VHS-CDC Project ASPIRE
Supported by Centers for Disease Control and Prevention -
Division of Global HIV & TB (CDC-DGHT)
(2020 - 2025 - ongoing project)

Goal

The goal of the project is to collaborate with government, CSOs and community to scale up proven strategies and demonstrate newer approaches to saturate access to critical primary prevention interventions, HIV case finding, linkages to treatment, social protection and vital health services including mental health to attain 95-95-95 targets among key population (KPs – Female sex workers, Men who have sex with men, transgenders, people who inject drugs) including adolescent KPs to achieve epidemic control in the state of Andhra Pradesh (AP).

This project has its Project Management Unit (PMU) office at VHS, Chennai and its field office at Andhra Pradesh.

Strategies and interventions

Strategies

Strategy 1: HIV case finding: The project’s primary focus is HIV case finding and VHS through Project ASPIRE is supporting APSACS, Government of Andhra Pradesh in fast tracking the UNAIDS’ first 95 target.

Index testing services - Through a collaborative effort, the project is implementing index testing at scale in all 26 districts of AP in 230 Integrated Counseling and Testing Centers (ICTCs), 53 Anti-retroviral testing (ART) centers, 84 Targeted interventions (TIs) of all districts and in community intervention sites through nine one stop centers, five informal sex workers intervention and three social network sites.

Social network testing services (SNS) – The project is demonstrating a non-incentivized network testing services model reaching out to underserved key populations who are left behind in the response.

Blending index testing with network testing – In order to reach out to the highly vulnerable key population and high-risk individuals, blending of network testing with index testing is being implemented among index clients since February 2024.

Strategy 2: Primary prevention: The project is focusing on prevention interventions for reaching the populations left behind by scaling up and implementing differentiated approaches tailored to the needs of those who remain underserved to close “last mile” gaps.

One stop centers - The project is implementing nine one-stop center intervention for all key populations by delivering six package of services (HIV prevention, general health/STI clinical services, gender based violence services, TG care services (helpdesk, gender affirmation, mental health, NCD, ART services), linkage to social protection services, referrals services for mental health & NCD, cervical cancer, ART services). Through this we have established a robust platform for providing combination prevention services to underserved key populations. The model implemented for transgender population is integrating transgender care in government health system through a TG helpdesk in government medical college hospitals.

Virtual intervention – The project is demonstrating a location-based dating platform intervention (LBDPi) from October 2021. The LBDPi is effective in identifying high-risk MSM/transgender and transitioning them (i) online to offline and (ii) online to online, for HIV services. The project is also demonstrating prevention interventions through a variety of social media platforms including Facebook, Instagram and WhatsApp that are being widely used by key populations and majority of them possess smart phones.

Informal sex workers intervention – The project has carried out a community-to-community listening exercise and designed an intervention tailored to informal networks of sex workers. The core strategies adopted are identifying network operators and reaching out to informal networks of sex workers. Secondly, snowballing technique is adopted to reach out to the underserved networks through the registered iFSWs and reaching out to their social media (WhatsApp, Facebook) and physical networks.

Adolescent and young key population (AYKP) - The project through a listening exercise among young key population gained a good understanding of the lived experiences and meanings of risk behavior and health seeking behavior from the perspectives of the young key populations themselves. It provided vital information to guide the development of an evidence-based intervention addressing the needs of young KPs. All the interventions of Project ASPIRE focus on HIV testing among Young KPs. The project is integrating the AYKP with the government Rashtriya Kishore Swasthya Karyakram (RKSK), Nehru Yuva Kendra (NYK) and other government departments for expanding the reach and sustaining the response.

Condom promotion - Project carried out a condom gap analysis in AP and designed a total market approach to address the condom gap in the state.

PrEP intervention program - VHS-Project ASPIRE is demonstrating a cost-subsidized payment PrEP model through the one stop centers and PrEP intervention is integrated in all prevention and HIV case finding interventions. The project is also demonstrating PrEP intervention through private health care providers and through tele-PrEP approach.

Strategy 3: The project works closely with community members on client-centered models for service delivery, innovations and monitoring. Under this strategy, the project is supporting APSACS in implementing the community systems strengthening activities including developing a team of community champions.

Strategy 4: Implement robust systems to carry out routine site level granular analysis, development of district level plans and program review for micro-targeting response and course correction.

Key Achievements

HIV case finding

• Index testing - The positivity rate attained is significantly high with 22-23% (as compared to the routine testing with 0.1 – 2.4% positivity) proving the efficiency of index testing case detection method. NACO has adopted the strategy and scaled up the index testing method to the entire country and VHS is one of the partners for providing technical assistance to other states on index testing services.
• SNS – The average positivity through this approach is 10%. It can be inferred that the network testing, especially in reaching out to the network of positive KP index client, is found to be very effective.
• Blending index testing with network testing – The initial results show that the positivity is 17% through this strategy and through this approach, 7% positives are young KPs. The positivity through blended approach is found to be an effective strategy for reaching the unreached KPs.

Primary prevention

• One stop centers – Through OSCs, 12694 KPs (4455 TGs, 2502 MSMs, 5737 FSWs) got registered in the OSCs, around 2000 KPs have availed various social protection services and the positivity rate is 4%.
• Virtual intervention – The positivity rate through virtual intervention is 9% and more number of young KP positives are detected through the intervention. This infers that virtual intervention is an efficient model to reach the young high-risk groups.
• iFSW intervention - The positivity rate was high with 10.3% indicating that iFSW population are highly vulnerable to HIV due to the stark inequality that they are subjected to in society. The project has mounted a comprehensive and strong prevention response including structural intervention by linking them to social protection programs to alleviate their poverty and reduce the risk of HIV infection.
• PrEP – Around 1000 individuals were initiated PrEP, out of which KPs constitute more than 50%. In the project, on average 28% of the PrEP takers are in the age group 19-29 years – this is higher when compared to other age groups.

Community system strengthening (CSS)

• The project has trained 131 community champions (25 FSW, 29 MSM, 22 H/TG, 6 IDU, 25 PLHIV, 24 youth KP) and facilitated forming state and district level community resource groups.

Other initiatives

• The project has developed a tele-health portal (Manam) to provide comprehensive health services to the key population. Services include HIV/STI prevention, PrEP, general health, mental health, counseling and referrals. The app provides online consultation, appropriate referrals based on the needs. It has been designed taking into consideration the privacy, safety and security of the KPs.

Key Publications

IEC materials developed by the project

Photos

Contact Us

Director - Projects
CHARTERED - Projects Division
The Voluntary Health Services (VHS)
Rajiv Gandhi Salai, TTTI Post,
Taramani, Chennai – 600 113.
Email ID: williams@vhsprojects.org

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