Anjana Das STI Capacity Building
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Transcript of Anjana Das STI Capacity Building
Community-centered Clinical Services: Case Studies and Lessons Learned from Implementing Key Population Programs in India
Anjana DasSTI Capacity Building
Scale and Scope of Avahan Program
Programcoverage
• 6 states, 83 districts, 600+ towns• 129 NGOs
• Combined State Population• ~ 300 million
• High risk groups covered• FSW – 221,000• MSM & TG – 81,000• IDU – 18,000• Men at risk – ~5 million
Prevention Package
• Outreach, BCC
• Commodities (condoms, lubricants, needles)
• Clinical services for STIs + counseling
• Referral - TB, HIV testing, ART
• Community mobilization
• Structural Interventions: Local advocacy, police sensitization, crisis response, community advisory committees
10 Years = USD $376 million2004 – 2013Phase 1 – Scale-up 2004-2009Phase 2 – Transition 2009 - 2013
STI service delivery structure
Community Led- Approaches for Clinical Service Provision
Phase 1(2004-2009)
Scale-up
Phase 2(2009-2013)Transition
• Training and supporting peer outreach workers
• Establishing service committees e.g. STI, care and support
• Appointment of community members in clinic staff positions
• Preparing CBOs to lead STI program components
• Service committees increasingly led by community non-peers
Community participation guidelines for planning, implementing and monitoring services in Avahan COGS & CMP
Refined with learnings
Documenting Community-centered Clinical Services: Case Studies and Lessons Learned
Purpose
Intended audience
Case study selection
criteria
• Document innovative approaches used in resource-constrained settings
• Share good practices and lessons learned
• Strengthen capacity of KP programs elsewhere
• Primary: KP program implementers
• Health officials, donors, policy makers
• Replicability and scalability
• Demonstrated improved outcomes
• Relatively simple processes
• Acceptable and accessible by KPs
List of Thematic Areas/Chapters
• Community-led Approaches for Clinical Service Provision
• Customizing STI Service Delivery Models • Sexually Transmitted Infections (STI) Care and
Treatment• Continuum of Care • Clinic Management Systems• Sustainability and Transition
Lessons Learned
Community Participation
Service Delivery Models
STI Care and Treatment
• Increased clinic utilization
• Has the potential to lead to a change from an externally-led to a community-led program
• Tailored to KP typology and local resources
• Improved accessibility
• Static + outreach clinics cost-effective in large urban areas
• Standardized guidelines and SOPs
• Regular quality monitoring and use of data improved services
• POC tests increased syphilis screening
Lessons Learned (2)
Continuum of care
Clinic Management
Systems
Sustainability and Transition
• Demand generation and HTC at outreach clinics led to four-fold increase in HIV testing
• Primary HIV care & support, TB screening provided on-site with referral linkages for higher-level care
• Capacity building mechanisms for clinic staff ensured quality of services
• Stock management systems for drugs and other commodities prevented stock-outs and wastage
• CBOs should be involved in transition planning, post transition support necessary
• Early planning for sustainable mechanisms for clinical services
Acknowledgements andKey References
• Bill & Melinda Gates Foundation
• Implementing agencies• Our community members