RFA # 11-001: Reduction Of New HIV Infections Through Enhanced Community Engagement In Combination HIV Prevention

CIVIL SOCIETY FUNDStrengthening civil society for improved HIV/AIDS and OVC service delivery in Uganda

Pre-bidders workshops ; 12th October 2011

WORKSHOP OBJECTIVES

• Orient potential applicants on the RFA 11-001 requirements• Share the national HIV Prevention Strategy;• Orient stakeholders about combination HIV Prevention and

its package in the context of Uganda;• Discuss approaches for supporting convergence of partners

and joint planning and partnerships frameworks for the 6 districts;

EXPECTED WORKSHOP OUTPUTS

• Improved understanding the RFA 11-001 requirements to enable them write appropriate concept papers/proposals

• Improved understanding of the national HIV Prevention Strategy, and combination HIV Prevention including its package in the context of Uganda;

• Orient stakeholders on the design and methodology for the Combination HIV Prevention pilot program;

• Suggested approaches for supporting convergence of partners and joint planning and partnerships frameworks for the 6 districts;

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UGANDA NATIONAL HIV PREVENTION STRATEGY..Expanding and doing HIV prevention better ….

BACKGROUND

• Uganda’s HIV epidemic is mature, and generalised

• Recent evidence shows that the epidemic has evolved – risk factors and drivers as well as population groups most affected have changed in recent years

• Although various HIV Prevention Interventions have piloted / implemented for 25 yrs, Uganda still has a run away epidemic

Over 124,000 new HIV Infections in 2009 New Infections exceeding AIDS deaths by about X2 New Infections exceed annual ART enrolment by X3

• HIV prevention is one of the priorities of the NDP (2010 -15)

TRENDS IN HIV PREVALENCE

About 731,000 potential new infection over next five years if status quo is maintained. Of these about 112,000 would be among children

HETEROGENEITY OF HIV BURDEN

• Very High HIV Prevalence– Sex Workers, Partners of Sex workers, Individuals with history of

same sex. Fishing communities• Average HIV Prevalence

– Antenatal women, Boda boda cyclists, Plantation workers• Relatively low HIV Prevalence

– University Students• Majority of new infections sexually transmitted

– 37% multiple partnerships– HIV discordant monogamous– Sex work and networks– Majority of sexual transmission among individuals over 25 years

• MTCT about 20-25% infections• Negligible blood borne infections

SOCIAL/STRUCTURAL DRIVERS OF HIV• Socio-cultural drivers

– Harmful cultural beliefs/practices e.g. polygamy, widow inheritance, courtship rape, rites of passage,

• Gender Norms– SGBV, multiple partnerships among men, Permissiveness

among women, Masculinity among men• Socio-Economic

– Poverty/wealth, Dependency , mobility• Human rights violations especially for women/girls

– access to justice- weak enforcement of existing laws • Inequities in access to health services• Stigma and Discrimination

WHY NEW HIV INFECTIONS REMAIN HIGH....

Quality of HIV prevention services not optimal

CONSIDERATIONS IN THE NEW STRATEGY• Aligning HIV prevention efforts to drivers of the HIV/AIDS

epidemic

• Target population groups with the highest risk of new infections

• Central theme of the new strategy is Combination HIV prevention approaches using proven interventions

– Minimum HIV prevention packages for the general population and specific groups brought to critical coverage

• Alignment to NDP NSP, HSSIP – i.e. the strategy to implement the HIV prevention component in these frameworks / strategic plans

THE NATIONAL HIV PREVENTION STRATEGY

MISSION & VISION

MissionThe strategy is to serve as a resource to stakeholders to

strengthen planning, implementation, coordination, and monitoring of HIV prevention programmes to significantly reduce new infections

Vision“Uganda where new HIV infections are rare, and where

everyone regardless of age, gender, ethnicity or socio-economic status has uninterrupted access to high quality and effective HIV prevention services free from stigma and discrimination”.

MISSION

MissionThe strategy is to serve as a resource to stakeholders to

strengthen planning, implementation, coordination, and monitoring of HIV prevention programmes to significantly reduce new infections

Vision“Uganda where new HIV infections are rare, and where

everyone regardless of age, gender, ethnicity or socio-economic status has uninterrupted access to high quality and effective HIV prevention services free from stigma and discrimination”.

GOAL

• To reduce new HIV infections by 30% based on the baseline of 2009 which would result in 40% reduction of the projected number of new HIV infections in 2015, in line with the targets in the NDP

• To reduce MTCT Rate reduced from 29% to less than 10% by 2015

40%

•40% Reduction in new infections based on projected 2015 levels•Equivalent to 30% reduction based on 2009 estimates of new infections•IR declines from 0.74 to 0.46 /100PYs•178,930 New HIV Infections averted

OUTCOMES BY 2015

PRIORITIES FOR HIV PREVENTION

• To adequately address the key drivers Scale up priority HIV prevention services i.e. PMTCT,

HCT, SMC, ART for HIV Prevention and Condom use Reduce "unsafe sex" i.e. multiple and concurrent

partnerships, early debut, cross generational , transactional and, casual sex

Make "unsafe sex" safer through condom promotion and increased male circumcision.

Reduce gender/socio-cultural/structural constructs that facilitate sexual transmission of HIV

Improved Coordination and M&E for HIV Prevention

PRIORITY POPULATION GROUPS

• General Population with a strategic shift to adults, married and previously married individuals, wealthy and working adults

• Residents of high prevalence / high risk locations e.g. urban residents, high HIV prevalence regions, transport corridors, boarder crossings, fish landing sites etc

• Most-at-risk population groups, especially sex workers and their partners, long-distance truckers, fish-mongers, men in military service,

• Vulnerable population groups e.g. victims of rape and sexual violence, non-infected partners of individuals in HIV sero-discordant relationships, widows, etc

• PLHIV

MINIMUM PACKAGE OF SERVICES FOR GENERAL POPULATION

Core Components:•PMTCT•Male circumcision•HIV counseling and testing•Antiretroviral Therapy•Condom promotion•BCC integrated into existing structures (religious institutions, work places, school, etc) focusing on multiple partnerships etcComplimentary Components:•IEC Messages and social norms reinforced through mass media•STI screening and treatment•Blood Transfusion Safety and Infection Control •Supporting policy and advocacy

MINIMUM PACKAGE OF SERVICES FOR MARPs• Community-based peer education and outreach• Risk reduction counseling (peer, outreach or in clinic settings)• Condom promotion and distribution• HIV counseling and testing• STI screening and treatment• Family planning and SRH services• Post Exposure Prophylaxis• HIV care and treatment• Access to health/social services• Structural issues (community mobilization initiatives and policy

level initiatives, including those which address stigma and discrimination)

IMPLEMENTATION STRATEGY

• Combination HIV Prevention– Referral linkages, Integration of services, Health Systems

Strengthening• Realignment of funding priorities

– Increased domestic and external resources, Fund HIV Prevention as a key and cross-cutting component of the NDP

• Improved Coordination– Multisectoral response, Health sector, Line Ministries, LGs

• Monitoring and Evaluation– Results-based, Strengthening of M&E systems, Alignment of

M&E systems, Improved reporting and surveillance, systems– Impact evaluation, Resource tracking, Improved information

management and sharing

INTRODUCTION TO RFA 11-001

INTRODUCTION TO RFA 11-001

• HIV/AIDS epidemic in Uganda , goal and purpose• The HIV Prevention Strategy • Combination HIV Prevention with emphasis on behavioural

and structural interventions • The community engagement concept• Eligible CSOs CBOs; cultural/religious institutions; NGOs;

networks and NNGOs. • principal recipients must have district presence of 3 years consortiums. • 6 focus districts • UGX 26 billion in a period of 36 months.

OBJECTIVES OF THE RFA

• The objectives for this RFA mirror those stipulated in the National Prevention Strategy. These include:

• To empower individuals and communities to effectively demand for quality HIV/AIDS services and to demand for inclusive delivery of these services.

• To increase adoption of safer sexual behaviors/practices• To create a sustainable enabling environment that mitigates

the underlying socio-cultural, gender based and other structural drivers of the HIV epidemic

• To achieve a well coordinated HIV prevention response

EXPECTED OUTCOMES OF THE RFA

Higher Level Outcomes• Increased demand for and utilization of HIV prevention and

care services in the targeted districts• Increased adoption of safer sexual behaviors /practices and

reduced risky behavior among targeted men and women• Improved community perception of the benefits of

sustained behavior change.• Well coordinated HIV prevention efforts at national, district

and community level.

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EXPECTED OUTCOMES OF THE RFA

Lower Level Outcomes• Increased proportion of adults who have ever received HCT

and know at least two benefits of testing. • Increased proportion of infected mothers and the exposed

infants accessing a minimum package of PMTCT • Reduced recent multiple concurrent partners among men

and women in the targeted communities• Increased average age for marriage or sexual debut for

individuals especially youth in the targeted communities• Increased proportion of risky sexual acts/encounters that

are consistently protected by condoms

EXPECTED OUTCOMES OF THE RFA

Lower Level Outcomes (cont..)• Increased percentage of women who make decisions about

their sexual and reproductive health rights independently or jointly with their partners

• Reduction of percentage of women who experience sexual violence

• Improved involvement of men in community based HIV prevention interventions

• Functional referral mechanisms/systems among the community and facility HIV/AIDS services

THE 4 KNOWS

• Know Your Epidemic– Analysis of data on prevalence and incidence to prioritize

populations and geographic areas that are most at risk for HIV.

• Know Your Context– Data to contextualize the epidemic. Ensure cultural relevance.

• Know Your Response– Tracking the epidemiological alignment, scope, coverage and

effectiveness of prevention efforts.

• Know Your Costs– Knowing what is spent, and what the output for investment is;

prioritizing interventions based on cost-effectiveness.

COMBINATION HIV PREVENTION

COMBINATION HIV PREVENTION

The National HIV Prevention Strategy for Uganda calls for a strategic shift towards Combination HIV PreventionDefinition (UNAIDS )

“The strategic, simultaneous use of different classes of prevention activities (biomedical, behavioral, social/structural) that operates on multiple levels (individual, community, societal), to respond to the specific needs of particular audiences and modes of HIV transmission, and to make efficient use of resources through prioritizing, partnership, and engagement of affected communities.”

BIOMEDICAL

• ART treatment for eligible patients and PreP• Safe Male Circumcision• PMTCT• Home-based HIV Testing• HIV Testing (routine/opt-out) linked to ART and behavioral

change programs TLC• Family planning• STI-screening and treatment of MARPs & PLHIV• Safe syringes

BEHAVIORAL

• Condom Use Promotion Programs• Peer education HIV prevention programs addressing

condom use, concurrency, age-mixing and transactional sex targeting high risk groups

• Couple counseling• Disclosure promotion programs• Delay sexual onset• Adherence to ART support programs• Positives Counseling Programs• Positive Health Dignity and Prevention (PHDP) • Abstinence and Faithfulness programs

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SOCIAL/STRUCTURAL

• Micro credit programs to support women’s economic situation

• Creating Demand for HIV Prevention Services Programs• GBV prevention programs• Conditional Cash Transfers• Women Empowerment Programs• PLHIV programs addressing stigma• Addressing widow inheritance• Human Rights and Empowerment Interventions for Sex

Workers, IDU’s• Easing access to care for Sex Workers, IDU’s

BENEFITS OF THE RIGHT COMBINATION

• Several HIV interventions have a proven, but partial efficacy • In combination a synergy effect can occur between different

interventions, which increases the effectiveness of all of the interventions when delivered together.

• According to the local epidemiology we will have a tailor made HIV prevention program for the area

• The tailor made approach adds effectiveness, high risk individuals and groups are targeted first to avert most new HIV infections

• Tailor made combined intervention taking place at the same time in the same place to a defined standard are know to be more effective.

COMMUNITY ENGAGEMENT

COMMUNITY ENGAGEMENT DEFINITION Community engagement is the process of working collaboratively with and through groups of people affiliated by geographic proximity, special interest, or similar situations to address issues affecting the well-being of those people.(adapted from Fawcett et al, 1995)

Different levels at which one engages with people:-* Inform* Consult* Involve* Collaborate* EmpowerN.B: Different situations require the use of different levels of engagement

COMMUNITY ENGAGEMENT PRINCIPLES

• Empowering the people to make decisions, raise question & problems and be part of the solution

• The rules of engagement between the target beneficiaries and the supporting agency need to be clarified

• Should be participatory (need awareness before this can be acted upon)

• Should include both men and women

• Focus on the power dynamics (women empowerment)

• Community ownership

• Accountability

BENEFITS OF COMMUNITY ENGAGEMENT

of engaging the community:- • the development of sustained, community-focused and led

interventions• Use of explicit methodologies that engage people in

discussion and collective action on the factors that influence risk and vulnerability to HIV in their particular communities.

• The development and/or strengthening of strategic partnerships and coalitions that help mobilize resources and influence systems, change relationships and serve as catalysts for changing policies, programs and practices.

• Innovative interventions in the following:-• Communication for social and individual behavior change• Gender norms and harmful social cultural practices• Coordination, collaboration, strategic partnerships

networks and referrals• Cross cutting issues• Engage with district and any other relevant• Capacity building interventions for communities and

selected duty bearers.

AREA OF FOCUS AND SUGGESTED INTERVENTIONS

• Consortiums -leverage resources and avoid duplication of efforts.

• Procurement restrictions• Niche/comparative advantage• Coverage of target populations

NOTES

Building Strategic Partnerships, Linkages and Referrals – The role of the various stakeholders in the district

• Establishing terms and conditions of partnership• Ensuring clarity of roles of all partners• Ensuring regular meetings of the partners• Ensuring transparency and accountability in the

partnerships• Strengthening forums for partnership development• Strengthening the capacity of service providers to manage

referrals

Strategies for strengthening partnership, linkages & referrals

OVERVIEW OF THE M&E SECTION

OVERVIEW OF THE M&E SECTION

The M&E section has three main components;

1. The M&E Matrix2. The M&E Narrative3. The M&E Resources4. The CSF M&E System

THE M&E MATRIX

Builds on the log frame and provides the following details:1. Overall Objective – what your project intends to contribute to.2. Outcome-desired change/ result that your project aims to

achieve3. Outputs - immediate results of project activities 4. Performance indicators (within prevention strategy framework)

and respective baselines and targets5. Means of Verification (MOV) - Data sources6. Frequency of data collection for each indicator7. Responsible person /entity for data collection for each indicator8. Frequency of data analysis and use for each indicator9. Responsible person /entity for data analysis for each indicator

THE NARRATIVE SECTION

Explain precisely the how, what, who, when and where regarding;

• Data collection

• Data storage

• Data analysis, reporting and utilization

• Other monitoring processes

• Data quality assurance

• M&E capacity building

• Monitoring external, uncontrollable factors

M&E RESOURCES

Provide a sufficient M&E budget (10 – 15% of the total project budget) cater for:-

– Full-time M&E personnel to carry out M&E functions

– Equipment for data capture, storage, processing and reporting e.g. computers, internet

– Short-term M&E resources e.g. consultants, data entrants

– M&E activities including data collection, analysis, storage, reporting, review meetings, trainings, assessments, tools production, field monitoring visits and the like.

The CSF M&E System

• Data collection tools: CSF has standardized data collection tools fro capturing HCT, HIV prevention, PMTCT, that are used by all the sub grantees. The sub grantees will therefore be required to adopt the available data collection tools.

• Reporting formats: CSF has standardized reporting formats for quarterly, semi annual and annual reports. All sub grantees are supposed to abide by the reporting timelines

• An online database: CSF has an online database for capturing sub grantee data and all are required to enter their data in this database.

• Indicators: CSF has standardized indicators that all sub grantees are required report against.

TARGET AND DENOMINATOR TABLE

CATEGORY (CSW, PHA, Fisher folk etc) District Female Male Total

Sub county Parish Age (Years)

Target Denominator Target Denominator Target Denominator

10-14

15-24

≥25

EXPECTED OUTCOMES OF THE RFAHigher Level Outcomes• Increased demand for and utilization of HIV prevention and

care services in the targeted districts• Increased adoption of safer sexual behaviors /practices and

reduced risky behavior among targeted men and women• Improved community perception of the benefits of

sustained behavior change.• Well coordinated HIV prevention efforts at national, district

and community level.

49

EXPECTED OUTCOMES OF THE RFA

Lower Level Outcomes• Increased proportion of adults who have ever received HCT

and know at least two benefits of testing. • Increased proportion of infected mothers and the exposed

infants accessing a minimum package of PMTCT • Reduced recent multiple concurrent partners among men

and women in the targeted communities• Increased average age for marriage or sexual debut for

individuals especially youth in the targeted communities• Increased proportion of risky sexual acts/encounters that

are consistently protected by condoms

50

EXPECTED OUTCOMES OF THE RFA

Lower Level Outcomes (cont..)• Increased percentage of women who make decisions about

their sexual and reproductive health rights independently or jointly with their partners

• Reduction of percentage of women who experience sexual violence

• Improved involvement of men in community based HIV prevention interventions

• Functional referral mechanisms/systems among the community and facility HIV/AIDS services

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THANK YOU