"To prevent the transmission of injecting related HIV we reach out with a range of evidence based, comprehensive and accessible services in 26 districts across Pakistan"
The Phase II (2013-2015) of the Global Fund Grant Round 9 for the prevention of HIV among people who inject drugs is a result of negotiations between the Global Fund Team, Nai Zindagi, National AIDS Control Program, other key stake holders in country, development partners and in particular the UNAIDS-Pakistan office. Based on in depth review and analysis of Phase I (2011-2012) of the grant, on ground realities including the socio-economic and security related environment in country, the capacity of sub recipients of the grant in program management and service delivery, availability and accessibility issues of essential services needed from the Public sector and other factors - the Phase II service delivery package was re-visited and adjusted for an improved response and effective implementation.
In country capacity to establish and deliver comprehensive HIV prevention services to marginalized communities of people who inject drugs is extremely limited.
A major task under the Global Fund grant has been the ongoing capacity building of service providers in program management, implementation, monitoring, quality control and reporting.
Four of our six sub-recipient organisations now delivering services are new to this field and as a result there is improved in-country capacity to deliver services.
Although the need still exceeds the available capacity, there is now a fairly streamlined process in place to train and engage others.
Cost effective and efficient on-going monitoring and evaluation is key to good programming.
Nai Zindagi has developed an on line web based 'Management Information System' (MIS) to record program and service delivery data, including client specific demographics, behavioural and other information.
This MIS has been developed over a period of 13 years and new modules are added to accomodate new package of services.
The MIS monitors Nai Zindagi's GF supported program on a daily basis to ensure the most efficient and relevant service delivery. This MIS system has been offered to the Provincial AIDS programs and could be the basis for a National Data Base for the country.
Opiate Substitution Therapy (OST) is essential in stablising active drug users. particularly those on ART. In spite of active lobbying and advocacy OST has not yet been approved in country for a scaled roll out.
Doctors at the special clinics are reluctant to initiate ART for active drug users due to low adherence to treatment regimen which can result in resistant strains of the virus. In Phase II the GF has approved residential drug treatment for clients in need of ART which will increase access to treatment.
Another barrier in the treatment cascade was the limited availability and accesibility of CD4 baseline testing for initiating ART. The Global Fund country team approved portable CD4 machines and residential drug treatment services to facilitate ART initiation.