SECTION 6: CCM REQUEST FOR RENEWAL
6.1
Programmatic Proposal
6.1.1
Program Objectives, SDAs, Indicators and Targets
Please provide a Performance Framework for the next Phase/Implementation Period and comment on whether
indicators and targets are aligned with the national program strategy, plans and systems.
This application represents a Request for Renewal of two HIV/AIDS grants from the Global Fund in the
Republic of Moldova and covers the following periods:
1. Grant MOL-H-PCIMU (Principal Recipient 1: Public Institution “Coordination, Implementation
and Monitoring Unit of the Health System Restructuring Project” [PI CIMU HSRP]) PI ): 01
January 2013 – 31 December 2014.
2. Grant MOL-809-G06-H (Principal Recipient 2: Center for Health Policies and Studies [PAS
Center]: 01 January 2013 – 31 December 2014.
Both programs have been previously consolidated into Single Stream of Financing (SSF) projects from
TGF HIV grants obtained in Rounds 6 and 8. At the stage of consolidation, the start dates and cycles
were aligned across the two SSF grants. As the projects are parts of one program application,
implemented by two entities representing governmental sector and non-governmental sector, and
complement each other, this section provides description of the content of the Request for Renewal for
both consolidated grants (and, respectively, both Principal Recipients), with indication of
implementation arrangements and other aspects by PR as required.
The proposal is built to support the key priorities of the National HIV Control Program 2011-2015,
namely HIV prevention among key affected populations, reduction of the negative impact of the HIV
epidemic through provision of care, treatment and support to PLHIV and their family members and
community capacity building, including PLHIV community. The Government of the Republic of Moldova
faces continuing fiscal constraints, exacerbated by the consequences of the global financial crisis during
the last three years that have resulted in the need to reduce the overall public expenditures and
reorient them towards strictly defined priority interventions, e.g. in the health sector. Nevertheless, the
Government has demonstrated commitment to HIV control, by covering 26% of the estimated cost of
the national program and explicitly committing to increase public spending to 40% share by the end of
2015 through take over of 1-line ARV drugs cost by National Health Insurance Company and cost of HIV
surveillance and M&E system. The Government bears substantial costs of staff and facility expenses.
At the same time, domestic funding resources remain insufficient to cover all costs of HIV prevention
and ART treatment interventions, and the mechanisms are not yet in place to channel public resources
for important community-based actions for HIV, which are best implemented by the non-state actors.
Therefore, the need of external funding for HIV control remains important in Moldova, and the current
application aims at obtaining additional resources from the Global Fund and channelling them
effectively towards priorities not covered by domestic funds.
OBJECTIVES, SERVICE DELIVERY AREAS AND INTERVENTIONS
The interventions included in the proposal for Period 2 are aligned with the priorities of the National
HIV/AIDS Control and Prophylaxis Programme 2011-2015 which continue to have focus on HIV
prevention among key affected populations, reduction of the negative impact of the HIV epidemic
through provision of care, treatment and support to PLHIV and their family members and community
capacity building, including PLHIV. The application is built to uphold the goal, scope and key directions of
the ongoing TGF-financed HIV program. At the same time, it complies with current TGF requirements
(including mandatory budget reduction); for this purpose, the activities implemented through both
Principal Recipients during the previous phase of the consolidated grants, have been re-organized under
5 main Objectives:
1. To prevent HIV transmission among key populations: IDU, CSW, MSM
2. To enhance and foster universal access of HIV/AIDS patients to treatment, surveillance and
PMTCT services
3. To develop capacity and ensure sustainability
4. To support PLHIV, PWID and ensure institutionalization
5. To ensure engagement of civil society and key affected population and promote human rights
A brief description of activities under each Objective is presented below.
OBJECTIVE 1. To prevent HIV transmission among key populations: IDU, CSW, MSM
The project will continue to support prevention activities in most at risk populations: IDUs, CSWs and
MSMs as a main priority according to the epidemiological profile of the country: concentrated epidemic
prevailing among certain subpopulations, such as injecting drug users (hereinafter – IDUs) and reflected
as such in the National HIV/AIDS Control and Prophylaxis Programme for 2011-2015.
The prevention services in vulnerable populations within the SSF grant (round 6 and 8) were actually
integrated as part of the 6th round, which comes to the end in 2012. Thus, in the renewals phase, the
costs to cover these activities: 574,107 EUR for 2013 and 300,023 EUR for the first half of 2014 are
coming from the savings obtained by PI “CIMU HSRP” during the SSF first phase of implementation
through the re-programming exercise.
Activity
No.
Activity No. and title
1
Providing prevention services for IDUs
2
Providing prevention services for CSWs
3
4
Providing prevention services for MSMs
Ensure proper coordination between NGOs and
state institutions on providing HR services
Implementing entity:
Service Delivery Area
Community outreach to vulnerable groups
IDUs
Community outreach to vulnerable groups
CSW
Community outreach in MSM
Supportive environment: Coordination and
partnership
development
(national,
community, public-private)
PR-1 (PI “CIMU HSRP”)
Taking into account the performance and developments in the phase 1 of the implementation
(described in the point 5.1.1 of the current application), the renewals phase is based on lessons learnt,
strengthened approach of community and peer involvement, particularly in services provision (peer
driven interventions), lead by the programmatic achievements of 45% - 60% coverage of key
populations with prevention services to 2015, based on the key population type (60% for IDUs and
CSWs) and 45% (MSMs).
Activity 1 reveals the continuity of ensuring access to HIV prevention services for IDUs, covering both
civil and penitentiary systems, the right and left bank of Nistru river (Transnistria). The activity will be
provided primarily by NGOs managed and coordinated by the sub-recipient Soros-Moldova Foundation,
carrying out this activity since 1999. The six projects (5 in civil sector and 1 in penitentiary system)
incorporate in the package of services related to risky behavior change (using sterile equipment and
protected sex) harm reduction ones ensuring easy access to sterile syringes, needles and condoms; easy
access to information, communication, and education; risk reduction counseling; community outreach;
peer education; referral system for health care, including HIV testing and counseling, substitution
treatment. The following service options/types of needle and syringe programs in order to attract/cover
as many drug injectors as possible to the service will be continued:
Fixed site – a specific place that injectors can come to collect and dispose of injecting
equipment;
Mobile services – usually with a regular route and regular hours of stopping in several locations;
Outreach/backpack – in which workers travel through the streets or other areas, distributing
clean needles and syringes and collecting used injecting equipment for safe disposal.
Mainly outreach methods to deliver the services will be used since most injecting drug users inject in
small groups, police efforts are making drug users afraid to congregate and the population of drug users
is spread across the cities, big villages. Outreach services will complement the work of fixed-site or
mobile exchanges when it is apparent that there are a number of injectors who are not making use of
the service. The use of peer educators, peer outreach workers and peer networks will increase the reach
of HIV prevention services to the most marginalized and hard-to-reach IDUs and helps to establish trust
between IDUs and health services. Program staff will provide referrals to appropriate services that suit
the needs of drug users and protect the general health of drug-using communities. Starting 2012, the
projects running prevention activities for IDUs succeeded to involve about 15 new outreach workers and
the achievement is to be kept in the following phase. The package of services to the beneficiaries will
include additionally to the basic ones: sterile equipment, condoms and IEC materials/counseling:
disinfectants, vitamins, hygienic packages. Diversifying the package makes the services more attractive
and motivates the new beneficiaries to address them. It was also achieved during the first phase to
elaborate the protocol on VCT referrals, thus the beneficiaries are referred to health services and VCT
counselors are providing services in the NGOs according to a pre-established and known schedule. This
cooperation is to be kept and improved during the next phase. A number of new 1550 drug users (55.1%
of coverage till July 2014, starting January 2013) are proposed to be covered with prevention services.
Activity 1.4 refers to drug substitution therapy, that service will be continued to be provided having two
aims: treating the drug dependence syndrome and reducing the health risks and negative health effects
(such as HIV infection) of drug use. Drug substitution treatment encourages a transition from injecting to
non-injecting drug use in the form of supervised prescribed treatment. In Moldova, this treatment is
provided exclusively by state institutions (Ministry of Justice’s Department of Penitentiary Institutions
and Ministry of Health’s Narcology Service in two sites: Chisinau and Balti). The project will provide
operational support to the 3 existing OST projects (2 in civil and 1 in penitentiary system) beyond Round
6 and 8 consolidated grants. The project will also procure necessary methadone (maintaining the
volume as per 2012 – 8 kg of pure substance in 2013 and 4 kg in 2014), tests, disposable glasses, tests to
ensure OST the maintenance of existent beneficiaries and ensure the enrolment of 25 new drug users
every semester.
Activity 2. Provide prevention services to CSW
The project will support continuation of service provision to CSWs mainly in 2 regions: Centre (Chisinau
and surrounding territories in Orhei and Ungheni) and North – Balti municipality through 3 projects. A
comprehensive range of well-coordinated and flexible services will be provided to FSWs, particularly
using the peer and community outreach and will count the lessons learnt in the first period. The HIV
prevention in sex work settings will be directed to ensure: increased condom use and safer sex; reduced
STI burden. A comprehensive approach to be able to adapt to changing needs and circumstances will be
maintained. The following approaches will be used: easy access to condoms; easy access to information,
communication, and education; risk reduction counselling; peer education; referral system for health
care, including HIV testing and counselling, as well as health services –VCT services provided within
NGOS, management of sexually transmitted infections. Around 500 new beneficiaries are planned to be
reached with prevention services in the first year and a half of the second phase in the above mentioned
territories, which is equal to almost 50% of the target established to be fulfilled by the National
Programme to 2015 (60%).
Activity 3. Provide prevention services to MSM
The project will support continuation of service provision to MSMs in the Chisinau and Balti
municipalities through one project run by an NGO. Service provision includes outreach work in cruising
areas and discos, provision of IEC, condoms and lubricants, counseling services and peer support.
Condoms with increased resistance and lubricant will be procured and distributed by outreach workers.
About 850 new beneficiaries are planned to be reached with prevention services in the first year and a
half of the second phase (years 3 and 4) in the above mentioned territories, which is equal to almost
32% of the target established to be fulfilled by the National Programme to 2015 (45%).
Size estimations of all described populations: IDUs, CSWs and MSMs to be covered are based on the
latest size estimations conducted in the country and the targets established in the National HIV/AIDS
Programme 2011-2015 (to 2015).
Activity 4. Ensure proper coordination between NGOs and state institutions on providing HR services
The activity relates to the effort of the SR to administrate the activities under objective 1 through
contributing to improved coordination between NGOs, as well as state and NGOS. It comprises mostly
the administration and overheads costs of the SR, well costs described in the budget.
Objective 2. To ensure access of HIV/AIDS patients to treatment, monitoring and PMTCT services
The project aims to continue the effort to ensure the universal access to treatment of patients in need,
including prophylaxis treatment to HIV pregnant women. All treatment services, financed through the
Global Fund grants came to end in December 2012 (SSF, part of round 6). Thus, in the renewals phase,
to continue to cover the costs of these services of the total of Euro 1,835,093 (year 3 and half of year 4)
are coming from the other part of savings obtained by PI “CIMU HSRP” during the SSF first phase of
implementation, the resources obtained from the reallocation of funds between the PRs through the reprogramming exercise.
No
Activity number and title
Service delivery area
1
Ensure access to ARV treatment and its monitoring
TREATMENT: Antiretroviral treatment of
(ARV) and monitoring
2
Ensure access to PMTCT services
Prevention
of
Transmission
3
Ensure the maintenance of the M&E SIME system
Informational
research
Implementing entity:
Mother
system and
to
Child
operational
PR-1 (PI “CIMU HSRP”)
Activity 1. Ensure access to ARV treatment and its monitoring
It is expected to cover in the second phase 2965 patients (expansion with 600 new patients) in 2013,
maintaining the number in the following half year of 2014. The treatment regimens and schemes are in
concordance with the National Guidelines on treatment and care in HIV/AIDS based on WHO protocols.
The number of HIV patients to be enrolled in ARV treatment (first- or second-line drugs) was defined
on the basis of forecasts presented in Excel file in Annex 16, sheet “TotalART”). The project will also
support the needs related to treatment monitoring: determining of viral load for patients, PCR and
testing of CD4 in patients for all those enrolled. It has to be underlined that the Technical Working
Group on treatment and care recommended including in the proposal the monitoring of diagnosed HIV
patients in pre-treatment phase (monitoring the viral load and CD4 in HIV persons – about 2000 persons
in 2013). PI “CIMU HSRP” will cover the costs of storage and distribution in the country and external
quality assurance of drugs (by KABS Canada).
The Government’s co-financing covers other substantial costs of staff, facility costs, opportunistic
infections diagnosis and treatment, STI diagnosis and treatment.
Activity 2. Ensure access to PMTCT services
Access to PMTCT services will be supported through SDA 2 Prevention PMTCT. Overall, the strategy calls
for scale up HIV testing by making it free of charge for pregnant women and also offering a rapid HIV
test to pregnant women before delivery in case when she has not been registered with a health facility.
This will offer an opportunity to reduce the risk of transmission from mother to child by offering both
short courses ARV.
To support the achievement of the overall objective the SDA 2 will employ the following activities:
-
offering a free of charge test for HIV to pregnant women during pregnancy (about 40,000
women per year tested twice)
offering a free of charge rapid test for HIV pregnant women not monitored by health system
during pregnancy
provision of short course ARV treatment during pregnancy, delivery and postpartum,
HIV and infant feeding support
All the estimations and costs and are provided in Excel file in Annex 16, sheets “Milk”, “Pregnant”,
“Children”
Activity 3. Ensure the maintenance of the M&E SIME system
As the M&E SIME HIV soft is being adjusted and a new module on ARV drug management is being
developed, tested and integrated into the general one in 2012, as well as the codification system of
CSWs and MSMs is planned to be developed and made functional during 2012, there is the need to
sustain the M&E unit covering several costs: the soft maintenance and the following specialists: an IT
and M&E ones. It is important to maintain the system functional, to respond to all the technical and soft
needs at the central and peripheral levels to which the soft extends. The M&E specialist is part of the
recording, reporting, validating and ensuring quality of the data for the PR 1. Actually there are sufficient
resources to cover these needs for year 3 – 2013, starting 2014 the costs are planned to be overtaken by
the state.
Objective 3. To develop capacity and ensure sustainability
This objective targets the health and social systems and its activities contribute to improving quality and
access of public clinical and non-medical services for PLHIV and their adaptation to a client-centered
model of service delivery and adjustments to the needs of most vulnerable populations. Activities under
this objective include capacity building, as well as developing new models of service delivery within
public services, with the aim to develop sustainable and equitable mechanisms that will exist beyond
project life and be as integrated as possible in the current service delivery infrastructure, as well as
piloting new state-of the-art models of capacity building, such as e-learning for health professionals.
No
Activity number and title
Service delivery area
1
Improving previously achieved performances
Health system strengthening
2
Institutionalizing capacity building of service providers
in HIV/AIDS through e-learning
Health system strengthening
3
Monitoring and supervision of social assistance for
PLHIV
Implementing entity:
Health system strengthening
PR-2 (PAS Center)
Activity 1. Improving previously achieved performances
In order to ensure higher accessibility for PLHA to clinical and non-medical services, in period 1 the grant
focused on decentralizing HIV clinical care, introducing a multi-sectoral approach and 18
multidisciplinary teams (MDT) at district level and establishing a National Reference Social System. As a
result, there are currently four regional ART teams in the Northern, Eastern and Southern regions of the
country and MDT in each of the 35 districts that have been formed, trained and are now operational.
The newly established regional ART teams and medical multidisciplinary teams around them need
further strengthening to provide a multispectral approach and case-management and to ensure clientcentered care models to the final beneficiaries, as well as to serve as referrals for the professionals from
district level. In this respect, there is a need to continue training of health specialists and from selected
MDT.
In order to maintain and improve the clinical competency to manage HIV care, four regional ART and
multidisciplinary teams will attend two five-day training courses on advanced HIV clinical care and
support services per year during years 2013 and 2014 at WHO Regional Knowledge Hub Center in Kiev,
Ukraine.
The MDTs have been established at rayon (district) levels comprising local authorities and civil society
actors with relevant specializations and is coordinated by a social assistance and are part of the National
Referral System (NRS), operational under the Ministry of Labor, Social Protection and Family (MSPFC).
MSPFC has expanded the Multidisciplinary Care teams to each region and municipality. The NRS is an
integrated system that provides comprehensive assistance for PLHIV and other vulnerable persons
through referrals to local authorities and civil society service providers. The MDT is the first point of
contact for an HIV-infected person seeking social protection services, thus the quality of services the
patient will receive depends on the level on training and knowledge of the MDT professionals. In order
to insure standard quality of services and compensate for turnover, new MDT members will attend one
local three-day training course per year years 2013 and 2014 on referral system, non-discrimination and
confidentiality.
Additionally, one local expert will provide technical assistance to improve multidisciplinary approach and
ensure interaction between the sectors involved in PLWH case management from national and local
institutions, public and civil society organizations and regional community centers.
To strengthen participation, communication and enhance case management and referrals of local
infectious disease specialists in the newly established NRS and MDT approach, training of infectious
diseases specialists will equip them with knowledge and skills to provide quality care and referrals to
PLHIV and to act as medical coordinators for MDTs at district level. To ensure adequate coverage, three
local training courses per year for 25 participants each during years 2013 and 2014 are planned.
The capacity of social assistants in working with the vulnerable groups to HIV needs continuous
improving for more comprehensive and better quality rights-based assistance. This objective will be
achieved through trainings designed specifically for social assistants. To achieve this, 75 social assistants
will be selected and trained in year 2013 (3 training courses during year 2013, at local level).
Activity 2. Institutionalizing capacity building of service providers in HIV/AIDS through e-learning
In period 1, the distance learning curriculum for HIV care and treatment has been developed and
mainstreamed into the regular curriculum of the School of Public Health. In period 2 the existing
curriculum will be periodically updated and a team of national consultants will periodically update the
curriculum based on latest WHO policies and protocols. The School of Public Health lecturers will serve
as tutors for the series of training courses based on e-learning technology. The training courses were
set-up in period one and will be continued in period two.
The e-learning program team at the School of Public Health comprises three persons: one coordinator,
one IT specialist and the accountant. The project will provide operational the e-learning program server,
to print certificates for trainees as well as will support the e-learning program office expenses.
Activity 3. Monitoring and supervision of social assistance for PLHIV
To maintain quality of non-medical services through supervision and program monitoring, the period 1
grant has developed additional modules and applications to the software for electronic reporting of
services provided based on the unique identifier to track the services provided by various stakeholders NGOs, government institutions, etc., to PLHA, which is currently in use by the Ministry of Labor, Social
Protection and Family. The grant currently provides training to social assistants on using these new
modules. For period 2, it is planned to conduct additional training courses for social assistants, once per
year for two days and covering 12 participants, to adjust to turnover of social service providers.
In order to continue implementation of the supervision mechanism in period 1 to monitor activities,
compliance with guidelines and minimum quality standard, and feed-back, the MLSPF unit will conduct
regular supervision visits to four social centers for PLHIV and MDT teams in rayons, so that each site is
visited at least once per month. Therefore, the project will support 8 visits per quarter during years 2013
and 2014.
Objective 4. To support PLHIV, PWID and ensure institutionalization
Under this Objective, the project supports activities for intensive patient support and follow-up as a
fundamental component for ensuring adherence to HIV and OST treatments. This program provides a
comprehensive set of measures including incentives and enablers, psychosocial support to both adult
patients and children infected and affected by HIV and patients in OST treatment. In addition to
institutionalization of non-medical service provision to PLHIV in the public social sector, as described
under Objective 3, the grant has provided support of wraparound services through a network of 10
NGOs. They currently provide peer-to-peer services, enhanced psycho-social support, counselling,
referrals, case-management and living support. Recently, in collaboration with the local public
authorities, four regional social centers (RSC) have been established in the same areas where ART has
been decentralized and act as referral for each of the 4 regions (North, Center, South and East). In
addition to this function, they offer support to children affected and infected with HIV. NGOs provide
additional support and implement community outreach activities around the four RSCs.
No
Activity number and title
Service delivery area
1
Increasing quality of life and improving ART adherence
Care and support of chronically ill
2
Psycho-social support to PWID and adherence to OST
Care and support of chronically ill
3
Supporting children infected and affected by HIV/AIDS
Care and support of chronically ill
4
Strengthening Regional Social Centres for PLHIV
Care and support of chronically ill
Implementing entity:
PR-2 (PAS Center)
Activity 1. Increasing quality of life and improving ART adherence
In period 1 the project established a food support program to the most vulnerable PLHIV in ART
treatment, based on a standardized assessment of socio-economic vulnerability, in both civilian and
penitentiary sectors, in order to improve quality of life of the most vulnerable patients. According to the
current estimations, each quarter 40-50% of patients on ART are assessed as eligible for food support
based on vulnerability index. The food support program will be continued in years 2013-2014, and it is
estimated that up to 800 patients on ART treatment will be eligible each quarter for food support aiming
at increasing adherence to treatment.
As identified by the PLHIV needs assessment, one of the main deterrents of accessing and care retention
is that PLHIV continue to experience stigma and discrimination when contacting public services. Peer
support and community-based self-support programs have proven successful in providing enhanced
wraparound services to PLHIV, while other project activities work on improving quality of public services
and non-discriminatory attitudes. The project will continue to provide support to NGOs and communitybased organizations to outreach to PLHIV and their families with a comprehensive support package,
including psycho-social support, mentoring, case-management and referrals. A total 10 grants per year
will be awarded annually during years 2013 and 2014.
Additionally, to complement and improve quality of services provided by the four regional social support
centers managed by the Ministry of Labour and Social Protection, each of the four regional centers will
continue to benefit from support of two grants, with the exception of the Southern RSC, where
catchment area and number of clients is smaller compared to the other three centers and will receive
only one grant. Thus, the project will provide 7 grants per year to non-governmental organizations
during 2013 and 2014.
Whereas period 1 focused on establishing new services and models of service delivery for PLWH, period
2 will work on standardizing and improving quality of the newly established services. With this purpose,
in 2013 a team of external and national experts will provide technical assistance in developing necessary
tools for quality audit of services provided to PLHIV, as well as provide recommendations for improving
supervision mechanism. Also, this team will work on improving collaboration and establishing
mechanisms of interaction and coordination between the health sector, social sector and NGO and
community-based sector.
Informational support aiming at promoting ART adherence and retention in contact with clinical and
non-clinical services will be developed, printed and distributed by NGOs among beneficiaries, with a
volume of 15,000 copies to be produced annually.
Activity 2. Psycho-social support to PWID and adherence to OST
During period 1 the project established support to five sites working with enrolling and maintaining
PWID in OST treatment. These sites are located in Chisinau, Balti, Cahul, Tiraspol and one mobile unit for
penitentiary system. This support aims to ensure outreach to PWID and family members to improve
enrolment for OST and adherence to treatment through self-support and psycho-social activities. The
new model has proved successful in achieving its targets of patient retention in OST treatment. The
program will continue to provide support to 5 community-based OST support sites in period 2.
In order to improve adherence to OST treatment, the most vulnerable people who inject drugs will
receive incentives (food parcels) in both civilian and penitentiary sectors. Based on current estimates, on
average 40-50% of the currently enrolled patients need incentives each quarter. In the framework of
this activity, up to 140 people will receive food support on a quarterly basis.
Informational support aiming at promoting OST adherence and retention for people who inject drugs
will be developed, printed and distributed by sub-recipients among beneficiaries. A total 10,000 copies
will be produced annually. Additionally, with the aim to develop a professional network or information
sharing of community-based OST supporters, a local expert will provide technical assistance in collecting
information and developing, publishing and disseminating informational bulletins each semester and
maintaining and developing content for a web site.
In order to continue advocacy activities for increasing tolerance and access of PWID to services, a series
of advocacy events dedicated to the International Day against drug abuse and illicit trafficking and to
World AIDS Day will be organized in years 2013-2014, twice per year at local level.
Activity 3. Supporting children infected and affected by HIV/AIDS
A total 97 children are currently living with HIV and annually up to 130 children are born to HIV-positive
mothers. In period 1, the project offered food support each quarter to all children living with HIV all and
to 90% of children born to HIV-positive mothers until their HIV diagnosis was excluded. Twice per year
school-age HIV-positive children receive clothing and school supplies support and are invited to summer
camps with their parents.
The project will procure and distribute food parcels to an estimated number of 272 children per year,
including those living with HIV and those with unknown status born from HIV infected mothers. In
addition, children living with HIV of school age will receive support with stationery and clothing HIV
infected children at school age. The estimated number is 90 children for 2013 and 95 children for 2014.
The project will organize and provide support to summer camps for children infected and affected by
HIV/AIDS including learning activities with their parents, with an estimated number of 125 persons per
summer.
In addition, for those children coming from vulnerable families without parental care and to sustain the
de-institutionalization of abandoned children, the project will provide support capacity building of foster
parents and staff of the family type houses that are involved in the Ministry of Labor, Social Protection
and Family program. (one training course per year, 25 participants, 2 days at local level).
Activity 4. Strengthening Regional Social Centres for PLHIV
During period 1, four regional social centers have been established in partnership with Ministry of Labor,
Social Protection and Family. The establishment of these services included developing the concept,
selection, allocation and refurbishment of these centers, developing regulatory framework and quality
standards. They are currently stand-alone legal entities with mixed subordination to local public
authorities and Ministry of Labor, Social Protection and Family. In parallel, development of internal
regulations, development of job descriptions and staffing norms and costing exercises are in process, so
that after project life they are taken over by public funding through the Ministry of Finance. Currently,
multidisciplinary teams are recruited.
In parallel with the annual exercise of costing and public budgeting, establishing minimum quality
standards and gradual takeover of financing, in period 2 the project will focus on providing full
functionality of these centers. The project will cover the staff costs of the multidisciplinary teams,
comprising a manager, social worker, medical worker, peer-to-peer counsellor and admin staff
(accountant, driver and janitor), operational costs, and minimal hospitality coverage, to make these
services more client-friendly. Newly recruited staff of the regional centers will receive professional
training on case management and provision of medical, social and psychosocial services. It is envisaged
to conduct two local training courses per year during years 2013 and 2014. To enforce quality standards,
technical assistance, one local expert will provide to ensure proper supervision and support to Regional
Social Centers.
Objective 5. To ensure engagement of civil society and key affected population and promote human
rights
This objective comprises all the activities related to ensuring human rights approach in service provision,
as well as enforcement of non-discriminatory mechanisms through national legislation, legal support
and litigation and community involvement in promoting human rights of PLWH and key affected
populations. An important achievement of period one was documentation and litigations of several
cases that lead to legislative modifications applied to HIV Law in 2010 and wining a case at European
Court of Human Rights.
No
Activity number and title
Service delivery area
1
Assessing the situation on human rights and HIV
Stigma reduction in all settings
2
Providing legal support and litigation
Stigma reduction in all settings
3
Ensuring engagement of civil society and key affected
population
Stigma reduction in all settings
Implementing entity:
PR-2 (PAS Center)
Activity 1. Assessing the situation on human rights and HIV
The first assessment of the human rights violations in Moldova was conducted in 2010-2011 and
presented to the large audience at WAD-dedicated event in 2011. It documented a series of violations in
all spheres of public service provision and has sensitised the involved stakeholders to the types of most
common violations. In period 2 of the project, a team of external and national experts will provide
technical assistance to conduct assessment of human rights violation for PLHIV including service
provision, in order to monitor progress from the previous report. The preliminary report of the
assessment of human right violations will be discussed with the local and international stakeholders
during the consensus building meeting and will contribute to societal sensitisation to human-right based
approaches in public service provision.
Activity 2. Providing legal support and litigation
An additional service to be provided by the newly established regional social centers includes legal
assistance for PLHIV through specialised professionals. As there is little experience in the country on
documenting human rights violations specific to HIV service provision, there is a need to build this
experience among lawyers and develop collaboration networks between social centers and legal
networks. Very limited legal aid services are provided by a handful of NGO, hence being dependant on
the existence of a source of funding, and by few legal clinics that function under the auspices of law
schools, hence capacity being very limited. In order to provide regional access to legal services, three
lawyers will ensure continued support to PLHIV remotely and through regular visits to the RSCs,
including Transnistrian region. The project will continue to provide operational support to the Institute
for Human Rights (IDOM) to ensure continued legal support to PLHIV. A litigation coordinator will ensure
selection, documentation and promotion of strategic litigation cases related to violation of human rights
of PLHIV, that will create legal and judiciary precedents for typical situations i.e. breach in confidentiality
in medical and social settings, refusal to provide services, or refusals to enrol children affected by HIV in
kindergartens and schools. In addition, a team of local experts will provide technical assistance and
expertise in documenting and preparing supporting documents and instrumenting selected litigation
cases for international courts, such as European Court for Human Rights.
In parallel, to ensure a basic legal awareness among community-based service providers, training
courses will be provided to non-governmental organizations and initiative groups who are responsible
for service provision to PLHIV on human rights, non-discrimination and mechanisms to act in case of
human rights violations once per year during 2013 and 2014. These will have the aim to develop some
basic skills in counselling peers in identification and referral of cases of human rights violations, as well
as skills to act as extra-judicial advocates.
In order to educate general audiences in the importance human-rights based service provision and build
tolerance, two media-based communication campaigns per year will be organized on the eve of notable
days (WAD, Candlelight) that will include partnering with local TV channels in developing a series of TV
shows. These events will showcase situations of discrimination and rights violations, broadcasting of TV
spots, and will foster public debates and education of non-discriminatory attitudes towards vulnerable
groups.
Activity 3. Ensuring engagement of civil society and key affected population
Activities under this SDA would enable and foster communities effectively advocate for implementation
and improvement of activities aimed at improving quality of life and human rights approaches to key
affected populations. These activities cover capacity building mechanisms aimed at increasing
professional networking and advocacy and lobby skills of community-based organizations.
In order to achieve this, in period 2 the project will provide support to personal training activities
attendance of international meetings and conferences civil society representatives in priority issues of
HIV/AIDS control, at an estimated rate of six persons per year during 2013 and 2014.
One main national advocacy and networking event is the national HIV conference, and the project will
support organizing the HIV national conference. This yearly event brings together for two days PLHIV,
representatives of most-at-risk populations, community activists, HIV/AIDS specialists and other local
and international stakeholders. The project will also support local lobby and advocacy workshops and
round tables at both central and local (rayon) level, aiming to increase commitment of local public
authorities and improving coordination between LPAs, health and social services, civil society and other
relevant actors for HIV control, with a plan to organize 10 events per year during 2013 and 2014.
In order to increase the communication component of community systems strengthening several
activities will be employed: (i) printing and distribution of a traditional civil society engagement bulletin;
(ii) development and broadcasting of TV and radio spots, on local and national stations during 4 months
per year (on the eve of notable days (WAD, Candlelight); (iii) local technical assistance to support civil
society and relevant partners active engagement in advocacy and awareness campaigns, obtaining
relevant endorsements with authorities, facilitate and monitor implementation.
In addition, the project will provide continuous operational support to a team of five civil society
representatives to ensure engagement of civil society and key affected populations in HIV response. In
addition, two training courses per year will be provided to civil society organizations who are involved in
service provision to PLHIV on advocacy, communication and social mobilization in 2013 and 2014.
INDICATORS AND TARGETS
The Performance Framework includes the following indicators.
Impact Indicators:
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“Percentage of infants born to HIV infected mothers who are HIV infected”. The indicator is
included in the revised National HIV/AIDS/STI Prophylaxis and Control Programme 2011 – 2015
(Annex 20). The targets for this indicator are in line with this document.

Percentage of adults and children with HIV known to be on treatment 12 months after
initiation of antiretroviral therapy. The source for the targets relates to the draft M&E Plan of
the National HIV/AIDS Program (NHAP) 2011 -2015. The targets have been calculated
considering targets established in the NHAP for 2015 and taking into account the intervention
periods planned to be covered financially under period 2.
Outcome Indicators:
TBD
Output / coverage indicators are presented as per Program Objectives:
OBJECTIVE 1: To prevent HIV transmission among key populations: IDU, CSW, MSM
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Number and % of injecting drug users (IDUs) reached with prevention programs. Targets
include baseline. In the next few years this activity shall be mainly supported by the current GF
grant. Targets for this indicator have been calculated based on: (1) the latest estimated
populations, (2) draft National HIV/AIDS Program (NHAP) 2011 -2015 and taking into account (3)
the intervention periods planned to be covered financially under phase II.
Number of drug users reached with drug substitution therapy. Targets include baseline. In the
next few years this activity shall be mainly supported by the current GF grant.
Number and % of commercial sex workers (CSWs) reached with outreach programes Targets
include baseline. In the next few years this activity shall be mainly supported by the current GF
grant. Targets for this indicator have been calculated based on: (1) the latest estimated
populations in the main intervention areas – Chisinau and Balti municipalities, (2) draft National
HIV/AIDS Program (NHAP) 2011 -2015 and taking into account (3) the intervention periods
planned to be covered financially under phase II.
Number and % of lesbian, gay, bi-sexual and trans-sexual (LGBT) reached with outreach
programes Targets include baseline. In the next few years this activity shall be mainly supported
by the current GF grant. Targets for this indicator have been calculated based on: (1) the latest
estimated populations in the main intervention areas – Chisinau and Balti municipalities, (2)
draft National HIV/AIDS Program (NHAP) 2011 -2015 and taking into account (3) the
intervention periods planned to be covered financially under phase II.
Objective 2. To enhance and foster universal access of HIV/AIDS patients to treatment, surveillance
and PMTCT services

“Number of people with advanced HIV infection that has started antiretrovirat combination
treatment”. Targets include baseline. The indicator is not part of the revised M&E Plan of the
NHP 2011 -2015 and reflects grant activities.

% of HIV-positive pregnant women who received ARV treatment to reduce the risk of motherto-child transmission. The indicator is part of Draft of M&E Plan of the National HIV/AIDS
Program (NHAP) 2011 -2015. The targets have been calculated considering targets established in
the NHAP for 2015 and taking into account the intervention periods planned to be covered
financially under phase II
The majority of the indicators were aligned to the ones of the National HIV Control and
Prophylaxis 2011-2105.
Objective 3. To develop capacity and ensure sustainability

Number of medical (doctors and nurses) and non-medical staff (psychologists, social
assistants, peer consultants) trained in HIV/AIDS. This is a composite non-cumulative indicator
related to activities: 3.1.1., 3.1.2., 3.1.4. & 3.1.5.
Objective 4. To support PLHIV, PWID and ensure institutionalization
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Number of PLHIV receiving food parcels to improve ARV treatment adherence. Targets for this
indicator have been calculated based on estimated quarterly increase by 10% in the number of
new beneficiaries. This is an annual indicator related to activity 4.1.1.
Number of people living with HIV/AIDS reached with care and support services. The
beneficiaries are provided with the following services: psycho-social counseling and support,
medical counseling and referral, distribution of information materials and peer counseling. The
beneficiary is considered "reached" if he/she has received at least one of the listed services.
Target includes baseline. This is a cumulative over program term indicator related to activities
4.1.2 and 4.1.3.
Number of children infected and affected by HIV/AIDS who receive social support. “Social
support” includes food parcels and clothing and school supplies for HIV infected children and
food support for children born from HIV positive mothers with unknown status. Targets for this
indicator have been calculated based on estimated an estimated quarterly increase by 10% in
the number of newborns to HIV-infected mothers. It is a composite annual indicator related to
activities: 4.3.1 and 4.3.2.
Number of IDUs on opioid substitution therapy that receive at least 3 support services from
NGOs working in DUs rehabilitation. The beneficiary is considered "reached" if s/he has
received at least three services from listed (psycho-social support, self-support groups, peer to
peer education, distribution of information materials, food support etc.). Target includes
baseline. It is cumulative over program term indicator related to activities 4.2.1. & 4.2.2.
Number and percentage of individuals currently on OST who have been on OST continuously
at least 6 months for the past 12 months. The numerator includes the number of individuals
completing at least 6 months of continuous treatment on OST that initiated treatment 6-12
months prior to the end of the reporting period and the denominator is the total number of
individuals that initiated treatment 6-12 months prior to the end of reporting period. The target
refers to the patient cohorts (both new and repeated cases) that initiated treatment in the first
6 months of the last 12 months period. This a not cumulative indicator related to activities 1.41.5 under Objective 1 and activities 4.2.1 and 4.2.2 under Objective 4.
Number of human rights strategic litigation cases for PLWH initiated. Indicator refers to cases
of PLHIV rights violation initiated for strategic litigation in order to change the existing practices.
This a not cumulative indicator related to activities 5.2.2 - 5.2.4.
Number of PLWH assisted by legal aid (consultancies offered by legal network). Indicator
refers to cases of PLHIV rights violation initiated for strategic litigation in order to change the
existing practices. This a not cumulative indicator related to activities 5.2.1 and 5.2.4.
Number of members of the civil society trained in service provision to PLHIV. Indicator refers
to training of members of the civil society in services provision to PLHIV. This a not cumulative
indicator related to activity 5.3.9.