In 2006, Karnataka had the second highest HIV prevalence in India at around 1.6% in the general population. The rural HIV prevalence was as high as urban prevalence and northern Karnataka was more severely hit by the epidemic. Under the National AIDS Control Program, targeted interventions and integrated counselling and testing centres had been scaled up with support from the National AIDS Control Organisation/Karnataka State AIDS Prevention Society and Avahan-Sankalp program. However, the need in Karnataka was a program that focused on rural areas, especially in northern Karnataka, that could enhance the response for the growing burden of HIV care and support.
United States Agency for International Development (USAID) supported the project which was selected after through a competitive process requesting for applications. The University of Manitoba/Karnataka Health Promotion Trust (UM/KHPT) was the prime recipient in technical partnership with Engender Health (EH) and Population Services International (PSI), working in close collaboration with the Karnataka State AIDS Prevention Society (KSAPS), the Andhra Pradesh State AIDS Control Society (APSACS) and National AIDS Control Organisation (NACO).
SAMASTHA interventions are implemented through a multifaceted combination of community based organizations and networks, non-governmental organizations and academic and training institutions. All partners work towards a comprehensive program of networked services for prevention, care and treatment through implementation, linkages across services and strengthening of public and private sector involvement.
SAMASTHA’s goal was to reduce the transmission and mitigate the impact of HIV in selected districts of Karnataka and Andhra Pradesh, with a special focus on rural areas.
SAMASTHA was strengthened by the active involvement of people from all walks of life. Shortly after its launch, the first milestone event was the then Karnataka Chief Minister’s stay at the home of a HIV affected family in Bagalkot. This stay helped to reduce the stigma and discrimination against people living with HIV and further expressed the solidarity of the State government with the project SAMASTHA.
In 2006, 12,214 villages with more than 500 population size were rapidly mapped. Using specific criteria, the direct rural intervention was implemented in about 2300 villages with greatest vulnerability and risk for HIV selected from 12 districts. A Kala Jatha campaign introduced rural communities to the complexity of HIV. This campaign served as an entry point for the ‘link worker’ to develop a strong base within the village for ongoing interventions. In 2009, using emerging evidence and program experience SAMASTHA made a strategic shift to completely focus on most-at-risk rural female sex workers in south Karnataka, while focus was more expanded to include high risk and vulnerable men and women in northern Karnataka.
Over the years, SAMASTHA’s comprehensive rural prevention, care and support interventions reached more than 250,000 vulnerable men and women and regularly reached about 15,000 rural female sex workers, using the link worker model. Today, the NACO has adopted the link worker model and scaled it up in more than 200 districts across India.
Across 16 districts in Karnataka and 5 coastal districts of Andhra Pradesh (AP), the project scaled up HIV care and support by engaging with district level networks of people living with HIV led by Karnataka network of positive people (KNP+) and with faith-based mission hospitals led by Snehadaan (Sneha Charitable Trust) in Karnataka and Lepra Society in coastal AP. The project provided umbrella care to over 70,000 people living with HIV including 20,479 orphan and vulnerable children. St John’s Medical College (SJMC), Engender Health (EH), National Institute of Mental Health and Neurosciences (NIMHANS), Swami Vivekananda Youth Movement (SVYM), Snehadaan and other institutions enhanced the quality of care in these centres through training, supportive supervision and clinical mentorship.
Working alongside the Karnataka State AIDS Prevention Society (KSAPS); ART services were scaled up, while lost to follow up rates were reduced to the lowest in the country. Karnataka has become one of the best performing states for TB-HIV cross referrals, and a national model for integration of prevention of parent to child transmission (PPTCT) of HIV into the National Rural Health Mission (NRHM). SAMASTHA’s innovative models of public private partnership (PPP) for HIV treatment, care, drop-in centers, and outreach have fed into recommendations for the National AIDS Control Program – Phase IV.
SAMASTHA has thus contributed significantly to strengthening the health system response to
HIV/AIDS in Karnataka and Andhra Pradesh, by enhancing the capacity of the government’s AIDS control programmes- the State AIDS Control Societies [SACS] and the District AIDS Prevention and Control Units [DAPCU].
Prior to the SAMASTHA project, orphans and vulnerable children affected by HIV was an unrecognized population. By the end of the project, SAMASTHA had registered more than 20,479 orphans. The SAMASTHA project mainstreamed care for children affected by HIV and AIDS with the department of Women and Child Development (WCD). 8319 were identified with special need and about 3000 had received a direct cash transfer from the Government scheme.
Catalyzed by the SAMASTHA project, the Rajiv Gandhi University of Health Sciences (RGUHS) implemented a pre-service pilot training on chronic care based on WHO’s Integrated Management of Adult and Adolescent Illnesses model (IMAI) and the first ever University recognized HIV fellowship in-service training in India.
What does SAMASTHA leave behind? The project created learning sites which continue to provide experiential learning to program implementers and managers for HIV targeted interventions, rural programming and care and support. Visitors to these sites are from across 17 states in India; from Srilanka, Thailand, Myanmar, China and Pakistan in Asia; and Nigeria, Kenya, Ghana, Uganda and other countries in Africa.
The State and NACO are committed to sustaining the targeted, rural, and care and support direct interventions until safe sexual and health seeking behavior is sustained. Village Health and Sanitation Committees and Panchayat Raj Institutions (PRI) are in the forefront of the response to care for women and children affected and infected by HIV.
Everyone who has journeyed with SAMASTHA, is today more enriched, more enlightened, more empowered and more energetic in the fight against HIV. At the SAMASTHA summit, the Consul General, Chennai, US Embassy congratulated the SAMASTHA project for working alongside the government and with communities to “Close the gap”. The call to action was to “celebrate life”, “enhance partnerships” and “translate knowledge to enhance quality”.