ACTIVITY HAS BEEN MODIFIED IN THE FOLLOWING WAYS FOR FY09:

SUMMARY

In FY08, Connect focused on establishing three additional PMTCT sites in private medical centers. Over

5,000 pregnant women have been counseled and tested and have received their results through six

Connect supported sites, with an average HIV positivity rate reported around 3% (greater than the average

rates reported from surrounding government and other ante-natal care (ANC) clinics).

In FY09, the Connect Project will focus on transitioning all Connect-supported PMTCT clinics to public-

private partnership (PPP) initiatives under National and State AIDS Control (NACO and SACS) programs or

relevant private medical sector partners. Connect will act as a catalyst to bring various players in India

together to share best practices and lessons learned while engaging the private medical sector for PMTCT

services.

ACTIVITIES 1, 2 & 5 from FY08 are being merged into one activity in FY09, entitled ‘Engage the Private

Medical Sector In and Around Most At Risk Populations to Implement PMTCT'.

In FY09, Connect will intensify its efforts to mobilize the private sector to support PMTCT among those

engaged in the most at-risk industrial sectors. Connect will coordinate institutional capacity building efforts

so that these institutions are equipped to run PMTCT services on their own. Connect will also strengthen

linkages with care and support/ART centers and TB services such as Revised National TB Control Program

(RNTCP) to monitor improved treatment outcomes for TB and HIV patients. Connect will also mobilize

various industry associations and corporate businesses to visit Connect-supported health facilities and

scale up services through PPP in other areas.

ACTIVITY 3 (FY 08): Involvement of Male Partners in Utilization of PMTCT Services

The counseling component will now also include prevention counseling for discordant couples, especially

HIV positive men with HIV negative pregnant wives, who are likely at very high risk of sero-conversion.

ACTIVITY 4 (FY 08): Raising Resources for Sustainability of PMTCT - No change

ACTIVITY 6 (FY 08): Capacity Building of Local NGOs and the SACS - No change

The following three activities are new in COP 2009:

ACTIVITY 7 (New - FY 09): Build Knowledge Base on the Best Practices Under the Private Sector PMTCT

Models Implemented in India

There is a strong need to build the inventory and knowledge base on the various models for engaging the

private medical sector in HIV/AIDS prevention and care services. The Connect project will constitute a

technical resource group of government, USG partners and other stakeholders to understand the

effectiveness of each of the models. The best practices will be documented to serve as a resource guide

(including a web-based system) for private sector engagement. The Connect project will conduct national

and state level workshops to disseminate the best practices to NACO/SACS/TSU, the private medical

sector and donors. The activity is envisaged to support NACO/SACS to strengthen the private sector

PMTCT/Integrated Counseling and Testing Center (ICTC) models.

ACTIVITY 8 (New - FY 09): Transfer Connect-Supported Private Sector PMTCT Sites to NACO to Serve as

Learning Sites under NACP-III

In FY09 the focus will be on transferring the Connect model sites to SACS and NACO to serve as learning

sites for private sector engagement, as part of the NACP-III strategies. The Connect project will conduct an

evaluation of the six PMTCT sites. The findings of this evaluation and overall lessons learned will be

disseminated to NACO/SACS and NGOs through a national symposium and two regional level workshops.

The Connect project will facilitate visits by SACS/NACO to demonstrate quality assurance mechanisms and

case management approach for monitoring the effectiveness of PMTCT programs. It is envisaged that by

the end of FY09, all six Connect supported PMTCT sites will be transferred to NACO.

ACTIVITY 9 (New - FY09): Mitigating Stigma and Discrimination against PLHA Among the Medical and

Paramedical Staff of Private Medical Sector

In FY09, Connect will mobilize and conduct a stigma reduction program with private medical and

paramedical staff. The key activity will be to design an overall training module and implementation plan to

break barriers and address myths and misconceptions related to PLHAs. Connect will seek the support of

local medical and paramedical professional associations, such as the Indian Medical Association (IMA) and

the Federation of Obstetricians and Gynecologists Societies of India (FOGSI), to reach out to private

medical and paramedical practitioners.

FY08 NARRATIVE

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

Activity Narrative: 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

(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

Activity Narrative: (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.

New/Continuing Activity: Continuing Activity

Continuing Activity: 14165

Continued Associated Activity Information

Activity Activity ID USG Agency Prime Partner Mechanism Mechanism ID Mechanism Planned Funds

System ID System ID

14165 14165.08 U.S. Agency for Population 6721 6721.08 Connect $250,000

International Services

Development International

Emphasis Areas

Gender

* Increasing gender equity in HIV/AIDS programs

Health-related Wraparound Programs

* Family Planning

* Safe Motherhood

* TB

Workplace Programs

Human Capacity Development

Public Health Evaluation

Food and Nutrition: Policy, Tools, and Service Delivery

Food and Nutrition: Commodities

Economic Strengthening

Education

Water

Estimated amount of funding that is planned for Water $2,500

Table 3.3.01:

ACTIVITY HAS BEEN MODIFIED IN THE FOLLOWING WAYS FOR FY09:

SUMMARY

In FY08, the Connect Project worked on building institutional capacity of State AIDS Control Societies

(SACS), employers' organizations, labor unions, and private and public companies to develop policies and

programs on HIV/AIDS and TB in Karnataka and Andhra Pradesh. In FY09, Connect and its sub-partners

will review and document various public-private partnership (PPP) models. The main goal will be to transfer

the lessons and provide technical assistance to public and private partners to scale up these innovative

models. Connect will advocate organizations to absorb the positions currently funded by Connect. Further,

Connect will work with these organizations to develop a plan ensuring the continued mentorship of the staff.

ACTIVITY 1 (FY08): Technical Assistance to NACO and SACS to Build the Private Sector Response to

HIV/AIDS

In FY09, Connect will support SACS to implement a ‘Most-at-Risk' Industry Assessment study in high

prevalence states. Connect will review PPP models that reach vulnerable populations and will support

NACO through a national Technical Support Unit (TSU) to replicate such models in other parts of country.

Connect will also initiate capacity building of partner NGOs, NACO and SACS to enable them to leverage

resources (financial and in-kind) from corporate India for HIV/AIDS and TB programs.

ACTIVITY 2, 3, 4 (FY08): No Change

ACTIVITY 5 (FY08): Mainstream HIV/AIDS and TB Programs into Public Sector Companies

In FY09, Connect will provide technical assistance to Federation of Indian Chambers of Commerce and

Industry (FICCI) and NACO/TSU/SACS to implement mainstreaming activities rather than work directly with

the organizations identified.

ACTIVITY 6 (FY08): Reduction of Stigma and Discrimination at Workplaces

In FY09, in addition to activities for reducing stigma and discrimination at workplace, Connect will target

health care personnel at hospitals and nursing homes to enable friendly services to PLHA at PMTCT and

CT clinics.

The following new activities will be undertaken in COP09:

ACTIVITY 7 (new - FY09): Expansion of Insurance Coverage for PLHA with Technical Assistance to

NACO/SACS, PLHA Networks and Insurance Sector

In FY07 and FY08, Connect facilitated the release of the first group insurance policy for PLHA. It also

facilitated a National Symposium to advocate with the insurance sector for PLHA-friendly insurance policies.

In FY09 Connect, in partnerships with the SACS, USG partners, NGOs and PLHA networks, will look to

expand the insurance cover for PLHAs to other states. Connect will support NACO to organize a Technical

Resource Group that will facilitate advocacy workshops with PLHA networks, private and public sector

insurance companies, and employers' organization (such as FICCI, Confederation of Indian Industry (CII),

The Associated Chambers of Commerce and Industry of India (ASSOCHAM)), and UN agencies. Efforts

will focus on removing HIV from the list of excluded pre-existing diseases for various group health insurance

products. Efforts will be made to extend insurance coverage of HIV positive women, including widows.

Another focus area will be integrating HIV coverage into the existing Below Poverty Line (BPL) government

insurance schemes, such as Rashtriya Swasthya Bima Yojana (supported by Ministry of Labor).

ACTIVITY 8 (FY09): Demonstrate Increased Utilization and Improved Quality of Care within Health Services

Leveraged through PPP for At-Risk Industrial Sector Workers

In FY09, Connect will evaluate health sector partnerships models in both the public (such as Employees'

State Insurance Corporation (ESIC)) and private sectors on the parameters of reach and access to at-risk

workers and also on improved quality of care for delivering HIV-related services. The project will strengthen

linkages with birth spacing products and services and treatment for STIs and TB. Connect will advocate

with NACO/SACS, Revised National Tuberculosis Control Program (RNTCP), industry associations and

corporations to recognize Connect-supported health facilities as model PPP demonstration sites.

ACTIVITY 9 (FY09): Develop and Disseminate ‘GEMSTONES' on Public Private Partnerships in HIV/AIDS

Prevention and Control Services

In FY09 Connect will conduct site visits, review literature and organize workshops with industry and

professional associations at the district, state and national level to unearth and document best practices of

PPP in HIV/AIDS and TB. These models of excellence, entitled ‘GEMSTONES,' will be further studied and

findings disseminated through national and regional level events by NACO, RNTCP, FICCI and other

partners. For wider circulation of lessons learned, the project will also publish articles and case studies in

national and international journals and publications.

FY08 NARRATIVE

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.

New/Continuing Activity: Continuing Activity

Continuing Activity: 19131

Continued Associated Activity Information

Activity Activity ID USG Agency Prime Partner Mechanism Mechanism ID Mechanism Planned Funds

System ID System ID

19131 19131.08 U.S. Agency for Population 6721 6721.08 Connect $250,000

International Services

Development International

Emphasis Areas

Gender

* Increasing gender equity in HIV/AIDS programs

Health-related Wraparound Programs

* Family Planning

* Safe Motherhood

* TB

Workplace Programs

Human Capacity Development

Public Health Evaluation

Food and Nutrition: Policy, Tools, and Service Delivery

Food and Nutrition: Commodities

Economic Strengthening

Education

Water

Estimated amount of funding that is planned for Water $0

Table 3.3.18: