Śvetana Phase II Elimination of Mother to Child Transmission of HIV and Syphilis Progress Update For Meeting of Country Coordinating Mechanism (CCM) March 5th 2019, New Delhi

Background: Śvetana Phase I vs. Phase II Oct. 2015 – Dec. 2017 Phase-II Jan. 2018 – Mar. 2021 SAATHII has been implementing Śvetana meaning ‘dawn’ to improve PPTCT services : Śvetana phase I contributions: 47,02,942 pregnant women were provided HIV testing and counseling among 3384 positive pregnant women were provided PPTCT cascade of services in 235 districts. 12 states and 2 UTs 3 Core Indicators Private Sector 25 states and 7 UTs 4 Core indicators Public and Private Sector

Śvetana Phase II Goals and Objectives Goal: “Elimination of new HIV infections among children and keeping their mothers alive” Project Śvetana will provide technical assistance towards accelerating scale-up of PPTCT coverage in both public and private health sector: Increase HIV testing among pregnant women from 85% to 95% Increase HIV testing among spouses of positive pregnant women from 74% to 90% Increase the proportion of HIV-positive pregnant women on ART from 97% to 100% Increase the proportion of HIV-exposed infants who completed their first EID within two months of birth from 51% to 95%

Śvetana Phase II Coverage: 361 districts of 22 States / UTs Direct Implementation by SAATHII Implementation by Partners Andhra Pradesh Andaman and Nicobar Delhi Haryana Goa Gujarat- 18 Districts Kerala Lakshadweep Maharashtra Pondicherry Rajasthan Tamil Nadu Telangana Uttarakhand West Bengal SVYM- Karnataka PRAYAS- Maharashtra 6 Districts- Ahmednagar, Pune, Solapur, Satara, Sangli and Kolhapur NCPI+ - Chandigarh, Punjab, Himachal Pradesh and Jammu Kashmir GSNP+ - 18 Districts, Daman Diu and Dadar Nagar Haveli

Structure of State Technical Assistance Units * - shared between states State Director * M&E Officer (1) Program Officer (@ district level, 1 per 4-5 districts) Administration and Finance Officer* (1) Program Manager (1) Medical Manager* (1) State Oversight Committee Chaired by Project Director, SACS Field Coordinators (@ district level, 1 per 2 districts) Admin Assistant

Strategy : Increasing Engagement of Private Sector in PPTCT Program Mapping of Private Facilities Enrolment as PPP (Model A, B or C) Reporting in national portals and ensuring linkages Advocacy and Coordination with Private Medical Associations HIV Physicians District Level and State Level Government Officials Capacity building Experience sharing Meetings District Level Sensitisation Technical Support Start-up Assistance Onsite Sensitisation Handholding Support Supportive Visits

Strategy: Increasing Coverage of ANC HIV Testing and Reporting in Public Sector Facility Level Interventions Community Level Interventions Demand Generation Activities Facilitating Review and Reduce Linkage Loss Facilitate Reporting (SIMS) Facilitate Community Based Testing (VHND) Saturating Public Facilities into ICTCs Facilitate Reporting (SIMS and PALS) Establish Testing in FICTC and Facilitate PMSMA Advocacy : NHM, NACO, Other Stakeholders Training: District Resource Team Gap Analysis

Strategy: Ensure Completion of PPTCT Care Cascade

Governance Mechanisms National Steering Committee State Oversight Committee District EMTCT Committee NACO, NHM, Non- Government, Bilateral Agencies and other PRs, Professional medical associations, PLHIV State Oversight Committee (SOC) and District EMTCT Committee *SACS & NHM State / District Health Officers, DAPCU, PLHIV community representative, Private providers / PMAs and other local Health/Government officials

Highlights of Śvetana Achievements 300+ Sensitization programs, advocacy with Professional Medical Associations (PMA) and public health officials on EMTCT 34,102 private facilities mapped, 25,251 enrolled (90% PPP Model C, 10% Model B/ A) Sensitization of public health officials on EMTCT and 12,000+ public and private facilities provided technical support Capacity building and strengthening of national reporting systems Follow up of 6000+ positive pregnant women (PPW) from identification through 18 month infant testing Continuous coordination with districts and state officials Achievements Increased ANC Testing & Reporting Coverage in: 37% to 50% in private sector 6% in public sector Scaled up HIV Pulse the web-based private sector reporting system from 5000 to over 13,000+ facilities Increased retention in cascade Spouse testing from 74% to 86% Increased first EID testing within 2 months (to 61%) and 18 month testing (to 71%)

Private Sector Reporting in HIV Pulse Low-cost technology-based solution for ensuring regular reporting from private sector facilities www.hivpulse.org 13,627 facilities out of 19,000 PPP Model C enrolled in HIV Pulse 10,993 (80%) of enrolled PPP Model C facilities reporting in HIV pulse 13,52,765 ANC testing reported in HIV Pulse – Jan 357 PPW identified and referred to ICTC

Target Vs Achievement 77% 86% of Estimated PW 92% (9,928,520/ Baseline Targets Achievement Jan- Sept 2018 Achievement ** Oct- Dec 2018 PPTCT 1: Pregnant women who know their HIV status 77% 86% of Estimated PW 92% (9,928,520/ 10,748,250 66% (3,056,009/ 4,621,748) PPTCT 2: Positive Pregnant women on ART 97% 97% of PPW (4,781/ 5,559) 93% (1182 / 1276) PPTCT 3: Exposed infants completed EID within 2 months 51% 70% of eligible 61% (2,516 / 4,132) 65% (1134/1757) HTS 1: Positive pregnant women (PPW) spouse who know their HIV status 74% 80% of PPW 86% (5,130 / 5,559) 85% (1083 / 1266) ** Data from SIMS data (SA ICTCs) are incomplete to due to system issues and will be corrected by Feb; ANC PPW line list data in process of updation 9.9 million pregnant women were screened for HIV, and learned about their HIV status exceeded the set target of 8.4 million 2 million out of 4.3 million pregnant women accessing care in the private sector were tested for HIV: 37% in 2017 to 50% in 2018 ( SIMS

Implementation Challenges Coordination Challenges Delay in getting buy-in from some SACS in phase II, getting HIV testing data from national portal Streamlining data sharing (state / district level data) in some states Programmatic Challenges First EID within 2 months in some areas : non availability of trained staff, distance to EID centers, and understanding on EID guidelines Linkage of the known positive pregnant women from ART centers with PPTCT Saturation of private facilities in metro cities requires intensive and repeated efforts Multiple reporting requirements to the government (Eg: HMIS, TB, Municipal corporations, etc.) Lack of uniform policy for mandatory reporting related to HIV screening and treatment Staffing and workload Challenges Limited travel budgets for FC (especially – in scattered, remote and hilly terrains) In some states POs manage 5-8 districts, and more time required for completion of activities High workload for POs and FCs in high burden states : have to visit 75 to 100 facilities per month, and manage positive pregnant women follow-up Staff turnover in the field due to opportunities in other programs with higher remuneration

Way Forward Increase and reallocate Field Coordinators (FCs) based on PPW burden and enhancement of FC travel allowance as required Intensive engagement of Professional Medical Associations at the district, state and national levels Ensure all PPW receive comprehensive, quality and timely PPTCT services through one-to-one counselling at facility, home, common place or phone and accompanied visits Institutionalize period reviews, data and experience sharing with high burden facilities, district officials, SACS, NACO, and NHM Strengthen capacity of field teams on technical guidelines, counselling skills, coordination with government, planning, prioritization, documentation and reporting Strengthen the data capture systems (program Management Information Systems), build capacities of M&E officers on data management, analysis and report generation and streamline routine data quality assurance

Expenditure: Jan- Sept and Oct – Dec 2018 Period Budget Expenditure % Jan – Sept 2018 1,19,922,359 97,613,579 81% Oct – Dec 2018 53,007,890 25,054,283 47%

Thank you

Śvetana Partners Staffing : Jan-Dec 2018 SR/SU State State Core team Program Officer Field Coordinators Total AP & TS Andhra Pradesh 4 6 13 23   Telangana 10 14 GSNP+ Gujarat 5 1 Dadra Nagar Haveli 2 Daman & Diu 12 16 GUJ-SU 17 27 KL-SU Kerala 7 Lakshadweep MH-SU Maharashtra 3 Goa 24 NCPI+ Chandigarh Himachal Pradesh 8 Jammu & Kashmir Punjab 20 PRAYAS RJ & DEL Delhi Haryana 15 Rajasthan 22 29 Uttarakhand 11 SVYM Karnataka 25 TN & PY Tamil Nadu Puducherry Andaman Nicobar WB-SU West Bengal 30 Grand Total  47 89 210 346