1. 2015 Kosovo HIV Concept Note CCM Meeting Discussion of the Draft 15 January 2015

2. Key Assumptions/Requirements  Same level of funding for 2.5 years;  Little likelihood of additional future funding;  Government to take over: contribution from 40% to full coverage;  Focus on key affected populations;  Address low coverage, treatment interruptions, MMT dropouts, and lack of behavioural changes

3. Highlights  Main allocation and above allocation  Counterpart financing and Willingness to pay  Online grant management platform, credentials, CCM endorsement

4. Process and Challenges  Changes in the Government and strategic planning processes;  KP’s representation weak; no networks/associations;  Key population estimates, IBBS in 3 sites, extrapolation problematic, implications of overestimating, more size estimates required;  Coverage increase – new outreach strategies, adjusted service combinations

5. Population size estimates: PWID City population Municipality population 2012 Adult population IBBS Size Estimate Total population drug use prevalence Adult population drug use prevalence Medium prevalence extrapolation Prizren prevalence extrapolation 1Pristina145149 2051331579523946 1.9236300352.4982208253946 2Prizren 851191817561399521113 0.6123594270.7952719831113 3Gjilan 542399141370388 1159560 4Peja 489629823775642 1246602 5Mitrovica 462307316056333 928448 6Ferizaj 4262811114185579 1409681 7Gjakova 408279607173975 1218588 8Vushtrri 272727104254702 901435 9Podueva 234538918568672 1131546 Total513879 1815606783196 130518918

6. Goal: Maintaining the low prevalence of HIV and improving the quality of life of affected people through the improved cascade of HIV prevention and care services

7. Target Populations  PLHIV  PWID  FSW  MSM  Prisoners  Migrants  Vulnerable women and girls  Vulnerable ethnic minorities (RAE)

8. Objectives and modules

9. Ob1: To improve access of KPs to quality HIV prevention and care (Mod.1-4)  Expand coverage:  Mobile service delivery;  Local peer educators;  Peer driven interventions;  Secondary service delivery  Service quality???:  High quality verbal BCC;  In-depth understanding of risk factors;  Risk management measures (PSCM);  Patient monitoring and treatment quality control

10. Ob2: To improve detection of HIV and facilitated access to care and treatment (Mod. 1-5)  Promotion/availability of HTC for KAP;  Promotion of HTC of pregnant women;  Strengthening continuum of prevention/care services:  linking HTC to prevention, care and treatment (regulations and referral mechanisms);  Improved retention through patient associations and community quality monitoring;  laboratory capacity to monitor the treatment effectiveness;  promote the development and rollout of treatment protocols

11. Ob3: To create supportive environment for sustainable HIV/AIDS response (Mod. 6-8)  Policy development and advocacy function (PAG);  Strengthening essential community systems (associations and networks) to address stigma and discrimination, monitor/ensure quality;  Client registration and service monitoring software, bio-behavioural monitoring, KP size estimates, formative studies;

12. Community Based Organisation Health facility Needles and syringes (PWID) Condoms (all KPs) Information (all KPs) HIV testing (up to 40%) TB screening HCV testing HBV testing STI testing 1 mobile clinic Counseling Social support Legal support Psychological OST (MMT) PDI Partners recruitment and education Unknown status HIV+ HIV- referral OST (MMT) ART Treatment Treatment for HIV Treatment for TB Treatment for STI HBV vaccination HIV Prevention Service model

13. Mod. 1. Prevention for PWID and their partners  Outreach strategies (staff, mobile, PDI, secondary);  Adequate number of needles;  Adequate types of needles;  Alcohol swabs and sterile water?;  Strengthened BCC procedures;  Better detection of HIV and linkages to care and treatment;  Limited room for complementary services (legal aid).

14. Mod.2-4. MSM, FSW, Other  Outreach strategies: peer workers etc. (all);  Condoms and lubricants (condoms for all);  Strengthened BCC (all);  Gynaecological and STI services (SW);  HIV (all), HBV, HCV testing;  Prison personnel: study visit  Women and RAE: IEC materials and group education sessions;  Migrants, Women and RAE: Testing during events;

15. Mod.5. Treatment, care and support  Community-based care and support  Monitoring of treatment effectiveness  Community monitoring of treatment quality

16. Mod.6. HSS: Procurement and supply chain management (PSCM)  Closer collaboration between stakeholders  Risk management strategy  International TA  Good storage practice workshop

17. Mod.7. HSS: Health information systems and M&E  Improved service monitoring;  Monitoring of drug scene and contextual factors to adjust interventions:  Operational studies (Prison NSP, RAE vulnerabilities)  Reports by frontline service providers  Assess the need of NSP in prisons  Feasibility of introduction of Low Dead Space (LDS) syringes  Preferred types of injecting instruments to inform procurement;  Consultations with prison health workers on situation changes;  Analysis and solutions for Naloxone;  KP size estimates (nationwide or in a selection).

18. Module 8. Removing legal barriers to access  PAG (including a legal analyst)  Legislation analysis and promotion of improvements (EU accession commitments, antidiscrimination legislation, legislation conflicts)  E.g. trafficking of humans and transactional sex – to standard practice of law enforcement officers etc.;  Policies and procedures to ensure the required level of service uptake and retention;  Development of community systems and community involvement in service monitoring and quality assurance;  Codes of professional practice and ToR;  Operations, routes and schedules of service delivery units (mobile unit);  Development of CBOs, including PLHIV networks and peer-support groups;  Prison programme advisory council;  BCC module related to OD;  Improved detection of HIV (pregnant women and symptomatic patients) - policies and procedures

19. Impact and outcome targets Indicator2011 base 2014 target 2014 IBBS 2017 target % SW living with HIV0%<5% % MSM living with HIV2.3%<5% % PWID living with HIV0%<5% % PWID who used sterile syringe during last injection 99%80%82%85% % MSM who used condom during last anal sex 53%85%66%85% % SW who used condom with latest client 43%85%62%85%

20. Coverage targets: PWID  Population size: 8918 in 9 municipalities  Essential services: 2134/3400/4500/ 5350  VCT: 719/1360/1800/ 2140  Needles/person: 10/100/100/ 100  MMT: 94/150/200/ 250 (Increase if clients of public facilities are included)

21. Coverage targets: MSM  Pop size: 13432  Basis services: 1533/1600/3000/ 5373  VCT: 182 (2013)/640/1200/ 2149

22. Coverage targets: FSW  Denominator: 4586  Basic services: 272 (2013)/1000/1500/ 1900  VCT: 272 (2013)/400/600/ 760

23. Other populations  Prisoners: 1380 (100%)  VCT: 552 ( 40%)  Women and girls: 9008/13512/ 13512  RAE: 5335/8002/ 8002  PLHIV care and support: 28/35/40/ 45

24. Budget Summary (Allocation) ModuleY1Y2Y3Total% Prevention programs for people who inject drugs (PWID)172 865317 651387 994878 51034% Prevention programs for MSM88 658149 432196 018434 10817% Prevention programs for sex workers and their clients56 41184 57689 724230 7119% Prevention programs for other vulnerable populations39 10579 95074 193193 2498% Treatment, care and support122 55545 50945 909213 9738% HSS: Procurement and supply chain management (PSCM)5 03600 0% HSS: Health information systems and M&E16 32547 92335 771100 0194% Removing legal barriers to access7 01015 26813 52035 7981% Program management98 451187 902 474 25618% Total 606 415928 2111 031 0322 565 658100%

25. Budget Summary (Above) ModuleY1Y2Y3Total% Prevention programs for people who inject drugs (PWID)44 41164 57272 587181 57137% Prevention programs for MSM12 2719 22411 34532 8417% Prevention programs for sex workers and their clients31 66236 63545 875114 17223% Prevention programs for other vulnerable populations9 6829 802 29 2866% Treatment, care and support32 92800 7% HSS: Procurement and supply chain management (PSCM)00000% HSS: Health information systems and M&E10 35568 24117 88696 48120% Removing legal barriers to access500 1 5000% Program management00000% Total 141 809188 974157 995488 778100%

26. Thank you and good luck!