Concept Paper on
HIV and AIDS Positive Prevention Project for
Expression of Interest (EOI) for Kavre District
(Prevention Care support and treatment to Fight HIV\AIDS through Integrated
VCT\STI services and outreach interventions with care support programs)
Submitted to:
The Country Director
FHI\Nepal
Baluwatar, Kathmandu
NEPAL
Submitted by:
National Health Foundation (NHF)
Bijulibazar, Kathmandu
GPO Box 10726, Kathmandu, NEPAL
E-mail: napi@mos.com.np
Tel: 01-4780791, Fax no: 4780431
Concept Paper On
HIV and AIDS Positive Prevention Project for
Expression of Interest (EOI) in Kavre District
CONTENTS
A. Technical and Financial Concept – 1
1. Background -1
2. Technical Concepts – 2
3. Goal and Objectives – 2
Goal – 2
Objectives – 2
4. Activities with their briefings and expected outcomes – 4
5. Budget outlining major costs – 8
B. Organizational Information – 9
1. Name of NGO – 9
2. Address – 9
3. Content Person – 9
C. Achievements of the organizations – 9
D. Human Resources – 12
1. Organ gram – 12
2. Current staffing – 13
3. Governing management bodies/board members – 16
Concept Paper On
HIV and AIDS Positive Prevention Project for
Expression of Interest (EOI) in Kavre District
(Prevention, Care support and treatment to Fight HIV/AIDS through integrated VCT/STI services and outreach interventions with care support programs)
A. Technical and Financial Concept
1. Background:
HIV and AIDS have posed greater threats to Nepal by affecting people from all walks of life. Currently, there are 70,256 people estimated to be living with HIV infection. Prevalence of HIV is exceeding more than 5 percent among most at risk populations (e.g. FSWs, IDUs, MSMs, Migrants and their spouses and it has pushed the country into a critical juncture of epidemic stage (source: National HIV/AIDS Strategy, 2006-2011).The dynamic of epidemic pursues a predictable course. HIV occurs in the most vulnerable groups at first. It spreads via the bridge populations of the clients of female sex workers. In another side, HIV and AIDS from these bridge populations reach to the general population including their wives and partners of the clients (source: Nepal Millennium Development Goals Progress Report 2005 p 51). To halt and reverse the spread of HIV and AIDS, plans and strategies are drawn at international and National levels.
Most importantly the proposed actions correlate and contribute towards achieving the millennium Development Goal 6, "Combat HIV and AIDS". From the national perspective, the actions included in this concept paper will directly contribute towards realizing the Health Sectors Objectives set by Three Year interim plan (2007/08-2009/10) – providing quality health services and ensuring enabling environment for utilizing available health services. These action are also directed towards addressing following strategies mentioned in National HIV/AIDS Strategy (2006-2011): 4.1 Expansion of Strategic Behavioral Communication, 4.3 Facilitate and Expand Interventions for safer migration and mobility , 4.4 Strengthen management and control of STIs 4.5 Expand Voluntary Counseling and Testing (VCT), and 4.6 Expand and Strengthen Prevention of Mother to Child Transmission Program.
Family Health International\Nepal (FHI\Nepal) is handling the USAID-funded ASHA Project (Advancing Surveillance, Policies, Prevention, Care and Support to Fight HIV\AIDS) in Nepal. The ASHA Project has network of 50 local implementing partners to support activities directed towards yielding measurable results in sustainable manner in partnership with the Nepal Government. INGOs NGOS and donors assisting to halt and reverse the spread of HIV and to reduce its impact. One of the key results areas of the ASHA Project is to enhance access to quality care. Support and treatment by mobilizing public, private and non-governmental sources for people living with HIV and AIDS (PLHA) and their families. Only a small section of PLHA know their HIV status and many PLHA still are devoid of access to care and treatment. One third of PLHA have unprotected anal and\ or vaginal sex. Because of ARV drug resistance and HIV super infection there is a need to strengthen HIV prevention efforts. If PLHA continue to resort to practicing unsafe sexual behavior, inject unsafely and become pregnant they can pass on a resistance of virus to other which may make future ART in effective. Therefore positive prevention focuses on supporting PLHA to live healthy lives through addressing their prevention needs to prevent further transmission. In this context, they need to be involved in facilitation understanding and an effective response in prevention of new and re-infection.
2. Technical Concept
Kavre is one of the districts in Nepal severely affected by HIV and AIDS. There has not been conducted any specific research in Kavre district about STIs including HIV and AIDS, but our experiences has shown that HIV and AIDS causes health problems resulting in adverse socio-economic consequences. As per the data announced on the occasion of the world AIDS day of 1st Dec 2007, there were 71 people identified with HIV and AIDS in Kavre district (source: Nawa Kshitij Weekly, 3rd Dec 2007). In the same occasion a six members of PLHA group (3 male & 3 Female) advocated to include PLHA along with community people that could help reduction of Stigma & Discrimination (source: Sanjiwanipatra Newspaper 3rd Dec 2007). To addressing these situations, National Health Foundation (NHF) has established an "Integrated Community Healthcare Program (ICHP) for VCT\STI services in Janagal, Kavre, Likewise. Nawa Deep kiran Kendra (a local NGO, run by PLHA in Kavre district) has been implementing community based intervention, home-based care support of HIV and AIDS for more than 5 year in the target district Kavre. NHF has identified 7 HIV positive people from the existing VCT\STI site out of 180 in the last 3 month, 2008. In the Kusadevi VDC, 3 PLHA (1 child) has been identified in one family where mother had already dead. The situations are not so far changed in the other targeted VDCs of the district. For this project, 7 VDCs Ugaratara Janagal, Sanga, Basdol, Mahendra Jyoti Tukucha Nala Kusadevi, Sathi Ghar and 3 Municipalities- Dhulikhel, Panuti and Banepa have been selected address the existing situation of HIV and AIDS in Kavre district. To run positive prevention intervention programs in these VDCs and Municipalities of kavre district. It has been realized the need of additional financial support for continuation of the existing VCT\STI services integrating with outreach activities in the communities. NHF has designed a concept project of integrated comprehensive package of HIV and AIDS to be implemented in the partnership with and experienced local level PLHA support organization, Nawa Deepkiran Kendra (NDK) in above target VDCs and Municipalities. AS per past experience of NHF and NDK, we both organizations have good relation with all community people in Kavre. In this district, most of youth migrants go to 3rd country for employment and return back to their homes\villages after 2-3 years by being HIV infected (source, annual report of VCT, NHF, 2007 and Kavre's DACC meeting discussion held in Sept 2008). These migrants play the role as bridging the highway sides where unsafe sexual acts happen with open and disguised sex workers.
The prevalence of HIV positive reports of existing VCT\STI service of NHF in Janagal (Kavre) was 1.8% among service recipients. Out of them, more than 90% infected were youth groups (source: Monthly Reports of NHF, Kavre, 2007). This report also reveals that most of the sex workers and the hoteliers are ignorant about how to use condom correctly for prevention of HIV transmission. ART taking people are not getting follow-up services and S & D is in increasing trend Coordination mechanism is not functioning well in context of utilizing existing ARV centers and OI management facilities up to Katmandu district. Limited organizations have initiated on positive prevention intervention program. It is realized that there is urgent need of integrated VCT\STI services to enhance the access of services to Most at Risk Populations (MARPs) and PLHAs in the selected 7 VDCs and 3 Municipalities for home\community base care support follow-up interventions for ARR\OI management and linkage program with HIV specialized services. Skill development and linkage of income generating programs (IGP) for HIV infected and affected populations in these target areas are required. Our integrated program will address these issues in the target district, Kavre.
3. Goal and Objectives
Goal:
The goal of this project is to mitigate the impact of HIV and AIDS epidemic in Kavre district.
Objectives:
The objectives of this project are set as below:
· Increase access to STI\HIV counseling, testing for most at risk group and PLHA.
· Increase safer sex counseling for PLHA and most at high risk groups:
· Increase the number of individual to adopt and sustain risk reduction activities dealing with disclosure, positive and healthy lifestyle choices for PLHA;
· Support PLHA in accessing referral services including prevention services, HIV care, OI management, nutritional advice, adherence to ART and prevention of mother to child transmission (PMTCT):
· Promote role of positive prevention among women groups to support positive prevention activities in the local community.
· Increase individual level interventions: mobilize HIV positive people as community mobilizers and counselors:
· Increase couple level intervention: couple counseling (sere concordant couples)
· Increase follow up mechanisms for individual and couple (sero discordant) infected by HIV and on ART:
· Facilitate support groups and networks formation to help infected and affected people to cope with HIV and access to services.
· Reinforcing positive prevention through home based care and support for families of PLHA.
· Increase advocacy for access to care and treatment services.
· Increase community level interventions: mobilize positive speakers Bureau in the community forums (including non-HIV\AIDS focused institutions) to reduce stigma and discrimination (S&D) and
· Increase collaboration of key stakeholders at district and community levels for a more coordinate and effective response to programs activities.
4. Activities with their briefings and expected outcomes:
| S.N | Activities | Target | Expected outcomes |
| Objective 1. | Increase access to STI\HIV counseling, testing for most at risk group and PLHA | | · Increased knowledge on STI\HIV among most at risk groups and PLHA and and their families in selected 10 outlets · PLHA and their sopuses adopted safer sex practices · PLHA and their families are assertive toward positive lifestyles of PLHA |
| 1.1 | Continuation of existing VCT\STI services in Janagal (Kavre) and integrating\expanding with 10 selected community outlets | 10 Outlets(7 VDCs and 3 Municipality) | |
| 1.2 | Selection of 3 Outreach Educators (to work with hoteliers) among PLHA and 10 PEs among target population (migrants\families, FSWs & their clients, IDUs, hoteliers) and FCGV of Government system | 13 persons | |
| 1.3 | Collect existing guidelines of PE and VCT\STI from concerning authorities | 15 sets | |
| 1.4 | conduct training on PE Procedure and Outreach intervention\home-base\community care support for 13 participants (5 days) | 13 persons (3 PE and 10 OE | |
| 1.5 | Collection of IEC related materials and distribution of them to the target audiences | 2000 copies | |
| 1.6 | Provide information and counseling to most at risk Groups (MARGs) and PLHA\family members of PLHA | 2000 persons | |
| Objective 2. | Increase safer sex counseling for PLHA | | |
| 2.1 | Identify PLHA Focusing on working VDCs | As per clients identified through VCTs | |
| 2.2 | Provide counseling training to counselors, Lab Assistant, Service Center facilitator (SCF) and OE | 13 Staff\OE | |
| 2.3 | Interaction with PLHA on safer sex practice | 50% of identified PLHA interacted | |
| 2.4 | Existing services of electronic Hotline (e-hotline) Counseling on HIV and STI and safer sex practice accessed | 2000 persons accessed | |
| 2.5 | Distribute condoms to needy clients after demonstration | 15,000 Pieces | |
| Objective 3. | Increase the number of individual to adopt and sustain risk reduction activities dealing with disclosure and positive and healthy life style choices for PLHA | | |
| 3.1 | Conduct life skills training for PLHA and their Family members | 15 persons | |
| 3.2 | Provide skill development training for PLHA and their family members | 20 persons | |
| 3.3 | Provide VCT and STI services to individual and link as well as refer PLHA for ARV | 10 persons supported | |
| 3.4 | Provide counseling to PLHA on positive and healthy life style and linked with existing income generating programs (IGPs) in and out of the district | | · Networking functional to provide essential services demanded by PLHA · Submitting monthly reports and Referred for PMTCT · PLHA and their families are assertive toward positive lifestyles of PLHA · Increased number of community women active in HIV and AIDS prevention activities · PLHA active in promoting HIV prevention activities in communities · Sero concordant couples adopted safer sex practices |
| Objective 4. | Support PLHA in accessing referral services including prevention services, HIV care, OI management, nutritional advice, adherence to ART and prevention of mother to child | | |
| 4.1 | Formation of strong networking with stakeholders, partners organizations for referral services with central laboratory and CMDN (a private lab that has been committed with NHF to provide free services | 1 | |
| 4.2 | MOU signing for referral services with hospital and other service centers | 1 hospital | |
| 4.3 | Outreach intervention by PE\FCHV and OE in communities, wards and hotels\resorts | 5000 reached by P E\FCHV and OE | |
| 4.4 | Refer the clients for services of PMTCT to the existing PMTCT centers and GBV\RH Center of NHF | 20 persons | |
| 4.5 | Referral HIV positive population for CD4 Count\ARV and OI management and follow up them | 20 persons | |
| Objective 5. | Promote the role of positive preventing among women group to support prevention activities in the local community | | |
| 5.1 | Formation of women support group to promote positive prevention activities in local community (9 in each group) | 10 Group | |
| 5.2 | conduct sensitization workshop program for influencing community people to aware on positive attitude towards PLHA | 3 workshops | |
| 53 | Conduct meeting by mobilizing women group in each VDCs | 10 VDCs | |
| 5.4 | Women groups encourage VDC to involve PLHA in Community development programs | - | |
| Objective 6. | Increase individual level intervention to mobilize HIV positive people as community mobilizers and counselors | | |
| 6.1 | Formation of 3 PLHA support groups consisting of 7 in each group to work as community mobilize volunteers | 3 groups | |
| 6.2 | Provide skill development training for PLHA and their family members | 10 persons | |
| 6.3 | Provide VCT and STI services to individual and link as well as refer PLHA for ARV | 7 VDCs and 3 Municipalities | |
| Objective 7. | Increase couple level intervention sero concordant couple | | |
| 7.1 | Provide Counseling to sero concordant couple on use of safer sex practice | 7 couples | |
| 7.2 | Refer them to concerning authorities for specialized servicesh | 20 persons |
| Objective 8. | Increase follow up mechanism for individual and couple (sero discordant couple) infected by HIV and on ART | | · Increased capacity of sero discordant couples on the use of ART safer sex practices and nutrition · Increased capacity of support groups to help infected and affected people to cope with HIV\AIDS · District networking functionalized to promote HIV and AIDS related activities · Increased knowledge of family members on positive prevention activities · Increased knowledge on care and treatment services on the part of PLHA · Members of Positive Speakers active in reducing stigma · discrimination at VDC levels · Positive discrimination activities disseminated through media |
| 8.1 | Follow up Counseling to sero discordant couple for use of ART, safe sex practices, nutrition, positive life style etc. | 5 couples | |
| 8.2 | Train the family members on palliative care | 20 persons | |
| Objective 9. | Facilitate support group and network formation to help infected and affected people to cope with HIV and access to services | | |
| 9.1 | Formation of support group in VDC consisting of 5 persons in each VDC | 10 persons | |
| 9.2 | Formation of Networking at District level | 1 group | |
| 9.3 | Conduct 2 events of training for support group member on infected and affected people to cope with HIV and access to service and S & D reduction (1 day sensitization training | 50 persons | |
| 9.4 | Coordinating and sharing meeting conduction among support groups\on also role and responsibility | 10 persons | |
| Objective 10. | Reinforcing Positive Prevention through home based care and support for families of PLHA | | |
| 10.1 | Organize 1 day orientation Training on Positive Prevention for Family Members of PLHA | 30 | |
| 10.2 | Conduct Home to Home Visit Program for Positive Prevention Though OE,s and PEs | 20 | |
| Objective 11. | Increase advocacy for access to care and treatment services | | |
| 11.1 | Conduction Coordination Meeting with DACCGO and NGOs at District level for Enhancing Access to care and Treatment Services | 20 | |
| 11.2 | Organize Campion and rally on Enhancing Access to care and Treatment Services | 2 rallies | |
| Objective 12. | Increase community level Intervention : Mobilize Positive speakers bureau in the community forums (Including non-HIV\AIDS) | | |
| 12.1 | Formation of Positive Bureau at VDCs level to reduce stigma discrimination consisting of 5 persons including woman group leaders, Religious leaders, Youth club teachers, Health institute | 15 | |
| 12.2 | Conduct 1 day orientation training on reducing stigma and discrimination towards HIV\AIDS (3 events) | 75 person | |
| 12.3 | Mobilize Bureau Members to speak on Reducing stigma and Discrimination towards HIV\AIDS in different occasion and social functions at VDC level | As per occasions | |
| 12.4 | Organize meeting with media persons to promote positive prevention activities towards HIV\AIDS at district level | 1 |
| Objective 13. | Increase collaboration of key stakeholders at district and community levels for more coordinated and effective response to program activities | | · Increased responses from stakeholders at district level · Increased response from stakeholders at VDC level · Approve programs effectively and efficiently implemented and managed |
| 13.1 | Meeting on mapping of stakeholders at District level of 7 persons | 1 | |
| 13.2 | Meeting on mapping of stakeholders at VDC level of 7 persons | 15 | |
| 13.3 | Organize 1 day workshop at district level among key stakeholders including DACC on enhancing collaboration. | 15 persons | |
| 13.4 | Organize 1 day workshop at VDCs level for stakeholders to enhance collaboration | 225 persons | |
| Objective 14. | To enhance effective implementation and management of the program | | |
| 14.1 | Develop monitoring and format for district level | 1 set | |
| 14.2 | Develop monitoring format for central level | 1 set | |
| 14.3 | Carry out monitoring activities by using developed format. | AS per action plan (based on the prescribed format by donors) |
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