors and Unilever, will conduct job training and job

creation, and develop other economic opportunities for OVC breadwinners. Learning from this first year of

programming, ROADS will expand the economic strengthening component. The project will also continue

supporting HIV risk-reduction and care strategies specifically for OVC who are breadwinner heads of

households, linking them with abstinence and faithfulness messaging, counseling and testing, and services

for sexually transmitted infection (STI) if required. ROADS will also provide PSS, linkages to food/nutritional

support, and emergency care in cases of rape and sexual assault. ROADS will introduce programming

specifically to address the needs of OVC caregivers by providing PSS, 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. Health services for OVC will include

voluntary counseling and testing for all children and caregivers in the family. FHI/ROADS will test a cash-

transfer model in one site as a methodology for addressing the needs of OVCs living in desperate poverty

situations. "Cash" for the cash-transfer will be leveraged from public-private partnership donations with

Emergency Plan funds managing and evaluating implementation. As ROADS moves into additional sites,

programming for OVC will also be expanded, especially with regard to identifying and providing supportive

services to OVC who may drift to the port of Dar and the dry dock in Isaka in search of work. Finally,

ROADS will build on its solid reputation with FBOs and other community groups to address stigma and

discrimination toward OVC through community education campaigns spearheaded by community leaders.

As an OVC program, ROADS will scale the implementation of the National Plan of Action (NPA) for OVC

and the national Data Management System (DMS). The data will be input to the national DMS.

LINKAGES: As a regional program, ROADS integrates with and adds value to USAID bilateral programs.

This entails linking closely with USG and non-USG partners. In Tanzania, ROADS has linked with T-MARC

on HIV prevention, and with Deloitte/FHI and Walter Reed/ DOD on care, support, and treatment in Njombe

and Mbozi districts. In Makambako and Tunduma, ROADS has linked with existing health services

(Ilembula and Vwawa hospitals). Furthermore, ROADS' strategy is predicated to building local capacity. In

Makambako and Tunduma, ROADS has linked with 51 indigenous volunteer groups, strengthening and

supporting community-based OVC care and support. ROADS also liaises regularly with district leadership,

including Council Health Management Teams to ensure health services are accessible to OVC and their

caregivers, and with the Most Vulnerable Children's Committees (MVCCs) to ensure partnership in the

implementation of the NPA. Basic mapping will be conducted in order to create linkages with other

programs to ensure effective service delivery.

CHECK BOXES: For this activity ROADS focuses on gender by ensuring that the rights and protection of

women are ensured. In addition, human capacity development is essential to training social welfare officers

and FBOs to deal with the needs of OVC, along with building capacity for local organizations. The program

will contribute in the area of strategic information by contributing to the national DMS. In addition, ROADS

will link with key wraparound programs in malaria, economic strengthening, and food security initiatives.

The target audiences include OVC and their caregivers. The project will encourage collaboration between

the business community, PLWHA, and religious leaders to provide care and support for OVC.

Activity Narrative: M&E: ROADS will adopt the national DMS for monitoring and evaluation. The program will ensure that sub

-grantees input information about identified OVC the local level, which will feed into the national system.

Data must also be available to MVCCs at the local level for planning, decision making, and monitoring.

ROADS will also build capacity of the district social welfare and M&E officers and purchase computers to

ensure data quality. FHI will conduct quarterly field visits to assess the quality of services provided, collect

data, and provide onsite refresher training as needed. In addition, ROADS will support implementers at the

district level to attend the Emergency Plan M&E capacity building trainings and meetings. Lastly, qualitative

and quantitative data will be collected by the ROADS site coordinators in liaison with indigenous volunteer

groups and local child welfare authorities.

SUSTAINAIBLITY: Because many of the local partners exist without external funding, the project activities

are highly sustainable. Capacity building will be done with local government authorities to incorporate

program activities into local plans, budgets, and priorities. Local businesses, market sellers, and farmers

are pillars of the community and will be essential in fostering sustainability. Additionally, it is critical to

manage the roster of care volunteers so that individual volunteers are not overburdened and do not drop out

of the program. ROADS has developed strategies to motivate volunteers (non-monetary incentives, and

planning so people implement activities within.

TITLE: Expanding HVCT in Tunduma, Isaka and Potentially the Port of Dar

NEED AND COMPARATIVE ADVANTAGE: Until recently quality CT was largely unavailable in Tunduma.

Historically, CT has had low uptake and has not been well promoted in the community, particularly among

MARPs. The new ANGAZA site has improved the situation, though there is still a need for outreach CT at

locations/hours convenient for truck drivers, their sexual partners, and sexually active youth. ROADS is

USAID's regional platform to address HIV along the transport corridors of East/Central Africa. It is a

comprehensive program focusing on the most underserved communities, extending prevention, care, and

support to address gaps and add value to bilateral programs. With its network of indigenous volunteer

groups and ties with the Mbozi district health team, ROADS is well placed to extend CT through fixed

outreach sites in Tunduma.

ACCOMPLISHMENTS: During January-June 2007 ROADS established the SafeTStop model in two sites,

linking indigenous volunteer groups, businesses, health facilities, and FBOs through joint community

planning, implementation, and branding. During January-June 2007, 147 people in Makambako and

Tunduma were referred for testing, accessed testing, and received their result.

ACTIVITIES: ROADS will work with the Mbozi district health team, medical professionals in Vwawa and

Tunduma, ANGAZA, and the youth and faith-based organization (FBO) clusters to establish fixed outreach

CT sites in Tunduma targeting truck drivers, their sexual partners, and sexually active youth. With FY 2007

funds, ROADS will address the gap in CT services for the above populations by establishing CT at the

SafeTStop Resource Center situated near the intersection of two major strips of bars. Services will be

provided by existing district CT counselors and by medical professionals to be trained by ROADS according

to national guidelines. ROADS has already collaborated on CT with Vwawa Hospital, which provided CT at

the official SafeTStop launch in May 2007. With FY 2008 funds, ROADS will extend CT to five additional

fixed outreach sites in Tunduma and five in Isaka, again focusing on MARPs at hours and locations most

preferable to them (e.g., in Tunduma drivers spend business hours queuing at customs; trucker assistants

spend almost all of their time in Tunduma at the truck park on the outskirts of town). With FY 2008 funds

ROADS will train 40 health professionals in the district to provide quality CT, in liaison with district partners,

to efficiently expand the pool of professional CT counselors. ROADS will also explore the possibility of using

lay counselors to further expand access to CT services. Training will include counseling skills related to

hazardous drinking behavior, a major driver of HIV risk behavior in Tunduma.

ROADS will coordinate with the DMO, ANGAZA, and Walter Reed to maximize coverage. As part of its work

with surrounding communities, ROADS will promote testing to all family members where the index patient is

found to be positive as appropriate. In Makambako, ROADS will continue to focus on referral to the four

existing CT sites. In both existing sites, as well as Isaka, CT services will benefit from and work in concert

with community mobilization to address stigma, discrimination, and gender-based violence that are major

barriers to CT services. The project will also strengthen referral of CT clients for family planning. In 2008,

ROADS will assess CT at the Port of Dar and strengthen and extend services as appropriate, while liaising

with USAID/Tanzania and other partners. ROADS will continue to look for innovative and new ways to reach

high-risk populations and will explore the possibility of introducing C&T services in pharmacies under the

GoT's direction and in accordance with national guidelines and policies.

LINKAGES: As a regional program, ROADS integrates with and adds value to USAID bilateral programs. In

Tanzania ROADS has linked with Tanzania Marketing and Communication for HIV/AIDS, Reproductive

health and Child Survival Project (T-MARC) on OP and with Family Health International (FH)I on care,

support and treatment. Since June 2006, ROADS has coordinated closely with Walter Reed in the Mbeya

Region to ensure synergy and jointly funded selected activities. In Makambako, ROADS has linked with the

existing CT sites, referring OP and AB audiences for CT. The SafeTStop strategy is predicated to build on

local capacity: in Makambako and Tunduma ROADS has organized more than 70 indigenous volunteer

groups and local businesses into clusters, strengthening and supporting referral for CT. ROADS also

liaises regularly with district leadership.

CHECK BOXES: For this activity ROADS focuses on construction/renovation of C&T space, gender,

human capacity development, local organization capacity building, strategic information, and integration of

family planning. ROADS target populations are adolescents 15-24, adults, mobile populations (including

military in Makambako), non-injecting drug users (alcohol), persons working in commercial/transaction sex,

and street youth. The project works on CT with PLHA, FBOs, discordant couples and the business

community.

M&E: As ROADS establishes CT at the SafeTStop resource center with FY 2007 funds and extends CT

through fixed outreach sites with FY 2008 funds, it will harmonize its M&E system with the national CT

monitoring system. Integrating with this system will build the M&E capacity of the myriad of community

groups who report data through ROADS/SafeTStop. Training of the 40 medical professionals in CT will

include training on the national CT monitoring system. Supportive supervision of these sites will include

M&E, specifically data collection (staff's understanding/ability to fill out forms, completeness of forms),

management and storage of data (registers and forms), and reporting of data to the district-level. We will

use the established national CT guidelines and training materials to assist in strengthening M&E capacity in

these facilities.

SUSTAINABILITY: Almost all partners on the project are local entities. As a result, project activities are

highly sustainable. Indigenous volunteer groups partnering with the project were established without outside

assistance and will continue functioning over the long term. Local businesses, market sellers, and farmers

are also part of the fabric of community life and will be present over the long term. It is critical to manage the

roster of volunteers so that individual volunteers are not overburdened and do not drop out of the program.

ROADS has developed strategies to motivate volunteers (non-monetary incentives, planning so people

implement activities within their immediate networks) to minimize attrition and enhance sustainability.