PEPFAR's annual planning process is done either at the country (COP) or regional level (ROP).
PEPFAR's programs are implemented through implementing partners who apply for funding based on PEPFAR's published Requests for Applications.
Since 2010, PEPFAR COPs have grouped implementing partners according to an organizational type. We have retroactively applied these classifications to earlier years in the database as well.
Also called "Strategic Areas", these are general areas of HIV programming. Each program area has several corresponding budget codes.
Specific areas of HIV programming. Budget Codes are the lowest level of spending data available.
Expenditure Program Areas track general areas of PEPFAR expenditure.
Expenditure Sub-Program Areas track more specific PEPFAR expenditures.
Object classes provide highly specific ways that implementing partners are spending PEPFAR funds on programming.
Cross-cutting attributions are areas of PEPFAR programming that contribute across several program areas. They contain limited indicative information related to aspects such as human resources, health infrastructure, or key populations programming. However, they represent only a small proportion of the total funds that PEPFAR allocates through the COP process. Additionally, they have changed significantly over the years. As such, analysis and interpretation of these data should be approached carefully. Learn more
Beneficiary Expenditure data identify how PEPFAR programming is targeted at reaching different populations.
Sub-Beneficiary Expenditure data highlight more specific populations targeted for HIV prevention and treatment interventions.
PEPFAR sets targets using the Monitoring, Evaluation, and Reporting (MER) System - documentation for which can be found on PEPFAR's website at https://www.pepfar.gov/reports/guidance/. As with most data on this website, the targets here have been extracted from the COP documents. Targets are for the fiscal year following each COP year, such that selecting 2016 will access targets for FY2017. This feature is currently experimental and should be used for exploratory purposes only at present.
Years of mechanism: 2008 2009
SUMMARY
The National AIDS Control Plan Phase 3 (NACP-3) has given high priority to the prevention of mother-to-
child transmission (PMTCT). Under NACP-3, existing counseling and testing (CT) and PMTCT centers are
being remodeled as a hub that integrates all HIV-related services, renamed Integrated Counseling and
Testing Centers (ICTC). ICTCs are envisaged as a key entry point for both men and women for HIV/AIDS
services. In FY08, the Avert project will provide technical support to Maharashtra State AIDS Control
Society (MSACS) and the Goa State AIDS Control Society (GSACS) to expand the coverage of quality
PMTCT services provided in the ICTCs. Avert project provide ongoing technical support, including
contracting a training institution to train ICTC staff. Avert will also fund two model PMTCT centers in the
private sector, and promote the expansion of private sector services.
BACKGROUND
The Avert Society project is a bilateral program implementing prevention, care, and treatment activities in
high-burden districts of Maharashtra State. The population of Maharashtra is over 96.8 million and the HIV
prevalence is 0.75% (sentinel surveillance, State of Maharashtra, 2006). Avert currently supports over 70
NGOs to implement prevention, care, and treatment programs in selected high-burden districts of
Maharashtra State. Under the umbrella of the Avert project, the Health Communication Partnership/Johns
Hopkins University (HCP/JSU) and the Hindustan Latex Family Planning Promotion Trust (HLFPPT) have
been awarded cooperative grants to support the state in scaling up the efforts on communication
(HCP/JHU) and condom social marketing (HLFPPT).
The National AIDS Control Organization (NACO) has asked the Avert project to assume responsibility for
the Technical Support Unit (TSU) to support the State AIDS Control Societies (SACS) in Maharashtra and
Goa to scale up HIV/AIDS prevention, care, and treatment programs in accordance with the third National
AIDS Control Program INACP-3). It is envisioned that Avert will also provide direct implementation support
to fill critical gaps in prevention services and/or demonstrate best practice models for specific populations.
ACTIVITIES AND EXPECTED RESULTS
This activity will strengthen the ICTC program of MSACS and GSACS through ongoing technical support
and capacity-building of ICTC staff. Avert will demonstrate best practices by establishing PMTCT models in
the private sector. Provision or referral for partner testing will be offered to all clients at antenatal clinics
(ANC) or at post-delivery irrespective of HIV test results. CDC will assist the Avert project in providing
technical support to the SACS for improving the efficiency and quality of PMTCT services including training
of ICTC staff and developing model programs.
Avert will develop strategies to address barriers to women's access to PMTCT services. These include
minimizing wage loss for working women by facilitating testing facilities on ANC days at the community-
based primary health centers. Community men and women leaders will be sensitized and engaged to
provide a supportive environment for women to access PMTCT services.
ACTIVITY 1: Capacity-Building of SACS to Provide Quality PMTCT Services
Avert will build the capacity of the SACS to ensure that a high proportion of pregnant women are tested for
HIV and most of those testing positive are provided with PMTCT services. Provider- initiated opt-out HIV CT
at sub-district hospitals and primary health centers with same day rapid test results will be promoted to
reach the largest number of pregnant women. Avert will provide ongoing technical support to the SACS and
field ICTC centers on the supply chain management of PMTCT test kits and ARV prophylaxis drugs,
counseling quality, minimizing losses to follow-up, and care and treatment services, including ARV
treatment during pregnancy and post-delivery.
With FY08 funds, Avert will contract a training institution to train around 1400 staff from 200 ICTC centers of
MSACS and two model centers, in accordance with the national and international PMTCT protocols and
guidelines. The curriculum will focus on quality PMCT services, client satisfaction, supply chain
management of test kits and ARV prophylactic drugs, follow-up of the mother-baby pair after delivery, and
testing and confirmation of the baby's status at 18 months of age. ICTC staff will also be trained in
establishing linkages and networking with ART treatment centers, community care centers, PLHA drop-in
centers, home-based care service providers and TB-DOTS centers for providing care and treatment
services.
ACTIVITY 2: Developing Model PMTCT Centers in the Private Sector
Avert will develop two model PMTCT programs in the private sector to provide safe, confidential, cost-
effective and accurate counseling and testing facilities that will reach 2000 pregnant women. These centers
will be located in private maternity care institutions/nursing homes. The sub-partner will fund the
infrastructure (space for outpatients, counseling, gynecological examination tables, a delivery room, and a
laboratory) and the ARV prophylactic drugs (in accordance with national guidelines). The cost of delivery
and ARV prophylaxis will be borne by the client as in line with a cost recovery model for public-private
partnership. Avert will fund staff salaries, build staff capacity and monitor the program. The mother-baby
pair will be followed up with ongoing breast feeding and early weaning counseling and at 18 months the
child will be tested to confirm his or her sero-status.
The aim of setting up these model centers is to expand PMTCT services in the private sector. The model
will be promoted by disseminating the lessons learned to the various forums of private healthcare
institutions. Efforts will be made to leverage ARVs, consumables, and managerial assistance from District
Supervisors through MSACS and/or UNICEF and CDC.
ACTIVITY 3: Referrals and Linkages to ICTCs
Avert will strengthen referrals and linkages to ICTCs and maternal and child health services as required to
receive the full range of PMTCT- related services. Avert will ensure the provision of free prophylactic ARV
for HIV-positive ANC mothers at government ICTC centers and outreach workers will follow-up these
women through home visits. Outreach workers will motivate mothers who are tested positive to undertake
hospital delivery. Trained counselors will provide support to mothers for optimal infant feeding, including the
promotion of exclusive breastfeeding (associated with lower rates of transmission than mixed feeding), as
Activity Narrative: appropriate. Referrals will be made for comprehensive HIV care including the prevention of opportunistic
infections and TB treatment, and HIV-positive mother will be linked to care and support programs. Linkages
will also be established for routine maternal and child health services for mothers and infants in the
postnatal period. Post-delivery HIV-positive mother and infants will be linked up to care and treatment
services, including ARV treatment.
ACTIVITY 4: Demand Generation for PMTCT Services
With FY08 funds, Avert will provide technical support to MSACS and GSACS to train NGOs implementing
prevention, care and support programs at the community level to develop referral linkages with ICTCs and
to motivate pregnant women to access PMTCT services.
ACTIVITY 5: Quality Assurance and Monitoring and Evaluation (M&E)
With FY08 funds, Avert will provide technical support to the SACS to establish a robust M&E system
including a Management Information System to assess the effectiveness of PMTCT service delivery.
Program activities will be monitored for effective logistic supply and delivery mechanisms, gender
sensitivity, and the maintenance of national and international standards. Avert will collaborate with the
government's District AIDS Prevention and Control Units' M&E teams in assessing the effectiveness and
improving the quality of ICTC services.
The Avert project will support the Maharashtra State AIDS Control Society (MSACS) and the Goa State
AIDS Control Society (GSACS) to implement a balanced abstinence, be faithful, and condom promotion
program targeting mobile populations (truckers and migrants), high-risk youth, and adults in the high-burden
districts of Maharashtra. Avert will train NGOs to promote abstinence and mutual fidelity and help
individuals to understand and personalize the risks of multiple partners and the benefits of mutual fidelity.
Avert will also support peer education programs to promote delayed sexual activity among high-risk youth.
NGOs and/or peer educators will help individuals know their HIV status and provide linkages with
counseling and testing (CT) centers and care and treatment programs. The interventions will cover 270,900
individuals, including 77,490 for abstinence related messages only. As a TSU, Avert project will provide
technical assistance to the SACS for selecting NGOs, building the capacity of NGO staff and monitoring and
evaluating the quality of interventions.
Avert is a bilateral program implementing prevention, care, and treatment activities in high-burden districts
of Maharashtra State. The population of Maharashtra is over 96.8 million and the HIV prevalence is 0.75%
(sentinel surveillance, State of Maharashtra, 2006). Under the umbrella of the Avert project, the Johns
Hopkins University Health Communication Partnership (JHU/HCP) and the Hindustan Latex Family
Planning Promotion Trust (HLFPPT) have been awarded cooperative grants to scale-up communication
(HCP) and condom social marketing (HLFPPT). The National AIDS Control Organization (NACO) has
recently requested Avert to take up a new role as manager of the Technical Support Unit (TSU) in
Maharashta and Goa states to support the scale-up of HIV/AIDS programs in accordance with the strategy
outlined in the third National AIDS Control Program (NACP-3), 2007-2012. In this role, Avert will support the
state AIDS control societies (SACS) to scale up evidence-based prevention, care, and treatment programs.
Avert will provide direct implementation support to fill critical gaps in prevention services and/or demonstrate
best practice models for specific populations.
Prevention programs will be designed to ensure equitable access to gender-appropriate prevention
messages and services by girls and boys and women and men. Specifically, girls and boys selected as
peer educators will be trained to form Red Ribbon Clubs to promote abstinence and be faithful messages.
Advocacy programs will be carried out for community male and female leaders to address male norms in
the society.
ACTIVITY 1: Delaying Sexual Debut among Youth
In FY08, four youth projects will be directly implemented by Avert project, reaching an estimated 72,000
youth. Avert will continue to directly support two existing interventions on youth: the Centre for Youth
Development and Activities (CYDA) and Nehru Yuva Kendra, (NYK) a community youth organization.
CYDA is presently implementing AB interventions using trained peer educators to reach students in 30
colleges in three high-burden districts: Solapur, Satara, and Sangli. Peer educators have established Red
Ribbon Clubs in the 30 colleges and organized discussions, debates and competitions focusing on delaying
sexual debut and risk reduction. In FY08, CYDA will continue interventions among college students and will
expand to reach rural and slum youth in the three high-burden districts. Avert will also continue to support
NYK to implement AB interventions among rural and slum youth in one high burden district, with a youth
population of 138,000.
NYK will implement interventions among rural and slum youth in two new high-burden districts. The
program will emphasize abstinence, reduction of casual sexual relationship, and endorse community
morals. Life skills education will be given to both boys and girls to help them make better choices. Linkages
to youth-friendly services for STI treatment and counseling and testing will be developed. Youth will be
reached through volunteers, peers educators (PEs) and by formation of village-level Red Ribbon Clubs
among boys and girls. Peer educators will be trained by master trainers through peer training modules that
teach the PEs how to provide information and engage the youth in discussions related to abstinence from
sex, delaying sexual debut until marriage, delayed age of marriage, and developing skills for practicing
abstinence. The peer educators will use the youth toolkit developed by JHU/HCP to facilitate discussions on
AB.
ACTIVITY 2: Promoting Sexual Abstinence and Fidelity among Migrants
Avert will reaching 58,400 short-term migrants through six interventions. In FY08, the project will support
three NGO interventions among construction workers, loom workers and textile workers. NGOs have
trained PEs to provide information on abstinence and mutual fidelity to these groups. PEs will conduct
interpersonal communication sessions and support community media activities such as street plays and
puppet shows to reinforce prevailing cultural norms on abstinence and fidelity. The NGOs will also create a
supportive environment for behavior change by sensitizing the contractors and owners of these industries.
Specifically, advocacy efforts will be carried out to frame policies for providing a safe environment for
women migrants. Avert will provide additional support and build the capacity of these NGOs to provide
training so the projects can serve as demonstration programs.
Avert will also support a demonstration program on source-destination migrants (Tamil Nadu-Mumbai) and
two new interventions in Karnataka-Mumbai and Uttar Pradesh-Mumbai. In a source-destination program,
outreach teams provide and link prevention education and referrals to other HIV services in both the migrant
source and destination locations. Additionally, Avert will conduct a mapping study to assess the dynamics of
short-term migrants in Maharashtra State. Based on this assessment, Avert will provide technical support in
planning and implementing interventions using various approaches among short-term migrants. Based on
the lessons learned from the demonstration programs, Avert project will develop a strategy for intervention
among short term migrants and will provide technical assistance to MSACS in operationalizing. The
program for short-term migrants is consistent with the NACP-3 strategic plan, and Avert project will provide
useful lessons in guiding the national strategies for interventions among short-term migrants.
ACTIVITY 3: Promoting Sexual Abstinence and Fidelity in Workplace Interventions
In FY08, Avert will contract three large institutions to implement workplace intervention programs, and will
support NGOs in these districts to implement interventions for unorganized workers. The International
Labor Organization (ILO) will provide technical support to Avert in scaling up workplace programs in these
districts. The program will sensitize senior managers, mid-level managers, and trade unions to support risk
avoidance and risk reduction behaviors among the workers. Master trainers and peer educators will be
identified using the ILO strategy and each company will develop and implement an HIV/AIDS workplace
policy. In the informal sector, NGOs will train peer educators to conduct interpersonal communication
sessions, street plays, and puppet shows promoting abstinence and fidelity among the workers. Avert will
partner with 50 companies to implement these activities.
ACTIVITY 4: Promoting Sexual Abstinence and Fidelity among Truckers
With FY08 funds, Avert will develop the existing two interventions among truckers into demonstration
Activity Narrative: programs, reaching an estimated 25,000 truckers with AB messages.. Avert will provide additional support
and build the capacity of two NGOs on a variety of training skills for transferring their knowledge of
intervention approaches to the NGOs supported by MSACS and GSACS.
Avert will provide technical assistance to MSACS and GSACS in planning and implementing interventions
for truckers and their sexual partners along the national highways. This will include support to the SACS for
selecting NGOs, capacity-building of NGO staff and monitoring and evaluating the quality of interventions.
NGOs will train peer educators to promote abstinence and fidelity messages through interpersonal
communications, street plays, exhibitions and puppet shows at truck halt points. NGOs will facilitate access
to STI treatment, condom skills building and supplies, counseling and testing, and care and treatment
services to the target community.
ACTIVITY 5: Ensuring Quality of Services through Capacity Building
Avert project will contract eight training institutions to develop a program for NGOs to strengthen the quality
of HIV behavior change interventions. The curriculum will cover basic facts on HIV/AIDS, peer education,
counseling and communication skills, interpersonal communication skills, and will include module on AB
interventions. Avert will contract two institutions each for peer education, counseling, basic facts on
HIV/AIDS, and communication skills. The training curriculum will be designed based on national and
international guidelines and a capacity-building needs assessment. Training modules will be reviewed and
updated. Two hundred sixteen NGO staff and 720 peer educators will be trained.
ACTIVITY 6: Printing and Distribution of BCC Materials
In FY08, Avert will print and distribute Information, Education and Communication toolkits comprising
flipcharts, and give-away materials on abstinence and fidelity to its directly-supported NGOs. HCP/JHU will
provide technical support in developing the prototypes of the tool kit and materials on AB, and will provide
technical support to train the NGOs on the use of materials.
The Avert Society project will provide technical support to the Maharashtra State AIDS Control Society
(MSACS) and the Goa State AIDS Control Society (GSACS) to scale-up and implement quality targeted
intervention programs among most-at-risk populations (MARP). Avert will also develop model programs on
targeted interventions among female sex workers (FSW) and men having sex with men (MSM) to serve as
demonstration sites for capacity building of NGOs supported by MSACS and GSACS. The USG-funded
Hindustan Latex Family Planning Promotion Trust (HLFPPT) will support the SACS in increasing access to
high quality condoms by expanding the condom social marketing program in 29 high-burden districts and in
high-risk locations in six moderate prevalence districts in the State of Maharashtra and in two districts of
Goa State (see the HLFPPT narrative). The Health Communication Partnership/Johns Hopkins University
(HCP/JSU) will provide technical support to the SACS in designing and implementing communication
programs for MARPs. Linkages will be established with counseling and testing and care and treatment
The Avert project is a bilateral program implementing prevention, care and treatment activities in high
burden districts of Maharashtra State. The population of Maharashtra is over 96.8 million and the HIV
NGOs to implement prevention, care, and treatment programs. Targeted interventions among FSW and
MSM are implemented by local NGOs and CBOs sub-contracted by Avert.
Under the umbrella of the Avert project, HCP/JHU and HLFPPT have been awarded cooperative grants by
USG to support the state in scaling up the efforts on communication (HCP/JHU) and condom social
marketing (HLFPPT). The National AIDS Control Organization (NACO) has recently suggested that Avert
could assume responsibility for the Technical Support Unit (TSU) in Maharashtra and Goa states to support
the scale-up of the states' HIV/AIDS prevention, care, and treatment programs in accordance with the
priorities of the third phase of the National AIDS Control Program (NACP-3). Avert project will also provide
direct implementation support to fill critical gaps in prevention services and/or demonstrate best practice
models for specific populations.
According to the MSACS Program Implementation Plan, there are over 129,000 sex workers in the state, of
which only 31,600 are reached; there are 25,000 MSM, with only 18,200 reached; and over 10,000 IDUs,
with only 2,000 reached. The aim of NACP-3 is to saturate the coverage of MARPs by reaching at least
80% of the estimated numbers. The behavioral surveillance survey conducted by Avert has shown that a
significant proportion of truckers and youth are engaging in high-risk behaviors. In FY08, Avert will provide
technical assistance to the SACS in planning and implementing programs for MARPs and develop model
programs to serve as demonstration sites for NGOs.
With FY08 funds, Avert will not focus on direct implementation of targeted intervention programs for MARPs
but will emphasize strengthening MSACS and GSACS to scale-up and provide quality preventive services
to these populations (FSW, MSM and IDU). Avert will continue to provide direct support for interventions
among bridge populations, including high-risk youth, and to develop demonstration programs to transfer
best practices. Avert will also develop strategies to address discrimination against FSW, MSM and IDU
populations in accessing preventive and health services such as STI treatment and counseling and testing.
ACTIVITY 1: Technical Support to MSACS and GSACS on Targeted Interventions
In FY 2008, as part of the TSU, Avert will support MSACS and GSACS in mapping MARPs in the two
states. Based on this mapping information, Avert will assist the SACS in developing and implementing a
plan to scale-up targeted interventions for MARPs. Avert will also provide technical assistance (TA) to
MSACS and GSACS in the planning and implementation of prevention programs targeting high-risk
truckers, migrants, workers, and youth.
Specifically, Avert will provide technical support to the SACS in NGO management including the selection
and capacity building of NGOs on core skills for implementing targeted interventions, and monitoring and
evaluation (M&E) to improve intervention quality. As there will be over 200 NGOs, a team of consultants will
be set up in each SACS to assist in M&E and provide ongoing technical support to the NGOs. Avert will also
coordinate the technical support activities of the USG-supported HCP/JHU communication program and the
HLFPPT condom social marketing program. The TSU will also provide technical assistance in integrating
gender concerns into prevention programs for MARPs, based on the lessons learned from the gender
integration pilot programs conducted in FY06.
MARPs will be reached by peer educators supported by NGOs to promote correct and consistent condom
use, referrals for STI treatment, and counseling and testing services. In FY08, Avert will build the capacity of
MSACS to reach 32,295 sex workers, 6337 MSM and 2000 IDU.
ACTIVITY 2: Developing Model MARP Projects
In FY08, Avert will support four model projects, two on FSW and two on MSM. One FSW model will be for
brothel-based and one for non-brothel-based sex workers. For MSM, one project will be in Mumbai and one
in Sangli. Both projects will be run by community-based organizations. FSWs, their clients and the MSM
population will be reached by outreach workers and peer educators to promote correct and consistent use
of condoms and other prevention methods for protection against HIV infection. The activities include
interpersonal communication, condom demonstrations, community media events, distribution of IEC
material and STI counseling and referral services. Additionally, linkages will be established with counseling
and testing and care and treatment programs.
These model projects will serve as demonstration sites to share best practices and provide hands-on-
training to NGOs supported by MSACS and GSACS. The intervention will provide training and
infrastructure support to the model projects and will build the capacity of staff on curriculum planning and
Activity Narrative: participatory training methods. The model projects will reach out to 4000 sex workers and 4800 MSM.
ACTIVITY 3: Programs for Mobile Populations, High Risk Youth and Adults in the General Population
The Behavioral Surveillance Survey conducted by Avert project in Maharashtra State in 2006 reported that
39% of unmarried male slum youth (20-24), 18% of the male college youth and 11% of female college youth
are sexually active. The study also reported that 50% of truckers have sex with commercial partners.
Based on this evidence, it is critical to promote consistent and correct condom use while simultaneously
emphasizing a return to abstinence and mutual fidelity.
With FY08 funds, Avert will provide direct support to 15 NGOs to implement balanced ABC programs
among truckers (two interventions), migrants (six interventions), youth (four interventions) and three large
interventions in the workplace. Trained peer educators and outreach workers will conduct interpersonal
communication sessions and support community media activities to promote correct and consistent use of
condoms along with Abstinence and Be Faithful messages. Additionally, linkages will be established with
counseling and testing and care and treatment programs.
ACTIVITY 4: Capacity-Building of NGOs and CBOs for MARP Interventions
With FY08 funds, Avert will contract training institutions to train those NGOs supported by MSACS, GSACS
and the Avert project in basic facts on HIV/AIDS, and peer education, counseling and communication skills
(including interpersonal and group communication methodology). Standard training modules on targeted
interventions for MARPs are available, and will be updated. Avert will contract two training institutions for
peer education, two for counseling, two for training on basic facts in HIV/AIDS, and two for communication
skills. The training curriculum will be designed based on national and international guidelines. Over 500
NGO staff and 600 peer educators, implementing targeted interventions, will be trained.
ACTIVITY 5: Printing and Distribution of Behavior Change Communication Materials
In FY08, the Avert project will print and distribute to outreach staff an Information, Education and
Communication toolkit comprising flipcharts and give-away materials focusing on correct and consistent
condom use, including abstinence and fidelity messages. HCP/JHU will provide technical support to
develop the prototypes of the IEC tool kit and materials for most-at-risk and bridge populations. HCP/JHU
will also provide technical support to train the NGOs on the use of materials.
The Avert Society's project aims to bridge critical gaps in Maharashtra State by providing quality HIV
palliative care services in nine districts through community care and support centers (CCC), drop-in-centers
also known as integrated positive prevention and care centers (IPPC) and home-based care linked with
government health services and community outreach. The palliative care services include management of
opportunistic infections (OIs) through outpatient and inpatient services, counseling, TB diagnosis and
referral to DOTS, and linkages to ARV services. The home-based care program provides nutrition
education, hygiene education, counseling for positive prevention, adherence to ARV treatment, and
linkages to socio-economic support services.
These activities will be targeted to adults, women, and children living with HIV/AIDS, with a focus on a
family-centered approach. Special efforts will be made to reach out to children and women. Training will
focus on doctors, nurses, counselors, outreach workers, family members and caregivers of PLHAs through
home-based care. Avert will implement a networked program in Sangli district integrating prevention, care,
and treatment services. Avert will also provide technical support to Maharashtra State AIDS Prevention and
Control Society (MSACS) and Goa State AIDS Prevention and Control Society (GSACS) in expanding and
improving palliative care services in the state.
high-burden districts of Maharashtra State. The population of Maharashtra State is over 96.8 million and the
HIV prevalence is 0.75% (sentinel surveillance, State of Maharashtra, 2006). Avert currently supports over
70 NGOs to implement prevention, care, and treatment programs in selected high burden districts of
In Maharashtra State, palliative care interventions are carried out by MSACS and the Avert project.
Together they support 37 care interventions in the state (MSACS, 17 and Avert, 20), which is not enough to
provide coverage to over 600,000 PLHAs (an estimated number of PLHA based on 0.75% prevalence
[National Family Health Survey, 2006]). MSACS and Avert will scale-up palliative care intervention to meet
the growing needs of the state.
Avert's palliative care program started with PEPFAR funding in 2006. In FY08, Avert will directly support 16
palliative care interventions to reach over 18,000 PLHAs. Avert will also provide technical assistance to
MSACS and GSACS to expand quality palliative care services.
Avert's program will address barriers to ensure equitable access to palliative care services by men and
women and MARPs. The outreach team will mobilize community support to eliminate the barriers women
face in accessing care, and encourage greater responsibility and participation by men to reduce the
disproportionate burden of care falling on women.
ACTIVITY 1: Providing Quality Palliative Care Services through CCCs
Avert will complement the efforts of MSACS by bridging the gaps in palliative care services in nine high-
burden districts. With FY08 funds, Avert will continue the support started in 2006 to seven CCCs and will
support a new CCC in Sangli district. Services provided at the CCCs include out-patient and in-patient
services for opportunistic infection (OI) management, psychosocial support, training of caregivers, ART
adherence, management of side effects, counseling for sexual and reproductive health and referrals to ART
and TB-DOTS services. The CCC will have linkages with ART centers and the Revised National TB Control
Program in the districts. The CCCs will integrate HIV care into existing medical services, safeguarding
against perceptions that the center is meant only for HIV/AIDS care, and ensuring that HIV care is
mainstreamed. This will contribute to the sustainability of services after the project period. Avert will support
the costs for staff, rent, nutritional support, supplies, and logistics to implement the program.
ACTIVITY 2: Ensuring a Safe and Conducive Atmosphere for PLHAs to Network and Seek Care
Currently nine drop-in centers (DICs) also known as integrated positive prevention and care centers
(IPPCC) serve as safe spaces for HIV-positive persons and family members to support each other. Within
these centers, counseling on ART, sexual and reproductive health, positive prevention, and psychosocial
support are provided. Additionally, follow-up of PLHAs, who dropped out or for TB and ART adherence, will
be carried out. The centers take a family-centric approach in dealing with nutrition, social, and health issues.
All services are managed by networks of positive people with support from the Avert project, MSACS and
the Network of Maharashtra Positive People.
Starting in FY 2006 and continuing in FY 2007, Avert project began transitioning six out of nine DICs to
MSACS. With FY08 funds, Avert will develop the three remaining DICs into demonstration programs to
serve as learning sites for new interventions supported by MSACS.
ACTIVITY 3: Home-Based Care
The third component in service delivery is community outreach through home-based care services. With
FY08 funds, Avert will continue the two home-based care programs initiated in FY06 and will initiate three
new interventions. The home-based care program will provide medical services, psychosocial support,
hygiene and nutrition education, and accompanied referrals to higher levels of care, TB and ARV treatment.
Activity Narrative: The home-based care team will motivate and refer family members for HIV testing. The team will also
facilitate linkages to faith-based organizations and government welfare programs to access social support
services. The home-based care program will establish systems to network with integrated counseling and
testing centers (ICTCs), RNTCP, ART centers, and social support programs.
ACTIVITY 4: Sangli Networked Model of Prevention, Care, and Treatment
The Sangli networked model initiated in FY06 will continue in FY08. The networked model is jointly
implemented by the Avert project and CDC in collaboration with MSACS. The model envisages expanding
high quality prevention, care, and treatment services by establishing formal linkages between services at
facilities and in the community or with a home-based care program. The networked model will also link
prevention programs among most at-risk populations (MARPs) to counseling and testing, care and support,
and ARV treatment services. There will be systematic referrals of patients and families from one location to
another. The Sangli networked model will be coordinated by the District AIDS Prevention and Control Unit
(DAPCU). The DAPCU will develop and monitor the systems for integration of services. CDC will provide
technical assistance to strengthen the quality of ART services.
ACTIVITY 5: Technical Support to SACS to Provide Quality Palliative Care Services
With FY08 funds, Avert will provide technical support to MSACS and GSACS in expanding and
strengthening palliative care services to PLHAs in Maharashtra and Goa States. Specifically, technical
assistance will be provided in the selection of community care and support centers, capacity-building of
palliative care staff and monitoring the quality of services. The Avert project will develop operational
guidelines for establishing linkages between the CCC and counseling and testing centers and ART
Avert will contract two training institutions to build the capacity of the staff of CCC, HBC, and DIC to provide
quality palliative care services to PLHAs, their spouse (infected/affected), family (affected) and children
(infected and affected). The staff of prevention, care, and treatment programs in the Sangli networked
model program will also be trained. The multidisciplinary care teams will be trained based on the guidelines
and the strategies of CCC, HBC, and DIC. Medical officers will be trained on the management of OIs and on
ARV treatment and nutritional care for PLWHAs. The nursing staff will be trained in universal precautions,
post-exposure prophylaxis and palliative nursing care services. The counselors will be trained in quality
counseling services including adherence counseling, nutrition counseling, behavior change counseling for
concordant and discordant couple, partner notification and testing, and positive living. Outreach workers will
be trained in providing home-based care, adherence to OI and ARV treatment, hygiene and nutritional care,
training of caregivers, and addressing stigma and discrimination, including gender issues. The project
coordinators and the documentation officers will be trained in project management, advocacy with
stakeholders, developing referrals and linkages, Management Information Systems, finance and human
resource management. A total of 528 individuals from the programs supported by MSACS, GSACS, and
Avert will be trained in providing quality palliative care services.
N/A
Under the National AIDS Control Program Phase 3 (NACP-3), existing counseling and testing (CT) centers
and facilities for the prevention of mother to child transmission centers are being re-modeled within one hub
that integrates all HIV-related services, and renamed Integrated Counseling and Testing Centers (ICTCs).
ICTCs are envisaged as a key entry point for both men and women for a range of HIV/AIDS services. The
Maharashtra State AIDS Control Society (MSACS) has scaled up these ICTCs rapidly to over 700 centers
in the state. However, this has not been matched by efforts to create a demand for these services, including
improving their quality.
In FY08, the Avert Society project will provide technical support to MSACS and the Goa State AIDS Control
Society (GSACS) to strengthen the ICTC. Avert will provide ongoing technical support including training of
ICTC staff to streamline systems to support quality CT services. Avert will contract one training institution to
train the staff of 200 ICTC centers supported by MSACS. Avert will also provide direct support for
strengthening and promoting the expansion of CT services in the private sector. In order to increase the
access of most-at-risk populations (MARPs) to CT services, two user-friendly CT centers that are sensitive
to MARPs will be supported by Avert.
The aim of this activity is to increase the coverage of CT services by strengthening the ICTC program of
MSACS and GSACS. It is estimated that more than 90% of HIV-infected people do not know their status.
Expansion of ICTC services will help individuals to learn their HIV status, and consequently in referrals to
HIV prevention, care, and treatment services. Avert, in collaboration with CDC, will provide support through
ongoing technical assistance to the SACS, capacity-building of ICTC staff, and the development of model
programs. Avert will also demonstrate best practices by establishing CT models in the private sector and
for MARPs. Provision or referral for partner testing will be offered to all clients at the ICTCs irrespective of
HIV test results.
NGOs in the intervention areas have observed that when husbands have tested HIV-positive they blame
their wives, and when the husband dies the women and their children are abandoned by the family.
Program approaches will address the unique needs of women and acknowledge the potential for violence
and abandonment and other negative outcomes women may also face in disclosing their own HIV-positive
status. Avert will plan programs to sensitize male and female community leaders to address these concerns
and protect women from discrimination.
ACTIVITY 1: Capacity-Building of SACS to Provide Quality CT Services
Avert will build the capacity of the SACS to increase coverage for different at-risk populations and
strengthen the quality of CT services. Technical assistance will be provided to SACS to establish working
linkages with the Revised National TB Control Program (RNTCP) and STI services. There will be a specific
focus on strengthening the supply chain management and counseling quality which are currently weak
areas of the SACS program.
With FY08 funds, Avert will contract a training institution to train the staff of 200 ICTC centers of MSACS,
adapting the training manual and curriculum from the national guidelines. Counselors will be trained in pre-
and post-test counseling; technicians in testing methods and quality assurance; and the outreach team in
community mobilization, promoting access to CT services, and addressing stigma and discrimination. ICTC
staff will also be trained to provide user-friendly services to CSW, MSM, IDU, and youth and establishing
linkages and networking with ART treatment centers, community care centers, PLHA drop-in centers and
TB-Directly Observed Treatment - Short Course centers.. Approximately 1845 personnel will be trained in
C&T.
ACTIVITY 2: Expanding Access to CT Services in the Private Sector
This activity will provide comprehensive CT services (both through stand alone and integrated facilities) in
the private sector. With FY08 funds, Avert will demonstrate best practices by supporting the integration of
CT services into three targeted intervention programs for MARPs. Avert project will also support CT centers
in six private hospitals/laboratories and one model integrated CT and care support services program, and
will promote the expansion of CT services in the private sector. The focus will be on pre-test counseling,
providing a safe, confidential, cost effective and accurate testing facility (staff, kits, laboratory), and post-test
counseling. In the private sector CT intervention, the sub-partner will provide space for an out-patient
department, and counseling and laboratory services. The cost of the test kits will be borne by the client, in
accordance with the cost recovery model of public-private partnership. Avert will fund staff salaries, build
the capacity of staff, and monitor the program.
ACTIVITY 3: Demand Generation for CT Services
Activity Narrative:
With FY08 funds, Avert will provide technical support to MSACS and GSACS to develop a plan and provide
training for NGOs and CBOs implementing HIV prevention, care and support programs to mobilize the
community in order to increase demand for both CT and PMTCT.
ACTIVITY 4: Quality Assurance for CT
With FY08 funds, Avert will provide technical support to the SACS in establishing a robust monitoring and
evaluation (M&E) system, including a Management Information System, to assess the effectiveness of CT
service delivery. Program activities will be monitored for effective logistic supply and delivery mechanisms,
gender sensitivity, and to ensure that national and international standards are maintained. Avert will
collaborate with the government District AIDS Prevention and Control Units' M&E team in assessing the
effectiveness and improving the quality of ICTC services.
As the Technical Support Unit (TSU) for the Maharashtra State AIDS Control Society (MSACS) and the Goa
State AIDS Control Society (GSACS), the Avert Society project, in collaboration with CDC, will provide
technical assistance (TA) to the SACS to improve coverage of quality ARV services. Avert will assist
MSACS in developing and implementing a plan to enroll patients in the pre-ART program, conduct periodic
follow-up and identify any change in a patient's ART- eligibility status. Avert will build the capacity of the
SACS to maintain the ARV supply chain, monitor and evaluate ARV services and ensure adherence
counseling. Avert will also train the ART team on standard protocols in ARV management. Additionally, in
Sangli district the Avert project, in collaboration with CDC, will demonstrate best practices in increasing the
coverage of quality ART services through the implementation of a networked model of prevention, care, and
treatment.
Maharashtra State.
Under the umbrella of the Avert project, the Health Communication Partnership/Johns Hopkins University
(HCP/JHU) and the Hindustan Latex Family Planning Promotion Trust (HLFPPT) have been awarded
cooperative grants to support the state in scaling up communication (HCP/JHU) and condom social
marketing (HLFPPT).
The National AIDS Control Organization (NACO) has recently suggested that the Avert project could take-
up the role of the TSU in Maharashtra and Goa states, to support the scale-up of HIV/AIDS prevention,
care, and treatment programs in accordance with the priorities of the National AIDS Control Program's third
phase (NACP-3). Avert will also provide direct implementation support to fill critical gaps in prevention
services and/or demonstrate best practice models for specific populations.
Maharashtra State AIDS Prevention and Control Society (MSACS) is currently supporting 13 ART centers
and plans to increase this to 29 centers in FY08.The state provides free ARV services in the government
and civil hospitals in various districts. Currently, MSACS provides ARV treatment to over 14,000 people
living with HIV/AIDS (PLHA) and plans to increase this to 21,000 by 2008. Avert will provide TA to support
the state's plans for ART scale-up, through capacity building of the SACS in ARV supply chain
management, monitoring the quality of ARV services and adherence counseling to prevent ARV resistance.
Avert will collaborate with CDC to strengthen the quality of ARV treatment services in the state. This will
include addressing barriers to ensure equitable access to ARV treatment services by men and women and
most at risk populations (MARPs). Avert will advocate with ART centers to adjust ART out-patient
department hours to times convenient to patients coming from distant places, and to provide user-friendly
services to MARPs.
ACTIVITY 1: Technical Support to ART Centers
In FY08, Avert will continue to support the Sangli networked model of prevention, care, and treatment
services. As part of this model, the Sangli ART center will be strengthened to expand quality ARV services
to various segments of infected people, including MARPs. With FY08 funds, Avert will fund a Management
Information Systems (MIS) officer, train the ARV team, and provide ongoing technical support for generating
demand and improving the quality of ARV services in the Sangli ART center. Through this effort, Avert will
support ART treatment for about 3,500 HIV positive people.
In collaboration with CDC, Avert will extend technical support to five more ART centers to expand quality
ART services. It will assist MSACS to develop a technical assistance plan for these five centers, specifically
focusing on increasing enrollment in the pre-ART program with periodic follow-up for ART eligibility,
strengthening supply chain management, and ensuring adherence to treatment. Through this effort, Avert
will indirectly support ARV treatment for 2,400 patients.
ACTIVITY 2: Training of ART Teams
In FY08, Avert will collaborate with CDC to contract an ART training institution to train ART teams in 29
State ART centers. The teams, of a medical officer and a counselor, will be trained in various aspects of
counseling for adherence to ARV treatment, factors influencing adherence, the cost of ARV drugs,
monitoring tests, side effects and resistance to ARV, the nutritional needs of PLHA on ARV, Directly
Observed Treatment - Short Course Therapy (DOTS) for TB, and coordination with home-based care
programs to follow up adherence to treatment. The training manuals and curriculum will be adapted from
the existing national and WHO manuals for physicians and counselors. The counselor and ARV team will
also be trained in establishing linkages and networking with other departments and organizations providing
services like community care centers, PLHA drop-in-centers, home-based care programs, and TB-DOTS
centers.
Onsite technical support will be provided to the ARV team by experts on patient management (including
reducing waiting time), adherence, linkages with pathologist/microbiologist for CD4 and viral load follow-up,
correlating laboratory reports and clinical management with counseling and improving data quality
assurance and management.
In FY08, the Avert Society project as the Technical Support Unit (TSU) of the state will support the Strategic
Information Management Unit (SIMU) of the Maharashtra State AIDS Prevention and Control Society
(MSACS) in collecting, analyzing, reporting, and using the information for program review and planning.
Avert will assist MSACS in monitoring NGO prevention, care, and treatment programs. Avert will also
support MSACS in conducting evidence-based studies such as behavioral surveillance surveys, mapping of
high-risk groups, and program evaluations.
AIDS Control Program (NACP-3). It is envisioned that Avert will also provide direct implementation support
Strategic Information (SI) is embedded in NACP-3 as a key strategy for program monitoring and evaluation
(M&E). In phase-2, NACO had established a computerized management information system (CMIS), which
provided information on all the components of NACP for program monitoring. However, there were gaps in
CMIS, specifically in the areas of reporting, quality of data and skills for analysis, interpretation, and using
information for program planning. In NACP-3, a strategic information management unit (SIMU) is planned to
be established at the national and state level to strengthen the SI component. The Avert project will help
MSACS in establishing and strengthening the SIMU.
ACTIVITY 1: Mapping High-Risk Groups for Evidence-Based Planning
The mapping of most-at-risk populations (MARPs), including female sex workers (FSW), men having sex
with men (MSM), injecting drug users (IDU) and other vulnerable groups (migrants, truckers and street
children) will provide a comprehensive database by identifying physical locations where high-risk activities
take place and estimating the size of high-risk populations. This exercise will be undertaken in all 35
districts of Maharashtra. The database will provide evidence for expanding the scope and operations of
targeted interventions in the state. An agency will be hired to carry out this exercise in the field in close
association with the NGOs, community-based organizations, and community members.
ACTIVITY 2: State-Level Behavioral Surveillance Survey (BSS)
Until FY07, the BSS was conducted in selected high-prevalence districts and did not represent the whole of
Maharashtra State. With FY08 funds, Avert will support a state-level BSS study among most-at-risk groups
such as FSW, MSM and IDU and vulnerable populations such as youth, truckers, workers and migrants.
Avert will hire a research agency to conduct this study.
ACTIVITY 3: Assessment of Targeted Intervention (TI) NGO Programs
MSACS and the Avert project have been supporting NGOs to implement targeted intervention programs
among high-risk groups for five years. It is critical to carry out a review of the TI program to assess its
strengths, weaknesses, and gaps. The findings of this assessment will be used to strengthen and scale-up
TI programs in the state. An agency will be hired to conduct this assessment.
ACTIVITY 4: Assessment of the Palliative Care Program
In Maharashtra State, the palliative care program is being implemented by MSACS, with the Avert project
providing care and support interventions on a lesser scale. To date, no assessment has been carried out to
test the efficacy of these care and support models in providing quality services to people infected and
affected with HIV/AIDS. Additionally, there are concerns about coverage and lack of linkages between the
care and support programs and prevention, counseling and testing, and ARV treatment services. Hence an
agency will be contracted to assess the palliative care programs in the state. The findings will be used to
support MSACS in scaling up and strengthening the state's care and support programs.
ACTIVITY 5: Assessment of Integrated Counseling and Testing Center (ICTC) Programs
MSACS has rapidly scaled up the number of ICTCs to over 700 centers, providing a range of services,
including counseling and testing and services for the prevention of mother to child transmission. A major
concern is the lack of efforts to build the capacity or create a demand for ICTC services. Hence, an
assessment is planned to review gaps in the functioning of these centers and make recommendations to
strengthen the ICTC program in the state.
ACTIVITY 6: Estimating the Number of OVC
Maharashtra State does not have a good estimate of the number of OVC due to HIV/AIDS. It is important to
know the number of OVC and their geographical location in order to plan and scale-up OVC programs in the
state. Avert will collaborate with Family Health International's Samarth project to carry out an assessment of
the number of OVC, together with a needs assessment, as a basis for designing the state's OVC program.
Activity 7: Review of Training Programs
Avert will contract an agency to assess the effectiveness of the training programs conducted by various
institutions on prevention, care, and treatment. Specifically, the agency will assess the training curriculum,
including modules, training processes, and the management of training by the institutions.
The Avert Society project's strategic focus under this program area is to provide technical assistance for
HIV- related policy development to the state government, state AIDS control societies (SACS), NGOs,
community-based organizations (CBOs), including people living with HIV/AIDS (PLHA) networks and
corporate houses. The aim is to create a supportive environment for HIV/AIDS programs, mainstream HIV
into other sectors, and mobilize political and community support for various policies, such as supporting
prevention programs for most-at-risk populations (MARPs) and care and treatment services for PLHAs and
addressing gender concerns. The program will also build the capacity of the SACS in systems for project
management.
The Maharashtra SACS has planned to support over 150 interventions to saturate coverage of MARPs.
Similarly, programs on counseling and testing (700 centers), community care and support (40 centers), and
ART services (39 centers) will be scaled-up to increase coverage of services. However, the systems in
MSACS and the District AIDS Prevention and Control Units (DAPCU) are not strong to manage the scale of
expansion planned for the state. Hence it is critical to strengthen the project management systems of these
agencies.
ACTIVITY 1: Technical Assistance for Institutional Capacity-Building of SACS
With FY08 funds, Avert project will conduct a needs assessment to identify gaps in the project management
systems of the SACS. Based on this assessment, Avert will develop a joint technical assistance (TA) plan
that includes timelines and processes for building the capacity of SACS. TA will be provided in program
management, strategic planning, logistic management, information system, and program monitoring,
including a Management Information System.
ACTIVITY 2: Capacity-Building of NGOs in Program and Financial Management
Avert will conduct training programs for NGO program and finance managers on guidelines for program
management and financial procedures for implementing the interventions. A curriculum plan and training
modules will be developed and experts will be hired to conduct the training. 170 staff of 85 NGOs will be
trained and ongoing technical assistance will be provided on program and financial management of
interventions.
ACTIVITY 3: Development of HIV/AIDS Workplace Policies
In FY08, Avert will mobilize industries to develop and implement workplace policies that address stigma and
discrimination at the workplace and access to prevention, care, and treatment services for workers and their
families. In FY08, 25 industries will develop and implement HIV/AIDS workplace policies.
ACTIVITY 4: Data Quality Assessment
A comprehensive plan will be prepared to check and ensure the quality of data received from the sub-
partners (NGOs, CBOs and training institutions) of the Avert project and MSACS through submission of
monthly technical reports and monthly financial reports. Avert will also assess the quality of the data at sub-
grantee level by visiting sub-partners periodically and providing technical support to improve data quality.
ACTIVITY 5: Geographical Information System (GIS)
In FY08, Avert will develop a GIS on HIV/AIDS prevention, care, and treatment programs for the States of
Maharashtra and Goa. GIS will help in capturing, storing, analyzing and managing data related to HIV/AIDS
in these states, helping users to have access to information related to ART centers, integrated counseling
and testing centers (ICTCs), community care and support centers (CCCs), drop-in centers (DICs), home-
based care centers (HBCs), STI clinics, help lines and healthcare providers at district and block level. An
agency will be contracted to develop the GIS.
