The World Bank Report No: ISR10303 Implementation Status & Results Barbados Barbados Second HIV/AIDS Project (P106623) Public Disclosure Copy Operation Name: Barbados Second HIV/AIDS Project (P106623) Project Stage: Implementation Seq.No: 9 Status: ARCHIVED Archive Date: 26-Jun-2013 Country: Barbados Approval FY: 2009 Product Line: IBRD/IDA Region: LATIN AMERICA AND CARIBBEAN Lending Instrument: Specific Investment Loan Implementing Agency(ies): 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 09-Nov-2012 Effectiveness Date 06-Jan-2009 Revised Closing Date 30-Nov-2013 Actual Mid Term Review Date 05-Dec-2011 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 Overall Ratings Previous Rating Current Rating Public Disclosure Copy Progress towards achievement of PDO Moderately Satisfactory Moderately Satisfactory Overall Implementation Progress (IP) Moderately Unsatisfactory Moderately Satisfactory Overall Risk Rating Low Implementation Status Overview Barbados is on track to achieve MDG 6 (halt or reverse HIV/AIDS) by 2015. Annual trends in estimated HIV incidence show a slow decline since the year 2000. Barbados has eliminated mother to child HIV transmission (MTCT) since 2007 and 100% of identified HIV positive pregnant women received a complete course of antiretroviral therapy (ART) to reduce MTCT in 2012. The rate of AIDS related mortality has dramatically decreased, largely due to the introduction of antiretroviral therapy (ART) in 2002. Barbados has exemplified regional leadership in expanding access to high quality treatment and care for HIV/AIDS. Currently, 88.9% of those in need of ART are receiving therapy (exceeding the project indicator target of 60%). Importantly, the quality of care is reflected in the very high rate of virological suppression in those patients retained in care. Barbados is one of the Page 1 of 5 The World Bank Report No: ISR10303 few countries globally to have undertaken such a comprehensive analysis of population level viral load. A wide range of prevention activities has been implemented by both the public sector and civil society. The interventions have focused on increasing knowledge and awareness, reducing stigma and discrimination, HIV testing and counseling, distribution of condoms, and training for development of HIV prevention interventions. As one of the key prevention Public Disclosure Copy activities, Barbados continues to scale up HIV testing and counseling. The new “Policy on HIV Testing in Barbados� was developed (Ministry of Health, September 2012) and provides the overarching policy on HIV testing and the guiding principles for different types of testing. The Grant Scheme to support civil society organizations (CSOs) was launched in September 2011 Since the launch of the CSO Grant Scheme, a total of 46 applications were received from 35 CSOs which resulted in the approval of 18 grants at March 2013. Of the 18 grants approved, 2 focus on MSM and one on Sex Workers with 6 projects having already been completed. Locations No Location data has been entered Results Project Development Objective Indicators Indicator Name Core Unit of Measure Baseline Current End Target Percentage of female sex workers reporting the Percentage Value 80.00 0.00 85.00 use of a condom with their most recent client Date 31-Dec-2006 18-Apr-2013 31-Dec-2012 Comments Baseline reported for 2006 No data on this indicator at this mission. The BSS survey for female sex workers (FSW) is under planning and will be conducted in May 2013. Percentage of men reporting the use of a Percentage Value 64.00 0.00 70.00 condom the last time they had sex with a male Date 31-Dec-2007 30-Jun-2012 31-Dec-2011 partner Comments Baseline reported for 2007. No data available for this indicator yet. The BSS survey is currently in the field collecting data for MSM and Public Disclosure Copy the study is encountering some difficulties and the Bank is working with the MOH to identify solutions. Percentage of young men and women aged Percentage Value 21.00 57.00 65.00 15-24 years reporting the use of a condom the Date 31-Dec-2006 12-Apr-2013 31-Dec-2013 last time they had sex with non marital non Comments Baseline reported for Data from 2009 KAPB study cohabitating sexual partner. 2005-2006 Page 2 of 5 The World Bank Report No: ISR10303 Percentage of young women and men aged Percentage Value 94.30 96.70 90.00 15-24 indicating sexual relations as a way of Date 31-Dec-2006 17-Apr-2013 31-Dec-2013 transmitting HIV Comments Baseline reported for Data from 2011 Youth KAPB Target is to maintain at least a Public Disclosure Copy 2005-2006 study rate of 90%. Percentage of identified HIV positive pregnant Percentage Value 96.00 100.00 95.00 women who gave birth in the last 12 months Date 31-Dec-2008 17-Apr-2013 31-Dec-2013 receiving a complete course of ARV to reduce Comments Baseline reported for year- Data for 2012 shows 100% Target is to maintain a MTCT end 2008. PMTCT rate above 95% over the 2008-2013 period. Percentage of people living with HIV on first Percentage Value 60.00 74.00 70.00 line antiretroviral regimen achieving virologic Date 31-Dec-2008 17-Apr-2013 31-Dec-2011 success within the first 6 months of treatment. Comments Baseline reported for year- Target achieved for <1000 Target is to maintain a end 2008. (WHO criteria) and 43% virologic success above 70%. under 50 because (i) data entry problems (i.e. existing viral load data not beingentered), and (ii) some patients not having viral load taken at start of treatment. Percent of most at-risk populations (female sex Percentage Value 0.00 0.00 70.00 workers and men who have sex with men) Date 17-Apr-2013 31-Dec-2012 reached with HIV prevention services. Comments No baselines The MSM and FSW BSS The target for FSW is 70% surveys will provide data for and the target for MSM is this indicator. The BSS 75%. survey started in 2012 for MEM and the BSS survey for FSW will be conducted in May 2013. Amount of funds spent by CSOs under results- Amount(USD) Value 0.00 77077.90 150000.00 based agreements. Date 31-Dec-2008 17-Apr-2013 31-Dec-2013 Public Disclosure Copy Comments Data from Grant Monitoring Reports Evidence-based Strategic Plan 2014-2018. Text Value Strategic PLan 2008-2013 In Progress. The TOR has 2014-2018 Plan developed by been approved and NHAC is June 2013 reviewing a shortlist of consultants. Date 31-Dec-2008 17-Apr-2013 30-Jun-2013 Comments The NHAC is coordinating the process. Page 3 of 5 The World Bank Report No: ISR10303 Intermediate Results Indicators Indicator Name Core Unit of Measure Baseline Current End Target Amount spent on HIV/AIDS in the past 12 Amount(USD) Value 6900000.00 7458720.00 6650000.00 Public Disclosure Copy months Date 31-Dec-2007 31-Mar-2012 31-Dec-2011 Comments US$6.9 million baseline US$7.5 million reported for Target is to be met every year reported for 2006-2007. 2011-2012 of 70% of Eligible Program Expenditures (EPEs) which is at least US$6.65 million. Data on Financial Performance (as of 03-Dec-2012) Financial Agreement(s) Key Dates Project Ln/Cr/Tf Status Approval Date Signing Date Effectiveness Date Original Closing Date Revised Closing Date P106623 IBRD-75850 Effective 07-Aug-2008 25-Sep-2008 06-Jan-2009 30-Nov-2013 30-Nov-2013 Disbursements (in Millions) Project Ln/Cr/Tf Status Currency Original Revised Cancelled Disbursed Undisbursed % Disbursed P106623 IBRD-75850 Effective USD 35.00 35.00 0.00 14.79 20.21 42.00 Disbursement Graph Public Disclosure Copy Key Decisions Regarding Implementation Page 4 of 5 The World Bank Report No: ISR10303 A Level II project restructuring was approved in March 2013 to (i) modify Project’s institutional arrangements to strengthen leadership and capacity of the Project; (ii) revise the results framework; and (iii) increase the percentage of Bank financing of Eligible Program Expenditures (under Component 1 to better utilize of all the funds and achieve the Project Development Objectives. Public Disclosure Copy Restructuring History Level two Approved on 29-Jul-2011, Level two Approved on 07-Mar-2013 Related Projects There are no related projects. Public Disclosure Copy Page 5 of 5