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
NEW ACTIVITY NARRATIVE
SUMMARY
The National AIDS Control Plan Phase 3 (NACP-III) has given high priority to the prevention of mother-to-
child transmission (PMTCT). Under NACP-III, existing counseling and testing (CT) centers and facilities for
PMTCT centers are re-modeled within one hub that integrates all HIV-related services, and renamed as
Integrated Counseling and Testing Centers (ICTCs). ICTCs are envisaged as a key entry point for both men
and women for a range of HIV/AIDS services. The Maharashtra State AIDS Control Society (MSACS) has
scaled up these ICTCs rapidly to over 600 centers in the state.
Although the ICTCs were scaled up, there has been little effort to mobilize the community to utilize these
services. In Maharashtra, of the total 665 ICTCs for which data is available, in 55.8% of the ICTCs less than
two persons access the services daily, in 32% of ICTCs between 2 to 4 persons access services daily, with
four or more accessing services daily in only 12.2% of ICTCs. The National AIDS Control Organization
(NACO) stated the need for community mobilization efforts to increase utilization of HIV/AIDS services in
the state. Hence it recommended that Avert Society implement community mobilization activities in the 6
priority districts.
In FY09, Avert Society will support six link worker programs to mobilize the community to utilize ICTC
services.
BACKGROUND
Avert Society is a bilateral program implementing prevention, care, and treatment activities in six high-
prevalence districts of Maharashtra State. The population of Maharashtra is 96.9 million and the HIV
prevalence is 0.75% (2006). Under the umbrella of the Avert project, the Johns Hopkins University (JHU)
and the Hindustan Latex Family Planning Promotion Trust (HLFPPT) have been awarded cooperative
agreements to support the state in scaling-up communication and condom social marketing activities. On
March 7, 2008, NACO provided new policy guidance to Avert Society that the project should focus on
saturating coverage of high-risk populations including migrants, and on implementing community
mobilization activities to increase the uptake of CT, PMTCT, care and treatment services in the six high
prevalence districts. Additionally, NACO recommended that the Avert project implement workplace
interventions in the entire state. The districts supported by Avert Society have changed and include
Aurangabad, Nagpur, Sholapur, Jalna, Thane and Mumbai (two zones). Sangli and Satara have been
handed over to Bill and Melinda Gates Foundation in the new allocation.
NACO has selected Avert Society as the Technical Support Unit (TSU) in Maharashtra and Goa states to
support the scale-up and strengthening of HIV/AIDS programs in accordance with the strategies outlined in
the third National AIDS Control Program (NACP-3).
ACTIVITIES AND EXPECTED RESULTS
ACTIVITY 1: Referrals and Linkages to ICTCs
Maharashtra state data for 2007 showed that only 38.6% of pregnant women were counseled and tested
under the PMTCT program in the six Avert priority districts. In addition, only 50% of pregnant women in the
six districts (with the exception of Mumbai) had institutional deliveries. Specific strategies need to be
designed to provide PMTCT services to pregnant women who undergo home deliveries.
In FY08 and continuing in FY09, Avert Society will support six lead NGOs to implement the nationally
approved Link Worker program to mobilize the community to utilize PMTCT services. In each district, 100
villages that are at high-risk will be supported with link workers. There will be a male link worker and a
female link worker for every five villages, amounting to 40 link workers in each district. The NGOs will
implement various community mobilization activities such as sensitizing community leaders, self-help
groups, block level committees and Nehru Yuvak Kendras to create a demand for the services. The NGOs
will also form Red Ribbon Clubs (RRC) in the villages to address stigma and discrimination issues and to
support the community mobilization efforts.
The NGOs will coordinate with community health workers such as Anganwadi Workers, Village Dais, Village
Health nurse and the PHC team to mobilize pregnant women to access the ICTC services. The NGOs will
also support 20 ICTCs that are planned to be established at the 24x7 PHCs to improve service coverage in
the 6 districts.
Link workers will motivate mothers who are tested positive to undertake hospital delivery. Trained
counselors will provide support to mothers for optimal infant feeding, including the promotion of exclusive
breastfeeding (associated with lower rates of transmission than mixed feeding), as appropriate. Referrals
will be made for comprehensive HIV care including the prevention of opportunistic infections and TB
treatment, and HIV-positive mothers will be linked to care and support programs. Linkages will also be
established for routine maternal and child health services for mothers and infants in the postnatal period.
Post-delivery HIV-positive mothers and infants will be linked up to care and treatment services, including
ARV treatment.
In FY08, Avert Society will increase the coverage of pregnant women utilizing ICTC services from 38% to
60%. In FY09, the coverage will be further increased from 60% to 75%.
New/Continuing Activity: Continuing Activity
Continuing Activity: 14096
Continued Associated Activity Information
Activity Activity ID USG Agency Prime Partner Mechanism Mechanism ID Mechanism Planned Funds
System ID System ID
14096 6114.08 U.S. Agency for Avert Society 6709 3940.08 $160,000
International
Development
10788 6114.07 U.S. Agency for Avert Society 5595 3940.07 $50,000
6114 6114.06 U.S. Agency for Avert Society 3940 3940.06 $855
Table 3.3.01:
Avert Society will implement Abstinence and Be-Faithful (AB) programs among bridge populations such as
migrants and industrial workers in the 6 high prevalence districts of Maharashtra State. Additionally, the
Technical Support Unit (TSU) of Avert Society will provide technical assistance to Maharashtra State AIDS
Control Society (MSACS), Mumbai District AIDS Control Society (MDACS) and the Goa State AIDS Control
Society (GSACS) in designing and scaling-up AB programs among migrants and truckers in the high
prevalence districts of these two states. Avert Society will adopt a balanced abstinence, be-faithful, and
condom promotion approach in implementing the prevention programs among bridge populations. Avert
Society will train NGOs to promote abstinence and mutual fidelity and help individuals to understand and
personalize the risks of multiple partners and the benefits of mutual fidelity. Avert will also support peer
education programs to promote delayed sexual activity among single unmarried high-risk migrants. NGOs
and/or peer educators will help individuals know their HIV status and provide linkages with counseling and
testing (CT) centers and care and treatment programs. The interventions will target 48,000 single male
migrants with an emphasis on AB messages within a more comprehensive ABC approach. As the TSU,
Avert Society will provide technical assistance to the three SACS for selecting NGOs, building the capacity
of NGO staff and monitoring and evaluating the quality of migrant interventions.
Avert Society will also implement AB programs among workers in the organized and unorganized sectors.
Avert Society will provide technical expertise to business organizations and peripheral bodies as well as
member companies across a wide range of areas; advocacy, policy development, initiating workplace HIV
programs and promoting partnerships with governments and civil society. It will cover 150 industries
reaching out to 70,000 male and 29,000 female workers to promote abstinence and mutual fidelity and
condom promotion.
Gender concerns will be addressed through various approaches in direct implementation programs and
through the technical assistance activities for the SACS.
March 7, 2008, the National AIDS Control Organization (NACO) provided new policy guidance to Avert
Society that the project should focus on saturating coverage of high-risk populations including migrants, and
on implementing community mobilization activities to increase the uptake of CT, PMTCT, care and
treatment services in the six high prevalence districts. Additionally, NACO recommended that Avert project
implement workplace interventions in the entire state. The districts of Avert Society have changed and
include Aurangabad, Nagpur, Sholapur, Jalna, Thane and Mumbai (two zones). Sangli and Satara have
been handed over to the Bill and Melinda Gates Foundation in the new allocation.
NACO selected Avert Society as the Technical Support Unit (TSU) in Maharashtra and Goa states to
Among the Indian States, Maharashtra registers a large volume of migration, especially in-migration from
other states. In Maharashtra State, out of the 96.9 million population, 3.2 million are migrants, with the
highest proportion of migrants from Uttar Pradesh (28.5%) followed by Karnataka (14.7%), Madhya Pradesh
(8.5%), Gujarat (7.6%), Bihar (7.1%) and Andhra Pradesh (6.0%). Based on criteria developed by the
Population Council from a research study, 25% of the male migrants are estimated to be engaging in high-
risk behavior. Using this formula, Avert Society has estimated that there are 1.55 million high-risk migrants
out of the 6.2 million migrants in the six Avert priority districts. Short-term migration to support livelihood has
been observed to be associated with considerable social vulnerability, exhibited most acutely by its link with
HIV risk. Hence NACO has accorded a high priority to scaling-up migrant interventions. NACO has recently
conducted a mapping of MARP populations including migrants in the state of Maharashtra. Based on this
data, Avert Society will concentrate its interventions in high-density migrant zones and reach out to a total of
240,000 migrants annually. Of these 240,000 migrants, 20% will be reached with an emphasis on
abstinence and mutual fidelity within a more comprehensive ABC approach.
Maharashtra is a highly industrialized state. The number of industries registered as of 2000 was 29,637
having a workforce of 7.4 million. There is also a huge workforce in the unorganized sector. The number of
workers engaged in construction work is estimated to be over 122, 000. Avert Society will reach out to 150
industries and a total of 99,000 workers through its work place interventions.
ACTIVITY 1: Promoting Sexual Abstinence and Fidelity among Migrants
In FY08, Avert Society will conduct a needs assessment study among migrant populations, especially single
short-stay male and female migrants who engage in high- risk behavior. Based on the mapping data and
the findings of the needs assessment study, Avert Society will support six lead agencies who will manage a
network of 24 NGOs to implement intervention programs among migrants. In FY09, Avert Society will
continue to support the six institutions and the network of 24 NGOs to reach out to 240,000 single male
migrants. Of these 48,000 migrants will be targeted with AB messages. The NGOs will train Volunteer Peer
Leaders to conduct interpersonal communication sessions and support community media activities such as
street plays and puppet shows to reinforce prevailing cultural norms on abstinence and fidelity including
condom promotion. The NGOs will also create a supportive environment for behavior change by sensitizing
the contractors and owners of the industries employing migrant laborers. Specifically, advocacy efforts will
be carried out to frame policies for providing a safe environment for women migrants. Avert Society will
build the capacity of the lead agencies and provide continuous technical support to manage the network of
NGOs implementing HIV prevention programs among migrants.
Activity Narrative: All prevention programs are designed and will be periodically updated to promote and ensure equitable
access to gender-appropriate prevention messages, services and commodities by women and men. It will
also incorporate policies and advocacy programs for male and female leaders to address traditional male
norms and endorse unbiased gender roles in the society.
ACTIVITY 2: Promoting Sexual Abstinence and Fidelity in Workplace Interventions
PSI has recently conducted a HIV/AIDS vulnerability study among the industries in the organized and
unorganized sectors in Karnataka and Andhra Pradesh. In FY08, Avert Society will seek technical
assistance from PSI and will conduct a vulnerability study in Maharashtra State to assess the HIV
vulnerability and programming needs of the formal and informal sector workforce. This study will help Avert
Society to prioritize intervention among the various industrial sectors that are vulnerable to HIV/AIDS.
Based on the findings of the study, Avert Society will scale up workplace interventions in the organized and
unorganized sectors by partnering with six lead agencies. The lead agencies will manage a network of 150
large and medium industries in the organized sector. Additionally, the lead agencies in 6 districts will
partner with an NGO to implement intervention programs in the unorganized sector. Out of 6 lead agencies
one will specially work with sugarcane industries in three districts. In FY09, Avert Society will continue to
partner with the six lead agencies to strengthen the network of 150 workplace intervention partners and
expand the program to reach an additional 200 industries. These 200 companies will develop and
implement HIV/AIDS policies and programs and 99,000 male and female workers will be given messages
emphasizing abstinence and mutual fidelity within a more comprehensive ABC approach.
Avert Society will build the capacity of the lead agencies and provide continuous technical support to
manage the network of industries in the organized sector and NGO partners working among the
unorganized sector. Avert Society has developed workplace intervention models on working with large
corporate, industrial associations, public sector and unorganized sector. The lead agencies will replicate
these models in scaling-up workplace interventions. The workplace intervention activities include
sensitization workshops for senior managers, a peer education program, mid media activities, condom
promotion, STI services and linkages to counseling and testing and care and treatment services for high-
risk workers. The interventions also aim to address issues such as gender equity and stigma and
discrimination in the workplace; and to focus on governance, ownership and sustainability of the HIV/AIDS
programs.
ACTIVITY 3: Technical Support to the State for Migrant and Trucker Interventions
In FY09, Avert Society will provide technical assistance to MSACS, MDACS and Goa SACS in planning and
implementing interventions for migrants and truckers. This will include support to the SACS for selecting
NGOs, capacity-building of NGO staff and monitoring and evaluating the quality of interventions. In FY09,
Avert Society will focus on monitoring the coverage and strengthening the quality of interventions.
ACTIVITY 4: Printing and Distribution of BCC Materials
In FY09, Avert Society will print an IEC toolkit comprising flipcharts and give-away materials emphasizing
mutual fidelity, including partner reduction, and education on the risks of sex with FSW. The IEC tool kit will
be distributed to the Avert-supported NGOs implementing migrant interventions. To increase visibility in
Avert priority districts, Avert society will undertake mid media activities like street plays and will also paint
the walls and hoardings at strategic locations in the districts with AB messages. JHU will provide technical
support in developing the IEC tool kit. Training will be conducted for 112 (NGO and lead agency) staff on
interpersonal communications skills including skills to use the IEC tool kit for effectively delivering messages
on Abstinence and Being Faithful.
Continuing Activity: 14097
14097 6116.08 U.S. Agency for Avert Society 6709 3940.08 $220,000
10789 6116.07 U.S. Agency for Avert Society 5595 3940.07 $700,000
6116 6116.06 U.S. Agency for Avert Society 3940 3940.06 $183,888
Emphasis Areas
Gender
* Addressing male norms and behaviors
* Increasing gender equity in HIV/AIDS programs
Workplace Programs
Human Capacity Development
Estimated amount of funding that is planned for Human Capacity Development $18,750
Public Health Evaluation
Food and Nutrition: Policy, Tools, and Service Delivery
Food and Nutrition: Commodities
Economic Strengthening
Education
Water
Table 3.3.02:
Avert Society will implement prevention programs among most-at-risk populations (MARPs) such as female
sex workers (FSW), men having sex with men (MSM), Intravenous Drug Users (IDUs) and high-risk
migrants in six districts of Maharashtra State. The sexual prevention activities will complement the activities
in the AB program. Additionally, the Technical Support Unit (TSU) of Avert Society will provide technical
assistance to Maharashtra State AIDS Control Society (MSACS), Mumbai District AIDS Control Society
(MDACS) and the Goa State AIDS Control Society (GSACS) in designing and scaling-up targeted
intervention programs among MARPs including bridge populations. The USG-funded Hindustan Latex
Family Planning Promotion Trust (HLFPPT) will support the Avert Society and the SACS in increasing
access to high quality condoms by expanding the condom social marketing program in the state. The Johns
Hopkins University/Health Communication Partnership (JHU/HCP) will provide technical support to the
SACS in designing and implementing communication programs for MARPs. Linkages will be established
with counseling and testing and care and treatment services.
Society that the project should focus on saturating coverage of high-risk populations including migrants and
on implementing community mobilization activities to increase the uptake of counseling and testing (CT),
prevention of mother-to-child transmission, care and treatment services in the six high prevalence districts.
Additionally, NACO recommended that the Avert project implement workplace interventions in the entire
state. The districts of Avert Society have changed and include Aurangabad, Nagpur, Sholapur, Jalna,
Thane and Mumbai (two zones). Sangli and Satara have been handed over to the Bill and Melinda Gates
Foundation in the new allocation.
As per NACO estimates, there are over 26,300 sex workers of which 10,574 are reached in the six Avert
priority districts and there are 19,088 MSM of which 11,089 are reached in the same districts. In FY08,
Avert Society will support 28 NGOs and CBOs to implement targeted intervention programs among FSW
(18 projects), MSM (9 projects) and injecting drug users (1 project) to saturate the coverage of MARPs.
Additionally, it will provide technical assistance to the SACS to scale-up targeted intervention programs to
saturate the coverage of MARPs in 13 MSACS priority districts including Mumbai and two districts in Goa.
Avert Society will also develop strategies to address discrimination against FSW, MSM and IDU populations
in accessing preventive and health services such as STI treatment and counseling and testing.
ACTIVITY 1: Promoting Condoms and Other Prevention among FSWs, MSMs and IDUs
In FY09, Avert Society will continue to support 28 targeted intervention programs to ensure consistent
condom usage in over 90% of the MARPs and to ensure that over 80% of STI treatment is provided by
qualified health care providers. Additionally, Avert Society will develop appropriate systems for establishing
linkages with CT services to ensure that over 80% of the MARPs are counseled and tested and receive
results. MARPs will be reached by outreach workers and peer educators to promote correct and consistent
use of condoms and other prevention methods for protection against HIV infection. The activities include
interpersonal communication, condom demonstrations, community media events, distribution of IEC
material and STI counseling and referral services. Avert Society will collaborate with HLFPPT to scale up a
female condom social marketing program among sex workers (see details in the HLFPPT narrative). In
FY09, Avert Society will provide prevention services to 26,300 sex workers, 10574 MSM and 300 IDUs.
ACTIVITY 2: Promoting Condoms and Other Prevention Programs among Migrants
In FY08, Avert Society is supporting 6 lead agencies who will manage a network of 24 NGOs to implement
targeted intervention programs to promote consistent condom usage among high risk migrants. In FY09,
Avert Society will continue to support the six institutions and the network of 24 NGOs to reach out to
240,000 single male migrants and ensure that over 80% of those engaging in high-risk behavior use
condoms consistently and over 50% are counseled and tested. The NGOs will train Volunteer Peer Leaders
in migrant intervention programs to conduct interpersonal communication sessions and support community
media activities such as street plays and puppet shows to reinforce prevailing cultural norms on abstinence
and fidelity and to promote consistent use of condoms. The NGOs will also create a supportive environment
for behavior change by sensitizing the contractors and owners of the industries employing migrant laborers.
Specifically, advocacy efforts will be carried out to frame policies for providing a safe environment for
women migrants. Avert Society will also provide counseling and testing services to the migrant populations
by supporting six mobile CT programs. Avert Society will build the capacity of the lead agencies and provide
continuous technical support to manage the network of NGOs implementing HIV prevention programs
among migrants.
All prevention programs are designed and will be periodically updated to promote and ensure equitable
also incorporate policies, practice and procedural level advocacy programs for male and female leaders to
address traditional male norms and endorse unbiased gender roles in the society.
ACTIVITY 3: Promoting Condoms and Other Prevention Programs in Workplace Interventions
In FY08, Avert Society will scale up workplace intervention in the organized and unorganized sectors by
partnering with six lead agencies. Specifically, Avert Society will give high priority to promoting consistent
Activity Narrative: condom use in the unorganized sector as the workers are more vulnerable to HIV/AIDS than workers in the
organized sector. In FY09, Avert Society will continue to strengthen the condom promotion activities in
workplace intervention programs, by partnering with the six lead agencies and the network of 150 workplace
intervention partners and expand the program to reach an additional 200 industries. These 200 companies
will develop and implement HIV/AIDS policies and programs and 99,000 male and female workers will be
educated in consistent and correct use of condoms as part of a comprehensive ABC prevention approach.
corporate, industrial associations, the public sector and the unorganized sector. The lead agencies will
replicate these models in scaling-up workplace interventions. The workplace intervention activities include
promotion, STI services and linkages to integrated counseling and testing centers and care and treatment
services. The interventions also aim to address issues such as gender equity and stigma and discrimination
in workplace; and focus on governance, ownership and sustainability of the HIV/AIDS programs.
Hence, through different activities a total of 318,100 individuals will be reached through community outreach
that promotes HIV/AIDS prevention through behavior change that emphasizes correct and consistent use of
condoms.
ACTIVITY 4: Technical Support to MSACS and GSACS on Targeted Interventions
In FY08, the Technical Support Unit of Avert Society will provide technical assistance to MSACS, MDACS
and GSACS in planning and implementing interventions for 104 NGOs targeting MARPS (65 NGOs),
migrants (28 NGOs) and truckers (12 NGOs).This will include support to the SACS for selecting NGOs,
capacity-building of NGO staff and monitoring and evaluating the quality of interventions. In FY09, Avert
Society will focus on monitoring the coverage and strengthening the quality of interventions.
The TSU will also provide technical assistance in integrating gender concerns into prevention programs for
MARPs based on the lessons learned from the direct implementation programs in the Avert priority districts.
ACTIVITY 5: Printing and Distribution of Behavior Change Communication Materials
In FY08, Avert Society with technical assistance from JHU will develop an IEC tool kit and materials on
condom promotion. Training will be conducted for 140 (NGO and lead agency) staff on interpersonal
communications skills including skills to use the IEC tool kit for effectively delivering messages on condom
promotion. In FY09, Avert Society will continue to support the IEC materials needs of the NGOs
implementing targeted intervention programs among MARPs. For visibility in the Avert priority districts,
Avert society will undertake mid media activities like street plays and will also paint the walls and hoardings
at strategic locations in high-risk areas of the districts on condom promotion.
Continuing Activity: 14098
14098 6117.08 U.S. Agency for Avert Society 6709 3940.08 $1,204,900
10790 6117.07 U.S. Agency for Avert Society 5595 3940.07 $1,000,000
6117 6117.06 U.S. Agency for Avert Society 3940 3940.06 $280,978
Estimated amount of funding that is planned for Human Capacity Development $121,250
Table 3.3.03:
In Maharashtra State, there are over one million HIV infected persons who need care and treatment
services. The Maharashtra Government has scaled-up the Integrated Counseling and Testing Centers
(ICTC), Community Care Centers (CCC) and ART services in the state. Currently there are 681 ICTCs, 27
ART centers and 26 CCCs, and plans to further upscale to 14 new CCCs, 15 new ART centers and 30 Link
ART centers (LAC).
The utilization of care and support and ART services by people living with HIV/AIDS has been reported to
be low. Additionally, it poses special challenges to women PLHAs in accessing services, as they cannot
leave their village to seek treatment because of having to care for a sick husband and manage the family.
Successful efforts have been made to reduce the extent of loss to follow-up of ART cases in the state,
which is now 6%. There is little data on the extent to which MARPs are using testing and care and treatment
services, although NGO experience indicates that the proportion of these groups utilizing HIV/AIDS services
is less than 5%.
The National AIDS Control Organization (NACO) and the Maharashtra State AIDS Control Society
(MSACS) have stated the need for community mobilization efforts to increase the utilization of the HIV/AIDS
services in the state. Hence, NACO recommended that Avert Society implement community mobilization
activities in its six priority districts.
mobilization activities to increase the uptake of counseling and testing, prevention of mother-to-child
transmission, and care and treatment services in the six high prevalence districts. Additionally, NACO
recommended that the Avert project implement workplace interventions in the entire state. The districts of
Avert Society have changed and include Aurangabad, Nagpur, Sholapur, Jalna, Thane and Mumbai (two
zones). Sangli and Satara have been handed over to the Bill and Melinda Gates Foundation in the new
allocation.
Avert Society through its programs will address barriers to ensure equitable access to palliative care
services by men and women, and by MARPs. The outreach team will mobilize community support to
eliminate the barriers women face in accessing care, and encourage greater responsibility and participation
by men to reduce the disproportionate burden of care falling on women. Avert Society will leverage support
from other resources, including UNICEF, CDC, and the Clinton Foundation, for strategic inputs on planning
of care and support programs and ensuring quality of interventions.
ACTIVITY 1: Community Mobilization through Link Worker Scheme
In FY08, Avert Society will support six lead NGOs to implement the Link Worker program to mobilize the
community to utilize care and treatment services. Additionally, the link workers will provide follow-up care
and support including home-based care for PLHAs. The Link Worker program will be implemented in
accordance with national guidelines in the six Avert districts.
Approximately 100 high-risk villages in each district will be supported with link workers. There will be a male
link worker and a female link worker for every five villages - that is approximately 40 link workers for each
district. The link workers will develop systems to improve access to services by establishing linkages
between ICTCs and care and treatment centers. Additionally, they will work with community-based
structures such as women's self help groups, youth clubs and community leaders to reduce stigma and
discrimination against PLHAs.
The home-based care provided by link workers will include nutrition education, hygiene education,
counseling for positive prevention, adherence to ARV treatment, and linkages to socio-economic support
In FY09, Avert Society will continue to support and strengthen the six lead NGOs to increase the uptake of
care and treatment services, and provide follow-up and home based care and support.
ACTIVITY 2: Ensuring a Safe and Conducive Atmosphere for PLHAs to Network and Seek Care and
Reducing Stigma and Discrimination
In FY08, Avert Society will support 6 drop-in centers (DICs) to serve as safe spaces for HIV-positive
persons and family members to support each other. The DICs will provide medical services, psychosocial
support, hygiene and nutrition education, and accompanied referrals to higher levels of care, TB and ARV
treatment. Additionally, follow-up of PLHAs who have dropped out of treatment and/or for TB and ART
adherence, will be carried out. The centers will take a family-centric approach in dealing with nutrition,
social, and health issues. All services will be managed by the networks of positive people.
The DICs will motivate and refer family members for HIV testing. The DICs will also facilitate linkages to
faith-based organizations and government welfare programs to access social support services. They will
establish systems to network with integrated counseling and testing centers (ICTCs), RNTCP, ART centers,
and social support programs.
Activity Narrative: In FY09, Avert Society will continue to support six drop-in-centers to provide quality care and treatment
services to 13,775 PLHIV. Avert Society will seek technical assistance and use the tools developed by
CDC in implementing positive prevention programs for 100 discordant couples.
ACTIVITY 3: Technical Support to MSACS, MDACS and Goa SACS on Community Mobilization for Care
and Treatment
In FY09, based on the lessons learned in the six districts, Avert Society will provide technical support to the
link workers programs of the MSACS, MDACS and Goa SACS to implement similar programs to mobilize
PLHAs to seek care and treatment services in various facilities such as community care centers, sub-district
and district hospitals. This TA will be based on Avert's experience in Activities 1 and 2 above.
ACTIVITY 4: Printing and Distribution of Care, Support and Treatment Materials
In FY09, Avert Society will print and distribute materials such as flipcharts and give-away materials to aid
the link workers in community mobilization. JHU will provide technical assistance in developing the
prototypes and will train the NGOs in use of the materials.
Continuing Activity: 14099
14099 6118.08 U.S. Agency for Avert Society 6709 3940.08 $700,000
10791 6118.07 U.S. Agency for Avert Society 5595 3940.07 $1,000,000
6118 6118.06 U.S. Agency for Avert Society 3940 3940.06 $755,496
* Increasing women's access to income and productive resources
Estimated amount of funding that is planned for Human Capacity Development $107,000
Table 3.3.08:
The Orphans and Vulnerable Children (OVC) intervention is primarily community-based and ensures that
children have access to the core intervention components: Care, Family and Community Responses,
Education, Child Protection, Stigmatization, Psycho-social Support, Health Care, Food Security and
Nutrition, Promoting Children's Participation, Community Mobilization and Mainstreaming Gender.
The activities include building the capacity of immediate, extended and foster families to protect and care for
their children, ensuring access to essential medical, immunization and nutrition services, providing support
for legal and social entitlements and mobilizing community support and government participation. The
primary targets are children orphaned and/or affected by HIV and AIDS, family members, and caregivers.
on implementing community mobilization activities to increase the uptake of counseling and testing,
prevention of mother-to-child transmission, and care and treatment services in the six high prevalence
districts. Additionally, NACO recommended that the Avert project implement workplace interventions in the
entire state. The districts of Avert Society have changed and include Aurangabad, Nagpur, Sholapur, Jalna,
Foundation in the new allocation. NACO has selected Avert Society as the Technical Support Unit (TSU) in
Maharashtra and Goa states to support the scale-up and strengthening of HIV/AIDS programs in
accordance with the strategies outlined in the third National AIDS Control Program (NACP-III).
Avert will provide direct support to two OVC programs to demonstrate best practices in OVC interventions
and will provide OVC support through six PLHA Networks (Drop In Centers) and six MARP interventions for
children of sex workers. Avert will design strategies to address the vulnerabilities of orphaned and
vulnerable children especially girls by ensuring adequate coverage of services for girls, particularly school
enrolment and community support for shelter and care for orphaned children.
ACTIVITY 1: Improving Access to Quality Services for OVC
In FY08, and continuing in FY09, Avert Society will continue to support its two existing OVC projects: one
program is located in a large brothel site and primarily reaches children of sex workers with OVC services.
The program also aims to prevent children of sex workers from entering into the sex trade. Through the
second program, HIV infected and affected children receive shelter and care, nutrition, school education
and life skills education/vocational training, protection, health care and psychosocial support.
Avert will scale-up the community based OVC program across the six districts by integrating the OVC
component into the six drop-in-centers (DICs) implemented by PLHA Networks and six projects working
with sex workers. A total of 5239 children who are vulnerable, infected and affected will be reached. Avert
will train the staff on OVC strategies to provide a minimum quality and standard of care for children infected,
affected, and vulnerable to HIV/AIDS in the PEPFAR core areas. Under this program, linkages will be
established with educational institutions, child survival programs, orphanages, and other social support
programs to leverage resources and maximize the effectiveness of the programs.
ACTIVITY 2: Improving the Quality of OVC Services
The Avert Society will carry out a range of trainings to address the different skills required by the range of
personnel who are needed to deliver a holistic OVC program. Avert will train medical officers and
counselors on providing pediatric care and support including treatment for pediatric opportunistic infections
(OI), ARV management, and adherence counseling. The training will cover ethical guidelines for counseling
children and child consent, and disclosing HIV status to children.
OVC project staff will also be trained in standards for OVC interventions, following national and international
guidelines. Training for caregivers of infected and affected children will cover the provision of home-based
care, including nutrition, health, and hygiene. A total of 120 caregivers will be trained in FY09 from the six
Avert districts. Life-skills teachers will be trained in identifying behavioral problems in children, nutritional
guidance, health and hygiene.
ACTIVITY 3: Printing and Distribution of Behavior Change Communication Materials
In FY09, Avert Society will replicate IEC materials for children orphaned and/or affected by HIV and AIDS,
family members, and caregivers. The materials will be on six core intervention components e.g.
food/nutrition, shelter and care, protection, health care, psychosocial support, and education.
Continuing Activity: 19370
19370 19370.08 U.S. Agency for Avert Society 6709 3940.08 $65,000
Estimated amount of funding that is planned for Human Capacity Development $22,250
Table 3.3.13:
Under the National AIDS Control Program Phase III (NACP-III), existing counseling and testing (CT) centers
and facilities for the prevention of mother-to-child-transmission (PMTCT) centers are re-modeled within one
hub that integrates all HIV-related services, and renamed as Integrated Counseling and Testing Centers
(ICTCs). ICTCs are envisaged as a key entry point for both men and women for a range of HIV/AIDS
services. The Maharashtra State AIDS Control Society (MSACS) has scaled up these ICTCs rapidly to over
600 centers in the state.
Although the ICTCs were scaled up, little effort has been made to mobilize the community to utilize these
services. Of the estimated high-risk population in six districts only 27% have been counseled and tested.
There is little data on the number of MARPs utilizing the ICTC services. The NGO experience indicates that
the proportion of these groups using HIV/AIDS services is less than 5%.
The National AIDS Control Organization (NACO) stated the need for community mobilization efforts to
increase utilization of the HIV/AIDS services in the state. Hence, it recommended that Avert Society
implement community mobilization activities in the six priority districts.
In FY09, Avert Society will support six link worker programs to mobilize the community to utilize the ICTC
services. Additionally, six mobile ICTCs will be supported to provide CT services to high-risk migrants in
Avert priority districts.
March 7, 2008, NACO provided new policy guidance to the Avert Society that the project should focus on
interventions in the entire state. The districts of Avert Society have changed and include Aurangabad,
Nagpur, Sholapur, Jalna, Thane and Mumbai (two zones). Sangli and Satara have been handed over to the
Bill and Melinda Gates Foundation in the new allocation.
support the scale-up and strengthening of HIV/AIDS programs in accordance with the strategies in NACP-
III.
The aim of this activity is to increase the coverage of CT services by reaching out to MARPs and difficult to
reach populations like migrants. It is estimated that more than 70% of HIV-infected people do not know their
status. Expansion of ICTC services will help individuals to learn their HIV status, and consequently it is
assumed this will increase referrals to HIV prevention, care, and treatment services.
ACTIVITY 1: Community Mobilization to Increase Uptake of CT Services through Link Worker Program
In FY08 and continuing in FY09, the Avert Society will support six lead NGOs to implement the Link Worker
program to mobilize the community to utilize counseling and testing services. In each district, 100 villages
that are at high-risk will be supported with link workers. There will be a male link worker and a female link
worker for every five villages - that is approximately 40 link workers in each district. The NGOs will
groups, block level committees and Nehru Yuvak Kendras to create a demand for the services. The NGO
The NGOs will also coordinate with targeted intervention NGOs to facilitate linkages with ICTC services.
Referrals will be made for comprehensive HIV care including the prevention of opportunistic infections and
TB treatment, and HIV-positive people will be linked to care and support programs including ARV treatment
In FY08, through community mobilization efforts, the link workers will ensure that over 80 % of the MARPs
will get counseled and tested. Similarly, the program will ensure the uptake of ICTC services by high-risk
individuals in the general population, with the goal of increasing this uptake from the current 20% to 40%; in
FY09, the coverage will be increased from 40% to 60%.
ACTIVITY 2: Expanding Access to Counseling and Testing Services to Migrant Populations
In FY08, the Avert Society will support six mobile ICTC programs to provide CT services to migrant
populations in the Avert priority districts. The mobile ICTCs will be implemented by four lead agencies
implementing migrant interventions in the districts of Nagpur, Aurangabad, Jalna, Solapur, Thane and
Mumbai (Zone 5 and 6). The mobile ICTCs will network with 24 NGOs implementing targeted intervention
programs among high-risk migrants to provide CT services at the migrant sites. The components of the
Mobile ICTC clinics will include STI screening and treatment (it is estimated that 5% of the migrant
population have STI infections), CT and referrals for ART and care and support services. The staff of the
Mobile ICTC clinic will include part-time medical officers (2), Nurse/Counselor (2), Laboratory Technician (1)
and Driver/Attendant (1). Rapid test kits supplied by SACS will be used for HIV testing. The mobile clinics
will provide good quality pre-test counseling; safe and confidential environment and post-test counseling will
be assured and monitored. Reporting formats will be developed in accordance with NACO and PEPFAR
guidelines. In FY09, Avert Society will continue to support six mobile CT vans and 12,000 out of 240,000
migrants will be counseled and tested. Migrants tested positive for HIV will be linked to the care and
Activity Narrative: treatment services.
ACTIVITY 3: Technical Support to MSACS, MDACS and Goa SACS on Community Mobilization
In FY08, the TSUs will assist MSACS, MDACS and Goa SACS to establish 126 public-private-partnerships
(PPP) programs on counseling and testing in 33 districts. Under the PPP program, the private sector will
provide the infrastructure and staff and the SACS will provide the test kits and technical assistance. In
FY09, the TSU will provide technical assistance to SACS to strengthen and scale-up the PPP programs.
Additionally, in FY09, based on the lessons learned in the Avert priority districts, the Avert Society will
provide technical support to MSACS, MDACS and Goa SACS in implementing community mobilization
programs, to increase the uptake of HIV/AIDS services in the rest of the state.
ACTIVITY 4: Printing and Distribution of Materials
In FY09, the Avert Society will undertake on-the-ground communication activities to increase the uptake of
ICTC services. JHU will provide technical assistance in developing campaign materials to support the
community mobilization efforts to increase access to CT services. IEC materials on CT for MARPs, migrants
and general population will be developed and printed. Avert Society will also undertake mid-media activities
like street plays and will paint the walls and hoardings at strategic locations in the districts with messages
on accessing ICTC services.
Continuing Activity: 14101
14101 6120.08 U.S. Agency for Avert Society 6709 3940.08 $400,000
10793 6120.07 U.S. Agency for Avert Society 5595 3940.07 $500,000
6120 6120.06 U.S. Agency for Avert Society 3940 3940.06 $10,404
Estimated amount of funding that is planned for Human Capacity Development $31,875
Table 3.3.14:
In FY09, Avert project as the Technical Support Unit (TSU) of Maharashtra State will support the Strategic
Information Management Unit (SIMU) of the Maharashtra State AIDS Control Society (MSACS), Mumbai
District AIDS Control Society (MDACS) and the Goa State AIDS Control Society (Goa SACS) in collecting,
analyzing, reporting and using the information for program review and planning. Avert Society will also
assist the three SACS in monitoring NGO activities of prevention, care and treatment programs. Besides, it
will support the three SACS in conducting evidence based studies such as behavioral surveillance surveys,
mapping of high-risk groups, program evaluations and operational research.
Thane and Mumbai (two zones). Sangli and Satara have been handed over to Bill and Melinda Gates
the third National AIDS Control Program (NACP-III).
Strategic information is embedded into NACP-III as a key strategy for program monitoring and evaluation. In
phase two of NACP, NACO established a computerized management information system (CMIS) which
provides information on all the components of NACP for program monitoring. However, there are gaps in
the CMIS, specifically in the areas of reporting, quality of data and skills for analyzing, interpretation and
using information for program planning. Under NACP-III a strategic information management unit (SIMU)
has been established at the national and the state level to strengthen the strategic information component.
The TSU will help MSACS in establishing and strengthening the Strategic Information Management Unit
(SIMU) as envisaged in NACP-III.
ACTIVITY 1: State level Behavioral Surveillance Survey (BSS)
In FY09 with support from MSACS, Avert Society will support a state level BSS study among MARPs and
vulnerable populations like truckers, youth, workers and migrants. It is also proposed to carry out a
comprehensive qualitative study to identify the problems MARPs face in accessing preventive services
including counseling and testing. The findings of the study will help understand the gaps in interventions
and guide the state in strengthening HIV/AIDS programming.
ACTIVITY 2: A Costing Study of the Link Workers Scheme
The link workers scheme will be implemented in FY08 in six priority districts of Avert Society. In FY09 it will
complete a year and the output of the program in the form of community mobilization is expected to become
visible. A study will be carried out on costing aspects of the program and plans developed for a later cost-
effectiveness study.
ACTIVITY 3: Assessing the Feasibility of Providing Health Insurance to PLHAs and Developing a Model
PLHAs are in high need of financial security for their health needs, because of their vulnerability to illness
and the weak financial and social support available to them. It has been difficult for PLHAs to obtain
insurance. Insurance is based on the principle of risk: the insurable event cannot be anticipated with
accuracy, hence to ensure the financial viability of the insurance scheme the risk has to be spread and
rated appropriately. In case of PLHAs, however, it is believed that the event of illness/hospitalization can be
predicted and the risk cannot be spread at an acceptable level as the costs of treatment for PLHAs are
expected to be higher.
Various countries have nevertheless designed insurance schemes for PLHAs and recently PSI has initiated
a scheme in Karnataka. Avert proposes to undertake a study to assess the feasibility of providing health
insurance to PLHAs. This will involve primary data collection from PLHAs about their ability and willingness
to pay, besides collecting information from the health care providers. A model will be developed based on
the findings of the study in consultation with experts to help other interested agencies develop similar
schemes for PLHAs.
ACTIVITY 4: Assessing Health-Seeking Behavior among High-Risk Groups
BSS and IBBA capture various dimensions of the HIV/AIDS program, particularly in terms of the
effectiveness of prevention program strategies. However, there have been no studies undertaken to assess
health-seeking behavior among high-risk groups. This study will cover a representative sample from all the
MARPs in six Avert priority districts to understand their preferred sources of health services and the reasons
for their choice. The study will throw light on crucial issues such as availability, accessibility, affordability of
services, and provider attitudes, including gender sensitivity/insensitivity, and gender equity in accessing
services. The findings will provide valuable input for strengthening program components, referrals and
sensitizing other departments for mainstreaming.
ACTIVITY 5: Identifying and Assessing the Vulnerability of Children to HIV
Activity Narrative: The issue of orphans and vulnerable children is highly complex. A formative study will be carried out to
explore various factors that contribute to their vulnerability to HIV/AIDS, and assess the extent of correlation
between these factors and their extent of vulnerability. The purpose is to assist in developing effective
strategies to reduce the children's risk of HIV.
ACTIVITY 6: Geographical Information System (GIS)
In FY08, the Avert Society will develop a GIS to collate and present data pertaining to six Avert priority
districts in user-friendly form. The GIS will be made available on the Avert website for wider dissemination.
The consolidated information will be displayed as the front page with links down to the sub-district level. The
software will be updated in FY09 to incorporate additional features and provide more information to users.
ACTIVITY 7: Technical Support to Strengthen Data Management and Analysis
A major concern identified by NACO is the lack of adequate capacity in data management, analysis and
using data for decision making. One of the core functions of the TSU is to strengthen the strategic
information systems of the SACS. In FY08, the TSU will contract technical experts in bio-statistics and
epidemiology from the Christian Medical College to build a strong technical team in Maharashtra State to
carry out data management, analysis and interpretation. In FY09, the technical support from these experts
will be continued to further strengthen data management systems up to district and sub-district level. A
technical team developed by these experts will carry out data analysis at state, district and sub-district
levels. The team will also be trained to carry out data triangulation and trend analysis.
ACTIVITY 8: Experience Sharing and Review Meetings (ESRM)
Experience Sharing and Review Meetings will be carried out by themes (2 ESRMs among MARPs, 1 each
among migrants, WPI, link workers, OVC, PLHIV and capacity building training institutions) once in six
months. The meetings will be attended by nearly 325 participants (i.e. five individuals from each of the 53
lead agencies and NGOs and 10 individuals from each of the six lead agencies for link workers) from 59
partners. Both qualitative and quantitative data will be shared by all the participating NGOs including best
practices, success stories and innovative measures to handle problems. The sharing of such experiences
will help NGOs learn from each other, besides motivating them to adopt innovative and effective strategies.
This will also aid in scaling up interventions.
ACTIVITY 9: Participatory Site Visits (PSV)
PSV is an important monitoring and evaluation tool of Avert Society and is conducted once in six months.
PSV will be conducted for 50 partners by an external consultant; who will assess and carry out on-site
capacity building, meet NGO staff, beneficiaries of the program, conduct a data quality assessment (DQA)
of the records and provide onsite capacity building.
ACTIVITY 10: Technical Support for MSACS, MDACS and Goa SACS on Monitoring and Evaluation
The TSU is mandated to carry out monitoring and evaluation activities of targeted intervention (TI) programs
supported by the SACS in Maharashtra and Goa States. In FY09, The TSU will provide technical
assistance to conduct PSVs for 104 TI NGOs twice in a year. Similarly, the TSU will also provide technical
assistance to the SACS in conducting the ESRMs once in six months.
Continuing Activity: 14103
14103 6122.08 U.S. Agency for Avert Society 6709 3940.08 $400,000
10795 6122.07 U.S. Agency for Avert Society 5595 3940.07 $400,000
6122 6122.06 U.S. Agency for Avert Society 3940 3940.06 $168,436
Estimated amount of funding that is planned for Human Capacity Development $27,500
Table 3.3.17:
Avert Society will provide technical assistance through six lead agencies in developing HIV policies and
programs with workplace intervention partners.
prevention of mother-to-children transmission, and care and treatment services in the six high prevalence
ACTIVITY 1: Providing Technical Assistance for Developing HIV/ AIDS Workplace Policies and Programs
In FY08, Avert Society will scale up workplace intervention in the organized and informal sectors by
partnering with six lead agencies. The lead agencies will manage a network of 150 large and medium
industries in the organized sector. Additionally, the lead agencies in six districts will partner with an NGO to
implement intervention programs in the informal sector. In FY09, Avert Society will continue to partner with
the 6 lead agencies to strengthen the network of 150 workplace intervention partners and expand the
program to reach an additional 100 industries. Program components include addressing issues of male
norms and gender equity.
unorganized sector. In FY09, nearly 100 companies will develop and implement HIV/AIDS policies and
ACTIVITY 2: Support to PLHA Networks to Address Stigma and Discrimination
In FY08, Avert Society will support PLHA networks in six Avert priority districts to address stigma and
discrimination in health settings, workplace and in the community. The network forms pressure groups at
the district level and, with the involvement of key stakeholders, addresses issues of stigma and
discrimination faced by PLHAs at their homes, health setting and workplaces. Avert Society will train four
individuals from six districts (24 individuals) as master trainers who in turn will train 120 individuals. They
will form the PLHA advocate and pressure groups. In FY09, Avert Society will continue to support the six
PLHA networks to scale-up programs to address stigma and discrimination issues.
ACTIVITY 3: Community Mobilization
Avert Society will collaborate with MYRADA, a CDC partner with extensive community mobilization
experience, in strengthening the six lead NGOs in implementing community mobilization programs to
increase the uptake of HIV/AIDS services.
ACTIVITY 4: Technical Assistance to MSACS, MDACS and Goa SACS
In FY08 and continuing in FY09, the technical support unit will provide ongoing support to the three SACS in
strategic planning and program development, strengthening targeted Interventions, capacity building, public
private partnership and mainstreaming.
Continuing Activity: 14104
14104 6123.08 U.S. Agency for Avert Society 6709 3940.08 $480,000
10796 6123.07 U.S. Agency for Avert Society 5595 3940.07 $400,000
6123 6123.06 U.S. Agency for Avert Society 3940 3940.06 $13,882
Estimated amount of funding that is planned for Human Capacity Development $32,250
Table 3.3.18:
