1. 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

2. Background: Śvetana Phase I vs. Phase II
Oct – Dec. 2017
Phase-II
Jan – 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

3. 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%

4. 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 Districts, Daman Diu and Dadar Nagar Haveli

5. 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

6. 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

7. 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

8. Strategy: Ensure Completion of PPTCT Care Cascade

9. 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

10. 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 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%)

11. Private Sector Reporting in HIV Pulse
Low-cost technology-based solution for ensuring regular reporting from private sector facilities
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

12. 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

13. 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

14. 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

15. 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%

16. Thank you

17. 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
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