The rationale should include a statement of the need/problem that is the basis of the project, how this was identified, the cause of the problem, an

Background

The rationale should include a statement of the need/problem that is the basis of the project, how this was identified, the cause of the problem, and its possible solutions. This section should clearly link in with your problem tree analysis. You must demonstrate a clear understanding of the context where the project is to be implemented. This section of your proposal should answer the questions of where and why: why this project needs to be done in this particular context and what is its relevance to existing interventions, policy, and priorities? The project should be supported by the most relevant studies, local health data, and reports published on the topic. (750 words)

In 2022, Ireland received most asylum applications from Georgia, Algeria and Somalia. Ireland only accepts around 32% of them, and the most successful applications have come from those from Afghanistan and El Salvador (World Data, 2022). As Ireland has this established history of working to help El Salvador, it is clearly a worthwhile endeavour to help address some of the health issues that the people in El Salvador are facing. El Salvador is the 36th highest country for STIs in the world. It has a 0.35% HIV rate, which seems to be abnormally large compared to the nearby countries of Guatemala (0.17%) and Honduras (0.1%) (Wisevoter, 2023). The majority of cases of STIs are concentrated in the urban areas around San Salvador (UNaids, 2004). The prevalence of bacterial STDs in San Salvador amongst men who have sex with men (MSM) is 12.7% (Creswell et al., 2012).

While Chlamydia and gonorrhoea are not as common, other STIs such as Mycoplasma genitalium, syphilis, and HSV-2 were found to be highly prevalent within San Salvadors HIV positive population (Paz-Bailey et al., 2012). Herpes simplex virus-2 also has high prevalence in MSM at 48.1% and Female Sex Workers (FSWs) at 82.0% (Shah et al., 2014). The high prevalence of other STIs amongst HIV positive individuals is indicative of a lack of condom usage. This is concerning considering that follow up in clinics has historically not been great, so antiretroviral therapy may not be consistent enough to make HIV+ individuals non-transmissible. One of the effective strategies found has been maintaining HIV+ in care and focusing on improving adherence to ART therapy (Dickson-Gomez et al., 2018).

The gap we are trying to address is within the goal of maintaining patients. HIV clinics were found to not be utilising the other clinics and community outreach centres to help them find patients who had missed appointments, despite the fact that many of the community centres could have helped them find these patients (Dickson-Gomez et al., 2018). This communication issue stems from the context of violence in San Salvador where employees were unable to travel to certain areas within the community due to gang violence. The understanding of the context of violence is necessary when working to address the STI transmission. Front line workers in this context said some implementations that would help them is the implementation of project-provided transportation and cell phones (Dickson-Gomez et al., 2018). We believe the communication issues can be improved through having representatives of vulnerable groups that are more at-risk work with the HIV clinics to help them understand where to find people and to simultaneously work with the established community outreach centres to consolidate the information they have gathered. We believe that a set role to facilitate communication between HIV clinics and community outreach centres, as well as providing the perspective of people from vulnerable groups subjugated to targeted violence will help clinics to maintain patients in order to reduce overall transmission of HIV.

It is important to incorporate the understanding of high gender-based violence and violence against the LGBTQ+ community in our implementations in order to help reduce new sexually transmitted infections (UNHCR, 2020). Child marriage in El Salvador is currently at 25.5% and lifetime physical and/or sexual intimate partner violence (IPV) is at 14.3% (UN Women, 2023). 65% of STIs were recorded in women, and violence and rape are the biggest contributors. 54.4% of women in El Salvador have reported physical, sexual, or psychological violence during their lives. 85% of adolescent girls reported that they were most afraid of becoming pregnant, which is amplified by the fact that pregnant adolescents have expressed mistreatment from medical personnel. Another concern adolescents had is the fact that the right to report sexual abuse is not guaranteed to them, and they lacked awareness of their rights regarding abortion and sexual pleasure. Boys seemed to report use of contraceptives more than girls, suggesting a possible need to increase agency in young sexually active girls to help alleviate that fear of becoming pregnant. The majority of adolescents expressed that women not giving consent to sex contributed to violent behaviour from others. This environment that young women are living in creates a situation where there is a need for education, support, and a safe place to spend time with one another. Having a safe place to go to at school with the guidance of a female teacher to help educate on things such as negotiation skills, early signs of abuse, how/where to find support, women's empowerment, and career skills as a woman. This space will help facilitate change in the community and behaviours through positive social support (Paz-Bailey et al., 2012).

Crepaz, N., Lyles, C. M., Wolitski, R. J., Passin, W. F., Rama, S. M., Herbst, J. H., Purcell, D. W., Malow, R. M., Stall, R., & HIV/AIDS Prevention Research Synthesis (PRS) Team (2006). Do prevention interventions reduce HIV risk behaviours among people living with HIV? A meta-analytic review of controlled trials. AIDS (London, England), 20(2), 143157. https://doi.org/10.1097/01.aids.0000196166.48518.a0

Creswell, J., Guardado, M. E., Lee, J., Nieto, A. I., Kim, A. A., Monterroso, E., & Paz-Bailey, G. (2012). HIV and STI control in El Salvador: results from an integrated behavioural survey among men who have sex with men. Sexually transmitted infections, 88(8), 633638. https://doi.org/10.1136/sextrans-2012-050521

Dickson-Gomez, J., Glasman, L.A., Bodnar, G. et al. A social systems analysis of implementation of El Salvadors national HIV combination prevention: a research agenda for evaluating Global Health Initiatives. BMC Health Serv Res 18, 848 (2018). https://doi.org/10.1186/s12913-018-3667-8

Shah NS, Kim E, de Maria Hernndez Ayala F, et al. Performance and comparison of self-reported STI symptoms among high-risk populations MSM, sex workers, persons living with HIV/AIDS in El Salvador. International Journal of STD & AIDS. 2014;25(14):984-991. doi:10.1177/0956462414526860

Paz-Bailey, G., Shah, N., Creswell, J., Guardado, M. E., Nieto, A. I., Estrada, M. C., Cedillos, R., Pascale, J. M., & Monterroso, E. (2012). Risk behaviors and STI prevalence among people with HIV in El Salvador. The open AIDS journal, 6, 205212. https://doi.org/10.2174/1874613601206010205

https://www.worlddata.info/america/el-salvador/asylum.php#google_vignette

https://wisevoter.com/country-rankings/std-rates-by-country/#nicaragua

file:///Users/catherinemillis/Downloads/estrategia-cooperacion-slv-2023-2027.pdf

https://data.unaids.org/publications/fact-sheets01/elsalvador_en.pdf

https://evaw-global-database.unwomen.org/en/countries/americas/el-salvador

https://www.unhcr.org/ie/news/stories/salvadoran-lgbti-people-moment-its-riskier-ever

Activities:

Maps documenting SH clinics, DVS, free condoms, schools, public transportation, LGBTQ+ centers, less dangerous routes:

Locate which schools we are working with, gather geographical data on schools, STI clinics/testing centers, locate routes of transportation and public transportation to STI clinics

Assemble data collectively on the map and print the maps

Distribute maps in school bathrooms/other designated locations

Spaces for women in schools - potentially weekly meetings

Locate schools willing to participate

Designate school representative (woman) to lead the weekly meetings and the representative can give the initial information to the girls in the secondary school

Perform Risk Assessment

Survey girls on knowledge towards location/services of STI clinics as well as rating sense of support and community

Designate and renovate space for weekly meeting in school/create an advisory board of student representatives for the project and school representative to communicate with

Research Assistants will check in bi-weekly with school representative to monitor progress

Condom dispensaries in schools/free access to condoms in schools

Research on potential condom donors and suppliers

Ask school representative for discrete locations to install condom dispensaries/allocate space for location of condom boxes

Order condoms (potentially order condom dispensaries)

Place machines and condoms in schools

Have advisory board check in on machines weekly/develop idea of how often machine/box needs to be replenished

Create community representative role for clinics led by TW, MSM, SW

Survey MSM, transmen and women, members of the LGBTQ community as a snowball sample to gain insight, trust, as well as ask community for interest in the the community representative position

Proceed with the application process for the community representative ( of the representatives come from TW, MSM, or SW)

Establish training criteria and participate in trainings to ensure the STI clinics are communicating with the trans, MSM, and sex work community

Distribution of STI kits/map/condoms

Community representatives will check in monthly with project coordinator

CHW survey bi-weekly in San Salvador who requests home STI kits and the following week will distribute the home STI kits. CHW will also refer to nearest STI clinic if necessary

Research Assistant will check in weekly/biweekly to monitor project as well as monitor utilization of services as well as number of tests

Training CHW to go out and deliver the home STI kits or help them set up a post method to send them out (Combined with Activity 4 - CHW employees will come from marginalized community)

STI Reduction San Salvador Monitoring and Evaluation Framework

INDICATOR DEFINITION

How is it calculated? BASELINE

What is the current value? TARGET

What is the target value? DATA SOURCE

How will it be measured? FREQUENCY

How often will it be measured? RESPONSIBLE

Who will measure it? REPORTING

Where will it be reported?

Goal Reduction in STI rates in San Salvador by 10 percent by 2025. (Targeting Adolescent girls and marginalized communities) Number of positive STI tests in San Salvador from 2025 divided by the number of STI positive STI tests in San Salvador from 2023 Look at rates 10 percent less than 2023 value Recorded data from the Ministry of Health of positive STI tests from each respective year. Annually Ministry of Health Annual Ministry of Health Report

Outcomes Increase utilization of sexual health services by communities in San Salvador

Increased knowledge of sexual health services and increased reports of confidence in sexual health knowledge

Number of patients visiting sexual health clinics in San Salvador 2025 divided by number of patients utilizing sexual health clinics in 2023.

Calculated by comparing mean of number of services reported by each girl pre intervention and post intervention 1.1 Current Ministry of Health Reports of monthly utilization

1.2 N/A TBD Month 1 of the project 1.1 10 percent increase from average monthly use of 2023

1.2 Average Score 3

(On average, each girl was able to report three services offered) 1.1 Recording the number of patients at SHR services each month.

1.2 Surveys asking each girl if they can name the closest SHR service, three services the clinic can offer, as well as ranking their confidence in their SHR knowledge. 1.1 Monthly

1.2 Every 6 months 1.1 SHR Services at healthcare facilities reporting to the Ministry of Health

1.2 Female school representative 1.1 Monthly report from Ministry of Health

1.2 Reported to Research Assistant for data analysis

Outputs Number of girls attending weekly support meetings at San Salvador schools Total number of girls who attended at least 50 percent of weekly meetings who completed the pre and post survey.

0 300 Question on post survey asking approximately what percentage of meetings were attended. Every six months Female School Representative School Female Representative Report

(given to Research Assistants and Project Manager for data analysis)

Number of patients who did not previously know about the SHR services in San Salvador/were accessed by the CHW. Total number of community members that respond to CHW question of did your knowledge of the SHR services increase. 0 500 Community Health Worker Reports number of patients who did not previously have info on SHR services of whom they were able to give knowledge or distribute map or STI kit. Weekly will be added up for combined total at the end of the project Community Health Worker CHW Report (given to Research Assistants and Project Manager for data analysis)

Log Frame

Project Descriptions Indicators Sources of Verification Assumptions

Goal: Reduce STI prevalence in adolescent girls and marginalized communities in San Salvador by 30% STI rates in adolescent girls from San Salvador (aged 14-18) by 2025

-Ministry of health STI rates

-Monthly Reports from STI clinics of utilization and patient follow-up visits, also checking data by demographic (TW, SW, MSM, and adolescent girls) Assuming that $ will incentivise TW, SW, and MSM to help train the clinics

Assuming that there is room in schools for a safe space for women

Assuming schools will allow dispensers and maps to be dispersed

Assume CHW can safely get places to deliver STI test

Assuming a teacher will be willing to supervise weekly meetings

Purpose:

Increase utilization of reproductive health services

Increase communication between established resources and the most at-risk communities -Number of visitors per month in clinics before and after intervention (disaggregated by age/marginalised group)

-Look at stage of infection when treated and number of follow-ups visits following intervention

-Measure who is getting follow-up visits and whether the clinic ensures continuous treatment for life-long STIs (HIV) -Monthly Reports from STI clinics of utilization and patient follow-up visits, also checking data by demographic (TW, SW, MSM, and adolescent girls)

- Card with information for those with incurable STIs that is cost efficient and measures follow ups and antiretroviral progression. The patient has their own copy as well as the clinic having a record of this information.

-Record number of daily visitors to the clinic. Increased utilization will come from more knowledge of projects

Increased communication will increase usage due to the update of STI status

Results:

Design and deliver a STI health service delivery awareness campaign targeting youth aged 10-14 and marginalised communities

Increase youth knowledge of where and how they can access information and SRH services

Design and facilitate school-based peer-support groups for girls aged X-X

Community groups and formal STI clinics meet on a regular basis to discuss

Strengthen referral systems between community and facility based SRH programming

Increase number of follow-up visits from clinicians to community

Increased communication between established sexual health resources and TW, SW, MSM, and adolescent girls -Number of ways clinic knows how to reach at risk patients

-Number of girls who can locate the nearest STI clinic/place that offers testing and name three services the clinic offers -End of project survey asking girls 10-18 to locate STI clinics as well as survey with confidence of sexual education (compared to the before project survey)

-Survey TW, MSM, and SW asking if they report an increased outreach to their community Activities:

Maps documenting SH clinics, DVS, free condoms, schools, public transportation, LGBTQ+ centers, less dangerous routes

Spaces for women in schools - potentially weekly meetings

Condom dispensaries in schools

Create community representative role for clinics led by TW, MSM, SW (These people will serve as the CHW)

Training CHW to go out and deliver the home STI kits or help them set up a post method to send them out Inputs

Production and printing of maps

Contact schools and renovate a room to serve as a space for adolescent female students

Contact schools about putting in condom dispensers and acquire both the dispensers and the condoms

Employ people from at-risk communities to serve as CRs

Figure out safest routes for CHW/CR and re-imburse them for travel costs. See where the most people are getting them done from and have more people stationed in the areas of higher use, rent space to use for packaging and shipping of STI tests, CHW gets transport to the houses Resources:

$1000 - Maps

$6,000 - Cover teacher stipend and food for meetings

$3,000 - Condom cost

$120,000 - Community Health Worker Salary (combined with transportation cost)

$100,000 - travel expenses as well as project role salary)

CHW and the CR role be the same person(s) and all encompassed within one job role

Staff is maintained throughout project

Road and Weather conditions allow for transportation for the whole duration of the project

Project Planning

In San Salvador, the project seeks to lower the prevalence of sexually transmitted diseases (STIs) among teenage females and underprivileged populations. With an emphasis on individuals who are more likely to transmit STIs; females from these groups between the ages of 10 to 18 constitute the target demographic. Better services for sexual and reproductive health are desperately needed in San Salvador, El Salvadors capital city where the initiative would be carried out. The project aims to improve health outcomes, lower STI rates, and empower the target community by addressing the challenges that underprivileged communities and teenage girls experience.

Project Objectives

From 2024 to 2026, the projects ultimate aim is to lower STI prevalence in San Salvadors underprivileged areas and among teenage females by 30%. The initiative aims to accomplish these specific objectives in order to reach this goal.

1st Objective : Greater use of services related to sexual and reproductive health.

2nd Objective : Cultivating knowledge about sexual and reproductive health

3rd Objective : Improve communication between at risk populations and recognized sexual health resources.

Implementation Strategy

A Results Based Framework (RBF) will serve as the projects guide, helping to track and assess its progress towards accomplishing the projects objectives. The framework will be used to monitor the projects implementation outcomes. It includes indicators, sources of verification and assumptions. The project will remain on course and allow for any required modifications to be made to maximize its impact if it is regularly monitored and evaluated.

Activities and Justification of Resources

Mapping sexual health clinics, distribution sites and community resources

Maps detailing the locations of free condom distribution sites, sexual health clinics and other relevant community services will be made and distributed. These maps which will include information like clinic addresses, operating hours and services offered, will be created in coordination with community stakeholders. This initiative intends to make it easier for people to use sexual and reproductive health services by increasing information availability, particularly for teenage females and underprivileged groups.

Creating Safe Spaces for Women in Schools

To provide safe space for women, school rooms would be remodeled. These areas will function as gathering spots for regular meetings and conversations around sexual and reproductive health. These meetings, which will cover subjects covering gender equality, menstrual health, contraception and STI prevention will be led by qualified instructors. The concept intends to promote open communication, information sharing and support among girls and women by offering a designated location within educational institutions. This program acknowledges the value of fostering an atmosphere that empowers a young women and promotes gender equality.

Installing Condom Dispensers in Schools

To guarantee that teenagers who are sexually active have simple access to contraception, free condom dispensers would be placed in schools. The purpose of this initiative is to lower the risk of STI transmission and encourage safe sexual behavior. It emphasizes the value of addressing teenagers in their educational setting and encouraging appropriate sexual conduct by focusing on schools. Comprehensive sexual educational programs that highlight the value of condom usage and give information on other forms of contraception will be implemented with the installation of condom dispensers.

Employing community representatives from populations at risk

To act as a bridge between the clinics and the community, community representatives (CR) from at-risk populations, such as Transgender Women (TW), Men who have Sex with Men (MSM) and Sex Workers (SW) would be hired. These CRs would be essential in fostering confidence, removing obstacles based on culture and making sure that the services offered are tailored to the particular requirements of these populations. They will take an active part in community outreach, actively interact with the community, offer support and information and make sexual and reproductive health services more accessible. The target demographic will receive treatment that is more inclusive and culturally sensitive as a result of the use of CRs.

Home delivery of STI kits

Teaching Community Health Workers (CHWs) on how to distribute STI kits at home or set up a post system for distribution is a potential method to improve access to STI testing and reach underserved groups. This would involve teaching CHWs the value of secrecy and privacy as well as instructing them on how to administer and collect the STI kits appropriately. If a post option is selected, they could also receive training on correct packaging and delivering techniques. The initiative can guarantee that STI testing reaches those who might encounter obstacles in accessing healthcare services by involving CHWs, who are trusted members of the community, in this process.

Gender Considerations

Gender issues were taken into account extensively throughout the project design and execution. The project acknowledges the particular difficulties underprivileged populations and teenage girls have in gaining access to sexual and reproductive healthcare. The initiative addresses the unique needs of girls and advances gender equality by establishing safe spaces for them in schools where they may express their worries, look for support and get accurate guidance on sexual and reproductive health. The initiative highlights the significance of hiring community members from TW, MSM and SW populations in order to provide services to their unique requirements. This methodology guarantees that the project considers the varied experiences and obstacles encountered by persons with varying gender identities and sexual orientation.

Budget Justification

Funds for the project will be allotted to a number of components, such as mapping initiatives, safe space renovations, condom dispenser installations, hiring community members, facilitator training and monitoring and assessment tasks. The resources allotted to each component are determined by the anticipated influence on achieving the project goals and predicted expenses of the execution. The budgetary allotment signifies the weight assigned to initiatives that directly boost education, communication with the target audience and access to sexual and reproductive health services.

Sustainability

The projects aim is to create a long lasting framework for tackling the incidence of STIs in young girls and under privileged areas of San Salvador. This involves improving the ability of regional stakeholders such as medical professionals, instructors and community leaders to carry on and broaden the projects operations after it has ended. To guarantee the long term viability of the treatments, the initiative will also push for modifications to policies and more financing for sexual and reproductive health services. The project will serve as a model for similar projects in other towns or areas experiencing similar difficulties by showcasing its efficacy and impact.

The project, which strives to meet the unique requirements and problems experienced by the target community is an evidence-based, comprehensive approach to reduce the incidence of STIs among teenage girls and underprivileged populations of San Salvador. The initiative aims to empower youth, advance gender equality and lessen the burden of STIs through enhanced communication, greater use of sexual and reproductive health services and education. The projects efficacy and long term impact are enhanced by the use of a result based methodology, the incorporation of gender issues and the focus on sustainability. The initiative will serve as a model for future interventions and enhance sexual and reproductive health outcomes in San Salvador overall by collaborating with local stakeholders.

Project Planning

In San Salvador, the project seeks to lower the prevalence of sexually transmitted diseases (STIs) among teenage females and underprivileged populations. With an emphasis on individuals who are more likely to transmit STIs; females from these groups between the ages of 10 to 18 constitute the target demographic. Better services for sexual and reproductive health are desperately needed in San Salvador, El Salvadors capital city where the initiative would be carried out. The project aims to improve health outcomes, lower STI rates, and empower the target community by addressing the challenges that underprivileged communities and teenage girls experience.

Project Objectives

From 2023 to 2025, the projects ultimate aim is to lower STI prevalence in San Salvadors underprivileged areas and among teenage females by 30%. The initiative aims to accomplish these specific objectives in order to reach this goal.

1st Objective : Greater use of services related to sexual and reproductive health.

2nd Objective : Cultivating knowledge about sexual and reproductive health

3rd Objective : Improve communication between at risk populations and recognized sexual health resources.

Implementation Strategy

A Results Based Framework (RBF) will serve as the projects guide, helping to track and assess its progress towards accomplishing the projects objectives. The framework will be used to monitor the projects implementation outcomes. It includes indicators, sources of verification and assumptions. The project will remain on course and allow for any required modifications to be made to maximize its impact if it is regularly monitored and evaluated.

Activities and Justification of Resources

Mapping sexual health clinics, distribution sites and community resources

Maps detailing the locations of free condom distribution sites, sexual health clinics and other relevant community services will be made and distributed. These maps which will include information like clinic addresses, operating hours and services offered, will be created in coordination with community stakeholders. This initiative intends to make it easier for people to use sexual and reproductive health services by increasing information availability, particularly for teenage females and underprivileged groups.

Creating Safe Spaces for Women in Schools

To provide safe space for women, school rooms would be remodeled. These areas will function as gathering spots for regular meetings and conversations around sexual and reproductive health. These meetings, which will cover subjects covering gender equality, menstrual health, contraception and STI prevention will be led by qualified instructors. The concept intends to promote open communication, information sharing and support among girls and women by offering a designated location within educational institutions. This program acknowledges the value of fostering an atmosphere that empowers a young women and promotes gender equality.

Installing Condom Dispensers in Schools

To guarantee that teenagers who are sexually active have simple access to contraception, free condom dispensers would be placed in schools. The purpose of this initiative is to lower the risk of STI transmission and encourage safe sexual behavior. It emphasizes the value of addressing teenagers in their educational setting and encouraging appropriate sexual conduct by focusing on schools. Comprehensive sexual educational programs that highlight the value of condom usage and give information on other forms of contraception will be implemented with the installation of condom dispensers.

Employing community representatives from populations at risk

To act as a bridge between the clinics and the community, community representatives (CR) from at-risk populations, such as Transgender Women (TW), Men who have Sex with Men (MSM) and Sex Workers (SW) would be hired. These CRs would be essential in fostering confidence, removing obstacles based on culture and making sure that the services offered are tailored to the particular requirements of these populations. They will take an active part in community outreach, actively interact with the community, offer support and information and make sexual and reproductive health services more accessible. The target demographic will receive treatment that is more inclusive and culturally sensitive as a result of the use of CRs.

Home delivery of STI kits

Teaching Community Health Workers (CHWs) on how to distribute STI kits at home or set up a post system for distribution is a potential method to improve access to STI testing and reach underserved groups. This would involve teaching CHWs the value of secrecy and privacy as well as instructing them on how to administer and collect the STI kits appropriately. If a post option is selected, they could also receive training on correct packaging and delivering techniques. The initiative can guarantee that STI testing reaches those who might encounter obstacles in accessing healthcare services by involving CHWs, who are trusted members of the community, in this process.

Gender Considerations

Gender issues were taken into account extensively throughout the project design and execution. The project acknowledges the particular difficulties underprivileged populations and teenage girls have in gaining access to sexual and reproductive healthcare. The initiative addresses the unique needs of girls and advances gender equality by establishing safe spaces for them in schools where they may express their worries, look for support and get accurate guidance on sexual and reproductive health. The initiative highlights the significance of hiring community members from TW, MSM and SW populations in order to provide services to their unique requirements. This methodology guarantees that the project considers the varied experiences and obstacles encountered by persons with varying gender identities and sexual orientation.

Budget Justification

Funds for the project will be allotted to a number of components, such as mapping initiatives, safe space renovations, condom dispenser installations, hiring community members, facilitator training and monitoring and assessment tasks. The resources allotted to each component are determined by the anticipated influence on achieving the project goals and predicted expenses of the execution. The budgetary allotment signifies the weight assigned to initiatives that directly boost education, communication with the target audience and access to sexual and reproductive health services.

Sustainability

The projects aim is to create a long lasting framework for tackling the incidence of STIs in young girls and under privileged areas of San Salvador. This involves improving the ability of regional stakeholders such as medical professionals, instructors and community leaders to carry on and broaden the projects operations after it has ended. To guarantee the long term viability of the treatments, the initiative will also push for modifications to policies and more financing for sexual and reproductive health services. The project will serve as a model for similar projects in other towns or areas experiencing similar difficulties by showcasing its efficacy and impact.

The project, which strives to meet the unique requirements and problems experienced by the target community is an evidence-based, comprehensive approach to reduce the incidence of STIs among teenage girls and underprivileged populations of San Salvador. The initiative aims to empower youth, advance gender equality and lessen the burden of STIs through enhanced communication, greater use of sexual and reproductive health services and education. The projects efficacy and long term impact are enhanced by the use of a result based methodology, the incorporation of gender issues and the focus on sustainability. The initiative will serve as a model for future interventions and enhance sexual and reproductive health outcomes in San Salvador overall by collaborating with local stakeholders.

DRAFT PROJECT TIMELINE

Project Title:Empowerment and Prevention: STI Prevalence Reduction among San Salvadors Marginalized CommunitiesDuration:2 years (2023-2025)Target Population:Underprivileged communities and teenage females in San SalvadorLocation:San SalvadorProject Timeline:Year 1: Planning, Setup, and Early ImplementationQUARTER 1 2023: Project Setup and Assessment- Finalization of project plan inclusive of RBF- Baseline assessment of STI prevalence- Resource allocation and budget approval- Recruitment and training of project staff and community representatives (CRs)- Engage community stakeholders for collaboration and supportObjective(s) covered:1, 2, 3QUARTER 2 2023: Community Mapping and Preliminary Outreach- Completion of mapping sexual health clinics and other resources- Initial community outreach to introduce project objectives- Commence development of educational materials targeting STI awarenessObjective(s) covered:1, 2QUARTER 3 2023: Establishment of Safe Spaces and Educational Programs- Begin renovation of designated school rooms to create safe spaces- Creation and testing of preliminary educational workshops on sexual and reproductive health- Deploy CRs in the field for community trust-buildingObjective(s) covered:1, 2QUARTER 4 2023: School-Based Initiatives- Complete safe space installations- Introduce comprehensive sexual education programs in schools- Install the first phase of condom dispensers in select schools- Monitor and adjust educational workshops based on feedbackObjective(s) covered:1, 2Year 2: Expansion, Monitoring, and SustainabilityQUARTER 1 2024: Enriching Community Engagement- Expand deployment of CRs to encompass wider areas and demographics- Roll-out full home delivery system for STI kits- Initiate advanced workshops and discussions in safe spaces- Conduct interim assessment to modify strategies as neededObjective(s) covered:1, 2, 3QUARTER 2 2024: Evaluating Progress and Further Implementation- Systematic installation of condom dispensers in all targeted schools- Analysis of home delivery system efficacy and expansion as necessary- Progress report created against initial RBF indicators- Further refinement of educational workshops based on gender considerationsObjective(s) covered:1, 2QUARTER 3 2024: Enhanced Focus on Gender Equality and Inclusivity- Special workshops addressing gender-specific issues in healthcare access- Strengthening of CRs roles to address cultural stigma and enhance service clarity- Adjustment and fine-tuning of all project components based on collected data and evaluationsObjective(s) covered:1, 2, 3QUARTER 4 2024: Consolidation and Planning for Sustainability- Final project evaluation against RBF indicators- Consultations with regional stakeholders to ensure the projects continuity- Organize a symposium sharing project outcomes with policymakers and potential donors- Creation of a sustainability plan to maintain project gainsObjective(s) covered:1, 2, 3Gender Considerations:Throughout the project, efforts will be made to ensure gender-sensitive approaches are forefront. For instance, the creation of safe spaces in schools will provide an environment where girls can discuss gender-specific issues related to sexual health. CRs selection and training will include gender sensitivity to ensure they engage effectively with populations of varying gender identities. The educational materials and projects will take into account the different needs of young males and females and other gender minorities.Budget Justification:The allocation of funds for mapping, safe space development, education programs, CR engagement, and STI kit distribution is designed to directly contribute to the projects objectives and ensure a successful outcome. These resources will support essential project components that are designed to increase service utilization, enhance knowledge, and improve communication, thereby aligning directly with the planned initiatives.Sustainability:The project is geared towards the establishment of a self-sustaining model through the empowerment of local stakeholders, policy influence, and by fostering a culture of ownership. This will create a replicable framework that could be adjusted and applied to similar interventions elsewhere.By following this timeline, the project is expected to systematically address STI prevalence, while fostering a supportive environment for sexual and reproductive health education, gender equality, and empowered decision-making among the target populations in San Salvador.

WRITE UP (DRAFT)

The project timeline for "Empowerment and Prevention: STI Prevalence Reduction among San Salvadors Marginalized Communities" spans over a duration of two years, from 2023 to 2025, with a primary focus on underprivileged communities and teenage females in San Salvador. The project aims to address the high prevalence of sexually transmitted infections (STIs) in marginalized communities and empower individuals to make informed decisions regarding their sexual health. This comprehensive timeline outlines the key activities and milestones for each quarter of both years, highlighting the strategies and objectives to be achieved.

In the first year, the project will commence with planning, setup, and early implementation. During the first quarter of 2023, efforts will be focused on project setup and assessment. This includes finalizing the project plan, which will outline the strategies and interventions, as well as the results-based financing (RBF) approach to be implemented. Additionally, a baseline assessment of STI prevalence will be conducted to establish the current situation in San Salvador. Resource allocation and budget approval will be secured during this quarter to ensure adequate funding for the project. Recruitment and training of project staff and community representatives (CRs) will also take place to form a competent team to implement the interventions. Furthermore, engaging community stakeholders for collaboration and support will be prioritized to ensure the project's success.

During the second quarter of 2023, community mapping will be conducted to identify sexual health clinics and other resources available to the target population. This will help in effectively utilizing existing infrastructure and services. An initial community outreach will be initiated to introduce the project's objectives and build rapport with the underprivileged communities. In parallel, the development of educational materials targeting STI awareness will commence to ensure the availability of comprehensive and culturally sensitive resources.

The third quarter of 2023 will focus on the establishment of safe spaces and the development of educational programs. Renovation of designated school rooms to create safe spaces will begin to provide a conducive environment for discussions related to sexual and reproductive health. Preliminary educational workshops on sexual health will also be developed and tested in these safe spaces. The engagement of CRs in the field will commence to build trust and rapport with the target communities.

In the fourth quarter of 2023, the project will expand its activities by introducing comprehensive sexual education programs in schools. This will involve the completion of safe space installations in schools and the implementation of a comprehensive sexual education curriculum. As part of the strategy to promote safe sexual practices, condom dispensers will be installed in select schools. Continuous monitoring and adjustments of educational workshops will take place based on feedback and evaluation, ensuring their effectiveness.

Moving into the second year of the project, the first quarter of 2024 will focus on enriching community engagement. CRs will be deployed to wider areas and demographics to ensure maximum coverage and participation. A full home delivery system for STI kits will be rolled out to improve access to testing and treatment. Advanced workshops and discussions will be initiated in safe spaces to delve into more complex topics related to sexual health. Interim assessments will be conducted to evaluate the project's progress and modify strategies, if necessary.

In the second quarter of 2024, the project will evaluate its progress and further implement interventions. Condom dispensers will be systematically installed in all targeted schools to ensure easy access to protection. The efficacy of the home delivery system will be analyzed, and expansion plans will be considered to reach a wider population. Progress reports will be created to measure the project's outcomes against the established RBF indicators. Additionally, educational workshops will be refined to incorporate gender considerations and address the specific needs of young males, females, and other gender minorities.

During the third quarter of 2024, an enhanced focus on gender equality and inclusivity will be emphasized. Special workshops will be conducted to address gender-specific issues in healthcare access, providing a platform for discussion and understanding. The roles of CRs will be strengthened to address cultural stigma and ensure service clarity. All project components will be adjusted and fine-tuned based on collected data and evaluations to optimize their effectiveness.

In the final quarter of 2024, the project will focus on consolidation and planning for sustainability. A final project evaluation will be conducted against the RBF indicators to assess the overall impact and success of the interventions implemented. Consultations with regional stakeholders will be held to ensure the project's continuity and seek their support for ongoing initiatives. Furthermore, a symposium will be organized to share project outcomes with policymakers and potential donors, creating awareness and garnering support for future initiatives. The project will also develop a sustainability plan to maintain the gains achieved and ensure the long-term impact of the interventions.

Throughout the project, gender considerations will be prioritized. Efforts will be made to ensure gender-sensitive approaches are adopted in all activities and interventions. Creating safe spaces in schools will provide girls with an environment where they can discuss gender-specific issues related to sexual health openly. CRs will be trained to be sensitive and responsive to the needs of individuals of diverse gender identities. The educational materials and projects will be adapted to address the specific needs and concerns of young males, females, and other gender minorities, promoting inclusivity and equitable access to sexual and reproductive healthcare.

The budget justification for the project highlights the allocation of funds towards essential project components directly contributing to the achievement of the project's objectives. Mapping, safe space development, education programs, CR engagement, and STI kit distribution are all key focus areas that have been identified to address the STI prevalence reduction and empower marginalized communities. The budget has been carefully designed to increase service utilization, enhance knowledge, and improve communication, aligning directly with the planned interventions.

The project aims to establish a self-sustaining model by empowering local stakeholders, influencing policies, and fostering a culture of ownership. Through the engagement and collaboration of community members, the project's impact will extend beyond its initial duration. By developing partnerships with regional stakeholders, the project will ensure its continuity, making it a landmark initiative in STI prevalence reduction and empowerment in San Salvador. The project will also create a replicable framework that can be adjusted and applied to similar interventions in other areas, serving as a valuable resource for future public health initiatives.

In summary, the project timeline provides a systematic approach to addressing STI prevalence reduction among marginalized communities in San Salvador. Through comprehensive sexual health education, the establishment of safe spaces, and the deployment of community representatives, the project aims to empower individuals and reduce STI prevalence. The timeline places significant emphasis on gender considerations, ensuring the inclusion of diverse gender identities and promoting gender equality. With careful resource allocation and a focus on sustainability, the project aims to create lasting change and contribute to improved sexual and reproductive health outcomes in San Salvador's underprivileged communities.

Results Based Framework

Project Descriptions Indicators Sources of Verification Assumptions

Goal: Reduce STI prevalence in in San Salvador by 30% by targeting interventions towards adolescent girls and marginalized communities. STI rates in adolescent girls from San Salvador (aged 14-18) by 2025

-Ministry of health STI rates

-Monthly Reports from STI clinics of utilization and patient follow-up visits, also checking data by demographic (TW, SW, MSM, and adolescent girls) Assuming that money will incentivise TW, SW, and MSM to help train the clinics

Assuming that there is room in schools for a safe space for women

Assuming schools will allow dispensers and maps to be dispersed

Assume CHW can safely get places to deliver STI test

Assuming a teacher will be willing to supervise weekly meetings

Purpose:

Increase utilization of reproductive health services

Increase communication between established resources and the most at-risk communities -Number of visitors per month in clinics before and after intervention (disaggregated by age/marginalised group)

-Determine stage of infection when treated and number of follow-ups visits following intervention

-Measure who is getting follow-up visits and whether the clinic ensures continuous treatment for life-long STIs (HIV) -Monthly Reports from STI clinics of utilization and patient follow-up visits, also checking data by demographic (TW, SW, MSM, and adolescent girls). Quarterly reports will be made to present to an Irish Aid representative and a Department of health representative from the Salvadoran government.

- Card with information for those with incurable STIs that is cost efficient and measures follow ups and antiretroviral progression. The patient has their own copy as well as the clinic having a record of this information.

-Record number of daily visitors to the clinic. Increased utilization will come from more knowledge of projects

Increased communication will increase usage due to the update of STI status

Results:

Design and deliver a STI health service delivery awareness campaign targeting youth aged 10-15 and marginalised communities.

Increase youth knowledge of where and how they can access information and SRH services.

Design and facilitate school-based peer-support groups for girls aged 10-15.

Community groups and formal STI clinics meet on a regular basis to discuss key findings and problems occurring.

Strengthen referral systems between community and facility based SRH programming

Increase number of follow-up visits from clinicians to community.

-Number of ways clinic knows how to reach at risk patients

-Number of girls who can locate the nearest STI clinic/place that offers testing and name three services the clinic offers -Baseline and end of project survey asking girls 10-18 to locate STI clinics as well as survey with confidence of sexual education (compared to the before project survey)

-Survey for TW, MSM, and SW asking if they report an increased outreach to their community Activities:

Design and distribute maps documenting SH clinics, DVS, free condoms, schools, public transportation, LGBTQ+ centers, less dangerous routes

Create or refurbish spaces for women in schools - potentially weekly meetings

Condom dispensaries in schools

Create community representative role for clinics led by TW, MSM, SW (These people will serve as the CHW)

Training CHW to go out and deliver the home STI kits or help them set up a post method to send them out. Inputs

Production and printing of maps

Contact schools and renovate a room to serve as a space for adolescent female students

Contact schools about putting in condom dispensers and acquire both the dispensers and the condoms

Employ people from at-risk communities to serve as CRs

Determine safest routes for CHW/CR and re-imburse them for travel costs. See where the most people are getting them done from and have more people stationed in the areas of higher use, rent space to use for packaging and shipping of STI tests, CHW gets transport to the houses Resources:

$1000 - Maps

$6,000 - Cover teacher stipend and food for meetings

$3,000 - Condom cost

$120,000 - Community Health Worker Salary (combined with transportation cost)

$100,000 - travel expenses as well as project role salary)

CHW and the CR role be the same person(s) and all encompassed within one job role

1. Staff is maintained throughout project

2. Road and Weather conditions allow for transportation for the whole duration of the project

Table 1.1. Results Based Framework for implementing a STI reduction intervention in San Salvador, El Salvador from 2024-2025.

Key Abbreviations:

CHW: Community Health Worker

CR: Community Representative

DVS: Domestic Violence Shelters

MSM: Men who have sex with men

SH: Sexual Health

SW: Sex Workers

TW: Trans Women