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Date of Review: 24.08.

2004 Programme Summary (as on 31st July 2004) Name of the Programme: HIV/AIDS Project Name 1. PPTCT Project Objectives (Annual Expected Results) 1. To suppot expanding the operational network of secondary and tertiary health facilities implementing component 3 of PPTCT. Four component Strategy with quality assurance in training and counseling. 2. To support NACO in working out a strategy and facilitating for sustained supply of Nevirapine. Partners: NACO Summary Status 1.1 .Currently, >322 teams have been trained, about 277 are providing services. mostly in the HPS and MPS. 1.2 Training Manuals for PPTCT teams training as well as the sensitization trainings and the training resource materials are being revised and will be available by September 2004... 1.3. Counseling training manual that also has counseling check lists etc. is being revised and will be available by September 2004.. Remarks Significant proportion of funds for RR resources were allocated to train 480 PPTCT teams in 2004 in medium and low prevalence states ( subproject 1) based on discussions with NACO in Dec 2003 with a caveat that a clear strategy for scaling up in low prevalence states , in which training would be an input. However, the strategy has not developed fully, resulting in revisions in outputs related to scaling up. Therefore it is estimated that a total of only about 337 teams (300 trained in 2003 and 37 in 2004) will be functional by end of 2004. Other outputs under sub- project 1 have been refined as more clarity has emerged on the over the last six months programme

3. To support NACO in 1.4. M & E indicators have been revised. operationalizing a comprehensive and integrated District Model of PPTCT based on the Fourth component Strategy in the selected districts.

4. To support design and implementation of a Feasibility Study of PPTCT Plus in 10 Centers of Excellence.

1.5. Standard Operating Procedure manual and advocacy tools for PPTCT are being developed to improve the consistency of services and rationalize the resources. 2. Nevirapine supplies from CIPLA have been 5 To support the care and negotiated and the delivery has begun. support services, with the help of 3 Two districts - Vellore and Dharavi -have UN partners, for HIV infected already begun implementation of the mothers, their children and decentralized services. Other 4 districts will partners in the high prevalence start implementation before the year end. states within the framework of 4. Design will be developed by end of year. 3x5 strategy as and when it is operationalised. 5.1 Appropriate linkages and partnerships have been developed with WHO and NACO for the 6. To initiate the processes, ART roll out for PPTCT programme including implementation of beneficiaries. Framework for action is yet to studies on HIV and infant developed feeding, with a view to support formulation of the IYCF policy 5.2 TORs for a national level technical advisory group has been developed. It is expected that the fist meeting of the group will be will be convened by Oct 04. 6. National Consultation on finalizing the IYCF guidelines is to be organized in AugustSeptember 2004.

Project Project Objectives Name (Annual Expected Results) 2. Adolescents To support NACO in: and young people 1. Implementing/expanding scaled up interventions on HIV prevention Education in-school 2. To support a national level discussion and strategy development on reaching young people out of school on HIV prevention 3. To collect, analyse and disseminate data pertaining to HIV/AIDS and young people, including case studies on skills-based prevention education for young people in and out of school, surveillance statistics, impact analysis and trends to ensure evidencebased HIV/AIDS programming

Summary Status 1. Peer and Preventive Education: Initiation of the SAEP (planning/design of SAEP and training of Core trainers) in low prevalence states of UP, Bihar, Rajasthan, Punjab, Haryana Scaled up implementation/expansion of the SAEP intervention in high prevalence States of AP, Karnataka, Maharashtra and Tamil Nadu. Focus has been on strengthening M & E, sustainability and quality of implementation Discussions with Ministry of Human Resource Development to increase leadership and ownerehsip of SAEP and ensure scaling up have begun. Clear programme and policy directions have to follow to ensure state level implementation. 2. Development of an evidence base and tools for implementation through: Based on request from NACO, evaluation of school AIDS programme has been comepleted. NACO and NCERET participated in regional workshops and international AIDS conference to promote and strengthen knowledge of life skill based strategies for implementing youth programmes toolkit for SAEP is in the final stages of the development.

Remarks The appointment of a consultant by Unicef for strategy development for reaching young people in most vulnerable communities (service) has been deferred pending completion of documentation of the exiting programmes.

3. The development of a strategy for reaching young people is still in the early stages towards developing an evidence base, the TOR for collation of out of school programmes has been prepared and shared with NACO (for comments) - this activity will be conducted with NACO Pilot demonstration projects have been supported (Haryana, AP, Mah). These project are in their final stages of implementation - tools and materials are being finalised, analysis and evaluation is expected to be completed by November 2004. Background concept note has been shared with NACO and draft proposal for esp vulnerable young people being discussed with DWCD 1. During the reporting period, communication strategic planning for PPTCT rather than for young people. 2. New programming orientations have emerged at national level, in particular the introduction of ART and the need to integrate communication in support of various HIV/AIDS Control Programme components. As a result, the understanding of optimal modalities for communication to support the PPTCT project has

3. Integrated 1. To develop advocacy tool kit Communicat to sensitize policy makers and ion partners on HIV/AIDS situation and multisectoral nature of response require for young people and women. 2. To strengthen national capacity in Behaviour and Social Change communication strategic planning 3. To develop / implement

1.1 Draft advocacy strategy paper aimed at opinion leaders and decision makers is currently in the process of finalization and has been subjected to a wider consultation with UNAIDS and other co-sponsors. 1.2 High level advocacy meetings involving Union HRD Ministers and key decision makers from line ministries have been held with a view to integrating and mainstreaming HIV/AIDS issues. 1.3 The communication brief for production of tools is ready and has been shared with NACO.

communication packages for PPTCT and Young People

Products are expected to be in place by October. 2.1 An innovative PPTCT communication formative research framework was developed in collaboration with NACO and the Tamil Nadu State AIDS Control Society (TNSACS). An external expert agency was recruited to develop and implement a research protocol for collecting qualitative and quantitative data needed to develop persuasive communication messages that can help address and overcome the factors coming in the way of attitudinal and behavioural change. The research framework also entails developing tools for identifying high-risk geographical areas and population sub-groups at increased risk of HIV infection to enable concentrated interventions. Though the formative research is being conducted in Tamil Nadu, the resulting protocol will serve as a prototype for need assessment in other states 2.2 In collaboration with the Mumbai District AIDS Control Society (MDACS) in Maharashtra, a Community Dialogue Initiative (CDI) was set up, which aims at mobilizing and building the capacity of NGOs and community based organisations (CBOs) to implement and monitor community-driven processes and interventions for HIV prevention. Through a variety of participatory techniques, communities are motivated to identify feasible solutions and devise a community action plan to provide

evolved, requiring adjusting planned activities. 3. Although the PPA has been prepared jointly clarity to define the scope and modality of support had to be sought at every stage. This reflects the need to improve a shared strategic understanding of the programme. Priority action points that will ensure delivery of products by end of 2004 are Recruitment of a consultant to finalize the national PPTCT communication strategy that is so as to integrate VCCT and ART Sub-contract a specialized agency to pilot a communication campaign on PPTCT

community-based care and support. If successfully implemented, MDACS will scale up the CDI approach to include other high-risk areas in the city and elsewhere. 3. PPTCT communication strategy addresses obstacles in availability, accessibility, utilization and coverage (AAUC) of existing PPTCT services. Based on the AAUC analysis, measures to strengthen programme management and objectives for pptct communication strategy were developed. The objectives will be achieved though combination of mass media campaign and inter personal communication aimed at bringing about social and behavioral change.

Recommendations : Prevention of Parent to Child Transmission Programme The approach taken by UNICEF this year following a research and rapid expansion during 2001- 03, has been to consolidate, improve quality and develop a strategic view of scaling up. Based on this approach following recommendations have been made. 1. UNICEF has focused its support on improving quality of services being provided at the existing centers rather than rapid expansion of services to sub district levels. However, many states have increased service delivery point in the absence of clear stram tegy for scaling up. Therefore in order to provide strategic direction to scaling up of PPTCT services, review of the programme in priority states is recommended. 2. Training of PPTCT teams and sensitization trainings at district level hospitals in medium and low prevalence states have been put on hold until a clearer strategy for low prevalence states develops. 3. Advocacy activities to position PPTCT as one of the services of MCH and strengthen ownership of the programme by various line department are recommended. They include, (a) high visibility national workshop for Hospital Deans to promote PPTCT programme through presentation of achievements by peers from Centers of excellence and existing audio-visual and print advocacy materials; (b) same workshop to be repeated at state level to enlist sensitized Deans and Medical Superintendent in implementation of programme strengthening measures; (c) negotiation with Director of Health Services for PPTCT to be discussed as part of RCH programme review meetings. 4. Convene a high level National level Technical Advisory Group to provide technical guidance on voluntary counseling, prevention of parent to child transmission and care and support including treatment with Anti Retroviral to that government and its partners and to focus the resources. Priority topics for discussions are i. Rational and criteria for scaling up VCT and PPTCT. ii. Infant feeding guidelines for children of mothers who are HIV positive iii. Management of pediatric AIDS. 5. .Given the intense focus on PPTCT and that the strategies for young people are evolving , it is recommended that development of supportive communication strategies for young people is postponed to next year.

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