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Annual Report 2007-2008 HIV Global Fund Round 4 PFI |
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1 Pages 1-10 |
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AnnAunnaul aRl eReppoorrtt
The Global Fund Round 4 HIV/AIDS program
“Access to Care and Treatment (ACT)”
April 2007 – March 2008
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Annual Report
The Global Fund Round 4 HIV/AIDS program
“Access to Care and Treatment (ACT)”
April 2007 – March 2008
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Abbreviations
Abbreviations
ACT
AIDS
ART
ARV
CCC
CCM
CCSCs
CETC
CII
CMIS
DAN
DLNs
DNO
DOTS
EHS
EQAS
FF
GFATM
HIV
IDU
INP+
MIS
MoU
NACO
NGOs
OI
PAB
PFI
PHCs
PLCs
PLHA
PR
PTE
SACS
SDPs
SPCU
SGM
SLN
SR
TCCs
Access to Care and Treatment
Acquired Immuno-Deficiency Syndrome
Antiretroviral Therapy
Antiretroviral
Community Care Center
Country Coordinating Mechanism
Comprehensive Care and Support Centers
Continuing Education and Training Center
Confederation of Indian Industry
Computerised Management Information System
Development Association of Nagaland
District Level Networks
District Network Officer
Directly Observed Treatment (Short course)
EngenderHealth Society
External Quality Assurance System
Freedom Foundation
The Global Fund to fight AIDS, Tuberculosis and Malaria
Human Immunodeficiency Virus
Injecting Drug User
Indian Network for People living with HIV/AIDS
Management Information System
Memorandum of Understanding
National AIDS Control Organization
Non-Governmental Organizations
Opportunistic Infections
Project Advisory Board
Population Foundation of India
Primary Health Centers
Positive Living Centers
People Living With HIV/AIDS
Principal Recipient
Peer Treatment Educator
States AIDS Control Society
Service Delivery Points
State Program Coordination Unit
Support Group Meeting
State Level Network
Sub Recipient
Treatment Counselling Centers
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CCoonntteenntsts
Topic
1. Executive Summary
2. Genesis
3. Care and Support Services
4. Corporate Art Centers
5. Capacity Building
6. Program Management
7. Facilitation by the Global Fund
8. Learning
9. Case Stories
Page No.
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EExxeeccuutitviveeSuSmummamryary
The Global Fund Round 4 HIV/AIDS Program on Care and Support was initiated
in April 2005 by the NGO consortium led by PFI. Acces to Care and Treatment
program complemented the scale up of the Anti–retroviral treatment centers in
public health facilities across the six high prevalence states by National AIDS
Control Organization. The first phase of implementation established service
delivery points. The second phase of the program was commenced
in April 2007. District Level Networks of PLHA (DLNs) have
been strengthened in 127 districts across the six states and have
provided services to 114,454 PLHA. Forty Treatment Counselling
Centers (TCCs) have been set-up and are providing treatment
District Level Networks
adherence counselling. Positive Living Centers (PLCs) have been
of PLHA (DLNs) have
set-up in 10 districts and have provided services to 6888 PLHA
through counselling, medical care, psycho-social support and
outreach activities. Comprehensive Care and Support Centers
been strengthened in
127 districts across
(CCSCs) have been set-up in Trichy, Tamil Nadu; Bagalkote,
Karnataka and a Community Care Center (CCC) in Dimapur,
Nagaland in Phase-II. Training has been provided to 112 peer
the six states and have
provided services to
educators, 193 counsellors and 7 doctors in the program. Sixty
114,454 PLHA.
five NGOs have also been trained in home-based care. In
Phase-II, refresher trainings have been conducted for service
providers. Three Corporate ART centers have been set-up,
providing services to the larger community. Memorandum of
Understanding (MoU) with four corporate centers have been
signed for setting-up corporate ART centers.
Efforts are being taken to strengthen outreach activities from the service delivery
points. Community based activities like interaction meetings and expositions have
raised the motivation of PLHA to come together and discuss their problems with
service providers. The special studies conducted in this program have helped in
addressing the gaps.
Frequent interactions with the Sub-Recipients (SR) for programmatic and financial
matters have helped in strengthening program implementation. Meetings with
NACO and SACS have also benefited the program implementation. The subsequent
years will focus more on reaching out to PLHA who are still unreached.
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GGeenneesissis
The Population Foundation of India as Principal Recipient (PR) signed an
agreement with the Global Fund for Round 4 HIV/AIDS program “Access to Care
and Treatment - ACT”, in March 2005. The program is being implemented in the six
high prevalence states - Tamil Nadu, Maharashtra, Karnataka, Andhra Pradesh,
Nagaland, and Manipur. In this program, National AIDS Control Organisation
(NACO) provides Antiretroviral Treatment (ART) through State AIDS Control
Society (SACS) in each of the six high prevalence states and the NGO/private sector
provides care and support services to People Living with HIV/AIDS (PLHA). The
partner agencies involved in implementing the care and support component of this
program are Indian Network for People living with HIV/AIDS (INP+), Chennai;
Freedom Foundation (FF), Bangalore; EngenderHealth Society (EHS), New Delhi
and Confederation of Indian Industry (CII), New Delhi. With the scaling-up of
ART and increasing access for PLHA, St. Joseph’s Leprosy Hospital and HIV/
AIDS Care Center in Tamil Nadu and
Development Association of Nagaland
Phase-I
Phase-II
(DAN) in Nagaland have been sub-
April 2005 to
March 2007
April 2007 to granted to provide care and support
March 2010 services to PLHA. This five-year
program was initiated in April 2005.
Phase-I of the program covering the
Phase-I ended
March 2007
first two years have been completed
successfully and now we are in the
second phase of the program.
Goal: To improve survival and quality of life of people living with HIV/AIDS and
reduce HIV transmission in the six high prevalence states.
Objective: To reduce morbidity and mortality associated with HIV/AIDS and the
transmission of HIV in six high prevalence states by combining care, treatment
(including antiretroviral treatment), prevention and support.
Strategies:
• Linking PLHA on ART from the public treatment centers of the state to PLHA
networks at their district and sub-district level for treatment education and
treatment adherence, nutrition, income generation and addressing legal issues.
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• Setting-up and operationalising Care and Support Centers.
• Coordinating with National AIDS Control Organisation and State AIDS Control
Societies for coordinating program implementation.
• Providing NGO capacity building training to local organisations in the high
prevalence states.
• Partnering with other NGOs to develop education materials.
• Instituting operations research and advocacy programs.
Main Activities of the Program:
• Setting up-
— District Level Networks for People Living with HIV/AIDS
(DLNs).
— Treatment Counselling Centers (TCCs),
— Positive Living Centers (PLCs).
— Comprehensive Care & Support Centers (CCSCs), and
— Corporate ART Centers.
• Capacity building of peer educators, social workers, counselors,
health care providers and NGOs.
• Conducting Operational Research studies/special studies.
Access to Care and
Treatment is a community
driven program with
emphasis on Greater
Involvement of People
Living with HIV/AIDS.
Achievements in Phase-I (April 2005—March 2007):
In Round 4 Phase-I HIV/AIDS program, care and support services were provided
to 68,739 PLHA through 102 District Level Networks (DLNs). 25 Treatment
Counselling Centers (TCCs) were established at public ART centers. 3167 PLHA
have been provided services through five Positive Living Centers (PLCs) and
two Care and Support Centers. Two corporate ART centers were established to
provide ART services. Capacity of 819 service providers including 151 master peer
educators has been enhanced to provide care and support services. The Phase-I of
the program was completed in March 2007.
ACT is a community driven program with emphasis on greater involvement of
People Living with HIV/AIDS. A sizable number of PLHA have been involved
in the planning and implementation of the program. Through this participatory
method, training and research activities, the program has touched the lives of
many. It has increased awareness and infused self-confidence in PLHA.
Entering Phase-II:
Since the inception of the program in April 2005, 127 DLNs, 40 TCCs, 10 PLCs,
5 CCCs and 3 corporate ART centers have been set-up, strengthened and are
providing services to PLHA in the six high prevalence states.
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CCaarreeaandndSuSpupporptoSretrvSiecervs ices
Service Delivery Points Established in the Program
District Level Networks (DLNs)
Through this program 127 DLNs have been established and 113,047 PLHA have
been enrolled in these DLNs. Out of a total of 113,047 enrolled PLHA, 37,832
PLHA are on ART. Average enrollment at each DLN has increased from 617 to
890 in last one year.
PLHA Enrolled at DLNs
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Activities at DLN
The key activities of the DLN are counselling, conducting Support Group Meetings,
Peer Treatment Education training and defaulter tracing. DLN conducts three
Support Group Meetings every month at the taluka level. Participation in these
meetings enables PLHA to come together and share their experiences. They
are educated and counselled for treatment adherence, home based care services,
positive living, nutrition, tests and treatment options, preventive behavior and
human rights. They are linked with other service delivery sites for legal aid,
nutrition support for children and various government schemes.
Group discussion–Support Group Meeting Display discussion—PTE Training
DLNs are organizing trainings for Peer Treatment Educators (PTE) twice in a
year. The Master Peer Treatment Educator and Treatment Access and Education
Officer after receiving training from EngenderHealth Society (EHS) train PTEs.
Trained PTEs follow up and refer PLHA to the DLNs. They also assist Treatment
Access and Education Officer to conduct SGMs. They attend SGMs and facilitate
other PLHA to come for the meeting.
Peer Convention
State level networks of INP+ have
conducted two peer conventions in
each of the states. The convention
forms a platform for get-together of
peer educators and is represented
equally by males and females. These
conventions provide them a stage to
share their experiences and to discuss
State level Peer Convention
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issues like drug adherence, regular use of condom, side effects, home based
care, advocacy etc.
Exposition
A two day exposition in each of the six states was organised. Near about 100 PLHA
from the DLNs participated. It was envisaged that the event would enable a better
understanding of care and treatment, disseminate the learnings and promote the
concept of positive living through various activities.
The state unit of Maharashtra, PFI along with Maharashtra Network of People
Living with HIV/AIDS (MNP+) organized an exposition to celebrate International
Women’s Day by involving Women Living with HIV/AIDS (WLHA) from DLNs of
Maharashtra. The idea was to bring women together and provide them a platform
The state unit of
Maharashtra, PFI along
with Maharashtra
Network of People
Living with HIV/AIDS
(MNP+) organized an
exposition to celebrate
International Women’s
Day.
Exposition held at Maharashtra
where they could receive information on the issues related to HIV and treatment.
There were sessions on Income Generation Programs and vocational training,
inheritance rights of women and treatment and adherence. These sessions were
facilitated by representatives from Chaitanya and Kasturbha Gandhi College,
Lawyers Collective and National AIDS Research Institute (NARI). The DLNs
enacted street plays, displayed handicrafts and participated in the cultural events.
Rangoli and poster competitions were also held. It also provided a feeling of
belongingness and an opportunity to share and encourage each other.
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Promoting Access to Treatment
Campaign
INP+ had organized the “Promot-
ing Access to Treatment” Campaign
across six states. This campaign
has helped in increasing awareness
and knowledge among the key dis-
trict level government functionaries,
other stakeholders and people living
with HIV on care, treatment, positive
prevention and services available.
Interaction Meeting
Interaction meetings with the service providers, care givers and PLHA were conducted
at the district levels in coordination with the DLNs. These meetings helped SDPs
in strengthening linkages. It also gives an opportunity for PLHA to bring out their
problems and seek support from the service providers. Some of the interaction meetings
were organized within the premises of government hospitals which helped the DLN to
improve rapport with the ART center and other departments of the hospital.
MIS Review
MIS reviews are conducted periodically
every quarter by INP+. The purpose of
the review is to check data quality for
reporting.
Good Practices
• The State Social Welfare Board,
Nagaland has provided financial
assistance to the State Level
Network for the preparation and
distribution of nutritious diet to the
PLHA.
MIS Review
• Kolhapur DLN has prepared snake and ladder game for providing life skills
education to adolescent group.
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• Thane DLN has started a Self Help
Group of 16 women. Each member of
the Self Help Group contributes Rs.50/-
a month towards savings. The savings
are being used for Income Generation
Programs (IGP) such as preparation
and selling of food items and dress
materials.
• The Inner Wheel Club of Deonar,
Mumbai is supporting the nutritional
needs of 3 Women Living with HIV/
AIDS for three months.
Life skill education kit prepared by
Kolhapur DLN.
Treatment Counselling Center
Forty Treatment Counselling Centers have been set-up in this program and are
placed in the ART health facilities. The TCCs have complemented the government
ART center in providing group and individual counselling on treatment adherence.
The TCC staff receives the defaulters list from the ART centers. These cases are
being followed-up on an on-going basis through the DLN outreach.
Out of the 7886 defaulters’ cases provided by the ART center, 19% were met and
41% of them reported back to the ART center.
Status of Defaulters
1.60%
49.70%
18.70%
11.80%
Met
Incorrect address
Out of Station/Migration
Death
Not met
Others (Specify)
13.70% 4.60%
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Good Practices
• Adherence monitoring has improved after the initiation of the coordination
meetings with ART center staff, NGOs and networks.
• Lost to follow-up cases have been traced out with the help of DLN through
telephone calls, letters and home visits.
• Discordant couples were counselled at the TCCs to discuss positive prevention
practices with the couples.
• ART center at Sassoon Hospital, shares the list of defaulters with the TCC every
month. TCC coordinates defaulter tracing with Thane and Mumbai DLN. Out
of the list of 171 defaulters DLNs were able to trace out 145 clients.
Positive Living Center (PLC)
Major activities done through the PLCs:
• Treatment for minor Opportunistic Infections (OIs), psychological support,
outreach activities for promotion of preventive behavior, treatment education
and adherence.
• PLC conducts Support
Group Meetings. In
these meetings a group
of PLHA are taken
through a seven session
module which focuses
on—basics of HIV,
hygiene, home-based
care, yoga, nutrition,
legal support, linkages
etc. The trained PLHA
act as peer educators in
their respective areas
after completing the
module.
Greeting cards prepared by children at Pune PLC
• Nutritional supplement, educational support, life skill education and recreational
trip for infected and affected children.
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• Networking with local stake holders like Government Hospitals, Primary
Health Centers, Taluk Hospital, ART Centre and NGOs to access care and
support services.
• Advocacy to sensitize the stake holders for referral.
• PLC, Pune, Maharashtra has formed 10 children’s clubs in 7 different
communities. They trained children on life skills education using Family
Health International Module. In addition activities like puppet shows, story
telling, movie, birthday celebration etc. were also carried out.
A trading company has agreed to support 60 children (Rs 250 per child per
month) for their nutritional requirements. Currently PLC is providing
nutritional support to 50 children. PLC also has obtained support from local
advocates and “Mahila Suraksha Samiti” (a committee of 6 people - 2 police,
2 NGO representatives and 2 lawyers) for legal issues of PLHA.
Comprehensive Care and Support Centers
Out-patient and in-
patient services to PLHA
are being provided from
the
Comprehensive
Care and Support
Center run by Freedom
Foundation at Guntur
in Andhra Pradesh and
St. Joseph’s Leprosy
Hospital & HIV/AIDS
Care Center at Tuticorin
in Tamil Nadu. Two
more CCSCs were setup
by Freedom Foundation CCSC at Bagalkot
during the year. The
centers are in Trichy, Tamil Nadu since December 2007 and Bagalkot, Karnataka
since February 2008. PFI has also sub-granted to Development Association of
Nagaland to run a 10 bedded Community Care Center at Dimapur in Nagaland.
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Centers at Guntur, Trichy
and Bagalkot have a
capacity of 50 beds and
the center at Tuticorin has
a capacity of 20 beds. The
range of services available
at the center include clinical
management, psychosocial
and nutritional support.
The services are provided
free of cost from these
centers to PLHA.
The centers at Guntur,
Trichy, Bagalkote, and
Tuticorin are equipped with CCSC at Trichy
basic lab equipment to conduct investigations for bio-chemistry tests along with
microscopic examination of urine and sputum. All other investigations are referred to
the Government Hospitals. Emergency Ambulance Services are also available in
these centers.
Opportunistic Infections (OIs) are taken care of at the center and clients in need
of specialised treatment are referred to high level of care. TB cases are referred to
the DOTs center for evaluation and treatment.
Recreation facilities like in door and out-door games, television and newspapers
are provided to PLHA in the centers. Activities like gardening, cleaning and
walking around the campus for relaxation, yoga, physiotherapy exercises are also
undertaken for the PLHA.
In case, any PLHA who is admitted in the care center is disowned by the relatives
and happens to breathe his/her last at the center, the center performs the last rites
of the deceased PLHA.
Demand Generation Through Community
Sensitization Activities
• Over 9000 people including VCTC counselors, anganwadi workers, municipal
corporation members, lorry drivers and the staff of Andhra Pradesh State Road
Transport Corporation depots, workers in industries like Coca Cola, TATA Motors,
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Kumar Piston Pumps etc., were sensitized by Guntur CCSC
through awareness generation programs on HIV/AIDS.
In the first month of its
establishment, CCSC
has received 29 referrals
• Government of AP has constituted a special legislative forum
on HIV/AIDS. The members of the forum were oriented on
HIV/AIDS and the services available at CCSC, Guntur. The
members also had an exposure visit to the CCSC.
from ART, 7 from DLN
and 23 referrals from
• Over 600 people including Red Cross members, SHG members,
auto drivers and railway porters were sensitized by the staff of
Trichy CCSC.
NGOs.
• The Bagalkote CCSC has developed linkages with ART Center,
DLNs, PLC, NGOs, government officials like District Collector,
Superintendent of Police, District Health Officers, ART medical
officers in-charge and staff of private labs and medical colleges,
journalists and many more. In the first month of its establishment, CCSC has
received 29 referrals from ART, 7 from DLN and 23 referrals from NGOs.
• The Development Association of Nagaland’s Community Care Center has
started demand generation activities through various NGOs and hospitals
by conducting community sensitization programs. 15 villages were covered
where 200 people were sensitized on HIV/AIDS and facilities available at the
center. The center has established linkages with the Nagaland SACS and
other organisations such as State Bank of India (SBI), Army Wife’s Welfare
Association (AWWA), Self Help Groups (SHGs) and local NGOs.
Good Practices
• Laboratory—External Quality Assurance Scheme (EQAS): The bio-chemical
tests performed at CCSCs are validated by CMC—Vellore through enrollment
into their EQAS.
• Bio-waste Disposal: The disposal of hospital waste generated at CCSC was
a challenge in Bagalkote as there has been no recognized agency to collect
the waste. Kumareshwar Medical College with the consent of Pollution
Control Board has agreed for bio medical waste management. The Municipal
Corporation has placed a dust bin near the CCSC for solid waste.
• Advocacy efforts have resulted in bringing down the commercial electricity
tariff charges to subsidize rates for Comprehensive Care and Support Center in
Guntur.
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• As an outcome of advocacy efforts, private hospitals and diagnostics centers
like NRI Institute of Medical Sciences, Guntur, and Kumareshwara Medical
College, Bagalkote have agreed for providing investigations and specialized
opinion services to PLHA at very subsidized costs.
• Advocacy efforts of CCSC, Trichy with the railway department have enabled
the railways to telecast an audio-visual on the services available at CCSC at
Trichy Railway Stations free of cost.
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Corporate ART Centers
Corporate ART Centers
Corporates have played an important role in scaling-up
interventions for HIV/AIDS prevention, care and treatment.
Through this program, Confederation of Indian Industry
(CII) advocated with corporates to set-up corporate ART
centers. CII has facilitated the setting-up of 3 corporate ART
centers. As result of advocacy and coordinatin of CII, NACO
is providing free ARVs, Rapid test kits and OI drugs to the
Corporate ART Centers.
The corporate ART centers set-up at Wadi,
Karnataka with the support of Associated Cement Companies Ltd., and at
Ballarshah, Maharashtra with the support of Ballarpur Industries
Ltd., Maharashtra in Phase-I of the program is providing care and sup-
port services. During Phase-II (Year 1) of the program, with the sup-
port of Associated Cement Companies and Christian Medical College,
Vellore, Tamil Nadu, one more ART center has become operational at CMC,
Vellore. These centers provide counselling, opportunistic infections management
and ART services.
Four more corporate ART centers have been identified and MoUs have been signed
between CII and the corporates to run the activities from those centers. However,
there have been certain procedural delays in the formal site assessment and sign-
ing of MoUs between the corporate agencies and NACO for free ARVs, Rapid test
kits and OI drugs.
A Corporate ART Center has provision for the following services:
1. Trained human resource (Doctor, nurse, laboratory technician, counsel-
lor, record-keeper, health assistant, peon/ward boy, ambulance driver)
2. Basic laboratory equipment and reagents for diagnosis of HIV, OIs &
STIs, and for monitoring ART related side-effects
3. CD4 count machine for initiating and monitoring treatment
4. An uninterrupted supply of ARVs (first line regimens)
5. Drugs for prophylaxis and treatment of OIs
6. Counselling services to ensure psychosocial support and treatment
adherence.
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BILT ART Center at Ballarshah,
Distt. Chandrapur, Maharashtra
The unit of Ballarpur Industries Ltd (BILT) is located at
Ballarshah which is one of the high prevalence areas for HIV/
AIDS in the country. BILT has a hospital, Voluntary Counselling
and Testing Center (VCTC) and an ART center. The ART
center is situated within the hospital premise and is open to the
community. The center is equipped with machines and equipment
including CD4/ CD8 cell counting machine. Up to March 2008,
634 individuals have been counselled and 208 PLHA have been
put on ART. The center has referral linkages for specialised
services/in-patient admission. The BILT ART center also receives
blood samples from the Chandrapur Government ART Center for
CD4 testing. The center stands as an example for public private
partnership.
The center is
equipped with
machines and
equipment including
CD4/CD8 cell
counting machine.
BILT ART center at Ballarshah
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CCaappaacictiytyBuBiludiilndging
Capacity building is a vital component in this program. EngenderHealth Society
(EHS) has developed training modules in Phase-I of the program. They provide
training to various categories of service providers through the Continuing
Education and Training Centers (CETCs) set-up in Chennai, Tamil Nadu; Mysore,
Karnataka, and Imphal, Manipur. The objective is to increase the number of
NGO sector providers capable of delivering quality care and support services in
accordance with the national guidelines.
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Continuing Education and Training Centers (CETCs)
In Phase-I, EngenderHealth Society had established two
Continuing Education and Training Centers (CETCs) to train
counsellors, social workers, master peer educators and health
care providers (doctors, nurses, paramedics). The CETC, Swami
Vivekananda Youth Movement (SVYM) Mysore, Karnataka
trains the service providers in the program from the states of
Karnataka and Maharashtra and DESH in Chennai, Tamil Nadu
trains the service providers in the program from the states of
Andhra Pradesh and Tamil Nadu. In Phase-II, EngenderHealth
Society has identified Diocesan Social Service Society (DSSS),
Manipur for setting-up a CETC to cover the states of Nagaland
and Manipur. A web-based MIS system is in place to track the
trainings at these centers.
112 master peer
educators, 193
counsellors, 15 health
care workers and 7
doctors have been
trained from various
service delivery points.
Training of Service Providers
112 master peer educators, 193 counsellors, 15 health care workers and 7 doctors
have been trained from District Level Networks, Treatment Counselling Centers,
A Training session on nutrition & ART at Maharashtra
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Positive Living Centers and Comprehensive Care and Support Centers. 65 NGOs
from six states have also been trained on home-based care.
Refresher Trainings
Refresher training for service providers was seen as an essential area in Phase-II.
Topics for the refresher trainings were identified through a consultative process to
provide trainings for peer educators and counsellors. The topics include: Second
line ART drugs, Nutrition, Bereavement Counselling, HIV and TB, Opportunistic
Infections, HBV and HCV Co-infection, Positive Prevention, Children living with
HIV and counselling, sexual and reproductive health for People Living with HIV/
AIDS, how to use the flip charts, checklist and training skills. Five batches of peer
educators and 7 batches of counsellors have been provided with refresher trainings
where 69 peer educators and 130 counselors participated.
Dissemination of Training Material and Job Aids
The training curricula, flip charts and adherence check lists developed in Phase-I
have been shared with project partners and other stakeholders including WHO,
NACO, State AIDS Control Societies, networks for people living with HIV, com-
munity based organizations and national and international NGOs working on HIV
prevention, treatment, care and support.
Home based care training for Health Care and field workers
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Program Management
Program Management
The Program Management Unit at New Delhi and the State Program Coordination
Units (SPCUs) of Population Foundation of India along with the partner agencies
are instrumental in implementing the ACT program for the past three years and
have established systems for managing and monitoring the program.
• Project Advisory Board (PAB) constituted by PFI for the
program, meets at regular intervals. Experts from the field
of HIV/AIDS, partner agencies and PFI’s Board members
constitute the PAB. They review the program and suggest cor-
rective measures.
• At national level, NACO and PFI review the program
quarterly. The quarterly reviews help in understanding and
solving issues related to policy and implementation of the
program at the national and state levels.
• Regular interactions with partner agencies at the national
level have been conducted. These meetings have resulted
in improved coordination between Principal Recipient and
partner agencies and helped in identifying gaps in the
program. Possible strategies have been worked out to bridge
the identified gaps.
The Review
Meetings with the
PFI state units have
been organized
regularly on a
quarterly basis.
• The Review Meetings with the PFI state units have been organized regularly on
a quarterly basis.
o The Coordination, Planning and Review meeting with the State Program
Units of Population Foundation of India (PFI) and Indian Network of People
Living with HIV/AIDS (INP+), was held in April 2007. The focus of the
meeting was to discuss the achievements and challenges faced in Phase-I
and plan for Phase-II.
o A four day joint Review and Planning Meeting for the Global Fund
Round 4 ‘Access to Care and Treatment – ACT’ and Round 6 ‘Promoting Ac-
cess to Care and Treatment – PACT’ Program was conducted at Bangalore
in January 2008. The national, state and regional program teams of Round
4 and Round 6 participated in the meeting. The purpose of the meeting
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State Coordination
Units of PFI have
initiated review
meetings with partner
agencies and SDPs in
their respective states.
was to share the experiences of Round 4 and Round 6 teams
and the progress made in the respective regions. Sessions
on basics of HIV/AIDS, counselling, care and support and
stress management were also undertaken in addition to the
regular progress review.
• State level program coordination committees have been formed
with respective State AIDS Control Societies in the six states.
The state level committee reviews the program at state level
and sorts out issues on program implementation. The Project
Directors of SACS chair the meeting which is convened by the
PFI State Coordinator.
• Apart from conducting SACS coordination meetings, PFI State
Coordination units have participated in meetings organised by
SACS. Some of them are state level partners meeting, Donor’s
Steering Committee, Coordination Meeting with ART Consultants and Monitor-
ing and Evaluation Committee. In these meetings the teams discussed about
the program activities and coordination and linkage issues.
• State Coordination Units of PFI have initiated review meetings with partner
agencies and SDPs in their respective states. These meetings helped SDPs to
learn from each other and utilise the
learnings in streamlining the activities.
• Tamil Nadu SPCU has initiated zonal
performance review meetings for the
ACT Program while the northeastern
states (Nagaland and Manipur) have
started their combined review meetings.
• Besides the regular visits from partner
agencies to the service delivery points
(SDPs), PFI state teams have support-
ed the SDPs to build their capacity in
terms of technical, managerial, finan-
cial and reporting skills. The PFI state
team has facilitated the implementa-
tion of MIS and CMIS at SDP level.
IEC Needs Assessment Workshop at
Chennai
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IEC Material Development
While implementing the program need for proper IEC materials
was felt for peer educators. A workshop and series of meetings
on Common Minimum Program (CMP) and IEC was held with
national team and state level networks of INP+. The workshop
brought out the key requirements and messages for the IEC
materials to be developed.
PFI with INP+ has facilitated and the development the IEC mate-
rial. The prototypes of IEC material have developed keeping in
view the need of peer educators.
PFI state units also
observed the “World
AIDS Day” on Dec
1, 2007 along with
SACSs and state level
networks (SLNs).
Observation of World AIDS Day on
1st December, 2007
On the occasion of World AIDS Day, Population Foundation of
India organized a staff meeting to discuss on issues involving prevention of HIV/
AIDS and care and support services among People Living with HIV/AIDS. On this
occasion, PFI team had arranged a street play where PFI staff, representatives
from key civil society organisations and local stakeholders (taxi/auto unions,
street/local vendors) from the adjoining areas participated. PFI state units also
observed the “World AIDS Day” on Dec 1, 2007 along with SACSs and State level
networks (SLNs).
Grants Management
During the year 2007-08, an amount of USD 5,588,842 was received from the
Global Fund. During the same period, utilisation of funds by PR and the SRs
amounted to USD 3,557,642. Overall, for the three years of the program since
commencement, the cumulative utilisation amounted to USD 7,307,621 against a
cumulative receipt of USD 9,350,283.
The Grants Department conducted Workshop on Grants Management in the
beginning of Phase-II which helped the partners in understanding the budget and
utilisation implications. PFI shared their experience as Principal Recipient on
“Coordination to Ensure Good Reporting – Issues, Challenges and Practices” in the
workshop conducted by the Global Fund in July 2007 for South Asian Countries.
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Monitoring and Evaluation
Trainings on MIS and CMIS
The Monitoring and Evaluation system for effective implementation of the program
was further strengthened by conducting various trainings for MIS and CMIS.
Participation of DLN staff in MIS Refresher Training
Two days MIS and
CMIS refresher
training was
organized by PFI for
central and state level
teams of INP+.
Two days MIS and CMIS refresher training was organized by PFI
for central and state level teams of INP+. Refresher trainings on
MIS were conducted for 115 DLNs. Trainings were also conducted
for the staff of the newly established service delivery points in the
year.
External Program Evaluation
The external program evaluation to review the program performance
for Phase-I was completed in April 2007. The team submitted
their report providing recommendations and suggested corrective
measures for the program.
External MIS Audit
The second round of external MIS audit was conducted for assessing the quality of
the program data and assist partner agencies to improve the quality of reporting.
During the second round, audit was undertaken to determine the improvement in
the data quality systems among the DLNs that were audited in the first round and
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to assess the quality of data among other DLNs that had not undergone the first
round of audit. The audit covered a total of 24 DLNs which included 9 DLNs which
had undergone first round audit and 15 new DLNs.
Special Studies
Three special studies conducted by PFI were disseminated in a satellite session
at the Asia Pacific Conference of Sexual and Reproductive Health held in October
2007 in Hyderabad. The three special studies are:
i) Assessing PLHA Expectation regarding Care and Support Services with a view
to strengthen networks of PLHA
ii) Understanding Support Group Meetings of People Living with HIV/AIDS
iii) Setting-up Guidelines for providing Care and Support Services including
Palliative Care for People Living with HIV/AIDS.
PFI instituted two studies in year three of the program. The description of the
studies is as follows:
Study Title Client Satisfaction at Positive Living Centers
Study Area Andhra Pradesh, Karnataka, Tamil Nadu, Maharashtra,
and Nagaland
Positive Living Centers provide care and support through health services,
outreach interventions, and by building linkages with existing services and
programs. When clients experience quality healthcare and their health
improves, they feel more satisfied. Client satisfaction has been characterized
as both a rational evaluation of, as well as an emotional reaction to, the
quality of care, that is, to the structure, process, and outcome of services.The
objective of the study was to understand the client satisfaction with respect
to services received at five PLCs in the program area. Exit interviews from
beneficiaries taking services from these centers were conducted. The research
was conducted by the state teams of PFI. The feedback from the study would
form an integral part of improving the quality of service delivery for PLHA.
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Study Title
Towards an integrated Continuum of Care (CoC)
for Injecting Drug Users (IDUs), including People Living
with HIV, in Imphal, Manipur: Situation Assessment of
Services and Action Plan for CoC
Study Area Imphal, Manipur
Manipur is one of the worst-affected HIV/AIDS epidemic
state in Northeast India. Studies have shown very high
risk behaviors among IDUs in Manipur with a significant
proportion sharing needles and equipment. HIV positive IDUs
in Manipur have a very high prevalence of Hepatitis-B virus
(HBV) and Hepatitis-C virus (HCV). Anecdotal evidence and
program experiences show that there is a lack of full range of
services and treatment options for IDUs; inadequate coverage
of IDUs in Imphal through existing services; lack of effective
referral linkages of existing services for PLHA; and lack of
comprehensive and effective strategies for reducing stigma and
discrimination against drug users and PLHA. Consequently,
these gaps can ultimately affect the effectiveness of HIV
prevention and drug-dependence treatment programs in
Imphal, Manipur. With the goal of having an integrated
continuum of care for IDUs, including those living with HIV
in Imphal, Manipur, PFI has commissioned a study with the
following objectives:1. To assess the current situation of the
various drug- and infection- related medical/non-medical
services (Govt./NGOs/CBOs/Networks, and Private sector)
available for IDUs, including PLHA, in Imphal, Manipur.
2. To develop an action plan to implement an integrated CoC
plan for IDUs including identification of appropriate pathway
of referrals across the various services in Imphal.
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FFaacciilliittaatitoionnbybtyhethGeloGbalol bFuanldFund
• As part of monitoring program, the Local
Fund Agent (LFA) team had visited the
states of Tamil Nadu and Nagaland.
The Executive Director, The Global
Fund to Fight AIDS, TB and Malaria
(GFATM) Prof. Michel Kazatchkine,
and Chairman, The Global Fund
Board, Mr. Rajat Gupta, along with
Team Leader, Mr. Taufiqur Rahman
and a team of The Global Fund visited Vice-Chair CCM, Mr. K.K. Abraham
India from 18–21st December, 2007.
The team visited the state of Tamil
shared his experience and expectations of
CCM at the Global Fund Consultation in
Nadu as part of their field program. New Delhi
The team also participated in the
NGO meeting organised by SATHHI,
PFI and INP+ in Chennai. A reception
dinner was hosted by PFI for the team
on 21st December 2007 in Delhi in
which the Governing Board Members of
PFI, Project Advisory Board Members
and all the sub-recipients of Round 4
and Round 6 participated.
• Mr. David Addison from the Office of Dr. Mary Verghese, Project Dircetor,
Inspector General, The Global Fund shared PFI’s experience with the Civil
visited the PFI office as part of the Society at the Global Fund Consultation
program audit on 2nd of November 2007. He conducted a detailed review of the
program, MIS and finance of the Global Fund Round 4 and Round 6 programs.
• Two day meeting of Private Sector Partnership to fight against HIV/AIDS,
Tuberculosis and Malaria was organized by the Global Fund in New Delhi on
13-14th December, 2007. The Global Fund partners in the South and West
Asia cluster, NACO, CCM, UNAIDS, ILO and representatives from the private
sector participated in the meeting.
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• The Global Fund organised a conference on Financial
Management under Performance-Based Funding from 25 to
27 July, 2007 in Hotel Oberoi, Kolkata, India. Many countries
presented their experiences in implementation of the program.
PFI shared their experience as a Principal Recipient from
India on ‘Coordination to Ensure Good Reporting – Issues,
Challenges and Practices’ in the workshop. TGF also had
a mock exercise on how to fill the Performance Update and
Disbursement Request which was well appreciated by the
participants.
• WHO South East Asia Region organised a workshop in
Bangkok to address the issue of capacity development in
grant negotiation and implementation in collaboration with
The Global Fund South West Asia cluster. The workshop
deliberated on the problems faced by countries in grant
negotiation and implementation. Representatives from Iran,
Nepal, Pakistan, Srilanka, Maldives, and Thailand attended
the conference. Population Foundation of India and Tata
Institute of Social Sciences as NGO Principal Recipients
participated in the workshop.
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LLeeaarrnniningg
• ACT project has facilitated the networks to build-up their
capacity to implement and manage the program.
• Coordination and frequent follow-up with NACO, SACS, ART
centers and district hospital authorities have helped in smooth
implementation of the program.
• Community sensitisation programs like interaction meetings
and exposition at district level has enhanced the motivation
level of PLHA to come together and discuss their problems
with the service providers.
There is a need
to have a strong
outreach strategy
and frequent home
visits for lost to
follow-up cases.
• There is a need to have a strong outreach strategy and frequent
home visits for lost to follow-up cases.
• It takes time for corporates to set-up the ART centers as it involves a lot of
planning and coordination with NACO and SACS for site assessment and
signing of MoU for free ART drugs.
• Effective coordination amongst ART centers, District TB center, other public
health facilities and District Level Networks helps in providing quality care and
support services to a large number of PLHA from the service delivery points.
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CCaasseeSStotorierises
After knowing the
status, Mari had
compelled his wife to
divorce and remarry.
But his wife didn’t
agree.
Mobile Chaat (Snack) Shop at Marina Beach
Mari (name changed) is a 30 year old man living in Triplicane
(Chennai) and is a member of the Chennai Network of Positive
People since 2006. His wife and two children (a boy and a girl)
are HIV negative. Since 2005, the couple faced many difficulties
when Mari’s HIV status came into light. The family refused to
accept the couple.
After knowing the status, Mari had compelled his wife to divorce
and remarry. But his wife didn’t agree. In this situation, the
couple approached the network and through proper counselling
and guidance, they have become regular participants of support
group meetings. With support of DLN, the couple was sanctioned
an amount of Rs. 7000 to start a shop. They decided to start a
Mobile Chaat Shop at Marina Beach. They are pioneers among
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the PLHIV community to start this initiative. Today, the couple is able to meet
their daily needs and live a happy life independently. Mari is a role model for
other PLHIV: a PLHIV who follows positive prevention and positive living till
date. He has also repaid the loan completely.
Treatment Counselling Center, Churachandpur, Manipur
Treatment Counselling Centers have been established at the
public ART centers by the Indian Network for People Living
with HIV/AIDS (INP+). TCCs are managed by peer counselors.
The focus of these centers is to improve drug adherence by
providing treatment education and counselling. Being managed
by community members, there is sharing of experiences of living
with HIV and linking them to the district level networks (DLNs)
for care and support services. In this way TCC acts as a bridge
between the community and the service providers.
Churachandpur TCC under the Round 4 ACT Project has been
actively engaged in strenghthing the linkages and referrals between
the ART center, DLN & NGOs operating in the district.
Treatment
Counselling
Centers have been
established at the
public ART centers by
the Indian Network
for People Living with
HIV/AIDS (INP+).
Be Positive (Vennila’s story – in her own words)
I am Vennila; I am a 29 year old woman living with my
three sisters in Vepanamputhur village, a few kilometers
from Namakkal district in Tamil Nadu. My father is in
real estate business and my mother is a house wife. I
got married in 1997, when I was doing my graduation.
My husband owned a lorry and was driving it at times.
I have a 9 year old son. Currently, I am working as
In-charge Counsellor in Treatment Counselling Centre at
Namakkal.
In 2001, my husband was very sick. He was tested for HIV and was found positive.
The doctors asked me and my son to take the test too. I was found HIV positive
and my son was negative. When they told me I was HIV +, I thought it is probably
a kind of blood group. During the counselling session at the Voluntary Counselling
and Testing Center (VCTC), they explained to me about HIV/AIDS.
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I was in complete shock and even before I could understand the
implications of the test in my life, my husband passed away – it
took only two months time. In all those times of sadness, there
After the death of my
was one comfort – my son’s HIV status was negative.
husband, my in-laws
were not supportive
After the death of my husband, my in-laws were not supportive
and were not willing to share the property with me and my son.
My parents supported me.
and were not willing to
For me, the biggest challenge was accepting my own HIV status –
share the property with as after my husband’s death, I believed that there was no purpose
me and my son.
in living. My son was my only hope and reason to continue to
live. My mother, who is my biggest strength, motivated me to
study further. I voluntarily worked for an NGO, Anbukarangal,
as an Outreach Worker providing service for PLHIV in 2001. I
joined a support group of people living with HIV - HIV Ullor Nala
Sangam (HUNS) in 2003. This was a moving experience. I had
friends who were positive too and I felt that I am not alone. When INP+ became
a partner in the ACT program, I got involved with the program. As I am a good
speaker and could make friends easily, they chose me to be the peer treatment
counselor.
In early 2006, after joining the Treatment Counselling Centre, I recieved my first
training on Treatment Education for counselors/social worker training on ART
& Adherence provided by EHS. I was trained as the master trainer through the
trainings of Engender Health Society focusing on HIV treatment education and
counselling. I also was part of the follow-up training which was provided in late-
2007. Training in my mother tongue Tamil helped me and my team to improve
our counselling skills on ART, adherence, side effects, resistance and positive
living for PLHIV. The follow-up training helped me to understand the various
opportunistic infections and the second line drugs.
The knowledge and information gained through EHS’s trainings helped me
to provide better counselling to PLHIV. The training also made me address
my own issues regarding treatment adherence and helped me to lead a better
quality of life.
Living with HIV for many years, I would like to say that if one has proper
information, HIV is like any other long term illness like Diabetes or Hypertension—
we can also continue to live just like others. Life is the same for everyone—a
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varied mixture of happiness and sorrow. As a positive person, I
am able to think positively at any point of time, even in the worst
situation, my confidence level can equal or is even much better
than a person without HIV.
My aspirations are high; I want to be a role model for the entire
HIV positive community in the country or may be even the world.
I am currently on first line drugs for HIV. I take it as if it is my
only option. I am completely committed to adhering to drugs so
that I can postpone taking the second line drugs as far as possible.
I am hopeful that I can see my son graduating from college and
making his life better—this keeps me going and I don’t miss my
drugs.
My life with HIV
has taught me to
move beyond these
boundaries.
I was a simple village woman and my house and my family was
my boundary. For me, nothing existed beyond them. My life with
HIV has taught me to move beyond these boundaries and while
taking care of my son, I am also able to help people like me—who are HIV positive
to live healthy lives.
Second chance at life—Sankari’s story, Chennai, Tamil Nadu
My name is Sankari. I am 32 years old and living with HIV. For several years I
suffered in silence but now, as a peer educator, I speak out and have the opportunity
to give others the second chance of life that was given to me. My journey began ten
years ago, when my life was changed forever.
My husband fell ill in 1998, so the doctors tested him for HIV and he was found
to be positive. A week later I learned I also had HIV. We were both shocked—we
didn’t know much about HIV, but we knew that our lives were at stake. There was
no counselling from the doctors. I felt that we were completely alone.
We didn’t disclose our HIV status to family or friends for the first three years
because we didn’t know how they would react. During this time, we were confused
and afraid. We didn’t know where to go for information as seeking information
on HIV/AIDS could give away our status. We finally had the courage to tell our
families about our HIV status. But our fears came true. They did not support us.
We were forced out of my in-laws’ house. So we set out on our own in the city of
Chennai.
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After participating in
trainings conducted by
EngenderHealth Society,
I now counsel other
people living with HIV
on how to manage the
disease.
By 2002, my husband’s condition was deteriorating. Fortunately,
he was able to get antiretroviral treatment that brought him back
from near-death. It was the most challenging thing I had ever
faced. But we quickly learned how powerful this treatment could
be and that people living with HIV can live longer.
I was able to get treatment and manage my HIV, but I needed
support and guidance. I became part of the Indian Network
of People Living with HIV/AIDS (INP+) and eventually a
peer educator. After participating in trainings conducted by
EngenderHealth Society, I now counsel other people living with
HIV on how to manage the disease and adhere to their treatments.
I always find time to tell them that I am HIV-positive too and
sometimes visit people at their homes, to ensure that they feel
safe. I have also trained other peer educators working in the field
to counsel clients on HIV treatment.
After testing positive, one thing has changed—I appreciate my life better. I have
a daughter, and today I dream for her to have a position that is far better than
mine. I believe that life’s experiences make you stronger. I started off working
as a candle-maker and now I am a peer counselor. Each day I look forward to
meeting people who are looking for information on HIV treatment because I know
how they feel—waiting for someone to take away their pain. I cannot explain the
happiness I get in bringing a spark of hope to people who are living with HIV—it’s
like magic.
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Photo Credits
Indian Network for People Living with HIV/AIDS (INP+)
Freedom Foundation
EngenderHealth Society (EHS)
The Confederation of Indian Industry (CII)
Population Foundation of India (PFI)
With Contributions from
Mary Verghese
S. Vijayakumar
Subrat Mohanty
Phanindra Babu Nukella
Rashmi Sharma
Aparna G.
Milan Rana
Rohini Gorey
Abhiram Mongjam
K. Balasubramanian
Everista Kapu
A.S. Kulloli
Vikas Panibatala
Alwin Leone Das D.
Vitsiatho Nyuwi
Vijaya P. Kanase
Prasad Kumar A.
Yumnam Sanjoy Singh
Neela Santhi
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B-28, Qutab Institutional Area, Tara Crescent,
New Delhi - 110 016
Tel.: 011-42899770, Fax: 011-42899795
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