1. Community-centered Clinical Services: Case Studies and Lessons Learned from Implementing Key Population Programs in India Anjana Das STI Capacity Building

2. Scale and Scope of Avahan Program Program coverage 6 states, 83 districts, 600+ towns 129 NGOs Combined State Population ~ 300 million High risk groups covered FSW – 221,000 MSM & TG – 81,000 IDU – 18,000 Men at risk – ~5 million Prevention Package Outreach, BCC Commodities (condoms, lubricants, needles) Clinical services for STIs + counseling Referral - TB, HIV testing, ART Community mobilization Structural Interventions: Local advocacy, police sensitization, crisis response, community advisory committees

3. STI service delivery structure

4. Community Led- Approaches for Clinical Service Provision Phase 1 (2004-2009) Scale-up Phase 2 (2009-2013) Transition Training and supporting peer outreach workers Establishing service committees e.g. STI, care and support Appointment of community members in clinic staff positions Preparing CBOs to lead STI program components Service committees increasingly led by community non-peers Community participation guidelines for planning, implementing and monitoring services in Avahan COGS & CMP Refined with learnings

5. Documenting Community-centered Clinical Services: Case Studies and Lessons Learned Purpose Intended audience Case study selection criteria Document innovative approaches used in resource-constrained settings Share good practices and lessons learned Strengthen capacity of KP programs elsewhere Primary: KP program implementers Health officials, donors, policy makers Replicability and scalability Demonstrated improved outcomes Relatively simple processes Acceptable and accessible by KPs

7. List of Thematic Areas/Chapters Community-led Approaches for Clinical Service Provision Customizing STI Service Delivery Models Sexually Transmitted Infections (STI) Care and Treatment Continuum of Care Clinic Management Systems Sustainability and Transition

8. Lessons Learned Community Participation Service Delivery Models STI Care and Treatment Increased clinic utilization Has the potential to lead to a change from an externally-led to a community-led program Tailored to KP typology and local resources Improved accessibility Static + outreach clinics cost-effective in large urban areas Standardized guidelines and SOPs Regular quality monitoring and use of data improved services POC tests increased syphilis screening

9. Lessons Learned (2) Continuum of care Clinic Management Systems Sustainability and Transition Demand generation and HTC at outreach clinics led to four-fold increase in HIV testing Primary HIV care & support, TB screening provided on-site with referral linkages for higher-level care Capacity building mechanisms for clinic staff ensured quality of services Stock management systems for drugs and other commodities prevented stock-outs and wastage CBOs should be involved in transition planning, post transition support necessary Early planning for sustainable mechanisms for clinical services

10. Acknowledgements and Key References Bill & Melinda Gates Foundation Implementing agencies Our community members