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Project Design Document - Model Answers-RAG Project
Project Design Document - Model Answers-RAG Project
Project Title: The Blood Borne Virus, Sexual Health and COVID-19 Regional Advisory Group (RAG)
Duration: March 2020 – February 2021 (or as the regional needs for the RAG change)
Country/Region: Asia and the Pacific Region
1. Background
On the 31st December 2019 the novel sars-cov2 virus was identified as a new virus in Wuhan, China.
On the 11th March 2020 the World Health Organisation (WHO) declared the and resulting illness
COVID-19 a pandemic. The virus had dramatic impacts across the world as large number of people
were taken ill and there were subsequent fatalities. By the 2 nd July 2020 there have been over 10.5
million confirmed cases and 512,842 deaths as a result of COVID-19 1.
To restrict disease transmission and respond to the pandemic, countries across the world put in
various measure including hygiene recommendations (masks, hand washing etc), physical distancing
(closure of schools, shops, offices etc) and reprioritisation of existing health services. Sars-cov-2 and
the related control measures poses unprecedented and serious challenges to the delivery of health
services to people affected by BBVs and STIs. These challenges are likely to affect service provision
across the treatment, care, support and prevention continuum. Furthermore, the rise of detrimental
stereotypes and widespread misinformation resulting in stigma and discrimination related to COVID-
191 has the potential to increase the likelihood of people living with BBVs, who may be more
vulnerable and are already marginalised to seek less testing, treatment and care related to COVID-19
possible symptoms thus fuelling morbidity and mortality.
In response, ASHM established the Blood Borne Virus, Sexual Health and COVID-19 Taskforce, with
the Regional Advisory Group (hereafter RAG) as the Regional arm of the Taskforce. The RAG offers
an opportunity for the regional BBVs stakeholders and sector partners to discuss the scientific,
clinical, BBV health service delivery and social implications of COVID-19, and to provide emerging,
consistent and evidence-based messaging including approaches to the healthcare workforce, sector
partners and community.
2. Stakeholder Consultation
To ensure the RAG included a multi-disciplinary and multi-country team of scientific, clinical and
community experts in BBVs and sexual health ASHM collated a list of in-country contacts from
previous projects and the ASHM Regional Network. We identified those with the appropriate
expertise to be approached to be a RAG member and invited RAG members to nominate others who
1
WHO. Coronavirus Disease Situation Report 164. 2 nd July 2020.
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could should be invited to either be a technical member of the RAG or a recipient of the RAG
guidance. This included working with Ministries of Health, professional societies of health workers,
UN agencies, universities and community organisations. Currently the RAG membership of experts
stands at 65 members from across 10 Asian and Pacific countries. Recruitment is open as new
members are identified. The RAG guidance recipient list reaches approximately 13,000 sector
individuals from across 15 counties in the Asia and Pacific. This list again is growing, and individuals
can subscribe through the ASHM website.
NB: Given the nature of the advisory group and that no in-country implementation is being carried
out in this project, formal partnership agreements and partner capacity assessments were not
conducted. Each RAG member received an invitation letter and responded via email with an
acceptance or decline of being a member.
3. Problem Description
In March 2020 ASHM sent out a survey to our network of approximately 300 health workers,
community organisations and sector partners across the Asia Pacific region to carry out a needs
assessment to identify support which could be provided by the RAG. Due to the urgency of the
pandemic this took place whilst establishing the RAG. The survey included a) technical areas where
guidance is required b) preferred methods of guidance dissemination (emails, newsletter, whatsapp,
social media, webinars etc) and for health workers whether there was an interest in receiving clinical
tele-mentoring to support BBV and SH case management which could be provided by an ASHM
clinical advisor. Only 7 survey responses were received, however this is likely to be due in part to
competing demands on health workers and other sector organisations during the pandemic and the
need to adapt work processes. To gain further understanding of the needs, follow up emails were
sent to RAG members and key ASHM contacts in countries such as the Ministries of Health. As the
pandemic has evolved so have the needs of health workers and other sector partners in the region.
Further understanding of guidance required has been gained from post RAG webinar surveys (x
responses to date) and emails to recent to 10 Ministries of Health in June 2020 to gauge their
interest in receiving clinical tele-mentoring. In regard to tele-mentoring we have received responses
from Thailand, the Republic of Marshall Islands, the Federated States of Micronesia and Tonga
expressing a need for further clinical mentoring support in HIV and sexual health.
Update-to -date knowledge and information on the biological interaction of COVID-19 and BBVs
and SH
Disruption of ARV/PrEP supplies and the need for multi-drug dispensing
Need for rapid guidance on adaptive service delivery models
Lack of protective personal equipment and guidance needed on increasing infection control in
health services
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Mental health implications of isolation on priority populations
Closure of SRH services/lack of access to essential SRH services
Increased demands on health care workers
Safe sex advice during COVID-19, including those for sex/service workers
Making tele-medicine a new normal for ART and PrEP, including HIV self-testing, STI self-
sampling
Stigma and discrimination towards COVID-19 cases/PUI, how lessons learnt from HIV can be
used to ‘prevent’ and address them
Translating the knowledge of prevention and infection control to their colleagues as well as their
patients
Supporting local and telehealth access and advocacy for abortion care, STI check and care, &
contraception care particularly in priority populations
How to reach adolescents with SRH services during the pandemic
Concerns that already limited aid budgets will be directed away from BBV and SH to COVID-19
Further guidance needs are illustrated in Figure 1 by those who completed the needs assessment
survey.
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Figure 2 illustrates preferred means of communication of RAG guidance
4. Proposed Solution
Project Goal: Effective management BBV and-Sexual health service delivery by the clinical
workforce in the Asia and the Pacific Region during COVID-19
Objective: By end of February 2021, the capacity of the BBV and sexual health workforce to
effectively deliver BBV and sexual health services and support during the COVID-19 pandemic in
respective countries will be strengthened.
Outcome 1: Increase the regional workforce knowledge in emerging clinical and psycho-social
issues, prevention, treatment, care and support approaches related to COVID-19, BBV-and sexual
health by disseminating relevant evidence-based guidance.
Outcome 2: Build the confidence and competency of health care workers through guidance and
telementoring service to provide BBV and sexual health prevention, treatment and care.
The ‘problem’ or ‘gap’ is a lack of evidence based guidance for HIV, sexual health and viral hepatitis
health workers and other sector partners in the Asia Pacific region to support the adaptation of
services, identify best practices and manage the challenges presented by the COVID-19 pandemic.
The ‘solution’ is to establish a multi-disciplinary group of experts to draw on evidence to provide the
required guidance and to facilitate south to south collaboration of best practices and lessons learnt
during this evolving and novel time.
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The BBV, SH and COVID-19 Regional Advisory Group has been established to provide this support
during the pandemic. Knowledge, support and guidance will be disseminated through weekly
bulletins, on the ASHM RAG webpage, through social media such as Facebook and Twitter, through
webinars and clinical tele-mentoring. The tele-mentoring adopts a similar approach to ward rounds
which clinicians use as a learning practice, in which a group of clinicians share and discuss cases. All
services are delivered online and through video conferencing to facilitate collaboration across the
region and to comply with travel and physical distancing restrictions as a result of COVID-19 to
reduce transmission. This approach is no only time saving and safe but also cost-effective with little
related costs other than the RAG secretariat and RAG members time. Support in dissemination of
guidance is provided by the ASHM Communications and Marketing team.
The establishment of the RAG is in align with DFAT’s Health for Development Strategy 2015-2020,
which articulates the importance for health security responses to address emerging infectious
diseases such as COVID-19 across the Pacific and Southeast Asia through strategic partnerships.
All guidance produced by the RAG is inline with World Health Organisation Guidance and
Frameworks including:
WHO COVID-19 guidance
Global health sector strategy on HIV 2016 – 2021
Global health sector strategy on viral hepatitis 2016-2021
Regional Action Plan for Viral Hepatitis in the Western Pacific 2016–2020
Regional framework for the triple elimination of mother-to-child transmission of HIV, hepatitis B
and syphilis in Asia and the Pacific, 2018-2030
The ASHM International’s Goal is to ‘Develop a sustainable HIV, viral hepatitis and sexual health
workforce globally’. The RAG Project contributes to the goal by supporting the HIV, viral hepatitis
and sexual health workforce continue to provide evidence based clinical and social care during the
COVID-19 pandemic.
The RAG project also aligns with 3 of the 4 ASHM International’s long-term programs:
Clinical training and mentoring
Building knowledge exchange and linkages
Policy and guidance development
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7. Complementarity
ASHM International has delivered BBV and sexual health clinical training, mentoring, guidance and
resources for over 17 years and has worked with a large network of health professional and
community groups from across the Asia Pacific region.
In response to COVID-19 ASHM also developed the National BBV, SH and COVID-19 Taskforce to
provide similar guidance and support in Australian and New Zealand. The RAG will leverage off
Taskforce resources and expertise where appropriate to do so.
8. Implementation Arrangement
RAG Structure
65 RAG members
1 RAG Chair
4 sub-groups each with a technical lead and ASHM coordinator
1)Clinical Care sub-group
2) Priority Populations sub-group
3) Science, Epidemiology and Research sub-group
4) Papua New Guinea sub-group
ASHM Secretariat support - program management, IT and communications and marketing
The group leads and coordinators meet fortnightly to discuss and plan guidance. An operations
meeting takes place fortnightly with secretariat members.
Guidance documents are developed by a lead expert and then reviewed by the broader RAG team.
The RAG and Taskforce Chair review and endorse the final piece. All guidance documents are ‘living’
documents and will be revised as the situation evolves.
Outputs:
1. Guidance is distributed through the RAG members networks, weekly bulletin, on ASHM’s RAG
webpage and through social media.
2. A fortnightly webinar is organised to share lessons learnt across the region.
3. Advocacy documents developed and disseminated.
4. Tele-mentoring support provided at the request of Ministries of Health.
NB: The Papua New Guinea sub-group work is funded and implemented under the ASHM Sexual and
Reproductive Health Integration Project for Papua New Guinea.
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9. Risk Management
# Risk Description Impact Likelihood Risk Risk Details Mitigation/ Proposed Solution
Rating
1 Lack of project 2 3 6 Lack of project funding can impact on Seeking donor funding
funding sustainability of project. Currently reliant
on volunteers and ASHM self-funding
2 Lack of secretariat 5 1 5 Lack of project management staffing due The project management is
support to COVID-19 or time constraints spread across the international
and broader ASHM team
3 Provision of 5 1 5 Guidance documents provide Guidance is written and
misinformation misinformation reviewed by a large pool of
experts and is evidence based
4 Lack of engagement 5 1 5 RAG members and in-country Large pool of RAG members.
with stakeholders and beneficiaries do not have time to engage Reducing the frequency
beneficiaries with the project bulletins and webinars.
6 IT technical issues 4 1 4 Zoom, emails, internet fails. IT team on hand to provide
support.
Impact
Negligible Minor Moderate Major Sever
1 2 3 4 5
Rare 1 1 2 3 4 5
Unlikel
2 2 4 6 8 10
y
Likelihood
Possibl
3 3 6 9 12 15
e
Likely 4 4 8 12 16 20
Almost
5 5 10 15 20 25
Certain
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Cross-Cutting Risk Considerations
- Ensuring guidance provided is applicable across the region and that it incorporates relevant
principles such as supporting gender equality and vulnerable populations
-Lack of sustainability due to lack of funding for the RAG and reliance on volunteers and ASHM
reserves
The project complies with ASHM’s gender equality policy and anti-discrimination policy. For
example, the project promotes the involvement of women with 30/65 members of the RAG being
women. The sub-group clinical leads comprise of 3 women and 2 men. The project also ensures the
project supports and is aligned with the needs of marginalised and vulnerable populations through
RAG membership and partnerships with people living with HIV, people living with viral hepatitis,
people who use drugs, sex worker, lesbian, gay, bisexual and transgender organisations. The
guidance developed with consider be considered through a gender lens where possible to ensure it
promotes gender equality. The policies have been shared with all RAG members.
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as per the policy. All RAG members work for well recognised and reputable institutions which are
highly unlikely to engage in any associated adverse practices with these policies.
10. Sustainability
The project aims to provide up-to-date evidence based guidance to support the sexual health and
BBV workforce across Asia and the Pacific whilst the COVID-19 pandemic continues. The guidance
and lessons learnt from across the region will ideally be utilised and embedded within service
delivery and practices as needed but particularly throughout the life span of the pandemic. The RAG
facilitates the cross sharing of lessons learnt from the pandemic which can be used to improve and
strengthen models of service delivery now and post the pandemic. The RAG also offers the
opportunity for the establishment of long term partnerships and collaboration between health
service delivery, university, community and other sector organisations within the region.
One threat to sustainability is the lack of funding support for the Regional Advisory Group to-date.
Currently the work on the group relies on the good will of volunteers and ASHM financial reserves.
The RAG structure, membership expertise and practices have applicability post the COVID-19 crisis
and could be used to provide continuing support in the BBV and SH response in the region or be
revitalised should another similar situation such as a pandemic or humanitarian emergency which
challenges the BBV and sexual health response occur in the future.
The RAG effectiveness and purpose will be regularly monitored (see M&E plan) and reviewed. When
there is no longer a need for the group it will be dissolved, and health care workers and sector
organisations will be provided with other sources of support such as through other ASHM projects
where possible.
The RAG Project is currently unfunded; however, a budget has been developed to use to seek
funding to increase the sustainability of the project.
See Annex 3 for the Budget and Annex 4 for the workplan.
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Annex 1: Regional Advisory Group Members
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Orphans and Sita Shahi, ICWAAP
vulnerable Kay Thi, APNSW
children, Gaj Gurung, Youth Lead
Incarcerated Eddy Rudram, Youth Lead
Justin Bionat, Youth Voices Count
Sangeet Kayastha, Y-Peer
Anand Chabungbam, ANPUD
Bikas Gurung, ANPUD
Eamon Murphy, UNAIDS Asia Pacific
Vladanka Andreeva, UNAIDS Cambodia
Amakombe Sande, UNAIDS China
Renata Ram, UNAIDS Fiji
Krittayawan Boonto, UNAIDS Indonesia
Thongdeng Silakoune, UNAIDS Lao PDR
Oussama Tawil, UNAIDS Myanmar
David Bridger, UNAIDS PNG
Louie Ocampo, UNAIDS Phillipines
Patchara Benjarattanaporn, UNAIDS Thailand
Marie-Odile Emond, UNAIDS Vietnam
George Ayala, MPact
Doan Thanh Tung, Lighthouse Social Enterprise
3. Clinical COVID-19 Dr Nittaya Phanuphak Pungpapong, Thai Red Cross Testing COVID-19 testing:
Care Clinical Care Dr Sophia Archuleta, University Hospital Singapore scientific basis
Dr Jeremy Beckett, Maluk Timor Clinical care role of testing (patient, health
Dr Ilya Abellanosa, The Philippines Cebu City Health Department worker)
Andrew Ball, WHO implications of a positive test
Dr Po-lin Chan, WPRO implications of a negative test
Dr Razia Pendse, WHO SEA availability and eligibility
Dr Anup Gurung, WHO PNG point-of-care
Dr Rajesh Pandav, WHO Timor-Leste Clinical care:
Professor David Lewis, University of Sydney home assessment
community triage
hospital admission and
inpatient management
HIV and Assoc Prof Catherine O'Connor, The Kirby Institute Co-infection issues
comorbidities Dr Nittaya Phanuphak Pungpapong, Thai Red Cross Keeping patients & staff safe:
(inc TB) Dr Arun Menon, Townsville Sexual Health Clinic infection control
Dr Jason Ong, Melbourne Sexual Health Clinic mental health
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Dr Suman Majumdar, Burnet Institute Access to care inc ART &
Dr Dashika Balak, Oceania Society for Sexual Health & HIV Medicine PrEP
Dr Sophia Archuleta, University Hospital Singapore Treatment supply
Assoc Prof Raja Iskandar Shah Raja Azwa, University of Malaya Models of care
Prof Charles Gilks, University of Queensland streamlined care
Dr Elizabeth Crock, Royal District Nursing Service telehealth
Dr Evy Yunihastuti, Indonesia Association of Physicians of AIDS Care differentiated care
Dr Ilya Abellanosa, The Philippines Cebu City Health Department outreach
Assoc Prof Maria Melgar, AIDS Society of the Philippines
Assoc Prof Kinh Nguyen, Vietnam Clinical HIV/AIDS Society
Dr Dung Nguyen, Vietnam Clinical HIV/AIDS Society
Dr Kiat Ruxrungthan, HIV-NAT
Dr Po-lin Chan, WPRO
Dr Razia Pendse, WHO SEA
Dr Anup Gurung, WHO PNG
Dr Debashish Kundu, WHO Timor-Leste
Eamon Murphy, UNAIDS Asia Pacific
Kel Brown, Pacific Adventist University
Bruce Parnwell, Burnet Institute
Dr Marcel Kalau, Consultant
Dr Nick Dala, National AIDS Council
Dr John Millan, PNG Sexual Health Society
Dr Peniel Boas, PNG National Department of Health
Graham Apian, Catholic Church Health Services of PNG
Viral Prof Ben Cowie, Doherty Institute Co-infection issues
Hepatitis Dr Nicole Allard, Doherty Institute Keeping patients & staff safe:
Assoc Prof Gail Matthews, The Kirby Institute infection control
Prof Robert Batey, University of Sydney mental health
Dr Arun Menon, Townsville Sexual Health Clinic Access to care inc testing &
Dr Dashika Balak, Oceania Society for Sexual Health & HIV Medicine treatment
Dr Ilya Abellanosa, The Philippines Cebu City Health Department Treatment supply
Jason Grebely, INSHU Models of care:
Dr Po-lin Chan, WPRO streamlined care
Jennifer Johnston, Coalition to Eradicate Viral Hepatitis in Asia Pacific telehealth
differentiated care
outreach
Sexual and Dr Janet Knox, Consultant Sexual Health Specialist Keeping patients & staff safe:
Reproductive Dr Alan Huynh, High Street Medical Clinic infection control
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Health Dr Arun Menon, Townsville Sexual Health Clinic mental health
Prof Tammy Myers, Chinese University of Hong Kong Access to care – STI testing &
Dr Pulane Tlebere, UNFPA Pacific treatment, contraceptives etc
Nate Henderson, Family Planning NSW Models of care:
Eva Hall, Marie Stopes International Australia streamlined care
Dr Shailendra Sawleshwarkar, Western Sydney Sexual Health Centre telehealth
differentiated care
outreach
Condom availability
4. Papua New PNG Special Nikki Teggelove, ASHM International Keeping patients & staff safe:
Guinea Interest Joanna Akritidu, ASHM International infection control
Group Dr John Millan, PNG Sexual Health Society mental health
Dr Arun Menon, Townsville Sexual Health Clinic Access to care
Graham Apian, Catholic Church Health Services of PNG Treatment supply
Rodney Stewart, Burnet Institute Models of care:
streamlined care
telehealth
differentiated care
outreach
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will you use to existing state/ post-project measured? data should be role or reported?
By end of February 2021, the measure the value of the target value? Where is the collected and / department) is
capacity of the BBV and sexual item(s) in the indicator? data to inform or at what time responsible for
health regional workforce to description the indicator the data should collecting the
effectively respond to column? coming from? be collected. data?
management of BBV and (e.g. interview, The time could
sexual health during COVID-19 survey, project be the stage of
in respective countries will be diary, field trip the project
strengthened. inspection (start/ end/
report, meeting after key project
minutes, design event) or a
document) specific month
and year.
Outcomes
1. Increase the # of stakeholder 0 100% of people Satisfaction Monthly ? RAG 6-monthly
regional workforce reporting the surveyed survey among 6-monthly Progress Report
knowledge in relevance and reported the people who Endline and End of
emerging clinical usefulness of relevance and received the project report
ASHM RAG usefulness of bulletin
and psycho-social
bulletins and RAG
issues, prevention, webinars in Satisfaction
treatment, care and supporting their survey among
support approaches work webinar
related to COVID- attendees and
19, BBV-and sexual Chat-board on
health by website
disseminating
relevant evidence-
based guidance.
2. Build the confidence % participants 0 100% of people Satisfaction Endline= End of project
and competency of reporting surveyed survey among report.
regional health care increased reported people who
workers through confidence and improved utilized the tele-
telementoring service competency in confidence and mentoring
to provide BBV and delivering BBV competence as service.
sexual health and SH services a result of the
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prevention, treatment as a result of tele-mentoring
and care. ASHM tele- service.
mentoring
services.
Outputs
1.0 Regional Advisory Group # of RAG 0 1 Fortnightly RAG 6 Fortnightly ASHM 6
convened convened bulletin releases monthly
Progress Report
4.0 Webinars delivered # webinars held 12 webinars Webinar Monthly RAG Operational
# webinar 50 attendees attendance Meeting
attendees 200 views on Website visitor Minutes
post-webinar analytics 6 monthly
# people video Chat-board progress reports
viewing post- and end of
webinar video 100% of those Post-webinar project report
recording within who completed survey
1 month after the satisfaction
webinar survey reported
Usefulness of the webinars t
information be useful and of
presented in the relevance
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webinar
Extent to which
people
acknowledge
the usefulness
of information
presented in the
webinar
5.0 Tele mentoring delivered #Tele-mentoring 8 tele mentoring Tele-mentoring Quarterly 6 monthly
session held sessions attendance progress reports
# tele mentee and end of
attending project report
# issues
discussed in tele
mentoring
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Annex 3: Budget
Budget line Unit Total Qtr 1 Qtr 2 Qtr 3 Qtr 4 Total
cost
Direct staffing
DCEO
Division Manager
Communications manager
Project Manager
Project Officer
Sub total
Educational resources
Clinical content writer-reviewer
Research content writer -
reviewer
Community related content
writer - reviewer
Educational videos and webinars
Sub total
Total
Overheads (20%)
Total
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Annex 4: Workplan
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