This ongoing cooperative agreement supports CAR PEPFAR Strategy Objectives 2 and 3. The goal is to provide TA to the Kyrgyzstan Republican Narcology Center (RNC) of the Ministry of Health (MOH) to strengthen it's capacity and expand access to high quality HIV prevention services. This project will support the establishment of two demonstration sites to provide high quality, MARPs- friendly Medication Assisted Treatment (MAT). Activities funded through this project will primarily target KG MOH staff and people who inject drugs (PWID). The Republican Narcology Center will establish protocols for MAT provision, using effective and cost efficient programs and processes, and a M&E system to allow tracking of indicators, such as retention rates, and monitoring of progress. Sustainability of the program will be fostered through systems strengthening, training and capacity building of the RNC and MAT site staff, allowing them to monitor and improve the quality and efficiency, including costs, of their program. A vehicle will be purchased to support this activity with the purpose to deliver methadone to MAT sites, and to deliver program tracking materials from the demonstration sites to the RNC. Currently, there is only one functioning vehicle (purchased by GFATM) serving 20 MAT sites across this mountainous, difficult-to-traverse country. RNC possesses two old vehicles which are essentially non functional.

This supports the CAR PEPFAR Strategy Objectives 1 and 2. This activity is linked to: (1) HVCT BCN Columbia University/IM #12872; (2) PSI/IM #12859; (3) RAC-KG /IM #13217; (3) TBD Harm Reduction Center/IM #13969; and (4) UNODC IM #12772. No FY12 ROP funding is being requested. Similar to the other countries in CAR, the predominant mode of HIV transmission in KG is unsafe injecting practices. Injection drug use has become more prevalent in recent years due to the countrys geographical location on key drug trafficking routes from Afghanistan to Russia and Europe. In 2010, it was estimated that approximately 26,000 PWID reside in KG. In 2009, HIV infection rates among PWID were 14% nationally, with the highest rate of 30% reported in Osh Oblast. As of January 2011, PWID accounted for 64% of all registered HIV cases, and only 61% were covered by HIV prevention services. PWID comprise almost 20% of the prison population. Data from 2009 show that 3% of KG prisoners are HIV infected; including 10% of prisoners from the Bishkek area. The goal of this cooperative agreement is to provide TA to the Republican Narcology Center to increase access and quality of HIV prevention services for PWID in underserved areas of KG. The project will give the KG MOH experience providing high quality, MARP friendly HIV prevention services via establishment of demonstration MAT sites both in community and prison settings. In addition, rapid HIV testing will be piloted at the MAT demonstration sites. KG currently does not use rapid HIV tests in their national testing algorithm and there is no data on how many PWID, who are on MAT, have been tested for HIV and know their HIV status. Through this program, USG will provide TA to pilot the use of rapid HIV testing as part of the HTC at the MAT demonstration sites. Rapid testing will be used for screening, and in the event of a positive screening result, venous blood will be collected and sent for confirmatory Western Blot testing at the National Reference Laboratory. People will receive appropriate post-test counseling and instructions for returning to receive their confirmatory result. For persons tested HIV positive, appropriate medical and social service referrals will be made. To insure quality assurance of counseling, intensive training will be conducted for counselors and laboratory specialists on use of the rapid HIV test kits, and QA/QC. The Project will closely work with other PEPFAR-funded partners, to leverage the resources and avoid duplication. The project indicators will include the number of PWID who are tested for HIV at MAT sites, the number of PWID referred for additional testing, counseling, and treatment services, and the number of persons trained in both the laboratory and counseling aspects of rapid HIV testing. Only FDA approved rapid HIV tests will be purchased. PEPFAR funds will be used to purchase rapid HIV tests to be implemented at the two demonstration MAT sites. Approximately 160-180 PWID will be tested. Random sample verification will monitor the quality of the rapid test results. These activities will be included into KG's National HIV Strategic Plan to eliminate duplication and complement existing services for MARPs.

This supports the CAR PEPFAR Strategy Objectives 1 and 2. This activity is linked to: (1) IDUP BCN Columbia University/IM #12872; (2) PSI/IM #12859; (3) UNODC/ IM #12772; (4) and Health Policy Project/IM#13973. Similar to the other countries in CAR, the predominant mode of HIV transmission in KG is unsafe injecting practices. Injection drug use has become more prevalent in recent years due to the countrys geographical location on key drug trafficking routes from Afghanistan to Russia and Europe. In 2010, it was estimated that approximately 26,000 PWID reside in KG. In 2009, HIV infection rates among PWID were 14% nationally, with the highest rate of 30% reported in Osh Oblast. As of January 2011, PWID accounted for 64% of all registered HIV cases, and only 61% were covered by HIV prevention services. PWID comprise almost 20% of the prison population. Data from 2009 show that 3% of KG prisoners are HIV infected. The goal of this cooperative agreement is to provide TA to the Republican Narcology Center to increase access and quality of HIV prevention services for PWID in underserved areas of KG. The project will give the KG MOH experience with providing high quality, MARP friendly HIV prevention services via establishment of demonstration MAT sites in both community and prison settings. KG was the first country in Central Asia to introduce MAT in 2002, however, less than 5% of PWID receive MAT services. This project will support the KG MOH established two new MAT sites, with enhanced services, such as expanded hours and more accurate methadone dosing, to encourage retention and improve the quality of the program. One MAT site will be established in Osh Oblast and one in a prison setting near Bishkek. These sites were chosen due to the high prevalence of drug users, high HIV infection rates in the target populations, and the clear need to expand access to MAT. The GFATM will purchase methadone for CDC supported MAT pilots.The program will monitor indicators using electronic databases and internal registration forms. Indicators will include coverage and reach of the services, including the number of people served, number of referrals made and provided, the number enrolling in MAT, retention rates at 3, 6, 9, and 12 months, and the number of people trained. Supervision will be provided by the MOH. Log sheets will be sent to the national MOH on a monthly basis, and shared with USG, for M&E purposes. The Republican Narcology Center works closely with GFATM and other international donors to leverage resources and avoid duplicative efforts. Since this will be a MoH implemented project, USG will work with both GFATM and the KG MOH to support the sites after successful implementation of these demonstration sites.