The Linkages across the Continuum of HIV Services for Key Populations Affected by HIV project, also known as LINKAGES, works with governments, leaders, and health care providers to expand their ability to plan and deliver services that reduce HIV transmission among key populations and sex partners, and to extend the lives of those already living with HIV.

The LINKAGES project will emphasize delivery of services to Key Populations (KPs) and strengthen the capacity of community-based partners who provide HIV services, through technical assistance (TA) and mentoring.  Interventions are aimed at accelerating the ability of the GoDj, advocates of Key Populations and private sector providers to collaboratively plan, deliver and optimize services that reduce HIV transmission among KPs and extend life for those who are HIV-positive. Support for the use of evidence based approaches to plan and implement comprehensive and sustainable services t is a key component of the project’s strategic approach.

LINKAGES will provide targeted information, education, and communication materials; conduct outreach and community empowerment, risk assessments, risk reduction counseling, and skills development; distribute condoms and lubricants; and provide active/accompanied referrals for testing. People living with HIV (PLHIV) will be referred and actively linked to Antiretroviral Treatment (ART). LINKAGES will develop a peer mobilization structure including peer coordinators (high level), peer supervisors (PSs)/navigators (PNs) and peer educators (PEs). The ratios for PEs will be approximately 1:20 for female sex workers (FSWs) and 1:10 for Priority Population (PPs)/Men having sex with men (MSM), and attempts will be made to contact each KP member approximately four times per year.

LINKAGES will support sexually transmitted infections (STI) screenings and provide culturally appropriate STI counseling, diagnosis, and treatment to FSWs, MSM, and Long Distance Truck Drivers (LDTD). STI diagnosis and treatment will be integrated with HIV testing and family planning services (with offers of the full range of methods available in Djibouti) to increase uptake of all three services. LINKAGES will establish a close partnership and referral system with the HIV/STI referral center.

LINKAGES will conduct HIV counseling sessions as a part of pre-test counseling. PEs and peer mobilizers will be motivated to refer new beneficiaries for testing and retest those at an elevated risk for HIV infection before the next 3-6 months HIV test. The Enhanced Peer Outreach Approach (EPOA) and contact tracing will be used to reach more hidden KP service beneficiaries as well in an attempt to reach higher numbers of HIV case findings. Each person who tests positive for HIV will be referred to an ARV dispensing center of his/her choice. Each clinic will have a focal person that will support the care, treatment, ongoing adherence and viral suppression support.

LINKAGES will use existing behavior change communication messaging and/or materials with the local government and other stakeholders within the Technical Working Group (TWG) to sensitize KPs on the health risks they face and the options they have. This will include basic HIV information, modes of transmission, how to prevent HIV transmission, skills-building and condom use negotiation, benefits of HIV testing, and treatment literacy.  In addition, FSWs will be provided with messaging on the full range of family planning options and other services available for KPs and PPs.

Implementing partner NGOs will convene monthly groups of 25-30 MSM and FSW stakeholders to build capacity for KP members to develop structures supporting HIV prevention programs and building small KP CBOs. These monthly meetings will offer on-going education and skills development to KP individuals so that they can pass on this information to their larger networks. Additionally, these groups will provide real-time feedback to the project and allow for the staff to adjust and tailor services to the changing needs of KPs.

LINKAGES will develop a referral chain network system to reach more MSM and young women engaged in transactional sex. Data collection tools will be adapted for the EPOA campaign. Data from the EPOA will be analyzed and used for outreach.

LINKAGES will also support the development and implementation of UICs (Unique Identifier Code) to register each service beneficiary in the project with a unique identity to provide coverage estimates without duplications, to track individuals across the cascade of services, and provide anonymity and confidential services.

The LINKAGES team will work closely with the Djibouti Ministry of Health (MOH), particularly to provide TA:

• To the Executive Secretariat (ES) to (1) strengthen multi-sectoral HIV/AIDS/STI/TB interventions, including technical and financial support to strengthen TWGs (planning and follow-up) and (2) build capacity of their M&E team on strategic information and data management. This will include strengthening their use of data for decision making in planning, implementation, and advocacy and analyzing program data and tracking national HIV program progress toward UNAIDS 90-90-90 goals.
• To the MOH HIV/AIDS National Program (PLSS) to improve HIV prevention, care, and treatment services including helping to develop policies and roll-out; supporting development of an STI/TB/HIV/FP integration strategy; and helping to roll out community-based HIV testing and integrating confirmatory rapid testing into a testing algorithm and CSO-based testing. LINKAGES will also provide technical support in strategic information: development of cascade models, HIV cascade analysis and gap identification; and data quality improvement and use.