USG has funded FHI 360 to provide technical assistance (TA) to National AIDS Control Organization (NACO) for Strategic Information (SI) since 2009. Core TA areas include: 1) M&E including project evaluation, data triangulation, operations research (OR) and qualitative and economic evaluations; 2) Surveillance including roll-out of Integrated Behavioral and Biological Assessment (IBBA); and 3) Data Use including support on SI Management System (SIMS). DAKSH supports PEPFAR/India strategy Goals 2 (Data for Decision making) and 4 (Capacity Building). In FY12, CDC will also leverage FHI 360 expertise in community-based interventions for enhancing access to HIV services, particularly among women with Gender Challenge funds. The project will be implemented in a district where FHI 360 has already been supporting GOI to integrate HIV with MCH services using existing community based mechanisms.

Project activities target M&E staff at national, state and district levels and NGOs implementing Targeted Interventions (TIs) for MARPs, Medical College faculty and program staff. The PEPFAR Gender project will target MARPs and their partners and wives of male migrants in Uttar Pradesh.

DAKSH maximizes cost-efficiency by leveraging GOI program investments through targeted TA that builds capacity for sustainability beyond project life. DAKSH ensures complementarity and coordination through regular partner meetings.

In-service training and TA provision to local organizations are measured through PEPFAR indicators. Other outputs and outcomes of the SI component will be tracked as per the indicators in the results framework and the 5 year strategy for PEPFAR/India. Gender project M&E systems at community and facility levels will be supplemented with case studies and success stories.

The gender project will work with wives of male migrants to improve their risk perception to HIV and improve their health seeking behavior including access to early HIV testing and treatment services. The project will work with existing Targeted Intervention being supported by the State AIDS Control Society (SACS) for a migrant intervention. Line lists of migrants whose spouses are living in the source district will be compiled and after following due process of informed consent, home visits will be made to improve access to HIV prevention, testing, care and treatment services.

ACTIVITY 1: Trainings to existing TIs and NGOs on Collectivization and addressing Gender-based violence

Trainings and other learning sessions will be conducted with the staff of 2 TIs to facilitate:-Formation of Gats (groups) of female sex workers and MSM to address violence/crisis e.g. police raids, fights with pimps, brothel owners, clients etc.-Establishment of a Rapid Response System for crisis intervention

ACTIVITY 2: Setting up a Rapid Response systems and formation of groups/Gats

DAKSH will introduce a Rapid Response System for timely interventions by peers and key influencers during any instance of reported crisis or violence related to MARPs. The NGO partners in Allahabad will maintain a system of tracking instances of reported violence and response time to monitor effectiveness. Peers will be trained to respond to such calls for assistance at the earliest and adopt different response strategies depending on the intensity of the crisis/problem. To be able to introduce and implement this system effectively, MARPs will be collectivized into groups or Gats. MARPs once collectivized will be trained on how to rapidly report and respond to instances of violence or crisis and what recourse to take during different instances including police raids.

ACTIVITY 3: Engaging men and community

The NGOs will work to increase male engagement and their sense of responsibility to identify and address harmful gender attitudes and practices that increase womens vulnerability to HIV. The NGO partner will be trained on counseling men on enhancing male responsibility with respect to sero-discordant status and positive prevention. This will include counseling men on early partner disclosure and notification, avoiding use of violence associated with HIV testing and disclosure towards partner, correct and consistent condom use, and STI treatment for self and partner. The NGO partner working with wives of male migrants will also conduct sensitization meetings with the community at large to create an enabling and supportive environment for increasing womens access to HIV service by reducing stigma and discrimination and for greater community participation to address gender based violence.

SI is one of the three pillars of the National AIDS Control Program, but SI capacities are limited to a few individuals. DAKSH is a key SI partner to NACO and strengthens NACOs response to the epidemic by promoting evidence-based HIV prevention, care, support and treatment services.

ACTIVITY 1: TA on M&E

CDC provides TA in the roll-out of NACOs SI Management System (SIMS), which has capacity for advanced data capture, aggregation and analysis, and is a repository of all data related to Indias HIV epidemic and response. DAKSH supports the process through capacity strengthening and quality control support. USG will also support finalization of 400 district epidemiological profile reports incorporating 2010 data, including analysis and dissemination. In FY11, DAKSH supported local institutions to develop an operations research protocol on PMTCT; TA to other Government Medical Colleges and Research Institutes will be provided in FY12. DAKSH will also design and conduct end-of-project evaluations for two CDC projects, including local institutions to build capacity throughout the process. Building on experience of conducting qualitative and economic evaluation of CDC-funded projects, DAKSH will provide TA on qualitative and economic evaluation to national and state government institutes. Finally, DAKSH will collaborate with NACO, WHO and UNAIDS on a national conference and regional workshops on program evaluation.

ACTIVITY 2: TA on Surveillance

NACO is planning an Integrated Biological and Behavioral Assessment (IBBA) at the national level. In FY11, DAKSH provided TA in design of the national IBBA and in FY12 will provide TA to plan the IBBA in collaboration with WHO. Also with WHO, DAKSH will support implementation of systems to routinely collect early warning indicators for HIV drug resistance and lay the ground for cohort analyses.

ACTIVITY 3: TA on Data Use

Over 11,000 government and non-government facilities deliver and report on HIV services. Maintaining quality of data generated by these reporting units, and ensuring their robust use at all levels is a significant challenge. In FY11, DAKSH in collaboration with National Technical Support Unit (NTSU) assessed skills building needed by M&E staff at all levels. In FY12 DAKSH will design a capacity and skills strengthening program including modules on data analysis, data presentation and data quality tools, and conduct trainings and provide mentoring support to government stakeholders. The project will provide TA in advanced data analysis to the National Data Analysis and Dissemination Unit to create skills in program data analysis and dissemination at the national level with a plan for transferring this capacity to the states. DAKSH will also continue its support to NACO to finalize and roll-out the NACP-IV implementation plan.

ACTIVITY 4: Gender and Vulnerability Analysis, M&E and Process Documentation

DAKSH will complete a Gender and Vulnerability Analysis related to HIV in the target community, including social constructs of male-female relationships and gender-based norms and practices governing risk perception, health seeking behavior and access to HIV testing, treatment, care and support services . The study will explore factors leading to vulnerability to GBV, stigma and discrimination. As part of establishing the project MIS, capacities of NGO will be built in collecting, collating and analyzing project data, and monitoring data quality.

The gender project will work with the State AIDS Control Society (SACS) and the District AIDS Prevention and Control Unit (DAPCU) to integrate gender approaches within ongoing targeted interventions funded by SACS in Allahabad district. The focus will be on building capacities of local NGOs as well as government frontline workers including Accredited Social Health Activists (ASHAs), Ancillary Nurse Midwives (ANMs) and Anganwadi Workers (AWWs) and their supervisors, [AWWs are frontline workers under the governments Integrated Child Development Scheme (ICDS)]. The focus of capacity building efforts will be on adopting innovative strategies to improve early and repeat HIV testing among MARPs and their partners, addressing issues of violence among MARPs, and interventions with spouses of male migrants to improve risk perception and health seeking behavior.

ACTIVITY 1: Capacity building of frontline workers and government healthcare providers at facility level

The Project will conduct trainings for government health care providers and frontline workers (ASHAs, ANMs, AWWs and their ICDS Supervisors and DAPCU staff) focusing on sensitization about current gender inequities that increase risk for HIV transmission and impede access to HIV services by MARPs as well as wives of migrants. Trainings will also cover the linkages between gender and health, particularly gender based violence (GBV) and HIV; risk perception for GBV; and referral mechanisms for women to link them to relevant services. The training will build basic skills in psychological counseling such as listening, assuring and not blaming women, and how to facilitate a process whereby women clients will visit and talk.

The gender project aims to mobilize early and repeat HIV testing among MARPs and their partners. One of the strategies will be to introduce voluntary HIV testing campaigns within existing TIs that will include generating line lists of sex workers prioritized for HIV testing, generating demand for services and ensuring laboratory supplies and personnel to facilitate higher rates of repeat HIV testing among MARPs. The project will build upon FHI 360s experience from the BMGF-funded Aastha project in Mumbai and apply the learnings to DAKSH. It is expected that by the end of the project, at least 50% of the MARPs will have been repeat HIV tested at least once.

ACTIVITY 1: Trainings to existing Targeted Intervention (TI) NGOs and service providers

DAKSH will train the 3 existing NGOs implementing TIs; training includes counseling on risk perception, importance of early and repeat HIV testing and effective referrals for HIV testing. Accompanied referrals will be conducted by the community-based and government healthcare providers and frontline workers and TIs to the target populations under this project to facilitate their timely access to counseling, testing and treatment services. As part of training, project staff will conduct follow up visits to ensure proper referrals. The trainings will include the Vivek model, an intensive VCT campaign in outreach settings implemented by FHI 360 as part of the Gates-funded Aastha project.

ACTIVITY 2: Roll out of Vivek Model for repeat testing among MARPs

Learnings from FHI 360s Aastha project will be shared with the TI NGOs in Allahabad including sharing of tools and resources (IEC materials) that have been developed under Aastha as part of this effort. The TI NGOs will be supported to pilot Vivek-like interventions in Allahabad district and will be supported to track increase in repeat HIV testing rates among the registered MARPs. This model involves intensive planning including preparing line lists of sex workers who are due for HIV testing, consistent with NACO guidance. The intervention will include demand creation activities by the NGO partners. Finally, DAKSH and the NGOs will collaborate with the State AIDS Control Society to ensure a sufficient and continuous supply of HIV test kits, laboratory consumables, and necessary trained personnel to handle increased demand for onsite HIV testing.

ACTIVITY 3: Working with partners of MARPs

DAKSH will support the two GOI-funded TI NGOs working with FSW and MSM in Allahabad to initiate interventions with partners of MARPs. The NGOs will be supported to generate line lists, consistent with NACO guidance, of FSW and MSM who are married or are living with regular partners. The NGOs will be trained on issues of partner notification and disclosure, safe sex including condom negotiation with regular partners, STI diagnosis and management, early HIV testing, and linkages to HIV care, support and treatment services. Training will include addressing issues of partner violence related to disclosure and HIV testing. The NGO partners will be supported to incorporate additional indicators for outreach and service delivery to monitor interventions with partners of MARPs.

Implementing Mechanism Indicator InformationRedacted