The World Bank Report No: ISR8536 Implementation Status & Results Afghanistan Afghanistan HIV/AIDS Prevention Project (P101502) Public Disclosure Copy Operation Name: Afghanistan HIV/AIDS Prevention Project (P101502) Project Stage: Implementation Seq.No: 9 Status: ARCHIVED Archive Date: 20-Nov-2012 Country: Afghanistan Approval FY: 2008 Product Line: IBRD/IDA Region: SOUTH ASIA Lending Instrument: Specific Investment Loan Implementing Agency(ies): Key Dates Board Approval Date 31-Jul-2007 Original Closing Date 31-Dec-2010 Planned Mid Term Review Date 03-Feb-2010 Last Archived ISR Date 05-Jun-2012 Effectiveness Date 17-Sep-2007 Revised Closing Date 30-Nov-2012 Actual Mid Term Review Date 11-Feb-2010 Project Development Objectives Project Development Objective (from Project Appraisal Document) The project development objectives is to slow down the spread of HIV and build up the national capacity to respond to the epidemic by i) behavior change among vulnerable groups at high risk, and ii) improving knowledge of HIV prevention and reducing stigma related to HIV and AIDS in the general population. Has the Project Development Objective been changed since Board Approval of the Project? Yes No Component(s) Component Name Component Cost Advocacy and Communications 1.26 Strengthening Surveillance 1.80 Targeted Interventions for at risk groups 4.94 Program management and Capacity building 1.98 Overall Ratings Public Disclosure Copy Previous Rating Current Rating Progress towards achievement of PDO Moderately Satisfactory Moderately Unsatisfactory Overall Implementation Progress (IP) Moderately Satisfactory Moderately Satisfactory Overall Risk Rating Implementation Status Overview The project has been implemented by the Ministry of Public Health's National AIDS Control Program, primarily through contracting NGOs to deliver harm reduction services to HIV most at risk population. To date, 98% of the Grant has been disbursed. In order to consolidate Bank financed health projects and avoid multiple projects in the health sector, to ensure continuity of HIV preventive services in the country, the financing of the HIV harm reduction activities have been transferred to one umbrella health project which is Strengthening Health Activities for Rural Poor (SHARP). The NACP has signed new contracts with existing implementing NGOs on single sources basis to finalize the work. The new Page 1 of 5 The World Bank Report No: ISR8536 contracts will expire on September 30, 2013. Based the first round of Integrated Behavioral and Biologic Surveillance (IBBS - 2009), the HIV prevalence is well below 0.1% among the general population. However, the study has found HIV prevalence of 7.11% among IDUs (the highest being in Herat at 18%; in Kabul city the prevalence has remained 3% which was also validated by previous surveys). Public Disclosure Copy According to the same surveillance data, the HIV prevalence among female sex workers and truckers was 0%. It also indicated an HIV prevalence of 0.6% and 1.6% among prisoners in Kabul and in Herat prisons respectively. The results of the second round of IBBS will be available by end of November 2012, which will provide information on whether: i) HIV epidemic is slowing down; ii) high risk behavior among high risk groups is decreasing, and iii) stigma against people living with the HIV/AIDS has decreased or not. While this data is not yet available, the Opioid Substitution Therapy (OST) pilot has shown good results in terms of stabilizing the Injecting Drug Users through daily dispensing of methadone. The OST clients will soon be enrolled in Vocational Training Program under National Skill Development Project of Ministry of Labor, Social Affairs, Martyrs and Disabled (MOLSAD). This will be a crucial step towards successful social re-integration of drug users. Cooperation with the Ministry of Counter Narcotics regarding methadone importation has not been as successful. Since its approval in July 2007, the project has contributed to strengthening the capacity of the National Aids Control Program (NACP) through (i) recruitment of seven national advisers and one international adviser; (ii) participation of NACP staff in national/international training activities; and (iii) exposure of NACP staff to well performing HIV/ AIDS programs abroad. The increased capacity of NACP has resulted in the adoption of the Afghanistan HIV Code of Ethics, an important milestone for the support and protection of people living with HIV/ AIDS in the country. The program has also finalized the policy on Opioid Substitution Therapy. The program has successfully managed the HIV harm reduction contracts with national and international NGOs. Locations No Location data has been entered Results Project Development Objective Indicators Indicator Name Core Unit of Measure Baseline Current End Target Percentage of health workers who correctly Percentage Value 19.30 19.30 75.00 identify ways of preventing HIV transmission Date 30-Dec-2011 30-Dec-2011 30-Nov-2012 Comments The data have been collected Data will be collected via via health facility assessment health facility assessment by in 2011. March 2013 Among health workers who have heard of HIV, Percentage Value 24.40 24.40 80.00 the percentage who are willing to care for Public Disclosure Copy Date 30-Dec-2011 31-Dec-2011 30-Nov-2012 patients with HIV Comments Data have been collected Data will be collected via Data will be collected via through health facility health facility assessment by health facility assessment by assessment (BSC) in 2011. March 2013 March 2013 Percentage of FSW reporting use of condom Percentage Value 58.00 58.00 60.00 with most recent client Date 30-Nov-2012 Comments IBBS, 2009 (IBBS 2009). This will be Data will be collected through updated after data is collected the second round IBBS in through the second round 2012. IBBS in 2012. Page 2 of 5 The World Bank Report No: ISR8536 Percentage of IDUs reporting use of sterile Text Value 45% (University of Manitoba, 95% (IBBS, 2009, weighted 30 percentage point increase injection equipment at last time of injection. 2007) average Kabul 98%, Herat Date 07-Jan-2008 30-Nov-2012 Public Disclosure Copy Comments Data will be collected through the second round IBBS in 2012. Percentage of IDU reporting use of condom at Text Value 27% (IBBS, 2009) 27% (IBBS, 2009) >40% last time of sex Date Comments This will be updated after data is collected through the second round IBBS in 2012. HIV prevalence in general population <0.5% Text Value <0.5% <0.1% <0.5% Date 15-May-2007 15-Apr-2011 30-Nov-2012 Comments Based on Modeling. Data will Data will be collected through be collected through the the second round of IBBS in second round of IBBS in 2012. 2012. HIV prevalence among high risk groups (IDU, Text Value IDU: 3% (UCSD/NAMRU, DU: 7.11% <=5% FSW) Kabul 2007) FSW: <1% FSW: 0% (UCSD/NAMRU Kabul, Jalalabad, Mazar-i-Sharif 2008) Date 18-Dec-2008 15-Nov-2010 30-Nov-2012 Comments (IBBS 2009 data. For IDU it is Data will be collected through weighted average; Kabul the second round of IBBS in 3.1%, Herat 18.2% and Mazar 2012. 1%). Data will be collected through the second round of IBBS in 2012. Intermediate Results Indicators Public Disclosure Copy Indicator Name Core Unit of Measure Baseline Current End Target IBBS maintained and expanded to southern Text Value 4 6 6 and eastern sites of the country Date 04-Oct-2012 Comments Number of drug users enrolled in OST Text Value 0 71 200 Date 04-Oct-2012 Comments Page 3 of 5 The World Bank Report No: ISR8536 Number of urban centers which have done high Text Value 4 cities 6 6 risk group mapping Date 04-Oct-2012 Comments Public Disclosure Copy Annual NACP reports and action plans Text Value Annual reports and actions nnual reports and actions Annual reports and actions informed by surveillance and routine monitoring plans available plans available plans available data Date 04-Oct-2012 Comments Percentage of most at risk populations (e.g., Text Value IDU: 62.4% DU: 62.4% IDU: 70% IDUs, FSWs, prisoners) reached by HIV- FSW: 1.4% FSW: 1.4% FSW: 10% prevention program. Prisoners: 30.7% Prisoners: 30 Prisoners: 80% Date Comments IBBS 2009 IBBS 2009. This will be updated after data is collected through the second round IBBS in 2012. Percentage of most at risk populations (e.g., Text Value IDU: 94.7% DU: 94.7% IDU: 75% IDUs, FSWs, prisoners) who correctly identify FSW: 32.4% FSW: 32.4% FSW: 20% two ways of preventing HIV transmission Prisoners: 79.1% Prisoners: 30% Date Comments IBBS 2009 IBBS 2009. This will be updated after data is collected through the second round IBBS in 2012. Percentage of TI sites meeting service quality Text Value IDU: 6 of 7 DU: 7 of 7 >75% standards FSW: 2 of 2 FSW: 1 of 1 Prisoner 1 of 1 Date 04-Oct-2012 Comments Based on NACP reports. Financial Management reports include physical Text Value Financial Management Done All Financial Management progress report reports do not include Reports to include physical Public Disclosure Copy physcial progress reports progress reports. Date Comments The project does submit Detail physical progress report. Data on Financial Performance (as of 01-Nov-2012) Financial Agreement(s) Key Dates Page 4 of 5 The World Bank Report No: ISR8536 Project Ln/Cr/Tf Status Approval Date Signing Date Effectiveness Date Original Closing Date Revised Closing Date P101502 IDA-H3280 Effective 31-Jul-2007 02-Sep-2007 17-Sep-2007 31-Dec-2010 30-Nov-2012 Disbursements (in Millions) Public Disclosure Copy Project Ln/Cr/Tf Status Currency Original Revised Cancelled Disbursed Undisbursed % Disbursed P101502 IDA-H3280 Effective XDR 6.60 6.60 0.00 6.46 0.14 98.00 Disbursement Graph Key Decisions Regarding Implementation The project needs to focus on the following priorities for the near future: i) make sure the second round of IBBS activities and the rapid assessment among IDUs in Farah and Nimroz provinces ares completed by November 30, 2012; ii) ensuring final decision of the government regarding OST acceptability/expansion in the country, which is critical in terms of HIV control in Afghanistan; iii) follow up closely with the MOLSAD on the vocational training for the OST clients. Public Disclosure Copy Restructuring History Level two Approved on 28-Jun-2012 Related Projects There are no related projects. Page 5 of 5