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
To assist this program, HHS/CDC will support the placement of a prevention of parent to child transmission
(PPTCT, as PMTCT is referred to in India) technical officer within the Tamil Nadu State AIDS Control
Society (TNSACS). This officer will be responsible for improving the linkage from Tamil Nadu's 718 ANC
centers to ICTC services to achieve the goal that all ANC women, and their partner, are tested for HIV
(715,000 targeted in FY08). Specific activities for this office include oversight for the implementation of the
program, including monitoring and evaluation and quality assurance, improving linkages and follow-up, and
expanding services into the private sector.
BACKGROUND
The Tamil Nadu State HIV/AIDS Control Society (TNSACS) is the implementing body for India's National
AIDS Control Organization (NACO) in the southern state of Tamil Nadu, a high HIV-burden state. TNSACS,
which is headed by a senior officer from the Indian Administrative Service (IAS), is the state-level authority
for HIV-related policy formation, activity and partner coordination, program implementation, as well as
monitoring, reporting, and evaluating on all activities related to the HIV epidemic in the state. In 1991,
TNSACS was the first state HIV agency to be formed in the country and has continued to serve as a model
for other such agencies around the country.
In 2002, HHS/CDC developed a formal relationship with TNSACS and in 2003 began providing fiscal and
technical support. The USG continues to play a strategic role in the operations of TNSACS despite
contributing 3% of the TNSACS HIV budget. The strong historical and technical relationship between
TNSACS and the USG has allowed the USG to leverage the entire budget of TNSACS ($16 million in FY07)
effectively. This relationship is also strategic as jointly funded projects are likely to be replicated throughout
the country as TNSACS is regarded as the leading state HIV agency in India. The technical support
provided to TNSACS by the USG has been one of the successful models of donor support for the country.
The extent, form, and specificity of our support is now being discussed with NACO in relation to the creation
of the new Technical Support Unit in Tamil Nadu (also to be supported by USG) and how that will interact
with the USG advisors currently in TNSACS.
ACTIVITIES AND EXPECTED RESULTS
TNSACS has established 718 integrated counseling and testing centers (ICTC) which are co-located with
ante-natal care services. In 2007, a reported 600,000 ANC attendees were tested for HIV in Tamil Nadu.
(PPTCT) technical officer within TNSACS. This officer will be responsible for improving the linkage from
Tamil Nadu's 718 ANC centers to ICTC services to achieve the goal that all ANC women, and their partner,
are tested for HIV (715,000 targeted in FY08). Currently, there are 718 PPTCT centers in Tamil Nadu that
provide ART prophylaxis to HIV-infected pregnant women (and their children). TNSACS plans to establish
780 additional PPTCT centers in FY08. In FY08, these centers will provide HIV counseling and testing to
715,000 ANC clients, resulting in 2646 HIV-infected pregnant women receiving PPTCT services as per GOI
guidelines.
Specific activities that this state-level officer will undertake in FY08 include: developing and implementing
standard operating practices for the PPTCT program, monitoring and evaluating program performance
based on standardized indicators, assessment visits to program sites, improving linkage and follow-up of
HIV-infected ANC clients to HIV treatment services, expanding high-quality PPTCT services into the private
sector, and partner coordination. HHS/CDC will provide direct technical support to this officer. All results
will be indirect and reflect systems strengthening for State PPTCT services.
Red Ribbon Club (RRC) is an on-campus and voluntary educational intervention among college youth in
Tamil Nadu that started in 2005. It is implemented with the twin objectives of reducing HIV infection among
youth by raising their risk perception and preparing youth as peer educators and agents of change. Each
RRC is made up of 10-50 college student volunteers motivated to some degree to address HIV and other
sexual health issues among their age group and/or community. CDC, in partnership with TNSACS and the
state Ministry of Higher Education, support this program by placing 30 district-level field officers (one per 40
RRCs), 5 regional managers, and one state-level director under TNSACS with technical support coming
from CDC. TNSACS, via NACO and state funding, provides seed funds to each RRC to help facilitate HIV
prevention and stigma-reduction programs both in the colleges and outside in the nearby communities.
CDC support includes curriculum development, training and monitoring and evaluation of RRC activities.
contributing 3% of the TNSACS budget. The strong historical and technical relationship between TNSACS
and the USG has allowed the USG to leverage the entire budget of TNSACS ($16 million in FY07)
of the new Technical Support Unit in Tamil Nadu (also to be supported by the USG) and how that will
interact with the USG advisors currently in TNSACS.
The RRC program began in 2005. Currently, there are 874 RRCs with a volunteer strength of above
50,000, who reach out to over 700,000 students in various higher educational institutions and an untold
number of out-of-school youth through community programs. RRCs serve as an ideal social support
platform for youth to understand the myths and misconceptions about sexual health and make the right
choices at the right time. Although conceptually sound, operationalizing the program so quickly and widely
has been a challenge. Over the past 6 months, standardization of program activities and monitoring has
been the focus of CDC, TNSACS, and educational leaders' efforts. With this, the debate to include RRC as
part of the mainstream curriculum has been initiated at the university and ministerial level. This cost-
efficient institutional capacity building intervention is being replicated in various states especially Andhra
Pradesh and Karnataka and has the full support of NACO.
In FY08, it is planned to add 250 more RRCs by extending the program to degree-level, community,
agricultural colleges which were not targeted previously.
ACTIVITY 1: Celebrating Life: Curriculum on Sex and Sexuality:
A curriculum on sex and sexuality encompassing the issues of HIV/AIDS, STI, vulnerabilities to HIV and life
skills to overcome the vulnerabilities was developed by CDC and its partners in FY07. The curriculum,
targeted at college youth, will be introduced throughout Tamil Nadu this academic year. The curriculum has
two components. The first is designed to be used in large groups as a 3-hour primer and the second by
small groups as ten 1-hour skill building modules. The curriculum has been pilot tested with both urban and
rural college youth, with many finding it engaging, informative, and practical. A formal evaluation of the
impact of the curriculum on sexual risk perceptions, self efficacy to make informed sexual decisions, and
behavior is being planned. TNSACS will be implementing the primer in at least 1250 RRCs and the ten
modules in 1250 institutions in FY08. The number of institutions/students covered will be gradually
increased with the goal of reaching out to all institutional youth by the end of FY09. CDC and TNSACS will
focus on efforts to mainstream the curriculum within the education system at the university, state, and
national levels.
ACTIVITY 2: Peer Education Convention
The Red Ribbon Club Program aims to create a pool of peer educators with the objective of creating in-
house agents of change. Peer to peer strategies are especially important in an environment where sex is
not openly discussed, yet the need for information, advice, and support is great. 1200 peer educators will
be trained in FY08 through intensive district-level trainings/conventions of 3-5 days duration. This year a
minimum of eight such trainings will be conducted in high prevalence districts, based on our experiences
conducting similar trainings in the past two years. An effort to provide ongoing support and refresher
trainings to these peer-educators via the TNSACS/CDC field officers and regional managers will be
developed in FY08.
ACTIVITY 3: Networking
Networking with like-minded institutions will help us reach out to the youth population effectively. The
National AIDS Control Plan, Phase Three (NACP-3) plans to work closely with district-level positive
networks and initiate programs with positive speakers in colleges. It is also planned to network with
established student bodies through their volunteer programs to reach out to institutional youth more
effectively.
ACTIVITY 4: Community Outreach by RRCs
One of the advantages of the RRC design is that out of school youth in the nearby communities can also be
reached through this "army of volunteers". To date, RRCs have been very creative in how they reach out to
their peers beyond the college campus. Street theater performances on HIV and sex rights, newspaper and
Activity Narrative: radio stories, group discussions within existing youth clubs are some of the ways RRCs are reaching others.
In FY08, HHS/CDC and TNSACS will directly reach 150,000 community members via the RRC program to
promote HIV/AIDS prevention through abstinence and be faithful messages. This program will also
indirectly result in an additional 1,800,000 community members indirectly exposed to abstinence and be
faithful community outreach by the RRC membership. Community blood drives are another way in which
RRC is serving the community and preventing HIV infections. In FY08, TNSACS and CDC will work to
standardize and evaluate these approaches.
ACTIVITY 5: Monitoring and Evaluation of RRC Programs
For this massive RRC effort to be successful and sustainable, a rigorous monitoring system down to the
RRC level must be strengthened. Program indicators and reporting formats have been developed. In
FY08, field staff will be trained in this, targets will be established, and performance reviews will be largely
based on the degree to which accurate data is being collected and these targets have been reached.
Equally important, HHS/CDC in collaboration with TNSACS will continue to advocate for better and more
periodic HIV risk assessments among 18-23 year old in school and out of school.
ACTIVITY 6: Targeted "Pilot" Programs for High Risk Youth
To date, it has been difficult to identify and target the sub-population of college youth engaged in high risk
behaviors. Youth in India are generally not comfortable discussing their personal sexual behaviors with
others, including their peers. RRCs, peer educators, sexuality curriculum are all helping to change this. As
youth open up, opportunities to develop more targeted interventions for high risk youth will emerge. In
FY08, TNSACS plans to develop a more substantial strategy to address this issue and pilot test at least one
intervention aimed at a high risk subpopulation such as men having sex with men (MSMs) and/or clients of
commercial sex workers (CSWs), populations that have traditionally been neglected and stigmatized in
India.
The Tamil Nadu State AIDS Control Society (TNSACS) will continue to support an innovative program that
reaches an estimated 5.2 million women through women's self-help groups (SHG), working in partnership
with the Tamil Nadu Women's Development Corporation. The potential of SHG to address health issues is
great, but has not previously been used as a channel for education and behavior change. The USG will
continue to provide guidance for this training program, delivered by the government, which reaches women
with comprehensive SHG messages, including the development of sexual negotiation and communication
skills, and where to seek services for HIV counseling and testing and STI treatment.
Self Help Groups (SHGs) have promoted micro finance by rural women for the past twenty years in India. In
the state of Tamil Nadu, population 62 million, and where an estimated 150,000 PLHA live, there is a
voluntary SHG membership of 5.2 million women. SHGs are village-level groups of women aged 18 to 60
years formally organized for economic and social empowerment. Each group has a membership between
12 and 20, and elects its own leader for administration, representation, advocacy and capacity building
called an ‘animator'. The government-owned Tamil Nadu Women's Development Corporation (TNWDC)
coordinates the functioning of all SHGs.
SHG groups meet regularly to discuss their finances and social issues. This process has had a significant
impact on gender equality issues in Tamil Nadu, with the SHG movement helping women to become
financially more independent and socially and politically more organized. The potential of SHGs to influence
health issues has not been focused upon, but logically makes sense based on the fact that health outcomes
are heavily influences by social and gender issues. HIV and reproductive health are obvious examples of
this.
With this in mind, TNSACS, HHS/CDC, and TNWDC developed a strategy to reach women in SHG to
educate them and mobilize them on sexual and reproductive health, with an emphasis on HIV. Beginning in
FY06, the collaborative team tapped into the existing government SHG network, and initiated a training
process, including use of pictorial flip books, guided discussions, problem-solving techniques, games, and
"homework." Women thus develop skills to address their sexual health concerns and seek services related
to HIV/AIDS and STI. The main objectives of the intervention are to: develop sexual negotiation and
communication skills in women; increase their knowledge about HIV/AIDS and STI; equip them with
information on how and where to seek care, support, and testing for HIV/AIDS and STI; promote and
increase their intention to be change agents in the community.
CDC staff and consultants developed the training material, including its overall messages, storyline, and
delivery style. USG funds were used to pilot test the curriculum/materials, print the training materials
(50,000 flipbooks), hire the project manager, and conduct a documentation process. TNSACS provided
resources for training, logistics, and monitoring. The multi-layered training program includes 4 stages;
selection and training of master trainers, selection and training of Panchayat-level trainers, training of
individual SHG animators, and training of SHG members. In the first phase more than 700,000 women were
reached at a cost of less than $1 per women. CDC leveraged $520,000 from the government for this
intervention.
Feedback on the program has been excellent, as many women state that this type of training is long
overdue. Anecdotal reports suggest that many SHGs are taking the training seriously and are mobilizing the
community to respond to sexual rights and gender issues. Male counterparts in these communities are now
asking to be trained as well. More objectively, preliminary analyses of TNSACS HIV testing data show a
greater than expected increase in HIV testing over the past 6 months in the districts where this massive
program has been completed compared to non SHG intervention districts. TNSACS has planned an
external, formal evaluation of this activity to be conducted in FY08.
USG will continue to support this innovative program for the above cited reasons. The recently released
National Health and Family Survey (NHFS) data found that HIV prevalence in Tamil Nadu only was 1.5
times higher in women than men for unclear reasons. This suggests that women are a vulnerable
population group in Tamil Nadu and must be reached and empowered in effective, holistic, and cost-
efficient ways.
ACTIVITY 1: Consultant to Manage the SHG Prevention Intervention
HHS/CDC has supported the recruitment of a consultant to manage the SHG prevention intervention. In
FY08, this consultant will continue to work with the government agencies that coordinate SHGs in the state.
Activity Narrative: He will organize review meetings, recruit master trainers and manage materials production and distribution
across the state. He will manage the state funded evaluation of the program. The consultant will get
mentoring and technical support from HHS/CDC staff.
ACTIVITY 2: Support for the Implementation and Expansion of SHG Program
In FY08, TNSACS, with HHS/CDC support, will continue to implement and expand the four-stage SHG
human capacity development program to 7 additional high prevalence districts in Tamil Nadu. The
previously successful multi-layered Train-the-Trainer strategy will be employed again; 1) selection and
training of 30 master trainers who 2) train 456 Panchayat-level trainers who; 3) train over 70,000 individual
SHG animators who 4) train approximately 850,000 SHG members. The training will be coordinated by
NGOs and monitored by a Block Level HIV Training Monitor. SHG women will receive the same interactive,
story-based training as previously developed and conducted. More emphasis will be placed on developing a
village action plan during the third training session.
The program will be monitored at the state, district, and village level. State level monitoring will be carried
out by TNSACS, Tamil Nadu Women's Development Corporation and HHS/CDC. District level monitoring
will be carried out by District Co-coordinators and the Project implementation unit of Tamil Nadu Women's
Development Corporation. The village level monitoring will be carried out by the Block Level HIV training
monitor. TNSACS has planned an external, formal evaluation of this activity to be conducted in FY08.
Over 95% of the funding for this program will come from leveraged resources (NACO, Tamil Nadu
Government, Children's Investment Fund Foundation). However, HHS/CDC will continue to have strong
influence over both the design and implementation of the program due to our familiarity with both the
training process and the message content.
ACTIVITY 3: Training Program for Men
In FY08, TNSACS, with HHS/CDC financial and technical support, will develop a complementary modular
training program for men residing in the villages reached by the SHG intervention. This program will focus
on gender issues, sexual rights issues, faithfulness, partner reduction, and condom promotion. An
interactive, story-based design, similar to the SHG flipbook design, will be used. The new training material
will be pilot tested and roll out in at least 2 districts in FY08/09.
ACTIVITY 4: Outreach Role for SHG Members
In FY08, TNSACS, with HHS/CDC financial and technical support, will identify specific ways that the trained
SHG workforce can be utilized in the state's HIV program. As part of their training, SHG women are
expected to pass on relevant HIV messages to their family members, spouses, and neighbors. They are
also expected to develop as a group some form of village action plan to prevent HIV, reduce stigma and
discrimination, and increase demand for testing. TNSACS is proposing to use some of the most highly
motivated and empowered women to monitor outreach programs and government HIV care services. They
may also be used to promote and distribute condoms in their communities as a micro-finance enterprise.
TNSACS will share ideas and experiences related to the post-training use of SHG women with other USG
partners working on this issue (Myrada, Lepra).
CDC will continue to support the appointment of a full-time consultant to manage the Integrated Counseling
and Testing Centers (ICTCs) of the Tamil Nadu State AIDS Control Society (TNSACS). The consultant's
responsibilities cover ensuring that all ICTCs deliver high-quality services in accordance with national
guidelines. This includes monitoring and external quality assurance. In FY08, the consultant will provide
overall supervision for training for nurses, laboratory technicians and health care workers in the private
sector and ensure that all ICTC staff have received refresher training. The consultant will also oversee the
expansion of services for high-risk populations. The results under this program area are the indirect results
of persons reached through systems strengthening for the State program.
TNSACS and the USG has allowed the USG to leverage the entire budget of TNSACS ($16 million in FY
'07) effectively. This relationship is also strategic as jointly funded projects are likely to be replicated
throughout the country as TNSACS is regarded as the leading state HIV agency in India. The technical
support provided to TNSACS by the USG has been one of the successful models of donor support for the
country. The extent, form, and specificity of our support is now being discussed with NACO in relation to
the creation of the new Technical Support Unit in Tamil Nadu (also to be supported by USG) and how that
will interact with the USG advisors currently in TNSACS.
The state currently has 718 functioning counseling and testing (CT) centers. TNSACS will expand
counseling and testing sites and numbers during FY08 by mainstreaming CT at the existing 24 hour
government primary health care units. TNSACS will expand CT to 780 more centers during this year and
plans to conduct 885,000 tests during the year. NACO has set a target of 1.6 million tests (including
PMTCT) for Tamil Nadu for FY08-09.
ACTIVITY 1: Standardization of CT in TNSACS Centers
The consultant will facilitate the adoption of national guidelines by the state and ensure they are available in
all centers for standardization of CT. Further the consultant will ensure follow-up counseling modules are
made available to all centers and that all staff in the new CT centers are trained in FY08. He will ensure
refresher training is organized for all staff from the existing centers and will coordinate with the SACS district
level program units for monitoring the centers and for supply of materials.
ACTIVITY 2: Training for Laboratory Technicians, Nurses and Private Sector Staff
In FY08, TNSACS will coordinate the training of 780 laboratory technicians from the expanded facilities in
testing and train 780 nurses in HIV CT using the counseling module prepared by NACO. The nursing staff
will undergo a two week course and technicians will have a one week course in testing and quality
assurance. The course will be organized in batches of 25 with a target to have all staff in the new centers
complete the course. TNSACS will also coordinate and implement the training of 200 private sector health
care workers in HIV CT. The training for counselors will include: basic counseling, testing guidelines, rapid
HIV testing techniques, recording, reporting and the use of follow up counseling modules developed by
HHS/CDC. The laboratory technician's course will cover testing, quality assurance, recording, reporting and
logistics. The existing 1500 (800 counselors and 700 technicians) staff will undergo technical skills refresher
courses during FY08. In FY08, HIV counseling and testing will be provided to an estimated 885,000 non-
ANC clients in Tamil Nadu. This is an indirect result from systems strengthening.
ACTIVITY 3: Monitoring and Supervision
District level officers appointed by TNSACS and coordinated by the HHS/CDC-supported consultant will
monitor all HIV counseling and testing centers. The officer will visit the centers based on need to provide
supervision and technical input and feedback. District level counseling review meetings will be organized
every month by district project managers in the presence of the Joint Director of Health to discuss issues
and solve field problems. Each center will enter their performance data through the web-based monitoring
system and the data will be analyzed at TNSACS and at the district level for management decisions.
ACTIVITY 4: External Quality Assurance
TNSACS, with CDC, will ensure external quality assurance (EQUAS) practice as required by NACO is
complied with by all centers by linking these new centers with the regional reference centers that are linked
to 14 medical colleges in the state. The reference centers will be responsible for training, updating and
mentoring the staff of the new centers in EQUAS
ACTIVITY 5: Expansion of CT to High-Risk Populations
TNSACS, in collaboration with CDC, will support the expansion of HIV CT to high-risk populations (migrant
laborers, commercial sex-workers and clients, prison inmates). The consultant will guide the expansion
which will focus on mobile testing facilities as called for in the recently released strategy of the third phase
of the National AIDS Control Plan. These high-risk populations have traditionally had limited access to HIV
Activity Narrative: counseling and testing services designed to meet their unique needs, for example with extended hours of
operation, and staff trained to meet the needs of high-risk clients.
To assist this program, HHS/CDC will support the placement of an ART technical office within the Tamil
Nadu State AIDS Control Society (TNSACS), and two other consultants to support ART. These officers will
be responsible for guiding the implementation of the State's ART program in 26 ART centers, to achieve
TNSACS' target of 14,400 new clients for ART in FY08. The consultants will also be responsible for training
and monitoring and evaluation for the State's ART program.
The extent, form, and specificity of USG support is now being discussed with NACO in relation to the
creation of the new Technical Support Unit in Tamil Nadu (also to be supported by the USG) and how that
ACTIVITY 1: ART Consultants to TNSACS
In FY08, HHS/CDC, in collaboration with TNSACS, will support the placement of one full time ART
consultant and two other consultants supporting ART as part of their broader job responsibilities in
TNSACS. These consultants, who will be located within TNSACS' main office or their southern regional
office, will support the expansion and monitoring of the Tamil Nadu ART program. The strategic plan,
developed by TNSACS and the National HIV/AIDS Control Organization (NACO), calls for establishing 26
ART centers in FY08 (from 19 in FY07). Currently, there are 22,000 patients receiving ART treatment in
TNSACS facilities. TNSACS has a target to newly initiate 14,400 clients on ART in FY08.
These HHS/CDC-supported consultants will be responsible for developing and implementing training for
ART health-care personnel, program monitoring and evaluation, and partner coordination (with the Global
Fund, WHO, NGOs) at the state level.
In collaboration with NACO and USG partners (such as PHMI, I-TECH), TNSACS will also be responsible
for piloting innovative system-level improvements such as accreditation systems, down referral systems,
and public-private partnerships and documenting their feasibility and effectiveness in Tamil Nadu.
HHS/CDC believes that placing ART technical officers within TNSACS is a strategically appropriate activity
which will result in improved efficiency and efficacy as the ART program expands rapidly.
Since 2004 HHS/CDC, in collaboration with the Tamil Nadu AIDS Control Society (TNSACS), has
supported the development and operations of state of the art laboratory services at the Government
Hospital of Thoracic Medicine, Tambaram (GHTM). In FY08, this will include support for a senior laboratory
manager to oversee laboratory services and five laboratory technicians. USG will also expand GHTM's
laboratory capacity to include TB/HIV diagnostic culture. A third activity will be to support a consultant within
TNSACS to expand an accreditation process for laboratories in Tamil Nadu state, particularly targeted at
the private and NGO sectors.
The Tamil Nadu State AIDS Control Society (TNSACS) is the implementing body for India's National AIDS
Control Organization (NACO) in the southern state of Tamil Nadu, a high HIV-burden state. TNSACS,
In 2002, CDC developed a formal relationship with TNSACS and in 2003 began providing fiscal and
ACTIVITY 1: Support for GHTM Laboratory Services
Since 2004 USG/CDC, in collaboration with TNSACS, has supported the development and operations of
state of the art laboratory services at the Government Hospital of Thoracic Medicine, Tambaram (GHTM).
The support is particularly strategic as GHTM is the largest HIV care and treatment center in India, currently
caring for over 30,000 HIV-infected patients annually, 6600 of whom are receiving ART. GHTM, with CDC
support has developed into a national HIV training center of excellence. Each year, GHTM performs 25,000
HIV tests, 20,000 CD4 tests, and 150,000 AFB smears to diagnose TB, as well as basic chemistries and
hematology tests for HIV-infected patients. Previous HHS/CDC support has included procurement of
diagnostic equipment, reagents, renovating laboratory space, regular technical assistance, and the
placement of laboratory technicians. As a result, GHTM is recognized as one of the most comprehensive
and high quality laboratory in India.
In FY08, CDC, in collaboration with TNSACS, will support a senior laboratory manager to oversee
laboratory services at GHTM. This laboratory manager will be responsible for quality assurance/quality
control (QA/QC) of GHTM lab services, ensuring timely generation of test results, record keeping and
reporting, expanding services, and lab staff management. This senior manager will also assist developing a
QA/QC training program for private sector laboratories involved in HIV diagnosis, care, and treatment. S/He
will report directly to TNSACS with direct technical assistance from HHS/CDC.
HHS/CDC will also support TNSACS in the placement of five laboratory technicians to assist with the high
volume of lab tests at GHTM. To ensure sustainability, TNSACS will assume an increasing proportion of
lab costs at GHTM (i.e. reagents) in FY08 with an agreement to assume total costs (i.e. personnel) in
subsequent years.
ACTIVITY 2: Establishing Capacity for TB Diagnostic Culture at GHTM
In FY08, CDC, in collaboration with TNSACS, will support the implementation of TB diagnostic culture
capacity at GHTM. As stated previously, GHTM cares for over 30,000 HIV-infected patients each year with
TB being their most common cause of morbidity and mortality. GHTM, which was established originally as
a TB sanatorium, is a certified TB DOTS treatment center, diagnosing and/or treating over 63,000 cases of
TB among HIV-infected clients from 2002 to 2006. The availability of TB culture will allow GHTM to provide
a more rapid and accurate diagnosis of smear AFB negative and extra-pulmonary TB, which are common
among HIV-infective patients with TB disease. The availability of TB diagnostic culture capacity will also
allow for diagnoses of treatment-resistant forms of TB. HHS/CDC and TNSACS will procure the TB culture
equipment with TNSACS assuming the annual costs of the reagents and maintenance.
ACTIVITY 3: Development of Laboratory Accreditation Processes
USG has recently begun developing laboratory accreditation processes in the private/NGO sector in Tamil
Nadu. The objective of this process is to ensure high quality and accurate HIV laboratory services in the
private sector. Private facilities receiving this accreditation will be eligible to receive HIV diagnostic and
treatment support from the Government of India at a reduced price which will be passed on the patient.
Initial findings from this program have been promising with 25 private, high-volume HIV testing centers
enrolling themselves in late FY07.
In FY08, HHS/CDC will support a consultant within TNSACS to develop and expand this accreditation
system in Tamil Nadu. Specific activities of this consultant will include developing a transparent and
standardized HIV lab accreditation and certification system, private laboratory assessments, program
monitoring and evaluation, and training TNSACS staff to expand this program.
USG will support the placement of a Strategic Information (SI)/Monitoring and Evaluation (M&E) officer
within the Tamil Nadu State AIDS Control Society (TNSACS) to oversee and coordinate timely and high
quality data collection, data analysis, and data reporting. The consultant will be responsible for oversight of
the state Management Information System (MIS) and for supervising the state surveillance system. USG
will also support capacity-building for the District AIDS Prevention and Control Units (DAPCUs), including
training in SI/M&E. Assistance will also continue to support the TB/HIV Information System at the General
Hospital for Thoracic Medicine, Tambaram, Chennai (GHTM).
and the USG has allowed the USG to leverage the entire budget of TNSACS ($16 million in FY '07)
ACTIVITY 1: Strengthening TNSACS Management Information System (MIS)
In FY08, CDC will support TNSACS' management information system (MIS). This web-based MIS regularly
collects standardized data from 1187 government and non-government supported sites. These include
blood banks, HIV care and support centers, STD treatment centers, PMTCT clinics, integrated HIV
counseling and testing centers (ICTCs), and targeted intervention (TI) sites. CDC will support the
placement of a SI/M&E officer within TNSACS to oversee and coordinate timely and high quality data
collection, data analysis, and data reporting. These data, via the MIS, are then reported to the National
AIDS Control Organization (NACO). CDC will also provide technical support to this officer and considers
the placement of this officer a strategic activity to leverage support for larger activities that will be supported
by TNSACS itself.
This state-level consultant will continue to be responsible for managing the annual sentinel surveillance
process in Tamil Nadu, including the analysis of the data and writing of a state surveillance report published
each year. In FY08, this consultant will advocate for ways to strengthen the sentinel surveillance system
especially the component that addresses most at-risk populations.
ACTIVITY 2: Capacity Building for District AIDS Prevention and Control Units (DAPCUs)
Funding and technical support will be provided to support capacity building of the DAPCUs, units that are to
be funded under Phase 3 of the National AIDS Control Program (NACP-3). The objective of capacitating
the DAPCUs is to decentralize program implementation and management down to the district level
(population: 2-2.5 million per district). Currently, Tamil Nadu has recruited and trained DAPCU staff at one
level, the District Program Managers (DPMs). As the DAPCU concept materializes, an additional 1-4 staff
will be hired under the DPM. DPMs have been placed in all 30 districts to supervise and strengthen HIV
prevention, care, and treatment services in those districts. Specific activities of the DAPCU will include; 1)
ICTC supervision; 2) field-level staff training and mentoring; 3) technical support to district government
officials in charge of health and social programming; 4) establishment of linkage systems between
prevention programs, ICTCs, and the ART center; 5) coordination of all district level partners and activities;
6) technical inputs into communication and condom social marketing campaigns; and 7) monitoring and
evaluation of all district-level HIV services.
CDC will play a technical role in training DAPCU staff on basic public health principles, field management
skills, HIV prevention strategies, HIV care and treatment operational guidelines, and monitoring and
evaluation skills. The exact training calendar will be determined in collaboration with TNSACS, APAC (as
the technical support unit for Tamil Nadu), and other technical agencies working in Tamil Nadu. This
activity will be undertaken with a USG partner, Public Health Management Institute (PHMI), located in
Hyderabad, Andhra Pradesh.
ACTIVITY 3: Support to the Government Hospital for Thoracic Medicine, Tambaram (GHTM)
In FY08 CDC, in collaboration with TNSACS, will provide technical, human, and financial support to the
TB/HIV Information System (T/HIS) at the Government Hospital for Thoracic Medicine, Tambaram (GHTM),
India's largest HIV care hospital. T/HIS is a comprehensive electronic database that holds longitudinal
patient records of over 370,000 (10 million patient interactions) patients at GHTM. The development and
implementation of T/HIS has been supported by CDC and TNSACS for the past five years (software
development, hardware (computers, printers, local area network), and personnel).
In FY08, CDC and TNSACS, will support basic maintenance of T/HIS by placing data-entry and supervisory
personnel at GHTM. These personnel will be responsible for entering accurate patient data into T/HIS,
network administration, and timely reporting to GHTM, and to TNSACS. Support will also be provided for
Activity Narrative: hardware upgrades, paper for patient records, network connectivity, and basic system upkeep (cleaning,
uninterrupted power). Technical support will be provided by CDC in the areas of data quality assurance and
data analysis. CDC will continue to strive for increased local (that is, GHTM and TNSACS) operational
control and support of T/HIS by decreasing overall financial support in FY08 relative to FY07.
Twelve USG-funded consultants are placed within various program areas of the Tamil Nadu State AIDS
Control Society (TNSACS) to provide strategic and technical leadership. These positions will continue to be
supported in FY08. Specific activities will include coordination and strengthening the state counseling and
testing program, developing laboratory accreditation processes for the private/NGO sector, capacity building
for the District AIDS Prevention and Control Units and for health care personnel; supporting inter-state
information exchange, and an in-state stakeholders' consortium.
TNSACS is the implementing body for India's National AIDS Control Organization (NACO) in the southern
state of Tamil Nadu, a high HIV-burden state. TNSACS, which is headed by a senior officer from the Indian
Administrative Service (IAS), is the state-level authority for HIV-related policy formation, activity and partner
coordination, program implementation, as well as monitoring, reporting, and evaluating on all activities
related to the HIV epidemic in the state. In 1991, TNSACS was the first state HIV agency to be formed in
the country and has continued to serve as a model for other such agencies.
the country. The technical support provided to TNSACS by the USG has been one of the successful models
of donor support for the country. The extent, form, and specificity of our support is now being discussed with
NACO in relation to the creation of the new Technical Support Unit in Tamil Nadu (also to be supported by
USG) and how that will interact with the USG advisors currently in TNSACS.
Consultants funded by HHS/CDC are placed in various program areas of TNSACS to provide strategic and
technical leadership. To date, HHS/CDC has provided 12 consultants to TNSACS who work under the
guidance of the TNSACS Project Director (PD). These positions will continue to be supported in FY08 as
they fulfill a key system strengthening need at TNSACS through state-level supervision, policy and guideline
development, program monitoring and evaluation, and strategic planning. They will receive mentoring from
HHS/CDC staff. It is expected that TNSACS will assume responsibility for these consultants in subsequent
years.
ACTIVITY 1: Coordination and Strengthening of Counseling and Testing Activities
TNSACS has established 718 integrated counseling and testing centers (ICTC) in Primary Health Centers
(PHC), select district headquarters hospitals, and medical colleges to facilitate the ‘integration' of HIV
counseling and testing (CT) services, with the objective of increasing CT accessibility for those clients most
in need of CT. The centers have been provided with trained counselors, test kits, and laboratory
technicians. TNSACS, as the state HIV coordinating body, has the responsibility to ensure appropriate HIV
CT practice, standardized data recording and reporting, human capacity development of ICTC staff, and
program monitoring and evaluation. HHS/CDC will support the placement of an ICTC technical officer within
TNSACS to coordinate and strengthen these ICTC activities in the state. Additional activities that will be
supported by this officer include establishing an appraisal system that ensures optimal placement of ICTCs,
expanding provider-initiated HIV CT services into other health-care settings (TB, ANC, STI, in-patient
centers), improving the ICTC supply chain management system, and strengthening the state ICTC quality
assurance/control system.
Funding and technical support will be provided to support the capacity building of DAPCUs. The objective of
capacitating the DAPCUs is to decentralize program implementation and management down to the district
level (population: 2-2.5 million per district). Currently, Tamil Nadu has recruited and trained DAPCU staff at
one level, the District Program Managers (DPMs). As the DAPCU concept materializes, an additional 1-4
staff will be hired under the DPM. DPMs have been placed in all 30 districts to supervise and strengthen
HIV prevention, care, and treatment services in those districts. Specific activities of the DAPCU will include;
1) ICTC supervision; 2) field-level staff training and mentoring; 3) technical support to district government
prevention programs, ICTCs, and ART center; 5) coordination of all district level partners and activities; 6)
technical inputs into communication and condom social marketing campaigns; and 7) monitoring and
evaluation of all district level HIV services.
HHS/CDC will play a technical role in training DAPCU staff on basic public health principles, field
management skills, HIV prevention strategies, HIV care and treatment operational guidelines, and
monitoring and evaluation skills. The exact training calendar will be determined in collaboration with
TNSACS, APAC (as the technical support unit for Tamil Nadu), and other technical agencies working in
Tamil Nadu. This activity will be undertaken with a USG partner, Public Health Management Institute
(PHMI), located in Hyderabad, Andhra Pradesh.
ACTIVITY 3: State-Wide Capacity Building and Training for Health Care Personnel
HHS/CDC will support a consultant within TNSACS to strategically support and coordinate capacity building
for the different levels of the health system involved in HIV/AIDS services. The consultant will coordinate
with medical college and government hospitals and will be responsible for developing public private
partnerships. In FY08, this consultant will focus on providing technical support to TNSACS-supported ART
centers and community care and support centers in the southern region of Tamil Nadu. This consultant will
work on creating stronger linkages between testing centers, NGO-run care and support centers, and ART
centers placed in government institutions. The consultant will also mentor the 7 DPMs in the region. A
regional training center is being proposed by TNSACS and the Tamil Nadu Health Minister, and if funded
Activity Narrative: will be developed with assistance from this consultant and HHS/CDC.
ACTIVITY 4: Public Health Training for District Collectors
HHS/CDC has recently received approval from the senior administrative officer of the Government of Tamil
Nadu to conduct a one-day HIV and public health training for all District Collectors, who are the highest
ranking government administrative officials in the district and future state level administrative leaders.
District Collectors oversee all health, development, and social programs in their designated district. The
goal of this training program will be to equip these District Collectors with strong program management and
data-driven decision making skills. The USG, in collaboration with TNSACS, recognizes the importance of
providing these officers with strong HIV program management skills and will support the training of a new
batch of district collectors in FY08 as a strategic system strengthening activity. USG plans to make this
training a routine activity across the four high prevalence southern states.
ACTIVITY 5: State-to-State Information-Sharing Workshops
To facilitate information sharing and collaboration with other state HIV/AIDS Societies (SACs) in FY08,
HHS/CDC will support TNSACS to organize state-to-state sharing workshops for the southern states
(Andhra Pradesh, Karnataka, Kerala, Goa and Pondicherry). Other agencies implementing USG state-level
programs will be invited to share their experiences and to identify best practices and strategies to
addressing HIV/AIDS in their respective states. TNSACS is the ideal SACS to coordinate such workshops
due to their experience and history of success.
ACTIVITY 6: Consortium of HIV/AIDS Stakeholders
In FY08, USG will support TNSACS to establish and lead a consortium of HIV/AIDS stakeholders. There is
an acute need to coordinate the growing number of HIV/AIDS agencies and stakeholders in Tamil Nadu in
order to minimize duplication of activities and geographic coverage and to develop standard materials
(trainings, IEC, recording and reporting) among these partners. TNSACS will coordinate regular meetings
for these partners and will establish standard operating procedures.
ACTIVITY 7: Laboratory Accreditation Processes
private sector. Private facilities receive this accreditation will be eligible to receive HIV diagnostic and
treatment support from the GOI at a reduced price which will be passed on the patient (i.e. customer). Initial
findings from this program have been promising with 25 private, high volume HIV testing centers enrolling
themselves in late FY '07. In FY '08, HHS/CDC will support a consultant within TNSACS to develop and
expand this accreditation system in Tamil Nadu. Specific activities of this consultant will include developing
a transparent and standardized HIV lab accreditation and certification system, private laboratory
assessments, program monitoring and evaluation, and training TNSACS staff to expand this program.
