PROJECT ŚVETANA (Dawn) Elimination of new HIV infections among children by Scaling up PPTCT services in private health sector Supported by Global Fund for AIDS, TB and Malaria (GFATM) Oct 2015 Dec 2017 Oct 6, 2015
There is a large population of HIV+ pregnant women and at-risk infants 26.4 million annual deliveries (Estimated Deliveries as per NHSRC-2012-13) 38,204 estimated HIV positive pregnant women needing PPTCT (National Strategic plan for PPTCT, 2013 NACO) 11,461 babies likely to be infected by HIV annually without intervention (30% of 38,204) Source: National Strategic plan for PPTCT, 2013 NACO
India s Delivery Patterns ( in millions) Total Estimated Deliveries 26.45 million Total Deliveries reported 19.88 Unreported Deliveries 6.56 Total Home Deliveries reported 3.45 Total Institutional Deliveries reported (Public & Private) 16.43 Sources: NHSRC 2012-13 (In millions) Institutional Deliveries Private - 4.26 million Institutional Deliveries Public - 12.17 million
Gaps in PPTCT coverage In 2013-14, 9.75 million (36.8%) of the estimated 26.4 million pregnant women were HIV tested About 12,008 (31.4%) of the 38,204 estimated positive pregnant women were reached with services to prevent mother-to-child transmission Nearly 26% of pregnant women in the country, who access services in the private sector, were not reached through the government program Stigma, discrimination, and misconceptions regarding HIV still exist among health care providers, public and private alike. Source: Annual Report 2014-15, NACO / NHSRC-2012-13 / National Strategic Plan, 2013-NACO
Project Śvetana Goals and Objectives Goal: Contribute to NACP-IV Objectives: Improve coverage of PPTCT services through enhanced access in private health sector, work towards elimination of pediatric HIV and keeping mothers alive and healthy
The Śvetana program targets the private sector PPTCT gaps At present, the PPTCT program as of Sept 2014 16,283 ICTC/PPTCT centres 5559 Stand alone ICTCs 10724 FICTCs including around 2000 PPP-ICTCs SAATHII in 5 states of Tamil Nadu, Andhra, Telangana, Maharashtra and Karnataka : 1312 PPP sites and 4655 Referral Sites (RS) support of EGPAF/Gilead and MAC-AIDS/Tides Geography: 12 states and two UTs prioritized based on PPTCT National Strategic Plan (NSP) States prioritized based on high number of private sector deliveries and high PPTCT burden in the state 3.61 million (85%) out of 4.62 million estimated private sector deliveries 7333 (91%) out of 8054 estimated positive pregnant women in private sector Implementation approach through Public Private Partnership (PPP) model Network of Referral Sites
Contribution of Project Śvetana focus states to Institutional and Private Sector Deliveries of WLHIV Estimated Positive Pregnant women (Public + Private together) Total =38204 Estimated Positive Pregnant women (Private) Total =8054 12523, 33% 25681, 67% 721,9% 7333, 91% 11 States + 2 UTs Rest of the Country 11 States + 2 UTs Rest of the Country 12 states and two UTs contribute to 67% of positive pregnant women burden in the country and 91% of estimated positive pregnant women in private health sector in the country Source: National PPTCT strategic Plan and NHSRC 2012-13 data on delivery patterns
Implementation geography and partners 235/292 districts in 14 states/uts as per NSP 12 states 1. Andhra Pradesh 13/13 2. Telangana -10/10 3. Karnataka 30/30 4. Maharashtra 35/35 5. Tamil Nadu -32/32 6. Kerala 10/15 7. Rajasthan 19/33 8. Goa 2/2 9. West Bengal 16/19 10. Jharkhand 7/24 11. Odisha 23/30 12. Gujarat 24/36 Two Union Territories 1. Delhi -9/9 2. Puducherry -4/4 Two Sub-Recipient (SR) partners 1. Karnataka Swami Vivekananda Youth Movement 2. Maharashtra (partial) - Prayas, Pune (6 districts) Nine SAATHII State Units (SU) 1. Andhra Pradesh and Telangana 2. Maharashtra (29 districts) and Goa 3. Tamil Nadu and Puducherry 4. Kerala 5. Rajasthan and Delhi 6. West Bengal 7. Jharkhand 8. Odisha 9. Gujarat Note: Green colored four states Plan will be implementing PPTCT outreach and SAATHII on private health sector PPTCT in these states
Activity 1: Establishment of PPP-ICTC/PPTCT and RS to increase counseling and testing and detection of HIV positive pregnant women - Mapping of private hospitals and signing of MoUs for different private hospitals Criteria Type of Site Private Maternity Facility -Provides HIV testing, referrals and/or deliveries -Willing to participate in program and share data with the government -Provides HIV testing -Unwilling or unable to provide other PPTCT services or participate as formal implementation site PPP Implementation Site Referral Site/ Data sharing Site Note: Some sites in a given implementation district are not formally engaged in the program. Engaging Professional medical associations FOGSI, IAP and IMA is essential for PPP/RS establishment
Private referral sites will be linked with PPP and/or Govt SA-ICTC so that HIV+ women identified in any private hospital is tracked and served Referral Site Referral Site Referral Site PPP Site/Govt. ICTC Referral Site Referral Site
Activity 2: Technical support to streamline service provision in PPP sites and their linkages with government Government ART Center Private Facilities (PPP Sites) ANC, Post Natal and Pediatric Care HIV counseling and testing HIV care (at selected sites) Referrals and linkages Delivery (not all facilities) In-depth counseling HIV care CD4 testing OI and ART/ARV prophylaxis and treatment Infant HIV testing Private or Public health facilities Pediatric care Delivery Community outreach
Activity 3 : Ongoing technical support to PPP sites for improving quality of services Reporting to the government Experience sharing meetings Site assessment Tripartite Agreement On-Site Sensitization Mentorship (counseling, lab and clinical) PPTCT Start-Up Assistance Regular Supportive Monitoring Visits Coordinating with DAPCU/SACS for training of PPP staff Handholding Ensuring continuous test kit supply, IEC materials, ART drugs, registers
Activity 4: Engaging professional medical associations of FOGSI/IAP/IMA for partnerships and reporting Conduct national, state and district level trainings for the members of the professional medical associations National level consultation State level consultation District level consultations one for 3-4 districts Getting support letters at national, state and district units for involvement of their members Motivate all private hospitals to report their HIV testing data and positives data to government
Activity 5: Referrals and stakeholder coordination for effective tracking of M-B pairs No dedicated outreach for private sector Establish referral and linkages between PPP/ RS sites with government ICTC/ART/TB services for confirmation of single test positives, for CD4/ART/TB treatment Establish tracking mechanisms by linkages with PPTCT outreach in four states, Vihaan outreach workers and front line health workers in all states for follow-up of pregnant women till 18 months post delivery Monitor mother-infant pair follow-up through individual tracking
Activity 6: Engagement and involvement of positive networks National level National Steering Committee of the project National level consultations State level State consultations State Oversight Committee Outreach coordination through existing outreach, wherever network partners implement outreach District level Coordination with district network partners for District level sensitization meetings - one meeting for 4 districts to be done by Technical Assistance partner Onsite sensitization at PPP site level, wherever possible Outreach coordination through existing outreach, wherever network partners implement outreach
Anticipated challenges from past experiences Reluctance of some private hospitals to join the program and /or report the data Lack of dedicated HIV counselors at PPP sites Supply chain interruptions in testing kits and ART/ARV/PEP drugs Lack of policy and regulation for the private sector Challenges in integration of PPTCT services with MCH and RCH services of NRHM Lack of dedicated PPTCT outreach in states that are not part of Plan India PPTCT work
Reporting and Data flow
PROGRAM MANAGEMENT UNIT National Steering Committee Chaired by AS&DG, NACO STATE TECHNICAL ASSISTANCE UNIT 11 Units (9SU+2SR) for 12 States and 2 Union Territories Program Director State Oversight Committee Chaired by Project Director, SACS Director, M&E (50%) Administration, Finance & Grants Director State Director M&E Managers (2) Regional Program Managers (2) Technical Managers (2) Administration, Finance & Grants Manager Program Manager-1 Medical Manager-1* Program Officer Administration (1) Officer Finance Officer (1) M&E & Documentation Officer -1 Program Officers (1 per 3-5 districts) Administration and Finance Officer-1* * - shared between states
SVETANA Project Targets: overall SAATHII GFATM SVETANA PROJECT TARGETS Coverage/Output indicator Oct 2015 to Mar 2016 Apl 2016 to Mar 2017 Apl 201 to Dec 2017 N # N # N # % % % D # D # D # PMTCT-1: Percentage of pregnant women who know their HIV status PMTCT-2: Percentage of HIVpositive pregnant women who received antiretrovirals to reduce the risk of mother-to-child transmission PMTCT-3: Percentage of infants born to HIV-positive women receiving a virological test for HIV within 2 months of birth 331380 842430 672075 18% 23% 24.8% 1806452 3612904 2709677 516 1739 1984 14.1% 24% 36.1% 3666 7333 5500 516 1739 1984 14.1% 24% 36.1% 3666 7333 5500 Reporting to NACO: PPTCT cascade indicators from ANC testing to 18 months of baby testing will be adhered to and reported to NACO
State Wise targets No. Of PPP Sites Oct 2015- Mar 2016 Apl 2016-Mar 2017 Apl 2017-Dec 2017 Positive Positive ANC Identifica No. Of ANC Identifica No. Of ANC Testings tion PPP Sites Testings tion PPP Sites Testings Positive Identifica tion State Name Telangana 121 39930 114 125 82500 285 125 61875 244 Andhra Pradesh 139 45870 137 150 99000 338 150 74250 289 Karnataka 250 52500 53 300 120750 241 300 94500 296 Tamilnadu 221 26520 37 244 73800 175 244 59670 231 Puducherry 4 480 0 6 1200 10 6 1080 15 Maharashtra 677 122100 132 692 247140 361 692 200160 381 Goa 4 480 1 8 1440 18 8 1440 21 Gujarat 105 18900 19 245 95550 116 245 77175 192 Odisha 40 4800 5 100 30000 40 100 22500 43 Rajasthan 60 7200 7 100 27000 47 100 27000 97 West Bengal 25 3000 3 100 24000 34 100 18000 38 Delhi 20 2400 5 20 7200 24 20 5400 31 Jharkhand 30 3600 4 60 12600 23 60 10800 31 Kerala 30 3600 1 75 20250 28 75 18225 77 Total 1726 331380 516 2225 842430 1739 2225 672075 1984 % of Positives from PPP 77 58 42 % of Positives from RS 23 42 58
OCTOBER 2015 DATA I II III IV PPP sites reporting No. Of PPP sites reported to SIMS during reporting period 1327 Referral Sites reporting No. of RS sites reported during reporting period 3334 Counseling and Testing Services PPP sites No. of pregnant women counseled 48032 No. of pregnant women tested for HIV 47878 Positive pregnant women served in private health sector A. No. of confirmed positive pregnant women seeking ANC services at PPP sites (identified + referred-in ) 49 B. No. of positive pregnant women identified with single test at RS referred to Govt. ICTC for confirmation 13 C.Out of above, number of pregnant women confirmed with HIV positive status at Govt. ICTC 9 A+C :Total confirmed positive pregnant women served in the program across PPP and RS 58
OCTOBER 2015 DATA V VI Treatment Services No. of HIV positive pregnant women on ART ( including women already on ART) 49 Delivery Services No. of Positive pregnant women delivered 47 No. of Still births to the positive pregnant women 1 VII No. of exposed infants administered ARV prophylaxis 46 Non-ANC Testing No. of non-anc (general clients) tested 31579 No. of non-anc (general clients) found positive 110
Vihaan Implementation in two states West Bengal and Jharkhand Continue to perform the Sub Recipient roles in two states MoU with India HIV/AIDS Alliance SAATHII will perform the roles of SR in reporting, trainings, participation in meetings, and partner management for uniformity Informing PR and seeking guidance and support from Alliance
Svetana- Budget Summary Total Budget from Global fund (US$); 44,99,931 PPTCT Share 36,74,989 Vihaan Share 8,22,942 PPTCT Budget Share 36,74,989 SAATHII (PR) 8,16,835 SAATHII State Units (9) 23,52,795 SVYM (SR) 3,30,341 Prayas (SR) 1,75,018 Vihaan Budget Share 8,22,942 West Bengal 5,10,949 Jharkhand 3,13,993
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