This is a midterm evaluation of the five-year (2016-2020), USAID/Central Asia HIV Flagship Project, being implemented by Population Services International (PSI) and its nongovernmental organization (NGO) implementing partners (IPs) in Kazakhstan, Kyrgyz Republic, and Tajikistan. The purpose of the evaluation was to determine: 1) how well the Project components worked; 2) strengths and weaknesses of the Project; and 3) gaps inhibiting project achievements.
The USAID/Central Asia HIV Flagship Project was successful in rolling out a new approach to HIV programming in Central Asia, focused on case detection, treatment initiation, and adherence. Peer-driven rapid HIV testing in community settings has significantly broadened access to testing for people who inject drugs (PWID) and their sexual partners. Large numbers have been tested, although ambitious targets were not met (66,747 HIV tests versus a target of 77,321). The overall HIV-positive, case-detection yield of 1.8 percent is well below expectations given the estimated HIV prevalence among PWID. The Project needs to expand testing to new networks of PWID not currently reached and undertake more testing among former PWID. The Project’s case management has made a significant contribution to antiretroviral therapy (ART) initiation, adherence, and retention in care, but there is still a significant gap between the number of new cases detected and the number of people who have initiated ART. Of the 1,192 newly found people living with HIV (PLHIV) through case detection, 735 (61.7 percent) commenced ART. The Project also supports ART re-/initiation by 2,132 loss to follow-up clients and PLHIV referred to the Project by AIDS Centers. While structural barriers play a significant part in limiting ART initiation, factors within the Project’s control are improving the quality of pre-test counseling, including treatment education and motivational skills of case managers.