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PFI Annual Report 2010 Global Fund Project |
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Annual Report
Access to
Care and Treatment
The Global Fund Round 4 HIV/AIDS Program
April 2009 - March 2010
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Acknowledgement
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T he “Access to Care and Treatment” (ACT) program has completed five years of
implementation in March 2010. The ACT program was implemented in six high
prevalence states in India for providing care and support services to People Living with HIV
(PLHIV). The services would now continue under the consolidated Rolling Continuation
Channel (RCC) program.
Population Foundation of India acknowledges the contribution of all the partner agencies,
Indian Network for People Living with HIV/AIDS (INP+), EngenderHealth Society, Freedom
Foundation (EHS), Confederation of Indian Industry (CII), St. Joseph’s Leprosy Hospital &
HIV/AIDS Care Center (SJLH), Development Association of Nagaland (DAN) and Meetei
Leimarol Sinnai Sang (MLSS) for their support and sincere efforts in implementing the
program.
The Governing Board, The Project Advisory Board and the management team of PFI have
consistently provided their support, supervision and guidance for the timely and smooth
implementation of the program. PFI expresses its gratitude to all the members.
Population Foundation of India also thanks the National AIDS Control Organisation
(NACO) and all the State AIDS Control Societies (SACS) for their support in implementing
the program.
Population Foundation of India expresses its gratitude to the Global Fund to Fight AIDS,
Tuberculosis and Malaria (GFATM) for extending their support to address the needs of the
PLHIV.
The PLHIV are at the core of the program. This program has enabled them to enhance
their capacity and access treatment, care and support services. Their participation in the
program demonstrates their commitment and dedication in improving the lives of their
peers.
We convey our appreciation and gratitude to the Executive Director, all the members of
the Project Management Unit at New Delhi and the State Program Coordination Units of
PFI for their coordinated efforts in managing the program.
Dr Mary Verghese
Project Director
Population Foundation of India
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Access to
Care and Treatment
Annual Report April 2009 - March 2010
Abbreviation
ACT
Access to Care and Treatment
MIS
Management Information System
AIDS
Acquired Immune Deficiency
MLA
Member of the Legislative Assembly
Syndrome
MLSS
Meetai Leimarol Sinnai Sang
ART
Antiretroviral Therapy
M&E
Monitoring and Evaluation
ARV
Antiretroviral
MoU
Memorandum of Understanding
BILT
Ballarpur Industries Limited
NABARD National Bank for Agriculture and Rural
BPL
Below Poverty Line
Development
CCC
Community Care Center
NACO National AIDS Control Organization
CCM
Country Coordinating Mechanism
NGO
Non-Governmental Organization
CCSC
Comprehensive Care and Support
OI
Opportunistic Infections
Center
OPD
Out Patient Department
CLHIV Children Living with HIV
PAB
Project Advisory Board
COPE
Client Oriented Provider Efficient
PFI
Population Foundation of India
CETC
Continuing Education and Training
PHC
Primary Health Center
Center
PLC
Positive Living Center
CII
Confederation of Indian Industry
PLHIV People Living with HIV
CMIS
Computerized Management
PPP
Public Private Partnership
CRPF
Information System
Central Reserved Police Force
PPTCT
Prevention of Parent to Child
Transmission
DAN
Development Association of Nagaland
PR
Principal Recipient
DLN
District Level Network
PTE
Peer Treatment Educator
DNO
District Network Officer
SACS
State AIDS Control Society
DOTS
Directly Observed Treatment (Short
SDP
Service Delivery Point
course)
SHG
Self Help Group
DRDA District Rural Development Agency
SJLH
St. Joseph’s Leprosy Hospital & HIV/
EHS
EngenderHealth Society
AIDs Care Center
EQAS
External Quality Assurance System
SPCU
State Program Coordination Unit
FF
Freedom Foundation
STI
Sexually Transmitted Infection
HIV
Human Immunodeficiency Virus
IBT
Indian Business Trust for HIV/ AIDS
ICTC
Integrated Counseling and Testing
Center
SGM
Support Group Meeting
SLN
State Level Network
SR
Sub Recipient
TAG
Treatment Adherence Group
IDU
Injecting Drug User
TB
Tuberculosis
IGP
Income Generation Program
TCC
Treatment Counseling Center
INP+
Indian Network for People Living with
TRG
Technical Resource Group
HIV/AIDS
TSC
Treatment Support Coordinator
4
MDACS Mumbai Districts AIDS Control Society
TSO
Treatment Support Officer
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Contents
Executive Summary
Genesis
Care and Support Services
District Level Networks for People Living with HIV
Positive Living Center
Treatment Counseling Center
Comprehensive Care and Support Centers
Community Care Center
Advocacy
Advocacy Conference
Capacity Building
Training under ACT Program
Program Management
Coordination Meetings
Assessment of District Level Network of PLHIV
Exposition
National Consultation on “Promoting Access to Care and Treatment”
International Women’s Day Celebration
World AIDS Day
Monitoring and Evaluation
Grants Management
Meetings and Workshop
Lessons from the Program
Financial Report
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08
11
12
14
16
17
18
20
21
23
24
26
27
28
28
30
32
32
32
33
33
34
36
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Executive Summary
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T he first HIV case in India was detected in 1986. It
was a time when there was not much knowledge
responsible for outreach services and coordination
with the ART centers.
and awareness about HIV. Until 2005, treatment
options were limited and expensive. Antiretroviral
(ART) services were available only in a handful of
public health facilities in the entire country. People
living with HIV faced a lot of stigma and discrimination.
They faced segregation in schools and hospitals, denial
or loss of employment, denial of shelter at home. They
felt ostracized by society.
Under the ACT Program, four Comprehensive Care and
Support Centers (CCSC) were set up by the Freedom
Foundation (one each in Karnataka and Tamil Nadu,
and two in Andhra Pradesh). Out of the four centers,
three were 50 bedded centers and one was a 20 bedded
facility, where PLHIV had access to free out-patient and
in-patient services for treatment and management of
opportunistic infections.
With support from The Global Fund to Fight AIDS,
Tuberculosis and Malaria, the “Access to Care and
Treatment” (ACT) program was implemented from
April 2005 in the six high prevalence states of
India. Under the ACT program, the National AIDS
Control Organisation (NACO) provided Antiretroviral
Treatment (ART) at the public health facilities and
The Confederation of Indian Industry (CII) facilitated
the establishment of seven Corporate ART Centers
under the ACT program. Under the public-private
partnership, NACO provided the ART drugs, test
kits and training while the corporates provided
infrastructure, funding of equipment and staff.
Population Foundation of India (PFI) and its partners EngenderHealth Society has built the capacities of
provided care and support services for PLHIV. The the service providers i.e. peer treatment educators,
ACT program became an example of a unique public- counselors, social workers, health care providers and
private partnership. The program completed five years field staff from the NGO sector. Three Continuing
of implementation in March 2010. The services will now Education and Training Centers were set up in Chennai
continue under the consolidated Rolling Continuation for Tamil Nadu and Andhra Pradesh, in Mysore
Channel (RCC).
for Karnataka and Maharashtra, and in Imphal for
Nagaland and Manipur.
Under the ACT Program, from April 2005 to March
2010, 2,25,868 People Living with HIV (PLHIV) have The program has come a long way. The ACT program
accessed care and support services. The Indian helped in mobilizing PLHIV to access services and
Network for People Living with HIV has established followup for treatment adherence. DLNs provided
130 District Level Networks for People Living with psycho-social support to the PLHIV and advocated
HIV (DLN). These community based organizations are with the community and the workplace for reduction
actively engaged in providing care and support to of stigma and discrimination. DLNs conducted
PLHIV.
support group meetings, counseled families and
Sixteen Positive Living Centers (PLC) were established
in the six high prevalence states which provided
psycho-social support to PLHIV with the help of trained
social workers and peer counselors. In the PLCs, special
emphasis was given to the needs of women and
children living with HIV.
developed linkages to access government schemes.
Care and support services under the program have
had a positive impact on the quality of lives of PLHIV.
There are still challenges to be met. Sustainability and
outreach are key issues. In the coming years the focus is
on further decentralization. Volunteer peer educators
would provide support at the taluk (block) level. This
Forty four Treatment Counseling Centers (TCC) were would also result in better outreach. Linkages with the
established in the six high prevalence states and government programs and social security schemes
they complemented the ART Centers by promoting would be vital steps towards the empowerment
treatment adherence. In 2009, the strategy for of PLHIV. We envisage a society free of stigma and
implementing TCCs has been revised in consultation discrimination, unhindered access to treatment, care
with NACO. The TCC staff were merged with the DLN and support services where PLHIV would live a life of
7
in the respective districts. The TCC staff at DLNs were dignity.
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Genesis
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C ombating HIV still remains a major concern
for developing countries like India. The
Government initiated the National AIDS
living with HIV, giving an estimated prevalence of
0.34%.
Control Program (NACP) in 1992 in response to the Access to Care and Treatment (ACT)
incipient epidemic of HIV that was first detected in Program
India in 1986. The first phase of the NACP (1992 -1999)
focused on creating awareness in the population on
modes of HIV transmission and on improving blood
safety. The NACP phase II (1999 – 2006) dealt with a
rapidly growing epidemic of HIV that had by now,
begun to gradually move into the general population.
During this phase emphasis was laid on establishing
a decentralized institutional framework at the state
The “Access to Care and Treatment” (ACT) program is
implemented by the NGO/ Private sector consortium
led by PFI under the Global Fund to Fight AIDS,
Tuberculosis and Malaria (GFATM) Round 4 program,
in the six high prevalence states of India (Andhra
Pradesh, Maharashtra, Karnataka, Tamil Nadu, Manipur
and Nagaland) in coordination with NACO.
level for HIV control efforts. It also focused on targeted
programs for the high risk sub-population, an effective
blood safety program, more clinics to treat STI and
condom distribution.
NGO consortium members are Population Foundation
of India (PFI), Indian Network for People Living with
HIV/AIDS, EngenderHealth Society, Confederation
of Indian Industry and Freedom Foundation.
Based on the lessons learned and achievements made
in the National AIDS Control Program Phase I & II, NACP
III was launched in April 2007. NACP III aims at halting
and reversing the epidemic in India over a period of
five years by integrating prevention, care, support
and treatment interventions. NACP III has adopted
a comprehensive strategy to strengthen family and
Besides this, Community Care Centers (CCC) run
by three other NGOs, i.e., St. Joseph’s Leprosy
Hospital and HIV/AIDS Care Center in Tuticorin,
Tamil Nadu; Development Association of Nagaland
in Dimapur, Nagaland; and Angel’s Care Center in
Moreh, Manipur,have also became part of this
program.
community care, provide psycho-social support to
individuals affected by HIV/AIDS and ensure accessible
and affordable treatment services.
The ACT Program started in April 2005 and completed
five years of implementation in March 2010. The
program will continue for another six years under
With the assistance of The Global Fund, under Round
4, first line ART services were launched in India in
the consolidated Rolling Continuation Channel (RCC)
program.
2005. ART Centers were set up in medical colleges,
tertiary hospitals and large district hospitals across the
Goal
country, based on HIV prevalence. When Round 4 was To improve survival and quality of life of People Living
initiated (2005) there were six high prevalence states with HIV and reduce HIV transmission in the six high
(Andhra Pradesh, Maharashtra, Karnataka, Tamil Nadu, prevalence states
Manipur and Nagaland). There is evidence to show that
HIV prevalence in these states is declining. When the Objective
Round 4 proposal was submitted, India was estimated
to have the second highest number of HIV cases in the
world (5.2 million) based on the sentinel surveillance
data. However, in 2006, estimates were down-sized
to 2.5 million (2.0 - 3.1 million) based on the new data
To reduce morbidity and mortality associated with HIV/
AIDS and the transmission of HIV in six high prevalence
states by combining prevention, treatment (including
antiretroviral treatment), care and support.
from the community based National Family Health Key Activities under the ACT Program
Survey. The 2007 prevalence estimates, based on the
2006 revision and new sentinel surveillance data, show • The care and support centers set up under the
9
that India has 2.31 million (1.8 - 2.9 million) people
ACT Program are:
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Access to
Care and Treatment
Annual Report April 2009 - March 2010
– District Level Networks for People Living with
HIV (DLN)
– Positive Living Centers (PLC)
– Treatment Counseling Centers (TCC)
– Comprehensive Care and Support Centers
and Community Care Centers (CCSC)
– Corporate ART Centers
• Capacity building of service providers like peer
educators, social workers, counselors, health care
providers and other NGOs outside ACT
• Conducting operational research/special research
studies
The table below shows the key indicators under
Global Fund Round 4 program and cumulative
achievements up to quarter 20 i.e. till March 2010
Indicator Description
Number of health facilities (corporate sector) providing quality
ART services
Targets till Q-20
Actual
Results till Q-20
Cumulative
10
7
Number of ART health facilities providing treatment counseling
50
44
Number of PLHIV enrolled in care and support services provided
by civil society organizations
Number of health facilities (PLCs & CCSCs) providing care & support
including palliative care
Number of people receiving care & support/palliative care (PLCs
& CCSCs)
Number of district level networks of PLHIV - civil society
organizations strengthened and actively engaged in providing
care & support to PLHAs
168,000
23
32,339
130
225,868
23
37,668
130
Number of peer treatment educators trained
14,204
15,304
Number of counselors, social workers, health care providers and
field staff from NGO sector trained in home and community based
care
Number of master peer treatment educators, counselors and
social workers receiving refresher training
Number of operations research/ special studies completed and
results disseminated.
1,214
612
11(11)*
1,347
690
12 (10)
* Number given in brackets refer to the number of operation research/special studies disseminated
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Care and Support Services
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Access to
Care and Treatment
Annual Report April 2009 - March 2010
T he care and support centers set up under the ACT
program are:
• District Level Networks for People Living with HIV
• Positive Living Centers
• Treatment Counseling Centers
• Comprehensive Care and Support Centers and
Community Care Centers
• Corporate ART Centers
District Level Networks for People Living
with HIV
Under the ACT program, as of March 2010, 130
District Level Networks (DLNs) have been established
and 2,25,868 PLHIV have accessed care and support
services. DLNs are Community Based Organizations
of PLHIV and are affiliated to the Indian Network for
People Living with HIV/AIDS (INP+). DLNs are registered
under the Society Registration Act. DLNs enroll PLHIV
and provide psycho-social support, conduct Support
Group Meetings (SGMs) and conduct outreach at the
district and taluk (block) level. DLNs also advocate
with service providers in case of discrimination and
denial of services. PLHIV are educated on positive
living, nutrition, preventive behavior, treatment
options and adherence. DLNs also refer women and
children for testing, Prevention of Parent-to-Child
Transmission (PPTCT) and ART services, and trace
Figure 1: State wise enrollment of PLHIV at
District Level Networks
70000
60000
50000
40000
Glimpse of a Support Group Meeting
PLHIV who have defaulted. DLNs have established
linkages with Government departments, NGOs and
private donors for availing of government schemes,
legal aid assistance and nutritional support for women
and children.
Support Group Meetings
DLNs conduct three SGMs every month at the taluk
(block) level. During 2009-10, there were 4295 SGMs
conducted across the six high prevalence states. These
meetings helped PLHIV to come together and share
their experiences. Participants were informed and
counseled on various issues like treatment options
and adherence, home based care, positive living and
nutrition.
“I have attended Support Group Meetings couple of
times and these meetings have been an eye opener
to me. I had no knowledge about ART treatment.
After participating in SGMs, I have learned about
importance and benefits of ART and treatment
adherence. Now I talk to my peers about the
advantages of treatment adherence”. Shillem, 35,
Male
30000
Peer Convention
20000
10000
Peer conventions were held across all the six states. The
conventions helped to motivate the peer educators
0
AP
KN
TN
MH
MN
NG
and acknowledged their dedication and voluntary
(23)
(26)
(34)
(30)
(9)
(8)
efforts. The best peer educators were awarded for their
2009-10 12304
2005-10 67634
15573
48670
10745
47867
17335
52079
1405
7316
691
2302
performance. The peer educators were also informed
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Note: The number of DLNs in each of the states is mentioned in
about HIV and available government schemes and
brackets
services.
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Review Meetings
cards which reach the DLN office are provided to
INP+ officers, State Level Networks (SLNs) and PFI
state offices conducted state level review meetings
on the program and Management Information System
(MIS) each quarter. The progress of the program was
reviewed and data was verified in these meetings.
the ART Center so that they are aware about the
cases which have been contacted. The new system
serves as an effective evidence and a tool to track
the outreach activities under the ACT program in
Andhra Pradesh.
Based on this review, feedback was given to Service
Delivery Points (SDPs) to develop their action plans.
• The Government of India has launched the
Antyodaya Anna Yojana (AAY) under which 35 kg
Skill building workshops
of rice per month is issued at a highly subsidized
rate of Rs. 3/- per kg to people below the poverty
INP+ organized two day skill building workshops for
line. The Mokokchung Network of People Living
SLN staff. These workshops were held at Bangalore
with HIV/AIDS (NMP+), Nagaland has advocated
and Kohima during August – September, 2009. The
with the Department of Food and Civil Supplies
main objective of the workshops was to enhance
and now 40 PLHIV are benefiting from this scheme.
the capacities of SLNs to implement the program
effectively. They were also informed about the
forthcoming RCC program, the human resources
policy, the importance of forming a support net
and the reduction of data mismatch, and system
planning.
• The Pune DLN advocated with the Tehsil of Junnar,
Maharashtra, and helped the PLHIV to obtain
Below Poverty Line (BPL) cards. With the help of the
Pune DLN, the PLHIV received training in animal
husbandry, beauticians’ and bakery courses. The
trained women started their own businesses of
Promising Practices
• Central Reserve Police Force (CRPF), Langjing,
Manipur supported vocational training programs
for Women Living with HIV. RPF supported five
DLNs, namely, Imphal East DLN, Imphal West DLN,
Thoubal DLN, Churachandpur DLN and Senapati
DLN, through their Civic Action Program. CRPF,
beauty parlors and bakery products at the village
level. Some also felt the need to come together and
start a business as a group. The DLN established
one support group in Junnar with nine members.
It has started goat rearing as an activity in Junnar
with the help of the Member of the Legislative
Assembly (MLA) of Junnar.
Langjing has provided sewing, embroidery and • To cater to the needs of Children Living with
wool knitting machines, raw materials and other
HIV (CLHIV), Hyderabad and Ranga Reddy DLNs,
items to the DLNs.
Andhra Pradesh organized a get-together for
• The Imphal East District Level Network, Manipur
started a Green Mile Biotech Project with the
support from Horticulture Department of Manipur.
Here the members of DLN have started a tomato
plantation. The greenhouse has been provided free
of cost by the Horticulture Department of Manipur.
This is a result of advocacy efforts by members of
Imphal East DLN.
children with HIV. Care takers of CLHIV also
attended these meetings. During the get-together
on 23rd January 2010, the counselors of the ACT
program carried out a nutrition demonstration
for the care takers. Recipes for locally available
low cost nutritious foods were demonstrated.
The Andhra Pradesh state unit of PFI supported
the nutrition kits. Nutrition kits comprised of
rice (12kg), green gram (1kg), groundnuts (1kg),
• When an outreach worker visits a client in the
field, he/she posts a card in the concerned village
mentioning the client ID and outcome of the
brown gram (1kg), ragi flour (1kg) and jaggery (1
kg). CLHIV on ART participated in the program
along with their caretakers.
visit. The address of the DLN is written on the • Mahbubnagar DLN, Andhra Pradesh has received a
13
card. Card reaches DLN with two stamps. Post
revolving fund of Rs. 5,00,000 from the District Rural
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Access to
Care and Treatment
Annual Report April 2009 - March 2010
HIV. Most of them are orphans or have a single
parent. The network advocated with the Children
and Welfare Department and the department has
given a building for ten years. Mr. Balachandra
Jarkiholi, Minister of Municipal Administration and
Department of Public Enterprises, Government of
Karnataka, donated an ambulance for the orphan’s
home. There are two caretakers to look after the
children.
Case Story
Girl standing and talking
Development Authority (DRDA).as a consequence
of approaching the DRDA with the skill profile of
100 PLHIV. The DLN distributed an amount of Rs.
5000 per PLHIV for income generation activities.
PLHIV who availed the loan were closely monitored
by the DLN to ensure that the loan was utilized
properly for income generation. PLHIV are repaying
the loan at the rate of Rs. 500 per month. The amount
collected is again disbursed as loan to new PLHIV.
Tailoring, detergent making, establishment of
small shops like tea shops, buffalo and goat rearing
are some of the income generating activities taken
up by beneficiaries.
• Dharmapuri District Positive Network (DDPWS+),
Tamil Nadu advocated with the local district
administration and got a loan of Rs.15000 for 96
PLHIV under the District Rural Development- Socio
Economic Improvement scheme. Eighty percent of
the beneficiaries were women. The network also
obtained 15 free homes for PLHIV under Indira
Awaas Yojana. From the State Welfare Board they
have received sewing machines for 137 women
living with HIV.
• Spandana Network for People Living with HIV in
Belgaum district, Karnataka, has stated an orphan’s
home named ‘Nandana Makkala Dhama’. The
home has fifty children infected and affected with
Bemma Laisram (name changed) hails from Imphal
East district of Manipur. She is a member of the
District Level Network of PLHIV. Beema is the sole
earning member and supports her four children on
her own.
‘Last year we got together as a group of around 12
members and had several discussions to start some
small business to support ourselves. But we did not
have any capital or training”, she says. “This support
from the CRPF comprising of sewing and knitting
machines along with raw materials has been like
a wish come true”. Today the group members got
orders for stitching school uniforms. Each member
now makes an earning of Rs 50 /- per day. We do
not take all the money we earn, 20% of the money
is deposited in the pool fund to help in times of
emergency.
Beema has put her two children back to school last
month. ‘I still have two more kids to be admitted in
school, but it will take some more time’, she says. Beema
and her peers have named their support group, Eikhoi
Hingminashi (Lets Live Together) and aim to involve
and empower other Women Living with HIV.
Positive Living Center
Under the ACT program, sixteen Positive Living Centers
were established in the six high prevalence states. In
2009-10, a total of 5858 PLHIV were provided care and
support services at the PLCs.
Andhra Pradesh Karnataka Tamil Nadu Maharashtra Manipur Nagaland Total PLC
14
2
3
4
3
2
2
16
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CLHIV presented with educational kit in PLC, Tamil Nadu
PLCs provide psycho-social support to PLHIV with the means of a seven session module focusing on basics
help of trained social workers and peer counselors. of HIV, treatment adherence, hygiene, home based
Here PLHIV and their families are counseled on care, yoga, nutrition support, legal aid and linkages.
management of opportunistic infections, positive After completion of the module, PLHIV act as peer
living and safe sex practices. The needs of women educators in their respective areas. PLCs provide
and children are looked into. The services of a part- drop-in center facilities, home visits, and refer PLHIV
time doctor are also available here. PLCs support to ART Centers.
activities such as support group meetings, nutrition
supplementation, educational support and life
skill education and recreation trips for infected and
affected children. In the PLCs PLHIV are trained by
The PLC model was designed in 2004 – 2005, but due
to subsequent developments has been dropped in
the RCC Program. As the ART program evolved from
Figure 2: Enrollment of PLHIV at Positive Living Centers
April 2005, the care and support services are being
5000
taken care of by the expanded decentralized model
4500
of the DLN through linkages with other stakeholders,
4000
access to government schemes and the community
3500
care centers. Hence the PLC model is dropped in the
3000
2500
RCC Program.
2000
1500
Promising Practices
1000
500
• In Tamil Nadu, PLCs organized life skill education
0
AP
KN
TN
MH
MN
NG
programs for the children infected and affected
(2)
(3)
(4)
(3)
(2)
(2)
with HIV, to develop their leadership and problem
2009-10 684
1457
1592
1764
158
203
2005-10 2430
4187
4087
4653
442
648
solving skills and to improve their general
15
Note: The number of PLCs in each of the states is mentioned in brackets
knowledge. 181 children were benefited through
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Access to
Care and Treatment
Annual Report April 2009 - March 2010
these programs. Two hundred and thirty eight
children infected and affected with HIV from four
PLCs were given educational support. PLCs also
provided training for caregivers of children infected
and affected with HIV. This year eight caregiver
trainings were conducted and 160 caregivers were
trained.
• PLC in Bagalkot, Karnataka organized Children’s
Day for 95 children infected and affected with HIV.
Various competitions like quiz, speech and games
were held. The function provided the children with
an opportunity to exhibit their talents. Prizes were
given to the winners of the competitions.
• Network of Maharashtra People with HIV (NMP+)
Maharashtra, and the PFI state unit of Maharashtra
organized a three day workshop for PLCs in
Maharashtra. Staff from the Pune, Beed and Wardha
PLCs participated in this workshop. The workshop
included sessions on sex and sexuality, HIV/AIDS,
ART and adherence, counseling skills and linkages
developments. An exposure visit to the Pune PLC
was organized for the staff of the Beed and Wardha
PLCs. The IEC display, the counseling, the medical
room and the registers maintained in the Pune PLC
helped the staff from the other two PLCs to learn
about documentation skills and best practices.
diseases, ART resistance and nutrition were
discussed by experts in great detail.
Treatment Counseling Center
Under the ACT program, 44 TCCs were established
in the six high prevalence states. TCCs complement
the ART Centers by promoting treatment adherence.
The counselors at the TCCs coordinate with the ART
Centers to get the defaulters list of PLHIV on ART.
They trace the defaulters failure to follow up through
linkages with DLNs.
In 2009, the strategy for implementing TCCs was
revised in consultation with NACO. The TCC staff has
been merged with the DLN in the respective districts.
The TCC staff at DLNs became responsible for outreach
services and coordination with the ART center.
The counselor in charge of the TCC was renamed as the
Treatment Support officer (TSO) and was responsible
for coordination with the ART Center. The TSO collected
information on missed and defaulters’ cases from the
ART Center and Link ART Center on a regular basis,
and informed the Treatment Outreach Workers (TOW)
for necessary follow up in a defined geographic area.
The new strategy has strengthened the DLN outreach
activities. The follow up of missed and defaulter ART
clients and pre-ART registration has increased.
• PLC in Bishnupur, Manipur organized Children’s
Day under the theme “Show us the true path of
life” in November 2009. Fifty children infected and
affected with HIV participated in the program.
Children participated in painting and recitation
competitions and in a talent show in which many
children performed dances, songs, monologues
and mimicry. The paintings of the children were
displayed for the guests in the Bishnupur Network
of Positive People (BNP+) conference hall. The
PLC also organized an exposure visit for children
infected and affected with HIV. Around sixty
children participated in this trip. They visited the
Science Museum and Singda Dam’ in Imphal.
In Maharashtra, the TCC component was merged
with DLNs in Sangali, Pune and Mumbai. Mumbai had
three TCCs at Sion, Nair and J.J. Hospitals. The staff
was placed at the Mumbai DLN as Treatment Support
Coordinator (TSC). The PFI Maharashtra state unit
facilitated discussions with Mumbai Districts Aids
Control Society (MDACS) and as a result geographical
areas for follow up of clients were divided between DLN
and Community Care Centers for tracing defaulters.
MDACS provided good support by informing ART
Centers regarding TSCs. Mumbai TSC unit was linked
with six ART Centers, KEM Hospital, Nair Hospital, Sion
Hospital, J.J. Hospital, Godrej and Larsen &Toubro
Hospital. The ART Centers regularly gave lists of
• In Nagaland, two day training on “Capacity Building missed and defaulter ART cases and the TSC submitted
16
for Health Care Givers” was conducted by the PLC. feedback regularly. The Godrej ART Center does not
Issues like positive prevention, sexually transmitted have many defaulters, so the TSC is conducting follow
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up of pre- ART clients for the CD4 test. The ART Centers
have appreciated the support of the TSCs.
Comprehensive Care and Support Centers
Under the ACT program, the Freedom Foundation set
up four CCSCs (one each in Karnataka and Tamil Nadu,
and two in Andhra Pradesh). The first CCSC was set up
in Guntur in 2005, followed by Tiruchirapalli, Bagalkote
and Kakinada. These centers were strategically located
in high HIV prevalence areas where a large number of
PLHIV were in need of these services. CCSCs provided
comprehensive care to PLHIV.
Bed Occupancy and Bed Turnover Ratio at
CCSC/CCC
April 2009 to March 2010
Bed
Bed Turn Over
Occupancy (%) Ratio in days
FF-Guntur
81.7
12.9
FF-Trichy
59.6
9.8
FF-Bagalkot
86.4
8.3
FF-Kakinada
75.1
9.0
St Joseph’s-
103.6*
8.5
Tuticorin
Of the four CCSCs, three were 50 bedded and one was
20 bedded, where PLHIV accessed free out-patient and
in-patient services for treatment and management
of major and minor opportunistic infections. CCSCs
form a bridge between tertiary care services available
in the public health system and primary health care.
The CCSCs focus on providing medical care including
palliative care to PLHIV including those on ART. They
also provide psycho-social counseling to the client
and family to enhance coping and adherence, and
promote health seeking behavior including positive
prevention. CCSCs also provide diagnostic facilities
and referral services to other centers. The centers are
equipped with a small laboratory where basic bio-
chemistry tests along with microscopic examination of
urine and sputum are done. Higher investigations are
outsourced to nearby facilities.
Figure 3: Enrollment of PLHIV at 4 CCSC and 3 CCCs
12000
DAN-Dimapur
55.3
8.8
MLSS-Moreh
67.3
11.0
* The possible explanation includes the provision of treatment using
some additional beds Since these additional beds were not funded
under ACT program, they have not been counted in the denominator.
Promising Practices
• Eleven Treatment Adherence Groups (TAGs) were
formed in CCSCs to enhance adherence to ART. The
group consists of PLHIV who have been on ART for
a long period as well as those who are newly put on
ART. After the closure intimation, most of the TAG
members have decided to continue their meetings
on a voluntary basis.
• The Bangalore center of the Freedom Foundation
was the training center for all CCSCs. The center
provided mentoring and on-the-job training to
the technical staff which included the medical
officers, counselors, lab technicians, nurses and the
10000
8000
6000
4000
2000
0 FF-
FF-
FF-
FF-
St
DAN MLSS
Bagalkot Guntur Kalkinda Trichy
(2) Dimapur Moreh
(Feb, 08) (Jul. 05) (Mar, 09) (Dec, 07) Joseph’s- (Sep, 07) (Jul, 08)
Tuticorin
(June, 06)
2009-10 1833 1490 1380
591
360
322
142
2005-10 11233 1876
4151
1401
1649
635
295
Note: The month and year of functioning of CCSC/CCCs is given in
17
brackets in the above figure
Treatment Adherence Groups Meeting in CCSC
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Access to
Care and Treatment
Annual Report April 2009 - March 2010
project coordinators of the CCSCs, both during the treatment to the PLHIV under the ACT program since
induction as well as during the refresher course. July 2008. The center has treated 142 new PLHIV in
These trainings oriented the staff to the treatment 2009-2010. The support from PFI ended on 31st March
protocols, universal precautions and infection 2010. In order to continue care and support services to
control measures to be followed at the centers. the PLHIV, the MLSS has been pursuing NACO, through
These internal trainings and mentoring programs the Manipur State AIDS Control Society to take over
helped the staff to share experiences and monitor the Angel’s Care Center.
cases.
Promising Practice
• Significant number of Children living with HIV/AIDS
were treated at CCSCs. The percentage of CLHIV
on ART ranged between 32% and 50% across the
CCSCs. Bagalkot had the maximum percentage
of CLHIV on ART at 50%. CCSCs also organized
children’s camps and recreational activities for
CLHIV.
PLHIV who participated at the Income Generation
Training Programme of the Angel’s Care Center, have
formed the Angel’s Collective Support Group (ACSG)
and are producing tailored items, and food items
under the brand name Nutringel made especially for
the PLHIV in consultation with the dietician.
Case Story
• Trained and experienced outreach workers carried
out the home visits. The outreach staff were
Miss Hoinu (name changed) aged 17, is the third
supervised by the social worker. Consent was
child of her parents. She was a happy and charming
obtained and confidentiality of the beneficiary was
maintained during the home visits. Considering
the client load at CCSC, it was difficult in practise to
follow up on eligible clients beyond the stipulated
geographical area. Hence CCSCs also followed up
clients by telephone.
little girl. In 2003, she fell ill and had to undergo
blood transfusion in a hospital in Myanmar. There
is a tradition in Myanmar where blood donation
to a needy patient is considered pious. Whenever
a person is in need of blood, a number of persons
volunteer to donate blood. Miss Hoinu was infected
Community Care Center
through blood transfusion. She came to know her
status only in 2009, when she came in contact with
Under the ACT program three Community Care Centers
the Angel’s Care Center. She was depressed initially.
were established at Moreh in Manipur, Dimapur in
After care and counseling at Angel’s Care Center she
Nagaland and Tuticorin in Tamil Nadu.
decided to live life. The homelike care and attitude of
Angel’s Care Center
the Angel’s Care Center created a sense of belonging.
She volunteered to provide care and support
Angel’s Care Center (ACC) is a 10 bedded Community
services to PLHIV. She also acts as an interpreter for
Care Center at Moreh, Manipur implemented by
PLHIV speaking tribal dialects of Myanmar with the
Meetei Leimarol Sinnai Sang (MLSS). Proximity to the
doctor, nurses and counselor.
GoldenTriangle and location at the international border
with Myanmar are important factors contributing to
the high prevalence of HIV in the district. Previous
to the establishment of this center, patients had to
travel to Imphal, a distance of 110 kms, for health care
needs. In many instances clients also visited the Tumu
Hospital in Myanmar.
Chavara Home
Chavara Home is a 10 bedded care center run by the
Development Association of Nagaland in Dimapur,
Nagaland. It is three kms away from the District Civil
Hospital where the ART Center is situated. Under
the ACT Program, Chavara Home was supported by
18
As a response to the situation at Moreh, Angel’s PFI from 1st September 2007 to 31st March 2010. The
Care Center has been providing care, support and Center has treated 322 new PLHIV during 2009-10.
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Medical Camp organized in Chavara Home
Under the ACT program, out patient and in patient
services for managing minor OIs were provided for
PLHIV. They were provided psycho-social support.
PLHIV were educated on treatment adherence,
positive living and nutrition. The center referred PLHIV
to other NGOs and government hospitals for other
treatment and services.
St Joseph’s Leprosy Hospital & HIV/AIDS Care Center
St Joseph’s Leprosy Hospital & HIV/AIDS Care Center
is a 20 bedded Community Care Center supported by
PFI since April 2007. The Center is located in located in
Tuticorin district in Tamil Nadu and is linked to Tuticorin
and Tirunelveli ART Centers.
The Center has provided care and support services
to a total of 2009 PLHIV since April 2007. In 2009-10,
360 new PLHIV were provided services. The Center has
also supported PLHIV, along with leprosy patients, in
forming self help groups (SHGs) for income generation
and by providing vocational training, interest free
housing loans and children’s education.
Since April 2010 PFI has discontinued funding
Comprehensive Care and Support Centers and
Community Care Centers established under the Round
4 ACT program. In the RCC proposal, NACO and PFI
as Principal Recipients (PRs) will be implementing
CCCs in defined geographical areas. Under RCC, PFI is
responsible for implementing CCCs in the nine highly
vulnerable northern states. PFI has requested the State
AIDS Control Societies (SACS) and NACO to continue
funding of CCCs from April 2010.
All the CCSCs and CCCs supported by PFI with over one
year of functioning as of November 2008 were included
in the national CCC assessment undertaken by NACO.
PFI has requested SACS and NACO to continue funding
of CCCs from April 2010. Based on the assessment
results, MLSS, DAN and SJLH CCCs will receive funding
from the respective SACS.
19
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3 Pages 21-30 |
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Advocacy
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U nder the ACT Program, the Confederation of
Indian Industry (CII) has been advocating and
facilitating setting up of Corporate ART Centers.
Advocacy with the corporate sector has been done
through advocacy conferences, focus group discussions
and small group meetings. The Corporate ART Centers
are unique models of Public Private Partnership (PPP)
where the corporate houses and NACO are partnering
to provide access to care and treatment. The corporate
houses provide both infrastructure and human
resources to set up ART Centers. NACO provides ARV
drugs, test kits, reagents and training to the staff of
Corporate ART Centers.
ART Center
ACC ART Center
ACTFID ART Center
Place/
Site
Wadi, District.
Gulbarga,
Karnataka
Vellore,
Tamil Nadu
BILT ART Center
Godrej ART Center
Ballarshah,
Distt
Chandrapur,
Maharashtra
Vikhroli,
Mumbai
Reliance - DAH ART Patalganga,
Center
Maharashtra
Corporate
Involved
Model of an
ART Center
ACC Limited
Standalone-
Corporate ART
Center
ACC Limited & Christian Part of the
Medical College (CMC),
Medical College
Vellore (jointly)
Avantha Group
(Ballarpur
Industries Ltd)
Part of existing
BILT hospital
Godrej
Memorial Trust
Reliance
Industries Limited
Part of Godrej
Memorial
Hospital
Part of Dhirubhai
Ambani Hospital
Bajaj – YCMH ART
Center
Pimpri,
Pune,
Maharashtra
Larsen &
Toubro ART Center
Andheri,
Mumbai,
Maharashtra
Bajaj Auto Limited
Larsen &
Toubro Limited
Part of Yeshwant
Rao Chavan
Municipal
Hospital
Part of L&T
Community
Health Center
Advocacy Conference
• Conference on Challenges in HIV / AIDS:
Prevention, Care, Support & Treatment “The Case
CII organized two advocacy conferences in New
for Partnerships” was held on March 12, 2010 in
Delhi to advocate with the corporate sector for
New Delhi. Dr. Syeda Saiyidain Hameed, Member,
mainstreaming HIV and facilitating setting up of
Planning Commission inaugurated the conference
Corporate ART Centers.
and also felicitated the corporates who came
21
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Access to
Care and Treatment
Annual Report April 2009 - March 2010
forward and showed commitment in setting up ART
Centers. The conference was also addressed by Mr.
K Chandramouli, Director General, NACO, Mr Tarun
Das, Managing Trustee, IBT, Mr. Taufiqur Rahman,
Regional Team Leader, South & West Asia, GFATM,
Mr A R Nanda, Executive Director, PFI and Mr
Suresh Neotia, Chairman, Ambuja Foundation. Mr.
Chandramouli congratulated the corporate sector
for successfully implementing the PPP model.
• Conference on “Dealing with HIV/AIDS: Business
Response to Prevention, Care, Support and
Treatment” was organized on 29th December,
2009 in New Delhi. Mr Dinesh Trivedi, Hon’ble
Minister of State for Health & Family Welfare
inaugurated the conference and emphasized the
need for more on-ground PPPs to combat HIV/
AIDS. He assured full cooperation to help execute
more PPPs in public health as also to help scale
up Corporate ART Centers across the country. Mr
Suresh Neotia, Chairman, Ambuja Foundation and
Mr Tarun Das, Managing Trustee, Indian Business
Trust for HIV/AIDS also addressed the conference.
The conference had a session on Corporate ART
Centers – experience sharing by Bajaj Auto and
Reliance Industries. Around 100 delegates from
various corporate houses, NGOs and Civil Society
organizations attended the conference.
(L to R): Mr. Tarun Das, Managing Trustee, IBT; Mr. A R Nanda, ED, PFI; Mr. K Chandramouli, DG, NACO; Dr (Mrs) Syeda Saiyidain Hameed, Member,
Planning Commission and Mr. Taufiqur Rahman, Regional Team Leader, South & West Asia , The Global Fund to Fight AIDS, Tuberculosis and Malaria
22
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Capacity Building
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3.5 Page 25 |
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Access to
Care and Treatment
Annual Report April 2009 - March 2010
E ngenderHealth Society (EHS) is responsible for
capacity building of service providers of the ACT
program for better treatment adherence. Health care
providers, counselors, social workers and master peer
educators were trained in the program in order to
provide quality services.
Training under Access to Care and
Treatment Program
Under the ACT program, EHS has set up three
Continuing Education and Training Centers-
Deepam Educational Society for Health (DESH)
at Chennai, Swami Vivekananda Youth Movement
(SVYM) at Mysore and Diocesan Social Service
Society (DSSS) at Imphal to train service providers
from all the six high prevalence states on treatment
adherence.
Master Peer
Educators
Peer Treatment
Educators*
Counselors and
Social Workers
Health Care
Workers
Field staff and
Health Care
Workers of NGOs
Regular Trainings
2009-10 2005-10
24
378
3420
14926
111
724
24
123
-
500
Refresher Trainings
2009-10 2005-10
21
267
-
-
102
423
-
-
-
-
Regular trainings
Regular trainings have been conducted for Master
Peer Educators, Counselors, Doctors and Health Care
Providers. During 2009-10, EHS trained a total of 159
service providers under regular training and 123
service providers under refresher training. The peer
treatment educator (PTE) training was provided by
DLN. Under this, 14,926 PTEs have been trained by
DLN.
Refresher Trainings
Refresher trainings were conducted to update
the knowledge of peer educators and counselors
about topics such as second line drugs, sexual and
reproductive health, positive prevention, positive
living, disclosure, opportunistic infections and co-
infections. The refresher training equipped service
providers with the skills to counsel and provide care
and support to people living with HIV. Last year, six
batches of refresher trainings were conducted by EHS
and 21 Master Peer Educators and 102 Counselors and
Social Workers were trained.
COPE
Client Oriented Provider Efficient (COPE) is a package
of participatory quality improvement tools and
approaches for use in improving health care delivery
in low resource settings. This tool was implemented
24
Participants in a team building game
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3.6 Page 26 |
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at seven service delivery facilities and enabled staff to
identify areas and issues pertaining to service delivery
which need improvement at their sites and take action
as a team to resolve these issues.
also HIV positive. A TV and DVD have been installed
in the waiting hall and short films on HIV related
information are shown so that visitors can improve
their understanding about HIV.
The follow up of COPE was conducted at the PLC,
Pune from 29-30 September, 2009. The follow up of
COPE was conducted at the PLC, Singarayakonda and
CCSC, Guntur, Andhra Pradesh between 6 and 8 May,
2009. Review of the action plan and discussion with
staff indicated that signboards in local languages
with information about services have been put up
at Singarayakonda. Proper record keeping has been
initiated by staff and a suggestion box has been
provided for obtaining clients’ feedback about the
services. Proper waste disposal is also being practiced
by site staff. At CCSC Guntur, information boards
have been put up properly. The CCSC is ensuring
record keeping and they have a counselor who is
The follow up of COPE was conducted between 29
and 30 October, 2009 in CCC, Moreh in Manipur. The
COPE committee at CCC, Moreh has decided to meet
and review the progress on the action plan every
fortnight.
The follow up was conducted between 21 and
22 October, 2009 for Chavara Home, Dimapur,
Nagaland. A suggestion box has been provided in
the indoor patient corridor area. Client records are
being maintained in proper files. The IEC material
developed by different agencies is being displayed
in Out Patient Department (OPD)/counseling area.
There is availability of technical material for staff.
25
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Program Management
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3.8 Page 28 |
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A s Principal Recipient, PFI is responsible for overall
management of the ACT program. PFI has a
included early detection and follow up with PLHIV for
care and support services, tracing ART defaulters and
Program Management Unit (PMU) in New Delhi and enabling access of PLHIV to livelihood opportunities
State Project Coordination Units (SPCU) in all the six and government social security schemes.
high prevalence states. A Program Advisory Board (PAB)
meeting was held periodically to review the progress
and provide guidance for the implementation of the
program. A PAB meeting was held in June 2009. The
members of PAB include external experts in the field
of HIV/AIDS and members from partner agencies and
members from the Governing Board of PFI.
Coordination Meetings
Coordination with partners
State Project Coordination Units (SPCU) of PFI
conducted monthly meetings with partner
organizations for effective implementation of the
ACT program in the respective states. These meetings
helped in coordination and program effectiveness. The
partners shared their action plan for the next month
and planned joint visits to SDPs for monitoring. Also
PFI coordinated with NACO and SACS periodically
for implementation of the program. PFI established
State Coordination Committees with respective SACS
in all the six states. These Committees reviewed the
state units provided hand holding support to SDPs. To
ensure better data quality, PFI state units participated
in MIS and computerized management information
systems review meetings for SDPs.
program implementation at state level and sorted out
coordination and linkages issues. The Project Director
of each SACS chaired these meetings which were
convened by the PFI State Coordinator.
Review Meetings
A review meeting was organized by PFI-PMU with all
the state units in New Delhi from 16th to 18th September,
2009. All state units of Round 4 and regional units of
The State Program Coordination meeting was Round 6 participated in this meeting.
organized with Tamil Nadu AIDS Control Society
(TANSACS) on May 4th 2009 at the TANSACS office.
Key discussions included redefining the strategies for
TCC and improving coordination among the service
delivery points . The second meeting was organized
on 8th October 2009 in which the program update
was shared with the Project Director, TANSACS. The
State Program Coordination meeting was organized
with Manipur AIDS Control Society (MSACS) on the
28th of October 2009 in the PFI State Office in Imphal.
Key discussions included institutionalizing monthly
Interaction Meetings
Interaction meetings were conducted in all the six
high prevalence states. Representatives from DLN, ART
Centers, ICTC Counselors, NGOs, PLHIV and Government
officials from the SocialWelfare Department participated
in these meetings. These meetings enabled service
providers to understand the needs of PLHIV and thus
bridge gaps in service provision. These meeting helped
SDPs to advocate for PLHIV needs and to improve
coordination and linkages.
ART-CCC and DLN coordination meetings, access to
alternate first line ARV and ensuring availability of staff
at the ART Center, particularly in the hilly districts of
the state. The meeting was followed by a State Steering
Committee Meeting organized by MSACS on the 29th
of October 2010. The mechanisms for institutionalizing
monthly ART-CCC and DLN coordination meetings
were shared and finalized with nodal officers of ART
Centers, S.M.Os/M.Os of ART Centers, representatives
from Positive-Networks, CCCs and DICs. The State
Program Coordination meeting was organized with
The service providers were supported in the following
ways:
Tamil Nadu State Coordination Unit of PFI had
organized nine interaction meetings in Tamil Nadu.
Through these meetings, coordination between ART
Centers and DLN improved. Interaction meetings also
increased the visibility of the program in the district
among other service providers. Better rapport of DLNs
with other stake holders was established due to the
interaction meetings.
the Nagaland State AIDS Control Society (NSACS) Maharashtra state unit conducted 11 interaction
27
on the 27th October 2009 in Kohima. Key discussions meetings in Maharashtra. Through these meetings,
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Access to
Care and Treatment
Annual Report April 2009 - March 2010
ICTC supervisors agreed to provide information
on HIV-TB along with Microscopy directory and
counseling points for TB patients. NGOs announced
that they will support PLHIV network in income
generation program (IGP) activities/ vocational
trainings. SHG members of Dhule DLN received
vocational training by NGOs.
As a result of the advocacy efforts in the interaction
meeting, the local MLA in Bishnupur, Manipur gave
Bishnipur DLN Rs 1 Lakh for Income Generation Project
(IGP) for Women Living with HIV for tailoring and
embroidery works.
The Zonal Education Officer (ZEO) of Bishnupur,
Manipur, gave text books from standard I to VIII to the
Bishnupur DLN for 23 CLHIV.
The interaction meeting in Tuensang district,
Nagaland resulted in better coordination with the
service providers like ART Center, ICTC, PPTCT, Directly
Observed Treatment (Short course), The National Rural
Health Mission, DAPCU and the civil hospital Tuensang.
Church leaders in Nagaland were sensitized about HIV
through interaction meetings.
Assessment of District Level Network of
PLHIV
PFI conducted an assessment of 128 District Level
Networks of PLHIV (including 50 DLNs with TCC)
and 16 PLCs in the six high prevalence states. The
assessment was done by a team of PFI and INP+
staff in February and March 2010. The assessment
used quantitative and qualitative methods to collect
data/information through structured tools, covering
program, monitoring & evaluation, finance and
administration.
The assessment has helped PFI and INP+ to
understand the strengths and weaknesses of the
program implemented by DLN, and the perception of
the beneficiaries regarding the services availed of by
them. Good practices, lessons learnt and challenges
were also documented.
This assessment will serve as the baseline for the RCC
period and will help to develop a need based program
implementation strategy. The State Level Network
(SLN) and PFI State/ Regional Unit will monitor that the
recommendations / key observations are addressed by
the DLN within a stipulated time frame.
Exposition
Since the last two years, PFI is organising state level
expositions in the six high prevalence states in India.
These expositions provided a platform for PLHIV
involved in the program to share their experiences
with a broad range of stakeholders. Moreover, these
fora helped PLHIV to represent their needs, get
motivated and become informed on services available.
Representatives from DLNs, PLCs, CCCs, CCSC, ART
Centers, SACS, senior officials of various government
departments, colleges, banks, National Bank for
Agriculture and Rural Development (NABARD), NGOs
and the media participated in these events.
Results of the DLN Assessment
The DLNs were scored on key parameters and ranked between A to D
S.No. State
Ranking of the DLN
D (0 to 25) C (26 to 50) B (51 to 75)
A (>75)
Total DLN
1
Tamil Nadu
0
4
15
10
29
2
Karnataka
0
2
18
6
26
3
Maharashtra
0
1
26
7
34
4
Andhra Pradesh
0
0
15
8
23
5
Manipur
0
2
5
1
8
6
Nagaland
28
Total
0
1
6
1
8
0
10
85
33
128
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CLHIV enjoying Iceland game- a game for unity at the state level
exposition of PFI, Andhra Pradesh State unit
Medical examination for Women living with HIV at the state level
exposition organized by PFI, Karnataka state unit
Youth Mohotsav
missing school for ART, and children refusing to take
Population Foundation of India, Maharashtra state unit
and Network of Maharashtra People with HIV (NMP+)
organized Yuvak Mahotstav from 9th June to 11th June
2009 to address the issue of HIV and youth. Around
100 HIV positive youth participated from 35 districts
of Maharashtra. The idea was to sensitize youth
medicines properly. Many of the CLHIV came to know
about their status, many care takers came to know
that children knew about HIV before coming to the
program and were surprised with their knowledge. It
was recommended to care givers that they should start
talking about health issues with CLHIV at an early stage.
about positive prevention. This was done by sharing
experiences, through games and clarifying doubts
through interactive sessions with experts. They were
provided information on sex and sexuality, Sexually
Transmitted Infections (STI), HIV and antiretroviral
therapy. The participants volunteered to form peer
groups to spread awareness about positive prevention.
Posters, slogans, poems competitions and street plays
were organized. The three best DLNs were given prizes.
Recognising the Change Makers
Population Foundation of India, Tamil Nadu state unit
organized a state level exposition from 29th to 31st
July 2009 at Mamallapuram with the theme “Change
Makers 2009”. The exposition promoted good practices
and provided PLHIV an opportunity to relax. Rewards,
recognition and capacity building were the major
tools used in the exposition to enhance motivation.
Around 100 PLHIV participated in the exposition.
Children and HIV
The participants were members of DLNs, TCCs, PLCs,
Population Foundation of India, Andhra Pradesh
state unit organized a state level exposition on 14th
and 15th July 2009 at Vishakhapatnam. The theme
for the exposition was “Children & Care Takers – A
platform to discuss about children living with HIV/
AIDS”. Participants were care takers of CLHIV and
CLHIV who are on ART. 50 care takers and 50 children
participated in the exposition. Officials from Andhra
Pradesh State AIDS Control Society, NGOs working in
HIV sector in Vishakhapatnam, DLN staff members and
representatives of the NGO/Private sector consortium
participated in the program.
Parallel sessions were organized for CLHIV and care
takers. The forum discussed important issues like the
social workers, counselors and outreach workers.
The sessions focused on the power of positive living.
Resource persons were from UNICEF, Tamil Nadu State
AIDS Control Society (TANSACS), AIDS Prevention
and Control Project (APAC) Lawyers Collective, and
Industrial Managements. Sessions revolved around
important issues like spirituality and health, leadership
and management. Expectations, responsibilities
and qualities required to be a good leader were
discussed through interactive sessions. The face to
face interaction between the networks and other
stakeholders helped to develop better understanding
and improved support to PLHIV.
Women and HIV
problems faced by care takers in providing care to Population Foundation of India, Karnataka state unit
CLHIV, for example discrimination in school, pressure to conducted a three day state level exposition from 20th
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cope with other students, lack of physical development, to 22nd July, 2009 at Kudalasangama of Baglkot District,
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Access to
Care and Treatment
Annual Report April 2009 - March 2010
Karnataka. The core participants were PLHIV especially
positive women who are working as Volunteer Peer
Educators in the ACT program.
The theme was “Women – Being the change makers in
health and development”. This was an effort to educate
and sensitize participants on issues like reproductive
tract infection, cervical cancer prevention, second
line ART, government schemes, low cost nutrition -
preparation and demonstration, gender and enhancing
health seeking behaviour among the women. Women
Living with HIV discussed the issues with experts and
cleared up their misconceptions and doubts. Addressing
the interactive session, the resource person from St
John’s Hospital, Bangalore gave an overview on cervical
cancer, causes, risk factors as well as treatment methods.
Treatment options for cervical cancer were discussed.
Sessions on gender equality were also held. A medical
camp was organized and medical tests like blood group
and Hb were conducted for the Women Living with HIV.
Livelihood and HIV
Population Foundation of India, Manipur state unit
organized a state level exposition with the theme
“Empowerment through Participation”. The broader
goal of the exposition was to address the economic
needs of the PLHIV in the state. Resource persons
were from NABARD, Social Welfare, All Manipur
Entrepreneurs Association (AMEA), and a proprietor of
a small scale industry – Romi Bag Industries. Sessions
focused on information about government schemes,
capacity building and livelihood options for PLHIV.
The exposition provided a stage for SHG members to
exhibit their products and also an opportunity for them
to learn about ways to improve the quality of their
products in order to market them. The SHG members
also developed links with the government officials and
private entrepreneurs through the resource persons
who came as panelists for the exposition.
Empowerment and HIV
Population Foundation of India, Nagaland state unit
organized a state level exposition in Dimapur Town Hall
in collaboration with the Nagaland State AIDS Control
Society (NSACS) and Network of Naga People Living
with HIV/AIDS (NNP+) on 25th and 26th August 2009.
The theme was “Empowering People, Strengthening
Networks”. More than 120 PLHIV participated in
this exposition. The participants were widows and
widowers from various SDPs of Nagaland. Dr Neiphi
Kire, Project Director, NSACS was the Chief Guest.
This exposition provided PLHIV an opportunity to get
information on issues related to HIV/AIDS and livelihood.
Various DLNs, Treatment Support Centers, PLCs and
CCCs established under the ‘Access to Care and
Treatment’ program shared their best practices and
lessons learned. Resource persons from NABARD and
State Bank of India explained and informed participants
about various schemes available. Mr Paul, Deputy
Manger, State Bank of India facilitated a session on how
PLHIV can access banking, insurance and loan facilities
from banks. He also explained the loan system for SHGs.
Ms Guite, Assistant General Manager, NABARD, Dimapur,
gave a clear picture on various government schemes
available like Swarnjayanti Gram Swarozgar Yojana,
Prime Minister’s Employment Guarantee Program,
National Rural Employment Guarantee Scheme and
schemes of Khadi and Village Industry Commission
and Institute of Rural Development Planning. For SHGs,
she explained training options and livelihood options
connected with fisheries, piggeries, bamboo ginger,
forestry, oil, milk, bio mass, pineapple, tea among others.
National Consultation on “Promoting
Access to Care and Treatment”
Population Foundation of India organized a national
consultation on “Promoting Access to Care and
Treatment” from 9th to 11th December, 2009 at Vishwa
Yuvak Kendra in New Delhi. The state level expositions
culminated in this national consultation. The
consultation provided a platform for people involved
Dr. Kh. Pramod Kumar, PD (Technical), Manipur, SACS interacting in the program to share their experiences with a broad
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to a SHG member at the state level exposition organized by PGFI,
Manipur State unit
range of stakeholders and learn from each other.
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Dr Priyo Kumar from Jawaharlal Nehru (JN) Hospital,
Manipur mentioned that drug abuse is a vital problem
and initiatives like making Opioid Substitution
Treatment (OST) and needle exchange and having
recovery centers with trained manpower to handle
injecting drug users are ways through which HIV could
be combated in Manipur.
The session on “Community Based Care and Role of
PLHIV had direct interface with government and other Networks” was chaired by Dr Anjali Gopalan, NAZ
stakeholders for livelihood options and availing of Foundation. The session highlighted different aspects
social security schemes. Around 350 representatives of communities engaged in caring for, rehabilitating
from PLHIV networks from 14 states, where Population and normalizing the lives of those infected and affected
Foundation of India and its partner agencies by HIV. It also brought out some powerful stories of the
operate, participated in the event. Along with them, exemplary work being done by the Positive Networks
representatives from NACO and SACS, bilateral and both in creating awareness and helping positive
multilateral agencies, civil society, media and experts people lead a life of hope and dignity. The session
from the field of HIV also participated in the event.
highlighted the importance of Home Based Care in the
Ms Aradhana Johri, Joint Secretary, Department of AIDS
Control, Ministry of Health and Family Welfare, was the
Chief Guest and Mr Patrice Coeur-Bizot, UN Resident
context of a resource limited developing nation as it is
a less expensive form of providing care and support to
infected and affected people.
Coordinator and UNDP Resident Representative in
India was the Guest of Honour. Two documentary films
“With Your Head Held High” and “Something New in My
Life” were released by the Chief Guest, Ms Aradhana
Johri. In her inaugural address, Ms Aradhana Johri, said
“We are proud of our unique public private partnership
programme under the Global Fund. Our care and
treatment programmes running for the past four years
have turned the infection once considered a death
warrant to a chronically manageable disease.” The
Guest of Honour, Mr Patrice Coeur-Bizot highlighted the
human rights perspective to ensure universal access to
care and treatment. He mentioned that the country’s
program should aim to be “equitable, sustainable,
affordable, accessible and comprehensive.” Mr
Taufiqur Rahman, Regional Team Leader of the GFATM
announced approval for continuing the treatment, care
and support program for another six years.
On the second day, an important session on“Role of Law
in Promoting and Protecting Rights of PLHIV”was chaired
by Dr Alka Narang, UNDP. This session highlighted a
number of testimonials from PLHIV. J Niranjan from
Tamil Nadu State AIDS Control Society (TANSANS)
Legal AIDS Clinic explained how a Legal Aid Clinic for
PLHIV acts a mechanism for PLHIV to get professional
assistance for legal and non legal problems related to
their rights and for fighting stigma and discrimination.
The focus of the session was to draw attention to gaps
in the legal framework and to create sensitivity and
awareness about the basic human rights of PLHIV.
The session on “Social Security Schemes and Health
Insurance” was chaired by Dr Indrani Gupta, Institute of
Economic Growth. The session discussed at length the
need for having a strong social and insurance sector that
could cater to the needs of those infected with HIV. Dr
Nishant Jain from GTZ Health Sector Support provided
In the consultation, various sessions were held on information on Rashtriya Swasthya Beema Yoyana which
crucial issues related to HIV. The session on “Universal is available in 21 states in India. He mentioned that in
Access to Treatment, Care and Support” was chaired by future the scheme would also harmonize with existing
Dr Damodar Bachani, Deputy Director General, NACO. micro health insurance schemes and use smart cards for
The session highlighted important efforts made by the other purposes. Ms Debapriya Sen spoke about the PSI
Gujarat State AIDS Control Society (GSACS) in scaling Connect project based on building partnership models
up access to treatment, care and support in Gujarat. and strengthening systems in PPP in HIV/AIDS/TB.
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Access to
Care and Treatment
Annual Report April 2009 - March 2010
PLHIV were at the center stage of the national dissemination workshop was conducted by PFI in the
consultation. It also provided an opportunity for PLHIV month of April 09. Strategy analysis was conducted
to exhibit their talents. The national consultation with the ACT district teams, state teams and PFI (state
provided an opportunity where they could forget their and national level) to understand and attribute the
worries for few days and relax with their friends. PLHIV results to the ACT interventions. This analysis provided
from 14 states came together as a family, shared their useful insights on what worked, what did not and what
experiences, inspired and learned from each other. changes need to be made in the program.
Through singing, dancing and other cultural events
they made the consultation lively.
PFI conducted a special study between April to
December 2008 entitled “Continuum of Care for
International Women’s Day Celebration
The state unit of Population Foundation of India, Tamil
Nadu observed the International Women's Day on
19th March, 2010 with the theme “Equal rights, Equal
opportunities: Progress for all”. PFI collaborated with
the ART Center of Madras Medical College (MMC) to
organize the event. Around 64 women and seven men
living with HIV participated. Dr. Sekar, Sr. Medical Officer,
ART Center gave awards to Women living with HIV who
had adhered to treatment and regular health check-ups.
Injecting Drug Users (IDUs) including IDUs living with
HIV, in Imphal city, Manipur: Current Situation, Needs
and Gaps”. Key stakeholders such as NACO, Manipur
State AIDS Control Society, Nagaland State AIDS
Control Society, UNAIDS, USAID, CDC and other NGOs
participated in the results dissemination workshop
held in April 2009. In this workshop, key findings/
recommendations were presented at discussions to
operationalize the recommendations.
Technical Research Group
Three positive networks namely, Network for Chennai The Technical Resource Group (TRG) to provide
People Living with HIV/AIDS, Positive Friend’s Welfare guidance for conducting Special Studies, Operations
Association, Thiruvallur and Positive Women Network Research Studies and Program Evaluations for Round 4
were awarded for effective outreach activities. Women and Round 6 programs of PFI was re-constituted with
participated wholeheartedly in the event. The day 11 members in November 2009. These members have
ended with a hand print campaign. This hand printed rich experience in the field of HIV/AIDS research and
banner was displayed at the ART Center of Madras program implementation.
Medical College. A kit containing an umbrella, lunch box
and biscuit packets were given to all participants.
The first TRG meeting was held on 7th November 2009
at PFI. The meeting was conducted to discuss the
World AIDS Day
On World AIDS Day, Population Foundation of India,
Maharashtra state unit released printed IEC materials
(posters, greeting cards and a booklet containing songs
and poems) developed by PLHIV members. Dr. Kudalkar,
Project Director, MDACS and Dr. Maulik ART consultant
MDACS were invited as Chief Guests and together with
Mr. Anil Dalvi, Board Member of Network of Maharashtra
People Living with HIV (NMP+) were the honorable
guests at the event. The members of SHGs from Thane,
methodology for conducting evaluations of the Round
4 and Round 6 programs. Meetings were also held
on 3rd February and 16th March 2010 to discuss the
concepts and approach for conducting the evaluation
of Round 4 and Round 6 programs. The final concept
note with the methodology and sample selection has
been prepared based on the suggestions provided by
the members of the group.
Exercise on Monitoring and Evaluation System
Strengthening Tool (MESST)
Raigad and Mumbai DLNs participated in this program. The Global Fund Unit has been implementing
Monitoring and Evaluation
Dissemination Workshops
Monitoring and Evaluation (M&E) systems in the Round
4 and Round 6 programs. Following the approval of
the RCC grant, it was found necessary to assess the
PFI had conducted a study entitled “Potential for current Monitoring and Evaluation Systems to identify
32
Impact – Analysis of ACT Project” during December their strengths and weaknesses. These strengths and
2008 to January 2009. A two day strategy analysis and weaknesses would be addressed in the M&E systems to
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be developed for RCC and, therefore, allow for stronger
M&E Systems in place during RCC.
The MESST tool developed by the Global Fund for the
self assessment of Monitoring and Evaluation systems
has been administered.
Population Foundation of India organized a workshop
at the PFI office in New Delhi on 17th February, 2010. A
total of 37 participants from PFI and the Sub-Recipients
participated in the workshop. The participants
represented the Program Management Unit and the
state units of PFI and partner organizations.
amounted to USD 4,598,035. Overall, the cumulative
utilization amounted to USD 16,499,192 against the
cumulative receipt of USD 16,788,748 during the five
years of the program since commencement.
The four sub-recipients’, namely Freedom Foundation,
St. Josephs’Leprosy Hospital, Development Association
of Nagaland and Meetei Leimarol Sinnai Sang have
submitted their audited accounts up to 31st March
2010. Closure process of these sub-recipients’ will take
place in the next quarter and the closure report will be
submitted in the month of July 2010.
Some of the key strengths and weaknesses that
emerged from this exercise were as follows:
Strengths
Meetings and Workshops
2009 HIV/AIDS Implementers’ meeting was held in
Windhoek, Namibia from June 10th to 14th , 2009
The Management Unit has documented data on ‘Optimising the response: Partnerships for
management processes that enable it to meet reporting Sustainability’. The Global Fund was a co-sponsor of
requirements (i.e., establishing responsibilities and the Implementers’ meeting along with Office of the US
timeliness).
Global AIDS Coordinator (OGAS), UNAIDS and Global
A robust reporting system exists with the component
of individual/beneficiary tracking, as per overall M&E
plan within the overall framework of the project
Modules on peer education for basics of HIV, treatment
adherence and positive living has been developed by
PFI and its partner EHS.
network of people living with HIV/AIDS. Dr. Mary
Verghese, Project Director, PFI Global Fund Programs
participated in this workshop. The topics discussed
in the meeting were mostly related to women and
children, evolving challenges in treatment, care
and support and laboratory services, responding
to challenges in HIV prevention and effective HIV
Weaknesses
prevention with a focus on men having sex with men
There is non-availability of data in the public domain of (MSM)/Transgender, drug-users, prisoners and sex
National and State level agencies
workers, along with performance based funding and
State and district level officials of the program lack systems strengthening.
sufficient skills in data analysis
The ninth International Congress on AIDS in Asia and
PFI and its sub-recepients (SRs) also participated in the
national MESST consultation organized by NACO and
made a presentation on findings, strengths, weaknesses
and accordingly the measures for strengthening the
MESST of PFI during 18th to 19th Feb 2010.
The filled-in tools of MESST have been shared with
NACO on 17th February 2010. NACO further shared
these tools with all stakeholders in the country during
the national consultation (18th to 19th Feb 2010) for
MESST organized by NACO.
Grants Management
the Pacific (9th ICAAP) was held in the Bali International
Convention Center, Nusa Dua, Bali, Indonesia, between
9th to 13th August 2009. The theme of the conference
was ‘Empowering People, strengthening Networks’.
Two officials from PFI, the Manipur state coordinator
Archan Oinam and Aparna Gurukuntala from PMU
participated in the conference. The Manipur State
coordinator presented a paper on ‘Armed conflict
impact on HIV/AIDS program in Manipur, North East
India’ which talked about the contribution of ‘Access to
care and treatment’ (ACT) program under Global Fund
Round 4 in facilitating access to care and treatment
For the year 2009-10, PFI received a disbursement services to PLHIV through nine DLNs, five TCCs, two
of USD 3,454,405 from The Global Fund. In the same PLCs and one CCC established under the program in
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period, utilization of funds by the PR and the SRs the state.
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Access to
Lessons from the Program Care and Treatment
Annual Report April 2009 - March 2010
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• Coordination, technical support and transparent
engagement with partner agencies helped to
strengthen partnerships and achieve the project
deliverables.
• The ACT program is a community led intervention
and has been largely implemented by PLHIV. They
are willing and earnest. Continuous in-depth focus
on empowering the networks of PLHIV by assessing
the systems for program implementation, MIS, and
financial management has helped in improving
their pro-active thinking and enhanced their
capacities.
• Monitoring and mentoring the trained personnel
at the service delivery point is important to sustain
the capacity building efforts.
• Ensuring effective Public Private Partnership is
a considerable process. It involves developing
linkages with the community and government,
ensuring transparency and capacity building.
Sufficient lead time is needed to establish the
Corporate ART Centers – minimum time required is
about 6 months as every step has to be coordinated
with NACO and SACS.
• Coordination and regular interactions with NACO,
SACS, hospital authorities, ART Centers and other
stakeholders have helped in strengthening linkages
and smoothening district level implementation of
the program.
• Community involvement showed an increasing
trend in off-take of services. More PLHIV are
accepting their status and accessing services
supported by the DLN. DLN is providing need based
services with necessary support for adherence and
beyond. The emotional support through peers is
greatly appreciated and the ‘demonstration effect”
works well.
• Approaches for moving closer to the community,
for instance support group meetings and outreach
efforts at sub-district level are essential to address
the identified gaps, such as early testing and
entry into continuum of care, livelihood, stigma
and discrimination, nutritional support and
transportation.
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Annual Report April 2009 - March 2010
Financial Report
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Annual Report April 2009 - March 2010
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Photograph Credits
• Indian Network for People Living with HIV/AIDS
• Freedom Foundation
• EngenderHealth Society
• The Confederation of Indian Industry
• Population Foundation of India
Our Team
Mary Verghese
S Vijayakumar
Phanindra Babu Nukella
Rashmi Sharma
Aparna G
Mialn Rana
Leena Krishnan
Sanjeev Ranjan
Piyali Sarkar
Bijit Roy
Tripti Chandra
Shariq Jamal
Neeraj Mishra
Pardeep Kumar Sangwan
Rohini Gorey
K Balasubramanian
Everista Kapu
Archana Oinam
Vikas Panibatala
Alwin Leone Das D
Vivian S Correa
Vitsiatho Nyuwi
Parsad Kumar A
Yumnam Sanjay Singh
Neela Shanti
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POPULATION FOUNDATION OF INDIA
B-28, Qutub Institutional Area, Tara Crescent, New Delhi-110 016
Phone: +91-11-43894100 Fax: +91-11-43894199
Website: www.popfound.org