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The reality of scaling up prevention programs

The reality of scaling up prevention programs. Bimal Charles (CDC) Tamil Nadu,India. Scaling Prevention – key issues. Prioritising who should be “covered” High risk groups (FSW, MSM, IDU) Bridge groups (male clients) Others – Youth, HIV Positive people What is coverage?

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The reality of scaling up prevention programs

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  1. The reality of scaling up prevention programs Bimal Charles (CDC) Tamil Nadu,India

  2. Scaling Prevention – key issues • Prioritising who should be “covered” • High risk groups (FSW, MSM, IDU) • Bridge groups (male clients) • Others – Youth, HIV Positive people • What is coverage? • Communities reached by programs with the appropriate services • What is scaling? • Increasing coverage of communities until critical mass has access and uses services • Saturation coverage = 75-85%) • Geographical and service breadth and depth

  3. Scaling Prevention – critical success factors • Critical Success Factors for scaling coverage • Knowing the denominator • Allocating the resources relative to causal chain of impact • Efficient Delivery mechanism • Replicable model • Cost effectiveness • Sustainablilty • The Tamil Nadu Experience…….

  4. Tamil Nadu experience … example of high risk groups • State population – 62 million • All 30 districts in state mapped • 84000 Female Sex workers • 21000 Male Sex Workers • Data improved by repeated mapping led by Apac over several years • Data enabled State and other players to decide where to focus resource for saturation coverage

  5. Tamil Nadu experience .. High risk group coverage The TN Experience Achieving saturated coverage via 3 Cs that support the 3 Ones Coordination – State plays leadership role with a steering committee of all players to take decisions Complementarity – Each player complements the others’ strengths Collaboration – MIS, information, data are shared between all players TN: Going forward: Continuing emphasis on HRG prevention as epidemic matures while also expanding attention to : Other groups (eg youth) Other strategies (eg VCT) Other needs (eg Care)

  6. Condom usage among sex workers in Tamil Nadu(%) Source: TN Behavior Surveillance Survey, APAC 2005

  7. Antenatal Prevalence in Tamil Nadu(Median %) Source: TNSACS Sentinel Surveillance

  8. Major Factors Behind TN impact • Motivated NGO sector • Substantial coverage of key populations (FSWs, MSMs and bridge groups by APAC, Avahaan, TNSACS) • Supportive government • Efficient fund use • Sharing of information / systems

  9. Challenges • Message fatigue • Knowledge divide • Youth and invisible groups • Political support • Resources for prevention - prevention Vs care

  10. THANK YOU

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