2015 Kosovo HIV Concept

NoteCCM Meeting Discussion of the Draft

15 January 2015

Key Assumptions/Requirements Same level of funding for 2.5 years;

Little likelihood of additional future funding;

Government to take over: contribution from 40% to full coverage;

Focus on key affected populations;

Address low coverage, treatment interruptions, MMT dropouts, and lack of behavioural changes

Highlights Main allocation and above

allocation

Counterpart financing and Willingness to pay

Online grant management platform, credentials, CCM endorsement

Process and Challenges

Changes in the Government and strategic planning processes;

KP’s representation weak; no networks/associations;

Key population estimates, IBBS in 3 sites, extrapolation problematic, implications of overestimating, more size estimates required;

Coverage increase – new outreach strategies, adjusted service combinations

Population size estimates: PWID

City population

Municipality population 2012

Adult population

IBBS Size Estimate

Total population drug use prevalence

Adult population drug use prevalence

Medium prevalence extrapolation

Prizren prevalence extrapolation

1Pristina 145149 205133 157952 3946 1.923630035 2.498220825 3946 3946

2Prizren 85119 181756 139952 1113 0.612359427 0.795271983 1113 1113

3Gjilan 54239 91413 70388 1159 560

4Peja 48962 98237 75642 1246 602

5Mitrovica 46230 73160 56333 928 448

6Ferizaj 42628 111141 85579 1409 681

7Gjakova 40827 96071 73975 1218 588

8Vushtrri 27272 71042 54702 901 435

9Podueva 23453 89185 68672 1131 546

Total 513879 1815606 783196 13051 8918

Goal: Maintaining the low prevalence of HIV and improving the quality of life of affected people through the improved cascade of HIV prevention and care services

Target Populations PLHIV

PWID

FSW

MSM

Prisoners

Migrants

Vulnerable women and girls

Vulnerable ethnic minorities (RAE)

Objectives and modules

Ob1: To improve access of KPs to quality HIV prevention and care

(Mod.1-4) Expand coverage:

Mobile service delivery;

Local peer educators;

Peer driven interventions;

Secondary service delivery

Service quality???:

High quality verbal BCC;

In-depth understanding of risk factors;

Risk management measures (PSCM);

Patient monitoring and treatment quality control

Ob2: To improve detection of HIV and facilitated access to care and treatment

(Mod. 1-5) Promotion/availability of HTC for KAP;

Promotion of HTC of pregnant women; 

Strengthening continuum of prevention/care services:

linking HTC to prevention, care and treatment (regulations and referral mechanisms);

Improved retention through patient associations and community quality monitoring;

laboratory capacity to monitor the treatment effectiveness;

promote the development and rollout of treatment protocols

Ob3: To create supportive environment for sustainable HIV/AIDS response (Mod. 6-8)

Policy development and advocacy function (PAG);

Strengthening essential community systems (associations and networks) to address stigma and discrimination, monitor/ensure quality;

Client registration and service monitoring software, bio-behavioural monitoring, KP size estimates, formative studies;

Community Based Organisation

Health facility

Needles and syringes (PWID)Condoms (all KPs)Information (all KPs)HIV testing (up to 40%)TB screeningHCV testingHBV testingSTI testing1 mobile clinic

CounselingSocial supportLegal supportPsychologicalOST (MMT)

PDI Partners recruitment and education

Unknown status

HIV+HIV-

referral

OST (MMT)ART TreatmentTreatment for HIVTreatment for TBTreatment for STIHBV vaccination

HIV Prevention Service model

Mod. 1. Prevention for PWID and their partners

Outreach strategies (staff, mobile, PDI, secondary);

Adequate number of needles;

Adequate types of needles;

Alcohol swabs and sterile water?;

Strengthened BCC procedures;

Better detection of HIV and linkages to care and treatment;

Limited room for complementary services (legal aid).

Mod.2-4. MSM, FSW, Other

Outreach strategies: peer workers etc. (all);

Condoms and lubricants (condoms for all);

Strengthened BCC (all);

Gynaecological and STI services (SW);

HIV (all), HBV, HCV testing;

Prison personnel: study visit

Women and RAE: IEC materials and group education sessions;

Migrants, Women and RAE: Testing during events;

Mod.5. Treatment, care and support

Community-based care and support

Monitoring of treatment effectiveness

Community monitoring of treatment quality

Mod.6. HSS: Procurement and supply chain

management (PSCM) Closer collaboration between stakeholders

Risk management strategy

International TA

Good storage practice workshop

Mod.7. HSS: Health information systems and

M&E Improved service monitoring;

Monitoring of drug scene and contextual factors to adjust interventions: Operational studies (Prison NSP, RAE vulnerabilities)

Reports by frontline service providers

Assess the need of NSP in prisons

Feasibility of introduction of Low Dead Space (LDS) syringes

Preferred types of injecting instruments to inform procurement;

Consultations with prison health workers on situation changes;

Analysis and solutions for Naloxone;

KP size estimates (nationwide or in a selection).

Module 8. Removing legal barriers to access

PAG (including a legal analyst) Legislation analysis and promotion of improvements (EU

accession commitments, antidiscrimination legislation, legislation conflicts)

E.g. trafficking of humans and transactional sex – to standard practice of law enforcement officers etc.;

Policies and procedures to ensure the required level of service uptake and retention;

Development of community systems and community involvement in service monitoring and quality assurance;

Codes of professional practice and ToR; Operations, routes and schedules of service delivery units (mobile

unit); Development of CBOs, including PLHIV networks and peer-support

groups; Prison programme advisory council; BCC module related to OD; Improved detection of HIV (pregnant women and symptomatic

patients) - policies and procedures

Impact and outcome targetsIndicator 2011

base2014 target

2014 IBBS

2017 target

% SW living with HIV 0% <5%

% MSM living with HIV 2.3% <5%

% PWID living with HIV 0% <5%

% PWID who used sterile syringe during last injection

99% 80% 82% 85%

% MSM who used condom during last anal sex

53% 85% 66% 85%

% SW who used condom with latest client

43% 85% 62% 85%

Coverage targets: PWID

Population size: 8918 in 9 municipalities

Essential services: 2134/3400/4500/5350

VCT: 719/1360/1800/2140

Needles/person: 10/100/100/100

MMT: 94/150/200/250 (Increase if clients of public facilities are included)

Coverage targets: MSM

Pop size: 13432

Basis services: 1533/1600/3000/5373

VCT: 182 (2013)/640/1200/2149

Coverage targets: FSW

Denominator: 4586

Basic services: 272 (2013)/1000/1500/1900

VCT: 272 (2013)/400/600/760

Other populations Prisoners: 1380 (100%)

VCT: 552 (40%)

Women and girls: 9008/13512/13512

RAE: 5335/8002/8002

PLHIV care and support: 28/35/40/45

Budget Summary (Allocation)Module Y1 Y2 Y3 Total %

Prevention programs for people who inject drugs (PWID) 172 865 317 651 387 994 878 510 34%Prevention programs for MSM 88 658 149 432 196 018 434 108 17%Prevention programs for sex workers and their clients 56 411 84 576 89 724 230 711 9%Prevention programs for other vulnerable populations 39 105 79 950 74 193 193 249 8%Treatment, care and support 122 555 45 509 45 909 213 973 8%HSS: Procurement and supply chain management (PSCM) 5 036 0 0 5 036 0%HSS: Health information systems and M&E 16 325 47 923 35 771 100 019 4%Removing legal barriers to access 7 010 15 268 13 520 35 798 1%

Program management 98 451 187 902 187 902 474 256 18%Total

606 415 928 211 1 031 032 2 565 658 100%

Budget Summary (Above)Module Y1 Y2 Y3 Total %

Prevention programs for people who inject drugs (PWID) 44 411 64 572 72 587 181 571 37%Prevention programs for MSM 12 271 9 224 11 345 32 841 7%Prevention programs for sex workers and their clients 31 662 36 635 45 875 114 172 23%Prevention programs for other vulnerable populations 9 682 9 802 9 802 29 286 6%Treatment, care and support 32 928 0 0 32 928 7%HSS: Procurement and supply chain management (PSCM) 0 0 0 0 0%HSS: Health information systems and M&E 10 355 68 241 17 886 96 481 20%Removing legal barriers to access 500 500 500 1 500 0%

Program management 0 0 0 0 0%Total

141 809 188 974 157 995 488 778 100%

Thank you and good luck!