The Central Asia Program on AIDS Control and Intervention Targeting Youth and High-Risk Groups (CAPACITY) project was a five-year, $13 million regional project designed to build technical capacity in launching large-scale and urgent responses to HIV/AIDS in the five countries of Central Asia and to develop institutions and networks to take a lead role in managing and implementing grants from the Global Fund to Fight AIDS, Tuberculosis and Malaria. John Snow, Inc. was the prime contractor for the project, along with partners Abt Global, Population Services International (PSI), International HIV/AIDS Alliance, Boston University, and others. The project ended in September 2009.

CAPACITY's four main goals were to strengthen coordination on HIV/AIDS and related issues, expand access to prevention, treatment, care, and support services, increase integration of services, and support regional networks and linkages to share approaches, lessons learned, and best practices.

The ultimate objective of the project was to bring HIV/AIDS services closer to those in greatest need. Abt Global was responsible for taking the lead on integrating HIV/AIDS prevention and control with primary health care (PHC) and broader health system strengthening efforts in the region. The project's approach in this activity area was to work with Ministries of Health, National HIV/AIDS Centers, and Country Coordination Mechanisms (CCMs) in each country to:

• Define the roles and relationships among key actors in HIV/AIDS;
• Support the integration of HIV/AIDS services into the broader health service delivery structure; and
• Address HIV/AIDS financing.

To this end, Abt worked together with CAPACITY partners and stakeholders in four Central Asian countries — Kazakhstan, Kyrgyzstan, Tajikistan and Uzbekistan. In all countries, we helped the project engage in policy dialogue with CCMs and other government, national, and international partners to better align HIV/AIDS institutions and actors to implement national HIV/AIDS strategies and Global Fund priorities and action plans.

Abt also designed and conducted a number of studies to provide information to country counterparts to better inform the development of HIV/AIDS policies and programs. A study in Karaganda oblast, Kazakhstan focused on assessing patient-flow, functionality and funding for HIV/AIDS and related services. In Kyrgyzstan and Tajikistan, Abt conducted functional analyses of the current institutional structure, roles and relationships of various agencies and programs involved in providing HIV/AIDS and related services and then made recommendations to better align these services to improve the delivery of HIV/AIDS care.

To support the integration of HIV/AIDS services into the broader health delivery structure rather than a stand-alone vertical structure, Abt, together with the CAPACITY regional technical team, Kazakhstan AIDS program and other related Ministry of Health (MOH) specialists, and the USAID ZdravPlus Project, designed and implemented a mini-pilot in Temirtau city in Karaganda oblast in Kazakhstan. The purpose of the quick pilot was to test the feasibility whether antiretroviral therapy (ARVT) could be provided on an outpatient basis at a PHC polyclinic — making delivery of ARVT more cost-efficient and accessible to the population than inpatient or hospital-based treatment. Abt provided technical assistance to help secure the needed legislative, regulatory, and policy support for implementing the pilot and to develop a coordination mechanism across the various relevant health agencies (regional/city PHC departments and the AIDS centers). Temirtau city was selected because of the high number of HIV-positive people resident there. Despite its limited nature, the mini-pilot demonstrated that PHC providers, when properly trained and supported with needed logistics, could provide quality ARVT to the surrounding community, and lead to: i) decreased stigma and discrimination among PHC personnel against the ARVT patients and persons living with HIV (PLHIV); ii) improved access of ARVT patients, not only to ARVT, but also to other needed basic medical care; and iii) increased adherence of the patients to ARVT. The experiences of this approach might be useful and appropriate in other HIV hotspots.

In Uzbekistan and Tajikistan, Abt provided technical assistance and financial support to national working groups to develop training modules for PHC providers on: i) stigma and discrimination reduction against PLHIV; and ii) universal precautions against HIV/AIDS. Abt supported implementation of the training programs for PHC physicians and relevant regional/district health specialists through a training of trainers and cascade training approach. To help better understand how HIV/AIDS resources are used, Abt organized a workshop on national health accounts (NHA) and HIV/AIDS and TB sub-analysis in Bishkek, Kyrgyzstan jointly with the Kyrgyz MOH, the Project HOPE TB Project, and WHO’s Health Policy Analysis Project. Twenty-two participants from the MOH, Republican AIDS Center, National TB Center, Republican Center of Informatics and Epidemiology, Center for Health Systems Development, and the Global Fund’s project implementation unit for AIDS and TB completed the training program. These trained specialists then led the development and analysis of HIV/AIDS sub-accounts in Kyrgyzstan.

Abt also conducted an analysis of the current budget financing system in Kyrgyzstan with a view to suggest possible ways for allowing public money to fund specific frontline prevention activities of HIV/AIDS NGOs. Identifying mechanisms to allocate public funds to HIV/AIDS activities managed by NGOs can help the NGOs be more financially viable in the long-term and can help the government ensure that its HIV/AIDS monies are reaching intended beneficiaries, including intravenous drug users, commercial sex workers, and youth, who may not seek services in traditional health facilities.