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
PHMI will provide ongoing support to the Andhra Pradesh State AIDS Control Society (APSACS) for the
management of the Integrated Counseling and Testing Center (ICTC) system, which is a key piece of the
prevention of mother to child transmission (PMTCT) program in Andhra Pradesh/India. This support will
focus on the placement of a senior ICTC consultant. Secondary support will come from two other PHMI-
supported APSACS consultants who focus on monitoring and evaluation and trainings. PHMI will also
support PMTCT by advocating for new policy initiatives, conducting management and system strengthening
training workshops (especially for district staff), and assisting with field-level assessments. The budget to
support the APSACS consultants is provided under Policy and Systems Strengthening, however there will
be substantial results (particularly indirect results) in this program area as a consequence of the
consultants' activities.
BACKGROUND
Mediciti SHARE India is a not-for-profit organization working in rural communities outside Hyderabad,
Andhra Pradesh specifically reaching out to about 300,000 rural populations with services including
maternal and child health, immunization, population control, cancer detection, HIV/AIDS and nutrition,
coordinated through their medical college and hospital. SHARE India is also recognized as a research
foundation by the Department of Science and Technology, Government of India.
In 2006, through a cooperative agreement with PEPFAR/CDC, SHARE India established the Public Health
Management Institute (PHMI) as a technical assistance and training organization. PHMI's objective is to
provide human resource capacity building and systems strengthening within the public health infrastructure
of Andhra Pradesh (AP). Its focus is on developing innovative quality improvement mechanisms such as
accreditation systems and on the job training programs. Its technical focus is on HIV but PHMI envisions a
broader role in building public health systems in AP.
Andhra Pradesh State AIDS Control Society (APSACS), the state's nodal agency for HIV control, has
scaled up counseling and testing (CT) services and prevention to mother to child transmission (PMTCT)
services to both rural and urban populations (unlike other states where these services are primarily urban
and peri-urban). These services are offered under one roof in 677 Integrated Counseling and Testing
centers (ICTCs) in the State. Almost all ICTCs are located in government medical care facilities (medical
colleges, district and sub-district hospitals, primary health centers) and therefore are designed to link clients
to support services, facility based palliative care, and ART screening and treatment. The system also
encourages provider- initiated testing by closing linking outpatient clinics and inpatient wards to the ICTC,
usually located in the same building.
ICTCs were conceptualized in 2005 by Tamil Nadu State AIDS Control Society (TNSACS) with the support
of CDC consultants and staff during the state's rapid scale up of testing services. APSACS went through a
similar scale-up and re-structuring process in 2006 and early 2007, with the help of LEPRA, CHAI, PHMI,
and CDC staff. Counseling and testing (CT) centers in Andhra Pradesh increased from 121 in 2004 to 677
today. APSACS-funded ICTCs currently perform over 1.5 million tests per year, of which 600,000 are for
antenatal women (positivity rate, 1.25%-2.5%) and 900,000 are for walk-in clients and non-antenatal
patients (provider initiated) with a positivity rate of 8-14%. NACO has set a target of 2.5 million tests for
FY08-09 for Andhra Pradesh, of which 1 million tests are for antenatal women. This does not include the
large number of tests in the private sector (except the few sites funded by APSACS such as the
APAIDSCON network of private medical colleges) since those numbers are not reported to APSACS.
In AP as well as elsewhere in India, the PMTCT program is relatively new and the public health systems to
monitor and follow-up antenatal women are generally weak. Therefore, it is not surprising that a large
number of pregnant women who test positive are lost to follow up. In 2006, over 4,000 pregnant women in
AP were found to be positive in the government sector (tested at ICTCs). Of these, approximately 42%
were documented as having received Nevirapine prophylaxis. This percentage appears to have increased
to 60% in select USG focus districts in 2007. This improvement appears to be due to a concerted effort by
APSACS to more aggressively counsel and follow pregnant women found to be HIV positive. A statewide
"Zero by 07" campaign may also be helping to mobilize communities, NGO outreach teams, and the
medical sector to ensure Nevirapine prophylaxis and institutional deliveries.
ACTIVITIES AND EXPECTED RESULTS
The State's 677 ICTCs are currently managed directly by the CDC/PHMI-funded ICTC consultant under the
guidance of the APSACS project director. Systems to manage ICTCs have evolved over the past two-three
years. APSACS has recently placed district level counseling supervisors in all 23 districts. USG supported
district management teams (placed in the 10 highest prevalence districts eight months ago) also provide
management support to the ICTCs as an part of their job responsibilities. These efforts to decentralize the
management process have been a great help to the system.
In FY08, PHMI will provide ongoing support to APSACS for the management of the Integrated Counseling
and Testing Center (ICTC) program, including PMTCT services. This support will continue to focus on the
placement of a senior state-level ICTC consultant.
ACTIVITY 1: Consultant's Management of PMTCT
The consultant will continue to play a leadership role in managing the entire ICTC system and create
strategies to continuously improve the structure of the program. This includes: a) strengthening training
programs for counselors, lab technicians, and nurse practitioners; b) ensuring that refresher trainings are
conducted annually for all field staff; c) improving the supervision skills and procedures for district level
counseling supervisors and district project managers; d) strengthening supply chain systems for HIV test
kits; e) using the web based monitoring system to analyze data and provide ongoing, timely feedback to
district teams and individual ICTCs; f) creating better human resource management systems including
annual performance reviews for all ICTC staff and g) taking steps to mainstream ICTCs into the medical
system.
Tthe consultant will ensure that newly-released ICTC operational guidelines (developed by NACO) are
adopted by the state and are made available in all centers, with a goal of standardizing counseling and
testing services. Further the consultant will ensure that the recently created follow-up counseling toolkit is
distributed to all centers and counselors are adequately trained in how to use this important teaching aid for
Activity Narrative: those testing positive.
ACTIVITY 2: Strengthened Linkages between ANC and ICTC Services
The ICTC consultant will play a leadership role in establishing stronger linkages between antenatal outreach
services and ICTCs where HIV testing is routinely performed. New strategies for reaching antenatal women
and promoting routine HIV testing will be developed. One possible strategy is to send ICTC teams to remote
primary health centers or sub-centers on select antenatal service days (perhaps once a month). Another is
for APSACS to develop closer relationships with private testing centers to ensure quality testing,
counseling, and patient follow up.
PHMI, through the ICTC consultant, will continue to remain engaged in the work to improve the rate of
Nevirapine administration to pregnant women identified as HIV-positive and will provide technical support
and input to other agencies as requested.
ACTIVITY 3: Support to District-Level Teams
The ICTC Consultant will support the district level teams and government officials who will, in turn, monitor
all HIV CT centers in their respective districts. The ICTC consultant will help develop monthly site visit
checklists, reporting formats, training calendars, review meeting agendas, testing targets, and budget
requirement, for each district team. The consultant will periodically join district team members in their
monitoring visits. He/she may visit the best and worst performing ICTCs in the district to better understand
the factors that directly impact program performance and find solutions to problems.
To support APSACS, PHMI will also work with the district teams on ways to improve the rate of Nevirapine
administration to pregnant women identified as HIV positive. This may include mentorship to the district
teams and other field managers on how to maximize outreach efficiency, track positive antenatal women,
encourage positive deliveries by medical staff, provide infant testing and care protocols, and ensure that
family planning services are made available post-delivery. PHMI will also support the evaluation and review
of PMTCT-related policies and procedures.
ACTIVITY 4: Development of Positive ANC Tracking Tool
The PHMI-supported consultant to APSCACS on data management systems will develop a Positive ANC
tracking tool to improve Nevirapine administration rates in the State. Initially, this will be a paper-based
system of positive ANC line-listing that will track and document all positive mothers from the time of
diagnosis till the time of delivery and subsequently follow up the child till s/he is 18 months of age. It will be
a useful field tool for the counselors, nurses and outreach workers.
management of the Integrated Counseling and Testing Center (ICTC) Program. This support will continue
to focus on the placement of a senior ICTC consultant at APSACS. Secondary support will come from two
other PHMI-supported APSACS consultants who focus on Monitoring and Evaluation (M&E) and training.
PHMI will also support counseling and testing by advocating for new policy initiatives, conducting
management and system strengthening training workshops (especially for district staff), and assisting with
field-level assessments.
Mediciti SHARE India (SHARE India) is a not-for-profit organization working in rural communities outside
Hyderabad, Andhra Pradesh specifically reaching out to about 300,000 rural populations with services
ranging from maternal and child health, immunization, population control, cancer detection, HIV/AIDS and
nutrition programs, coordinated through the SHARE India medical college and hospital located nearby.
SHARE India is also recognized as a research foundation by Department of Science and Technology,
Government of India.
Management Institute (PHMI) as a technical assistance and training organization. PHMI's main objective is
to provide human resource capacity building and systems strengthening within the public health
infrastructure of Andhra Pradesh (AP). The current focus is on developing innovative quality improvement
mechanisms such as accreditation systems and on the job training programs. The technical focus is
currently on HIV but PHMI envisions a broader role for the Institute in building public health systems in AP.
scaled up counseling and testing services to both rural and urban populations unlike other states where the
services are primarily urban and peri-urban. Currently totaling about 677 centers, the integrated counseling
and testing centers (ICTCs) offer PPTCT services, CT services and TB-HIV linkages. Almost all ICTCs are
located in government medical care facilities (medical colleges, district and sub-district hospitals, primary
health centers) and therefore are designed to link clients to support services, facility based palliative care,
and ART screening and treatment. The location also encourages provider-initiated testing by closely linking
outpatient clinics and inpatient wards to the ICTC, which is usually located within the same building.
The ICTC concept was developed in 2005 by the Tamil Nadu State AIDS Control Society (TNSACS) with
the support of CDC consultants and staff during the state's period of rapid scale up of testing services.
APSACS went through a similar scale up and re-structuring process in 2006 and early 2007, with the help of
CDC staff and USG subpartners LEPRA, CHAI, and PHMI. Testing and counseling centers in Andhra
Pradesh increased from 121 in 2004 to 677 today. APSACS-funded ICTCs currently perform over 1.5
million tests per year, of which 600,000 are among antenatal women with a positivity rate of 1.25 to 2.5%
and 900,000 are among walk-in clients and non-antenatal patients (provider-initiated) with a positivity rate of
8-14%. NACO has set a target of ~2.5 million tests for FY08-09 for Andhra Pradesh, of which 1.5 million
tests are to be performed on non-antenatal populations. This does not include the large number of tests
being done in the private sector (except those few testing sites funded by APSACS such as the
APAIDSCON network of private medical colleges) since those numbers are not reported to APSACS
currently.
The state's counseling and testing systems are currently managed directly by the CDC/PHMI- funded ICTC
consultant under the guidance of the APSACS project director and associate project director. Systems to
manage ICTCs have evolved over the past 2-3 years. APSACS has recently placed district level counseling
supervisors in all 23 districts. USG-supported district management teams (placed in the 10 highest
prevalence districts 8 months ago) have also been providing management support to the ICTCs as an
important part of their job responsibilities. These efforts to decentralize the management process have been
a great help to the system.
In FY '08, PHMI will provide ongoing support to APSACS for the management of the Integrated Counseling
and Testing Center (ICTC) Program. This support will continue to focus on the placement of a senior state-
level ICTC consultant.
ACTIVITY 1: Management of the AP State ICTC System
strategies to continuously improve the structure of the program. This includes; a) strengthening training
annual performance reviews for all ICTC staff and g) taking steps to mainstream ICTCs into the general
health care delivery system.
As part of this, the consultant will ensure that newly-released ICTC operational guidelines (developed by
NACO) are adopted by the state and are made available in all centers, with a goal of standardizing
counseling and testing services. Further the consultant will ensure that the recently created follow-up
counseling toolkit is distributed to all centers and counselors are adequately trained in how to use this
important teaching aid for those testing positive.
ACTIVITY 2: Establishing Stronger Linkges between Care Providers and ICTCs
The consultant will play a leadership role in establishing stronger linkages between care providers and
ICTCs, with a continued focus on strong referral systems for patients with active TB or sexually transmitted
Activity Narrative: infections. He/she will also strengthen the referral linkages between ICTCs and community care centers,
positive networks, and ART centers (and other PLHA services available in the district). A system to monitor
and evaluate these referral linkages will be developed and pilot tested in FY08.
ACTIVITY 3: District Level Monitoring and Supervision
District level officers will be supported and coordinated by the PHMI Consultant who will monitor all HIV
counseling and testing centers. The officer will visit centers based on need to provide supervision and
technical input and feedback. District level counseling review meetings will be organized every month by the
district managers in consultation with the consultant.
ACTIVITY 4: Promoting Routine External Quality Assurance
PHMI, mostly through the work of the state-level consultant with mentorship from CDC and others, will
ensure that external quality assurance (EQAS) as required by NACO is routinely conducted involving all
ICTCs. The consultant will assist APSACS in identifying and strengthening the EQAS reference centers in
the state. The consultant will also develop and implement a strategy to address ICTCs that fail EQAS.
ACTIVITY 5: Expand HIV Counseling and Test to High-Risk Populations
support the expansion of HIV counseling and testing into high-risk populations (migrant laborers,
commercial sex-workers and clients, and prison inmates). The consultant will guide the expansion, which
will focus on mobile testing facilities as called for in the recently released NACP-3 strategy. These high-risk
populations have traditionally had limited access to HIV counseling and testing services specific to their
unique needs (such as extended hours of operation, staff trained to meet their specific needs). PHMI will
partner with LEPRA (another USG partner) on this effort since LEPRA is carrying out a demonstration
project for the State on mobile testing.
The Public Health Management Institute (PHMI) will continue to develop a simple accreditation process for
small, for-profit labs who conduct a large number of HIV tests. In FY08, the accreditation process will focus
on HIV testing procedures and quality assurance systems. In FY09, accreditation may be expanded to
include other simple microbiologic tests and other HIV-related tests.
mechanisms such as accreditation systems and on the job training programs. Its technical focus is
Expansion of high quality laboratory services is recognized as a key deliverable under the Government of
India's new five- year strategy, also known as Phase 3 of the National AIDS Control Program (NACP-3).
The quality and accountability of HIV-related laboratory services within the private sector must improve.
PHMI believes that this can be partially addressed by developing a process for certification and eventual
accreditation of laboratories.
PHMI has already begun this process. Country experts from the National Accreditation Board for Testing
and Calibration Laboratories (NABL) and the Quality Council of India (QCI), two national laboratory quality
control bodies in India, have been recruited to help build an accreditation strategy in 2007. A PHMI
laboratory accreditation working group has been meeting regularly and has decided to focus the initial effort
on HIV testing. Standard operating procedures for HIV rapid test kit use and ELISA testing have been
collected and incorporated into the group's draft training materials and accreditation checklist.
ACTIVITY 1: HIV Laboratory Accreditation Program:
In FY08, PHMI will continue its effort to develop a HIV focused laboratory accreditation process for private
sector laboratories. The initial target audience will continue to be small, for-profit laboratories that conduct a
large number of HIV tests with little existing quality assurance systems. Small unregulated labs may be
motivated to participate in a training, monitoring, and accreditation system in order to build up consumer
confidence in their services, expand their consumer base, and gain credibility in the local medical
community. PHMI will focus on improving HIV testing quality first. In FY08 or 09, PHMI will likely expand
the accreditation process to include other common microbiologic tests such as acid fast TB staining, malaria
smears, and bacterial/fungal cultures. HIV-related tests such as CD4 testing, viral load testing, and
cryptococcal India ink testing may also be added for higher level private laboratories in future years.
As part of the accreditation process, PHMI and its collaborators will develop basic standards of HIV testing
(based on NACO guidelines), an accreditation checklist, and procedures to assess HIV laboratory practices
periodically. This will involve the creation of inspection teams and the use of an external quality assurance
system (EQAS).
In FY08, this will be piloted in at least 15 laboratories in one state and revised based on the experience and
feedback from key stakeholders. A second level accreditation involving a number of common microbiologic
tests besides HIV testing may be developed and pilot tested with FY08 funding.
Both Level One and Level Two accreditation are major undertakings and will be developed in collaboration
with the USG technical team, other USG partners, technical consultants, NACO/SACS, and other
national/international laboratory institutions. Additional funding will be required and sought to complete this
activity. A laboratory accreditation system is required to standardize HIV/Tb/Malaria testing procedures,
empower consumers, and address the reality that laboratory services in India remain highly unregulated.
ACTIVITY 2: Marketing Campaign for PHMI Accredited Laboratories
Accreditation as a strategy will only be successful if laboratories see some benefit for improving their quality
and systems. One potential benefit is more customers and thus, more business. In FY08, PHMI will
develop a social marketing campaign highlighting the benefits of using a PHMI accredited laboratory for HIV
testing (and other tests in the future) in the communities where pilot accreditation activities are taking place.
PHMI will monitor the impact of the accreditation process and marketing campaign on HIV testing load for
each of the pilot labs. PHMI will try to leverage funds from APSACS to expand the reach and intensity of the
campaign.
The important objectives of program activities in 2008-09 are to 1) continue support for strategic data
management and data analysis of the Tambaram Health Information System (T/HIS) through the placement
of a Health Information Specialist at the Government Hospital of Thoracic Medicine, Tambaram (GHTM); 2)
build local in-country capacities in public health management through the initiation of a public health
management training program for mid-career NGO and government personnel; and 3) organize workshops
in collaboration with the Andhra Pradesh State AIDS Control Society (APSACS) and other key agencies
and institutions working in Andhra Pradesh to disseminate timely and important HIV-related reports and
operational research findings from India and especially from Andhra Pradesh.
Andhra Pradesh specifically reaching out to about 300,000 of the rural population with services ranging from
foundation by the Department of Science andTechnology, Government of India.
mechanisms such as accreditation systems and on the job training programs. PHMI's technical focus is
currently on HIV but it envisions a broader role in building public health systems in AP. PHMI advocates for
and develops better strategic information systems to support public health programs and interventions.
ACTIVITY 1: Support for a Patient Information System.
In FY08, PHMI will support the placement of a Health Information Specialist at the Government Hospital of
Thoracic Medicine, Tambaram (GHTM). This specialist will assist with the strategic management and data
analysis of the Tambaram Health Information System (T/HIS). T/HIS is a comprehensive electronic
database that holds the longitudinal patient records of over 370,000 patients at GHTM, including 10 million
patient visits. The development and implementation of T/HIS has been supported by HHS/CDC for the past
five years (software development, hardware, and personnel). To strategically support T/HIS, the specialist
will be placed at GHTM and will be responsible for quality assurance of data-collection, entry, and analysis
using system data. S/he will also utilize T/HIS to generate regular reports to GHTM and Government of
India stakeholders. HHS/CDC, PHMI, and GHTM will provide technical supervision to the specialist. It is
anticipated that the support for this specialist will be assumed by the Tamil Nadu State AIDS Control
Society (TNSACS) in subsequent years.
In FY08, PHMI will support the general maintenance of T/HIS. Specific activities include software and
hardware repairs as needed and hardware upgrades. The support for this activity has been significantly
reduced relative to previous years, with GHTM and TNSACS assuming greater responsibility and ownership
in the system. It is expected that by the conclusion of FY10, all support for T/HIS will come from the
Government of Tamil Nadu and/or the Government of India.
ACTIVITY 2: Capacity Development for SI through the Public Health Field Leaders Fellowship (PHFLF).
With no schools of public health or formal field public health training, there is a significant lack of field-level
expertise in population level disease control and prevention (HIV and otherwise) in the state. As a part of
the commitment to address this critical issue and build local in-country capacities, PHMI has initiated a
public health management training program to begin in early FY08. PHFLF is designed as a one year on-
the-job training program for approximately 20 mid-career NGO and government personnel responsible for
developing or managing HIV related field interventions. The curriculum consists of six weeks of group
contact sessions combined with distance learning modules and field mentorship. Significant attention is
given to data for decision making, qualitative data collection and analysis, survey design and analysis, high
risk mapping, continuous quality improvement processes, and evidence based planning. Using FY08 funds,
PHMI will continue to improve the quality of the fellowship curriculum and structure. It also may expand the
fellowship to more than one batch per year.
PHMI will partner with a number of academic institutions, including the newly formed Public Health
Foundation of India to recruit the most talented public health resource persons for the fellowship. Other
contributing partners will likely include the Indian Institute of Management, Ahmedabad (IIM-A), the George
Institute, University of Chicago, and the Council for Social Development. In FY08, these partnerships will
continue to develop and may lead to other important collaborative training programs and field-level
evaluations.
ACTIVITY 3: Dissemination of HIV-Related Information of Strategic Importance to AP
A recurrent issue in India is that the need for more effort to provide scientific information to both state
leaders and field staff and to present this information in a way that allows these stakeholders to come to
appropriate conclusions about how this information should affect programs and policies. In FY08, PHMI will
organize workshops to disseminate timely and important HIV-related reports and operational research
findings from India and especially from Andhra Pradesh. These workshops will be run in collaboration with
APSACS and other key agencies and institutions working in AP.
As part of this activity, PHMI will advocate for more and better quality strategic information in Andhra
Pradesh, such as HIV prevalence data among most at-risk populations and potential bridge populations,
behavioral data among youth, operational research data on effectiveness of various programs and
interventions, etc. PHMI will assist APSACS and other agencies in designing and analyzing SI projects.
However, due to funding limits in FY08, PHMI will not likely be able to directly fund any large scale
operational research projects or sentinel surveillance initiatives.
The Public Health Management Institute (PHMI) was established in 2006 as a means of providing human
resource capacity building and systems strengthening within the public health infrastructure of Andhra
Pradesh (AP). PHMI will support the AP State AIDS Control Society (APSACS) by placing technical
consultants with APSACS, to focus on ART, management of the Integrated Counseling and Testing Centers
(ICTCs), monitoring and evaluation (M&E) and training.
Hyderabad, AP, reaching about 300,000 of the rural population with services including maternal and child
health, immunization, population control, cancer detection, HIV/AIDS and nutrition, coordinated through
their medical college and hospital located nearby. SHARE India is also recognized as a research foundation
by the Department of Science and Technology, Government of India.
Management Institute (PHMI) as a technical assistance and training organization. PHMI's current focus is
on developing innovative quality improvement mechanisms such as accreditation systems and on the job
training programs. Its technical focus is currently on HIV but PHMI envisions a broader role for the Institute
in building public health systems in AP.
ACTIVITY 1: Human Resource Capacity Development through Public Health Field Leaders Fellowship
(PHFLF)
expertise in population level disease control and prevention in the state. To build local in-country capacity,
PHMI has initiated a public health management training program to begin in early FY08. PHFLF is designed
as a one year on-the-job training program for approximately 20 mid-career NGO and government personnel
who develop or manage HIV- related field interventions. The curriculum consists of six weeks of group
sessions combined with distance learning modules and field mentorship. Subjects include project
management skills development, science-based intervention design, and evidence-based planning. Using
FY08 funds, PHMI will continue to improve the quality and structure of the fellowship curriculum and may
expand the fellowship to more than one batch per year.
IN FY08, PHMI will continue to partner with academic institutions, including the new Public Health
Foundation of India (tasked to establish five schools of public health in India in the next three years), the
Indian Institutes of Management, the George Institute, and University of Chicago. This partnership may lead
to additional collaborative training programs and field-level evaluations in FY08.
ACTIVITY 2: Partnership with AP Government to Provide Technical Support
This ongoing activity provides three full-time technical experts to support statewide HIV activities through
the Andhra Pradesh State AIDS Control Society (APSACS). The areas covered are surveillance/M&E,
Integrated Counseling and Testing Center (ICTC) activities, and training. The consultants' role will be to
provide technical support to the government HIV/AIDS intervention and program officers, many of whom
have limited experience and technical knowledge in their areas of responsibility. Consultants report to the
APSACS Project Director and are mentored by CDC and PHMI staff. They are responsible for strengthening
systems in their areas of expertise, building organizational capacity to monitor and evaluate programs,
creating minimum standards for all training programs, establishing procedures for routine program reviews,
advocating and developing better systems for program supervision, field evaluations, supplies and
equipment maintenance, and developing tools and processes for collecting, consolidating and analyzing
data at the state and district level.
PHMI will work closely with the future AP Technical Support Unit (TSU) for HIV programming (to be
supported by the Bill and Melinda Gates Foundation). Since the Gates Foundation's programs focus on high
-risk prevention, USG support via PHMI and others will continue to play an essential role in building HIV
prevention and care systems in the state. PHMI will coordinate inter-state learning exposure visits for SACS
staff/officers. PHMI will also build the skills and understanding of the APSACS Project Director in health
economics and advanced program management.
ACTIVITY 3: Support to National AIDS Control Organization (NACO)'s ART Program
PHMI will work with NACO to strengthen the national ART delivery systems. This will include support for two
consultants at NACO, five consultants at SACS, international consultants and in-country contractors to work
on ART issues, with direct technical assistance from CDC India team and CDC Atlanta. NACO's goals are
to establish an ART center accreditation system, a down referral system, and an improved human resource
management system. The ART support package will also assist NACO to establish 10 ART centers of
excellence in care, training, and operational research and to create models for private sector involvement in
ART delivery.
ACTIVITY 4: HIV Laboratory Accreditation Program
In FY08, PHMI will continue its effort to develop an HIV-specific laboratory accreditation process for private
sector laboratories. This is major undertaking will be developed with the USG technical team, other USG
partners, technical consultants, NACO/SACS, and other national and international laboratory institutions. An
accreditation system is required to standardize HIV testing procedures, empower consumers, and address
the reality that laboratory services in India are highly unregulated. PHMI and its collaborators will develop
basic standards of HIV testing (based on NACO guidelines), an accreditation checklist, and procedures to
assess HIV laboratory practices. In FY08, this will be piloted in at least 15 laboratories in one state.
The target audience is small for-profit laboratories who conduct a large number of HIV tests but have few
quality assurance systems. Small unregulated labs may be motivated to participate in a training, monitoring,
and accreditation system in order to build up consumer confidence in their services, expand their consumer
base, and gain credibility in the local medical community. PHMI will first focus on improving HIV testing
quality and later expand the accreditation process to include other common microbiologic tests.
ACTIVITY 5: Clinical Accreditation Program
In FY08, PHMI will also promote as HIV-specific clinical accreditation process for private sector clinics and
Activity Narrative: hospitals. This major undertaking will be developed with the USG technical team, other USG partners,
technical consultants, NACO/SACS, and WHO India. A clinical accreditation system is required to
standardize HIV care and treatment services, empower consumers, and address the reality that medical
care in India remains highly unregulated. PHMI and collaborators will develop basic standards of HIV care,
an accreditation checklist, and procedures to assess HIV care practices. In FY08, this will be pilot tested in
one state.
Activity 6: Andhra Pradesh HIV Consortium:
In FY08, PHMI will work with APSACS to establish a consortium of HIV/AIDS stakeholders in the state.
There is an acute need to coordinate the growing number of HIV/AIDS agencies and stakeholders in AP in
order to minimize duplication of activities and geographic coverage, and to develop standardized materials
(trainings, package of services, IEC, reporting formats) among these partners. PHMI will coordinate regular
meetings of the consortium and its working groups and will establish standard operating procedures.
In addition to the formal consortium, PHMI will support and/or conduct periodic workshops for various
stakeholders to share, analyze, and process operational research findings, surveillance reports, and
scientific studies. This is also a forum for discussing specific policies and/or operational and technical
guidelines, especially as they relate to new findings from the field. PHMI will advocate for more and better
quality strategic information in AP, such as HIV prevalence data among most at-risk populations and
potential bridge populations.
Activity 7: Training of District AIDS Prevention and Control Units (DAPCUs):
Under Phase 3 of the National AIDS Control Program (NACP-3), DAPCUs will be formed in all districts in
the high prevalence states. The objective of building the capacity of the DAPCUs is to decentralize program
implementation and management down to the district level. DAPCU activities 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 among prevention programs,
ICTCs, and ART center; 5) coordination of district level partners and activities; 6) technical inputs into
communication and condom social marketing campaigns; and 7) M&E of all district-level HIV services.
The process of recruiting and training DAPCU staff is a tremendous opportunity. USG and its partners have
already developed some early experience in district capacity building. With APSACS concurrence, USG has
established HIV management teams in 10 districts in AP and will conduct skills-based trainings for these
district staff. PHMI has been identified as CDC's lead partner in DAPCU trainings and capacity building and
will seek inputs from other USG partners in designing and conducting the trainings. The curriculum and
calendar will be determined in collaboration with each State AIDS Control Society, each technical support
unit, and other technical agencies.
