The Tamil Nadu State HIV/AIDS Control Society (TANSACS) is the implementing body for India's National AIDS Control Organization (NACO) in the southern state of Tamil Nadu, a high HIV-burden state. TNSACS, which is headed by a senior officer from the Indian Administrative Service (IAS), is the state-level authority for HIV-related policy formation, activity and partner coordination, program implementation, as well as monitoring, reporting, and evaluating on all activities related to the HIV epidemic in the state. In 1991, TNSACS was the first state HIV agency to be formed in the country and has continued to serve as a model for other such agencies around the country.

In 2002, the USG developed a formal relationship with TANSACS and in 2003 began providing fiscal and technical support. In FY10, the USG would renew its fiscal support for next five years. The USG continues to play a strategic role in the operations of TANSACS despite contributing only 3% of the TANSACS budget. The strong historical and technical relationship between TANSACS and the USG has allowed the USG to leverage the entire budget of TANSACS (approximately $20 million in FY08) effectively. This relationship is also strategic as jointly funded projects are likely to be replicated throughout the country as TANSACS is regarded as the leading state HIV agency in India. The technical support provided to TANSACS by the USG has been one of the successful models of donor support for the country. The extent, form, and specificity of our support was discussed with NACO, which resulted in the creation of the Technical Support Unit in Tamil Nadu that works directly with the USG advisors based at TANSACS.

There has been a consistent decline in overall trends of HIV prevalence in Tamil Nadu as well as in the country. However, some districts continue to have high prevalence in spite of all prevention efforts. It has been difficult to comprehend the factors associated with such disparate distribution of the disease in the state. The existing circumstances warrant strengthening the capacity for understanding the epidemiology of the epidemic including analysis and interpretation of data within the state AIDS control societies and state government staff in general. TANSACS and the USG have decided to develop a specialized training program in coordination with a U.S.-based university specializing in HIV epidemiology, with National Institute of Epidemiology (NIE) being considered as the most appropriate local organization to conduct the program. This training program is being developed for state (& central) government officials (from all over the country including TN) who would be deputed full time for the training period from their respective agencies/ departments. The agencies/ departments will commit to the deliverables from the staff that would be undergoing the training program. The following competencies will be expected from the trainees:

Become part of the HIV surveillance teams at the state or national level (as required)

Able to use statistical software (as defined by the program) to analyze relevant data from the field/ program

Able to epidemiologically interpret the surveillance data and prepare reports

Able to undertake both qualitative and quantitative research studies

Able to write scientific papers and send them for publications to various peer reviewed national as well as international journals

Able to conduct good quality HIV epidemiology and data management training sessions for program staff at the district and state level

The program, which will be one year duration, is expected to train 50 such epidemiologists over a period of five years, five happening within the first year.

With the continued financial, infrastructural and technical support provided by the USG, Government Hospital of Thoracic Medicine, Tambaram (GHTM) has been running successfully as the first Center of Excellence (COE) for HIV care in India. The USG through its partner ITECH has been providing technical support to NACO to strengthen the other COEs as well as strengthen and expand the national ART program through a very senior and experienced HIV physician. This will be further strengthened through additional two consultants hired through TANSACS. They will coordinate with NACO and ITECH and provide technical assistance to the other COEs (for training, research and lab strengthening) and evolve the implementation guidelines and do its follow up.

The USG will continue to support Government Hospital of Thoracic Medicine, Tambaram (GHTM) laboratory through Lab Manager, who will ensure the quality of lab investigations in GHTM. Further, as GHTM is State Reference Laboratory, he will provide technical assistance and monitoring to over 50 ICTCS under its supervision. The USG will also provide technical support to GHTM Lab for accreditation through National Accreditation Board for Laboratories (NABL). TheUSG will continue to support strengthening of external quality assurance system in the state and national level and it will evolve the systems to provide quality OI diagnostics at the level of state reference labs.

The USG will continue to provide technical, human, and financial support to the TB/HIV Information System (T/HIS) at the General Hospital of Thoracic Medicine, Tambaram (GHTM) and also identify means of mainstreaming it with NACO's MIS. T/HIS is a comprehensive electronic database that holds longitudinal patient records of over 370,000 (10 million patient interactions) patients at GHTM. The development and implementation of T/HIS has been supported by CDC and TNSACS for the past seven years through software development, hardware (i.e. computers, printers, local area network) and personnel.

In FY10 and FY11, the USG and TANSACS will continue their efforts to mainstream Red Ribbon Club (RRC) activities with the GOI Department of Higher Education and Department of Youth Affairs. RRC is an on-campus and voluntary educational intervention among college youth in Tamil Nadu that started in 2005. It is implemented with the twin objectives of reducing HIV infection among youth by raising their risk perception and preparing youth as peer educators and agents of change. Currently more than 1000 colleges across Tamil Nadu are being covered under this initiative.

The Tamil Nadu State AIDS Control Society (TANSACS) will continue to support an innovative program that reaches an estimated 5.2 million women through women's self-help groups (SHG), working in partnership with the Tamil Nadu Women's Development Corporation. The potential of SHG to address health issues is great, but previously has not been used as a channel for education and behavior change. The USG will continue to provide guidance for this training program, delivered by the government, which reaches women with comprehensive SHG messages, including the development of sexual negotiation and communication skills, and where to seek services for HIV counseling and testing and STI treatment.

The recently revised National AIDS Control Organization (NACO) estimates that 2.5 million people in India are living with HIV; meeting the demand for care and support for these PLHIV is a growing concern in India. To address this issue, TANSACS aims to train Health Care Providers on key aspects of Positive Prevention, specifically training on the Positive Prevention Counseling toolkit which was developed by the USG, TANSACS and partners. The complex physical, psychological and social vulnerabilities associated with being a PLHIV necessitate the integration of other key health care providers into the counseling infrastructure. This training will be complementary to other PLHIV-services-related trainings conducted by TANSACS including advanced counseling training, TB screening and referral, OI prophylaxis treatment and referral, and counseling on nutrition and psychosocial support).

SUMMARY

In India, an estimated 2.31 million people have HIV, all of whom require access to quality care. Counselors are often the first point of contact with the health care system. They play a critical role in linking people living with HIV (PLHIV) to services and provide significant emotional support. Meeting the demand for care and support for these PLHIVs is a growing concern in India. Current counseling programs focus on prevention and testing of HIV. While this is important, equally important is the array of advanced issues that clients present during follow-up counseling sessions after receipt of positive results.

Positive Prevention has scientifically been shown to be both efficient & effective at preventing secondary infections. Changes in risk behavior of HIV positive persons are likely to have a larger effect on the spread of HIV than commensurate changes in risk behavior of HIV negative persons. There is also a growing body of evidence to support the counseling efficacy among PLHIV since studies show that after receiving counseling, HIV+ individuals are likely to reduce risk more than HIV- individuals. The globally accepted goals of Positive Prevention are to: prevent HIV transmission to partners; protect the HIV-infected patient from new strains of HIV and other STIs; and to prevent mother-to child transmission of HIV.

ACTIVITIES AND EXPECTED RESULTS

Activity 1: Training of Counselors on positive prevention

CDC, in partnership with India-CLEN, developed the Living Positively with HIV- A Follow-up Counseling Toolkit. In FY2010, TNSACS aims to train Counselors at ART centers, Link ART centers and Community Care Centers on the Follow-up Counseling toolkit. The complex physical, psychological and social vulnerabilities associated with being a PLHIV necessitate the integration of other Positive Prevention into the counseling infrastructure. This training will be complementary to other PLHIV-services related trainings conducted by TNSACS. The 5 -day training will provide skills and tools on issues specific to PLHIV.

ACTIVITY 2: Evaluation of the Toolkit

In 2010, TANSACS in partnership with the USG, will initiate an evaluation of the Toolkit to assess the effectiveness of the Toolkit as a programmatic prevention intervention strategy. Since ART counselors will have more frequent and consistent interaction with PLHIV clients, the evaluation will be done on this group. The specific objective of the evaluation will be to study the impact of the Toolkit on the specific outcomes in PLHIV, such as Improvement in quality of life, Reduction in depression, Reduction in perceptions of stigma and discrimination, Improvement of knowledge and practice of safer sex and Increase in partner notification and testing.

SUMMARY

The USG will continue to provide technical assistance for Strategic Information (SI)/Monitoring and Evaluation (M&E) to TNSACS so that the vast amount of data collected is analyzed, interpreted and use for improving quality of program and appropriate decision making. USG in collaboration with TANSACS, National Institute of Epidemiology (NIE) and U.S.-based university specializing in HIV epidemiology will organize a HIV Epidemiologist Training Program for state (and central) government officials (from all over the country including TN). The trainees attending this program will be intensively engaged in understanding, analyzing and interpreting data from the MIS of TANSACS as well as GHTM and other state government agencies. They will also be engaged in developing the SI and M& E capacity of the state and district level staff involved in NACP III.

The USG will also continue to provide assistance to the TB/HIV Information System (T/HIS) at the General Hospital of Thoracic Medicine, Tambaram (GHTM) and continue to remain intensively engaged with the Quality Improvement Group at GHTM.

Activity 1: HIV Epidemiologist Training Program:

This has been described in details in the Section on OHSS. The existing disparate distribution of the disease in spite of strong prevention programs in different parts of the country warrant strengthening the capacity for understanding the epidemiology of the epidemic including analysis and interpretation of data within the state AIDS control societies and state government staff in general.

TANSACS and the USG will address the issue of human capacity development in HIV epidemiology and biostatistics. With the support of National Institute of Epidemiology (NIE), TANSACS and the USG will develop a specialized training program in coordination with a U.S.-based university specializing in HIV epidemiology for state (and central) government officials (from all over the country including TN). The agencies/departments deputing the trainees will commit to the deliverables from the staff that would be undergoing the training program.

The following competencies will be expected from the trainees: Become part of the HIV surveillance teams at the state or national level (as required) Able to use statistical software (as defined by the program) to analyze relevant data from the field/ program Able to epidemiologically interpret the surveillance data and prepare reports Able to undertake both qualitative and quantitative research studies Able to write scientific papers and send them for publications to various peer reviewed national as well as international journals Able to conduct good quality HIV epidemiology and data management training sessions for program staff at the district and state level

ACTIVITY 2: Strengthening TNSACS Management Information System (MIS)

Through the HIV Epidemiologist Training Program as mentioned above, efforts will be focused on building the capacity of the newly functional/recruited program divisional staff in TNSACS to analysis and interpret data generated by the state program. The trainees of the program will be involved in building the capacity of the 112 NGOs working in prevention and care programs funded by TNSACS and the refresher training on SI for the relevant staff (approximately 1100) at Integrated Counseling and Testing Centers, ART centers, Community Care Centers, blood banks, and NGOs.

Additionally, technical assistance will through this HIV Epidemiologist training program will help in further refining the annual sentinel surveillance process in Tamil Nadu and will help in addressing more at-risk populations. This activity will continue through FY11. There will be a greater focus on the analysis of existing data to create a scientific body of evidence to assist in program planning.

ACTIVITY 3: Capacity Building for District AIDS Prevention and Control Units (DAPCUs)

Through the HIV Epidemiologist Training program will provide technical assistance to build the SI capacity of these DAPCU teams in collaboration with APAC. The focus will be to strengthen skills on basic public health principles, field management skills, HIV prevention strategies, HIV care and treatment operational guidelines, and monitoring and evaluation skills. Additionally, the USG will work closely with TNSACS to build the SI capacity of the District Health Officers, who will be required to oversee the HIV/AIDS programs in their districts.

ACTIVITY 4: Support to GHTM, Tambaram through TB/HIV Information System (T/HIS)

Over the past decade, Government Hospital of Thoracic Medicine (GHTM) at Tambaram, has established itself as a Center of Excellence in patient care, particularly related to HIV/AIDS and Tuberculosis (TB) care and treatment. This is reflected in the high quality of patient care and outcomes as well as in the high number of patients that seek care there. This has been possible largely because of the dedicated efforts by GHTM staff and its partners towards providing high-quality care and treatment to those infected and affected by HIV/AIDS.

The USG has supported GHTM by establishing the TB/HIV Information System (T/HIS). T/HIS is an electronic health management information system developed to improve the efficiency and effectiveness of care provided to patients and to provide patient and program data that can be used in better program management at the State, and National level. T/HIS holds longitudinal patient records of over 370,000 (10 million patient interactions) patients at GHTM in a comprehensive electronic database. Over the past seven years, the USG and TANSACS have supported in development and implementation of T/HIS through software development, hardware (computers, printers, local area network), and personnel.

While some of the recurring infrastructural support costs in maintaining the TB/HIV Information System (T/HIS) have been taken over by the hospital through national program funding, the USG will continue to support the basic operation of T/HIS by placing data managers and supervisory personnel at GHTM in FY10 and FY11. The USG technical focus will remain on the analysis of existing data to create a scientific body of evidence to assist in program planning.

GHTM has formed a Quality Improvement Committee to develop a strategic plan (5 year) for operational research activities at GHTM. This strategy, which would be based on context-specific needs and in-line with national policy, would serve as a guideline or road map for research activities to be defined, prioritized, and carried out at GHTM. This committee will also provide strategic direction and infrastructure support to the TB-HIV Information System (THIS) currently used for patient record management at GHTM. It includes members from GHTM, TANSACS, the USG and its partners. Specific job responsibilities of this Committee include: Develop/ update the research agenda for GHTM (which may include components of NACO research agenda) and promote it Develop and carry out a mentoring plan for the researchers in GHTM Identify areas for Operationalization and infrastructure improvements to THIS Compile and promote the research activities and case studies done/ developed through GHTM Identify additional sources (internal and external) of funding and technical support for GHTM research activities. USG will continue to be intensively involved in the Quality Improvement Committee of GHTM.

SUMMARY Due to the technical and financial support provided by the USG for technical consultants in TANSACS in past 3-4 years, TANSACS has been able to demonstrate and document successful program management and implementation, which has led to the leveraging of national-level funds by TANSACS to directly fund and regularize in the State program the activities/support activities (partially or fully). This has benefited the mainstreaming of programs like the SHG prevention intervention, monitoring for Integrated Counseling and Testing (ICT) and Prevention of Mother-to-Child Transmission programs, Red Ribbon Club (RRC) programs, operational and maintenance costs at GHTM and M&E systems.

In FY10 and 11, the USG and TANSACS will focus on strengthening health systems by rolling out an HIV Epidemiologist Training Program. Through this program, efforts will be made to develop human capacity of District AIDS Prevention and Control unit Staff too and organize state to state information sharing workshops. TheUSG will continue efforts to maintain quality while mainstreaming Self Help Group (SHG) HIV prevention intervention programs with the Tamil Nadu Women Development Corporation (TNWDC). The USG and TANSACS will also continue to work closely with the State Department of Higher Education to mainstream Red Ribbon Club programs- the HIV prevention program for college based youth.

ACTIVITIES AND EXPECTED RESULTS

Activity 1: HIV Epidemiologist Training Program:

Significant efforts have been made through the Tamil Nadu state and national program to control HIV Epidemic since HIV virus was first identified in 1986 in Tamil Nadu-India. Through the BSS, the state has been tracking prevalence of the disease and has been able to show a consistent decline, due to its proactive efforts, in ANC HIV prevalence from 1.13% in 2001 to 0.25% in 2007. However, there have been certain districts where the prevalence continues to remain high such as Namakkal, Salem, Krishnagiri, Trichy, Theni, etc. in spite of all the prevention efforts. It has been difficult to comprehend the factors associated with such disparate distribution of the disease in the state. The existing circumstances warrant strengthening the capacity for understanding the epidemiology of the epidemic including analysis and interpretation of data within the state AIDS control societies and state government staff in general.

TANSACS and the USG had a series of discussions to address the issue of human capacity development in HIV epidemiology and biostatistics. The National Institute of Epidemiology (NIE) in Chennai has a successful track record of delivering both short and long term programs in epidemiology and biostatistics and is also a member of NACO's Technical Resource Group for HIV epidemiology. NIE is in the ninth year of conducting Field Epidemiology Training Program (FETP) in India in collaboration with CDC-Atlanta known as Masters in Applied Epidemiology (MAE). Further, NIE launched the ICMR School of Public Health with its MPH program in 2008. TANSACS and the USG have decided to develop a specialized training program in coordination with a U.S.-based university specializing in HIV epidemiology, with NIE being considered as the most appropriate organization to conduct the program.

This training program is being developed for state (and central) government officials (from all over the country including TN) would be deputed full time for the training period from their respective agencies/ departments. The agencies/ departments will commit to the deliverables from the staff that would be undergoing the training program.

The following competencies will be expected from the trainees: Become part of the HIV surveillance teams at the state or national level (as required) Able to use statistical software (as defined by the program) to analyze relevant data from the field/ program Able to epidemiologically interpret the surveillance data and prepare reports Able to undertake both qualitative and quantitative research studies Able to write scientific papers and send them for publications to various peer reviewed national as well as international journals Able to conduct good quality HIV epidemiology and data management training sessions for program staff at the district and state level

The concept of the program will be based on Initial 9 months undergoing the basics at NIE along with regular support from faculty from external agency/ university In mid part of the course (3rd month onwards), trainees work with TANSACS and other important government health related data either at TANSACS/ GHTM/ NIE or convenient agency. This will continue throughout the training period. Trainees would also be sent for field visits for epidemiological investigations to various sites in country and will be expected to assess the situation, interpret and analyze data and prepare reports. In the last part of the training (approx. 3 months), trainees will undergo advanced epidemiological sessions, including understanding the newer developments/ systems in U.S., applying the same for data collected/ analyzed earlier and undergo an examination. Successful completion of the course will be certified by external university, NIE, CDC and TANSACS.

There will be a technical review committee (including members from key stake holders) which will review the progress of activities on a regular basis and will ensure the quality of the program.

Recruitment of the trainees will be in such a way that over a period of five years, 50 trained HIV Epidemiologist would be available to State and Central Government of India. In the first year 5 candidates will be trained.

ACTIVITY 2: Capacity Building for District AIDS Prevention and Control Units (DAPCUs)

As mentioned in the SI program area, the USG through the trainees and staff of the HIV Epidemiologist Training Program will provide technical support to TNSACS and TSU for capacity building of the DAPCUs. Workshops would be organized by TANSACS to develop skills of District Health Officials as well as DAPCU staff on basic public health principles, field management skills, HIV prevention strategies, HIV care and treatment operational guidelines, and monitoring and evaluation skills.

ACTIVITY 3: State-to-State Information-Sharing Workshops

To facilitate information sharing and collaboration with other state HIV/AIDS Control Societies (SACS) in FY10, the USG will support TNSACS to organize state-to-state sharing workshops for the southern states (Andhra Pradesh, Karnataka, Kerala, Goa and Pondicherry). Other agencies implementing USG state-level programs will be invited to share their experiences and to identify best practices and strategies to addressing HIV/AIDS in their respective states. TNSACS with the support of National Institute of Epidemiology (NIE) is the ideal SACS to coordinate such workshops due to their experience and history of success. This will provide opportunity to develop skills for good scientific writing and documentation, and epidemiological and public health skills.

ACTIVITY 4: Technical assistance for maintain quality of mainstreaming SHG program

The Tamil Nadu State AIDS Control Society (TANSACS) working in partnership with the Tamil Nadu Women's Development Corporation (TNWDC) supports training of rural women's of Self-Help Groups (SHG) to address health issues and to empower them to become change agents in society. SHGs have also made women financially independent and socially and politically organized. The potential of SHGs to influence health issues has been focused upon and is being used by all sectors of the government to address health and development issues in the community. Women in SHGs are being trained on HIV/AIDS and STIs, communication issues on sex and sexuality and sexual negotiation skills and where to seek services for HIV counseling and testing and STI treatment. TANSACS will continue to provide technical assistance for this training program, delivered by the government, through the SHG movement. TNSACS and TNWDC will continue to work in partnership. The USG will continue to support this initiative of TANSACS through a consultant who will coordinate training, logistics, and monitoring of the program in coordination with TNCDW. In FY10, he will assist TANSACS in planning and implementation of the scale up of the SHG program to the entire state. The consultant will also assist in developing a sustainability plan involving the relevant government agency, TNCDW, to support the program from its own budget. The consultant will independently monitor the program for effectiveness and quality and will assist in revising the modules as required.

ACTIVITY 5: Technical Assistance for mainstreaming Red Ribbon Club Programs

Red Ribbon Club (RRC) is an on-campus and voluntary educational intervention among college youth is being implemented all over the country with the twin objectives of reducing HIV infection among youth by raising their risk perception and preparing youth as peer educators and agents of change. NACO has recognized the efforts of the USG in development of the Celebrating Life curriculum which is being used to train all the students on HIV prevention. TheUSG, in partnership with TNSACS and the state Ministry of Higher Education, supports this program being implemented across more than 1000 colleges in 14 universities in the state of Tamil Nadu by placing 28 university-level field officers (two per university) and 2 regional managers under the Technical Officer for Youth Affairs of TNSACS with technical support coming from the USG. TNSACS, via NACO and state funding, provides seed funds to each RRC to help facilitate HIV prevention and stigma-reduction programs both in the colleges and outside in the nearby communities. USG support includes curriculum development, training and monitoring and evaluation of RRC activities. In FY10, efforts will be continued to mainstream these activities with the state Department of Higher Education and Department of Youth Affairs.

Some key steps by which the mainstreaming efforts will be continued further through FY10 and 11 are as follows: Field Officers will be university based and thus would be supporting universities through colleges under them to implement RRC programs instead of direct implementation as was done earlier. Professors and Peer Educators from the colleges would identified and trained to conduct Celebrating Life module training for the students RRC C-Life module (developed by the USG) will be introduced as part of students' college curriculum thus ensuring uniform access to life skills and knowledge for prevention of HIV. Reporting by the colleges will also be which will further increase ownership Generation of Corpus Funds in colleges for RRC so that RRC activities could be continued in the colleges without the financial support of TANSACS. Formation of the RRC State level Advisory Committee headed by Secretary Higher Education a senior Indian Administrative Officer heading the State Department of Higher Education which will oversee the mainstreaming activities.

SUMMARY:

Red Ribbon Club (RRC) is an on-campus and voluntary educational intervention among college youth in Tamil Nadu that started in 2005. It is implemented with the twin objectives of reducing HIV infection among youth by raising their risk perception and preparing youth as peer educators and agents of change. Each RRC is made up of 10-50 college student volunteers motivated to some degree to address HIV and other sexual health issues among their age group and/or community. CDC, in partnership with TNSACS and the state Ministry of Higher Education, supports this program being implemented across more than 1000 colleges in 14 universities in the state of Tamil Nadu by placing 28 university-level field officers (two per university) and 2 regional managers under the Technical Officer for Youth Affairs of TNSACS with technical support coming from CDC. TNSACS, via NACO and state funding, provides seed funds to each RRC to help facilitate HIV prevention and stigma-reduction programs both in the colleges and outside in the nearby communities. CDC support includes curriculum development, training and monitoring and evaluation of RRC activities. In FY10, efforts will be continued to mainstream these activities with the state Department of Higher Education and Department of Youth Affairs.

ACTIVITIES AND EXPECTED RESULTS

The Red Ribbon Club (RRC) program is an ideal social support platform for youth to understand the myths and misconceptions about sexual health in the context of HIV and gain skills in decision making for protecting their health. There are Red Ribbon Clubs (RRCs) in over 1000 colleges in Tamil Nadu State, with a volunteer strength of above 57,660, reaching over 150,000 students in various higher educational institutions (and an undocumented number of out-of-school youth through community programs). RRC volunteers undergo training using the Celebrating Life curriculum, which is a ten hour package that addresses socio-cultural influences and vulnerabilities to HIV particular to both young adult men and women to HIV. In FY08, this program was endorsed by NACO and adopted as a national strategy and adopted in NACP3. In FY09, plans were developed to mainstream this program within the Ministry of Education so that there is a sustained mechanism to address HIV/AIDS in this vulnerable age group. In FY10, these mainstreaming efforts will be continued.

ACTIVITY 1: Celebrating Life: Curriculum on Sex and Sexuality

The curriculum has been rolled out with urban and rural college youth with supervision by the USG-supported RRC Regional Managers and Field Officers. It includes topics on adolescent vulnerability, HIV/AIDS and STI, gender-based issues/vulnerabilities, life skills and sexual rights and responsibilities. Nearly 787 three-hour Primer and 500 ten-hour curricula have been rolled out in 1023 colleges from FY06-09 and the program will continue through FY10, with the addition of 200 more RRCs in Law, Agriculture, Medical and Paramedical (pre-service) colleges which were not targeted previously.

NACO has endorsed the Celebrating Life curriculum by including it in the NACP3 Operational Guidelines. The USG and TNSACS will provide TA to NACO in the finalization of the guideline by incorporating lessons learned in the field. Additionally, the USG and TNSACS will advocate for mainstreaming the RRC Program and curriculum within the Department of Higher Education and Department of Youth Affairs. Regional Managers and Field Officers will help TNSACS train 1023 RRC Program officers at district level on the three-hour curriculum and give them an orientation to RRC. Emphasis will also be on identifying trainers from within colleges for training college students and peer educators, in order to create college-based ownership of the program.

By ensuring more trainers are available from within colleges, support provided through field officers will be gradually reduced, which will reflect in the reorganization of the program and the efforts to mainstream it into the GOI throughout FY10-11.

ACTIVITY 2: Peer Education Training and Convention

In addition to peer leaders' conventions, RRC Regional managers and RRC Field Officers will focus on strengthening the team of Peer Educators in every RRC. A curriculum will be prepared, piloted, and implemented for training the peer educators to enable them to organize three to six campaigns in their colleges every year. Each peer educator will reach 10 to 30 peers through peer education. The peer educators training will focus on transitioning the program implementation and reporting to the college students.

ACTIVITY 3: Networking

In order to increase the reach of the HIV/AIDS program to young adults, TNSACS started interactive sessions of community people with college youth through RRCs. College youth will interact with: a) PLHIV to orient them on stigma and discrimination issues, b) Trans-genders to understand the issues faced by sexual minorities; and c) IDUs to understand HIV transmission through a non-sexual route. ICTC counselors will also visit colleges to encourage counseling and testing.

ACTIVITY 4: Community Outreach by RRCs

In FY09 the RRC District Managers and RRC Regional Managers reached out to nearly 35,000 RRC members with the Celebrating Life Curriculum and nearly 15,000 Peer Educators on skills training. The Peer Educators will further reach out to about 150,000 peers. Peer Educators will also reach out to youth outside the college campus through village awareness campaigns and programs on radio and TV, and street theater performances. Community blood donation drives are another way by which RRC staff will reach out to the community and spread messages of safe blood donation. Collaborations will be made with the National Service Scheme (NSS) so that peer educators (who may also be NSS volunteers) are allowed to conduct sessions on HIV/AIDS. This innovative plan will reach out to more than 100,000 NSS volunteers in FY10 and 11.

ACTIVITY 5: Monitoring and Evaluation of RRC Programs

Program indicators and reporting formats will be further streamlined and efforts to capture the impact made by the peer educators. There will also be a focus on establishing a formal reporting system for colleges for RRC activities (at least on a six monthly basis). Field level staff will be trained to capture these indicators.

SUMMARY

Since 2004 HHS/CDC, in collaboration with the Tamil Nadu AIDS Control Society (TNSACS), has supported the development and operations of state of the art laboratory services at the Government Hospital of Thoracic Medicine, Tambaram (GHTM). In FY08, a senior laboratory manager was supported by the USG to oversee laboratory services and additional five laboratory technicians were hired. In FY09, TANSACS has regularized the positions of the Lab technicians through NACO (Governmentt of India) funding and thus in FY10, the USG will continue to support the senior Lab manager position to maintain quality of lab services. GHTM Lab is also recognized as the State Reference Laboratory and thus Lab Manager would be providing technical and monitoring support for external quality assurance (EQAS) to over 80 ICTCs under their supervision. The USG would also work closely with TNSACS and NACO to expand opportunistic infection diagnosis capability of the SRLs in the country.

ACTIVITIES AND EXPECTED RESULTS

ACTIVITY 1: Support for GHTM Laboratory Services

Since 2004 USG/CDC, in collaboration with TNSACS, has supported the development and operations of state of the art laboratory services at the Government Hospital of Thoracic Medicine, Tambaram (GHTM). The support is particularly strategic as GHTM is the largest HIV care and treatment center in India, currently caring for over 30,000 HIV-infected patients annually, 6600 of whom are receiving ART. GHTM, with CDC support has developed into a national HIV training center of excellence. Each year, GHTM performs 25,000 HIV tests, 20,000 CD4 tests, and 150,000 AFB smears to diagnose TB, as well as basic chemistries and hematology tests for HIV-infected patients. Previous HHS/CDC support has included procurement and maintenance of diagnostic equipment, reagents, renovating laboratory space, operational cost for running the laboratory, regular technical assistance, and the placement of laboratory technicians. As a result, GHTM is recognized as one of the most comprehensive and high quality laboratory in India and also as the State Reference Laboratory for HIV testing. In FY09, TANSACS has absorbed the operational and maintenance costs of GHTM as well as the positions of the lab technicians through NACO (GOI) funding. These were previously supported by USG and thus have been mainstreamed in the national program.

In FY10 and FY 11, CDC, in collaboration with TNSACS, will continue to support senior laboratory manager to oversee laboratory services at GHTM. This laboratory manager will be responsible for quality assurance/quality control (QA/QC) of GHTM lab services, ensuring timely generation of test results, record keeping and reporting, expanding services, and lab staff management. This senior manager will also assist developing a QA/QC training program for private sector laboratories involved in HIV diagnosis, care, and treatment. S/He will report directly to TNSACS with direct technical assistance from HHS/CDC.

ACTIVITY 2: Role as State Reference Laboratory for HIV testing under NACPIII

GHTM Lab has been recognized as State Reference Laboratory for HIV testing and thus the Senior Lab Manager would be responsible for the supervision and quality assurance of over 80 ICTCs (Integrated Counseling and Testing Centers) labs under their jurisdiction. He will be conducting training of all the lab staff of the ICTCs two times a year and will be carrying out four rounds (quarterly) of EQAS as per the national program guidelines.

ACTIVITY 3: Increasing the diagnostic capabilities for opportunistic infections (OIs) at the State Reference Laboratories (SRLs)

GHTM lab is a comprehensive public health laboratory which not only diagnoses HIV but carries out various hematology, biochemistry and microbiological tests for monitoring HIV and the opportunistic infections associated with it. The USG will continue its efforts in FY10 and FY 11 to increase the capabilities of SRLs for OIs by developing training material as well as conducting trainings for the lab personnel in the Tamil Nadu state (and other parts of the country).