The World Bank Report No: ISR3767 Implementation Status & Results Barbados Public Disclosure Copy Barbados Second HIV/AIDS Project (P106623) Operation Name: Barbados Second HIV/AIDS Project (P106623) Project Stage: Implementation Seq.No: 6 Status: ARCHIVED Last Modified Date: 20-Jul-2011 Country: Barbados Approval FY: 2009 Product Line: IBRD/IDA Region: LATIN AMERICA AND CARIBBEAN Lending Instrument: Specific Investment Loan Implementing Agency(ies): National Commission on HIV/AIDS Key Dates Board Approval Date 07-Aug-2008 Original Closing Date 30-Nov-2013 Planned Mid Term Review Date 05-Dec-2011 Last Archived ISR Date 21-Nov-2010 Effectiveness Date 06-Jan-2009 Revised Closing Date 30-Nov-2013 Actual Mid Term Review Date Project Development Objectives Project Development Objective (from Project Appraisal Document) The project would support the implementation of the 2008-2013 Barbados National HIV/AIDS Strategic Plan, specifically to increase: - Adoption of safe behaviors, in particular amongst key populations at higher risk. - Access to prevention, treatment and social care, in particular for key populations at higher risk. - Capacity of organizational and institutional structures that govern the NAP. - Use of quality data for problem identification, strategy definition and measuring results. Has the Project Development Objective been changed since Board Approval of the Project? Yes No Component(s) Component Name Component Cost Component 1: Prevention and Care 31.50 Component 2: Institutional Strengthening 3.50 Public Disclosure Copy Overall Ratings Previous Rating Current Rating Progress towards achievement of PDO Satisfactory Moderately Satisfactory Overall Implementation Progress (IP) Moderately Satisfactory Moderately Satisfactory Overall Risk Rating Implementation Status Overview This project is an integral part of the National AIDS Program (NAP) and is one of the main sources of financing for the National Strategic Plan (NSP) 2008-2013. The Bank team reviewed the achievements towards the project development objectives and noted that the National AIDS Program continues to make progress in many areas, particularly in the reduction of mortality from AIDS and preventing vertical HIV transmission. From the introduction of free antiretroviral therapy (ART) in 2002 to December 2010, a total of 1301 HIV Page 1 of 6 The World Bank Report No: ISR3767 patients are under treatment and care and 91 percent of them are under ART as of December 2009. As a result, the AIDS case fatality rate has been reduced from 6 percent in 2002 to 2 percent in 2008. The proportion of identified HIV-positive pregnant women who receive a complete course of ART to reduce the risk of mother-to-child transmission has been Public Disclosure Copy maintained about 90 percent (91percent in 2008 and 89.5 percent in 2010). A thorough review of missed cases under prevention of mother-to-child transmission (PMTCT) was conducted and results have been used in improving targeting and the follow-ups. Significant progress has been made in epidemiological surveillance and the quality of the 2008 surveillance report is high. The surveillance data provided information to have a better understanding of the nature of the epidemic in Barbados. The focus of the National AIDS Program has increasingly shifted to most-at-risk population (MARP) groups and evidence- based interventions are being carried out. However, lack of detailed epidemiological data on MARPs has hampered the formation of effective targeting and interventions. The National HIV/AIDS Commission (NHAC) and the Ministry of Health (MOH) are now working closely together to prepare behavioral surveillance surveys for MARPs. Results Project Development Objective Indicators Indicator Name Core Unit of Measure Baseline Current End Target Increase in the percentage of sex workers who Text Value 80% 86% 95% report the use of a condom with their most recent client from 80% to 95% Date 31-Dec-2006 29-Jun-2011 30-Nov-2013 Comments Most current data available provided during July 2010 supervision mission. Percent of men reporting the use of a condom Text Value 64% 67% 75% the last time they had anal sex with a male partner Date 31-Dec-2007 29-Jun-2011 30-Nov-2013 Comments Most current data available provided during July 2010 supervision mission. Increase the percentage of young people aged Text Value 21% 26% 31% 15-24 years reporting the use of a condom the last time they had sex with a non-marital, non- Date 31-Dec-2006 29-Jun-2011 30-Nov-2013 cohabitating sexual partner from 21% in 2008 Comments Most current data available to 31% in 2013. provided during July 2010 Public Disclosure Copy supervision mission. KAPB conducted biennially. Increase in the number of people from key Text Value 250 350 500 populations at higher risk accessing preventive services from 250 in 2009 to 500 in 2013. Date 30-Jun-2008 31-Mar-2010 30-Nov-2013 Comments Most current data available provided during July 2010 supervision mission. Page 2 of 6 The World Bank Report No: ISR3767 Indicator Name Core Unit of Measure Baseline Current End Target Maintain the percentage of HIV-positive Text Value 96 100% above 95% Public Disclosure Copy pregnant women receiving a complete course of anti-retroviral prophylaxis to reduce the risk Date 31-Dec-2006 31-Mar-2010 30-Nov-2013 of mother to child transmission above 95% Comments Target achieved. during 2008 to 2013. Most current data available provided during July 2010 supervision mission. All pregnant women were approached and3 declined treatment. Maintain the percentage of people living with Text Value 69 65% above 70% HIV on antiretroviral treatment achieving virologic success in the last 12 months above Date 31-Dec-2003 29-Jun-2011 30-Nov-2013 70% during 2008 to 2013 Comments Most current data available provided during July 2010 supervision mission. The 2009-2010 data will be available by December 2011. Increase in funds disbursed to CSOs under Text Value 0 US$17,250 US$502,000 results-based agreements w/NHAC to facilitate implementation of targeted program Date 30-Jun-2008 31-Mar-2010 30-Nov-2013 interventions for key populations at higher risk Comments As per discussions held in during 2008-2013. January 2011 supervision mission, target is being revised as CSO Grant System not operational at present. Prepare a Strategic Plan for 2013-2018 based Text Value Barbados National AIDS 2014-2018 Plan will be Barbados Strategic Plan on surveillance and monitoring and evaluation Strategic Plan (BNASP) developed by June 2013 2013-2018 prepared. data gathered during the Project. 2008-2013 approved. Date 30-Jun-2008 29-Jun-2011 30-Nov-2013 Public Disclosure Copy Comments The new date was agreed upon during the January 2011 supervision mission. Maintain the percentage of young people 15-24 Percentage Value 94.30 92.30 90.00 years spontaneously indicating sexual relations as a way of transmitting HIV at leastat 90% Date 31-Dec-2005 29-Jun-2011 30-Nov-2013 from 2008 to 2013. Comments The term "Spontaneously" was deleted from indicator description as questions were always asked with options. Intermediate Results Indicators Page 3 of 6 The World Bank Report No: ISR3767 Indicator Name Core Unit of Measure Baseline Current End Target Funds budgeted for HIV/AIDS annually from $9 Text Value US$9 million US$8.55 US $11 million Public Disclosure Copy million in 2008 to US$11 million in 2013 Date 31-Dec-2008 29-Jun-2011 30-Nov-2013 Comments Due to the impact of the Global economic and financial crisis, the government of Barbados experienced a reduction in revenue. The budget allocation for 2010/2011 was reduced by 21 percent from US$10.78 million to US$8.55 million. 70% execution EEPs in the first semester FY09 Text Value NA 85.23% 70% Date 31-Dec-2008 29-Jun-2011 30-Nov-2013 Comments Target Achieved. The data were provided to the July 2011 mission. Data on Financial Performance (as of 23-Feb-2011) Financial Agreement(s) Key Dates Project Loan No. Status Approval Date Signing Date Effectiveness Date Closing Date P106623 IBRD-75850 Effective 07-Aug-2008 25-Sep-2008 06-Jan-2009 30-Nov-2013 Disbursements (in Millions) Project Loan No. Status Currency Original Revised Cancelled Disbursed Undisbursed % Disbursed P106623 IBRD-75850 Effective USD 35.00 35.00 0.00 7.85 27.15 22.00 Public Disclosure Copy Disbursement Graph Page 4 of 6 The World Bank Report No: ISR3767 Public Disclosure Copy Key Decisions Regarding Implementation The Bank and the Government teams have jointly reviewed project implementation and agreed that the Project needs to improve its performance in the following areas: Improving effectiveness of prevention programs. Despite the scaling up of prevention and treatment under the National AIDS Program from 2000, the number of newly diagnosed HIV cases (used as a proxy for HIV incidence) has not shown a declining trend. The epidemiological data suggest low coverage and/or lack of effectiveness of preventive activities. More attention needs to be paid to prevention programs. The recent finalized Barbados Prevention Plan (2008-2013) is a key step in further defining target populations and the prevention strategy. Scaling up HIV testing and counseling. Less than 2 percent of the population was tested for HIV in 2010. The number of HIV tests completed in the public sector declined from 5904 in 2009 to 5053 in 2010 and identified HIV+ cases through testing were low in comparison to the prevalence rate and more women than men were tested even though HIV infection among men is higher than in women, demonstrating that testing has not effectively reached higher risk groups. The MOH has increased its efforts in promoting provider initiated Public Disclosure Copy testing and counseling (PITC); rolling out rapid testing, and engaging the NGOs and private sector to share the responsibility. Increasing early case detection. Even though there has been some improvement in HIV/AIDS detection, a large proportion of patients are still being identified at a late stage of infection, especially for men. There is a need to improve leadership and coordination among the implementers of the National AIDS Program. Key line ministries such as the MOH, the Ministry of Education, the Attorney General's Office, and the Ministry of Family, Culture, Sports and Youth are actively implementing their HIV/AIDS Programs. However, the activities are fragmented and there is a lack of coordination and monitoring of the results. This calls for the NHAC to play a more active role in improving intra-ministry as well as inter-ministry coordination. There is a need for increased involvement of high-level Ministerial decision-makers and improved leadership to ensure access to allocated HIV/AIDS funds at each Ministry to support their implementation of HIV activities. Restructuring History There has been no restructuring to date. Page 5 of 6 The World Bank Report No: ISR3767 Related Projects There are no related projects. Public Disclosure Copy Public Disclosure Copy Page 6 of 6