The Abt Associates-led Private Sector Partnerships-One (PSP-One) project would like to commemorate World AIDS Day by highlighting the work that it does with the private sector to strengthen strategic approaches in public private partnership, enhance the quality and reach of interventions, and apply best practices in sector approaches to HIV/AIDS. The project works with the commercial sector on issues such as HIV policy, financing mechanisms, and service delivery approaches for workplace and community investments in HIV. With private providers, PSP-One clarifies the impact of HIV on human capacity and ways providers can enhance the quality, sustainability, and reach of their HIV/AIDS services for populations seeking HIV/AIDS care. Additionally, the project utilizes social marketing approaches to uniquely package and deliver much needed HIV/AIDS-related products.

Click the audio player above to hear Yma Alfaro, PSP-One Guatemala Chief of Party, provide a brief summary of HIV/AIDS project activities.

PSP-One Guatemala HIV/AIDS Activities

The HIV prevalence in Guatemala is estimated at just under 1%, with most-at-risk populations (MARPs) such as commercial sex workers (CSW) and men who have sex with men (MSM) making up 36% of the total number of people living with HIV/AIDS. The estimated prevalence among MARPs is 5% for CSW and 12% for MSM. Currently there are many efforts to strengthen the public sector and NGOs working in Guatemala in the fight against HIV. However, the private sector plays an important role in this fight, with many clients getting tested for HIV in private clinics and private labs. Recognizing the importance of the private health sector in the response to the HIV epidemic in Guatemala, USAID/Guatemala launched the Abt Associates-led PSP-One Guatemala project, with the goal of improving the quality of the HIV CT services provided by the private sector to MARPs. Please read below to better understand PSP-One Guatemala HIV/AIDS project activities.

Stigma Study

PSP-One Guatemala conducted a qualitative study to assess stigma and discrimination faced by high-risk populations when seeking HIV tests with private health care providers. A similar study was conducted in the public sector in Guatemala and the results from the PSP-One study will allow for a comparison of stigma and discrimination between the public and private health sectors. Results of the study will also be used in the development of the training curriculum for private providers.
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Policy Work Related to HIV/AIDS

Increasing the government’s leverage on the private sector and promoting dialogue between the public, private and NGOs sectors is key to achieving improved CT services in the private sector. PSP-One is implementing several policy activities that for the first time in Guatemala are actively engaging the private health sector in the fight against HIV/AIDS. PSP-One has formed a national public-private sector commission which is composed of 12 representatives including the national HIV/AIDS program director and representatives of Medical and biochemists professional boards and associations. This national commission has drafted a plan of action and has embarked on key priority activities aimed at strengthening the private health-sector role in counseling and testing through improved public-private dialogue. This national commission was officially launched on May 30, 2008 in a public event attended by the deputy minister of health and key stakeholders from private and public sectors.

• National Commission on HIV/AIDS
• Strategic Linkages with Professional Associations
• PSP-One and the Guatemala Medical Association Partner to Fight HIV/AIDS
• USAID/PSP-One and Guatemala Medical Association Sign Declaration to Address HIV/AIDS

Private Provider Survey

PSP-One conducted a rapid assessment of the HIV CT services offered by private physicians and laboratory biochemists. The results show that the private sector has an important potential since they are indeed seeing and being consulted by HIV/AIDS patients and that there are important gaps in knowledge about national norms and guidelines, and hence there are many lost opportunities in counseling and testing. The results of this survey point out for a series of political, educational and logistic interventions that will be necessary such as: sustainable standardized education and training, informed consent processes, patient follow-up, patient notification and referral. This was the first time anyone assessed these services in the private sector in Guatemala, and the assessment findings have been key to informing PSP-One project activities.

• Rapid Assessment of CT Services in the Private Sector

Training

A training platform of 14 applied 4-hour courses for private physicians and clinical laboratory biochemists is being implemented by PSP-One in the different project areas. The courses are delivered by national clinical experts who address topics such as epidemiology, national testing guidelines, HIV/AIDS local law, counseling norms, early diagnosis and referral, case-clinic discussions. Pre and post tests conducted at each course show positive results among attendees.

• PSP-One Co-Sponsors Special Initiative to Reach Private Laboratory Owners and Biochemists
• PSP-One Guatemala Launches Training Course for Private Physicians on HIV/AIDS Counseling and Testing

Research Model

In 2008 PSP-One began a research process to identify and develop cost-effective models for delivering quality CT services to most-at-risk populations (MARPs), which are suitable to the private sector. At this point at least three possible modalities have been identified and are being discussed with key partners prior to launching the next phase which is to pilot test theses modalities which include a mobile counselors concept.

• Development of New CT Models

Additional PSP-One HIV/AIDS Activities

PSP-One Ethiopia Private Provider Survey

To meet the growing demand for care and treatment in countries with high HIV prevalence, governments and patients seeking HIV/AIDS care and treatment will increasingly rely on the private sector. However, little information has been gathered on the potential for increased private sector provision of HIV and AIDS services. Ethiopia presents a compelling case for better understanding the current and potential future role of the private sector. The country has a population of 77 million and an adult HIV prevalence rate of 1.4 percent, the private health sector in Ethiopia is rapidly developing, and the public sector has signaled a growing interest in working with the private health sector. The Abt Associates-led PSP-One project, funded by USAID, undertook a survey of 285 private health clinics and 118 pharmacies in three regions to better understand the role of the private health sector in the delivery of HIV and AIDS services and information, as well as existing referral mechanisms. Results of the study show that while 60% of private clinics are active in condom promotion, only 12% provide VCT services, with other HIV services even less frequently offered. While current delivery of HIV services is low, private providers expressed a strong interest in receiving training and in providing HIV and related services, signaling the potential for expanding access to such services in partnership with the Federal Ministry of Health.

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The Role of the Private Health Sector in HIV Prevention and Treatment: Financing and Utilization Trends

Governments and donors are increasingly considering the private sector as a potential partner in addressing the growing demand for sustaining HIV and AIDS treatment. However, little is known about this sector’s role in delivering these services. A study, conducted by the Abt Associates-led PSP-One project, analyzes existing data sources, including Demographic and Health Surveys, AIDS Indicator Surveys, and National Health Accounts to better articulate the role of the private sector in HIV and AIDS services. Findings indicate that the extent to which the private sector contributes to HIV and AIDS services depends on country-specific variables, including donor funding levels. In light of increasing bottlenecks in the public health care delivery system (e.g. lack of infrastructure and personnel), further engagement of the private sector may be warranted.
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Comparative Study on the Quality of Counseling, Testing and Referrals in Zambia

Quality of care is an important aspect of all health service delivery, but is particularly critical in the delivery of HIV/AIDS and related services. However, not enough is known about the quality of HIV/AIDS services, including counseling and testing (CT) and referrals, in the private sector. To address this gap, PSP-One is undertaking a comparative study to assess the quality of HIV/AIDS care in the public, NGO, and private for-profit health sectors in Zambia. As a country with high HIV prevalence, and growing commitment from both the public and private sectors to respond to the epidemic, Zambia represents an optimal country in which to explore this issue. In partnership with the MOH in Zambia and the Health Systems and Services Project, the Abt Associates-led PSP-One project will conduct a study to assess the quality of CT services, and to track referrals made for follow-up care. Quality will be assessed using mystery clients, exit interviews, and the analysis of service statistics in both urban and rural CT sites in Zambia.

Fostering Public-Private Partnerships for HIV/AIDS Prevention in Swaziland

Swaziland has one of the most severe HIV and AIDS epidemics in the world, with an estimated HIV prevalence among pregnant women attending antenatal clinics of 39.2% in 2006. Swaziland has adopted a comprehensive HIV prevention approach in order to address the multiple factors that fuel the spread of infection in the country. As part of the approach to implement new interventions, the Government of Swaziland has developed a policy on male circumcision for HIV prevention, which provides approximately 66% protection against new infections for men. The Government has published a Male Circumcision Implementation Plan which calls for conducting 150,000 circumcisions over the next five years. It is clear that reaching this aggressive goal will require the coordinated effort of all sectors. PSP-One is supporting the Family Life Association of Swaziland (FLAS) to scale up the MC services it already provides. PSP-One staff is assisting FLAS to improve its clinical services, financial foundation, and organizational and management capacity, all necessary for FLAS to take a leadership position in providing MC services in the private sector. After a rapid assessment of FLAS’s needs, interventions will include staff training on cost accounting, management and leadership training and coaching, and clinical training for Swazi doctors.

Review of Evidence for Economic Interventions to Target Groups Affected by HIV/AIDS

The USAID funded Private Sector Partnerships-One project (PSP-One) is conducting a review of economic -strengthening interventions within communities impacted by HIV/AIDS to shed light on the available evidence or lack thereof for the impact of economic strengthening activities in improving household income, household/community well-being, nutritional status, reduction of risky behaviors for orphans and vulnerable children, vulnerable girls, and people living with HIV. The review will comprise an analysis of published and “grey literature” from institutions involved in economic development and interviews with key informants. The review will answer the following questions:

• To what extent are economic support interventions improving the wellbeing of people living with and affected by HIV/AIDS?
• How can programs more effectively serve these communities and assess impact?

The review will identify best practices in implementing and monitoring economic support initiatives, distill lessons learned, and offer guidance to implementers, policy makers and donors to improve the well-being of communities affected by HIV/AIDS. Specifically, it will offer practitioners a monitoring and evaluation framework to understand whether and how economic strengthening approaches have impacted on communities affected by HIV/AIDS, and provide guidelines on monitoring and evaluation indicators to help practitioners identify, adapt and/or design appropriate economic support interventions for specific target groups.

HIV/AIDS Services through the Workplace: A Survey in Four Sub-Saharan African Countries

Over the course of the HIV/AIDS epidemic, the commercial sector has played an increasingly important part in responding to the epidemic and offering treatment services. While some studies have highlighted the practices of particular companies, particularly in South Africa, there is still limited understanding about the relationship between companies and the public sector concerning the provision of HIV/AIDS services for their employees in the region as a whole. The Abt Associates-led PSP-One project recently conducted a study to examine how companies in Kenya, Namibia, Ethiopia and Zambia are meeting and financing HIV/AIDS care and treatment needs of their employees. Human resources personnel or health clinicians from 121 companies participated in the survey via an online, self-administered questionnaire, or phone interviews. The data were then analyzed using univariate and bivariate analyses. Additional qualitative data were collected through key informant interviews with company personnel from four companies in each of the study countries. Results have recently been disseminated through a full study report and individual country snapshots.
Click to view workplace survey report
Click here to read the country snapshots