SUMMARY

The Connect Project, implemented by Population Services International (PSI), aims to increase private

sector engagement in PMTCT through demonstration of pilot private sector service delivery models. In

FY08, key activities funded through both GHAI and Child Survival funds will include providing PMTCT

services at three private sector hospitals, improving the quality of services, increasing the client flow at

PMTCT services through innovative demand creation activities, involving the male partners of pregnant

women to support safe disclosure and the involvement of fathers in follow-up, mobilizing local resources to

support PMTCT program activities, and building the capacity of private hospitals and NGOs to provide high

quality services and linkages with care and treatment for HIV-positive parents. The primary target

population is 500 pregnant women and their male partners. Targets under this program area will be

achieved by using both GHAI and Child Survival funds to achieve results.

BACKGROUND

The Connect project has been implemented by Population Services International (PSI) since October 2006,

in partnership with the Federation of Indian Chambers of Commerce and Industry (FICCI), Y.R, Gaitonde

Centre for AIDS Research and Educations (YRG CARE) and the Karnataka Health Promotion Trust

(KHPT). The project aims to increase private sector engagement in HIV/AIDS through workplace

interventions and the development of public-private partnerships for a continuum of prevention to care

services. The main strategies include mobilizing companies for workplace interventions, developing private

models of service delivery in counseling and testing (CT) and PMTCT, and provision of technical assistance

to government on mainstreaming HIV/AIDS in the private sector. The geographical focus is Karnataka,

coastal Andhra Pradesh and selected port towns (Mumbai, Vashi, Mangalore, Tuticorin, Chennai and Vizag)

in the USG focus states. The International Labor Organization (ILO) provides technical support to the

project.

ACTIVITIES AND EXPECTED RESULTS

Under the national program in India, PMTCT is referred to as PPTCT or Prevention of Parent to Child

Transmission, to mitigate any stigma associated with the mother/woman as a vector of the infection. The

PMTCT component under the Connect project is implemented through two model PMTCT sites established

within the private sector hospitals in Chennai (Tamil Nadu) and Vizag (Andhra Pradesh). The activities are

led by YRGCARE (Y.R. Gaitonde Center for AIDS Research and Education) which is supported and

managed by PSI. The focus in FY08 will be on assessing sites in two other high prevalence states to study

the feasibility of expanding the model, in addition to further strengthening service delivery, improving its

quality and mobilizing resources for PMTCT services.

ACTIVITY 1: Demonstrate High-Quality Models of Service Delivery in the Private Sector

Connect project will continue to provide high quality PMTCT services to two centers that started operating in

FY07, and will expand to a third site. Starting in October 2007, a mystery client study will be carried out at

the PMTCT centers to assess the current levels of adherence to standard quality protocols in accordance

with the national guidelines. Based on the gaps identified by the mystery client studies, specific training

programs will be designed for the counselors and case management workers at the PMTCT centers. The

capacity building plan for FY08 includes training 10 counselors and case management workers in

implementing standard quality protocols in accordance with the national guidelines, with an emphasis on

quality assurance for PMTCT services and data quality assurance. The activity's aim is that at least 70% of

the standard protocols are followed at the PMTCT centers. Quality assurance will include ensuring the

complete package of elements of PMTCT is provided, including community mobilization, partner counseling,

ARV prophylaxis for the mother-baby pair, counseling on safe disclosure, safe elective surgeries and

linkages with the government ARV centers for follow-up for the mother (and positive baby) for ARV and OI

treatment. The Connect project will follow the national protocols for promoting exclusive breastfeeding;

however it will leverage infant food wherever appropriate as part of an informed choice package.

ACTIVITY 2: Demand Creation for PMTCT Services

Demand creation activities will continue at the community level through identification and motivation of

pregnant women to access PMTCT services. In FY08, training of private ANC providers will be conducted to

increase their knowledge of the national PMTCT program, approved medication regimens, and counseling

techniques to motivate them to refer clients for PMTCT services. Regular meetings will be conducted under

the aegis of the Indian Medical Association and Federation of Obstetric and Gynecological societies of India

to mobilize local private practitioners. Outreach activities by the YRG Care team will reach women through

NGOs working with women's groups, women's clubs and women's self help groups. Regular stakeholders'

meetings with community influencers will be conducted with NGOs to motivate them to promote demand for

PMTCT services. Innovative communication materials in the form of brochures, flip charts, pamphlets,

posters and newsletters will be developed to address the benefits of PMTCT. In FY08, around 1800 women

will be counseled and tested at the private PMTCT centers, and around 60 mother-baby pairs will receive

the complete package of PMTCT services. Testing of other younger children from previous pregnancies will

also be encouraged.

ACTIVITY 3: Involvement of Male Partners in Utilization of PMTCT Services

In FY08 specific interventions will be conducted in the community to target male partners through the

PMTCT intervention. All pregnant women accessing services at the PMTCT centers will be motivated to

bring their partners for HIV testing. Partner testing and counseling for safe disclosure will be strongly

encouraged as also referral to community-based organizations to mitigate possible negative effects of

disclosure and increase community support. Counselors will be trained in motivating women to bring their

male partners for HIV CT. Male partners will also be reached to motivate them to access PMTCT services

as a couple. Communication material will be developed emphasizing the need for male partner participation

in the PMTCT component. Around 100 male partners will be counseled and tested at the PMTCT centers.

ACTIVITY 4: Raising Resources for Sustainability of PMTCT.

In FY08, the project will focus on leveraging resources for nutritional support, the cost of elective caesarian

section, salary for human resources, and the training and research cost. Local donors like Rotary and the

Lions Clubs will be targeted to raise funds for the elective caesarian section for HIV-positive mothers, which

are currently subsidized service at the private sector hospitals. Partner hospitals will be motivated to

assume the cost of salaries for the human resources dedicated to PMTCT services.

The long-term goal is to demonstrate the success of this model to the National AIDS Control Organization

Activity Narrative: (NACO) and incorporate it under the national program. A public-private partnership Community Advisory

Board will be established in each project site. The Community Advisory Board will consist of representatives

from local NGOs, SACS, local PLHA networks, partner hospitals and the community. These community

advisory boards will provide guidance in overall program implementation and most critically ensure

leveraging of resources from different stakeholders in society. The Connect project will aim to increase the

engagement of the private sector (through corporate social responsibility) and the NGO/CBO sector to build

the long term sustainability.

ACTIVITY 5: Referral Linkages for Care and Treatment of HIV Positive Parents

Connect will conduct an assessment of the care and treatment facilities in the three project sites to assess

the quality of services at these centers. An intensive network will be mapped out of government and private

(NGO) service providers to which HIV-positive clients can be referred for care, support and treatment

(ncluding ART). Referred clients will be tracked through a card system monitored through field and

community outreach. This activity plans to refer 150 HIV positive clients to care and treatment services.

ACTIVITY 6: Capacity Building of Local NGOs and the SACS

Connect will design and conduct training programs for local NGOs and the State AIDS Control Societies

(SACS) to build their institutional capacity to manage and monitor private sector PMTCT models.

Operational guidelines and standard operating procedures at the PMTCT centers will be shared with the

SACS to assist in strengthening the quality of services in public sector PMTCT centers. The operational

guidelines will include the steps to set up a private sector PMTCT model that provides a range of

comprehensive services going from community mobilization to follow-up of mother-baby pair with ARV/OI

treatment services; a training plan; and monitoring protocols to measure services, client satisfaction and

data quality. The training programs will use a mixed methodology that has classroom sessions followed by

on-site technical assistance and field visits to the PMTCT center. This activity will aim at training 20

individuals from different NGOs in PMTCT protocols.

This is a continuing activity, for which PSI received $300,000 in GHAI in FY 2007. Early funding is needed

to continue expanding partnerships for interventions with the private sector in all program areas and avoid

any loss of momentum in the third quarter of FY 2008. This will also enable us to be responsive to the

national program's request that we build capacity in the private sector.