Background:

Under the CDC-funded Project Sunrise, FHI 360 aims to enhance institutional and human capacity to accelerate HIV/AIDS response and scale-up and strengthen the quality of the comprehensive package of services primarily for People Who Inject Drugs (PWID) in the eight North East states. Based on North East strategy, Assam State AIDS Control Society (ASACS) in consultation with National AIDS Control Organization (NACO) and FHI 360 has developed a state level implementation plan for Assam which includes supporting select prison Interventions in Assam.

Assam has six central jails, out of which Kamrup Central Jail has been chosen to roll-out the prison intervention. The Kamrup Central Jail has a capacity of 1,000 inmates, though its operating at more than full capacity with 1,028inmates of which 994 are male prisoners and 34 are females. Approximately 75 percent inmates are under trials and their average duration of stay in the prison is around six months. Kamrup Jail has a medical facility with a capacity of 45 beds. Preliminary screening for HIV had been conducted by Assam SACS for the first time in August 2016 using a mobile van ICT, during which 83 inmates (14 females and 69 males) were tested. No HIV positive cases were detected. During counseling of the jail inmates, it was observed that there are various high risks behavioral practices. Around 82 male prisoners and 6 female prisoners have been identified to have a history of drug use. The data has been shared with the Health Secretary, Assam and NACO.

Drug and HIV are issues of least priority inside the jails resulting in low awareness about HIV and drug related issues among the jail authority as well as prison inmates. With the exception of the SACS which makes periodic visits and conducts health camp, counselling for inmates, provision of other psycho-social or medical services has been minimal. There is high percentage of first time offenders who are vulnerable to sexual exploitation from the senior inmates. There are reported cases of sexual aggression without adequate protection thereby exposing prison inmates to high risk behaviours. Use of drugs in small circles is still prevalent inside the jail. Approximately, 10-15 percent prisoners are into some form of substance use or the other at the time of arrest. There is no provision to handle withdrawal symptoms, only first aid is administered through the ANM, Pharmacist etc.

Under Project Sunrise, Emanuel Hospital Association (EHA) has been selected by FHI 360 through a competitive bidding process to implement a HIV prevention intervention in the Central Jail of Assam. The project will be implemented in close collaboration with Assam State AIDS Control Society (ASACS) and State Prison Department. The period of performance for the below scope of work is 15 December 2016 to 31 March 2017.

Scope of Work:

Objective 1: To advocate with SACS and State prison authorities and other stakeholders for setting-up a Prison HIV intervention in Assam.

Activities:

1.1 Collaborate with SACS to get a department order (DO) from the Prison Department: The Project Sunrise State Coordinator for Assam will work closely with Assam SACS to get a DO letter issued from the Home Secretary to the Prison Superintendent of the Kamrup Central Jail on the proposed prison intervention. Once the DO is issued, EHA will undertake inception visits to the Jail to introduce the project to the Jail Superintendent and other key officials. These visits will be undertaken jointly by the State Coordinator, Assam and Assam SACS representatives. The Jail Superintendent will nominate a Nodal Point Person in the Jail to act as the contact point for all communication between ASACS, EHA and the Jail. The person will be responsible for coordination of all prison intervention activities.

1.2 Formation of Prison Working Group within the Project Sunrise State Oversight Committee: A State Oversight Committee has been constituted under Project Sunrise to oversee project activities including sensitization of Law Enforcement and interventions in prisons. The Inspector General (IG) Prisons is a member of the State Oversight Committee, along with the Project Director of Assam SACS as the convener. EHA will be keep Assam SACS informed on progress related to the prison interventions for representation of issues before the State Oversight Committee. A Prison Working Group/Prison HIV Committee will be formed constituting of Assam SACS representative, FHI 360 State Coordinator, Prison personnel, EHA Project Coordinator, representative from oral substitution therapy (OST) center/district hospital and community expert. The Terms of Reference (ToR) for the Prison Working Committee which will be drafted by FHI 360 and EHA in consultation with Assam SACS. The members of the committee will meet once in three months to discuss issues laid-out in its terms of reference (ToR).

1.3 Staff recruitment and induction training: EHA will hire a full-time Project Coordinator who will act as the nodal point person for all prison activities to be undertaken by EHA. In addition, two full-time Field Managers will be assigned to the project to undertake day-to-day field activities and BCC within the Prison. A Finance and Data Assistant will support the Project Coordinator in tracking budget spends and maintaining all the project data for reporting. The Director of EHA based in Guwahati will contribute 25 percent time and will provide overall management oversight to the project. The Nurse/Doctor if required during health camps will be paid on a daily basis. EHA will complete the recruitment of all project staff and conduct their induction training within the first month of signing of the agreement with FHI 360.The staff will be trained on the NACO Prison guidelines and the quantitative and qualitative formats developed by FHI 360.

1.4 Prison Project launch: A project launch will be organized at Kamrup Central Jail with representation of Assam SACS and other key stakeholders such as the Home Department (Prisons), Secretary of Home Department (Jails), Jt. Secretary Home Department (Jails), Principal Secretary Home Department (Jails), Director General Prisons and the Additional Inspector General (Jails). EHA will lead the prison launch with support from Assam SACS and the State Coordinator, Assam. The brochures for the launch on the Prison Intervention will be provided by FHI 360.

1.5 Vulnerability and risk assessment of prisoners: EHA will undertake a vulnerability and risk assessment for all 1086 Prison inmates. This assessment will be conducted by the EHA full-time staff by filling-up an intake form which will be shared with EHA by FHI 360.The EHA staff will be trained by FHI 360 in administering the intake form. The procedure of the assessment will be discussed and finalized in consultation with the Prison Working Committee. The assessment will be completed within the first two months of signing of the agreement with FHI 360. The findings from the assessment will be analyzed by EHA in consultation with FHI 360 and will shared with Assam SACS and the prison personnel. The findings will inform the preparation and fine-tuning of the implementation plan for EHA. The assessment report will be drafted by EHA and shared with FHI 360 by the end of the third month.

1.6 Conduct project inception meetings with TI NGOs: EHA in collaboration with Assam SACS will conduct a project inception meeting with the targeted intervention (TI) NGOs supported by Assam SACS in Kamrup to inform them about the prison intervention and discuss areas of support required from them as part of the post-release follow-up strategy.

Objective 2: To improve access to health and HIV services for the prison inmates of the Assam Central Jail.

2.1. Sensitization and orientation of prison officials: EHA with support from Assam SACS and Project Sunrise will conduct orientation sessions with the prison officials on HIV/AIDS - treatment and prevention, harm reduction, OST, sexually transmitted infections (STI), overdose management and prevention. These sessions will ensure that key personnel at the prison site are sensitized and supportive towards the program. These sessions will also help in sustaining the program objectives in the long-run. A total of 94 officials- 86 males and 9 females (as highlighted in the table below), will be sensitized on HIV, drug use behavior, harm reduction and related issues and more importantly on the role they can play in addressing the issue of drug use in the prison context.

2.2 Identification of Peer Volunteers and Peer Counselors (Peer Leader): EHA along with the prison officials will identify Peer Volunteers in the ratio of 1:125; and Peer Counselors in the ratio of 1:25 from among the prison inmates. Around 43 Peer Volunteers and 10 Peer Counselors will be identified. These Peer Volunteers and Counselors will be trained by EHA on HIV/AIDS and will be given the responsibility for delivering messages to their peers on issues such as modes of HIV transmission, knowledge on drug use and HIV, addressing myths related to drugs, HIV and STIs, and services available in prison settings. The Peer Counselors will support in timely execution of other prison activities in the Jail including sessions to be conducted by the Peer Volunteers. The Peer Counselor and Peer Volunteers will be reimbursed in-kind for their contribution towards the project activities.

2.3 Translation of newly developed IEC/BCC material: FHI 360 will facilitate the adaptation / development of prison specific IPC and BCC materials such as posters, pamphlets, booklets and audio- visuals etc. These will be further reproduced by EHA at the State level in the local language. EHA will compile the BCC material used by them in other projects (such as Punjab) and share with FHI 360.

2.4 Training of Peer Volunteers and Peer Counselors: Once the BCC and IPC materials are developed by FHI 360 and the Peer Volunteers and Peer Counselors are recruited by EHA, they will be trained on conducting one-to-one and one-to-group BCC sessions with the prison inmates. These sessions will cover a range of topics like HIV/AIDS - treatment and prevention, harm reduction, OST, STI including reproductive and child health for female injecting drug users (FIDU).

Objective 3: To facilitate establishment of an institutional mechanism for ensuring post-release social reintegration of prisoners and linking them to various services to sustain positive behaviour change.

3.1 Development of Resource Directory for referral and linkages: For post release support, the prison intervention team will design and compile a user friendly Resource Directory for referral and linkages, enriched with information pertaining to different services available across the State of Assam including ART, ICTC and OST centers, STI clinics, TI projects, social security schemes and others. The draft resource directory will be shared with ASACS and FHI 360 for their inputs.