Goal and objectives:The Khmer HIV/AIDS Non-Governmental Organization Alliance (KHANA) will improve the health and quality of life of Cambodians by reducing the impact of HIV on vulnerable populations including people living with HIV and most-at risk populations through services delivered through indigenous partners. The objectives of the project are to: 1) provide community-based care to people living with HIV; 2) provide HIV prevention messages to most-at-risk populations; and 3) strengthen the organizational capacity of local partners.

Geographic coverage and target populations:Project activities will deliver community-based care in nine provinces with the largest populations of HIV-infected individuals, and in three provinces with the largest populations of individuals at risk for HIV infection. Target groups include female entertainment workers; men who have sex with men and transgendered persons; injecting drug users; and persons living with HIV.

Cost-efficiency:KHANA is a local partner with indigenous sub-partners and operates with lower overhead costs than most international non-governmental organizations. In FY 2012, KHANA will advocate to national policy-makers that persons living with HIV should attend five clinical visits per year rather than the current 12 to reduce costs and the logistical burden on healthcare professionals. Studies in the United States show that the quality of care can be maintained with fewer visits.

Monitoring and evaluation:KHANA has a monitoring plan that specifies expected program results with indicators, mid-term milestones or benchmarks, and end-of-project results.

Vehicles:Two new vehicles will be leased in FY 2012 and FY 2013.

Global Fund / Programmatic Engagement Questions

1. Is the Prime Partner of this mechanism also a Global Fund principal or sub-recipient, and/or does this mechanism support Global Fund grant implementation? Yes2. Is this partner also a Global Fund principal or sub-recipient? Sub Recipient3. What activities does this partner undertake to support global fund implementation or governance?

Budget Code Recipient(s) of Support Approximate Budget Brief Description of ActivitiesHBHC Persons living with HIV. 587881 Social welfare support to the poorest persons living with HIV;Formation of village savings and loan groups amongst people living with HIV to generate community resources and to support livelihood activities;Provide referral for most in need persons living with HIV to access health and non-health services;Provide community-based care and support to those persons living with HIV; andSelf-help group meetings amongst persons living with HIV to implement targeted and integrated messages related to sexual and reproductive health/family planning, positive prevention, risk reduction counseling, adherence counseling; and support;Provide livelihood skill training to persons living with HIV to equip them with skills in livestock management and home gardening which can contribute to an improved socio-economic status in order to support their treatment adherence; andProvide seed grant support to persons living with HIV to generate their livelihood activities.HKID Orphans and vulnerable children. 290409 Provide social welfare support to most-in-need orphans and vulnerable children;orphans and vulnerable children support group education sessions on HIV, sexual and reproductive health, drug use, gender based violence, and domestic violence;Community-based care and support for orphans-and-vulnerable-children foster care services;Provide support for the function and the meeting of commune councils for women and children at the Commune/Quarter level in order to address the needs and the issues of orphans and vulnerable children;Support to the National Orphans and Vulnerable Children Taskforce and the Provincial Orphans and Vulnerable Children Taskforces to develop policies, guidance and procedures that are in the best interests of the orphans and vulnerable children;Provide referral of most in need orphans and vulnerable children to access skill training, seed grant support to generate income for supporting their schooling and treatment, and to improve their long-term living condition and food security; andProvide referral support to most-in-need orphans and vulnerable children to access HIV treatment.HVCT Entertainment workers , men who have sex with men, and injecting drug users. 97957 Roll out community/peer-initiated testing and counseling implementation in close collaboration with the national program in order to support entertainment workers, men who have sex with men, and injecting drug users to learn their HIV status and access early treatment;Outreach activities to reach entertainment workers, men who have sex with men, and injecting drug users, and to provide couples counseling on condom use, sexually transmitted infection testing, HIV testing, diagnosis and treatment;Drop-in center for entertainment workers, men who have sex with men, and injecting drug users to access couples counseling on condom use, HIV testing, diagnosis and treatment;Persons living with HIV self-help group meetings to provide couples counseling on condom use, HIV testing, diagnosis, and treatment; andProvide support for the referral of 18 months-old orphans and vulnerable children to access HIV counseling and testing.HVOP Entertainment workers and men who have sex with men. 141764 Conduct outreach activities to target hard-to-reach individuals and their sexual partners with message and interventions linked to behavior change such as access to condoms and lubricants;Operate drop-in centers as safe spaces for entertainment workers and men who have sex with men to access HIV messaging, building social capital, exchange life experiences in living with HIV, and also to access vocational skill training to minimize the risk to HIV transmission;Support the implementation of the Community most-at-risk populations Partnership Initiative to create enabling environments that will improve the access to services amongst those most-at-risk populations;Condom and lube demonstration and distribution;Support for referral of those who are most in need for sexual and reproductive health, and family planning, sexually transmitted infections diagnosis and treatment.HVSI Implementing partners and KHANA internal monitoring and evaluation systems 35860 Operations research on community-based care and support and HIV prevention amongst most-at-risk persons;Revise current monitoring and reporting tools and systems to be able to better track data for producing strategic information;Provide training in monitoring and evaluation and the revised tools to KHANA s partners once a year and provision of coaching through quarterly technical support and monitoring visits; andUpgrade the capacity of KHANA staff on monitoring, evaluation, and research.HVTB Persons living with HIV. 35414 Provide referral and support for tuberculosis screening amongst persons living with HIV under community-based care and support; andProvide referral of persons living with HIV with tuberculosis to access tuberculosis treatment.IDUP Injecting drug users. 249325 Outreach activities to the hotspots of injecting drug uses to provide information, education and communication messaging;Operate drop-in centers;Provide clean needles and syringes and other safe injecting materials;Condom and lube demonstration and distribution;Referrals to access methadone maintenance therapy; andReferrals to access antiretroviral therapy.MTCT Discordant couples, concordant couples, and women and men of reproductive age living with HIV. 45178 Develop, design, print Information, education and communication messaging and behavior change communication materials;Support for referral of pregnant women living with HIV and newborns to access prevention-of-mother-to-child-transmission-of-HIV services (those in need);Self-help group meetings; andCoordination meeting between facility-based and community-based service providers on treatment adherence and follow-up.OHSS The general population, Health Center Management Committees and village volunteers. 309191Support health centers and commune councils to form and restructure Health Center Management Committees and Village Health Support Group networks by cooperating with the Provincial Health Department and Operational Districts in accordance with Ministry of Health policies and guidelines;Support the regular function of Health Center Management Committees and village volunteers;Connect the Health Center Management Committee to the commune development plan and the commune investment plan by identifying health care service needs of the community; andSupport Health Center Management Committees to pay for the referral of clients from the community to health facilities.

Target populations:Adult care activities will target 9,510 people living with HIV.

Interventions:KHANA and its implementing partners will deliver care and prevention services through home- and community-based care. KHANA and its partners will train volunteers and leaders of support groups for orphans and vulnerable children to coordinate 419 self-help groups of 20 people living with HIV each, and 496 orphan and vulnerable children support groups. Volunteers will hold bi-monthly meetings to provide information and referrals for opportunistic infections treatment, antiretroviral therapy, CD4 count testing, sexual and reproductive health, tuberculosis, prevention of mother-to-child transmission of HIV/AIDS, and a counseling on a broad range of topics that includes livelihoods, inheritance protection, birth registration, vocational skills, nutritional counseling and referrals, hygiene and sanitation, child rights and legal information. Volunteers will identify, track, and provide couples counseling to discordant couples, conduct community campaigns to reduce stigma and discrimination, and strengthen welfare funds for transport to people living with HIV and orphans and vulnerable children most in need. KHANA will strengthen livelihoods through training for a variety of skills including fish farming, chicken raising, food production, and small business management through the KHANA Livelihood Learning Centre.

KHANA will place members of the national people-living-with-HIV network at service delivery points to assist medical staff with registrations, appointment scheduling, and appointment reminders. These volunteers will provide HIV treatment adherence counseling and will help trace clients to prevent loss to follow-up.

Target populations:IN FY 2012 KHANA will provide services to 12,392 orphans and vulnerable children.

Interventions:Leaders of support groups for orphans and vulnerable children will run age-specific education sessions on HIV, sexual and reproductive health, drug use, gender-based and domestic violence, child rights and life skills for young people up to the age of 18. KHANA and partners will refer HIV-positive children to antiretroviral treatment and provide transport costs for most in need. KHANA will continue the Happy-Happy Program?a play group to bring orphans and vulnerable children and children from the general community together to provide opportunities to enhance social development and reduce stigma and discrimination. Support groups will also be formed for children of most-at-risk individuals. KHANA and its sub-partners will also supply school uniforms and materials for those most in need, and will advocate with schools and teachers to waive informal school fees.

In collaboration with religious groups and local authorities, KHANA and its partners will start a community resource mobilization initiative for long-term care of orphans and vulnerable children. Partners will mobilize community and local authorities to form orphans-and-vulnerable-children foster care programs. Livelihood activities including training and seed grants for households will provide economic strengthening, better access to food security, health care, and schooling. KHANA will contribute to national, provincial, and commune orphan and vulnerable children taskforces. KHANA and its partners, including orphans and vulnerable children support-group leaders, will work with the Department of Local Administration within the Ministry of Interior, as well as with commune women and child protection committees to reduce stigma and discrimination.

Target populations:Target populations include tuberculosis patients and 562 people living with HIV.

Interventions:KHANA will contribute to the national HIV strategy with specific objectives to: 1) reduce the rate of tuberculosis among persons living with HIV and most-at-risk populations; and 2) increase the rate of HIV counseling and testing among tuberculosis patients. KHANA will provide tuberculosis information, screen clients, and facilitate the initiation of tuberculosis treatment to persons living with HIV. KHANA will train and mentor implementing partners on tuberculosis/HIV co-infection to enhance capacity to deliver tuberculosis/HIV interventions.

KHANA will collaborate with National Tuberculosis Program to ensure that data is reported as required and will monitor the implementation of tuberculosis and HIV activities through supervisory visits and technical support to implementing partners, surveys, data-verification, external assessments, routine use of KHANAs data and health information system and continuous quality improvement. The quality of programming will be monitored according to International HIV/AIDS Alliance good practice programming standards for tuberculosis/HIV integration, which are informed by global evidence and experience.

In collaboration with the national program, KHANA will participate in the implementation of quality improvement initiatives to enhance the quality of service delivery to people living with HIV, orphans and vulnerable children, and most-at-risk populations. Through an existing memorandum of understanding with the National Institute of Public Health, KHANA will continue to play a major role in research in the areas of HIV, health, and development. KHANA will revise current monitoring and reporting tools and systems to better track data to produce strategic information and will continue to share good practices and keep its partners updated on the latest monitoring and evaluation systems related to HIV, health, and development by providing yearly trainings and quarterly technical support and monitoring visits.

KHANA will document best practices from its current project, partner programs, and KHANA demonstration centers. Best practices will be shared globally and with KHANA partners to link program monitoring to strategic information and knowledge sharing to improve program quality and inform policy, communications and the national research agenda. As part of a transition from service delivery to the provision of technical leadership, KHANA will focus on disseminating high-quality research to increase the evidence base for quality programming in HIV, sexual and reproductive health, and tuberculosis.

Target populations:Target populations include entertainment workers, men who have sex with men, injecting drug users, and people living with HIV.

Interventions:KHANA will use safe referral systems to track HIV-infected clients and provide them with information, transport costs, and money for making counseling appointments by phone. Representatives of people-living-with-HIV networks will remind clients about missed appointments through telephone calls. KHANA and its partners will implement community and peer-initiated testing and counseling with active referrals for HIV care and treatment services in close collaboration with the national HIV program. The testing will be conducted in safe spaces for most-at-risk populations such as drop-in centers, beer gardens, restaurants, and clubs. KHANA and partners will conduct two trainings per year for peer educators on effective HIV counseling for most-at-risk populations, people living with HIV, and orphans and vulnerable children. KHANA will strengthen links between testing and counseling by ensuring that clients are provided with results as well as money to make counseling appointments. KHANA will strengthen referral systems to provide people living with HIV with information and referrals to sexual and reproductive health and family planning, tuberculosis, livelihoods, nutrition, and other services.

Target populations:Target populations include 4,159 entertainment workers and their sexual partners, and 4,031 men who have sex with men and their partners in the urban areas of Phnom Penh, Siem Reap, and Battambang provinces. KHANA will provide HIV-focused prevention education, screening for sexually transmitted infections and tuberculosis, and referrals of members of most-at-risk populations to other relevant services as needed.

Interventions:KHANA and its sub-partners will deliver: HIV prevention and sexual and reproductive health education; counseling; supplies of condoms and lubricants; referrals for voluntary confidential counseling and testing; testing for sexually transmitted infections; gender-based violence education; information on the prevention of mother-to-child transmission of HIV/AIDS; and basic health services. Activities will target entertainment workers, men who have sex with men, and their partners through outreach and drop-in centers. KHANA will improve the quality of outreach activities through national-level contributions to policy dialogue, support to technical working groups, and collaboration with the National AIDS Authority to improve service delivery access to most-at-risk populations. KHANA will also develop policy papers for the integration of sexual and reproductive health and tuberculosis services into the existing community prevention and care package.

KHANA will implement an incentive scheme for community-based peer educators to improve coverage. Peer educators will provide information on correct condom use and access to condoms and lubricant in brothels, entertainment venues, clubs, and bars. KHANA and its sub-partners will organize community and peer initiated testing and counseling for HIV in safe spaces in collaboration with government providers. To increase involvement of men and boys in HIV prevention activities, KHANA will recruit and train the clients of entertainment workers to work as peer educators.

KHANA and its partners will collaborate with Population Services International to ensure condom availability and to promote social marketing for condoms.

Target populations:KHANAs Meanchey Drop-in Center and its non-governmental organization sub-partner Korsang will target 650 male and female injecting drug users (primarily aged 15-49 years).

Interventions:KHANA and Korsang will provide interventions recommended by the World Health Organization and in compliance with the International HIV/AIDS Alliance evidence-based good practice standards. KHANA will: support access to methadone maintenance therapy; collaborate with National Center for HIV/AIDS, Dermatology and Sexually Transmitted Diseases to provide testing and counseling for HIV and other sexually transmitted infections; conduct education sessions on HIV and sexually transmitted infections prevention, safer sex and harm reduction; provide access to condoms and lubricant; provide basic medical care and treatment including drug overdose treatment; and provide sexual and reproductive health information and referrals.

Through drop-in centers and outreach, KHANA and Korsang will mobilize community members and local police to form project advisory committees that will meet with the Provincial Drug Control Committee to address injecting drug user issues. KHANA and Korsang will collaborate with the National AIDS Authority and the National Authority for Combating Drugs to enhance the enabling environment for work with injecting drug users. KHANA will continue to advocate National Authority for Combating Drug to provide licenses for a needle and syringe exchange program for non-governmental organization sub-partners.

Target populations:Target populations include people living with HIV, discordant couples (couples where one person is HIV-positive and one person is HIV-negative), entertainment workers, and people who inject drugs.

Interventions:KHANA will increase access to prevention of mother-to-child transmission of HIV services by: 1) strengthening referral networks and links to voluntary confidential counseling and testing, sexual and reproductive health, and family planning services; 2) increasing community awareness on family planning, prevention of mother-to-child transmission of HIV, antenatal care, safe delivery and safe breastfeeding; and 3) increasing community and peer-initiated counseling and testing in most-at-risk populations. KHANA will integrate these activities into their existing support structures at the community level. KHANA will place representatives of the persons-living-with-HIV networks in health facilities to improve referrals to other needed health services. Finally, community-based networks will provide post-natal follow-up during home visits to monitor feeding practices, to encourage HIV testing for infants, and to ensure that persons living with HIV are receiving adequate nutrition.