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
CONTINUING ACTIVITY - NEW ACTIVITY NARRATIVE
SUMMARY
USG and LEPRA, through its sub-partner, the Catholic Health Association of India (CHAI), will continue
PMTCT activities from the previous year. These activities are part of the broader PHC Enhancement
Project. Based out of a Primary Health Center (PHC) hub, activities include: developing linkages with
health workers for follow-up of HIV-positive pregnant women; motivating them to seek HIV counseling and
testing; following up HIV-positive pregnant women to access PMTCT; linking them to existing PMTCT
centers; supervising the delivery of PMTCT services at the PHCs, and continuous training of nurses and
community resource persons (CRP) in PMTCT outreach services. Specific target populations for this
activity include pregnant women, women in self-help groups, Village Health Committees, and community
resource persons. Presently, services are being delivered in the 266 PHCs spread across 10 high-burden
(prevalence greater than 1%) districts in the state, covering the PHCs' population of approximately 13
million. In the fourth year of the program, these activities will continue to be implemented primarily by CHAI.
In FY09, the responsibility of supportive supervision and management of the PHC Enhancement Project will
be shared between USG partners and the Government of India-appointed District AIDS Prevention and
Control Unit (DAPCU). USG funding of the current district teams will cease in FY09. This is part of the
sustainability plan for the PHC Enhancement Project, which will be handed over to the government in FY09,
with activities taken over by the DAPCU.
BACKGROUND
LEPRA Society, an NGO based in Hyderabad, in the southern state of Andhra Pradesh (AP), works among
sub-populations in select villages across 53 districts in four states of India: AP, Orissa, Bihar and Madhya
Pradesh. Current programs include activities in public health and rural development, such as TB
interventions, HIV awareness and prevention, care and support to PLHA, malaria, and prevention of
blindness. LEPRA's strengths are grassroots-level interventions for rural, vulnerable, and difficult-to-reach
sub-populations. LEPRA emphasizes sustainability and cost-effectiveness by building individual and partner
agency capabilities. LEPRA Society is a leading partner of the Andhra Pradesh State AIDS Control Society
(APSACS) in implementing a large scale HIV counseling and testing program in over 500 health facilities
and is also a joint implementing partner of APSACS in other critical state-level HIV interventions.
USG has been working in AP with LEPRA, and its sub partner the Catholic Health Association of India
(CHAI), since 2005. CHAI, established in 1943, is India's largest NGO in the health sector with nearly 3,273
member institutions that include large, mid-sized and small hospitals, health centers, and diocesan social
services societies. CHAI promotes community health and enables the community, especially the poor and
the marginalized, to be collectively responsible for attaining and maintaining their health, demand health as
a right, and ensure the availability of quality health care at reasonable cost.
Andhra Pradesh (AP), a state in South India with a population of 80.8 million, has an estimated 500,000
PLHA. Antenatal HIV prevalence is over 1% in 19 of the 23 districts, yet access to HIV services is scarce,
especially in the rural areas. Each PHC, the basic health care unit in India, serves a population of 30,000.
Given the vast coverage of PHCs, and the urgent need for rural access to testing, care, and treatment
services, the integration of HIV/AIDS services into the existing PHC level was urgently needed. APSACS
expanded counseling and testing services to the rural PHC level, unlike in other states in India, where the
services remain exclusively urban and peri-urban. There is a total of 677 Integrated Counseling and Testing
Centers (ICTCs), which offer PPTCT, counseling and testing, and TB/HIV care, support and treatment
services at the PHC level. Facility based palliative care is provided on an out-patient basis.
ACTIVITIES AND EXPECTED RESULTS
Unlike other ICTC testing facilities, the PMTCT services in LEPRA's program are offered by a nurse
practitioner (NP), supported by APSACS and trained by USG, in the PHC facilities. The strategy is not only
cost efficient, but also facilitates the integration of HIV services into routine PHC services. The nurse
practitioners are government staff, not paid for by LEPRA. The USG pays for the system of supervision,
whereby one supervisor for every 10-15 NPs visits each center on an average once every 4 weeks to
provide on-site supervision, training, and feedback. In FY09, USG-supported PHCs will provide increased
access to quality HIV services and enhanced patient follow-up by program-trained nurses. The
administration of Nevirapine to mother-baby pairs at these centers is estimated to be more than 80 % with
the help of linkages established at PHC.
ACTIVITY 1: PHC Enhancement Project (PHCEP)
In partnership with the SACS and CHAI, CDC/India funded a pilot model for strengthening services at 20
PHCs in high-burden districts. The strategy provided a nurse to each PHC, who was trained in the delivery
of comprehensive HIV/AIDS care and treatment services - ncluding counseling and testing, PMTCT,
treatment of opportunistic infections and STIs - as well as in community prevention outreach, home based
follow-up care, and referral services. These services provide a continuum of care for PLHA by networking
with other existing HIV care, treatment, and support providers. They include counseling and testing for the
surrounding communities, demand generation for PMTCT services through outreach, administration of
Nevirapine prophylaxis, and referrals for treatment and support through partnerships with local NGOs and
CBOs. HIV-positive clients are linked to government centers for CD4 screening and ART, if appropriate.
In addition, state government resources were leveraged to support training activities, the nurses' salaries,
and supplies. USG funded the supervision system. The supervision system includes a District Program
Manager in 6 of 10 districts and two nurse-supervisors for each district at the sub-districts (all positions
funded by USG). Within 12 months in FY07, this model was scaled up from 10 to 266 PHCs, covering 36.2
million people in 10 high-burden districts. Between January and December 2007, 112,483 pregnant clients
accessed counseling and testing (CT) services at the program's PHCs, of which 1,120 clients were HIV
positive (0.91%). In FY09, it is expected that approximately 100,000 women will access CT for PMTCT and
that around 470 women will be given Nevirapine during delivery.
Activity Narrative: As part of PMTCT services at the PHCs, there is a focus on safe motherhood, through care for the
antenatal, intra-partum and post-natal period for HIV-infected women. Infant-feeding options and related
counseling and follow of HIV-exposed infants until 18 months of age, as well as routine immunization are
linked to the child survival services at the PHC level.
USG-funded supervisors are trained in comprehensive HIV prevention, care, and treatment with a major
focus on supportive supervision, home based care and community level risk mapping. They are the
immediate mentors of the Nurse Practitioners. They provide direct supervision of NPs in the field and
through the district supervisors connect the NPs with district and state units. In FY09, the nurse supervisors
will be trained in mentoring the NPs on replacement feeding and support services, so that NPs can provide
antenatal, peri- and postpartum counseling and support to HIV-positive mothers on: infant feeding options
and vertical transmission; on-going nutritional and clinical assessment of exposed infants; replacement
feeding support, and associated counseling. Linkages between the staff of PHC and TB programs will
continue. This will include screening of HIV-infected pregnant mothers for TB as part of PMTCT services.
CHAI, in collaboration with the district health authorities, will also train existing PHC staff in HIV counseling
and testing. This includes couple counseling and partner notification and PHC staff are expected to
encourage testing for spouses. Nurses will be provided annual refresher training on PMTCT skills.
Auxiliary nurse midwives (ANM) and PLHA outreach workers will be expected to follow up with HIV-positive
pregnant women during pregnancy and babies of HIV-positive mothers for 18 months after birth.
ACTIVITY 2: Sustainability Plan for PHCEP, including Supervision, Monitoring and Program Management of
District-Level PMTCT Services in AP
USG will support mainstreaming of PHCEP activities into the routine work of the PHC. This is in line with
the National AIDS Control Plan's (NACP-III) strategy to scale up the delivery of HIV/AIDS services at the
PHC level. In FY09, an outcome review of the PHCEP program will be carried out. A sustainability plan
has been developed in coordination with the Government of India and other major donors to ensure
continuation of the PHCEP program through mainstreaming. The District Program Managers will be
transitioned to the DAPCU team with responsibility for overall supervision and monitoring of district
activities, including PMTCT services. The nurse supervisors will, however, continue to be funded by USG.
ACTIVITY 3: A Demonstration Project on PMTCT in Orissa
LEPRA Society will provide technical assistance to the Orissa State AIDS Control Society (OSACS) for a
demonstration project in PMTCT in FY08-FY09. This objective of this project is to provide prevention of
mother-to-child transmission (PMTCT) services to women in need who have minimal access to services and
thus minimize the rate of PMTCT. The providers will advocate institutional deliveries for positive women,
administer Nevirapine in institutional and non-institutional deliveries, provide positive mothers with child
rearing information, enhance follow-up services, and work towards developing sustainable linkages at the
community level.
The TA will focus on training, supportive supervision, and monitoring. In collaboration with OSACS, USG
partners will train and place 12 outreach workers, two block supervisors and one project officer in two
blocks of Ganjam and Koraput districts. The block supervisor and project officer will monitor activities. The
outreach workers will facilitate HIV testing of antenatal mothers at ICTCs: those who are seropositive will be
closely followed up until institutional delivery and administration of Nevirapine to the mother-baby pairs.
The newborn will also be followed up on by the outreach worker until 18 months of age. LEPRA will
disseminate and demonstrate this model to facilitate scaling it up to other high prevalence districts in Orissa
state.
New/Continuing Activity: Continuing Activity
Continuing Activity: 14297
Continued Associated Activity Information
Activity Activity ID USG Agency Prime Partner Mechanism Mechanism ID Mechanism Planned Funds
System ID System ID
14297 6216.08 HHS/Centers for Leprosy Relief 6767 3966.08 $55,000
Disease Control & Association India
Prevention
10881 6216.07 HHS/Centers for Leprosy Relief 5616 3966.07 $115,000
6216 6216.06 HHS/Centers for Leprosy Relief 3966 3966.06 $65,000
Emphasis Areas
Health-related Wraparound Programs
* Child Survival Activities
* Safe Motherhood
* TB
Human Capacity Development
Public Health Evaluation
Food and Nutrition: Policy, Tools, and Service Delivery
Food and Nutrition: Commodities
Economic Strengthening
Education
Water
Table 3.3.01:
NEW ACTIVITY NARRATIVE
LEPRA Society, with support from USG and the Andhra Pradesh State AIDS Control Society (APSACS),
rolled out a large comprehensive prevention, care, treatment, and support program, the Primary Health
Care Enhancement Project (PHCEP) in 2006 through its sub-partner, the Catholic Health Association of
India (CHAI). The program's services are delivered through Primary Health Centers (PHCs) across 10 high
burden districts in Andhra Pradesh (AP).
HIV prevention activities are being undertaken by nurse-practitioners and nurses at PHC level. There will
be a continued focus on sexual prevention activities in the community. More specifically, the USG-
supported PHCs will reach out to adolescents and high school children with messages of
abstinence. Outreach activities to existing womens' groups such as Self-Help Groups, Development of
Woman and Child in Rural Areas (DWCRA) groups, and male fan clubs will also focus on this program
area.
In FY09, the supportive supervision and management of the PHC Enhancement Project will be shared
between USG partners and the government-appointed District AIDS Prevention and Control Unit (DAPCU).
To date, district teams for supervision of the PHC HIV/AIDS activities in the ten high-burden district have
been supported by USG funds, which will end in FY09 due to the integration of the project into the national
DAPCU structure. This integration forms part of the sustainability plan for the PHC Enhancement Project,
which will be handed over to the government as the project enters its fifth year of USG support.
USG has been working in AP with LEPRA, and its sub partner, the Catholic Health Association of India
(CHAI), since 2005. CHAI, established in 1943, is India's largest faith based organization in the health
sector with nearly 3,273 member institutions that include large, mid-sized and small hospitals, health
centers, and diocesan social services societies. CHAI promotes community health and enables the
community, especially the poor and the marginalized, to be collectively responsible for attaining and
maintaining their health, demand health as a right, and ensure availability of quality health care at
reasonable cost.
Andhra Pradesh, a southern state in India with a population of 80.8 million, has an estimated 500,000
PLHIV. Antenatal HIV prevalence is over 1% in 19 of the 23 districts, yet access to HIV services is scarce,
especially in the rural areas. APSACS has scaled up counseling and testing (CT) services to the rural
primary health center level, unlike other states in India, where the services remain exclusively urban and
peri-urban. A total of 266 Integrated Counseling and Testing Centers (ICTCs) offer prevention of mother-to-
child transmission, CT, and TB/HIV care, support and treatment services at the PHC level. Each PHC, the
basic health care unit in India, serves a population of 30,000. Given the vast coverage of PHCs and the
urgent need for rural access to testing, care, and treatment services, the integration of HIV/AIDS services
into the PHC system makes services very accessible.
Community outreach activities have been undertaken by PHC nurses for about four to eight days per month
so far. This will be continued in FY09, with sexual prevention of HIV in rural areas as an important focus
ACTIVITY 1: AB Education through the Primary Health Center Enhancement Project
The PHCEP will provide adolescent youth and the general community with HIV prevention activities through
outreach by the 266 nurses working in the PHCs. Technical support for and supervision of the nurses is
through USG-supported Nurse Supervisors. The nurses spend an average of 16 working days per month in
the facility and four to eight days in the community. The nurses will use available opportunities to reach
youth groups and high-school children at least once a month with abstinence messages. The project
targeting youth will promote gender-equity and will also organize school-based programs to address male
norms, encouraging them to respect women
The nurses will also work with existing outreach workers and village volunteers to convey messages on
mutually being faithful to spouse/partner, especially reaching existing women's groups and fan clubs in the
villages. Positive prevention activities and linkages with positive network groups will also be continued.
Based on previous outreach activities, it is estimated that the nurses will reach to about 76,608 people as
part of sexual prevention activities in FY09, which includes reaching 63,840 with a specific focus on
abstinence.
New/Continuing Activity: New Activity
Continuing Activity:
Gender
* Addressing male norms and behaviors
* Increasing gender equity in HIV/AIDS programs
Table 3.3.02:
Most-at-risk populations (MARPs) and bridge populations in Andhra Pradesh (AP) need access to
prevention messages on safer sex practices. Strategic interventions must focus on encouraging correct and
consistent condom use, reducing the number of partners and reinforcing mutual monogamy in marriage.
Other important issues are sexual and gender violence, the need for counseling and testing (CT), and early
detection and treatment of sexually transmitted infections (STI). In FY09, these messages will continue to
be delivered through two channels: mobile vans visiting villages and outreach by the nurses working in the
Primary Health Care Enhancement Project (PHCEP) implemented through the Catholic Health Association
of India (CHAI) in ten high-burden districts in AP.
In FY09, the supportive supervision and management of the PHCEP will be shared between USG partners
and the government-appointed District AIDS Prevention and Control Unit (DAPCU). To date, district teams
for supervision of the Primary Health Care (PHC) HIV/AIDS activities in the ten high-burden district have
DAPCU structure. This integration forms part of the sustainability plan for the PHCEP, which will be handed
over to the government as the project enters its fifth year of USG support.
Pradesh. Programs include activities in public health and rural development, such as TB interventions, HIV
awareness and prevention, care and support to PLHA, malaria, and prevention of blindness. Its strengths
are grassroots level interventions for rural, vulnerable, and difficult-to-reach sub-populations. LEPRA
emphasizes sustainability and cost-effectiveness by building individual and partner agency capabilities.
AP has a population of nearly 80.8 million, divided in 23 administrative districts. It has an estimated 500,000
people living with HIV/AIDS (PLHA), the largest number in the country. LEPRA is a leading partner of the
Andhra Pradesh State AIDS Control Society (APSACS), is implementing an HIV CT program in over 500
health facilities and is also a joint implementing partner of APSACS in other critical state-level HIV
interventions. USG has been working in AP with LEPRA, and its sub-partner the Catholic Health
Association of India (CHAI), since 2005. LEPRA, with support from USG and APSACS, rolled out a large
comprehensive prevention, care, treatment, and support program, the PHCEP, in AP in 2006. These
activities are being continued in FY09.
The program focuses on providing HIV prevention messages on safer sex practices, including correct and
consistent condom use and being faithful. The key target groups include most-at-risk populations (MARPs),
including female sex workers (FSWs), and MSMs, and also target mobile populations, truckers, migrant
laborers and youth at risk. Messages also address the need for counseling and testing, early detection and
treatment of STIs, and condom negotiation skills. The project will deliver these messages via mobile vans
and will also mainstream these messages in HIV/AIDS prevention education for the Self-Help Group (SHG)
services provided by Indira Kranthi Patham (IKP) to women in rural areas.
ACTIVITY 1: Mobile Vans for Prevention and Demand Generation for Counseling and Testing (CT)
NACP-III supports mobile testing for high risk and remote communities: having cost-efficient Indian models
as learning sites will promote implementation of this strategy.
LEPRA supports a mobile van to provide CT services and spread prevention messages in selected high risk
and difficult to reach areas, where there is evidence of large numbers of high risk communities. These
include such areas as urban and rural markets where sex work is common and areas that employ large
numbers of migrant men. The target group is about 5000 men and women.
Staff in the mobile units, which are accessed by MARPs and the community, will promote comprehensive
HIV prevention education that includes AB, and awareness regarding correct and consistent condom use.
The program offers one-to-one counseling and group education sessions and provides services including
treatment for STIs and opportunistic infections, antenatal care, education on HIV via audio-visuals and
opportunities for the community to ask questions about health issues. A mobile information, education and
communication (MIEC) van goes to the target area ahead of the testing van to generate demand for testing.
The MVCT and MIEC vans also serve as mobile condom depots where the community can access free
condoms. LEPRA also aims to provide 15 condom outlets for free condoms in strategically planned
locations in the communities. Test kits and supplies are leveraged from the Andhra Pradesh State AIDS
Control Society (APSACS).
In FY09 LEPRA will continue to provide these services and will document implementation, and disseminate
lessons learned to other partners, especially APSACS, to promote scaling-up the program. For
sustainability, it is planned that the new condom outlets established will be handed over to the local NGOs
and government institutions for ongoing management.
ACTIVITY 2: Prevention Education by PHC Nurses
As part of the PHCEP project supported by LEPRA and implemented through CHAI, the 226 PHC nurses
working in government PHCs will continue to conduct prevention outreach and promotion of condoms. They
will focus their efforts in communities where high rates of HIV are documented, based on results from ANC
and walk-in testing at the district PHC. The program will also support 266 target condom service outlets at
the PHC level, managed by the nurses. Each nurse covers a population of about 30,000. The nurses are
government staff, not paid for by LEPRA; however, their work is monitored by Nurse Supervisors supported
with USG funding.
Nurses visit villages, conduct outreach education sessions for women in childcare centers and for men in
Activity Narrative: community halls, and lead prevention sessions with women's groups (Self-Help Groups and Development
of Women and Children in Rural Areas [DWARCA] groups). The activities with these groups will include a
focus on the empowerment of women with respect to their sexual health and condom usage with
partners/spouses. The overall target population for this outreach is nearly 127,680 rural men and women.
LEPRA Society will also give technical assistance (TA) to IKP to promote the sustainability of the project
through training IKP's master trainers on health issues, HIV and reproductive health. The IKP master
trainers will in turn train the trainers at the village level.
ACTIVITY 3: Improving Health-Seeking Behavior among At-Risk Populations
Nurse Practitioners in the PHCEP, mentored by the Nurse Supervisors, are conducting community risk
mapping at the village level to gain information about high-risk behaviors. The mapping exercise will help to
identify the populations at risk, provide them with information on safe sex, improve health-seeking behavior,
and increase referrals to the Integrated Counseling and Testing and STI centers.
The PHCEP system also helps in increasing gender equity in accessing health services, through building
the capacity of the female nurse practitioners (NPs) in outreach and provision of HIV services at the PHC
level. The NPs are encouraged to track the male partners of those HIV-positive women receiving PMTCT
services for couple counseling and testing. Involving women's groups to reach the community also helps to
increase awareness of HIV and sexual health among these women, who may otherwise be beyond the
reach of the health care providers.
Continuing Activity: 14299
14299 6215.08 HHS/Centers for Leprosy Relief 6767 3966.08 $125,000
10880 6215.07 HHS/Centers for Leprosy Relief 5616 3966.07 $50,000
6215 6215.06 HHS/Centers for Leprosy Relief 3966 3966.06 $25,000
Table 3.3.03:
rolled out a large comprehensive prevention, care, treatment, and support program in 2006 delivered
through Primary Health Centers (PHCs) across 10 high burden districts in Andhra Pradesh (AP). These
activities are being continued in FY09. Services will include: opportunistic infections (OI) prophylaxis;
counseling on nutrition and hygiene; demand generation for care and support through follow up counseling
modules; positive prevention, including discordant couple counseling; referral of people living with HIV/AIDS
(PLHA) for TB testing; DOTS treatment and linkages with existing services in government and NGO
settings. The palliative care program focus is on training for pain and symptom management, increasing
demand generation for access to services, and facilitating linkages. The target group includes those
infected and affected by HIV and community members of the districts in which there are USG-supported
PHCs.
USG has been working in AP with LEPRA, and its sub-partner Catholic Health Association of India (CHAI),
since 2005. CHAI, established in 1943, is India's largest faith based organization in the health sector with
nearly 3,273 member institutions that include large, mid-sized and small hospitals, health centers, and
diocesan social services societies. CHAI promotes community health and enables the community,
especially the poor and the marginalized, to be collectively responsible for attaining and maintaining their
health, demand health as a right, and ensure availability of quality health care at reasonable cost.
especially in the rural areas. APSACS has scaled up counseling and testing services to the rural primary
health center level, unlike other states in India, where the services remain exclusively urban and peri-urban.
A total of 266 Integrated Counseling and Testing Centers (ICTCs) offer PPTCT, counseling and testing
(CT), and TB/HIV care, support and treatment services at the PHC level. Each PHC, the basic health care
unit in India, serves a population of 30,000. Given the vast coverage of PHCs, and the urgent need for rural
access to testing, care, and treatment services, the integration of HIV/AIDS services into the existing PHC
level makes services very accessible.
A major impetus for placing a nurse at a PHC was to address the unmet needs for palliative care of PLHA at
the community level. The nurse practitioners (NPs), along with Nurse Supervisors (NS) and outreach
workers (ORWs), mobilize men and women in the community for testing and counseling. Additionally, the
nurses provide comprehensive HIV prevention, care, and treatment services for PLHA through basic
nursing care, clinical staging and referrals, including cross-referrals for TB/HIV. Support from local NGOs
and care and support centers is leveraged for services, such as nutrition and in-patient treatment. In FY09,
the NPs will offer psychosocial support and improve palliative care services for 1,275 PLHA.
ACTIVITY 1: Primary Health Center Enhancement Project (PHCEP)
Two hundred and twenty six PHC nurses, appointed to government PHCs by CHAI and APSACS and paid
for by the government, will continue to provide palliative care services to PLHA at the community level.
Nurses have been placed in the communities where the HIV burden is the greatest or in districts where high
-risk behavior is most prevalent. Each nurse covers a population of about 30,000. Nurses visit villages and
conduct outreach education sessions for PLHA and their families. The activities of the nurse are monitored
by Nurse Supervisors supported by USG funding and by the Medical Officer of the PHCs, who also
participate in the provision of palliative care services to PLHA.
Community and home-based activities are an integral part of the PHC Enhancement Project. At the PHC,
PLHA are provided medical care, including syndromic management for STIs, treatment for other
opportunistic infections, psychosocial support, and referral services for ART, TB screening, and CD4 count
tests. The services provide a continuum of care for PLHA by networking with other existing HIV care,
treatment, and support providers. HIV-positive clients are linked to government centers for CD4 screening
and ART, if appropriate. NPs, with active support from Nurse Supervisors, make follow-up visits to PLHA
homes to provide medical and psychological support. Outreach workers and staff nurses also help refer
PLHA to additional services. Mainstreaming referrals into the regular functions of the PHC staff will ensure
sustainable HIV service networks.
Advocacy by LEPRA and its sub-partner CHAI at both state and district levels will ensure drug availability at
the PHC level for opportunistic infection prophylaxis.
ACTIVITY 2: Training of PHC Staff and Nurse Practitioners
The PHCEP works closely with the HIV-TB division of APSACS to train field staff on HIV-TB coordination
and cross referrals. Activities such as TB-HIV cross-referrals, screening and DOTS referral for TB-HIV co-
infection, ART, and reporting as per the Revised National TB Control Program guidelines will continue to be
done at PHC level. The NPs are trained to track cross-referrals and complete treatment of all those
diagnosed with TB at the PHC. They are supervised and given technical support through the USG funded
nurse supervisors, who work at the district level.
The project aims at ensuring gender equity in access to palliative care services by focusing on PLHAs and
Activity Narrative: their infected/affected spouses. Screening for TB amongst family members, partner screening for STI and
treatment will be integral part of these services.
In FY09, all 266 Nurse practitioners will undergo training on follow-up counseling techniques, STI
management and pain management. The capacity of PHC Medical Officers to deliver care to HIV-positives
will also be strengthened.
Sustainability for the delivery of quality services will be achieved through mainstreaming these activities into
the routine work of the PHC through integration with the National Rural Health Mission. Linkages between
staff of the PHC and the TB program (TB supervisors) are also important to ensure sustainability of the
activities.
Continuing Activity: 14300
14300 6219.08 HHS/Centers for Leprosy Relief 6767 3966.08 $50,000
10884 6219.07 HHS/Centers for Leprosy Relief 5616 3966.07 $125,000
6219 6219.06 HHS/Centers for Leprosy Relief 3966 3966.06 $125,000
Table 3.3.08:
Care Enhancement Project (PHCEP), in 2006 through its sub-partner, the Catholic Health Association of
India (CHAI), delivered through Primary Health Centers (PHCs) across 10 high burden districts in Andhra
Pradesh (AP). HIV care and support services, including TB/HIV services are provided with help of nurses
who are posted in the PHCs. These activities will be continued in FY09 as the services are planned to be
mainstreamed into HIV-related services in the state.
Activities such as clinical screening, referral for sputum examinations, and follow-up and referrals of DOTS
treatment are done by the nurse practitioner (NP) based at the PHC. The target group includes those
PHCs. USG will continue to strengthening the linkages between the National TB Program and HIV services
by increasing the number of cross-referrals. The focus of palliative care efforts is on training of the PHC
staff, screening and treatment for TB, and facilitating linkages for TB/HIV co-infection in PLHAs.
for supervision of the PHC HIV/AIDS activities in the ten high-burden district have been supported by USG
funds, which will end in FY09 due to the integration of the project into the national DAPCU structure. This
integration forms part of the sustainability plan for the PHC Enhancement Project, which will be handed over
to the government as the project enters its fifth year of USG support.
USG has been working in AP with LEPRA, and its sub-partner CHAI, since 2005. CHAI, established in
1943, is India's largest faith-based organization in the health sector with nearly 3,273 member institutions
that include large, mid-sized and small hospitals, health centers, and diocesan social services societies.
CHAI promotes community health and enables the community, especially the poor and the marginalized, to
be collectively responsible for attaining and maintaining their health, demand health as a right, and ensure
availability of quality health care at reasonable cost.
peri-urban. A total of 266 Integrated Counseling and Testing Centers (ICTCs) offer PPTCT, CT, and
TB/HIV care, support and treatment services at the PHC level. Each PHC, the basic health care unit in
India, serves a population of 30,000. Given the vast coverage of PHCs and the urgent need for rural
The PHCEP works closely with the State TB Control Society, combining efforts to track all cross-referrals
and complete treatment of all patients diagnosed with tuberculosis. The PHCs also function as DOTS
centers and TB diagnosis and treatment facilities are present and operational in all PHCs. Establishment of
sustainable linkages between HIV and TB services are an important activity carried out by the nurses. TB is
a major cause of morbidity and mortality among PLHA so the integration of these services is vital.
ACTIVITY 1: Primary Health Center Enhancement Project
In FY09, there will be a stronger focus on making TB/HIV cross-referral services a routine part of PHC
processes under the PHCEP. Existing data in AP shows that there continues to be loss of TB cases after
referral, resulting in difficulty in follow-up. The project will strengthen referrals of clients from ICTCs to TB
centers, as well as the provision of counseling and testing services for all TB patients referred from TB
centers. TB/HIV specific counseling will also be strengthened. Focus areas will include tracking all referred
cases to diagnostic facilities for TB and establishing an efficient reporting system. This will be done by
facilitating greater coordination between the nurse and the district TB program staff, which will be ensured
through monthly review meetings and supervision by USG's district-level nurse supervisors and the
DAPCU.
Screening for TB among family members, partner screening for STI and treatment will be integral part of
these services. It is estimated that the nurses will reach about 521 clients with TB/HIV co-infection for
treatment.
PHCEP nurses will be given refresher training on TB/HIV reporting during the review meetings organized by
APSACS and the DAPCUs. These activities will be monitored through the USG-funded supervision system.
Continuing Activity: 16415
16415 16415.08 HHS/Centers for Leprosy Relief 6767 3966.08 $25,000
Table 3.3.12:
Leprosy Relief Association (LEPRA) is a nodal NGO providing technical assistance and support to the
Government of Andhra Pradesh AIDS Control Society (APSACS) in the area of counseling and testing (CT).
Through the Primary Health Care Enhancement Project (PHCEP), USG supports the state in a scaled up
CT initiative in 266 Primary Health Centers (PHCs) spread across 10 high-burden districts, covering
approximately 13 million persons. A mobile CT van provides services for areas with high concentrations of
vulnerable groups (migrants, clients of sex workers, truckers at halt points, industries, and tribal
communities). Additionally, LEPRA will roll out a Prevention with Positives intervention, with a focus on
follow-up counseling, to support care and treatment services for PLHA.
LEPRA, an NGO based in Hyderabad, in the southern state of Andhra Pradesh (AP), works with sub-
populations in selected villages across 53 districts in 4 states of India: AP, Orissa, Bihar and Madhya
prevention, care and support to PLHA, malaria, and prevention of blindness. Its strengths are grassroots
level interventions for rural, vulnerable, and difficult-to-reach sub-populations. LEPRA emphasizes
sustainability and cost-effectiveness by building individual and partner agency capabilities. LEPRA is a
leading partner of APSACS in implementing a large scale HIV CT program in over 500 health facilities and
also partners with APSACS in other state level HIV interventions.
USG has been working in AP with LEPRA and its sub-partner the Catholic Health Association of India
(CHAI) since 2005. CHAI, established in 1943, is India's largest faith-based organization in the health sector
with nearly 3,273 member institutions that include large, mid-sized and small hospitals, health centers, and
With a population of 80.8 million, AP has an estimated 500,000 PLHA. Antenatal HIV prevalence is over 1%
in 19 of the 23 districts, yet access to HIV services is scarce, especially in the rural areas. APSACS has
scaled up CT services to the rural primary health center level. A total of 677 Integrated Counseling and
Testing Centers (ICTCs) offer PPTCT, CT, and TB/HIV care, support and treatment services, of which 266
are located at the PHC level. Each PHC, the most basic health care unit in India, serves a population of
30,000. Given the vast coverage of PHCs, the integration of HIV/AIDS services into the existing PHC level
makes services very accessible.
The PHCEP supports supervision and training in HIV/AIDS services for a nurse for each PHC in the project.
The comprehensive training includes CT, PMTCT, OI and STI treatment, community prevention outreach,
home based follow-up care, and referral services. The target population is mostly from the rural community,
including high-risk men and women, referrals within the PHC or by local health practitioners, persons
suspected of TB, and families of PLHA. The nurses are government staff, not paid for by LEPRA. USG
pays for the a system of supervision, whereby one supervisor for every 10-15 NPs visits each center, on
average once every four weeks, to provide on-site supervision, training, and feedback.
Each PHC offers CT services, reaching out to the surrounding communities, demand generation for CT
through outreach, pre- and post-test counseling, and referrals for PMTCT, OI and STI treatment as needed.
HIV-positive clients counseled for positive prevention and linked to government centers for CD4 screening
and ART, as appropriate. HIV testing is carried out at the PHCs using GOI protocols. From January-
December 2007, 168,215 clients received counseling and were tested for HIV, of which 12,755, were
diagnosed HIV-positive. In FY09, it is estimated that about 143,959 client will be screened for HIV and
counseled at the 266 centers. A community risk mapping process will be completed to improve HIV testing
referral in CT settings.
ACTIVITY 2: Training and On-Site Supervision for PHC Staff
IN FY09, USG, in collaboration with district health authorities, will provide follow-up training for technicians
and outreach staff of the PHCs on HIV counseling and testing. Hands-on refresher training for the 266
nurses at the PHCs will address both the counseling skills and processes and the quality of counseling.
The training will also address encouraging the testing or spouses, couple counseling and partners
notification. This will support sustainability of the quality of services in these high-burden districts as the
project is transitioned to management by the DAPCUs. The Nurse Supervisors and the nurses will also be
trained on capturing gender-disaggregated information about HIV testing and counseling, as well as on
health-seeking behavior and gender-related risk mapping.
Field visits will be used to improve the skills of Nurse Supervisors and nurses. The Nurse Supervisors are
trained and will be further capacitated in supportive supervision and quality control mechanisms. Quality
assurance mechanisms and supply chain systems for CT and other elements of the PHCEP program will be
monitored and strengthened through technical advisory support and advocacy with government
counterparts. In FY 09 the Supervisors, with support from the newly appointed DAPCU team at the district
level, will mentor the NPs on issues like cross referral from CT for TB and STI, and loss to follow up.
Activity Narrative: ACTIVITY 3: Mobile Voluntary Counseling and Testing Van (MVCT) in AP
Under the National AIDS Control Program Phase 3 (NACP-III), mobile CT will be scaled up to reach high-
risk and remote communities. Implementation can be facilitated by using cost-efficient Indian models as
learning sites. In FY09, LEPRA will continue to provide CT services through its mobile CT van, and will
document implementation and disseminate lessons learned to help scale-up of this approach.
The goal of the MVCT is to reach MARPs, truckers, tribal populations and migrant populations at
construction sites and the population at the remote location of East Godavari where no VCTC services are
available. The MVCT consists of a medical officer and a trained lab technician/ counselor (male). The
MVCT has flexible working hours to reach the service areas and provides syndromic treatment for STIs, OI
treatment, and antenatal care, in addition to HIV individual and group counseling and testing. A mobile
communication van visits the area in advance to generate demand. The van also screens audio-visuals on
HIV, and staff answers questions from the community. Two Link Workers have been recruited to provide
PLHAs with psychosocial support, family counseling and need-based referrals to service centers, such as
ICTCs, ART, Care Treatment and Support centers. In FY09, the MVCT will provide CT to nearly 6,500
people..
Since 2006 the van has operated in 3 divisions of East Godavari District, including remote tribal areas, with
a population coverage of nearly 250,000. The project has developed networks and linkages with the
Government, private and NGO sectors. HIV test kits, registers and reporting formats, and medication to
treat STI and OI are contributed by APSACS, while LEPRA supports the human resources.
The project is now being scaled up. The MVCT concept, operation and performance have been shared
among various NGOs and APSACS for promotion, support and utilization of its services. After observing the
performance of the MVCT in the East Godavari, APSACS in collaboration with District Collector, Hyderabad
and Automotive Manufactures has rolled out similar MVCT in Hyderabad Urban and is about to scale up to
five more MVCTs for high-burden districts in AP. LEPRA will give TA to APSACS for this roll out and will
share the data reporting formats that were developed for use on the MVCTs.
In FY09, LEPRA will expand mobile CT to at least one more district with USG support and is likely to
leverage government funds to expand this concept to 4 more districts in the next two years. Discussions
have also begun with the Andhra Pradesh State Aids Control Society (APSACS) about APSACS funding to
meet the running costs of the MVCT, specifically vehicle maintenance and MVCT staff.
ACTIVITY 4: Training in Follow-Up Counseling
LEPRA will continue a Positive Prevention program in FY09, in line with NACP-III's strategic approach.
Current counseling programs primarily focus on the prevention of HIV for those at risk. LEPRA will integrate
follow-up counseling into the existing counseling structure, to address the array of advanced physical,
psychological and social issues and vulnerabilities that clients present during follow-up counseling sessions
after immediate post-test counseling and thereby improve the quality of life of PLHAs. The program will use
a six-module toolkit developed by CDC and IndiaCLEN. The toolkit complements NACO counseling
materials and
focuses on the long-term issues of living with HIV/AIDS beyond adherence to antiretroviral therapy (ART).
In FY08, LEPRA funded training in follow-up counseling for 700 district-level counselors and PHC nurses
and will continue to monitor this activity in FY09. LEPRA will also train members of the Telugu Network of
Positive People (TNP+) and counselors from its partner NGOs to provide follow-up counseling. In FY09,
nearly 200 counselors at ART and Community Care Centers will also be trained by LEPRA. As this is the
final year of the project, the monitoring and further training will then be taken over by APSACS.
ACTIVITY 5: Mobile Voluntary Counseling and Testing (MVCT) in Orissa
Orissa is a Northeastern coastal state with a poorly developed health infrastructure and low health
indicators. Five of its 30 districts are classified as high prevalence. LEPRA was requested to provide
technical assistance to strengthen ICTC services in the state of Orissa, including strengthening the MIS
system.
In FY09, LEPRA will start MVCT services to serve two blocks in Ganjam, the district with the highest HIV
prevalence of in the state of Orissa. The project will use the MVCT to reach high-risk and remote
communities with CT, STI syndromic case management, and referral services for PLHAs. Running costs for
the vehicle and staff in FY09 will be met by LEPRA. The Orissa State AIDS Control Society (OSACS) will
provide HIV kits, laboratory consumables, registers, reporting formats and IEC material, though the daily
and monthly reporting formats develop by LEPRA for the MVCT will be shared with OSACS. In FY09, the
MVCT is expected to provide CT services to 3,500 people.
Depending on operational feasibility, MVCT services will be expanded to Koraput district. Beyond the
project period, LEPRA will transition the MVCT to OSACS.
Continuing Activity: 14301
14301 6217.08 HHS/Centers for Leprosy Relief 6767 3966.08 $100,000
10882 6217.07 HHS/Centers for Leprosy Relief 5616 3966.07 $130,000
6217 6217.06 HHS/Centers for Leprosy Relief 3966 3966.06 $130,000
Estimated amount of funding that is planned for Human Capacity Development $10,000
Table 3.3.14:
LEPRA, with support from USG and the Andhra Pradesh State AIDS Control Society (APSACS), provides
strategic information (SI) technical assistance and support at the state and district level for program
planning, management, and implementation. A key area of USG support is the strengthening a system of
decentralized, district-level data management, and facilitating its use for strategic decision making.
The southern state of Andhra Pradesh (AP) has a population of nearly 78 million, divided in 23
administrative districts. It has an estimated 500,000 PLHA, the largest number in the country. LEPRA, with
support from USG and APSACS, rolled out a large comprehensive prevention, care, treatment, and support
program, the Primary Health Care Enhancement Project (PHCEP) in AP in 2006. These activities will
continue through FY09 and will benefit from the SI activities.
LEPRA Society, an NGO based in Hyderabad, AP, works among sub-populations in select villages across
53 districts in four states of India: AP, Orissa, Bihar and Madhya Pradesh, covering a total population of 12
million. Current programs include activities in public health and rural development, such as TB interventions,
HIV awareness and prevention, care and support to PLHA, malaria, and prevention of blindness. Its
strengths are grassroots level interventions for rural, vulnerable, and difficult-to-reach sub-populations.
LEPRA emphasizes sustainability and cost-effectiveness by building individual and partner agency
capabilities. LEPRA Society is a leading partner of the Government of Andhra Pradesh, APSACS, in
implementing a large scale HIV counseling and testing program in over 500 health facilities and is also a
joint implementing partner of APSACS in other critical state level HIV interventions.
USG has been working in AP with LEPRA, and its sub partner Catholic Health Association of India (CHAI),
since 2005. CHAI, established in 1943, is India's largest NGO in the health sector with nearly 3,273 member
institutions that include large, mid-sized and small hospitals, health centers, and diocesan social services
societies. CHAI promotes community health and enables the community, especially the poor and the
marginalized, to be collectively responsible for attaining and maintaining their health, demand health as a
right, and ensure availability of quality health care at reasonable cost.
Under the National AIDS Control Program Phase III (NACP-III), there is a strong emphasis on district level
program planning, implementation, and review through new District AIDS Prevention and Control Units
(DAPCUs). With PEPFAR funds, LEPRA developed the District Program Management (DPM) concept to
demonstrate a decentralized model of district level program and data management in the state. The
intention is for the DPM model to work in synergy with NACP-III's DAPVU management model as the
national plan moves into its implementation phase.
APSACS has already put in place DPMs and Monitoring and Evaluation Officers to monitor all HIV program
interventions at the district level. The DAPCUs will be set up by NACO in 2009, so USG support for the
DPM initiative will end by the end of 2008. The responsibilities covered by the DPM will then be shared
between the Nurse Supervisors and the new DAPCU team. CHAI and LEPRA Society will transfer
technical and managerial training and capacity building from the DPM teams to the DAPCUs in the six
intervention districts as needed.
ACTIVITY 1: Data Management and SI Systems Strengthening of the State Integrated Counseling and
Testing Center (ICTC) Program
With continuing USG support, routine data from the Primary Health Centers (PHC) related to counseling,
HIV testing, PMTCT, and outreach activity are consolidated at district level and analyzed locally to support
evidence-based program planning and decision making. This program is supported in ten high-burden
districts through Nurse Supervisors supported and trained by USG. The PHC nurses, who maintain the
date, are funded by the state government. USG provides skills-based and technical trainings on a regular
basis.
ICTC data from the USG-enhanced PHCs under the PHCEP program is of strategic significance as
evidence to inform program strategy and implementation. These facilities, located in rural community
settings, are possibly more accurate surrogate markers of HIV prevalence in the rural general population
than the HIV sentinel surveillance data that comes from urban and peri-urban facilities during a limited three
-month period each year. Nurse Supervisors, M&E officers, and DAPCU teams will be trained in internal
data management and information generation at the PHC and district level. The plans for the program differ
from the expansion of support to DPMs described in the FY08 County Operational Plan, which have been
discontinued as the DPMs will be disbanded and replace by DAPCUs.
ACTIVITY 2: Data Management Capacity Support to Field Staff
LEPRA trains USG-supported field staff in the districts on internal program review and monitoring forms.
The information collected informs USG programs about existing and emerging high-risk communities within
districts, CT-seeking behaviors, VCT needs and testing volumes, and supports routine reviews. The
supervisors were trained in FY07 (Community Risk mapping). Refresher training for supervisors will
continue until FY09. An internal program review at the PHC and sub-district level will also be carried out in
FY09.
Continuing Activity: 14305
14305 6221.08 HHS/Centers for Leprosy Relief 6767 3966.08 $100,000
10886 6221.07 HHS/Centers for Leprosy Relief 5616 3966.07 $50,000
6221 6221.06 HHS/Centers for Leprosy Relief 3966 3966.06 $50,000
Estimated amount of funding that is planned for Human Capacity Development $1,000
Table 3.3.17:
systems strengthening support at the state and district level for program planning, management, and
implementation. A key area of USG support has been strengthening the capacities of the district-level
program management team to support management of HIV/AIDS, in accordance with the third phase of the
National AIDS Control Plan (NACP-III). With the integration of national programs and support for district
teams now available through the National Rural Health Mission, LEPRA's focus for health system
strengthening is now on building the capacity of the nurses in the Primary Health Care Enhancement
Project (PHCEP), the Government ART centres and the Community Care Centres through a specialised
training and mentoring program. The PHCEP will continue its efforts to strengthen care and treatment
services at the PHC level.
When the district level management tier is discontinued (at the end of 2008), the PHCEP Nurse Supervisors
will need managerial skills and skills of delegation to enable the nurse-practitioners at PHC level to manage
multiple tasks efficiently. The nurse supervisors and district teams need to be trained in basic management,
such as supply chain management, time management, stress management, interpersonal skill building, and
understanding group dynamics. In addition, a new activity to strengthen the public health system by
capacity-building of nurses is proposed.
which will be handed over to the government as the project enters its fifth year of USG support. Major
activities will include: identifying an owner agency and completing the handover of the PHCEP to this
agency; completing dissemination and advocacy workshops at the national, state and district levels; and
sensitization workshops/field visits for the PHC doctor, DAPCUs and field staff.
(CHAI), since 2005. CHAI, established in 1943, is India's largest faith-based organization in the health
With a population of 80.8 million, AP has an estimated 500,000 PLHA. Antenatal HIV prevalence is over
1% in 19 of the 23 districts, yet access to HIV services is scarce, especially in the rural areas. APSACS has
Under NACP-III, there is a strong emphasis on scaling up care, support and treatment services. Skilled
medical, nursing and para-medical staff are required to provide quality services and ensure optimal
utilization of services by the PLHA.
In FY09, the USG will continue funding the management and supervision support of the PHCEP program to
ensure sustainability of the capacities built at the PHC level in the 10 high-burden districts. LEPRA will also
work with the DAPCUs to leverage other partners to join in supporting Indian Nurse Specialists in HIV/AIDS
and supporting ART (INSHAA) curriculum development and training. In FY09 50 nurses will be trained.
This activity is in addition to supervisor training for the PHCEP district nurse supervisors.
ACTIVITY 1: Systems Strengthening of HIV/AIDS Service Delivery at the Primary Health Care Level in
Andhra Pradesh
Since 2005, the PHCEP, supported by USG and APSACS, has worked to build the capacity of PHC nurses
to delivery quality HIV/AIDS services. In FY07, this model was scaled up from 10 to 266 PHCs, covering
36.2 million people, in 10 high-burden districts.
The strategy provided a nurse for each PHC, who was trained in comprehensive HIV/AIDS care and
treatment, including VCT, PMTCT, OI and STI treatment, community prevention outreach, home based
follow-up care, and referral services. The project targets the rural community, including high-risk men and
women, referrals within the PHC or by local health practitioners, persons suspected of TB, and families of
PLHA. The nurses are government staff, not paid for by LEPRA.
The PHCEP provides comprehensive supportive supervision, including joint participation with the
government authorities in district level reviews. Nurse Supervisors, supported in 10 districts with PEPFAR
funds, monitor the work of the PHC nurses and mentor them on technical and administrative issues to
ensure quality in service delivery. Additionally, Nurse Supervisors help build referral links with public,
private, and NGO sector hospitals for services not available in the PHC. In collaboration with the district,
the supervision team also works to strengthen supply chain systems, improve referrals and follow up, and
standardize supervisory monitoring protocols. Specific activities under the PHCEP are also described in the
relevant technical activity narratives.
The management and leadership skills of the Nurse Supervisors and the senior management team will be
Activity Narrative: strengthened by training activities for this cadre of staff. Refresher training for the PHC nurse, medical
officers and other staff in technical areas will continue, including training on national guidelines on infection
control and bio-waste management. Linkages with other programs, such as the Revised National TB
Control Program, and follow-up of pregnant, post-natal mothers and HIV-exposed infants will also continue
to be important in order to strengthen the long-term sustainability of high-quality HIV//AIDS services at the
PHC level.
ACTIVITY 2: Training for Indian Nurse Specialists on HIV/AIDS and ART (INSHAA)
Nurses are usually the first contact point for the community and individual patients with care providers. In
AP nurses are placed at various levels to provide HIV/AIDS services, including Community Care Centers
(CCC), ART centers and Primary Health Centers. There is a huge need for trained nurses at these levels.
USG will support human capacity development in AP in FY09, in which 50 nurses from ART centers, CCC
and nursing schools will be trained on specialized care of PLHA and ART. The four-week training program
will be followed by on-site mentoring of the nurses for a year, and will include the management of HIV/TB co
-infection, treatment of OIs in women, and for antenatal and post-natal HIV-positive women. By working
with nurses already posted in government settings, such as clinics, nursing schools, and colleges, the USG,
with LEPRA Society and CHAI, is working to ensure the sustainability of the HIV/AIDS program.
The training will sensitize nurses on gender issues and measures that need to be adopted to ensure gender
equity within health settings. The nurses will gain an understanding of the legal rights of women that will in
turn enable service providers to provide women increased access to services
As a result of these capacity-building measures, it is expected that the quality of services provided by the
nurses, as envisaged in NACP-III, will improve and an increased number of adult and pediatric patients will
access health facilities with minimal loss to follow-up.
Existing public and private institutions will be partners in the program by providing clinical sites for training
and technical resource.
ACTIVITY 3: Providing Technical Assistance in Mainstreaming HIV/AIDS Prevention
LEPRA will collaborate with APSACS to mainstream HIV/AIDS prevention activities into the Self-Help Group
services provided through the Indira Kranthi Padham (IKP) in partnership with the Society for Eradication of
Rural Poverty (SERP) in Andhra Pradesh. Women's Federations will be leveraged to build a sustainable
approach for the intervention. In FY09, LEPRA Society will provide TA to IKP planning and supervision to
IKP's Master Trainers in six districts. The TA is focused on ensuring quality for the program. This activity
will serve as the model for mainstreaming HIV/AIDS prevention activities to other districts in AP. A
dissemination and sensitization workshop will be organized by USG and other partners to share the
mainstreaming lessons and challenges
ACTIVITY 4: System Strengthening of State ICTC and PMTCT in Orissa
In FY09 LEPRA Society will be provide TA to the Orissa State AIDS Control Society (OSACS) to strengthen
the ICTC program by supporting one Monitoring and Evaluation Consultant, one ICTC consultant at the
state level (OSACS) and 4 zonal coordinators. Training on ICTC and monitoring and evaluation (M&E)
procedures will be provided to all concerned ICTC program staff at the state, district and sub-district level
(including to an M&E consultant, ICTC Consultant, the zonal coordinators, 25 counselors and 25 Medical
Officers). Training on mainstreaming HIV/AIDS services will also be provided to the state level Mission
Shakthi (Women's Federation) resource team to increase access to counseling and testing services.
To strengthen PMTCT services in the state, LEPRA will also support a demonstration project on PMTCT
that will be monitored and disseminated to enable scale-up to other districts (see the LEPRA PMTCT
narrative).
Continuing Activity: 14306
14306 6222.08 HHS/Centers for Leprosy Relief 6767 3966.08 $202,489
10954 6222.07 HHS/Centers for Leprosy Relief 5616 3966.07 $90,000
6222 6222.06 HHS/Centers for Leprosy Relief 3966 3966.06 $65,000
* Increasing women's legal rights
Estimated amount of funding that is planned for Human Capacity Development $120,000
Table 3.3.18:
