SUMMARY

In the fourth year of collaboration with CDC's Global AIDS Program, INP+ continues its efforts to provide

psychosocial support services such as peer counseling, promoting prevention for positives messages,

linking People Living with HIV/AIDS (PLHA) to local health service institutions for treatment and care, and

training PLHA in skills to lead a productive life. These services are provided through Family Counseling

Centers, Drop-in Centers and through training programs at various locations. By empowering PLHA

through the establishment of district networks of positive people, accountability within the government and

private health sector is being strengthened, leading to higher quality care and treatment services. The area

of operation is focused in the southern Indian states of Tamil Nadu, Karnataka and Andhra Pradesh.

BACKGROUND

The Indian Network for People living with HIV/AIDS (INP+), which started in 1997, is a leading advocacy

organization of PLHA in India. It has more than 60,000 PLHA as members through its 120 affiliated district

level networks (DLNs). The organization works toward improving the quality of life of PLHA through 1)

establishing independent state and district level groups; 2) improving grassroots level care and support

services; and 3) leading advocacy activities locally and nationally. National AIDS Control Organization

(NACO) has recognized INP+ as a strong partner. INP+ is a co-chair of the Country Coordinating

Mechanism of the Global Fund for AIDS, Tuberculosis and Malaria (GFATM).

In India, PLHA are not getting adequate information about HIV/AIDS, access to care and treatment services

and support from other PLHA in the locality. HIV/AIDS is still viewed with stigma by health care workers,

local political leaders and government officers. INP+ works toward helping PLHA to find solutions to all

these problems to improve their quality of life.

ACTIVITIES AND EXPECTED RESULTS

ACTIVITY 1: Family Counseling Center (FCC)

To provide on-going psychosocial counseling to PLHA visiting the Government Hospital of Thoracic

Medicine (GHTM), Tambaram (Chennai, Tamil Nadu) the largest HIV Care Center in India, INP+ started its

first Family Counseling Center (FCC) in 2004. Symbolically, this has helped PLHAs and INP+ advocate for

a more holistic approach to care and treatment and more specialized PLHA support since GHTM is seen as

a model government HIV care center in India.

The INP+ counselors at GHTM currently provide partner counseling, individual bed side counseling and

group counseling on various issues facing PLHA. Special effort is placed on "prevention for positive"

messages. This activity has helped PLHA in various issues such as reducing stigma and discrimination,

exercising women's legal rights as widows and availing inheritance for children from their deceased parents.

Group counseling on self-care, home care, nutrition and positive living is part of the counseling process.

CDC started a similar facility in Hyderabad, Andhra Pradesh attached to the Government Chest Hospital.

This activity is currently integrated into the CT Center at the hospital. In FY08, CDC will assess whether it is

better to keep this as an integrated activity with standard pre-post testing counseling or separate it both

physically and operationally from standard CT.

In FY 2008, INP+ plans to introduce a standard of counseling care protocol at the FCC and a standardized

monitoring tool for PLHA counseling. INP+ plans to reach 30,000 PLHA and their family members through

this activity. Once successfully implemented, this will be expanded to other HIV care centers in Tamil Nadu

and India.

ACTIVITY 2: Follow-up Counseling Training

The FCC experience indicated the need for equipping counselors with teaching aids that would assist them

during PLHA counseling. The result is a ‘Toolkit on Follow-up Counseling' created jointly by the Indian

Clinical Epidemiological Network (IndiaCLEN) and CDC experts. The toolkit, which is now being used by the

GHTM counselors, has tools to deal with stigma, mental health, partner disclosure, disclosure to other

people, safer sex and on general basics of HIV for PLHA to lead a productive life. There are flip charts and

trigger tapes which the counselor can use appropriately when the client seeks help with any of these

problems. INP+ support the training of PLHA master trainers, who will in turn train peer counselors at the

district level.

In FY 2008, INP+ will train 300 peer counselors in Follow-up Counseling at their drop-in centers and district

support groups in Tamil Nadu and Andhra Pradesh. This focus on standardizing counseling support beyond

the post test session for those who test positive is new in India. INP+ will play a key role in advocating for

its inclusion in all palliative care packages and for NACO to make it part of all its counseling and testing

centers as well as its care and support centers and ART centers.

ACTIVITY 3: Life Focus Center (Drop-in Center)

Life Focus Center (LFC) was initiated in 2004 as an extension of the Family Counseling Center at GHTM,

Tambaram (Chennai). Essentially this center acts as a drop-in center primarily for providing psychosocial

support, one-on-one peer counseling, and to train PLHA on topics such as income generation (economic

strengthening) and nutrition (food security). The center also has facilities like a library, a computer and a

place for relaxation for PLHA coming from far away to access services at the hospital. The center

encourages PLHA to gain correct information and connects them to district PLHA networks and service

providers. In FY 2008, we plan to provide services to 7,200 PLHA through this center.

ACTIVITY 4: Positive Speakers Program

This is a new initiative of INP+ for FY 2008. We will train 200 PLHA in the southern states of Tamil Nadu

and Andhra Pradesh with a special focus on general prevention messages as well as positive prevention

messages to PLHA. The trained PLHA speakers will chalk out a state and national plan for active

involvement in prevention activities in their communities. This activity will reduce stigma and promote

prevention. It will also advocate for gender equality as well as legal rights issues.

ACTIVITY 5: Strengthening District Level Networks (DLNs)

The mainstay of INP+ structure and support comes from district and state level networks of positive people.

USG funding is focused on strengthening these organizational units as both advocacy and service units.

Activity Narrative: DLNs receive funds under GFATM to provide ART support services, hire outreach workers to track down

ART defaulters,assist positive pregnant women find a safe place to deliver and receive treatment, and

establish drop-in counseling and support centers. DLNs are also tasked to provide effective linkages

between PLHAs and care providers, including services for TB treatment.

In FY08, USG will focus on ways to strengthen these services to be provided or managed by DLNs (as an

example of leveraging). Training in human resource management, monitoring and evaluation, HIV care and

treatment packages, and ART operational guidelines will be organized by INP+ using USG support.

ACTIVITY 6: Support for Potential Accreditation Scheme

DLN and state level networks also have a tremendous role to play in advocating for improved care and

treatment services in their districts and states. In FY08, INP+ will more actively involve itself in effort to

improve and regulate care providers and institutions. It will actively participate in accreditation guideline

development and promote accreditation as a way to empower PLHAs to make smart and meaningful health

care choices. As part of a potential accreditation system, INP+ will work with NACO and others to ensure

that all externally funded and NACO-funded care centers follow established care guideline (standard

minimal package of services, clinical guidelines, etc.) and are evaluated on this annually.

SUMMARY:

The program will support an innovative approach to using People Living with HIV/AIDS (PLHA) to

complement the District AIDS Prevention and Control Unit (DAPCU)'s system for district and state

monitoring services in the State of Andhra Pradesh. A District Reporting Associate (DRA) from the PLHA

networks will meet regularly with the District Program Manager to provide systematized information on the

use of services. In addition, PLHA skills in understanding and using data for planning and advocacy will be

strengthened through training.

BACKGROUND:

The Indian Network for People living with HIV/AIDS (INP+), which started in 1997, is a leading advocacy

organization of PLHA in India. It has more than 60,000 PLHA as members through its 120 affiliated district

level networks (DLNs). INP+ has its headquarters in Chennai, Tamil Nadu and has a coordinating office in

Delhi. The organization works toward improving the quality of life of PLHA through: 1) establishing

independent state and district level groups; 2) improving grassroots level services by linking with

government and private service providers; and 3) strengthening advocacy activities locally and nationally.

National AIDS Control Organization (NACO) has recognized INP+ as a strong partner in their policy level

discussions. INP+ is a co-chair of the Country Coordinating Mechanism of the Global Fund for AIDS,

Tuberculosis and Malaria (GFATM).

CDC, Global AIDS Program (GAP) has partnered with INP+ under a Cooperative Agreement since 2004.

ACTIVITIES AND EXPECTED RESULTS

Under the third phase of the National AIDS Control Program (NACP-3), there is a strong emphasis on

district level data collection and decentralized management through the District AIDS Prevention and

Control Units (DAPCU). In Tamil Nadu and Andhra Pradesh, the SACS have already placed District

Program Managers (DPM) to monitor HIV Prevention and care activities. It is in this context that INP+

initiated its District Documentation and Reporting Program in the state of Andhra Pradesh as a model.

Until recently the national or state HIV control programs did not see PLHA networks as a valuable

mechanism for collecting information on the quality of care, service delivery and prevention efforts by

government-sponsored and other NGOs. Second, there is no mechanism at present at the district-level to

document the quality of the services provided by various NGOs in the state and provide feedback to those

care providers. By helping in gathering strategic information, PLHA will complement the ability of the local

government (district-level) to collect data, map out service delivery areas, and gather information on the

number of people reached by specific activities systematically. This will strengthen the MIS systems of the

Andhra Pradesh State AIDS Control Society (APSACS).

ACTIVITY 1: District Documentation and Reporting Program.

This activity is seen complementing the data gathering mechanism of the national State AIDS Control

Program. The Andhra Pradesh State PLHA network (TLN+), with the support of the Andhra Pradesh District

Level Networks (DLN) and technical guidance from INP+ and CDC, launched the District Documentation

and Reporting Program in July 2007.

In this activity, a District Reporting Associate (DRA), who is a qualified (high school pass) PLHA assists the

District Program Manager (DPM) of DAPCU. The DRA makes systematic visits to hospitals, to NGOs and

other service delivery outlets, meets PLHA, collects data on services provided to PLHA (besides ART),

identifies the issues and gaps in service delivery, and passes this information to the respective DPM and

the District Monitoring and Evaluation (M&E) Officer. Previously, the district authorities in the six districts

where DRA are working had limited access to any of these service outlets, and then only to government

service centers. A direct output of this activity will be to strengthen advocacy with the SACS by State and

District level PLHA as burning issues will be backed by evidence. This will give greater recognition to the

voice of PLHA

The expected outcome is that this model will be replicated in other districts where there are high numbers of

PLHA. In FY 2008, the DRA program will be strengthened by working with the district M&E officer to

implement systems and mechanisms for data collection. In FY 2008 INP+ plans to scale up this service to

six more districts, thus operating in 12 districts in AP.

ACTIVITY 2: Training of INP+ Staff and Qualified PLHAs in Strategic Information

While it is important that PLHA are involved in policy-level discussions at the national, state and district

levels, it is also important to invest in training PLHA in data collection and analysis. This will give them an

opportunity to study the epidemic from different angles and to express their considered opinions supported

by evidence. Hence, in FY08, INP+ plans to train 60 qualified PLHA in the basic aspects of strategic

information gathering and data analyzing methods.

ACTIVITY 3: Improve the Capacity of Positive Networks to Monitor and Evaluate Their Programs. Positive

networks have advocated for a greater role in implementing care and support programs and have been

given that responsibility in recent years. Examples include USG funded family counseling centers and drop

in centers and GFATM/NACO funded ART peer support services and outreach workers schemes.

However, the ability of the positive networks to monitor their own work and evaluate its impact is minimal.

In FY08, INP+ with mentorship and support from CDC and USAID will develop and implement a strategy to

address this weakness related to monitoring and evaluation. Concepts like monthly reporting, target setting,

performance based budgeting, and formal evaluations of key intervention models will be strengthened,

especially at the state and district level.

SUMMARY:

The program, which will be running at its fourth year in FY08, aims at strengthening People Living with

HIV/AIDS (PLHA) network organizations, which are independently registered groups at the state and district

levels in India. These networks are currently receiving (or may receive in the future) financial support from

various national and international governments and other agencies. This activity focuses on training PLHA

organizations affiliated to INP+, on management, monitoring and evaluation and reporting systems. The

activity will be within the states of Tamil Nadu, Karnataka and Andhra Pradesh

Institutional system strengthening helps PLHA groups to conceptualize innovative programs and promote

sustainability plans. It also strengthens the skill of PLHA to manage their programs better.

BACKGROUND:

The Indian Network for People Living with HIV/AIDS (INP+), which started in 1997, is a leading advocacy

organization of PLHA in India. It has more than 60,000 PLHA as members through its 120 affiliated district

level networks (DLNs). INP+ has its headquarters in Chennai, Tamil Nadu and has a coordinating office in

Delhi. The organization works towards improving the quality of life of PLHA through 1) establishing

independent state and district level groups; 2) improving grassroots level services by linking with

government and private service providers; and 3) strengthening advocacy activities locally and nationally.

The National AIDS Control Organization (NACO) has recognized INP+ as a strong partner in their policy

level discussions. INP+ is a co-chair of the Country Coordinating Mechanism of the Global Fund for AIDS,

Tuberculosis and Malaria (GFATM).

CDC's Global AIDS Program (GAP) has partnered with INP+ under a Cooperative Agreement since 2004. It

is well known that the INP+ as an organization originated from the health status of its members who do not

necessarily have the managerial capacity to run programs. On the other hand, involving PLHA groups in

prevention and care programs has become mandatory for funding agencies who have adopted the UNAIDS

concept of the Greater Involvement of People with AIDS (GIPA). This activity will help PLHA to be more

equipped to run their organization by learning leadership and management techniques.

ACTIVITIES AND EXPECTED RESULTS:

Activity 1 has been in operation since the inception of the program. Activity 2 is a leadership and

management training (Healthy Plan-It) that encourages PLHA to take a responsible role in the building of an

institution. It teaches consensus decision making and participatory management. It was first introduced in

Tamil Nadu in 2004. This was later extended to Andhra Pradesh.

ACTIVITY 1: On-site Management and Technical Support to District and State-Level Networks

In this activity INP+ will develop monitoring systems in the states. The Monitoring and Evaluation (M&E)

department of INP+ conducts visits to the state and district-level INP+ networks to strengthen their

information and other management systems, including the registration and legal procedures required for a

locally registered organization. During the current year INP+ has used the services of a clinical consultant

who visits the networks to impart basic clinical knowledge to the network leaders, who in turn motivate

members to access proper clinical services at the local services. As an institution, providing clinical services

has become a part of the service delivery systems of the PLHA network.

In FY 2008, INP+ plans to assist the formation of 50 subdivisional/taluk-level and district-level networks in

the states of Andhra Pradesh and Tamil Nadu. It also plans to train the staff of 50 taluk and district level

networks in M&E, book keeping and regular office procedures.

ACTIVITY 2: Leadership and Management Training Program (Healthy Plan-It)

"Healthy Plan-It" is a series of management programs conduced for the board members of district level

networks for strengthening their leadership and management skills. This training helps the leaders to

prioritize an issue, plan, and act on various issues. This activity has many features that give hope and

confidence to PLHA. It has been proved very effective through its participatory approach, brainstorming,

community-based decision making, and training in advocacy, proposal writing and evaluation. In 2004 CDC

sent one INP+ manager to Atlanta to undergo a six-week course on Management for International Public

Health (MIPH). This training has trickled down to benefit a large number of PLHA in India.

Each trained PLHA is expected to roll out the same program at their local level and train a minimum of five

more leaders in their network (multi-level training). Six months after the training there is a follow up meeting

when every participant shares his or her experience in implementing the lessons learned at the Healthy

Plan-it training.

So far INP+ has trained 200 leaders in the three southern states of India, Andhra Pradesh, Karnataka and

Tamil Nadu. In FY 2008 this training will be extended to 200 more PLHA in all the three states.

ACTIVITY 3: Strengthening District Level Network (DLN) Services

The mainstay of INP+ structure and support comes from district and state level networks of positive people.

USG funding is focused on strengthening these organizational units as both advocacy and service units.

DLNs currently receive funds under the Global Fund for AIDS, Tuberculosis and Malaria to provide ART

support services, hire outreach workers to track down ART defaulters, assist positive pregnant women to

find a safe place to deliver and receive treatment, and establish drop-in counseling and support centers.

DLNs are also tasked to provide effective linkages between PLHAs and care providers, including services

for TB treatment.

In FY08, USG will focus on ways to strengthen these services to be provided or managed by DLNs (as an

example of leveraging). Training in human resource management, monitoring and evaluation, HIV care and

treatment packages, and ART operational guidelines will be organized by INP+ using USG support and

mentorship.

ACTIVITY 4: Enhanced DLN Advocacy for Quality Care and Treatment

DLN and state level networks also have a tremendous role to play in advocating for improved care and

treatment services in their districts and states. In FY08, INP+ will more actively involve itself in the effort to

improve and regulate care providers and institutions. It will actively participate in accreditation guideline

development and promote accreditation as a way to empower PLHAs to make smart and meaningful health

Activity Narrative: care choices. As part of a potential accreditation system, INP+ will work with NACO and others to ensure

that all externally funded and NACO-funded care centers follow established care guidelines (such as a

standard minimal package of services, and clinical guidelines) and are evaluated on this annually.