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 UNCHANGED FROM FY2008
FY 2008 NARRATIVE
SUMMARY
The Andhra Pradesh AIDS Consortium (APAIDSCON), a consortium of 15 private medical colleges, plans
to continue activities under this program area including: training of medical providers on positive deliveries,
managing integrated counseling and testing centers (ICTCs) in each of its 15 member medical colleges,
and motivating and following HIV-positive pregnant women to access and use PMTCT services through the
use of peer educators/outreach workers. The focus will be on improving the number of HIV-positive
pregnant women provided with Nevirapine prophylaxis and delivered in an institutional setting.
BACKGROUND
In India, over 80% of curative health care is provided in the private sector where facilities range from state
of the art to barely adequate. Traditionally medical education has been the preserve of government medical
schools; however in the last five years there has been an explosive growth of private medical schools and
over the next decade the bulk of newly trained medical graduates will come from the private sector.
In 2005, Science Health Allied Research and Education (SHARE)/MediCiti established APAIDSCON, a
consortium of 15 private medical colleges. Recently, as an effort to reach out to the private for-profit health
sector, 25 private small to medium size hospitals were added to the consortium. Fundamentally,
APAIDSCON was established as a mechanism to strengthen the organizational capacity of its member
institutions.
The fact that 15 independent and often competing private medical colleges came together and formed a
consortium to address HIV and medical education issues is a noteworthy initial outcome and model for the
country. The formation of a consortium has led to more substantive system strengthening, including the
successful completion of joint training programs, curriculum sharing, advocacy for government funded HIV
testing and counseling centers in all 15 colleges, and a linkage system for subsidized CD4 testing.
The primary aim of the consortium is to ensure that future medical graduates (over 1500 annually) as well
as nurses and allied health professionals are well trained to address HIV AIDS. APAIDSCON builds
collaborative programs with private entities as well as Government agencies, promotes the implementation
of national guidelines and best practices in addressing the HIV AIDS epidemic, and is supporting a
comprehensive multi-disciplinary strategy to combat the HIV/AIDS epidemic in the state with the highest
estimated burden of HIV in India.
ACTIVITIES AND EXPECTED RESULTS
FY07 activities for PMTCT will continue with FY08 funding. They will center on monitoring the progress of
the PMTCT program in the 15 private medical colleges and 5 nursing homes in the Consortium, through
support for staff and ongoing supervision and monitoring. PMTCT activities also include motivating
pregnant women to access counseling and testing for HIV with informed consent, using the test results to
make decisions about PMTCT, and providing appropriate referrals for follow-up care, treatment, and
support, including family planning guidance. The target population is predominantly rural in areas catered to
by the respective private medical colleges.
The objective of the PMTCT program is to make these services available to as many pregnant women as
possible. In addition to this, the program encourages institutional deliveries, especially for HIV positive
women so that prophylaxis with antiretrovirals can be administered to a mother and baby pair and
subsequent follow up is ensured.
ACTIVITY 1: Monitoring and Administration of PMTCT Program Sites
APAIDSCON is in charge of monitoring the progress of the PMTCT program in the 15 Private Medical
Colleges and 5 nursing homes (small hospitals). A counselor and a laboratory technician are placed by the
Andhra Pradesh State AIDS Control Society (APSACS) in all the institutes to provide the basic PMTCT
services. These two personnel will report to the Integrated Counseling and Testing Centers (ICTC) director
of the institute. A Field Coordinator and Program Manager are supported by APAIDSCON at state level,
who make frequent visits to the institutes to guide the counselors and laboratory technicians in providing
services in accordance with the National AIDS Control Organization (NACO) guidelines. The supervisory
staff is also responsible for data management of the PMTCT centers at the State level and for sending
regular reports to APSACS. The program is expected to cover a population of approximately 38700
antenatal mothers in FY2008.
APAIDSCON serves as a conduit for test kits, delivery kits, laboratory technicians and counselors provided
by APSACS in the 15 private medical college hospitals. The funds for these staff and commodities have
been leveraged from APSACS and are valued at over $125,000 per year. This will continue in FY2008.
ACTIVITY 2: Appointment of Peer Counselors
In FY08, to strengthen the follow up procedure for ANC mothers, 15 peer counselors will be placed in
APAIDSCON partner institutes in order to strengthen Ante-Natal Care (ANC), peri-natal prophylaxis in
infected mothers and follow up. The peer counselors' work will be field-based and they will report to the
ICTC director of each institute. As a result, it is expected that the percentage of pregnant women identified
as HIV positive who deliver in an institution and receive single dose Nevirapine (NVP) will increase from
under 50% currently to at least 70% by the end of FY08.
ACTIVITY 3: Demand Generation
Awareness will be created in the regions surrounding the medical institutes and nursing homes (small
hospitals) to encourage more and more pregnant women to access the PMTCT services provided at the
centers. To achieve this objective Information Education Communication (IEC) material in the form of
posters, flip charts, leaflets, and booklets will be supplied to the centers on a regular basis. The institutes
will conduct regular outreach activities in the community to make them aware of the facilities available at the
Activity Narrative: institute. The outreach activities will include such activities as street plays, puppet shows, and door-to-door
campaigns.
ACTIVITY 4: Training of Medical Providers
In FY08, APAIDSCON will provide OB/GYN physicians and nurses with advanced clinical training as well
refresher sessions to overcome fear and reduce stigma and discrimination. This will encourage them to
conduct more positive deliveries and provide NVP to the mother and baby pair. APAIDSCON will continue
to explore creative ways to encourage more active participation in the PMTCT program by physicians and
hospital management.
In addition, all counselors and laboratory technicians will continue to be trained on the basics of PMTCT
services. Quarterly review meetings of the counselors and the laboratory technicians will be organized at
the state level. In these review meetings/refresher courses, the skills counselors and the laboratory
technicians will be upgraded and they will be kept current with NACO guidelines.
New/Continuing Activity: Continuing Activity
Continuing Activity: 14578
Continued Associated Activity Information
Activity Activity ID USG Agency Prime Partner Mechanism Mechanism ID Mechanism Planned Funds
System ID System ID
14578 11503.08 HHS/Centers for Share Mediciti 6879 3967.08 APAIDSCON $10,000
Disease Control & (Networking)
Prevention
Emphasis Areas
Gender
* Increasing gender equity in HIV/AIDS programs
* Increasing women's access to income and productive resources
Human Capacity Development
Estimated amount of funding that is planned for Human Capacity Development $10,000
Public Health Evaluation
Food and Nutrition: Policy, Tools, and Service Delivery
Food and Nutrition: Commodities
Economic Strengthening
Education
Water
Table 3.3.01:
FY08 NARRATIVE
The Andhra Pradesh AIDS Consortium (APAIDSCON) will continue to strengthen palliative care services
within the consortium and beyond by conducting advanced clinical trainings, supporting the development of
one-two centers of excellence, establishing a low cost central pharmacy, developing partnerships with
community care centers, hiring peer educators/counselors, and strengthening HIV-focused medical
education systems.
APAIDSCON was established to strengthen the organizational capacity of its member institutions.
consortium to address HIV and medical education issues is a noteworthy initial outcome. The formation of a
consortium has led to more substantive system strengthening, including the successful completion of joint
training programs, curriculum sharing, advocacy for government funded HIV testing and counseling centers
in all 15 colleges, and a linkage system for subsidized CD4 testing.
The primary aim of the consortium is to ensure that future medical graduates (over 1,500 annually) as well
as nurses and allied health professionals are trained to address HIV/AIDS. APAIDSCON builds
collaborative programs with private entities as well as government agencies, promotes the implementation
of national guidelines and best practices and supports a comprehensive multi-disciplinary strategy to
combat the HIV/AIDS epidemic.
ACTIVITY 1: Training in Care
With FY08 funding, APAIDSCON will provide high-quality HIV palliative-care training to its health-care staff
and to the community at large. In India, there is thought to be a high variability in the quality and practices of
HIV care. APAIDSCON has developed two-day palliative-care curricula training specific to medical officers,
nurses, medical students, and house-keeping staff, that will equip participants with basic HIV care
knowledge and skills in accordance with national and international standards. Over 70% of medical and
nursing faculty and over 50% of housekeeping staff have been trained to date; the remaining staff will be
trained with FY08 funding.
APAIDSCON believes in intensive, hands-on training for medical personnel if the goal is to provide quality
HIV care services. Post training follow-up and refresher workshops are important. APAIDSCON has
developed and pilot tested a five-day hands-on training program based on this principle. The training, which
includes skills-based instruction (case-studies, bedside teaching, mentored clinical care opportunities),
teaches best practices for the prevention and treatment of opportunistic infections (OIs) associated with
HIV/AIDS. Other topics include: HIV staging, routine clinical monitoring and management of HIV/AIDS
complications, symptom diagnosis and relief, and psycho-social support, including organization of basic
necessities such as nutrition, financial assistance, legal aid, mental health services, and bereavement
support for family members. Special emphasis is placed on the cross training of these care providers on
ART screening and management.
With FY08 funding, APAIDSCON will continue to conduct these hands-on trainings for 15-20 physicians at
least quarterly. A Level 2 training program will be developed for those caring for People Living with
HIV/AIDS (PLHA) who need additional skills-based training. Level 1 and Level 2 trainings are designed to
reach members of consortium institutions in order to build their skills. However, some physicians from
NGOs and government who are providing HIV care and support services will also participate. All physicians
trained by APAIDSCON who are part of the consortium will receive quarterly follow-up visits (mentorship
visits) to ensure that acquired care and treatment skills are incorporated into practice.
ACTIVITY 2: Development of HIV Care and Training Centers
In FY08, APAIDSCON will devote time and resources to developing one or two HIV care and training
centers. In collaboration with the Andhra Pradesh State AIDS Control Society (APSACS), APAIDSCON and
CDC will likely focus on building an existing government HIV/ART center into a NACO center of excellence,
by providing technical inputs, staffing support, and training expertise while leveraging NACO/APSACS
resources to develop infrastructure, better operational systems, and a more functional and updated
laboratory. A specific center (Government Chest Hospital, Hyderabad) has been identified and relationships
between this hospital, APSACS, CDC, and APAIDSCON have grown.
A second HIV care and training center may be developed in one of the 15 medical colleges. A full
assessment of the capacities, interest, and needs of the better performing medical colleges to develop such
a center will be completed in FY08. Based on this assessment, a cost-feasible investment in strengthening
one medical college as a referral center and training center for the consortium will be considered.
ACTIVITY 3: Increase Access to HIV Care and Treatment in the Private Sector
To increase access to HIV care and treatment in the private healthcare sector, APAIDSCON will collaborate
with APSACS to establish a central pharmacy for APAIDSCON facilities and partners. The objective will be
Activity Narrative: to provide high-quality, low-cost medicines (via high-volume purchasing) to PLHAs accessing services at
APAIDSCON and partner facilities. With FY08 funding, APAIDSCON will support a pharmacy coordinator
and appropriate space for the procurement, storage, and distribution of medicines for HIV/AIDS care
(cotrimoxazole, TB treatment regimens) and treatment (ARVs).
ACTIVITY 4: Expand Care and Treatment Services
In FY08, APAIDSCON will continue to expand its care and treatment services. To date, mainstreaming of
HIV services into young, developing medical college institutions has been more difficult than expected.
Resistance remains high due to HIV-related stigma, poor technical skills to manage HIV, limited ability to
generate net income from HIV services, and poor access to affordable medication, especially ARVs.
APAIDSCON will continue to address these fundamental issues. At the same time, alternative strategies
that do not require these medical college hospitals to provide comprehensive services to huge number of
PLHAs will be implemented.
In FY08, APAIDSCON will develop closer relationships and linkages to NACO-funded community care
centers and ART centers. APAIDSCON will support their local HIV community care centers by requiring
faculty and students to rotate through these centers and provide specialty consultations. APAIDSCON will
also create ways for consortium member institutions to provide laboratory and radiological support services
to these centers. This process will also help create better linkages between institutions and will help develop
the technical capacities of the community care centers.
ACTIVITY 5: Strengthen Follow-Up
In FY08, to strengthen the follow up procedure for those who test positive, 15 peer counselors will be placed
in the partnering institutes. The job of the peer counselors will be to provide follow-up counseling support to
any PLHA seeking services in the institution. Both the peer counselors and the testing center counselor will
be provided with the CDC follow up counseling toolkit and taught how to use it as a teaching aid. This will
help ensure and standardize PLHA support services such as mental health counseling, prevention for
positives, partner notification, and dealing with stigma and discrimination. As a result of this effort, the
percentage of PLHAs who notify their partner of their status and return to the institution for follow up
counseling services will substantially increase by the end of FY08.
ACTIVITY 6: Strengthen Training Approaches
APAIDSCON has developed a HIV curriculum for medical students that is being implemented in many of
the 15 private medical colleges as an elective. In FY08, this curriculum will be strengthened based on
feedback from students and faculty. APAIDSCON and CDC will work to mainstream this as a required
module in all 15 consortium medical colleges and advocate for it to be included as a statewide module or
elective in all medical colleges.
APAIDSCON will also work to ensure that 4th and 5th year medical students and advanced year nursing
students have an opportunity to care for PLHAs on the wards or in the clinics as part of their clinical
experience. To do this, access to PLHAs and faculty bedside teaching skills related to HIV must be
improved. This will accomplished by either increasing the number of PLHAs being cared for in the medical
college hospital or making it easier for students to visit HIV care centers in the community. APAIDSCON will
also set up an elective for students to work at a tertiary HIV care and training center. In FY08, APAIDSCON
hopes to send 200 students (nursing and medical) to such centers.
Continuing Activity: 14580
14580 6226.08 HHS/Centers for Share Mediciti 6879 3967.08 APAIDSCON $50,000
6226 6226.06 HHS/Centers for Share Mediciti 3967 3967.06 $100,000
Health-related Wraparound Programs
* TB
Estimated amount of funding that is planned for Human Capacity Development $75,000
Table 3.3.08:
The Andhra Pradesh AIDS Consortium (APAIDSCON) of 15 private medical colleges have tertiary care and
treatment hospitals offering general and specialized medical and surgical services. APAIDSCON envisages
engaging these hospitals in offering both inpatient and out patient care, support and ART treatment services
to People Living with HIV/AIDS (PLHA) both as direct ART facilities as well as developing linkages with the
existing government sector ART services. APAIDSCON will also develop private sector models of ART
treatment services in partnership with NACO and APSACS.
In 2005, Science Health Allied Research and Education (SHARE)/MediCiti established a consortium of 15
private medical colleges named the Andhra Pradesh AIDS Consortium (APAIDSCON). Recently, as an
effort to reach out to the private for-profit health sector, 25 private small to medium size hospitals were
added to the consortium. Fundamentally, APAIDSCON was established as a mechanism to strengthen the
organizational capacity of its member institutions.
ACTIVITY 1: Training in ART
In FY 08, APAIDSCON plans to utilize its position within the private health care sector as well as its
relationship with the public health-care system to provide high-quality ART training to its health-care staff
and to the community at large. In India, there is thought to be a high variability in the quality and practices
towards ART management. APAIDSCONS has developed two-day curricula training specific to medical
officers, nurses, medical students, and house-keeping staff, that will equip participants with basic HIV care
and treatment knowledge and skills as per national and international standards. To date, over 70% of
medical and nursing faculty have been trained and over 50% of housekeeping staff have been trained. In
FY08, the remaining medical and nursing faculty and housekeeping staff will be trained.
APAIDSCON fundamentally believes in the value of more intensive, hands-on training for medical personnel
if the goal is for these trainees to provide quality HIV care services, including ART management. Post
training follow-up and refresher workshops are equally important. APAIDSCON has developed and pilot
tested a 5 day hands-on training programs based on this principle. The training, which includes skills-based
(i.e. case-studies, bedside teaching, clinical care opportunities) instruction from HIV/AIDS technical experts
from around the world, teaches best practices for the management of HIV, with a focus on ART. Specific
topic areas include: routine clinical monitoring and management of ART and its complications, diagnosis
and treating of immune reconstitution syndrome, diagnosis and management of ART drug failure, and how
to assess and encourage medication adherence.
In FY08, APAIDSCON will continue to conduct these hands-on trainings for 15-20 physicians at least
quarterly. A level 2 training program will be developed for those caring for PLHAs who require and want
additional skills-based training. Level 1 and level 2 trainings are designed to reach consortium members in
order to build their skills and capacities. However, some select physicians from NGOs and government who
are providing HIV care and support services will be allowed to participate. All physicians trained by
APAIDSCON who are part of their consortium will receive quarterly follow-up visits (mentorship visits) to
ensure that acquired care and treatment skills are retained and incorporated into practice.
ACTIVITY 2: Development of Training Centers
In FY08, APAIDSCON will devote substantial time and resources into developing 1-2 HIV/ART care and
training centers. In collaboration with the Andhra Pradesh State AIDS Control Society (APSACS),
APAIDSCON and CDC will likely focus on building an existing government HIV/ART center into a NACO
center of excellence, by providing technical inputs, staffing support, and training expertise while leveraging
NACO/APSACS resources to develop infrastructure, better operational systems, and a more functional and
updated laboratory. A specific center (Government CHEST Hospital, Hyderabad) has already been
identified and relationships between this hospital, APSACS, CDC, and APAIDSCON have grown.
A second HIV care and training center may be developed in one of the existing 15 medical colleges. A full
assessment of the capacities, interests, and needs of the better performing medical colleges to develop
such a center will be completed in FY08. Based on this assessment, a cost-feasible investment in
strengthening one medical college as a referral center and training center for the consortium will be
considered. APAIDSCON and USG would work with NACO to provide free ART to this non-governmental
Activity Narrative: medical college as part of this strategy.
ACTIVITY 3: Development of Central Pharmacy and Low-Cost ART Package
APAIDSCON will collaborate with APSACS to establish a central pharmacy for APAIDSCON facilities and
partners. The objective will be to provide high-quality, low-cost medicines (via high-volume purchasing) to
PLHAs accessing services at APAIDSCON and partner facilities. In FY08, APAIDSCON will support a
pharmacy coordinator and appropriate space for this pharmacy for the procurement, storage, and
distribution of medicines for HIV/AIDS care (e.g. co-trimoxazole, TB treatment regimens) and treatment
(ARVs).
As a related strategy, APAIDSCON will attempt to develop a low cost monthly ART package and market it
to PLHAs who cannot or do not want to receive ART through the government system. Private sector
physicians trained by APAIDSCON would be eligible to take part in this system. Patients would be offered a
package of standard ART services include first line drugs, periodic CD4 testing, basic labs, counseling
support, nutrition support, and physician fees for a standard monthly fee. The fee would have to be
significantly cheaper than the current market price for these services, which may be possible with bulk drug
purchases and a centralized subsidized lab service as exists in APAIDSCON. If successful, this could serve
as an important model for the state and India.
ACTIVITY 4: Expanding Treatment Services
In FY08, APAIDSCON will continue to find ways to expand its care and treatment services. To date,
mainstreaming of HIV services into young, developing medical college institutions has been more difficult
than expected. Resistance remains high due to HIV-related stigma, poor technical skills to manage HIV,
limited ability to generate net income from HIV services, and poor access to affordable medication,
especially ARVs. APAIDSCON will continue to address these fundamental issues. At the same time,
alternative strategies that do not require these medical college hospitals to provide huge number of PLHAs
comprehensive services will be implemented.
Consequently, in FY08, APAIDSCON will develop closer relationships and linkages to NACO-funded
community care centers and ART centers. APAIDSCON will support their local HIV community care center
by requiring faculty and students to rotate through these centers and provide specialty consultations.
APAIDSCON will also create ways for consortium member institutions to provide laboratory and radiological
support services to these centers. This process will also help create better linkages between institutions and
will help develop the technical capacities of the community care centers as ART link centers (ART down
referral centers under NACP3).
ACTIVITY 5: Increase Hands-On Training in ART
APAIDSCON will increase the clinical exposure of 4th and 5th year medical students and advanced year
nursing students, to caring for PLHAs on the wards or in clinics, including experience of ARV diagnosis and
treatment. To do this, faculty bedside teaching skills related to HIV and access to PLHAs will have to be
college hospital or making it easier for students to visit HIV ART centers in the nearby community.
APAIDSCON will also set up an elective for students to work at a tertiary HIV care and training center. In
FY08, APAIDSCON hopes to send over 200 nursing and medical students to such centers for more in depth
HIV teaching and sensitization.
Continuing Activity: 14583
14583 6225.08 HHS/Centers for Share Mediciti 6879 3967.08 APAIDSCON $25,000
6225 6225.06 HHS/Centers for Share Mediciti 3967 3967.06 $50,000
Workplace Programs
Table 3.3.09:
NEW ACTIVITY NARRATIVE:
SHARE India has established an innovative "consortium" structure, the Andhra Pradesh AIDS Consortium
(APAIDSCON) to reach out to private medical colleges in Andhra Pradesh (AP). This consortium will
continue to be strengthened in FY09 and in doing so, will be able to participate in a number of important
system strengthening activities and policy initiatives across the state. The consortium's aim is to ensure
that future medical graduates are well trained to address HIV/AIDS, including training in palliative care for
both adults and children.
In India most health care (~80%) is provided in the private sector where facilities range from state of the art
to barely adequate. Traditionally medical education has been the preserve of Government Medical Schools;
however in the last five years there has been an explosive growth of private medical schools and over the
next decade the bulk of newly trained medical graduates will come from the private sector.
Private Medical Colleges named the Andhra Pradesh AIDS Consortium (APAIDSCON). Recently, as an
added to the consortium. By establishing APAIDSCON, SHARE/MediCiti has developed and promoted a
as nurses and allied health professionals are well trained to address HIV / AIDS. APAIDSCON builds
collaborative programs with private entities as well as government agencies to enhance access to
counseling, testing and care for HIV-infected individuals and implement effective programs. APAIDSCON
promotes the implementation of national guidelines and best practices in addressing the HIV AIDS
epidemic.
Fundamentally, APAIDSCON was established as a mechanism to strengthen the organizational capacity of
its member institutions. The fact that 15 independent and often competing private medical colleges came
together and formed a consortium to address HIV and medical education issues is a noteworthy initial
outcome and model for the country. Of course, the formation of a consortium has led to more substantive
system strengthening, including the successful completion of joint training programs, curriculum sharing,
advocacy for government- funded HIV testing and counseling centers in all 15 colleges, and a linkage
system for subsidized CD4 testing.
To strengthen the services and linkages of the consortium members with the public health system,
APAIDSCON has appointed peer counselors. The peer counselors are themselves HIV positive and our
experience shows that they are well accepted in the community/society. They play a major role in follow up
of HIV positive mothers.
Palliative care is a holistic approach that begins with the diagnosis of HIV infection and continues
throughout the course of this chronic condition. Palliative care is complementary to antiretroviral therapy
(ART) and becomes increasingly important as the disease progresses. The need for palliative care services,
and the types of services needed, changes due to the progressive and fluctuating nature of HIV disease
and the evolving needs of the individual and the family.
Paediatric care is an essential component in the HIV epidemic. It starts with PMTCT: reaching an HIV-
positive mother with ARV prophylaxis is the first step towards paediatric care. Children born to an HIV-
positive mother then need to be followed up by the peer counselors to ensure that the children get support
in their first few years of life. These children are monitored for the infection through regular follow up to
ensure testing and management of the infection in the public sector at regular intervals.
ACTIVITY 1: Follow Up and Referral Mechanisms for Medical Services
Many pregnant women are diagnosed HIV seropositive during the third trimester, or late in pregnancy or
during labour. This reduces the likelihood that they have visited an Integrated Counseling and Testing
Center (ICTC), which means the women lack knowledge about the available health facilities for child
diagnosis and about referral systems.
APAIDSCON has appointed peer counselors who are PLHIV working with the partner institutes (PIs) in the
Consortium and the ICTCs to link the PIs to various public programs. Peer counselors play a major role in
referral and follow up of the PLHIV from the PIs to various public sector medical-service institutions.
APAIDSCON through the peer counselors will establish a mechanism to follow up all children born to HIV-
positive mothers in order to link these children to infant HIV diagnostic facilities in the public sector. Early
identification of HIV- seropositive status will also facilitate substitution for prolonged breast feeding.
The peer counselors will follow up all HIV-positive mothers delivered within their intervention area. They will
conduct regular home visits to monitor the children's health and well being and link them with the medical
college or a nearby healthcare institution for any health problems. They will also link children as needed
with the NACO- run ART centers for timely cotrimoxazole prophylaxis and diagnosis of opportunistic
infections, and will follow up children living with HIV (CLHIV) who are linked to the ART center to monitor
adherence.
Various other organizations provide services to HIV-positive children, such as nutrition, family counseling,
and child support. The peer counselors will identify the institutions providing these non-medical services in
their locality and link the pediatric patients/children of HIV-mothers for various non-medical services like
nutrition, counseling, and education.
ACTIVITY 2: Building the Capacity of Medical Personnel
In AP the NACO-run ART centers provide ART to eligible CLHIV at all centers but there is only one referral
Activity Narrative: Pediatric Center. With 0.88% being the HIV-prevalence among pregnant women and an estimated one third
of this population HIV-positive if there is no intervention, there is a sizeable population of CLHIV. To
address the needs of these children, APAIDSCON will build the capacity of the partnering institutes on the
management of pediatric HIV. All APAIDSCOM member institutions have a pediatrics department as a
specialty and hence the capacity building program will enhance clinical skills in providing palliative care for
children.
Pediatricians and physicians will be offered an intense four day hands-on clinical training at centers
established in providing care for PLHIVs. This will provide them with much needed experience in outpatient
and inpatient services, diagnosing and treating opportunistic infections and concepts of antiretroviral
management. Review programs will be offered to strengthen the capabilities and provide a platform for the
clinicians to interact with other clinicians and trainees to share experiences and difficulties.
ACTIVITY 3: Providing Care to CLHIV
APAIDSCON partners, specifically the medical colleges that are tertiary level care providers, will support the
palliative care of children living with HIV/AIDS in their institutes by providing routine clinical monitoring and
follow up, which will include diagnosis and management of HIV/AIDS related complications. The PIs will
also work towards managing opportunistic infections both at the prevention and treatment levels. The
trained pediatricians and physicians will be expected to start providing care in line with national standards
and protocols.
New/Continuing Activity: New Activity
Continuing Activity:
* Child Survival Activities
Estimated amount of funding that is planned for Human Capacity Development $20,000
Program Budget Code: 11 - PDTX Treatment: Pediatric Treatment
Total Planned Funding for Program Budget Code: $25,000
Total Planned Funding for Program Budget Code: $0
Table 3.3.11:
The Andhra Pradesh AIDS Consortium (APAIDSCON) will continue to strengthen TB-HIV services within
the consortium and beyond by conducting advanced clinical trainings, supporting the development of one to
two centers of excellence, establishing a low cost central pharmacy and developing partnerships with
community care centers. Linkages between TB services and HIV testing and treatment will be
mainstreamed within the care delivery system for each partnering institution in FY08. Many of these TB
activities are also described under the Palliative Care program area.
sector, 25 private small to medium size hospitals were added to the consortium. Many of these hospitals are
designated as microscopy centers under the Revised National TB Control Program (RNTCP).
its member institutions.
of national guidelines and best practices in addressing the HIV/AIDS epidemic, and is supporting a
ACTIVITY 1: Training in TB/HIV
In FY08, APAIDSCON plans to use its position within the private health care sector as well as its
relationship with the public health care system to provide high-quality TB-HIV training to its health care staff
and to the community at large. In India, there is thought to be a high variability in the quality and practice of
HIV care. APAIDSCON has developed a two-day curricula training specific to medical officers, nurses,
medical students, and housekeeping staff, that will equip participants with basic TB-HIV care, knowledge
and skills in accordance with national and international standards. To date, over 70% of medical and
nursing faculty have been trained. With FY08 funding, the remaining medical and nursing faculty will be
trained.
APAIDSCON believes in the value of more intensive, hands-on training for medical personnel if the goal is
for these trainees to provide quality HIV care services. Post training follow-up and refresher workshops are
equally important. APAIDSCON has developed and pilot tested a five-day hands-on training programs
based on this principle. The training, which includes skills-based (case-studies, bedside teaching rounds)
instruction from HIV/AIDS technical experts from around the world, teaches best practices for the prevention
and treatment of opportunistic infections (OIs) associated with HIV/AIDS, with a special focus on TB-HIV co-
infection. Trainees are informed on the clinical, epidemiologic, and programmatic overlap of the TB and
HIV/AIDS epidemics (TB/HIV). Standard practices for regular screening, diagnosing, and treating TB among
HIV-infected patients are taught. Special emphasis is also placed on the referral and screening of TB/HIV
patients for ART care.
quarterly. A Level 2 training program will be developed for those caring for People Living with HIV/AIDS
(PLHA) who require and want additional skills-based training. Level 1 and Level 2 trainings are designed to
reach consortium members in order to build their skills and capacities. However, some select physicians
from NGOs and government who are providing HIV care and support services will be allowed to participate.
All physicians trained by APAIDSCON who are part of their consortium will receive quarterly follow-up visits
(mentorship visits) to ensure that acquired care and treatment skills are retained and incorporated into
practice. All personnel will also come from centers that have been approved by the RNTCP to provide TB
treatment as per national guidelines (that is, using DOTS).
In FY08, APAIDSCON will devote substantial time and resources into developing one-two HIV care and
updated laboratory. A specific center (the government Chest Hospital in Hyderabad) has already been
identified and relationships between this hospital, APSACS, CDC, and APAIDSCON have grown. The
Chest Hospital currently provides extensive TB management. Its faculty is chest physicians with expertise in
TB and to some degree TB-HIV.
Activity Narrative: A second HIV care and training center may be developed in one of the existing 15 medical colleges,
following a full assessment. This center will also include an extensive program and training in TB
management.
ACTIVITY 3: Establishment of Central Pharmacy
partners. The objective of this central pharmacy will be to provide high-quality, low-cost medicines (via high-
volume purchasing) to PLHAs accessing services at APAIDSCON and partner facilities. In FY08,
APAIDSCON will support a pharmacy coordinator and appropriate space for this pharmacy for the
procurement, storage, and distribution of medicines for HIV/AIDS care (cotrimoxazole, TB treatment
regimens) and treatment (ARVs).
ACTIVITY 4: Expanding Care and Treatment Services
alternative strategies that do not require these medical college hospitals to provide a huge number of
PLHAs comprehensive services will be implemented.
centers and ART centers. APAIDSCON will support local HIV community care centers by requiring faculty
and students to rotate through these centers and provide specialty consultations. APAIDSCON will also
create ways for consortium member institutions to provide laboratory and radiological support services to
these centers, with a special focus on TB diagnostic services. This process will also help create better
linkages between institutions and will help develop the technical capacities of the community care centers.
Continuing Activity: 14581
14581 11502.08 HHS/Centers for Share Mediciti 6879 3967.08 APAIDSCON $5,000
Estimated amount of funding that is planned for Human Capacity Development $5,000
Program Budget Code: 13 - HKID Care: OVC
Total Planned Funding for Program Budget Code: $1,425,338
Program Area Narrative:
Overview: There is limited data on the number of HIV-infected children in India and it is estimated that about 94,000 children are
living with HIV/AIDS (Technical Estimation Group, NACO, 2007). Similarly there is a paucity of information on orphans (defined as
a child under age 18 who has lost one or both parents) infected or affected by HIV. Based on the 2007 revised estimate of the
number of HIV-infected adults (2.47 million), there may be anywhere between 6-8 million Indian children with an HIV-positive
father, mother or both (estimate presented by UNICEF at the release of the National Policy on Children and AIDS, 2007).
Responsibility for providing services for orphans and vulnerable children (OVC) rests with several government agencies: the
National AIDS Control Organization (NACO), the Ministry of Health and Family Welfare (MHFW); the Ministry of Women and Child
Development (MWCD) and its new flagship $476 million project, the Integrated Child Protection Scheme (ICPS). Children
impacted by HIV/AIDS are the responsibility of District child protection units of the ICPS, which address legal rights and
entitlements and deal with cases of discrimination or abuse of children arising from any cause. Other stakeholders are the
Ministry of Social Justice and Empowerment and the Ministry of Human Resource Development and the Lawyers Collective.
OVC are not a priority under India's third AIDS Control Plan (NACP-III), with ‘affected children' (as they are referred to in the
NACP-III document) being addressed only in the context of the provision of pediatric care and treatment if they are infected, or
infant diagnosis through the PMTCT program. Most OVC programs have been implemented through USG support or by faith-
based and non-governmental organizations through private funding. Coordination between the various government nodal
agencies for different functions related to the holistic development of children is also inadequate.
As a key member of the National Task Force Committee on Children Affected by HIV/AIDS, USG advocates for policy and
guidelines for OVC. Collaboration with UNICEF has successfully resulted in the launch of a national policy framework for children
and AIDS, followed by USG-supported development of national guidelines. The national guidelines for implementing OVC
programs outline steps for ensuring access to care, support, treatment, and protection services for children affected by HIV/AIDS
and define the minimum package of services for such children. These are: health/medical care, psychosocial support, nutrition
support, education support, and special services such as social protection, economic strengthening, legal support and
shelter/alternative care. The national definition of children infected and affected by HIV/AIDS and the package of proposed
services is consistent with the PEPFAR policies on OVC.
Leveraging and Coordination: Many players provide support for OVC in India. These include UNICEF, Save the Children, the
Clinton Foundation, the HIV/AIDS Alliance, the Children's Investment Fund Foundation (CIFF), the Elton John AIDS Foundation,
FHI, CARE, the Lawyers' Collective and the Global Fund Round 6 funds. The large number of players makes possible leveraging
by USG for services beyond medical care such as education, psychosocial care and food security. Through the national-level
Mainstreaming Task Force, USG has actively promoted the coordination at the district level of health, nutrition and education
services for all children, including OVC. The Task Force promotes the mainstreaming of HIV/AIDS activities across 31 priority
Ministries, including the Ministries of Human Resource Development (Education) and Rural Development. USG is the only non-
UN member of this Task Force, which includes UNIFEM, UNDP and UNICEF, along with NACO.
USG-supported OVC programs also leverage with schools to enroll children in OVC programs and with district health services that
provide care and ART treatment, and promote families' access to the Government of India's food subsidy programs. USG's
activities with women's self-help groups support family income by facilitating access to vocational training, an AIDS widows'
pension scheme, and loans for income generation. Other examples of leveraging are linkages with faith-based organizations such
as Catholic Relief Services, which sponsors livelihood support for OVC, and pharmacists' associations that provide drugs for OI
treatment to the USG OVC programs.
Current USG Support: USG was one of the first donors to initiate OVC programs in India. Under the IMPACT project, Family
Health International established 34 programs reaching around 50,000 vulnerable children in Tamil Nadu, Maharashtra, Andhra
Pradesh (AP) and Delhi and firmly built the foundation for a robust OVC program. These have since been taken over by the AIDS
Prevention and Control Project (APAC), the Avert Society Project and the Enhance Projects funded by USG. Over the last six
years, USG has invested in programs for care and support; stigma reduction; community training; prevention education; socio-
economic support; family strengthening and foster care for children affected by HIV/AIDS and vulnerable children in India. USG
also developed a tool kit with guidelines on caring for children, life skills education and counseling protocols for children vulnerable
to, affected by, and living with HIV/AIDS. In Karnataka and five coastal districts of AP, USG programs work with PLHA networks to
link OVC programs with PMTCT, ART and care and support services. Priorities are providing services for children of most-at-risk
populations (MARP) and HIV-infected single mothers. Programs for single mothers include linking women to self-help groups,
legal assistance for widows' and children's rights, and facilitating birth registrations.'
USG FY09 Support: USG will continue to support a modest OVC program. Activities will focus on technical assistance at state
and national levels, and limited direct interventions, as follows:
1. Strengthen SACS, DAPCU capacity to implement OVC programs: There is limited understanding of the guiding principles for
OVC programs and of the elements that comprise a complete package of services for an affected child. Following the 2007
release of the National Policy on Children and AIDS, the national operational guidelines are being strengthened to include case
studies and best practices. The focus of USG activities in USG priority states will be on capacity building for operationalization of
the OVC guidelines, specifically building the capacity of the SACS and the new district AIDS Prevention and Control Units
(DAPCUs), to plan, manage and monitor OVC programs. Training will also be carried out for SACS-supported local organizations
to strengthen the depth and quality of OVC programs.
2. Direct implementation of selected OVC programs: USG will continue to support selected OVC interventions in the four focus
states that ensure children receive a complete package of OVC services. Key issues that will be addressed are:
• Minimizing stigma and discrimination- USG will build the capacity of NGOs, CBOs and communities to respond to HIV/AIDS and
reduce stigma and discrimination against OVC, including advocacy with district education departments and sensitizing school
administrations. In Karnataka and Andhra Pradesh, education for the Village Health Committees to avoid stigma and
discrimination for OVC will continue.
• Family and community-based approaches- In Karnataka, Maharashtra and AP, close to 7,000 OVC will be reached through USG
directly supported care and support facilities. Over 4,000 OVC will be provided primary direct services and linked to GOI services
for ART, immunization, and pre-school play centers. Community-based care to promote a family-centered approach will continue
to be the first priority, however technical assistance to build the capacity of a faith-based network which implements the USG
supported community care centers (CCC) will also be undertaken to ensure adequate care. A special focus on girl children to
ensure they are socially protected from vulnerable situations like trafficking will be undertaken through follow-up by link workers, a
cadre of outreach workers for linkages with community-care programs. Community leaders will be involved in increasing
awareness of child rights and linking with government schemes to provide a basket of services.
• Building the capacity of local organizations- Capacity-building in selected districts ( categorized as A districts based on high-
prevalence) will include training in planning OVC programs, exposure to state-of-the-art programs and training in data monitoring
systems. The OVC demonstration project in Delhi will serve as a learning site for comprehensive HIV services.
3. Increase identification of OVC: The main entry points to identify OVC are integrated counseling and testing centers (ICTC),
community care centers and drop-in centers, and positive networks. USG programs will use both NGO outreach and linkages with
direct service points to identify OVC to increase their access to services. In rural Karnataka, for example, 600 USG-supported link
workers across 1,300 villages, who provide outreach to most-at-risk and vulnerable populations, are also expected to reach an
estimated 3,000 OVC, who can be linked with services. USG will also support the Karnataka Network of Positive People (KNP+)
in coordinating and managing 18 integrated prevention and care/drop-in centers for positives (established under Global Fund
Round 6) which is another entry point for identifying OVC. Similarly, in Maharashtra, USG will work with drop-in centers in 6
districts managed by the district level networks to intensify the identification and coverage of OVC.
4. Promote linkages and coordination with GOI and NGOs: USG OVC programs will coordinate with GOI clinical services,
DAPCUs, and positive networks to ensure a full and unduplicated package of services. USG will also promote links with
community-level staff in GOI's integrated health programs: the National Rural Health Mission (NRHM)'s ASHA workers, NACO's
link workers, and MWCD's anganwadi workers and Child Protection Officers, to ensure optimal utilization of their services,
including medical care, nutritional supplementation, child protection and education. In the NGO sector, USG programs will
coordinate with the Clinton Foundation, CARE, CRS and the HIV/AIDS Alliance for services in nutrition, food and livelihood
security. Prevention programs, life skills education and focus on AB messages will also be a part of the OVC package of services.
5. Mainstream OVC issues in governance systems: At the national level, USG will collaborate with the Lawyers Collective (a
consortium of lawyers, legal academicians, legal activists and women's rights activists committed to using the law to effect policy
and judicial reforms based on the human rights framework), to review the draft HIV/AIDS Legislation Bill to ensure that it
incorporates the issues set out in the national policy and operational guidelines on OVC (developed with USG support).
Additionally, USG programs will continue to advocate with community systems, such as local self government (panchayati raj) and
the Village Health Committees, to mainstream OVC issues, such as equal access to education and health, into the processes of
local government departments. As noted above, as a member of the Mainstreaming Task Force, USG will also advocate to
mainstream HIV/AIDS programming related to children in the plans and activities of relevant Ministries.
Table 3.3.13:
APAIDSCON manages and supervises quality delivery of services in integrated counseling and testing
centers (ICTCs) in each of its 15 member medical colleges. The funds for these centers have been
leveraged from APSACS and are valued at over $125,000 per year. APAIDSCON focuses on provider-
initiated testing within the hospital setting. Streamlining the process of testing among at-risk patients is a
key FY08 activity.
As per NACO guidelines, counseling will remain an important part of the testing process. The focus of the
counseling sessions is on risk assessment, risk reduction, partner notification and testing, and linkages to
care, treatment, and support. Couple HIV Counseling and Testing (CHCT) and follow-up counseling of
PLHAs are important services provided by these ICTCs. These activities will continue in FY2008.
In India the majority of health care (~80%) is provided in the private sector where facilities range from state
of the art to barely adequate. Traditionally medical education has been the preserve of Government Medical
Schools; however in the last five years there has been an explosive growth of private medical schools and
Private Medical Colleges named Andhra Pradesh AIDS Consortium (APAIDSCON). Recently, as an effort
to reach out to the private for-profit health sector, 25 private small to medium size hospitals were added to
the consortium. Fundamentally, APAIDSCON was established as a mechanism to strengthen the
ACTIVITY 1: Support for Direct CT Services
APAIDSCON is in charge of monitoring the progress of the CT program in the 15 Private Medical Colleges.
A counselor and a laboratory technician are placed in all the institutes to provide the basic CT services.
These two personnel report to the Integrated Counseling and Testing Centers (ICTC) director of the
institute. A Field Coordinator and Program Manager are supported at state level and make frequent visits to
the institutes to guide the counselors and laboratory technicians in providing services in accordance with
National AIDS Control Organization (NACO) guidelines. These consultants are also responsible for data
management of the CT centers at the State level and for sending regular reports to Andhra Pradesh State
AIDS Control Society (APSACS). The program is expected to cover a population of approximately 54,000
with FY08 funding.
by Andhra Pradesh AIDS Control Society (APSACS) in the 15 private medical college hospitals. The funds
for this have been leveraged from APSACS and are valued at over $125,000 per year. This will continue in
FY08. As TB services are provided at these hospitals under the same roof, clients are cross-referred
between the CT and TB services.
In FY08, to strengthen follow up procedures for those who test positive, 15 peer counselors will be placed in
the partner institutes. The job of the peer counselors will be to provide follow-up counseling support to any
PLHA seeking services in the institution. They will report to the ICTC director of the institute. As a result,
the percentage of PLHAs who notify their partner of their status and return to the institution for follow up
counseling services is expected to increase substantially by the end of FY08.
To achieve this objective Information Education Communication (IEC) material in the form of posters,
leaflets, and booklets will be supplied to the centers on a regular basis. In addition, the institutes will
conduct regular outreach activities to make the community aware of the facilities available at the institute.
The outreach activities will include street plays, puppet shows, and door-to-door campaign. In FY08,
APAIDSCON will provide technical assistance and funding to individual medical colleges (specifically, the
community and social medicine departments) to manage this activity.
ACTIVITY 4: Training of Counseling and Testing Staff
In addition, all counselors and laboratory technicians will continue to be trained on the basics of CT
the state level. In these review meetings/refresher courses, the skills of counselors and the laboratory
technicians will be upgraded, and they will be kept abreast of NACO guidelines.
Continuing Activity: 14582
14582 6224.08 HHS/Centers for Share Mediciti 6879 3967.08 APAIDSCON $10,000
6224 6224.06 HHS/Centers for Share Mediciti 3967 3967.06 $75,000
Table 3.3.14:
ACTIVITY HAS BEEN MODIFIED IN THE FOLLOWING WAYS:
ACTIVITY 1: Certification for Private Laboratories (title changed in FY09)
In FY09, APAIDSCON will continue its effort to develop a HIV-focused laboratory accreditation process for
private sector laboratories. The initial target audience will continue to be small, for-profit laboratories that
conduct a large number of HIV tests with little existing quality assurance systems. Small unregulated labs
may be motivated to participate in a training, monitoring, and accreditation system in order to build up
consumer confidence in their services, expand their consumer base, and gain credibility in the local medical
community. APAIDSCON will focus on improving HIV testing quality first. In FY09, APAIDSCON will likely
expand the accreditation process to include other common microbiologic tests such as acid fast TB staining,
malaria smears, and bacterial/fungal cultures. HIV-related tests such as CD4 testing, viral load testing, and
cryptococcal India ink testing may also be added for higher level private laboratories in future years.
As part of the accreditation process, APAIDSCON and its collaborators will develop basic standards of HIV
testing (based on NACO guidelines), an accreditation checklist, and procedures to assess HIV laboratory
practices periodically. This will involve the creation of inspection teams and the use of an external quality
assurance system (EQAS).
In FY09, this will be piloted in at least 30 laboratories in one state and revised based on the experience and
feedback from key stakeholders. A second level accreditation involving a number of common microbiologic
tests besides HIV testing may be developed and pilot tested with FY09 funding.
Both Level One and Level Two accreditation are major undertakings and will be developed in collaboration
with the USG technical team, other USG partners, technical consultants, NACO/SACS, and other
national/international laboratory institutions. Additional funding will be required and sought to complete this
activity. A laboratory accreditation system is required to standardize HIV/TB/Malaria testing procedures,
empower consumers, and address the reality that laboratory services in India remain highly unregulated.
ACTIVITY 2: Building Laboratory Capacity within the APAIDSCON Network (title changed in FY09)
APAIDSCON will build laboratory capacity within its network of private medical colleges, APAIDSCON will
train the microbiologists and lab managers on the diagnosis of opportunistic infections. This is to strengthen
the capacity of the lab personnel to practice HIV diagnostic services within the medical colleges to facilitate
care and treatment to PLHIV.
SHARE India through the Andhra Pradesh AIDS Consortium (APAIDSCON) will continue to support the
delivery of HIV/AIDS diagnosis and management services through a networked approach in which
advanced HIV-related tests will be performed at one institution but made available to the entire consortium
via a rapid specimen distribution system. This system is already in place for CD4 testing as described
below. In FY 08-09, viral load testing and opportunistic infection diagnostics may be added. A system to
expose students and post-graduates interested in microbiology and pathology to HIV-related tests and
pathogens will also be a focus.
Activity 1: CD4 Testing Reference Laboratory
One of the prime objectives of APAIDSCON leadership was to provide the consortium members the facility
of performing CD4 test at an affordable rate for their patients. The CD4 test is a basic minimum test that is
required by an attending physician to provide optimum care for the patient infected by HIV. However, the
current market cost ($20-35 per test) is prohibitively expensive and well beyond the reach of most patients.
APAIDSCON, by providing CD4 counts at a subsidized rate of Rs 200/- per test ($5 per test), has made it
possible for an expanded number of patients to get tested and seek appropriate treatment. The lower price
is attainable because: 1) the CD4 flow cytometry was provided free of cost; 2) reagent costs have been
Activity Narrative: brought down due to bulk purchase and negotiations with suppliers; 3) lab directorship is subsidized by
USG funds; 4) specimen collection systems are provided free of charge by partner institutions and overnight
delivery services are provide at no charge by a leading mail service company; 5) profits have been
removed; and 6) USG provides a subsidy of approximately $4 per test to bring the cost down to $5 per test.
The subsidized CD4 count testing is offered to patients who are registered with any of APAIDSCON's 15
partner medical colleges. The newly added small and mid-sized hospitals will also be given access to this
CD4 testing system but possibly at a slightly higher charge per test, since their HIV clients may have greater
purchasing power than the average medical college client.
Generally all samples are analyzed within few hours of receipt and no later than 24 hours. A robust system
for the timely reporting of results to both the patient's care institution and APAIDSCON has been developed.
To ensure the quality and reliability of the CD4 tests APAIDSCON had to create a system to collect and
transport samples for CD4 testing to the central lab without deterioration of the sample due to the high
summer temperatures in India. A special transport bag was designed for this purpose. SHARE/MediCiti,
APAIDSCON's prime partner, has also collaborated with Gati Ltd to arrange the logistics of clinical
specimen transport from various partnering institutes to the central laboratory and has obtained grant
funding from Gati Ltd to provide free transport of the clinical specimens.
In FY08, these activities will continue, as a cost-efficient model for high quality laboratory testing in India. It
is expected that approximately 2000 CD4 tests will be conducted in FY08. Efforts to showcase this system
to medical college leaders, government officials, and NGO directors in Andhra Pradesh and neighboring
states will be a USG priority, especially with the CD4 testing needs in India likely to increase dramatically in
the next few years.
ACTIVITY 2: Viral Load Testing
APAIDSCON is planning to acquire the capability to perform viral load testing for HIV and offer a service
similar to the CD4 reference laboratory to partnering institutes of the consortium. It is anticipated that
approximately 200 tests will be performed in Year 3? PCR equipment will not be purchased using USG
funds. USG funds will be used to pay staff to obtain equipment and supplies, develop protocols and quality
control systems, and leverage funds from private and government sources to make this affordable to most
persons with HIV. USG funds may be used to subsidize the patient cost of viral load testing but only if
deemed strategically necessary and an efficient use of the funds.
ACTIVITY 3: Opportunistic Pathogens
APAIDSCON plans to implement a system of providing reference laboratory services for the diagnosis of
opportunistic and unusual pathogens causing infections in individuals with HIV / AIDS. USG support will be
used to train a select number of microbiologists, pathologists, and technicians on the laboratory
identification of specific pathogens and conditions commonly found in HIV patients. USG funds may also be
used to develop a specimen transportation and reporting system and for salary support to specific staff in
this reference laboratory. USG funds may also be used to provide essential reasonably priced reagents
(i.e., serologies, antigen testing kits) and equipment.
As part of the strategy to build laboratory capacity within this network of private medical colleges,
APAIDSCON will support the development of a module to teach medical students the laboratory and
pathology aspects of HIV medicine. Students will have the opportunity to spend time in this reference
laboratory. This will be especially important as some of these medical colleges develop post-graduate
training programs (equivalent to residency programs in the US) in microbiology and pathology.
Continuing Activity: 14585
14585 6227.08 HHS/Centers for Share Mediciti 6879 3967.08 APAIDSCON $219,000
10906 6227.07 HHS/Centers for Share Mediciti 5621 3967.07 $1,000
6227 6227.06 HHS/Centers for Share Mediciti 3967 3967.06 $25,000
Estimated amount of funding that is planned for Human Capacity Development $50,000
Table 3.3.16:
system strengthening activities and policy initiatives across the state. The consortium also works with the
partnering private medical college institutions to build human resource capacity for managing private sector
engagement in health programs, particularly HIV/AIDS programs, at the state level in AP. This includes
setting up effective Monitoring and Evaluation systems and Management Information Systems.
of the art to barely adequate. Traditionally medical education has been the preserve of Government medical
schools, however in the last five years there has been an explosive growth of private medical schools and
as nurses and allied health professionals are well trained to address HIV/AIDS. APAIDSCON builds
collaborative programs with private entities as well as Government agencies to enhance access to
counseling, testing and care for HIV infected individuals and implement effective programs to reduce mother
to child transmission of HIV. APAIDSCON promotes the implementation of national guidelines and best
practices in addressing the HIV AIDS epidemic.
outcome and model for the country. Forming a consortium has also led to more substantive system
strengthening, including the successful completion of joint training programs, curriculum sharing, advocacy
for government funded HIV testing and counseling centers in all 15 colleges, and a linkage system for
subsidized CD4 testing. The process of jointly applying for USG funding, developing consortium guidelines
and annual workplans, establishing monitoring and evaluation systems, and conducting review meetings
has been an additional capacity-building experience for the original 15 member institutions.
ACTIVITY 1: Data Management Capacity Support to Integrated Counseling and Testing Center (ICTC)
Staff
The APAIDSCON partner institutes are spread over 12 districts in AP. Under the Public Private Partnership
initiative of the Andhra Pradesh State AIDS Control Society (APSACS), 15 Partner Institutes (PIs) have
been sanctioned to run ICTCs. A counselor and laboratory technician have been placed and appointed in
the institutes by APSACS to provide the ICTC services. These personnel will continue to be in place at the
counseling and testing (CT) and PMTCT centers.
Data management support to run the CT and PMTCT services will be provided to the institutes. From April
2007 onwards these counselors and laboratory technicians have been placed under the direct supervision
of APAIDSCON by APSACS. This is a partnership with the state government to provide support to the
partnering institutes on behalf of APSACS. This arrangement will help the state-level team in the following
ways:
•Guide the counselors and laboratory technicians in providing services in line with NACO guidelines
•Collect PMTCT and VCTC data form the partnering institutes every month. The data is analyzed and
feedback provided to the partners and APSACS.
•Monitor the working of the counselors every quarter by organizing review meetings in consultation with
APSACS.
•Conducting regular refresher trainings for the counselors and laboratory technicians.
As a part of routine monitoring of the ICTC, a Computerized Management Information System (CMIS)
format has been designed by NACO/APSACS. APAIDSCON will take up the role of supportive supervision
for the ICTC personnel to ensure data management in the prescribed national CMIS formats. The
counselors and lab technicians will be trained and mentored to send regular monthly reports to APSACS.
APAIDSCON will also analyze the monthly reports to provide regular feedback to the partnering institution
and APSACS.
Regular review meetings are being held under the guidance of APSACS; mentoring and support will be
provided to the counselors and lab technicians to present the data in an effective manner. APSACS also
conducts regular partners' meetings which are attended by the representatives of CDC and APAIDSCON
where the ICTC data from all the PIs is discussed with the purpose of improving the interventions.
ACTIVITY 2: Data Management Capacity Support to Community Care Center (CCC) Staff
Under the APSACS Public Private Partnership initiative, some of the PIs have been sanctioned to establish
Community Care Centers (CCCs). These centers are set up in accordance with the national guidelines
(including recommended staff and personnel) to give services to PLHIV. The CCCs are 10-bedded centers
providing non-ART care and treatment to PLHIV. A project coordinator is appointed to coordinate and
Activity Narrative: manage the manpower and services of the center.
As a part of the initiative monthly reporting has to be completed in line with the national guidelines. A
specific format (CMIS) has been designed by NACO/APSACS. The training and supportive supervision
required for fulfilling this requirement of data management and reporting will be taken up by APAIDSCON.
Mentoring and support will be provided to the project coordinator to present the data in an effective manner.
The monthly reports will be analyzed by APAIDSCON to provide regular feedback on the CCC's functioning
and performance to the CCC and APSACS.
Regular review meetings are being held under the guidance of APSACS. APSACS also conducts regular
partners meetings which are attended by the representatives of CDC and APAIDSCON, in which data from
all CCCs at the PIs is presented and discussed in order to improve the interventions.
ACTIVITY 3: Data management and SI Systems Strengthening of the PIs
The PIs of the consortium conduct regular activities including outreach, care, treatment and trainings. The
nodal officer of the PI, who is a member of the Steering Committee (SCM) has to submit a report monthly
on the activities conducted in the PI. Various templates and reporting formats have been designed for use
by the SCM; training and supportive supervision through on-site mentoring of the SCM for this regular
reporting will be carried out.
The data generated through these reports will be used for various implementation improvements. All SCM
from various PIs meet once a quarter at APAIDSCON to review the overall program. During these meeting
data from each PI will be presented, as a platform for the SCM to share experiences and use this shared
learning to better the program. These reviews also give an opportunity for the less well-performing PIs to
learn from others.
ACTIVITY 4: Data Management of the Training Programs
APAIDSCON undertakes various training programs to increase the clinical capacities of the PIs. The
programs are targeted at clinicians and healthcare professionals in different departments. The three
programs conducted are (i) Advanced Clinical hands-on training for physicians, pediatricians,
dermatologists, and chest physicians; (ii) OBGYN training for doctors from the Department of Obstetrics and
Gynecology; and (iii) Microbiologist training for microbiologists and lab managers.
The training programs are evaluated based on pre and post tests. It is also planned to conduct a long-term
evaluation and outcome assessment. These evaluations will inform the program on areas where
improvement is needed and will also provide continuous input and review from the health-care professionals
on their training needs. APAIDSCON staff managing the training programs will be trained on the
methodologies of training evaluation and assessment. They will also be trained on training outcome
assessment techniques and processes.
Estimated amount of funding that is planned for Human Capacity Development $30,000
Table 3.3.17:
CONTINUING ACTIVITY: NEW ACTIVITY NARRATIVE:
SHARE India has established an innovative consortium structure, the Andhra Pradesh AIDS Consortium
that future medical graduates are well trained to address HIV/AIDS. The consortium also works with the
partnering private medical college institutes to build human resource capacity for managing private sector
engagement in health programs, particularly HIV/AIDS programs, at the state level in AP.
Private Medical Colleges named the Andhra Pradesh AIDS Consortium (APAIDSCON). By establishing
APAIDSCON, SHARE has developed and promoted a comprehensive multi-disciplinary strategy to combat
the HIV/AIDS epidemic in the state with the highest estimated burden of HIV in India.
counseling, testing and care for HIV infected individuals. APAIDSCON promotes the implementation of
national guidelines and best practices in addressing the HIV/AIDS epidemic.
advocacy for government funded HIV testing and counseling centers in all 15 colleges, and a linkage
ACTIVITY 1: Strengthening the Health Care Consortium Concept
In FY09, APAIDSCON will continue to strengthen the concept of a health care consortium, which is
relatively new and underutilized in India. Consortium by-laws will be updated and strengthened to give the
consortium more authority in allocating budget, hiring staff, and monitoring progress. The role of the
consortium is evolving as individual member institutions and their representatives become more familiar
with this novel consortium concept and gain more trust and confidence in this mechanism for enacting
change. The consortium's steering committee will continue to meet quarterly. Mechanisms will be created
to build representation of the newly joined small and mid-sized private hospitals on the steering committee
and to allow them some decision-making responsibilities.
ACTIVITY 2: Establishing an HIV Core Committee at Partnering Institutes
In FY09, APAIDSCON will ensure that each of the medical college member institutes will establish a HIV
core committee made up of the head of all clinical departments, a representative from management, and a
representative from the housekeeping staff. This core committee will meet at least four times a year to
review progress on HIV-related services and address staffing and system issues. Each core committee will
also select their representative to the APAIDSCON steering committee and review his/her performance
annually. The core committee will be expected to advocate for more comprehensive and higher quality HIV
services in the institution and will be leaders in efforts to train medical and nursing students in HIV clinical
care. Newly joined mid-sized hospitals will also be encouraged to establish core committees made up of
clinicians, nurses, management, and housekeeping staff.
ACTIVITY 3: Production of "Awakenings" Newsletter
In FY09, APAIDSCON will continue to produce a quarterly newsletter, Awakenings, as a tool to share
information on consortium activities and provide HIV medical updates to all members and others in the
medical community. This will be part of a broader objective of reaching out to local community physicians to
sensitize them in HIV care and treatment needs and develop testing and referral linkages.
ACTIVITY 4: Seed Funding to Member Institutions
In FY09, APAIDSCON will develop and initiate mechanisms to provide seed funding to member institutions
to develop or strengthen prevention, testing, and/or care initiatives in their institutions or in the nearby
community. This will encourage member institutions to take more ownership of the program. This will also
build the capacities of individual institutional faculty members by teaching them to write proposals, create a
work plan and budget, and manage a new public health activity.
ACTIVITY 5: Advocacy for Including HIV in the Medical School Curriculum
In FY09, APAIDSCON will continue to advocate for greater emphasis on HIV within the medical school
curriculum both at a national/state level and at an individual institutional level. APAIDSCON will focus on
the concept that HIV must be taught as a pre-clinical topic within microbiology, pathology, immunology,
pharmacology, as well as an essential component of the clinical rotations in years 4 and 5. APAIDSCON
has developed a HIV curriculum for medical students that will be implemented in the private medical
colleges as an elective. In FY09, this curriculum will be strengthened based on feedback from students and
faculty. APAIDSCON and CDC will work to mainstream this as a required module in all consortium medical
colleges and advocate for it to be included as a statewide module or elective in all medical colleges.
APAIDSCON will work towards developing the capacity of the interns towards management of PLHIV.
APAIDSCON will ensure that 4th and 5th year medical students and advanced year nursing students have
an opportunity to care for PLHAs on the wards or in the clinics as part of their clinical experience. To do
this, faculty bedside teaching skills related to HIV will have to be improved. Access to PLHAs must also be
Activity Narrative: improved. This will accomplished by either increasing the number of PLHAs being cared for in the medical
college hospital or by making it easier for students to visit HIV care centers in the nearby community.
FY09, APAIDSCON hopes to send 200 students (nursing and medical) to such centers for more in depth
ACTIVITY 6: Strengthening Community Demand
In FY09, APAIDSCON will continue to strengthen the consortium to provide health care to PLHIV and to
supplement this with activities to generate demand in the local community about the services available to
PLHIV in their respective institutes. To achieve this the consortium members will conduct community- level
demand generation for the HIV services through outreach activities, and through the community medicine
department and other allied departments. The Red Ribbon Clubs established in the medical colleges will
also play a role in generating awareness and demand for the HIV services being provided at the institutes.
ACTIVITY 7: Strengthening the Capacity of Consortium Members to Deliver HIV/AIDS Services
In FY09, APAIDSCON will continue to strengthen the consortium's capacity to carry out HIV-related
activities, supplemented by an emphasis on strengthening consortium members' capacity on blood safety
and safe injection issues. APAIDSCON will conduct training programs for consortium members on the
rationale use of blood transfusion, safe injection usage and blood safety protocols. APAIDSCON will also
provide assistance to the consortium members in establishing safe blood banking and blood transfusion
practices.
Continuing Activity: 16431
16431 16431.08 HHS/Centers for Share Mediciti 6879 3967.08 APAIDSCON $15,000
Table 3.3.18:
