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
Prevention of mother-to-child transmission (PMTCT) programs in the state of Tamil Nadu are relatively less
developed and are primarily implemented in public sector health care settings. Additionally, there is an
overall lack of expertise within the medical community in the area of PMTCT programs. In FY08, the AIDS
Prevention and Control (APAC) project will support comprehensive PMTCT initiatives in the private sector
through: supporting a network of 19 private hospitals, building the capacity of 300 private physicians
working with medical associations, and ensuring linkages of the trained physicians with PLHA networks and
other care continuum providers. The project will also build the capacity of the public sector through provision
of technical assistance (TA) to the local State AIDS authorities for comprehensive scale up of a quality
PMTCT program.
BACKGROUND
For the past twelve years, with USG support, Voluntary Health Services (VHS) has been implementing the
APAC project in the southern state of Tamil Nadu. APAC initially focused primarily on targeted interventions
for most-at-risk-populations (MARPs), but has expanded efforts over the last few years to support a more
comprehensive approach to HIV/AIDS prevention, care and treatment. Tamil Nadu has been successful in
controlling HIV (prevalence among antenatal women has dropped from 1.13% in 2001 to 0.5% in 2005) and
the APAC project has significantly contributed to this success. The National AIDS Control Organization
(NACO) has recognized the expertise and contributions of the APAC project and has requested APAC to
provide technical support to the State AIDS Control Societies (SACS) of Tamil Nadu, Puducherry and
Kerala by setting up a Technical Support Unit (TSU) in Tamil Nadu and Kerala, consisting of a core team of
consultants/experts co-located with the SACS, with a mandate to assist the SACS in scaling-up programs,
improving efficiency and quality. APAC also serves as the vice-chair on the Technical Working Group on
Targeted Interventions for the country.
PMTCT services for pregnant women in India are primarily concentrated in the public sector. Despite a high
proportion of pregnant women in India accessing antenatal services in the private sector, PMTCT has still
not received adequate emphasis from private sector health care providers. The national objective of
reducing infections in the newborn can be attained if access to PMTCT services is expanded to private
health care settings. Existing data from public sector health care institutions in Tamil Nadu indicate that
while there is an increase in the number of pregnant women getting counseled and tested, a large
proportion (more than 30%) of HIV-positive pregnant women do not receive ARV prophylaxis due to lack of
adequate follow-up. Data pertaining to the private sector is also sparse at best. The APAC project will
support activities that encourage the private sector to provide comprehensive PMTCT services, thereby
complementing public sector efforts. The APAC project will also coordinate with the SACS and other
stakeholders to evolve systems to increase the proportion of HIV positive pregnant women receiving
prophylaxis and follow-up care from public health care settings.
ACTIVITIES AND EXPECTED RESULTS
ACTIVITY 1: Increasing Access to Comprehensive PMTCT Services through a Network of Private Hospitals
The APAC project will support 19 private hospitals (16 secondary-level hospitals with provision for
institutional deliveries and three tertiary-level hospitals to provide comprehensive PMTCT services) in
selected high-prevalence districts in the states of Tamil Nadu and Puducherry. These hospitals will provide
PMTCT, TB-HIV co-infection management, and palliative care services including ARVs. Through this
initiative, APAC aims to increase the coverage of antenatal women in these high-prevalence districts,
motivate private sector health care institutions to get involved in HIV/AIDS management, and establish
sustainable models for replication. In each of the private hospitals, the project will support the services of
trained counselors who will provide counseling for antenatal, delivery and postnatal care for all pregnant
women. Counselors will be part-time. Each counselor will provide services to a minimum of two private
hospitals, each having a good client load of antenatal women. The PMTCT package of services will include
counseling and testing for pregnant women, ARV prophylaxis for HIV-infected pregnant women and
newborns, counseling and support for maternal nutrition, post delivery follow-up for safe infant feeding
practices, infant diagnosis and need-based linkages to care and treatment services for the mother, child and
family. Counselors will also focus on counseling and motivating the husbands of the antenatal women for
HIV testing.
APAC will train health care providers in private hospitals on: a) provision of comprehensive PMTCT
services; b) national PMTCT guidelines and standard operating protocols; c) universal precautions; and d)
establishing strong linkages with NGOs, PLHA networks and other care continuum providers. The private
hospitals will also provide palliative care services, thus ensuring that HIV-positive pregnant women and their
families have access to clinical services under one roof even after delivery. Quality assurance and
accreditation of the private hospitals is planned though State AIDS Control Societies and other agencies.
Demand generation for PMTCT services will be done through NGOs (both APAC- and SACS-supported),
networking with other health care providers, agencies and local communication campaigns. It is estimated
that nearly 6000 antenatal mothers will benefit annually through this initiative. This initiative is based on the
existing experience of APAC's support to IRT Perundurai Medical College, which is a tertiary care center
that has been supported by APAC since FY06.
ACTIVITY 2: Increase the Pool of Trained Health Care Providers Providing PMTCT Services
In two high-prevalence districts of Tamil Nadu, APAC plans to collaborate with the Federation of Obstetrics
and Gynecologists Society of India (FOGSI) to train obstetricians on comprehensive PMTCT services,
thereby increasing the pool of trained health care providers in the district. A total of 350 obstetricians will be
trained and followed-up. Existing training modules will be reviewed and modified to comply with the national
guidelines and protocols. The training curriculum will have a focus on: a) provider initiated counseling and
testing; b) counseling HIV- positive pregnant women on continuation of pregnancy and delivery; c) ARV
prophylaxis for HIV-infected pregnant women and newborns; d) counseling and support for maternal
nutrition and safe infant feeding practices; and e) referral for the continuum of care services. There will be
periodic follow-up of trained health care providers and experience-sharing meetings with other doctors in
the state. Linkages between the trained health care providers and local NGOs working on HIV programs
Activity Narrative: will be established. FOGSI will be the coordinating agency for training the doctors. Efforts will be begun to
mobilize support from leading pharmaceutical companies to sponsor training costs and the cost of providing
subsidized drugs to the trained health care providers. This initiative is designed to facilitate sustainable
networks between FOGSI, trained doctors, NGOs and pharmaceutical companies.
ACTIVITY 3: Strengthen Systems in the Public Sector for Comprehensive PMTCT Services through TSU
Support
APAC will provide assistance to the SACS through the TSU to scale up the PMTCT programs in Tamil
Nadu and Kerala. APAC, in coordination with SACS and other USG partners including CDC, will assess
gaps in the delivery of PMTCT services in public sector health care settings through a review of data from
public sector PMTCT sites, carry out joint field assessments, and develop a plan to improve systems for
delivery of comprehensive PMTCT services in public health care settings. APAC support will also include
strengthening the Management Information System at the state level to help better understand the program,
identify gaps, and facilitate timely and effective program-related decisions. The TSU will also assist the
District AIDS Prevention and Control Units to effectively monitor the quality of field-based PMTCT
programs.
SUMMARY: Interventions among bridge & other selected sub-populations continue to be a priority in the
third phase of the National AIDS Control Plan. The most recent Behavioral Surveillance Survey conducted
in Tamil Nadu indicates that a significant proportion of bridge populations and youth engage in risky sex
behaviors. Current interventions primarily focus on condom promotion with limited emphasis on other
options. APAC will promote expansion of options by providing comprehensive and gender sensitive
information on abstinence, fidelity, partner reduction, condom promotion for groups with established risk
behaviors, and promoting value-based lifestyles.
In FY08, APAC will support interventions among bridge and other selected populations through delivering a
behavior change communication (BCC) package based on risk assessment of these sub-populations.
Important strategies to address these populations will include supporting NGOs and social networks to
reach out to the selected target audience, and capacity enhancement of the NGOs to scale up and improve
the quality of interventions. APAC will support two model university programs and a limited number of
projects with truckers' associations for demonstrating effective mainstreaming strategies. As a Technical
Support Unit, APAC will also assist the State AIDS Control Societies of Tamil Nadu and Kerala to
strengthen their capacity for project management including evidence-based planning and monitoring, with
the aim of scaling up interventions at the state level and quality improvement.
BACKGROUND: VHS has been implementing the APAC project in Tamil Nadu for 12 years. APAC initially
targeted most-at-risk-populations, but has expanded efforts over the last few years to support a more
controlling HIV and APAC has significantly contributed to this success. The National AIDS Control
Organization has recognized the expertise and contributions of the APAC project and has requested APAC
to provide technical support to the SACS of Tamil Nadu, Puducherry and Kerala by setting up a Technical
Support Unit at Tamil Nadu and Kerala, consisting of a core team of consultants/experts co-located with the
SACS, with a mandate to assist the SACS in scaling-up programs, improving efficiency and quality. APAC
also serves as the vice-chair for the Technical Working Group on targeted interventions for the country.
In a recent development, the Tamil Nadu State AIDS Control Society has taken a decision that it would take
the lead to support bridge and vulnerable population interventions for the entire state of Tamil Nadu, and
has requested the other stakeholders to saturate coverage of MARPs in their respective districts. As a
follow-up of this decision, APAC starting Oct 08, will transition all its bridge and vulnerable population
intervention programs in Tamil Nadu and support more NGOs / CBOs to saturate coverage of MARPs.
Only one migrant intervention will be supported by the project. Due to this change the overall budget and
targets in the Abstinence and Be Faithful program area have been decreased.
ACTIVITY 1: Community Outreach Services for Bridge Populations and Other Sub-Populations in High-
Prevalence Districts
Eight NGO sub-partners will use peer educators to deliver A and B messages to target populations in
selected high-prevalence districts of Tamil Nadu and Puducherry. Peer educators will strategically
encourage unmarried young adults to abstain from sex, married adults to remain faithful, and those with
established high-risk behavior to use condoms and access VCT services. USG funds will support capacity
building of NGO staff and peer educators, increase access to preventive services through community-based
peer educator programs, create an enabling environment for behavior change and support advocacy efforts
for stigma reduction. Community drop-in-centers will be established by APAC's sub-partners to provide
space for the community to share experiences, as well as offer counseling and testing and basic medical
support to the target populations. APAC will build the capacity of sub-partners through regular training,
exposure visits and monitoring, and will support 1320 peer educators with motivational strategies. This
activity aims to reach nearly 69,000 individuals from bridge and other populations with A and B messages.
Efforts to reach women (spouses of truckers and migrating women involved in construction, agriculture
work) will also be supported through NGO outreach and workers' associations.
ACTIVITY 2: Transitioning Targeted Interventions to the Private Sector and SACS
Since 1996, APAC has supported NGOs by building their capacity to manage projects and mobilize
resources from other donors. In FY08, APAC will support initiatives to transition 16 NGO sub-partners
(involved in interventions with bridge and other selected populations at risk) to SACS and other agencies.
APAC will build the capacity of sub-partners to showcase achievements and leverage resources from
private companies through tapping corporate social responsibility opportunities. APAC will establish a
coordination team to develop mechanisms for transition and follow-up of transitioned projects to ensure
continuance of the quality and scale of interventions.
ACTIVITY 3: Technical Assistance to SACS on Targeted Interventions
In line with the NACP-3 policy, NACO has designated APAC to be the Technical Support Unit to provide
ongoing technical assistance to the SACS of Tamil Nadu and Kerala and build capacity for effective
interventions among bridge and selected sub-populations. Technical support to SACS will cover a range of
areas such as a) strengthening project management systems; b) standardizing training modules consistent
with the national guidelines and strengthen the capacity of NGO and CBO training institutions; c) evidence-
based planning including periodic mapping, size estimation and need assessment of target populations; d)
documentation and dissemination of best practices for learning and replication; e) development of a
mainstreaming strategy; and f) periodic evaluation and behavioral impact assessments. APAC and SACS
will develop a joint technical support plan and technical assistance will be provided based on the plan.
APAC will also build NGO capacity by supporting two demonstration projects (one each for truckers and
migrants) as centers of learning.
ACTIVITY 4: Demonstration Projects for Mainstreaming HIV/AIDS Programs in Universities
APAC will support two model projects in universities to integrate HIV/AIDS programs for HIV/AIDS
prevention education, with an emphasis on abstinence. Volunteer peer educators will be selected and
trained to deliver appropriate HIV/AIDS information to the students. The training content will particularly
emphasize the vulnerability of women to HIV/AIDS and build their skills in handling risky situations. A few
peer educators will be trained as peer counselors to provide counseling to at-risk youth and link them with
NGOs and other support agencies. An infotainment troupe will provide HIV information through traditional
and modern media. Two youth-friendly centers offering holistic youth services (career guidance, personality
development, sexual and premarital counseling, fitness and personal care) will be established in partnership
with private companies to serve as a pull factor and help leverage resources from the private sector.
APAC will collaborate with the Ministry of Parliamentary Affairs to conduct youth parliaments on HIV/AIDS
issues in colleges. District-level competitions will be conducted in various colleges with awards given to the
teams. Winners from each district will participate in state-level youth model parliaments. An estimated 5000
college youth will be reached through these model projects. To ensure greater ownership and sustainability,
the project will involve the principals and key faculty in designing college-specific interventions and a
monitoring strategy, and build the capacity of the faculty in counseling and handling youth-specific issues.
Activity Narrative: The experience of these model projects will be disseminated to NACO, SACS and the Ministry of Youth for
replication.
ACTIVITY 5: Promoting HIV/AIDS to Out Of School Youth through Social Networks
APAC will support a pilot project in one high-prevalence district to mainstream HIV/AIDS within Nehru Yuva
Kendra, a large social network. The project will address out-of-school youth in 25 large slums of Tamil
Nadu. NYK will establish Youth Health and Development Clubs in these slums to promote awareness on a
range of HIV/AIDS and social issues, and link out-of-school youth to various government-aided programs.
Through this initiative, over 1250 out-of-school youth will be reached. In each slum, 25 male and female
youth will be identified as peer educators and trained on HIV/AIDS prevention messages, life-skills
education, and other social and health issues. Efforts will be made to sustain the activities by ensuring
coordination with local NGOs, FBOs, the Tamil Nadu slum clearance board, the Women's Development
Corporation and other social networks.
ACTIVITY 6: Build the Capacity of NGO Staff and Peer Educators
APAC will identify and support strong organizations to build the capacity of NGO staff and peer educators in
interventions among selected populations focusing on promoting A and B messages. Risk assessment tools
will be developed for outreach workers and peer educators to ascertain the risk behavior of bridge and other
populations. NGO staff and peer educators will be provided a series of trainings focusing on issues such as
participatory mapping and needs assessment, risk assessment, interpersonal communication, gender, and
project management. The project will train 176 NGO staff and 1320 peer educators.
Mapping studies estimate there are 80,000 female sex workers and 35,000 men who have sex with men in
Tamil Nadu. Sex work in Tamil Nadu is not brothel-based, but rather street and home-based. Currently the
AIDS Prevention and Control project, through Voluntary Health Services, the Tamil Nadu State AIDS
Control Society, and the Bill and Melinda Gates Foundation are the three major agencies involved in
targeted interventions among Most At-Risk Populations reaching 60-70% of FSW. However, coverage of
MSM and injecting drug users continues to be low.
In FY08, the APAC project implemented by VHS in Tamil Nadu, will support a variety of behavior change
interventions addressing MARPs implemented through a network of 16 NGOs and civil society. The
interventions will include: behavior change communication through community outreach, increasing access
to condoms, building capacity of NGO staff and retailers on social marketing of condoms, linking MARPs
and their partners to counseling and testing and STI services, and promoting risk reduction strategies
among IDU. The APAC project will also provide technical assistance to the State AIDS Control Societies in
Tamil Nadu and Kerala to enhance their capacity and systems for effective interventions with MARPs.
For the past twelve years, with USG support, VHS has been implementing the APAC project in the southern
state of Tamil Nadu. APAC initially focused on targeted interventions for MARPs, but has expanded its
efforts over the last few years to support a more comprehensive approach to HIV/AIDS prevention, care and
treatment. Tamil Nadu has been successful in controlling HIV and the APAC project has significantly
contributed to this success. The National AIDS Control Organization has recognized the expertise and
contributions of the APAC project and has requested APAC to provide technical support to the SACS of
Tamil Nadu, Puducherry and Kerala by setting up a Technical Support Unit at Tamil Nadu and Kerala,
consisting of a core team of consultants/experts co-located with the SACS, with a mandate to assist the
SACS in scaling-up programs, and improving efficiency and quality. APAC also serves as the vice-chair on
the national Technical Working Group on Targeted Interventions.
The third phase of the National AIDS Control Program aims to halt and reverse the epidemic. A key strategy
to achieve this objective is to saturate coverage of MARPs including FSW, MSM, and IDU by tripling the
number of targeted interventions amongst MARPs from 700 to 2100, and engaging community-based
organizations more intensively. Estimates indicate that there are 1.2 million FSW, 2.3 million MSM, and
220,000 IDU in the country and nearly 10% of these MARPs are estimated to be HIV infected. Recent
studies also indicate that sex work is no longer confined to urban areas but has spread to rural areas,
making interventions with MARPs more complex and challenging.
intervention programs in Tamil Nadu and support more NGOs/CBOs to saturate coverage of MARPs. Only
one migrant intervention will be supported by the project.
ACTIVITY 1: Community Outreach for Most-at-Risk Populations in Selected High-Prevalence Districts
The APAC project will support 16 sub-partners to implement comprehensive HIV/AIDS interventions with
MARPs in selected high-prevalence districts of Tamil Nadu and Puducherry. The project will make
additional efforts to improve coverage of MSM by increasing the number of interventions. NGO staff will
impart behavior change messages to MARPs through interpersonal communication, and will promote
consistent condom use, and encourage periodic STI check-ups and HIV testing. Sub-partners will identify
community-preferred health care providers for STI treatment, refer MARPs for periodic STI check-ups and
follow up for treatment adherence. Periodic NGO and Health Care Provider meetings will be organized for
coordination and sharing of information. In FY06, the Gates Foundation supported the establishment of STI
clinics in APAC-supported NGO sites. During FY08, APAC will continue to leverage support from the Gates
Foundation for STI treatment for MARPs. Community drop-in-centers will be established by sub-partners to
provide space for the community to share experiences as well as to offer user friendly counseling and
testing and basic medical services to MARPs. APAC sub-partners will establish linkages with the Link
Workers to reach-out to MARPs and bridge populations in rural areas.
MARPs infected with HIV will be linked to a continuum of care services and followed-up for ART adherence.
APAC's sub-partners will coordinate with APAC-supported and other care and support NGOs to ensure that
family members of PLHAs are trained to provide home care and to ensure a good quality of life for PLHAs.
USG funds will support: capacity building of NGO staff and peer educators, increased access to preventive
services through community-based peer education programs, creation of an enabling environment for
behavior change and advocacy with stakeholders. APAC will build the capacity of its sub-partners through
regular training, exposure visits and monitoring. The project will support 960 peer educators and adopt
motivational strategies for their continued involvement in the program. Through this activity, the project
plans to reach 20,000 MARPs and 46,000 high-risk individuals from bridge and other selected risk
populations.
ACTIVITY 2: Increasing Access to Condoms by MARPs in Selected High-Prevalence Districts
APAC will support leading condom manufacturers to strengthen condom distribution networks and promote
condoms in NGO intervention areas in the high-prevalence districts. This will be achieved through
promoting condom sales through non-traditional outlets and by increasing demand. The project will support
linkages between NGOs and condom manufacturers to service outlets in intervention areas thereby
ensuring increased access and expanding product range to MARPs and bridge populations. This initiative
will also ensure sustainability of services and greater coordination between condom manufacturers and
NGOs in condom social marketing. Successful interventions between APAC and condom manufactures in
the past have resulted in tripling of commercial condom sales in Tamil Nadu from 17 million in 1996 to 54
million in 2006. Innovative marketing initiatives by NGOs to enhance condom distribution to MARPs will be
explored. Condoms for free distribution and demonstration will be leveraged from the Government of India.
Retail audit reports will be used to assess trends in the condom market, and for reporting to USG and other
agencies.
ACTIVITY 3: Assessments of Condom Use among MARPs and Sero-Discordant Couples
Behavioral Surveys indicate the nearly 36% of FSW and 40% MSM report inconsistent condom use, citing
objections due to reduced pleasure. APAC will support pilot initiatives to market lubricants among MSM and
female condoms among FSW while assessing the impact on consistent condom use. An assessment of
condom use patterns among sero-discordant couples, including motivating factors and constraints, will be
also undertaken by APAC.
ACTIVITY 4: Build Capacity of NGOs and Retailers for Condom Social Marketing
In FY08, a capacity-building agency will be contracted by the project, as in the past year, to train 400 NGO
Activity Narrative: staff on the concepts and the processes of condom social marketing and train 500 potential retailers in
marketing techniques.
ACTIVITY 5: Technical Support to SACS to Strengthen State-Wide Interventions with MARPs
continuous technical assistance to the SACS of Tamil Nadu and Kerala and build capacity for effective
targeted interventions. Technical support to SACS will cover a range of areas such as: a) strengthening
project management systems for targeted interventions; b) standardizing training modules and
strengthening the capacity of training institutions involved in training NGOs and CBOs; c) evidence-based
planning, including periodic mapping, size estimation and needs assessment of target populations; d)
documentation and dissemination of best practices for learning and replication; e) developing a
will develop a joint technical support plan and specific areas of technical assistance will be determined.
APAC will also support three demonstration projects as learning sites (one each for FSW, MSM and IDU) to
build the capacity of NGO staff.
ACTIVITY 6: Build Capacity of NGO Staff in Enhancing the Quality of Interventions
The APAC project will identify and support training institutes to build the capacity of NGO staff and peer
educators on targeted interventions. The areas of training, conforming to national standards, will include a)
participatory mapping and needs assessment; b) risk assessment; c) interpersonal communication; d)
gender; e) condom social marketing; f) CBO formation and management; g) project management; and g)
reporting and management information systems. The project will train 128 NGO staff and 960 peer
educators.
Palliative care services for people living with HIV/AIDS (PLHA) are primarily provided through the public
health care system. Many private health care institutions do not treat PLHA due to inadequate knowledge,
stigma, and lack of infrastructure. In FY08, the AIDS Prevention and Control (APAC) project will support 18
home-based care projects in selected high-prevalence districts to provide palliative care services to 6000
PLHAs and their family members. The project will also support a network of 19 private health care
institutions in these high-prevalence districts to provide facility-based clinical care and psychosocial support
to PLHAs. The project will train private physicians on palliative care, link them up with NGOs and PLHA
networks and follow up these physicians periodically. As the Technical Support Unit, APAC will build the
capacity of the State AIDS Control Societies (SACS) in the states of Tamil Nadu and Kerala to increase
demand for palliative care services, implement national guidelines and deliver comprehensive palliative care
services to PLHAs.
APAC project in the southern state of Tamil Nadu. APAC, which initially focused on targeted interventions
for most-at-risk-populations (MARPs), has expanded its efforts over the last few years to support a more
Kerala by setting up a Technical Support Unit at Tamil Nadu and Kerala, consisting of a core team of
improving efficiency and quality. APAC also serves as the vice-chair of the national Technical Working
Group on Targeted Interventions.
The recent findings of the third National Family Health Survey estimated there are 170,000 to 200,000
PLHAs in the states of Tamil Nadu and Kerala. Palliative care services supported by the SACS include
community care centers and PLHA drop-in-centers. Less than 40% of the estimated PLHAs are currently
registered with the SACS and receive palliative care services. Major gaps include the limited awareness of
the palliative care service providers, and the quality and comprehensiveness of the services.
Provision of palliative care services will be an ongoing activity funded by APAC. In FY06, APAC supported
five NGOs to deliver home-based care, providing 6,000 PLHAs with clinical care and psychosocial support.
Of the 6,000 PLHAs reached by the project, 10% were treated for TB and 10% are on ART. In FY06, the
project also supported a private medical college in a high-prevalence district, Perundurai, for diagnosis,
monitoring and institutional care of PLHA, resulting in 3,000 PLHAs getting clinical services.
ACTIVITY 1: Improving Access to Home and Community Care for PLHAs and their Family Members
APAC will support 18 NGOs to provide home and community care to people living with HIV in selected high-
prevalence districts of Tamil Nadu and Puducherry. The NGO staff (which includes outreach workers and
nurses) will sensitize community leaders, and coordinate with Government of India Link Workers and PLHA
networks to create demand for a continuum of care services in public and private health care settings. At
the community level, the NGO staff will be involved in strengthening HIV/AIDS awareness among
community leaders, advocacy with community leaders concerning stigma and discrimination affecting
PLHA, and mobilizing community support for PLHA and their family members. The NGO team will visit
PLHA homes at regular intervals to: a) counsel PLHA and family members on health monitoring and
periodic medical check-ups; b) identify opportunistic infections (OI) and assist with possible management at
home; c) train and follow-up PLHA and their family members on self-care, care-giving, positive living, and
treatment adherence for DOTS and ARV; d) refer for medical and non-medical needs to secondary and
tertiary level institutions; and e) provide end of life care. The home and community based care NGOs will
also network with other agencies involved in issues such as nutritional care and legal aid, to provide wrap-
around services. All these services will also be provided by the NGOs and PLHA networks at selected
project supported drop-in-centers. Though this initiative, 6000 PLHA will be able to get quality palliative
care services at different locations and 1200 PLHAs will be treated for TB infection through public and
private sector hospitals.
ACTIVITY 2: Increasing Access to Palliative Care for PLHAs through Facility-Based Private Sector Support
To increase access to care, and model the involvement of private physicians, APAC will train and support a
network of 100 private physicians in selected high-prevalence districts to provide medical care to PLHA.
The physicians will be trained in HIV/AIDS management including management of OI and counseling, and
linked to NGOs and other care continuum providers in the district. APAC will support the physicians by
providing basic infrastructure (for ensuring confidential counseling and treatment), and nominal
remuneration for maintenance of quality standards at their clinic and for reporting to APAC. The
experiences of these physicians will be shared with physicians' associations, SACS and other stakeholders
for learning and replication.
APAC will also support a network of 16 private hospitals for secondary care and three private hospitals for
tertiary care. In these hospitals, APAC will support a part-time counselor and train related health care
providers. The trained counselors will counsel antenatal women, TB patients attending the hospital and
PLHAs. Linkages will be established between these private hospitals, NGOs and other care continuum
service providers. In FY06, APAC's support to IRT Perundurai Medical College resulted in increased
coverage of PLHA. The approaches adopted by APAC include: a) supporting medical camps to promote
health care services including HIV/AIDS services; b) strong networking with private physicians, NGOs, and
PLHA networks to refer PLHA for treatment; c) training health care providers based on national guidelines
for quality of health care; d) supporting the cost of counselors for antenatal women, TB patients and PLHA;
e) strengthening management information systems; and f) subsidizing the cost of clinical diagnosis and
Activity Narrative: treatment for needy PLHAs. In FY08, using a similar approach, APAC will support two more private
hospitals for tertiary care services, but it will be on a smaller scale in terms of coverage of PLHA and range
of services. Through this initiative, over 5,000 PLHA will be provided with palliative care services and 1000
PLHAs will be treated for TB infection from the project supported private sector hospitals. About 9,500
registered TB patients will receive HIV counseling and testing under this initiative.
ACTIVITY 3: Building the Capacity of Private Sector Health Care Providers in Palliative Care
APAC will support one state-of-the-art training institute to build the capacity of private physicians on
HIV/AIDS palliative care, thereby expanding the pool of qualified and trained health care providers. An
estimated 300 physicians will be trained by the project, focusing on building the knowledge and skill of
health care providers. Due focus will be given to gender-based inequities and special needs for women on
palliative care. The trained doctors will be periodically monitored by APAC consultants and through a
system of self-assessment checklists/toolkits. The training of private health care providers complements the
SACS' initiative on providing quality clinical care for PLHA. Partnerships will be established with private
pharmaceuticals for the supply of basic medicines at subsidized rates. Similarly local philanthropists,
advocates and village volunteers will be coordinated to mobilize resources to support the nutritional,
livelihood and legal needs of PLHA.
ACTIVITY 4: Technical Support to SACS
APAC will provide technical support to SACS to strengthen their systems on palliative care as part of
APAC's role as the Technical Support Unit for the states of TN and Kerala. Technical assistance will include
training the SACS team on palliative care policies and guidelines, technical updates through national and
international consultants, exposure visits, monitoring of community care centers, and technical assistance to
training institutes (those involved in training NGOs) and public health care institutes (involved in training on
HIV/AIDS care and treatment).
In the second phase of the National AIDS plan, there was minimal emphasis on the issue of OVCs. During
the same period, the USG took the lead in developing models of OVC programming. In the current, third
phase of the National AIDS Control Program (NACP-3), there is now an emphasis on supporting activities
on orphans and vulnerable children (OVC) who are infected or affected by HIV/AIDS. Much of the guidance
in this new area for national policy has been provided by USG. In FY08, the AIDS Prevention and Control
(APAC) project will provide comprehensive home-based OVC services to over 1000 children. It will support
two demonstration projects on OVC, one being a faith-based initiative and the other led by the NGO
community. The project will also provide technical assistance to build the capacity of State AIDS Control
Societies (SACS) to promote OVC programs in the state.
and improving efficiency and quality. APAC also serves as the vice-chair of the national Technical Working
In general, little importance was given to the issue of OVC in the second phase of the National AIDS Plan.
Consequently, except for support from USG and a handful of other agencies, there were minimal activities
addressing OVC, both nationally and in Tamil Nadu. It is recognized that limited information is available on
OVC, however, broad estimates suggest there are 3500 HIV- infected children in Tamil Nadu. In FY06,
APAC supported six NGOs to provide primary and secondary services to OVCs, reaching 400 HIV infected
and 2000 affected children with OVC services. Of the total of 2000 infected and affected children, 1000
children were provided support for education, 10 for shelter and 100 for other support services.
ACTIVITY 1: Provision of OVC Services through Home Based Care Projects
The project will continue to provide comprehensive OVC services to over 1000 children, in their homes,
through existing and proposed home-based care projects providing palliative care services. USG funds are
used to provide medical/clinical care to the children who are also regularly monitored in all six of the core
PEPFAR OVC areas. Other needs of the children such as education, nutrition, and child protection are
fulfilled by leveraging resources through linkages or local fund generation. This home-based care OVC
project utilizes the medical care team of the palliative care intervention to provide clinical services to the
children, thus saving resources and promoting synergy for the program.
ACTIVITY 2: Develop a NGO-Managed Model OVC Project
APAC will support one sub-partner with long experience of working with OVC to become a model project on
OVC. This program will reach 500 HIV/AIDS infected and affected children. The activities will include life
skills education training for children, provision of medical, nutritional and educational aid, linkages with CT
services, and strengthened referral linkages with government, corporates and other stake holders to
leverage resources. The project will become a learning site and a training center to build the capacity of the
State and will provide support to the APAC project in its role as the manager of the State's Technical
Support Unit.
ACTIVITY 3: Developing a Community Based Model Project for OVC
The APAC project will support one Faith-Based Organization (FBO) as a model community based project to
provide care for OVC. In this project, faith leaders will take the lead in planning and providing support for the
OVC program. The faith leaders will assist in undertaking stigma reduction activities, and will facilitate
support for wrap-around activities such as nutrition support, provide admissions for OVCs to schools
managed by the FBOs, and promote adoption and foster care. The OVC programs will primarily focus on
health, education and nutrition, and will reach 200 OVC. The APAC project will provide assistance to the
FBO for system strengthening, quality of programming including counseling for children, and monitoring and
evaluation.
SACS has limited experience in supporting OVC projects and needs a considerable amount of capacity
building. Since there is an increased emphasis on this activity in the national plan, APAC, as part of its role
as manager of the State Technical Support Unit, will build the capacity of SACS staff and their NGO
partners on the national OVC policy, guidelines and OVC programming and expose them to some of the
important OVC projects in the state and country.
National estimates indicate that less than 10% of people living with HIV know their status. Most-at-risk-
populations (MARPs) and bridge populations do not access public sector counseling and testing centers
due to inconvenient timing, distance and lack of privacy. The AIDS Prevention and Control (APAC) project
will support activities to increase access to counseling and testing services for MARPs, bridge and other
selected sub-populations at risk through a network of NGO-based and private-hospital-based counseling
and testing (CT) centers. The project will increase access to CT services in rural areas of high-prevalence
districts through innovative approaches such as mobile CT. The project will encourage CT services in the
private sector and build the capacity of counselors and lab technicians to provide quality CT services in
accordance with the national guidelines. As the Technical Support Unit for the states of Tamil Nadu and
Kerala, APAC will also support an assessment of public sector CT centers to improve quality and client
friendly services, explore accreditation of private CT centers and strengthen systems for CT.
for MARPs, has expanded its efforts over the last few years to support a more comprehensive approach to
HIV/AIDS prevention, care and treatment. Tamil Nadu has been successful in controlling HIV prevalence
(prevalence among antenatal women has dropped from 1.13% in 2001 to 0.5% in 2005) and the APAC
project has significantly contributed to this success. The National AIDS Control Organization (NACO) has
recognized the expertise and contributions of the APAC project and has requested APAC to provide
technical support to the State AIDS Control Societies (SACS) of Tamil Nadu, Puducherry and Kerala by
setting up a Technical Support Unit at Tamil Nadu and Kerala, consisting of a core team of
improving efficiency and quality. APAC also serves as the vice-chair on the national Technical Working
Counseling and Testing (CT) is an integral part of the prevention, care and treatment initiatives of APAC. In
FY06, APAC supported NGOs to establish user-friendly CT centers that are easily accessible to MARPs
and bridge populations. APAC also supported district-level communication campaigns on the theme of
"Know your Status" and introduced mobile CT units to reach rural areas and inaccessible urban areas in
selected high-prevalence districts. The evaluation of the campaigns confirmed that the initiative increased
access to CT. Over 24,000 individuals were provided CT services over a period of two months. Based on a
request from the Tamil Nadu State AIDS Control Society (TNSACS), APAC conducted the first state-wide
assessment of public and private sector CT centers. The findings include: lack of adequate infrastructure,
the sub-optimal quality of counseling, issues of confidentiality, and weak referral linkages and follow-up. The
activities proposed by APAC in FY08 are based on this assessment and will continue to support the national
and state priority of increasing access to CT services for MARPs, bridge and other selected at-risk
In a recent development, National AIDS Control Organization (NACO) and Tamil Nadu State AIDS Control
Society (TANSACS) have taken a decision that the project should withdraw its support to 25 NGOs
implementing CT services in the targeted intervention programs as the CT services to the MARPs will now
be offered by the government run ICTCs in these districts. However, the project will continue to support the
19 private hospitals for the CT services.
ACTIVITY 1: Improving Access to CT Services for Most-at-Risk and Bridge Populations
In FY08, APAC will continue support to 16 NGO based CT centers in selected high- prevalence districts that
will primarily cater to MARPs and bridge populations. In addition, in these high prevalence districts APAC
will also support the establishment of CT centers at 19 private hospitals to enable MARPs, bridge
populations, pregnant women, TB patients, and the general public who choose to use private facilities for
health care, to access CT services. NGOs supported by APAC for prevention activities will promote these
services and create demand for CT through interpersonal communication and mid-media activities. The 19
private hospitals will also provide PMTCT, TB/HIV management and palliative care services including
ARVs. Linkages for palliative care will be established with care and treatment NGOs, networks of people
living with HIV/AIDS, and private and public sector hospitals. Through this initiative, APAC expects to
counsel and test 32,000 individuals. The HIV test kits for NGO-run CT centers will be leveraged from
TNSACS.
ACTIVITY 2: Improving Access to CT in Rural Areas in Selected High-Prevalence Districts
In selected high-prevalence districts, APAC will support mobile CT units to extend services to rural areas
which have limited access to CT services. The project will establish linkages with the Government Primary
Health Centers, Link Workers (two Link Workers to be appointed under NACP 3 for every village having
5000 population in High-Prevalence Districts) to promote access to CT services. This activity is based on
learning from APAC's previous experience of supporting mobile units and will be implemented in
coordination with other USG partners and TNSACS. APAC will also develop operational guidelines for the
mobile units and quality control mechanism will be an inherent part of the protocol. APAC will assess the
impact of the mobile CT units for addressing gaps, cost effectiveness, quality of services, follow-up, and,
linkages to care and treatment. Through this initiative, 4000 individuals will be counseled and tested. The
entire process will be documented and the findings disseminated to SACS, NACO and other agencies for
learning and replication.
ACTIVITY 3: Capacity Building of Counselors and Lab Technicians
APAC will support one state-of-art training institute to provide training to counselors on CT, consistent with
the national guidelines. This institute will also undertake field assessments to assess the quality of services
provided at NGO run centers, private hospital based centers and will also provide onsite training to
counselors. The counselors will go through periodic refresher trainings for improving quality of service
provision. Examples of the training components for counselors and lab technicians include: risk
assessment, pre/post test counseling, universal precautions and waste management. Apart from these
topics, the counselors will be trained to counsel on handling specific situations such as counseling
unmarried individuals who test positive, counseling discordant couples, antenatal women and their spouse,
Activity Narrative: MARPs, infected children, drug adherence, and positive prevention. The training institute will support the
development of reporting formats, counseling case sheets and other Quality control and Monitoring
documents.
A regional experience sharing workshop will be organized by the APAC project for the counselors
representing different agencies from all the southern states of India. The three-day program, with an
estimated presence of 250 Counselors, will provide an opportunity for the counselors to share their
experience, learnings and challenges. APAC will also support one training institute to train lab technicians
on CT services. The training curriculum will include testing procedures, confidentiality and ethics, universal
precautions, waste management, and Quality assurance. APAC will also explore the feasibility of
collaborating with the Directorate of Medical Education in Tamil Nadu to include a special training on
HIV/AIDS testing to the budding lab technicians passing out from public and private paramedical
institutions.
ACTIVITY 4:Facility Assessment of Public and Private Sector CT Centers
In FY 08, APAC will support another assessment of CT centers in public and private settings. This will
include areas such as facility assessment, quality of service provision, and follow up. The findings of the
assessment will be disseminated to stakeholders and policy makers.
ACTIVITY 5: Technical Assistance to the State AIDS Control Societies
The third phase of the National AIDS Control Program has planned for counseling and testing 21 million
individuals in the next five years. As part of its role as the TSU for the state of Tamil Nadu and Kerala, the
APAC project will provide Technical Assistance to the SACS to improve quality of counseling and demand
generation in line with the findings of the CT assessment study carried out by the project. The project will
assist the SACS in strengthening counseling protocols, possible accreditation of private CT centers and
linkages after testing. The project will work closely with the SACS to develop specific information materials
such as counseling aids for sero-discordant couples, positive children, and MARPs.
(deleted 10/3/08 per Aug 08 reprogramming activity sheet)
The National AIDS Control Organization (NACO) has emphasized the need for evidence-based
interventions. The AIDS Prevention and Control (APAC) project has extensive expertise in this area. In
FY08 APAC will continue to support initiatives to build the capacity of its NGO partners on Management
Information Systems (MIS) and strategic information, and will conduct behavioral and facility assessments.
As the Technical Support Unit (TSU) for the states of Tamil Nadu, Puducherry, and Kerala, APAC will
strengthen the MIS of the State AIDS Control Societies (SACS) and the District AIDS Prevention and
Control Units (DAPCUs) to collect, analyze and effectively use field data for program planning and
monitoring.
provide technical support to the SACS of Tamil Nadu, Puducherry and Kerala by setting up a Technical
Support Unit in Tamil Nadu and Kerala, consisting of a core team of consultants/experts co-located with the
also serves as the vice-chair of the national Technical Working Group on Targeted Interventions.
APAC has extensive experience in establishing systems and conducting assessments that provide strategic
information that helps to guide evidence-based planning for the state of Tamil Nadu and the APAC project.
In its twelve years of experience, APAC has conducted a large number of assessments and studies,
examples of which include: a) eleven rounds of behavioral surveillance surveys (BSS); b) two rounds of STI
prevalence studies; c) two rounds of health care provider assessments; d) condom quality assessments; e)
assessment of public and private sector VCT centers; and f) mapping of MARPs. Most of these
assessments have been used by SACS and NACO for program planning and decision making. APAC
supports the SACS in implementing the UNAIDS "Three Ones Principle" of a unified monitoring and
evaluation (M&E) framework and has played a significant role in the implementation of one M&E system in
Tamil Nadu. APAC has trained SACS officials from other states on strategic information and many of its
systems and procedures have been adopted by SACS and NACO.
ACTIVITY 1: Capacity Building of NGOs on Data Quality Assurance
In FY08, the APAC project will continue to support efforts to build the capacity of sub-partners on MIS,
develop data quality assurance protocols and checklists, and share/disseminate project information to
SACS and other stakeholders as part of its commitment to the "Three Ones Principle". The project will
continue to adopt existing approaches such as participatory site visits, experience-sharing meetings, and
cluster-level meetings to get more detailed information on field activities and to enhance the quality of
information and interventions. Training on data analysis and data use will be provided to NGO staff.
APAC will also continue to support the state's Geographic Information System (GIS), which was developed
using F06 funds, to collect and update information pertaining to health and more specifically HIV/AIDS. The
GIS will help APAC and other policy makers in the state to make better decisions based on evidence.
ACTIVITY 2: Behavioral Surveillance and Other Assessments
APAC will support another round of state level BSS to understand the behavior of MARPs and other
selected populations in the states of Tamil Nadu and Puducherry. In addition, the project will support
assessments such as mapping MARPs, district health facility resource mapping and other assessments that
will provide data to support the project and the state in planning evidence-based interventions.
ACTIVITY 3: Technical Assistance to the State on Strategic Information
APAC will build the SACS' capacity to carry out data quality assurance at the field level and strengthen
institutions that are involved in training NGOs and other agencies on MIS. As a TSU, APAC will strengthen
the MIS of the SACS and DAPCUs for greater coordination of data collation, analysis and use. The project
will strengthen the Strategic Information and Management Unit located within SACS to be able to analyze
data more effectively and make program-related decisions. Need-based assessments that help with state-
level planning by assessing the impact of interventions will also be supported. APAC will share examples of
best practices (such as multi-faceted monitoring strategies) in Strategic Information (SI) and monitoring and
evaluation (M&E) with the SACS. APAC also will play a critical role in promoting the implementation of
"Three Ones" Principles by all partners in the states, through establishing donor coordination committees for
SI/M&E.
The third phase of the National AIDS Control Program (NACP-3) has underscored the need for system
strengthening and developing appropriate policies/guidelines to facilitate the scale up of high quality
HIV/AIDS activities. Several new polices and systems have been developed, such as the policy for orphans
and vulnerable children (OVC), the ART policy, and policies related to decentralized program management.
Other operational guidelines such as guidelines for NGOs on targeted interventions, guidelines for TSUs
are in the process of being finalized with USG playing an important role. National implementation of NACP-
3 is a major challenge for the GOI and will require extensive strengthening of infrastructure, management
systems and staff skills at all levels. In FY08, the AIDS Prevention and Control (APAC) project will support
system strengthening and policy change initiatives, primarily at the State level, but also at the national level
through technical assistance and demonstrating best practices. As the Technical Support Unit (TSU) for the
states of Tamil Nadu and Kerala, APAC will play a critical role in strengthening state systems at various
levels in the public and private sector. In the public sector, the project will support the State AIDS Control
Societies (SACS) and District AIDS Prevention and Control Units (DAPCUs) to strengthen existing program
management systems and develop new systems as required. APAC will support specific initiatives with faith
-based organizations, the Lawyers' Collective, PLHA networks and political leadership to influence policy
change. APAC will also work with a number of associations in the private sector to develop/strengthen their
systems to integrate HIV/AIDS activities into their ongoing programs.
With the establishment of Technical Support Unit under the project, the reach will increase for institutional
capacity building and community mobilization in the three states - Tamil Nadu, Puducherry and Kerala.
Kerala by setting up a Technical Support Unit in Tamil Nadu and Kerala, consisting of a core team of
APAC in its twelve years of experience has played a significant role in influencing decision- makers to
support policy change. It has worked with the state government, the Confederation of Indian Industries (CII),
faith-based organizations and physicians' associations to bring about policy change and strengthen the
organizational systems of these institutions. In FY08, APAC will continue to support these initiatives and
expand to work with newer groups on system strengthening, mainstreaming and promoting policy change.
ACTIVITY 1: Systems Strengthening of State-Level Public and Private Sector Agencies
The APAC project has been identified by NACO as the TSU for the SACS of Tamil Nadu, Puducherry and
Kerala. The primary objective of the TSU is to strengthen State systems to manage HIV/AID and build the
capacity of SACS in various areas. As the TSU, APAC will support a unit of 6-8 consultants/advisors, co-
located with the SACS in Tamil Nadu and Kerala. The team will assist the SACS in identifying and
organizing the technical expertise available in the state to strengthen the State's to respond to a well
designed, evidence-based technical assistance (TA) plan. Areas for TA from the TSU include strategic
planning, project management (including the selection, management and monitoring of NGOs), monitoring
and evaluation, capacity building, training, human resource planning and management, increased private
sector engagement, and mainstreaming. The TSU will also assist the SACS in developing systems to
support planning and implementation of HIV/AIDS activities implemented by the new DAPCUs., who will
play a critical role in coordinating and monitoring district-level HIV/AIDS activities.
The TSU will also assist in system development and building the capacity of other agencies such as
industry associations, associations of trucking companies, and physicians' associations to develop and
implement workplace policies and increase their engagement in HIV/AIDS activities.
ACTIVITY 2: Supporting Faith-Based Organizations to Develop and Implement HIV/AIDS Policies
APAC has initiated advocacy programs among the 17 dioceses of the Tamil Nadu Bishops' Council (TNBC)
and provided training for bishops and religious sisters in implementing the HIV/AIDS policy developed by
Catholic Bishops' Conference of India (with USG assistance). In FY08, the project will continue its support
to TNBC to strengthen the implementation of their HIV/AIDS policy in their educational, health and religious
institutions. In FY08, APAC will support Hindu and Muslim religious institutions to develop and implement
HIV/AIDS policies that support HIV/AIDS programs. In high-prevalence districts, committed religious leaders
will be identified and their capacity built to promote HIV/AIDS prevention messages and support for
individuals infected and affected by HIV/AIDS. APAC will also support one regional experience-sharing
workshop for showcasing and cross-learning about faith/spiritual initiatives.
ACTIVITY 3: Promoting the Rights of Women PLHA through Capacity Building and Systems Strengthening
of Legal Support Institutions
Women are more vulnerable to HIV/AIDS, exploitation, and in many cases their legal rights have been
compromised. Instances of women PLHA being denied property and basic rights have been reported across
the country. In the high-prevalence districts of Tamil Nadu, the APAC project will support a women's
lawyers' collective to advocate for and support the rights of women (particularly of marginalized, infected
and affected women). In these districts, through the lawyers collective, a panel of women lawyers will be
trained and supported to take up issues related to the rights of women PLHA. Linkages between NGOs,
CBOs, PLHA networks, and the women's lawyers' collective will also be established.
Activity Narrative:
ACTIVITY 4: Systems Strengthening of District PLHA Networks
In FY06, APAC supported the Indian Network of Positive People (INP+) to build the systems and capacity of
district PLHA networks. SACS and other agencies have also supported PLHA networks to strengthen their
governance and management and technical capacity. In FY08, APAC will support an initiative to assess the
existing gaps in the capacity of PLHA networks. Based on the findings, the project will support one strong
PLHA network to build the systems and capacity of other district networks in areas such as project
management, monitoring and evaluation, human resource planning, and financial management. The
project will also support the PLHA network to advocate with government and other stakeholders to develop
PLHA-friendly policies.
ACTIVITY 5: Training and Advocacy with Legislative Assembly Members
In FY08, APAC will support a public sector institution to work with Legislative Assembly members to
educate them on HIV/AIDS issues and on the need to develop/amend policies that will facilitate the
implementation of robust, evidence-based HIV/AIDS programs and the protection of PLHA rights.
