AMDA-Nepal links all HIV-positive diagnosed from static and mobile clinics with CBS of Sahara Nepal for facilitated referral to ART as well as for diagnostic services; for regular follow-up and for education/information on adherence and retention, self-care, positive prevention and treatment literacy. AMDA-Nepal also line these PLHIV with CBOs of NAP+N and NFWLHA for support group/adherence club and/or treatment literacy sessions. AMDA-Nepal will also collaborate with Sahara Nepal and support to CBOs of NAP+N and NFWLHA to facilitate support group/adherence club meeting, treatment literacy session and community group discussion forums.
 
AMDA-Nepal conduct edutainment activities in waiting rooms of the static clinics, facilitated by receptionist/registration clerk. AMDA-Nepal also coordinate with Sahara Nepal to establish and strengthen referral and follow-up mechanism with service providers at the district level. AMDA Nepal maintain and regularly update referral directory for referral and linkages with government and non-government HIV service sites. AMDA-Nepal will support in facilitated referral coordinating with Sahara Nepal, including accompanied referral and assistance from PNs to enroll newly diagnosed HIV-positives in ART, as well as for diagnostic services (CD4 count, Viral load and TB) will be provided to ensure the referral. AMDA-Nepal, in collaboration with LINKAGES Nepal HIV prevention IAs, will use the “Three Rs”, refer, review (follow-up and review the barriers) and reminder (through SMS from STEP Nepal, a LINKAGES IA managing SMS center), to strengthen referral and follow-up. AMDA-Nepal, in collaboration with LINKAGES Nepal HIV prevention IAs, will also engage service providers from referral site in the process through regular coordination and review meetings to review the achievements, good practices, issues and challenges and will identify a way forward to strengthen referral and follow-up mechanisms. This will also include sensitization training for the service providers, to provide FSWs and PLHIV-friendly services and to reduce stigma and discrimination.

AMDA-Nepal support STEP Nepal to implement the use of web-SMS and Interactive Voice Response (IVR) (if implemented) for information dissemination, referral and follow-up among FSWs and PLHIV through collecting the mobile number of FSWs and PLHIV who have pending visits for HTC and FSWs and PLHIV who are lost to follow-up, and providing information of web-SMS facilities to FSWs and PLHIV.

AMDA-Nepal support Sahara Nepal to implement a performance-based incentive scheme for PNs by providing information required for the performance-based incentive scheme as per the LINKAGES Nepal guidelines.
 

AMDA-Nepal use peers through Social Networking Scheme (SNS) for testing and case identification. Any client who has received HTC services from the project’s clinic will be selected as a “seed” and will receive a coupon for referring his/her friends/partners to the clinic. The seed will receive incentives if the referred clients (not already reached by CBS and PNs) attend the clinic and access HTC services. AMDA-Nepal also use known HIV-positive FSWs and clients of FSWs to bring in others for testing.  AMDA-Nepal participate in commemoration of national and international special days and events at the district level in coordination with government and non-government stakeholders.
 

To ensure the client confidentiality, information regarding service utilization and HIV status will not be shared with the PNs and will remain in the clinic records. Similarly, HIV status of the client will only be shared with other staff and service providers for the purpose of follow-up and linking with care, support and treatment services strongly contingent on the positive client’s consent. Performance-based incentive will be provided as a cumulative amount (lump-sum) without providing any details to the PNs so that PNs will not have a way to know and link the individual client they referred with the incentive amount for the service outcome such as the HIV status. Performance-based incentive is provided only after the verification and recommendation from the CBS and M&E staff. Ensuring clients’ privacy and confidentiality is regularly discussed during review meeting and supportive supervision and onsite coaching. Moreover, as per standard practice, all project staff (management, service providers and outreach staff) and PNs sign “Oath for Confidential and Voluntary Services” and is kept in the file. 

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In line with USG’s Unified Policy Guidelines for Trafficking in Persons (TIP), AMDA-Nepal identify all suspected forms of trafficking among FSWs reached from the clinics; provide HIV-related services; report these cases to LINKAGES Nepal and refer them to local NGOs working in the districts