Supporting the Continuum Prevention Services: Supporting the Continuum Prevention Care Treatment All IP Meeting, June 20, 2013

Who gets which Services? Activity: Who gets which Services?

So…all populations receive a Core Package Here’s a reminder of that package and a bit more about the referral system.

Core Package of Services: Outreach Behavior Change Communications (BBC) (messages change quarterly) Condoms & Lubricant for MSM, TG (free and/or socially marketed) Service referrals (for SW/MSM/TG/PWID and partner) HIV STI RH/FP Etc.

Referral System Promote 2 HIV tests and 4 STI screenings/year Community Facility Referral System Promote 2 HIV tests and 4 STI screenings/year Promote condom/lubricant; promote condom + another contraceptive method for FSWs Facilitate on-site testing/ screening Provide referral card and service directory Visit health facilities monthly to collect referral cards

Delivered by Outreach Workers in hotspots and DICs Selected from their community Transparent selection criteria and methods Receive regular training Provided with the necessary equipment Provided an allowance of $60/month Meet one-on-one and/or in small groups (6-8 individuals)

Ensure changing needs and issues are addressed NO more PREACHING or BORING messages & materials Ensure changing needs and issues are addressed Materials and messages invigorated on a quarterly basis

Quarterly Training Model Conduct Training Needs Assessment Develop annual communication log frame/plan Develop training curriculum Training to master trainers Training to outreach workers and field staff Quarterly Training Model HIV Flagship TA to IPs to develop and use Quarterly tool/topic IP-led

Implementation: Staff ratio & targeted groups Protocol Standards Outreach Workers (1 cover 80-100 EW/MSM/TG; 1 cover 50 PWUD; 1 cover 30 PWID) NGO Staff (1 cover 4 OWs) Depends on geography; # of contacts per client per year

All populations receive an Expanded Core Package of services, as needed Needle and Syringe Program (NSP) Methadone Maintenance Therapy (MMT) Pre-ART and ART Services Reproductive Health Services Psychosocial support Note: Pause between animation to ask the question.

Police Community Initiative Program Strategic Information Service Delivery is Supported by… Networks Capacity Building/OD Police Community Initiative Program Strategic Information Coordination

Services are delivered using a branded approach Because branding works! EW, it’s SMARTgirl MSM, it’s MStyle TG, it’s…? PWID, it’s…?

means I am… SMARTgirl MStyle Beautiful/Handsome Talented / Creative Modern Strong – I know what I want and how to get it I want to get the most out of life for myself and my family I am Industrious – I work hard I am Smart, of course, especially when it comes to my health!

Client Identification with the Brand "I was working as a hostess when I first heard about SMARTgirl. It sounded very inspirational to me, because we are usually called “Karaoke girl or Beer garden girl…” …"Now I feel that I am a new person. I feel so proud whenever people call me SMARTgirl." –Keo Kheng, SMARTgirl Peer Leader

Identification/ Community Building Information sheet Club signage Stickers (I Love SMARTgirl, I love MStyle) T-shirts, Bags, ID card for OWs and field staff Membership card Chip/Token (to identify "new" vs "repeat" reach) SBC materials Strength of the brand, helps

High Coverage Brand recognition = Reach and retention Mobile SWs can find known, quality service across the country Brand recognition = Reach and retention Brand name hides identity, as desired Historically, SG and MS have had very high reach and coverage – approximately ½ of all EWs in the country and approximately ¾ of MSM. For EWs, SG plays a key role. As EWs are moving, having a recognizable and consistent service in different provinces, even delivered through different organizations helps retain clients in the program. For MSM, MS plays a key role by not calling the program an MSM program, MSM can maintain their identity a secret, if they wish to do so. In this way, also facilitates reach of discreet/hidden MSM.

HIV and Syphilis Testing Lay counselors conduct testing in hotspots/DICs using Finger Prick testing

Social marketing of commodities (EC, implants) “Condom Plus another Contraceptive Method” Generate demand Actively refer Address barriers to service uptake Ensure commodities/ supplies are available Provide immediate follow-up/support Social marketing of commodities (EC, implants)

Reaching the Hidden and Hard to Reach MStyle Website and MStyle Facebook page Strengthening the Community: Transitioning to local ownership/ management http://www.mstylekhmer.net/

Condom Social Marketing Building capacity of IPs to forecast, sell and ensure supplies are available and visible where needed Peer-to-peer selling Promotion and sales through street-based vendors 'peer-to-peer selling' (outreach workers distribute to select EWs -- peer sales reps -- who sell on to others at their workplace) and 'promotion and sales through street-based vendors

Case Management Ensuring clients don’t drop out along the cascade Outreach Test + Enroll in care Start ART Adherence CD4 Testing Ensuring clients don’t drop out along the cascade

Recognizing TG as a distinct population Establishing a TG national and local network Developing a branded program for Transgender individuals

Key Messages The B-CoPCT is a single SOP for all MARPs Same core package of services for all Expanded packages meet additional needs EW and MSM programs are SMARTgirl and MStyle because branding works (and more branding is coming) We have been effective, but more is needed to eliminate HIV in Cambodia (3.0 goal), so we have “Boosted” the CoPCT