REACH covers a breadth of key technical and cross-cutting areas, and supports and mobilizes local partners in the HIV/AIDS response. Its goals are to "enhance the scale, quality and effectiveness of the HIV prevention, care, support and treatment interventions in the region through the efficient provision of grants along with organizational capacity building."

REACH covers Burma, Thailand, Laos, China and Regional. Objectives are: 1) Reduce HIV transmission among MSM; 2) Improve quality of life of MARPs and PLHA by increasing livelihood skills and income generating opportunities and enabling access to prevention, care and support; 3) Develop, and disseminate effective models and methodologies for prevention, care and support for PLHA/MARP livelihoods.

REACH provides a grants mechanism to improve CBOs' service delivery through tailored organizational capacity building (OCB) using participatory methods. OCB includes training and mentoring in business planning and managing livelihoods projects for PLHA/MARP support groups and PLHA-run businesses. The result is civil-society strengthening, good governance and improved linkage of PLHA groups to local markets for sustainability, access to care and treatment, and public-private partnerships (PPPs). Other benefits include technical innovation; linking comprehensive prevention community care and support pilots for MARPs including supportive interventions; support for SI including PACT's approach to monitoring and evaluation, research and learning (MERL) at the CBO level; documentation of models; and scale up with GFATM.

REACH achieves efficient programming by combining grants with OCB for CBOs to become more sustainable; working with CBOs to use financial data to improve budgeting and resource allocation; leveraging models and scaling them with GFATM funds; and developing cost-effective approaches to TA from local providers.

REACH develops M&E plans and works with CBO partners to improve data quality and harmonized reporting frameworks. REACH develops MERL guidelines for prevention, care, support and livelihoods interventions, and TA on M&E for improvements in implementation, targeting and effectiveness. In FY10, Pact will introduce the MERL approach to build community buy-in for M&E and participatory approaches.

Pact's livelihoods strengthening (LS) models (i.e., economic strengthening) for PLHA/MARPs fortify other CPS interventions and are a critical supporting intervention for stigma reduction and community mobilization, governance and civil society development. Vocational skills training and counseling for recovering IDUs eases reintegration from drug rehabilitation treatment into the community, reducing the risk of relapse and reducing internal stigma. LS improves community mobilization and participation of MARPs.

REACH implements 6 partnerships in 4 hotspots: 3 hospital-based PLHA support groups; 1 support group of MMT clinic clients living with HIV; 1 IDU drop-in center; and 1 medium-sized social enterprise managed by and employing rehabilitated IDU. By FY11 Pact will develop operational guidelines, and focus on scaling up and refining these models through TA.

As a sub-partner, the International HIV/AIDS Alliance (Alliance) focuses on MARP community mobilization, in order to expand coverage, ensure appropriateness of interventions, and generate community ownership. This is critical for tackling the internal stigma and denial that exists within MARPs.

Alliance supports 4 models of community-organizing: 1) managed community team (to reduce dependency on government partners); 2) independent commercially-registered CBOs (AIDS Care China), 3) MARP network with government leadership; and 4) MARP network without government membership.

Key contributions to HSS include MARP group institutional capacity building; network development; strengthening MARP community involvement in prevention and care; peer-led MMT adherence; and care and support programming for MSM.

In Yunnan province, target groups are MSM Care and Treatment Support, PLHA Network Support and PLHA small grants, and MSM network support in Kunming; MSM Drop in Center and outreach in Kaiyuan, Gejiu and Mengzi; and IDU PLHA psychosocial support in Gejiu. In Guangxi province, target groups are IDU peer-led MMT and ART adherence support, MSM network support, MSM care and treatment adherence support, and PLHA CBO peer treatment adherence support in Nanning; and PLHA CBO peer treatment adherence support in Luzhai. Other hotpots in Guangxi include Ningming and Pingxiang.

Gender equity is addressed in relation to treatment access, prevention access for IDU, and care and support access. Male norms and behaviors are directly addressed by all interventions targeting MSM and prevention programming targeting IDU.

A key strategy for cost efficiency is to ensure the transfer of technical capacity from USAID interventions to the larger pool of local government- and donor-supported interventions. Mechanisms include toolkits which enable replication, learning exchanges, leveraging other donors' funds for scale up, and technical workshops.

Partners report quarterly against annual indicators. Partners receive TA to develop their own monitoring systems and conduct an annual review and re-planning process.

GHCS (USAID) = $313,600

GHCS (State) = $156,000

With FY10 funding, Pact, through the Alliance, will continue to support care and support activities at 5 sites in Yunnan and Guangxi.

Activities will be conducted with HIV+ IDU in Gejiu; HIV+ MSM in Kunming and Nanning; PLWHA in Nanning and Luzhai; and HIV+ MMT Clinic attendees in Nanning. Activities include home & hospital visits, peer psycho-social support/counseling, PLWA support group, positive prevention activities, and family support groups. These will be located in government-run clinics or hospitals ensuring direct linkages with, and referrals between, clinical services and include a peer-ART treatment adherence support service component.

Support will be provided to local partners to develop and monitor the quality of programs, including client database development support, training on counseling and psycho-social support skills, supporting the development of basic peer-support service protocols, and PLWA group development support.

Pact will provide livelihood strengthening support for PLHIV and their family members through interventions with partner PLHA support groups. This will involve support in small business development through training and mentorship, a micro-loans scheme for individual PLHA and their families, capacity building for project planning, implementation and evaluation for the group leadership, and other related interventions as needed.

In FY11, Pact will disseminate its program experience and promote the use of tools and materials through an AIDS and livelihoods capacity building center which will have been set up in FY10. The center will be the hub for local capacity development and for a network to support scale up of the program and TA provision to GoC and GFATM.

Pact will scale up its interventions through direct support to current partners, especially in the hotspots where the COPCT interventions are being developed. Pact will also develop variations of its model through initiating cooperation with new partners. Interventions will be linked with other services through a network of referrals. Pact will also work to reduce barriers and create linkages for PLHIV to access mainstream livelihoods services such as micro-loans and health insurance.

GHCS (USAID) = $86,800

GHCS (State) = $30,000

Under COP10, Pact, through the Alliance, will continue to support ART adherence interventions at 4 sites, adding a fifth site following a Participatory Community Assessment conducted among HIV+ MSM in Nanning in FY10. All adherence activities are integrated into the care and support programs funded by USG and GoC.

The activities will be conducted among the following populations in specific geographic locations: HIV+ IDU in Gejiu; HIV+ MSM in Kunming and Nanning; PLWHA in Nanning and Luzhai; and HIV+ MMT Clinic attendees in Nanning.

The service model consists of clinic and hospital-based peer-led ART adherence support. Model implementation varies according to the 3 service delivery point. At China CDC sites, newly diagnosed PLHA and existing patients returning to CDC (for additional drug supplies, management of side effects and/or adjustment of treatment regimen) are referred to the peer-run DiC for adherence support counseling. For PLHA coming to the hospital for in-patient care, adherence support will consist of counseling from peers. For MMT Clinic Based ART adherence support, HIV+ IDU attending the MMT clinic for daily doses of methadone doses receive adherence support counseling from peers.

In addition to centre-based services, USG funding supports an SMS messaging service providing treatment information and advice delivered by AIDS Care China PLHA CBO. Education on ART adherence is also integrated into group education and support activities for PLHA.

USG funding also supports the AIDS Care China CBO database which is used to monitor treatment adherence. It records the individual client's treatment regimen, the date of their next appointment (so that reminders can be issued) and reasons for discontinuing treatment (such as loss to follow up, and death.) The database enables AIDS Care China to identify which patients are experiencing adherence issues and are in need of additional support.

A Chinese-language training manual to train peers in the delivery of adherence support services has been produced and will be disseminated widely. The manual gives a comprehensive overview of treatment issues from the perspective of people on treatment.

GHCS (USAID) = $232,200

GHCS (State) = $115,000

Livelihoods activities are a critical support intervention for stigma reduction, community mobilization, and governance and civil society development, achieving cross-program impact that supports and leverages health and HIV/AIDS interventions with private sector and market contributions. The resulting improved local governance positively impacts local communities and the enabling environment.

PACT's livelihoods strengthening has psychosocial and health benefits in the community. As income is generated through small enterprise and vocational training, PLHA groups are strengthened. Individuals' status within the family is also positively affected. PACT is developing pro-bono field internships with companies (e.g., McKinsey) to mobilize private sector in microenterprise and business planning. PACT creates a platform of technical exchange with Chinese experts. As local models are validated and shared, local and provincial government is engaged in a way that strengthens CBOs over time.

Pact's work through Alliance focuses on community mobilization. This includes leadership and governance training and support, institutional capacity building for MARP groups, and TA to GFATM around community mobilization. The following activities will be implemented in under COP10:

MARP group development support for MARP teams working on GFATM programs

PLHA and MSM network development support (1 provincial PLHA network in Yunnan; 2 provincial MSM networks in Yunnan and Guangxi)

Institutional capacity building support to the only autonomous MARP-led CBO within the USAID program (AIDS Care China)

Small grants program to support PLHA group institutional capacity building.

Toolkits to promote more effective community responses to HIV/AIDS.

Systemic barriers to strengthening MARP capacity in the health systems response to HIV/AIDS are: a) absence of a supportive legal framework to promote autonomous MARP-led CBOs; b) most MARP teams are created and led by government entities, inhibiting community ownership; c) IDU and FSW are criminalized; and d) stigma (from health workers and even between different MARP communities) hinders intervention effectiveness and community involvement.

GHCS (USAID) = $37,900

GHCS (State) = $0

Pact, through Alliance, will support the Honghe Brothers MSM group targeting MSM in three hotspot cities in Honghe Prefecture. The prefecture includes 3 hotspot cities: Gejiu pop 380,000, Kaiyuan pop 260,000 and Mengzi pop 310,000 that are home to anestimated 5,000-8,000 MSM.

Alliance supports the MSM DiC in Kaiyuan and conducts outreach in the nearby cities of Gejiu and Mengzi. Funds are subgranted through the Kaiyuan Health Education Institute to MSM CBOs as most MARP groups working on HIV in China are not a registered. Service components include:

Twice weekly outreach prevention

Daily online Interventions: QQ (Chinese Messenger application) & Chatroom "outreach"

Twice weekly IEC dissemination

Twice weekly condom education and distribution

Weekly pre-test and post-test counseling for DiC-based VCT services

Alliance provides the following support to CBO and local government partner to ensure quality of intervention:

Assistance with the design of service protocols

Skills training to ensure effective service delivery, eg. outreach skills

Organizational development support

Financial management training

Trainings and support are delivered through field visits and through large group trainings.

For STI services the group refers clients to Gejiu CDC where staff have already been trained by FHI on the delivery of STI services including services for MSM

For VCT the collaboration with Kaiyuan CDC will be developed to include DiC based rapid testing with pre and post-test counseling by peers and blood collecting and results by CDC staff

The Honghe Brothers are member of the Yunnan MSM network enabling them to connect with more developed MSM programs in Kunming

The group provides technical support to other government-led MSM groups in nearby cities

Alliance supports groups to participate in the national MSM network.

GHCS (USAID) = $232,500

GHCS (State) = $116,000

The GoC has committed to an ambitious MMT program that has seen the number of clinics nationally grow to 600 by the end of 2008, with a further 100 new clinics scheduled to open by the end of 2009. By December 2008, over 170,000 persons had registered in the program of whom over 93,000 were thought to be currently in treatment. In the same period Guangxi province opened 60 MMT clinics with 13,014 registered clients of whom 6,040 were still actively on treatment.

Pact, through the Alliance, will support a peer-led MMT adherence support program with an accompanying package of support services for HIV+ MMT clinic attendees implemented by the Guangxi Red Cross (GXRC) and run through 4 government-run MMT clinics in Guangxi Province. Interventions were selected and designed in response to the relatively high drop-out rates (40-50%) from MMT program and the need to build stronger linkages with care and support services.

Intervention components include peer-led MMT adherence support; HIV peer education; outreach to bring in new clients; family support activities; IEC dissemination; peer psycho-social counseling; and home visits. Support will be provided to the GXRC to ensure the quality of the intervention through; support for monitoring and supervision systems, TA for service model protocols, IEC materials and peer training program curriculum development; and training for peers, clinicians and staff.

Anecdotal evidence reports that having a job and receiving rehabilitation support can reduce the risk of relapse and therefore HIV transmission. PACT will support two employability and employment skills training models: an enterprise-based model and a MMT clinic-based model. These combine job opportunity and job training in a supportive environment, a peer rehabilitation support system, including relapse prevention, and mechanisms supporting family reintegration. Direct support will be provided to a small number of pilot sites. TA will be provided to interventions funded by the GoC, GFATM and other donors to replicate the models.

Pact will also develop linkages with IDU rehabilitation centers and community-based support initiatives to enable smooth flow of IDU coming out of government facilities to these services.