Field Activities

The Issue: Kenya’s pioneering Food by Prescription (FBP) Program, which provides nutritional assessment, counseling, and supplementation to people living with HIV, needed an assessment to determine its potential as a global model.

The Response: AIDSTAR-One gathered data to assess perceptions of services and analyzed challenges and promising practices. Overall response from clients and providers was favorable.

The Outcome: USAID/Kenya will apply the findings to improve program quality. The assessment also offers a framework for developing checklists and incorporating promising practices.

The Issue: Alcohol use is broadly recognized as contributing to HIV risk, but few HIV/STI prevention programs have the time or resources to address drinking behaviors.

The Response: The Phaphama Program, a research intervention based in Cape Town, combined counseling to reduce hazardous drinking with HIV risk reduction counseling in a single 60-minute session.

The Outcome: An evaluation found that Phaphama’s intensive, time-efficient approach led to a 65 percent reduction in unprotected sex for participants, who reported significantly more risk reduction than did the comparison group.

The Issue: Multiple and concurrent partnerships (MCP), which increase HIV risk, fuel the HIV epidemic in Swaziland.

The Response: The 2006 Makhwapheni (“Secret Lover”) Campaign used blunt, fear-based media messages about the dangers of MCP to change behavior.

The Outcome: Despite significant negative reaction to the original campaign, the “buzz” surrounding the campaign spurred widespread discussion about MCP. Post-campaign survey data also revealed some immediate positive changes in men’s behavior; the number reporting two or more partners in the preceding four weeks dropped by nearly half.

The Issue: At 30 percent, Swaziland’s HIV prevalence is one of the highest in Africa. Aiming to increase uptake of HIV testing and to place more HIV-positive people on treatment, Swaziland is implementing various HTC strategies, including a home-based HIV testing and counseling (HBHTC) pilot program.

The Response: AIDSTAR-One facilitated the south-to-south exchange of technical assistance (TA) to pilot door-to-door, HBHTC services in Swaziland. The AIDS Support Organization (TASO), based in Uganda, provided the TA. Activities included: training, recommendations for behavior change strategies, suggestions to improve HBHTC data collection tools, and a trial run of HBHTC implementation.

The Outcome: The Swaziland HIV Counseling and Testing Core Group is implementing a six-month project to determine the feasibility and acceptability of HBHTC. The group will consider scale-up after the project is evaluated.

The Issue: In 2007, in response to the WHO Provider-Initiated Testing and Counseling Guidelines, health care providers (HCPs) in Cambodia began to routinely refer clients to the nearest HIV testing site. Little was known about how this strategy works and whether clients were getting tested.

The Response: AIDSTAR-One assessed services in four provinces to identify promising practices and challenges faced by clients and staff regarding the implmentation of PITC in Cambodia. The data showed that most HCPs do refer clients for testing, yet some clients do not get test results and counseling.

The Outcome: The findings, currently being reviewed by USAID and the Cambodian Ministry of Health, point to specific challenges. Recommendations are presented that may help reduce barriers to HIV testing.

The Issue: HIV prevalence among men who have sex with men (MSM) is disproportionately high, yet this marginalized population has been underserved by HIV programming in India.

The Response: Founded two decades ago as an advocacy organization for sexual minorities, the community-based Humsafar Trust now provides a range of HIV and health services to MSM in and around Mumbai.

The Outcome: Humsafar has successfully linked community advocacy with effective HIV and health services in India’s largest city, although HIV programming for MSM needs further expansion to reach necessary scale in India.

The Issue: Alcohol consumption can increase sexual risk taking, but few prevention programs conduct outreach in drinking establishments to promote behavior change.

The Response: In Chennai, Y.R.G. Care, an NGO, undertook formative research to design bar-based prevention activities using a Popular Opinion Leader peer education (PE) strategy.

The Outcome: Initial findings suggest the project’s use of evidence, focus on risk reduction, and use of “I statements” in PE communication have contributed to increasing bar patrons’ knowledge and reducing their risk.

The Issue: Reaching most-at-risk populations (MARPs) with HIV testing services and STI testing and treatment is a challenge in India, particularly in the State of Maharashtra, where HIV prevalence among MARPs remains high.

The Response: USAID/India, in collaboration with the Indian Government, began a mobile clinic demonstration program implemented by the Avert Society. Six mobile clinics provide MARPs throughout Maharashtra with HIV testing and counseling and STI testing and treatment.

The Outcome: After a year of operation, the program has become a model partnership between the government and NGOs, reaching increasing numbers of people in need.

The Issue: Facing an extensive and growing HIV epidemic, the Democratic Republic of Congo (DRC) aims to improve low rates of coverage and uptake of HIV testing and counseling (HTC) by adopting provider-initiated testing and counseling (PITC).

The Response: AIDSTAR-One is providing technical assistance and support to the National AIDS Program (PNLS) and USAID/DRC. The activities include:

• development of an operational plan for updated national HTC guidelines (which feature PITC)
• development of an HTC pocket guide for counselors
• pilot training in PITC

The Outcome: AIDSTAR-One's technical assistance and support in DRC is ongoing, and the development of the above materials is underway. After the PITC training, participants who have conducted PITC over a period of time will form the pool of trainees that will participate in the "PITC Training of Trainers" that will help scale-up PITC in DRC.

The Issue: NGOs and CBOs provide dedicated prevention and care services for most-at-risk populations (MARPs) and people living with HIV (PLWH), but little is known about how effective these services are and if they collaborate.

The Response: AIDSTAR-One conducted two assessments of community-based services and activities, including a situation analysis.

The Outcome: The assessment team recommended strategies for strengthening the capacity of the organizations and improving collaboration, including with private sector services. This information will help USAID implement service networks targeting MARPs and PLWH.

The Issue: Most-at-risk populations (MARPs) need comprehensive, community-based HIV programs rarely available in developing countries.

The Response: The Avahan Initiative, based in six Indian states, has developed evidence-based combination prevention programming for MARPs, providing comprehensive services, addressing difficult structural issues, and achieving unprecedented levels of scale-up, financial sustainability, and community ownership.

The Outcome: Recognizing Avahan’s success, India’s national and state AIDS agencies are assuming management of many of the initiative’s activities.

The Issue: PEPFAR’s 2008 reauthorization requires USAID to establish framework documents with partner countries to promote sustainable approaches that strengthen country capacity.

The Response: USAID/India requested assistance from AIDSTAR-One to develop a Technical Assistance Model (TAM) to guide PEPFAR’s collaboration with the Government of India.

The Outcome: AIDSTAR-One facilitated the TAM development process, holding stakeholder meetings, participating in TAM working groups, conducting assessments to inform the process, and guiding the
development of the final TAM document.

The Issue: Reaching most-at-risk populations (MARPs) with HIV testing services and STI testing and treatment is a challenge in India, particularly in the State of Maharashtra, where HIV prevalence among MARPs remains high.

The Response: USAID/India, in collaboration with the Indian Government, began a mobile clinic demonstration program implemented by the Avert Society. Six mobile clinics provide MARPs throughout Maharashtra with HIV testing and counseling and STI testing and treatment.

The Outcome: After a year of operation, the program has become a model partnership between the government and NGOs, reaching increasing numbers of people in need.

The Issue: In 2007, the Ministry of Health asked the U.S. Government to investigate an HIV outbreak among infants at two urban health facilities.

The Response: After poor infection control was identified as one cause, AIDSTAR-One conducted a situation analysis of infection prevention practices at nine hospitals and found that injection and waste disposal equipment, infection prevention guidelines, and staff training were inadequate.

The Outcome: AIDSTAR-One trained staff at seven hospitals in infection prevention. Follow-up assessments found significant increases in safe provider practices.

The Issue: NGOs and CBOs provide dedicated prevention and care services for most-at-risk populations (MARPs) and people living with HIV (PLWH), but little is known about how effective these services are and if they collaborate.

The Response: AIDSTAR-One conducted two assessments of community-based services and activities, including a situation analysis.

The Outcome: The assessment team recommended strategies for strengthening the capacity of the organizations and improving collaboration, including with private sector services. This information will help USAID implement service networks targeting MARPs and PLWH.

The Issue: In 2007, the Ministry of Health asked the U.S. Government to investigate an HIV outbreak among infants at two urban health facilities.

The Response: After poor infection control was identified as one cause, AIDSTAR-One conducted a situation analysis of infection prevention practices at nine hospitals and found that injection and waste disposal equipment, infection prevention guidelines, and staff training were inadequate.

The Outcome: AIDSTAR-One trained staff at seven hospitals in infection prevention. Follow-up assessments found significant increases in safe provider practices.

The Issue: Kyrgyzstan has high HIV prevalence, yet too little is known about whether current HIV services for most-at-risk populations (MARPs) are meeting their HIV prevention, care, and treatment needs.

The Response: At the request of USAID/Central Asia Regional Mission, AIDSTAR-One first mapped, then assessed existing services for MARPs in Chui Oblast and in the capital city of Bishkek, using qualitative research methods.

The Outcome: The research showed that Kyrgyzstan’s recent efforts to integrate HIV services into family health centers are improving access to key services for MARPs, but that serious funding, human resources, and data collection challenges threaten sustainability. USAID is working with the Health Outreach Project, the Quality Health Care Project, and government partners to develop and implement strategies to address these challenges.

The Issue: HIV prevalence among pregnant Swazi women is more than 40 percent, creating overwhelming demand for services to prevent mother-to-child transmission (PMTCT).

The Response: AIDSTAR-One has partnered with the NGO mothers2mothers (m2m) to scale up its PMTCT program to 16 new sites. m2m also trains mothers living with HIV as PMTCT peer educators and provides support services to PMTCT clients.

The Outcome: m2m will train 80 field staff, launch high-quality PMTCT education and support services at new sites, and continue to focus on program innovations in PMTCT service delivery.

The Issue: At 30 percent, Swaziland’s HIV prevalence is one of the highest in Africa. Aiming to increase uptake of HIV testing and to place more HIV-positive people on treatment, Swaziland is implementing various HTC strategies, including a home-based HIV testing and counseling (HBHTC) pilot program.

The Response: AIDSTAR-One facilitated the south-to-south exchange of technical assistance (TA) to pilot door-to-door, HBHTC services in Swaziland. The AIDS Support Organization (TASO), based in Uganda, provided the TA. Activities included: training, recommendations for behavior change strategies, suggestions to improve HBHTC data collection tools, and a trial run of HBHTC implementation.

The Outcome: The Swaziland HIV Counseling and Testing Core Group is implementing a six-month project to determine the feasibility and acceptability of HBHTC. The group will consider scale-up after the project is evaluated.

The Issue: Although heterosexual HIV prevalence in Thailand has leveled off at 1.4 percent, prevalence continues to rise rapidly among men who have sex with men (MSM).

The Response: AIDSTAR-One’s 2009 situation analysis of HIV testing and counseling (HTC) services for MSM in four provinces found very few community-based HTC options.

The Outcome: AIDSTAR-One hosted a stakeholder meeting in Bangkok to discuss findings, examine capacity and potential for collaboration, and develop action plans for a U.S. Government-supported project to introduce community-based, rapid, same-day HTC for MSM.