The Essential Elements Framework, which is the basis of the present document and of the Safe Youth Worldwide program itself provides a useful framework for youth focused HIV prevention programs that attends both to ensuring program quality and institutional capacity for scale-up. The framework provides a simple way of assessing the needs of programs - whether they are run by NGOs, governments and/or private enterprises - at the beginning of the technical assistance phase. It then guides the programs and the technical advisors through a process of identifying and building capacity in those areas that need most attention. And finally, it provides a framework for monitoring and evaluating the progress and results of the program. This document shows the reader how the Essential Elements Framework (EEF) was applied to programs in five countries: Chad, Dominican Republic, Namibia, Nepal and South Africa. The EEF was used with promising programs - sometimes the leading program in a country - over a relatively short time period ranging from one to two years. The document explains what the EEF consists of, how it was used in each country program and what lessons were learned from its application in these five very diverse settings. The EEF proved extraordinarily useful in all of these settings in identifying the programs' many strengths but also finding important areas that needed improvement, and is now being applied by MSCI in other countries. Further development will provide specific training modules for each of the essential elements as well as more work on establishing monitoring and evaluation approaches. This report begins by describing in detail the components of the EEF and how the framework was applied in each country. It then presents the major lessons learned from the entire initiative as it was carried out in all five countries. Next, we provide short summaries of each country context and program, so that the reader can see specifically how the EEF was applied in that context. Since the entire initiative was quite short, there was not enough time to address all the needs that had been detected; however, the descriptions demonstrate the range of areas that were addressed and give a good idea of how the framework could be used on a more sustained basis. Finally, we have included a section of recommendations for technical assistance agencies and donors that we hope will help others in their efforts to support similar expansion efforts for youth-focused HIV prevention programs. Among the many lessons learned, we found that:á even promising programs that are good candidates for expansion - and may be the best in a given country - may require assistance to improve operations in each of the main dimensions of the EEF: guiding approaches, program strategies and managerial practices; even when program staff are aware of the importance of the guiding approaches such as promotion of gender equity, positive sexuality, and youth rights, they may require technical support to understand how to foster those fundamental issues in their programs; no matter how comprehensive, well designed and managed the programs are, they need to be linked with broader strategies that seek to reduce poverty, bring about economic improvement, and foster greater community access to resources and better living conditions; although financial inputs are certainly critical for delivering HIV prevention programs, organizations often require assistance to improve their performance, manage resources efficiently, and demonstrate accountability. But these are only glimmers of the specific lessons we learned and recommendations the reader will find in this document. We hope that you will read on and explore the specificity of each program and the richness of the options described in the report. And even more importantly, we hope that the Essential Elements Framework itself will serve to motivate more programs to work with young people on HIV prevention and do so in increasingly effective ways.