Afghanistan (Total GHCS-State: $500,000)
USAID ($250,000): USAID will conduct a series of studies to understand the dynamics of HIV risk among MSM in Afghanistan. Despite the consensus among most of the people who met with the team that MSM were a possible key risk group, there are almost no plans to conduct surveillance activities among this group. USAID will invest funds into formative research which would gather data on male-to-male sexual behavior and help formulate appropriate interventions. USAID will also support policy and advocacy efforts through direct assistance to the Secretariat of the Government of the Islamic Republic of Afghanistan's HIV/AIDS Coordinating Committee for Afghanistan (HACCA). The HACCA is a multi-sectoral structure established by the Ministry of Public Health at the national level intended to strengthen and advocate for the policy, strategy and coordination of the national HIV response.
HHS/CDC ($250,000): CDC will provide TA to existing blood banking activities, to establish national HIV testing algorithm and to establish an HIV case reporting system. CDC will conduct a technical assessment of Afghanistan's current blood banking system, including private, public and military. The assessment will provide information on what is in place for blood banking services and identify gaps in order to support the process of setting national standards and guidelines for the blood banking system. CDC laboratory experts will meet with National AIDS Control Program leadership and provide in-country consultation regarding HIV testing to identify the most appropriate HIV tests and testing algorithm for a low-resource setting such as Afghanistan. Finally, CDC will develop a case reporting system that provides standardized information on cases diagnosed with HIV, to help with program planning and resource allocation.
Central Asia Regional Program- $2,198,000
USAID ($715,000): USAID will utilize regional funds to provide technical and management support to USAID's HIV/AIDS programs in Kazakhstan, Kyrgyzstan, Tajikistan, Turkmenistan, and Uzbekistan. These programs are funded bilaterally, with a combination of GHCS-State and GHCS-USAID funds. Throughout the region, USAID will work to improve medical practices to prevent facility-based blood-borne infections, assist with scaling up successful pilots to decrease HIV/TB co-infection, integrate medical HIV/AIDS curricula into pre-service and in-service medical education, support policy changes to introduce VCT, build the capacity of medical associations and AIDS-serving community organizations, support community outreach activities to most-at-risk MARPs, support policy changes to introduce medication-assisted therapy (MAT) for IDUs, and build the capacity of local institutions working on HIV/AIDS prevention. Regional GHCS-State funds directly support technical and administrative staff to advise individual country programs. USAID also plans to support the development of PEPFAR Partnership Frameworks in Central Asia. Resources will support additional management costs, including the hiring of an interagency PEPFAR Coordinator for the region.
HHS/CDC ($1,483,000): The CDC Central Asia Regional office will utilize regional funds to support activities in Kazakhstan, Kyrgyzstan, Tajikistan, Turkmenistan, and Uzbekistan. CDC works closely with MoHs to provide technical assistance in fighting the HIV/AIDS epidemic in the region by preventing medical transmission of HIV/AIDS; through laboratory strengthening; and by implementing disease surveillance. CDC will utilize regional funds to provide technical assistance to MoH to prevent medical transmission of HIV by improving coordination of national blood safety programs to ensure a safe and adequate blood supply. This activity will include assisting MoHs in development of national strategy for voluntary donor recruitment, assisting MoHs on drafting regulatory documents on establishing transfusion committees, and by assisting MoHs on safe injection practices and by working with them to prevent other facility-based blood borne infections at healthcare facilities. CDC also provides technical assistance to MoHs on laboratory issues, including screening/diagnosis of HIV/AIDS, establishing quality control systems, and by inviting laboratories to participate in external proficiency testing. Laboratory assistance is also provided to MoHs in screening blood banks for blood-borne pathogens. In addition, CDC will utilize the funds to implement sentinel surveillance to monitor epidemiologic trends in the region. Regional GHCS-State funds will also support technical and administrative staff involved in implementation of CDC programs in the region. Additional resources will help support additional management costs related to the development of PEPFAR Partnership Frameworks in Central Asia.
Kazakhstan (Total GHCS-State: $600,000)
USAID ($580,000): USAID will assist the Government of Kazakhstan to implement Global Fund grants for HIV/AIDS and improve prevention practices. This funding will also be used to improve medical practices to prevent facility-based blood-borne infections through updating legal framework based on state-of-the-art infection prevention control (IPC) standards, building capacity of sanitary epidemiological services to follow World Health Organization (WHO) guidelines. Activities to introduce, demonstrate and scale up quality improvement systems will support providers to follow evidence-based medicine guidelines. USAID will assist with scaling up successful pilots to decrease HIV/TB co-infection. USAID will integrate medical HIV/AIDS curricula into pre-service and in-service medical education that will include such aspects as HIV/TB prevention and management and voluntary counseling and testing. USAID will support policy changes to introduce VCT and MAT, as well as community outreach activities to MARPs (including IDUs and CSWs) to increase demand for these services. In collaboration with the Global Fund, USAID will support scale-up of drug demand reduction models and HIV prevention services among MARPs. Finally, USAID will build the capacity of NGOs to use HIV sentinel surveillance data for program design. USAID will enhance interagency collaboration and information exchange.
Peace Corps ($20,000): These funds will be used to organize a cascading HIV/AIDS peer educator training program for Peace Corps volunteers and their counterparts throughout the country. A core group of peer educators trainers will be trained in BCC related to comprehensive sexual prevention, drug and alcohol use prevention, peer support and mentoring techniques. These trainers will train peer educators in their regions. Trained peer educators will conduct outreach activities with community members, particularly targeting at-risk and marginalized youth and others engaged in high-risk behavior. The program will employ non-formal education and field-tested peer education techniques.
Kyrgyzstan (Total GHCS-State: $475,000)
USAID ($455,000): USAID plans to assist provide assistance to local organizations responsible for infection control training and supervision. USAID will support policy changes to address stigma and marginalization of PLWHA and provide assistance in scaling-up and improving model programs for MAT for drug addiction and VCT, while concurrently conducting outreach activities to MARPs to increase demand for these services. USAID will also support the Government of Kyrgyzstan to build upon the successful model created by previous USAID projects by scaling-up quality treatment of HIV/TB co-infection, and will provide counseling to target groups about dual HIV/TB infection and importance of its diagnosis and prevention. USAID will provide TA in support of Global Fund grants, including supporting the Government of Kyrgyzstan, encouraging NGOs to participate on the Global Fund CCM, and strengthening the capacity of NGOs to implement evidence-based prevention activities as recipients of Global Fund grants by building their capacity for human resource and financial management, commodities procurement and logistics, information systems, and performance monitoring of HIV programs.
Peace Corps ($20,000): Peace Corps will continue its work in HIV/AIDS prevention with a focus on at-risk youth. Over the last two years, Peace Corps has been able to utilize PEPFAR funding to build a cadre of volunteer and local counterpart trainers who then went on to conduct HIV/AIDS prevention and life skills activities during summer and winter camps and other training events in local communities. Peace Corps proposes to train additional volunteer and local counterparts to conduct HIV/AIDS prevention and life skills activities in their communities. Peace Corps will set aside a part of these funds for small grants that communities will be able to apply for to carry out these activities.
Tajikistan (Total GHCS-State: $524,000)
USAID ($524,000): USAID will work to improve medical practices to prevent facility-based blood-borne infections through updating legal framework based on state-of-the-art IPC standards, building capacity of sanitary epidemiological services to follow WHO guidelines for inspection and supportive supervision of IPC protocols and developing a cadre of national IPC trainers. Activities to introduce, demonstrate and scale up quality improvement systems will support providers to follow evidence-based medicine guidelines. USAID will assist the Government of Tajikistan with scaling up successful pilots to decrease HIV/TB co-infection, and will integrate medical HIV/AIDS curricula into pre-service and in-service medical education. USAID will introduce best practices for VCT and support implementation of MAT for drug addiction, as well as conducting outreach activities to improve awareness among MARPS these services. Finally, USAID will provide TA in support of Global Fund grants, including supporting the Government of Kyrgyzstan, encouraging NGOs to participate on the Global Fund CCM, and strengthening the capacity of NGOs to implement evidence-based prevention activities as recipients of Global Fund grants.
Turkmenistan (Total GHCS-State: $75,000)
USAID ($75,000): USAID will utilize these funds in combination with other USAID funding to assist the Government of Turkmenistan to improve prevention practices. USAID will work to strengthen the Sanitary and Epidemiological Services to act as the coordinator of national IPC activities; provide technical assistance to work towards the long-term goals to support and improve safe medical practices; and establish quality improvement systems to support providers to follow evidence-based medicine guidelines. USAID will also support outreach to MARPs, such as IDUs and CSWs, to encourage involvement with drug demand reduction programs and HIV prevention activities that were implemented by other USAID-funded programs. USAID will strengthen the governance role of the Global Fund CCM and will provide policy support to integrate medical HIV/AIDS curricula into pre-service and in-service medical education.
Uzbekistan (Total GHCS-State: $590,000)
USAID ($590,000): These funds will support HIV activities in the areas of both supporting and building the capacity of government institutions and civil society organizations and conducting outreach programs. The majority of the funds will the used to support government institutions and civil society organizations. As part of the planned outreach activities, USAID will introduce quality improvement approaches to model facilities implementing VCT services and MAT to treat drug addiction. USAID will also create a model referral system to ensure that STI patients are screened for HIV, using data from this model to provide policy support for scale-up, and will support outreach activities to MARPs to increase their access to quality HIV prevention services. Outreach will also be oriented towards increasing demand among MARPs for quality VCT, MAT, and STI treatment services. The aim of this is to increase access to counseling for MARPs by expanding the range of settings where high-quality counseling is available, such as STI clinics, narcology dispensaries, TB facilities, prisons, pharmacists, etc, and will involve AIDS servicing NGOs and organizations of PLWHA in the provision of counseling.
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