28 June, 2013 Ali Arsalo, M.D., Chair of the HIV/AIDS & AI EG Outi Karvonen, ITA of the HIV/AIDS & AI EG Strategic Plan of NDPHS Expert Group on HIV/AIDS & Associated Infections

2 Elements of a basic LF matrix Objective hierarchy IndicatorsSources of verification Assumptions and risks Overall objectives Often quantitative and qualitative PURPOSE Often qualitative Results Often qualitative Activities Often quantitative Preconditions Resources

3 Underlying factor Underlying contextual factor Sub-cause 3.1Sub-cause 3.2 Core problem Sub-cause 2.1 Immediate cause (Problem area) 2 Immediate cause (Problem area) 1 Consequences Sub-cause 1.2 Sub-cause 1.1. Underlying factor Immediate cause (Problem area) 3 Basic structure of the ”Problem Tree”

4 Sub-projects x Assumptions Underlying factors Project 3.1 Concrete, immediate objective Project 2.1 Programme Area I Strategic objectives Project 1.2Project 1.1. Assumptions Project 3.1 Programme Area 2 Programme Area 3 Sub-projects x Sub-projects x The idea of the Strategy tree

Materialization of the planning process Meetings, discussions and consultations Unofficial discussions, meeting in Porvoo, June, 2011 – All EG members were invited in short notice for 1,5 days – Brain storm discussions about HIV and TB problems within partner countries – Preliminary analysis and the first versions of Problem and Objective Trees Official group meetings in October 2011, December 2011 and March 2012 NGO Forum in St. Petersburg, November, 2012 Comments, corrections and complementary information asked from various stakeholders: “Give your views freely” New “Tree” versions after meetings and consultations

Overall objectives given from NDPHS Hierarchical order of different levels of objectives -Goals (from NDPHS): – Prevention of HIV/AIDS and related diseases in the ND Area has improved – Social and health care for HIV infected individuals in the ND Area is integrated -Overall objectives (for the EG, from NDPHS) – Reinforcing policy recommendations – G eographical and priority thematic areas as well as key populations at higher risk in urgent need for further local or regional projects are identified, partners to be involved in these projects are recommended and project planning supported – Best practices document(s) developed – Review of evidence based experiences and best practices on integration of social and health care services for HIV+ people is prepared

Main areas of problems and needs Results from identification 1.Existing policies and practices do not fully support the prevention of the spread of HIV and AIs 2.Unsatisfactory monitoring and provision of epidemiological info of key populations at risk in the ND Area 3.Continuous spread of HIV, TB and associated infections 4.Deteriorating infectious disease situation among key populations at risk, migrants and minorities 5.Complexity of the HIV-AIDS-TB situation is not properly responded by traditional approaches 6.Insufficient capacity of the health care systems to respond to the burden of HIV, TB and AIs

Definition of core problem and purpose of the Action Plan ● Ineffective prevention with harmful impacts of HIV, AIDS & AI (TB, hepatitis B & C, syphilis, gonorrhea) in the ND Area – due to insufficiency of international cooperation and joint activities (to be adapted according to prevailing conditions within countries) ● Strengthened prevention and reduction of impacts of HIV, AIDS & AI (TB, hepatitis B & C, syphilis, gonorrhea) in the ND Area – through facilitation of cooperation by joint international activities (to be adapted according to prevailing conditions within countries

Proposed main working areas Based on identified problem areas 0. Management component of the Strategy and Action Plan 1.Provision of support to policy development and cooperation 2.Improved monitoring and data on epidemiological situation of key populations at risk in the ND Area 3.Effective prevention of the spread of HIV, TB and associated infections 4.Improved tuberculosis situation in key populations at risk, migrants and minorities 5.Complexity of the HIV and TB situation recognized and new collaborative activities developed 6.Improved capacity of the health care systems as response to the burden of HIV, TB and AIs

Strengthened prevention and reduction of impacts of HIV, AIDS & AI (TB, hepatitis B & C, syphilis, gonorrhea) in the ND Area through facilitation of cooperation by joint international activities (to be adapted according to prevailing conditions within countries) 3. Effective prevention of the spread of HIV, TB and AIs 4. Improved tuberculosis situation in key populations at risk, migrants & minorities 6. Improved capacity of the health care systems as response to the burden of HIV, TB and AIs 5. Complexity of the HIV and TB situation recognized & new collaborative activities developed 2. Improved monitoring & data on epidemiological situation of key populations at risk in the ND Area 0. Program (EG Strategy) Management NDPHS HIV/AIDS&AI EG Draft of the “Objective Tree” for internal Action Plan Goal 2: Prevention of HIV/AIDS and related diseases in the ND Area has improvedGoal 3: Social and health care for HIV infected individuals in the ND Area is integrated O.T Reinforcing policy recommendations O.T Geographical and priority thematic areas and key populations at higher risk in urgent need for further local or regional projects identified, partners for these projects recommended and project planning supported O.T Best practices Document(s) developed O.T Review of evidence based experiences and best practices on integration of social and health care services for HIV + people is prepared 0.1. Develop updated Action Plan for the EG Clarify the needs and expectations of members for the EG Prepare long-term Action Plan, including principles for EG meetings 0.2. Further development of reporting mechanisms and practices Follow-up reporting of projects and EG activities Reporting to the Secretariat and CSR Reporting to governments as relevant Making publicity as relevant 0.3. Promotion of project development Identification of relevant project ideas, based on EG Action Plan Provision of support to identification of project partners Support to project planning Provision of support for applications 0.4. Identification of funding sources and mechanisms 1. Provision of support to policy development and cooperation

Strengthened prevention and reduction of impacts of HIV, AIDS & AI (TB, hepatitis B & C, syphilis, gonorrhea) in the ND Area through facilitation of cooperation by joint international activities (to be adapted according to prevailing conditions within countries) 3. Effective prevention of the spread of HIV, TB and AIs 4. Improved tuberculosis situation in key populations at risk, migrants & minorities 6. Improved capacity of the health care systems as response to the burden of HIV, TB and AIs 5. Complexity of the HIV and TB situation recognized & new collaborative activities developed 2. Improved monitoring & data on epidemiological situation of key populations at risk in the ND Area 0. Program management NDPHS HIV/AIDS&AI EG Draft of the “Objective Tree” for internal Action Plan Goal 2: Prevention of HIV/AIDS and related diseases in the ND Area has improvedGoal 3: Social and health care for HIV infected individuals in the ND Area is integrated O.T Reinforcing policy recommendations O.T Geographical and priority thematic areas and key populations at higher risk in urgent need for further local or regional projects identified, partners for these projects recommended and project planning supported O.T Best practices Document(s) developed O.T Review of evidence based experiences and best practices on integration of social and health care services for HIV + people is prepared 0.1. Develop updated Action Plan for the EG Clarify the needs and expectations of members for the EG Prepare long-term Action Plan, including Principles for EG meetings 0.2. Further development of reporting mechanisms and practices Follow-up reporting of projects and EG activities Reporting to the Secretariat and CSR Reporting to governments as relevant Making publicity as relevant 0.3. Promotion of project development Identification of relevant project ideas, based on EG Action Plan Provision of support to identification of project partners Support to project planning Provision of support for applications 0.4. Identification of funding sources and mechanisms 1. Provision of support to policy development and cooperation 1.1. People living with HIV more involved in decision making Improved knowledge about second generation HIV surveillance 1.4. Improved integration of HIV and STIs, hepatitis and TB surveillance 1.3. Improved follow-up of HIV+ belonging to key populations at risk 1.2. Improved follow-up of all HIV+, including medical care and counseling 1.9. Updated legislation and related training 1.8. Decision makers are informed and aware of future costs caused by infections and their treatment 1.7. Results from monitoring and evaluations of programs are effectively made use of 1.6. More research fulfilling international standards 1.5. Improved access to existing services for relevant populations at risk The understanding of HIV and AIs among the public has improved Civil society organizations are more involved in prevention and support Improved skills for advocacy and lobbying to inform decision makers on HIV resource allocation and to recommend optimal choices based on local characteristics Sexual health education included in schools curricula Mechanisms established for NGOs’ participation in the development and supervision of public programmes Strengthened networks of NGOs and GOs in the field of HIV and TB Stigma and discrimination more clearly addressed in legislation and programmes

Strengthened prevention and reduction of impacts of HIV, AIDS & AI (TB, hepatitis B & C, syphilis, gonorrhea) in the ND Area through facilitation of cooperation by joint international activities (to be adapted according to prevailing conditions within countries) 3. Effective prevention of the spread of HIV, TB and AIs 4. Improved tuberculosis situation in key populations at risk, migrants & minorities 6. Improved capacity of the health care systems as response to the burden of HIV, TB and AIs 5. Complexity of the HIV and TB situation recognized & new collaborative activities developed 2. Improved monitoring & data on epidemiological situation of key populations at risk in the ND Area 0. Program management NDPHS HIV/AIDS&AI EG Draft of the “Objective Tree” for internal Action Plan Goal 2: Prevention of HIV/AIDS and related diseases in the ND Area has improvedGoal 3: Social and health care for HIV infected individuals in the ND Area is integrated O.T Reinforcing policy recommendations O.T Geographical and priority thematic areas and key populations at higher risk in urgent need for further local or regional projects identified, partners for these projects recommended and project planning supported O.T Best practices Document(s) developed O.T Review of evidence based experiences and best practices on integration of social and health care services for HIV + people is prepared 0.1. Develop updated Action Plan for the EG Clarify the needs and expectations of members for the EG Prepare long-term Action Plan, including Principles for EG meetings 0.2. Further development of reporting mechanisms and practices Follow-up reporting of projects and EG activities Reporting to the Secretariat and CSR Reporting to governments as relevant Making publicity as relevant 0.3. Promotion of project development Identification of relevant project ideas, based on EG Action Plan Provision of support to identification of project partners Support to project planning Provision of support for applications 0.4. Identification of funding sources and mechanisms 1. Provision of support to policy development and cooperation 2.2. Improved data on prevalence of HIV and hepatitis among key populations at risk (MSM, CSWs, PWID) Mechanisms developed to reach “sex tourists” and travelers more effectively 2.7. More and better data on prevalence and risk behavior in ethnic minorities, including Roma and marginalized people 2.6. Increased counseling and testing rates and services for migrants and other vulnerable groups 2.5. Improved HIV and hepatitis testing coverage in pregnant women 2.4. Effective approaches developed to collect relevant data on bridging populations (sex partners of PWID, female partners of MSM, clients of CSWs) 2.3. Mechanisms developed to deliver data on the situation of HIV, TB and AIs among PWID 2.9. Mechanisms in place to produce data on situation of infectious disease in prisons 2.8. More and better data on prevalence and risk behavior in neglected children, including minors involved in commercial sexual exploitation 2.1. (WHO A2) HIV prevalence among TB patients and TB prevalence among PLWH determined

Strengthened prevention and reduction of impacts of HIV, AIDS & AI (TB, hepatitis B & C, syphilis, gonorrhea) in the ND Area through facilitation of cooperation by joint international activities (to be adapted according to prevailing conditions within countries) 3. Effective prevention of the spread of HIV, TB and AIs 4. Improved tuberculosis situation in key populations at risk, migrants & minorities 6. Improved capacity of the health care systems as response to the burden of HIV, TB and AIs 5. Complexity of the HIV and TB situation recognized & new collaborative activities developed 2. Improved monitoring & data on epidemiological situation of key populations at risk in the ND Area 0. Program management NDPHS HIV/AIDS&AI EG Draft of the “Objective Tree” for internal Action Plan Goal 2: Prevention of HIV/AIDS and related diseases in the ND Area has improvedGoal 3: Social and health care for HIV infected individuals in the ND Area is integrated O.T Reinforcing policy recommendations O.T Geographical and priority thematic areas and key populations at higher risk in urgent need for further local or regional projects identified, partners for these projects recommended and project planning supported O.T Best practices Document(s) developed O.T Review of evidence based experiences and best practices on integration of social and health care services for HIV + people is prepared 0.1. Develop updated Action Plan for the EG Clarify the needs and expectations of members for the EG Prepare long-term Action Plan, including Principles for EG meetings 0.2. Further development of reporting mechanisms and practices Follow-up reporting of projects and EG activities Reporting to the Secretariat and CSR Reporting to governments as relevant Making publicity as relevant 0.3. Promotion of project development Identification of relevant project ideas, based on EG Action Plan Provision of support to identification of project partners Support to project planning Provision of support for applications 0.4. Identification of funding sources and mechanisms 1. Provision of support to policy development and cooperation Decreasing share of late presenters (low CD4) among newly diagnosed HIV Networks of collaboration partners established Improved public awareness about the need for active case finding and cross-testing between HIV TB, hepatitis and STIs Needs of vulnerable groups are met through LTC services, including buses The quality of counseling improved by using established and evaluated methods Improved and more active involvement of PHC and GPs in prevention and testing People living with HIV, youth and NGOs are involved in planning and implementation of prevention programs Availability of targeted prevention programs for specific risk groups (migrants, MSM, CSWs, HIV+, PWID etc.) Availability of client – and youth-friendly services Sexual Health education included in schools’ and other institutions’ curricula, including information on sexual minorities and HIV, TB and STI prevention Improved access to specific services for PWID, including harm reduction, total prevention packages and services outside big cities 3.7. Knowledge about and access to post exposure prophylaxis for HIV and hepatitis B are available 3.1. (WHO B1) TB case finding intensified and high quality anti-TB-treatment ensured 3.3. (WHO C1) HIV testing and counseling provided to patients with presumptive and diagnosed TB 3.2. (WHO B2) TB prevention initiated with Izoniazide preventive therapy and early ARVT when feasible 3.4. (WHO C2) HIV prevention interventions available for patients with presumptive and diagnosed TB 3.6. (WHO C4) HIV prevention interventions treatment and care available for TB patients living with HIV 3.5. (WHO C3) Co-trimoxazole preventive therapy Available for TB patients living with HIV HIV prevention cooperation between youth from different regions and countries developed HIV and AI prevention among special groups of children and youth at risk (juvenile offenders, marginalized families, migrants, mental and physical disabilities, working youth) 3.9. Making use of the potential of peer education and empowerment of vulnerable groups Indicators to measure the effectiveness of prevention programmes are developed and available Training programmes developed for school nurses (incl. themes concerning MSM, PWID, SW, migrants etc.) 3.8. Promotion of the use of new technologies (e.g. mobile equipment, internet etc.) in prevention

Strengthened prevention and reduction of impacts of HIV, AIDS & AI (TB, hepatitis B & C, syphilis, gonorrhea) in the ND Area through facilitation of cooperation by joint international activities (to be adapted according to prevailing conditions within countries) 3. Effective prevention of the spread of HIV, TB and AIs 4. Improved tuberculosis situation in key populations at risk, migrants & minorities 6. Improved capacity of the health care systems as response to the burden of HIV, TB and AIs 5. Complexity of the HIV and TB situation recognized & new collaborative activities developed 2. Improved monitoring & data on epidemiological situation of key populations at risk in the ND Area 0. Program management NDPHS HIV/AIDS&AI EG Draft of the “Objective Tree” for internal Action Plan Goal 2: Prevention of HIV/AIDS and related diseases in the ND Area has improvedGoal 3: Social and health care for HIV infected individuals in the ND Area is integrated O.T Reinforcing policy recommendations O.T Geographical and priority thematic areas and key populations at higher risk in urgent need for further local or regional projects identified, partners for these projects recommended and project planning supported O.T Best practices Document(s) developed O.T Review of evidence based experiences and best practices on integration of social and health care services for HIV + people is prepared 0.1. Develop updated Action Plan for the EG Clarify the needs and expectations of members for the EG Prepare long-term Action Plan, including Principles for EG meetings 0.2. Further development of reporting mechanisms and practices Follow-up reporting of projects and EG activities Reporting to the Secretariat and CSR Reporting to governments as relevant Making publicity as relevant 0.3. Promotion of project development Identification of relevant project ideas, based on EG Action Plan Provision of support to identification of project partners Support to project planning Provision of support for applications 0.4. Identification of funding sources and mechanisms 1. Provision of support to policy development and cooperation 4.2. The general awareness among professionals and the public about TB is improved 4.8. International treatment standards on TB are met 4.7. Improved collaboration between TB, HIV and narcology services and migrant centers 4.6. Improved collaboration between civilian and penitentiary TB services 4.4. Modern TB information programs implemented among the public, professionals and decision makers 4.3. Implementation of activities focusing on decreasing the number of cases of MDR and XDR TB 4.5. (WHO B3) TB infection control programs implemented in health care and especially in HIV settings (including LTSCs) 4.9. Outreach work and psycho-social support methods among risk groups for TB are developed 4.1. Collaborative TB/HIV activities are promoted and implemented as recommended by WHO Support to provision of information in migrants’ languages

Strengthened prevention and reduction of impacts of HIV, AIDS & AI (TB, hepatitis B & C, syphilis, gonorrhea) in the ND Area through facilitation of cooperation by joint international activities (to be adapted according to prevailing conditions within countries) 3. Effective prevention of the spread of HIV, TB and AIs 4. Improved tuberculosis situation in key populations at risk, migrants & minorities 6. Improved capacity of the health care systems as response to the burden of HIV, TB and AIs 5. Complexity of the HIV and TB situation recognized & new collaborative activities developed 2. Improved monitoring & data on epidemiological situation of key populations at risk in the ND Area 0. Program management NDPHS HIV/AIDS&AI EG Draft of the “Objective Tree” for internal Action Plan Goal 2: Prevention of HIV/AIDS and related diseases in the ND Area has improvedGoal 3: Social and health care for HIV infected individuals in the ND Area is integrated O.T Reinforcing policy recommendations O.T Geographical and priority thematic areas and key populations at higher risk in urgent need for further local or regional projects identified, partners for these projects recommended and project planning supported O.T Best practices Document(s) developed O.T Review of evidence based experiences and best practices on integration of social and health care services for HIV + people is prepared 0.1. Develop updated Action Plan for the EG Clarify the needs and expectations of members for the EG Prepare long-term Action Plan, including Principles for EG meetings 0.2. Further development of reporting mechanisms and practices Follow-up reporting of projects and EG activities Reporting to the Secretariat and CSR Reporting to governments as relevant Making publicity as relevant 0.3. Promotion of project development Identification of relevant project ideas, based on EG Action Plan Provision of support to identification of project partners Support to project planning Provision of support for applications 0.4. Identification of funding sources and mechanisms 1. Provision of support to policy development and cooperation 5.9. Improved adherence to treatment of double infections Promotion of best practices with country specific approach 5.5. Training of GPs, PHC and LTSC staff developed and implemented on raising awareness of mass media, the public and service providers on contacting, servicing and educating risk groups) 5.4. More & closer collaboration & projects with Russian drug police and other law enforcement agencies developed 5.3. (WHO A4) Monitoring and evaluation of collaborative TB / HIV activities 5.2. (WHO A3) Provision of support to joint TB/HIV planning to integrate the delivery of TB and HIV services Effective use of the potential of EU Health Program and small facility scheme 5.8. New approaches developed for international collaboration, partnerships and networking Development of TB services as entry points for improving HIV prevention, diagnostics, treatment and care Support to planning and implementation of collaborative studies to promote evidence-based approaches Support to the development of integrated services for detection of infections and improvement of the adherence to treatment of patients with triple diagnosis (TB + HIV + drugs) 5.6. Training of PHC staff on co-infection HIV/TB 5.1. (WHO A1) Provision of support to establish and functions of coordinating body for collaborative TB/HIV activities 5.7. Improved cross sectoral (incl. social aspects) disease control, management, mechanisms and approaches Wider involvement of stakeholders in the development of TB and HIV projects and approaches

Strengthened prevention and reduction of impacts of HIV, AIDS & AI (TB, hepatitis B & C, syphilis, gonorrhea) in the ND Area through facilitation of cooperation by joint international activities (to be adapted according to prevailing conditions within countries) 3. Effective prevention of the spread of HIV, TB and AIs 4. Improved tuberculosis situation in key populations at risk, migrants & minorities 6. Improved capacity of the health care systems as response to the burden of HIV, TB and AIs 5. Complexity of the HIV and TB situation recognized & new collaborative activities developed 2. Improved monitoring & data on epidemiological situation of key populations at risk in the ND Area 0. Program management NDPHS HIV/AIDS&AI EG Draft of the “Objective Tree” for internal Action Plan Goal 2: Prevention of HIV/AIDS and related diseases in the ND Area has improvedGoal 3: Social and health care for HIV infected individuals in the ND Area is integrated O.T Reinforcing policy recommendations O.T Geographical and priority thematic areas and key populations at higher risk in urgent need for further local or regional projects identified, partners for these projects recommended and project planning supported O.T Best practices Document(s) developed O.T Review of evidence based experiences and best practices on integration of social and health care services for HIV + people is prepared 0.1. Develop updated Action Plan for the EG Clarify the needs and expectations of members for the EG Prepare long-term Action Plan, including Principles for EG meetings 0.2. Further development of reporting mechanisms and practices Follow-up reporting of projects and EG activities Reporting to the Secretariat and CSR Reporting to governments as relevant Making publicity as relevant 0.3. Promotion of project development Identification of relevant project ideas, based on EG Action Plan Provision of support to identification of project partners Support to project planning Provision of support for applications 0.4. Identification of funding sources and mechanisms 1. Provision of support to policy development and cooperation 6.1. The health and social care systems are capable to respond effectively to and cope with prevailing challenges, including migration and IDUs Improved Involvement of workplaces 6.9. PHC & sexual health services are provided without stigmatization, discrimination and violation of basic human rights 6.7. Strengthened integration of HIV care in the PHC 6.8. Improved capacity of PHC concerning the identification, vaccinations and referring for treatment of associated chronic infections (e.g. HBV & HCV) Strengthened service systems to meet clients practical needs 6.4. Adequate case management is in place 6.3. Improved adherence to treatment 6.2. Functioning access to treatment Development of inter-regional seamless and comprehensive migrant services Provision of support to planning and implementation of training for specialists concerning stigma, discrimination and human rights 6.6. (WHO C5) Contribution to ensuring ARVT for TB patients living wth HIV Promoting comprehensive activities to defend rights of HIV- and TB patients to decrease stigma and discrimination in health and social services Promotion of client centered and user-friendly approaches in the health care system Development of rehabilitation systems in penitentiary Institutions (concrete programs and standards, “peer-to-peer”, adherence to treatment) 6.5. Investigation of accessibility to health care services among migrants Training of pharmacists in relevant HIV and TB matters Establish resource centers to work with socially deprived vulnerable groups