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
ACTIVITY HAS BEEN MODIFIED IN THE FOLLOWING WAYS:
ACTIVITY 1: Launching Full Service PMTCT Centers
This activity will continue as planned in COP08, however, the sixth PMTCT site will now be based in Andhra
Pradesh, taking the total number of model PMTCT sites in Karnataka to five.
PMTCT sites, now called Integrated Counseling and Testing Centers (ICTC), are set up at various levels,
such as primary health centers, taluka health centers and district health centers. In Karnataka there are
561 ICTC, which require quality improvement in standard operating procedures, client-friendly services,
work environments, supportive supervision and mentorship. The Samastha program will use the model
ICTC sites in Karnataka and Andhra Pradesh as best practice "experiential learning sites" - providing hands
-on training - under a public private partnership model with the respective State AIDS Control Societies.
The model sites will test innovative tools such as individualized CMIS, development of standard operating
procedures and for showcasing a replicable and quality driven model of ICTC. While doing so, these sites
will adhere to national guidelines and will demonstrate functional standard operating procedures, regular
and significant supportive supervision, application of quality assurance monitoring tools such as COPE©
(developed by EngenderHealth), on-site trainings on stigma and discrimination and other necessary inputs.
This initiative is in line with the NACP-III and the GFATM7, under which supportive supervision of
counselors is envisaged.
In sub-district level PMTCT sites, there is only one counselor, usually a male. In such instances, the
Samastha program will provide an additional female counselor to ensure gender equity practices and to
encourage MARPs, especially FSWs to utilized CT services.
ACTIVITY 2: Building Capacity for Quality Service Delivery
No change
ACTIVITY 3: Creating Demand for Services
In previous years, it was assumed that there would be only a few centers that would accept HIV+ pregnant
women for delivery. However, all centers recognized through the Yeshaswini Health Insurance Scheme
and the National Rural Health Mission are now required to perform deliveries of positive women. Thus, the
target for number of positive deliveries at USG-supported sites has been reduced in COP09.
ACTIVITY 4: Careful Screening for Quality Assurance
The following new activity is proposed for COP09:
ACTIVITY 5: Integrating HIV care with the National Rural Health Mission (NRHM)
The Government of Karnataka launched the Yeshaswini scheme under the NRHM to increase access
among rural and urban pregnant women to institutional deliveries in 2008. HIV positive pregnant women
are now included in this scheme. Hospital delivery is jointly planned by the medical officer of the Primary
Health Center, the Auxiliary Nurse midwife and the HIV positive pregnant women, in the spirit of shared
confidentiality. The Government of Karnataka covers the cost of a hospital delivery in recognized private
and government centers. The program will use field level community outreach workers, such as Link
Workers, to mobilize pregnant women to undergo HIV testing and hospital deliveries and to ensure that
those HIV infected receive Nevirapine prophylaxis and follow-up HIV care. The District RCH officer of the
state government is responsible for ensuring availability of Nevirapine and delivery kits to the hospital. The
former is provided through the KSAPS, whereas the latter is a state initiative under the NRHM. This model
of integration between the NACP-III and NRHM is unique within the country.
FY 2008 NARRATIVE
SUMMARY
The Samastha project will establish six model integrated counseling and testing centers (ICTCs) which are
combined Counseling and Testing (CT) and PMTCT centers. These centers will be provided with
supportive supervision and role-based training in skills, knowledge, and practice. The centers will be
supported by well-planned outreach to ensure that women and their partners play an effective role in their
utilization. The remaining PMTCT centers funded through Karnataka State AIDS Prevention Society
(KSAPS) will be provided with follow-up capacity-building and supportive supervision for their personnel.
BACKGROUND
The University of Manitoba (UM) implements the Samastha project- a comprehensive prevention, care and
treatment project implemented in partnership with Population Services International (PSI) and
EngenderHealth (EH) in 15 districts in Karnataka and 5 selected coastal districts of Andhra Pradesh.
PMTCT is a key prevention strategy under the third phase of India's National AIDS Control Program (NACP
-3). Sites for model PMTCT centers will be decided in an evidence-based manner, taking into account the
needs of the community. By the end of September 2007, the National Institute of Mental Health and Neuro
Sciences (NIMHANS), an accredited national center for counseling, will propose guidelines and implantation
plans for establishment of model PMTCT centers and plans during the following year, 2007-2008.
This program activity will be implemented in collaboration with KSAPS, NIMHANS, EH, and PSI to leverage
logistics, human resources, capacity-building, outreach communication, supportive supervision and
monitoring.
ACTIVITIES AND EXPECTED RESULTS
These six model ICTCs will be established in non-governmental community settings. The PMTCT center will
Activity Narrative: be located within or linked to maternity care institutions to ensure HIV+ pregnant women deliver in
institutional settings with ARV prophylaxis delivered to the mother and baby. Each center will have two
counselors, one medical officer, and one lab technician. The model centers will allow KSAPS to establish
sustainable standard operating procedures in a PMTCT setting and offer the full-range of PMTCT services:
(1) counseling and testing for pregnant women and their spouse; (2) ARV prophylaxis to prevent MTCT for
those who test positive; (3) counseling and support for safe infant feeding practices; (4) family planning
counseling and services or referral; (5) sero-discordant couples counseling; (6) and linkage to the nearest
IPPCC (Integrated Positive Prevention and Care Centers), CSC (Care and Support centers) and ART
centers for ongoing HIV care. Providers, outreach workers, and Link Workers (a cadre of community
workers to be established under NACP-3 to link prevention outreach activities with care services) will be
linked to PLHA support groups to follow-up on adherence and provide supportive community-level
counseling.
Efforts will be made to leverage testing kits, ARVs, consumables and managerial assistance from District
Supervisors through KSAPS and/or UNICEF.
Personnel from each of the six model PMTCT centers, such as the medical doctor, nurse, lab technician,
and counselors (approximately 30 persons in 6 districts) will be provided need/role-based training in
necessary skills, knowledge, and practice according to national and international standards. To create a non
-threatening environment for the clients, non-PMTCT center staff (approximately 60) in the hospital or care
institution will also undergo training in stigma and discrimination, values and attitudes, sexual and
reproductive health, and the needs and objectives of PMTCT interventions. These trainings will be directly
planned and implemented by the Samastha project.
Apart from the six model centers, PMTCT centers across the state will be provided supportive supervision
and mentored through district supervisors and supervision teams.
A well-defined outreach plan to maximize the number of pregnant women accessing services will be a
primary focus. Outreach will be led by Link Workers and other outreach staff, with each center aiming to
reach a minimum of 100 pregnant women per year with quality counseling, testing, and test results.
Referrals through active promotion of institutional deliveries, especially for women who test HIV-positive, will
result in an estimated 60 HIV-positive pregnant women receiving a complete course of ARV prophylaxis in a
PMTCT setting
Care providers will be trained in outreach, linkages, and appropriate referral skills to ensure PMTCT
programs are an entry-point to other care and support services on the care, prevention and support service
continuum. PMTCT personnel will be trained in government and non-governmental services to increase and
improve utilization of all available services.
Outreach will also focus on long-term follow-up of mother and child for OI treatment and ART, to ensure
adherence to drugs, safe infant feeding practices, immunizations, HIV testing of the infant at 18 months,
and integration of RCH services. Involvement of men as partners in care and support will be a priority
through community outreach and a counseling approach that facilitates safe disclosure for men and women.
Program activities will be monitored for effective implementation, logistic supply and delivery mechanisms,
gender sensitivity, and to ensure that national and international standards are maintained. District
supervisors, regional coordinators, and zonal coordinators from the state level supportive supervision teams
(SST) system as well as the Samastha project's own regional and zonal managers will monitor these
centers.
New/Continuing Activity: Continuing Activity
Continuing Activity: 14166
Continued Associated Activity Information
Activity Activity ID USG Agency Prime Partner Mechanism Mechanism ID Mechanism Planned Funds
System ID System ID
14166 10934.08 U.S. Agency for University of 6715 3942.08 Samastha $35,360
International Manitoba
Development
10934 10934.07 U.S. Agency for University of 5783 5783.07 $110,000
Emphasis Areas
Gender
* Addressing male norms and behaviors
* Increasing gender equity in HIV/AIDS programs
Health-related Wraparound Programs
* Safe Motherhood
Human Capacity Development
Estimated amount of funding that is planned for Human Capacity Development $16,219
Public Health Evaluation
Food and Nutrition: Policy, Tools, and Service Delivery
Food and Nutrition: Commodities
Economic Strengthening
Education
Water
Estimated amount of funding that is planned for Water $500
Table 3.3.01:
Evidence has shown that abstinence-only programs are less relevant in concentrated epidemics. As such,
the target for abstinence-only has been completely eliminated in COP09. The budgetary allocation for
abstinence / be-faithful has also been significantly reduced due to the reduction in time that the link workers
and other field staff will spend on this activity. Since all link workers have been trained in previous years
and subsequent supportive supervision obviates the need for further training, the target is only to maintain
current levels and train newly recruited link workers as a result of the turnover within the project.
Samastha will also discontinue its work with youth ages 10 - 14 for sexual abstinence
messages/programming. The project discovered over the course of its intervention that youth ages 10-14
are not at as great of a risk for HIV infection and therefore, the project's time and resources could be more
efficiently utilized by increasing emphasis among higher-risk target groups. Therefore, Activity 1 in COP08
will be discontinued.
All other activities described in COP08 will be maintained during COP09, however at reduced levels.
Under the Samastha project, HIV prevention activities in rural Karnataka will target the general population
and focus on at-risk youth (including married adults) and school dropouts. The population groups covered
under this program area and the specific behavioral objectives are: boys and girls, age 10-14, for sexual
abstinence; men and women, age 15-49, for sexual abstinence and fidelity. Epidemiological data shows that
HIV prevalence among age 15-24 in Karnataka has consistently been over 1% since 2001, while poverty
and unemployment continue to fuel high rates of early marriages and school dropouts in rural Karnataka.
These factors make it relevant to focus on at-risk youth and school dropouts. The prevention intervention
will include community mobilization using gender sensitive and need-based communication strategies that
will stimulate discussion on delaying sexual debut until marriage, delayed age at marriage, and developing
skills for practicing abstinence.
The University of Manitoba's (UM) Samastha project is implementing a comprehensive prevention and care
and treatment project across 15 districts in Karnataka and 5 coastal districts in Andhra Pradesh. This
project began in 2006, is reaching full scale in 2007, and continuing in 2008. In eleven of the 15 districts,
local NGOs are sub-contracted and supported with technical assistance from UM and Population Services
International (PSI) to implement prevention activities. In the remaining four districts, UM directly implements
interventions. The 15 intervention districts were selected in coordination with KSAPS (Karnataka State AIDS
Prevention Society), which leads its own HIV prevention, care, support, and treatment activities in
Karnataka's remaining 14districts. The Samastha Project is consistent with the National AIDS Control
Organization (NACO) strategic plan and KSAPS's interventions targeting youth and general population, and
UM provides strategic and technical support to KSAPS to ensure sharing of best practices.
Under this program area, the project aims to reduce transmission of HIV in rural Karnataka. The target
group of this activity is boys and girls, men and women in the general population in rural Karnataka.
The project will continue to provide information on abstinence and fidelity to young boys and girls and men
and women in 1200 villages across 15 districts. Two hundred and fifty thousand individuals (including
50,000 individuals for abstinence related messages) will be covered during the period. Sexual abstinence
and fidelity behavior changes can be difficult to sustain and therefore it is crucial to work with the target
population in groups, fostering social and community norms to sustain change. The project will also train
Peer Leaders and Stepping Stones Volunteers in the activity area so that community volunteers can carry
on HIV prevention messages.
ACTIVITY 1: Delaying Sexual Debut among Youth
For boys and girls, the focus will be on school dropouts. Peer leaders selected by the youth groups will be
trained to provide information and engage the youth (boys and girls) in discussions related to abstinence
from sex, delaying sexual debut until marriage, delayed age at marriage, and developing skills for practicing
abstinence. Stepping Stones (SS) provides a tool for behavior change to be used with men and women in
groups to emphasize the need to eliminate casual sexual relationships, develop skills to sustain marital
fidelity, and endorse community norms to support and promote marital fidelity. This tool has been adapted
to the Indian context following successful field-testing which demonstrated significant impact on behavior
change among those who had availed the SS training. Adults and older or married youth among the school
dropouts who are assessed with at-risk behaviors will be linked with other Samastha project activities,
utilizing interpersonal communication to reduce risk through increased condom usage and partner
reduction.
ACTIVITY 2: Leveraging Local Value Systems to Promote Sexual Abstinence and Fidelity
The Link Worker system, designed under NACP-3, will be supported by Samastha in 14 districts of
Karanataka. Link Workers target specific groups in rural areas, including youth in their outreach activities to
initiate community mobilization and ensure accessibility and linkage to services. The Samastha project will
build the capacity of the Link Workers to address issues related to sexual abstinence and fidelity using
methods and messages sensitive to local cultures and values. This activity provides refresher training as
well as a forum for Link Workers to share and address challenges in the field. In 2008-09, the project will
also invest resources to train Peer Leaders and community volunteers to mobilize the community to take
responsibility for behavior change and support sustainability of changed behavior.
Activity Narrative: ACTIVITY 3: Gender Sensitive and Need-Based Communications
The project will pursue a fuller understanding of the needs of boys and girls, and men and women through
separate forums on the specific needs of each group. Male and female Link Workers will continue to
support males and females separately in changing and maintaining HIV preventive behaviors. Tools to
address gender issues in the context of HIV, like Stepping Stones, will be continued with all target groups to
ensure gender violence is reduced, gender-related vulnerability of men and women is reduced, and gender
equity is facilitated. This will encourage boys and men to adopt more accountable and responsible
behaviors while empowering girls and women to take decisions to reduce the risk of HIV. Six thousand
individuals from the target population will be trained in using Stepping Stones, and encouraged to become
behavior change volunteers for the community.
ACTIVITY 4: Mobilizing Communities to Sustain Behavior Change
Coverage of the general population to increase HIV preventive behaviors and the mobilization of
communities to take part in HIV prevention programming is consistent with and supportive to the Third
Phase of the National AIDS Control Program (NACP-3, 2007-2012) to reduce HIV in India. The use of Link
Workers is specifically outlined in NACP-3 for communication activities among general population and high-
risk target groups.
Village Health Committees (VHC) will be formed in 600 villages in the 15 districts. The members include
both male and female village leaders, elected representatives, teachers, local health workers, and youth
leaders. The role of these committees will be to create a supportive environment for behavior change
among the target group. The VHC will publicly support and encourage activities related to prevention and
being faithful. This activity will foster long-term sustainability of behaviors promoted by the project.
ACTIVITY 5: Dissemination of Lessons Learned
The University of Manitoba will work closely with NACO and KSAPS to form a collaborative implementation
plan for the Samastha project and KSAPS intervention districts. Experiences, challenges, and best
practices will be documented and shared through the learning systems being set up under Samastha.
Continuing Activity: 14135
14135 6128.08 U.S. Agency for University of 6715 3942.08 Samastha $295,360
10818 6128.07 U.S. Agency for University of 5601 3942.07 $685,000
6128 6128.06 U.S. Agency for University of 3942 3942.06 $435,000
Estimated amount of funding that is planned for Human Capacity Development $246,665
Table 3.3.02:
The University of Manitoba's (UM) Samastha Program will continue to target Female Sex Workers (FSW)
and their clients and other high-risk men and women to reduce the transmission of HIV through the
promotion of consistent condom use in selected rural areas of Karnataka. FSWs will be reached through
teams of Peer Educators who will implement activities designed to build and strengthen FSWs position
when dealing with their male clients, including the creation and maintenance of collective commitments to
condom use.
Karnataka has a rural HIV prevalence of over 1% with pockets of generalized HIV infection, especially in
northern Karnataka. Additionally, evidence from polling booth surveys (anonymous behavioral surveys on
randomly selected general population groups conducted in small groups) have indicated that 12-16% of
men in rural areas have concurrent sexual partnerships, including 8% who visited sex workers in the last six
months. Prevention activities targeting FSWs and their clients are implemented by local NGOs and
Karnataka Health Promotion Trust (KHPT) in nine districts with technical support from UM and PSI.
The project linkages with village health communities, a unit established at the village level to deal with
health issues, will be drawn upon to increase sensitization of village communities (including male clients) on
reducing the vulnerability of FSWs to HIV. Male clients and vulnerable women will be targeted through link
workers, who will deliver messages designed to increase motivation to use condoms, thereby reducing the
challenge and burden of condom negotiation by FSWs. Both FSWs and clients will be targeted for
increased STI treatment and referrals for testing.
In COP08, the Samastha Program exclusively targeted FSW and their clients in 9 districts under this
program area. This year, the program will expand the target group to pockets ( additional 75 villages) of
general HIV prevalence in three more northern Karnataka districts to include men and women in the general
population who are at risk or vulnerable to HIV, for correct and consistent condom use and to access STI
treatment and referrals for testing. The modification ( in terms of the expanded focus) is applicable to all the
activities in this program area but is highlighted under Activity 3 as this activity permits the expanded
description of this sub-group at elevated risk.
Since most of the field level functionaries would have already received training and continue to receive
supportive supervision, only those newly recruited will undergo training during the year.
ACTIVITY 1: Leveling the Imbalance of Power through Gender Equity
No Change
ACTIVITY 2: Mobilizing Village Communities to Support Gender Equity
ACTIVITY 3: Facilitating Joint Commitments for Consistent Condom Use
This activity will now expand to included sub groups at elevated risk in three more districts. Included among
men at risk will be regular and occasional clients of female sex workers, those reporting sex with another
man or sex with a transgender, men with multiple concurrent sexual partners, those identified to have
symptoms of STI, rural men who migrate or are mobile casual laborers, and those known to be accessing
larger numbers of condoms from male link workers. The number of condom outlets is reduced, as the
funding for the rural social marketing of condoms by PSI will cease in the previous year.
Included among women at risk and vulnerable to HIV will be female sex workers, widows in rural settings,
women with symptoms of STI, spouses or partners of at-risk men listed above, including alcoholics, and
those subjected to violence in the domestic setting.
These at-risk individuals will be met through one-to-one communication through link and outreach workers.
Additionally, smaller groups of married and unmarried men and women will be taken through sessions
derived from the "Stepping Stones" module.
ACTIVITY 4: Reducing Vulnerability to HIV Infection through STI Treatment
The University of Manitoba's (UM) Samastha project will target female sex workers (FSW) and their clients
to reduce the transmission of HIV through the promotion of correct and consistent condom use in selected
rural areas of nine districts in Karnataka. Samastha seeks to catalyze widespread social change within
rural-based FSW populations by normalizing condom negotiation and use between FSW and their clients.
Involving the greater village community through village health committees will help sustain the impact of
these activities. Condom use promotion and negotiation will be addressed by two approaches: by teams of
peer educators targeting FSW to build and strengthen their ability to negotiate condom use with male
clients, and by outreach workers targeting male clients with messages to increase motivation to use
condoms. Both FSW and clients will also be targeted for increasing sexually transmitted infection (STI)
treatment. In FY08, Samastha will initiate interventions with other MARPs like men having sex with men
(MSM), which will be informed by studies which are underway in FY07 to determine the MSM populations in
rural areas.
The Samastha project has been funded by PEPFAR to implement a comprehensive HIV prevention
program in rural Karnataka, and a care and treatment program across Karnataka and selected coastal
districts in neighboring Andhra Pradesh. The prevention component has targeted FSW in selected rural
areas in Karnataka since 2006, has reached full scale in 2007, and will scale up activities to include
Activity Narrative: interventions targeting rural clients in 2008. Prevention activities targeting FSW and their clients are
implemented by local NGOs sub-contracted using PEPFAR funds in 11 of the 15 Samastha districts, with
technical support from UM and Population Services International (PSI). UM directly implements
interventions targeting urban and rural FSWs in the four remaining districts with financial support from the
Bill and Melinda Gates Foundation. UM's 15 intervention districts were selected in coordination with KSAPS
(Karnataka State AIDS Prevention Society), which leads its own HIV prevention, care, support and
treatment activities in Karnataka's remaining 14 districts.
The Samastha project is consistent with the third phase of the National AIDS Control Program (NACP-3,
2007-2012) and KSAPS's interventions targeting FSW. UM provides strategic and technical support to
KSAPS to ensure sharing of best practices.
The guiding principle under this program area is to strengthen the ability of each FSW to protect herself
from HIV infection through the promotion of gender equity. The Samastha project aims to catalyze
widespread social change by normalizing condom negotiation and use between 9,000 FSW and their
clients, while involving the greater village community to reduce human rights abuses and sustain the impact
of these activities well beyond the life of the project. UM will implement four separate activities in this
program area, as described below:
The first activity is to reduce the risk of HIV transmission to FSW by building and maintaining collective
commitments for consistent condom use. The program will deliver messages designed to increase safer
sex, build the capacity of FSW to negotiate condom use with clients, and mobilize them to reject clients who
refuse to use condoms. By creating an environment in which there is strong social pressure among FSW for
consistent condom use, FSW can negotiate condom use from a position of power as the client must agree
or forgo sex.
The second activity will reduce the vulnerability of FSW by linking them with social entitlements and
providing them with skills to empower themselves. Social entitlements provided by the Government of
Karnataka to individuals living below the poverty line include ration cards, hostel accommodations for their
children, and other housing facilities. Increasing FSW access to these social entitlements will reduce the
desperate financial circumstances they face which often prompt them to agree to unsafe sex in exchange
for higher fees from clients.
Village communities are often highly involved in decision-making around FSW practice, including the age of
the sex worker, location and migration patterns. In many situations, FSW do not have the authority to
determine their migration or work patterns. The project will support the sex workers to engage in a dialogue
with the broader community. This would entail holding community meetings for educating the community
about the issues that FSW face. By bringing the plight of FSW out into the open, the communities will be
less likely to engage in trafficking, or other such human rights abuses, and come forward to protect them.
Addressing these structural issues will reduce obstacles to health seeking and enhance health seeking
behavior by FSW.
In addition to working directly with sex workers, the Samastha project will promote consistent condom use
by clients of sex workers, with both FSW as well as their regular partners. This will be carried out primarily
in villages with large concentrations of FSW. Decreasing resistance to condom use by clients will reduce the
burden and challenge of condom negotiation by FSW. By making condom use a joint decision, the number
of instances in which a sex worker may experience duress to forgo condom usage is reduced, thereby
decreasing risk of HIV infection.
FSW and clients will be targeted to seek medical treatment for STI and referred to local counseling and
testing (CT) centers. Peer educators will reach out to FSWs, while Link Workers will target clients. STI
treatment camps will be implemented directly by Samastha's subcontracted NGOs, or referrals made to
local STI specialists trained under the Samastha project to ensure convenient and timely access to
treatment. The project will also leverage STI treatment facilities made possible under a grant by the Bill and
Melinda Gates Foundation to UM. Effective treatment of STI will reduce the risk and vulnerability of FSW to
HIV infection. The project will aim to increase accessibility of CT services with a focus on counseling for
safe disclosure, as well as partner counseling and testing. The project will also leverage HIV-related
services for FSW through other care components under the Samastha project, including referrals and
linkages to palliative care, TB treatment, and HIV prevention.
Saturation coverage of FSWs to reduce their risk and vulnerability to HIV transmission is consistent with
and supportive to NACO's NACP-3 strategic plan to reduce HIV in India. The scaling up of the project's sex
work intervention to include clients of FSW is also consistent with NACO's NACP-3 strategic plan. The use
of Link Workers is specifically outlined in NACP-3 for communication activities among general population
and most-at-risk target groups. As discussed, coverage will be expanded to include MSM population
through interventions designed to increase condom usage as well as STI treatment and referral.
practices will be documented and shared jointly through the learning systems established under Samastha,
ensuring a measurable impact on risk behavior and vulnerability among FSW across the state of Karnataka.
Continuing Activity: 14136
14136 6129.08 U.S. Agency for University of 6715 3942.08 Samastha $780,000
10819 6129.07 U.S. Agency for University of 5601 3942.07 $990,000
6129 6129.06 U.S. Agency for University of 3942 3942.06 $1,305,000
* Increasing women's access to income and productive resources
* Increasing women's legal rights
* Reducing violence and coercion
Table 3.3.03:
The project provides quality HIV care services in twelve districts in Karnataka and five coastal districts of
Andhra Pradesh through Care and Support Centers (CSC), now referred to as Community Care Centers,
and Integrated Positive Prevention and Care Centers (IPPCC), now referred to as IPPC-DIC (drop-in
centers) that are linked with government supported services and community outreach. The palliative care
services include management of opportunistic infections, TB diagnosis and treatment, ART adherence,
nutrition education and supplementation, referral for family planning, positive prevention, linkages to social
support services and Home Based Care (HBC) among a host of other services. The activities are targeted
to reach adults and children living with HIV/AIDS, with a focus on using a family-centric approach. Special
efforts will be made to reach out to children and women. Training will focus on doctors, nurses, counselors
and others, and will include family members for home-based care.
In addition to PEPFAR funds, the activities are financially and technically supported through the Karnataka
Health Promotion Trust (KHPT). EngenderHealth provides technical support, strategic inputs for planning
and quality improvement. St. John's Medical College is responsible for the capacity building of care
providers in partnership with Snehadaan, Swami Vivekananda Youth Movement and the National Institute
of Mental Health and Neurosciences. KHPT regional staff in Karnataka and LEPRA Society in Andhra
Pradesh coordinate all activities at the district level.
ACTIVITY 1: Providing Quality HIV Clinical Care and Support through Care and Support Centers
With the introduction of the GFATM-6 project in Karnataka, Samastha direct support to community care
centers (CCC) has decreased substantially. Under the GFATM-6 project, 37 new CCC will be established
in Karnataka before January 2009. The Samastha project will provide technical assistance to the CCC
through practical training, clinical mentorship and continuing education, and creation of experiential learning
sites, including the institution of a six-month residential HIV fellowship for doctors. Samastha will also
provide technical assistance to implement an individualized MIS system in all centers.
Samastha's support to CCC will continue in geographic locations of high HIV prevalence that do not fit the
GFATM-6 criteria of proximity to ART centers and for population groups currently not focused on under the
same (orphaned children).
Samastha will continue to implement innovative models of care and support programs, such as the model of
a combined CCC/ART center within the same institution and public private partnerships leveraging space,
facilities and supplies from government with personnel and technical assistance from Samastha.
In 2009, seven centers will be supported as experiential learning sites - best practice locations that provide
the opportunity for hands-on experience. Three sites are supported in high-prevalence geographic
locations in Karnataka and 2 PPP models in partnership with government of Karnataka.
ACTIVITY 2: Ensuring a Safe and Conducive Atmosphere for PLHAs to Network and Find Care
In FY09, support for this activity will be leveraged from KSAPS and other donors.
ACTIVITY 3: Extending HIV Care and Support to the Door Step
ACTIVITY 4: Linkages and Referrals
ACTIVITY 5: Ensure Quality through Capacity Building, Supportive Supervision and Mentoring
This activity is being modified by adding a new component of training under capacity building: This is a
residential six-month fellowship in HIV that will prepare doctors for ART and CCC services and is expected
to begin in 2008 and will continue in the 2009. A similar residential training is planned for qualified nurses
and counselors in experiential learning sites for a period of 6 months.
The following new activity will be undertaken in FY09:
ACTIVITY 6: Integrate HIV Care into Existing Targeted Interventions
Starting in FY09, Samastha will introduce several initiatives to integrate HIV services into existing
interventions. For one, Samastha will promote the formation of support groups for HIV positive FSW and
MSM-Transgender (MSM-T) through community based organizations. The skills of counselors within these
programs will be enhanced to provide counseling, including ART adherence, nutrition education, pain relief
and psychosocial support.
HIV positive peer educators who are open about their status will be recruited to link HIV positive FSW to
ART and other care services.
Doctors providing services to these populations will be trained on basic HIV management, including ART
provision, with the goal of making these targeted intervention clinics link ART centers in partnership with the
government.
With funding from either the Gates-supported Avahan project or the Karnataka State AIDS Prevention
Society (KSAPS), Samastha will integrate ICTC for sex workers and MSM-T into existing STI clinics, using
NACO's PPP model. These will be set up within clinics that have already initiated syphilis screening.
Linkages with Revised National Tuberculosis Control Program (RNTCP) will strengthen care initiatives by
encouraging provider-initiated counseling and testing for those found positive for TB.
Alternative livelihood options will be explored in partnership with CBOs for those who opt out of sex work.
Support will be leveraged from government and other schemes for destitute, single and widowed women.
These activities are in line with NACP-III and contribute to a wrap around along with the GFATM 6 and
Activity Narrative: GFATM 4 projects. The targets for adult care are increased from 12,000 to 15,000. All care staff will
receive refresher training during the year.
Activities under this program area are a continuation of initiatives under the Samastha project that
commenced in 2006 and continues in 2008. The project aims to provide quality HIV palliative care services
in fifteen districts in Karnataka and five coastal districts of Andhra Pradesh through: a) 16 Care and Support
Centers (CSC), 12 in Karnataka and 4 in Andhra Pradesh, b) 20 Integrated Positive Prevention and Care
Centers (IPPCC), 19 in Karnataka and 1 in Andhra Pradesh, linked with government supported services
and c) community outreach. The palliative care services include management of Opportunistic Infections
(OI), TB diagnosis and treatment (see Activity Narrative HIV/TB Care for details), ART adherence, nutrition
education and supplementation, counseling for family planning, positive prevention, linkages to social
support services and home-based care (HBC). Activities will reach adults and children living with HIV/AIDS,
with a focus on using a family-centric approach. Special efforts will be made to reach out to children and
women. Linkages and referrals will be made across districts. Training will focus on doctors, nurses,
counselors and others, and will include family members for HBC.
The University of Manitoba (UM) implements Samastha, a comprehensive prevention, care and treatment
project through a consortium led by its implementing partner, the Karnataka Health Promotion Trust
(KHPT). The partners include EngenderHealth (EH), which provides technical support and strategic inputs
for planning and quality improvement; St. John's Medical College (SJMC), responsible for the capacity-
building of care providers; the National Institute of Mental Health and Neuro Sciences (NIMHANS), a
premier medical institution accredited as a national counseling training center; and a host of local NGO
partners, including Snehadaan, Swami Vivekananda Youth Movement, and LEPRA . KHPT coordinates all
activities at the district level in Karnataka, while the LEPRA society coordinates activities in Andhra
Pradesh.
The Samastha project supports 12 CSCs In Karnataka, nine of which are located within Catholic Mission
institutions run by Snehdaan, a faith-based organization. The other three CSCs are run by Swami
Vivekananda Youth Movement in Mysore, KHPT in Bagalkot and SJMC in Bangalore. In FY07, KHPT
provided technical assistance to the Bangalore-based Kidwai Institute of Medical Sciences to establish a
CSC. If approved by NACO, the Samastha project will provide TA to build the capacity of this center. The
Karnataka Network of Positive People (KNP+) is the lead coordinating agency for managing the Integrated
Positive Prevention and Care Centers (IPPCC) as drop-in centers for PLHA with support counseling
facilities and special services, such as access to legal entitlements and addressing stigma and
discrimination. Nineteen such centers will be supported by the Samastha project in Karnataka, primarily
through capacity-building of positive networks and support of counseling services.
In coastal Andhra Pradesh, the LEPRA Society will coordinate implementation of four CSCs by the Catholic
Health Association of Andhra Pradesh (CHAAP), while the IPPCC will be implemented by RASI, a
community-based NGO in Guntur District within the Telugu Network of Positive People (TNP+).
By the end of the project, these services will have been transitioned to implementing partners in a
sustainable manner. Starting in 2008, consultations will begin with these organizations to develop
sustainability plans for the last 2 years of the project.
At least 15,000 individuals will receive HIV-related palliative care through Activities 1-3 below, including
3000 who will receive treatment for TB disease, and the individualized monitoring and information system
will capture this information to eliminate duplication in reporting.
Services provided in the CSCs include: outpatient and inpatient medical care including diagnosis, treatment
and prophylaxis for OI, psychological support, training of family members and others to provide home-based
care, ART adherence counseling and side effects management, counseling and services for sexual and
reproductive health, and referrals to other medical and social support services. Some CSCs provide or are
linked to short-term or extended-stay services for destitute women and OVC. CSCs will have linkages with
KSAPS/APSACS run ART clinics at government medical colleges and district hospitals, and the RNTCP
Program. CSCs will also integrate and mainstream HIV care into existing medical services while avoiding
perceptions that the center is meant only for HIV/AIDS care. This will contribute to the sustainability of
services after the project period. In 2008, 16 CSCs will continue to provide services (12 in Karnataka and 4
in coastal Andhra Pradesh).
Twenty IPPCCs will be supported to serve as safe spaces for positive persons and family members. Within
these centers, counseling is provided on ART, sexual and reproductive health, positive prevention, and
psychosocial support. Outpatient clinical and medical services are provided on an itinerant basis within the
IPPCCs and government sub-district hospitals. Follow-up of PLHA who dropped out or lost contact for
follow-up TB treatment or ART will be a priority. IPPCCs take on a family-centric approach in dealing with
nutrition, social and health issues. Within select IPPCCs, an OVC coordinator oversees capacity-building
activities for children living with or affected by HIV (see OVC Activity Narrative for details). All services are
managed by networks of positive people with support from KHPT, EH and SJMC.
Starting in 2007 and continuing in 2008, KHPT will transfer management responsibility of IPPCCs to
Activity Narrative: PLWHA networks in those areas where they are run by the NGOs. Twenty IPPCCs will be functional by the
end of FY08 (18 in Karnataka and 2 in Coastal AP).
The third component of service delivery is community outreach through NGO Link Workers and outreach
workers based at IPPCCs and CSCs. Link Workers and their supervisors will educate, mobilize, and
accompany community members to seek HIV services and follow up cases requiring HBC, ART adherence,
TB treatment, and HIV positive pregnant women. This team will be responsible for OVC outreach activities
in their respective areas, coordinating with outreach staff of CSCs and IPPCCs. Family members will be
trained on home-based care.
Linkages and referrals will be made to address needs of PLHA. This includes linkages for ART in
government-recognized centers, PPTCT, VCTC, Revised National TB Control Program (RNTCP), Family
Planning, and other public health programs. At the community level, lead NGOs will use Link Workers to
reach out to people, mobilize them for services including OVC intervention and home-based care, sensitize
the community on HIV/AIDS stigma and discrimination, provide referral, and follow up with other linkages in
the area.
The Samastha project will undertake capacity-building activities with Care and Support Center staff to
sustain quality of services and to ensure client satisfaction. SJMC and its sub-contracted agencies,
Snehadaan and Swami Vivekananda Youth Movement Training will lead the training component. EH will
provide technical support in quality improvement, training, and capacity building. The health care team will
be provided with continuing education through printed materials and a web-based learning system.
Regional managers of KHPT and the clinical staff of SJMC will mentor care providers. The CSC staff will
continue to implement and apply COPE© tools (quality improvement tool) to ensure quality of services
among all staff, from the top manager to housekeeping staff. Once trained, the staff of each service delivery
point will be able to use this tool to assess site performance and client satisfaction, as well as identify
solutions for most issues. All staff, whether involved with HIV care or not, will receive sensitization and
training on stigma and discrimination.
In 2008, the Samastha project will train at least 190 staff to provide quality HIV palliative care.
Continuing Activity: 14137
14137 6131.08 U.S. Agency for University of 6715 3942.08 Samastha $2,071,160
10821 6131.07 U.S. Agency for University of 5601 3942.07 $1,010,000
6131 6131.06 U.S. Agency for University of 3942 3942.06 $580,000
Estimated amount of funding that is planned for Human Capacity Development $99,674
Estimated amount of funding that is planned for Food and Nutrition: Policy, Tools $870
and Service Delivery
Estimated amount of funding that is planned for Food and Nutrition: Commodities $31,755
Table 3.3.08:
The Samastha project will continue to provide quality Anti-Retroviral Therapy (ART) services at three sites
in Karnataka and one site in Andhra Pradesh under the PPP model of National AIDS Control Organization
(NACO). PEPFAR funds will be used to provide partial support to these existing and any additional NACO-
approved sites in the form of personnel, capacity building, mentorship in clinical management of HIV
infection (including ART), and ART adherence counseling. These centers will have linkages with supportive
services offered by other centers including the Integrated Positive Prevention and Care Drop-in Centers and
Community Care Centers.
Starting in early 2007 and continuing through 2009, the Samastha project will provide partial support to four
ART centers with financial support from PEPFAR. In Karnataka, St John's Medical College and Hospital -
Bangalore, Kempegowda Institute of Medical Sciences - Bangalore and SVYM, Sargur - Mysore have been
recognized as ART centers by NACO. PEPFAR's contribution will complement NACO's ART program to
this centre by providing support for personnel at the center. The Assisi Hospital at Pedana in Krishna
District of Andhra Pradesh supported by Samastha as a community care centre will continue to offer ART
services through private funding.
ACTIVITY 1: Providing Human Resources at ART Centers
With the increase in the number of sites, the numbers of people provided ARV services will double from the
previous year.
ACTIVITY 2: Improving the Quality of Service Delivery at ART Centers
Activities described in this section in the previous year continue. In 2009, refresher training for 5 staff from
each of the centers will be conducted using PEPFAR funds. Training will also be offered to government
ART center staff. Funds for this training will be leveraged from state funds. Another new activity is a
residential six-month fellowship in HIV that will prepare doctors for ART and CCC services. This will begin
in 2008 and will continue in the 2009. A similar residential training is planned for qualified nurses and
counselors in experiential learning sites. The duration of this course has not yet been determined.
Compared with other high prevalence states, Karnataka has reported limited progress in terms of provision
of ARV services. To enhance the scale-up of ARV services as envisaged under the Karnataka State AIDS
Control Society (KSAPS), the Samastha project will through its care and treatment component, provide
quality Anti-Retroviral Therapy (ART) services at three sites in Karnataka and one site in Andhra Pradesh.
Two of these Samastha supported centers in Karnataka are under consideration by the National AIDS
Control Organization (NACO) for direct central support as ART centers; should they be approved,
Samastha will limit its role to provision of technical support and supportive supervision. Currently, Samastha
provides support in the form of personnel, capacity building, and mentorship in clinical management of HIV
services offered by IPPCCs, Care and Support Centers (CSC) both within and outside the project. ART
drugs are not supported by PEPFAR funds.
The Samastha project is a comprehensive prevention, care and treatment project, implemented by the
University of Manitoba (UOM) in partnership with the Karnataka Health Promotion Trust (KHPT), Population
Services International (PSI) and EngenderHealth (EH), reaching 15 districts in Karnataka and 5 coastal
districts of Andhra Pradesh). Karnataka is one of the high prevalence states in India with the second largest
number of positive people on ARV.
Starting in early 2008 and continuing through 2009, the Samastha project will provide partial support to four
ART centers with financial support from PEPFAR and the aim of transitioning management completely to
the government. Under the leadership of UM, in Karnataka, the Kempegowda Institute of Medical Sciences,
Bangalore has been recognized as a designated ART center by NACO. PEPFAR's contribution will
complement NACO's ART program to this center by providing support for personnel at the center. In
addition, the Assissi Hospital at Pedana in Krishna District of Andhra Pradesh, supported by Samastha, will
continue to offer ART services. Other CSC sites will seek NACO support for ART, with Engender Health
providing overall technical support in capacity building and quality improvement.
In 2007, the National AIDS Control Organization (NACO) included NGOs and Private Medical Colleges in its
ART program in order to increase access to services by PLHA. This initiative only provides funding for ART,
and sites are expected to identify funding from other sources for personnel and other expenses. One site
(mentioned above) has been approved by NACO as a designated ART center, and PEPFAR funds will be
used to support the following personnel: doctors, counselor, lab technician, pharmacist, nurse, and a data
manager. Another site in Andhra Pradesh is offering ART services through non-government sources. These
sites are expected to register and start ART for at least 200 PLHA between 2006 and 2008.
Based on current experiences by SACS at the government ART centers, attrition rates average
approximately 20% per year, with reasons including discontinuation of ART due to side effects, death, lost
to follow-up and those who may have restarted ART after discontinuing. The project will attempt to ensure
Activity Narrative: that at least 80% continue ART at end of each year. Based on this target, it is expected that at least 160
PLWHAs from the two sites will be on ART at the end of 2009. These figures will go up substantially if
NACO approves the two ART centers mentioned above.
The sites will be provided ongoing technical support and supervision by EngenderHealth and KHPT.
Engender Health will train the site staff to use COPE© Quality Improvement tools to ensure high quality
ART services at the site. Once oriented and trained the staff of the service delivery point will be able to use
this quality improvement tool to assess the performance of the site and client satisfaction, and identify
solutions for most issues. All site staff, starting from the top manager to the housekeeping staff will be
involved in this exercise. Technical support will include "on site whole site" training and sensitization of all
staff (whether involved with HIV care or not) on stigma and discrimination and infection prevention
practices. These activities will contribute to the sustainability of quality services after the project period.
In 2008, 20 staff from the project-supported ART centers, will be trained to deliver ART according to
national standards. The curriculum for training on ART will be in accordance with NACO and WHO
guidelines. Training on ART for doctors, nurses, counselor and HIV-positive peer educators will be
conducted based on job responsibilities at the ART site.
To keep the pace with the fast changing technology of HIV/AIDS, Continuing Medical Education (CME)
activities will be made available in the form of fact sheets and online courses. St. John's Medical College
will be primarily responsible for this activity. Furthermore, the staff at the ART centers will be mentored at
their work sites by the Medical Regional Managers of KHPT and the Supportive Supervisory Team (for
counselors). EngenderHealth will provide guidance and technical support for both activities.
Program activities require that Samastha work and collaborate with NACO/SACS. Training for government
ART center staff will also be conducted with financial support from PEPFAR. Continued support and
partnership with the state government combined with specific efforts to obtain funding for the activities
currently supported by PEPFAR will allow the sites to continue to function after the project period.
These outcomes will contribute to PEPFAR goals by increasing access to quality ART services, thus
contributing to an improved quality of life for PLHA. In the process of achieving these targets, the project will
complement NACO's plans under the National AIDS Control Program Phase Three to scale up and
increase access to ART.
Continuing Activity: 14141
14141 10941.08 U.S. Agency for University of 6715 3942.08 Samastha $169,000
10941 10941.07 U.S. Agency for University of 5601 3942.07 $275,000
* TB
Estimated amount of funding that is planned for Human Capacity Development $12,774
Estimated amount of funding that is planned for Food and Nutrition: Policy, Tools $130
Estimated amount of funding that is planned for Food and Nutrition: Commodities $4,745
Table 3.3.09:
NEW ACTIVITY NARRATIVE
The University of Manitoba's (UM)/Karnataka Health Promotion Trust (KHPT) Samastha Program will
implement a Pediatric Care and Support intervention based primarily within institutions, to ensure that
children have access to the six core intervention components namely: food/nutrition, shelter and care,
protection, health care, psychosocial support, and education. The activities include supporting facility-
based care for children, building capacity of caregivers to protect and care for the children, ensuring access
to essential medical, immunization and nutrition services, providing support for legal and social entitlements
and mobilizing community support and government participation and monitoring and providing support to
the intervention with a focus on improving and maintaining quality. There is clear understanding that
institutional care is a transitory phase for many children and every effort will be made to reintegrate these
children into homes, families and society at large.
This activity is a continuation of initiatives under Samastha that began in 2006 and continues through 2009,
but were then described in part under the OVC narrative and in part under the palliative care narrative. The
target group here is therefore a subset of the children covered under OVC. The activities are financially and
technically supported through the KHPT. EngenderHealth provides technical support, strategic inputs for
planning and quality improvement. St. John's Medical College, with partners including Snehasadan and
Swami Vivekananda Youth Movement, is responsible for capacity building for care providers. KHPT
regional staff in Karnataka and LEPRA society in Andhra Pradesh lead coordination of all activities at the
district level.
Within Karnataka, Sneha Charitable Trust coordinates three pediatric care and support centers in South
Karnataka (Snehadaan and Infant Jesus Home in Bangalore and Snehasadan in Mangalore). There will be
two community-run institutional care centers in North Karnataka (one in Bagalkot and one in Bijapur), and
one pediatric care and support center (St Joseph's Hospital, East Godavari) in coastal AP. In seven other
adult-care centers, pediatric care is integrated into the overall care provided. These centers are Snehadaan
in Bangalore, SVYM in Mysore, BIRDS-Heal in Gulbarga, Arunodhaya in Bagalkot, Snehadaan PPP model
in Kolar. Kempegowda Institute of Medical Sciences and St John's Medical College are supported for both
Adult Treatment and Adult Care and Support, but will integrate pediatric care and treatment within these
initiatives.
ACTIVITY 1: Improving Access to Quality Services for Orphans and Vulnerable Children
The six core components required to address the basic needs of OVC are: food/nutrition, shelter and care,
protection, health care, psychosocial support, and education. At least 150 OVC will be reached through
these centers, all of who will receive primary direct services.
To ensure access to nutritional needs the following activities will be undertaken: nutritional assessments,
growth and development monitoring, nutrition education and counseling, nutritional training of the
caregivers, medical interventions to reduce malnutrition, developing and leveraging nutritional support at the
local and state and national level.
Field workers will provide awareness and promote adoption of orphaned children among village
communities. Linkages with government services like ICTC, ART, TB DOTS, immunization, etc., will
continually be focused upon. All children living with HIV will be periodically assessed for eligibility for ART
and those who need ART will receive it through linkages with government and private ART centers.
Psychosocial counseling and support to children and their caregivers will be provided primarily in the
centers and in schools. Efforts are being made to have an open school curriculum for children in a few of
the centers. In other centers, the project staff will support infected and affected children to access the local
schools. This will include sensitizing school administration and advocating with district education
departments as well as leveraging essential support for educational materials and school bags and uniform.
There will be activities to access vocational training facilities for older children and parents that do not have
employable skills.
ACTIVITY 2: Improving the Quality of OVC Services
Capacity building activities will improve skills of three target groups: staff of the project/implementing
partners, caregivers and community staff of centers, and members of the community. CCC staff members
will be trained in nutrition assessment, child rights issues, Home Based Care, age specific counseling
services and child-centerd communication skills. The clinical staff at Community Care Centers will be
trained in clinical management of pediatric HIV and ART adherence counseling for children.
Life-skills education will be conducted for groups of children in the same age group. The program will
conduct LSE for at least one group of children in each of the supported CCC for pediatric care and support.
ACTIVITY 3: Monitoring and Evaluation for Quality Assurance
Activities will be monitored through the MIS, qualitative reports, on site visits and interaction at the service
delivery facilities. Linkages with other centers and the community will be monitored by regional managers.
The activities are in line with NACP-III strategy.
New/Continuing Activity: New Activity
Continuing Activity:
* Child Survival Activities
Estimated amount of funding that is planned for Human Capacity Development $32,076
Estimated amount of funding that is planned for Food and Nutrition: Policy, Tools $1,000
Estimated amount of funding that is planned for Food and Nutrition: Commodities $68,438
Table 3.3.10:
CHANGES TO ACTIVITIES AND EXPECTED RESULTS
The Orphans and Vulnerable Children (OVC) intervention is primarily community-based and ensures that
children have access to the six core intervention components namely; food/nutrition, shelter and care,
protection, health care, psychosocial support, and education. The activities include building 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.
This activity is a continuation of initiatives under PEPFAR-funded Samastha project that began in 2006 and
continues through 2009. The overall coordination of activities is through the Karnataka Health Promotion
Trust (KHPT). EngenderHealth provides technical support and strategic inputs for planning and quality
improvement whereas St. John's Medical College is responsible for the capacity building of care providers
in partnership with others; including Sneha Charitable Trust and Swami Vivekananda Youth Movement.
Coordination of all activities at the district level is led by KHPT regional staff in Karnataka and LEPRA
society in Andhra Pradesh.
KHPT leverages significant support for this component from other resources including the Clinton
Foundation, UNICEF, Deshpande Foundation, local contributions, and government schemes.
In FY08, this activity was actively jointly undertaken by leveraging services from the Clinton Foundation,
especially for nutrition and transport. However, the Clinton Foundation support will cease in June 2009.
Hence, other donors/government programs will need to considered for leveraging this support as USG
funds will not be used for this component.
The scale up of ART centers has ensured wider availability of pediatric ART and periodical assessments of
eligibility of children living with HIV for ART will be a priority, as will be ensuring ART adherence for those on
ART.
The capacity building activities will aim to improve skills of three target groups: staff of the
project/implementing partners, caregivers and community. NGO staff managing and employing Link
Workers, outreach workers of Integrated Positive Prevention and Care -Drop in Centers (IPPC-DIC) and
within Community Care Centers will be trained in nutrition assessment, child rights issues, ART adherence
for children, home based care, age specific counseling services and child centric communication skills. The
clinical staff at Community Care Centers and IPPC-DIC will continue to be trained in clinical management of
pediatric HIV and ART for children.
Two hundred and twenty caregivers will be trained to provide for and monitor the child's nutritional needs
and how to access social entitlement in case of need, as well as on child rights issues. The caregivers will
also be trained in the area of Home Based Care, use of Home Care Kits, and ART adherence. If the
caregivers are HIV infected and sick and require ART or other health care services, the project staff will
make this a priority and ensure access to such services, enabling parents and caregivers to provide better
care for their children. Vocational training will be leveraged from other sources to cater to the needs of
parents who require financial support. The link workers, community volunteers, and child peer educators
will also receive training in core areas to assist in addressing the needs of OVC.
Link workers from the implementing NGOs/CBOs will sensitize village health committees to the topic of child
rights issues and encourage them to frame guidelines to protect the OVC in their communities.
The training will be done through a TOT (Training of Trainers) cascade. EngenderHealth's adaptation of
existing material in the area of child and family counseling pertaining to OVC issues will be used along with
existing EngenderHealth material on HBC.
KHPT leverages support for its community based interventions from resources including: local staff and
private contributions, local donors, local panchayats and other foundations. Efforts are continuously made
to link to government schemes for nutrition, education and other basic services.
The activities are in line with the National Guidelines for the Protection, Care and Support for children living
with or affected by HIV and AIDS (2007).
Under Samastha, the OVC intervention is primarily community-based to ensure children have access to the
six core intervention components: food/nutrition, shelter and care, protection, health care, psychosocial
support, and education. Activities include building the capacity of immediate, extended and foster families to
protect and care for 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/AIDS, family members and
caregivers.
Activity Narrative: The Samastha project is a comprehensive prevention, care and treatment project implemented by the
University of Manitoba (UM) through the Karnataka Health Promotion Trust (KHPT), in partnership with
Population Services International (PSI) and EngenderHealth (EH). Samastha is implemented in 15 districts
in Karnataka and 5 coastal districts in Andhra Pradesh (AP). Samastha collaborates closely with St. John's
Medical College and various NGOs, including Snehasadan and the Swami Vivekananda Youth Movement,
for capacity building of care providers to implement the OVC project. Coordination of district-level activities
is led by KHPT regional staff in Karnataka and the LEPRA society in Andhra Pradesh. This activity is a
continuation of PEPFAR-funded Samastha initiatives commenced in 2006 and continuing through 2007.
OVC care is integrated into the overall palliative care provided by the 16 Care and Support Centers (CSCs)
and the family continues to be the unit of care for OVC identified through the centers. The Integrated
Positive Prevention and Care Centers (IPPCC), run by positive networks in collaboration with the Karnataka
Network of Positive People (KNP+) and the Telugu Network of Positive people (TNP+), serve as additional
support units for OVC and affected families to access services including entitlements and food and
livelihood security. The Samastha project supports two CSCs in Karnataka (in Bangalore and Mangalore)
and one care and support center in Andhra Pradesh (in Pedana), which provide institutional care to
abandoned infected and affected children without family support. KHPT leverages support from other
sources including the Clinton Foundation, UNICEF, government schemes and others.
The six core components to address the basic needs of OVC are: food/nutrition, shelter and care,
protection, health care, psychosocial support, and education. At least 3,000 OVC will be reached with these
activities, out of which 1,200 will access primary direct services and 1,800 supplemental direct services.
OVC will be provided comprehensive medical care through IPPCCs and CSCs as well as through linkages
with government services like Voluntary Counseling and Testing Centers (VCTC), (Anti-Retroviral Therapy
(ART), Tuberculosis Directly-Observed Therapy Short-course (TB DOTS), immunization, etc. In FY08, the
project will continue with the established linkages with Clinton HIV/AIDS Initiative for leveraging pediatric
ARV.
To ensure access to nutritional needs the following activities will be undertaken: nutrition assessments and
growth and development monitoring, nutrition education and counseling, nutrition training of the caregivers,
medical interventions to reduce malnutrition, developing and leveraging nutrition support at the local and
state and national level.
Shelter and care needs will be provided through identification of potential caregivers for each child and
support and training of immediate, extended or foster family to care for the children even before the loss of
their parents. The project will also identify private and state-run homes that provide residential care for
OVC. Field workers will also increase awareness and motivation of families within the community to adopt
orphaned children from the community. If required, the child will have access to temporary shelter and
project-supported care until a permanent solution is found. The project will coordinate closely with the new
government-sponsored Integrated Child Protection Scheme (ICPS), which aims to expand the framework of
child rights to explicitly include OVC as ‘children under special circumstances' and ensure every child has
equal access to education, health services, shelter and protection, including addressing sexual exploitation
and abuse.
Psychosocial counseling and support to children and caregivers will be provided primarily at home, school,
and through IPPCCs and CSCs. This includes counseling on bereavement, disclosure of child's HIV status
to parents, and related issues. The project staff will support school-aged OVC to ensure access to local
schools. This will include sensitizing school administration and advocacy activities targeting district
education departments. There will be activities to provide access to vocational training facilities for older
children and parents.
Approximately 900 villages will be covered by the 600 Link Workers (a new cadre of community-based
workers linking prevention and care services to key populations as outlined in the National AIDS Control
Program, Phase Three. One male and one female Link Worker will be present in every 2-5 villages, each
with an estimated five OVC under their care. Communities and their leaders will be sensitized to the needs
and rights of the children as well as made aware of Link Worker activities.
Capacity-building activities will aim to improve the skills of three target groups: staff of the
project/implementing partners, caregivers, and communities. NGO staff managing the Link Workers, as well
as IPPCC and CSC outreach workers, will be trained in nutrition assessment, child rights issues, home-
based care, age-specific counseling services, and child-centered communication skills. The clinical staff at
CSCs will be trained in clinical management of pediatric HIV/AIDS and ART adherence counseling for
children.
Five-hundred caregivers will be trained to provide and monitor children's nutritional needs, child rights
issues, and access to social entitlements. Caregivers will also be trained in the area of home-based care of
these children, use of home care kits, and ART adherence. If caregivers are HIV-positive and require health
care, including ART, the project staff will provide access to services. Vocational training will be leveraged
from other sources to cater to the needs of parents who require financial support.
Community leaders will be trained in child rights issues and encouraged to develop guidelines to protect
OVC in their community. This will be implemented by Link Workers, with support from district and sub-
district supervisors from KHPT. Link Workers, community volunteers, and child peer educators will also
receive training in core areas to assist in addressing the needs of OVC.
Activity Narrative: Training will be conducted through a Training of Trainers (TOT) cascade. EH will adapt and utilize existing
material on child and family counseling in OVC issues as well as material on home-based care. Two TOTs
are planned (20 trainees each) for district supervisors, IPPCC counselors, OVC coordinators, and CSC
outreach workers. Of the original 40, at least 30 will conduct training for an average of 15 people, reaching
out to nearly 500 Link Workers, community volunteers, and child peer educators.
Activities will be monitored through the State Management Information System, qualitative reports, site
visits and interaction at service delivery facilities; and at the field-level by regional managers, using
checklists specified in the national operational guidelines for OVC.
Continuing Activity: 14139
14139 10943.08 U.S. Agency for University of 6715 3942.08 Samastha $335,400
10943 10943.07 U.S. Agency for University of 5601 3942.07 $550,000
Estimated amount of funding that is planned for Food and Nutrition: Policy, Tools $7,500
Estimated amount of funding that is planned for Food and Nutrition: Commodities $37,500
Table 3.3.13:
strengthen six existing Integrated Counseling and Testing Centers (ICTC) - five in Karnataka and one in
coastal AP. At present, Karnataka has 561 functioning ICTC supported by the State Government and a
target of an additional 100 ICTC to be established under Public Private Partnerships (PPPs). Therefore,
establishing ICTC experiential learning sites to improve quality is critical. These centers provide on-the-job
training for new counselors. Supportive supervision and mentorship to these sites will be more intensive
and frequent, and personnel will be provided with refresher and role-specific trainings. The centers will also
be sites to develop standard operating procedures and protocols.
The program's implementing partner, the National Institute of Mental Health & Neuro Sciences (NIMHANS)
will develop guidelines for establishing model ICTC and standard operating procedures protocols for all
ICTC, in consultation with NACO and other national and state level capacity building partners.
ACTIVITY 1: Expanding Access to Counseling and Testing Services
These centers will be established in existing ICTC settings, which are already staffed by a counselor, a
medical officer and a lab technician. As an experiential learning site, an additional counselor will be
supported to ensure the availability of both a male and female counselor and the time to train and mentor
new counselors recently recruited by the state.
Establishment of model counseling and testing sites will strengthen ICTCs and their personnel. It will
provide opportunities to test innovative tools such as individualized CMIS, development of standard
operating procedures for showcasing a replicable and quality driven model of ICTC functioning, and
development and testing of new procedures and ideas.
While doing so, these sites will adhere to national guidelines and will demonstrate functional standard
operating procedures, regular and significant supportive supervision, application of quality assurance
monitoring tools such as COPE, onsite trainings on stigma and discrimination and other necessary inputs.
The HIV test kits, consumables and managerial assistance from District Supervisors will be leveraged
through Karnataka State AIDS Prevention Society (KSAPS).
ACTIVITY 2: Improving the Quality of Counseling and Testing Services
In the coming year, under GFATM-7, it is expected that NACO will be directly implementing Supportive
Supervision Teams (SST) for mentorship of counselors. NIMHANS is expected to play a technical role at
the national level and Bangalore University will be the nodal agency for the SST in Karnataka. Additionally,
Gulbarga University, Roshini Nilaya and Samraksha have been recognized by NACO as training institutes
for counselors. Samastha project will work with these institutions to plan, coordinate and monitor capacity
building efforts as a support to KSAPS. Thirty counselors will be trained to implement ICTC services using
PEPFAR funds. These are counselors of community care centers and targeted intervention projects who
will be responsible for running ICTC under PPP model with KSAPS.
ACTIVITY 3: Linkages and Demand Creation for Counseling and Testing Services
ACTIVITY 5: Integration and Support to Government
Samastha project will establish ICTC under NACO's Public Private Partnership model in all CCC and TI
projects supported by KHPT under the Samastha or Sankalp/Corridors projects that have a counselor,
laboratory technician and functioning lab within or intricately linked to the project sites. These ICTC will
cater to spouse and family members of known PLHA and MARP, including female sex workers and MSM-
Transgender. Test kits, consumables, registers and PEP drugs will be leveraged from KSAPS. The activity
will support KSAPS target of establishing 100 ICTC under public private partnership.
Since Karnataka has 565 functioning counseling and testing (CT) centers, establishment of CT learning
sites becomes critical. Hence six new model ICTCs (Integrated Counseling and Testing Centres) are
planned under the Samastha project, which will function as combined CT and PMTCT centers, in
accordance with guidelines under the Third Phase of India's National AIDS Control Program (NACP-3). As
a replicable model for government scale-up, these new ICTCs will be established in community settings and
within the private or public sector, and also double-up as on-the-job training centers for new recruits.
Counseling quality will be ensured through onsite supportive supervision visits and periodic regional
meetings. Supportive supervision will be provided through the project and personnel will be provided with
role-specific and refresher trainings. The Karnataka State AIDS Control Society (KSAPS) will undergo
institutional capacity building to scale up, manage, and monitor the 500 plus CT centers in the state. The
National Institute of Mental Health and Neuro Sciences (NIMHANS) will offer technical assistance through
proposed guidelines and implementation plans for establishment of model ICTCs.
The Samastha project is a comprehensive prevention, care and treatment project that covers 15 districts
Activity Narrative: across Karnataka and 5 coastal districts of Andhra Pradesh. It has been implemented since 2006 by the
University of Manitoba (UM) in partnership with Population Services International (PSI) and EngenderHealth
(EH), with plans to scale up in 2007 and be fully operational across districts in 2008. The activities under
CT will be implemented through the combined efforts of KSAPS, NIMHANS, EH, and PSI, each with
comparative advantages in leveraging logistics, human resources, capacity building, supportive supervision,
monitoring, outreach, and communication.
The six new model ICTCs will preferably be established in non-governmental and community settings. They
will have two counselors (one male and one female), one medical officer, and one laboratory technician.
These centers will provide KSAPS with replicable ICTC models for sustainable, standard operating
procedures. The centers will: (1) increase focus on most-at-risk populations (female sex workers, men who
have sex with men, and their clients), (2) provide TB patients and voluntary walk-ins with counseling and
testing (pre and post) services following effective outreach and referral; (3) provide effective and appropriate
referral and linkages to IPPCC (Integrated Positive Prevention and Care Centers) or CSC (care and support
centers) to ensure continuum of prevention and care; (4) provide well-trained providers capable of
addressing the medical and health needs of the community; (4) provide linked outreach to the community so
that ICTCs become an entry point to prevention and care; (5) provide quality counseling services to both
those who test negative and those who test positive; (6) provide follow-up and appropriate referrals.
Efforts will be made to leverage testing kits, consumables, and managerial assistance from district
supervisors through KSAPS and/or UNICEF.
Supportive supervision, exposure visits, periodic site visits by experts, regional review meetings, and
trainings are included in capacity-building efforts to improve the quality of counseling services at these
centers. Medical doctors, lab technicians, and counselors (approximately 30 persons) will be trained to
national and international standards, with refresher courses based on emerging needs from counselors.
In order to sensitize non-ICTC staff, approximately 60 employees in the hospital setting will undergo
trainings in the areas of stigma and discrimination, values and attitudes related to HIV/AIDS, sexual health
and reproductive counseling, counseling to couples to remain sero- discordant, and needs and objectives of
CT interventions.
Apart from the six model ICTCs, other ICTCs across the state will be provided supportive supervision and
mentored by district supervisors and the supportive supervision team (SST) system - a cadre of 15 district
level supervision teams supported by the Samastha project which strengthen KSAPS in monitoring and
quality assurance of HIV services in the state.
The program will establish working linkages between the CT centers and the TB Control Program (RNTCP),
ART, and STI services. A well-defined outreach plan will be designed allowing counselors to coordinate
activities with implementing partners.
Link workers and outreach staff will generate demand in the target community. Each center will aim to reach
300 individuals (especially most-at-risk populations) annually to provide clients with counseling and testing.
Additional outreach efforts and demand generation will bring in approximately 60 clients with TB per center
for counseling and testing.
To ensure quality, periodic review meetings at regional and state levels will be conducted.
Centers will be monitored by district supervisors, regional coordinators, zonal coordinators from the SST
system as well as Project Samastha's own regional and zonal managers. Monitoring will ensure effective
logistic supply and delivery mechanisms are in place, linkages and referrals (to and from) are working, and
activities are appropriately gender sensitive and in accordance with national and international standards.
Continuing Activity: 14140
14140 6130.08 U.S. Agency for University of 6715 3942.08 Samastha $29,640
10820 6130.07 U.S. Agency for University of 5601 3942.07 $550,000
6130 6130.06 U.S. Agency for University of 3942 3942.06 $290,000
Estimated amount of funding that is planned for Human Capacity Development $16,220
Table 3.3.14:
The University of Manitoba's (UM) Samastha Program will consolidate its Computerized Management
Information System (CMIS), build the capacity of program sub-partners to analyze and use CMIS data for
their program review and planning, and continue the collection of data for routine program outcome
monitoring. This program activity includes support to the Karnataka state program in strategic information
and annual program review and reflections. District MIS Officers, District Program Coordinators (DPC), Link
Workers (LW) and Peer Outreach Workers (POW) under implementing NGOs, doctors and counselors in
Integrated Positive Prevention and Care-Drop In Centers (IPPC-DICs) and Community Care Centers
(CCCs) will be involved in this activity. The monitoring and evaluation personnel from Karnataka State
AIDS Prevention Society (KSAPS), Karnataka State Technical Support Unit (TSU), APSACS, and AP
District Program Management Team will also be involved.
The Strategic Information activities under Samastha include: 1) consolidation and refinement of the
comprehensive district Computerized Management Information System at all levels for program review and
planning, 2) collecting periodic data on selected behavioral outcomes in target populations, 3) supporting
the State AIDS Prevention Society for establishing "One State-level monitoring and evaluation" platform and
4) ensuring quality of data at all levels.
All activities in COP08 will continue in COP09, except for the following changes:
ACTIVITY 8: Measuring the Reach and Effect of Communications on Target Audiences
PSI's subcontract under the Samastha program will be completed at the end of FY09, and the
Communication Output Tracking Surveys (OTS) implemented by PSI will no longer be conducted.
The following new activity will be undertaken in COP09:
ACTIVITY 11: Technical Support in Computerized Management Information System (CMIS) to GFATM
Round-6 in Karnataka and Maharashtra
The purpose of this activity is to provide TA in establishing an individualized CMIS and continuous support
in MIS in the States of Karnataka and Maharashtra under GFATM Round-6. Under this activity, CMIS will
be set up in all GFATM-supported CCCs for tracking individuals in the program and generating the monthly
progress report, as per the NACO guidelines. In addition, technical support will be provided for the analysis
of CMIS data for identifying program coverage gaps. All technical and program staff will be trained to use
the CMIS and generate web-based reports. In addition to this, technical assistance will be given in periodic
data quality audit.
An important objective of program activities in 2008-09 is to consolidate the existing Samastha
Computerized Management Information System (CMIS), build the capacity of program partners in analysis
and utilization of CMIS data for their program review and planning, and collect data for the routine program
outcome monitoring. Program activities also include support to the state program in strategic information
and mid-term program review and reflections. The district MIS officers, district program coordinators, Link
Workers under the implementing NGO, as well as the peer outreach workers, doctors and counselors at the
Integrated Positive Prevention Care centres (IPPCC) managed by the PLHA networks and the Care and
Support Centres (CSC) will be involved in this activity. The monitoring and evaluation personnel from the
Karnataka State AIDS Control Society (KSAPS), Karnataka State Technical Support Unit (TSU), Andhra
Pradesh State AIDS Control and Prevention Society (APSACS), and AP District Program Management
Team will be key stakeholders in this exercise as part of long-term institutional capacity-building.
The Samastha project is a comprehensive prevention, care and treatment project implemented by the
University of Manitoba (UM) in 15 districts in Karnataka and 5 coastal districts of Andhra Pradesh (AP)
through a consortium led by the Karnataka Health Promotion Trust (KHPT) in partnership with Population
Services International (PSI), EngenderHealth (EH) and NGO partners.
ACTIVITIES AND EXPECTED RESULTS:
SI activities under Samastha include: (1) establishing a comprehensive district Computerized Management
Information System at all levels for program review and planning (2) collecting periodic data on expected
behavioral outcomes in target populations, (3) supporting the State AIDS Prevention Society for establishing
"One agreed state-level monitoring and evaluation" as outlined in the third phase of the National AIDS
Control organization (NACP-3)and; (4) ensuring quality of data at all levels. Eleven activities are planned.
ACTIVITY 1: Monitoring Program Coverage and Quality Assurance
This is an ongoing activity. District-wide monthly, quarterly and annual reports as well as additional analysis
of CMIS data are reviewed periodically by Samastha program staff to give feedback to the Implementing
Partners (IPs) on program coverage and gaps therein. Efforts to strengthen the quality of data collected at
various program levels will be continued. These include data quality checklists and systems for regular data
review with sub-partners.
ACTIVITY 2: Examining Program Status and Progress
This is an ongoing activity, involving three types of review meetings: monthly review meetings, half-yearly
review meetings, and thematic meetings. Each implementing subpartner (IP) will have monthly review
meetings organized with them, KHPT will organize program review meetings with all the implementing
partners (IPs) twice a year, and special meetings will be organized with the IPs from time to time, each
Activity Narrative: focusing on separate themes related to the project.
ACTIVITY 3: Observing Implementation in the Field
This is an ongoing activity, wherein personnel at different program management levels visit project sites.
The Regional Managers (RM) visit the district program at least once a month, the MIS Officers visits at least
once in two months and the Samastha Monitoring and Evaluation (M&E) Manager visits at least once in a
quarter to review the data quality and to support record keeping. Periodic field visits by the senior project
managers will be organized to understand and provide support to the IPs on field strategies, extent, and
quality of coverage.
ACTIVITY 4: High Quality Analysis of Program Information
The purpose of the training is to build the capacity of district MIS officers in techniques for analysis of CMIS
and other available data for the district, to understand levels, differentials and trends in program coverage
and service delivery, and to identify gaps therein. The training is expected to improve skills in analysis and
utilization of information for program planning and review. After this training, the District MIS officers will
carry out periodic district data analysis and share results and interpretations with program staff. This is a
new activity. A total of 25 MIS officers from 20 organizations will be trained.
ACTIVITY 5: Improving Implementers' Abilities to Make Evidence-Based Decisions
This training will develop the skills of program staff to understand and utilize information on levels,
differentials, and trends in program coverage for program review and planning at various levels. This is a
new activity.
This training program will be carried out in two phases; RMs from the Samastha project will be trained who
in turn will train district implementing staff in the second phase. In the second phase, one training program
in each of the 15 project districts in Karnataka and one in Coastal AP will be conducted. All program staff of
the IPs will be involved in this training. In Karnataka, 600 Link Workers (a cadre of outreach community
workers planned under NACP-3 to link prevention outreach activities with HIV related services) and 240
other program staff will be trained in 24 batches. In Coastal AP, one training workshop will be organized to
cover all doctors and counselors from six partner agencies.
This training is expected to enhance the capacity of the Link Workers and supervisors to use analyses
prepared by district MIS officers, to appreciate and identify gaps in program and service coverage, and plan
for effective implementation of the program. In terms of care and support service delivery, training will
facilitate improvements in the treatment and services provided to the PLHA in the district.
ACTIVITY 6: Evaluating Program Impact on Risk Behavior
The second round of Polling Booth Surveys (PBSs) will be carried out to study change in sexual behavior in
the general population as well as among female sex workers (FSW). PBS is a simple evaluation mechanism
to provide confidential self-administered assessments of behavior change. The sample population is guided
through a set of structured questionnaires for behavior change, for which they ‘poll' answers on the spot
using a polling booth, assuring self-administration and confidentiality. In the general population, the PBS will
be done among six demographic groups (unmarried males 15-24, unmarried females 15-24, married males
15-24, married males 25-44, married females 15-24, and married females 25-44) in 900 villages where the
project is implemented. There will be two segments of villages selected: a group of 100 selected villages
where the PBS will be done every year and another group of 100 villages randomly selected in every round
of the PBS. In every selected village, there will be about 12 PBS sessions, and there will be about ten
individuals in each PBS session. Hence, a total of 2,400 PBS sessions will be conducted covering about
24,000 individuals.
Among the FSWs, there will be a minimum of ten polling booth sessions per district, with ten participants in
each group.
ACTIVITY 7: Monitoring Improvements in the Quality of Life of PLHAs
This is an ongoing activity. The second round of recruitment of PLHAs for this assessment and the third and
fourth rounds of data collection from the PLHAs recruited in the first and second phase will be carried out in
FY08. The purpose of the study is to assess the impact of the program on PLHA's quality of life, in terms of
such components as physical, social and psychological well being, access to and effectiveness of services
provided, and experience of stigma and discrimination. 200 PLHA subjects will be included in this year's
assessment.
This is an ongoing activity. As a part of the periodic communication need assessments, information on
selected expected behavioral outcomes will be collected at regular intervals through sample surveys, in
collaboration with PSI.
ACTIVITY 9: Analysis and Interpretation of Program Achievements
This is a new activity, and replaces the annual reflection exercise carried out by UM. The purpose of this
review/reflection is to assess in detail the achievements of various program components with reference to
project goals and objectives. The implementing partners, KHPT/UM and external consultants, and the
community will carry out this review jointly.
ACTIVITY 10: Exchanging Lessons Learned with Program Stakeholders
This is a new activity wherein the experiences of planning and implementing a rural HIV/AIDS prevention,
care and support program will be documented and disseminated to a wider audience including NACO,
KSAPS, APSACS, other national and international agencies involved in HIV/AIDS prevention, care and
support programs, academicians and community-based organization. The method of dissemination includes
seminars, publication of manuals and reports, presentations in national and international conferences as
well as publications in peer-reviewed scientific journals.
Continuing Activity: 14142
14142 6132.08 U.S. Agency for University of 6715 3942.08 Samastha $299,520
10822 6132.07 U.S. Agency for University of 5601 3942.07 $275,000
6132 6132.06 U.S. Agency for University of 3942 3942.06 $290,000
Estimated amount of funding that is planned for Human Capacity Development $1,751
Table 3.3.17:
ACTIVITY UNCHANGED FROM FY 2008
A significant thrust of the Samastha project is the provision of technical assistance for HIV-related policy
development for state government, primarily the Karnataka State AIDS Control Society (KSAPS) and the
partner NGOs/CBOs (including PLHA and sex worker networks). Technical assistance is aimed at
improving the enabling environment for HIV programs, mainstreaming HIV programming into large
development initiatives, galvanizing political and popular support for HIV policies and programs at state and
district level, and capacity-building of government and non-governmental organizations to participate in and
lead policy development. Capacity building and strengthening of social structures includes training at
various levels from field-based outreach to government personnel at KSAPS.
across Karnataka and 5 coastal districts of Andhra Pradesh. Implemented by the University of Manitoba
(UM) since 2006, the Samastha project will be scaled up in 2007 and operational across 15 districts by
2008. The Samastha project will provide technical assistance to the state programs in Karnataka and
Andhra Pradesh to enhance their capacity to manage scaled-up programs as envisaged under the Third
Plan of the National AIDS Control Program (NACP-3) and ensure the quality of interventions. Samastha will
work with civil society to build institutions and programs to deliver HIV prevention and care services.
By 2008, decentralization of HIV programming to the district level as part of NACP-3 and the setup of district
HIV societies and program implementation units will be completed. Village-based structures for
mainstreaming, such as Village Health Committees (VHC) under the National Rural Health Mission
(NRHM), will be established in most of the villages in the state. At the state level, the State Council for
AIDS, headed by the Chief Minister with members from elected representatives, civil society (including
women's self-help groups and positive networks), donors and NGOs, will focus on mainstreaming HIV/AIDS
activities in government policy. Samastha will work with structures at state, district and village-level to help
build the capacity of members for an enhanced and sustainable response to HIV/AIDS.
ACTIVITY 1: Technical Assistance for HIV-related Policy Development
Samastha will provide technical assistance to the state government and in particular to KSAPS through
several initiatives. Effective mechanisms will be developed to work with the State AIDS Council and other
government stakeholders to mainstream HIV/AIDS treatment while increasing access by HIV-affected and
vulnerable populations to supportive social services, such as education, nutrition, and housing.
Samastha will work towards enhancing the capacity of the District AIDS Prevention and Control Units
(DAPCUs) set up under NACP-3, as well as their capacity to design and monitor evidence-based HIV/AIDS
programs. To meet programming challenges, including planning, monitoring, implementation, and
mainstreaming of HIV programs into other development programs, district health and family welfare officers
and other local health officials will be trained. The Samastha project will support bi-annual meetings of the
Legislator's Forum, a committee comprised of elected representatives, in the development of favorable
policy initiatives for affected and vulnerable populations, focusing on women.
Samastha will support fifteen Supportive Supervision Teams (SST) for ongoing technical assistance to
various levels of health care providers such as counselors at the integrated counseling and testing centers
(ICTCs), and doctors in OI management and ARV treatment across the 15 project districts
A peer-support system will be developed wherein trained counselors will mentor and support their peers. A
computerized Management Information System (MIS) and Linked MIS (LMIS) system will be developed to
ensure the flow of data to KSAPS, management of supplies and an inventory of kits and consumables.
Developing learning systems for NGOs to share experiences is another priority. The large number of civil
society organizations (CSOs) provides fertile ground for the establishment of systems to share lessons
learned and best practices. This will be achieved through online collaboration, forums, and other methods
of knowledge sharing and dissemination. Formal training will be conducted to meet demand from the NGOs
and CBOs.
ACTIVITY 2: Technical Assistance for Institutional Capacity Building
Samastha works through NGO partners and CBOs of positive people and sex workers to deliver prevention
and care services. Capacity-building of Samastha NGO and CBO partners, as well as partners of KSAPS,
will begin in 2006. The learning systems set up under the project will ensure cross-learning between
partners. NGOs will be trained in the first two years on financial management, management of drugs and
commodities, and linkages with supportive services for the community. In 2008, they will be provided with
support for monitoring in these areas.
Samastha has a specific mandate to build the capacity of CBOs of HIV-positive people. In the first year of
the project, a detailed assessment of the capacity of positive network members was completed. It helped
inform the capacity building plan for the Karnataka Network of Positive People (KNP+) and its district
networks to manage the functioning of integrated positive prevention care centers (IPPCCs) in 9 districts. In
the remaining districts, NGOs will manage the IPPCCs. The IPPCCs are HIV service delivery centers
planned under the third phase of the National AIDS Control Plan (NACP-3) which are managed by PLHA
networks and have out-patient facilities, drop-in centers and vocational centers to support PLHA.
In 2008, it is expected that the management of all IPPCC networks will be transitioned to the local chapters
of the district level networks affiliated to KNP+. CBOs will receive support for financial and human resource
Activity Narrative: management, expanding their membership base, and leadership and management of drugs and
commodities. Training will be provided in networking and advocacy with other stakeholders to promote
access to supportive services. Positive speakers will be trained to represent their communities in various
fora, including district HIV/AIDS societies along with capacity-building of networks to manage projects and
leverage other resources. The capacity-building of positive networks will be done in collaboration with CDC
using existing protocols and manuals developed under Global Fund Round 4. The care and support centers
(CSCs) under Samastha will be run by a network of hospitals operated primarily by faith-based
organizations (FBOs), which will be provided refresher and supportive supervision training on technical
issues related to HIV/AIDS.
Two learning sites, one for comprehensive care and support, and one for OVC , will be ready by 2008-09.
NACP-3 envisages linking CSCs with ART centers, especially for ART adherence support. In 2008, these
centers will be linked with the ART centers established by the government.
ACTIVITY 3: Reduction of Stigma and Discrimination
Samastha will continue to reduce stigma in health care settings and community settings to ensure affected
and vulnerable populations are not discriminated against, and are able to access services. One hundred
health care providers will be trained using the modules developed by EngenderHealth. Regional managers
of KHPT will undergo TOT and will train the entire staff of the CSCs to reduce stigma and discrimination in
this health care setting.
Village Health Committees (VHCs) will be a focal point to work on reduction of stigma and discrimination in
community settings. VHCs will be comprised of local leaders, opinion makers, and village-level government
functionaries. Samastha will facilitate the activation of existing VHCs under the National Rural Health
Mission (NRHM), or set up VHCs if they do not exist. By 2008, one-third of the villages under Samastha will
have active VHCs, and at least two members from each VHC will be trained to work on stigma and
discrimination reduction. Samastha will enhance the capacity of functionaries in the (VHC) to advocate for
HIV related issues
ACTIVITY 4: Training and Systems Strengthening for Grass-Roots Link Workers
Under NACP-3, the NACO will support a new cadre of Link Workers, who will identify villages for community
mobilization in HIV prevention and care, targeting youth, female sex workers (FSWs), PLHA, OVC, widows,
men with STIs, and people with TB. Initially, Samastha will directly support salaries and travel costs for Link
Workers in 14 districts of Karnataka to ensure a strong foundation for this system. Grass roots level workers
will continue to be trained in FY08 to equip them to be effective frontline workers. In FY08, the program will
focus on training new field staff at the rate of 20 per district, resulting in 240 field staff trained.
Continuing Activity: 14143
14143 10887.08 U.S. Agency for University of 6715 3942.08 Samastha $1,184,560
10887 10887.07 U.S. Agency for University of 5601 3942.07 $400,000
* Family Planning
Estimated amount of funding that is planned for Human Capacity Development $524,363
Estimated amount of funding that is planned for Food and Nutrition: Policy, Tools $1,250
Table 3.3.18:
