Detailed Mechanism Funding and Narrative

Years of mechanism: 2008 2009

Details for Mechanism ID: 5586
Country/Region: China
Year: 2009
Main Partner: Chinese Center for Disease Prevention and Control
Main Partner Program: NA
Organizational Type: Host Country Government Agency
Funding Agency: HHS/CDC
Total Funding: $1,080,000

Funding for Biomedical Prevention: Prevention of Mother to Child Transmission (MTCT): $25,000

N/A

New/Continuing Activity: New Activity

Continuing Activity:

Emphasis Areas

Human Capacity Development

Estimated amount of funding that is planned for Human Capacity Development $2,500

Public Health Evaluation

Food and Nutrition: Policy, Tools, and Service Delivery

Estimated amount of funding that is planned for Food and Nutrition: Policy, Tools $750

and Service Delivery

Food and Nutrition: Commodities

Estimated amount of funding that is planned for Food and Nutrition: Commodities $2,500

Economic Strengthening

Education

Water

Table 3.3.01:

Funding for Sexual Prevention: Other Sexual Prevention (HVOP): $90,000

N/A

New/Continuing Activity: New Activity

Continuing Activity:

Emphasis Areas

Human Capacity Development

Estimated amount of funding that is planned for Human Capacity Development $27,000

Public Health Evaluation

Food and Nutrition: Policy, Tools, and Service Delivery

Food and Nutrition: Commodities

Economic Strengthening

Education

Estimated amount of funding that is planned for Education $27,000

Water

Table 3.3.03:

Funding for Prevention: Injecting and Non-Injecting Drug Use (IDUP): $150,000

N/A

New/Continuing Activity: New Activity

Continuing Activity:

Emphasis Areas

Human Capacity Development

Estimated amount of funding that is planned for Human Capacity Development $45,000

Public Health Evaluation

Food and Nutrition: Policy, Tools, and Service Delivery

Food and Nutrition: Commodities

Economic Strengthening

Education

Estimated amount of funding that is planned for Education $75,000

Water

Program Budget Code: 07 - CIRC Biomedical Prevention: Male Circumcision

Total Planned Funding for Program Budget Code: $0

Program Budget Code: 08 - HBHC Care: Adult Care and Support

Total Planned Funding for Program Budget Code: $1,317,333

Total Planned Funding for Program Budget Code: $0

Program Area Narrative:

In 2003, GoC issued the "Four Frees and One Care" policy that includes free ART for socioeconomically disadvantaged PLHA,

HIV testing, schooling for AIDS orphans, and PMTCT as well as social support for PLHA. In support of this policy, the Minister of

Civil Administration (2004) and GoC (2006) separately issued the "Strengthening Support for HIV Positives, their Families, and

Orphans" and the "Five Year Action Plan 2006-2010," respectively. China achieved remarkable changes for care and support to

PLHA in the last year. At the end of 2007, estimated coverage of care and support for PLHA was 31%, CD4 testing at initiation

into HIV care was around 70%, and CD4 testing rates at all four recommended time points during the first year (i.e., quarterly)

based on national guidelines was over 10%.

Nevertheless, the GoC faces many challenges for implementation of the "Four Frees and One Care" policy. These include the

following: 1) lack of an adapted comprehensive care and support approach (mini-care package); 2) lack of linkage mechanisms

between VCT and care, treatment, and support; 3) lack of referral mechanisms between prevention [MMT, needle exchange

programs (NEP), PMTCT, and CUP] and care and treatment; 4) strong focus on ARV distribution but lagging focus on adherence,

psychological counseling and social support, and palliative care; 5) low coverage with cotrimoxazole prophylaxis (due in part to

user fee mechanisms in the hospital setting and cotrimoxazole prophylaxis being so cheap that the health provider cannot earn

any profit); 6) lack of opportunistic infection (OI) prophylactic treatment in most of high epidemic provinces; 7) stigma and

discrimination that still exists among health providers and their communities; 8) lack of family and community involvement; 9)

relative lack of experience in providing quality HIV-related care to IDU, pregnant women, and MSM; 10) limited human resource

capacity of rural health care providers; 11) poorly functioning three-tier county/township/village network health system in many

rural areas that does not provide quality care and support services to PLHA; and 12) lack of cooperation between civil

administration and health departments at the implementation level.

To address the above challenges, USG continues to support GoC and GFATM Round 3 in scaling up the Essential Care Package

(ECP) model in 72 counties to meet the needs of AIDS patients, 60% of whom live within these 7 Global Fund targeted provinces.

ECP is a comprehensive approach for providing quality care and support services for PLHA (such as ARV adherence, home-

based care and support, OI prophylaxis, regular follow-up services for ARV clinical monitoring, and condom promotion), through

the involvement of the rural three-tier (village, township, and county) health network system, community, and family members of

PLHA.

USG has focused on the Prevention with Positives (PwP) strategy through strengthening linkages between case finding (VCT)

and case management (prevention, care, and support), setting up referral mechanisms between prevention programs and care

and treatment services, building the capacity of rural health staff in 15 USG-supported provinces to address the major lost-to-

follow-up and low coverage of care and support issues that China faces. The follow-up rate among newly tested-positive PLHA

has already increased from 13.1% in 2006 to 31.7% in 2007, and is expected to increase above 40% in 2008.

USG has supported GoC in strengthening three-tier health network services that include the provision of OI and follow-up services

to PLHA in Anhui and Henan provinces, using a strategy similar to the Tuberculosis (TB) Directly Observed Treatment

Shortcourse (DOTS) strategy to conduct HIV ARV adherence counseling and support models through rural DOT volunteers and

village doctors. USG will continue to provide technical and management support to help build capacity among village, township

and county-level physicians, improve the current ART referral system, recruit family members and PLHA as DOT volunteers to

improve ART adherence, and support county CDCs who provide HIV-positive patients with prevention and follow-up services

including quarterly CD4 monitoring and annual viral load testing.

USG supported the enrollment of IDU PLHA into Guizhou and Qinghai MMTs, and the provision of peer psychological support and

follow-up services to IDU PLHA in Anhui, Guangxi, Guizhou, Jiangsu, Qinghai, and Yunnan. Since 2006, USG has supported

Guangxi and Yunnan on case finding (VCT and surveillance) and case management (prevention, care, and treatment) through

setting up linkage and incentive mechanisms. Subsequently, the informing rate increased to 51% in Guangxi and 61% in Yunnan

by the end of 2007. USG will continue to support Guangxi and Yunnan provinces on strengthening linkage mechanisms between

VCT, prevention, care, and treatment to increase follow-up and referral rates, and support the development of a care package.

USG will also support the use of IDU peers to improve ART adherence among PLHA in Guangxi and Yunnan, and the training of

PLHA as counselors for adherence counseling and support in Anhui, Heilongjiang, and Henan.

USG will continue to assist NCAIDS, China CARES, and GFATM Rounds 3 and 4 counties in improving the planning and

operation of quality care and support services for PLHA. In FY 2009, USG will assist GFATM Round 4 to scale up MMT clinics as

a platform for care and support to HIV- positive IDU in 126 counties within Guangxi, Guizhou, Xinjiang, and Yunnan provinces as

well as promote the integration of care and support with ART services in seven GFATM Round 4-supported provinces. Activities

will include establishing PLHA self-help groups for improving enrollment rates, follow-up rates and adherence, setting up DOT in

MMT clinics, conducting quarterly CD4 testing, providing cotrimoxazole for OI prevention, and setting up referral services to ANC,

ARV, and TB clinics.

In Anhui, Beijing, Heilongjiang, Jiangsu, Shandong, and Yunnan where MSM HIV prevalence is growing, USG supported the

development of self-help groups among MSM PLHA networks that include web-based support, telephone hotlines, and peer

support particularly in VCT, MSM- friendly STI services, ART, and OI prophylaxis services. USG will expand this model to

Guangdong and Guangxi provinces in the next year.

In central Chinese provinces where former plasma donors (FPD) account for the majority of PLHA, PwP among sero-discordant

couples has been a main focus of USG support. USG will assist provincial and county CDCs and health bureaus to train DOT and

adherence counselors in Anhui and Henan to promote condom use through BCC. Since 2003, China's National Free ART

Program has successfully and rapidly scaled-up the availability of first-line ART regimens, presently covering at least 1,440

counties in all 31 provinces. The mortality rate among persons started on ART has decreased from 9.0 per 100 person-years in

2004 to 3.3 in 2007. By the end of June 2008, a total of 48,551 AIDS patients have been on ART. Of these, 4,122 died mainly due

to delays in case detection; 1,957 dropped-out mainly due to side effects and individual decisions to stop ART; and 348 were lost

follow-up. The remaining 39,066 people are currently on ART, of which 45.1% contracted HIV through plasma donations, 27.1%

through sexual contact, 12.9% through injection drug use, and 14.8 % have unknown causes. A majority of PLHA in China (70%)

reside in rural areas.

Based on China's National Free ART Program manual, the 12-month survival rate with ART is close to 90%; the follow-up rate for

periodic physical health examinations is 33.8%; CD4 testing (four times per year) is 10%; and viral load testing is currently 6%. A

survey conducted by NCAIDS in 2007 showed that the prevalence of HIV-1 drug resistance among MSM to be 25% in Tianjin,

13.6% in Beijing, and 2.1% in Chengdu, and 3 to 4% in drug users in Hunan, Sichuan, and Xinjiang. It is estimated that a total of

5,000 to 6,000 ARV drug resistant patients need second-line ART in China. In March 2008, GoC piloted a second-line ART

program in Anhui, Henan, and Hubei provinces. The main reasons for treatment failure, primarily among FPD, were poor

adherence (~70%), drug resistance, side effects, wrong dosage, and lost-to-follow-up.

In FY 2008, a pilot evaluation of virologic outcomes among adult AIDS patients receiving ART through the National Free ART

Program in 24 counties in 8 provinces was carried out with partial support from USG. The results demonstrated that virologic

suppression was achieved in the majority of adult patients. However, virologic response was poorer among those who had started

the program earlier (before 2005) and those who started on a ddI- containing first-line regimen. In addition, county hospitals (or

above) generally had better virologic outcomes than smaller township hospitals or village clinics. Males also were at higher risk of

treatment failure than females.

Ongoing challenges faced by the nationwide Free ART Program include: 1) poor cooperation and coordination between hospital

administration and the CDC system; 2) lack of incentive mechanisms in hospitals for providing ART services; 3) lack of human

capacity in rural areas; 4) poor functioning of the three-tier health service system in providing quality ART services; 5) lack of

counseling and patient service mechanisms for supporting ARV adherence; 6) lack of PLHA and community participation; 7)

limited availability of second-line ARV drugs; 8) lack of funds for laboratory testing and clinical monitoring beyond CD4 testing; 9)

lack of free OI management to meet patients' needs; 10) low viral load testing rates (albeit rapidly increasing in recent months)

among patients on ART; 11) low coverage rates among IDU, TB patients, pregnant women, and MSM living with HIV infection; 12)

lack of supervision and training of rural health workers; and 13) lack of appropriate ART models for different HIV epidemic

settings.

To address these challenges, USG in FY 2008 assisted GoC in revising its second version of the National Free ART Program

manual (including ART for TB patients, IDU, pregnant women, and OI prophylaxis), and is in the process of developing a national

implementation guideline for the second-line ARV program. USG will provide technical and management support to NCAIDS in

the training and implementation of the manual's guidance. USG, together with the Clinton Foundation, will also support expanding

the second-line ARV program to other non-pilot provinces. In addition, USG developed health education tools for PLHA and their

family members to improve ART adherence, and assisted NCAIDS in developing a tool for improving adherence among IDU.

Given the lack of experienced Chinese health workers in providing ART services to MSM and TB patients, USG will support GoC

in developing and analyzing ART service models for these populations using the existing health services infrastructure. USG will

also help improve certain aspects of the National Data Fax System, particularly its data collection quality, data analysis, and

usage. To help improve the quality of HIV care and treatment services, USG will provide technical assistance and support to

NCAIDS on integrating a M&E plan into the National Free ART Program.

USG, in partnership with Clinton Foundation, will continue to support the Anhui Lixin Rural AIDS Clinical Training Center in

capacity building among county-level physicians on management of ART and OI, and also provide post-training technical

assistance for trainees back in their home counties. By the end of August 2008, 72 physicians have been trained through this

Center. Of them, 90% are providing ART and OI services to PLHA in their home counties. Based on a provider survey conducted

in September 2008, these rural physicians have provided ART and HIV care services to about 15,755 HIV/AIDS patients in China.

USG will continue to produce trainees to provide home- and community-based HIV care and support in their respective provinces

upon their return to Anhui, Gangsu, Guizhou, Heilongjiang, Henan, Hunan, Inner Mongolia, Jiangsu, Ningxia, Qinghai, Shandong,

Sichuan, Tibet, Xinjiang, and Yunnan. In FY 2009, USG will expand this training model to IDU-driven provinces to help GoC scale-

up ART services to more rural or sub-urban IDU populations, especially those already receiving methadone maintenance

services.

Table 3.3.08:

Funding for Care: Adult Care and Support (HBHC): $175,000

N/A

New/Continuing Activity: New Activity

Continuing Activity:

Emphasis Areas

Human Capacity Development

Estimated amount of funding that is planned for Human Capacity Development $105,000

Public Health Evaluation

Food and Nutrition: Policy, Tools, and Service Delivery

Estimated amount of funding that is planned for Food and Nutrition: Policy, Tools $8,750

and Service Delivery

Food and Nutrition: Commodities

Economic Strengthening

Education

Estimated amount of funding that is planned for Education $35,000

Water

Table 3.3.08:

Funding for Treatment: Adult Treatment (HTXS): $80,000

N/A

New/Continuing Activity: New Activity

Continuing Activity:

Emphasis Areas

Human Capacity Development

Estimated amount of funding that is planned for Human Capacity Development $40,000

Public Health Evaluation

Food and Nutrition: Policy, Tools, and Service Delivery

Estimated amount of funding that is planned for Food and Nutrition: Policy, Tools $4,000

and Service Delivery

Food and Nutrition: Commodities

Economic Strengthening

Education

Estimated amount of funding that is planned for Education $16,000

Water

Table 3.3.09:

Funding for Care: Pediatric Care and Support (PDCS): $50,000

N/A

New/Continuing Activity: New Activity

Continuing Activity:

Emphasis Areas

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

Estimated amount of funding that is planned for Food and Nutrition: Policy, Tools $5,000

and Service Delivery

Food and Nutrition: Commodities

Economic Strengthening

Education

Water

Table 3.3.10:

Funding for Treatment: Pediatric Treatment (PDTX): $30,000

N/A

New/Continuing Activity: New Activity

Continuing Activity:

Emphasis Areas

Human Capacity Development

Estimated amount of funding that is planned for Human Capacity Development $9,000

Public Health Evaluation

Food and Nutrition: Policy, Tools, and Service Delivery

Estimated amount of funding that is planned for Food and Nutrition: Policy, Tools $3,000

and Service Delivery

Food and Nutrition: Commodities

Estimated amount of funding that is planned for Food and Nutrition: Commodities $6,000

Economic Strengthening

Education

Water

Table 3.3.11:

Funding for Care: TB/HIV (HVTB): $15,000

N/A

New/Continuing Activity: New Activity

Continuing Activity:

Emphasis Areas

Human Capacity Development

Estimated amount of funding that is planned for Human Capacity Development $3,000

Public Health Evaluation

Food and Nutrition: Policy, Tools, and Service Delivery

Food and Nutrition: Commodities

Economic Strengthening

Education

Water

Table 3.3.12:

Funding for Testing: HIV Testing and Counseling (HVCT): $215,000

N/A

New/Continuing Activity: New Activity

Continuing Activity:

Emphasis Areas

Human Capacity Development

Estimated amount of funding that is planned for Human Capacity Development $64,500

Public Health Evaluation

Food and Nutrition: Policy, Tools, and Service Delivery

Food and Nutrition: Commodities

Economic Strengthening

Education

Estimated amount of funding that is planned for Education $21,500

Water

Table 3.3.14:

Funding for Laboratory Infrastructure (HLAB): $100,000

N/A

New/Continuing Activity: New Activity

Continuing Activity:

Emphasis Areas

Human Capacity Development

Estimated amount of funding that is planned for Human Capacity Development $20,000

Public Health Evaluation

Food and Nutrition: Policy, Tools, and Service Delivery

Food and Nutrition: Commodities

Economic Strengthening

Education

Water

Program Budget Code: 17 - HVSI Strategic Information

Total Planned Funding for Program Budget Code: $1,197,350

Total Planned Funding for Program Budget Code: $0

Program Area Narrative:

In China, the USG strategic information (SI) strategy focuses on providing SI technical assistance and support for HIV/AIDS

prevention, care, and treatment activities conducted by GoC, GFATM, and other donors while strengthening linkages between the

national and provincial levels. For FY 2009, the major SI priorities will be to: 1) support SI capacity building and technical transfer

among national, provincial, and GFATM counterparts; 2) ensure full collaboration and partnership between GoC and other donors

(particularly GFATM) to integrate second generation surveillance among MARPs including estimating new HIV infections; 3)

increase data analysis and use for strategic planning; 4) strengthen existing health management information systems (HMIS); and

5) expand the implementation of proven SI models at the provincial level.

The USG SI Team is currently composed of three staff members: 1) a Medical Epidemiologist who works closely with the

CDC/GAP China project officers and serves as the SI Liaison; 2) an ASPH Fellow who concentrates on M&E and surveillance,

and 3) a SI Specialist who works with the USAID RDM/Asia HIV/AIDS team and serves as the SI point person for USAID activities

in Guangxi and Yunnan provinces.

During the FY 2009 Mini-COP development process, target setting was undertaken by the USG SI Team members from

CDC/GAP China and USAID RDM/Asia and reviewed by the SI Advisor from CDC/GAP Atlanta. Meetings and discussions were

held with USG technical project officers and partners to set downstream (direct) and upstream (indirect) targets for FY 2009 and

FY 2010 based on their FY 2008 program results, projected programmatic growth, and expected expansion. The USG SI Team

also met with MoH and GFATM to discuss their program results, future plans, and targets; their targets were used to estimate

USG China's upstream targets.

China CDC identified data systems integration as a priority for better program management and, since 2006, USG has provided

technical assistance and support to China CDC on the development of a new Comprehensive Response Management Information

System (CRMIS) for HIV/AIDS, which was officially launched in January 2008. USG helped to improve data collection forms and

questionnaires, conduct a pilot study of CRMIS, and develop the system infrastructure. This HIV/AIDS Web-based information

and reporting platform covers all levels (national, provincial, prefecture, and county), and improves the efficiency of data

collection, reporting, analysis, and use as well as security. CRMIS also produces electronic HIV/AIDS statistics on a monthly,

quarterly, or annual basis. In FY 2009, USG will support China CDC to strengthen its training activities for CRMIS.

China's first National HIV/AIDS M&E Framework was approved by MoH in June 2007 as part of China's Action Plan for

Containment and Control of HIV/AIDS (2006-2010). The M&E framework uses existing data collection systems as its major source

of information, and investigates specific topics or issues when needed. Seventeen major indicators measure four areas: 1)

implementation of guarantee measures, 2) implementation of prevention and care activities, 3) knowledge and behavior change,

and 4) impact of prevention and care efforts. Coordination and harmonization between organizations and projects is of high

priority in the national M&E framework; and, multiple sectors, NGOs, and affected populations are actively represented. In FY

2008, the USG provided technical assistance for a mid-term evaluation of China's Action Plan using the new M&E framework and

indicators. USG assisted with the evaluation design and methodology and training of the data collectors, and will continue to

provide assistance in FY 2009 with the analysis and interpretation of the data. Results of the evaluation will guide the strategic

direction of the next five-year action plan. USG will also support the development of a national M&E framework for the National

Free ART program.

China CDC also convenes multi-sectoral NGOs or TWGs on an ad hoc basis. For example, a few MSM NGOs actively

participated in the first round of the recent national MSM survey; and a multi-sectoral TWG was formed to assist with projections

of the number of HIV/AIDS cases by 2020 using five different methods (the Delphi method, Asian Epidemic Model, SPECTRUM,

workbook method, and rough estimation).

In FY 2007, a baseline HMIS assessment in Guangxi and Yunnan provinces (using Lot Quality Assurance Sampling [LQAS] to

validate routine facility- and county-level information systems) found fragmented HIV/AIDS information systems, low knowledge

and skills in data analysis, interpretation, and use, limited technical supervision and feedback, poor quality software, and limited

linkages between different HIV/AIDS services and integration of their available information. During FY 2008, the USG developed

and piloted a training curriculum (entitled Continuous Improvement of HMIS Performance: Quality and Information Use) in

Guangxi and Yunnan to improve knowledge and skills in data analysis, interpretation, and use and strengthen the VCT, MMT,

PMTCT, ART, and HIV/AIDS case reporting systems. The curriculum was well received by the two provincial CDCs and

implemented in 12 counties, which showed marked improvements when evaluated in early October 2008. In FY 2009,

implementation of the training curriculum will be expanded to additional counties in Guangxi and Yunnan and offered to other

USG partners including GFATM.

During FY 2008, USG provided technical assistance and support to strengthen HIV/AIDS information systems in Guangxi and

Yunnan provinces, which can serve as models of how to successfully implement solid information systems at the national level. In

FY 2009, USG will help establish a data warehouse to integrate different types of HIV/AIDS information into a unified system, and

initiate and facilitate dialogue among the GoC, GFATM, and NGOs in the need to develop a community-based information system

for HIV/ AIDS services in the two provinces. At the national level, USG will provide technical support to scale up the use of LQAS

as a baseline assessment tool to identify critical gaps in existing information systems and recommend potential interventions. In

FY 2009, USG will also support the NARL to develop an electronic information management system for internal quality control and

expand its use to the provincial level. In the USG-supported provinces, USG will strengthen the capacity of provincial laboratories

to standardize procedures and organize and manage the internal quality control system more efficiently.

USG is committed to ensuring the successful implementation of the national M&E framework and indicators at the provincial level,

as well as supporting the institutionalization of standard M&E definitions, clear and consistent data collection and reporting

procedures, and routine data quality assessments. In FY 2009, USG will support strengthening the provincial M&E frameworks in

Guangxi and Yunnan, and improving the quality of services in eight provincial "hot spots" for MARPs. USG will also support the

development and implementation of M&E frameworks in the other 13 USG-supported provinces.

The Integrated Analysis and Advocacy (A2) project successfully used data to develop five-year HIV/AIDS operational plans in

Guangxi and Yunnan provinces. In Guangxi, as a result of the A2 project, the provincial AIDS committee received increased

funding from the provincial authority. In FY 2008, the USG assisted the Guangxi and Yunnan CDCs in applying the Asian

Epidemic Model (AEM) as part of the A2 project to organize data, refine trend analyses, and validate forecasts to effectively

allocate and maximize resources for provincial HIV/AIDS programming. Currently, AEM and other tools are being used by GoC to

project HIV/AIDS epidemic trends at the national level. USG will continue to build capacity among its government counterparts in

using modeling and forecasting tools. In FY 2009, USG will develop and pilot a simplified A2 module (A2 Lite) with more limited

data inputs needed for local analysis to help increase its accessibility and usability at the provincial level in Guangxi and Yunnan

and other USG-supported provinces.

USG recognizes the importance of having evidence-based data to enhance and improve HIV/ AIDS interventions. In FY 2009,

USG will support a "tracking" survey among FSW and IDU in the cities of Kaiyuan, Kunming, and Mengzi to measure the intensity

and impact of their exposure to BCC interventions. In FY 2010, USG will synthesize and share lessons learned, as well as

analyze the cost effectiveness of the "tracking" survey methodology within the China context. If this methodology works well, its

use will be expanded to other USG-supported sites in Guangxi and Yunnan provinces.

USG works closely with China CDC to implement surveillance and survey activities by improving national protocols, piloting new

methods such as Respondent Driven Sampling (RDS) and Time-Location Sampling (TLS), providing quality assurance during

implementation, helping with data analysis and interpretation, and linking surveillance and survey results with HIV/AIDS

programming.

USG will continue to provide technical assistance and support for strengthening surveillance systems and size estimation for

MARPs at the national and provincial levels. In FY 2009, USG will focus on improving second generation surveillance among

MARPs, and helping to establish and refine the MARP surveillance network in each of the 15 USG-supported provinces. The

networks will gradually be handed over as local governments guarantee continued financial support for them.

To estimate the population size for MARPs, USG advocates using the multipliers method within existing surveillance systems or

undertaking MARP mapping as an integral part of community-based prevention activities. In FY 2008, USG used the multipliers

method by adding special questions to FSW, IDU, and MSM questionnaires implemented in some major cities. In FY 2009, USG

will expand its use of the multipliers method to additional populations and USG-supported provinces. In FY 2010, the USG will

undertake MARP mapping in select counties in Guangxi and Yunnan provinces.

China CDC established the national Behavioral Sentinel Surveillance (BSS) system in 2001. In FY 2009, USG will provide

technical assistance to China CDC to refine the protocol for integrating current surveillance systems with a focus on BSS, simplify

and improve the surveillance questionnaires, sampling methods, and data collection procedures, and expand the system to more

sites. USG will continue to mentor the Guangxi and Yunnan CDCs and build their technical capacity to refine questionnaires,

select sampling methods, implement data collection procedures, and analyze, interpret, and use the data collected.

During FY 2008, USG supported NCAIDS in using RDS in 10 major cities and TLS in Shenzhen as part of the national MSM

survey. USG also developed and piloted Integrated Biological and Behavioral Surveillance (IBBS) studies using RDS among MSM

in the cities of Beijing, Guangzhou, Jinan, and Yunnan. In FY 2009, USG will work with China CDC to expand the MSM IBBS

surveillance protocol to at least 5 other major cities in the USG-supported provinces.

In FY 2008, USG supported NCAIDS to conduct a social network analysis among newly- identified HIV/AIDS cases in Chongqing,

Guangdong, Henan, and Yunnan provinces to better understand the social networks of cases, strengthen the epidemiologic

investigation of HIV- positive contacts, and identify major sources of the HIV/AIDS epidemic. In FY 2009, USG will continue to

support NCAIDS' expansion of social network analysis to additional provinces and provide technical assistance for data analysis.

During FY 2008, USG conducted special surveys among other locally significant populations at risk for HIV/AIDS, including

women from high HIV prevalence provinces who marry local men in Shandong, migrant IDU in Guangdong, high-risk heterosexual

migrants in Guangzhou, and sexually active male tin miners in Yunnan. USG also supported the NARL's use of BED assay to

estimate HIV incidence and project trends among IDU in five provinces (see Laboratory Infrastructure narrative). In FY 2009, USG

will expand these special surveys to other provinces and other populations (like pregnant women in high HIV prevalence areas) to

detect possible new epidemics and trends. Results from these surveys will form the basis for planning targeted prevention

programs.

This PHE activity, "Enhanced Evaluation of ART Program in Guangxi Province, China" was approved for inclusion in the FY09

Mini-COP. The PHE Tracking ID associated with this activity is: CN.07.0012.

Table 3.3.17:

Funding for Strategic Information (HVSI): $150,000

N/A

New/Continuing Activity: New Activity

Continuing Activity:

Emphasis Areas

Human Capacity Development

Estimated amount of funding that is planned for Human Capacity Development $75,000

Public Health Evaluation

Food and Nutrition: Policy, Tools, and Service Delivery

Food and Nutrition: Commodities

Economic Strengthening

Education

Estimated amount of funding that is planned for Education $7,500

Water

Table 3.3.17:

Cross Cutting Budget Categories and Known Amounts Total: $613,000
Human Resources for Health $2,500
Food and Nutrition: Policy, Tools, and Service Delivery $750
Food and Nutrition: Commodities $2,500
Human Resources for Health $27,000
Education $27,000
Human Resources for Health $45,000
Education $75,000
Human Resources for Health $105,000
Food and Nutrition: Policy, Tools, and Service Delivery $8,750
Education $35,000
Human Resources for Health $40,000
Food and Nutrition: Policy, Tools, and Service Delivery $4,000
Education $16,000
Human Resources for Health $10,000
Food and Nutrition: Policy, Tools, and Service Delivery $5,000
Human Resources for Health $9,000
Food and Nutrition: Policy, Tools, and Service Delivery $3,000
Food and Nutrition: Commodities $6,000
Human Resources for Health $3,000
Human Resources for Health $64,500
Education $21,500
Human Resources for Health $20,000
Human Resources for Health $75,000
Education $7,500