The World Bank Report No: ISR1729 Implementation Status & Results Trinidad and To Public Disclosure Copy T&T: HIV/AIDS Prevention and Control Project (P075528) Operation Name: T&T: HIV/AIDS Prevention and Control Project (P075528) Project Stage: Implementation Seq.No: 15 Status: ARCHIVED Last Modified Date: 02-Dec-2010 Country: Trinidad and To Approval FY: 2003 Product Line: IBRD/IDA Region: LATIN AMERICA AND CARIBBEAN Lending Instrument: Adaptable Program Loan Implementing Agency(ies): Ministry of Finance Key Dates Board Approval Date 27-Jun-2003 Original Closing Date 31-Dec-2008 Planned Mid Term Review Date 01-Dec-2005 Last Archived ISR Date 28-Jun-2010 Effectiveness Date 23-Dec-2003 Revised Closing Date 30-Sep-2010 Actual Mid Term Review Date 13-Mar-2006 Project Development Objectives Project Development Objective (from Project Appraisal Document) On November 4, 2009, the Board approved a first-order restructuring of the Project. The revised PDOs are aimed at assisting the Borrower in controlling HIV/ AIDS epidemic through: (a) scaling up of prevention services for vulnerable groups and general population; (b) expanding and strengthening of treatment, care and support services for people living with HIV/AIDS; and (c) strengthening the institutional capacity of the MOH, other government agencies and CSOs to ensure an effective multi-sectoral response to the HIV/AIDS epidemic. Has the Project Development Objective been changed since Board Approval of the Project? Yes No Component(s) Component Name Component Cost Public Disclosure Copy PREVENTION OF THE SPREAD OF HIV/AIDS 8.06 TREATMENT, CARE AND SUPPORT 11.13 ADVOCACY AND HUMAN RIGHTS 0.45 SURVEILLANCE AND RESEARCH 2.52 PROGRAM MANAGEMENT, COORDINATION AND EVALUATION 2.02 Overall Ratings Previous Rating Current Rating Progress towards achievement of PDO Moderately Satisfactory Moderately Satisfactory Overall Implementation Progress (IP) Moderately Satisfactory Moderately Satisfactory Overall Risk Rating Page 1 of 8 The World Bank Report No: ISR1729 Implementation Status Overview Progress has been made in the five priority areas defined in the National Strategic Plan (NSP). Achievements by priority areas follows: Public Disclosure Copy a. Prevention. The focus has been on raising awareness of HIV in the general population through mass media, educational campaigns at cultural events and support to Civil Society Organizations including those working with Most At Risk Populations (MARPs). Capacity for HIV testing has increased and more condoms have been distributed. However the number of people tested has remained low as has the percent of people reporting using condoms. The new National Strategy Plan, which is under development will focus more attention to prevention and target the MARPs. b. Treatment. Free antiretroviral therapy (ART) is provided for people living with AIDS. MOH reports that 6452 HIV/AIDS patients were receiving treatment and care as of June 30, 2010. Of these, 4487 patients (69.5%) were on ART showing an increase of 895 patients or 15.5% on ART compared to 2009. The deaths due to AIDS has significantly reduced since the introduction of ART. c. Advocacy & Human Rights. A legislative assessment has been conducted on the impact of the laws of Trinidad & Tobago on people living with and affected by HIV &AIDS (PLHIV). A national HIV policy is being prepared and would be followed by drafting legislation to deal with the issue of stigma and discrimination of PLHIV. d. Surveillance & Research. An IT based surveillance system has been pilot tested in seven sites improving the capture of HIV data and with the potential of reporting nationally once a central database has been established and the seven sites agree to share the data captured. The system will be rolled out to more treatment and testing sites. A number of research projects have sought to improve the evidence base on HIV in the country. e. Program Management Coordination and Evaluation. The Government of Trinidad & Tobago has funded a national committee and a secretariat in Trinidad and also in Tobago to coordinate amultilevel response including financial inputs from other development partners and other implementers. M&E indicators have focused on process and output measures with limited evidence of outcomes achieved. Results Project Development Objective Indicators Indicator Baseline Current End Target Indicator Name Value Value Value 1. Annual number of people living with HIV receiving antiretroviral 0.00 4827.00 4500.00 combination therapy Date Date Date Public Disclosure Copy 30-Jun-2004 30-Jun-2010 30-Sep-2010 Type Unit of Measure Comment Comment Comment Custom Indicator Number The data include the estimated number for Pediatric EW MSC as well as the numbers of people on ARV from Health Promotion Clinic inTobago (340). Page 2 of 8 The World Bank Report No: ISR1729 Indicator Baseline Current End Target Public Disclosure Copy Indicator Name Value Value Value 2. Number of individuals tested and counseled for HIV in the last 12 14140.00 31261.00 30000.00 months Date Date Date 30-Jun-2004 31-Dec-2009 30-Sep-2010 Type Unit of Measure Comment Comment Comment Custom Indicator Number This value consists of 15636 rapid tests and 15625 PMTCT. This only includes the individuals tested and counseled within the public health system. Indicator Baseline Current End Target Indicator Name Value Value Value 3. Number of men who have sex with men reached by HIV prevention 907.00 1692.00 2400.00 interventions in the last 12 months Date Date Date 30-Jun-2004 31-Dec-2009 30-Sep-2010 Type Unit of Measure Comment Comment Comment Custom Indicator Number The data are from three organizations: Red Initiative (120); Free Forum Magazine (400) and Community Intervention Project (1172) Intermediate Results Indicators Indicator Baseline Current End Target Indicator Name Value Value Value 4.A: Number of condoms distributed in the last 12 months and financed 0.00 Public Disclosure Copy 610560.00 600000.00 out of project funds (Public sector, NACC) Date Date Date 30-Jun-2004 31-Dec-2009 30-Sep-2010 Type Unit of Measure Comment Comment Comment Custom Indicator Number This is the latest data available. Page 3 of 8 The World Bank Report No: ISR1729 Indicator Baseline Current End Target Public Disclosure Copy Indicator Name Value Value Value 4.B: Number of condoms distributed in the last 12 months and financed 416200.00 1074096.00 out of project funds (Population Program, MOH) Date Date Date 30-Jun-2004 31-Dec-2009 30-Sep-2010 Type Unit of Measure Comment Comment Comment Custom Indicator Number UNFPA distributed 470,020 N/A condoms Indicator Baseline Current End Target Indicator Name Value Value Value 4.C: Number of condoms distributed in the last 12 months and financed 399284.00 8100000.00 1177764.00 out of project funds (Private Sector, PSI) Date Date Date 30-Jun-2004 31-Dec-2009 30-Sep-2010 Type Unit of Measure Comment Comment Comment Custom Indicator Number Estimated actual- Data from Maxine Wedderburn Hope Caribbean based on data received from the central statistical office giving the number of condom imports and exports for 2008 and 2009 Indicator Baseline Current End Target Indicator Name Value Value Value 5.A: Number of HIV testing and counseling sites established 1.00 32.00 28.00 Date Date Date 30-Jun-2005 30-Jun-2010 30-Sep-2010 Public Disclosure Copy Type Unit of Measure Comment Comment Comment Custom Indicator Number Page 4 of 8 The World Bank Report No: ISR1729 Indicator Baseline Current End Target Public Disclosure Copy Indicator Name Value Value Value 5.B: Number of HIV testing and counseling sites funded by the WB 1.00 7.00 20.00 Date Date Date 30-Jun-2005 30-Jun-2010 30-Sep-2010 Type Unit of Measure Comment Comment Comment Custom Indicator Number The government used its funds to establish 32 VCTs and they requested to reimburse only 7 from the Bank fund. Indicator Baseline Current End Target Indicator Name Value Value Value 6. % of HIV positive pregnant women receiving a complete course of 71.40 79.90 90.00 ARV therapy to reduce the risk of MTCT in the last 12 months Date Date Date 30-Jun-2005 31-Dec-2009 30-Sep-2010 Type Unit of Measure Comment Comment Comment Custom Indicator Percentage The target was not achieved based on the data received. However this number does not include the data for St. Georges Central and Tobago. Indicator Baseline Current End Target Indicator Name Value Value Value 7. % of pregnant women tested for HIV in the last 12 months 96.00 96.80 97.00 Date Date Date 30-Jun-2004 31-Dec-2009 30-Sep-2010 Public Disclosure Copy Type Unit of Measure Comment Comment Comment Custom Indicator Percentage Data incomplete for Tobago and St. Georges Central Indicator Baseline Current End Target Indicator Name Value Value Value 8. Annual number of people living with HIV reached by CSOs providing 101.00 1600.00 HIV related care and support Date Date Date 30-Jun-2004 31-Dec-2009 30-Sep-2010 Type Unit of Measure Comment Comment Comment Custom Indicator Number Awaiting data from a survey Page 5 of 8 The World Bank Report No: ISR1729 Indicator Baseline Current End Target Public Disclosure Copy Indicator Name Value Value Value 9. HIV/AIDS national policies approved by Cabinet 0.00 7.00 5.00 Date Date Date 30-Jun-2004 31-Dec-2009 30-Sep-2010 Type Unit of Measure Comment Comment Comment Custom Indicator Number Cabinet approved 7 HIV related Policies: 1. Education Sector Policy on HIV/AIDS; 2. National Work place Policy on HIV; 3. National Post-exposure Prophylaxis Policy; 4. PMTCT Policy; 5. Health Sector HIV Policy; 6. HIV VCT Policy and 7. HIV Rapid Test Algorithm Policy. Indicator Baseline Current End Target Indicator Name Value Value Value 10. Number of healthcare providers receiving HIV related training in the 796.00 1200.00 last 12 months Date Date Date 30-Jun-2010 30-Sep-2010 Type Unit of Measure Comment Comment Comment Custom Indicator Number This number is only the data received from TTHTC and did not include the retaining conducted by the MOH and the RHAS. The project is in the process of collecting the training data. Public Disclosure Copy Indicator Baseline Current End Target Indicator Name Value Value Value 11. Number of line ministries implementing HIV/AIDS related work 1.00 5.00 10.00 programs Date Date Date 30-Jun-2004 31-Dec-2009 30-Sep-2010 Type Unit of Measure Comment Comment Comment Custom Indicator Number The Cabinet was authorized every ministry to have AIDS Coordinator. However, at the end of the project, only 5 ministries have prepared and implemented AIDS work-plans. Page 6 of 8 The World Bank Report No: ISR1729 Indicator Baseline Current End Target Public Disclosure Copy Indicator Name Value Value Value 12. Number of CSO proposals funded 0.00 34.00 35.00 Date Date Date 30-Jun-2004 31-Dec-2009 30-Sep-2010 Type Unit of Measure Comment Comment Comment Custom Indicator Number Including the NGO proposals funded for special IEC events. Indicator Baseline Current End Target Indicator Name Value Value Value 13. % of CSOs funded by the NACC that are providing satisfactory 0.00 100.00 90.00 reports to the NACC Date Date Date 30-Jun-2004 31-Dec-2009 30-Sep-2010 Type Unit of Measure Comment Comment Comment Custom Indicator Percentage Indicator Baseline Current End Target Indicator Name Value Value Value 14. Preparation and implementation of a costed M&E roadmap None A costed M&E plan prepared in Implementation initiated Date 2008. The progress has been Date made in 2009 harmonizing 30-Jun-2004 indicators for UNGASS reporting 30-Sep-2010 Type Unit of Measure Comment for 2008 and 2009. The National Comment Custom Indicator Text AIDS Spending Assessment has been completed, which tracked on costing and spending on AIDS> Date Public Disclosure Copy 31-Dec-2009 Comment 2009: implementation initiated. Data on Financial Performance (as of 23-Nov-2010) Financial Agreement(s) Key Dates Project Loan No. Status Approval Date Signing Date Effectiveness Date Closing Date P075528 IBRD-71840 Closed 27-Jun-2003 27-Jun-2003 23-Dec-2003 30-Sep-2010 Disbursements (in Millions) Page 7 of 8 The World Bank Report No: ISR1729 Project Loan No. Status Currency Original Revised Cancelled Disbursed Undisbursed % Disbursed P075528 IBRD-71840 Closed USD 20.00 20.00 0.00 18.84 1.16 94.00 Public Disclosure Copy Disbursement Graph Key Decisions Regarding Implementation The country is at a critical point in maintaining control of the HIV/AIDS epidemic. Despite of the progress made so far, sustained effort is needed to control the spread of HIV through prevention and treatment programs to avoid a reversal of the trend. The National AIDS Program will need to address the following challenges: a. Need for strengthening Prevention Programs b. Need for improving Monitoring and Evaluation and information system and having a better understanding of the drivers of the AIDS epidemic c. Need for improving Institutional Arrangements for the National AIDS Program Public Disclosure Copy d. Need for sustaining the National Response with limited external financing Restructuring History Board Approved on 04-Nov-2009, CD Approved on 09-Nov-2009 Related Projects There are no related projects. Page 8 of 8