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PFI Global Fund ACT Project Annual Report 2005-2006 |
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POPULATION FOUNDATION OF INDIA
Message
From the desk of the Executive Director
It gives me immense pleasure that The Global Fund Round 4 Program, "Access to Care and
Treatment (ACT)" has completed its first year of implementation. The program is a
partnership between the public and private sector on HIV/AIDS care and support in the 6
high prevalence states of India namely, Maharashtra, Andhra Pradesh, Karnataka, Tamil
Nadu, Manipur and Nagaland. National AIDS Control Organization (NACO) is providing
Antiretroviral Treatment (ART) through the public health facilities. NGO/private sector
consortium is providing care and support to people living with HIV/AIDS (PLWHAs). The
program aims at improving survival and quality of life of people living with HIV/AIDS and
reducing HIV transmission.
The primary role of NGO/Private sector is to provide care and support focusing on PLWHAs
who are put on ART by the national program. The main activities of the program are
strengthening district level networks (DLNs) of PLWHAs to provide care and support services.
DLNs identify PLWHAs to be trained as peer educators for providing education on treatment
adherence, nutrition and other related issues. DLNs also advocate on medical, economic and
legal issues. Treatment Counselling Centres (TCCs) are established within the premises of the
public ART centres. In TCCs, individuals and family members are counselled and linked to
the larger care and support services for follow up. Positive Living Centres (PLCs) provide basic
primary health care facilities for PLWHAs, address the needs of infected and affected women
and children and create an enabling environment through advocacy and multi-sectoral
linkages. Comprehensive Care & Support Centre (CCSC) provides care and support services
including palliative care. Corporate sector is also involved in the project to advocate setting
up of ART centers at corporate health facilities. Capacity building of counsellors, social
workers, health care workers, peer educators and field staff of NGO/CBO staff is done through
the program.
Detailed information about the program, our efforts, targets, achievements and lessons learnt
are part of this Annual Report. I hope this report will facilitate sharing of experiences and
lessons learnt to all who are providing care and support services to PLWHAs.
A.R. NANDA
Executive Director
Population Foundation of India
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POPULATION FOUNDATION OF INDIA
Acknowledgement
The Global Fund Round 4 “Access to Care and Treatment - ACT” program is being
implemented in the six high prevalence states of India. Through the ACT program, care and
support services are provided to people living with HIV/AIDS. The first year of the program
is completed and most of the targets have been achieved successfully.
The progress of the past year has been the result of the contributions of the partner
organizations - Indian Network for People living with HIV/AIDS, Freedom Foundation,
Confederation of Indian Industry and EngenderHealth Society. Our sincere thanks to them.
Our profound thanks to the Governing Board, the management of PFI and the Project
Advisory Board members, who have been providing timely guidance and support to the
program.
We are grateful to National AIDS Control Organization and State AIDS Control Society
officials, staff at tertiary and district ART centers, and NGOs, for their cooperation in steering
the project ahead.
We would like to thank the Project Management team and state coordination teams at
Population Foundation of India, for their sincere efforts in managing the program.
We would like to acknowledge the contribution of the Global Fund for supporting the
program, addressing the needs of the people living with HIV/AIDs. This program is directly
touching the lives of people and it is our endeavour to continue to do so in the coming years.
In implementing the program, we have been having close interactions with the people living
with HIV/AIDS. While we have been doing our best, it is THEY who have understood,
accepted and kept their best foot forward in accepting and welcoming the program. It is
needless to say, that the entire credit goes to them.
DR. MARY VERGHESE
Project Director
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Contents
Overview of HIV/AIDS Epidemic in India
Access to Care and Treatment - ACT
Care and Support Services
Corporate Health Facilities Providing ART Services
Capacity Building
Program Management
Learnings
Finance Report
POPULATION FOUNDATION OF INDIA
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POPULATION FOUNDATION OF INDIA
Abbreviations
ACT
AIDS
ART
CBO
CCSC
CII
CSW
DLN
DOTS
EHS
FF
HIV
GFATM
IDU
IEC
INP+
M&E
MoU
MPE
NACO
NGO
OPD
PAB
PFI
PLC
PLWHA
PMU
PPTCT
SACS
SDP
STD
TB
TCC
PTE
VCTC
WHO
Access to Care & Treatment
Acquired Immuno Deficiency Syndrome
Anti Retroviral Therapy
Community Based Organization
Comprehensive Care and Support Center
Confederation of Indian Industry
Commercial Sex Worker
District Level Networks
Directly Observed Treatment Short-course
EngenderHealth Society
Freedom Foundation
Human Immuno Deficiency Virus
The Global Fund to Fight AIDS, Tuberculosis and Malaria
Injecting Drug Users
Information, Education & Communication
Indian Network for People living with HIV/AIDS
Monitoring & Evaluation
Memorandum of Understanding
Master Peer Educator
National AIDS Control Organization
Non-Governmental Organization
Out Patient Department
Project Advisory Board
Population Foundation of India
Positive Living Center
People Living with HIV/AIDS
Project Management Unit
Prevention of Parent To Child Transmission
State AIDS Control Society
Service Delivery Point
Sexually Transmitted Disease
Tuberculosis
Treatment Counselling Centre
Peer Treatment Educator
Voluntary Counselling & Testing Centre
World Health Organization
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POPULATION FOUNDATION OF INDIA
The National Health Policy (NHP 2002) and
India Vision 2020 commits the country to fight
against all communicable and preventable
diseases. With increasing life expectancy,
contemporary public health scenario in India
indicates two dominant trends - an
epidemiological transition towards greater
incidence of non-communicable/life style diseases
and the growing challenges of communicable and
preventable diseases now accentuated by
HIV/AIDS. The Millennium Development Goals
(MDGs) commit all countries to reverse the spread
of HIV/AIDS by 2015. As a signatory, India stands
committed to achieve this goal through its
National AIDS Control Program.
Overview of
HIV/AIDS
Epidemic in India
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POPULATION FOUNDATION OF INDIA
HIV/AIDS EPIDEMIC IN INDIA
Since the first report of HIV infection in India in
1986, the virus has spread all over the country
although there is geographic variation. According
to NACO the number of HIV infected persons in
India is estimated to be 5.2 million with a total
prevalence of 0.91% in 2005, the second largest
in the world. Over the years, the virus has moved
from urban to rural and from high risk to general
population in all the states and Union Territories
(UTs) increasingly affecting women and the youth.
The main transmission route continues to be
heterosexual (85%). Both HIV serotypes 1 and 2
exist in India and HIV-1 C is the commonest sub-
type reported. Spread of HIV in intravenous drug
use settings is localized mostly in the north-
eastern region and metropolitan cities. Parent to
child transmission is also on the rise. Dual
epidemics of HIV and tuberculosis, increase in the
number of infected women, stigma and
discrimination are the main concerns in the Indian
HIV/AIDS scenario.
DISEASE BURDEN
During 2005 there were estimated 5.2 million HIV
infections in the country and out of this 38.4%
were women and 57% of these infections were in
rural areas. HIV infection among STD population
group has been found to be 1.7 million in
comparison to 1.33 million during 2004. An
overall prevalence of HIV infection among adult
population is observed to be 0.91% during 2005.
(Nagaland and Manipur) predominantly by
injecting drug use. These six states with a
combined population of 291 million accounts for
almost 84% of the total 67,416 AIDS cases-
reported in the country as of February 2004.
RESPONSE TO THE CHALLENGE
India's initial response to the HIV/AIDS challenge
was in the form of setting up an AIDS Task Force
by the Indian Council of Medical Research (ICMR)
and a National AIDS Committee (NAC) headed by
the Secretary of Health. In 1990 a Medium Term
Plan (MTP 1990-1992) was launched in four
states, namely, Tamil Nadu, Maharashtra, West
Bengal, and Manipur and four metropolitan cities,
i.e., Chennai, Kolkata, Mumbai, and Delhi. The
Medium Term Plan facilitated targeted IEC
campaigns, establishment of surveillance system
and safe blood supply.
In 1992, the Government launched the first
National AIDS Control Program (NACP-I) with an
IDA Credit of US 84 million dollars and
demonstrated its commitment to combat the
disease. NACP-I was implemented during 1992-
1999 with an objective to slow down the spread
of HIV infections so as to reduce morbidity,
mortality and impact of AIDS in the country. To
strengthen the management capacity, a National
AIDS Control Board (NACB) was constituted
and an autonomous National AIDS Control
Organization (NACO) was set up to implement the
project.
The highest prevalence rates in the adult
population are reported in six states, four Southern
states where the transmission is predominantly
heterosexual (Tamil Nadu, Maharashtra, Karnataka,
and Andhra Pradesh) and two North-Eastern states
The key outcomes of the project included capacity
development at state level in the form of State
AIDS Cells (SAC) in 25 states and seven Union
Territories, a well functioning blood safety
program aimed at reducing HIV transmission
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POPULATION FOUNDATION OF INDIA
through blood, expansion of HIV sentinel
surveillance system, collaboration with non-
government organizations on prevention
interventions and intensified communication
campaigns. During this period bilateral
partners like USAID (Tamil Nadu), DFID (Andhra
Pradesh, Gujarat, Kerala, Orissa, and West
Bengal) and CIDA (Karnataka and Rajasthan)
also implemented focused programs successfully
and contributed to the state and national
level efforts.
In November 1999, the second National AIDS
Control Project (NACP-II) was launched with
World Bank credit support of US 191 million
dollars. Based on the experience gained in Tamil
Nadu and other states and the evolving trends of
HIV/AIDS epidemic, the focus shifted from raising
awareness to changing behavior, decentralization
of program implementation to the states and
greater involvement of NGOs. The policy and
strategic shift was reflected in the two key
objectives of NACP-II:
• To reduce the spread of HIV infection in India.
• To increase India's capacity to respond to
HIV/AIDS on a long-term basis.
The aim was to keep: (i) HIV sero-prevalence
below 5% of adult population in high prevalence
states, (ii) below 3% in states where prevalence
was moderate and (iii) below 1 and 2 per cent in
the remaining states where the epidemic was at a
nascent stage.
During NACP-II, a number of policy initiatives
were taken. These included adoption of National
AIDS Prevention and Control Policy (2002),
National Blood Policy, a strategy for Greater
Involvement of People living with HIV/AIDS
(GIPA), launching of the National Rural Health
Mission, National Adolescent Education
Programe, provision of Anti-Retroviral Treatment
(ART), formation of inter-ministerial group for
mainstreaming and constitution of the National
Council on AIDS chaired by the Prime Minister.
(Data Sources: HIV Sentinel Surveillance, NACO; Behavioral
Surveillance Survey (BSS), NACO; AIDS Case Surveillance,
NACO; STD Surveillance, NACO; Census of India, 2001;
UNAIDS and WHO, 2003.)
“My husband passed away just few months back, I am on ART
and my child is negative. It was very frightening to lose my
husband, but my father-in-law supported me, he even
encouraged me to be the part of the network - I have laughed
cried and learnt with my friends here”.
— A PLWHA
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POPULATION FOUNDATION OF INDIA
Access to
Care and
Treatment
- ACT
The Global Fund Round 4 HIV/AIDS program in
India contributes to the global "3-by-5"
initiative launched by WHO/UNAIDS. The
resources from the Global Fund are enabling
access to free Anti-Retroviral Treatment (ART) for
People Living with HIV/AIDS (PLWHAs) through
public-private partnerships, with wider
engagement of civil society.
The Global Fund Round 4 Program is a public -
private sector partnership where the National
AIDS Control Organization (NACO) provides free
Anti-Retroviral Treatment (ART) at the public
health facilities. The Population Foundation of
India led NGO/Private Sector consortium provides
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POPULATION FOUNDATION OF INDIA
ongoing care & support and follow-up services
to PLWHAs. This care and support program is
titled "Access to Care and Treatment (ACT)"
and is being implemented in the six high
prevalence states of India. The first phase of the
program is for two years from 1st April 2005 to
31st March 2007.
GOAL
This program aims at improving the survival and
quality of life of people living with HIV/AIDS and
reducing HIV transmission.
2. Care & support services are provided to
PLWHAs through NGO/Private sector
consortium in the six high prevalence states.
PRINCIPAL RECIPIENTS
1. NACO is the Principal Recipient of funds for
the public sector activities.
2. Population Foundation of India is the Principal
Recipient of funds for the NGO/Private sector
activities.
NGO/PRIVATE SECTOR CONSORTIUM
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.
STRATEGY
1. ART is provided at the public teaching, tertiary
and district hospitals through the NACO
program.
GF supported states India
PMU
Nagaland
Manipur
Maharashtra
Karnataka
Andhra Pradesh
Tamil Nadu
The organizations responsible for implementing
the program are:
• Population Foundation of India (PFI)
• Indian Network for People living with
HIV/AIDS (INP+)
• Freedom Foundation (FF)
• EngenderHealth Society (EHS)
• The Confederation of Indian Industry (CII)
The Population Foundation of India (PFI) is the
Principal Recipient for the program. Indian
Network for People Living With HIV/AIDS (INP+),
Freedom Foundation, EngenderHealth Society and
Confederation of Indian Industry (CII) are the sub-
recipients to implement the program. PFI is
responsible for managing the program and grants,
conducting operation research studies, monitoring
and evaluating the program and is responsible for
the overall deliverables to the Global Fund. INP+
and Freedom Foundation are responsible for
providing care and support services to PLWHAs.
CII is responsible for advocating with the
corporate sector in order to facilitate the
corporate sector health facilities to provide ART
services. EngenderHealth Society (EHS) is
responsible for capacity building activities.
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Care and
Support
Services
Three things that Rani (PLWHA)
considered very important to
make a person adhere to a
regime are:
z Proper information - both
positive and negative
implications
z Self-motivation to live
z Peer support
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The care and support model followed in the
program is depicted below. All the service
delivery points are linked to each other for
PLWHAs to access services. The District Level
Networks (DLNs) of PLWHAs form the core of
the program in terms of scale of operations and
in providing care and support services.
Activities
Program and Grants Management
Monitoring and Evaluation
District Level Networks (DLN)
Treatment Counselling Centre (TCC)
Positive Living Centre (PLC)
Comprehensive Care & Support Services (CCSC)
Capacity Building
ART Services at Corporate Sector Health facilities
Health Smart Card Feasibility Study
Agencies
Population Foundation of India
Indian Network for People Living with HIV/AIDS (INP+)
Freedom Foundation
EngenderHealth Society
Confederation of Indian Industry (CII)
District Level Networks (DLNs) of
PLWHAs - Civil Society Organizations
Indicator
Number of district
level networks of
PLWHA-civil society
organizations
strengthened and
actively engaged
in providing
care & support
to PLWHAs
Number of PLWHAs
enrolled in care and
support services
provided by civil
society
organizations
Targets
Results
(Apr 05-Mar 06) (Apr 05-Mar 06)
60
60
14,400
18,019
Indian Network for People living with HIV/AIDS
(INP+) is setting up 102 District Level Networks
(DLNs) in 138 districts in the six high prevalence
states for providing care and support services.
Each DLN comprises of a District Level Network
Officer (DNO), counsellor and a social worker. The
main activities of the DLN are to provide
counselling, support PLWHAs on ART to adhere to
treatment through Peer Treatment Educators,
conduct support group meetings and refer
PLWHAs to other service delivery points.
Enrolment of PLWHAs in District Level
Networks (DLNs)
The primary activity of District Level Network is to
enroll PLWHAs both on ART and not on ART.
60 DLNs have been set up in the first year of the
ACT program and 18,019 PLWHAs have been
enrolled in care and support services provided by
the district level networks. The following bar
diagram provides a state-wise representation of
PLWHAs enrolled. The DLNs have been
strengthened in a phased manner across the states.
In the states like Andhra Pradesh, district level
networks have been established in most of the
districts. In the other states, as more number of
DLNs are being established, the PLWHAs are
informed of the services provided by the DLNs
accounting to the increased enrollment. Relatively
lower enrolment in North-eastern states is because
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State-wise Enrollment of PLWHAs in DLNs
the program was initiated in Manipur by quarter 3
(Oct-Dec,05) and in Nagaland by the quarter 4
(Jan-March,06) of the first year. In Nagaland
the networks are in their infancy and requires
strengthening.
PFI state office in Nagaland, in coordination
with Nagaland SACS organized an exposure trip
for the DLN members along with ART
counsellors to Namakkal ART Centre in Tamil
Nadu, in order to understand the roles,
responsibilities and functioning of the networks
and treatment counselling.
Counselling
The counsellor at DLN counsels PLWHAs to cope
better with the infection. Counselling enables
PLWHAs to make informed decisions in managing
their physical and psychological needs, prevent
secondary infection, adopt safe sex practices and
adhere to treatment.
Counselling is also provided to family members,
care providers and supporters. This helps in
alleviating fear, increases acceptance and support
to PLWHAs.
Support Group Meetings (SGMs)
Besides other activities, every month District Level
Networks (DLNs) organize Support Group
Meetings (SGMs) for PLWHAs.
Support group meetings serve multiple purposes.
It is one of the entry points for PLWHAs to the
networks. Support group meetings provide a
platform for PLWHAs to socialize, share and
receive information, psychological and emotional
support, develop new friends, know about
government schemes, develop self-confidence and
enhance self-esteem. PLWHAs are made aware of
their rights. Linkages for legal aid and other
welfare services are facilitated where possible.
Family members of PLWHAs, care providers and
supporters are also encouraged to participate in
the meetings. This helps in reducing stigma and
discrimination. Some DLNs are conducting the
meeting at taluk level (taluk is a block below the
district). This helps to reduce travel time, money
and other physical problems. In many SGMs,
local service providers serve as resource persons
and provide information to PLWHAs.
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SGM also increases the visibility of the epidemic
and strengthens networks of PLWHAs. This also
facilitates in influencing policy, benefiting PLWHAs
at large. For example, the advocacy activity of the
DLN in Namakkal, Tamil Nadu, resulted in age
relaxation of widows living with HIV from 40 to
21 years to access widow pension schemes.
Peer Education
The main focus of peer education is on treatment
adherence. The staff of the DLN identify peer
18%
4% 0%
34%
7%
Andhra Pradesh
Karnataka
37%
Maharastra
Manipur
Nagaland
Tamil Nadu
Trained Peer Educators
educators during counselling and support group
meetings.
The District Level Network Officer is the master
peer educator. He trains treatment peer educators
who are PLWHAs. The treatment peer educator
visits other PLWHAs on ART. He monitors and
educates them about treatment adherence, shares
experiences about ART, refers them for availing
services from DLN and other centres, promotes
positive living and safe sex practices.
Referral linkages
Some DLNs have prepared a district resource map
and maintained a resource diary so that they can
refer PLWHAs to various service delivery sites
according to the needs of the people.
Good Practices at DLNs
• In Trichy district, Tamil Nadu, the DLN staff
motivated PLWHAs who are economically
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District Level Network, Bellary, Karnataka
This is a case study of a District level Network in the ACT program which has provided services for
PLWHAs by networking with different organisations, besides counselling, referring and conducting
support group meetings. Nearly 50 PLWHAs got loans in the form of materials to carry out income
generation activities. Accounts officer reported that 98% of PLWHAs are repaying the loan amount
promptly. As a result of networking, nearly 500 infected and affected children are getting free
books and uniforms. The DLN officials co-ordinated effectively with District Health Authorities and
other NGOs. This enabled them to implement the program successfully.
Thanjavur DLN, Tamil Nadu
With the support of the hospital authorities, the DLN is conducting weekly street plays on
prevention, voluntary counselling and testing, care and support and positive living at the outpatient
department of the hospital. This DLN also obtained approval from the State Government to form
Self Help Groups (SHGs). Presently there are 10 groups, each consisting of 12 members with 75%
PLWHAs. Eight groups have got approval for a loan of Rs.25000/ to start self-employment. This is
an example where both PLWHAs and non-PLWHAs are the members of the same SHG due to
reduced stigma and discrimination.
well-off and unwilling to join the network to
support the DLNs in cash or kind. Eight
PLWHAs came forward to contribute hundred
rupees each. This amount of eight hundred
rupees was utilized for the education and
nutrition of children of PLWHAs.
• Some DLNs negotiated with local NGOs for
employment of PLWHAs. The staff of Madurai
DLN facilitated four PLWHAs to get employed
as field workers in the ICMR research survey
for a period of six months. Three more
PLWHAs were placed in an NGO as field
workers. The DLN also invited leaders from
faith-based organizations to deliver lectures
on spirituality and peace of mind. This was
welcomed by the participants.
• In Theni, Tamil Nadu and Sangli, Maharashtra
DLNs convene quarterly coordination
meetings with VCTC counsellors and nearby
NGOs in the DLN office to discuss referrals
and other issues. These meetings help
DLNs to identify new PLWHAs and build
linkages.
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• DLN provides lunch during support group
meetings. It was suggested to DLNs that for
making support group meetings livelier and
informative, they could demonstrate some
nutritional recipes and distribute the same to
the members in the meetings rather than
offering tea and snacks. Many DLNs have
adopted this practice. It sensitizes PLWHAs to
cook locally available nutritious recipes at
affordable cost.
• Guntur DLN, Andhra Pradesh has sensitized
Anganwadi Workers to increase the
awareness activities in the villages and refer
PLWHAs to the networks. This helps in
reducing social stigma.
• Some DLNs have initiated yoga classes, Self
Help Groups and income generation program
for PLWHAs. Many DLNs have also
established linkages with government social
welfare department so that PLWHAs, widows
and those below poverty line can access and
avail social welfare schemes.
Challenges
• PLWHAs from different sectors of society have
come together to form networks. Their
capacity needs to be enhanced for
understanding various components of the
program and managing the activities at
different levels.
• In many places, establishing a premise for the
district level network is a challenge. The
house owners and the neighborhood feel
uneasy to have an establishment of positive
people in their vicinity.
• The geographical location, frequent strikes and
conflicts in Manipur and Nagaland make the
implementation of the program challenging.
Treatment Counselling Centre (TCC)
Indicator
Targets
Results
(Apr 05-Mar 06) (Apr 05-Mar 06)
Number of ART health
10
10
facilities providing
treatment counselling
PLWHAs on ART need counselling and social
support at various stages in order to adhere to life
long treatment. INP+ has set up Treatment
Counselling Centres (TCC) at the public
tertiary/district hospitals providing ART to
strengthen the counselling services. The
counsellors provide treatment education,
individual/group counselling and family
counselling. They prepare clients to accept their
status, motivate them to adhere to treatment and
provide social support by referring them to the
respective DLNs.
There are three counsellors at each TCC – two
counsellors and one peer counsellor. One of the
counsellors is the TCC incharge and is responsible
for the overall documentation and reporting,
besides providing counselling.
Treatment Education and Counselling
The counsellors in the centre provide information
and counsel the PLWHAs to make informed
decisions. Information is provided on
opportunistic infections (OIs), OI prophylaxis, anti-
retroviral drugs, side effects, treatment options,
importance of adherence, viral resistance and
positive prevention while on ART.
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Referrals
Good Practices at TCCs
Clients are linked with the respective district level
networks for further follow-up. In DLNs, the
treatment peer educators provide further
assistance for those who require information on
ART, drug adherence and side effects. TCC
counsellors also refer PLWHAs to other services,
when needed.
The first TCC was established at Namakkal, Tamil
Nadu in June 2005. It is located within the ART
centre of Government General Hospital,
Namakkal. 1319 PLWHAs availed services from
the TCC in the first year. Out of 1319 PLWHAs,
998 clients were on ART. The centre has
witnessed 99.7% treatment adherence. One of
the main reasons for high adherence level is the
good coordination and relationship with the
clinical team, hospital management, TCC
counsellors and the DLN.
The centre provides peer counselling, individual
and group counselling services to the clients. It
also links PLWHAs to DLN for follow-up and
monitoring adherence.
• The TCC staff conduct group sessions during
OPD hours regularly. The peer counsellor
provides information, discusses issues and
clarifies myths and misconceptions. The peer
counsellors in some TCCs, volunteer to guide
PLWHAs to access different departments in
the hospital.
• Many TCCs have good linkages with the
surrounding DLNs. This helps in monitoring
the adherence, of people who are on ART and
in following up with the defaulters.
• TCC counsellors also visit the ART ward along
with the ART Medical Officer and provide
counselling services to PLWHAs and their
family members.
• Some TCCs have developed linkages with
other NGOs for the basic requirements of
PLWHAs like nutrition and medical care.
Challenges
• Treatment counselling centres are in demand.
Time is required for coordination between
SACS and the hospital authorities for approval
in setting up a TCC within the ART premises,
as space is a constraint in many of the
hospitals.
• Follow up of defaulters is evolving in some of
the centres and this needs to be further
strengthened.
Positive Living Centre (PLC)
Indicator
Number of PLCs
providing care &
support services
Number of people
receiving care &
support
Targets
Results
(Apr 05-Mar 06) (Apr 05-Mar 06)
2
1
260
346
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private, voluntary), laboratories, VCTC, NGOs,
professionals (police, lawyers, social workers),
government departments, associations (trucking
associations, industry associations, trade unions,
community organizations) and PLWHAs.
The Positive Living Centres are envisaged to
provide basic primary health care facilities,
address needs of infected and affected women
and children and provide an enabling
environment through advocacy and multi-sectoral
linkages.
The first PLC under round IV was established
by INP+ at Bagalkot district, Karnataka in
December 2005.
The team at PLC consists of project manager,
centre manager, accountant, part time doctors,
paramedic staff, social worker, centre counsellors,
field counsellors, out/reach workers and part time
consultants.
This mapping exercise has helped the PLC staff to
have a clear idea about other service providers.
This would enable PLWHAs to access services.
Education
H
W
C
Health & Medicine
Social Acceptance
Human Rights & Legal
Information collected during resource
mapping
Orientation and Capacity Building of
PLC Staff
The Project Officer, INP+, oriented the newly
recruited staff to the activities of the PLC. The
counsellors and social workers of the PLC
attended a 5-day training program organized by
EngenderHealth Society at Bangalore in February
2006. The out-reach workers and counsellors
insisted the Indo Canadian HIV/AIDS Project
(ICHAP) for exposure to fieldwork, communication
skills and dealing with sensitive issues.
Building Linkages
The PLC team invited the VCTC counsellors to
orient them to the services being provided by the
PLC. This initiative has strengthened the linkage
between PLC and VCTC.
All the NGOs in Bagalkot are part of the BDP
(Bagalkot Demonstration Project) and they meet
once in a month to discuss about the progress of
Resource Mapping Exercise
A mapping exercise was done to collect
information from key-informants and service
providers such as doctors, hospitals (government,
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the project. The PLC team made a presentation in
the meeting held in March' 06. This helped to
create awareness about the PLC services in the
local community. The PLC team also solicited
referrals from other NGOs.
The Centre Manager and the Counsellor visited
Hubli TCC and ART centre to strengthen the
linkages and referrals
The Program Officer along with the Project
Manager of PLC met the Member of the
Legislative Assembly (MLA - publicly elected
political leader) and briefed about the PLC
services.
Sensitization Meetings
PLC team along with ICHAP conducted a program
for gram panchayat members on March 12, 2006
to create awareness about HIV/AIDS as well as
service providers. More than 200 participants
attended the meeting
Support Group Meetings
PLC conducts support group meetings every
month. Members of each SGM attend meetings
for a period of six months. The PLC staff provide
adequate information and build their capacity
during this period. The group is then dissolved.
Each member of the group returns to their
respective taluk/village and further organizes
support group meetings at the local level.
This has enabled PLWHAs to avail the medical
services at the PLC.
Comprehensive Care and Support
Centres (CCSC)
Indicator
Targets
Results
(Apr 05-Mar 06) (Apr 05-Mar 06)
Number of CCSC
1
1
providing care &
support services
including palliative
care
Number of people
165
185
receiving care &
support/palliative
care at CCSC
Freedom Foundation is setting up Comprehensive
Care and Support Centres (CCSCs) for providing
comprehensive care and support services
including palliative care. A centre had been
established at Guntur district of Andhra Pradesh.
Due to the initial delay in setting up the CCSC,
Freedom Foundation provided services from the
Hyderabad unit. This decision was taken
collectively after the quarterly Andhra Pradesh
State Coordination Committee meeting. The
Guntur centre started providing services since
February 2006. The centre currently has a
capacity of 37 beds.
Resource Mobilization
The staff of PLC submitted a proposal to
Karnataka Health Promotion Trust (KHPT) seeking
support for drugs. In response to this, KHPT has
provided drugs for opportunistic infection/Sexually
Transmitted Infections worth Rs. 5 lakh to the PLC.
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POPULATION FOUNDATION OF INDIA
Demand Generation Activity
Counselling services
Freedom Foundation invited 80 NGOs along with
the District Leprosy Officer, District TB Officer,
PPTCT incharge, Medical Officer - ART, DLN
President and PFI state coordinator for a meeting
on December 22, 2005 to inform them about the
services provided from the Guntur centre.
Medical Facilities
The centre presently has a capacity of 37 beds.
Both out-patient and in-patient services are
available at the centre. A regular OPD is run on
each day of the week. The centre has one doctor
specialized in chest diseases. OIs are managed at
the centre. Tuberculosis cases are referred to the
district tuberculosis units for evaluation and
treatment.
Counsellors provide pre and post-test counselling.
They also counsel on risk reduction, positive living,
ART adherence, death, grief and bereavement
counselling through individual and family
counselling sessions.
Laboratory Services
The centre has set up a laboratory for basic
biochemistry tests along with microscopic
examination of blood, urine and sputum. Other
investigations are outsourced.
The centre maintains good co-ordination with the
government ART centre. The centre has necessary
facilities to provide palliative care and the facilities
include oxygen, water beds and round the clock
nursing. CCSC also takes up activities like
cremation for those who are disowned by their
families.
Liaison
• The centre facilitates pre- and post-ART
monitoring of PLWHAs.
• CCSC have established referral linkages with
DLNs, TCCs, PLCs, ART centre, VCTCs, PPTCTs/
DOTS centres. Spouses and children of
PLWHAs are referred for voluntary counselling
and testing.
“If I become resistant, how
will I ever be able to afford
or procure second line
treatment - this is my
biggest concern for the
future.”
— A PLWHA on ART
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POPULATION FOUNDATION OF INDIA
Corporate Health
Facilities
Providing
ART Services
Indicator
Targets
Results
(Apr 05-Mar 06) (Apr 05-Mar 06)
Number of health
2
1*
facilities (corporate
sector) providing
quality ART services
* MoU has been signed between CII and The Associated Cement
Companies Ltd. for setting up a corporate ART centre.
Confederation of Indian Industry (CII) is
responsible for advocating with the corporate
sector and facilitating the corporate sector health
facilities to provide ART services. CII undertook
the following initiatives:
1. Advocacy with the corporate sector for
mainstreaming HIV/AIDS issues and
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POPULATION FOUNDATION OF INDIA
facilitating corporate health facilities to
provide ART services.
2. Health Smart Card feasibility study.
Advocacy
Advocacy with the corporate sector has been
carried out through:
1. Large advocacy conferences
2. Focus group discussions
3. Small group meetings
Large Advocacy Conferences
The Confederation of Indian Industry organized
seven advocacy conferences in the first year of the
project in Delhi, Chennai, Kolkata, Bangalore,
Hyderabad, Surat, and Pondicherry. Around 300-
500 delegates attended these conferences with a
wide representation from large corporates, small
and medium-sized enterprises, government
(including NACO and SACS), private and public
hospitals, schools and colleges, NGOs, bilateral
and multilateral agencies, WHO, Global Fund and
the consortium members.
The large conferences aimed at accelerating the
response of corporates and engaging them in the
continuum of prevention, treatment, care and
support for HIV/AIDS. During these conferences,
the current country scenario of HIV/AIDS, response
of the government to tackle the problem and the
need for the corporate sector to step-in was
addressed.
In the conference held in Delhi on May 26, 2005,
CII publicly launched the 'Health Smart Card'. A
demonstration of the health smart card was made
to Mr. Bill Clinton, former President USA. He said,
“the health smart card will become the norm for
health records, in every society of the world”.
Focus Group Discussions (FGDs) and Small
Group Meetings
Thirteen FGDs and six small group meetings were
conducted in the first year of the project. These
meetings focused on:
i. One-on-one advocacy with corporates/ private
hospitals for setting up ART centres.
ii. Understanding and assessing the existing
infrastructure and profile of services at the
corporate health facility to determine the
appropriateness and preparedness of the
facility to start ART services.
iii. Brainstorming with experts on HIV/AIDS from
different backgrounds to work out the best
possible models for setting up ART centres.
iv. Facilitating discussions between the
corporates involved in setting up ART centres
and representatives from INP+ and DLNs.
Corporate ART Centres
The Associated Cement Companies Ltd. (ACC) is
setting up the first corporate ART centre in Wadi,
Gulbarga district in Karnataka. Gulbarga district
was chosen in consultation with Karnataka State
AIDS Control Society.
CII has signed an MoU with ACC for setting up the
stand alone ART centre. The centre will be
operational in year two of phase I.
CII is also in different stages of discussions with
other corporates for establishing ART centres.
Challenges
i. Companies do not want to integrate ART
centre with the company hospitals:
The corporate hospitals are located in a gated,
secure environment. They do not encourage
providing services to the community through
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POPULATION FOUNDATION OF INDIA
the hospitals located in such an environment.
However, they are open to undertake social
initiatives for the community outside the
campus.
ii. Setting up a stand-alone ART centre is a
lengthy process:
This involves work starting from earmarking
existing land or purchasing it for the centre,
taking permissions from local authorities,
developing a suitable design for the centre,
constructing a building and procuring
equipment and drugs for operationalizing the
centre. It thus takes minimum 8-10 months
for the centre to start functioning.
iii. Recurring costs of running an ART centre are
high:
ART drugs are a recurring cost and corporates
are cautious in making commitments towards
this. They are willing to provide medicines for
their employees but are exploring options
while providing services to the neighbouring
community.
iv. Interested corporates have withdrawn from
setting up an ART centre during the final
stage of signing the MoU
The Health Smart Card
The health smart card is an innovative solution to
capture real-time health data with an in-built
robust system for maintaining confidentiality and
security of the information.
The key benefits of the health smart card are:
• Acts as a portable medical record;
• Plays a crucial role in time-sensitive
emergency situations;
• Ensures data privacy and confidentiality;
• Ensures security and protection to sensitive
information;
• Facilitates easy storage of data;
• Provides an alternative for storing data using
the latest technology;
• Generates a set of important MIS reports;
• Monitors treatment to ensure adherence.
The health smart card was tested out for its
operational and technical feasibility at the Indian
Spinal Injury Centre at New Delhi. This was
further piloted at two government ART centres, Dr.
Ram Manohar Lohia Hospital and LRS Institute of
TB and Respiratory Diseases, New Delhi.
‘The Health Smart Card’ being demonstrated to Mr. Bill Clinton
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POPULATION FOUNDATION OF INDIA
Indicator
Targets
Results
(Apr 05-Mar 06) (Apr 05-Mar 06)
Number of Master
60
57
Peer Treatment
Educators trained
Number of counsellors, 22
25
social workers,
health care providers
and field staff from
NGO sector trained
in home-based &
community-based
care
EngenderHealth Society (EHS) is responsible for
developing a package of training modules and
building the capacity of providers working at
service delivery sites within the program. In
addition, they will train field staff from100 NGOs
Capacity
Building
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POPULATION FOUNDATION OF INDIA
in the six high prevalence states in home-and
community-based care.
Curriculum Development
Four training curricula are developed under this
program. The curricula are for the following
cadres of providers:
1. Peer Educators.
2. Counsellors and social workers.
3. Health care workers (Doctors, Nurses and
Paramedics).
4. NGOs working in the field of home-and
community-based care.
The flow-chart 1 shows the process carried out for
the development of these training curricula.
for Caregivers of People Living With HIV/AIDS
guide and handbook developed by I-TECH India
would be adopted for training NGOs in home-and
community-based care. Since NACO and WHO
were preparing the Health Care Workers (HCWs)
curricula, EHS would use this manual for training
HCWs.
Three regional level workshops were conducted in
August 2006 at Chennai, Bangalore and New
Delhi with key stakeholders to assess the training
needs as well as to prioritize content and
methodology for the development of curricula.
Consultations were held with NACO, WHO,
Consortium members and I-TECH in order to
harmonize and avoid duplication in module
development at the national level. A consensus
was arrived that EHS would develop the curricula
for peer educators and counsellors to support ART
adherence adapting the WHO's Integrated
Management of Adolescent and Adult Illness
(IMAI) modules. The Home Based Care Handbook
The draft training curricula prepared by a team of
national and international writers within EHS for
peer educators and counsellors/social workers
were pre-tested in three workshops for
counsellors and five workshops for peer educators
from six states. A technical advisory group (TAG)
meeting was also held in February 2006. Based
on feedback, new sessions on special
populations- children, men having sex with men
(MSM), intravenous drug users (IVDU) and ART
adherence, condom demonstrations were added.
The curricula are being translated into five
languages - Tamil, Telugu, Marathi, Kannada, and
Hindi and will be completed in quarter five.
Consultations and meeting with NACO, WHO, Consortium
members & I-TECH
Desk based
Review
Training
Needs
Assessment
Key
contents
Curriculum
writing
Pilot
testing
Editing
Printing
Translation
Finalizing TAG Meeting
Flow-Chart 1 - Process for the development of training curricula
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Training of Service Providers
EHS is mandated to train 124 master trainers
among various categories of service providers.
Seventy five DLNs officers were trained as Master
Peer Educators in the five day's training of trainers
conducted in year one at Mumbai, Chennai,
Banglore, and Imphal. The Training of Trainers
(ToT) was done with the English draft version of
curriculum. However, the training was conducted
in the regional languages.
A Training of Trainers workshop was held in
Bangalore for counsellors and social workers from
INP+ and Freedom Foundation. In the ToT
workshop 19 counsellors/social workers were
trained. Six field staff from NGOs were trained in
Home- and Community-Based Care from the
NGOs of four states - Maharashtra, Andhra
Pradesh, Tamil Nadu and Karnataka.
Job aids (HIV treatment and
Adherence Counselling Aid)
Two job aids - a flip chart and a treatment
adherence checklist is being developed for
counsellors/social workers and peer educators.
Establishment of Continuing Education
and Training Centres (CETC)
EHS strategy is to enhance the institutional
capacity of two NGO/private sector Continuing
Education and Training Centres (CETCs) to serve
the six high prevalence states. The process of
identifying CETCs was initiated in March 06 and
will be finalized by June 06.
Learning
• Translating the key messages of peer
educator's treatment curricula in local
language increased the efficiency of the
workshop and helped retain participants'
confidence and interest in learning.
• Having PLWHAs in the counsellors/social
workers treatment adherence workshop
enabled participants to see PLWHAs as people
who have taken complete responsibility of
their own lives and their treatment rather than
as mere clients.
• Conducting common training program with
participants from different states (speaking
different languages) is not a workable
strategy. The service providers of each state
have to be trained in the respective local
languages.
Challenges
• A one-time training of Master Peer Educators
is inadequate to equip them with the
necessary skills to perform their role as Master
Trainers.
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Program
Management
As Principal Recipient, Population Foundation
of India is responsible for the overall
management of the program, "Access to Care and
Treatment." Systems are set in place for oversight
of the program.
Project Advisory Board
PFI has set up a Project Advisory Board (PAB). The
members of the PAB include external experts in
the field of HIV/AIDS, members of the sub-
recipients and some governing board members of
PFI. The meeting is held each quarter to review
the progress of the project and provide guidance
to the implementation of the proposed activities.
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POPULATION FOUNDATION OF INDIA
Program Management
Population Foundation of India has set up the
Program Management Unit (PMU) with a core
team at New Delhi and state offices in each of the
six high prevalence states. Before entering into a
sub-grant agreement PMU has assessed each
sub-recipient with regard to their programmatic,
monitoring and financial systems. PMU provides
assistance to organizations and service delivery
points for development of management,
technical, organizational and financial skills
whenever required. PMU also ensures timely
implementation of the program and submission of
reports to The Global Fund.
Grant Management
Grant management includes fund management,
procurement management and administration.
PMU is responsible for overall financial
management of the project and monitors timely
receipt of funds and disbursement to the
implementing members. During the first year of
Phase-I, PMU has disbursed grants to 4 sub-
recipients. The grant has further been sub-granted
to 66 civil society organizations. Initially the grant
is disbursed in advance for a quarter and
thereafter the grant is disbursed on receipt of
audited utilization certificate. Guidelines for
procurement are laid down.
Coordination and Liaison Activities
In order to have a coordinated implementation of
the program at the national and state level, the
following mechanisms have been set in place.
coordinated implementation of the program. This
has been done in consultation with the Director
General, National AIDS Control Organization. PFI
convenes meetings with NACO every quarter to
share experiences, address ground realities, and
assist in the smooth roll-out of program.
The first coordination meeting with National AIDS
Control Organization was held on October 4,
2005 at NACO office. Dr. S.Y. Quraishi, Special
Secretary and Director General of NACO chaired
the meeting. The second coordination meeting
with National AIDS Control Organization was held
on January 16, 2006 at PFI office. Ms. Sujatha
Rao, Additional Secretary and Director General
chaired the second meeting. In both the
meetings, representatives from WHO, UNICEF,
UNAIDS, PFI, sub-recipients and NACO
participated. The progress, future plans and key
issues that needed coordination with NACO were
discussed.
Coordination Committee with State AIDS
Control Societies (SACS)
PFI has established State Coordination
Committees with respective State AIDS Control
Societies (SACS) in each of the six high prevalence
states. PFI convenes meetings with the Project
Directors, Additional and Deputy Directors, ART
Consultants, Monitoring and Evaluation
Consultants of SACS along with representatives of
INP+, state level networks for people living with
HIV/AIDS, Freedom Foundation, EngenderHealth
Society and Confederation of Indian Industry to
facilitate implementation of state specific plans.
Coordination Committee with National
AIDS Control Organization (NACO)
The Coordination Committee with NACO has
been constituted at the national level to facilitate
Coordination Meetings with Sub-Recipients
PMU coordinates meetings with sub-recipients on
a regular basis at the state and national level to
resolve issues of implementation.
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POPULATION FOUNDATION OF INDIA
State Review Meetings
PMU conducts review meetings with state
program units for planning, reviewing and
providing feedback on the state specific progress
each quarter. Three meetings were conducted
from 3-5 August, 21-24 November 2005, and
21-24 February 2006 respectively.
Monitoring and Evaluation
PMU supervises and monitors the activities of the
program through the management information
system, field visits and regular communication
with the sub-recipients.
Management Information System (MIS)
progress reports are generated at different levels.
The MIS software is in the process of
development.
Field Visits
Regular field visits enhance interaction with staff
of service delivery points and help to achieve the
deliverables, identify challenges, provide support
and sort issues. Alternate feasible solutions were
provided to the staff based on mutual
consultation. These visits helped to build capacity
of service providers, strengthen referral linkages,
facilitate service delivery points in developing
strategies based on field realities and ensure
regular reporting.
Each sub-recipient was consulted individually for
developing the MIS. Wherever possible, the
existing MIS of the sub-recipients was further fine
tuned to the needs of the program. The existing
national level indicators were kept in mind and
program indicators were standardized
accordingly. The MIS of INP+ was pre-tested
during August-Sept. 05 at multiple service delivery
sites across the program area. The pre-test
findings were shared in a workshop in October
‘05 and MIS is finalized.
Management Information Systems (MIS) in place
enables each of the sub-recipients to assess their
accomplishments and measure the progress of
their activities. It encourages identifying issues
that need attention and suggest corrective steps.
The MIS consists of registers for each of the
service delivery points. Monthly and quarterly
Operations Research/Special Studies
Four studies have been initiated:
1. Assessing PLWHAs' expectations about
quality of care and support services with a
view to help District Level Networks.
2. Understanding support group meetings of
people living with HIV/AIDS (PLWHAs).
3. Setting up standard guidelines for providing
care & support services including
palliative care.
4. Documentation of various training models in
HIV/AIDS in select states of India.
Program Evaluation
PFI instituted an external annual evaluation of the
program in March 2006. The evaluation will be
completed by end of May 2006.
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• Regular and continuous networking with
NACO and SACS helps in implementation of
the program.
• Coordination with SACS, directorate of
medical education & training and hospital
authorities is very important to set up TCC in
the public ART centres.
• Linkages with PPTCT, VCTC and DOTS centre
with ART centres and District Level Networks
is required for better implementation.
• Setting-up district level networks from the
beginning of a quarter helps in enrolling and
providing services to more number of
PLWHAs.
Learnings
• Regular interaction with sub-recipient helps in
meeting the deliverables.
• To set up a new infrastructure and
operationalise it, requires time.
• Follow-up of Peer Treatment Educators’
training is required to maintain quality.
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Finance Report
28
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POPULATION FOUNDATION OF INDIA
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POPULATION FOUNDATION OF INDIA
30
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This is about living, hope, courage, being positive,
creating change in the people who listen and ACT.
Photo Credits
z Indian Network for People living with
HIV/AIDS (INP+)
z Freedom Foundation (FF)
z EngenderHealth Society (EHS)
z The Confederation of Indian Industry (CII)
z Population Foundation of India (PFI)
With Contribution From
z Rashmi Sharma
z Aparna G.
z Nidhi Sinha
z Champa Chakravartti
z Subrat Mohanty
z Phanindra Babu Nukella
z S. Vijayakumar
z Rohini Gorey
z Abhiram Mongjam
z Bhavani Shankar
z K. Balasubramanian
z Everista Kapu
z A.S. Kullolli
z Alwin Leone Das D.
z Vikas Panibatla
z Vitsiatho Nyuwi
z Vijaya P. Kanase
z Yumnam Sanjoy Singh
z Prasad Kumar A.
z Mary Verghese
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POPULATION FOUNDATION OF INDIA
B-28, Qutab Institutional Area, Tara Crecent,
New Delhi - 110 016