Our Capacity Statement
The HIV Foundation Asia Innovation at the cutting edge of HIV service delivery for key populations in Asia
Our Capacity Statement
Photographs on the cover page, pages 6 and 10 by Christine McNab www.christinemcnab.com Thank you to acon for permission to adapt their business planning templates www.acon.org.au Thank you to Sam Avrett of The Fremont Centre for reviewing our corporate series. Our particular thanks to Lou McCallum, Dave Burrows and the team at APMGlobal Health for their ongoing guidance and support www.apmglobalhealth.com.
The HIV Foundation Asia 149/19-21 Surawongse Road, Bangrak Bangkok 10500 Thailand PO BOX 1028 Silom Bangkok 10500 Thailand Telephone: +66 2 6340541 Facsimile: +66 2 6340545 Email: contact@hivfoundation.com Website: www.hivfoundation.com
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Our Capacity Statement
Our capacity to deliver our priorities Management and Leadership Capacity The HIV Foundation Asia was established in January 2012 as The HIV Foundation Thailand. We are a regional technical hub that designs new service methods to interrupt HIV transmission, illness and death. We deliver these innovations in Asian cities to people living with and affected by HIV. We currently have a head office in Bangkok and a local foundation in Yangon, Myanmar. At the time of publication we employ 14 full time staff consisting of: 5 PLHIV case management staff. 3 HIV prevention and campaigns staff. 3 management/leadership staff. 2 finance and administration staff. 1 media and communications staff. We currently deliver projects in Bangkok and are due to start service provision in Yangon in March 2015. Since June 2012 we have: Tested 1,614 high risk men for HIV in Bangkok. Supported 700 people with HIV to access treatment and care services in Thailand. Maintained a zero loss-to-follow-up rate among newly HIV diagnosed people. Supported 150 migrants with HIV to repatriate for ART and access to care. Paid medical costs for 196 people with HIV. Past and current clients and donors: UNAIDS, UNDP and UNESCO USAID Asia Population Services International (PSI) The University of North Carolina APMGlobal Health Rotary International Financial management experience includes managing and acquitting grants up to US$240,000. Members of our team have experience acquitting grants for USAID and GFATM and the foundation currently acts as a fiscal agent for local HIV groups and regional networks in Asia.
“As an Accountant I ensure best practice accounting that is keenly responsive to our donors.” Nikorn Chimkong Executive Director Strong leadership and governance Sound finance and administration capacity Solid project management and M&E Skills in research and communications Reducing undiagnosed HIV in cities “With 25 years of HIV experience my role is to ensure new thinking, and to design and drive service innovation within local teams.” Scott Berry Regional Advisor HIV prevention and education expertise Mapping ‘high HIV incidence networks’ Finding undiagnosed PLHIV in cities Health campaigning / web-based innovation Linking people with HIV to care
“As a doctor I help link PLHIV to care. I work with MSM and TG people in Bangkok and Yangon.” Dr Sai Pye Myo Kyo, Regional Manager Case management services - linking to care Online and 1-2-1 group education for PLHIV Treatment adherence counselling support Hepatitis, TB and malaria and STI’s Populations and health issues we specialize in
“I help women and children access care. I work with migrants and especially with women who have HIV and who also sell sex.” Sukanya Deejom, HIV Coordinator Migrants with HIV linked to care Reproductive rights of women with HIV Sexual health of MSM and TG people Support and care for people who use drugs Support to women with HIV in sex work
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Our Capacity Statement
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Our Management Team Nikorn Chimkong, Executive Director Nikorn has over 15 years of experience in HIV and is founder and president of Bangkok Rainbow, a community-based group focused on HIV prevention among MSM in Bangkok. Through Bangkok Rainbow and The HIV Foundation, Nikorn has managed projects funded by the GFATM, USAID, ILO, UNAIDS and the Government of Thailand. Nikorn is a registered Accountant and a co-founder of The HIV Foundation Asia. Qualifications: Bachelor of Accounting.
Sukanya Deejom, HIV Coordinator Sukanya has experience supporting families, women and children with HIV in the slums of Bangkok. She coordinates services to families and case manages women and children with HIV. With a particular focus on the reproductive health rights of women with HIV, Sukanya supports pregnant women to term and ensures that both mother and newborn get the care they need to live well.
Dr Sai Pye Myo Kyo, Regional Manager Dr Sai Pye is a medical doctor with 6 years of experience in HIV. Dr Sai speaks Myanmar, Thai and English and mostly supports MSM and TG people. Dr Sai has previously worked for Pact Myanmar. He has experience mapping high HIV incidence networks and managing teams supporting PLHIV in Bangkok and Yangon. Qualifications: Bachelor or Medicine, Master of Public Health.
Nitisak Taratargunwattana, Senior Caseworker Nitisak has over 15 year of experience in HIV. He has previously worked for the Thai Network of People Living with HIV as a coordinator of HIV services. Nitisak has particular experience coordinating services for people with HIV from within government clinics and hospitals in Thailand. Qualifications: Bachelor of Community Development.
Ivan Fernandes, Communications Advisor Ivan is a journalist with over 25 years of experience in social development issues in South and Southeast Asia. He speaks multiple Asian languages and has contributed to newspapers including The Times of India, The Indian Express and The Statement before taking the position of Managing Editor for UCA News. Qualifications: Bachelor of Philosophy, Bachelor of Arts (English), Master of Arts (English).
Scott Berry, Regional Advisor Scott has 25 years of experience in HIV. He has worked in multiple countries in the Asia Pacific region. Scott has delivered, designed and managed services for MSM, needle and syringe programs for PWID and women’s support services. Scott is experienced in HIV research, health promotion social marketing, home care and peer-led counselling for PLHIV and is a co-founder of The HIV Foundation Asia. Qualifications: Bachelor of Arts (Hons), Bachelor of Languages (Thai), GradDip in Psychotherapy, and GradDip in Management.
Our Capacity Statement
What our partners say Fiscal management capacity Ms Natt Kraipet, Executive Director of the Asia Pacific Network of Transgender People says, “In 2014 we asked the HIV Foundation to act as a fiscal agent for a UNAIDS grant. We were so pleased with their responsiveness and financial competence that we quickly moved all our grants over to them until we receive our own local registration.”
Local capacity building Ms Kaewta Sangsuk, Director of Our Choice – a Thai community based group says, “We are a small, unregistered NGO in Chiang Mai, in the north of Thailand. In 2013 we partnered with The HIV Foundation to deliver HIV case management. They transferred their model to us easily. They coached us as we started to deliver the model in Chiang Mai and they ran workshops and training sessions with the team and our clients. Now, we are an organization that has the confidence of medical staff in hospitals and clinics across Chiang Mai.”
HIV prevention outreach for MSM and transgender people Don Baxter, Co-Chair of The Global Forum for MSM says, “The HIV Foundation has developed an innovative model for interrupting HIV in high prevalence epidemics among MSM and transgender people that shows very promising results. I’ve interviewed Khun Nikorn and his team at length about their work and seen their comprehensive data set which demonstrates their results firsthand. They have developed a unique model in Bangkok that I strongly believe should be better understood and replicated in other cities with high HIV prevalence epidemics not only in Asia but in other global south cities around the world.”
Project management capacity Lou McCallum, Director at APMGlobal Health says, “We have had a long-standing partnership with the foundation on work among people affected by HIV in Thailand, Myanmar and in South Asia and find them to be a responsive, professional and accountable partner. Their leadership team has a great mix of management, HIV technical, research and service delivery skills. We love their passion, their focus, their commitment to innovation and their openness to testing new ways of working.”
The quality of our service delivery Dr Jan Willem de Lin van Wijngaarden, HIV development practitioner says, “I undertook a small internal review of HIV case management systems in the foundation in April 2014. I interviewed 10 staff and clients, reviewed case files and other documents. What I found was inspiring. This is an organization that does what it promises to do. It is making a tangible difference in the lives of MSM and other people with HIV in Bangkok. I commend them to you.”
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Our Capacity Statement
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Comprehensive HIV positive prevention The HIV Foundation Asia has developed a unique HIV positive prevention model. HIV positive prevention uses traditional prevention-outreach techniques that have previously been used to keep HIV negative people HIV free. Using traditional outreach techniques we locate undiagnosed people with HIV and retain them in care. This model incorporates the entire continuum of HIV prevention-to-care. It is a comprehensive HIV testing and ‘linkages to care’ service. The HIV Foundation tested this model in Bangkok among MSM and TG people’s networks between June 2013 and September 2014. It includes: (i) Outreach to the places key populations meet/In-reach to HIV diagnosing clinics. (ii) Accompanying to HIV testing facilities and being present after post-test counseling. (iii) Case management for the newly HIV diagnosed to ensure baseline CD4 result received and HIV treatment initiation where appropriate. (iv) Online and group interventions to build health literacy, provide adherence counseling, retain people with HIV in care. Prevention
Outreach / In-reach
Treatment
Accompany to HCT site
Care
Case Management
Support
Online networking / group engagement
Enabling the environment for health seeking through accompanying and case management. Our results at a glance:
With between 4-to-6 staff we accompanied a total of 1,614 MSM and transgender people for HIV testing in Bangkok over a 16-month period. 100% received their HIV test result - we attribute this to outreach workers accompanying clients to HCT facilities and sitting with them as they wait to receive their test result. 24% of the total number tested received an HIV positive result (n=393). We achieved a zero loss-to-follow-up rate among newly HIV diagnosed clients we attribute this to outreach workers ‘transforming’ in to caseworkers at diagnosis.
Our Capacity Statement
Mapping high HIV incidence/prevalence networks in urban settings The HIV Foundation Asia uses a unique community-based prevention-outreach system that borrows from incidence and prevalence research field techniques. We map urban settings to identify networks with higher numbers of undiagnosed PLHIV and with the potential for high levels of HIV transmission. We have applied this method to reducing undiagnosed HIV among MSM and TG people in Bangkok with promising results (reported below). We use a traffic light system to categorize urban networks for HIV. We categorize them as high, medium or low incidence/prevalence. We identify a new network and test 10 people randomly in that network. We track what we learn on a map of the city and our service decisions are based on the numbers of people who test HIV positive who didn’t previously know their HIV status. High (Red or pink stickers on the map below): where 4-or-more out of 10 people tested in one network were positive for HIV. Conclusion: stay in this network and keep testing. Engage other organizations at this site to provide the means to prevent HIV as well as HIV and STI health education. Medium (Amber or orange stickers on the map below): where 2-to-3 out of 10 people tested in one network were positive for HIV. Conclusion: stay in this network and keep testing. Engage other organizations to provide the means to prevent HIV as well as HIV and STI health education. Low (Green on the map below): where 0-to-1 out of 10 people tested in one network were positive for HIV. Conclusion: move on from this network and find a new site. Encourage other organizations to service this site. The image below is a snapshot of an HIV incidence-map of Bangkok taken at one point in time. Team meetings, held at the end of each month, engage the outreach team in categorizing the networks they are working in. During these meetings, decisions are made about whether a network is high, medium or low incidence/prevalence for HIV and the team adds colored stickers to the urban map in order to identify them as such. We coach the team intensively to continuously map the city and to find new networks of key populations.
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Our Capacity Statement
Case management – linking people to care The HIV Foundation Asia has developed a social work-based case management system that prevents loss-to-follow-up among newly HIV diagnosed people and effectively links PLHIV to ongoing treatment and care. We have applied this method to newly HIV diagnosed MSM and TG people in Bangkok and Chiang Mai and have maintained a zero loss-to-follow-up rate among newly diagnosed men and transgender people. We train outreach educators in counseling and social work. We deliver a service in which outreach workers who accompany people for HIV testing have the skill to ‘transform’ in to case workers and provide basic counseling support when a person they accompany is newly diagnosed with HIV. We use a traffic light system to categorize the needs of clients in to high need, medium need and low need. We work within a client-centered framework to determine with the client their level of need. We are not a medical service and we collaborate with and take the advice of medical staff in our assessments, where this is necessary. Red is high need – a client with high needs has a CD4 result of 200 or below and CD4 percentages of 15% or lower but is not yet taking ART. These clients may present with HIV-related illnesses but are not yet taking prophylactic medication. Many require hospitalization or intensive outpatient support. Pregnant women with HIV in their last trimester but not yet taking ART are always high need. Suicidality is always high need, regardless of other factors. Psychosocial factors are also considered. High need clients receive intensive support - accompanying to hospital appointments and linking to health, welfare and community services beyond HIV. Amber is medium need – a client categorized as having not urgent but significant need is someone with a CD4 test result of between 350 and 201 and CD4 percentages between 16-24% but is not yet taking ART. Pregnant women with HIV in their first or second trimester are categorized as medium need. Psychosocial presentations such as mental health issues, migration, homelessness, social isolation, violence and poverty are all part of a medium need assessment. Medium need clients receive semi-intensive support that includes accompanying to hospital appointments, online and face-to-face workshops and group support. Green is low need – a client categorized as having non-urgent need is someone with a CD4 test result of 500 or more and CD4 percentages above 24%. These are often newly diagnosed clients who have considerable psychosocial adjustments to the news they are living with HIV. They may be emotionally distressed and, although they may have partners, friends and family nearby, may not disclose their HIV status to them. Low need clients receive initial intensive support to ensure baseline CD4 results and ART initiation where possible. Low need clients are connected to other people with HIV through online and face-to-face workshops and groups and are, once stable, supported by phone.
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Our Capacity Statement
Monitoring and Evaluation – reporting and learning from our results The HIV Foundation Asia has collaborated on Unique Identifier Coding (UIC) systems. We also maintain our own database and evaluate service quality independently. Here is a snapshot of selected demographics of our HIV positive prevention services to MSM in Bangkok. This was 16months of service activity in which we tested 1,614 MSM and transgender people for HIV: Caseload by Nationality 62% of the caseload were Thai citizens (n=997) and 30% were Myanmar migrants in Bangkok (n=476). Others were Cambodian or Laotian people and 12 were from the Philippines, Indonesia, Taiwan and Malaysia. 7 clients were Caucasians from Europe, America or Australia.
Caseload by Age The majority of our clients, approximately 88%, were between 18 and 45 years of age (n=1,421). A small number were below 18 years of age and we supported these clients because they presented with AIDS-defining symptoms that required immediate treatment and/or hospitalization.
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Our Capacity Statement
Caseload by Education 36% of the caseload had undergraduate or postgraduate degrees (n=584). 61% had a trade certificate or lower (n=984) with 31% had graduated high school (n=503) and 11% having graduated primary school only (n=172). 46 clients chose not to answer questions on education.
HIV+ caseload by baseline CD4 result 100% of newly HIV diagnosed clients were linked to care and received a baseline CD4 result. Not all chose to disclose CD4 results to us (8.3 percent). 60% returned baseline CD4 results below 350 CD4 cells. 30% returned baseline CD4 counts of below 200 cells. 12.7% returned CD4 counts below 100. The majority of newly diagnosed MSM needed intensive support as either ‘high’ or ‘medium’ need clients at diagnosis.
Only migrants died from HIV or related diseases in our caseload during this period (n=8). This fact underlined the vulnerability of migrants with HIV in Asian cities. It resulted in us prioritizing HIV case finding among migrant MSM and TG people in Bangkok, support to migrant MSM newly diagnosed with HIV and all migrants with HIV.
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Our Capacity Statement
HIV research and policy development in Asian cities The HIV Foundation Asia has become a leader in the design and delivery of city-based inquiry methods for key populations for HIV in Asia. Members of our technical team are key authors of global and regional documents for key populations in urban settings for UNAIDS Asia Pacific, UNDP New York and UNDP Asia Pacific. Members of our team have advised ASEAN on city-based projects for key populations. We have designed and implemented city-based projects on MSM and TG people in ASEAN countries including Indonesia, Myanmar, China, the Philippines, Thailand and Vietnam. We have participated in design and coordination of city-based research on MSM and TG people in South Asian countries including, India, Sri Lanka, Nepal, Bangladesh, Bhutan, Afghanistan and Pakistan. We have partnered with USAID’s AIDSTAR-One for HIV case study research in Thailand. We have partnered with MEASURE Evaluation and The University of North Carolina for HIV network analysis in Chiang Mai, Thailand.
Key populations for HIV The HIV Foundation Asia emerges from key populations for HIV in Asia. We have experience working for and delivering services to key populations for HIV, including people living with HIV. Our key mission is to design service innovations that bridge gaps between key populations and the health and welfare services that can save their lives. Our experience with key populations for HIV: Men who have Sex with Men and Transgender People – we have designed and implemented HIV prevention and case management services to MSM. We have delivered research projects on MSM and TG people. Women in sex work with HIV – we have designed and delivered services to women with HIV who are selling sex either full time or semi-regularly. We are experienced advocating for the sexual and reproductive health rights of women with HIV. People who use drugs – we have experience delivering services to people who use drugs and living with HIV and related diseases, including hepatitis B and C. Migrants, stateless people and refugees – the foundation has experience designing and case managing support services to mobile people living with HIV without health rights.
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Our Capacity Statement
Street-based and Internet social marketing/service delivery Health promotion social marketing and online service delivery is a core aspect of our work. We’ve designed and implemented street-based and Internet social marketing campaigns in Bangkok and are about to implement street-based and Internet campaigning in Yangon. These campaigns raise awareness of HIV and encourage a more supportive environment for people living with HIV in those cities. The use of social media to encourage members of the general public to address HIV in their family and friendship networks is a core strategy. We are moving to establish Internet-based service delivery to PLHIV in Asia in 2015. We have development partnerships with online media and design companies in the region to design and deliver these online services.
Our plan to build our capacity and extend our services From 2015 to 2018 we aim to build our capacity and extend our service in the following areas:
Apply HIV incidence/prevalence mapping techniques to other key populations in cities. Develop Internet services to support HIV treatment literacy for PLHIV in Asian languages. Replicate our HIV positive prevention model in cities beyond Bangkok. We are concerned about cities in India, Vietnam, Myanmar and China. We are particularly concerned about Manila and Cebu, where an emerging HIV epidemic among MSM shows no signs of abating. Strengthen civil society service delivery to and with key populations groups in selected cities in South Asia.
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Our Capacity Statement
Talk to us We can achieve the vision that we have outlined but only through the generosity of individuals like yourself and organizations that come forward to support us. We seek partners who share our vision and are willing to form an alliance to finance and resource it. Please talk to us about funding our services so we can further develop this lifesaving work. For English, please speak to: Scott Berry, Regional Advisor The HIV Foundation Asia 149/19-21 Surawongse Road, Bangrak Bangkok. 10500. Thailand. PO BOX 1028 Silom Bangkok. 10504 Thailand. Telephone: +66 2 6340541 | Facsimile: +66 2 6340545 Email: scott@hivfoundation.com Website: www.hivfoundation.com
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The HIV Foundation Asia 149/19-21 Surawongse Road, Bangrak Bangkok. 10500. Thailand. PO BOX 1028 Silom Bangkok. 10504 Thailand. Telephone: +66 2 6340541 | Facsimile: +66 2 6340545 Email: contact@hivfoundation.com Website: www.hivfoundation.com