Bill & Melinda Gates Foundation support to the National AIDS Control Organisation - North East Regional Office, under the National AIDS Control Programme – Phase III
Revised and expanded version August 2014
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Contents Foreword Acronyms and Abbreviations Acknowledgments Executive Summary
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Introduction North East India Context Epidemiology of HIV in the North East The National AIDS Control Programme – Response to the Epidemic in the North East
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National AIDS Control Programme - Phase III (2007-2012) The North East Regional Office Unique features of NERO Collecting Data to Inform the Processes
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Support from the Bill & Melinda Gates Foundation Focus of the BMGF-Supported Functions Dual Role of NERO BMGF-Funding Objective One - Improve the Quality and Support of Scale-Up of Targeted Interventions for IDUs & OST Progress in the North East. 1. Achieving Improved Quality & Support 2. Achieving Improved Scale-Up of TIs for IDUs 3. Achieving Improved Scale-Up of OST
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OST Programme Testimonials
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BMGF-Funding Objective Two - Strengthen the Capacity of the District AIDS Prevention & Control Units (DAPCUs) in Scaling-Up of District Response in Relation to the NACP.
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1. Achieving Capacity Strengthening for Scale-Up Response 2. Achieving Improved Monitoring 3. Achieving Convergence and Integration with NRHM DAPCU Coordinators - Other Strategic Inputs
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NERO-NACO TSU report for NACP III (2008-2011) NERO-NACO Annual report (2012-2013)
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Other Sucessess High-Level Overview of NERO General Achievements
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Challenges and Suggestions for Future Improvements
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Conclusion
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Annexures North East States TI Performance at a glance
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(Excerpts from Presentation by Dr Rebecca Sinate, NERO, August 2014)
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Foreword Department of AIDS Control N. E. REGIONAL OFFICE Ministry of Health & Family Welfare, Govt. Of India Beltola Road, Near Housefed Bus Stop, H.No:1, 3rd Floor, Guwahati PIN:781006, Phone:0361-2234917,18,20 Fax-234919 Date: 15-01-2014 North East Regional Office of DAC was launched in New Delhi on 12th October 2007 by the then Minister of State for Health and Family Welfare, Govt. of India, in presence of the International Donor agencies, senior officials of NACO (DAC) and stake holders from National and State level. With a multi Donor support environment which is unique in nature and first of its kind in the entire North East, the NERO was formally inaugurated in Guwahati by then Director General of NACO on 22nd February 2008. AusAid is the major funding agency along with SIDA through UNAIDS. Other agencies like BMGF through PHFI (EHA), BBC World Trust, and UNDP are also having their support for providing Technical staff in different field. The BMGF funding through EHA has supported the IDU, DAPCU and OST component in rolling out, developing, nurturing, monitoring, capacity building and hand holding support of 125 IDU TI, 25 DAPCU, 14 LWS and roll out of 102 OST Centers in the entire North East. Upscale of service utilization to the saturation level and ensuring good quality program implementation is the main focus in bringing down or in combating the menace of HIV/AIDS problems in the Region. I take this opportunity to express my gratitude for the committed and dedicated staff supported by BMGF at NERO. While acknowledging the present support, looking forward for more convergence in this respective field in the years to come. With regards
Pankaj Kumar Sarma Team Leader DAC - North East Regional Office Ministry of Health & Family Welfare Guwahati, Assam - 781006 Phone: +91 361 2234917/18 Fax: 0361- 2234919 Mobile: 09706010520
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Acronyms AAP AIDS ART AP BBC BMGF CABA CC CMIS CST DA DAC DAP DAPCU DHS EHA FSW GFATM HCV HIV HSS ICTC IDU IEC ILFS LWS MSM NACO NACP NE NERO NRHM NTSU OST PHFI PLHIV PO PWID RC RCO RPA RPO RTI RTO SACS SIMS SP
Annual Action Plan (State Plan) Acquired immunodeficiency syndrome Anti-retroviral therapy Arunachal Pradesh British Broadcasting Commission Bill & Melinda Gates Foundation Children infected and affected by HIV/AIDS Core-composite Computerised Management Information System Care, support and treatment Divisional Assistant Department of AIDS Control (also known as NACO) District Action Plan District AIDS Prevention & Control Unit District Health Society Emmanuel Hospital Association Female sex workers Global Fund for AIDS, Tuberculosis and Malaria Hepatitis C virus Human immunodeficiency virus HIV Sentinel Surveillance Integrated Counseling and Testing Centres Injecting drug user Information, education and communication Infrastructure, Leasing and Financial Services Limited Link Worker Scheme Men who have sex with men National AIDS Control Organisation (also known as DAC) National AIDS Control Programme North East (region of India) North East Regional Office National Rural Health Mission National Technical Support Unit (NACO) Opioid Substitution Therapy Public Health Foundation of India People living with HIV Project Officer People Who Inject drugs Regional Coordinator (NERO) Reginal Communication Officer (NERO) Regional Programme Advisor (NERO) Regional Programme Officer (NERO) Reproductive Tract Infection Regional Technical Officer (NERO) State AIDS Control Society Strategic Information Management System Spasmoproxyvon
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Acronyms SP STI STRC TB TI UNAIDS UNDP UNICEF
Spasmoproxyvon Sexually transmitted infection State Training and Resource Centre Tuberculosis Targeted intervention Joint United Nations Programme on HIV/AIDS United National Development Programme United Nations Children’s Fund
WHO
World Health Organisation
* Although PWID (people who inject drugs) is a more current and accepted acronym, which is preferably used over IDUs, this document will refer to IDUs as it was more commonly used during the reporting period.
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Acknowlegements First of all I would like to thank the Department of AIDS Control for the region in combating the challenging HIV/AIDS problems. The commitment and efforts put in by all my colleagues at NERO has helped in setting up positive trends to improving the targeted intervention programmes in the North East. The never-ending “team spirit� at NERO has been the driving force for each one of us in overcoming various pressures and setbacks that we have encountered since the ness will continue in the days to come. My special regards and thanks to DAC TI Team and NTSU for their technical support and timely intervention to any kind of support needed at NERO. I would like to thank the respective Project Directors of the eight North East State AIDS Control Societies, for being so accommodative towards NERO. I extend my heartfelt gratitude to all the North East JD/DD/AD TIs for their cooperation, coordination and openness to our technical support and guidance. My appreciation and regards also goes to the entire district-based
I would like to thank the Emmanuel Hospital Association and the Public Health Foundation of India for constantly being available in supporting us at all times with noninterference. We feel blessed to be associated with them.
Coordinators were instrumental in achieving the progress of the Bill & Melinda Gates Foundation-funded programme. As such, we would like to particularly recognise the following staff members for their work and commitment during NACP-III and for their help in compiling this record of their work: Mr. Soubhagya Chakrabarty
Regional Technical
Mr. Khyuchamo P. Ezung
Regional Programme
Mr. Deepak Kshetrimayum
Regional Technical
Mr. Shantanu Chowdhury Mr. Gautam Salam
DAPCU Coordinator DAPCU Coordinator
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Lastly, I would like to thank the Bill & Melinda Gates Foundation for supporting and investing in the NERO IDU TI Team and the DAPCU empowering and capacitating the people of North East India for combating the menace of HIV/AIDS issues in the region. The achievements of NERO described in this report are as a result of the collaborative efforts of many organisations, including the SACS. With regards,
Dr. Rebecca Sinate Regional Programme Advisor-TI
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Executive Summary and received funding from the Bill & Melinda Gates Founfocussed on supporting the technical team, particularly for programme, headed by the Regional Programme Advisor DAPCU Coordinators and their roles in establishment and capacitation of District AIDS Prevention & Control Units
While there remains scope for improving in some areas for sustainable outcome, BMGF-supported staff, based with the other technical staff at NERO, have enabled and assisted progression towards achievement of NERO’s objectives. Through NERO, scale-up of TIs for IDUs was achieved by establishing TIs and facilities, thereby increasing coverage of services. OST availability increased across the region via the establishment of OST centres. All objectives of the programme were supported by quality and support initiatives, which involved focus on monitoring and performance assessment, reconciliation and validation of data and mapping, onsite support and implementasystems. Through the efforts of district-based staff and the DAPCU Coordinators, capacity strengthening, monitoring and supportive supervision eventuated in the establishment of DAPCUs in all 25 districts deemed “high prevalence”, in accordance with the objectives of Phase-III of the NACP.
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Introduction North East India Context Manipur, Meghalaya, Mizoram, Nagaland, Sikkim and Tripura. Stretching from the foothills of the Himalayas in the east, international neighbors border 96 per cent of this region. China and Bhutan lie to the north, Myanmar to the east, Nepal to the west and Bangladesh to the south and west.
Figure 1 - Map of India with North East region highlighted Source: Wikipedia
The Northeastern region is largely made up of serene hills and valleys. Many of the hill states, such as Arunachal Pradesh, Meghalaya, Mizoram and Nagaland, are predominantly inhabited by tribesmen, with a fairly high degree of ethnic diversity, even within these tribal groups.
68 per cent live in the state of Assam.
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Table 1 – Socio-Economic profile of the Northeastern states
State
No. of Districts
Population
Decad al Growth rate
Arunachal Pradesh
16
1,382,611
25.9
Sex Ratio ( Female per 1000 Male)
Birth Rate (Per 1000)
Infant Literacy Mortal- rate ity Rate (Per 1000)
920
20.5
31
23.2
58
16.9
Assam
Manipur
Density Populatin (Perso n per km)
9
122
132
Meghalaya
Mizoram
11
Nagaland
11
66.95%
22.8
52
0.5
119
931
Sikkim
86
889
Tripura
350
961
1,980,602
55
986
91.58%
16.8
23
80.11%
30
82.20%
Source: Census of India, 2011
The northeast Indian states are geo-politically complex making it a challenging prospect at times for public health and development programs. States such as Nagaland, Manipur and Mizoram share a porous border with Myanmar and therefore experience uncommon access to heroin and opium. Injecting drug use, most commonly of heroin and Spasmo-
a result of unsafe injecting practices since the early 80s, the states of Manipur and Nagaland are two amongst the six highest HIV prevalence states in the country even though the accumulative population of these states is low when compared to the rest of India. Though primarily an epidemic driven by injecting drug use, HIV prevalence has also been seen to be contributed through the sexual route as indicated by the increasing HIV infections in the north-east states.
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Epidemiology of HIV in the North East years in majority of the north-eastern states, albiet declining AIDS-related deaths due
At present, as a result of targeted intervention programs initiated by the government and non-governmental organizations, the two northeastern states that have historically
300
257 1,200
250 1,156
204
1,000
577
104
400 200
150
729
128
600
200
918
161
800
100
20
24
32
2008
2009
2010
18
42
50
0
0
2007 PLHIV
Number of Adult New Infections/Deaths in Arunachal Pradesh
1,400
458
Number of PLHIV IN Arunachal Pradesh
in both HIV prevalence and new HIV infections in adults.
2011 AIDS-Related Deaths
Adult New Infections
14,000
3,000
12,000
2,500 2,408
10,000
2,018
8,000 6,000 4,000
6,225
2,000
257
1,693
1,428
1,219 7,444
8,908
12,804
10,675
304
272
2,000 1,500 1,000
343
388
0
500
Number of Adult New Infections/ Deaths in Assam
Number of PLHIV in Assam
Source: HIV Epidemic Status Report 2013)
0 2007 PLHIV
2008
2009
Adult New Infections
Source: HIV Epidemic Status Report 2013)
2010
2011 AIDS-Related Deaths
Number of PLHIV in Meghalaya
3,000
500 460 450 400 382 350 317 300 263 250 218 200 2,381 1,952 150 1,602 1,317 100 1,085 88 77 69 60 52 50 0 2007 2008 2009 2010 2011
2,500 2,000 1,500 1,000 500 0
PLHIV
Adult New Infections
Number of Adult New Infections/ Deaths in Meghalaya
15
AIDS-Related Deaths
FIGUR
2,500 2,000 '
Number of PLHIV in Mizoram
3,000
1,500 1,000 500 0
500 460 450 400 382 350 317 300 263 250 213 200 2,381 1,952 150 1,602 1,317 100 1,085 88 77 69 60 52 50 0 2007 2008 2009 2010 2011
PLHIV
Adult New Infections
FIGUR Source: HIV Epidemic Status Report
Number of Adult New Infections/ Deaths in Mizoram
Source: HIV Epidemic Status Report
AIDS-Related Deaths
700
94
Number of PLHIV in Sikkim
600
84 75
500
66
60
400 300 200
357
100
404 19
24
21
20
593
521
459
25
0 2007 PLHIV
2008
2009
2010
Adult New Infections
100 90 80 70 60 50 40 30 20 10 0
Number of Adult New Infections/ Deaths in Sikkim
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2011 AIDS-Related Deaths
FIGUR
Number of PLHIV in Tripura
6,000 5,000 4,000 3,000 2,000 1,000 0
1,000 900 835 800 736 700 646 600 567 500 5,684 4,963 400 4,336 3,791 300 279 3,318 249 226 202 200 181 100 0 2007 2008 2009 2010 2011 951
PLHIV
Adult New Infections
FIGUR Source: HIV Epidemic Status Report
Number of Adult New Infections/ Deaths in Tripura
Source: HIV Epidemic Status Report
AIDS-Related Deaths
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As a result of targeted programmes instigated by the government and development organisations, the two northeastern states that have historically
26,800 26,600 26,400 26,200 26,000 25,800 25,600 25,400 25,200 25,000 24,800 24,600
2,500
2,372
1,730
26,569
2,117
2,059
1,594
1,544
26,300
1,999
2,000 1,905
1,433
1,500 1,354 1,000
26,024 25,696
500
25,369
0 2007
2008
PLHIV
2009
2010
Number of Adult New Infections/ Deaths in Manipur
Number of PLHIV in Manipur
declines in both HIV prevalence and new HIV infections in adults.
2011 AIDS-Related Deaths
Adult New Infections
Source: HIV Epidemic Status Report
Number of PLHIV in Nagaland
839 9,600
800
778
9,700 667
739 666
621
596
573
9,500
9,716
9,400
9,354
9,378
400 300
9,529
9,300 9,200
700 581 600 560 500
9,425
200 100 0
9,100 2007 PLHIV
2008
2009
2010
Adult New Infections
Source: HIV Epidemic Status Report
Number of Adult New Infections/ Deaths in Nagaland
900
9,800
2011 AIDS-Related Deaths
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Table 2 - State-Wise Adult HIV Prevalence Trend in North East India, 2007 - 2011 Adult HIV Prevalence Trend in North East India (%) 2007
2009
2010
2011
0.09
0.11
0.13
0.05
0.06
0.08
0.09
0.11
2008
0.06
Arunachal Pradesh Assam Meghalaya Sikkim
0.10
0.11
0.12
Tripura
0.16
0.16
0.19
0.15 0.22
0.35 0.3 0.25 0.2 0.15 0.1 0.05 0 2006
2007
2008
Arunachal Pradesh
Assam
2009 Meghalaya
2010 Sikkim
2011 Tripura
INDIA
0.13
2012
19
1.6 1.4 1.2 1 0.8 0.6 0.4 0.2 0 2006
2007
2008 Manipur
2009
2010
Mizoram
Nagaland
2011
2012
INDIA
Source: HIV Estimates 2011, Department of AIDS Control
Manipur
1.51
1.22
1.29
1.36
Mizoram Nagaland
0.82
has shown the highest estimated HIV prevalence among the states of the NE, with an
7,000
70,000
Number of PLHIV in NE
60,000
6,000
5,909
50,000
4,959
40,000
4,120
30,000 52,313
5,509
5,135
5,000
3,848
54,221
4,000 3,714 3,594 63,049 3,000 59,451
3,805
56,569
20,000
2,000
10,000
1,000 0
0 2007
PLHIV
Source: HIV
2008
2009
Adult New Infections
2010
2011
AIDS-Related Deaths
Number of Adult New Infections/ Deaths in NE
6,460
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Table 3 - State-wise Estimated Adult (15-49) HIV Prevalence and Number of HIV Infections, 2011 ESTIMATED ADULT HIV PREVALENCE, 2011 % Arunachal Pradesh
0.13 1.4 1.22
Assam
1.2
Manipur 1.22 Meghalaya
0.13
1
Mizoram
0.6
Nagaland
0.4 0.2
Sikkim
0.74
0.8
0.13
0.24
0.27
Tripura
INDIA
0.15
0.13
0.07
0.15
0.73
0
Tripura NE Total
Arunachal Pradesh
Assam
Manipur Meghalaya Mizoram Nagaland Sikkim
-
Estimated HIV Prevalence (%), 2011
India
ESTIMATED NUMBER OF HIV INFECTIONs, 2011 Arunachal Pradesh
1,156
Assam
Tripura
Arunachal Pradesh
Sikkim
Assam 63,049
Manipur
25,369
Meghalaya
2,381
Nagaland
Mizoram
2,025,593 Mizoram
Nagaland Meghalaya
Sikkim
Manipur
593
Tripura NE Total India
2.088m
Source: HIV Estimates 2012,
rtment of I
Control
HIV Estimates North East
HIV Estimates rest of India
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The National AIDS Control Programme – Response to the Epidemic in the North East the state of Manipur in 1990 from blood samples collected amongst injecting drug
following the formation of the high-powered National AIDS Committee in 1986, Manipur immediately set up a State AIDS Committee under the chairmanship of the Chief Minister. Under this, a State AIDS Cell was established in the State Health Directorate
and care and support programs under the auspices of both the government and local NGOs assisted by international agencies. The State AIDS Policy was soon adopted to have a State AIDS Policy. Indeed, HIV intervention programs have been in place in some hardest-hit regions in the NE for the past two decades, but not at a scale and a response needed to combat the growing epidemic across the 8 states. The advent of Hep B and C and the rise in sexual transmission with UN and through generous funding from AusAID, BMGF and others opened a ing up India’s response to HIV epidemic in a cohesive and effective way in NE under dinated and effective NACP response in the region that would lead to stemming the epidemic and achieving the targets for the region. Today, the HIV response at the state level is led by the State AIDS Control Societies
northeastern states of India, which is a nation-wide response to the HIV epidemic in India. Under the NACP, each of the states are provided with a suite of standardised services and support initiatives.
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National AIDS Control Programme - Phase III (2007-2012) The goal of the
per cent in the vulnerable states, to stabilise the epidemic. This was to be achieved through a four-pronged strategy:
programmes at district, state and national levels.
aimed at integration of NACP interventions in the National Rural Health Mission services to the end customer and patients. It also endeavoured to ensure long-term sustainability of interventions.
The North East Regional Office expertise and attention to the northeastern HIV epidemic.
provide specialised technical support as part of its response to intensify HIV prevention efforts under the in the region. NERO’s purpose is to strengthen the capacity of the SACS and key stakeholders for quality and sustainable programme implementation for the eight northeastern states.
Facilitate improvement in performance deliver quality programmes with a special focus on the 25 high prevalance districts. Strengthen existing systems, ensuring quality management processes and better implementation states. Create an enabling environment in partnership with other donor agencies
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Unique features of NERO* 1.
Existence of positions for all the divisions of the national AIDS programme, unlike Technical Support Units elsewhere in the country.
2.
Several of the staff includes high risk group community members
3.
The positions are supported by multiple sources of funding viz. SIDA/AusAIDUNAIDS-NACO, BMGF- PHFI-EHA, UNAIDS, UNDP and BBC World Trust. Multisource funding managed under one administration is one of the most unique
High-Level Process of NERO Support to State
against the Annual Action Plan targets Regular feedback to the state Field visit by NERO staff Support in development of State Implementation Plans Field-level handholding of new staff at TI Ensuring completion and quality of training, in coordination with
Training and onsite supportive supervision
Capacity building and monitoring of district-based POs, for providing onsite supportive supervision to TIs Cross learning and experience sharing Facilitating addressal of administrative issues with the state
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A number of international and local partners have been instrumental in enabling optimal functioning of NERO to achieve its objectives, by funding particular aspects of the division and thereby jointly promoting progress against the epidemic in the NE. further prevention initiatives under
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Organogram of the North East Regional Office, National AIDS Control organisation
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In addition to support provided by BMGF, BBC World Trust, UNAIDS and UNDP were funded, as is detailed in Figure. 13. Under the agreed-upon model for funding of the BMGF-supported functions, the
PHFI delegated much of the oversight for the programme to the EHA, whose role included procurement sary logistic support to the BMGF-supported staff, EHA was also the reporting conduit to the funding agency. This document will illustrate the activities and achievements of the BMGF-funded functions of NERO, outlining progress made in these important endeavors and discussing challenges and improvements for the future of the response to the HIV epidemic in the NE.
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Collecting Data to Inform the Processes At the onset of the ascertain the severity of the epidemic in particular districts of India. This process ensured appropriate focus was placed on the most affected areas of the region. Based on epidemiological and vulnerability criteria, 25 districts in the NE are deemed “A” and “B” category. Table 4 – Number of Category “A” And “B” Districts in the North East
State
Number Category “A”
Number Category “B”
Total “High Prevalence”
Arunachal Pradesh
1
-
1
Assam
-
1
1
Manipur
9
-
9
Meghalaya
-
-
0
Mizoram
2
1
3
Nagaland
10
-
10
Sikkim
-
-
0
Tripura
-
1
1
22
3
25
North East Region
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work. HRG mapping, which was completed in most of the NE states during the 20082010 period, is a system that provides indicative information to quantify the number of HRGs according to location. The purpose of HRG mapping was threefold:
1
, in order to align the
placement of TIs and reach the most vulnerable. are most at risk. 1
For the purposes of HIV and migration, high-risk migrants
temporarily or semi-permanently and return back to their origin for up to 3-6 months.
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vulnerability factors and service provider accessibility and availability, which would facilitate the subsequent programme implementation. Collated mapping data revealed substantial variation in the estimated number of HRGs when compared to pre-existing data, as well as TI coverage that already existed. This was especially the case in the Aizawl district of Mizoram, the Dimapur district of Nagaland and several districts of Manipur. Validation exercises were therefore undertaken by SACS and NERO in these districts to ensure appropriate rationalisation of services that correspond to HRG needs.
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Support from
Bill & Melinda Gates Foundation Focus of the BMGF-Supported Functions Of the functions held within NERO, three key areas were chosen to be funded by BMGF:
For these focus areas, the primary objectives of NERO were two-fold viz. of Targeted Interventions for IDUs & OST Progress in the North East.
Relation to the NACP. The two primary objectives of the BMGF-funded programme of work were determined functions, in accordance with NERO’s key agenda. Focus was placed on:
The selection of BMGF’s areas of focus was made in consideration of BMGF’s specialised knowledge of and demonstrated experience in TIs in India, including in the southern states. Further to this, it was recognised that in the NE, IDUs are the most at-risk. As a result, BMGF’s funding to NERO was focussed squarely on the functions of the Regional Programme Advisor for Targeted Intervention, the IDU-related functions situated in the TI team and the DAPCU Coordinators’ roles, which have a clear interrelation with the IDU and OST functions.
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Dual role of NERO NERO, unlike other TSUs in the country and in the light of its strategic coverage of the 8 north-eastern states, has been accorded a dual role functioning as a NACO
Role of NERO as NACO sub-office:
Selection of agencies: NERO provides support to the SACS in order to identify centres for implementation of
SACS staff recruitment: NERO provides assistance to the states for recruitment of staff in all the eight north eastern states, by providing them technical support for development of systems and tools for recruitment and also assisting in the interviews for the key positions in SACS. Periodic program reviews and meetings: Review of the program against the Annual Action Plan and constant feedback remains one of the key processes for monitoring the progress of implementation of the NACP. However, as travel from north eastern states to Delhi, in order to attend ings at regional-level since its inception and also represents the region in various national-level review programs. This has facilitated faster communication and feed-
Bridge between DAC and the SACS:
eight SACS in the NE to ensure effective rolling out of activities as a result of effective communication. Logistic coordination: NERO facilitates logistic arrangement and relocation of commodities such as sexually kits in the eight NE states.
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Role of NERO as Technical Support Unit: Supportive supervision and hand holding: NERO has been regularly providing technical support to all NE states. There are 28 NERO analyses the CMIS reports of each component and provides feedback to the SACS and giving hand holding support to build capacity. Ensuring correct reporting and data quality:
shared with NACO and corrective measures have been taken by NACO accordingly. support for reporting on SIMS. Capacity building and training: NERO helped SACS to identify training institutes and ensured trainings were completed in time. NERO also facilitated training needs assessment, as well as resource pool development, for each state by facilitating and conducting ToTs.
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BMGF-Funding Objective One - Improve the Quality and Support of Scale-Up of Targeted Interventions for IDUs & OST Progress in the North East Improve the quality and support of scale-up of targeted interventions for IDUs & OST progress in the North East 2. Scale-up of TIs for IDUs
3. Scale-up of OST
Regularly Reconcile and Update HRG data
Undertake HRG Validation Activities
Undertake Site Feasibility Assessments at select Districts
Assist in the State Annual Action Planning
Ensure Scale-up of Service Provision
Facilitate Staff Recruitment
1. Quality & Support
Ensure Capacity
Undertake Onsite Mentoring and Supportive Supervision Establish an Evaluation and Screening System for Tendering NGOs Improve Monitoring Mechanisms by Setting Up Feedback System
TI Performance Assessment Undertake an Annual Evaluation of the TIs
Coordinate Other Development Partners
Facilitate Staff Training
Facilitate Stakeholder Sensitization
Provide Regular Supportive Supervision to OST Sites Facilitate OST Demand Generation and Undertake Ongoing Advocacy for Increasing OST Utilisation Ensure Monitoring, Report Analysis and Feedback
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1.
Achieving Improved Quality & Support Regularly reconcile and update HRG data to better understand the requirements of the region Assist in the state Annual Action Planning(AAP) by increasing the capacity of the SACS and providing support and guidance Ensure capacity building with training institutes to effectively empower stakeholder staff Undertake onsite mentoring and supportive supervision Establish an evaluation and screening system for tendering NGOs to ensure quality partners Improve monitoring mechanisms by setting up feedback system so all required action is accounted for Undertake quarterly TI performance assessment so required amendments become visible Undertake annual evaluation of the TIs to ensure relevance and effectivenss
Support to implementing partners was a hallmark of the BMGF-supported functions under A number of activities were undertaken, either in a one-off manner, or on an ongoing basis, in order to ensure that these organisations were aptly empowered and that they and their processes were supported and undertaken at high quality. Regularly Reconcile and Update HRG Data HRG data required regular monitoring and updating to allow for changes in the population, including client relocations, stopping of injecting and deaths, as well as for new
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Assist in the State Annual Action Planning Since its inception, NERO has been providing hand holding support to build the
ments in order to facilitate the preparation of a robust AAP for each NE SACS. This resulted in the following:
where the mapping estimates showed zero MSM. The MSM population was then
Mizoram and Imphal East and West of Manipur. The minimum population criterion for conducting a TI for the migrant population run a migrant TI in other Indian states.
with the appropriate number of these clinics. Female sex workers’ injecting drugs was highlighted and recognised as a problem. Accordingly, Mizoram adopted a strategy to address the issue of FSW who inject drugs, after NERO collected and shared relevant information shedding light on the problem. The Commercial Driver Intervention was initiated in Mizoram and then replicated to other states. Gradual progress made in assisting state agencies with their annual planning preparation has thus progressed from the initial hands-on approach to oversight of the process, with the SACS now able to independently undertake the preparation. Ensure Capacity Building with Training Institutes
from SACS. After its establishment, all training of new SACS staff was organised by NERO, whose staff also helped with training through onsite hand holding. Further, it was observed that there was huge backlog and overall underachievement of training targets for the TI staffs of implementing NGOs. In close collaboration with training institutes, an emphasis was placed on ensuring capacity building was delivered to the implementing organisations.
training targets.
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Undertake Onsite Mentoring and Supportive Supervision Prior to NERO, it can be said there was basically no onsite mentoring and support made available to the TIs. Heavy reliance was placed on a lone JD-TI under each SACS to
between eight to 20 TIs each. Their tasks include monthly visits to each TI and spending a minimum of three to four days to provide the necessary support. Further, a TI
onsite mentoring and supportive supervision, which has resulted in gradual improve-
high priority in the NE states, based on performance analysis of existing TIs and comparative high HIV positivity rates. These visits enable hand holding support to the staffs program. Establish an Evaluation and Screening System for empanelment of NGOs For selection of good partner NGOs for implementing TIs, NERO facilitated the selection of external consultants for the Joint Appraisal Team.
Improve Monitoring Mechanisms by Setting Up Feedback System NERO has substantially improved data management activities, progressing from primarily monitoring of timeliness and completeness of reporting during 2008-09, to providing segregated, component-wise feedback during 2010. The team is now in a position to analyse and provide reporting on state responses against the status of the epidemic in the NE.
inform TI programme operations. Undertake Quarterly TI Performance Assessment Through District-Based PO Any systemic or programmatic constraints are addressed by regular joint reviews with TI staff and service providers, facilitated by the NERO teams. Poorly performing TIs were given particular attention in order to close any gaps in service provision.
Phase - III
37
Undertake Annual Evaluation of the TIs for Performance Assessment and Contract Renewal In order to address overlapping in coverage of TIs to particular locations, teams worked to eliminate duplications and realign TIs in accordance with HRG mapping activities.
2.
Achieving Improved Scale-Up of TIs for IDUs Undertake HRG validation activities to ensure coverage and saturation of TIs to HRGs Ensure scale-up of service provision including facility scale-up and increased testing Coordinate with other development partners to promote information
Undertake HRG Validation Activities Revalidating the distribution of HRGs was instrumental in ensuring effective TI coverage, ruling out overlapping of services and exploring uncovered ground for all HRGs, including IDUs. NERO developed tools and a methodology for HRG validation, which was approved by NACO. The validation exercise was completed for all eight NE states. This gives an approximate indication of different types of HRGs existing in each state; an indication of areas and HRGs which are not covered by the existing TI. revalidation exercises are ongoing, occurring periodically, and continue to lead to tion was achieved in 2011-12. 80,000
66,531
69,826
74,282
73,036
66,272
65,770
46,574
46,752
46,272
70,000 60,000 43,421
43,506
3,800
4,600
5,400
6,450
7,566
2,400
2007-08
2008-09
2009-10
2010-11
2011-12
2012-13
50,000 40,000
33,710
30,000 20,000 10,000 0
MSM
Source:
FSW
IDU
38
Ensure Scale-Up of Service Provision Building on the solid foundations laid by HRG validation and TI realignment, teams were able to effectively work towards the scale-up of service provision in all of the northeastern states.
126 in 2010-11. In 2012-13, the number of programmes was 119. Core-composite
39
The establishment of new facilities was a key aspect in the overall TI scale-up programme.
establishment of 31 mobile ICTCs, which operate in the region to provide HIV testing services. Table 5 – State-wise Number of People Tested for HIV in North East from 2007-08 to 2011-12
State
2007-08
Arunachal Pradesh Assam
2008-09
2009-10
2010-11
2011-12
28,295 56,182
333,660
Manipur Meghalaya
1,018
Mizoram
9,896
16,935
Nagaland
86,928
Sikkim
2,130
Tripura
0
23,911
26,306
40
800,000
727,587
700,000 578,475
600,000 458,758
500,000 400,000 279,716
300,000 200,000
131,604
100,000
0 2007-08
2008-09
2009-10
2010-11
2011-12
People Tested for HIV
Source
120 Tripura
100 80 60 40 20 0
6 5 11 8 8 10
9 6
6 5 11
11
8 8
8 8
10
10
14
14
15
6
6
6
11
11
11
8 8
8 8
9
10
10
10
27
27
28
Nagaland Mizoram
8
23
25
12
14
14
16
17
17
2007-08
2008-09
2009-10
2010-11
2011-12
2012-13
20
Sikkim
Meghalaya Manipur Assam Arunachal Pradesh
1
Source 1
Reproductive Tract Infection
Clinics in the North East,
41
300
250
9
9 5 5
43 38 6
100
52
52
41
41
41
8
8
8
54
54
43 150
14 6
5
6 200
15 8
6
52
52
57
14 6 Tripura 52 37
Nagaland
8
Mizoram
66
53
40
Assam 52
56
60
60
62
12
15
21
21
23
23
2007-08
2008-09
2009-10
2010-11
2011-12
2012-13
0
Meghalaya Manipur
52 50
Sikkim
Arunachal Pradesh
to 2012-13 Source
STATE 12,000
Arunachal Pradesh
2009
2
2012
88
10,000
Assam
833
2,
8
5,925
10,
5
8,000
Manipur 6,000
Meghalaya 4,000
2,000
0 2009
Source
2010
2011
2
8
Mizoram
633
1,91
Nagaland
1,589
3,68
2012
Arunachal Pradesh
Assam
Manipur
Meghalaya
Mizoram
Nagaland
Sikkim
Tripura
Sikkim
39
Tripura
1
3 3
42
In addition to the establishment of facilities, numerous other activities contributed to the accumulative scale-up of TI presence in the region. These include increasing linkages
suggests an increase in positive health-seeking behavior among these risk groups. An increase in self-referral to these centres has also been observed and linkages to other clinics and centres is improving
120,000
140%
107,224 82,518
100,000
100%
80,000 60,000
120%
110%
80%
74%
49,080
60% 40,000
40% 12,840
20,000
4,757
9,917
0%
0 FSW 2008-09
Source
20%
MSM 2011-12
IDU Achievement in %
43
heightened awareness leading to safer sexual practices, there has also been a gradual decrease in the rate of STI treatments for most HRGs, including for IDUs.
4.50% 3.90%
4.00% 3.50% 3.00%
2.63%
2.49%
2.50% 2.00% 1.26%
1.50% 0.80%
1.00% 0.50%
0.38%
0.00% FSW
MSM 2008-09
IDU
2011-12
Source
Analysis for data for actual visits to ICTCs by IDUs between 2008-09 to 2011-12 saw a see Figure 22 although concerning rates of HIV positivity persist in some states. Assessment and Evaluation NACO sought the involvement of NERO to conduct different feasibility assessments in North East. NERO was also involved in the evaluation and performance assessments of facilities of the NE SACS and other SACS of the country. (a) Mobile Integrated Counseling and Testing Centre assessment: NERO conducted a performance assessment of the mobile ICTCs of Nagaland, Mizoram and Manipur. A report was submitted to NACO and the SACS with recommendations. NACO instructed the SACS to continue mobile ICTC service and follow the recommendations of the report.
44
(b) OST feasibility assessment:
North East. In 2012-13, a government-lead OST centre concept was introduced leading to the requirement for 118 OST centres to be established in the NE in government facilities. NERO was assigned to facilitate and conduct feasibility assessments for the establishment of these 118 government-lead OST centres. Accordingly, NERO, along with the SACS, conducted 102 feasibility assessments and shared their report with the DAC.
NE. (c) Migrant labour targeted intervention feasibility assessment: In 2011-12, NACO introduced new a migrant intervention strategy. The new strategy was a result of the fact that most of the migrant-focussed interventions were not eligible to continue because the mandated requisite numbers for this type of intervention were not being reached. The minimum target was 10,000 destination migrants, however most of the migrant TIs in the NE involved fewer than 10,000 migrants. NERO advocated NACO to reduce the minimum target population for the NE so that migrant interventions could continue. NERO collected evidence for the ongoing need of migrant intervention in the NE, even though the target population would likely remain to be lower and shared the concern with NACO. As was recommended, NACO instructed NERO and the SACS to conduct feasibility assessments for migrant interventions, with a reduced minimum of 5,000 in population. Upon sharing the feasibility assessment results with the DAC it was decided to reduce the target of migrant interventions in the NE states from 10,000 to 5,000 migrant laborers. (d) Commercial driver feasibility assessment: In 2010-1,1 most of the truckers’ interventions were scaled down as the new truckers’ intervention strategy made them ineligible. Only two truckers’ interventions had existed number of HIV positive cases being detected amongst short-distance truckers and other drivers. NERO therefore advocated to intervene with this group. NACO subsequently instructed NERO to do a feasibility assessment and advise on possible models of intervention, which was undertaking in Mizoram accordingly. NACO approved commercial driver interventions for the states of Mizoram and Tripura. (e) ART centre evaluation:
evaluation in other states of the country.
45
Coordinate with Other Development Partners A programme of coordination with and information sharing among regional stakeholders was developed. Taking place from time to time, WHO consultants and members of UNICEF, ILFS and NRHM met with NERO teams and SACS representatives. These agencies. NERO also coordinated evidence-based information sharing by these organisations with the SACS to better develop relevant programmes. Training, programme imple-
3.
Achieving Improved Scale-Up of OST
Undertake site feasibility assessments at select districts to identify sites for OST programme implementation Facilitate OST staff recruitment in coordination with the SACS Facilitate staff training to build capacity Facilitate stakeholder sensitisation departmental representatives and medical experts for sensitisation at district and state levels Provide regular supportive supervision to OST sites Facilitate OST demand generation and undertake ongoing advocacy to generate OST utilisation to drive up-take of OST Ensure monitoring, report analysis and feedback is undertaken regarding allocation of commodities, stock management, logistics support and review
Undertake Site Feasibility Assessments at Select Districts Feasibility assessments were undertaken in order to determine eligibility of a site for implementation of an OST centre.
service centres. Targets for OST site scale-up were ascertained as part of the state annual action planning process. Unfortunately not all target sites were deemed feasible, however 21
46
Table 6 - Summary of OST Centres operating in the North East (as at December 2013) State
Total Norequired in the state
No.of Functional Centres
Total Assessment done
Centres further approved by NACO( DAC)
ApPending proved Assessand ment pending rollout
1
1
0
1
2
Total
NGO sites
Govt. sites
1
0
1
3
0
3
10
Manipur
11
9
2
23
18
18
9
Meghalaya
3
3
0
2
1
1
0
9
18
Arunachal Pradesh Assam
10
Mizoram
23
13
Nagaland
33
19
5
Tripura
3
3
0
3
2
0
2
55
21
34
Sikkim Total
118
0
38
12
3
3
0
0
3
1
0
49
36
13
102
2
Facilitate OST Staff Recruitment NERO members were included on the recruitment board at the time of selection by the SACS, in order to ensure the selection of competent staff to man the OST centres.
Facilitate Staff Training In addition the provision of on-site technical assistance to OST providers, careful review of training needs was ongoing in order to ensure all training requirements were met. Six regional induction-training sessions, covering all states, were provided. Technical assistance was also provided for the development of programme implementation protocols.
reduction-related training to implementing partner organisations by SACS.
47
Facilitate Stakeholder Sensitisation As OST sites were often established within existing care facilities, considerable efforts were made by the NERO staff to sensitise the existing staff to the operations and intent of the new facilities. Referral linkages for the OST centres to other services, such as STI clinics and ART centres were made in order to further capacitate the OST provider and enable more integrated care to clients. Provide Regular Supportive Supervision to OST Sites All NE OST sites were visited at regular intervals for monitoring and so that support could be provided at the sites. NERO staff ensured that all district-based POs were oriented on the OST monitoring tools and that regular review ensured adequate performance. Facilitate OST Demand Generation and Undertake Ongoing Advocacy to Generate OST Utilisation. In a collaborative role with the UNODC, NERO OST staff have helped to facilitate a pilot study to scale-up the levels of OST uptake by the IDU communities in order to further inform demand in the region. Ensure Monitoring – Report Analysis and Feedback
and the SACS. Monthly, quarterly and annual reports were provided. Feedback was highlighted to SACS for deliberation and action.
48
OST Programme Testimonials
- 32 year-old, male client, MNP+ OST centre, Imphal, Manipur
This client has been taking OST for the past three years following referral to the OST centre by a friend. Prior to his attendance at the centre, he was using heroin for the episode after testing positive to HIV. This client, from Moirangkhom, Imphal West, could not maintain his ART on time and regularly enough as his search for heroin occupied much of his time, in order to inject three to four times a day. His health considerably deteriorated, however he has found improved health and stability as a result of continued attendance at MNP+ OST centre in Imphal. He also takes his antiretroviral drugs on time and has become much more conscious of his health.
- Client, OST centre DPU, Kumbi, Bishnupur, Manipur
49
- Client, OST centre DPU, Kumbi, Bishnupur, Manipur
- 34 year-old, female client, SHALOM OST Centre, Churachandpur, Manipur
This client is a mother of two children. She and her husband were IDUs who injected this led her to the extreme measure of engaging in sex acts in order to feed her children, obtain drugs and earn money.
and her friend informed her about the programme, which was distributing a “magic drug” that cures addicts.
“
- Clients, Guwahati Medical College Hospital OST centre, Kamrup, Assam
These clients, who used to live and take drugs together, have both been taking OST
programme. Following much stigma, verbal abuse and judgment from friends and family, the couple, who decided to marry after six months in the programme, are now able to support themselves and save some money and are planning to start a family.
- Parent of an OST client, Diphu Civil Hospital OST centre, Karbianglong, Assam
50
BMGF-Funding Objective Two - Strengthen the Capacity of the District AIDS Prevention & Control Units (DAPCUs) in Scaling-Up of District Response in Relation to the NACP
further recognised the importance of decentralisation of the HIV epidemic response in India, programme implementation under was further decentralised to district and sub-district levels. Drawing upon HSS data and the subsequent categorisation of high prevalence districts in the NE, it was decided that District AIDS Prevention & Control Units would be implemented. Establishment of DAPCUs started with those districts known to have the highest
Table 7 - DAPCU Districts in the North East Region of India
State
District
Category
Arunachal Pradesh
Lohit
A
Assam
Kamrup
B
Manipur
Bishnupur Chandel Churachandpur Imphal East Imphal West Senapati Tamenglong Thoubal Ukhru
A A A A A A A A A
Distribution
51
State
District
Category
Mizoram
Aizawl Champai Kolasib
A A B
Nagaland
Dimapur Kiphire Kohima Mokokchung Mon Peren Phek Tuensang Wokha Zunheboto
A A A A A A A A A A
Tripura
B
Total
25 (22 “A” & 3 “B”)
Distribution
Every “A” and “B” category district’s DAPCU undertook to implement AIDS control and prevention strategies, synchronised with public health infrastructure and programmes.
for
52
Institutionalisation of DAPCU NACO NERO
SACS DHS
Reproductive & Child Health NRHM Immunization Committee
Tuberculosis Committee
District AIDS Prevention & Control Comittee
Malaria Committee
Blindness Control Committee
District AIDS District Programme Management Unit
District AIDS Prevention & Control Unit District Programme
Accountant
Monitoring & Evaluation Assistant
Programme Supervisor
DAPCU’s role is to ensure implementation and supervision of ongoing activities and to further facilitate civil society partnerships at the district level with implementing partners working in the area of HIV/AIDS in the district. DAPCUs also facilitate for effective prevention, detection, referrals and treatment strategies through convergence with the ongoing interventions of the NRHM, such as for
53
Role of District AIDS Prevention & Control Units
Provision of supportive Supervision and Monitoring of NACP thematic components at the District level. Convergence With NRHM to integrate NACP activities in the public health system intersectoral convergence for mainstreaming and HIV/AIDS
As NERO staff members, funded by the BMGF, DAPCU Coordinators played a central oversight and coordination role for the DAPCUs, ensuring effective facilitation of programmes, planning, knowledge dissemination and technical expertise.
Strengthen the capacity of the District AIDS Prevention & Control Units in scaling-up of district response in relation to the NACP 1. Capacity Stregthening for Scale-up response
2. Improved Monitoring
Enhance the Understanding of DAPCUs’ Roles
Establish an Annual Plan for Supportive Supervision and Monitoring
Facilitate Preparation of Annual Plans for DAPCU Activities Facilitate Preparation of District Action Plans Enhance the Performance of the NACP Facilities Scale-up of HIV/STI/TB Testing
Ensure DAPCUs are Performing
Measure Performance Against the DAP Ensure that the DAPCU team performs timely and complete reporting of information via SIMS information by the Peripheral Units
3. Convergence & Integration with the NRHM Aid Integration of the NACP Strengthen Mainstreaming of NACP with Public Health System
54
Preliminary DAPCU consultation at North East Regional Office Guwahati, March 2009 Core group of regional resource persons trained
Work plan developed for Nagaland, Manipur and Mizoram, with timelines
Regional-level DAPCU consultation at NSACS Kohima (for Nagaland, Manipur and Mizoram), May 2009 Orientation of DAPCU operational guideline
Road map for operationalizing DAPCU in the state
State level consultative workshop on DAPCU implementation Mizoram, June 2009 Orientation on DAPCU operational guideline
Road map for operationalizing DAPCU in the district
undertaken for all DAPCU staff in all 25 districts in the North EAst
1.
Achieving Capacity Strengthening for Scale-Up Response
by orienting the DAPCU and training in understanding and analysis of NACP components Facilitate preparation of annual plans for DAPCU activities for standardised, effective responses Facilitate preparation of District Action Plans so they are aligned with district needs Enhance the performance of the NACP facilities against the District Action Plans Scale-up of HIV/STI/TB Testing by facilitating joint coordination meetings
55
Refresher training on programme management, monitoring and evaluation, adminisNERO DAPCU Coordinators, with a focus places on supportive supervisions and monitoring of the NACP components and facilities. DAPCU staff were comprehensively briefed on all components of the NACP. DAPCU staff also received training in order to analyse and report on NACP gaps and operations. NERO staff facilitated a number of training sessions, which were administered by the SACS and other training institutions, according to programme components. The DAPCU Coordinators further analysed DAPCU monthly reports in order to ensure requested to be taken by the DAPCU in order to address any such gaps. Facilitate Preparation of Annual Plans for DAPCU Activities Preparation of Annual Work Plans aimed to enable DAPCUs to identify gaps against agreed targets. Drafting of these plans was facilitated by the DAPCU Coordinators, in accordance with the approved state AAP 2011-12, in order to best achieve supportive supervision and monitoring of district-wise NACP activities, within district budgets. By way of their development, DAPCUs became thoroughly acquainted with the state AAP and district targets, as well as the district-level Implementation and Monitoring Plans.
Facilitate Preparation of District Action Plans -
focus, involving multi-level, multi-lateral consultative processes at national, state, district and intervention levels. This evidence based planning exercise involved desk review of state and districts’ review of district-level and other pertinent information. To achieve best practice, DAPs were ultimately incorporated into state AAPs in 201112.
56
Enhance the Performance of the NACP Facilities NERO teams sought to strengthen the districts' response to the NACP by enhancing the performance of the NACP facilities by regularly visiting the peripheral units, such as ICTC centres, ART centres, STI centres, blood banks and TIs. NACP facilities’ performance against activities in the DAP were monitored by DAPCU Coordinators and action was requested according to any slip in performance. Scale-Up of HIV/STI/TB Testing An increase in HIV, STI and tuberculosis cross-referrals and testing was realised by facilitating quarterly, joint coordination meetings with all the NACP facilities and NRHM. STI and TB district-level campaigns were proposed and conducted in some districts of Mizoram and Nagaland.
57
2.
Achieving Improved Monitoring Establish an annual plan for supportive supervision and monitoring of district-wise activity Ensure DAPCUs are performing per their guidelines Measure performance against the DAP to determine progress Ensure that the DAPCU team performs timely and complete reporting of information via SIMS by the peripheral units in order to achieve complete and accurate reporting to SACS
Establish an Annual Plan for Supportive Supervision and Monitoring Workshops were held at state level for the dissemination of Annual Action Plans and the development of DAPCU annual plans. These annual plans included outlines for supportive supervision activities in order to monitor district-wise activity. Ensure DAPCUs are Performing
visits and ensure DAPCUs were performing according to guidelines. Any gaps in monitoring and supervision of NACP components by DAPCU were addressed as part of regional-level review meetings involving DAPCUs, DAPCU Coor-
Measure Performance Against the DAP DAPCUs’ performance against divisional workplans was documented and dissemireview meetings. Ensure That the DAPCU Team Performs Timely and Complete Reporting of Information via SIMS by the Peripheral Units DAPCU Coordinators had ensured training of the DAPCU team in the SIMS reporting format and monitoring of the peripheral unit staff handling the reports.
58
3.
Achieving Convergence and Integration with NRHM Aid integration of the NACP within the public health infrastructure Strengthen mainstreaming of NACP with public health system at district level
Aid Integration of the NACP To achieve convergence of the NACP with the NRHM, public-health infrastructure remained a priority of NACP-III. NERO teams ensured their participation in monthly meetings between DAPCU and NRHM in order to further enable integration. Strengthen Mainstreaming of NACP with Public Health System NERO resources also participated in quarterly District AIDS Prevention & Control Committee meetings under the chairmanship of the District Coordinator. These meetings were held in all 25 priority districts every quarter.
DAPCU Coordinators - Other Strategic Inputs In addition to their existing core responsibilities, DAPCU Coordinators undertook the “A” and “B” category districts. In order to fully understand performance and scale-up, the LWS, which was rolled out in some of the “A” and “B” category districts, was continually monitored by way of supportive supervisory visits to the districts. Special focus was placed on ensuring no overlap in service delivery. DAPCU Coordinators initiated the review of the overlap during the HRG revalidation exercise. DAPCU Coordinators were instrumental in mobilising DAPCUs to execute “innovative
They also took up the responsibility of developing the TI revalidation tools in coordination with the TI staff.
59
INNOVATIVE IDEAS CABA PROJECT- IMPHAL EAST, MANIPUR Care, Support and Treatment to the Female Care Givers, Guardians or Parents of Children Infected and Affected By HIV/AIDS (CABA) The CABA Project in Manipur’s Imphal East district, funded by the District Innovation Fund, aims at giving vocational training, economic support to and creating self employment for 1000 female parents, guardians and care givers of CABA over a period of 3 years. DAPCU Coordinators capacitated the DAPCU team in mobilising the District Innovation Fund in order to enable this innovative idea.
Objectives of the CABA Project are:
women. levels and thereby creating self-employment opportunities.
and marginalised women infected and affected by HIV/AIDS, that can be replicated by other organisations in the state of Manipur.
60
INNOVATIVE IDEAS MOTOR VEHICLE PROGRAMME – CHAMPHAI DISTRICT, MIZORAM Provision of Motor Vehicle for HIV/AIDS-Related Activities in Champhai District of Mizoram As a category “A”, high HIV-prevalence district of Mizoram, Champhai deals with a HIV epidemic that affects both the high-risk groups, as well as the general population. It also endures very high HIV detection among youth. Although there are HIV interventions running in the district, misconceptions around HIV and AIDS still run high. This is in part due to a lack of accessibil-
In order to approach this issue and lessen the gap in service accessibilty, DAPCU Champhai, mobilised by the NERO DAPCU Coordinators and with funding support from the State Bank of India, has driven an initiative to procure a hilly terrain vehicle. This cost-effective measure is an important enabler in allowing access to HIV and tuberculosis services to those district members who cannot ordinarily access them due to their isolated, remote locations. Services enabled by the DAPCU vehicle include:
campaign to: - generate awareness on HIV-TB.
-
Centres/ Primary Health Centres and to reduce TB morbidity in the district. scale-up HIV-TB cross-referrals and reduce HIV-TB-related deaths in the district.
areas of the district: - Health camps in coordination with NRHM. - HIV/AIDS awareness and sensitisation programmes.
the -
DAPCU team: Strengthening service provision in NACP facilities. Ensuring availability of consumables in these facilities. The vehicle maintenance and fuel costs covered by DAPCU Champhai from the monthly operational expenses provided to the DAPCU.
61
NERO TSU Performance Report in NACP III providing technical support for all the functions of NACP-III to all the eight states of NE hati w.e.f February 2008. NERO primarily functions as TSU for the entire 8 states in the North eastern States of India. Key areas of technical support to SACS
HIV prevention, treatment and care for the eight North East states
assistance at the local level and establishing close collaboration with the other programs of the Government of India and civil society
resources from all partners
program components and State AIDS Control Society to ensure training programs gets completed on time and equipping the training institutes to monitor the quality of the training programs.
States covered by NERO
62
Number of TIs in state currently (typology wise and coverage) FSW: 138% of the estimated number. Except for the state of Nagaland and Tripura, the remaining 6 states had saturated FSW coverage. IDU: Tripura all the states had saturated IDUs coverage. MSM: MSMs are yet to be covered. Remaining states had saturated MSM coverage. The IDU, FSW and MSM coverage is inclusive of Project ORCHID- Avahan supported projects in Manipur and Nagaland. CORE COMPOSITE: included in the overall state coverage for FSW, IDU and MSM. MIGRANTs & TRUCKERS: There are 20 Migrant TIs with coverage of 120000 and there are 2 trucker TI with coverage of 10000 truckers. No mapping was conducted for bridge population. HRGs Validation exercise was conducted in all the states in 2010 based on which consolidated and it is expected to be completed by December 2011. Table 8 - FSW TI Status FSW TI STATUS Name of the State
FSW estimate as per mapping
Current Coverage
TI Number
% Coverage
Manipur
3320
6920
6
218%
1850
2
Nagaland Mizoram Assam Arunachal
19560
2
196%
38
183%
2536
136%
Tripura
8650
9
Meghalaya
1839
3
111%
Sikkim
900
902
2
100%
Total
3977
44663
66
138%
63
Table 9 - IDU TI Status IDU TI STATUS Name of the State
IDU estimate as per mapping
Current Coverage
TI Number
% Coverage
Manipur
3320
6920
6
218%
1850
2
Nagaland Mizoram Assam Arunachal
19560
2
196%
38
183%
2536
136%
Tripura
8650
9
Meghalaya
1839
3
111%
Sikkim
900
902
2
100%
Total
3977
44663
66
138%
TI Number
% Coverage
120%
Table 10 - MSM TI Status MSM TI STATUS Name of the State
MSM estimate as per mapping
Current Coverage
Manipur
1031
1900
Nagaland
999
1200
3
Mizoram
0
600
1
Assam
905
Arunachal
120
Tripura
5
265%
0
0
0%
800
1
95%
Meghalaya
0
200
0
Sikkim
80
0
0
0
Total
3977
7100
14
178%
64 Table 11 - Migrants MIGRANTS State
Current Coverage
TI Number
Manipur
15000
2
Nagaland
5000
1
Mizoram
20000
2
Assam
55000
6
Arunachal
35000
6
Tripura
20000
2
Meghalaya
10000
1
Sikkim
0
0
Total
160000
20
CORE COMPOSITE State
Manipur
Table 12 - Core Composite
TI Number
9
Nagaland Table 13 - Truckers
Mizoram
8
Assam
2
Arunachal
8
Tripura
1
Meghalaya
1
Nagaland
5000
1
Sikkim
0
Assam
5000
1
Total
46
Total
10000
2
TRUCKERS State
Current Coverage
TI Number
65
Program Performance a. Support provided for regional location of the POs NERO has been facilitating recruitment of POs for all the North east states. Each of the SACS Project Director or senior level staff and NACO staff were member of the recruitment board. SACS put up the advertisement at the state level and short listing is done by a committee formed at NERO. After recruitment, locations of the PO were pur, Nagaland, Mizoram and Assam where TI number are large each of the PO are allocated 8-10 SACS supported TIs. In smaller state like Arunachal, Tripura, Meghalaya and Sikkim the ratio is 6 to 8 per PO. b. Map indicating regional location of POs and number of TIs managed by them
66 Table 14 - Month wise visits by each PO from April to November 2011
67
68
69
d. Feedback by TSU to PO, TL TI visit reports
Assam, 3 in Arunachal, 2 in Tripura and 1 each in Meghalaya and Sikkim.
they are supposed to submit soon after a visit is conducted to a TI sites. This TI visit reports are submitted to NERO and SACS on regular basis. Feedbacks are provided as and when the reports are received by NERO TI staff. State Coordination Committee is formed which consist of NERO TI staff, SACS JD/DD/AD TI and POs. PD of each SACS attendee the meeting as and when they are available. Regular meeting has been held where each PO shares their detail TI visit and highlighting key issues that needs SACS attention.
regular basis work out their monthly movement plan, provide feedback to their reports and consolidate their monthly and quarterly PO reports. The reporting division.
with the concerned state POs are is conducted which serves a very fruitful feed back mechanism. e. Efforts taken in mapping of HRGs in NACP III The HRG mapping data was provided to all SACS where mapping was conducted by Nagaland, Assam, Meghalaya, Tripura and Sikkim. No mapping was conducted in Mizoram and Arunachal. It was observed there is huge discrepancies and disparity
agency hence many of the hotspot areas covered by the TI were left out due to which
appointment of the 28 POs in North East, revalidation of HRGs was conducted by POs in coordination with the NGO staff. The various methods used were hotspot wise mapping, interaction with PEs and tracking the HRGs registered with each PEs and linelisting active HRGs registered with the TIs. This updated list was submitted to SACS for reference.
70
f. Efforts to scale up the number of TIs
gradually since 2008 to ensure saturation of coverage of HRGs and this increase approval.
Table 15 - TI number in Northeast states in 2007-08
State
5
2
0
3
2
51
0
1
8
0
0
16
0
0
3
1
30
Project ORCHID
3
1
0
15
Mizoram
2
1
Assam
23
1
0
6
6
0
0
13
0
10
Manipur
39
Project ORCHID Nagaland
26
0
2
Arunachal
3
5
0
5
Tripura
0
6
0
0
Meghalaya
0
1
0
0
0
0
1
Sikkim
2
2
0
0
0
1
5
Grand Total
109
47
6
30
20
12
224
MSM = 1
IDU =5 CC=5 FSW=2 MSM=1
71
Table 16 - TI number in Northeast states in 2011-12
State
Existing Existing Existing Existing Existing
Existing
Existing
Existing
Manipur
6
3
1
2
0
0
58
Project ORCHID
0
1
8
0
0
0
16
Nagaland
0
2
10
1
1
0
Project ORCHID
2
1
0
0
0
Mizoram
23
2
1
8
2
0
0
36
Assam
8
38
5
2
6
1
0
60
Arunachal
3
0
8
6
0
0
21
Tripura
2
9
1
1
2
0
0
15
Meghalaya
3
3
0
1
1
0
0
8
2
0
0
0
0
0
6
66
14
46
20
2
0
275
Sikkim Grand Total
127
72
institutionalising of individual tracking system NERO facilitated completion of TI data collection training in all the 8 NE states. This is during the supervisory visit. Regular follow up in done for ensuring setting up of outreach planning system in each TI sites. In most of the TI sites individual tracking system are in place and POs are constantly handholding the outreach team with focus on reaching out to the most at risk HRGs. h. Efforts taken towards improving STI service delivery mechanism and quality NERO staffs were constantly involved during training of the STI state resource team and regularly emphasized that SOP procedure is maintain in the entire STI clinic. Hands on training were provided to the nurses, PM and doctors to ensure that the entire clinic of the PPP doctors and they are helping out the TI in providing consumption pattern ing that formal induction training are conducted. i. Efforts taken to improve clinic access and reduction of STI
and symptoms, timely treatment and consistent use of condoms was reinforced so that the information is incorporated into the ongoing counselling, awareness and other BCC activities.
staff especially PEs, clients and service providers is made mandatory in order to assess the gaps/barriers in clients accessibility to clinic access and the facilitated for necessary measures to be taken up by the service providers, clients, project
With such efforts, there has been evidence of increase in service uptakes.
73
j. Efforts taken towards improving condom utilisation
develop in collaboration with Condom TSG. Whenever there was stock out of condom in state we relocate condom from nearby state who has condom stock.
of last week recall, some of them use Polling both method also
has facilitated to conduct sensitization and stack holder meeting along with HLFPPT the implementing agency. Regular support is provided by PO of NERO to the
coordination meeting with Social Marketing Agency, PO,STRC and SACS. Social Marketing agency PO and NERO share their work plan to joint program implementation. k. Effort taken to improve syphilis screening
on the need for testing all the HRGs for syphilis bi annually. NGOs were continually assist in working out their monthly target, tracking dues for testing and linking them the ICTC centres for availing the syphilis testing facilities available at the centres
has been suggested to SACS for training up the Mobile ICTC staff in syphilis screening. This suggestion is yet to be implemented.
syphilis is conducted by the nurse. It was suggested to SACS to train up all the nurse in syphilis screening to enhance achievement of the target but this suggestion is yet to be considered and roll out
74
l. Efforts taken to improve linkages between TI and ICTC + improvement of HIV testing + improvement in linkage to ART
HIV testing and for linkages of all the positive cases to ART by training all the POs
ICTC, stock out of testing Kit at ICTC and non availability of Syphilis testing kit in most of the ICTC. mobile ICTC for enhancing coverage for HRGs facilities like DSRC, ICTC, ART are also visited to enhance linkages with the TIs m. Effort taken to develop Learning sites in the state
GFATM Rd 9 has selected list of learning sites in the region. Key role of NERO will in ensuring that competency based training are focus upon during the TI staff training. n. Efforts taken to conduct site validation
was shared with respective SACS for reference during the AAP preparation.
programme has been implemented partners working in the district to minimise overlapping issues
75
o. Efforts taken towards improving quality of TI data , analysis and feedback TI data feedback system has been set up at NERO for providing feedback to the state CMIS reports. All POs are taught how to analyse the data and they are constantly following up with the PMs in each TI sites. It is still observed in some TI sites there is no uniformity in understanding the TI data collection tools hence on site training is provided in such a situation. NERO M&E point person and NERO TI staff also provide feedback to the CMIS data in related to consistency, completion and timeliness in submission of the reports. NERO TI staff along with POs participated in the state TI Review during which feedbacks are provided in term of status of achievement of target both for physical and action points are develop for each TI for ensuring that the key gaps areas are focus upon by both TI staff with the help of POs. p. Efforts taken towards capacity building
MSDRB for Mizoram & Arunachal and STRC-EHA for Manipur and Nagaland. Till NERO TI staff has been facilitating completion of training in these three states by closely coordinating with SACS and sometime by providing training directly to the TI staff as and when needed.
creating database for Master Trainers, Release of fund from SACS to STRCs and submission of SOEs by STRCs to SACS.
quality assurance q. Other support provided to SACS
implementation of NACP III in the region not only for TI component but the entire program components of NACP.
76
Salient accomplishments in this period: 1. PLANNING
Plan 2011-12 and implementation of 2010-11 work plan, in close collaboration with the other programs of the government of India, development partners and civil society organizations Aizawl district of Mizoram for 2011-12, involving the NACP facilities, NRHM, PLHIV and government department with support from NTSU. The DAPCU team members are involved in the state AAP preparation in their respective states. 2. SYSTEM STRENGTHENING AND CAPACITY BUILDING 2.1 Human Resource Support
improving the quality of program implementation in the states.
2.2 Training One of the most important roles that NERO plays is coordination with SACS and NACO components of NACP-III and training quality assurance. In order to do so, the following measures were taken up:
of training funds to the respective training institutes. counsellors working at ICTC, ART, CCC and STI clinics were trained through 26 of Meghalaya, Tripura, Sikkim and Arunachal Pradesh. A regional level TOT on organized and conducted resulting in roll out of state level training.
77
gaps in the training program for TI NGOs especially where there is no STRC In addition taking lead role in organizing and conducting TI data collection tools and roll out of SIMU training for the entire NE states.
regular orientation and experience sharing platforms working towards improving quality of the trainings by maintaining minimum standards of organizing and conducting training.
2.3 Supportive Supervision NERO staff in coordination with SACS have made supportive supervisory visits to the facility centres in the states for the necessary on site technical assistance to the service providers as well as facilitated meeting with key stakeholders which gives overview of the progress made by the states in implementation of approved annual action plan along with feedback to the states on the processes to improve the performance. The supportive supervision plans are developed on the basis of CMIS report analysis and gathering relevant feedbacks from NACO to the SACS. 3. ASSESSMENT/ EVALUATION The NERO team members are involved in the evaluation of TI, JAT and annual performance evaluation for CCC, ART in all the NE states, SRL feasibility assessment in Arunachal Pradesh, ICTC- PPP assessments in Nagaland and Arunachal and Sentinel site evaluation in Nagaland, Manipur and Meghalaya TI Feasibility assessments for implementing migrant TI in Mizoram, Manipur and also for setting up of OST in Govt. Set up were also conducted by NERO.
78
4. COORDINATION MECHANISM In order to improve the coordination between various agencies and institutes in the region to reduce communication gap and to improve the performance of institutions/ service delivery points platforms for coordination has been established between
of the development partners support for TI program.
NERO team also facilitated reallocations of the testing kits, ART drugs and condoms between the states in case of surplus availability at any state and non availability of the above consumables and drugs to ensure non disruption of services in the states. SPECIAL HIGHLIGHTS 1. Operationalization of DAPCU in 25 A and b category districts in NE states
DAPCC, Orientation and Capacity building of District teams
points for supervision the DAPCU performance in the region. 2. Multimedia Campaign: Taking forward the initiative of multimedia campaign in the states of Nagaland, Mizoram and Manipur in previous year , NERO under the guidance of NACO facilitated the conceptualization, development of roadmap, implementation and completion of multimedia campaign in all the 8 NE states
79
NERO - Progress of the program in North-eastern states NACO Annual Report 2012-2013
Progress of the programme and schemes in the North-Eastern States The comprehensive package of services under the National AIDS Control Programme is provided to the North-Eastern States to address their special needs. State AIDS Control Societies have been strengthened in all North-Eastern States by providing
NACO, is the result of national response to intensify the effort of HIV prevention, treatment and care services by providing technical support to the eight North Eastern States. Facilitating and strengthening the response to the epidemic by improving the coverage and quality of programme planning, implementation, capacity building and monitoring and reporting are the focus area of NERO. DAPCU has been operationalised in 25 districts with formation of Districts AIDS Prevention Control Committee. DAPCU have initiated and are following up the process of convergence with NRHM and related stakeholders at State and district levels. District Initiative Campaigns of varied nature have been initiated and documented to increase scale up of service uptake. Details of the facilities and services provided under the National AIDS Control Programme in North-Eastern States have been summarized in Tables 12.2 & 12.3 respectively.
Major activities undertaken during 2012-13 Preparation of Annual Work Plans pur, Mizoram and Nagaland. Key action plan was developed based on the key issues in the districts majorly on referral and linkages, meetings, reporting, programme performance, linkages to PLHIV schemes and targets were set for the year. Comprehensive data analysis
80
Comprehensive data analysis has been completed for Assam, Manipur, Mizoram and Nagaland and shared with SACS for further analysis and use in the preparation of AAP for 2013-1 Table 17 - Details of Facilities under National AIDS Control Programme in the North-Eastern States (as on December 2012)
State
Arunachal P 1
21
1
Assam
1
62
2
28
Manipur
9
69
9
10
Meghalaya
0
10
2
8
Mizoram
3
Nagaland
10
53
Sikkim
0
6
Tripura
1
0
Total
25
29
83
0
0
50
0
1
13
9
10
9
1
11
0
1
1
1
25
3
2
3
9
10
5
1
0 3
136
29
3
8
3
8
6
91
199
11
60
0
0
6
12
3
0
1
2
1
1
33
18
38
2
0
6
1
2
96
28
61
25
23
1026
103 298
* 1 ART plus centre in Assam, Mizoram and Nagaland, 1 CoE and 1 Pediatric CoE in Manipur
81
Table 18 - Details of Programme activities in North-Eastern States during 2012-13 (till December 2012)
NE State
Arunachal P 2025
300
Assam 25100 1900
Meghalaya
1050
Mizoram
12550 550
Nagaland
Tripura NE Total
3223
20680
Manipur
Sikkim
3860
6950
2 89
8150
31026
200
56%
80%
300 16625
12332
85
2928
85%
18615
93%
39815
10165
15216
0 600
11
60%
1320 1500
69%
1163
123 6323
30302
132
2162
5 13 86620
82
DAPCU Annual Work Plans With an aim of ensuring effective implementationof approved annual action plan in the SACS to disseminate the approved action plans to the DAPCU teams. Annual Work nical support from NERO, followed up the implementation. As a result all, DAPCUs were enabled to submit the monthly report on time and accurately. These reports are analysed by the National DAPCU Resource Team and feedback provided to the concerned States with recommendations. NERO team followed it up and submitted Action Taken Reports to NACO and NTSU. Meetings
collaboration with State governments, development partners, civil society and positive networks aiming to share best practices, innovations and learning of the programme and experiences from across the country. Training and Capacity Building
conducting various training activities under different programme components of NACP
master trainers for each of the States and approval from NACO, roll out of training as per approved training calendar and supervision of training quality assurance by observing the training conducted by training institutes, training report submission by training institutes to SACS, NERO and NACO for training staff of TI NGOs, there are 3 STRCs are: MSDRB STRC at Aizawl for Mizoram and Arunachal Pradesh: Emmanuel Hospital Association, Dimapur for Manipur and Nagaland; and Emmanuel Hospital Association, Guwahati for Assam, Tripura and Meghalaya. Following important trainings were organised by NERO during 2012-13:
completed in all the NE States.
of SACS and NERO
Supervisors from Arunachal, Assam, Manipur, Mizoram, Nagaland and Tripura participated in the training.
83
Assam, Arunachal Pradesh, Meghalaya, Sikkim and Tripura. Total 25 participants attended the training.
Government health care settings of OST sites of Assam, Mizoram, Meghalaya and
follow up action points were discussed and developed for each State for
research in Guwahati from 26 - 28 July, 2012. Facility assessment
assessment in the NE States.
baseline assessment for Moreh in Manipur. Reports submitted to PD for follow up strategic planning for Moreh.
Guideline/ Format development
individual record keeping SIMS application in NACO, New Delhi.
84
Transitioning NERO facilitated initiation of transition process of TI in Manipur and Nagaland and the assessment of the second batch TI for transition has been completed. The status of the transition process is given in the table below.
Table 19 - Typology-wise Transition Status in Nagaland and Manipur Feasibility Assessment in process, to be completed by March, 2013
Target
Transitioned
Feasibility Assessment completed
IDU
6
3
1
2
MSM
1
1
0
0
FSW
2
0
2
0
2
1
1
6
4
3
3
3
1
Typology
NAGALAND
Core Composite Total
13
MANIPUR IDU MSM
1
1
0
0
Core Composite
8
0
0
8
Total
16
4
3
9
85
Validation of Core HRG population HRG mapping was conducted in most of the NE States during 2008-2010. An analysis of the mapping data shows the variations in the estimated number of HRGs in comparison with the existing TI coverage and data available with SACS from other sources/studies. This also led to concerns regarding overlap in the geographical coverage of nearby TIs and duplication of HRGs between TIs of same typology. Following the TI review of all the NE States conducted by NACO in Delhi on 28-29August, 2012, NERO in conjunction with NE SACS developed an operational manual for validation of Core HRG population with an aim to reconcile the mapping rationalize the resource allocations for prevention programme and ensure service approved by NACO. Orientation of SACS and POs on the tools has been completed in all the NE States except for Arunachal, Mizoram and Nagaland. The initial data collection has been started in all the States. Red Ribbon Express
2012 and reached out to population of various age groups with an aim to create mass awareness on HIV/ AIDS. NERO assisted the SACS in planning and execution of RRE
Multi-media Campaign The multi-media campaign on HIV/AIDS, Red Ribbon Super Stars’, targeted youth and Sikkim. Arunachal Pradesh is conducting the campaign during February, 2013. The campaign uses a combination of music competitions, dramas and sports tournaments organised at district level culminating into the State level mega events. These Owing to the culture of the North-east, over 100 faith based organisations were sensitised and involved in the campaign. A special effort was made to reach out to the out-of-school youth in the States. BCC messages were developed and disseminated by RRCs and Colleges youth. The winners of the music competitions, positioned as “youth icons or the super stars” are further taking messages on HIV/ AIDS to the community through road shows at villages and blocks of every district. NERO facilitated SACS and research agency for the smooth evaluation of the campaign conducted last year. Mid-media and Outdoor SACSs of Assam, Manipur, Tripura and Sikkim have conducted folk media campaign as vital outreach activities in rural areas through IEC exhibition vans, folk troupes and condom demonstration outlets. In the States of Assam and Nagaland through which the RRE passed, these activities were aligned with the RRE project. In addition, hoardings, bus panels and information panels were installed by the States to disseminate information on HIV and AIDS.
86
Red Ribbon Club
peer to peer messaging on HIV prevention, and a safe space for young people to seek are functional across the NE region. Legislative Forum on AIDS Legislative Forums on AIDS are functioning in Assam, Nagaland, Manipur, Meghalaya,Mizoram, Sikkim and Tripura with support from the SACS. An advocacy Meeting of the Arunachal Pradesh Legislators’ Forum on HIV/AIDS was organized to mark World AIDS Day 2012 in the Assembly Secretariat in Naharlagun. Donor coordination meeting for North Eastern region A coordination meeting chaired by Additional Secretary, NACO was held with the
Region on 29 August, 2012 at New Delhi. The need was emphasized to avoid duplication of efforts between agencies and channelise resources in areas which require priority as per national programme objectives. Discussions at the meeting focused on developing an inventory State-wise on the projects being implemented, informing SACS and working synergistically with involvement of respective SACS and NERO to facilitate implementation and development of transition plan for the end of the project. It was decided to hold the next meeting in the North-East. Following this, the details of various ongoing projects has been compiled State-wise and shared with the SACS.
87
Other Successes High-Level Overview of NERO General Achievements NACO-NERO capacitated SACS to achieve the following: Timeliness
and monthly meetings. Increased Capacity to SACS
TI Saturation
140 120
120
123
126
69
67
67
35
37
38
10
12
13
13
13
2008-09
2009-10
2010-11
2011-12
2012-13
121
119
66
64
109
100 80 60
47
40
30
20
6
43
49
0 2007-08
FSW
Source
MSM
IDU
CC
88
OST Scale-Up Improvement in Supply Chain Management
Coordination of Funding Bodies Successful multi-donor model under one administration Decrease of Staff Vacancy Level in the SACS
staff turnover Increase in Number of Trained Staff in the SACS Enhanced capacity building for SACS staffs through facility based as well as exposure visits Improvement in District-Level Strategic Planning
Improvement of Coordination and Communication System between NACO (DAC) and the SACS Effective co-ordination to minimize delays, setbacks in communication and program delivery Improved the Utilisation of Funds in all the North East States
89
Challenges & Suggestions Challenges and Suggestions for Future Improvements ing as most challenging:
need for initiation and reorientation and resulting in stilted progress of the overall programme. Sustained political and bureaucratic advocacy for retention of deputed POs, with a minimum term of three years, is advised.
challenge as the level of convergence unfortunately remains at a minimal level at this point of time. Colocation of HIV/AIDS-related services within the general health services will be the main focus in the years ahead for sustainability of the programmes.
provided for overlapping of programmes and issues in determination of implementation areas and responsibilities.
interrupted, thereby compromising effective implementation of the programme.
national guidelines; recruiting adequate talent in the NE poses issues and
The national guidelines do not cater to the region’s talent acquisition problems. under the guidelines would provide much more recruitment and retention scope.
to stilted progress. This is in part due to facilities not being ready when required, thus leading to issues with mainstreaming due to a lack of infrastructure.
programme, provided barriers to service provision.
90 A needs-based programme and services designed for the NE are desirable in order to reach saturation and optimal uptake. Certain services are not community oriented; there is a lack of need-based issues including care and support for HCV and tuberculosis are also desirable. More community-driven programmes will make for more robust programmes in the NE. Focus should be placed on:
in order to build and comprehensive suite of resources for future referral, benchmarking and comparison.
Conclusion This joint initiative of different donor agencies through NERO has helped in determining the needs-based strategies from each of the NE states, which are at different levels of HIV/AIDS programme implementation.
the SACS in the NE. Under the supported areas within the TI programme, substantial achievement was made in terms of the establishment of facilities and TIs and saturation of coverage of high-risk groups. Gradual programanalysis. The OST programme is still in the scaling-up stage, with focus placed on facility establishment in government health set-ups and recruitment and training of staff, with continual advocacy to stakeholders, both in the general community and with health care providers. With the establishment of DAPCUs, district-level programme planning and monitoring has taken a positive move, and now includes active has resulted in better coordination of all the peripheral units and linkages with other line departments.
facilities now operational, the saturation of coverage of HRGs, increased access to services, as well as increased utilisation of allocated funds. Employing technical expertise from the region has added values of sustainability to the overall programme of work. Based on these positive experiences and despite all the challenging circumstances, this kind of joint initiative is highly recommended.
collate this document.
91
Annexures North East States TI Performance at a Glance Excerpts from presentation by Dr Rebecca Sinate, NERO, August 2014
HSS Prevalence-FSW !!
2003$
2004$
2005$
2006$
2007$
2008$
2010$
Arunachal$ Pradesh$
!
!
!
0!
!
0!
0.28!
Assam$
0!
0!
0.76!
0.46!
0.44!
0.80!
0.46!
12.8!
12.4!
10!
11.6!
13.07!
10.87!
2.8!
Meghalya$
!
!
!
!
!
!
!
Mizoram$
!
13.69!
14!
10.4!
7.2!
9.2!
!
Nagaland$
4.4!
4.44!
10.8!
16.4!
8.91!
14.06!
3.21!
Sikkim$
!
!
!
!
0!
0.44!
0!
Tripura$
!
!
!
!
!
!
0.21!
Manipur$
14 12 10 8 6 4 2 0 2003-05
Trend of FSW prevalence Three years moving average
2004-06 Assam
2005-07 Manipur
Mizoram
2006-08 Nagaland
2007-10
TI Coverage-FSW AAP$target$coverage$vs$Achievement$ 2011E12$ AAP$Target$$
State$$ Arunachal$ Assam$ Manipur$ Meghalaya$ Mizoram$ Nagaland$ Sikkim$ Tripura$
2012E13$
$$$Actual$$$$$ Coverage$
AAP$Target$$
2013E14$
$$$Actual$$$$$ Coverage$
AAP$Target$$
$$$Actual$$$$$ Coverage$
3472!
3472!
3860!
3860!
3250!
3250!
19640!
19640!
20680!
20680!
21000!
20600!
5500!
5500!
6950!
6950!
5000!
5100!
1679!
1679!
1751!
1751!
1300!
1300!
1470!
1470!
1470!
1470!
1100!
1100!
3127!
3127!
3127!
3127!
3000!
3000!
761!
761!
761!
761!
764!
764!
8650!
8650!
7600!
7600!
7600!
7600!
Clinic Attendee-FSW $$
Clinic$AGended$ 2012E13$
State$$ Arunachal! Assam! Manipur! Meghalaya! Mizoram! Nagaland! Sikkim! Tripura!
2011E12$ 2013E14$ Target( clinic Target( clinic visit- 4 times in visit- 4 times Target( clinic visit year)$ Achievement$- 4 times in year)$ Achievement$ in year)$ Achievement$ 13888! 4928! 15440! 4371! 13000! 6061! 78560! 57521! 82720! 59747! 82400! 59206! 22000! 18845! 27800! 22762! 20000! 19494! 6716! 910! 7004! 2120! 5200! 2317! 5880! 3216! 5880! 2615! 4400! 2337! 12508! 6635! 12508! 9313! 12000! 9115! 3044! 1747! 3044! 2024! 3056! 1650! 34600! 17658! 30400! 25417! 28200! 24814!
120% 97%
100%
86%
Source Data : NACO CMIS
80%
73% 72%
74%
72% 55%
60% 40%
82%
47% 35%
45%
53% 44%
84%
76%
53%
88%
66% 57%
54%
51%
30%
28% 14%
20% 0% Arunachal
Assam
Manipur % Achieved(11-12)
Meghalaya Mizoram Nagaland % Achieved(12-13) % Achieved(13-14)
Sikkim
Tripura
Percent diagnosed and treated for STI out of clinic attendees 25%
23% 20%
20%
15%
15%
14%
13% 12% 10%
11% 10%
7% 6%
6% Source Data : NACO CMIS
9%
8%
8%
5%
5%
6%
6% 4%
8% 6%
5% 3% 3%
2% 0% Arunachal
Assam
Manipur
Meghalaya
2011-12
Mizoram
2012-13
2013-14
Nagaland
Sikkim
Tripura
% Tested for HIV at ICTC-FSW $$
ICTC$tested$ 2011E12$ 2012E13$ 2013E14$ Target(Twice Target(Twice Target(Twice in in a year)$ Achievement$ in a year)$ Achievement$ a year)$ Achievement$ 6944! 4176! 7720! 4240! 6500! 4351! 39280! 26583! 41360! 25749! 41200! 22878! 11000! 5119! 13900! 8072! 10000! 8331! 3358! 509! 3502! 1159! 2600! 1127! 2940! 1944! 2940! 1461! 2200! 1129! 6254! 2881! 6254! 3320! 6000! 4328! 1522! 1248! 1522! 1450! 1528! 1031! 17300! 9634! 15200! 11810! 15200! 11422!
State$$ Arunachal! Assam! Manipur! Meghalaya! Mizoram! Nagaland! Sikkim! Tripura! 120%
95%
100% 83%
80%
67% 60%
60%
55%
68%
82% 66%
62%
58%
56% 47%
Source Data : NACO CMIS
72%
43%
40%
50% 51%
78% 75% 67% 56%
53% 46%
33% 15%
20% 0% Arunachal
Assam
Manipur
Meghalaya 2011-12
2012-13
Mizoram 2013-14
Nagaland
Sikkim
Tripura
ICTC Positivity-FSW !! Arunachal! Assam! Manipur! Meghalaya! Mizoram!
2011D12!
Nagaland! Sikkim! Tripura!
2012D13! 0.02%! 0.14%! 0.76%! 3.93%! 1.54%!
2013D14! 0.00%! 0.07%! 0.31%! 2.07%! 0.82%!
0.00%! 0.07%! 0.22%! 1.51%! 1.68%!
1.53%! 0.08%! 0.06%!
0.81%! 0.07%! 0.07%!
0.37%! 0.10%! 0.06%!
4.50% 4.00% 3.50% 3.00% 2.50%
Source Data : NACO CMIS
2.00% 1.50% 1.00% 0.50% 0.00% 2011-12
2012-13
2013-14
Arunachal
Assam
Manipur
Meghalaya
Mizoram
Nagaland
Sikkim
Tripura
HIV Positivity and referral to ART centre !!
State!! Arunachal! Assam! Manipur! Meghalaya! Mizoram! Nagaland! Sikkim! Tripura!
Linked!to!ART! 2011D12! 2012D13! 2013D14! No.!of!PosiKve! Linked!to!ART! No.!of!PosiKve! Linked!to!ART! No.!of!PosiKve! Linked!to!ART! detected! detected! detected! 1! 36! 39! 20! 30! 44! 1! 6!
0! 48! 39! 20! 17! 33! 1! 8!
0! 19! 25! 24! 12! 27! 1! 8!
0! 33! 28! 23! 7! 25! 0! 6!
0! 17! 18! 17! 23! 16! 1! 7!
0! 47! 20! 11! 18! 17! 3! 9!
350% 300%
300%
276%
250%
Source Data : NACO CMIS
200%
174% 133%
150%
133% 100%
100%
112%
111%
100%
96% 65%
50% 0%
57%
58%
78%
106% 93% 75%
0% 0% 0% Arunachal
100%
129%
75%
0% Assam
Manipur
Meghalaya
2011-12
2012-13
Mizoram
2013-14
Nagaland
Sikkim
Tripura
Syphilis Testing 2011D12! 2012D13! 2013D14! Target$(Twice in Target$(Twice in Target$(Twice in a year)$ a year)$ a year)$ Achievement$ Achievement$ $Achievement$ 6944! 2521! 7720! 2052! 6500! 2281! 39280! 8786! 41360! 13716! 41200! 11616! 11000! 4327! 13900! 5815! 10000! 8733! 3358! 241! 3502! 489! 2600! 1074! 2940! 1586! 2940! 1222! 2200! 1047! 6254! 2119! 6254! 2301! 6000! 4650! 1522! 815! 1522! 942! 1528! 1031! 17300! 3179! 15200! 4476! 15200! 7694!
State!! Arunachal! Assam! Manipur! Meghalaya! Mizoram! Nagaland! Sikkim! Tripura! 100%
87%
90%
78%
80% 70%
62%
60%
54%
Source Data : NACO CMIS
50% 40% 30%
35% 27%
33% 22%
54%
51%
48%
42% 36%
67%
41%
39%
42% 34%
28%
20%
37% 29% 18%
14% 7%
10% 0% Arunachal
Assam
Manipur
Meghalaya 2011-12
2012-13
Mizoram 2013-14
Nagaland
Sikkim
Tripura
Condom Distribution-FSW Condom$distribuKon$ 2012D13!
2011D12! State!! Arunachal! Assam! Manipur!
2013D14!
Demand! 700512! 5532672! 2124639!
DistribuKon! 653464! 5223166! 1800646!
Demand! 622980! 5654460! 2005428!
DistribuKon! 549479! 5134768! 2083550!
Demand! 489578! 5155920! 1812622!
DistribuKon! 437747! 4781066! 1551441!
279828! 352800! 750480! 190620! 1883580!
241494! 343069! 528142! 149358! 1291925!
488268! 374400! 623513! 167976! 1277640!
414740! 322263! 594915! 122958! 1131106!
331332! 219589! 614513! 136910! 1211431!
275492! 205698! 617085! 97968! 997877!
Meghalaya! Mizoram! Nagaland! Sikkim! Tripura! 120% 100% 93%
89% 88%
94%
104% 93%
91%
80%
85%
86%
86%
97% 85%
100% 94%
95%
86% 83%
89% 78%
70%
73%
72%
82%
69%
Source Data : NACO CMIS
60% 40% 20% 0%
Arunachal
Assam
2011-12 % distributed against demand
Manipur
Meghalaya
Mizoram
21012-13 % distributed against demand
Nagaland
Sikkim
Tripura
2013-14 % distributed against demand
Programmatic Performance Analysis – FSW
State$
%$HIV$ %$of$ %$CD4$ new$ %$$HRGs$ %$$HRGs$ condom$ test$ infec.$ undergone$HIV$ %$Found$posiKve$ undergone$ Green$ Green$ Green$ TEST$ Green$(<.20%),$ Syphilis$TEST$ %$Clinic$visits$ (95E100%) (>95%),$ (<10%),$ Green$(>75%),$ Yellow$(.21E. Green$(>70%),$Yellow$(50E74%),$ Green$(>75%),$ ,$Yellow$ Yellow$ Yellow$ Yellow$ Yellow$ 50%),$Red$(>. Red$(<50%)$ (80E94%),$ (80E94%),$ (10E30%),$ (60E74%),$Red$ (60E74%),$Red$ 50%)$! Red$ Red$ Red$ (<60%)$ (<60%)$ (<80%)$! (<80%)$! (<30%)$ AprEJun$
Manipur! Nagaland! Mizoram!
Source Data : NACO CMIS
Arunachal! Pradesh! Meghalaya! Tripura! Assam! Sikkim!
JulE Sep$
Oct$E$ Dec$
JanE OctE AprESep$ Mar$ Mar$
AprE Sep$
OctEMar$ AprESep$
OctE Mar$
Annual$
Annual$
Annual$
HSS Prevalence - IDU Name of the state
2003
2004
2005
2006
2007
2008-09
2010-11
D!
D!
D!
0.00!
0.00!
0.23!
0.24!
ASSAM!
5.56!
4.48!
7.86!
2.86!
2.14!
3.64!
1.46!
MANIPUR!
24.47!
21.00!
24.10!
19.80!
17.90!
28.65!
12.89!
MEGHALAYA!
0.00!
0.00!
0.00!
3.33!
4.17!
D!
6.44!
MIZORAM!
6.40!
6.80!
4.80!
3.05!
7.53!
5.28!
12.01!
NAGALAND!
8.43!
3.22!
4.51!
2.39!
1.91!
3.17!
2.21!
SIKKIM!
D!
D!
0.48!
0.20!
0.47!
1.45!
0.00!
TRIPURA!
D!
D!
10.92!
0.00!
0.00!
0.42!
0.45!
ARUNACHAL!PRADESH!
25 20
Source Data : NACO CMIS
15 10 5 0 2003-05 ARUNACHAL PRADESH
2004-06 ASSAM
2005-07 MANIPUR
MEGHALAYA
2006-08 MIZORAM
2007-10 NAGALAND
TRIPURA
Coverage against validated no. of IDUs State$
Arunachal!
No.$of$TI$
Mapping$$ data$
Source Data : NACO CMIS
20212!
18000! 96%!
3! 1452!
1400! 102%!
22! 10545!
10750! 106%!
29! 15255!
16169! 121%!
4! 1380!
Tripura!
3455 89%!
16398! Sikkim!
2635!
47!
12800! Nagaland!
1900! 131%!
405! Mizoram!
2080!
7!
10324! Meghalaya!
%$of$coverage$against$ validated$ďŹ gure$
91%!
828! Manipur!
Coverage$$$ (2013E14)$
3! 1503!
Assam!
Validated$ďŹ gure$$$$ (2013E14)$
1197!
1450! 152%!
2! 940!
428!
650!
Clinic Attendee-IDU 2011D2012! 2012D2013!! Target!! Achievement!!! Target!! Achievement (denominator!will! (denominator!will! Name of the state be!2!Kme!in!a!year! be!2!!Kme!in!a! for!all!HRGs!! year!for!all!HRGs!! ARUNACHAL! PRADESH! 3524! 864! 4050! 1040! ASSAM! 8240! 3467! 7034! 4344! MANIPUR! 39400! 34482! 50200! 58122! MEGHALAYA! 3012! 1813! 2100! 1917! MIZORAM! 27900! 27697! 25100! 28238! NAGALAND! 30696! 14518! 38858! 29147! SIKKIM! 2900! 374! 3000! 998! TRIPURA! 1600! 1480! 1286! 2024!
1214! 4890! 56511! 2538! 26305! 35086! 1892! 2066! 157
116
120
113 91
88
100 80
62
60 25
26
32
92
122
99
94
93
75
70
65
60 47
42
33 13
20 0 ARUNACHAL PRADESH
ASSAM
MANIPUR 2011-12
MEGHALAYA 2012-13
MIZORAM
159
NAGALAND 2013-14
SIKKIM
TRIPURA
Source Data : NACO CMIS
140 Percentage
3800! 7000! 37000! 2760! 21500! 37400! 2900! 1300!
153
160
40
2013D2014!! Target!! Achievement!!! (denominator!will! be!2!Kme!in!a!year! for!all!HRGs!!
Percent diagnosed and treated for STI out of clinic attendees- IDU 2011-2012 Name of the state
Percentage Source Data : NACO CMIS
2013-2014
Clinic attendee
No of IDUs treated
Clinic attendee
No of IDUs treated
Clinic attendee
No of IDUs treated
864 3467 34482 1813 27697 14518 374 1480
339 578 10723 31 656 2545 468 430
1040 4344 58122 1917 28238 29147 998 2024
101 284 7761 10 389 1983 73 13
1040 4344 58122 1917 28238 29147 998 2024
168 65 3412 197 165 1888 65 3
ARUNACHAL! PRADESH! ASSAM! MANIPUR! MEGHALAYA! MIZORAM! NAGALAND! SIKKIM! TRIPURA!
140 120 100 80 60 40 20 0
2012-2013
125
39 10 16
17
31 7 1
13 6
2 1 10
2011-12
2012-13
2 1 1
2013-14
18
29 7 6
7 7
1 0
% Tested for HIV at ICTC-IDU 2011D2012! 2012D2013!! 2013D2014!! Target!! Achievement!!! Target!! Achievement!!! Target!! Achievement!!! (denominator!will! (denominator!will! (denominator!will! Name of the state be!2!Kme!in!a! be!2!Kme!in!a! be!2!Kme!in!a! year!for!all!HRGs!! year!for!all!HRGs!! year!for!all!HRGs!! ARUNACHAL! PRADESH! 3524! 1750! 4050! 1756! 3800! 2316! ASSAM! 8240! 3160! 7034! 2819! 7000! 5336! MANIPUR! 39400! 17541! 50200! 25796! 37000! 25997! MEGHALAYA! 3012! 703! 2100! 570! 2760! 1035! MIZORAM! 27900! 15401! 25100! 12674! 21500! 12102! NAGALAND! 30696! 10608! 38858! 16304! 37400! 18832! SIKKIM! 2900! 2576! 3000! 2616! 2900! 2339! TRIPURA! 1600! 1012! 1286! 1197! 1300! 1138! 100
89 76
80 Percentage
70 60 50
43 38
40
40
81
88
70
61 50
93
45
55
51
50
23
50 42
38
30
63
56 35
27
20 10 0 ARUNACHAL PRADESH
ASSAM
MANIPUR
MEGHALAYA
2011-12
2012-13
MIZORAM
2013-14
NAGALAND
SIKKIM
TRIPURA
Source Data : NACO CMIS
90
87
Percentage of HIV Positivity against ICTC testing 2011D2012!
2012D2013!!
2013D2014!!
No!of!IDUs! No!of!IDUs!tested!No!of!IDUs! No!of!IDUs!tested!No!of!IDUs! No!of!IDUs!tested! tetsted!at! PosiKve! tetsted!at!ICTC!! PosiKve! tetsted!at!ICTC!! PosiKve! Name of the state ICTC!!
ARUNACHAL! PRADESH! ASSAM! MANIPUR! MEGHALAYA! MIZORAM! NAGALAND! SIKKIM! TRIPURA!
1750! 3160! 17541! 703! 15401! 10608! 2576! 1012!
1.6
0! 10! 274! 4! 210! 70! 0! 1.6 0!
1756! 2819! 25796! 570! 12674! 16304! 2616! 1197!
0! 10! 227! 2! 98! 82! 0! 0! 1.4
1.4
2316! 5336! 25997! 1035! 12102! 18832! 2339! 1138!
0! 8! 162! 9! 158! 27! 0! 0!
1.3
0.9
1.0 0.8
0.6
0.6 0.3
0.4 0.2
0.9
0.8
0.6
0.4
0.7 0.5
0.4
0.1
0.1
0.0 0.0 0.0
0.0 0.0 0.0
0.0 0.0 0.0
SIKKIM
TRIPURA
0.0 ARUNACHAL PRADESH
ASSAM
MANIPUR
MEGHALAYA
2011-12
2012-13
MIZORAM
2013-14
NAGALAND
Source Data : NACO CMIS
Percentage
1.2
HIV Positivity and referral to ART centre 2011D2012!! Name of the state
2012D2013!!
2013D2014!!
Number!of!HRG! No.!of!HRG! Number!of!HRG! No.!of!HRG! Number!of!HRG! No.!of!HRG! found!HIV!! referred!to!ART! found!HI!!PosiKve! referred!to!ART! found!HI!!PosiKve! referred!to!ART! PosiKve!tested! centre!! tested! centre!! tested! centre!!
ARUNACHAL! PRADESH! ASSAM! MANIPUR! MEGHALAYA! MIZORAM! NAGALAND! SIKKIM! TRIPURA!
0! 10! 274! 4! 210! 70! 0! 0!
0! 19! 194! 5! 141! 68! 0! 0!
0! 10! 227! 2! 98! 82! 0! 0!
0! 5! 208! 5! 112! 43! 1! 0!
0! 8! 162! 9! 158! 27! 0! 0!
0! 8! 159! 7! 113! 19! 0! 0!
250 250 190
150
125 100
100
92 98
114 78
71 50
67
100
97 72 52
70
50 0
0
0
0
0
0
0
0
0 ARUNACHAL PRADESH
ASSAM
MANIPUR
MEGHALAYA
2011-12
2012-13
MIZORAM
2013-14
NAGALAND
SIKKIM
TRIPURA
Source Data : NACO CMIS
Pecentage
200
Syphilis Testing - IDU 2011D2012! 2012D2013!! 2013D2014!! Target!! Achievement!!! Target!! Achievement!!! Target!! Achievement!!! (denominator!will! (denominator!will! (denominator!will! Name of the state be!2!Kme!in!a! be!2!Kme!in!a! be!2!Kme!in!a! year!for!all!HRGs!! year!for!all!HRGs!! year!for!all!HRGs!! ARUNACHAL! 3524! 471! 4050! 525! 3800! 1260! PRADESH! ASSAM! 8240! 1496! 7034! 2096! 7000! 866! MANIPUR! 39400! 7127! 50200! 14722! 37000! 30100! MEGHALAYA! 3012! 30! 2100! 127! 2760! 968! MIZORAM! 27900! 9366! 25100! 9777! 21500! 10442! NAGALAND! 30696! 7149! 38858! 12469! 37400! 17558! SIKKIM! 2900! 655! 3000! 45! 2900! 2632! TRIPURA! 1600! 190! 1286! 813! 1300! 936!
91
100 81
90
72 63
70 60
49
50
33
40 30 20
13
13
30 18
35
29 12
34
32 23
18 1
10
47
39
23 12
6
2
0 ARUNACHAL PRADESH
ASSAM
MANIPUR
MEGHALAYA
Series1
Series2
MIZORAM
Series3
NAGALAND
SIKKIM
TRIPURA
Source Data : NACO CMIS
Percentage
80
Condom Demand Vs Distribution 2011D2012! 2012D2013!! 2013D2014!! Demand!as!per! DistribuKon!!!Demand!as!per!actual!! DistribuKon!!! Demand!as!per! DistribuKon!!! actual!!done!by!Pos!! done!by!Pos!!13! actual!!done!by! 13!indicator!and! indicator!and!NGO! Pos!!13!indicator! NGO!performance! performance!tracking!! and!NGO! tracking!! performance! tracking!!
Name of the state
ARUNACHAL!PRADESH! ASSAM! MANIPUR! MEGHALAYA! MIZORAM! NAGALAND! SIKKIM! TRIPURA!
120
99
109
161370! 338580! 1866960! 144324! 1131312! 1136540! 228912! 107664!
116
100
112 99 86
97
160529! 289855! 2085904! 97806! 1076454! 1063467! 200699! 87247!
132425! 280800! 2134190! 160800! 934330! 1077198! 199370! 73261!
144944! 278792! 2345177! 88420! 890463! 1112456! 178535! 65782!
95
88
95
123502! 246406! 1682258! 83561! 701744! 886778! 715770! 61482!
116
105
110
106780! 253634! 1921604! 104816! 669243! 900987! 617255! 73261!
94
103
98
80
88
90
81
90
84
68
80
55
60
20 0 ARUNACHAL PRADESH
ASSAM
MANIPUR
MEGHALAYA
2011-12
MIZORAM
2012-13
2013-14
NAGALAND
SIKKIM
TRIPURA
Source Data : NACO CMIS
40
Needle/Syringe demand Vs Distribution
Name of the state
2011D12! 2012D2013!! 2013D2014!! Demand!as!per! DistribuKon!!! Demand!as!per! DistribuKon!!!Demand!as!per! DistribuKon!!! actual!!done!by!Pos!! actual!!done!by!Pos!! actual!!done!by! 13!indicator!and! 13!indicator!and! Pos!through!31! NGO!performance! NGO!performance! indicator!! tracking!! tracking!!
160 140 120 100 80 60 40 20 0
273600! 993242! 2908800! 475632! 2150856! 2132742! 595453! 126054!
222482! 759934! 4492136! 390712! 1951754! 2563892! 682726! 107478!
180488! 823680! 4597421! 361464! 1850757! 2222862! 708928! 94093!
173959! 588680! 5278625! 396857! 1869339! 2515170! 712191! 83321!
171512! 489401! 4085450! 373384! 1658226! 1741114! 564402! 86752!
200347! 622302! 3743275! 343894! 1650124! 1822716! 557483! 85012!
154 127
117 81
96
77 71
115 92
110 82
2011-12
120 92
2012-13
91
101
100
2013-14
113
105
115 100
99
85
89
98
Source Data : NACO CMIS
Percentage
ARUNACHAL!PRADESH! ASSAM! MANIPUR! MEGHALAYA! MIZORAM! NAGALAND! SIKKIM! TRIPURA!
Needle/Syringe Distribution Vs Return
100 90 80 70 60 50 40 30 20 10 0
ARUNACHAL PRADESH
2013D2014!! DistribuKon!!!!! Return!
222482!
112082!
173959!
87684!
200347!
126707!
759934!
391026!
588680!
382655!
622302!
361615!
4492136!
2954247!
5278625!
3877143!
3743275!
2823852!
390712!
313322!
396857!
300435!
343894!
277052!
1951754!
1739975!
1869339!
1653806!
1650124!
1537800!
2563892!
1700332!
2515170!
1869331!
1822716!
1523071!
682726!
530916!
712191!
541728!
557483!
419631!
107478!
68384!
83321!
56220!
85012!
57226!
65
63 50 50
2012D2013!! DistribuKon!!!!! Return!
51
58
ASSAM
66
73 75
MANIPUR
80
76
81
89 88
93 84 66
MEGHALAYA
2011-12
2012-13
MIZORAM
2013-14
74
NAGALAND
78
76
75 64
SIKKIM
67 67
TRIPURA
Source Data : NACO CMIS
Percentage
Name of the state ARUNACHAL! PRADESH! ASSAM! MANIPUR! MEGHALAYA! MIZORAM! NAGALAND! SIKKIM! TRIPURA!
2011D2012! DistribuKon!!!!! Return!
OST Performance Sl.$ No.!
Indicator!
Assam!
3500!
Arunachal*!
Manipur!
Mizoram!
Meghalaya!
Nagaland!
Sikkim!
1900!
20212!
10750!
1052!
15254!
1450!
Tripura!
1!
No$of$IDU$ populaKon$!
2!
No$of$Center$ Propose$State$wise$!
10!
4!
37!
23!
5!
33!
4!
3!
119!
3!
No$of$centers$ approve$State$Wise$!
7!
2!
28!
17!
5!
31!
3!
3!
96!
4!
No$of$centers$ funcKonal$$State$ wise$!
3!
1!
10!
13!
3!
22!
2!
3!
57!
5!
No$of$IDUs$on$OST$ State$Wise$!
405!
88!
2439!
837!
450!
1970!
154!
114!
6457!
6!
No$of$regular$client$ State$Wise$!
82!
31!
1162!
704!
317!
597!
35!
40!
2968!
7!
No$of$Client$ completed$ treatment$State$ Wise$!
1!
0!
198!
413!
9!
278!
0!
0!
899!
8!
No$of$client$drop$ out$State$Wise$!
254!
39!
324!
86!
45!
553!
82!
11!
1394!
Source Data : NACO CMIS
652!
Total!
54770!
HSS Prevalence - MSM Name of the state
2003
2004
2005
2006
2007
2008-09
2010-11
0.78!
2.78!
0.41!
1.40!
10.40!
16.40!
17.21!
10.53!
ARUNACHAL$ ASSAM$ MANIPUR$
29.20!
14.00!
15.60!
MEGHALAYA$ MIZORAM$ NAGALAND$
13.58!
SIKKIM$ TRIPURA$
HIV Prevalance in NE - MSM (Moving Average)
Source Data : NACO CMIS
30 20
19.60
14.13
13.33
10 0 2003-05
2004-06
2005-07 Assam
Manipur
14.67 1.32 2006-08
14.71 1.53 2007-10
Coverage against validated no.of MSMs
State$
Arunachal!
1+(3!CC)!
Assam!
5+(5CC)!
Manipur! Meghalaya!
Source Data : NACO CMIS
No.$of$TI$
4! 1CC!
Mizoram!
1+!1CC!
Nagaland!
3!+1CC!
Sikkim!!
0!
Tripura!
2CC!
TOTAL!
14+!13CC!
Mapping$$ data(2008-10) $
338!
Validated$ďŹ gure$ (2012-14)
377!
905!
2797!
1031!
1257!
0!
274!
D!
564!
1004!
1186!
80!
D!
840!
576!
4198$
7879$
Coverage$$$ (2013E14)$
%$of$coverage$against$ validated$ďŹ gure$
375!
99%!
2700!
97%!
1400!
111%!
200!
73%!
500!
89%!
1370!
116%!
0! 600!
104%!
7195!
99%!
Clinic Attendee - MSM 2011D2012!
2012D2013!
2013D2014!
Target!! Target!! (denomin (denomin Target!!(denominator! Average!%! ator!will! Average!%! ator!will! Average!%! Achieve Achievem Achievem will!be!4!Kme!in!a!year! Clinic! Clinic! be!4!Kme! Clinic! be!4!Kme! ment!! ent!! ent!! for!all!HRGs)! a^endee! in!a!year! a^endee! in!a!year! a^endee! for!all! for!all! HRGs)! HRGs)! State! ARUNACHAL$ 800! 355 44%! 1200! 458 38%! 1500! 231! 15%! ASSAM$ 9200! 6208 67%! 10800! 9088 84%! 10800! 5503! 51%! MANIPUR$ 7600! 1893 25%! 7600! 1424 19%! 5600! 3649! 65%! MEGHALAYA$ 800! 207 26%! 800! 439 55%! 800! 682! 85%! MIZORAM$ 2200! 720 33%! 2200! 1424 45%! 2200! 1044! 47%! NAGALAND$ 5080! 3087 61%! 5480! 2670 49%! 5480! 2705! 49%! SIKKIM$ 0! 0 0%! 0! 0! 0%! 0! 0! 0%! TRIPURA$ 2400! 370 15%! 2400! 732 31%! 2400! 771! 32%! Source$â&#x20AC;&#x201C;$31$INDICATOR$&$CMIS$data$
Clinic Attendee Achievement -MSM (%) 80% 60% 40% 20%
85%
84% 67% 44%
65%
38% 25%
15%
19%
61%
55%
51% 26%
33%
45% 47%
49% 49% 31% 32% 15% 0% 0% 0%
0% Arunachal
Assam
Manipur % Achieved (11-12)
Meghalaya
Mizoram
% Achieved (12-13)
Nagaland % Achieved (13-14)
Sikkim
Tripura
Source Data : NACO CMIS
100%
STI Diagnosed & Treated out of Clinic Attendees - MSM 2011D2012! State$
2012D2013!
2013D2014!
Clinic$aGendee$
STI$Treated$$
%$
Clinic$aGendee$
STI$Treated$$ $
%$
ARUNACHAL$
355!
13!
4%!
458!
46!
10%!
231!
31!
13%!
ASSAM$
6208!
212!
3%!
9088!
161!
2%!
5503!
112!
2%!
MANIPUR$
1893!
57!
3%!
1424!
42!
3%!
3649!
24!
1%!
MEGHALAYA$
207!
0!
0%!
439!
10!
2%!
682!
9!
1%!
MIZORAM$
720!
3!
0%!
1424!
5!
0%!
1044!
6!
1%!
NAGALAND$
3087!
407!
13%!
2670!
334!
13%!
2705!
134!
5%!
SIKKIM$
0!
0!
0%!
0!
0!
0%!
0!
0!
0%!
0!
0%!
732!
19!
3%!
771!
6!
1%!
TRIPURA$
370! Source$â&#x20AC;&#x201C;$31$INDICATOR$&$CMIS$data$
Clinic$aGendee$ STI$Treated$$
%$
STI Diagnosed & Treated out of Clinic Attendees - MSM (%) 13% 10%
10% 5%
13% 13%
4%
3%
5% 2% 2%
3% 3% 1%
0% Arunachal
Assam
Manipur
STI Treated % (11-12)
2% 0%
1%
Meghalaya
3% 0% 0% 1% Mizoram
STI Treated % (12-13)
0% 0% 0% Nagaland
Sikkim
STI Treated % (13-14)
0%
1%
Tripura
Source Data : NACO CMIS
15%
% Tested for HIV at ICTC - MSM 2011D2012! Target!! (denominator! will!be!2!Kme! Achievement!! in!a!year!for!all! HRGs)! STATE! ARUNACHAL$ 400! 281! ASSAM$ 4600! 2893! MANIPUR$ 3800! 993! MEGHALAYA$ 400! 59! MIZORAM$ 1100! 682! NAGALAND$ 2540! 944! SIKKIM$ 0! 0! TRIPURA$ 1200! 282! Source$â&#x20AC;&#x201C;$31$INDICATOR$&$CMIS$data$
2012D2013!
%!
70%! 63%! 26%! 15%! 62%! 37%! 0%! 24%!
2013D2014!
Target!! (denomin ator!will! be!2!Kme! Achievement!! in!a!year! for!all! HRGs)! 600! 564! 5400! 3873! 3800! 906! 400! 163! 1100! 563! 2740! 808! 0! 0! 1200! 501!
%!
94%! 72%! 24%! 41%! 51%! 29%! 0%! 42%!
Target!! (denomina tor!will!be! Achievement!! 2!Kme!in!a! year!for!all! HRGs)! 750! 5400! 2800! 400! 1100! 2740! 0! 1200!
106! 2363! 1636! 192! 773! 1438! 0! 557!
%!
14%! 44%! 58%! 48%! 70%! 52%! 0%! 46%!
ICTC HIV Testing Achievement - MSM (%) 94%
100% Source Data : NACO CMIS
80%
70%
63%
60%
72% 44%
40% 20%
62%
58% 41% 26%24%
14%
48%
70% 52%
51% 37%
42%46%
29%
24%
15% 0% 0% 0%
0% Arunachal
Assam
Manipur
ICTC Achievement % (11-12)
Meghalaya
Mizoram
ICTC Achievement % (12-13)
Nagaland
Sikkim
ICTC Achievement % (13-14)
Tripura
HIV Positive and Linked to ART Centre - MSM 2011D2012!
2012D2013!
2013D2014!
Number!of! Number!of! No.!of!HRG! No.!of!HRG!! Number!of! No.!of!HRG! %!Linked!to! HRG!tested! %!Linked!to! %!Linked!to! HRG!tested! Linked!to! to!ART! HRG!tested! Linked!to! HIV!! ART!centre! ART!centre! ART!centre! HIV!PosiKve! ART!centre! centre! HIV!!PosiKve! ART!centre! PosiKve! STATE! ARUNACHAL$ 0! ASSAM$ 11! MANIPUR$ 14! MEGHALAYA$ 0! MIZORAM$ 8! NAGALAND$ 14! SIKKIM$ 0! TRIPURA$ 0! Source$â&#x20AC;&#x201C;$31$INDICATOR$&$CMIS$data$
0! 15! 8! 0! 5! 9! 0! 0!
0%! 100%! 57%! 0%! 63%! 64%! 0%! 0%!
0 22 2 3 4 4! 0! 4!
0 20 15 2! 5! 17 0! 3!
0%! 91%! 100%! 67%! 100%! 100%! 0%! 75%!
0! 5! 5! 3! 4! 2! 0! 2!
0! 3! 3! 1! 4! 7! 0! 2!
0%! 60%! 60%! 33%! 100%! 100%! 0%! 100%!
HIV Positive Linked to ART Achievement - MSM (%) Source Data : NACO CMIS
150% 100% 91%
100%
100% 60%
57%
100%100% 67%
60%
0% 0% 0% Arunachal
64%
0% Assam
Manipur
ART Linked % (11-12)
100% 75%
33%
50% 0%
63%
100%100%
Meghalaya
0% 0% 0% Mizoram
ART Linked % (12-13)
Nagaland ART Linked % (13-14)
Sikkim
0% Tripura
HIV Positive detected out of HIV Tested at ICTC – MSM HIV Positivity - MSM (%) 2011D2012!
2012D2013!
2013D2014!
Number!of! No.!of!HRG! Number!of! No.!of!HRG! Number!of! No.!of!HRG! PosiKvity! PosiKvity! PosiKvity! HRG!tested! tested!HIV! HRG!tested! tested!HIV! HRG!tested! tested!HIV! (%)! (%)! (%)! for!HIV! PosiKve! for!HIV! PosiKve! for!HIV! PosiKve! STATE! ARUNACHAL$ 281! ASSAM$ 2893! MANIPUR$ 993! MEGHALAYA$ 59! MIZORAM$ 682! NAGALAND$ 944! SIKKIM$ 0! TRIPURA$ 282! Source$–$31$INDICATOR$&$CMIS$data$
0! 11! 14! 0! 8! 14! 0! 0!
0.0%! 0.4%! 1.4%! 0.0%! 1.2%! 1.5%! 0.0%! 0.0%!
564! 3873! 906! 163! 563! 808! 0! 501!
0 22 2 3 4 4! 0! 4!
0.0%! 0.6%! 0.2%! 1.8%! 0.7%! 0.5%! 0.0%! 0.8%!
106! 2363! 1636! 192! 773! 1438! 0! 557!
0! 5! 5! 3! 4! 7! 0! 2!
0.0%! 0.2%! 0.3%! 1.6%! 0.5%! 0.5%! 0.0%! 0.4%!
2.0% 1.4%
1.5% 1.0% 0.5% 0.0%
0.0%0.0%0.0% Arunachal
0.6% 0.4% 0.2% Assam
0.2%0.3% Manipur
Positivity (%) (2011-12)
1.8% 1.6%
1.5% 1.2% 0.7% 0.5%
0.8% 0.5%0.5%
0.0% Meghalaya
0.4% 0.0%0.0%0.0%
Mizoram
Positivity (%) (2012-13)
Nagaland
Sikkim
Positivity (%) (2013-14)
0.0% Tripura
Source Data : NACO CMIS
HIV Positivity out of ICTC HIV Testing - MSM (%)
Syphilis Testing - MSM 2011D2012!
2012D2013!
Target!! (denominator!will! Achievement!! be!2!Kme!in!a!year! for!all!HRGs)!
2013D2014!
Target!! Target!! (denominator! (denominator! will!be!2!Kme!in!Achievement!! %! will!be!2!Kme! Achievement!! %! a!year!for!all! in!a!year!for! HRGs)! all!HRGs)!
%!
STATE! ARUNACHAL$
400!
156!
39%!
600!
210
35%!
750!
64!
9%!
ASSAM$
4600!
766!
17%!
5400!
473
9%!
5400!
1261!
23%!
MANIPUR$
3800!
802!
21%!
3800!
435
11%!
2800!
1660!
59%!
MEGHALAYA$
400!
30!
8%!
400!
28
7%!
400!
192!
48%!
MIZORAM$
1100!
81!
7%!
1100!
142
13%!
1100!
773!
70%!
NAGALAND$
2540!
1421!
56%!
2740!
717
26%!
2740!
1661!
61%!
SIKKIM$
0!
0!
0%!
0!
0!
0%!
0!
0!
0%!
0!
0%!
1200!
167
14%!
1200!
246!
21%!
TRIPURA$
400! Source$â&#x20AC;&#x201C;$31$INDICATOR$&$CMIS$data$$
Syphillis Testing Achievement- MSM (%) 72%
80% Source Data : NACO CMIS
60% 40% 20%
70% 59%
39%
31% 9%
17%
23%
21%
54%
56%
48%
61%
56% 41%
28% 8%
18% 21% 7%
0% 0% 0%
0% Arunachal
Assam
Manipur
Syphillis Testing % (11-12)
Meghalaya
Mizoram
Syphillis Testing % (12-13)
Nagaland
Sikkim
Syphillis Testing % (13-14)
0% Tripura
Condom Distribution â&#x20AC;&#x201C; MSM 2011D2012!
2012D2013!
2013D2014!
Demand!! DistribuKon!! %! Demand!!DistribuKon!!%! Demand!! DistribuKon!! %! distributed! distributed! distribut Vs!Demand! Vs! ed!Vs! Demand! Demand! STATE! ARUNACHAL$ ASSAM$ MANIPUR$ MEGHALAYA$
Source Data : NACO CMIS
MIZORAM$ NAGALAND$ SIKKIM$ TRIPURA$
D!
45789!
58698
47599!
81%!
8874
7719
87%!
424387!
675288
549854!
81%!
377698!
367575!
97%!
310351!
331000
166293!
50%!
158745!
130932!
82%!
27589!
55152
47747!
87%!
45396!
29238!
64%!
110156!
104000
110070!
100%!
54329!
54105!
100%!
193688!
304800
90968!
30%!
242414!
224882!
93%!
D!
D!
!D!
D!
D!
D!
103104
45972!
45%!
36664!
30823!
84%!
D! 19449!
SOURCEE$31$INDICATORS$and$CMIS$data$
D!