Targeted Programmatic Support Across Countries (CDC1950)
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. 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 15 years in fighting the HIV epidemic. It also leverages AIHA’s close to 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.
AIHA has developed a Resource Library that includes training materials developed by AIHA to strengthen the capacity of Civil Society Organizations (CSO) in the areas that have been highlighted in the Organizational Capacity Assessment (OCA), including finance management, human resources management, social enterprise, communications, and volunteer management. We are happy to share these resources with CSOs, CBOs, and local NGOs as a legacy of the CDC-funded Capacity Strengthening Project for Key Populations. These resources include training materials in English, Spanish and French and various templates and worksheets that will be useful.
This project has thus far operated in 10 countries: the Philippines, Thailand, 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. In 2022/3, the Philippines has been the focus of AIHA’s activities under CDC1950.
The project has three main components:
- Capacity building: Supporting PEPFAR programs, Ministries of Health (MOHs) and other key stakeholders to implement innovative, effective and comprehensive capacity building strategies for service delivery and human resources for health (HRH) to ensure implementation of HIV programs in line with PEPFAR/UNAIDS and national policies and guidelines;
- Service provision: Supporting PEPFAR programs, MOHs, and other key stakeholders to implement high-quality, high-effectively and evidence-based HIV prevention, care and treatment services for populations at high risk;
- Strategic information: Supporting PEPFAR programs, MOHs, and other key stakeholders to design and implement innovative strategic information approaches to generate data driven evidence to improve HIV policies and programs.
The project’s long-term outcomes are:
- Increased capacity and ownership of country MOH and other key stakeholders to control HIV epidemics in a sustained manner;
- Decreased HIV transmission among high-risk and vulnerable populations;
- Increased viral load suppression for all populations living with HIV on ART.
Click here or on the image below to expand and read more.
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 have been targeted towards improving the capacity of local civil society organizations comprised of and representing vulnerable and marginalized populations to address the pandemic in their communities.
According to the most recent UNAIDS report released in 2021, key populations and their sexual partners accounted for 65% of HIV infections worldwide in 2020 and 93% of infections outside of sub-Saharan Africa. These populations—which include sex workers, people who inject drugs, prisoners, transgender people, and gay men and other men who have sex with men—constitute small proportions of the general population, but they are at elevated risk of acquiring HIV infection, in part due to discrimination and social exclusion. The risk of acquiring HIV is:
- 25 times higher among gay men and other men who have sex with men.
- 35 times higher among people who inject drugs.
- 26 times higher for sex workers.
- 34 times higher for transgender women.
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.
HIV Key Population Civil Society Organizations (CSO) often have limited sources of financial support, and some depend primarily on one single source for their operations. The sources are mostly large international donors and NGOs. 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, threatening to undo progress towards HIV elimination. Key populations (KP) are especially at-risk because national governments may also be reluctant to adopt mechanisms for funding CSOs that are KP-led or -driven, because they commonly face multiple barriers including 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, as 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 will focus on strengthening these organizations to incorporate Social Enterprise initiatives to make them more sustainable, and be able to deliver the critical HIV services needed.
Overall, there were three phases to the capacity building component:
(1) Organizational Capacity Assessment and development of tailored Capacity Building Training and Mentorship Programs specific to each CSO cohort and country,
(2) Participation from eligible countries (Kenya, Nigeria, and Zambia) in Organizational Capacity Building micro grant management programs, and
(3) Strengthening alternative mechanisms for CSO Sustainability (e.g. Organizational Social Enterprise skill building).
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.
Key Results of eligible CSOs’ Phase 2 Capacity Building Grants
- 27 KP-led CSOs participated and successful completed organizational capacity grants;
- 7 Zambian KP-led CSOs awards
- 10 Kenyan KP-led CSOs awards
- 10 Nigeria KP-led CSOs awards
- CSOs identified their greatest organizational need and submitted proposals to initiate their organizational development projects;
- 7 CSOs developed their 1st Organizational Strategic Plans
- 4 CSOs developed their 1st M&E Framework
- 5 CSOs developed their 1st Board Charter and provided Board Trainings
- 4 CSOs developed their 1st Advocacy and Communication Strategic Plans
- 2 CSOs revised all their organizational policies and/or developed SHEA policies
- 2 CSOs developed their 1st Human Resource Policies and Manuals
- 1 CSO created a GBV Care Manual for KP-led Communities
- 1 CSO conducted a KP-Service Delivery Landscape Analysis Report
- 1 CSO created a Mental Health and Wellness Manual for KP-led CSOs Staff and Communities
Key Results of Phase 3 Social Enterprise Initiative
- 8 Social Enterprise trainings conducted in seven countries
- Social Enterprise mini-grants awarded to 16 KP-led CSOs
- 162 KP-led CSOs participants trained in social enterprise from seven countries;
- 54 CSOs participated in social enterprise trainings in seven countries; and
- 35 CSOs submitted social enterprise business plans for Social Enterprise min-grants
Phase (1) OCA-based trainings and mentorship and Phase (2) Capacity Building Projects concluded (Kenya, Nigeria, and Zambia), Phase (3) Social Enterprise Implementation of Start-Up continued through the end of September 2021. To bring together all the unique elements of this capacity building project initiative, AIHA is planning an on-line region-based Learning Exchange Forum in November 2021 for KP-led CSOs and relevant stakeholders. The Learning Exchange Forum will include panelist round tables reflections from CSOs, Consortiums, CDC, and faculty. The Forum will include dissemination of key results from the trainings and mentorship, sharing and discussion of challenges and lessons learned, and the conveyance of priority recommendations. Additionally, at this time AIHA will launch a small online capacity resource library highlighting and disseminating training materials and tools, manuals and resource developed from this initiative to continue to enable more CSOs to learn, engage, and develop their capacities as well.
Click here for a Powerpoint Overview of this project: The Role of International Partners in Localization and Transition to Local Ownership
In Southeast Asia, AIHA started project implementation in the Philippines in 2021. Since 2022, the Philippines has been the focus of AIHA’s activities under CDC1950.
The Philippines has the fastest growing HIV epidemic in the Southeast Asia/Pacific region, with a sevenfold increase in newly diagnosed cases from 2010 to 2018. HIV/AIDS transmission is the highest and most rapidly growing among Key Populations (KP). In the Philippines, initiating testing, especially among KP, has lagged other countries, and thus achievement of the 95-95-95 goals has been elusive in that country.
Key to overcoming this is to build capacity of and partner with Filipino HIV/AIDS and KP-led Civil Society Organizations (CSOs) and to deploy improved techniques to enhance targeted case finding 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 in order to be more effective at their work. AIHA is working in two of the most challenging regions of the Philippines to implement our activities: region 6 (Western Visayas) and Region 7 (Central Visayas).
In the beginning of 2023, AIHA started a Direct-Service Delivery (DSD) project in these two regions. We conducted community-based HIV screening and testing and supported 10 local Community-Based Civil Society Organizations (CSOs) represented by Key Populations (KPs).
AIHA tested about 6,000 clients and linked 95% of those found positive to care and started life-saving treatment.
AIHA implemented various assessments to determine knowledge, skills, and competencies of CSO front-line workers as well as organized focus groups with MSM (Men who have Sex with Men), Transgender, and PWID/PWUD (People Who Inject or Use Drugs) to understand better 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 (DOH) HIV101 course to be used in 2024.
Click here or on the image below to read one of the success stories of our program in the Philippines.
In September 2023, AIHA organized an Implementers Summit that was attended by the CDC team, UNAIDS, UNODC, Philippines Shell Foundation (PR for Global Fund), Department of Health from both Regions, representatives of 10 CSOs n , and AIHA. The participants discussed the results of their work in 2023, learned about most effective strategies reaching out to KPs, discussed collaboration with other implementing partners, as well as plans for 2024.
We also awarded the best performers of the year – three Peer Navigators that identified the most reactive clients.
Plans for 2024:
Based on a review of the most up to date epidemiological information related to HIV case-finding in the Philippines, in 2024, we will modify some of our interventions.. By June 2023 about 47 percent of newly diagnosed HIV-positive clients were found to be under 25 years old and the majority of them represented Young Key Populations (YKPs). As a result, AIHA will focus data-driven outreach to this group, and implement a targeted and diversified prevention and testing strategy and access points for YKP, including self-testing.
Another important initiative is to advocate for policy change to significantly expand, simplify, and make HIV confirmatory testing more accessible. We will also offer differentiated TG programming.
The main goal in 2024 remains to improve HIV-case finding and linkage to care via community-based screening and testing in partnership with CBOs via the following interventions:
- Enhance Social Network Strategy (SNS) rollout and HIV self-testing
- Enhance social media campaign
- Introduce and roll out community-based index testing to local CSOs
- Community messaging for U=U (Undetectable=Untransmissible) and stigma reduction for KP
- Establishment and support of Community Advisory Boards (CABs)
- PrEP demand creation
- Improve health literacy among PLHIV and KPs