This activity relates to HVCT (#8944) and HVOP (#8940).

The Corridors of Hope II (COH II) is a new contract under Research Triangle Institute (RTI) that follows on from the original Corridors of Hope Cross Border Initiative (COH). COH II will both continue the activities of COH and expand the program to ensure a more comprehensive and balanced prevention program. COH II will have three basic objectives focusing on other prevention, AB activities, and CT services. These three program areas will fit together and be 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/AIS, other behavioral and biological data, and lessons learned from the original COH, COH II will: refocus 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 OP services; and facilitate linkages to other program areas such as treatment and care. To accomplish this, COH II will work closely with communities and local leaders, and with existing governmental structures such as District Health Management Teams (DHMTs) and the District AIDS Task Forces (DATFs). COH II will coordinate and collaborate with UGS partners and other donors to eliminate redundancy and ensure services are comprehensive. COH II will also have a strong focus on sustainability through building the capacity of local partners and non-governmental organizations (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 from five hub areas will be covered: 1. Livingstone and Kazungula, 2. Chipata and Katete, 3. Kapiri Mposhi, 4. Ndola, and 5. Chirundu. These sites represent populations that have the highest HIV prevalence and number of 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 in these areas will be reached with AB interventions, of which 50,000 will be pre-adolescents, adolescents and youth for abstinence only activities. A cadre of 400 individuals will be trained, on the average 100 per site, in implementing AB prevention activities and programs.

COH II is built on the successes of the original COH. In FY 2005 and 2006, COH I 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 through interpersonal counseling and group discussions with behavior change messages; and reached 36,000 youth with abstinence only messages. In addition, COH provided technical support to 33 trucking companies for HIV prevention and workplace programming. COH conducted three Behavioral Surveillance Surveys over the life of the project. The surveys indicated a very positive trend in behavior change as a result of the interventions, including an increase of condom use among sex workers with clients from 50% to 75% and a reduction in the number of sexual partners among truck drivers and other high risk men.

COH II will ensure a continuum of prevention interventions that reach not only the Most at Risk Populations but the wider community and will significantly increase AB activities in these very high prevalent locations. In particular, this program will 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 use participatory research methods 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 focus on sustainability by building the capacity of communities, local religious, traditional and civic leadership to ignite social and behavioral change, engage them in programming, and increase program ownership. COH II will provide sub-grants to local organizations to implement the 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 pre-adolescents aged 7-9, 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 sub grantees 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 provide technical assistance to strengthen all facets of the local implementing partner 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 their sub partners, COH II will develop a timeline for the phase-out of technical assistance (exit strategy) and develop a full graduation plan that will indicate 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 specified locations, and will network and link to economic development programs, education and vocational training programs, police sexual violence prevention programs, and MOH HIV/AIDS services. COH II will 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.

This activity relates to HVAB (#8938) and HVCT (#8939).

The Corridors of Hope II (COH II) is a new contract under Research Triangle Institute (RTI) that follows on from the original Corridors of Hope Cross Border Initiative (COH). COH II will both continue the activities of COH and expand the program to ensure a more comprehensive and balanced prevention program. COH II will have three basic objectives focusing on other prevention, AB activities, and CT services. These three program areas will fit together and be integrated as a cohesive prevention program.

In FY 2005 and 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.

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 will refocus on sexual networks, address sexually active youth and provide them with contextually appropriate intervention alternatives, address gender disparities, sexual violence, and transactional sex, provide services and activities for CT, AB, and Other Prevention, and facilitate linkages to other program areas such as care and treatment. To accomplish this, COH II will implement moonlight outreach services in bars, clubs, truckstops, and other key gathering places. COH II will also have a strong focus on sustainability through building the capacity of local partners and NGOs to provide Other Prevention services.

COH II will reduce HIV/AIDS transmission among Most at Risk Populations and Most Vulnerable Populations (MARPs) within seven border and high transit corridor areas through five hub areas covering: 1. Livingstone and Kazungula, 2. Chipata and Katete, 3. Kapiri Mposhi, 4. Ndola, and 5. Chirundu. These locations represent populations that have the highest HIV prevalence and number of 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 there will be 50 targeted condom service outlets. Training will be provided to 250 individuals in inter-personal behavior change communication for partner reduction and correct and consistent condom use.

COH II will 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 target women and men engaged in transactional sex and intergenerational sex, age appropriate 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 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), provision of Post-Exposure Prophylaxis (PEP) for victims of sexual violence, referrals for medical care and treatment, and links to economic and education programs. Interpersonal counseling will address the social and behavioral sexual norms that lead to HIV transmission. Specific services related to sexual violence, multiple and concurrent partnerships, drug and alcohol abuse, and transactional sex will be established and or strengthened and will be addressed in counseling sessions. Women's legal rights will be increased with this integrated approach. There will be a specific focus on providing appropriate services targeted at sexually active 15 - 24 year olds. Condom promotion and distribution will be targeted at spots

frequented by most at risk populations. COH II will work with law enforcement and health facilities to ensure Post-Exposure Prophylaxis for victims of sexual violence.

This activity will address the issue of HIV and Alcohol at COH II sites through sub-contracting local experts. It is a well known fact that excessive alcohol use not only increases vulnerability to HIV and risky sexual behaviors but also impairs efficacy of HIV medications, reduces compliance to treatment and generally contributes to poorer HIV treatment outcomes. The sub-contractor will develop key messages in collaboration with the National HIV/AIDS/STI/TB Council (NAC), District AIDS Task Forces (DATFs), and HCP. Interpersonal counseling and communications tools, mass media spots for local television and radio, pamphlets, and posters will be developed to raise awareness on the ill effects of alcohol abuse on HIV transmission. The sub-contractor will train outreach workers, local partners, and District Health Management Teams (DHMT) staff to give out specific information on Alcohol and its close association with HIV/AIDS transmission and the health of people living with HIV/AIDS (PLWHAs).

COH II's mandate is to sustain Other Prevention services and activities beyond the project period. COH II will work with sub-partners and other selected local organizations to build their capacity to conduct participatory research, implement effective programs addressing MARPs, and provide comprehensive prevention services such as CT, STI diagnosis and treatment, and PEP, and link to other services including ART, PMTCT, and palliative care. COH II through technical assistance will strengthen 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), quality assurance, and commodity/equipment logistics management. COH II also has a strong focus on training 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 be trained in STI management using national guidelines and additional persons will be trained in PEP provision and counseling for victims of sexual violence. In conjunction with their sub-partners, COH II will develop a timeline for the phase-out of technical assistance and develop a full graduation plan that will indicate 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 MoH HIV/AIDS services. COH II will collaborate with the Prevention of Sexual Transmission Group to eliminate redundancy with the work of other USG partners, NAC, and other donors.

This activity relates to HVAB (#8935) and HVOP (#8939).

The Corridors of Hope II (COH II) is a new contract under Research Triangle Institute (RTI) that follows on from the original Corridors of Hope Cross Border Initiative (COH). COH II will both continue the activities of original project and expand the program to ensure a more comprehensive and balanced prevention program. COH II will have 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 refocus 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 PMTCT, care, and ART. To accomplish this, COH II will work with communities and with existing governmental structures such as District Health Management Teams (DHMTs) and coordinate and collaborate with USG partners and other donors to eliminate redundancy and ensure services are comprehensive. COH II will also 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 high risk women. These data reinforced the importance of expanding CT services and linkages to care and treatment services in the new COH II project.

Building on these lessons learned, COH II will continue to expand CT services in five static facilities and mobile services in: 1. Livingstone and Kazungula, 2. Chipata and Katete, 3. Kapiri Mposhi, 4. Ndola, and 5. Chirundu. These locations represent populations that have the highest HIV prevalence and number of 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. In FY 2007, COH will provide 20,000 individuals with increased access to CT services, and train 40 counselors, health workers and lab technicians in CT.

COH II will promote universal CT and community prevalence findings will be utilized to inform community members of the real risk of HIV transmission in their area, to reduce denial, and increase personal risk perception. COH II will provide static and mobile community-based CT services. CT will be an entry point to prevention, care, and treatment services and strong linkages will be established for referrals. COH II and their local partners will work closely with communities to establish post-test clubs and support 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 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 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, M&E, quality assurance, and commodity/equipment logistics management. In conjunction with their sub partners, COH II will develop an exist strategy with graduation plan and timeline for the phase-out of technical assistance that will indicate the technical and capacity building needs of each local partner leading up to 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: prevention of mother-to-child transmission, prevention and clinical management of

HIV-related illnesses and opportunistic infections, antiretroviral therapy, tuberculosis control, and psychosocial support. COH II will collaborate with the District AIDS Task Forces (DATFs) and the District Health Management Teams (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.