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What is The HIV/AIDS Flagship?

The HIV/AIDS Flagship Project (“Flagship”) is a 5-year project implemented by a consortium of KHANA (prime), FHI 360 and PSI/PSK. The focus of Flagship is to develop and test new technical innovations targeting most-at-risk populations (MARPs), which includes entertainment workers (EWs), men who have sex with men (MSM), transgender people (TG) and people who inject drugs (PWI); and people living with HIV (PLHIV) through Centers of Excellence (CoEs). This model is central in the facilitation of skills transfer from Flagship to local partners; and provides a foundation for future HIV financing. In year (YR) 3, Flagship will continue working closely with the first cohort of 10 community CoEs and six Flagship-supported Health Facilities to develop and test high impact and cost-effective technical innovations. Flagship will also establish a second cohort of two community CoEs to work with PWID and MSM.

In Year 3 (YR 3), Flagship will sustain, review, and document current innovations and develop new ones in response to Cambodia’s changing HIV environment and new policy directions from NCHADS.

In the area of prevention, Flagship will continue to strengthen and support the roll-out of quality strategic behavioral communication (SBC) for SMARTgirl, MStyle and Srey Sros; strengthen sexual and reproductive health / family planning and HIV integration into SMARTgirl by adding injectables to the social marketing package and by working with the national program to integrate STI/HIV testing and sexual and reproductive health / family planning within the Methadone clinic; utilize mHealth strategies ― on-line (social media) and mobile (interactive voice response system) technologies ― to expand the reach of HIV prevention information and services; continue to improve access to condoms and lubricants by strengthening on-site peer marketing of condoms and lubricants and street-based sellers near high risk sites for increased access to prevention commodities; as well as the use of condom vending machines in high-risk entertainment establishments. Flagship will also continue to support the networks of most-at-risk populations (MARPs) for their meaningful participation in policy and program.

To accelerate identification of new HIV cases, Flagship will continue to strengthen community-based finger-prick testing by lay counselors by implementing quality assurance (QA) and quality improvement (QI) tools and strategies, and training master trainers, and will continue to test the risk-tracing snowball approach based in Chhouk Sar clinic as an innovative approach to reaching high risk individuals.

New innovations this year entail using technology-based HIV risk screening tools during outreach; developing a branded comprehensive service package for PWID/PWUD; working with local business partners to implement an incentivized approach (eg. using technology, loyalty card, etc.), likely targeting the partners of TG individuals for HIV testing; enhancing the capacity of CoEs on conducting facility and community-based case management of MARPs to improve case detection, active referrals and partner tracing, and in performing QA/QI to ensure effective implementation. Flagship will also hone its efforts on gender-based violence (GBV) to ensure MARPs who frequently experience violence have access to emergency medical and legal care. 

In the area of care and treatment, Flagship will continue to support Flagship-supported Health Facilities for direct costs of enrolled PLHIV, including CD4 and VL test samples transportation costs and basic clinical consumables. Support will also be provided to Health Facilities to implement point-of-care HIV testing and counseling (particularly at antenatal care and delivery wards); and the Continuous Quality Improvement mechanism within Pediatric AIDS Care, voluntary confidential counseling and testing centers, family health clinic/STI services and pre-ART/ART sites. Flagship will also support local partners to implement, use and analyze the CQI dashboard indicator system to better identify gaps and take action to improve quality.

Flagship will support the implement of the Option B+ strategy for prevention of mother-to-child transmission, which includes active referrals for HIV-positive pregnant women to antenatal care and HIV/syphilis testing, and close follow-up of HIV-exposed infants for immediate enrolment in pediatric AIDS care, if necessary. Flagship will support Angkor Hospital for Children improving and sharing best-practices of Early Infant Diagnosis and early treatment initiation in children.

Chhouk Sar clinic will also be supported to provide further integrated comprehensive care and treatment services for MARPs and implement TasP, Option B+ and active case management. Chhouk Sar will also continue with its pilot of risk tracing snowball approach to increase HIV detection among difficult-to-reach individuals who are at-risk. 

Flagship will continue to support the Operational District (OD) case manager coordinator (CMC) and his/her assistant (supported by Flagship), along with Active Case Management Providers (CMPs) to conduct integrated active case management in all Flagship-supported ODs, focusing on newly identified cases (particularly pregnant women), HIV-exposed infants, sero-discordant couples and treatment as prevention initiation, lost-to follow-up and poor adherent patients, as well as TB/HIV co-infected patients. To improve retention of adolescents living with HIV in care and treatment, Flagship will support the development of a standard operating procedure and two innovations for implementing it. To further enhance the case management approach and to improve service quality, accessibility and retention of clients, Flagship will provide TA to CoEs, other health facilities and the national program to implement and monitor the use of Unique Identifier System at health facilities.

Flagship will work to improve Medical Waste Management at each health facility CoE, including Chhouk Sar clinic and Angkor Hospital for Children; and develop standard operating procedures and implement systematic screening strategies for human papilloma virus (HPV) and hepatitis B/C (HVB/C)-HIV co-infection among MARPs and PLHIV at pre-ART/ART services, using Chhouk sar clinic as a pilot site.

Flagship will continue to provide economic strengthening and livelihoods support interventions to PLHIV, households of orphans and vulnerable children and MARPs. The KHANA Livelihoods Learning Center (KLLC) will provide TA to CoEs/IPs on establishing Village Savings and Loans groups, livelihood skills training, and strengthening links with other social protection programs.

Under Objective 3, Several exploratory and evaluation research studies will be designed and implemented in collaboration with a range of partners from the USAID Innovate and Evaluate project, national program and academia. A feasibility study on uptake of take-home self-testing will be conducted; as well as an EW census and the size estimations of MSM and TG populations will be to provide a better understanding of risk behaviors and epidemiological characteristics among these MARP groups.

Flagship will continue to improve its analyses and utilization of data from Geographic Information System (GIS) mapping, Unique Identifier System, TG Integrated Behavioral and Biological Survey and population size estimations to refine program strategy and intervention design, and to inform the development of a directory of service points in Flagship ODs. GIS mapping will be utilized as a platform to integrate routine field data to visualize and identify gaps in services for better targeting of interventions. Training on the use of GIS mapping tools, methodology and analysis will be provided to CoEs, IPs and the national program at the OD level to enhance capacity and ownership of this technology and process. Flagship will continue to coach and mentor CoEs/IPs on implementing the UIS and will provide training and TA on client Unique Identifier Code registration. On-going monitoring and TA will be provided to strengthen the implementation of UIS in CoE/IPs and health service providers.

Flagship will continue to build systems and capacities of all CoE in M&E/MIS, strategic information and data utilization through participatory workshops, mentoring and coaching; and provide TA to support CoEs to apply this new system and tools. Flagship is currently piloting a web-based data system (DHIS-2) and will document the experiences, challenges and lessons learned, and improve its alignment with the specific program of each CoE for more efficient data management. Flagship will develop tools and methodology for data collection, and set up the finger print system for the risk-tracing approach currently implemented at Chhouk Sar CoE. Flagship will provide support in developing a Data Quality Audit plan and perform the audit at COE/IPs every six months for measuring the progress of data quality.

Objective 4 focuses on using innovative technical assistance approaches to build capacity in governance and leadership, systems strengthening, strategic planning, and resource mobilization. Under Objective 4, the Joint Technical Team (JTT) will conduct regular reviews of Flagship management arrangements, roles and responsibilities; and hold weekly JTT and Objective Team meetings to facilitate more cohesive coordination and communication within the Flagship. Furthermore, Flagship will provide TA to CoEs, other implementing partners and community networks to build their capacity in governance and leadership, systems strengthening, strategic planning, and resource mobilization. Mondul Meanchey Centre will be closing out after Q1 YR 3; while Flagship TA to the KHANA Livelihood Learning Centre and KHANA Research Centre will gradually be reduced in YR 3.

Flagship is supporting select community IPs and health facilities as Centers of Excellence (CoE), building their capacity to develop and test high impact and cost-effective technical innovations. By building on current program successes and structures, Flagship benefits from existing expertise, and contributes to sustainability and alignment. The CoE model is central to the Flagship’s mandate of skills transfer to local partners, and provides a foundation for a cohesive, coordinated, and evidence-informed program framework for future HIV financing, in particular from the Global Fund to Fight AIDS, TB and Malaria (GFATM).
Flagship will update its Technical Assistance Framework and develop an annual Technical Assistance implementation plan. This will also include updated Quality Assurance and Quality improvement tools and will be monitored on a quarterly basis. An independent evaluation of the framework and TA approaches will be conducted in Year 3 and documentation of the Flagship Technical Implementation process.

FC partners FHI 360 and PSI/PSK will provide additional support on Flagship management and coordination, including mentoring and coaching to Objective Teams on best practice and technical areas; tailored knowledge transfer and skills development of the key personnel; and facilitation of thematic sessions on a technical innovation for knowledge sharing and discussion on ways to improve the delivery of innovations, and the national AIDS convention to improve collaboration between partners for a more effective national response.

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