Provincial AIDS Strategies
Mid-Term Review of the Response:
Khyber
Paktunkhwa.
Sindh,
Balochistan and Punjab
PAKISTAN
February 2015
Drafted by Bettina T. Schunter, Lead Consultant for the Mid-Term Review of
Provincial AIDS Strategies, Development of Pakistan AIDS Strategy III and the Global
Fund Concept Note processes and Dr. Syed Amer Raza, National Consultant, with
inputs from Karabi Baruah, Gender Consultant and Vu Ngoc Uyen, Costing
Consultant. Islamabad, Pakistan January 2015.
2
Outline
Acronyms
5
Executive Summary
7
I.
Introduction and Rationale of the Review
9
I.1. Objective of the Mid-Term Review of the Provincial AIDS Strategies 11
II.
III.
MTR Process
11
II.1. Supervision & Technical Oversight
11
II.2. Methodology
12
II.3. Constraints
13
Goal and Guiding Principles
15
IV.
III.1. Goals
16
III.2. Guiding Principles
16
Context Analysis
17
IV.1. Situation Analysis
17
IV.2. Response Analysis
18
IV.3. Implications and key directions for the next five years
18
V.
VI.
VII.
IV.4. Gender Analysis
19
KeyFindings, Gaps and Recommendations
20
V.1. Key Findings
20
V.2. Key Gaps
23
V.3. Key Recommendations
23
SpecificRecommendations by Province
26
VI.1. Results Framework
26
VI.2 Monitoring Framework Indicators
51
Implementation Arrangement
63
VII.4. Financial management
63
VII.3. Capacity building and technical assistance
63
VII.2. Contracting and Public-Private partnership
63
VII.1. Governance and Coordination of the response
63
VIII.
Monitoring, Evaluation & Research
64
3
IX.
VIII.1. Monitoring
64
VIII.2. Evaluation
65
VIII.3. Research
65
Resource needs
65
Annexes
Annex I.
Key Findings and Gaps by Province
Annex II.
Proposed Terminology Section
66
95
Annex III.
Interview Tools
98
Annex IV.
Schedule and participants of Key Informant Interviews,
Focus Group Discussions and Provincial Dialogues
103
4
Acronyms
ACP
AIDS Control Programmes
AIDS
Acquired Immune Deficiency Syndrome
APLHIV
Association of People Living with HIV
ART
Antiretroviral Therapy
ARV/s
Antiretroviral/s (medication)
CBO
Community-Based Organization
CCM
Country Coordination Mechanism
CHBC
Community and Home-Based Care
CoPC
Continuum of Prevention and Care
CSO
Civil Society Organization
FATA
Federally Administered Tribal Areas
FSW
Female Sex Worker
GF
Global Fund
GFATM
Global Fund to Fight AIDS, Tuberculosis and Malaria
GoP
Government of Pakistan
HIV
Human Immunodeficiency Virus
HSW
Hijra Sex Worker
IDP
Internally Displaced Person
IDU
Injecting Drug User
KP
Key Population
KPK
Khyber Pakhtunkhwa
M&E
Monitoring and Evaluation
MoE
Ministry of Education
MoH
Ministry of Health
MoIPC
Ministry of Inter-Provincial Coordination
MoLJ
Ministry of Law, Justice and Human Rights
MSM
Men who have Sex with Men
MSW
Male Sex Worker
MTCT
Mother to child Transmission
MTR
Mid-Term Review
NACP
National AIDS Control Program
NCPI
National Commitment and Policy Instruments
NCSW
National Commission on the status of Women
NEP
Needle Exchange Program
NMHA
Naz Male Health Alliance
NPM
National Program Manager
NSEP
Needle Syringe Exchange Program
NSF
National Strategic Framework
NTP
National Tuberculosis Program
5
NZ
Nai Zindagi
OST
Opiate Substitution Therapy
P&D
Planning and Development
PACP/s
Provincial AIDS Control Programme/s
PAS
Pakistan AIDS Strategy
PC
Planning Commission
PC-1
Planning Commission Proforma – one (Project Document)
PLHIV
People living with HIV
PPM
Provincial Program Manager
PPTCT
Prevention of Parent-to-Child Transmission
PR
Principal Recipient/s - GFATM
PWID
People who Inject Drugs
SDP
Service Delivery Package
SR
Sub-Recipients - GFATM
SRA
Situation Response Analysis
SRH
Sexual and Reproductive Health
SWD
Social Welfare Department
TWG
Technical Working Group
UN
United Nations
UNAIDS
United Nations Joint Program on HIV/AIDS
UNDP
United Nations Development Programme
UNICEF
United Nations Children’s Fund
UNODC
United Nations Office on Drugs and Crime
WHO
World Health Organization
6
Executive Summary
Pakistan is experiencing a concentrated HIV epidemic, driven mainly by unsafe
injection drug use among people who inject drugs (PWID). However, data from
Integrated Biological and Behavioural Surveillance (IBBS) rounds and otherstudies
show incidence and prevalence rising in males who have sex with males (MSM, male
sex workers) and hijra (including hijra sex workers). AIDS Epidemic Modelling (AEM)
for Punjab and Sindh indicate the epidemic in people who inject drugs (PWID)
stabilising around 2016 or 2017 and HIV incidence amongMSM and hijra climbing
significantly. The urgency to meet specific HIV response needs in the country led to
the formulation of first official provincial AIDS strategies in 2012, tailored to their
specific context with budgets and monitoring frameworks. Given that the epidemic
is concentratedamong key populations in every province, individual provincial AIDS
strategies share the same 3 goals/outcomes and almost the same 10 outputs.
The objective of the mid-term review of the Provincial AIDS Strategies was to
examine current provincial HIV programme implementation status against the
existing articulated AIDS strategies and targets set for Khyber Pakhtunkhwa, Sindh,
Baluchistan and Punjab, and to provide recommendations for strengthening the
individual Strategies. The review was undertaken through literature review, focus
group discussions, key informant interviews and provincial dialogues in all the four
provinces from 19th November to 12th December 2014.
The Mid-Term Review (MTR)process indicated that most of the findings, gaps and
recommendations were the same in every province. A major finding was the nonavailability of PC-1 funds in provinces other than Punjab significantly hampered the
implementation of the Provincial Strategies. Moreover the PC-1s were not
completely aligned with provincial strategies, especially budget forecast (Strategy)
and allocation (PC-1), in particular in terms of advocacy, multi-sectoral
coordination,
generation/utilization
of
strategic
evidence
and
resource
mobilization efforts (Outcome III in the Strategies). In addition, interventions
supported by the Global Fund to Fight AIDS, Malaria and TB taking place across
provinces
and
on-going
Government-supported
programming
and
other
implementers supported programmeswerenot aligned in their efforts to achieve
provincial, national and global targets. This is evidenced from lack of information
7
sharing, incoherent MIS systems, lack of data aggregation, and weak coordination
and referral system.
The gaps being reported are services that were not mentioned in the Strategies.
Significant gaps included the lack of a specific output for provision of care and
support services; a clear output strategy for harm reduction services for PWID
inclusive of detoxification and rehabilitation services. Specific linkages to the
hepatitis programme across prevention and care and support Outcomes were also
lacking, as was specific services for spouses of HIV positive male key populations,
not only spouses of PWID, but also spouses of HIV positive MSM and hijra. Lastly, a
significant gap in services provision is a Quality Assurance (QA) mechanism for HIV
diagnostics and treatment services (including pharmaco-vigilance), resulting in a
lack of focus on standardization of HIV commodities such as testing kits.
Throughout the MTR process, several recommendations were raised, either to
strengthen existing interventions or propose new ones, based primarily on issues
of/or gaps in the existing strategies. Recommendations have been consolidated and
streamlined
across
all
provinces.
Significant
recommendations
include
detoxification services for PWID irrespective of their CD4 count and rehabilitative
adherence-centred support; voluntary and confidential HIV Testing and Counselling
(HTC) sites in public sector in all districts in every province and a specific site in
each Division providing safe delivery services for HIV positive women, paediatric
AIDS care and provision of antiretroviral therapy (ART). It was also recommended
that service delivery packages (SDPs) providing services to key populations
(including HTC) should also provide care and support services to their own HIV
positive clients. Lastly, a coherent MIS system in each province capable of
consolidating all HIV related service data for triangulated analysis and provincial,
national and global reporting was strongly recommended in all provinces.
As the MTR process will lead to a consolidation of Provincial AIDS Strategies into a
Pakistan AIDS Strategy III through 2020, an effort was made to consolidate the
Outputs and Output Strategies in the Results Framework and to suggest targets in
the Monitoring Framework in line with global targets for 2020. The MTR process of
the Provincial AIDS Strategies and subsequent revision recommendations are the
backbone of the development of the PAS III and the subsequent Global Fund New
Funding Model Concept Note to be submitted April 2015.
8
9
I.
Introduction and Rationale of the Review
The HIV epidemic in Pakistan has progressed silently since 1987 with 7,732 PLHIV
registered against an estimated total of 68,000 people living with HIV.1 Pakistan is
currently experiencing a concentrated HIV epidemic, driven mainly by people who
inject drug (PWID). However, data from all IBBS rounds and other studies clearly
indicate a rapid spill over to other key at-risk populations especially hijra sex
workers (HSWs) making sexual transmission of HIV as the second major route of
country’s expanding epidemic. 2 The epidemic has become entrenched and with
geographical expansion and potential for ‘bridging’ through sexual risks to
vulnerable segments of the population – such as spouses of PWIDand other sexual
partners, as well as among those with multiple sexual partners in various contexts,
prisoners, returning migrants and their families, and at-risk adolescents such as
street-associated adolescents. HIV prevalence is still reported to be lowat < .01, in
the general population.
The Government of Pakistan (GoP) has maintained a sustained response to the HIV
epidemic since 1987 through a close collaboration between the National AIDS
Control Programme (NACP), Provincial and AJK AIDS Control Programmes, UN
agencies, bilateral and multilateral donors, and a consortium of NGOs and CSOs,
including PLHIV representative organizations, operating at national, provincial and
grass-root levels. Since 2005 under the Enhanced AIDS Control Programme (EHACP)
Pakistan has been following an investment approach, programming strategically
according to its concentrated epidemic. Services to people living with HIV (PLHIV)
and key populations (KPs) are supported through 2 primary mechanisms: the Global
Fund and through public-private partnerships between Government and NGOs and
CSOs.3
The 2nd National Strategic Framework completed its five-year timeframe in
December 2011. Under Devolution, a process begun in 2011, the Ministry of Health
was devolved to the provinces and the National AIDS Control Programme placed
initially under the newly established Ministry of Inter-Provincial Coordination and
eventually moved under the Ministry of National Health Services Regulation and
1
Prepared by www.aidsdatahub.orgbased on UNAIDS. (2014). UNAIDS HIV Estimates 1990 - 2013 and
www.aidsinfoonline.org
2 Midterm Review Pakistan: Closing the Gap-2011 UN General Assembly Political Declaration.
3The Pakistan Country Report: Global AIDS Response Progress Report 2013.
10
Coordination, established in 2013. The abrupt post devolution transition process
impeded/delayed the development of a third national strategy (framework) on HIV
and AIDS. The delay was further compounded by the national elections in 2013
resulting in a change of government at the national level and at provincial level in
KP and Balochistan. While provinces have always had autonomous prevention
programmes, Devolution has provided the Provincial AIDS Control Programmes
more autonomy, especially in terms of procurement and in the implementation of
their respective public sector treatment programmes. At a national level, however,
devolution resulted in the National AIDS Programme’s responsibilities significantly
diminished.4Although technically NACP retained some of its mandate, devolution
left a vacuum in terms of guideline and protocol development, national
surveillance, and a coherent vision of the national response, a vacuum that UNAIDS
has tried to fill as well as the CCM5, and now the Technical Working Group on HIV
of the CCM officially launched October 2014.
In the post devolution scenario, with diminished NACP responsibilities, provinces
developed their own Provincial AIDS Strategies outlining modalities of planning,
design and implementation of programmes in local contexts with an articulated
strengthened coordination with other provincial multi-sectoral actors. Moreover, it
was planned to have a national strategic framework based on the consolidation of
the provincial AIDS strategies, which also would have provided the strategy for HIV
interventions in AJK, Gilgit/Baltistan (GB),FATA and ICT areas. Currently Provincial
AIDS Strategies are in place for all 4 provinces, tailored to their specific context
with
budgets
and
monitoring
frameworks.
Given
that
the
epidemic
is
concentratedamong key populations in every province, individual provincial AIDS
strategies share the same 3 goals/outcomes and almost the same 10 outputs. 6
However the national strategic framework with strategies focusing on AJK, GB,
FATA and ICTare lacking at national level.
4
In October 2011, the then Government of Pakistan Ministry of inter-Provincial Coordination notified the
National AIDS Control, National Tuberculosis, and National Malaria Programmes’ as having the following three
key functions: a) To act as Principle Recipient for all Global Fund supported health initiatives; b) Preparation of
proposals and liaising with international agencies for securing support of such partner agencies; and c) Providing
technical and material resources to the provinces for successful implementation of disease control strategies,
and disease surveillance.
5The CCM has acted by default as a national steering committee.
6Strategies for Punjab and Khyber Pakhtunkhwa include an additional output on increased uptake of PPTCT
services.
11
Towards the end of 2014, three programme development components of the AIDS
response in Pakistan came together: a mid-term review of the Provincial AIDS
Strategies, the development of a Pakistan AIDS Strategy III (the 3rd edition – the
previous two were called National Strategic Frameworksand this one will be called
the Pakistan AIDS Strategy III to reflect the devolution of health from national
level) and the development of a Concept Note for the Global Fund under the New
Funding Model. 7 The PAS-III, in line with the overall health and development
strategies as well with international commitments and MDGs, will consolidate the
four provincial documents under one overarching framework and provide context
for the development of the new Global Fund Concept Note. As part of a National
strategic perspective it will also include the Federally Administered Tribal Areas,
Gilgit Baltistan and Azad Jammu and Kashmir and Islamabad Capital Territory. It is
important to note that Global Fund concept note for the proposed period is
unlikely to be approved in the absence of a Pakistanstrategy on HIV and AIDS for
the same period or beyond.
I.1. Objective of the Mid-Term Review of the Provincial AIDS Strategies
The objective of the mid-term review of the Provincial AIDS Strategies was to
examine current provincial HIV programme implementation status against the
existing articulated AIDS strategies and targets set for Khyber Pakhtunkhwa, Sindh,
Baluchistan and Punjab, and to provide recommendations for strengthening the
respectiveStrategies. The review simultaneously determined programme and
financial gaps, 8 redundancies, bottlenecks and solutions or recommendations for
strengthening all four AIDS strategies.9The MTR Report follows the outline of the
Provincial AIDS Strategies to ensure clear communication on findings and
recommended points for strengthening the strategies.
II.
Mid-Term Review Process
7
See Inception Document: Mid-Term Review of Provincial AIDS Strategies, Development of Pakistan AIDS
Strategy III and the Global Fund Concept Note (New Funding Model), NACP and UNAIDS, November 2014. The
Inception Document outlines processes for moving forward with these three components including targets and
timeframes and draft tools.
8 Financial gaps to be consolidated and full costing to be included in the PAS III based on consolidated
programming and programme recommendations. Costing analysis includes funding allocations made and
released by the Provincial AIDS Control Programmes, Global Fund, the United Nations, and other development
partners.
9 Guidance will be taken from National HIV Strategies for Impact: A Guidance Note for Getting to Zero July 2014.
UNAIDS and the World Bank and Guide to Conducting Programme Reviews for the Health Sector Response to
HIV/AIDS October 2013.
12
II.1. Supervision & Technical Oversight
A team of consultants comprised of one Lead Consultant, oneNational Consultant,
oneCosting Consultant and oneGender Consultant was hired to conduct the MTR,
and to develop the PAS III and Global Find Concept Note. Supervision of this team
was conducted by the National AIDS Control Programme, UNAIDS Pakistan and by
the Technical Support Facility.The Country Coordination Mechanism’s Technical
Working Group for HIV (henceforth referred to as TWG) provided further technical
support and oversight for the MTR process led by National AIDS Control
Programme. 10 As the national response is broader than the Global Fund and the
activities they support, the constituted inclusive group of both members and
observers was expanded slightly to includethe National and Provincial AIDS Control
Programmes, KP Health Directorate (as there is no more KP Provincial AIDS Control
Programme) relevant UN agencies (namely, UNAIDS, UNICEF, WHO, UNDP, UNFPA
and UNODC), civil society organizations including for PLHIV, CSO’s for MSM and
hijra and people who inject drugs, private sector, and educational institutions. The
Technical Working Group’s responsibilities for the MTR review were primarily to
provide technical feedback and sign-off on the Inception Document (including
Interview Tools); feedback on the initial findings of the MTR and to review and
comment on the MTR draft report.
II.2. Methodology
The methodology of the MTR was approved by the TWG through the Inception
Document and included the following steps:
 Literature Review. A continuous process of review was undertaken and findings
of which were incorporated into the tool development, interviews and
determination of gaps and recommendations.
 Questionnaire Tool Finalization (see Annex II Interview Tools). Tools included 1)
1) Provincial Strategy Review Tool including Framework Progress Tool (against
Outputs); 2) the Monitoring Framework Review Tool measuring achievements for
current data against 2014 targets; 3) the Policy & Management Review Tool to
gather data on implementation arrangements.
 Field visits for Key Interviews, Focus Group Discussions and Provincial
Dialogues (see Table 1 below and Annex III Schedule and participants of Key
Informant Interviews, Focus Group Discussions and Provincial Dialogues). FGDs
10
The appointment of the CCM HIV TWG as the overall technical group for all three processes was verbally
communicated to the consultant by UNAIDS on 24th October 2014 following the first official CCM HIV TWG.
13
with each KP in each province were preferred rather than community visits, to
ensure
inclusiveness,
in-depth
and
focused
discussions
and
useful
recommendations. Field visits followed almost the same schedule: four days of
KIIs and FGDs, culminating in a presentation of the findings, gaps and
recommendations from that week to key stakeholders to ensure any remaining
issues were included in the Review for that province.
Table 1. List of key Field Visits for MTR (and PAS for Costing Consultant) by Province and
Islamabad
Province/ICT
Consultant
Date
Activity
Peshawar
Dr. Syed Amer Raza
19th – 20th Nov
KIIs, FGDs
Bettina T. Schunter
Dr. Syed Amer Raza
21st Nov
Provincial Dialogue
Vu Ngoc Uyen
5th December
KIIs
Dr. Syed Amer Raza
25th – 27th Nov
KIIs, FGDs
Bettina T. Schunter
Dr. Syed Amer Raza
28th Nov
Provincial Dialogue
Vu Ngoc Uyen
3rd Dec
KIIs
Dr. Syed Amer Raza
1st – 3rd Dec
KIIs, FGDs
Bettina T. Schunter
Dr. Syed Amer Raza
3rd Dec
Provincial Dialogue
Vu Ngoc Uyen
2nd Dec
KIIs
Dr. Syed Amer Raza
8th – 11th Dec
KIIs, FGDs
Bettina T. Schunter
Dr. Syed Amer Raza
12th Dec
Provincial Dialogue
Vu Ngoc Uyen
4th Dec
Provincial Dialogue
Bettina T. Schunter
1st – 3rd, & 8th 9th Dec
KIIs, FGDs
Vu Ngoc Uyen
1st Dec,
6th December
KIIs
Karachi
Quetta
Lahore
Islamabad
Participant attendance was noted for all FGDs and Provincial Dialogues. While
notes were taken during the KIIs, FGDs and the Provincial Dialogues, specific
comments were not attributed to specific populations to protect confidentiality
given the sometimes sensitive nature of public-private partnerships solely
implemented with public funds.
14
Following the Provincial Dialogues initial recommendations (and cursory findings
and gaps) were sent to the individual Programme Managers: 3rd December KP; 21st
December Sindh; 21st December Balochistan and 23rd December Punjab). A follow
up meeting highlighting information deficiencies during provincial visits and
request for provision of information was held 24th December with Provincial PMs.
The initial findings of the MTR (expanded findings, gaps and recommendations)
were sent to the Technical Working Group on 25thDecember 2014. A deadline for
feedback was given by the NACP (as TWG Coordinator) and no-response was
presumed to be agreement. A Summary Gender Assessment
II.3. Constraints
There were several significant constraints and challenges in conducting the Midterm Review. Firstly there was a lack of understanding on key aspects of the
Provincial AIDS Strategies in all provinces by all stakeholders, indicating that they
were never perhaps disseminated back to the stakeholders involved in their
development. Secondly, while the AIDS Control Programmes (including KP’s Public
Health Directorate) are committed implementing an effective response in their
provinces, a disconnect between the Strategies and the provincial implementation
realities was evident. For example, while reviewing the draft and approved PC-1s
of the four provinces (all drafted post Strategy development), no mention of the
Strategies was found, and resource requirements for PC-1s were not aligned with
the scope of the proposed budgets in the Strategies. This limited the scope of the
MTR as interventions found on ground were not specifically based on outputs and
output strategies mentioned in the Provincial AIDS Strategies.
Disconnect from the Strategies limited the coordination of stakeholders for Key
Informant Interviews (KIIs), Focus Group Discussions (FGDs) and the Provincial
Dialogues. Draft visit schedules were shared with, and agreed to by, PPMs through
the Inception Document 24th October 2014. Field visits started the following week
in KP. While efforts were made on short notice in KP to meet relevant
stakeholders, in other provinces, arrangements to meet stakeholders was made on
an ad hoc basis and invitations to the Provincial Dialogue sent the week of the field
visit itself. Perhaps due to the ad hoc nature of the arrangements, and despite an
email sent to provinces requesting them to ensure the inclusion of all relevant
stakeholders in their respective province, not all stakeholders were met or
15
included in the Provincial Dialogues (see Annex IV). This was in part due to time
limitations: four days in each Province (on average) was not enough time to meet
all the stakeholders (see Annex IV). Attempts were made to meet relevant
Government representatives – especially from HIV, Health, Prisons, Social Welfare
and Planning, but representatives were often busy. UN agencies were requested to
meet in all provinces but not all agencies attended the individual provincial or the
capital level FGDs. FGDs were held with key populations where they could be
located.
Another significant constraint was the inability to locate individual key population
stakeholders in the provinces beyond Global Fund supported organizations and SDPs
in Punjab given the fact that the PC-1s in Sindh and Balochistan at the time only
support operational costs and there wasno PC-1 in KP for HIV. Despite this
constraint, the Association of People Living with HIV was represented at all the
Provincial Dialogues and members were met in each province. As GF programming
for PWID wasin Punjab, Sindh and Balochistan, and the PACP hadSDPs, PWID were
well represented in the Provincial Dialogues and in the FGDs. MSM and hijra were
represented in Punjab and Sindh, but as GF does not have MSM programming in KP
or Balochistan and the PC-1s werenot yet operational for programming in those
provinces, they were not represented in the provincial dialogues. Female sex
workers were the least represented. There are currently only SDPs for FSW in
Punjab, and they were represented only in the Punjab Provincial Dialogue.
Organizations and clinicians providing care and support services to migrants were
represented in KP, Balochistan and Punjab. Returned migrants themselves were not
present at any of the Provincial Dialogues except Punjab.
Perhaps the most significant constraint was the lack of complete data on
achievements against the indicators in the Monitoring Framework of the respective
Strategies. A key finding throughout the MTR was the lack of a coherent 11 MIS
between
GF
interventions
and
Government
and
other
donor-supported
interventions, and a systematic way to collate data at the provincial level from all
HIV-related service providers to maintain an overall provincial perspective with the
ability to generate immediate, reliable, data. The MTR was limited by the lack of
11
The report refers throughout to a “coherent MIS” rather an “integrated MIS” as different service providers
have developed MIS’. It is unrealistic to assume there will be one integrated MIS per province. It is more realistic
to propose an MIS system that uses similar data collection tools, collect data on the same indicators aligned with
global commitments, and formalizes the way information is shared from field-level service delivery up to the
PACP for consolidation, triangulation and further reporting.
16
validated aggregated provincial data and mostly relied on verbal information
provided by stakeholders, information which could not be validated through
another source such as programme records or reports. Further, as no recent survey
or study had been undertakenamong key populations except the bio-behavioural
study in five prisons in Sindh province commissioned by UNODC in 2012,
information on impact/outcome indicators related to key populations relied on the
2011 Round IV of IBBS. It is recommended Punjab should revise its Strategy based
on the recent, as yet unpublished, IBBS data (meant to be released on last week of
January 2015) and the other provinces should revise their Strategies based on
Round V IBBS to be conducted in 2015 (date not finalized).
Lastly, the MTR process was made more difficult by the staff turn-over within
almost all the Provincial AIDS Control Programmes (PACP’s). The MTR found that
most of the Programme Managers had been appointed after the development of
current Strategies. In the case of KP, the AIDS Programme was replaced by the, as
yet to be fully established/functional, HIV unit under the Department of Public
Health. In Sindh and Balochistan most of the staff has been inducted recently and
lacked institutional knowledge on development, progress and challenges for their
respective provincial Strategies. The review found that except for few staff in
Sindh and Punjab provinces, most of the staff was new and not present at the time
of Strategy development. This constraint is reflected in few of the MTR findings,
which appear non-coherent with suggested activities in the strategies. For
example, while most of the provinces claimed that they have regular multi-sector
meetings, a clear understanding based on the Strategies on why multi-sectoral
meetings should be held (linked to advocacy and an enabled policy environment)
was not articulated in the Provincial Dialogues.
III.
Goals and Guiding Principles
III.1. Goals
The Goals, or Outcomes, of the four strategies are the same and should remain the
Outcomes with no change until 2015 - 2020. They are:
1. HIV prevalence is reduced among Key Populations and is maintained at less
than 0.1% in the General Population.
17
2. HIV-related morbidity and mortality is reduced, and the quality of life of
People Living with HIV is improved.
3. Policy environment and the AIDS response is enhanced for HIV prevention,
treatment, care, and support.
III.2. Guiding Principles
The four strategies also share the same six guiding principles and should remain the
Outcomes with no change until 2015 - 2020. It is important in this section to not
only state the principles, which guide the Strategies, but also evidence of how they
were used to guide the development. The six principles are as follows:
1.
Prioritization: A prioritized approach was followed in the selection of key
strategies and actions.
 This requires more explanation or specific reference to the Response
Analysis section (and explanation included there). How were the
populations
and
interventions
prioritized?
Will
there
be
a
review/reprioritization periodically (linked to any new available strategic
information)– especially if the Strategies are extended until 2020.
2.
Evidence-based: The priorities are based on the existing evidence, even though
limited, from epidemiological, public health and social research in the
Province and, more generally, in Pakistan.
 An explanation of the evidence used to date and foreseen to be used (e.g.
future IBBS and DHS)
3.
Results-based: The plan includes specific, measurable and realistic targets
aligned with the goals of Universal Access and other national and international
commitments.
 International and national commitments should be mentioned here.
4.
Efficiency and sustainability: As external resources are on the decline, the plan
seeks greater integration, where feasible, into existing health and social
support systems.
 There should be a caveat mentioned here about the vertical nature of
programming in Pakistan, and specific provincial constraints to multisectoral programming.
18
 Cost efficiency studies need to be undertaken periodically to improve
programming and advocacy interventions.
5.
Participatory: The plan was developed with inputs from relevant stakeholders,
including government, civil society, communities, and development partners.
 More explanation about the meetings, time period, which multi-sectoral
partners (if any) were involved, which UN agencies, key populations etc.
 While participation in the process of development of the Strategies by
relevant
stakeholders,
the
document
itself
needs
highlight
the
meaningful involvement of respective communities. Where concerned
communities are engaged, the chances that planned outputs will be
reached is considerably higher.
6.
Gender and age-sensitive: Gender and age are important determinants for
vulnerability and access to services. This shall be reflected in the
implementation of the plan.
 Implementation of the (action) plan or the Strategy?
 See Annex II. Proposed Terminology Section and specific Outputs and Output
Strategies below in The Results Framework through 2020.
 Consider adding: Activities throughout the Strategy are gender responsive.
Recommendation for including an additional guiding principle:
7.
The programming should be cognizant of the rapidly changing implementation
environment occurring due to security situation, natural disasters and
catastrophes. A risk mitigation plan should be developed in each provincial
strategy
IV.
Context Analysis
IV.1. Situation Analysis
The Situation Analyses of the provinces follow what is available from the last round
of the IBBS. However, Punjab and Sindh do not take into account the AEM
modelling (January 2014) which clearly indicates a projected epidemic among MSM
surpassing the PWID epidemic by 2017. This is primarily due to the fact that
information from modelling was made available after, the provincial strategies and
PC-1s had been approved in these provinces. The MTR also notes that sex work is
19
lumped together in all the strategies. Given the difference between the epidemics
among HSW, MSW and FSW, it is recommended that the Situation Analysis be reorganized to reflect specifically to reflect the Output prioritization: PWID; MSM
(including MSW); hijra (including HSW); FSW; prisoners; returned migrants. While
KP and FATA (with no HIV and AIDS Strategy) have the highest burden of HIV
positive migrants, the situation analysis for this population was very limited. As
migrants compose a portion of all HIV positive clients in each province, it would be
useful for each province to cover returned migrants in their situational analyses if
only to say they are not a priority for the province. The Situation Analysis should
also mention Vulnerable Populations as they are covered in Output 2.1.1, as well as
gender and age disaggregation considerations, especially given the proportion of
adolescents among key populations. Lastly, there is no mention of spouses of key
populations, in particular wives of PWIDand intimate partners of sex workers.
The Situation Analyses will have to be revised among all provinces after the results
of the Round V and Punjab IBBS’. It is expected that if the Strategies are extended
until 2020, they may be further evidence that would inform provinces’ strategies.
IV.2. Response Analysis
The Response Analysis should be updated to current levels of implementation,
aligned with findings from the MTR.
IV.3. Implications and key directions for the next five years
Only KP and Punjab outlined key directions for the next five years. KP shares
Punjab’s four key directions while adding a specific key direction on PWID and one
on migrants. It is recommended that the following key directions are adopted in
Strategy revisions:
I.
Increasing outreach and engagement with PWID, Transgender communities,
MSM and FSWs.
II.
Expanded uptake of HTC services for key and vulnerable populations, in
settings and contexts where they will be able to access and receive quality
services.
III.
Improved referral linkages along the Continuum of Care from prevention
outreach and HTC to ART and related health units like STI clinics and
Hepatitis treatment centres.
20
IV.
Improved linkages for HIV + and HIV- PWID into evidence-based drug
treatment services, including detoxification, rehabilitative adherence
support and Opiate Substitution Therapy (OST) when it becomes available.
V.
Improved management structures and systems for an integrated response,
including expanded capacities and an enabling environment.
And additionally for KP:
VI.
Increased information and service access to internal migrant populations
(both outgoing and returning).
VII.
Increased coordination with FATA for cost efficiency of resources to ensure
services to FATA beneficiaries in the province, till the time FATA establishes
its own identified centre/s.
IV.4. General Gender Analysis
A significant gap in the situational analyses of the Provincial AIDS Strategies is a
gender analysis. Inclusion of some analysis is critical given the HIV risk of males
who have sex with males, hijra and female sex workers is driven to a large extent
by underlying gender inequality and social marginalization. For these populations,
stigmatization (or the condoning violence) occurs in large part because society
perceives their behaviour as violating the accepted norms of what women or a man
should do. Stigmatization in turn, makes the task of reaching key populations with
HIV prevention, care and treatment services difficult.
The epidemic in Pakistan is driven in part, and will continue to be, norms around
acceptable
behaviouras
well
as
common
perspectivesaround
unacceptable
behaviour such as women's awareness about condoms and negotiating condom use
with spouses/intimate partners, or the cultural barriers to the discussion of SRH for
adolescent girls and boys. Punitive laws against behaviors that are not viewed as
acceptable by the wider society, make key populations hard to identify, monitor
and reach with HIV prevention programmes. The Penal Code, Section 377,
criminalizes male-to-male sex as “carnal intercourse against the order of nature”
with the punishment of imprisonment with the possibility of fines.12 Sharia law also
carries heavy penalties for homosexuality – of imprisonment for 2-10 years or for
12
Pakistan Country review-2011: Prepared by www.aidsdatahub.org based on HIV/AIDS Surveillance Project,
IBBS round I, II, III and special round for FSW, NACP, MOH, Pakistan, 2005 – 2009.
21
life, or of 100 lashes or stoning to death (depending on whether the person is
married or not).13 Sex work is also illegal and Section 9 of the Control of Narcotics
Substances
Act
(CSNA),
1997
allow
for
the
death
penalty
for
drug
offencesdepending on the quantity of the narcotic drug, psychotropic substance or
controlled substance.14
For key populations including PWID, the risk of HIV is generated through sexual
relationships that are influenced by underlying gender norms and other factors,
such as economic vulnerability. If HIV risk is to be successfully reduced over the
long term in Pakistan, programmes that serve key populations must also address
the gender norms and inequalities that drive HIV risk.In addition to focusing on
individual, peer-driven behaviour change models, interventions for key populations
should be supplemented by a focus on partner transmission – especially intimate
and commercial – to support an increase in uptake of services,reduced violence
within relationships, better communication and joint responsibility for safe sex,
contributing to an ultimate reduction in partner transmission.
V.
General Findings, Gaps and Recommendations
Findings, gaps and recommendations were gathered through a common tool against
the Outputs and Output Strategies articulated in the individual Strategies.
Additional information was sought through tool looking at management and
implantation arrangements. Most of the findings, gaps and recommendations were
the same in every province. Key findings and recommendations are organized
below by Outcome. For a complete list of Findings and Gaps by province, see
Annex II Key Findings and Gaps by Province.
V.1. Key Findings
Most of the findings, gaps and recommendations were the same in every province.
General Key findings and gaps are organized below by Outcome. For a complete list
of specific Findings and Gaps by province, see Annex II Key Findings and Gaps by
Province. Many of the key findings (against Outputs and Output Strategies) are
under Outcome III. In general, within an Investment Approach perspective15, the
13
Ibid.
Ibid.
15Schwartländer B, Stover J, Hallett T, Atun R. Towards an improved investment approach for an effective
response to HIV/AIDS. Lancet 2011; 377: 2031–41
14
22
Strategies have allocated appropriate levels of programming to Basic Activities
such as programming with key populations and treatment and care, although
interventions on the ground may need strengthening, expanding or may have been
stalled due to PC-1 approval. Critical Enablers and Development Synergies, have
not been explicated specifically in any of the strategies. Given the concentrated
nature of the epidemic, advocacy efforts must be strengthened in order to be able
to scale up services to key populations in order to have an impact on the epidemic.
Likewise, with diminishing resources globally for HIV, and subsequently nationally,
concerted efforts to create synergies with multi-sectoral stakeholder development
partners is critical.
A substantial finding was that the only the Punjab PC-1 was fully approved and
funds released. In Sindh the PC-1 expired June 2014 and all service delivery
packages stopped. Currently SACP has a one-year extension for operational costs.
Their new PC-1 is under final approval. Balochistan has had no PC-1 since the
strategy was developed. Their new PC-1 was approved recently in principle, but
not signed. When PACP in Khyber Paktunkhwa was dissolved and integrated under
the Public Health Directorate, their pending PC-1 was suspended. The unresolved
status of the PC-1s has significantly hampered the implementation of the
Provincial Strategies. Moreover KP is currently absorbing expense (through GF
and Government funding) for FATA patients in it ART and CHBC centres.
V.1.a. Key Findings under Outcome I
 Adolescents: Nothing specific to adolescents was initiated in the provinces –
either specific programming for adolescent key populations, or with streetassociated or other adolescents at risk. The PACP conducted testing in the
Punjab Child Protection Welfare Bureau’s rehabilitation centre but the activity
was not attached to any programming.
 Prison interventions: Other than in Punjab, all interventions currently in prisons
are supported by UNODC. A significant disconnect was found between the
UNODC supported services and the Government supported services, or
comprehensive knowledge of the UNODC project by Government AIDS Control
Programmes.
V.1.b. Key Findings under Outcome II
23
 Referral system: Referral / linkages are not formally in place consequently
patient tracking and monitoring is lacking.
 Staffing: Clinicians in the treatment centres are overburdened – either due to
staffing levels or capacity issues.
 Medicines: STI drugs are generally available in the treatment centres but no
opportunistic infection medications were available.
 Stigma: There is still evidence of stigma in the health care services including
confidentiality in testing sites, treatment sites, and in PPTCT service provision
 TB/HIV co-infection: There is anecdotal evidence that primarily verbal screening
for TB is being conducted in the ART centres without any quality assurance (data
validation, testing kit quality, monitoring by HIV programme), resulting in
perhaps sub-optimal detection rates. Evidence to date suggests only <1% of TB
patients are HIV positive16, while WHO estimates that 2.6% (1.2% - 3.4%) of TB
patients in Pakistan are HIV positive.17
 CHBC: Stand-alone CHBC sites are not meeting the needs of key populations as
they are providing care and support services to PLHIV while KP receive other
services through SDPs. The CoPC+ model which provides care and support under
GF to PWID by an SDP for PWID should be evaluated for application with other
key populations (see specific recommendations).
 Despite a specific output (and indicator in the Monitoring Framework), no
linkages were made with Social Welfare or any other social protection
mechanism outside the CHBC or COPC+ models. Social protection schemes are
especially important for women and children affected by HIV.18
V.1.c. Key Findings under Outcome III
 Advocacy: Only Sindh has HIV legislation but rules of business have not been
drafted so the legislation has not yet been enacted. There is no other HIV
legislation in any other province. Advocacy in general is weakly articulated in
Strategies.
 Multi-sectoral coordination: There is a lack of realizations of multi-sectoral
contributions – including prisons, migrants, education sector, and social welfare.
16Hasnain
J, Memon GN, Memon A. Screening for HIV among tuberculosis patients: a cross-sectional study in
Sindh, Pakistan. BMJ Open. 2012 Oct 18;2(5).
17World Health Organization.Global Tuberculosis Report 2014. Geneva 2014. Table 2.1 (no page numbers).
18 44.9% of women living with HIV are unemployed as compared 32% male. 20% of female reported that they
have a children orphaned by HIV/AIDS as compared to 3.4% male. (Country Report on National Research Study
on HIV Community Access To Treatment, Care And Support Services In Pakistan. Safdar Kamal Pasha. 2013).
24
Similarly weak coordination between DoPH (KP) and FATA Secretariat is leading
to significant expenditure in KP HIV interventions.
 Strategic evidence: There is a considerable disconnect between programmes
being implemented under GF, Government and other implementers –
coordination, MIS, information sharing – coherent move towards achieving same
targets (e.g. Punjab MIS and GF MIS not coherent). Data from service provision is
not aggregated at the Provincial level. During the MTR process, primarily
anecdotal contributions were received at provincial level. A system of validation
for data is not in place. Regarding strategic information generation, there has
been little generated through studies, research, etc., and no capacity
assessments conducted
or capacity building plans developed(except Sub
Recipient assessments conducted under GF, but these were not shared during
the MTR process). No SDP model has been evaluated. Lastly, M&E units are not
in place – generally staffed with one individual M&E Coordinator, except Punjab
where recently Epidemiologist, M&E Officer and Surveillance Coordinator
postswere filled.
 Resource mobilization: No resource mobilisation strategies were completed in
any of the provinces. There has also been a delay in release of committed
funding due to different factors including delays in receiving GF disbursements
(NZ, NACP and NHMA); only half the PACPs are approved SRs (Punjab and
Balochistan); and PC-1s are delayed, except Punjab. Many of the factors are
capacity issues.
 Implementation arrangements: The MTR found frequent staff turn-over of top
managers or lack of full-time managers; PACPs are not fully staffed, operating
with ad-hoc arrangements instead of permanent arrangements. As mentioned
above, PC-1s are a stumbling block for implementation. They are not aligned
with the Strategies and only Punjab as fully operational PC-1.
V.2.Key Gaps
Gaps reported are services that were not mentioned in the Strategies. They were
raised through KIIs, FGDs and at the Provincial Dialogues.
 PWID: Lack of financial and technical support for detoxification and
rehabilitation services PWID.
 Procurement: ACP’s do not have procurement supply management (PSM) units
except Punjab, with procurement and logistic technical staff and a logistics MIS
25
(either specific or integrated into provincial MIS). Punjab PSM unit has a
Procurement Specialist, Procurement Assistant and Logistic Assistant.
 Quality Assurance: No Quality Assurance (QA) of HIV diagnostics and treatment
(no pharmaco-vigilance). No standardization of HIV commodities such as testing
kits – blood banks and others procuring their own branded.
 Hepatitis: No link to provincial Hepatitis programmes.
 Care and Support: There is no output in the strategy covering provision of care
and support services.
V.3. Key Recommendations
Recommendations have been consolidated and streamlined across all provinces (for
details on the recommendations see VI. Specific Recommendations by Province).
Throughout the MTR process, recommendations were raised, either to strengthen
existing interventions or propose new ones, based primarily on issues of/or gaps in
the existing strategies. Recommendations raised by most or all provinces are listed
broadly below in bullet.In addition to the recommendations grouped under
Outcome I, II, and III, several procedural recommendations are proposed:
1) Strategies should be more aligned than they already are – Outputs and Output
Strategies should be the same except for a few small exceptions as noted in the
Results Framework below. This is for ease of comparison among provinces and a
more comprehensive overview of the HIV response in Pakistan, and to ensure
coherence betweenthe Provincial AIDS Strategies and the Pakistan AIDS Strategy III.
The Pakistan AIDS Strategy will consolidate the Provincial AIDS Strategies’ Results
Frameworks and recommendations agreed to by provinces. Alignment of Provincial
AIDS Strategies during revision should be based on the priorities set in the
Pakistan AIDS Strategy III on behalf of the provinces.
2) The Strategies should have an Operational Plan that incorporates the narrative
around the Output Strategies into time-bound activities with process indicators
(e.g. # ART sites expanded [time-bound and against total target]), as well as
specified roles and responsibilities.
3) In addition, Output Strategies cannot elucidate all the components of particular
interventions, e.g. “comprehensive” programming for MSM, PWID, Prisoners etc. A
26
key recommendation for all Strategies is to have a Terminology Section where
terms, including programmatic interventions, can be explained in detail.
Definitions of terms during Provincial AIDS Strategies’revisions, should be aligned
with definitions set out in the PAS III (e.g. “comprehensive” package for key
populations in Pakistan).
4) The Results and Monitoring Frameworks should be revisited every 2 years or
upon the availability of new data (e.g. new round of IBBS) and revised if necessary.
V.3.a. Key recommendations under Outcome I
 PWID: Detoxification services for PWID irrespective of their CD4 count and
rehabilitative adherence-centred support for HIV positive PWID with a CD4 <500.
Also, service provision for wives and children of HIV positive PWID should be
attached to PWID services, not stand-alone service by different service
providers.19,20
 Other Key Populations: Service provision for wives and children of HIV positive
MSM and transgender persons should be attached to service provision for those
populations; and services for husbands and children of FSW should be attached
to service provision for FSW.
 Scaled up comprehensive HIV services for prisoners.
 Prioritization: More prioritization is needed in the Strategies and specific
mention that interventions will be rolled out according tokey population and
geographic prioritization and in a phased approach (to be defined based on IBBS
and AEM and other validated evidence) contingent upon funding. Further, the
targets for selected prioritized cities and peripheries across the province can be
different.
V.3.b. Key recommendations under Outcome II
19A
mid-term assessment of a UNODC supported project highlighted the vulnerability of the spouses and children
of PWID who remained remain marginalized and are not getting any support from the public sector or from the
society at large. In cities where the HIV prevalence among PWIDs is as high as 40% and majority of them married
and with families, the need and relevance of the projects catering to spouses and children of PWID had been
underscored (UNODC: HIV/AIDS prevention, treatment and care for female injecting drug users and female
prisoners in Pakistan Mid Term Review – February 2010 By Jo Kittelsen and Abid Atiq).
20A recent study which highlights the vulnerability of the wives of PWIDs found that up to 15% of the wives of HIV
positive IDUs were already infected. Eighty percent reported not having used a condom in their last sexual act
with their husbands and approximately half had never heard of HIV or AIDS. (Pakistan Country review-2011:
Prepared by www.aidsdatahub.org based on HIV/ AIDS Surveillance Project, IBBS round I, II, III and special round
for FSW, NACP, MOH, Pakistan, 2005 – 2009).
27
 Expand free HTCservices (public and private) expanded to every district: 21
Capacity building of HTC staff on counselling (with specific attention paid to
providing specific counselling for different key populations). In public sector to
be aligned with PPTCT/Paediatric AIDS/ART divisional sites (below).
 Expand treatment servicesto at least one hospital facility per divisional level:
ART centres with MNCH safe (HIV) delivery and paediatric HIV treatment
capacity.
 SDPs providing services to key populations should provide care and support
services to their HIV positive clients and CHBC sites to only cater to non-key
populations (vulnerable and general populations) and key populations not served
by an SDP.
 Nutritional support needs to be resolved (active solicitation of support from
GAIN, WFP or other nutritional support mechanisms in country). If blanket donor
support is unavailable, nutritional support criteria should be revised. Children
and pregnant and lactating mothers should be prioritized. Further criteria needs
to be worked out but could, for example be based on a) social criteria, 2)
incentive for detoxification, treatment, retention in care, adherence etc., or 3)
based on clinical criteria such as nutritional status.22
V.3.c. Key recommendations under Outcome III
 MIS: Coherent MIS systems between service providers - irrespective of funding
source. This would mean standardization of indicators collected across service
providers. Indicators should be aligned with GARP indicators and those collected
through IBBS. There is also an urgent need to align population terms with
populations on whom data is actually collected. Currently the Monitoring
Framework reports achievements against indicators on transgender persons and
MSM while information currently available (IBBS R IV) is on HSW and MSW. Data
collected in the field must differentiate between MSM who do/do not sell sex
and hijra who do/do not sell sex.
21
Examine the gender related barriers including cost in accessing HTC and related services; ensure that health
care addresses these barriers by providing mobile or community based services at locations and hours most
appropriate to the populations being served- especially female PLHIV and spouses.
22
For a detailed discussion on provision of nutritional support for PLHIV see FANTA-2 and WFP. Toolkit: For
Countries Applying for Funding of Food and Nutrition Programs under the Global Fund to Fight AIDS, Tuberculosis
and Malaria (Round 11). Washington, D.C.: FANTA-2 Bridge, FHI 360, 2011.
28
Quality Control/Assurance: There should be quality control and quality
assurance for testing among SDPs (including GF supported), blood banks,
medical services, surgical services, VCCT centres, private labs etc. In addition
there should be pharmaco vigilance (e.g. drug resistance testing) for treatment
service.
 Capacity building: There is a need to undertake capacity building assessments
(twice by 2020) and subsequent plans developed and implemented.
 Provincial HIV Steering Committees must be launched based on clear TORs, with
a regular schedule. Steering Committees should be linked to a national forum
such as the CCM HIV TWG or TACA (comes under Implementation Arrangements).
VI.
Specific Recommendations by Province
VI.1. The Results Framework through 2020
The Results Frameworks for the four Provincial Strategies have been aligned.
Reference to previous Outputs and Output Strategies deleted or moved are clearly
marked under “changes made.” Bulleted points under “Output Narrative
recommendations” are proposed to be integrated under the current narrative
around Output Strategies in the respective Strategies. They are predominantly new
recommendations raised through the Provincial Dialogues or recommendations to
strengthen the previous Output Strategies: they are additional and not meant to
replace the Output Strategy narrative in the current Strategies.
29
Recommended Revised Results Framework through 2020
KHYBER PAKHTUNKHWA
SINDH
BALOCHISTAN
PUNJAB
Outcome I: HIV Prevalence is reduced among Key Populations and maintained at less than 0.1% in the General Population
Output 1.1
Increased coverage (to 80%) of
effective HIV prevention programmes
for persons who inject drugs and their
sexual partners and children in select
cities.
Output Narrative
recommendation
s
Changes made
Output Strategy
1.1.1
Output Strategy
Narrative
recommendation
s
 Define effective; define coverage by
NSEP
Increased coverage (to 80%) of
effective HIV prevention
programmes for persons who
inject drugs and their sexual
partners and children in select
cities.
 Define effective; define
coverage by NSEP
Increased coverage (to 80%) of
effective HIV prevention
programmes for persons who
inject drugs and their sexual
partners and children in select
cities.
 Define effective; define
coverage by NSEP
Increased coverage (to 80%) of
effective HIV prevention
programmes for persons who
inject drugs and their sexual
partners and children in select
cities.
 Define effective; define
coverage by NSEP
 Wording slightly changed
Progressively expand access to
comprehensive quality harm
reduction services for PWID in priority
districts and peripheries in
accordance to international and local
good practices
 Link with 2.1.1 Increase availability
and uptake of HTC for KP and other
vulnerable populations through a
targeted approach
 Including female
 Define comprehensive harm
reduction services for PWID
 Define ”progressively expand” by
city based on updated IBBS
 SOPS for detox developed by public
and private sectors and UN. Detox
to be linked with either ART
provision and adherence support, or
vocational training and linkages for
employment.
 Wording slightly changed
Progressively expand access to
comprehensive quality harm
reduction services for PWID in
priority districts and peripheries
in accordance to international
and local good practices
 Link with 2.1.1 Increase
availability and uptake of HTC
for KP and other vulnerable
populations through a
targeted approach
 Including female
 Define comprehensive harm
reduction services for PWID
 Define ”progressively expand”
by city based on updated IBBS
 SOPS for detox developed by
public and private sectors and
UN. Detox to be linked with
either ART provision and
adherence support, or
 Wording slightly changed
Progressively expand access to
comprehensive quality harm
reduction services for PWID in
priority districts and peripheries
in accordance to international
and local good practices
 Link with 2.1.1 Increase
availability and uptake of HTC
for KP and other vulnerable
populations through a
targeted approach
 Including female
 Define comprehensive harm
reduction services for PWID
 Define ”progressively expand”
by city based on updated IBBS
 SOPS for detox developed by
public and private sectors and
UN. Detox to be linked with
either ART provision and
adherence support, or
 Wording slightly changed
Progressively expand access to
comprehensive quality harm
reduction services for PWID in
priority districts and peripheries
in accordance to international
and local good practices
 Link with 2.1.1 Increase
availability and uptake of HTC
for KP and other vulnerable
populations through a
targeted approach
 Including female
 Define comprehensive harm
reduction services for PWID
 Define ”progressively expand”
by city based on updated IBBS
 SOPS for detox developed by
public and private sectors and
UN. Detox to be linked with
either ART provision and
adherence support, or


Changes made
Increased access to detox for all HIV
positive PWID23
Service delivery for PWID should
provide non-injecting drug users
found in same service delivery
geographical areas minimal services
(to be defined) to mitigate shift to
injecting and reach those who may
only sporadically inject.24
 Previous outputs 1.1.1 and 1.1.2
integrated.




vocational training and
linkages for employment.
Increased access to detox for
all HIV positive PWID25
Service delivery for PWID
should provide non-injecting
drug users found in same
service delivery geographical
areas minimal services (to be
defined) to mitigate shift to
injecting and reach those who
may only sporadically inject.26
Previous outputs 1.1.1 and
1.1.2 integrated.
Previous 1.1.3 (Evaluate
existing models for
comprehensive services for
people who inject drugs,
spouses and partners and
disseminate good practices)
moved to Output 3.3 “Generate
strategic evidence for planning
and tracking the response.”




vocational training and
linkages for employment.
Increased access to detox for
all HIV positive PWID27
Service delivery for PWID
should provide non-injecting
drug users found in same
service delivery geographical
areas minimal services (to be
defined) to mitigate shift to
injecting and reach those who
may only sporadically inject.28
Previous outputs 1.1.1, 1.1.2
and 1.1.3 integrated (key
populations other than PWID
integrated into 1.2)
Previous output 1.4 (Enhance
understanding of the dynamics
of HIV and sex work across the
Province through specific
assessments for informed
programming) moved to Output
3.3 “Generate strategic
evidence for planning and
tracking the response.”




vocational training and
linkages for employment.
Increased access to detox for
all HIV positive PWID29
Service delivery for PWID
should provide non-injecting
drug users found in same
service delivery geographical
areas minimal services (to be
defined) to mitigate shift to
injecting and reach those who
may only sporadically inject.30
Previous outputs 1.1.1 and
1.1.2 integrated.
Previous 1.1.3 (Evaluate
effectiveness of diverse
prevention models and
disseminate good practices.
services for people who inject
drugs, spouses and partners
and disseminate good
practices) moved to Output 3.3
“Generate strategic evidence
for planning and tracking the
response.”
23
Although detox is currently being provided under GF for HIV positive PWID with a CD4 of <500, the recommendation is to provide to all HIV positive PWID. Although many ultimately relapse
after detox, the time away from potentially sharing, and the subsequent injecting-free period (as long as it may be) ensures the virus is not shared from that individual to other HIV-negative
injecting individuals.
24Majority of opiate users (heroin) are smoking, chasing or sniffing (oral use). Non-injectors co-exist with injectors and the potential of co infections (HIV, HepC etc.) are high due to sporadic
exchange of used syringes and needles among injectors and non injectors. The PWID services should incorporate a portion of budget and some services to help prevent shift to injecting
and/or sporadic syringe sharing that occurs.
25 Ibid detox.
26Ibid non-injectors.
27 Ibiddetox.
28Ibid non-injectors.
29 Ibiddetox.
30Ibid non-injectors.
31
Output Strategy
1.1.2
Progressively expand access to HTC
and referral services in priority
districts and peripheries for
spousesand other sexual partners of
40% of HIV positive PWID and 100% of
children of HIV positive spouses
meeting National Testing Criteria for
HIV affected children (estimated #
children 4% of total HIV positive
PWID)31
Output Strategy
Narrative
recommendation
s
To be implemented in districts where
PWID programming exists and scaled up
in alignment with expansion of PWID
service provision
Changes made
Output 1.2
ADDED
Increased phased coverage (to 85% by
2020) of effective HIV prevention
programmes for Transgender persons,
MSM and FSW
Output Narrative
recommendation
s
Changes made
 Define effective; define phased
coverage
Output Strategy
1.2.1
31
Progressively expand access to
HTC and referral services in
priority districts and peripheries
for spouses and other sexual
partnersof 40% of HIV positive
PWID and 100% of children of
HIV positive spouses meeting
National Testing Criteria for HIV
affected children (estimated #
children 4% of total HIV positive
PWID)
To be implemented in districts
where PWID programming exists
and scaled up in alignment with
expansion of PWID service
provision
ADDED
Increased phased coverage (to
85% by 2020) of effective HIV
prevention programmes for
Transgender persons, MSM and
FSW
 Define effective; define phased
coverage
Progressively expand access to
HTC and referral services in
priority districts and peripheries
for spouses and other sexual
partnersof 40% of HIV positive
PWID and 100% of children of
HIV positive spouses meeting
National Testing Criteria for HIV
affected children (estimated #
children 4% of total HIV positive
PWID)
To be implemented in districts
where PWID programming exists
and scaled up in alignment with
expansion of PWID service
provision
ADDED
Increased phased coverage (to
85% by 2020) of effective HIV
prevention programmes for
Transgender persons, MSM and
FSW
 Define effective; define phased
coverage
Progressively expand access to
HTC and referral services in
priority districts and peripheries
for spouses and other sexual
partnersof 40% of HIV positive
PWID and 100% of children of
HIV positive spouses meeting
National Testing Criteria for HIV
affected children (estimated #
children 4% of total HIV positive
PWID)
To be implemented in districts
where PWID programming exists
and scaled up in alignment with
expansion of PWID service
provision
ADDED
Increased phased coverage (to
85% by 2020) of effective HIV
prevention programmes for
Transgender persons, MSM and
FSW
 Define effective; define phased
coverage
 Coverage increased to 85% by 2020 in
line with new UNAIDS 2020 targets
 Wording slightly changed
 Coverage increased to 85% by
2020 in line with new UNAIDS
2020 targets
 Wording slightly changed
 Coverage increased to 85% by
2020 in line with new UNAIDS
2020 targets
 Wording slightly changed
 Expand comprehensive prevention
interventions for Transgender
 Expand comprehensive
prevention interventions for
 Coverage increased to 85% by
2020 in line with new UNAIDS
2020 targets
 Previous Output: 1.2: (Reduced
risks of HIV transmission among
vulnerable populations through
mainstreaming HIV prevention
into health services) moved
down to Output 1.3.
 Expand comprehensive
prevention interventions for
 Expand comprehensive
prevention interventions for
Based in IBBS Round IV marriage rates slightly inflated for expected increase: PWID 34% married. Estimate of 10% positivity among spouses is based on Nai Zindagi data.
32
People and MSM in priority districts
and peripheries, through
community-based approaches.
Output Strategy
Narrative
recommendation
s
Changes made
 Define comprehensive
 Define phased approach for
expansion
 TG and MSM inclusive of sex workers
 Define Community-based approach
 Wording slightly changed
 Previous 1.2.2 Enhance understanding
of dynamics of sex work –
female/male – for informed
programming moved to Output 3.3
“Generate strategic evidence for
planning and tracking the response.”
Transgender People and MSM
in priority districts and
peripheries, through
community-based approaches.
 Define comprehensive
 Define phased approach for
expansion
 TG and MSM inclusive of sex
workers
 Define Community-based
approach
 Wording slightly changed
Transgender People and MSM
in priority districts and
peripheries, through
community-based approaches.
 Define comprehensive
 Define phased approach for
expansion
 TG and MSM inclusive of sex
workers
 Define Community-based
approach
 Derived from previous 1.1.1
and 1.1.2
 Previous - 1.2.1 (Implement HIV
prevention, care and support
across priority prisons through
integration of these services in
prison health services in a
phase-wise approach); 1.2.2
(Develop pre-departure
prevention education for
intending migrants, and referral
system to HTC, ART and PPTCT
for returning migrants and
families); 1.2.3 (Mainstream
and support HIV preventive
education, HTC, STI and
referrals for vulnerable
populations in public-private
sector and voluntary services,
with a priority on districts
where the populations of
miners, street youths,
fishermen, displaced and
refugees are substantial.) and
1.2.4 (Integrate and support
PPTCT in selected health
services in prioritized districts)






Transgender People and MSM
in priority districts and
peripheries, through
community-based
approaches.
Define comprehensive
Define phased approach for
expansion
TG and MSM inclusive of sex
workers
Define Community-based
approach
Wording slightly changed
Merged with previous 1.2.2
Build on the community-based
MSM initiative and support its
expansion.
33
Output Strategy
1.2.2
Output Strategy
Narrative
recommendation
s
Changes made
Output Strategy
1.2.3
Expand comprehensive prevention
interventionsfor female sex workers,
including through participation of
peers.
 Define comprehensive
Expand comprehensive
prevention interventionsfor
female sex workers, including
through participation of peers.
 Define comprehensive
 Wording slightly changed
 Merged with 1.2.3
 Wording slightly changed
 Previous 1.2.1 (Implement HIV
prevention, care and support
across priority prisons through
integration of these services in
prison health services in a
phase-wise approach); and
1.2.2 (Develop pre-departure
prevention education for
intending migrants, and referral
system to HTC, ART and PPTCT
for returning migrants and
families) moved to 1.3.
Establish comprehensive
prevention for spouses of 15% of
HIV positive transgender
persons, 20% of HIV positive MSM
and 70% of HIV positive FSW; and
100% of children of HIV positive
spouses of transgender persons
and MSM, and FSW meeting
National Testing Criteria for HIV
affected children (estimated #
children 2% of total HIV positive
MSM, 1.5% of total HIV positive
transgender persons and 70% of
Establish comprehensive prevention
for spouses of 15% of HIV positive
transgender persons, 20% of HIV
positive MSM and 70% of HIV positive
FSW; and 100% of children of HIV
positive spouses of transgender
persons and MSM, and FSW meeting
National Testing Criteria for HIV
affected children (estimated #
children 2% of total HIV positive MSM,
1.5% of total HIV positive transgender
persons and 70% of HIV positive
FSW).32
shifted down to 1.3
Expand comprehensive
prevention interventionsfor
female sex workers, including
through participation of peers.
 Define comprehensive
Expand comprehensive
prevention interventionsfor
female sex workers, including
through participation of peers.
 Define comprehensive
 Derived from previous 1.1.1
and 1.1.2
 Wording slightly changed
 Shifted from previous 1.2.3
Establish comprehensive
prevention for spouses of 15% of
HIV positive transgender
persons, 20% of HIV positive MSM
and 70% of HIV positive FSW; and
100% of children of HIV positive
spouses of transgender persons
and MSM, and FSW meeting
National Testing Criteria for HIV
affected children (estimated #
children 2% of total HIV positive
MSM, 1.5% of total HIV positive
transgender persons and 70% of
Establish comprehensive
prevention for spouses of 15% of
HIV positive transgender
persons, 20% of HIV positive MSM
and 70% of HIV positive FSW; and
100% of children of HIV positive
spouses of transgender persons
and MSM, and FSW meeting
National Testing Criteria for HIV
affected children (estimated #
children 2% of total HIV positive
MSM, 1.5% of total HIV positive
transgender persons and 70% of
32
Based in IBBS Round IV marriage rates rounded up for expected increase in marriage rates among these populations: MSW 16% married; HSW 13% married; FSW 64% married. Estimate of
10% positivity among spouses is based on Nai Zindagi data. Estimates to be revised based on IBBS Round V.
34
Output Strategy
Narrative
recommendation
s
Changes made
Output 1.3
Changes made
1.3.1
 Define comprehensive prevention
N/A
Reduced risks of HIV transmission
among vulnerable populations,
including through mainstreaming into
health and social sectors.
 Define vulnerable populations
 Wording slightly changed
Develop pre-departure prevention
education for intending migrants, and
a referral system to HTC, ART and
PPTCT for returning migrants and
their families.
Output Strategy
Narrative
recommendation
s
 Link with 2.2.2 (Design referral
system within the CoC for improved
linkages)
 Includes training for a) laboratories
for immigration; b) immigration
services/travel agents; c) FIA/port
staff; material development
Changes made
None
Output Strategy
1.3.2
Implement HIV services across priority
prisons through integration in prison
HIV positive FSW).33
 Define comprehensive
prevention
HIV positive FSW).34
 Define comprehensive
prevention
HIV positive FSW).35
 Define comprehensive
prevention
N/A
Reduced risks of HIV
transmission among vulnerable
populations, including through
mainstreaming into health and
social sectors.
 Define vulnerable populations
 Wording slightly changed
Develop pre-departure
prevention education for
intending migrants, and a
referral system to HTC, ART and
PPTCT for returning migrants
and their families.
 Link with 2.2.2 (Design referral
system within the CoC for
improved linkages)
 Includes training for a)
laboratories for immigration; b)
immigration services/travel
agents; c) FIA/port staff;
material development
Shifted from previous 1.3.2 and
then wording changed. Evidence
generation is mentioned under
3.3.3 (migrants, adolescents and
migrants).
Implement HIV prevention, care
and support across priority
N/A
Reduced risks of HIV
transmission among vulnerable
populations, including through
mainstreaming into health and
social sectors.
 Define vulnerable populations
 Wording slightly changed
Develop pre-departure
prevention education for
intending migrants, and referral
system to HTC, ART and PPTCT
for returning migrants and
families
 Link with 2.2.2 (Design referral
system within the CoC for
improved linkages)
 Includes training for a)
laboratories for immigration; b)
immigration services/travel
agents; c) FIA/port staff;
material development
Shifted from previous 1.2.2
N/A
Reduced risks of HIV
transmission among vulnerable
populations, including through
mainstreaming into health and
social sectors.
 Define vulnerable populations
 Wording slightly changed
Develop pre-departure
prevention education for
intending migrants, and a
referral system to HTC, ART and
PPTCT for returning migrants
and families
 Link with 2.2.2 (Design referral
system within the CoC for
improved linkages)
 Includes training for a)
laboratories for immigration; b)
immigration services/travel
agents; c) FIA/port staff;
material development
Shifted from previous 1.3.2
Implement HIV prevention, care
and support across priority
Implement HIV prevention, care
and support across priority
33
Ibid.
Ibid.
35 Ibid.
34
35
health services in a phase-wise
approach
Output Strategy
Narrative
recommendation
s





HIV services to be defined
Link with 2.1.1 Increase availability
and uptake of HTC for KP and other
vulnerable populations through a
targeted approach
Include not only men and women,
but juveniles as well, especially
where mixed with adult prison
population.
Develop Provincial SOPs for
providing HIV services in prisons
(link with UNODC) – including HIV
education, detoxification and
rehabilitation,, HTC [3 rapid] and
formal referral system for prisoners
found to be HIV (see Output 2.2 for
further explanation) as well as
accessing intimate partners of
prisoners testing HIV positive.
Programming scaled up, capacity
built, and handed over to prison
authorities in phased approach to at
least 5 prisons by 2020 (based on
SoPS – prevention and treatment,
care and support). Link with Output
2.2.
Changes made
 Wording slightly changed
1.3.3
Mainstream and support services for
vulnerable populations, including
preventive education, HTC and STI
services through relevant health and
prisons through integration in
prison health services in a
phase-wise approach
 HIV services to be defined
 Link with 2.1.1 Increase
availability and uptake of HTC
for KP and other vulnerable
populations through a
targeted approach
 Include not only men and
women, but juveniles as well,
especially where mixed with
adult prison population.
 Develop Provincial SOPs for
providing HIV services in
prisons (link with UNODC) –
including HIV education,
detoxification and
rehabilitation,, HTC [3 rapid]
and formal referral system for
prisoners found to be HIV (see
Output 2.2 for further
explanation) as well as
accessing intimate partners of
prisoners testing HIV positive.
 Programming scaled up,
capacity built, and handed
over to prison authorities in
phased approach to at least 10
prisons by 2020 (based on SoPS
– prevention and treatment,
care and support). Link with
Output 2.2.
 Wording slightly changed
 Shifted from previous 1.3.1
Mainstream and support services
for vulnerable populations,
including preventive education,
HTC and STI services through
prisons through integration in
prison health services in a
phase-wise approach
 HIV services to be defined
 Link with 2.1.1 Increase
availability and uptake of HTC
for KP and other vulnerable
populations through a
targeted approach
 Include not only men and
women, but juveniles as well,
especially where mixed with
adult prison population.
 Develop Provincial SOPs for
providing HIV services in
prisons (link with UNODC) –
including HIV education,
detoxification and
rehabilitation,, HTC [3 rapid]
and formal referral system for
prisoners found to be HIV (see
Output 2.2 for further
explanation) as well as
accessing intimate partners of
prisoners testing HIV positive.
 Programming scaled up,
capacity built, and handed
over to prison authorities in
phased approach to at least 4
prisons by 2020 (based on SoPS
– prevention and treatment,
care and support). Link with
Output 2.2.
 Wording slightly changed
 Shifted from previous 1.2.1
 Mainstream and support
services for vulnerable
populations, including
preventive education, HTC
prisons through integration in
prison health services in a
phase-wise approach
 HIV services to be defined
 Link with 2.1.1 Increase
availability and uptake of HTC
for KP and other vulnerable
populations through a
targeted approach
 Include not only men and
women, but juveniles as well,
especially where mixed with
adult prison population.
 Develop Provincial SOPs for
providing HIV services in
prisons (link with UNODC) –
including HIV education,
detoxification and
rehabilitation,, HTC [3 rapid]
and formal referral system for
prisoners found to be HIV (see
Output 2.2 for further
explanation) as well as
accessing intimate partners of
prisoners testing HIV positive.
 Programming scaled up,
capacity built, and handed
over to prison authorities in
phased approach to at least 10
prisons by 2020 (based on SoPS
– prevention and treatment,
care and support). Link with
Output 2.2.
 Wording slightly changed
 Shifted from previous 1.3.1
Mainstream and support services
for vulnerable populations,
including preventive education,
HTC and STI services through
36
Output Strategy
Narrative
recommendation
s
Changes made
social sectors.
relevant health and social
sectors.
 Coordinate with LHW programme and
provide technical assistance to ensure
HIV risk and referral messages are
integrated in priority districts (those
with high number of overseas
migrants)
 Ensure district and provincial level
schools training healthcare providers
(in-service) include HIV in curricula
including when and where to refer for
testing (includes pregnant women to
be referred to VCCT for testing not
MNCH)
 Provide technical assistance to
Ministry of Education to include
sexuality education in curricula
 District HIV Training curricula
(developed by NACP) revised and
training on new curricula including
revision of checklist on potential HIV
case referrals for HTC from
Dermatology, Urology, Paediatrics
and Gynaecology (part of the District
HIV Training)
 Capacity building of the Child
Protection Authority to identify and
refer for HTC street-associated and
other at-risk children
 Ensure district and provincial
level schools training healthcare
providers (in-service) include
HIV in curricula including when
and where to refer for testing
(includes pregnant women to be
referred to VCCT for testing not
MNCH)
 Provide technical assistance to
Ministry of Education to include
sexuality education in curricula
 District HIV Training curricula
(developed by NACP) revised
and training on new curricula
including revision of checklist
on potential HIV case referrals
for HTC from Dermatology,
Urology, Paediatrics and
Gynaecology (part of the
District HIV Training)
 Capacity building of the Child
Protection Authority to identify
and refer for HTC streetassociated and other at-risk
children
 Define “at-risk”
 Wording slightly changed
 Define “at-risk”
 Wording slightly changed.
 Merged with previous 1.3.4
(Mainstream and support








and STI services through
relevant health and social
sectors.
Ensure district and provincial
level schools training healthcare
providers (in-service) include
HIV in curricula including when
and where to refer for testing
(includes pregnant women to be
referred to VCCT for testing not
MNCH)
For vulnerable populations in
public-private sector and
voluntary services, with a
priority on districts where the
populations of miners, street
youths, fishermen, displaced
and refugees are substantial
Provide technical assistance to
Ministry of Education to include
sexuality education in curricula
District HIV Training curricula
(developed by NACP) revised
and training on new curricula
including revision of checklist
on potential HIV case referrals
for HTC from Dermatology,
Urology, Paediatrics and
Gynaecology (part of the
District HIV Training)
Capacity building of the Child
Protection Authority to identify
and refer for HTC streetassociated and other at-risk
children
Define “at-risk”
Wording slightly changed
Shifted from previous 1.2.3
relevant health and social
sectors.
 Ensure district and provincial
level schools training healthcare
providers (in-service) include
HIV in curricula including when
and where to refer for testing
(includes pregnant women to be
referred to VCCT for testing not
MNCH)
 Provide technical assistance to
Ministry of Education to include
sexuality education in curricula
 District HIV Training curricula
(developed by NACP) revised
and training on new curricula
including revision of checklist
on potential HIV case referrals
for HTC from Dermatology,
Urology, Paediatrics and
Gynaecology (part of the
District HIV Training)
 Capacity building of the Child
Protection Welfare Bureau to
identify and refer for HTC
street-associated and other atrisk children
 Define “at-risk”
 Wording slightly changed
37
Output Strategy
1.3.4
Output Strategy
Narrative
recommendation
s
Changes made
Scale up PPTCT services in prioritized
divisions and districts for women of
child bearing age at risk for or living
with HIV
 At least one hospital at each
divisional level orientated for PPTCT –
pre and postal natal management of
HIV positive women.
 Develop a PPTCT strategy (after
Evaluation under Outcome 3) with
special attention to 1) the particular
migrant situation in the province; 2)
reaching spouses/female partners of
males in key and vulnerable
populations; 3) implementation
consequences of Option B+ on HIV
Clinic - with Option B+ PPTCT
regimen protocol, pregnant women
will be immediately initiated onto
ART for life; their clinical
management will be supported
through the HIV Clinics, not MNCH.
Linked in 2.1.1 and 2.2.2.
 Safe delivery kits placed at ART
Centres and allocated to positive
pregnant women
 Wording slightly changed
 Shifted from previous Output
1.4/1.4.1
preventive education, HTC and
STI services reaching vulnerable
populations through relevant
health and social sectors)
Scale up PPTCT services in
prioritized divisions and districts
for women of child bearing age
at risk for or living with HIV
 At least one hospital at each
divisional level orientated for
PPTCT – pre and postal natal
management of HIV positive
women.
 Develop a PPTCT strategy (after
Evaluation under Outcome 3)
with special attention to 1) the
particular migrant situation in
the province; 2) reaching
spouses/female partners of
males in key and vulnerable
populations; 3) implementation
consequences of Option B+ on
HIV Clinic - with Option B+
PPTCT regimen protocol,
pregnant women will be
immediately initiated onto ART
for life; their clinical
management will be supported
through the HIV Clinics, not
MNCH. Linked in 2.1.1 and
2.2.2.
 Safe delivery kits placed at ART
Centres and allocated to
positive pregnant women
 Was not in previous strategy.
Scale up PPTCT services in
prioritized divisions and districts
for women of child bearing age
at risk for or living with HIV
 At least one hospital at each
divisional level orientated for
PPTCT – pre and postal natal
management of HIV positive
women.
 Develop a PPTCT strategy (after
Evaluation under Outcome 3)
with special attention to 1) the
particular migrant situation in
the province; 2) reaching
spouses/female partners of
males in key and vulnerable
populations; 3) implementation
consequences of Option B+ on
HIV Clinic - with Option B+
PPTCT regimen protocol,
pregnant women will be
immediately initiated onto ART
for life; their clinical
management will be supported
through the HIV Clinics, not
MNCH. Linked in 2.1.1 and
2.2.2.
 Safe delivery kits placed at ART
Centres and allocated to
positive pregnant women
 Wording slightly changed
 Shifted from previous 1.2.4
(Integrate and support PPTCT in
selected health services in
prioritized districts)
Scale up PPTCT services in
prioritized divisions and districts
for women of child bearing age
at risk for or living with HIV
 At least one hospital at each
divisional level orientated for
PPTCT – pre and postal natal
management of HIV positive
women.
 Develop a PPTCT strategy (after
Evaluation under Outcome 3)
with special attention to 1) the
particular migrant situation in
the province; 2) reaching
spouses/female partners of
males in key and vulnerable
populations; 3) implementation
consequences of Option B+ on
HIV Clinic - with Option B+
PPTCT regimen protocol,
pregnant women will be
immediately initiated onto ART
for life; their clinical
management will be supported
through the HIV Clinics, not
MNCH. Linked in 2.1.1 and
2.2.2.
 Safe delivery kits placed at ART
Centres and allocated to
positive pregnant women
 Wording slightly changed
 Shifted from previous Output
1.4/1.4.1
38
Outcome II: HIV related mortality and morbidity is reduced, and quality of life of people living with HIV is improved
Output 2.1
Output Narrative
recommendation
s
Changes made
Output Strategy
2.1.1
Output Strategy
Narrative
recommendation
s
Increase quality and coverage of early
diagnosis of HIV through HTC and
provider-initiated testing and
counselling (PITC).
Indicate scope of PITC
Increase quality and coverage of
early diagnosis of HIV through
HTC and provider- initiated
testing and counselling (PITC).
Indicate scope of PITC
Increased quality and coverage
of early diagnosis of HIV through
HTC and Provider- Initiated
Testing and Counselling (PTCT).
Indicate scope of PITC
Increased quality and coverage
of early diagnosis of HIV through
HTC and Provider- Initiated
Testing and Counselling (PTCT).
Indicate scope of PITC
N/A
Increase availability and uptake of
HTC for Key and other vulnerable
populations through a targeted
approach.
 Increased provision of HTC through
SDPs for KPs (100% of clients tested)
 3-rapid test methodology employed
 SOPs for community based testing
developed (link with UNAIDS)
 Innovative strategies for testing
uptake for KP and vulnerable and
isolated communities (e.g. streetassociated children, IDPs, refugees
etc.to be supported including
community based/mobile testing)
N/A
Increase availability and uptake
of HTC for Key and other
vulnerable populations through a
targeted approach.
 Increased provision of HTC
through SDPs for KPs (100% of
clients tested)
 3-rapid test methodology
employed
 SOPs for community based
testing developed (link with
UNAIDS)
 Innovative strategies for testing
uptake for KP and vulnerable
and isolated communities (e.g.
street-associated children, IDPs,
refugees etc.to be supported
including community
based/mobile testing)
 Wording slightly changed
Mainstream and support critical
HIV related risk-reduction
interventions, including HTC, in
general health services in
selected locations across the
province.
 Define risk reduction
N/A
Increase availability and uptake
of HTC for Key and other
vulnerable populations through a
targeted approach.
 Increased provision of HTC
through SDPs for KPs (100% of
clients tested)
 3-rapid test methodology
employed
 SOPs for community based
testing developed (link with
UNAIDS)
 Innovative strategies for testing
uptake for KP and vulnerable
and isolated communities (e.g.
street-associated children, IDPs,
refugees etc.to be supported
including community
based/mobile testing)
 Wording slightly changed
Mainstream and support critical
HIV related risk-reduction
interventions, including HTC, in
general health services in
selected locations across the
province.
 Define risk reduction
Wording slightly changed
Increase availability and uptake
of HTC for Key and other
vulnerable populations through a
targeted approach.
 Increased provision of HTC
through SDPs for KPs (100% of
clients tested)
 3-rapid test methodology
employed
 SOPs for community based
testing developed (link with
UNAIDS)
 Innovative strategies for testing
uptake for KP and vulnerable
and isolated communities (e.g.
street-associated children, IDPs,
refugees etc.to be supported
including community
based/mobile testing)
 Wording slightly changed
Mainstream and support critical
HIV related risk-reduction
interventions, including HTC, in
general health services in
selected locations across the
province.
 Define risk reduction
Changes made
Output Strategy
2.1.2
 Wording slightly changed
Mainstream and support critical HIV
related risk-reduction interventions,
including HTC, in general health
services in selected locations across
the province.
Output Strategy
 Define risk reduction
39
Narrative
recommendation
s
 At least one VCCT site established in
phased approach in every district –
public sector, free of cost
 Cadre of Master Trainers identified
and trained on VCCT (through an
accredited institution) and ensure
Medical Technicians in district sites
are trained
 SoPs for VCCT sites adapted
(developed under GF R9)
 PEP guidelines developed and
disseminated to HCPs and SDPs (for
public and private service providers –
linked to 2.2.5)
 Support to establish with relevant
partners including Health Regulatory
Authority a quality assurance/quality
control system on HIV testing (public
& private) from district level
 Support to establish with BTA a blood
transfusion policy including test kit
procurement and HIV status
disclosure
 Facilitate/ provide infection control
and waste management policy /
support to relevant health sector
stakeholders
Changes made
 Wording slightly changed to
accommodate any HIV-related
intervention in health services up to
2020
Ensure sustainability of procurement
and supply chain management of HIV
diagnostic and other testing kits
Output Strategy
2.1.3
 At least one VCCT site
established in phased approach
in every district – public sector,
free of cost
 Cadre of Master Trainers
identified and trained on VCCT
(through an accredited
institution) and ensure Medical
Technicians in district sites are
trained
 SoPs for VCCT sites adapted
(developed under GF R9)
 PEP guidelines developed and
disseminated to HCPs and SDPs
(for public and private service
providers – linked to 2.2.5)
 Support to establish with
relevant partners including
Health Regulatory Authority a
quality assurance/quality
control system on HIV testing
(public & private) from district
level
 Support to establish with BTA a
blood transfusion policy
including test kit procurement
and HIV status disclosure
 Facilitate/ provide infection
control and waste management
policy / support to relevant
health sector stakeholders
 Wording slightly changed to
accommodate any HIV-related
intervention in health services
up to 2020
Ensure sustainability of
procurement and supply chain
management of HIV diagnostic
and other testing kits
 At least one VCCT site
established in phased approach
in every district – public sector,
free of cost
 Cadre of Master Trainers
identified and trained on VCCT
(through an accredited
institution) and ensure Medical
Technicians in district sites are
trained
 SoPs for VCCT sites adapted
(developed under GF R9)
 PEP guidelines developed and
disseminated to HCPs and SDPs
(for public and private service
providers – linked to 2.2.5)
 Support to establish with
relevant partners including
Health Regulatory Authority a
quality assurance/quality
control system on HIV testing
(public & private) from district
level
 Support to establish with BTA a
blood transfusion policy
including test kit procurement
and HIV status disclosure
 Facilitate/ provide infection
control and waste management
policy / support to relevant
health sector stakeholders
 Wording slightly changed to
accommodate any HIV-related
intervention in health services
up to 2020
Ensure sustainability of
procurement and supply chain
management of HIV diagnostic
and other testing kits
 At least one VCCT site
established in phased approach
in every district – public sector,
free of cost
 Cadre of Master Trainers
identified and trained on VCCT
(through an accredited
institution) and ensure Medical
Technicians in district sites are
trained
 SoPs for VCCT sites adapted
(developed under GF R9)
 PEP guidelines developed and
disseminated to HCPs and SDPs
(for public and private service
providers – linked to 2.2.5)
 Support to establish with
relevant partners including
Health Regulatory Authority a
quality assurance/quality
control system on HIV testing
(public & private) from district
level
 Support to establish with BTA a
blood transfusion policy
including test kit procurement
and HIV status disclosure
 Facilitate/ provide infection
control and waste management
policy / support to relevant
health sector stakeholders
 Wording slightly changed to
accommodate any HIV-related
intervention in health services
up to 2020
Ensure sustainability of
procurement and supply chain
management of HIV diagnostic
and other testing kits
40
Output Strategy
Narrative
recommendation
s
 (Linked with 2.2.3)
 Establish PSM unit at PMU
 Procurement of HIV diagnostic kits
including 3-rapid test methodology
with appropriate proportions for 1st
test (all); 2nd test (less) and 3rd test
(even less)
 Procurement of CD4 and viral load
test kits
 Link with 3.1.1 (Advocate for
Provincial Health Regulatory
Authority or PACP (acquires the
authority) to establish regulation of
HIV testing (including VCCT sites,
SDPs, public labs, private labs, BTA
and blood transfusion services)
including use of WHO pre-qualified
kits, and disclosure/referral for
confirmatory testing by testing
services).
Changes made
Output 2.2
ADDED
Improve quality and coverage of
medical management and ART for
people living with HIV.
Changes made
Output Strategy
2.2.1
No change.
Scaled up quality HIV management
and treatment services for improved
access and adherence
Output Strategy
Narrative
recommendation
s
 Scaled up phased approach of
establishing at least one ART centre
at each Divisional level with
paediatric capacity; MNCH trained on
managing and delivering HIV positive
pregnant woman; x-ray and
 (Linked with 2.2.3)
 Establish PSM unit at PMU
 Procurement of HIV diagnostic
kits including 3-rapid test
methodology with appropriate
proportions for 1st test (all);
2nd test (less) and 3rd test
(even less)
 Procurement of CD4 and viral
load test kits
 Link with 3.1.1 (Advocate for
Provincial Health Regulatory
Authority or PACP (acquires the
authority) to establish
regulation of HIV testing
(including VCCT sites, SDPs,
public labs, private labs, BTA
and blood transfusion services)
including use of WHO prequalified kits, and
disclosure/referral for
confirmatory testing by testing
services).
ADDED
Improve quality and coverage of
medical management and ART
for people living with HIV.
No change.
Scaled up quality HIV
management and treatment
services for improved access and
adherence
 Scaled up phased approach of
establishing at least one ART
centre at each Divisional level
with paediatric capacity; MNCH
trained on managing and
delivering HIV positive pregnant
 (Linked with 2.2.3)
 Establish PSM unit at PMU
 Procurement of HIV diagnostic
kits including 3-rapid test
methodology with appropriate
proportions for 1st test (all);
2nd test (less) and 3rd test
(even less)
 Procurement of CD4 and viral
load test kits
 Link with 3.1.1 (Advocate for
Provincial Health Regulatory
Authority or PACP (acquires the
authority) to establish
regulation of HIV testing
(including VCCT sites, SDPs,
public labs, private labs, BTA
and blood transfusion services)
including use of WHO prequalified kits, and
disclosure/referral for
confirmatory testing by testing
services).
ADDED
Scaled up art coverage with
improved quality of medical
management for people living
with HIV.
No change.
Scaled up quality HIV
management and treatment
services for improved access and
adherence
 Scaled up phased approach of
establishing at least one ART
centre at each Divisional level
with paediatric capacity; MNCH
trained on managing and
delivering HIV positive pregnant
 (Linked with 2.2.3)
 Establish PSM unit at PMU
 Procurement of HIV diagnostic
kits including 3-rapid test
methodology with appropriate
proportions for 1st test (all);
2nd test (less) and 3rd test
(even less)
 Procurement of CD4 and viral
load test kits
 Link with 3.1.1 (Advocate for
Provincial Health Regulatory
Authority or PACP (acquires the
authority) to establish
regulation of HIV testing
(including VCCT sites, SDPs,
public labs, private labs, BTA
and blood transfusion services)
including use of WHO prequalified kits, and
disclosure/referral for
confirmatory testing by testing
services).
ADDED
Scale up coverage and quality of
medical management and ART
for people living with HIV.
No change.
Scaled up quality HIV
management and treatment
services for improved access and
adherence
 Scaled up phased approach of
establishing at least one ART
centre at each Divisional level
with paediatric capacity; MNCH
trained on managing and
delivering HIV positive pregnant
41
ultrasound facility; mobile CD4
 Expand treatment services in
accordance with the ‘Continuum of
Care’ model, including Community,
Secondary and Tertiary level or
three-tier approach.
 Capacity building of paediatricians of
each divisional hospital on new
consolidated guidelines
 Awareness of ART services (incl. PEP)
built among public & private HCP in
coordination with APLHIV36
 Pilot and evaluate community-based
ARV provision – joint Government
NGO pilot
 Treatment literacy materials and
adherence plans developed for clients
at ART centres and at SDP, CHBC and
CoPC+ levels.
 Awareness on ART services among
vulnerable and key populations
(linked to community-specific HTC
promotional messages 2.1.1) in
coordination with APLHIV
 SoPs for ART centres developed
(including confidentiality; sharing
CD4 results and other investigations
with clients; specific actions to plug
leaky treatment cascades)
 Revision of National District Level HIV
training (developed by NACP in 2010)
rolled-out to select divisional sites.
Training inclusive of ART, PEP, PPTCT







woman; x-ray and ultrasound
facility; mobile CD4
Expand treatment services in
accordance with the
‘Continuum of Care’ model,
including Community,
Secondary and Tertiary level or
three-tier approach.
Capacity building of
paediatricians of each divisional
hospital on new consolidated
guidelines
Awareness of ART services (incl.
PEP) built among public &
private HCP in coordination
with APLHIV37
Pilot and evaluate communitybased ARV provision – joint
Government NGO pilot
Treatment literacy materials
and adherence plans developed
for clients at ART centres and
at SDP, CHBC and CoPC+ levels.
Awareness on ART services
among vulnerable and key
populations (linked to
community-specific HTC
promotional messages 2.1.1) in
coordination with APLHIV
SoPs for ART centres developed
(including confidentiality;
sharing CD4 results and other
investigations with clients;







woman; x-ray and ultrasound
facility; mobile CD4
Expand treatment services in
accordance with the
‘Continuum of Care’ model,
including Community,
Secondary and Tertiary level or
three-tier approach.
Capacity building of
paediatricians of each divisional
hospital on new consolidated
guidelines
Awareness of ART services (incl.
PEP) built among public &
private HCP in coordination
with APLHIV38
Pilot and evaluate communitybased ARV provision – joint
Government NGO pilot
Treatment literacy materials
and adherence plans developed
for clients at ART centres and
at SDP, CHBC and CoPC+ levels.
Awareness on ART services
among vulnerable and key
populations (linked to
community-specific HTC
promotional messages 2.1.1) in
coordination with APLHIV
SoPs for ART centres developed
(including confidentiality;
sharing CD4 results and other
investigations with clients;







woman; x-ray and ultrasound
facility; mobile CD4
Expand treatment services in
accordance with the
‘Continuum of Care’ model,
including Community,
Secondary and Tertiary level or
three-tier approach.
Capacity building of
paediatricians of each divisional
hospital on new consolidated
guidelines
Awareness of ART services (incl.
PEP) built among public &
private HCP in coordination
with APLHIV39
Pilot and evaluate communitybased ARV provision – joint
Government NGO pilot
Treatment literacy materials
and adherence plans developed
for clients at ART centres and
at SDP, CHBC and CoPC+ levels.
Awareness on ART services
among vulnerable and key
populations (linked to
community-specific HTC
promotional messages 2.1.1) in
coordination with APLHIV
SoPs for ART centres developed
(including confidentiality;
sharing CD4 results and other
investigations with clients;
36GF
R9 trainer on CoC for service providers.
R9 trainer on CoC for service providers.
38GF R9 trainer on CoC for service providers.
39GF R9 trainer on CoC for service providers.
37GF
42





(MNCH), checklist for other
departments for suspected cases,
stigma and discrimination, and
referrals.
Develop minimum qualifications for
technical staff (function-specific) and
minimum levels defined and met
(including client tracing function
preferably from PLHIV community)
Pharmaco-vigilence system to be
developed (no drug resistance
tracked) with reputable facility e.g.
SIUT.
National guidelines on TB/HIV to be
revised and implemented at
provincial level
Develop Provincial SOPs for providing
HIV treatment and referral services to
prisoners found to be HIV positive
including blood collection/
confirmatory testing, CD4, ART
initiation and referrals to detox and
rehabilitation for drug using inmates,
and care and support mechanisms
when they are released. Link with
Output 1.3.2.
Link with Output 3.3.2 Quality
Assurance for ART services






Changes made
 Wording slightly changed

specific actions to plug leaky
treatment cascades)
Revision of National District
Level HIV training (developed
by NACP in 2010) rolled-out to
select divisional sites. Training
inclusive of ART, PEP, PPTCT,
checklist for other departments
for suspected cases, stigma and
discrimination, and referrals.
Develop minimum qualifications
for technical staff (functionspecific) and minimum levels
defined and met (including
client tracing function
preferably from PLHIV
community)
Pharmaco-vigilence system to
be developed (no drug
resistance tracked) with
reputable facility e.g. SIUT.
National guidelines on TB/HIV
to be revised and implemented
at provincial level
Develop Provincial SOPs for
providing HIV treatment and
referral services to prisoners
found to be HIV positive
including blood collection/
confirmatory testing, CD4, ART
initiation and referrals to detox
and rehabilitation for drug using
inmates, and care and support
mechanisms when they are
released. Link with Output
1.3.2.
Link with Output 3.3.2 Quality
Assurance for ART services
Wording slightly changed







specific actions to plug leaky
treatment cascades)
Revision of National District
Level HIV training (developed
by NACP in 2010) rolled-out to
select divisional sites. Training
inclusive of ART, PEP, PPTCT,
checklist for other departments
for suspected cases, stigma and
discrimination, and referrals.
Develop minimum qualifications
for technical staff (functionspecific) and minimum levels
defined and met (including
client tracing function
preferably from PLHIV
community)
Pharmaco-vigilence system to
be developed (no drug
resistance tracked) with
reputable facility e.g. SIUT.
National guidelines on TB/HIV
to be revised and implemented
at provincial level
Develop Provincial SOPs for
providing HIV treatment and
referral services to prisoners
found to be HIV positive
including blood collection/
confirmatory testing, CD4, ART
initiation and referrals to detox
and rehabilitation for drug using
inmates, and care and support
mechanisms when they are
released. Link with Output
1.3.2.
Link with Output 3.3.2 Quality
Assurance for ART services
Wording slightly changed







specific actions to plug leaky
treatment cascades)
Revision of National District
Level HIV training (developed
by NACP in 2010) rolled-out to
select divisional sites. Training
inclusive of ART, PEP, PPTCT,
checklist for other departments
for suspected cases, stigma and
discrimination, and referrals.
Develop minimum qualifications
for technical staff (functionspecific) and minimum levels
defined and met (including
client tracing function
preferably from PLHIV
community)
Pharmaco-vigilence system to
be developed (no drug
resistance tracked) with
reputable facility e.g. SIUT.
National guidelines on TB/HIV
to be revised and implemented
at provincial level
Develop Provincial SOPs for
providing HIV treatment and
referral services to prisoners
found to be HIV positive
including blood collection/
confirmatory testing, CD4, ART
initiation and referrals to detox
and rehabilitation for drug using
inmates, and care and support
mechanisms when they are
released. Link with Output
1.3.2.
Link with Output 3.3.2 Quality
Assurance for ART services
Wording slightly changed
43
 Merged with previous 2.2.2
Output Strategy
2.2.2
Output Strategy
Narrative
recommendation
s
Design referral system within the
continuum of care for improved
linkages
 Formal referral system developed for
all services in the HIV Continuum of
Care from Prevention through Care
and Support: 1. HTC (including
overseas migrants, travel agents, predeparture screening authorities etc.
and medical services e.g. STI,
dermatology, thalessemia, blood
transfusion centres, TB, Hepatitis and
IDPs, refugees); 2. ART (from private
labs, SDPs, C&S, detox centres); 3.
PPTCT (ART); 4. Care and Support
Services (e.g. through CHBC, CoPC+ referrals from SDPs/KP families, ART
centre, labs, prisons/prisoners
families); 5. SDPs with KP (prisons,
ART centres, CHBC, labs); 6. Social
services (e.g. SW, CPA, zakat, BISP,
bait ul maal, vocational etc.); 6.
Hospice care
 Orientate relevant stakeholders
through multi-sectoral meetings
(Output Strategy 3.2.1) as well as
private hospitals in high HIV burden
districts on referral system
 Link with Output 3.3.2 Quality
Assurance for ART services
 Merged with previous 2.2.2
 Includes previous 2.2.4
(Improve case holding for preART and ART services.)
Design referral system within the
continuum of care for improved
linkages
 Formal referral system
developed for all services in the
HIV Continuum of Care from
Prevention through Care and
Support: 1. HTC (including
overseas migrants, travel
agents, pre-departure screening
authorities etc. and medical
services e.g. STI, dermatology,
thalessemia, blood transfusion
centres, TB, Hepatitis and IDPs,
refugees); 2. ART (from private
labs, SDPs, C&S, detox centres);
3. PPTCT (ART); 4. Care and
Support Services (e.g. through
CHBC, CoPC+ - referrals from
SDPs/KP families, ART centre,
labs, prisons/prisoners
families); 5. SDPs with KP
(prisons, ART centres, CHBC,
labs); 6. Social services (e.g.
SW, CPA, zakat, BISP, bait ul
maal, vocational etc.); 6.
Hospice care
 Orientate relevant stakeholders
through multi-sectoral meetings
(Output Strategy 3.2.1) as well
as private hospitals in high HIV
burden districts on referral
system
 Link with Output 3.3.2 Quality
Assurance for ART services
 Merged with previous 2.2.2
 Merged with previous 2.2.2
Design referral system within the
continuum of care for improved
linkages
 Formal referral system
developed for all services in the
HIV Continuum of Care from
Prevention through Care and
Support: 1. HTC (including
overseas migrants, travel
agents, pre-departure screening
authorities etc. and medical
services e.g. STI, dermatology,
thalessemia, blood transfusion
centres, TB, Hepatitis and IDPs,
refugees); 2. ART (from private
labs, SDPs, C&S, detox
centres); 3. PPTCT (ART); 4.
Care and Support Services (e.g.
through CHBC, CoPC+ - referrals
from SDPs/KP families, ART
centre, labs, prisons/prisoners
families); 5. SDPs with KP
(prisons, ART centres, CHBC,
labs); 6. Social services (e.g.
SW, CPA, zakat, BISP, bait ul
maal, vocational etc.); 6.
Hospice care
 Orientate relevant stakeholders
through multi-sectoral meetings
(Output Strategy 3.2.1) as well
as private hospitals in high HIV
burden districts on referral
system
 Link with Output 3.3.2 Quality
Assurance for ART services
Design referral system within the
continuum of care for improved
linkages
 Formal referral system
developed for all services in
the HIV Continuum of Care
from Prevention through Care
and Support: 1. HTC (including
overseas migrants, travel
agents, pre-departure
screening authorities etc. and
medical services e.g. STI,
dermatology, thalessemia,
blood transfusion centres, TB,
Hepatitis and IDPs, refugees);
2. ART (from private labs,
SDPs, C&S, detox centres); 3.
PPTCT (ART); 4. Care and
Support Services (e.g. through
CHBC, CoPC+ - referrals from
SDPs/KP families, ART centre,
labs, prisons/prisoners
families); 5. SDPs with KP
(prisons, ART centres, CHBC,
labs); 6. Social services (e.g.
SW, CPA, zakat, BISP, bait ul
maal, vocational etc.); 6.
Hospice care
 Orientate relevant
stakeholders through multisectoral meetings (Output
Strategy 3.2.1) as well as
private hospitals in high HIV
burden districts on referral
system
44

Changes made
 Wording slightly changed
 Integrated: 2.3.1 (Build linkages with
social welfare programmes/
initiatives for PLHIV and their
families); and 2.3.2 (Establish
referral of PLHIV between
prevention-outreach, HTC, CHBC and
treatment centres.)
 Wording slightly changed
 Integrated: 2.3.2 (Increase
referral of PLHIV between
prevention programs, HTC,
ART, and continuum of care
services); and 2.3.3 (Reduce
barriers to social welfare
services for PLHIV)
Output Strategy
2.2.3
Ensure sustainability of procurement
and supply chain management of ART
and HIV related medicines
Output Strategy
Narrative
recommendation
s
 Linked with 2.1.3
 Uninterrupted supply of ARVs and
supply of HIV-related drugs such as
drugs for opportunistic infections
(including INH TB prophylaxis), STI
drugs, and relevant vaccinations
maintained at appropriate levels at
treatment centres
 Addressing LMIS needs of ART centres
to ensure un-interrupted supply and
or loss of ARVs at the treatment sites.
 Capacity building of provincial PSM
Units for international procurement /
international standards (including OIs,
ARVs etc.)
Changes made
 Wording slightly changed
Output 2.3
Improve quality and coverage of care,
support and social services for people
living with HIV and their families.
Ensure sustainability of
procurement and supply chain
management of ART and HIV
related medicines
 Linked with 2.1.3
 Uninterrupted supply of ARVs
and supply of HIV-related drugs
such as drugs for opportunistic
infections (including INH TB
prophylaxis), STI drugs, and
relevant vaccinations
maintained at appropriate
levels at treatment centres
 Addressing LMIS needs of ART
centres to ensure uninterrupted supply and or loss of
ARVs at the treatment sites.
 Capacity building of provincial
PSM Units for international
procurement / international
standards (including OIs, ARVs
etc.)
 Wording slightly changed
 Shifted from previous 2.2.5
Improve quality and coverage of
care, support and social services
for people living with HIV and
 Wording slightly changed
 Integrated: 2.3.2 (Increase
referral of PLHIV between
prevention programs, HTC,
ART, and continuum of care
services); and 2.3.3 (Build
linkages with social welfare
programmes/initiatives for
PLHIV and their families)
Ensure sustainability of
procurement and supply chain
management of ART and HIV
related medicines
 Linked with 2.1.3
 Uninterrupted supply of ARVs
and supply of HIV-related drugs
such as drugs for opportunistic
infections (including INH TB
prophylaxis), STI drugs, and
relevant vaccinations
maintained at appropriate
levels at treatment centres
 Addressing LMIS needs of ART
centres to ensure uninterrupted supply and or loss of
ARVs at the treatment sites.
 Capacity building of provincial
PSM Units for international
procurement / international
standards (including OIs, ARVs
etc.)
 Wording slightly changed
Link with Output 3.3.2 Quality
Assurance for ART services
 Wording slightly changed
 Integrated: 2.3.2 (Increase
referral of PLHIV between
prevention programs, HTC,
ART, and continuum of care
services); and 2.3.3 (Build
linkages with social welfare
programmes/initiatives for
PLHIV and their families)
Ensure sustainability of
procurement and supply chain
management of ART and HIV
related medicines
 Linked with 2.1.3
 Uninterrupted supply of ARVs
and supply of HIV-related drugs
such as drugs for opportunistic
infections (including INH TB
prophylaxis), STI drugs, and
relevant vaccinations
maintained at appropriate
levels at treatment centres
 Addressing LMIS needs of ART
centres to ensure uninterrupted supply and or loss of
ARVs at the treatment sites.
 Capacity building of provincial
PSM Units for international
procurement / international
standards (including OIs, ARVs
etc.)
 Wording slightly changed
Improve quality and coverage of
care, support and social services
for people living with HIV and
Improve quality and coverage of
care, support and social services
for people living with HIV and
45
Changes made
Output Strategy
2.3.1
 Wording slightly changed
 See changes made under 2.2.2
Support to PLHIV peer and advocacy
organisations and Networks.
Output Strategy
Narrative
recommendation
s
 Capacity building of the Association
of People Living with HIV and other
PLHIV networks on advocacy and
networking.
 Support development of a women’s
branch of the APLHIV to champion for
an enabling environment that
promotes and protects the human
rights of women and girls and their
empowerment and appropriate
resource allocation.40
Changes made
 Shifted from 2.3.3
 Wording slightly changed
Increased provision of care and
support to reach registered PLHIV
meeting criteria (80%)
 Define care and support service for
monitoring – suggest transport
facilitation as the proxy
 Define “criteria”
 Develop specific CoC strategy per
province including specific definition
of CoC (from testing through to care
and support)
 SOPS for ART adherence support
Output Strategy
2.3.2
Output Strategy
Narrative
recommendation
s
40
their families.
 Wording slightly changed
 See changes made under 2.2.2
Support to PLHIV peer and
advocacy organisations and
Networks.
 Capacity building of the
Association of People Living
with HIV and other PLHIV
networks on advocacy and
networking.
 Support development of a
women’s branch of the APLHIV
to champion for an enabling
environment that promotes and
protects the human rights of
women and girls and their
empowerment and appropriate
resource allocation.41
 N/A
their families.
 Wording slightly changed
 See changes made under 2.2.2
Support PLHIV peer and
community advocacy
organisations and Networks.
 Capacity building of the
Association of People Living
with HIV and other PLHIV
networks on advocacy and
networking.
 Support development of a
women’s branch of the APLHIV
to champion for an enabling
environment that promotes and
protects the human rights of
women and girls and their
empowerment and appropriate
resource allocation.42
 N/A
their families.
 Wording slightly changed
 See changes made under 2.2.2
Support PLHIV peer and
community advocacy
organisations and Networks.
 Capacity building of the
Association of People Living
with HIV and other PLHIV
networks on advocacy and
networking.
 Support development of a
women’s branch of the APLHIV
to champion for an enabling
environment that promotes and
protects the human rights of
women and girls and their
empowerment and appropriate
resource allocation.43
 N/A
Increased provision of care and
support to reach registered
PLHIV meeting criteria (80%)
 Define care and support service
for monitoring – suggest
transport facilitation as the
proxy
 Define “criteria”
 Develop specific CoC strategy
per province including specific
definition of CoC (from testing
through to care and support)
Increased provision of care and
support to reach registered
PLHIV meeting criteria (80%)
 Define care and support service
for monitoring – suggest
transport facilitation as the
proxy
 Define “criteria”
 Develop specific CoC strategy
per province including specific
definition of CoC (from testing
through to care and support)
Increased provision of care and
support to reach registered
PLHIV meeting criteria (80%)
 Define care and support service
for monitoring – suggest
transport facilitation as the
proxy
 Define “criteria”
 Develop specific CoC strategy
per province including specific
definition of CoC (from testing
through to care and support)
UNAIDS: SCORECARD QUESTIONNAIRE (2013‐2014)‐ PAKISTAN.
41Ibid.
42Ibid.
43Ibid.
46




Changes made
developed by public and private
sectors.
Increased access to ART adherence
support for all HIV positive PWID on
ART (ART centred rehabilitation)
Support through care and support
SDPs baseline lab investigations and
treatment
Innovative care and support
mechanisms e.g. provincial HIV
helplines supported and SDPs
facilitate access to treatment and
care for their HIV positive
constituents
Scale up nutritional package pursued
through linkages with other sectoral
partners
ADDED
 SOPS for ART adherence support
developed by public and private
sectors.
 Increased access to ART
adherence support for all HIV
positive PWID on ART (ART
centred rehabilitation)
 Support through care and
support SDPs baseline lab
investigations and treatment
 Innovative care and support
mechanisms e.g. provincial HIV
helplines supported and SDPs
facilitate access to treatment
and care for their HIV positive
constituents
 Scale up nutritional package
pursued through linkages with
other sectoral partners
ADDED
 SOPS for ART adherence support
developed by public and private
sectors.
 Increased access to ART
adherence support for all HIV
positive PWID on ART (ART
centred rehabilitation)
 Support through care and
support SDPs baseline lab
investigations and treatment
 Innovative care and support
mechanisms e.g. provincial HIV
helplines supported and SDPs
facilitate access to treatment
and care for their HIV positive
constituents
 Scale up nutritional package
pursued through linkages with
other sectoral partners
ADDED
 SOPS for ART adherence support
developed by public and private
sectors.
 Increased access to ART
adherence support for all HIV
positive PWID on ART (ART
centred rehabilitation)
 Support through care and
support SDPs baseline lab
investigations and treatment
 Innovative care and support
mechanisms e.g. provincial HIV
helplines supported and SDPs
facilitate access to treatment
and care for their HIV positive
constituents
 Scale up nutritional package
pursued through linkages with
other sectoral partners
ADDED
Outcome III: Policy Environment and AIDS Response is Enhanced
Output 3.1
Output Narrative
recommendation
s
Changes made
Output Strategy
3.1.1
Supportive public policy environment
for scaled-up access to HIV services in
place.
 Contribute to national and provincial
assessments of laws, policies and
strategies that either hamper or
facilitate access to HIV services.
N/A
Implement targeted and sustained
advocacy actions with policy-makers,
parliamentarians, communityreligious leaders, and media.
Supportive public policy
environment for scaled-up
access to HIV services in place.
 Contribute to national and
provincial assessments of laws,
policies and strategies that
either hamper or facilitate
access to HIV services.
N/A
Implement targeted and
sustained advocacy actions with
policy-makers, parliamentarians,
community- religious leaders,
and media.
Supportive policy environment
for scaled-up access to HIV
services in place.
 Contribute to national and
provincial assessments of laws,
policies and strategies that
either hamper or facilitate
access to HIV services.
N/A
Implement targeted and
sustained advocacy actions with
policy-makers, parliamentarians,
community- religious leaders,
and media.
Supportive policy environment
for scaled-up access to HIV
services in place.
 Contribute to national and
provincial assessments of laws,
policies and strategies that
either hamper or facilitate
access to HIV services.
 Wording slightly changed
Implement targeted and
sustained advocacy actions with
policy-makers, parliamentarians,
community- religious leaders,
and media.
47
Output Strategy
Narrative
recommendation
s
 Appoint Communications Advocacy
Coordinator44
 Develop advocacy strategies per
province with operational plan.
 Finalization of OST strategy and
operational plan including advocacy
and participation of MoN and DRA facilitated by the OST TWG.
 Advocate with law enforcement
authorities on public health
consequences of criminalization of
drug use and sex work (and on the
CRC for <18 adolescents engaging in
such behaviour)and the positive role
that law enforcement officials can
have in protecting public health.
 Advocacy with Home Department,
Prison authorities to establish
comprehensive HIV prevention
services and formal linkages to
treatment serviceswith
relevantrevision of prison manual
where required.
 Advocate for Provincial Health
Regulatory Authority or PACP
(acquires the authority) to establish
regulation of HIV testing (including
VCCT sites, SDPs, public labs, private
labs, BTA and blood transfusion
services) including use of WHO prequalified kits, and disclosure/referral
for confirmatory testing by testing
 Appoint Communications
Advocacy Coordinator45
 Develop advocacy strategies per
province with operational plan.
 Finalization of OST strategy and
operational plan including
advocacy and participation of
MoN and DRA - facilitated by
the OST TWG.
 Advocate with law enforcement
authorities on public health
consequences of criminalization
of drug use and sex work (and
on the CRC for <18 adolescents
engaging in such behaviour)and
the positive role that law
enforcement officials can have
in protecting public health.
 Advocacy with Home
Department, Prison authorities
to establish comprehensive HIV
prevention services and formal
linkages to treatment
serviceswith relevant revision of
prison manual where required.
 Advocate for Provincial Health
Regulatory Authority or PACP
(acquires the authority) to
establish regulation of HIV
testing (including VCCT sites,
SDPs, public labs, private labs,
BTA and blood transfusion
 Appoint Communications
Advocacy Coordinator46
 Develop advocacy strategies per
province with operational plan.
 Finalization of OST strategy and
operational plan including
advocacy and participation of
MoN and DRA - facilitated by
the OST TWG.
 Advocate with law enforcement
authorities on public health
consequences of criminalization
of drug use and sex work (and
on the CRC for <18 adolescents
engaging in such behaviour)and
the positive role that law
enforcement officials can have
in protecting public health.
 Advocacy with Home
Department, Prison authorities
to establish comprehensive HIV
prevention services and formal
linkages to treatment
serviceswith relevant revision of
prison manual where required.
 Advocate for Provincial Health
Regulatory Authority or PACP
(acquires the authority) to
establish regulation of HIV
testing (including VCCT sites,
SDPs, public labs, private labs,
BTA and blood transfusion
 Appoint Communications
Advocacy Coordinator47
 Develop advocacy strategies per
province with operational plan.
 Finalization of OST strategy and
operational plan including
advocacy and participation of
MoN and DRA - facilitated by the
OST TWG.
 Advocate with law enforcement
authorities on public health
consequences of criminalization
of drug use and sex work (and
on the CRC for <18 adolescents
engaging in such behaviour)and
the positive role that law
enforcement officials can have
in protecting public health.
 Advocacy with Home
Department, Prison authorities
to establish comprehensive HIV
prevention services and formal
linkages to treatment
serviceswith relevant revision of
prison manual where required.
 Advocate for Provincial Health
Regulatory Authority or PACP
(acquires the authority) to
establish regulation of HIV
testing (including VCCT sites,
SDPs, public labs, private labs,
BTA and blood transfusion
44
This post was added during the drafting of the MTR report given the observed number of advocacy and communications activities necessary for basic activity implementation proposed
through Provincial Dialogues.
45 Ibid.
46 Ibid.
47 Ibid.
48
services.
 Advocate to enlist HIV drugs on
essential drug list notified at
Provincial level
 Results of operational research/best
practice/evaluations to disseminate
or improve programme
implementation based on the findings
(including PLHIV community research)
 Advocacy with religious leaders to
enable the environment to reach
priority populations and have open
public dialogue on HIV;
 Advocacy with education sector to
include health and sexuality
education into first extra-curricula
(short-term) and school curricula
(longer-term);
 Advocate with Parliamentarians to
support provincial level HIV Acts
 Advocate with media to develop
appropriate reporting and messages
around HIV.
 Mass Communication Campaign with
Media (gender sensitive including
transgender sensitive)
 Advocate to re-invigorate the ZakaBait-ul-Mal notification from NWFP
(year?)








services) including use of WHO
pre-qualified kits, and
disclosure/referral for
confirmatory testing by testing
services.
Advocate to enlist HIV drugs on
essential drug list notified at
Provincial level
Results of operational
research/best
practice/evaluations to
disseminate or improve
programme implementation
based on the findings (including
PLHIV community research)
Advocacy with religious leaders
to enable the environment to
reach priority populations and
have open public dialogue on
HIV;
Advocacy with education sector
to include health and sexuality
education into first extracurricula (short-term) and
school curricula (longer-term);
Advocate with Parliamentarians
to support provincial level HIV
Acts
Advocate with media to develop
appropriate reporting and
messages around HIV.
Mass Communication Campaign
with Media (gender sensitive
including transgender sensitive)
Advocate with social protection
systems such as Bait ul maal and
Zakat to notify support for
PLHIV








services) including use of WHO
pre-qualified kits, and
disclosure/referral for
confirmatory testing by testing
services.
Advocate to enlist HIV drugs on
essential drug list notified at
Provincial level
Results of operational
research/best
practice/evaluations to
disseminate or improve
programme implementation
based on the findings (including
PLHIV community research)
Advocacy with religious leaders
to enable the environment to
reach priority populations and
have open public dialogue on
HIV;
Advocacy with education sector
to include health and sexuality
education into first extracurricula (short-term) and
school curricula (longer-term);
Advocate with Parliamentarians
to support provincial level HIV
Acts
Advocate with media to develop
appropriate reporting and
messages around HIV.
Mass Communication Campaign
with Media (gender sensitive
including transgender sensitive)
Advocate with social protection
systems such as Bait ul maal and
Zakat to notify support for
PLHIV








services) including use of WHO
pre-qualified kits, and
disclosure/referral for
confirmatory testing by testing
services.
Advocate to enlist HIV drugs on
essential drug list notified at
Provincial level
Results of operational
research/best
practice/evaluations to
disseminate or improve
programme implementation
based on the findings (including
PLHIV community research)
Advocacy with religious leaders
to enable the environment to
reach priority populations and
have open public dialogue on
HIV;
Advocacy with education sector
to include health and sexuality
education into first extracurricula (short-term) and
school curricula (longer-term);
Advocate with Parliamentarians
to support provincial level HIV
Acts
Advocate with media to develop
appropriate reporting and
messages around HIV.
Mass Communication Campaign
with Media (gender sensitive
including transgender sensitive)
Advocate with social protection
systems such as Bait ul maal and
Zakat to notify support for
PLHIV
49
Changes made
Output Strategy
3.1.2
 Wording slightly changed
Contribute to national and provincial
assessments of laws, policies and
strategies that either hamper or
facilitate access to HIV services.
Output Strategy
Narrative
recommendation
s
Changes made
N/A
Output 3.2
Multi-sector coordination enhanced at
provincial level.
 None
Organise regular coordination
meetings, inclusive of relevant
sectors, civil society, and community
organizations.
 Regular multi-sectoral meetings
increased (including CoC issues) to
4x/year.
 Multisectoral partners to be
identified. Public sector partners
should include (but not limited to):
Social Welfare, Child Protection
Authority, Prison Authorities, Home
Department, Police, Education,
Ministry of Women Development,
BOEO.
 Participation on national TWG for
OST.
 Expand current District AIDS Councils
(under GF Objective 1) to include
relevant additional stakeholders such
as MSM, transgenders and FSW.
 Provincial-level Migrant Task Force
(Specific coordination and joint
Changes made
Output Strategy
3.2.1
Output Strategy
Narrative
recommendation
s
 Wording slightly changed
 Shifted from 3.1.2
Contribute to national and
provincial assessments of laws,
policies and strategies that
either hamper or facilitate
access to HIV services.
N/A
 Wording slightly changed
Contribute to national and
provincial assessments of laws,
policies and strategies that
either hamper or facilitate
access to HIV services.
N/A
 Wording slightly changed
Contribute to national and
provincial assessments of laws,
policies and strategies that
either hamper or facilitate
access to HIV services.
N/A
 Wording slightly changed
 Shifted from 3.1.1
Multi-sector coordination
enhanced at provincial level.
 None
Organise regular coordination
meetings, inclusive of relevant
sectors, civil society, and
community organizations.
 Regular multi-sectoral meetings
increased (including CoC issues)
to 4x/year.
 Multisectoral partners to be
identified. Public sector
partners should include (but not
limited to): Social Welfare,
Child Protection Authority,
Prison Authorities, Home
Department, Police, Education,
Ministry of Women
Development, BOEO.
 Participation on national TWG
for OST.
 Expand current District AIDS
Councils (under GF Objective 1)
to include relevant additional
stakeholders such as MSM,
transgenders and FSW.
 Wording slightly changed
 Wording slightly changed
Multi-sector coordination
enhanced at provincial level.
 None
Organise regular coordination
meetings, inclusive of relevant
sectors, civil society, and
community organizations.
 Regular multi-sectoral meetings
increased (including CoC issues)
to 4x/year.
 Multisectoral partners to be
identified. Public sector
partners should include (but not
limited to): Social Welfare,
Child Protection Authority,
Prison Authorities, Home
Department, Police, Education,
Ministry of Women
Development, BOEO.
 Participation on national TWG
for OST.
 Expand current District AIDS
Councils (under GF Objective 1)
to include relevant additional
stakeholders such as MSM,
transgenders and FSW.
Multi-sector coordination
enhanced at provincial level.
 None
Organise regular coordination
meetings, inclusive of relevant
sectors, civil society, and
community organizations.
 Regular multi-sectoral meetings
increased (including CoC issues)
to 4x/year.
 Multisectoral partners to be
identified. Public sector
partners should include (but not
limited to): Social Welfare,
Child Protection Authority,
Prison Authorities, Home
Department, Police, Education,
Ministry of Women
Development, BOEO.
 Participation on national TWG
for OST.
 Expand current District AIDS
Councils (under GF Objective 1)
to include relevant additional
stakeholders such as MSM,
transgenders and FSW.
50
information sharing with the FIA to
reach deported migrants; Home
Department and Prison authorities to
establish comprehensive HIV
prevention services and formal
linkages to treatment).
Changes made
 Wording slightly changed to include
provincial and district level meetings
Output Strategy
3.2.2
Output Strategy
Narrative
recommendation
s
Ensure enhanced participation of
public sector partners including Home
Department, Prisons, BEOE, and ANF
in AIDS response.
 Multisectoral partners to be
identified. Public sector partners
should include (but not limited to):
Social Welfare, Child Protection
Authority, Prison Authorities, Home
Department, Police, Education,
Ministry of Women Development,
BOEO.
Changes made
 Wording slightly changed
 Provincial-level Migrant Task
Force (Specific coordination and
joint information sharing with
the FIA to reach deported
migrants; Home Department
and Prison authorities to
establish comprehensive HIV
prevention services and formal
linkages to treatment).
 Wording slightly changed to
include provincial and district
level meetings
Ensure enhanced participation of
public sector partners including
Home Department, Prisons,
BEOE, and ANF in AIDS response.
 Multisectoral partners to be
identified. Public sector
partners should include (but not
limited to): Social Welfare,
Child Protection Authority,
Prison Authorities, Home
Department, Police, Education,
Ministry of Women
Development, BOEO.
 Wording slightly changed
Output 3.3
Enhanced use of strategic evidence to
monitor service coverage, quality and
impact.
Enhanced use of strategic
evidence to monitor service
coverage, quality and impact.
Changes made
Output strategy
3.3.1
N/A
Undertake population mapping and
Integrated Biological and Behavioural
Surveillance (IBBS) at two-three years
intervals, at provincial level.
Output Strategy
 Mention increasing geographic
N/A
Undertake population mapping
Integrated Biological and
Behavioural Surveillance at twothree years intervals, at
provincial level.
 Mention increasing geographic
 Provincial-level Migrant Task
Force (Specific coordination and
joint information sharing with
the FIA to reach deported
migrants; Home Department
and Prison authorities to
establish comprehensive HIV
prevention services and formal
linkages to treatment).
 Wording slightly changed to
include provincial and district
level meetings
Ensure enhanced participation of
public sector partners including
Home Department, Prisons,
BEOE, and ANF in AIDS response.
 Multisectoral partners to be
identified. Public sector
partners should include (but not
limited to): Social Welfare,
Child Protection Authority,
Prison Authorities, Home
Department, Police, Education,
Ministry of Women
Development, BOEO.
 Wording slightly changed
 Provincial-level Migrant Task
Force (Specific coordination and
joint information sharing with
the FIA to reach deported
migrants; Home Department
and Prison authorities to
establish comprehensive HIV
prevention services and formal
linkages to treatment).
 Wording slightly changed to
include provincial and district
level meetings
Ensure enhanced participation of
public sector partners including
Home Department, Prisons,
BEOE, and ANF in AIDS response.
 Multisectoral partners to be
identified. Public sector
partners should include (but not
limited to): Social Welfare,
Child Protection Authority,
Prison Authorities, Home
Department, Police, Education,
Ministry of Women
Development, BOEO.
 Wording slightly changed
Enhanced used of strategic
evidence to monitor and
evaluate coverage, quality and
impact.
N/A
Undertake population mapping
and Integrated Biological and
Behavioural Surveillance (IBBS)
at two-three years intervals, at
provincial level.
 Mention increasing geographic
Enhanced use of strategic
evidence to monitor service
coverage, quality and impact.
 Wording slightly changed
Undertake population mapping
and Integrated Biological and
Behavioural Surveillance (IBBS)
at two-three years intervals, at
provincial level.
 Mention increasing geographic
51
Narrative
recommendation
s
coverage and population coverage.
 Map numbers and locations of
returned and overseas migrants
Changes made
3.3.2
 Wording slightly changed
Strengthen M&E and reporting on
service quality and statistics.
 M&E Unit established with 1 M&E
manager; 1 epidemiologist/
researcher; 2 M&E Officers
 Support to develop a common
monitoring and evaluation framework
(MIS) for HIV service providers based
on international reporting
commitments and age and sex
disaggregated (same across
provinces).48
 Develop monitoring tools for assessing
quality of referrals and regular
monitoring and assessment of quality
of referrals;
 Monitor quality of services & client
satisfaction of ART centres through
monitoring framework developed
with community (APLHIV) (data
collection methodology to be
defined)
 Partners to be identified for
coordinated research and/or
dissemination including APLHIV, UN
and academic institutions;
 A prison specific MIS, data
Output Strategy
Narrative
recommendation
s
coverage and population
coverage.
 Wording slightly changed
Strengthen M&E and reporting on
service quality and statistics.
 M&E Unit established with 1
M&E manager; 1
epidemiologist/ researcher; 2
M&E Officers
 Support to develop a common
monitoring and evaluation
framework (MIS) for HIV service
providers based on international
reporting commitments and age
and sex disaggregated (same
across provinces).49
 Develop monitoring tools for
assessing quality of referrals
and regular monitoring and
assessment of quality of
referrals;
 Monitor quality of services &
client satisfaction of ART
centres through monitoring
framework developed with
community (APLHIV) (data
collection methodology to be
defined)
 Partners to be identified for
coordinated research and/or
coverage and population
coverage.
 Map numbers and locations of
returned and overseas migrants
 Wording slightly changed
Strengthen M&E and reporting on
service quality and statistics.
 M&E Unit established with 1
M&E manager; 1
epidemiologist/ researcher; 2
M&E Officers
 Support to develop a common
monitoring and evaluation
framework (MIS) for HIV service
providers based on international
reporting commitments and age
and sex disaggregated (same
across provinces).50
 Develop monitoring tools for
assessing quality of referrals
and regular monitoring and
assessment of quality of
referrals;
 Monitor quality of services &
client satisfaction of ART
centres through monitoring
framework developed with
community (APLHIV) (data
collection methodology to be
defined)
 Partners to be identified for
coordinated research and/or
coverage and population
coverage.
 Wording slightly changed
Strengthen M&E and reporting on
service quality and statistics.
 M&E Unit established with 1
M&E manager; 1
epidemiologist/ researcher; 2
M&E Officers
 Support to develop a common
monitoring and evaluation
framework (MIS) for HIV service
providers based on international
reporting commitments and age
and sex disaggregated (same
across provinces).51
 Develop monitoring tools for
assessing quality of referrals
and regular monitoring and
assessment of quality of
referrals;
 Monitor quality of services &
client satisfaction of ART
centres through monitoring
framework developed with
community (APLHIV) (data
collection methodology to be
defined)
 Partners to be identified for
coordinated research and/or
48As
much as possible every project MIS should have desegregated data on TGs, MSMs, MSWs and HSWs. The MIS should have the option of “other” in gender for calculation of data related
to TGs, MSMs, MSWs and HSWs. MIS development should be a consultative process to see how the community want to identify themselves. Needs to be coordinated with IBBS.
49Ibid.
50Ibid.
51Ibid.
52
recording/sharing protocol and an
M&E system be developed, which
addresses the reporting, referral and
coordination requirement of prison
intervention.
Changes made
Output Strategy
3.3.3
 Wording slightly changed
Support and disseminate HIV-related
substantive and operational research.
Output Strategy
Narrative
recommendation
s
 Including efficiency and cost
effectiveness reviews of the
Provincial AIDS response
 Evaluate existing models for
comprehensive services for key
populations and disseminate good
practices (including harm reduction
and community-based MSM)
 Enhance understanding of the
dynamics of sex work, including
transactional, for informed
programming.
 Operational, including communitybased, research on approaches to
reducing HIV vulnerability and
provision of services for migrants and
other vulnerable populations.
 Evaluate current harm reduction
models including CoPC+ model for
SDPs to provide C&S services to KPs
 Evaluate public and private detox and
rehabilitation centres (AAU and any
others)
 PPTCT operational research (adding
pilot districts in Balochistan and KP)
dissemination including APLHIV,
UN and academic institutions;
 A prison specific MIS, data
recording/sharing protocol and
an M&E system be developed,
which addresses the reporting,
referral and coordination
requirement of prison
intervention.
 Wording slightly changed
Support and disseminate HIVrelated substantive and
operational research.
(3.3.5)
 Including efficiency and cost
effectiveness reviews of the
Provincial AIDS response
 Evaluate existing models for
comprehensive services for key
populations and disseminate
good practices
 Enhance understanding of the
dynamics of sex work, including
transactional, for informed
programming.
 Operational, including
community-based, research on
approaches to reducing HIV
vulnerability and provision of
services for migrants and other
vulnerable populations.
 Evaluate current harm reduction
models including CoPC+ model
for SDPs to provide C&S services
to KPs
 Evaluate public and private
detox and rehabilitation centres
(AAU and any others)
dissemination including APLHIV,
UN and academic institutions;
 A prison specific MIS, data
recording/sharing protocol and
an M&E system be developed,
which addresses the reporting,
referral and coordination
requirement of prison
intervention.
 Wording slightly changed
Support and disseminate HIVrelated substantive and
operational research.
 Including efficiency and cost
effectiveness reviews of the
Provincial AIDS response
 Evaluate existing models for
comprehensive services for key
populations and disseminate
good practices
 Enhance understanding of the
dynamics of sex work, including
transactional, for informed
programming.
 Operational, including
community-based, research on
approaches to reducing HIV
vulnerability and provision of
services for migrants and other
vulnerable populations including
coal miners, ship breakers and
fishermen.
 Evaluate current harm reduction
models including CoPC+ model
for SDPs to provide C&S services
to KPs
 Evaluate public and private
detox and rehabilitation centres
(AAU and any others)
dissemination including APLHIV,
UN and academic institutions;
 A prison specific MIS, data
recording/sharing protocol and
an M&E system be developed,
which addresses the reporting,
referral and coordination
requirement of prison
intervention.
 Wording slightly changed
Support and disseminate HIVrelated substantive and
operational research.
 Including efficiency and cost
effectiveness reviews of the
Provincial AIDS response
 Evaluate existing models for
comprehensive services for key
populations and disseminate
good practices
 Enhance understanding of the
dynamics of sex work, including
transactional, for informed
programming.
 Operational, including
community-based, research on
approaches to reducing HIV
vulnerability and provision of
services for migrants and other
vulnerable populations.
 Evaluate current harm reduction
models including CoPC+ model
for SDPs to provide C&S services
to KPs
 Evaluate public and private
detox and rehabilitation centres
(AAU and any others)
 Evaluate current
53
with LHW programme on provision of
HIV-risk information and referrals.
 With National and provincial partners
analyse impact of natural and
humanitarian disasters (including
Earthquake and recent floods, IDPs)
on HIV response and develop SoPs for
emergencies.
 Undertake joint end-of-Project (EOP)
implementation review of Provincial
AIDS Strategy
Changes made
ADDED (from Sindh)
Output 3.4
Increased sustainability of the
response.
N/A
Output Narrative
recommendation
s
Changes made
Output Strategy
3.4.1
Changes made
Wording slightly changed
Reduce costs of the HIV response
through mainstreaming and efficiency
improvements.
No change.
Output Strategy
3.4.2
Increase domestic resource allocation
for sustainability of the Response.
MSM/MSW/HSW (including
adolescents) models (Sindh and
Punjab) for programme
development/integration into
ongoing SDP packages
 PPTCT operational research
(adding pilot districts in
Balochistan and KP) with LHW
programme on provision of HIVrisk information and referrals.
 With National and provincial
partners analyse impact of
natural and humanitarian
disasters (including Earthquake
and recent floods, IDPs) on HIV
response and develop SoPs for
emergencies
 Undertake joint end-of-Project
(EOP) implementation review of
Provincial AIDS Strategy
 Evaluate current
MSM/MSW/HSW (including
adolescents) models (Sindh and
Punjab) for programme
development/integration into
ongoing SDP packages
 PPTCT operational research
(adding pilot districts in
Balochistan and KP) with LHW
programme on provision of HIVrisk information and referrals.
 With National and provincial
partners analyse impact of
natural and humanitarian
disasters (including Earthquake
and recent floods, IDPs) on HIV
response and develop SoPs for
emergencies
 Undertake joint end-of-Project
(EOP) implementation review of
Provincial AIDS Strategy
Shifted bullet “Undertake joint
end-of-Project (EOP)
implementation review of
Provincial AIDS Strategy “ from
previous Output strategy 3.3.4
Increased sustainability of the
response.
N/A
 Evaluate current
MSM/MSW/HSW (including
adolescents) models (Sindh and
Punjab) for programme
development/integration into
ongoing SDP packages
 PPTCT operational research
(adding pilot districts in
Balochistan and KP) with LHW
programme on provision of HIVrisk information and referrals.
 With National and provincial
partners analyse impact of
natural and humanitarian
disasters (including Earthquake
and recent floods, IDPs) on HIV
response and develop SoPs for
emergencies
 Undertake joint end-of-Project
(EOP) implementation review of
Provincial AIDS Strategy
ADDED (from Sindh)
ADDED (from Sindh)
Increased sustainability of the
response.
N/A
Increased sustainability of the
response.
N/A
N/A
Reduce costs of the HIV response
through mainstreaming and
efficiency improvements.
Wording slightly changed. Shifted
from previous 3.3.4
Mobilise additional external
resources to ensure
N/A
Reduce costs of the HIV response
through mainstreaming and
efficiency improvements.
Wording slightly changed
Wording slightly changed
Reduce costs of the HIV response
through mainstreaming and
efficiency improvements.
No change.
Increase domestic resource
allocation for sustainability of
54
Changes made
Output Strategy
3.4.3
No change.
Mobilise and align additional external
resources to ensure implementation
of priority HIV programming.
Changes made
Words slightly changed
Output Strategy
Narrative
recommendation
s
 Advocacy and Communications
Coordinator (recommended post)
tasked to identify funding
opportunities and develop concept
note/proposals for submission
implementation of priority HIV
services.
No change.
Mobilise and align additional
external resources to ensure
implementation of priority HIV
programming.
Words slightly changed
Shifted from previous 3.4.2.
 Advocacy and Communications
Coordinator (recommended
post) tasked to identify funding
opportunities and develop
concept note/proposals for
submission
the response.
No change.
Mobilise and align additional
external resources to ensure
implementation of priority HIV
programming.
ADDED
No change.
Mobilise and align additional
external resources to ensure
implementation of priority HIV
programming.
Words slightly changed
 Advocacy and Communications
Coordinator (recommended
post) tasked to identify funding
opportunities and develop
concept note/proposals for
submission
 Advocacy and Communications
Coordinator (recommended
post) tasked to identify funding
opportunities and develop
concept note/proposals for
submission
55
VI.2. The Monitoring Framework Indicators
Information was collected against the indicators to date. Technically, however, the
Strategies and their relevant budget allocations are through June 2016 currently,
and proposed to be through June 2020. Although the global reporting mechanism is
through the end of the calendar year, this dis-alignment will not be an issue with
well-functioning MIS systems.
Achievements and Targets:
Coding:
Coding:
KP
Balochistan
Sindh
Punjab
OUTCOME 1: HIV prevalence is reduced among KP and is maintained at <0.1% in the General
Population
HASP
Recommended
Current
2011/
Indicators
changes to
Baseline
2014
Achievem
2016
2020
GARPR
indicator
ents
2013
OUTPUT: 1.1 Increased coverage (60 to 80%) of effective HIV prevention programmes for injecting
drug users and their sexual partners
80%
(needl
e
5% Pesh,
14%
TBD
N/A
80%
excha
HASP R IV
nge
enroll
ment)
IBBS: KHI:
80%
84%/84%
(needl
SKR:
e
"Reached" needs
100% of
43%
60%
36%/35%;
80%
excha
to be
36% SDPs
LRK: 9%/9%
nge
defined.Disaggre
- SDPs 36%
enroll
gate data by age
target
ment)
and gender. This
indicator can use
80%
Percentage of a proxy if you do
(needl
IBBS: QTA:
PWID reached not want to
e
81%
by
compile all (to
78%
80%
N/A
80%
excha
aware/78%
prevention
be tracked at
nge
utilized
programs
programme
enroll
level). For
ment)
example could
Awareness
use needle
of
exchange target
SDPs/utiliz
as the proxy for
ation of
80%
"reached."
SDPs: LHE:
(needl
5%/5%;
e
FBD:
14%
TBD
N/A
80%
excha
10%/10%;
nge
SGD:
enroll
53%/52%;
ment)
MLT:
2%/1%;
DGK:
1%/0%
GARPR
2013
Number of
Disaggregate
reported
syringes
data by age and
131.1
distributed
gender. This
syringes
per person
should be a
N/A
TBD
N/A
365
730
per PWID per year by
target so
denominat
NSEP (GARPR
coverage can be
or as
2013
measured - e.g.
91,000 – all
reported
100% of
PWID
131.1
registered clients
syringes per
receive 365
218 (Al
PWID per
syringes per
Nijat, Pak
123
TBD
IBID
365
730
year)
year.
Soc &
Ghazi)
Percentage of
PWID
reporting the
use of
condom at
last sexual
intercourse
Disaggregate
data by age and
gender. There is
no 2020 target
(only condoms
use targets are
70% for MSM and
90% for SW)
TBD
TBD
N/A
IBID
365
730
84
365
N/A
730
730
25%
60%
N/A
60%
80%
59%
60%
N/A
IBID
GARPR
2013
reported
22.6% incl.
small # of
FWID
IBID
80%
80%
28%
60%
N/A
IBID
80%
80%
26%
60%
Ibid
IBID
80%
N/A
25.8%
Pesh;
59.4%
Haripur
HASP IV
80%
80%
80%
80%
80%
(needl
e
excha
nge
enroll
ment)
80%
(needl
e
excha
nge
enroll
ment)
80%
(needl
e
excha
nge
enroll
ment)
25.8%
Percentage of
PWID who
reported
using a new
syringe the
last time they
injected
(GARPR 2013
reported 66%
overall incl.
small # of
FWID)
Disaggregate
data by age and
gender. Would
consider
changing wording
as IBBS uses:
Proportion of
IDUs always using
a new syringe for
injecting in past
month.
TBD
60%
N/A
KHI: 54.8%;
SKR:
16.2%;
LRK:
22.2%;
DDU:
60.8%
77%
80%
N/A
QTA: 4.7%;
TRB:
64.9%
N/A
IBBS IV:
Proportion
of IDUs
injected
with used
syringes/ne
edles on
last
injection
by city:
LHE: 42%;
FBD: 43%;
SGD: 43%;
MLT: 47%;
DGK: 46%;
GUJ: 60%;
PKP: 12%;
RYK: 58%
26%
Number of
partners of
PWID reached
by
prevention
programmes
(awareness of
SDP/utilizatio
n of SDP)
ONLY SINDH
HAS THIS
INDICATOR
BUT WOULD
Specificy male
(for female
injectors),or
female. Indicator
reflects number
and target is a
coverage
target."Reached"
needs to be
defined.Disaggre
gate data by
age. How is the
baseline
information
60%
60%
80%
80%
(needl
e
excha
nge
enroll
ment)
60%
100%
To be added with same targets as Sindh
N/A
60%
N/A
N/A
53
RECOMMEND
ALL
PROVINCES
REPORT ON
IT.
collected? Would To be added with same targets as Sindh
consider being
more specific: "%
of partners of
HIV positive
married PWID
reached with
..." Package for
them needs to be To be added with same targets as Sindh
determined: only
testing and
referral into
T/C? Followed by
CoPC+ site? What
is SDP is only SDP
and not CoPC+?
OUTPUT: 1.2 Scaled up coverage of prevention services to progressively reach 60% of Transgender
people and other KP
3.5% heard
of SDP 2.2%
participated
Peshawar
11%
40%
N/A
(IBBS);
60%
85%
GARPR 2013
reported
10.8% all
FSW
KHI:
26.5%/26.3%
; SKR:
16.8%/16.5%
; LRK:
"Reached" needs
99% of
36%
40%
63.7%/63.7% 60%
85%
to be
23%
(IBBS);
defined.Disaggre
GARPR 2013
gate data by
reported
age. This
10.8% all
indicator can use
FSW
a proxy if you do
not want to
IBBS:
Percentage of
compile all (to
Awareness/
female sex
be tracked at
utilization:
workers
programme
26.1%/22.6%
reached by
level). For
23%
40%
N/A
(IBBS);
60%
85%
HIV
example could
GARPR 2013
prevention
use condom
reported
programs
distribution
10.8% all
target as the
FSW
proxy for
Punjab:
"reached." Would
heard of
need to have a
SDPs/partici
distribution
pated @
target per
least once:
registered client.
LHE:
16.5/14.7%;
FBD:
9.6%/9.3%;
6%
40%
N/A
SGD:
80%
85%
0.6%/0.6%;
MLT:
20.3%/19.5%
; DGK:
30.1%/30.1%
(IBBS);
GARPR 2013
reported
10.8% all
54
FSW
Percentage of
female sex
workers
reporting
condom use
at last paid
sexual
intercourse
(both vaginal
and anal)
(GARPR 2013
reported
41.5% vaginal
and 31.5%
anal all FSW)
KP/Sindh/Pun
jab:Percenta
ge of male
sex workers
and MSM
reached by
HIV
prevention
programmes
(9.7% all MSW
R IV HASP)
Balochistan:N
umber of TG
and MSM
reached by
HIV
prevention
programmes
WOULD
CONSIDER
CHANGING
TO BE
ALIGNED
WITH OTHER
PROVINCES
Disaggregate by
age.
"Reached" needs
to be
defined.Disaggre
gate data by
age. This
indicator can use
a proxy if you do
not want to
compile all (to
be tracked at
programme
level). For
example could
use condom
distribution
target as the
proxy for
"reached." Would
need to have a
distribution
target per
registered client.
19%
40%
N/A
49%
60%
N/A
57%
60%
N/A
33%
40%
N/A
8%
40%
N/A
20%
60%
100% of
41%
8%
40%
N/A
6%
40%
N/A
Pesh:
vaginal:
43%; anal
12%.
Haripur: 44%
vaginal:
36%; anal.
Vaginal/Anal
: KHI:
67%/52%;
SKR:
21%/39%;
LRK:
58%/13%
IBBS:Vaginal
/Anal:
57%/56%
Punjab:
LHE:
46%/49%;
FBD:
43%/41%;
SGD:
35.5%/19%;
MLT:
48%/23%;
RWP:
14%/10%;
DGK:
32%/36%
0% Pesh
IBBS/MSW:
KHI:
28.8%/28.8%
; SKR:
1.7%/1.1%;
LRK:
39.2%/39.2%
IBBS MSW:
QTA:
Awareness/
utilization:
8.1%/7.5%
(9.7% all
MSW R IV
HASP):
Punjab:
awareness
of
SDPs/utiliza
tion of SDPs:
LHE:
0.8%/0.8%;
FBD:
1.9%/1.9%;
SGD:
0.3%/0.3%;
MLT:
60%
90%
60%
90%
60%
90%
60%
90%
60%
85%
60%
85%
60%
85%
60%
90%
for
MSW;
70%
for
MSM
55
2.2%/1.4%
KP/Sindh/Pun
jab:
Percentage of
male sex
workers and
MSM reporting
the use of
condom at
last anal sex
with clients
(27.4% all
MSW R IV
HASP)
BALOCHISTAN
: Percentage
of male sex
workers
reporting the
use of condom
at last anal
sex with
clients
WOULD
CONSIDER
CHANGING TO
BE ALIGNED
WITH OTHER
PROVINCES
KP/Sindh/Pun
jab: Number
of
Transgender
population
reached by
HIV
prevention
programmes
(19.8% all
HSW R IV
HASP)
Balochistan:
Number of TG
SW reached
by HIV
prevention
programmes
WOULD
CONSIDER
CHANGING TO
BE ALIGNED
WITH OTHER
PROVINCES
15%
Disaggregate by
age. Consider
having separate
indicators.
N/A
35% Pesh;
21% Haripur
(IBBS RIV)
60%
60%
60%
TBD
60%
N/A
IBBS/MSW:
KHI: 16%;
SKR: 11%;
LRK: 52%
41%
60%
N/A
IBBS/MSW:
QTA: 41%
N/A
Punjab:
LHE: 36%;
FBD: 19%;
SGD: 18%;
MLT: 7%;
RWP: 47%;
25%
Reached needs
to be
defined.Disaggre
gate data by
age. This
indicator can use
a proxy if you do
not want to
compile all (to
be tracked at
programme
level). For
example could
use condom
distribution
target as the
proxy for
"reached." Would
need to have a
distribution
target per
registered client.
40%
40%
2.3% heard
of SDP 2%
participated
Peshawar
KHI:
53.8%/48.7%
; SKR:
47.6%/46.8%
; LRK:
63.1%/62.5%
90%
for
MSW;
70%
for
MSM
90%
for
MSW;
70%
for
MSM
90%
for
MSW;
70%
for
MSM
80%
90%
for
MSW;
70%
for
MSM
60%
85%
60%
85%
12%
40%
N/A
53%
60%
N/A
78%
80%
N/A
IBBS/HSW:
30.5%/29%
80%
85%
N/A
Punjab:
heard of
SDPs/partici
pated @
least once:
LHE:
15.6%/13.7%
; FBD:
6.7%/6.2%;
SGD:
35.5%/5.4%;
MLT:
1.7%/1.7%
80%
85%
10%
40%
56
KP/Sindh/Pun
jab:
Percentage of
Transgender
population
reporting the
use of
condom at
last anal sex
with clients
(36.6% all
HSW R IV
HASP).
Consistent
condom use:
24% Pesh
(clients; 17%
regular
partners; 66%
Haripur
clients; 56%
regular
partners.
60%
90%
60%
90%
80%
90%
BALOCHISTAN
29%
40%
N/A
80%
:Percentage
of TG SW
reporting the
use of
condom at
last anal sex
with clients
WOULD
CONSIDER
CHANGING TO
BE ALIGNED
WITH OTHER
PROVINCES
OUTPUT: 1.3 Improved access to HIV prevention among selected Vulnerable Populations
90%
Percentage of
prisoninmates
reached by
HIV
prevention
programmes
Percentage of
BEOE
Regional
Training
Centres that
have
integrated
HIV
information
into their
predeparture
orientation
N/A
40%
N/A
26%
60%
N/A
54%
60%
N/A
43%
Peshawar;
68% Haripur
(IBBS R IV)
KHI: 35%;
SKR: 18%;
LRK: 52%
QTA: 54%
Disaggregate by
age.
Punjab:
LHE: 31%;
FBD: 30%;
SGD: 35.6%;
MLT: 13%;
RWP: 34%
"Reached" needs
to be defined.
Disaggregate
data by age and
gender. Add "in
targeted prisons"
Disaggregate by
age. Need to
determine the
baseline of
number of
centres
N/A
30%
N/A
N/A
60%
100%
N/A
40%
64.2%
N/A
60%
100%
TBD
TBD
N/A
N/A
60%
100%
1%
30%
N/A
N/A
60%
100%
N/A
TBD
N/A
N/A
50%
100%
N/A
80%
0%
N/A
TBD
TBD
N/A
TBD
100
%
50%
0%
50%
Ibid
N/A
80%
100%
100%
100%
57
sessions
OUTPUT: 1.4 Increased uptake of PPTCT services by Women
Percentage of
HIV +ive
pregnant
women who
received
ARVs to
reduce the
risk of
mother-tochild
transmission
SINDH DOES
NOT HAVE
THIS
INDICATOR RECOMMEND
IT IS ADDED
Disaggregate by
age. Would
consider
reporting on 2
indicators: #
positive pregnant
women reached
out of estimated
(need to set) and
number reached
out of identified
positive pregnant
women (100%).
1%
20%
N/A
N/A
40%
60% of
estima
ted
positiv
e
pregna
nt;
100%
of all
identif
ied
positiv
e
pregna
nt.
ADD DATA
N/A
80%
N/A
N/A
N/A
TBD
1%
20%
N/A
N/A
40%
TBD
OUTCOME 2: HIV-related Morbidity and Mortality is reduced, and Quality of Life of People Living
with HIV is improved
Recommended
Current HASP
201
Indicators
changes to
Baseline
2014
Achiev
2011/GARP
2020
6
indicator
ements R 2013
OUTPUT: 2.1 Increase quality and coverage of early diagnosis of HIV through voluntary confidential
counseling and testing (HTC) and provider-initiated testing and counseling (PITC)/Increased
coverage and quality of HTC
PSH: 0.4%
PWID in
came to SDP
for test;
N/A
N/A
N/A
60%
90%
MSW N/A;
HSW: 0%;
FSW: 0%
(IBBS IV)
HIV test at
SDP in last 6
Percentage of
mos: PWID:
KP who
KHI: 10.1%;
received HIV
SKR: 0%;
tests in the
LRK: 3%.
last 12
HSW: KHI:
months and
Disaggregate by
0.2%; SKR:
know their
age and gender.
TBD
40%
N/A
5.9%; LRK:
60%
90%
status (IBBS R
40.2%. MSW:
IV: FSW:
KHI: 24%;
5.7%;
SKR: 0%;
HSW:13.9%;
LRK: 56.7%.
PWID: 9.1%)
FSW: KHI:
46%; SKR:
0%; LREK:
5.9%.
QTA: HIV
test: SDP
last 6 mos
2%
30%
N/A
PWID: 2.2%; 60%
90%
HSW: 1%;
MSW: 0%;
FSW: 58.9%
58
N/A
N/A
Number of
women and
men who
received HIV
test in the
last 12
months and
know their
status
Recommend
deleting this
indicator.
Collecting a
number without
a baseline to
measure
coverage or
without having
any
understanding of
the transmission
does not tell us
anything about
the epidemic.
N/A
TBD
N/A
N/A
N/A
30%
N/A
N/A
N/A
N/A
Testing
services
utilized in
last 6
months by
city: (PWID:
MLT: 0%;
FBD: 0.5%;
SGD: 0%;
LHR: 0%;
DGK: 5.5%);
(MSW: LHE:
0%; FSB: 0%;
MUL: 0%;
RWP: 50%);
(HSW: : LHE:
7%; FSB:
4.2%; SGD:
4.8%; MUL:
0%; RWP:
40%); (FSW:
LHE: 0%;
FSB: 0%;
SGF: 0%;
MUL: 2.6%;
RWP: 0%;
DGK: 5%)
N/A
N/A
N/A
60%
Rec
om
men
d
rem
ovin
g
Rec
om
men
d
rem
ovin
g
60%
90%
Recom
mend
removi
ng
Recom
mend
removi
ng
Recom
mend
removi
ng
Rec
om
Recom
men
mend
4297
N/A
N/A
N/A
d
removi
rem
ng
ovin
g
OUTPUT: 2.2 Improve quality andcoverage of medicalmanagement and ARTfor people living
withHIV/ Scaled up coverage and quality of medical management and ART for people living with
HIV
Disaggregate by
100
Number of
age and gender.
N/A
5000
N/A
N/A
90%
00
eligible
Suggest aligning
adults and
this indicator
children
with GARPR and
1405
currently
new 2020 Target
till Oct
273
542
1638
N/A
90%
receiving ART Indicators:
2014
0
either 1)
(86%)
59
Number
/Percentage of
adults and
children
currently
receiving
antiretroviral
therapy among
all adults and
children living
with HIV or 2)
Number/Percent
age of adults
and children
living with HIV
who receive
access to
antiretroviral
therapy
2%
240
370
N/A
60%
90%
900
2500
N/A
N/A
500
0
90%
N/A
N/A
N/A
N/A
N/A
90%
N/A
90%
N/A
N/A
90%
90%
TBD
TBD
N/A
N/A
TBD
90%
83%
90%
N/A
N/A
100
%
90%
N/A
N/A
N/A
N/A
N/A
90%
N/A
N/A
N/A
N/A
N/A
90%
TBD
TBD
N/A
N/A
TBD
90%
61%
80%
N/A
N/A
100
%
90%
Latest
SPECTRUM
projection data
for "needing
ART" should be
used to
determine
baselines for
2020 targets and
2016 where they
are not
available. Need
both number
and coverage
rates.
Percentage of
adults and
children with
HIV known to
be on
treatment 12
months after
initiation of
ART
Disaggregate by
age and gender.
Percentage of
estimated
HIV +ive
incident TB
cases that
received
treatment
both for TB
and HIV
(Need to get
from
Treatment
data)
Disaggregate by
age and gender
Could
consideralso
collecting this
indicator at the
actual level: %
of registered
clients on ART
testing TB
positive
receiving ART
and TB
treatment.
OUTPUT: 2.3 Improve quality and coverage of care, support and social welfare for people living
with HIV and their families/ Increased coverage and quality of care, support, and social services for
people living with HIV
60
Number of
registered
PLHIV
receiving
CHBC support
(Need to get
from CHBC
data)
Percentage of
registered
PLHIV and
their families
receiving
support from
Social
Welfare
Programmes
(Need to get
from CHBC
data)
Can this be
converted to a
coverage rate"
Suggest % of
registered PLHIV
eligible for care
and support
receiving care
and support
(proxy indicator
for care and
support
suggested to be
transport
facilitation). It
is not clear if
the CHBC model
is going to
remain and
COPC+ currently
also provides
C&S.
Recommend
deleting this
indicator.
Depending on
Social Welfare is
too unreliable.
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
50%
TBD
N/A
N/A
TBD
TBD
240
N/A
N/A
480
TBD
50%
N/A
N/A
60%
TBD
N/A
N/A
N/A
N/A
50%
N/A
N/A
0%
N/A
50%
N/A
0%
N/A
Ibid
N/A
80%
N/A
N/A
50%
Recom
mend
removi
ng
Recom
mend
removi
ng
Recom
mend
removi
ng
Recom
mend
removi
ng
OUTCOME 3: Policy Environment and AIDS Programme Response is Enhanced and Sustained for HIV
prevention, treatment, care and support
Recommended
Current HASP
201
Indicators
changes to
Baseline
2014
Achiev
2011/GARP
2020
6
indicator
ements R 2013
3.1 Supportive public policy environment in place to scale-up service
Increased
score for
supportive
policy
environment
by 2016 (NCPI
>8)
This needs to be
scored province
by province at
the time of the
NCPI during the
GARP process.
Currently
although
provinces are
consulted, the
score is
aggregated at
the national
level.
N/A
N/A
N/A
N/A
>8
>8
5
5
5
2013 GARPR
3.2
>8
>8
TBD
TBD
5
2013 GARPR
3.2
>8
>8
N/A
N/A
N/A
GARPR 2013:
>5
>8
>8
2
N/A
N/A
2
4
2
Individ
ual
N/A
2
4
OUTPUT: 3.2 Multi-Sector Coordination enhanced
Two multisector
coordination
List of regular
participants
should be
1
1
61
meetings held
per year
drafted
Mtgs
only >2
1
2
N/A
N/A
2
4
1
2
Ibid
N/A
2
4
OUTPUT: 3.3 Enhanced use of strategic evidence to monitor and evaluate coverage, quality and
impact/Strategic Evidence generated for planning and tracking the response
ADD DATA
Periodic IBBS
reports
produced.
KP DOES NOT
HAVE THIS
INDICATOR SUGGEST
ALIGNING
WITH OTHER
PROVINCES
M&E Unit
established
and staffed at
PACP
Define
"periodic" - how
many before the
end of 2020?
Would consider
removing this
indicator as it
is a once-only
achievement
(if keeping then
List of functions
and
qualifications
should be
drafted)
2011
2011
2011
IBBS R IV
201
5
TBD
2011
2011
2011
IBBS R IV
201
5
TBD
x
TBD
IBBS R IV
201
5
TBD
2011
N/A
x
N/A
N/A
x
TBD
TBD
No
N/A
x
N/A
x
1 staff
N/A
x
N/A
N/A
N/A
N/A
x
Recom
mend
removi
ng
Recom
mend
removi
ng
Recom
mend
removi
ng
Recom
mend
removi
ng
This indicator
would suggest
N/A
N/A
N/A
N/A
2
2
that an MIS
SUGGEST
system is set up
ADDING FOR
in each province N/A
N/A
N/A
N/A
2
2
ALL
that is coherent
PROVINCES:
N/A
N/A
N/A
N/A
2
2
with any other
Number of
MIS systems
M&E reports
being used by
generated by
SDPs (similar
a functioning
data collection
MIS system
tools, indicators
(inclusive of
and a system of
all public and
N/A
N/A
N/A
N/A
2
2
feeding
private HIV
information up
service
to PACP). The
delivery)
type of report
would have to
be determined.
OUTPUT: 3.4 Increased sustainability of the response/Resources mobilized for sustainability of the
response
Of the total
Would be useful
needed
to have a
30%
resources,
baseline here:
fro
20%
40%
N/A
N/A
60%
public sector
"increased
m
allocation for
annually by 10%
60%
HIV programs
from…"
62
is
proportionatel
y increased by
10 % annually
VII.
Would be useful
to have a
baseline here:
"increased
annually by 10%
from…"
Would be useful
to have a
baseline here:
"increased
annualy by 10%
from…"
Would be useful
to have a
baseline here:
"increased
annualy by 10%
from…"
40%
60%
?
N/A
60%
60%
20%
40%
N/A
N/A
60%
TBD
20%
40%
N/A
60%
TBD
Ibid
Implementation
Arrangements
VII.1. Governance and Coordination of the response
All Strategies mention a Provincial Steering Committee (PSC) to coordinate the
provincial response. Sindh’s strategy states that their PSC is chaired by the Minister
of Health and has been notified by the DOH. The MTR did not find any evidence
that any PSC was functional in any province, and only few of the activities
indicated under this section, have been implemented mostly in Punjab given the
status of their PC-1 and release of funds.
VII.2. Contracting and Public-Private partnership
Mentioning the specific Government procurement policy or notification that the
province follows for contracting of service providers could strengthen this section.
As PPP is in itself a proven strategy for implementation in Pakistan, a brief
explanation here of its implementation efficacy since 2005 would be helpful in
elucidating the SDP concept given almost all programming is implemented through
this model. It is also proposed that contracts include a community involvement
component whereby organisations that are not 100% community-based should be
required to hire a certain percentage from the community they serve under that
contract – not just outreach staff but management and even Board members where
appropriate and possible.
63
VII.3. Capacity building and technical assistance
Capacity building activities are included throughout the Outputs and Output
Strategies. Although the strategies mention capacity plans to be developed on a
yearly basis or spelled out in detailed action plans, no evidence of a capacity
building plan was seen during the MTR. It was evident that some capacity building
had taken place over the last two years, primarily through the support of UN
agencies. While some capacity building needs may be unforeseen, a broad-stroke
capacity building plan should be part of the revised AIDS Strategies including
foreseen capacity building exercises to reach proposed targets through 2020.
VII.4. Financial management
The Punjab AIDS Control Strategy only includes this section but limited to
reference for resource mobilization. No resource mobilization plan was shared by
Punjab during the MTR. The Outcome 3 covers resource mobilization and therefore,
this aspect should be replaced with reference to specific Government processes
utilized to ensure transparency and accountability in financial management.
VIII.
Monitoring, Evaluation & Research
VIII.1. Monitoring
Monitoring was found to be a weakness throughout the provinces. Several key
issues were identified: 1) lack of coherence between monitoring of SDPs
(Government and otherwise) and GF monitoring (same indicators not being
reported on); 2) lack of coordination of strategic information at the provincial level
(data aggregation, monitoring plans, research focus, piloting of innovative
strategies etc were not being collated and analysed on GF supported and Provincial
ACPs supported SDPs, despite a specific GF supported Coordinator placed in Punjab
and Sindh ACPs); 3) Lack of provincial aggregated data, based on SDP and GF
services, to indicate the achievement against the indicators and targets set in the
strategies. While it is unrealistic at this point to merge existing MIS’s (GF and ACP
supported) and /or expect all service providers to use the same, there is a need to
create coherent data collection tools (same indicators), coherent means of analysis
among the different MIS, and a coherent system of reporting data from service
providers up through ACPs and the NACP for reporting on international
64
commitments, and from District through Provincial through National for HIS
indicators (see The Results Framework through 2020).
While the Monitoring Framework is similar for all provinces, many of the indicators
rely on IBBS for their means of verification and are not collected at field level.
Round V of the national IBBS is meant to get underway with Global Fund and
UNAIDS support in 2015 and Punjab has reportedly completed their provincial IBBS
although this MTR was unable to incorporate data as the results had not yet been
made available. WHO-supported Epi Sythesis of the data based on Round IV IBBS
and current program data is also underway and will indicate the trends of HIV
epidemic by province. The results of national IBBS and Epi Synthesis should form
the basis of new official estimationsand projections. The only survey conducted
during2012-2014 was the national survey on drug use, including injecting drug use,
conducted by the Pakistan Bureau of Statistics, in coordination with the Narcotics
Control Division and with support from UNODC and the United Nations Country
Team published in 2012. As the estimated number of people who inject drugs
wasalmost four times the previous Government estimated number, UNAIDS and the
National AIDS Control Programme are waiting results from both the Punjab and the
upcoming country-wide IBBS for triangulation before a new official estimation of
PWID will be reported.
VIII.2. Evaluation
While GF supported projects up to now may have conducted operational
evaluations of their service provision models, no evaluation reports weremade
available for the MTR. The only evaluation reviewed was the Punjab AIDS Control
Programme's Third Party Evaluation (End Project Evaluation) of the Enhanced
HIV/AIDS Control Program Phase II (2009-13) conducted by Development Health
Systems Evaluation in June 2013. In the absence of programme data or IBBS results
for Punjab, data from the evaluation was used when possible, given it is the most
current information.
VIII.3. Research
While GF supported projects may be conducting their own research, the only other
research has been partially conducted by APLHIV under APN+ regional PLHIV grant.
No other research has been conducted from 2012-2014.
65
IX.
Resource needs
All Provincial AIDS Strategies outline their resource needs in broad strokes52based
on the estimated costs of interventions outlined in the Strategy. Based on the
review of the provincial strategies, a Costing Consultant is currently costing current
and planned interventions and management arrangements through 2020 for the PAS
III. The costing analysis, based on both planned (AIDS Strategies and PC-1s) and
actual costs (current implementation), The costing analysis should be finalized by
February 2014 and will be available for Provincial AIDS Strategy revisions.
For example, Advocacy costs are broadly estimated to be 5% in the first year of Strategies and 7%
thereafter.
52
66
Annex I.
Key Findings and Gaps by Province
Khyber Pakhtunkhwa
OUTCOME 1: HIV prevalence is reduced among KP and is maintained at <0.1% in the General
Population
STRATEGIES
FINDINGS
GAPS
OUTPUT 1.1 Increased coverage (80%) of effective HIV prevention
drug users and their sexual partners
1.1.1 Establish
• The PWIDs projects in KPK are currently being
comprehensive
supported through GF and ANF resources.
HIV prevention
• There are no SDPs awarded on PWIDs in the
services for
province.
people who
• 02 NGOs are working with PWIDs in the
inject drugs in
province, NZ and Dost Welfare in Peshawar.
Peshawar and
• Detox facilities are available in 12 Tertiary
expand to other
and Secondary Public Sector Hospital but most
cities where
are dormant and quality of detoxification
evidence of
services in relation to international standards
injecting drug
are not established.
use exists.
• Absence of formal referral mechanism from
PWIDs harm reduction services to HIV related
services.
• There is no OST project in the province.
• NZ plans to expand ART adherence unit (AAU)
under NFM of GF grant. The unit prepares
PWIDs for ART initiation and adherence.
programmes for injecting
• Absence of linkages
with free detox/rehab
services in public/private
sector to support
preventions and harm
reduction strategies
• Absence of the need to
have coordinated and
joint MIS & monitoring for
public and private sector
interventions. Lack of
coordination for transfer
in/out patients
1.1.2
Improve See above
See above
access to quality
harm reduction
services through
combined public
and
private
service delivery
models
in
Peshawar.
OUTPUT 1.2: Scaled up coverage of prevention services to progressively reach 60% of
Transgender people and other KP
1.2.1
Re- • NO SDPs extended nor any GF grant available • The current strategy
establish
for interventions related to TGs, Male/Female does not mention the
comprehensive
sex
workers
or
other
KPs. need of trainings of the
HIV
prevention • NGOs in KPK have no formal experience of stakeholders to work with
interventions for working on TGs, Male/Female sex workers or TG, M/F sex workers
Transgender
in other KPs.
population
priority districts,
• The strategy does not
through
mention if there is a need
community-based
to do mapping of TG, M/F
approaches.
Sex Workers.
1.2.2
Enhance • No operational research has been conducted IBBS is mentioned under
understanding of on any HIV intervention in the province. • No 3.3.1 but lacking details
dynamics of sex progress has been made on understanding the on the population to be
work
– dynamic of sex work.• No study is planned to assessed. DoH having an
female/male
– understand the dynamics. • There is no M&E
unit
led
by
for
informed strategy for advocacy to disseminate or Epidemiologist with skills
programming
improve programme implementation based on and
experience
of
the finding of a study.
developing
research
concepts is lacking in the
67
current strategy.
1.2.3 Reach sex
workers
–
female/male
–
with
essential
prevention
interventions,
including through
participation of
peers.
• NO SDPs extended nor any GF grant available
for interventions related to TGs, Male/Female
sex
workers
or
other
KPs.
• NGOs in KPK have no formal experience of
working on TGs, Male/Female sex workers or
other KPs.
• The current strategy
does not mention the
need of trainings of the
stakeholders to work with
TG, M/F sex workers
population
• The strategy does not
mention if there is a need
to do mapping of TG, M/F
Sex Workers
OUTPUT 1.3: Improved access to HIV prevention among selected Vulnerable Populations
1.3.1Develop
pre-departure
prevention
education
for
intending
migrants, and a
referral system
to HTC, ART and
PPTCT
for
returning
migrants
and
their families.
• Significant segment of population in KPK and
FATA working in middle eastern countries being
deported for their HIV positive status
• Un regulated movement of travellers and
refugees between Pakistan and Afghanistan
borders is contributing to the problem
• No progress has taken place for introducing
HIV prevention activities for migrant workers or
at risk adolescents. This includes the effort by
DoH to extend SDP(s) or acquiring donor
funding.
• The population of migrant workers is not
among the KPs. Therefore this population has
not been assessed under Surveillance system or
IBBS.
• Further, DoH has made little effort to involve
the Ministries of; Labour, Overseas, Home
department
or
FIA.
• No research has been undertaken to assess
the magnitude of the issue related to migrant
workers, adolescents etc.
1.3.2 Provide HIV
prevention
for
prison
inmates
through
integration
in
prison
services
and their referral
to ART.
• No Prison related SDP have been awarded in
KPK.
• An initial sensitization of Prison officials and
staff in Peshawar with testing, referral to ART
has started recently.
• DoH has not developed Manual for HIV
services in Prison
• UNODC undertaken a limited training of
prison official and staff and has not conducted
a research
• UNODC has recently undertaken consultation
with DoH to develop Provincial strategies for
HIV prevention in prisons.
• The co-infection of Hepatitis B and C is not
being addressed.
• DoH has not undertaken sensitization of the
Home Department of KPK.
• The current strategy
has not defined the other
population under this
strategy, such as people
daily crossing Pak/Afghan
Border in the province,
the deportees from the
Middle Eastern countries
etc.
• The current strategy
has
not
proposed
activities with Ministries
of; Labour, Overseas,
Home department or FIA
• Research to assess the
magnitude of the issue
related
to
migrant
workers, adolescents etc.
• Base on the evidence of
the issues surrounding
migrant workers, priority
of
introducing
intervention
for
this
population of migrant
workers be established.
• The strategy had not
taken into consideration
that special effort will be
required for developing
MIS, protocols on data
sharing/reporting, and
monitoring for
interventions in the
prison.
• The strategy does not
mention services for
spouses/partners of
prisoners with HIV
infection.
• The strategy states
Prisons department to
assume the responsibility
of providing budget
68
related to HIV
intervention, but
understates the need for
regular capacity building
of the prison
management and staff,
keeping in view the
regular staff turnover in
public sector.
1.3.3 Mainstream
and support HIV
prevention
education
and
services
for
vulnerable
populations
in
health, education
and
other
relevant sectors.
ADD: 1.3.4 Scale
up PPTCT for
vulnerable
women through a
focused
and
integrated
approach.
• There is 01 PPTCT site in the province at HMC
which is functioning in limited manner.
• Few HIV positive cases have been identified
through
referral
from
other
sites
• Unicef has provided support through trainings
of HCPs and safe delivery kits. However CS-Kits
were made available but not available anymore
• Nurses/staff have beentrained butthe
numbers and capacity is inadequate and may
have resulted in turning away cases requiring
PPTCT
services.
• The HIV testing of risky cases in the
Gynaecology units have not yielded any HIV
positive case requiring PPTCT services. The
cases for PPTCT services have mostly been
referred by units outside the centres.
• The strategy has been
PPTCT centric and not
focused on reaching out
for communities where
high risks/ HIV cases have
been identified. There is
significant risk that
unknown number of
potential cases may have
been reluctant to access
the PPTCT services either
due to distance to the
site, transportation cost,
fear of stigma and
discrimination or due to
ignorance about the
available services.
• The strategy has not
focused on enhancing the
referrals from community
sites.
• The capacity
building/sensitization of
the adjacent
Gynaecology units
(especially senior HCP
and nurses) to PPTCT
sites has not been
focused.
OUTPUT 1.4: Increased uptake of PPTCT services by Women
OUTCOME 2: HIV-related Morbidity and Mortality is reduced, and the Quality of Life of
People Living with HIV is improved
STRATEGIES
FINDINGS
GAPS
OUTPUT 2.1: Increased coverage and quality of HTC
2.1.1
Increase • No SDPs on VCT PWIDs, Transgender, Sex
availability and Worker
&
Prison
uptake of HTC • There are 6 VCT sites (2 each in public,
for KP and other private and camps) established in the province
• There has been no
strategy on scaling up CB
testing.
• The massive increase in
69
vulnerable
populations
through
targeted
approach.
a
providing HTC. The private sector includes 2
CHBC and 2 sites in the Refugee camps being
managed
by
UNHCR.
• The plan to ensure the HTC services are
available at each district has not been
developed.
• Similarly negligible trainings/ refresher on
VCT have taken place since the development of
current
strategy.
• However linkages have been established
between CHBC and ART sites
See above
HIV testing also required
a comprehensive quality
assurance and quality
certification
system,
which was not considered
in the strategy.
2.1.2 Mainstream
See above
and support HTC
in general health
services
in
selected districts
through PITC.
RECOMMEND ADDING
Add: 2.1.3 Ensure sustainability of procurement and supply chain management of HIV diagnostic
kits
Add: 2.1.4 Establish quality assurance mechanism through referral lab
OUTPUT 2.2: Scaled up coverage and quality of medical management and ART for people
living with HIV
2.2.1
Reduce • There are 02 ART sites in the province, •
There
was
no
barriers to ART Peshawar and Kohat, providing ART services awareness
raising
for
PWID, • 1440 patients have been registered till to- activities suggested for
Transgender and date with significant number lost to f/u. ART
services.
other KPs.
• CD4 facility is available; however Viral load is • Further, Protocols or
not being conducted in the province and support for Post Exposure
samples
sent
to
Islamabad. Prophylaxis
(PEP)
in
• There has been no stock out of ARVs. health settings have to
• Health care providers at ART and PPTCT sites be established and widely
have
received
trainings. disseminated to reduce
• Transportation cost to the ART site is the stigma and discrimination
biggest
barrier. in the health settings.
• Protocols or support for Post Exposure •
No
training
on
Prophylaxis (PEP) in health settings have not treatment adherence was
been established, to develop confidence of proposed in the strategy.
HCPs to manage HIV cases. The wider The trainings are likely to
dissemination on the availability of PEP service address many of the
has
not
taken
place. technical, management
• No services available for terminally sick cases and social barriers which
through
palliative/hospice
care. can negatively impact the
• No linkage with social services (Bait ul Mal, access to ART services.
Zakat, BISP etc.)
• There is no plan to
undertake
PharmacoKP is currently absorbing the burden of FATA vigilance to track trend
patients through GF and Government funding.
of
resistance
being
developed in people on
ART.
• Lastly, no monitoring or
an evaluation has been
proposed
on
client
satisfaction for the ART
services.
2.2.2
Expand See above
See above
treatment
services
geographically to
70
improve access
and adherence.
2.2.3
Improve
referral linkages
within
the
continuum
of
treatment
and
care,
including
for TB.
2.2.4
Ensure
sustainability of
procurement and
supply
chain
management of
ART
• The community service providers like CHBC
sites are linked with ART services and regular
client
referral
is
taking
place.
• However, referral from ART centres to the
community service providers is weak. Moreover
the entire referral mechanism is weak, not
documented or formalized. No referral
mechanism established for prisoners, IDPs and
Refugees to access the relevant services
• The ART services are linked with TB DOTS and
contributing in the continuum of care.
• The coordination for a comprehensive CoC is
weak and no formal and regular meetings are
held among the relevant stakeholders.
• The absence of an integrated MIS has
contributed to weak referral, coordination and
monitoring
mechanism
from
BACP.
• No meetings on CoC has taken place between
relevant stakeholders in the province.
Further,KP is currently absorbing the burden of
FATA patients through GF and Government
funding.
• No formal PSM unit is established at DoH,
other than one procurement staff. • DoH is not
undertaking procurement of ARVs, however
supply of ARVs to all the ART sites is the
responsibility of DoH. It has a storage room
which does not meet international storage
standards.• No formal quantification and
forecasting system is followed at DoH and the
supplies are received from NACP on Push
system, rather than the Pull system.• No
regular monitoring of ART sites is being carried
by DoH and further the monitoring lacks the
coordination with related stakeholders.
OUTPUT: 2.3 Increased coverage and quality of care, support, and
living with HIV
2.3.1
Build
linkages
with • No linkages have been established by any
social
welfare stakeholder with Social Welfare department,
programmes/initi Zakat, Bait ul Mal and Benazir Income support
atives for PLHIV program
(BISP).
and
their • No sensitization of Social Welfare Department
families.
has taken place on HIV.
2.3.2
Establish
referral of PLHIV
between
preventionoutreach, HTC,
• There have been two CHBC service providing
sites in the province till recently and they have
been referring cases for CHBC services to ART
site
in
Peshawar
and
Kohat.
• However, no documentation of referral is
• There is no strategy
developed for improving
the case holding. Further
there
is
no
focus/
capacity
/
resources
available for patients
follow up at ART site.
•
There
is
no
role/contribution
mentioned
of
the
Association for PLHIV in
ensuring CoC in the
province.
• A formal referral
mechanism
among
relevant stakeholders and
monitoring the quality of
referral and its follow up
is not mentioned in the
strategy.
•
The
role
of
establishment of Logistic
MIS
has
not
been
considered
in
the
strategy.
social services for people
• The linkages of the
APLHIV officewith social
services have not been
ensured in the strategy
•
Likewise
the
development
of
the
capacity
building
of
APLHIV chapter of the
province to advocate,
facilitate and improve
the linkages with social
services in the province
has not been mentioned
in the strategy.
•
Formal
referral
mechanisms
among
relevant stakeholders is
not
present
• The strategy does not
71
CHBC
treatment
centers.
and
mention the importance
of monitoring to assess
the quality of referral its
mechanism
and
how
follow
up
will
be
undertaken.
MISSING: An output strategy on providing care and support services through NGO partners.
2.3.3
Support
peer
and
community
advocacy
organisations and
networks
in
advocacy
for
care and support.
available.
• The APLHIV chapter has opened in the
province
and
is
operational
• Advocacy of APLHIV limited to service
delivery
points
and
not
with
wider
stakeholders.
• There is no training
mentioned for PLHIV on
advocacy
and
networking.
OUTCOME 3: Policy Environment and AIDS Response is Enhanced for HIV prevention,
treatment, care and support
STRATEGIES
FINDINGS
GAPS
OUTPUT 3.1 Enabling Policy environment ensured
3.1.1
Reinvigorate and
implement
targeted
and
sustained
advocacy actions
among
policymakers,
parliamentarians,
community
religious leaders,
and media.
3.1.2 Contribute None found
No Findings
to national and
provincial
assessments
of
policies
that
either hamper or
facilitate access
to HIV services.
OUTPUT 3.2: Multi-Sector Coordination enhanced
3.2.1
Organise None found
No Findings
regular provincial
coordination
meetings,
inclusive of civil
society,
community
organizations and
relevant sectors.
3.2.2
Ensure None found
No Findings
enhanced
participation of
the Home Dept.,
BEOE, Education
Dept.,
Social
Welfare
OUTPUT 3.3: Strategic Evidence generated for planning and tracking the response
72
3.3.1 Undertake None found
No Findings
Integrated
Biological
and
Behavioural
Surveillance
periodically with
progressively
increasing
geographic
coverage
and
KPs.
3.3.2 Strengthen None found
No Findings
M&E and HIV
research capacity
at the provincial
level.
OUTPUT 3.4: Resources mobilized for sustainability of the response
3.4.1
Reduce
costs of the HIV
response through
efficiency
improvements.
3.4.2
Increase
domestic
resource
allocation
for
sustainability of
response.
3.4.3
Mobilise
and
align
external
resources
for
implementation
of priority HIV
strategies.
None found
No Findings
None found
No Findings
None found
No Findings
SINDH PROVINCE
OUTCOME 1: HIV prevalence is reduced among KP and is maintained at <0.1% in the General
Population
STRATEGIES
FINDINGS
GAPS
OUTPUT 1.1 Increased coverage (60-80%) of effective HIV prevention programmes for
injecting drug users and their sexual partners
73
1.1.1
Reach
between 60 to 80%
of people who
inject drugs and
their spouses with
prevention,
care
and
support
services.
1.1.2 Improve the
quality of harm
reduction services
provided
in
accordance
with
national
and
international good
practice
1.1.3
Evaluate
existing models for
comprehensive
services for people
who inject drugs,
spouses
and
partners
and
disseminate good
practices
• PWIDs projects being supported through PC1, GF and UNODC. GF and Government
providing bulk of resources but UNODC
providing
limited
assistance.
• 7 NGOs are providing prevention services to
PWIDs
• 3 SDPs have been extended from PC-1, to 4
NGOs, with targets of 25% coverage for PWIDs
population
• 1 GF grant is providing support to 3 NGOs in
9 districts for coverage of 42% of PWIDs
population
• The prevention services include NSEP, PHC,
STI, VCT, Spouse testing and support
• There are few NGOs providing detoxification
and
rehabilitation
services
• There is no OST project in the province.
However, the budget related to OST was
available in the previous PC-1 as well as the
new proposed PC-1. Pilot OST is under
planning.
• Separate monitoring being conducted by
SACP and NZ for their respective grant
projects.
• NZ plans ART adherence unit in KHI under
NFM of GF grant. NZ has been bringing
patients with lower CD4 for registration (NZ
clients) due to the facility of AAU and thus
reducing the hardships of transporting the
patients twice, i.e., once for registration and
once for eligibility of ART.
• No progress has been made on evaluating
the existing services models, referral system
or coordination on essential or comprehensive
(including detox and rehab) services for PWIDs
in SDPs (supported by PC-1) or CoPC+ sites
(supported by GF) or Female DUs/IDUs
(supported
by
UNODC).
• The SDPs on PWIDs were late in starting,
after 2012 strategy, and since July 2014, are
not being implemented due to non-approval
of new PC-1. Therefore no effort has been
made
to
evaluate
them.
• The MIS of different PWID related
interventions in the province have not been
evaluated.
• The COPC+ concept of NZ where social
support to spouses and CD4 testing is provided
has
also
not
been
evaluated.
• There is no strategy for advocacy to
disseminate
or
improve
programme
implementation based on the finding of an
evaluation.
• Absence of linkages with
free detox/rehab services
in public/private sector to
support preventions and
harm reduction strategies
• Absence of the need to
have coordinated and joint
MIS & monitoring for public
and
private
sector
interventions.
Lack
of
coordination for transfer
in/out patients
• Evaluation of newly
emerging models on PWIDs
interventions
was
not
mentioned in the current
strategy.
OUTPUT 1.2: Increased coverage (60%) of effective HIV prevention for the transgender
community and other Key Populations.
74
1.2.1 Reach 60% of
Transgender with
comprehensive
prevention,
care
and
support
services
1.2.2 Maintain HIV
prevention
outreach,
programs
and
surveillance
for
male/female sex
workers and for
MSM in selected
cities
• The SDPs do not differentiate between TGs,
MSMs,
MSWs
and
HSWs.
• PC-1 and GF Regional funding is available
for
projects
on
this
population.
• There are 3 SDPs with one each in KHI,
Sukkur,
Hyderabad.
• 5 NGOs and 5 CBOs are working for this
population with community based approach–
• NGOs are working with adolescents but not
being specifically supported.
• Confidentiality is being
compromised at treatment
facilities where for testing
and
subsequently
for
treatment protocols are
not
followed;
• TGs have persisted with
male gender option in CNIC
and create difficulty in
data calculation for TG
specific interventions; No
operational research has
been conducted on TGs,
specifically on stigma and
discrimination at health
facilities; No linkages with
social welfare have been
established
OUTPUT 1.3: Reduced risks of HIV transmission among vulnerable populations through
mainstreaming into health and social sectors.
1.3.1
Implement
HIV
prevention,
treatment,
care
and
support
services
across
prisons.
• Prison intervention supported through PC-1
grant
and
UNODC
• 1 SDP has been extended through one NGO
(SBB) in 10 out of the total 23 prisons in 4
districts of the province with KHI-4, HYD 3,
SKR-2
&
LRK-1.
• It has targeted 18,000 of the total 24,000
prisoners
in
the
province.
• The services include PHC, STI infection,
VCCT, registration awareness sessions, syringe
exchange if PWID need and ART support when
required. The doctors are available in Prisons
to oversee the intervention but counsellors
are
not
available.
• The co-infection of Hepatitis B and C is not
being
addressed.
• SACP has not undertaken sensitization of
the Home Department of Sindh. However,
Superintendents of Prisons and other relevant
prison staff (where interventions have been
initiated) have been sensitized on the issue
and
intervention.
• UNODC has conducted a research on male
prisoners and supporting female IDUs in
prisons which provides limited information on
this situation in the province. (Report
awaited).
• The requirement to revise prison manual
has not been ascertained.
• The strategy had not
taken into consideration
that special effort will be
required for developing
MIS, protocols on data
sharing/reporting,
and
monitoring
for
interventions in the prison.
• The need for revision of
Prison Manual was not
suggested in the strategy.
• The strategy states
Prisons
department
to
assume the responsibility
of providing budget related
to HIV intervention, but
understates the need for
regular capacity building of
the prison management
and staff, keeping in view
the regular staff turnover
in public sector.
75
1.3.2
Generate
evidence
on
adapted
approaches
to
reducing
HIV
vulnerability and
provision
of
services
for
migrants,
at-risk
adolescents
and
other populations.
• No progress has taken place for introducing
HIV prevention activities for migrant workers
or at risk adolescents. This includes the effort
by SACP to extend SDP(s) or acquiring donor
funding.
• The population of migrant workers is not
among the KPs. Therefore this population has
not been assessed under Surveillance system
or
IBBS.
• Further, SACP has made little effort to
involve the Ministries of; Labour, Overseas,
Home
Department
or
FIA.
• No research has been undertaken to assess
the magnitude of the issue related to migrant
workers, adolescents etc.
1.3.3 Mainstream
and
support
services
for
vulnerable
populations
in
public
sector
health services.
• There were 03 PPTCT sites in the province
with 2 operational and one closed.
• 48 positive pregnant women have been
referred through ART centres for PPTCT
services.
• The HIV testing of risky cases in the
Gynaecology units have not yielded any HIV
positive case requiring PPTCT services. The
cases for PPTCT services have mostly been
referred by units outside the centres.
• PPTCT sites are supported by UNICEF
through safe delivery kits and training of
doctors.
• Lately safe delivery kits have not been
made available at the PPTCT sites.
• Stigma and discrimination has been
reported by Senior HCP (Gynaecologist) in
adjacent ward to the PPTCT Centres, for
management or admission of potential cases
in
their
units.
• The referral from service delivery points
(SDPs, CHBC and CoPC+) has been weak for
cases
requiring
PPTCT.
• The staff numbers and capacity (as
informed by clients) is in-adequate and has
resulted in turning away cases requiring
PPTCT services.
1.3.4 Mainstream
and
support
preventive
education,
HTC
and STI services
reaching
vulnerable
populations
through relevant
health and social
sectors
• SACP has shown moderate progress in
mainstreaming HIV in relevant health and
social sectors. SACP was able to establish a
number of HTC in various public sector
hospitals and through its SDPs, while the GF
grant has also established HTC through its
CHBC
and
CoPC+
sites.
• The STI services are generally weak and
inadequate in public sector while none are
available under GF grant interventions. The
drugs are not available nor are the
• The current strategy has
not defined the other
population
under
this
strategy
• The current strategy has
not proposed activities
with Ministries of; Labour,
Overseas,
Home
department
or
FIA
• Research to assess the
magnitude of the issue
related
to
migrant
workers, adolescents etc.
• Base on the evidence of
the
issues
surrounding
migrant workers, priority
of introducing intervention
for this population of
migrant
workers
be
established.
• The strategy had been
PPTCT centric but has
started
focusing
on
reaching
out
for
communities where high
risks/ HIV cases have been
identified as in Larkana.
There is a significant risk
that an unknown number
of potential cases may
have been reluctant to
access the PPTCT services
either due to distance to
the site, transportation
cost, fear of stigma and
discrimination or due to
ignorance
about
the
available
services.
• The strategy has not
focused on enhancing the
referrals from community
sites.
•
The
capacity
building/sensitization
of
the adjacent Gynaecology
units (especially senior
HCP and nurses) to PPTCT
sites has not been focused.
• The linkages with Blood
Transfusion Authority were
not suggested in the
current
strategy
for
mainstreaming
HIV
in
health
services
and
regulation of public and
private blood banks for
ensuring
quality
HIV
testing.
• Similarly a linkage with
76
investigations freely available for STI cases in
public sector STI clinics. Patient end up
spending out of their pockets for management
of STI among HIV and high risk cases.
• The infection control and waste
management is also a weak area for the
testing centres, who find it difficult to
properly dispose their used products, due to
dearth of waste management infrastructure in
most of the province. The GF grant projects
under Nai Zindagi courier disposedsyringes
and waste products to the known incinerators
sites
for
proper
disposal.
• A large number (hundreds of thousands) of
blood bags are screened for HIV in public and
private blood banks and similarly unknown
numbers of HIV tests are performed by
private laboratories in the province.
Unfortunately, both the blood banks and the
private laboratories are not been regulated in
the
province.
• Meanwhile the linkage with TB program has
resulted in ensuring that TB treatment
services (TB DOTS) are available for the
referred
HIV
cases.
However,
the
identification and subsequent referral of HIV
cases from TB program has been very weak,
even though thousands of TB cases get
screened
for
HIV
in
DOTS
clinics.
• Similarly, hospitals conducting routine HIV
tests for surgery and blood transfusion (like
DHQ Larkana -17000 test in one year) report
zero case detection of HIV. One of the
plausible reason maybe the kits being used for
testing are not WHO qualified, beside the fact
that HIV prevalence in general population is
less than 0.1% and therefore the likelihood of
HIV identification remains very low during
routine screening.
Health
Regulatory
Authority for regulation of
HTC in private laboratories
was
not
suggested.
• Linkages with Provincial
Disaster
Management
Authority (PDMA) has also
not been suggested to
build the capacity of
service providers during
disaster or relief of people
being displaced and having
potential high risk cases.
1.3.4: “Scale up PPTCT services in a phased approach selected districts in all divisions”.
OUTCOME 2: HIV-related Morbidity and Mortality is reduced, and the Quality of Life of People
Living with HIV is improved
STRATEGIES
FINDINGS
GAPS
OUTPUT 2.1: Increase quality and coverage of early diagnosis of HIV through HTC and
provider-initiated testing and counselling (PITC)
2.1.1
Increase
availability of HTC
for Key Affected
and
other
vulnerable
populations
through a targeted
approach.
• Significant numbers of sites in the province
are
providing
HTC/PITC.
• The PC-1 supported SDPs on PWIDs,
transgender; sex workers and prison have
HTC/PITC. Further the CHBC and CoPC+ sites
supported by GF grants have similar services.
• The trainings on VCCT have become
infrequent and most of the new sites in last
• There has been no
strategy on scaling up CB
testing.
• The massive increase in
HIV testing also required a
comprehensive
quality
assurance
and
quality
certification system which
77
year or so have not had their staff trained, was not considered in the
while few refresher trainings were offered. strategy.
• VCCT centres have linkages established with
ART
sites.
• PLHIV Registration in designated public HIV
facility indicates trust deficit for private
sector testing.
Add: 2.1.3 Ensure sustainability of procurement and supply chain management of HIV
diagnostic kits
Add: 2.1.4 Establish quality assurance mechanism through referral lab
2.1.2 Mainstream
and support HTC in
general
health
services in key
locations
across
Districts.
OUTPUT 2.2: Improve quality and coverage of medical management and ART for people living
with HIV
2.2.1
Reduce
barriers to ART for
persons who inject
drugs, transgender
and
other
marginalised
persons living with
HIV
2.2.2 Increase the
number of ART
sites based on
need and in a
quality
assured
manner.
2.2.3
Improve
referral
linkages
within a continuum
of care for PLHIV.
• AIDS Bill passed in September 2013 includes
legislation on stigma and discrimination
• PWIDs & Transgender encounter stigma at
ART sites. This is further compounded by the
fact that the arrangements for maintaining
confidentiality
are
weak
and
often
complained
about
by
the
patients.
• Transportation cost to the ART site is the
biggest
barrier.
• Varying degree of quality of services (staff
and skills) at the ART sites is a barrier for
patient coming regularly for their treatment.
• Weak infrastructure of the ART sites (space,
rooms, furniture), staff number, stationery,
power back up are some of the management
barriers, having adverse impact on access for
ART
services.
• Protocols or support for Post Exposure
Prophylaxis (PEP) in health settings have not
been established, to develop confidence of
HCPs to manage HIV cases. The wider
dissemination on the availability of PEP
service
has
not
taken
place.
• No services available for terminally sick
cases through palliative/hospice care.
• There was no awareness
raising activities suggested
for
ART
services.
• Further, Protocols or
support for Post Exposure
Prophylaxis (PEP) in health
settings
have
to
be
established and widely
disseminated to reduce
stigma and discrimination
in the health settings.
• No training on treatment
adherence was proposed in
the strategy. The trainings
are likely to address many
of
the
technical,
management and social
barriers
which
can
negatively
impact
the
access to ART services.
• Lastly, no monitoring or
an
evaluation
was
proposed
on
client
satisfaction for the ART
services.
• The community service providers like SDPs,
CHBC & CoPC+ sites are linked with ART
services and regular client referral is taking
place.
• However, referral from ART centres to the
community service providers is weak.
Moreover the entire referral mechanism is
weak, not documented or formalized. No
referral mechanism established for Prisons,
IDPs and Refugees to access the relevant
services
• The ART services are linked with TB DOTS
and contributing in the continuum of care.
• The coordination for a comprehensive CoC
is weak and no formal and regular meetings
are held among the relevant stakeholders.
• The absence of an integrated MIS has
contributed to weak referral and coordination
mechanism.
•
There
is
no
role/contribution
mentioned
of
the
Association for PLHIV in
ensuring
CoC
in
the
province.
•
A
formal
referral
mechanism among relevant
stakeholders
and
monitoring the quality of
referral and its follow up is
not mentioned in the
strategy.
78
2.2.4 Improve case
holding for preART
and
ART
services.
See 2.2.1 and 2.2.2
See 2.2.1 and 2.2.2
2.2.5 Increase the
sustainability
of
ART procurement
and supply chain
management.
• No formal PSM unit is established at SACP,
other than one procurement and logistic
staff.
• SACP is not undertaking procurement of
ARVs, however supply of ARVs to all the ART
sites is the responsibility of SACP. It has a
storage room which does not meet
international
storage
standards.
• No formal quantification and forecasting
system is followed at SACP and the supplies
are received from NACP on Push system,
rather
than
the
Pull
system.
• No regular monitoring of ART sites is being
carried by SACP and further the monitoring
lacks the coordination with the program staff.
• The role of Logistic MIS
has not been considered in
the strategy.
OUTPUT 2.3 Improve quality and coverage of care, support and social welfare services for
people living with HIV and their families.
2.3.1 Support to
PLHIV peer and
advocacy
organizations and
networks.
• The APLHIV chapter has opened in the
province
and
is
operational
• A number of CBOs have been developed for
Transgender, MSM, FSWs communities, while
a solitary CBO on female drug users has been
developed with the assistance of UNODC.
• Advocacy of APLHIV limited to service
delivery points and not with wider
stakeholders.
• There is no training
mentioned for PLHIV on
advocacy and networking.
2.3.2
Increase
referral of PLHIV
between
prevention
programmes, HTC,
ART
and
Continuum of Care
services.
See 2.3.3 below
See 2.3.3 below
2.3.3
Reduce
barriers to social
welfare
services
for PLHIV
• No linkages have been established by any
stakeholder with Social Welfare department,
Zakat, Bait ul Mal and Benazir Income support
program
(BISP).
• No sensitization of Social Welfare
Department has taken place on HIV.
OUTCOME 3: Policy Environment and AIDS Response is Enhanced for HIV prevention,
treatment, care and support
STRATEGIES
FINDINGS
GAPS
OUTPUT 3.1 Supportive public policy environment for scaled-up access to HIV services in
place.
79
3.1.1 Contribute to
national
and
provincial
assessment
of
policies
and
strategies
that
either hamper or
facilitate access to
HIV services
3.1.2
Implement
targeted
and
sustained advocacy
actions
with
policy-makers,
parliamentarians,
communityreligious leaders,
and media
No progress reported against these strategies
and it is recommended to continue including
them in the strategy till 2020.
OUTPUT 3.2: Multi-Sector Coordination enhanced at provincial level
3.2.1
Organise
regular provincial
partnership
meetings, inclusive
of sectors, civil
society,
and
community
organizations.
3.2.2 Mainstream
and support HIVrelated
policies
into
Narcotics
Control,
Prisons,
Education,
Emigration
and
Overseas
Employment, and
other
relevant
sectors
No progress reported against these strategies,
except the intervention in Prisons. It is
recommended to continue including them in
the strategy till 2020.
OUTPUT 3.3: Enhanced use of strategic evidence to monitor service coverage, quality and
impact
3.3.1
Undertake
Integrated
Biological
and
Behavioural
Surveillance (IBBS)
at two-three years
intervals.
3.3.2
Ensure
programme
monitoring
and
reporting
on
service quality and
statistics
No progress reported against these strategies
and it is recommended to continue including
them in the strategy till 2020. The IBBS is
being planned with the help of UNAIDS while
programme monitoring is limited to SDPs
processes while no
80
3.3.3 Support and
disseminate HIVrelated substantive
and
operational
research
3.3.4
Undertake
joint mid-term and
End-of-Project
(EOP)
implementation
review of SAS
3.3.5 Reduce costs
of
the
HIV
response through
efficiency
improvements
OUTPUT 3.4: Increased sustainability of the response
3.4.1 Advocate for
resource allocation
from the public
sector plans for
the AIDS response
from health and
other
social
sectors
3.4.2
Mobilise
additional external
resources
to
ensure
implementation of
priority
HIV
services
The PC-1 from 2012 to 2014 was approved but
from July 2014 onwards the allocation of
funds from public sector has ceased as the
PC-1 from 2014 to 2016 is yet to be approved.
Not much progress has been reported against
these strategies and it is recommended to
continue including them in the strategy till
2020.
BALOCHISTAN
OUTCOME 1: HIV prevalence is reduced among KP and is maintained at <0.1% in the General
Population
STRATEGIES
FINDINGS
GAPS
OUTPUT 1.1 Increased coverage (60-80%) of effective HIV prevention programmes for people
who inject drugs, transgender and other Key Populations
• PWIDs projects being supported through GF, • The current strategy
1.1.1
Sustain UNHCR
&
ANF does not mention the need
comprehensive HIV • There are no SDPs awarded in the province. of
trainings
of
the
prevention,
care • 03 NGOs are working with PWIDs in Quetta stakeholders to work with
and
support and Turbat, while 1 has experience of working TG, M/F sex workers
services for people with TGs in Quetta and none with population
who inject drugs, Male/Female sex workers or other KPs. • The strategy does not
TG and other KPs • Funds are being made available by for PWID mention if there is a need
in Quetta with intervention
only. to do mapping of TG, M/F
access to 60-80% • The preventions services on PWIDs include Sex workers while IBBS is
of
these NSEP, VCT, Spouse Referral to ART mentioned under 3.3.1 but
populations
• No operational research has been conducted lacking details on the
on any HIV intervention in the province.
population to be assessed.
81
1.1.2
Establish
essential services
for PWID, TG and
other
KPs
in
priority
districts
cities
of
the
Province through a
single
service
provider with a
community-based
approach
See above
See above
1.1.3 Improve the
quality of harm
reduction services
provided, including
introducing
OST
pilot,
in
accordance
to
national
and
international good
practices
• Only ANF supported facilities are providing
detoxification services with quality in relation
to international standards not established.
• Absence of formal referral mechanism from
PWIDs harm reduction services to HIV related
services.
• There is no OST project in the province.
However, the budget related to OST is
available in the PC-1. Pilot OST is under
planning.
• Separate monitoring being conducted by
BACP and NZ for their respective grant
projects
and
lack
coordination.
• NZ plans to expand ART adherence unit
(AAU) under NFM of GF grant. The unit
prepares PWIDs for ART initiation and
adherence.
• Absence of linkages with
free detox/rehab services
in public/private sector to
support preventions and
harm reduction strategies
• Absence of the need to
have coordinated and joint
MIS & monitoring for public
and
private
sector
interventions.
Lack
of
coordination for transfer
in/out patients
1.1.4
Enhance
understanding of • No progress has been made on
the dynamics of understanding the dynamic of sex work. • PACP having an M&E unit
HIV and sex work • No study is planned to understand the led by Epidemiologist with
across
the dynamics.
skills and experience of
Province through • There is no strategy for advocacy to developing
research
specific
disseminate
or
improve
programme concepts is lacking in the
assessments
for implementation based on the finding of a current strategy.
informed
study.
programming
OUTPUT 1.2: Reduced risks of HIV transmission among vulnerable populations through
mainstreaming HIV prevention into health services.
82
1.2.1
Implement
HIV
prevention,
care and support
across
priority
prisons
through
integration
of
these services in
prison
health
services
in
a
phase-wise
approach
• Prison related SDP not awarded
• UNODC funded prison project by an NGO
since
2011
in
Quetta
• Sensitization, Testing, referral to ART
• BACP has not developed Manual for HIV
services
in
Prison
• UNODC has conducted a research on male
prisoners and supporting female IDUs in
prisons which provides limited information on
this
situation
in
the
province.
•
UNODC
has
recently
undertaken
consultation with BACPs to develop Provincial
strategies for HIV prevention in prisons.
• The co-infection of Hepatitis B and C is not
being
addressed.
• BACP has not undertaken sensitization of
the Home Department of Balochistan.
1.2.2 Develop predeparture
prevention
education
for
intending
migrants,
and
referral system to
HTC,
ART
and
PPTCT
for
returning migrants
and families
• Significant segment of population in southwest Balochistan working in Oman and middle
eastern countries being deported for their HIV
positive status
• Un regulated movement of travellers and
refugees between Pakistan, Afghanistan and
Iran borders is contributing to the problem
• No progress has taken place for introducing
HIV prevention activities for migrant workers
or at risk adolescents. This includes the effort
by BACP to extend SDP(s) or acquiring donor
funding.
• The population of migrant workers is not
among the KPs. Therefore this population has
not been assessed under Surveillance system
or
IBBS.
• Further, BACP has made little effort to
involve the Ministries of; Labour, Overseas,
Home
department
or
FIA.
• No research has been undertaken to assess
the magnitude of the issue related to migrant
workers, adolescents etc.
• The strategy had not
taken into consideration
that special effort will be
required for developing
MIS, protocols on data
sharing/reporting,
and
monitoring
for
interventions in the prison.
• The strategy does not
mention
services
for
spouses/partners
of
prisoners
with
HIV
infection.
• The strategy states
Prisons
department
to
assume the responsibility
of providing budget related
to HIV intervention, but
understates the need for
regular capacity building of
the prison management
and staff, keeping in view
the regular staff turnover
in public sector.
• The current strategy has
not defined the other
population
under
this
strategy, such as people
daily crossing Pak/Afghan
Border in the province, the
deportees from the Middle
Eastern
countries
etc.
• The current strategy has
not proposed activities
with Ministries of; Labour,
Overseas,
Home
department
or
FIA
• Research to assess the
magnitude of the issue
related
to
migrant
workers, adolescents etc.
• Base on the evidence of
the
issues
surrounding
migrant workers, priority
of introducing intervention
for this population of
migrant
workers
be
established.
83
1.2.3 Mainstream
and support HIV
preventive
education,
HTC,
STI and referrals
for
vulnerable
populations
in
public-private
sector
and
voluntary services,
with a priority on
districts where the
populations
of
miners,
street
youths, fishermen,
displaced
and
refugees
are
substantial.
was able to establish a number of HTC in 2
public sector hospitals but none through SDPs,
while the GF grant has also established HTC
through its CHBC and CoPC+ sites.
• The STI services are generally weak and
inadequate in public sector while none are
available under GF grant interventions. The
drugs are not available nor are the
investigations freely available for STI cases in
public sector STI clinics. Patient end up
spending out of their pockets for management
of STI among HIV and high risk cases.
• The infection control and waste
management is also a weak area for the
testing centres, who find it difficult to
properly dispose their used products, due to
dearth of waste management infrastructure in
most of the province. The GF grant projects
under Nai Zindagi courier disposedsyringes
and waste products to the known incinerators
sites
for
proper
disposal.
• A large number (hundreds of thousands) of
blood bags are screened for HIV in public and
private blood banks and similarly unknown
numbers of HIV tests are performed by
private laboratories in the province.
Unfortunately, both the blood banks and the
private laboratories are not been regulated in
the
province.
• Meanwhile the linkage with TB program has
resulted in ensuring that TB treatment
services (TB DOTS) are available for the
referred
HIV
cases.
However,
the
identification and subsequent referral of HIV
cases from TB program has been very weak,
even though thousands of TB cases get
screened for HIV in DOTS clinics.
• The linkages with Blood
Transfusion Authority were
not suggested in the
current
strategy
for
mainstreaming
HIV
in
health
services
and
regulation of public and
private blood banks for
ensuring
quality
HIV
testing.
• Similarly a linkage with
Health Care Commission
for regulation of HTC in
private laboratories was
not
suggested.
• Linkages with Provincial
Disaster
Management
Authority (PDMA) has also
not been suggested to
build the capacity of
service providers during
disaster or relief of people
being displaced and having
potential high risk cases.
84
1.2.4:
Integrate
and support PPTCT
in selected health
services
in
prioritized districts
• There is 01 PPTCT sites in the province;
Quetta.
• No HIV positive cases have been identified
through
referral
from
other
sites
• Unicef has provided support through
trainings of HCPs and safe delivery kits.
However CS-Kits have not been made
available.
• Very few Nurses/staff have beentrained on
HIV and PPTCT and their numbers and
capacity is in-adequate and may have
resulted in turning away cases requiring
PPTCT
services.
• The HIV testing of risky cases in the
Gynaecology units have not yielded any HIV
positive case requiring PPTCT services. The
cases for PPTCT services have mostly been
referred by units outside the centres.
• The strategy has been
PPTCT centric and not
focused on reaching out for
communities where high
risks/ HIV cases have been
identified. An unknown
number of potential cases
may have been reluctant
to access the PPTCT
services either due to
distance to the site,
transportation cost, fear of
stigma and discrimination
or due to ignorance about
the available services.
• The strategy has not
focused on enhancing the
referrals from community
sites.
•
The
capacity
building/sensitization
of
the adjacent Gynaecology
units (especially senior
HCP and nurses) to PPTCT
sites has not been focused.
OUTCOME 2: HIV-related Morbidity and Mortality is reduced, and the Quality of Life of People
Living with HIV is improved
STRATEGIES
FINDINGS
GAPS
OUTPUT 2.1: Increased quality and coverage of early diagnosis of HIV through HTC and
Provider-Initiated Testing and Counselling (PITC)
2.1.1
Increase
availability
and
uptake of HTC for
KP
and
other
vulnerable
populations
through a targeted
approach.
• No SDPs on VCT PWIDs, Transgender, Sex
Worker
&
Prison
• There are 19 sites established in the
province with 2 in public 17 in private sector
providing HTC. The private sector include 2
CHBC and CoPC+ sites each while another 13
sites are in the Refugee camps in the province
being managed by UNHCR. In all there are 15
functional
sites.
• The plan to ensure the HTC services are
available at each district has not been
developed.
• Similarly negligible Trainings/ refresher on
VCT have taken place since the development
of
current
strategy.
• However linkages have been established
between CHBC/CoPC+ and ART sites
• There has been no
strategy on scaling up CB
testing.
• The massive increase in
HIV testing also required a
comprehensive
quality
assurance
and
quality
certification system which
was not considered in the
strategy.
2.1.2 Mainstream
and support HTC in
general
health
See above
See above
services in key
locations
across
districts
Add: 2.1.3 Ensure sustainability of procurement and supply chain management of HIV
diagnostic kits
Add: 2.1.4 Establish quality assurance mechanism through referral lab
85
OUTPUT 2.2: Scaled up coverage and quality of medical management and ART for people
living with HIV
• There was no awareness
raising activities suggested
for
ART
services.
• Further, Protocols or
support for Post Exposure
• There are 02 ART sites in the province, Prophylaxis (PEP) in health
Quetta and Turbat, providing ART services settings
have
to
be
• 131 patients have been registered till established and widely
todate with 13 of them lost to f/u. disseminated to reduce
• CD4 facility is available, however Viral load stigma and discrimination
is
not
being
conducted. in the health settings.
• There has been no stock out of ARVs. • No training on treatment
• Health care providers at ART and PPTCT adherence was proposed in
2.2.1
Reduce
sites
have
received
trainings. the strategy. The trainings
barriers to ART for
• Transportation cost to the ART site is the are likely to address many
PLHIV, transgender
biggest
barrier. of
the
technical,
population
and
• Protocols or support for Post Exposure management and social
other KPs
Prophylaxis (PEP) in health settings have not barriers
which
can
been established, to develop confidence of negatively
impact
the
HCPs to manage HIV cases. The wider access to ART services.
dissemination on the availability of PEP • There is no plan to
service
has
not
taken
place. undertake
Pharmaco• No services available for terminally sick vigilance to track trend of
cases
through
palliative/hospice
care. resistance being developed
• No linkage with social services (Bait ul Mal)
in
people
on
ART.
• Lastly, no monitoring or
an evaluation has been
proposed
on
client
satisfaction for the ART
services.
2.2.2
Expand
treatment services
in accordance with
the ‘Continuum of
Care’
model,
including
See above
See above
Community,
Secondary
and
Tertiary level or
three
tier
approach
86
• The community service providers like CHBC
• There is no strategy
& CoPC+ sites are linked with ART services
developed for improving
and regular client referral is taking place.
the case holding. Further
• However, referral from ART centres to the
there is no focus/ capacity
community service providers is weak.
/ resources available for
Moreover the entire referral mechanism is
patients follow up at ART
weak, not documented or formalized. No
site
referral mechanism established for Prisons,
•
There
is
no
2.2.3
Improve IDPs and Refugees to access the relevant
role/contribution
referral
linkages services
mentioned
of
the
within a continuum • The ART services are linked with TB DOTS
Association for PLHIV in
of care for PLHIV and contributing in the continuum of care.
ensuring
CoC
in
the
including TB
• The coordination for a comprehensive CoC
province.
is weak and no formal and regular meetings
•
A
formal
referral
are held among the relevant stakeholders.
mechanism among relevant
• The absence of an integrated MIS has
stakeholders
and
contributed to weak referral, coordination
monitoring the quality of
and monitoring mechanism from BACP.
referral and its follow up is
• No meetings on CoC has taken place
not mentioned in the
between relevant stakeholders in the
strategy.
province.
• No formal PSM unit is established at BACP,
other than one procurement and logistic
staff.
• BACP is not undertaking procurement of
ARVs, however supply of ARVs to all the ART
2.2.4 Increase the sites is the responsibility of BACP. It has a
• The role of establishment
sustainability
of storage room which does not meet
of Logistic MIS has not
ART procurement international
storage
standards.
been considered in the
and supply chain • No formal quantification and forecasting
strategy.
management
system is followed at BACP and the supplies
are received from NACP on Push system,
rather
than
the
Pull
system.
• No regular monitoring of ART sites is being
carried by BACP and further the monitoring
lacks the coordination with the program staff.
OUTPUT 2.3 Increased coverage and quality of care, support, and social services for people
living with HIV
2.3.1
Support • The APLHIV chapter has opened in the
and
is
operational
PLHIV peer and province
• There is no training
• Advocacy of APLHIV limited to service
community
mentioned for PLHIV on
delivery points and not with wider
advocacy
advocacy and networking.
organisations and stakeholders.
networks
•
Formal
referral
mechanisms
among
• There were no CHBC services in the
relevant stakeholders is
2.3.2
Increase province till recently and now since few
not
present
referral of PLHIV months the ART Centre in BMC has started
• The strategy does not
from HTC and HIV referring cases for CHBC services in Quetta
mention the importance of
management
monitoring to assess the
services to CHBC
quality of referral its
mechanism and how follow
up will be undertaken.
MISSING: An output strategy on providing care and support services through NGO partners.
87
2.3.3
Build
linkages
with
social
welfare
programmes/initia
tives for PLHIV and
their families
• No linkages have been established by any
stakeholder with Social Welfare department,
Zakat, Bait ul Mal and Benazir Income support
program
(BISP).
• No sensitization of Social Welfare
Department has taken place on HIV.
CHBC and CoPC sites and neither APLHIV have
established linkages with Social services for
PLHIV
• The linkages of APLHIV
chapter
with
social
services have not been
ensured in the strategy
•
Likewise
the
development
of
the
capacity building of APLHIV
chapter of the province to
advocate, facilitate and
improve the linkages with
social services in the
province has not been
mentioned in the strategy.
OUTCOME 3: Policy Environment and AIDS Response is Enhanced for HIV prevention,
treatment, care and support
STRATEGIES
FINDINGS
OUTPUT 3.1 Enabling Policy environment ensured
3.1.1 Reinvigorate
and
implement
targeted
and
sustained advocacy
actions
among
None found
policy-makers,
parliamentarians,
communityreligious leaders,
and media
3.1.2 Contribute to
national
and
provincial
assessments
of
None found
polices that either
hamper
or
facilitate access to
HIV services
OUTPUT 3.2: Multi-Sector Coordination enhanced
3.2.1
Organise
regular provincial
coordination
meetings, inclusive
None found
of civil society,
community
organizations and
relevant sectors.
3.2.2 Mainstream
and support HIV
prevention
and
care policies into
Narcotics Control,
None found
Home, Education,
Social Welfare as
well
as
other
relevant
departments.
GAPS
No Findings
No Findings
No Findings
No Findings
OUTPUT 3.3: Strategic Evidence generated for planning and tracking the response
88
3.3.1
Undertake
Integrated
Biological
and
Behavioural
Surveillance (IBBS)
at two to three
years intervals
None found
No Findings
3.3.2 Strengthen
M&E and HIV at
the provincial level
None found
No Findings
OUTPUT 3.4: Resources mobilized for sustainability of the response
3.4.1 Advocate for
allocation of funds
for
the
AIDS
response
from
public plans in the
ohealth and social
sectors
None found
No Findings
PUNJAB
OUTCOME 1: HIV prevalence is reduced among KP and is maintained at <0.1% in the General
Population
STRATEGIES
FINDINGS
GAPS
OUTPUT 1.1 Scaled up coverage of prevention services to reach 80% of PWID (New UNAIDS
Targets recommend “Needle exchange programme enrolment for PWID” at 80% both in 2020
and 2030)
• PWIDs projects being supported through PC1, WB, GF, UNODC and the US Embassy.
Government/WB and GF providing bulk of
resources but UNODC and US Embassy
providing limited assistance to Female PWIDs
in
prison
settings.
• 5 NGOs are providing prevention services to
PWIDs.
• 7 SDPs have been extended from PC-1, to 3
NGOs for 10 sites targeting 16,500 or 26%
• Absence of linkages with
(16,500/63,578 x 100) coverage for PWIDs
free detox/rehab services
population. The current service deliveryhas
in public/private sector to
reached approximately 39-40% of 16,500
support preventions and
PWID.
1.1.1 Progressively
harm reduction strategies
• 1 GF grant is providing support to 2 NGOs in
expand
essential
• Absence of the need to
14 districts for coverage of 42% of PWID
prevention
have coordinated and joint
population.
services for PWID.
MIS & monitoring for public
• The prevention services include NSEP, PHC,
and
private
sector
STI, VCT, Spouse testing and support.
interventions.
Lack
of
• Teaching hospitals and ANF supported
coordination for transfer
facilities are providing detoxification services
in/out patients
with quality in relation to international
standards
not
established.
• Absence of formal referral mechanism from
PWIDs harm reduction services to HIV related
services.
• There are 2 institutions providing
detoxification and rehabilitation services,
Institute of Mental Health (Lahore) and NZ
(Islamabad/Rawalpindi).
• There is no OST project in the province.
89
However, the budget related to OST is
available in the PC-1. Pilot OST is under
planning.
• Separate monitoring being conducted by
PACP and NZ for their respective grant
projects
and
lack
coordination.
• NZ plans to expand ART adherence unit
(AAU) under NFM of GF grant. The unit
prepares PWIDs for ART initiation and
adherence.
1.1.2
Improve
access to quality
harm
reduction
services
in
accordance
to
international and
local
good
practices.
See Above
See Above
1.1.3
Evaluate
effectiveness
of
diverse prevention
service models and
disseminate good
practices.
• No progress has been made on evaluating
the existing services models, referral system
or coordination on essential or comprehensive
(including detox and rehab) services for PWIDs
in SDPs (supported by PC-1) or CoPC+ sites
(supported by GF) or Female DUs/IDUs
(supported by UNODC).
• There has been one national study Drug Use
in Pakistan – 2013 supported by Ministry of
and Interior and Narcotics Control, Pakistan
Bureau ofStatistics and UNODC with
information on Punjab province. Plan
International has also conducted a study on
Most at Risk Adolescents (MARAs) with
information on drug use.
• There are different MIS in place for projects
related to PC-1, NZ, UNODC and Ministry of
Narcotics. The MIS of different PWID related
interventions in the province have not been
evaluated.
• The COPC+ concept of NZ where social
support to spouses and CD4 testing is provided
has also not been evaluated.
• There is no strategy for advocacy to
disseminate or improve programme
implementation based on the finding of an
evaluation.
• Evaluation of newly
emerging models on PWIDs
interventions
was
not
mentioned in the current
strategy.
90
OUTPUT 1.2: Scaled up coverage of prevention services to progressively reach 60% of
Transgender People and other KP.
1.2.1
Expand
comprehensive
prevention
interventions for
Transgender
People and MSM in
priority districts,
through
community based
approaches.
• PC-1/WB and GF Regional funding is
available for projects on this population.
• There are 5 SDPs – 2 LHR, FBD, MLN, SGD
with plan to achieve 80% coverage.
• 1 GF regional grant is provided to NHMA.
• The SDPs do not differentiate between TGs,
MSMs,
MSWs
and
HSWs.
• 8 NGOs are working for this population with
community based approach. However NMHA
contends that community based approach is
not fulfilled by NGOs as the office bearers are
not
from
the
community).
• SDPs awarded on the basis of low cost of
services and not on the basis of experience
and quality of services being offered.
• No operational research has taken place on
TGs.
• The issue of non-availability of beneficiary’s
CNIC is addressed through CNIC of closest
relative
or
acquaintance.
• NGOs are working with adolescents but they
are not being specifically supported.
• The community faces
discrimination from HCPs
due
to
their
low
sensitization on the issues
of
this
community.
Confidentiality is being
compromised at treatment
facilities where for testing
and
subsequently
for
treatment protocols are
not
followed.
• TGs have persisted with
male gender option in CNIC
and create difficulty in
data calculation for TG
specific interventions; No
operational research has
been conducted on TGs,
specifically on stigma and
discrimination at health
facilities; No linkages with
social welfare have been
established.
1.2.2 Build on the
community-based
MSM initiative and
support
its
expansion.
See Above
See Above
1.2.3 Reach sex
workers
with
essential
prevention
interventions,
including through
participate on of
peers.
• PC-1/WB is available for projects on this
population.
• There are 5 SDPs – 2 LHR, FBD, MLN, SGD
with plan to achieve ---% coverage.
• The SDPs do not differentiate between TGs,
MSMs,
MSWs
and
HSWs.
• 6 NGOs are working for this population with
community
based
approach.
• SDPs awarded on the basis of low cost of
services and not on the basis of experience
and quality of services being offered.
• The community faces
discrimination from HCPs
due
to
their
low
sensitization on the issues
of
this
community.
Confidentiality is being
compromised at treatment
facilities where for testing
and
subsequently
for
treatment protocols are
not
followed.
• No operational research
has been conducted on sex
workers, specifically on
stigma and discrimination
at health facilities; No
linkages
with
social
welfare
have
been
established.
1.2.4
Enhance
understanding of
the dynamics of
sex
work
for
informed
programming.
• IBBS has been conducted and report is
awaited.
• However no operational research has been
conducted nor planned to understand the
dynamics
of
sex
work
• UNAIDS and Regional GF grant.
• Nothing significant.
OUTPUT 1.3: Improved access to HIV prevention among selected Vulnerable Populations.
91
1.3.1 Provide HIV
prevention
and
referral to ART
services for prison
inmates
through
integration
in
prison services.
• Prison related SDP not awarded.
• 1 NGO Phoenix Foundation working for
FSW/FIDUs
in
prison
of
Lahore.
• PACP has provided testing services to 50,000
prisoners in 2013 and as and when required.
• PACP has developed Manual for HIV services
in
Prison
• UNODC has conducted a research on male
prisoners and supporting female IDUs in
prisons which provides limited information on
this
situation
in
the
province.
•
UNODC
has
recently
undertaken
consultation with PACPs to develop Provincial
strategies for HIV prevention in prisons and
has also developed aquestionnaire to identify
the
risks
in
prison
setting.
•
Home
Dept.
not
Sensitized
• The co-infection of Hepatitis B and C is not
being
addressed.
• PACP has not undertaken sensitization of
the Home Department of Punjab.
1.3.2 Develop predeparture
prevention
education
for
intending
migrants,
and
referral
systems
for HTC, ART and
PPTCT
for
returning migrants
and families.
• No progress has taken place for introducing
HIV prevention activities for migrant workers
or at risk adolescents. This includes the effort
by PACP to extend SDP(s) or acquiring donor
funding.
• The population of migrant workers is not
among the KPs. Therefore this population has
not been assessed under Surveillance system
or
IBBS.
• Further, PACP has made little effort to
involve the Ministries of; Labour, Overseas,
Home
department
or
FIA.
• No research has been undertaken to assess
the magnitude of the issue related to migrant
workers, adolescents etc.
1.3.3 Mainstream
and support STI
services
for
vulnerable
populations
in
public
sector
health services.
• PACP has shown moderate progress in
mainstreaming HIV in relevant health and
social sectors. PACP was able to establish a
number of HTC in various public sector
hospitals and through its SDPs, while the GF
grant has also established HTC through its
CHBC
and
CoPC+
sites.
• The STI services are generally weak and
inadequate in public sector while none are
available under GF grant interventions. The
drugs are not available nor are the
investigations freely available for STI cases in
public sector STI clinics. Patient end up
spending out of their pockets for management
of STI among HIV and high risk cases.
• The infection control and waste
• The strategy had not
taken into consideration
that special effort will be
required for developing
MIS, protocols on data
sharing/reporting,
and
monitoring
for
interventions in the prison.
• The strategy does not
mention
services
for
spouses of prisoners with
HIV
infection.
• The strategy states
Prisons
department
to
assume the responsibility
of providing budget related
to HIV intervention, but
understates the need for
regular capacity building of
the prison management
and staff, keeping in view
the regular staff turnover
in public sector.
• The current strategy has
not defined the other
population
under
this
strategy
• The current strategy has
not proposed activities
with Ministries of; Labour,
Overseas,
Home
department
or
FIA
• Research to assess the
magnitude of the issue
related
to
migrant
workers, adolescents etc.
• Base on the evidence of
the
issues
surrounding
migrant workers, priority
of introducing intervention
for this population of
migrant
workers
be
established.
• The linkages with Blood
Transfusion Authority were
not suggested in the
current
strategy
for
mainstreaming
HIV
in
health
services
and
regulation of public and
private blood banks for
ensuring
quality
HIV
testing.
• Similarly a linkage with
Health Care Commission
for regulation of HTC in
private laboratories was
not
suggested.
• Linkages with Provincial
92
management is also a weak area for the
testing centres, who find it difficult to
properly dispose their used products, due to
dearth of waste management infrastructure in
most of the province. The GF grant projects
under Nai Zindagi courier used syringes and
waste products to the known incinerators
sites
for
proper
disposal.
• A large number (hundreds of thousands) of
blood bags are screened for HIV in public and
private blood banks and similarly unknown
numbers of HIV tests are performed by
private laboratories in the province.
Unfortunately, both the blood banks and the
private laboratories are not been regulated in
the
province.
• Meanwhile the linkage with TB program has
resulted in ensuring that TB treatment
services (TB DOTS) are available for the
referred
HIV
cases.
However,
the
identification and subsequent referral of HIV
cases from TB program has been very weak,
even though thousands of TB cases get
screened for HIV in DOTS clinics.
Disaster
Management
Authority (PDMA) has also
not been suggested to
build the capacity of
service providers during
disaster or relief of people
being displaced and having
potential high risk cases.
OUTPUT 1.4: Increased uptake of PPTCT services by Women.
1.4.1 Building on
the experience of
the PPTCT district
model, scale up
PPTCT services in
selected districts.
• There are 06 PPTCT sites in the province;
Lahore, GJT, SGD, FBD, DG Khan.
• 19 HIV positive cases have been identified in
2014 through referral from mostly CoPC and
CHBC
site
• Unicef has provided support through
trainings
of
HCPs
• Safe Delivery Kits have been provided to the
PPTCT centers through PC-1. However CS-Kits
have
not
been
made
available.
• Nurses/staff are beingtrained with two such
training
in
2014.
• The HIV testing of cases with potential to be
HIV infected in the Gynaecology units have
not yielded any HIV positive case requiring
PPTCT services. The cases for PPTCT services
have mostly been referred by units outside
the
centres.
• The referral from service delivery points
(SDPs, CHBC and CoPC+) require further
improvement for referral of high risk cases
requiring
PPTCT.
• The staff numbers and capacity is inadequate (as reported by clients) and has
resulted in turning away cases requiring
PPTCT services.
• The strategy had been
PPTCT centric and now
also focusing on reaching
out for communities where
high risks/ HIV cases have
been identified. There is a
significant risk that an
unknown
number
of
potential cases may have
been reluctant to access
the PPTCT services either
due to distance to the site,
transportation cost, fear of
stigma and discrimination
or due to ignorance about
the available services.
• The strategy has not
focused on enhancing the
referrals from community
sites.
•
The
capacity
building/sensitization
of
the adjacent Gynaecology
units (especially senior
HCP and nurses) to PPTCT
sites has not been focused.
OUTCOME 2: HIV-related Morbidity and Mortality is reduced, and the Quality of Life of People
Living with HIV is improved
STRATEGIES
FINDINGS
GAPS
OUTPUT 2.1: Increased coverage and quality of HTC.
93
2.1.1
Increase
availability
and
uptake of HTC for
KP
and
other
vulnerable
populations
through a targeted
approach.
• The PC-1 supported SDPs on PWIDs,
transgender; sex workers and prison have
HTC/PITC. Further the CHBC and CoPC+ sites
supported by GF grants have similar services.
• Significant numbers (54) of sites in the
province are providing HTC/PITC. The
breakdown of the sites is as follows; SDPs 21,
Public Hospitals 9, CHBC 6, CoPC+14 and
UNODC 4 with 100% of the sites being
functional.
• BTA and DHQ procuring their kits.
• The trainings on VCCT have become
infrequent and most of the new sites in last
year or so have not had their staff trained,
while few refresher trainings were offered.
• VCCT centres have linkages established with
ART
sites.
• PLHIV Registration in designated public HIV
facility indicates trust deficit for private
sector
testing.
• Plan on VCT services at Districts not
developed.
• There has been no
strategy on scaling up CB
testing.
• The massive increase in
HIV testing also required a
comprehensive
quality
assurance
and
quality
certification system, which
was not considered in the
strategy.
2.1.2 Mainstream
and support HTC in
general
health
services
in
selected locations
across districts.
See Above
See Above
RECOMMEND ADDING
Add: 2.1.3 Ensure sustainability of procurement and supply chain management of HIV
diagnostic kits
Add: 2.1.4 Establish quality assurance mechanism through referral lab
OUTPUT 2.2: Scaled up coverage and quality of medical management and ART for people
living with HIV
94
2.2.1
Reduce
barriers to ART for
PWID, Transgender
people and other
KP.
• There are 08 ART sites in the province,
providing treatment of satisfactory quality
• However most of the sites to be over
worked
• CD4 and Viral load facility is available
•
No
stock
out
of
ARVs
• Training HCPs on ART and PPTCT
• No legislation on stigma and discrimination
• PWIDs & Transgender encounter stigma at
ART sites. This is further compounded by the
fact that the arrangements for maintaining
confidentiality
are
weak
and
often
complained
about
by
the
patients.
• Transportation cost to the ART site is the
biggest
barrier.
• Varying degree of quality of services (staff
and skills) at the ART sites is a barrier for
patient coming regularly for their treatment.
• Weak infrastructure of the ART sites (space,
rooms, furniture), staff number, stationery,
power back up are some of the management
barriers, having adverse impact on access for
ART
services.
• Protocols or support for Post Exposure
Prophylaxis (PEP) in health settings have not
been established, to develop confidence of
HCPs to manage HIV cases. The wider
dissemination on the availability of PEP
service
has
not
taken
place.
• No services available for terminally sick
cases through palliative/hospice care.
• There was no awareness
raising activities suggested
for
ART
services.
• Further, Protocols or
support for Post Exposure
Prophylaxis (PEP) in health
settings
have
to
be
established and widely
disseminated to reduce
stigma and discrimination
in the health settings.
• No training on treatment
adherence was proposed in
the strategy. The trainings
are likely to address many
of
the
technical,
management and social
barriers
which
can
negatively
impact
the
access to ART services.
• Lastly, no monitoring or
an
evaluation
was
proposed
on
client
satisfaction for the ART
services.
2.2.2
Expand
treatment services
in accordance with
‘Continuum
of
Care’
model
(Community,
Secondary
and
Tertiary level –
three
tier
approach).
See Above
See Above
2.2.3
Improve
referral
linkages
within
the
continuum
of
treatment
and
care, including for
TB.
• The community service providers like SDPs,
CHBC & CoPC+ sites are linked with ART
services and regular client referral is taking
place.
• However, referral from ART centres to the
community service providers is weak.
Moreover the entire referral mechanism is
weak, not documented or formalized. No
referral mechanism established for Prisons,
IDPs and Refugees to access the relevant
services
• The ART services are linked with TB DOTS
and contributing in the continuum of care.
• The coordination for a comprehensive CoC is
weak and no formal and regular meetings are
held among the relevant stakeholders.
• The absence of an integrated MIS has
contributed to weak referral and coordination
•
There
is
no
role/contribution
mentioned
of
the
Association for PLHIV in
ensuring
CoC
in
the
province.
•
A
formal
referral
mechanism among relevant
stakeholders
and
monitoring the quality of
referral and its follow up is
not mentioned in the
strategy.
95
mechanism.
2.2.4 Increase the
sustainability
of
ART procurement
and supply chain
management.
• No formal PSM unit is established at PACP,
other than one procurement and logistic staff.
• PACP is not undertaking procurement of
ARVs, however supply of ARVs to all the ART
sites is the responsibility of PACP. It has a
storage room which does not meet
international
storage
standards.
• No formal quantification and forecasting
system is followed at PACP and the supplies
are received from NACP on Push system,
rather
than
the
Pull
system.
• No regular monitoring of ART sites is being
carried by PACP and further the monitoring
lacks the coordination with the program staff.
• The role of Logistic MIS
has not been considered in
the strategy.
OUTPUT: 2.3 Increased coverage and quality of care, support, and social services for people
living with HIV.
2.3.1
Support
PLHIV peer and • The APLHIV chapter has opened in the
• There is no training
community
province and is operational
• Advocacy
mentioned for PLHIV on
advocacy
of APLHIV limited to service delivery points
advocacy and networking.
organisations and and not with wider stakeholders.
networks.
2.3.2
Increase
referral of PLHIV
from HTC and HIV Findings linked with below
Gaps linked with below
prevention
services to CHBC.
• A number of CBOs have been developed for
Transgender, MSM, FSWs communities, while
2.3.3
Build
a solitary CBO on female drug users has been
linkages
with
developed with the assistance of UNODC.
social
welfare
• No linkages have been established by any
programme/
stakeholder with Social Welfare department,
initiatives
for
Zakat, Bait ul Mal and Benazir Income support
PLHIV and their
program
(BISP).
families.
• No sensitization of Social Welfare
Department has taken place on HIV.
96
OUTCOME 3: Policy Environment and AIDS Response is Enhanced for HIV prevention,
treatment, care and support
STRATEGIES
FINDINGS
OUTPUT 3.1 Enabling Policy environment ensured
3.1.1
Implement
and
sustain
focused advocacy
among
decision- None found
makers,
community leaders
and media.
3.1.2
Introduce
policy
changes
based on national
None found
provincial
policy
and
legislation
review.
GAPS
No Findings
No Findings
OUTPUT 3.2: Multi-Sectoral Coordination enhanced.
3.2.1
Organise
regular provincial
coordination
meetings
among
government, CSO
and
community
partners.
3.2.2
Ensure
enhanced
participation
in
the AIDS response
of
the
Home
Dept.,
BEOE,
Education Dept.,
Social
Welfare
Dept. and ANF.
None found
No Findings
None found
No Findings
OUTPUT 3.3: Strategic Evidence generated for planning and tracking the response.
3.3.1
Undertake
Integrated
Biological
and
Behavioural
Surveillance
periodically.
3.3.2 Strengthen
monitoring
and
evaluation,
and
HIV
research
capacity at the
provincial level.
None found
No Findings
None found
No Findings
OUTPUT 3.4: Mobilise resources for sustainability of the response.
3.4.1 Reduce costs
of
the
HIV
response through
mainstreaming and
efficiency
improvements.
None found
No Findings
97
3.4.2
Increase
domestic resource
allocation
for
sustainability
of
response.
3.4.3 Mobilise and
align
external
resources
for
implementation of
priority
HIV
strategies33.
None found
No Findings
None found
No Findings
98
Annex II. Proposed Terminology Section
The Terminology Section suggested terms below for are not complete but contain
some of the terms that were flagged throughout the MTR process as needing
additional definition. The elaboration of this section should happen through the
Strategy revision process and aligned with the PAS III (based on global evidencebased definitions and relevant for Pakistan).
 At-risk adolescents: suggest street-associated or engaged in selling sex and/or
using drugs.
 Care and support service for monitoring – suggest transport facilitation as the
proxy
 Community-based: TBD. Suggest working with NHMA to define.
 Comprehensive harm reduction services for PWID: TBD.
 Comprehensive migrant services: Consider including:
o
Include
spouses/partners
in
pre-departure
and
returning
migrants
(female/male) with prevention education and counselling including on STI
management, HIV, ART and PPTCT & sexual violence [recent study indicate
very low awareness on PPTCT];
o
Needs of migrants, especially female migrants are more comprehensively
addressed (namely, on STI management, on HIV, TB and especially on PPTCT
which in a recent study showed a very low level of awareness, advocacy on
sexual violence for all genders).
o
Health communication strategies and the pre-departure health orientation
is a further means to promote health awareness among female migrants,
and those with reduced access to the general media while in their
destination country.
 Comprehensive prevention for hijra and MSM spouses: Consider including:
o
Access –at minimum –to commodities (condoms including female condoms
and lubricants)
o
STI /HIV testing, treatment and management services,
o
Link with reproductive health and family planning services
o
Screening for gender-based violence.
o
Couple counselling that also includes condom education and distribution
99
o
Information on access to HIV diagnostics, AIDS treatment, care and support
services-ensure flexible, low-threshold services that are more convenient
for women with children;
 Comprehensive prevention for PWID spouses: Consider including:
o
Access –at minimum –to commodities (condoms including female condoms
and lubricants)
o
STI /HIV testing, treatment and management services,
o
Link with reproductive health and family planning services
o
Screening for gender-based violence.
o
Couple counselling that also includes condom education and distribution
o
Information on access to HIV diagnostics, AIDS treatment, care and support
services-ensure flexible, low-threshold services that are more convenient
for women with children;
o
Develop specific guidelines and targets to address the needs of women who
use drugs.
o
Include in relevant policies the promotion of and support for incomegenerating interventions for women who use drugs and spouses of male
injecting drug users;
 Comprehensive prison package: TBD.
 Continuum of Care: Suggest todefine as from diagnosis through care and support
(CDC).
 Coverage: Harm reduction for PWID/NSEP: Consider using needles distributed as
proxy for "reached." Would need to have a distribution target per registered
client.Optimal coverage of OST: 40% of opioid dependent individuals.
 Coverage: HSW/MSM/MSW/FSW: Consider using condom distribution target as
proxy for "reached." Would need to have a distribution target per registered
client.
 Criteria for care and support provision: TBD.
 Detoxification services: TBD
 Effective coverage: as in effective coverage by NSEP
 Key Populations: Female sex workers, Hijra (including those who sell sex), Males
who have sex with males (including those who sell sex), People living with HIV,
People who inject drugs.
 Mainstream: TBD
 Multi-sectoral Partners: Include Civil Society, UN, donors, academic institutions,
and Public sector. Public sector partners should include (but not limited to):
100
Social
Welfare,
Child
Protection
Authority,
Prison
Authorities,
Home
Department, Police, Education, Ministry of Women Development, BOEO.
 PPTCT services: TBD: Suggest including OB/GYN departments at identified sites
are able to manage HIV positive deliveries; HIV disease managed through ART
centres (Option B+); FSW and spouses of key population males and registered
HIV positive males the priority; then testing in HIV high burden districts.
 Quality Harm Reduction Services: TBD
 Retention in services: TBD
 Rehabilitation: Suggest rehabilitative adherence support for PWID with a CD4 of
<500
 Risk-reduction interventions in general health services: TBD
101
Annex III. Interview Tools
a. Provincial Strategy Review Tool
Out
puts
1.3. Improved access to HIV prevention among selected 1.2. Scaled up coverage of prevention services to 1.1. Scaled up coverage of prevention
vulnerale populations
progressively reach 60% of TG and other KP
services to reach 80% of PWID
Outc
ome
1. HIV prevalence is reduced among the KP and is maintained at <0.1% in the General Population
Halt new HIV infections and improve the health and quality of life of people living with and affected by HIV
Goa
l
Strategies
What
worked
What did
not work
What
was
the gap in the
strategy
Recommendation
1.1.1. Progressively expand
essential prevention services for
PWID
1.1.2. Improve access to quality
harm reduction services in
accordance to international and
local good practices.
1.1.3. Evaluate effectiveness of
diverse prevention service
models and disseminate good
practices.
1.2.1. Expand comprehensive
prevention interventions for
Transgender People in priority
districts, through communitybased approaches.
1.2.2. Build on the communitybased MSM initiative and
support its expansion.
1.2.3. Reach sex workers with
essential
prevention
interventions,
including
participation of peers.
1.2.4. Enhance understanding of
the dynamics of sex work for
informed programming.
1.3.1. Provide HIV prevention
and
referral
to
ART services for prison inmates
through
integration in prison services.
1.3.2. Develop pre-departure
prevention
education
for intending migrants, and
referral
systems
for HTC, ART and PPTCT for
returning
migrants
and families.
1.3.3. Mainstream and support
STI services for vulnerable
populations in public sector
health services.
102
3. Policy Environment and AIDS Response is Enhanced 2. HIV-related Morbidity and Mortality is reduced, and the Quality of Life of People Living with HIV is
for HIV prevention, treatment, care and support
improved
2.3. Increased coverage and
2.2. Scaled up coverage of ART and improved
3.2.
2.1. Increased coverage 1.4. Increased uptake of
Multi-sectoral 3.1. Enabling policy quality care, support and social
quality of medical management for people living
coordination enhanced
services for people living with
and quality of HTC
PPTCT services
environment ensured
with HIV
HIV
1.4.1.
Building
on
the
experience of the PPTCT
district model, scale up PPTCT
services
in
selected districts.
2.1.1. Increase availability and
uptake of HTC for KP and other
vulnerable populations through
a targeted approach.
2.1.2. Mainstream and support
HTC in general health services in
selected
locations
across
districts.
2.2.1. Reduce barriers to ART
for PWID, Transgender people
and other KP.
2.2.2.
Expand
treatment
services in accordance with
‘Continuum of Care’ model
(Community, Secondary and
Tertiary level – three tier
approach).
2.2.3. Improve referral linkages
within the continuum of
treatment and care, including
for TB.
2.2.4. Increase the sustainability
of ART procurement and supply
chain management.
2.3.1. Support PLHIV peer and
community
advocacy
organisations and networks
2.3.2. Increase referral of PLHIV
from HTC and HIV prevention
services to CHBC.
2.3.3. Build linkages with social
welfare
programme/
initiatives for PLHIV and their
families.
3.1.1. Implement and sustain
focussed
advocacy
among
decision-makers,
community
leaders and media.
3.1.2. Introduce policy changes
based on national provincial
policy and legislation review
3.2.1.
Organise
regular
provincial
coordination
meetings among government,
CSO and community partners.
3.2.2.
Ensure
enhanced
participation in the AIDS
response of the Home Dept.,
BEOE, Education Dept., Social
Welfare Dept. and ANF.
103
3.3. Strategic evidence
3.4. Resources mobilized for generated for planning
sustainability of the response
and
tracking
the
response
3.3.1. Undertake Integrated
Biological and Behavioural
Surveillance periodically.
3.3.2. Strengthen M&E and HIV
research capacity at the
provincial level.
3.4.1. Reduce costs of the HIV
response through efficiency
improvements.
3.4.2.
Increase
domestic
resource
allocation
for
sustainability of response.
3.4.3. Mobilise and align
external
resources
for
implementation of priority HIV
strategies
b. Policy and Management Queries Tool
What
worked
What
did not
work
What
was the
gap
in
the
strategy
Recom
mendat
ion
Situation analysis and programming: clarity and relevance of priorities and strategies selected based on a
sound situation analysis
Are the goals still relevant
How was the PAS prioritized
Who prioritized
Were the priorities appropriate? Was there a gap?
Now what are the priorities?
Have the priorities changed and why
Are priorities based solely on epi
Have the key directions for the last 5 years
changed?
Process: soundness and inclusiveness of development and endorsement processes for the provincial
2
strategy
What was the endorsement process for the
strategy
Implementation & management: soundness of arrangements and systems for implementing & managing
3
the programmes contained in the strategies
How much was the province prepared to take over
Devolution
the post-devolution expected role?
How long did it take for them to establish sound
arrangements and system for implementing and
managing the programs?
What impact has there been at provincial level due
to central level planning?
What impact has there been at provincial level due
to central level programming?
What impact has there been at provincial level due
to central level surveillance?
Is there a provincial MIS that accommodates data
MIS
from both SDPs and GF?
Is the provincial system aligned with a national
system? Is provincial data reflected adequately in
the national data?
1
104
Are reports shared and with whom? GF recipients?
Is MIS provincially incorporated into provincial
HMIS? Which indicators?
Manageme
nt
&
Coordinatio
n
Procuremen
t
Was there an implementation or operational plan
prepared for the PAS? Does it include capacity
building?
Was a Provincial Steering Committee formed?
Who is on it?
What coordination mechanism exists between:
a.
PACP
and
NACP
B.
PACP
and
its
SDP
partners
c. PACP and GF SRs under both the grants (i.e.,
COPC+
and
CHBC
sites
implementers)
d.
SDP
Partners
and
GF
SRs
e. PACP and relevant Govt. Line departments
f.
PACP
and
development
partners
g. Within PACP office
Is your website operational and why not?
Are the staffing levels currently adequate
What has been the staff turn-over trend
Are posts permanent - which ones?
Was a resource mobilisation strategy developed? Is
it being implemented?
Were comprehensive services developed with
SMART objectives and indicators for Key
Populations based on lessons learnt developed?
Are these different from the services and
indicators articulated in the Strategy?
Was in-house in-house capacity built, as well as
partners for implementation of PAS? What
specifically was done?
Does the Provincial Government have the capacity
to do international procurement? Allowed?
Experience (in which department if not PACP)?
Do they have a QA/QC plan and system?
Have they undertaken storage facilities
assessments? Was there a plan to upgrade storage
facilities?
Are drugs being requested through NACP in line
with the National Strategy
What is quality assurance for testing (referral
laboratory)
Contracts
Were new guidelines and mechanisms for public
private partnerships while outsourcing services for
Key Populations based on lessons learnt
developed?
Are the output specifications of the PPP contracts
aligned with the targets in the Strategy?
Have enough SDP contracts been issued to reach
prevention targets?
What are the basic standards of service laid out in
the contracts?
Are the SDPs meeting the basic standards? Are
they improving upon them? How?
Monitoring, evaluation and review: soundness of review and evaluation mechanisms and how their results
4
are used.
Was a detailed M&E framework developed?
Is programme output and monitoring done on a
montly basis? Quarterly basis? Annual basis?
105
IBBS/Resear
ch
Are Progress Reports being generated? Who do
they go to?
Was NACP supported to carry out IBBS? How was
this coordinated with provincial IBBS efforts?
Have any HIV incidence studies been done?
106
Annex IV. Schedule and participants of Key Informant Interviews, Focus Group Discussions and Provincial
Dialogues
Khyber Pakhtunkhwa Province Field Visits and Provincial Dialogue 19 th through 21st November
Khyber Pakhtunkhwa
Date
Name
Designation
Email
Key Informant Interviews
Held as requested
Dr Shaheen Afridi
Deputy Director Public Health
shaheenafridi@gmail.com
Directorate of Public Health 19th Nov -14
– HIV Unit
19th Nov -14
Dr Mustafa Alam
Assistant Director
dermosurgeon@hotmail.com
th
IG Prisons
20 Nov -14
Masud ur Rahman
SSP Central Prison Peshawar
Masudrahman3@gmail.com
TB Control
19th Nov -14
Dr Ubaid Hussain
Program Director
Could not be held as requested
Secretary/DG of Health, Ministry of Planning, Ministry of Finance/AG Office, Department of Communicable Diseases, Ministry/Department of Social Welfare,
Dost Welfare Foundation
Focus Group Discussions
FGD#1 – ART Centres
HMC (ART, PPTCT and
20th Nov -14
Dr Abdur Rahim
Incharge – ART unit
arahim@yahoo.com
Paediatrics)
LRH - Peshawar
Could not come
KDA - Kohat
Could not come
APLHIV
20th Nov -14
Mohammad Shafique
Provincial Coordinator
Mohd.shafique@live.com
FGD#2– CHBC Implementers
Association for Community
Dr Akmal Naveed
Director
akmal@acd.org.pk
19th Nov -14
Site
Manager
asimanabi@acd.org.pk
Development
Asim Nabi
Project Manager
Mohammadarif.yusuf@savethechildren.or
Arif Yusaf
Save the Children
g
19th Nov -14
Dr Mehsan Sattar Khan
Site Manager
Mehsan.sattar@savethechildren.org
Uzma
Rashid
Site
Manager
leouzma@gmail.com
Khawendo Kor
19th Nov -14
Ammara Mahmood
Psychologist
Peshpsychologist@yahoo.com
APLHIV
FGD#3– UN Agencies
WHO
UNHCR
UNFPA
20th Nov -14
Mohammad Shafique
Provincial Coordinator
Mohd.shafique@live.com
20th Nov -14
20th Nov -14
20th Nov -14
Dr Bilawal B. Khan
Dr Abdul Basit
Lubna Tajik
Provincial Officer
Bilawal.bahrawar@gmail.com
basit@unchr.org
tajik@unfpa.org
Khyber Pakhtunkhwa
Provincial Dialogue
Directorate of Public Health
– HIV Unit
Date
Name
Designation
Email
21st Nov -14
21st Nov -14
21st Nov -14
21st Nov -14
21st Nov -14
21st Nov -14
21st Nov -14
Dr Shaheen Afridi
Dr Mustafa Alam
Shafaullah Khan
Fazeelat Jehan
Masud ur Rahman
Dr Akmal Naveed
Asim Nabi
Deputy Director Public Health
Assistant Director
Health Educator
shaheenafridi@gmail.com
dermosurgeon@hotmail.com
shafullahkhan@yahoo.com
fazilatjehan@yahoo.com
Masudrahman3@gmail.com
akmal@acd.org.pk
asimanabi@acd.org.pk
Finance - Public Health
IG Prisons
Association for Community
Development
21st Nov -14
Save the Children
Khawendo Kor
APLHIV
WHO
NACP
CCM Secretariat
UNAIDS
Did not participate
SSP Central Prison Peshawar
Director
Site Manager
Mohammadarif.yusuf@savethechildren.or
g
st
21 Nov -14
Dr Mehsan Sattar Khan
Site Manager
Mehsan.sattar@savethechildren.org
21st Nov -14
Uzma Rashid
Site Manager
leouzma@gmail.com
21st Nov -14
Ammara Mahmood
Psychologist
Peshpsychologist@yahoo.com
21st Nov -14
Mohammad Shafique
Provincial Coordinator
Mohd.shafique@live.com
21st Nov -14
Dr Bilawal B. Khan
Provincial Officer
Bilawal.bahrawar@gmail.com
st
21 Nov -14
Dr Sofia Furqan
Senior Project Officer
sofiafurqan@hotmail.com
21st Nov -14
M. Naeem Khan
Program Officer
Naeem_nacp@yahoo.com
21st Nov -14
Rajwal Khan
Advisor
khanr@unaids.org
st
21 Nov -14
Fahmida Iqbal Khan
Advisor
khanf@unaids.org
Secretary/DG of Health, Ministry of Planning, Ministry of Finance/AG Office, Department of Communicable Diseases,
Ministry/Department of Social Welfare, Ministry/Department of Labour,
Ministry/Department of Education,
Ministry/Department of Religious Affairs, Ministry/Department of Population & Welfare, Dost Welfare Foundation
Arif Yusaf
Project Manager
Sindh Province Field Visits and Provincial Dialogue 25th through 28thNovember
108
Sindh
Key Informant Interviews
Held as requested
Sindh
AIDS
Control
Programme
Date
Name
Designation
Email
25th Nov -14
Dr Sikandar Ali Shah
Programme Manager
Info.sacp@gmail.com
th
25 Nov -14
Dr Aftab Ahmad
M&E Officer
aftabahmadlsukkur@yahoo.com
26th Nov -14
Dr Rana Muzaffar
Professor
ranamuzaffar@gmail.com
SUIT
(re
Resistance
26th Nov -14
Dr Sabiha Anis
Assistant Professor
Sabiha_anis@hotmail.com
Monitoring)
26th Nov -14
Dr Salma Batool
Assistant Professor
salmabatool@gmail.com
Civil Hospital – Ref. Lab
26th Nov -14
Pathologist
memonashraf@hotmail.com
Dr Ashraf Memon
th
Civil Hospital - PPTCT
26 Nov -14
Dr Zahida Parveen
PPTCT Coordinator
Civil Hospital - PPTCT
26th Nov -14
Dr Fauzia Sheikh
PPTCT Coordinator
Could not be held as requested
Secretary/DG of Health, Ministry of Planning, Ministry of Finance/AG Office, Department of Communicable Diseases, Ministry/Department of Social Welfare,
IG Prison, Sindh TB Control Programme
Focus Group Discussions
FGD#1 – ART Centres
26th Nov -14
Dr Azra Ghayas
HIV Physician
azraghayas@yahoo.com
Civil Hospital - Karachi
Indus Hospital
Aga Khan Hospital
FGD#2– CHBC Implementers
Bridge Consultants
Mehran Welfare Trust
FGD#3– TG/MSM/MSW/HSW
Humraz Male Health Soc.
Pakistan Society
Naz Male Health Alliance
Parwaz Male Health Soc.
26th Nov -14
26th Nov -14
26th Nov -14
Not available
Dr Zahida Parveen
Dr Fauzia Sheikh
Dr Samreen Sarfraz
PPTCT Coordinator
PPTCT Coordinator
Associate Consultant (ID)
Samreen2002@gmail.com
25th Nov -14
25th Nov -14
Dr Ghulam Sarwar
Ameer Ali Abro
Regional Coordinator
Programme Manager
drsarwarsoonam@yahoo.com
Ameerlai_abro@yahoo.com
27th Nov -14
27th Nov -14
27th Nov -14
27th Nov -14
M. Siddique Wali
Naimatullah Khan
Mohammad Osama
Usama Bin Ather
Social Mobilizer
Program Manager
Project Manager
Siddique.wali@HMHS.org.pk
muhammadusman@nmha.org.pk
Usama.ather@parwaz.org.pk
109
PIREH – Larkana
FGD#4– PWIDs
Bridge Consultant Found.
Al-Nijat
Pakistan Society
SBDDS – Sukkur
Nai Zindagi
FGD#5– UN Agencies
UNFPA - Sindh
WHO - Sindh
WFP – Sindh
UNHCR
Sindh
Provincial Dialogue
Ministry of Health
Finance Department
IG Prison
Sindh
AIDS
Programme
UNAIDS
WHO
UNFPA - Sindh
NACP
CCM Secretariat
Civil Hospital Karachi
Civil Hospital Karachi
Control
27th Nov -14
Wajid Ali
Manager
Wajid.ali@pirech.org.pk
25th Nov -14
25th Nov -14
25th Nov -14
25th Nov -14
25th Nov -14
25th Nov -14
Dr Manzoor Ahmed
Dr Ghous
Azhar Hussain Magsi
Dr. Muhammad Naeem
Syed M. Farrukh
Salman Qureshi
Project Manager
Project Manager
Project Manager
Project Manager
Dr.manzoor.ahmed@gmail.com
alnijat@gmail.com
azmagsi@yahoo.com
mnrsbds@yahoo.com
mnrsbds@yahoo.com
salman@naizindagi.com
27th Nov -14
27th Nov -14
27th Nov -14
27th Nov -14
Sajida Qureshi
Dr Khalid H Khan
Dr Aftab Bhatti
Bilal Agha
Date
Name
Designation
28th Nov -14
28th Nov -14
28th Nov -14
28th Nov -14
28th Nov -14
28th Nov -14
28th Nov -14
28th Nov -14
28th Nov -14
28th Nov -14
28th Nov -14
28th Nov -14
28th Nov -14
28th Nov -14
28th Nov -14
Dr M Aslam Pechuho
S. Baglar Raz
Ashraf Ali Nizammani
Dr Sikandar Ali Shah
Dr Preetam Jesrani
Dr Aftab Ahmad
Dr Sunnil A. Ho
Farhatullah
Fahmida Iqbal Khan
Dr Ghulam Nabi Kazi
Shurti Dhan Tripathi
Dr Sofia Furqan
Dr Sajid Ahmad
Dr Nargis Sohail
Dr Ashraf Memon
Additional Secretary Health
Section Officer
DIG Prison
Programme Manager
Deputy Programme Manager
M&E Officer
Finance Manager
Account Officer
Advisor
Advisor
IPC
Senior Project Officer
CCM Coordinator
Assistant Medical Superitend.
Pathologist
Senior Program Manager
saquershi@unfpa.org
khankhal@pak.emro.who.int
Aftab.bhatti@wfp.org
aghab@unchr.org
Email
Ashrafali2009@hotmail.com
Info.sacp@gmail.com
drpjesrani@yahoo.com
aftabahmadlsukkur@yahoo.com
0332-2092274
Fkhan@unaids.org
kazig@pak.emro.who.int
tripathi@unfpa.org
sofiafurqan@hotmail.com
Sajid@ccmpakistan.org.pk
Nargis_memon@hotmail.com
memonashraf@hotmail.com
110
Civil Hosp. ART – Karachi
JPMC – Karachi
PMCH
PMHS
LMH – Hyderabad/Jam
Indus Hospital –Karachi
Zia ud Din Hosp. Karachi
SIUT
SIUT
APLHIV –Sindh
Bridge
Mehran Welfare Trust
Sessi
Pakistan Society
Al Nijat
Al Nijat
Nai Zindagi
Naz Male Health Alliance
Parwaz Male Health Soc.
PIREH – Larkana
Govt. of KPK?
Did not participate
28th Nov -14
Dr Azra Ghayas
HIV Physician
azraghayas@yahoo.com
th
28 Nov -14
Dr Urooj Lal Rehman
Senior Registrar
mef.foundation@gmail.com
28th Nov -14
MS
Haqayaz53@gmail.com
Dr M. Haq
th
28 Nov -14
Dr Khurram
STI Specialist
DOC.JAM@MSN.COM
28th Nov -14
Dr Rafique ul Hassan
Medical Superintendent
Rafiquekhokhar_966@hotmail.com
28th Nov -14
Dr Samreen Sarfraz
Associate Consultant (ID)
Samreen2002@gmail.com
28th Nov -14
MS
Anoop_dwani@yahoo.com
Dr Anoop Dawani
th
28 Nov -14
Dr Sabiha Anis
Assistant Professor
Sabiha_anis@hotmail.com
28th Nov -14
Dr Salma Batool
Assistant Professor
salmabatool@gmail.com
28th Nov -14
Mukhtiar Ali Memon
Provincial Coordinator
Mukhtiarali645@gmail.com
th
28 Nov -14
Regional Coordinator
drsarwarsoonam@yahoo.com
Dr Ghulam Sarwar
28th Nov -14
Ameer Ali Abro
Programme Manager
Ameerlai_abro@yahoo.com
28th Nov -14
Dr Shah M Noorani
Medical Advisor
Slaln49@yahoo.com
th
28 Nov -14
Azhar Hussain Magsi
Project Manager
azmagsi@yahoo.com
28th Nov -14
Dr Ghous
Project Manager
alnijat@gmail.com
28th Nov -14
Dr M. Zakria
President
alinijat@gmail.com
th
28 Nov -14
Salman Qureshi
Senior Program Manager
salman@naizindagi.com
28th Nov -14
Mohammad Osama
Program Manager
muhammadusman@nmha.org.pk
28th Nov -14
Usama Bin Ather
Project Manager
Usama.ather@parwaz.org.pk
28th Nov -14
Wajid Ali
Manager
Wajid.ali@pirech.org.pk
28th Nov -14
Zaffar Iqbal
Secretary Lab
Zaffariqbal140@yahoo.com
Ministry of Planning, AG Office, Ministry/Department of Social Welfare, Ministry/Department of Labour, Ministry/Department
of Education, Ministry/Department of Religious Affairs, Ministry/Department of Population & Welfare
Balochistan Province Field Visits and Provincial Dialogue 1 st through 3rd December
Balochistan
Key Informant Interviews
Held as requested
Ministry of Health
Date
Name
Designation
1st & 2nd Dec -14
Rehmat Saleh Baloch
Minister of Health
Email
111
Ministry of Health
2nd Dec -14
Balochistan AIDS Control 2nd Dec -14
Programme
2nd Dec -14
IG Prisons
2nd Dec -14
TB Control
2nd Dec -14
Could not be held as requested
Ministry of Planning, Ministry of Finance/AG Office,
Focus Group Discussions
FGD#1 – PWIDs
Socio Pakistan
3rd Dec - 14
Socio Pakistan
3rd Dec - 14
Socio Pakistan
3rd Dec - 14
Socio Pakistan
3rd Dec - 14
Socio Pakistan
3rd Dec - 14
Shadow
3rd Dec - 14
Shadow
3rd Dec - 14
FGD#2 – CHBC
Shadow
3rd Dec - 14
Shadow
3rd Dec - 14
Taleem Foundation
3rd Dec - 14
FGD#3– UN Agencies
UNHCR
2nd Dec -14
WHO
Not available
UNFPA
Not available
Balochistan
Provincial Dialogue
Ministry of Health
PACP
PACP
PACP
Socio Pakistan
Date
3rd Dec - 14
3rd Dec - 14
3rd Dec - 14
3rd Dec - 14
3rd Dec - 14
Secretary of Health
Dr Fareed Sumalani
Dr Gul Sabeen Azan
Syed Abdul Razzak
Dr Ghulam Murtaza
M&E Officer
AIG Prisons
Program Manager
drsumalani36@gmail.com
Dr.gsapacp@gmail.com
razzakshah@gmail.com
Department of Communicable Diseases, Ministry/Department of Social Welfare
Amanullah Kakar
Faisal Ghicki
Zubair Khan
Mohammad Bilal
Muhammad Ali
Gulzar Ahmed
Tahira Khurshid
CEO
Project Officer
Gulzar Ahmed
Tahira Khurshid
Hameeda Baloch
sociopak@gmail.com
faisalghicki@gmail.com
Zubairjan343@gmail.com
bilal_85@hotmail.com
Muhammadali216@gmail.com
shadowbalochistan@gmail.com
shadowbalochistan@gmail.com
shadowbalochistan@gmail.com
shadowbalochistan@gmail.com
hamidabaloch@hotmail.com
Dr Badar Munir
Provincial Officer
munirb@unhcr.org
Name
Designation
Email
Mohammad Khan Zehri
Dr Gul Sabeen Azan
Dr Manzoor Hussain
Amanullah Kakar
Secretary Health
Deputy Program Manager
M&E Officer
Project Officer
CEO
Mk.zehri14@yahoo.com
Dr.gsapacp@gmail.com
Dr_manzoor@yahoo.com
sociopak@gmail.com
112
Socio Pakistan
Socio Pakistan
Socio Pakistan
Shadow
Shadow
Taleem Foundation
Nai Zindagi
CPO
Prisons
BMCH – Quetta
BMCH – Quetta
NACP
UNAIDS
Did not participate
3rd Dec - 14
Faisal Ghicki
faisalghicki@gmail.com
rd
3 Dec - 14
Zubair Khan
Zubairjan343@gmail.com
3rd Dec - 14
Mohammad Nadeem
Peer Educator
Nadeemhuhammadi20B@yahoo.com
3rd Dec - 14
Muhammad Ali
Muhammadali216@gmail.com
rd
3 Dec - 14
Gulzar Ahmed
shadowbalochistan@gmail.com
3rd Dec - 14
Tahira Khurshid
shadowbalochistan@gmail.com
3rd Dec - 14
Hameeda Baloch
hamidabaloch@hotmail.com
3rd Dec - 14
ghazanfar@naizindagi.com
Ghazanfar Imam
rd
3 Dec - 14
Abdul Rasool Zehri
CPO
zehriar@yahoo.com
3rd Dec - 14
Syed Abdul Razzak
AIG Prisons
razzakshah@gmail.com
3rd Dec - 14
Dr Rafi S. Ahmed
HIV Physician
Dr_shan2@yahoo.com
3rd Dec - 14
Dr KD Usmani
HIV Physician
Drkd_usmani@yahoo.com
rd
3 Dec - 14
Dr Sofia Furqan
Senior Project Officer
sofiafurqan@hotmail.com
3rd Dec - 14
Fahmida Iqbal Khan
Advisor
Fkhan@unaids.org
DG of Health, Ministry of Planning, Ministry of Finance/AG Office,
Ministry/Department of Social Welfare,
Ministry/Department of Labour,
Ministry/Department of Education, Ministry/Department of Religious Affairs,
Ministry/Department of Population & Welfare
Punjab Province Field Visits and Provincial Dialogue 8th through 12th December
Punjab
Key Informant Interviews
Held as requested
Ministry of Health
P&D
Date
10th Dec -14
10th Dec -14
8th Dec -14
8th Dec -14
Punjab
AIDS
Control
8th Dec -14
Programme
8th Dec -14
8th Dec -14
Could not be held as requested
Name
Designation
Email
Salman Shahid
Saleem Sandhu Masih
M. Faisal Majeed
Dr. Tayyab Rashid
Mohmmad Usman
Rashid Munir
Dr Fayzan
Addl. Secretary Health
Chief Health
Program Manager
Treatment Coordinator
Program Officer
Program Coordinator
M&E Officer
faisalmajeedch@yahoo.com
tayyaba.rashidpacp@gmail.com
musman.pacp@yahoo.com
Rashidmunir1@gmail.com
hafiz.fayzan@gmail.com
113
Secretary/DG of Health, Ministry of Finance/AG Office, Ministry/Department of Social Welfare, IG Prison, Punjab TB Control Programme
Focus Group Discussions
FGD#1 – ART Centres
Services Hospital Lahore
11th Dec - 14
Incharge ART
0336-5085972
Dr Ismail M Saqlain
th
Benazir Shaheed Hosp. RWP 11 Dec - 14
Dr Shahryar Malik
Incharge ART
0334-69595
DHQ Hospital DG Khan
11th Dec - 14
Dr Rubina Khan
Medical Officer
0307676070
DHQ Hospital Sargodha
11th Dec - 14
Dr Sikandar Warriach
Incharge ART
0321-6046666
DHQ Hospital Gujrat
11th Dec - 14
Dr Basharat Warraich
Incharge ART
Dr.biwaraich@yahoo.com
Allied Hospital Faisalabad
11th Dec - 14
Dr Ayesha Khalid
Consultant
0321-7843686
th
Jinnah Hospital Lahore
11 Dec - 14
Dr Syed Hunain Riaz
Incharge ART –
0333-4262531
Allied Hospital Faisalabad
11th Dec - 14
Dr Amber Khalid
Incharge PPTCT
0304-5370020
11th Dec - 14
Dr Shumaila Malik
Consultant
0336-300810
th
PACP
11 Dec - 14
Sumaira Ashraf
PPTCT Supervisor
0333-6969152
DHQ Hospital DG Khan
11th Dec - 14
Dr Sadia Sheraz
Incharge ART
0334-4165959
Mayo Hospital Lahore
11th Dec - 14
Dr Inam Ul Haq
Incharge ART
0300-8482009
Allied Hospital Faisalabad
11th Dec - 14
Dr Arshad Bashir
Incharge ART
0300-6673382
FGD#2– UN Agencies
11th Dec - 14
Dr. Muhammad Babar PCO
mbabaralam@gmail.com;
UNFPA-Punjab
Alam
mualam@unfpa.org
th
WHO - Punjab
11 Dec - 14
FGD#3– TG/MSM/MSW/HSW
Homeopathic Assoc. Pak
10th Dec -14
Altaf H Tariq
Chairman
ahtariq@yahoo.com
th
Khawaja Sira Society
10 Dec -14
Sarah Gill
Project Manager
sararhgill_mis@kss.org.pk
Naz Male Health Alliance
10th Dec -14
Mohammad Osama
Program Manager
muhammadusman@nmha.org.pk
Naz Male Health Alliance
10th Dec -14
Dr M Moiz
Technical Manager
Muhammadmoiz92@gmail.com
Dostana Male Health Soc.
10th Dec -14
Ali Ikram
Program Manager
Ali.ikram@dmhs.org.pk
th
Contech International
10 Dec -14
Dr Aneeqa M. Joyia
mumtazaneeqa@gmail.com
Contech International
10th Dec -14
Irum Shezadi
ishezadi@gmail.com
Active Help Organization
10th Dec -14
Dr Kulsoom Akhtar
Director
activehelp@gmail.com
Pakistan AIDS Consortium
10th Dec -14
Saeed Mirza
Aamirza69@gmail.com
th
Pakistan AIDS Consortium
10 Dec -14
Shadman Aziz
shamanaziz@gmail.com
114
APAOP
FGD#4– CHBC
New Light
Pak Plus Society
Roshan Rasta
Roshan Rasta
Pakistan AIDS Consortium
APLHIV - Punjab
FGD#5– PWIDs
Roshan Rasta
Roshan Rasta
BFRD. FSD
Nai Zindagi
Nai Zindagi
PFRD
PFRD
Aghaz e Nau
Aghaz e Nau
Rutger WPF
10th Dec -14
Haji Hanif
Director
aidspak@gmail.com
8th Dec - 14
8th Dec - 14
8th Dec - 14
8th Dec - 14
8th Dec - 14
8th Dec - 14
Nazir Masih
Waris Ali
Dr Hamayun
Ahmad Baksh Awan
Saeed Mirza
Mohammad Arshad
Director
Program Manager
newlightaids@gmail.com
warisnlacs@gmail.com
Hmirza57@yahoo.com
abaawan@yahoo.com
Aamirza69@gmail.com
9th Dec - 14
9th Dec - 14
9th Dec - 14
9th Dec - 14
9th Dec - 14
9th Dec - 14
9th Dec - 14
9th Dec - 14
9th Dec - 14
Dr Hamayun
Ahmad Baksh Awan
Rana Ijaz Mahmood
Salman Qureshi
Dr Mubashir Ahmed
Javeria Anjum
Dr Sadia Faisal
Dr Shehryar
Belal Ahmad
Muhammad Ashraf
CEO
Consultant
Punjab
Provincial Dialogue
Date
Name
Designation
Email
12th Dec - 14
12th Dec - 14
12th Dec - 14
12th Dec - 14
12th Dec - 14
12th Dec - 14
12th Dec - 14
12th Dec - 14
12th Dec - 14
M. Faisal Majeed
Dr. Tayyab Rashid
Mohmmad Usman
Rashid Munir
Dr Fayzan
Nazir Masih
Waris Ali
Dr Hamayun
Ahmad Baksh Awan
Program Manager
Treatment Coordinator
Program Officer
Program Coordinator
M&E Officer
Director
Program Manager
faisalmajeedch@yahoo.com
tayyaba.rashidpacp@gmail.com
musman.pacp@yahoo.com
Rashidmunir1@gmail.com
hafiz.fayzan@gmail.com
newlightaids@gmail.com
warisnlacs@gmail.com
Hmirza57@yahoo.com
abaawan@yahoo.com
Punjab
AIDS
Programme
New Light
Pak Plus Society
Roshan Rasta
Roshan Rasta
Control
Consultant
Provincial Coordinator
Senior Program Manager
Prov. Coordinator Punjab
Project Manager
PM- UNODC Prison
CEO
Project Coordinator
Social Mobilizer – Kasur
Consultant
Hmirza57@yahoo.com
abaawan@yahoo.com
BFRD.PK@gmail.com
salman@naizindagi.com
Malikdr2005@gmail.com
Somibilizer.kasur@tugersWPFPak.org
115
BFRD. FSD
Naz Male Health Alliance
Naz Male Health Alliance
Dostana Male Health Soc.
APAOP
SHEED Society
SHEED Society
Contech International
Contech International
Active Help Organization
Phoenix Foundation
Phoenix Foundation
Pakistan AIDS Consortium
Pakistan AIDS Consortium
Nai Zindagi
Nai Zindagi
UNAIDS
NACP
UNAIDS
Did not participate
12th Dec - 14
12th Dec - 14
12th Dec - 14
12th Dec - 14
12th Dec - 14
12th Dec - 14
Rana Ijaz Mahmood
Qasim Iqbal
Mohammad Osama
Ali Ikram
Haji Hanif
Syed Tayyab H Shah
Lubna Tayyab
Dr Aneeqa M. Joyia
Irum Shezadi
Dr Kulsoom Akhtar
Dr Sadia Faisal
Sundas batool
Saeed Mirza
Shadman Aziz
President
Program Manager
Program Manager
Director
Program Manager
Director
BFRD.PK@gmail.com
Qasim.iqbal@nmha.org.pk
muhammadusman@nmha.org.pk
Ali.ikram@dmhs.org.pk
aidspak@gmail.com
Sheed_society@hotmail.com
12th Dec - 14
mumtazaneeqa@gmail.com
12th Dec - 14
ishezadi@gmail.com
th
12 Dec - 14
Chairperson
activehelp@gmail.com
12th Dec - 14
sadiapfrd@gmail.com
12th Dec - 14
sundasbatool@gmail.com
th
12 Dec - 14
Aamirza69@gmail.com
12th Dec - 14
shamanaziz@gmail.com
12th Dec - 14
CEO
tzafar@naizindagi.org.pk
Tariq Zafar
th
12 Dec - 14
Salman Qureshi
Senior Program Manager
salman@naizindagi.com
12th Dec - 14
Dr Mubashir Ahmed
Prov. Coordinator Punjab
Malikdr2005@gmail.com
12th Dec - 14
Advisor
Fkhan@unaids.org
Fahmida Iqbal Khan
th
12 Dec - 14
Dr Sofia Furqan
Senior Project Officer
sofiafurqan@hotmail.com
th
12 Dec - 14
Rajwal Khan
Advisor
khanr@unaids.org
Ministry of Planning, AG Office, Ministry/Department of Social Welfare, Ministry/Department of Labour, Ministry/Department
of Education, Ministry/Department of Religious Affairs, Ministry/Department of Population & Welfare
116
Federal Capital1st to 8th December 2014
Federal Capital
Key Informant Interviews
Held as requested
Nai Zindagi
APLHIV
Focus Group Discussions
FGD#1 – UN Agencies
Date
Name
Designation
Email
1stDec -14
5thDec -14
Salman ul Hasan Qureshi
Asghar Satti
Senior Project Officer
National Coordinator
salman@naizindagi.com
Satti_30@yahoo.com
Country Community
Mobilization and Networking
Advisor
HIV/AIDS Specialist
Adviser DDR & HIV/AIDS,
Public Health Officer
National Program Officer-HIV
AIDS
fkhan@unaids.org
8th Dec - 14
UNAIDS:
UNICEF
UNODC
UNHCR
UNDP
8th Dec - 14
8th Dec - 14
8th Dec - 14
8th Dec - 14
Fahmida Khan
Fahmida Iqbal Khan
Dr. Nasir Sarfraz
Dr.Manzoor-ul-haq
Dr Pervez Shaukat
Dr. Aurang Zeib
|
nsarfraz@unicef.org
manzoor.ul.haq@unodc.org
aurang.zeib@undp.org
117
118
:
119
Annex II. Interview Tools
1. Provincial Strategy Review Tool_v2_15Nov
2. Policy and Management Queries Tool_v2_15Nov
Annex III. Schedule and participants of Key Informant
Interviews, Focus Group Discussions and Provincial
Dialogues
121