PIPPSE Sets a Benchmark by Developing TI based Data Management Automation Tool
The Monitoring & Evaluation (M&E) team of PIPPSE project has developed excel based data management automation tool for Targeted Interventions (TIs) as a step towards strengthening HIV/AIDS prevention program in the country.
The tool is a one-stop shop solution with the features such as individual tracking of high risk groups (HRGs), People Living with HIV (PLHIV) tracking sheet, single tool for all core groups, uniform denominators, automated service due/undue calculations, grading of TIs based on performance, and output for NACO’s Strategic Information Management system (SIMS). The tool was pre-piloted in Rajasthan.
The revised tool was piloted in around 140 TIs in Gujarat and Maharashtra (27 in Gujarat and 110 in Maharashtra) for more than two months. PIPPSE team presented the results to NACO; the Project Directors of the two states (AIDS control societies) also provided encouraging feedback on the tool. NACO has decided to roll-out of the tool across the country. NACO has also requested PIPPSE to develop a tool for TSU data compilation.
This tool is a need-assessment outcome of the visits made by Chief of the Party (COP) along with PIPPSE team to all the eight PIPPSE supported TSUs namely Goa, Gujarat, Kerala, Maharashtra, Rajasthan, Tamil Nadu, Uttar Pradesh and Uttrakhand during May-June, 2015. Cross state TSU teams guided by PIPPSE HO have developed the tool.
District Network Model
India’s NACP has been globally acclaimed as a success story. Substantial declines in adult HIV prevalence, incidence, and AIDS related morbidity and mortality in the country testify this success. Drawing lessons from its earlier phases, the NACP IV (2012-17) seeks to consolidate the gains made in high prevalence states and strengthen the response in low prevalence but highly vulnerable states. To accelerate the reversal of the epidemic, innovative programming is one of the thrust areas under NACP IV. To complement and supplement the efforts of the NACO in innovative programming, PIPPSE Project is piloting District Network Model (DNM) in Thane and Palghar Districts of Maharashtra. The DNM, a joint initiative of NACO, Maharashtra State AIDS Control Society (MSACS), Thane District Administration, and Municipal Corporations in Thane district and PIPPSE Project, was formally launched on February 14, 2014.
DNM has the potential to demonstrate innovations and offer solutions to improve the service uptake, and plug the drop outs in the prevention to treatment continuum among core groups and bridge populations that are most-at-risk of acquiring and/or transmitting HIV infection. The central tenet of the DNM is “synergizing interventions and leveraging resources through networking of stake-holders.” DNM envisages that by pooling the resources (infrastructure, human, institutional and organizational), and services/schemes of different stakeholders, the pilot will reach more people with programs, products and services in a timely and cost effective manner to reduce the time and conversion gaps. DNM will be scaled up in similar geographic settings across the country with high concentration of and sexual mixing of core groups and bridge populations that augments the spread of the HIV epidemic.
Further, the DNM envisions that the HIV/AIDS program, in the Thane and Palghar districts, is planned, funded and implemented by Municipal Corporations. Fig. 1 presents an overview of areas of support, for MCs to provide.
DNM project has also generated global interest, particularly with its innovations like Community Based HIV testing (CBT) through targeted intervention (TI) called as TTTI and AIDS Prevention and Treatment System (APATS), a tab based system for real time registration of clients, service delivery across prevention to care continuum, and monitoring and reporting.
National Migrant Unit
The NACO rolled out a National Migrant Strategy in 2009, further revised in 2010 based on the insights received from different stakeholders. Unlike core group interventions, migrant programming is still evolving. Programming for different typologies of migrant populations require different approaches and models. Prior to NACP-IV, institutional mechanisms to support NACO and SACS to rollout quality migrant interventions and to address issues of access to quality services were limited.
Considering the need to strengthen institutional mechanism at country level for rolling out of quality migrant interventions, the PIPPSE project set up the National Migration Unit (NMU) in 2013 in NACO to work under NACO leadership (Fig. 2).
Key Roles and responsibilities of NMU
Source Destination Linked Corridor Program
In coherence with the revised National Migrant strategy, PIPPSE project implements source--destination linked corridor program (hereafter, SDLCP), on a pilot basis, to test and refine the program strategies and approaches, which then can be scaled up to the national level. The SDLCP is piloted in two high migration corridors, namely, Eastern UP – Thane (Maharashtra) and Ganjam, Cuttack (Odisha) – Surat (Gujarat) corridors. These corridors connect low prevalence source sites/districts with high prevalent destination states. Linking source and destination sites for continued access to program and service coverage is fundamental to the SDLCP approach.
Objectives of the SDLCP
Under SDLCP, PIPPSE in collaboration with NACO has also developed a web based tool called Migrant Service Delivery System (MSDS) to (a) facilitate effective utilization of data from different sources (program outreach and services) at source and destination sites and (b) link data across source and destination states for better program planning, implementation. It has been envisaged that the tracking and sharing of data through MSDS will support the SACS and TIs to carry out evidence-informed planning and implementation of migrant interventions focusing on the linked corridor programming. Fig. 3 shows the support of MSDS in planning, monitoring and implementation
Technical Support Unit
To realize its ambitious targets set for NACP-III, NACO has created strong institutional structures to ensure program management, supervision, quality assurance and capacity building of Targeted Interventions for core groups and bridge populations.
A National Technical Support Unit (NTSU), State Training and Resource Centres (STRCs), Technical Support Units (TSUs) and Technical Support Groups (TSG) have been set up within this mandate. Currently, 18 TSUs are operational across India, funded by NACO and its development partners, namely, USAID and Gates Foundation.
Unlike other donor-funded TSUs, PIPPSE also seeks to provide need-based technical assistance and capacity building support to TSUs so as to enable them to provide value-added support to their respective State AIDS Control Societies (SACS). PIPPSE is supporting eight TSUs, which in turn provide support to 11 SACS: Ahmedabad, Goa, Gujarat, Kerala, Maharashtra, Mumbai, Puducherry, Rajasthan, Tamil Nadu, Uttarakhand and Uttar Pradesh. Unlike other donor-funded TSUs, about 40percent of the Targeted interventions (TI) in the country are directly supported by the eight PIPPSE TSUs. TSUs extend the supportive supervision and technical assistance to TI projects for core groups and bridge populations and Opioid Substitution Therapy (OST) centres in the state.
Integrated Biological Behavioral Survey (IBBS)
The National Integrated Biological and Behavioural Surveillance (IBBS) was launched in 2013 by NACO. This National initiative has been supported by various International donors including United States Agency for International Development (USAID), FHI 360, Centres for Disease Control and Prevention (CDC), Population Council, and World Health Organization (WHO). The IBBS is a second generation surveillance for HIV/AIDS that focuses on the study of HIV prevalence coupled with a deeper understanding of the risk behaviours and vulnerabilities that drive the HIV-epidemic in a given region. The four major objectives of IBBS are as follows:
PIPPSE has been providing technical support at different stages of IBBS. The four different stages of IBBS in which PIPPSE supported were as follows; a) Pre Surveillance Assessment (PSA): PIPPSE provided support in the selection of agencies to carry out PSA, assistance in developing the methodology, training, data collection and analysis; b) Sampling Frame Development and Community Preparation: PIPPSE supported in organizing and participating in Technical Advisory Group (TAG) meetings, preparation of tools for SFD, pre-testing and close monitoring of data collection to ensure the correctness, completeness and consistency of data; c) Behavioural and Biological Data Collection: PIPPSE supported preparation of tools, manuals and methodology pertaining to Migrants and Currently Married Women, training of research Institutes and technical teams, regular monitoring of data collection to ensure the data quality, supported the IT component including using Computer Assisted Personal Interviewing (CAPI) for the data collection by the National programme; and d) Data analysis and interpretation, top-line findings, preparation of reports: PIPPSE supported data analysis, preparation of reports and documenting success.
Employer Led Model
India’s HIV/ AIDS response is globally acclaimed as a success story. The NACP, launched in 1992, is being implemented as a comprehensive programme for prevention and control of HIV/AIDS in India. Over time, the focus has shifted from raising awareness to behaviour change, from national response to a more decentralised response and to increasing involvement of NGOs and PLHIV. Over 2.17 million people are HIV positive in India with over 83 percent of them in the age group of 15-49 years, the productive workforce of industries.
Evidence suggests high risk of HIV/AIDS among the migrant labourers and their spouses. About 41percent of new HIV infections are reported from high out migration states in India. Evidence has shown that migrant labourers are significantly more likely to practice high risk behaviour which might cause HIV infection. India has achieved about 57 percent reduction in new infections between 2001 and 2011. It is a challenging task to sustain the trends of reduction, as every new infection could reverse the trend and further fuel the epidemic. There is need for a multi sector approach to further the national response to HIV epidemic in India.
The NACO envisages reaching the migrant informal workforce linked with industries through the Employer Led Model (ELM) by integrating HIV/AIDS prevention to care program within existing systems and structures of the Employers (Industries for the benefit of informal workers, linked workers in supply chains and communities). PIPPSE project is providing technical assistance to NACO at National level and SACSs through TSUs for the implementation of this initiative and has contributed to:
The impact of HIV on communities, households and individuals is beyond scope of the health sector and there is a dire need for multi-sectoral response to stabilize the epidemic and address its negative impact on the social and economic fabric of the country.
In NACP IV, mainstreaming HIV is one of the six guiding principles.
Since August 2014, the PIPPSE project is supporting the national program to forge multi-sectoral collaboration with government departments at the national and state level by providing technical assistance through the Regional Program Managers (RPMs). The RPMs with the support of the NACO have been able to initiate evidence-based advocacy at the state level for rolling out the MoUs signed at the national Level with other ministries / departments, modification of existing policies and schemes for pro-active inclusion of HIV services, and formulation of HIV-specific social protection policies and schemes wherever possible. The pace and rigour of the team in accomplishing the success has been tremendous. The project facilitates the expansion of key HIV/AIDS services through integration with health systems of various stakeholders. The program has been able to influence policies, programs and schemes to provide social protection for PLHIV and HRGs.
According to National Family Health Survey (NFHS)-3, only about 85 percent of men and 60 percent of women in the age group of 15-49 years have heard of AIDS. This justifies the need for a platform to provide comprehensive information related to HIV/AIDS to different population groups. NACO, therefore, with technical assistance (TA) from PIPPSE Project launched the National HIV/AIDS Helpline-1097 on December 1, 2014, in observance of World AIDS Day.
The launch was a need based initiative as in the third phase of NACP III: 2007-12, there were multiple helplines for HIV/AIDS across different parts of the country, which were locally managed by NGOs and state run systems. Accessible through various paid/toll-free numbers, these helplines were functioning independently without a standardized protocol of providing the HIV/AIDS information and counselling services; and the service was available only in some locations of the country. Analysing the gaps, NACO felt a need to establish a single National AIDS Helpline utilising latest technology and infrastructure that would provide standard HIV/AIDS information and counselling services across India. Thus under NACP-IV, the Helpline became operational and has all types of callers, be it PLHIV, high risk groups (HRG), migrants, truckers or general population.
The National HIV/AIDS Helpline encompasses four major objectives of providing comprehensive health information related to HIV/AIDS and STIs render professional counselling services to the needy ensuring caller anonymity, enhance utilisation of the network of referral services for HIV prevention, care and treatment and provide information and guidance about the social protection schemes relevant to HIV/AIDS that can be availed by various beneficiary groups.
The Helpline has features like the convenience of 24X7, multilingual, confidential, anonymous and a toll free (four digit short code, 1097) number, accessible across India from any phone (mobile/fixed); a huge incentive for people to call and know about HIV/AIDS. It is designed to have a Hub and Spoke model, which allows to add more staff and languages as desired/required. The ‘Hub and Spoke’ model includes hubs setup in three different locations viz. Jaipur for North Region, Guwahati for Eastern Region and Hyderabad for South and West Region. Depending upon the language (Hindi, English, Assamese, Bengali, Kannada, Marathi, Telugu and Tamil), chosen by the caller, the calls are forwarded to the appropriate regional hub (spokes). Further, Central data repository is located at Hyderabad and disaster recovery site in Guwahati. The helpline was launched with 22 trained and experienced.
Since the launch of the Helpline, on December 1, 2014, a total of 729,102 calls (as of September 30, 2015) have been received at the server. The Helpline is also contributing towards UNAIDS announced 90-90-90 global strategy as callers seek answers to their queries on HIV/AIDS, or seek counselling, get information on integrated counselling and testing centres (ICTC), ART Centres and other service delivery centres.