Targeted Programmatic Support Across Countries (CDC1950)  

(2019-present)

In September 2019, the U.S. Centers for Disease Control and Prevention (CDC) awarded AIHA a five-year grant to implement a wide range of activities to combat the HIV/AIDS pandemic, which has since been extended through September 2025. This multi-year, multi-country project is broad in nature, and provides a vehicle by which AIHA can assist the CDC at the global and country level, in support of the President’s Emergency Plan for AIDS Relief (PEPFAR) and the Global Fund to Fight HIV/AIDS, Tuberculosis and Malaria.

The goal of the project – entitled Targeted Programmatic Support Across Countries (CDC1950) – is to provide comprehensive and cost-effective technical support for the acceleration of evidence-based HIV prevention and treatment program implementation, as well as aligned health systems strengthening activities. Among other things, the project aims to increase capacity, particularly of civil society organizations, and to implement direct service delivery (DSD) activities, to address HIV/AIDS across PEPFAR countries globally. This grant builds on AIHA’s successes and collaboration with the CDC, other US government agencies, and other partners over the past 20 years in fighting the HIV epidemic. It also leverages AIHA’s more than 30 years of working to improve capacity among individuals, organizations, governments, and institutions to address various public health issues, particularly among front-line health care workers.

The project’s long-term outcomes include:
  • Increased country-level ownership and capacity to control HIV epidemics in a sustained manner among ministries of health; civil society organizations (CSOs), especially KP-led groups; and other key stakeholders;
  • Decreased HIV transmission among high-risk and vulnerable populations; and
  • Increased HIV case-finding and linkage to care for all individuals living with HIV and receiving ART.

To date, this project has operated in 10 countries across three regions: the Philippines, Thailand, and Laos in Southeast Asia; Zambia, Tanzania, Nigeria, and Kenya in sub-Saharan Africa; and the Dominican Republic, Haiti, and Guatemala in Latin America and the Caribbean.

Civil society organizations (CSOs) that serve HIV key populations (KPs) often have limited sources of financial support, with some depending primarily on just one single source for their operations. These sources are mostly large international donors and NGOs. But the level of overseas funding for HIV programs has stagnated and countries that have achieved success in reducing transmission have often experienced fluctuations in donor support. Rapid donor funding transitions and cuts can result in closures and interruptions of essential services, which threatens to undo progress made toward the elimination of HIV. KPs are at particular risk because national governments may also be reluctant to adopt mechanisms for funding CSOs that are KP-led or KP-driven because they commonly face multiple barriers, including stigma and discrimination. CSOs with more diversified streams of funding are better equipped to maintain services when there are fluctuations in funding. Organizations that apply commercially viable strategies to maximize social objectives are often in a better position to withstand these fluctuations because they are not entirely reliant on the uncertainties of donor funding and fund-raising efforts. Organizations that incorporate social enterprise activities are more like for-profit businesses that sell products or services to acquire capital. AIHA focuses on strengthening KP CSOs to incorporate social enterprise initiatives to make them more sustainable as organizations and key resources delivering critical HIV services to vulnerable populations.

Since 2022, the Philippines has been the primary focus of AIHA’s activities under this CDC award. Currently, AIHA’s main goal in 2024 remains to improve HIV-case finding and linkage to care via community-based screening and testing in partnership with 10 community-based organizations (CBOs) from Regions 6 and 7 of the country. Recognizing that about 47 percent of clients newly diagnosed with HIV in 2023 were under the age of 25 and most of them represented young key populations (YKPs), AIHA is focusing on data-driven outreach to this group, along with implementation of a targeted and diversified prevention and testing strategy. We also developed GIS YKP Mapping for Ili-Ilo City and scaled up the existing social network strategy (SNS) rollout and self-testing.

From October 2023 through May 2024, AIHA provided capacity-building activities to all our partner CBOs, including training on utilization of the OHASIS online platform, SNS coaching and mentoring, and regular project site visits to monitor progress and address any gaps or challenges. These overall objective of these activities was to continuously improve the strategies and approaches for HIV case finding, linkage to treatment and care, and prevention and support efforts. AIHA also conducted a project performance review of all project site personnel to ensure quality work.

Specific recent highlights of AIHA’s technical assistance in the Philippines include:

Community representatives during a CAB planning meeting in Capiz Region 6.

Establishment of HIV Community Advisory Board (CAB) in Capiz Province, Regions 6 and 7 as dynamic platforms for collaboration, empowerment, and advocacy to drive positive change for individuals and communities affected by HIV/AIDS. In 2024, AIHA initiated two CABs pilot sites – one in Region 6 involving MSM and one in Region 7 for PWID. AIHA works on establishing these CABs in partnership with Provincial Health Offices, Provincial Hospitals, and KP organizations and individuals representing these vulnerable groups.

Young Key Population Mapping Activities in Region 6 form part of AIHA’s strategy and approach to improve targeted case-finding and linkage to care that will  increase the reactivity rate among YKPs through the development of an interactive YKP mapping tool that displays a heat map of high-risk sites in Iloilo city and province. The tool also shows profiles of young people, including their social and sexual practices. The goal of the YKP mapping tool is to integrate information that can help establish community PrEP stations, reach people through SNS, promote self-testing, and reduce stigma and discrimination among YKPs. A total of 44 high-risk sites, 21 of which were found in Jaro District.

Social Network Strategies (SNS) implementation in regions 6 and 7, which has been shown to increase the uptake of HIV testing among KPs, including individuals who have not previously accessed testing services.

According to the CDC, Social Network Strategy (SNS) is an evidence-supported approach to identify, engage and motivate people with undiagnosed HIV infection to accept HIV testing. SNS is based on the underlying principles that people in the same social network share the same behaviors that increase the chances of getting or transmitting HIV, and, in addition, that people in the same social network know and trust each other. SNS has been studied to be successful in reaching people engaged in sex work, men who have sex with men, and people who use drugs.

The SNS strategy has improved access to testing and care services by engaging individuals within their social networks, resulting in reduced barriers related to stigma, discrimination, and lack of awareness. By consistently monitoring and evaluating the SNS approach, data-driven decision-making has allowed for the refinement of strategies and the identification of areas for improvement in HIV case-finding efforts. Between October 2023 and March 2024, AIHA identified 59 HIV-positive clients via SNS methodology.

Click here to read the story of Bret, a sex worker and peer navigator who is involved with the outreach efforts of two Cebu-based CSOs supported through our project. Click here to read about Santhy and Klif, two “Seeds” who are helping link people in their social networks to testing and treatment services.

The SNS approach has been shown to increase uptake of HIV testing among KPs, including individuals who have not previously accessed testing services. This strategy has improved access to testing and care services by engaging individuals within their own social networks, resulting in reduced barriers related to stigma, discrimination, and lack of awareness. AIHA follows the coupon and SNS tracking system adopted by CDC. While the SNS approach demonstrated a significant impact on HIV case finding, there were challenges encountered in both regions, such as the recruitment of quality “seeds.” This graphic demonstrates how it works: one CSO/CBO recruited “seeds” (light blue), who are volunteers who distributed coupons with referral for testing among people in their network who engage in risky behaviors, but have not yet been tested. Red circles represent clients who were HIV-reactive.

AIHA’s participation in the PEPFAR Philippines Regional Operation Planning (ROP) meeting included supporting the participation of two out of five KP organization representatives in March 2024, where they contributed to the development of priority programmatic shifts to help sustain and increase HIV case finding, care, and treatment, as well as viral load suppression.

PEPFAR Ambassador Dr. John N. Nkengasong poses with AIHA’s YKP representative during the March 2024 ROP meeting.

The ROP meeting provided an opportunity for AIHA to develop strategies for our work in the 2024-2025 fiscal year to strengthen community engagement among the youth in HIV prevention, testing, and treatment programs. AIHA plans to establish a Youth HIV Community Advisory Board to achieve this. We also aim to expand access to HIV testing and counseling services by utilizing targeted outreach and community-based testing initiatives that will target the 15-24 age group through our YKP mapping activities.

In addition, AIHA plans to implement innovative testing approaches, such as scaling up PrEP and HIV self-testing, and incorporating these with a social network strategy. Other planned activities include supporting the integration of HIV services through one-stop shops that also offer mental health and substance use support and addressing the structural barriers, stigma, and discrimination KPs face when they attempt to access HIV services.

Supporting Development and Implementation of a National U=U Campaign that will design and deliver culturally appropriate messages and visuals targeting KPs and other groups vulnerable to HIV infection. This activity launched the first week of June 2024 with a workshop that convened some 65 experts and community stakeholders, including specialists from the Philippines Department of Health, the Philippine National AIDS Counsel, CDC/PEPFAR, AIHA, and a number of local KP CSOs. Click here to learn more about this event.

It’s important to note that the Philippines has the fastest growing HIV epidemic in the Southeast Asia and Pacific region, with a seven-fold increase in newly diagnosed cases from 2010 to 2018. HIV/AIDS transmission is the highest and most rapidly growing among the country’s KPs. Initiating testing, especially among KPs, has lagged behind other countries making achievement of the 95-95-95 goals elusive. Partnering with local HIV/AIDS and KP-led CSOs is therefore critical to building sustainable local capacity and to deploy improved techniques to enhance targeted case finding. These include interventions such as community-based index testing, self-testing, and social network strategies with linkage to treatment.

Stigma and discrimination also play an important role and AIHA is working with KP and CSO-led organizations, along with other stakeholders, to combat that. Finally, AIHA is helping to enhance the technical and organizational skills of CSOs and KP groups so they can be more effective at their work. AIHA is working in two of the most challenging parts of the Philippines to implement our activities: Region 6 (Western Visayas) and Region 7 (Central Visayas). Starting in early 2023, AIHA launched a direct service delivery (DSD) project in these regions, conducting community-based HIV screening and testing and supporting 10 local community-based KP-focused CSOs. AIHA tested about 6,000 clients and linked between 87-95 percent of those who tested positive to care and life-saving treatment, depending on site.

AIHA implemented various assessments to determine knowledge, skills, and competencies of CSO front-line workers. We also organized focus groups with KPs including MSM, PWID, and transgender individuals to better understand the expectations of each group and develop effective messages around HIV prevention, testing, and linkage to care. These findings were included in a revised Department of Health HIV 101 Course to be launched in 2024.

In September 2023, AIHA organized an Implementers Summit that was attended by representatives from the CDC team, UNAIDS, UNODC, Philippines Shell Foundation (Global Fund principle recipient for the Philippines), regional departments of health, and 10 partner CSOs. Participants discussed the results of their work in 2023, shared the most effective strategies they used to reach out to KPs, and discussed collaboration with other implementing partners, as well as plans for 2024. Below are some photos from the event.

Initial Work Under the Project

In the first year of the project, AIHA implemented activities in Thailand and Laos in Southeast Asia; Zambia, Tanzania, Nigeria, and Kenya in sub-Saharan Africa; and Guatemala in Latin America. Activities in Thailand and Laos focused on improving the quality and confidentiality of HIV testing among high-risk and vulnerable populations, tracing their contacts, and linking them to prevention and care services. In sub-Saharan Africa, interventions were targeted toward improving the capacity of local CSOs comprised of and representing vulnerable and marginalized populations to better address the pandemic in their communities.

In the second year of the project, AIHA continued capacity building activities in Zambia, Tanzania, Nigeria, and Kenya in sub-Saharan Africa; and Guatemala in Central America. Project activities also expanded to Haiti and the Dominican Republic. AIHA supported KP-led organizations to deliver KPIF services via strengthened organizational capacity and increased resiliency through Social Enterprise.

Overall, there were three phases to the capacity building component:

  • Organizational capacity assessment and development of tailored capacity building training and mentorship programs specific to each CSO cohort and country;
  • Participation from eligible countries (Kenya, Nigeria, and Zambia) in organizational capacity building micro grant management programs; and
  • Strengthening alternative mechanisms for CSO sustainability, including skills building for organizational social enterprise.

Phase 2 CSO Capacity Building Results – 27 KP-led CSOs participated and successfully completed organizational capacity grants, including seven in Zambia and 10 each in Kenya and Nigeria. Through the project, these CSOs identified their greatest organizational needs and submitted proposals to initiate their organizational development projects. As a result:

  • 7 CSOs developed their first organizational strategic plans;
  • 4 CSOs developed their first M&E framework;
  • 5 CSOs developed their first board of directors charter and provided related board trainings;
  • 4 CSOs developed their first advocacy and communication strategic plans;
  • 2 CSOs revised all their organizational policies and/or developed SHEA policies;
  • 2 CSOs developed their first human resources policies and manuals;
  • 1 CSO created a GBV care manual for KP-led communities;
  • 1 CSO conducted a KP service delivery landscape analysis report; and
  • 1 CSO created a mental health and wellness manual for KP-led CSO staff and communities.

Phase 3 CSO Capacity Building Results – During this phase, AIHA:

  • Conducted eight social enterprise trainings in seven countries;
  • Awarded social enterprise mini-grants to 16 KP-led CSOs;
  • Provided social enterprise trainings to 162 representatives from 54 KP-led CSOs in seven countries; and
  • Received social enterprise business plans and applications for mini-grants from 35 CSOs.

Ultimately, the project provided KP-led organizations opportunities to strengthen their skills and abilities to enable them to become recipients of US/PEPFAR and other donors as detailed in the graphic below.

Phase 1 OCA-based trainings and mentorship and Phase 2 capacity building projects concluded, while Phase 3 social enterprise implementation of start-up continued through the end of September 2021.

Regional Learning Exchange Forum

To bring together all the unique elements of this capacity building project initiative, AIHA established an on-line region-based Learning Exchange Forum in November 2021 for KP-led CSOs and relevant stakeholders. The Learning Exchange Forum included panelist round tables with reflections from CSOs, consortiums, the CDC, and faculty. The Forum included dissemination of key results from the trainings and mentorship, sharing and discussion of challenges and lessons learned, and the conveyance of priority recommendations. Additionally, AIHA launched a small online capacity resource library highlighting and disseminating training materials and tools, manuals, and other resources developed from this initiative to continue to enable more CSOs to learn, engage, and develop their capacities. 

Patient education brochure targeting youth in the Philippines.

Patient education and outreach brochure targeting PWID in the Philippines.

Click here for a Powerpoint overview of this project, titled “The Role of International Partners in Localization and Transition to Local Ownership.”