Minimum Prevention Package Intervention-MPPI Operationalization

Operationalization of MPPI:
(MARPS)

Session Objectives
By the end of the session, the participants are expected to:
•Understand and identify different types of MARPs
•Understand the principles of HIV prevention programming for MARPs
•Understand the key considerations for programming for MARPs
•Understand how to operationalize the MPPI within their scope of work
for MARPs

Topics
Topic 1 Introduction
Topic 2 Types of MARPs (FSWs, MSMs, IDUs)
Topic 3 Program Implementation for MARPs
Topic 4 Program Implementation for FSWs - ‘How to’ implement MPPI for FSWs
Topic 5 Program Implementation for MSMs & IDUs - ‘How to’ implement MPPI for MSMs & IDUs
Topic 6 Key M & E considerations in programing for MARPs- HIV Prevention Indicators

Who are the MARPs?
• Female Sex Worker (FSW) – any female who undertakes sexual activity with a man in return for
financial or material benefit
• High Risk Men who have sex with Men (MSM) – men who have sex with other men as a matter of
preference or practices, regardless of their sexual identity or sexual orientation, and irrespective of
whether they also have sex with women or not
• Injecting Drug User (IDU)- person who injects drugs, for non-therapeutic purposes, irrespective of
the type of drug injected
The National Prevention Plan prescribes that HIV
prevention programs for MARPs be implemented
through a combination prevention approach – MPPI
Concept

The “How To” in implementing MPPI for the
HIV Prevention –Triple 3 for 2
3 Implementation Platforms – Individual, Community and
Structural
 3 Intervention prongs –Behavioral, Biomedical and Structural
3 Phases of activity implementation- Entry, Intensive and Exit
2 Target Population Groups – General Population and MARPs
Program activities-key activities by phases of implementation

MPPI Overview- Tripple 3 for 2
Program Platforms Program Interventions Implementation
Phases
MARPS General Population
INDIVIDUAL BEHAVIOURAL ENTRY • Outreach
• Peer Education
• Condom and lubricant programming
• Outreach
• Peer Education
• Condom and lubricant
programming
COMMUNITY BIOMEDICAL INTENSIVE • HCT
• PMTCT
• Condom and lubricant programming
• STI control and Treatment
• Harm reduction intervention for IDUs
• HCT
• PMTCT
• Condom and lubricant
programming
• STI control and Treatment
SOCIETAL/STRUCTURAL
Structural-
gender issues,
S&D, policy
issues,
individual
empowerment
)
EXIT • Community mobilization and Dialogue
(empowerment and capacity building)
• Advocacy
• Individual Empowerment/Income
Generating Activities
• Community mobilization
and Dialogue
(empowerment and capacity
building)
• Advocacy
• Individual
Empowerment/Income
Generating Activities

Entry Phase Series of activities carried out to gain entrance into a community in preparation for
project implementation
Intensive Phase Mix of interventions conducted to promote behaviour change amongst target
populations
Exit Phase Series of activities conducted at the end of the implementation period to promote
community ownership and sustainability

Implementation Strategies for the 3 phases
Entry Phase Intensive Phase Exit Phase
Strategies
 Community
 Condom Programming and
Distribution
 HIV Prevention services
Strategies
 Community
 Condom Programming and
Distribution
 HIV Prevention services
Strategies
 Community

Program Implementation for Female Sex
Workers

FSW & Types of sex work
Female Sex Worker (FSW) – any female who undertakes sexual activity with a man in return
for financial or material benefit
Brothel – Based Sex Work
Brothel-based sex workers operate from an establishment with a number of rooms that clients and SWs can use for sexual activities. Clients visit the
brothel to drink and make contact with the sex workers. The client may use a room at the brothel or take the sex worker to another location.
Non Brothel based Sex Work
• Street/Public-Based Sex Work
This type of sex worker solicits clients on the streets, car parks and/or other public places. Sexual services are provided on the side street, in the car,
brothels, homes or hotels.
• Home-Based Sex Work
Home-based sex work is the exchange of sex for money in one’s home, providing privacy. Clients contact sex workers directly and set up
appointments to meet with them or they frequent the home of known sex workers
• Venue – Based Sex Work: Bars, Night Clubs, and Casinos
Venue-based sex workers exchange sex for money in a designated location. These venue-based sex workers operate from locations such as bars,
night clubs.
• Venue – Based Sex Work: Hotels and Lodges
Venue-based sex workers exchange sex for money in a designated location. These venue-based sex workers operate from locations such as hotels
and lodges.

• Massage Parlour
Massage parlours are premises licensed and opened to the public for the provision of massage services. Many times these locations are
discretely used for a range of other services, including sex work
• Escort Service
Escort service is the most discreet type of sex work. The client usually contacts an escort (i.e. sex worker) by calling a listed phone number,
through a contact, hotel staff or online. Services are provided at the client’s home or a hotel room.
•Hostel/Campus
This type of sex worker solicits clients at on university campuses. Campus FSWs reside at university campuses in hostels and may or may not be
students. They meet clients mainly on campus and sexual activity often takes place in hotels and other locations usually outside the campus.
• Trailer and Truck Stops
This type of sex worker solicits clients at trailer and truck stops. Their clients are long distance trailer and truck drivers who stop briefly at
truck/trailer stops to eat, sleep, have sex or sell goods.

HIV infection among FSW plays an
important role in Nigeria’s HIV
epidemic
•Potential for transmission to the
general population through their male
clients
FSW contribution to HIV
epidemic

FSWs are vulnerable to HIV and
sexually transmitted infections (STIs)
•Individual risk behaviors
•Society and community factors - rejection
within communities, stigma, Nigeria’s law
against sex work
•Violence
•Limited opportunities and access to HIV
preventive services
FSW vulnerability to
HIV/AIDS

Key considerations in programming for FSWs
• Engage community stakeholders and gatekeepers all through intervention phases to promote
support and ownership
• Involve community members in planning, implementation, monitoring and evaluation
• Interventions should be target specific keeping in mind the FSW typology, location and culture
• Ensure steady access to services and products
• Mobilize community for program sustainability (Advocacy and Community Mobilization)
• Plan for Program Sustainability from entry phase through exit phase

Entry Phase
Mapping of population specific stakeholders
 Advocacy to stakeholders (entry level advocacy to gatekeepers of the society, program
recipients, others)
• Build up justification for program intervention (to achieve buy in).
• Identify already existing social structures and platforms e.g meetings, community groups
• Identify/adapt relevant advocacy messages/tools from SACA, partners & etc
• Develop specific advocacy messages (where necessary) for stakeholders.
• Describe the process of identification of peer educators.
• Continuous tracking and reporting using appropriate tools
Conduct baseline survey using Participatory Monitoring and Evaluation
 Engagement of target population for sustainable programming
• Identify structures within community for continuity after ‘exit’ of program (aim to establish CBOs or
utilizing structures within society)

Entry phase contd….
Conduct community stakeholders/target population members dialogue
 Facilitate dialogue with identified key stakeholders
 Introduce program and its objectives
 Share baseline data on HIV prevalence among target population
 Solicit target population and significant others ‘buy in’ to program
 Select Peer Educators from target population/introduce out reach workers of the program
Completion of cluster spreadsheet-mapping of service delivery points, ancillary services
 Identify HIV prevention service sites-HCT, PMTCT, SRH, STI, etc

Intensive phase
Peer Education
 Training of the peer Educators and program outreach workers.
 Track interactions (dosage and intensity)
 Carry out periodic mentoring and supportive supervision of peer sessions as scheduled
in your programme.
 Conduct refresher training where need be.
 Continuous tracking and reporting using appropriate tools
PE’s to conduct periodic outreach to peers and target population members (monthly)
 Form peer groups of 10-20 peers max
 Minimum of 2 sessions per month
 Condon distribution
 HCT service information/provision (mobile/referral)
 Use PEP model tool

Intensive phase
Provide services (condoms, referrals, testing) to target population
 Identify traditional/non traditional condom outlets and establish distribution linkages and systems
 Estimate condom requirement for target population
 Collect condoms and distribute through Peer educators
 Provide HCT, STI services (for CSOs with capacity)
 Provide referrals for HIV prevention service sites-HCT, PMTCT, SRH, STI, etc
 Strengthen linkages between community based activities and facility based activities-referrals,
community/facility liaison officers
Capacity building of organizations/structures for sustaining program after ‘exit’
phase
 Training on program management-record keeping, documentation, advocacy, referrals, technical
information, etc
 Conduct target population/community stakeholder’s meetings quarterly to review and provide
update on program

Exit phase
• Transfer management of program to sustainability structures of target
population identified during entry phase whose capacity were built
during intensive phase. (see behavioral exit level)
• Strengthen existing linkages of community structures to supporting
organizations (youth friendly centers, health facilities, community based
structures, IGA, social &psychosocial structures etc.).
• Continuous tracking and reporting using appropriate tools
• Link community structures for sustainability of programs to Government
structures (State Government, LGA and Federal Government), donor
partners, private sector organization and NGOs

Program Implementation for Brothel Based
FSW

Program Implementation for Non Brothel Based
FSW

EXIT Level
Activities
• Development of sustainability plans by internal and external beneficiary community
• Support the formation of cooperatives of target community where possible

Programme Intelligence
• Local HIV Epidemic Appraisals
• Mapping of MARPs (FSW, MSM, IDUs)
• Venue Profile
• Rural assessment
• Mapping of MARPs provides information on
• Location of hot spots where MARPs frequent
• Size estimates of MARPs at each spot

Estimated Number of FSWs per Spot per LGA- Cross River State
LGA # of Spots Average number of FSWs
ABI 27 327
AKAMKPA 45 638
AKPABUYO 24 315
BAKASSI 17 259
BEKWARRA 21 262
BIASE 24 238
BOKI 31 423
CALABAR MUNICIPALITY 122 2472
CALABAR SOUTH 62 444
ETUNG 18 227
IKOM 77 1112
OBANLIKWU 14 134
OBUBRA 30 503
OBUDU 32 359
ODUKPANI 23 221
OGOJA 46 822
YAKURR 42 594
YALA 37 486
Total 692 9838

Prioritizing and setting targets
Using the mapping of MARPs information, State SACAs
were able to:
• Select Priority Geographic Coverage Areas (LGA) – LGAs with
the highest average FSW estimates were selected for HIV
prevention intervention
• Targets were set using the total population estimates of FSW
in prioritized LGAs

Prioritized LGAs and FSW Target –Cross River State
LGA Average number of FSWs
CALABAR MUNICIPALITY 2472
IKOM 1112
OGOJA 822
AKAMKPA 638
YAKURR 594
OBUBRA 503
YALA 486
CALABAR SOUTH 444
BOKI 423
OBUDU 359
ABI 327
BEKWARRA 262
BAKASSI 259
Total 8702

Group work on MPPI-FSW
• Groups should be allocated based on target population (BBFSW, NBBFSW).
• Identify relevant entry level activities for the target population.
• Ensure the activities are relevant to your scope of work and contract
• Outline steps to reach the target allocated to you.
• Where possible, link the activities to other service areas
• Share experience with other CSOs in the similar programme areas

Group work on MPPI-General Population and
MARPs
• Groups should be allocated based on target population-MARPs and
General Population.
• Identify relevant entry, Intensive and exit level activities for the target
population.

Entry level activities
• Behavioral
• Biomedical
• Structural

Behavioural activities
Programme Component Activities for Implementation Expected output
Behavioural
Outreach
•Small group discussions
•Interpersonal communication
•Community stakeholders
meetings
•Focus Group Discussions
Entry level
•Identify key stakeholders in the community e.g.
brothel owners/managers, local pimps, chairladies,
madams, law enforcement agents, others as
applicable
•Conduct community stakeholder dialogue
•Key influencers/gatekeepers pre-intervention
dialogue
•Baseline PM&E
•Validation of identified hotspots/intervention sites
•Update Cluster spread sheet
•Selection of peer educators within respective target
community
•Training of Outreach workers (NBBFSW)
Increased proportion of beneficiaries
reached by outreach and behavioural
education
activity checklist
•Key stakeholders buy in for the
programme
•community members sensitized on the
programme and willing to participate in the
programme
•intervention sites validated
•service delivery point clusters identified
and sensitized
•increased proportion of beneficiaries and
key stakeholders involved/ recruited into
the programme

Behavioural activities Cont…
Condom and
Lubricant
programming
•Demonstration,
promotion of use and
distribution of male
and female condoms
and water-based
lubricants
Entry level:
•Estimate condom requirement for target community
•Collect required number of condoms from SACA
•Direct distribution and tracking of condoms to target
communities
•Identification and use of traditional/non traditional
outlets for condom distribution
•Condom demonstration and lubricant distribution
Increased proportion of
beneficiaries using condoms
correctly and consistently with
regular and irregular partners
Activity checklist
•Required quantity of condom
received and distributed
•Documentation of condom
distribution
•Consistent and correct use of
condom demonstrated

Biomedical activities
STI Control and
Management
•Screening and treatment of
STIs
•Training on STI syndromic
case management
Entry level:
•Identification of sites where clinical services will be provided to target communities
•Adapt the existing national standard operational guideline for STI management
•Advocacy to relevant stakeholders and policy makers to include budgetary allocation for
continuity of biomedical intervention for target communities
•Identify and build capacity of existing community structures (CBOs, target community
leaders and other community groups) to continue with support implementation after exist
of program
•Complete cluster spreadsheet for biomedical services
•Sensitize facilities providing STI services on MARP friendly service provision

Biomedical activities Cont…
HIV Counselling and
Testing
•Mobile HCT
•Facility-based HCT
•Community-based HCT
•Referrals
Entry level:
•Adopt the national SOP for counselling and testing for HIV
•Identify organizations that can be linked to the program to provide HCT
services, if the program does not provide these services directly
•Training of personnel (counsellor, nurses, community based organizations)
on HIV counselling
•Establish linkages between HCT service providers with comprehensive
clinics in hotspots

Structural activities Cont…
Structural Interventions
1. Community
Mobilization
and Dialogue
2. Advocacy
3. Individual
Empowerment
/ Income
generating
activities
Entry level:
•Analyze environmental context (social, cultural, gender-
related economical and geographical) of target population
activity within locality
•Conduct stakeholder analysis (Internal, external, Clients)
•Analyze key issues of relating to stigma & discrimination;
violence (physical, sexual, gender-related and emotional), and
exploitation members of local target communities ( law
enforcement agencies, bar man, brothel owner, area boys,
boyfriends etc)
•Prioritize key issues to be addressed and develop mitigation
plan
•Develop Advocacy plan and materials

Intensive level activities
• Behavioral
• Biomedical
• Structural

Session Objectives
•Understand and identify the intensive level activities of
implementation
•Understand how to operationalize the intensive level activities of
MPPI within their scope of work for FSWs

Group work on intensive level of MPPI
• Identify relevant intensive level activities for the target population.

Behavioural activities Cont…
Peer Education
•Social peers
•Counselling and skills
building
•IPC
•FGDs
Intensive level
•Train Peer Educators/out reach workers on the program
•PEs/ORW to conduct periodic contacts to the respective beneficiary
communities (monthly) using drama/role plays, film shows, games etc– refer to
national community tool – PEP model
•Conduct monthly review and refresher meetings with trained PEs/ORWs.
•Conduct community stakeholders’ update meetings regularly (quarterly)
•Process documentation and dissemination
•Drama/role play
•Film shows
•Games – board games, cards, community conversation toolkit

Behavioral Intensive activities
Condom service delivery
•Continually demonstrate correct and consistent use of condoms
•Identify traditional/ non-traditional outlets and establish condom
distribution systems in all sites
•Quantify and procure condoms
•Directly distribute to and track condoms (male and female) for target
communities/population

Biomedical intensive activities
Intensive level:
• Follow up of target communities for regular testing and counselling
( mobile HCT)
• Refer pregnant women (gen. pop and MARPS) for HIV testing
• Facilitate HIV positive pregnant target communities to access
appropriate PMTCT services
• Promote community counselling systems, particularly PLHIV networks
• Continuous condom delivery

Biomedical intensive level
•Training and retraining of clinic staff (counsellors, nurse, doctors, prevention officers) on the SOP and
needs of target communities
•Provide counselling for STI at the clinic to all target communities
•Referrals and/or treatment for target communities for STI – syndromic management
•Partner notification and treatment (clients and non-paying partners)
•Institute follow up systems for target communities undergoing STIs management in line with the national
guideline
•Strengthen linkages between community level activities and health care facilities to ensure sustainability

PMTCT
•HIV treatment, care and
support
•Reproductive and allied
health services FP, ANC,
and postpartum/natal
care.
Intensive level:
•Refer HIV positive target community members to PMTCT
•Refer for tests for LFT, RFT and CD4 (where Medical Personnel is available)
•Initiate/ refer for initiation of ART and CTX (where Medical personnel is
available)
•Provide/ refer for adherence counselling
•Follow up of HIV positive target communities by HIV positive peers or
acceptable outreach staff
•Promote PMTCT among target community as part of peer education package
•Refer for family planning services (pills, condoms, injectable contraceptives) to
target communities
•Refer for cervical, anal cancer, HPV and HSV2s screening for target communities
•Refer target community for other services like diabetes and hypertension
screening and other services that the target community need
•Referrals to other services related to rape support

Biomedical intensive level cont..
• Intensive level:
• Follow up of target communities for regular testing and counselling
( mobile HCT)
• Refer pregnant women (MARPS) for HIV testing
• Facilitate HIV positive pregnant target communities to access
appropriate PMTCT services
• Promote community counselling systems, particularly PLHIV networks

Structural activities .
• Intensive level:
• Engagement with external and internal target community (bar owners;
managers, etc) through awareness creation and dialogues
• Engagement with external community (host communities; law
enforcement agencies and transport worker associations) through
formal and informal policy change; institutional capacity development
• Improve access to financial mitigation activities through partnerships
with relevant public and private sector organization and entities
• Strengthen self worth through life skills training

Exit level activities
• Behavioral
• Biomedical
• Structural

Session Objectives
•Understand and identify the different exit level activities of
implementation
•Understand how to operationalize the exit level activities of MPPI
within their scope of work (FSWs)

Group work on exit level activities of
MPPI
• Identify relevant exit level activities for their programme areas.
• Identify activities relevant to the target population
• Ensure the activities relevant to your scope of work and contract

Behavioral exit activities
• Exit level:
• Outlet sustainability of condom distribution
• Formation of community-led social structures/groups
• Plan for sustainability of formed social structures/groups
• Promote voluntary PEs from the community
• End of project evaluation/dissemination
• Sustainable sexual behaviour programs

Biomedical exit level
• Exit level:
• Strengthen linkages between community level activities and health
care facilities
• Institute fora for the continued engagement of community
stakeholders with health facilities and target community groups that
would look at progress review, feedback processes and
recommendations for sustainability
• Linkages with network

HIV Counselling and
Testing
•Mobile HCT
•Facility-based HCT
•Community-based HCT
•Referrals
Exit level:
•Linkages with networks

Structural exit activities
• Exit level:
• Development of sustainability plans by internal and external
beneficiary community
• Support the formation of cooperatives of target community where
possible

Summary
•Entry level is about investigation
•Intensive level about execution and
•Exit level is about sustainability and
continuity

Additional Resource Materials
• National FSW Implementation Guideline
• SFH manuals
• National Prevention Plan 2014

Implementing MPPI for MSM & IDUs
Module 4

Situational MSM
• Some circumstances that men find themselves could lead to Male-to-
Male sex.
• Prison
• Military situation
• Male-only hostel
• Economic circumstances: sex work
• Rape

CSOs have an important role to play in addressing HIV and other health
issues among MSM communities in Nigeria because:
•They serve as entry points to necessary prevention services at the community level.
•They are the community gatekeepers
•They are influencers for effective HIV prevention, treatment, care and support.
•They can act as a link between the MSM and the government stakeholders

CSO DO NOT’S
• Some CSO staff are seen as unfriendly and
judgmental towards MSM
• CSOs do not provide accurate information and basic
counseling for HIV prevention, treatment or refer
MSM to needed services.
• CSOs do not provide condoms and FP methods when
requested by MSM
• CSOs trying to change the sexual orientation of MSM
CSO DO’S
• CSOs need to provide friendly, non-judgmental and
confidential services
• Support access to SRH products (Condoms, Lubes, FP
methods).
• Support access STIs and HIV related treatment.
• Support client access to needed care and support
services through referrals.
• CSOs need to improve their role as models to reduce
stigma and discrimination

HIV Programming for MSM in Nigeria

Behaviors that increase HIV risk among MSM
• Incorrect and Inconsistent condom use
• Inadequate use of lubricants during sexual intercourse
• Multiple sexual partnerships
• Inadequate/poor treatment of STIs

Entry Level
Activities
• Analyze environmental context (social, cultural, economical and geographical) of target population within locality
 Specific for MSM community
 Baseline survey on MSM social, cultural, economic and political realities and how it relates to HIV
• Conduct stakeholder analysis (Internal, external)
 Engage with experienced organizations who have managed MSM specific interventions
 Meetings with MSM
 Meetings with other stakeholders and allies
• Analyze key issues relating to stigma & discrimination; violence (physical, sexual, emotional), and exploitation of target
population
 Use stigma index tool
• Analyze issues related to Health service access for MSMs
• Complete cluster spread sheet for service delivery within the LGA
• Prioritize key issues to be addressed and develop mitigation plan
 Engage with MSM community to identify key issues and draw up a plan which is responsive

Intensive Level
Activities
• Engagement with internal target population community (bar owners; managers) through awareness creation and dialogues
 MSM community and allies
• Engagement with external community (host communities; law enforcement agencies) through formal and informal policy
change; institutional capacity development
 Identify the stakeholders
 Sensitize them on the HIV prevention needs of MSM
 Organize interactive sessions between MSM and law enforcement agencies
• Improve access to financial mitigation activities through partnerships with relevant public and private sector organization and
entities
 Baseline survey of MSM to ascertain economic vulnerability
 Identify and select those most vulnerable
 Identify specific, viable IGA for the MSM
 Train the MSM on those IGA
 Link with SMEDAN, NDE, Microfinance Banks NGO etc for loan and further support
• Strengthen self worth through life skills training
• Provide HIV prevention services –direct services and through referrals (Behavioural, Biomedical and Structural)

Exit Level
Activities
• Development of sustainability plans by internal and external community
 This is done from the entry and further developed and implemented alongside the other activities
 The area of institutional and technical ability is very paramount
 Utilize identified means of ‘reaching’ MSM community (web based, telephone, social gatherings, etc)
• Support the formation of cooperatives for target population where possible
 This is applicable though the MSM need to be grouped and regrouped based on local realities which is different for every
community

BEHAVIORAL Interventions:
Outreach and peer education

Entry Level
Activities
• Identify key stakeholders in the community
 (list - MSM organized groups and leaders)
 SACA in respective states
 SASCP in respective states
 MSM community members and their allies
• Conduct community stakeholder dialogue
 MSM community leaders and members need to be involved in the planning and implementation of the stakeholders dialogue
 venue need to be agreed upon by the group for obvious reasons
 known MSM organizations should be used to invite relevant stakeholders to the dialogue session
• Key influencers/gatekeepers pre- intervention dialogue
 Baseline PM&E (identify, select and train MSM who will be supported to reach other community members. FGDs, KII, questionnaires can be used.
CSO, SACA, SASCP, LACA could also provide useful information on MSM in respective states
 Validation of identified hotspots/intervention sites (organized MSM groups and leaders can be helpful. Trained MSM HIV service providers can also
validate hotspot, hotspot coordinators can be helpful too)
 Selection of peer educators within respective target community (use Heartland Alliance PE selection criteria)

Intensive Level
Activities
• Train Peer Educators on the program
 identify and select MSM and train them as PE
 Use of MSM specific training materials is advised
 The PEP Manual for MSM can be used as reference materials
• PEs to conduct periodic outreach to the respective target communities (monthly) using drama/role plays, film shows, games
 The PEP Manual for MSM can be used as reference materials
• Conduct monthly review and refresher meetings with trained PEs.
 There is need for Outreach Coordinators/Community Outreach workers to be trained to supervise the PEs
• Conduct community stakeholders’ update meetings regularly (quarterly)
 Standard guide provided for the meetings
• Process documentation and dissemination
 Trained MSM community members could be supported by relevant NGOs to do this

Exit Level
Activities
• Formation of community-led social structures/groups
 Identify and support MSM groups (existing and nascent)
 Institutional and technical support required
 Mentoring and on-the-job training required
 Supportive supervision structures need to be put in place
•Plan for sustainability of formed social structures/groups
 Institutional and technical support required
 Mentoring and on-the-job training required
 Supportive supervision structures need to be put in place
•Promote voluntary PEs from the community
Incentivize via trainings
Provide certificates
Provide IEC and commodities
Provide opportunities for growth and carrier development
•End of project evaluation/dissemination
 Engage consultants who have an understanding of the MSM peculiarities
•Sustainable sexual behaviour programs
 Ongoing projections for commodities
 Follow up on commodity logistics to avoid OS for prevention commodities

CONDOM PROMOTION AND
DISTRIBUTION

Entry Level
Activities
•Identify a system of condom procurement-Contact SACA for collecting condoms
•Estimate condom requirement for target population
Conduct assessment of consumption rate of condoms
Conduct assessment of lubricants use
Make projections for condoms and lubricants
Use of national LMIS tools for commodities
Intensive level
Activities
•Direct distribution and tracking of condoms to the target population through outreach team
Use of condom outlets
Use of PE and outreach coordinators and outreach workers
Use of national tools for tracking condoms distribution
•Identify traditional/ non-traditional outlets and establish distribution systems in all sites
•Demonstrate correct and consistent use of condoms
Exit level
Activities
• Outlet sustainability of condom distribution
 Need for hotspots to have hotspots coordinators who coordinate condom distribution
• Linkage of CBO to condom supply facilities

Entry Level
Activities
• Identification of sites where clinical services will be provided
Clinics must be those that have trained HCWs
Need for the PE and outreach coordinators and outreach workers to select and/or endorse sites
Safe Spaces/DIC at the sites already have some clinical services going on and needs to be strengthened
•Adapt the existing national standard operational guideline for STI management
Need for attention to anorectal health
•Advocacy to relevant stakeholders and policy makers to include budgetary allocation for continuity of biomedical intervention for target
population
NACA, SACA, FMoH, SMoH
•Identify and build capacity of existing community structures (CBOs and other community groups) to continue with support implementation
after exit of program {Safe Spaces/DIC at the sites already have some clinical services going on and needs to be strengthened
INTENSIVE LEVEL
• Training and retraining of clinic staff on the SOP and needs of target population
 Training of HCWs at the clinics be MARPS friendly and or provide dispassionate services to MARPS
 Adapt SOPs for HCWs from Heartland Alliance, Population Council SFH and other MARPS IP in Nigeria
(Only when CSO has adequate capacity and funding to do this)
• Provide counseling for STI at the clinic to target population
 integrated STI counseling alongside other HIV interventions/counseling
• Referrals and/or treatment for STI – syndromic management
 STI syndromic management at the DIC and clinic. Work with trained HCWs
• Partner notification and treatment (clients and non-paying partners) institute follow up systems for persons undergoing STIs management in line with the
National guideline

Exit Level
Activities
• Strengthen linkages between community level activities and health care facilities
 Through trained PE, OC, HCWs, advocacy
• Institute fora for the continued engagement of community stakeholders with health facilities and target groups that would look at progress
review, feedback processes and recommendations for sustainability
 Through trained PE, OC, HCWs, advocacy and at support group meetings

Entry Level
Activities
• Adopt the national SOP for counseling and testing for HIV
 Using the national SOP with trained providers who understand the peculiarities of MSM
• Identify organizations that can be linked to the program to provide HCT services, if the program does not provide these services directly
 Through trained MSM PE, OC, and HCWs,
• Training of personnel (counselor, nurses) on HIV counseling
 MSM should be trained to provide these services
 Other providers should be trained to be responsive and non-judgmental in services delivery
• Establish linkages between HCT service providers with comprehensive clinics in hotspots/intervention site
 Hotspot coordinators will facilitate this with MSM organizations
INTENSIVE LEVEL
• Follow up of target population for regular testing and counseling ( mobile HCT)
 Integrate HCT into DIC activities,
 Conduct mobile HCT to hotspots and other service delivery outlets. Referral for the HIV positive MSM
• Refer other members of the target population for HIV testing
 Other family members of the MSM encouraged to access HCT and referral services for advanced care and possible t
• Facilitate HIV positive pregnant members of the target population to access appropriate PMTCT services
 Pregnant wives and female sexual partners of MSM supported to access PMTCT interventions
• Promote community counseling systems particularly PLHIV networks
 MSM supported to attend support groups and receive community counseling psychosocial support

Exit Level
Activities
• Development of sustainability plans by internal and external community
 This is done from the entry and further developed and implemented alongside the other activities
 The area of institutional and technical ability is very paramount
• Support the formation of cooperatives for target population where possible
 This is applicable though the MSM need to be grouped and regrouped based on local realities which is different for every community
• Linkages with positive network
 MSM support groups supported to register with NEPWHAN and participate actively in activities of the PLHIV in Nigeria and globally

Community Mobilization and Dialogue/
Advocacy/ Individual Empowerment/
Income generating activities

Entry Level
Activities
Analyze environmental context (social, cultural, economical and geographical) of target population within locality
 Specific for MSM community
 Baseline survey on MSM social, cultural, economic and political realities and how it relates to HIV
• Conduct stakeholder analysis (Internal, external)
 Engage with experienced organizations who have managed MSM specific interventions
 Meetings with MSM
 Meetings with other stakeholders and allies
Analyze key issues relating to stigma & discrimination; violence (physical, sexual, emotional), and exploitation of target population
 Use stigma index tool
• Prioritize key issues to be addressed and develop mitigation plan
 Engage with MSM community to identify key issues and draw up a plan which is responsive
NTENSIVE LEVEL
• Engagement with internal target population community (bar owners; managers)through awareness creation and dialogues
 MSM community and allies
Engagement with external community (host communities; law enforcement agencies) through formal and informal policy change; institutional
capacity development
 Identify the stakeholders
 Sensitize them on the HIV prevention needs of MSM
 Organize interactive sessions between MSM and law enforcement agencies
Improve access to financial mitigation activities through partnerships with relevant public and private sector organization and entities

Session 2: HIV prevention programming for IDUs

Definition of IDU (PWID)
• Injecting drug users are people who inject psychoactive substances as
a habit.
• They include men and women , youth and adults, rich and poor,
literate and illiterate, etc.

Why should we target injecting drug
users in Nigeria?
•Between 2007 – 2010, increase in HIV prevalence of:
• 13.5% to 17.2% among MSM ( 27.5%)
• 5.6% - 4.2% among IDUs ( 25.0% )
• 37.4% to 27.4% among BB FSWs ( 26.7%)
• 30.2% - 21.1% among NB FSWs ( 30.1%)

Comprehensive HIV prevention package for IDUs
• Community-based outreach;
• Opioid substitution therapy (OST) and other drug dependence treatment;
• HIV counseling and testing (HCT);
• ART for IDUs living with HIV;
• Prevention and treatment of sexually transmitted infections (STIs);
• Condom programs for IDUs and their sexual partners;
• Targeted information, education and communication (IEC) for IDUs and their
sexual partners;
• Prevention, diagnosis and treatment of tuberculosis.
• Needle and Syringe Programs
• Vaccination, diagnosis and treatment of viral hepatitis

Minimum Prevention Package of
Intervention for IDU
• Social peers cohort development
Entry Phase Intensive Phase Exit Phase
Month 1 Month 2 Month 3 Month 4 Month 5 Month 6
Week 1 Social peer and cohort
development
IPC & CFQ/CMD IPC & CFQ/CMD IPC & CFQ/CMD EXIT BM
Week 2 IPC & CFQ/CMD IPC & CFQ/CMD IPC & CFQ/CMD EXIT BM
Week 3 CM & CFQ/CMD
Referral for HTC /STI and Harm
Reduction and detoxification
CM & CFQ/CMD
Referral for HTC /STI and
Harm Reduction and
detoxification n
CD & CFQ/CMD
Referral for HTC /STI and Harm
Reduction and detoxification
EXIT
Referral for HTC /STI
and Harm Reduction
and detoxification
BM

Linking prevention to continuum of care for
IDU
• Harm reduction strategies for IDU
• Drug dependency Treatment
• Referral and Linkages

CONTACT MAPING FOR IDUs
Name of PE:.............................................. LGA:.....................................................
Targeted intervention:.............................. Location:...................................................
Spots:...............................................................................................................................................................
Estimated no of IDUs in the town/village:.....................................................................................................
Sl.no. Hot spot 1: Hot spot 2: Hot spot 3: Hot spot 4:
Name of the contacts Name of the contacts Name of the contacts Name of the contacts
1
2
3
4
5
11

Overview of the monitoring & Evaluation
system for prevention
Module 5 & 6 ( for 2 days)

SESSIONS
Session 1 Background
Session2 Indicators for Prevention Monitoring
Session 3 Prevention Monitoring Tools
Session 4 Data flow
Session 5 Training on Monitoring tools

Session 2: INDICATORS FOR prevention MONITORING
Time frame: XXXX

Indicators for Prevention Monitoring
Behavioural
•Number of peer sessions held
•Number of new peers attending Peer sessions
•Total No of peers that participated in PE session
•Number of condoms distributed
•Number of lubricants distributed

Biomedical
•Number of beneficiaries referred for STI services
•Number of beneficiaries treated for STIs that go for a follow-up visit for STI
treatment
•Number of individuals referred for HCT services
•Number of individuals counselled, tested and received their result
•Number of pregnant beneficiaries referred for ANC services

Structural
•Number of influencers that participated in community dialogue
•Number of community dialogues held
•Number of individuals referred for IGA
•Number of IGA held
•Number of persons that benefited from the IGA

Minimum Prevention Package Intervention-MPPI Operationalization

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