2015 kosovo hiv concept note ccm meeting discussion of the draft 15 january 2015
TRANSCRIPT
Key Assumptions/Requirements Same level of funding for 2.5 years;
Little likelihood of additional future funding;
Government to take over: contribution from 40% to full coverage;
Focus on key affected populations;
Address low coverage, treatment interruptions, MMT dropouts, and lack of behavioural changes
Highlights Main allocation and above
allocation
Counterpart financing and Willingness to pay
Online grant management platform, credentials, CCM endorsement
Process and Challenges
Changes in the Government and strategic planning processes;
KP’s representation weak; no networks/associations;
Key population estimates, IBBS in 3 sites, extrapolation problematic, implications of overestimating, more size estimates required;
Coverage increase – new outreach strategies, adjusted service combinations
Population size estimates: PWID
City population
Municipality population 2012
Adult population
IBBS Size Estimate
Total population drug use prevalence
Adult population drug use prevalence
Medium prevalence extrapolation
Prizren prevalence extrapolation
1Pristina 145149 205133 157952 3946 1.923630035 2.498220825 3946 3946
2Prizren 85119 181756 139952 1113 0.612359427 0.795271983 1113 1113
3Gjilan 54239 91413 70388 1159 560
4Peja 48962 98237 75642 1246 602
5Mitrovica 46230 73160 56333 928 448
6Ferizaj 42628 111141 85579 1409 681
7Gjakova 40827 96071 73975 1218 588
8Vushtrri 27272 71042 54702 901 435
9Podueva 23453 89185 68672 1131 546
Total 513879 1815606 783196 13051 8918
Goal: Maintaining the low prevalence of HIV and improving the quality of life of affected people through the improved cascade of HIV prevention and care services
Target Populations PLHIV
PWID
FSW
MSM
Prisoners
Migrants
Vulnerable women and girls
Vulnerable ethnic minorities (RAE)
Ob1: To improve access of KPs to quality HIV prevention and care
(Mod.1-4) Expand coverage:
Mobile service delivery;
Local peer educators;
Peer driven interventions;
Secondary service delivery
Service quality???:
High quality verbal BCC;
In-depth understanding of risk factors;
Risk management measures (PSCM);
Patient monitoring and treatment quality control
Ob2: To improve detection of HIV and facilitated access to care and treatment
(Mod. 1-5) Promotion/availability of HTC for KAP;
Promotion of HTC of pregnant women;
Strengthening continuum of prevention/care services:
linking HTC to prevention, care and treatment (regulations and referral mechanisms);
Improved retention through patient associations and community quality monitoring;
laboratory capacity to monitor the treatment effectiveness;
promote the development and rollout of treatment protocols
Ob3: To create supportive environment for sustainable HIV/AIDS response (Mod. 6-8)
Policy development and advocacy function (PAG);
Strengthening essential community systems (associations and networks) to address stigma and discrimination, monitor/ensure quality;
Client registration and service monitoring software, bio-behavioural monitoring, KP size estimates, formative studies;
Community Based Organisation
Health facility
Needles and syringes (PWID)Condoms (all KPs)Information (all KPs)HIV testing (up to 40%)TB screeningHCV testingHBV testingSTI testing1 mobile clinic
CounselingSocial supportLegal supportPsychologicalOST (MMT)
PDI Partners recruitment and education
Unknown status
HIV+HIV-
referral
OST (MMT)ART TreatmentTreatment for HIVTreatment for TBTreatment for STIHBV vaccination
HIV Prevention Service model
Mod. 1. Prevention for PWID and their partners
Outreach strategies (staff, mobile, PDI, secondary);
Adequate number of needles;
Adequate types of needles;
Alcohol swabs and sterile water?;
Strengthened BCC procedures;
Better detection of HIV and linkages to care and treatment;
Limited room for complementary services (legal aid).
Mod.2-4. MSM, FSW, Other
Outreach strategies: peer workers etc. (all);
Condoms and lubricants (condoms for all);
Strengthened BCC (all);
Gynaecological and STI services (SW);
HIV (all), HBV, HCV testing;
Prison personnel: study visit
Women and RAE: IEC materials and group education sessions;
Migrants, Women and RAE: Testing during events;
Mod.5. Treatment, care and support
Community-based care and support
Monitoring of treatment effectiveness
Community monitoring of treatment quality
Mod.6. HSS: Procurement and supply chain
management (PSCM) Closer collaboration between stakeholders
Risk management strategy
International TA
Good storage practice workshop
Mod.7. HSS: Health information systems and
M&E Improved service monitoring;
Monitoring of drug scene and contextual factors to adjust interventions: Operational studies (Prison NSP, RAE vulnerabilities)
Reports by frontline service providers
Assess the need of NSP in prisons
Feasibility of introduction of Low Dead Space (LDS) syringes
Preferred types of injecting instruments to inform procurement;
Consultations with prison health workers on situation changes;
Analysis and solutions for Naloxone;
KP size estimates (nationwide or in a selection).
Module 8. Removing legal barriers to access
PAG (including a legal analyst) Legislation analysis and promotion of improvements (EU
accession commitments, antidiscrimination legislation, legislation conflicts)
E.g. trafficking of humans and transactional sex – to standard practice of law enforcement officers etc.;
Policies and procedures to ensure the required level of service uptake and retention;
Development of community systems and community involvement in service monitoring and quality assurance;
Codes of professional practice and ToR; Operations, routes and schedules of service delivery units (mobile
unit); Development of CBOs, including PLHIV networks and peer-support
groups; Prison programme advisory council; BCC module related to OD; Improved detection of HIV (pregnant women and symptomatic
patients) - policies and procedures
Impact and outcome targetsIndicator 2011
base2014 target
2014 IBBS
2017 target
% SW living with HIV 0% <5%
% MSM living with HIV 2.3% <5%
% PWID living with HIV 0% <5%
% PWID who used sterile syringe during last injection
99% 80% 82% 85%
% MSM who used condom during last anal sex
53% 85% 66% 85%
% SW who used condom with latest client
43% 85% 62% 85%
Coverage targets: PWID
Population size: 8918 in 9 municipalities
Essential services: 2134/3400/4500/5350
VCT: 719/1360/1800/2140
Needles/person: 10/100/100/100
MMT: 94/150/200/250 (Increase if clients of public facilities are included)
Coverage targets: MSM
Pop size: 13432
Basis services: 1533/1600/3000/5373
VCT: 182 (2013)/640/1200/2149
Coverage targets: FSW
Denominator: 4586
Basic services: 272 (2013)/1000/1500/1900
VCT: 272 (2013)/400/600/760
Other populations Prisoners: 1380 (100%)
VCT: 552 (40%)
Women and girls: 9008/13512/13512
RAE: 5335/8002/8002
PLHIV care and support: 28/35/40/45
Budget Summary (Allocation)Module Y1 Y2 Y3 Total %
Prevention programs for people who inject drugs (PWID) 172 865 317 651 387 994 878 510 34%Prevention programs for MSM 88 658 149 432 196 018 434 108 17%Prevention programs for sex workers and their clients 56 411 84 576 89 724 230 711 9%Prevention programs for other vulnerable populations 39 105 79 950 74 193 193 249 8%Treatment, care and support 122 555 45 509 45 909 213 973 8%HSS: Procurement and supply chain management (PSCM) 5 036 0 0 5 036 0%HSS: Health information systems and M&E 16 325 47 923 35 771 100 019 4%Removing legal barriers to access 7 010 15 268 13 520 35 798 1%
Program management 98 451 187 902 187 902 474 256 18%Total
606 415 928 211 1 031 032 2 565 658 100%
Budget Summary (Above)Module Y1 Y2 Y3 Total %
Prevention programs for people who inject drugs (PWID) 44 411 64 572 72 587 181 571 37%Prevention programs for MSM 12 271 9 224 11 345 32 841 7%Prevention programs for sex workers and their clients 31 662 36 635 45 875 114 172 23%Prevention programs for other vulnerable populations 9 682 9 802 9 802 29 286 6%Treatment, care and support 32 928 0 0 32 928 7%HSS: Procurement and supply chain management (PSCM) 0 0 0 0 0%HSS: Health information systems and M&E 10 355 68 241 17 886 96 481 20%Removing legal barriers to access 500 500 500 1 500 0%
Program management 0 0 0 0 0%Total
141 809 188 974 157 995 488 778 100%