Pilots in Pakistan

Mainline supports several innovative pilots under the Bridging the Gaps 2 programme. Most in collaboration with our main innovation partner Nai Zindagi  and APLHIV in Pakistan. 

Here, you will find more information about the several innovations that have been implemented.

1. Innovative service delivery monitoring

In 2015, a pilot was set up on biometrics-based client identification and service delivery monitoring to further improve their current data management system. Nai Zindagi developed and improved a sophisticated data management information system (MIS) to monitor their service delivery. 

The pilot proved that the introduction of biometrics in service delivery improved the efficiency and quality of service delivery. New modules were added over time not only to measure the outreach-based needle and syringe exchange programme but also to include HIV counselling and testing, services provided to (sexual) partners, residents of the ART Adherence Unit (AAU) and other social activities.

The MIS is functional, adaptable and effective in monitoring and evaluating the quantity and quality of the services provided under Nai Zindagi’s Global Fund grant. The MIS gives real-time information on the HIV treatment cascade and can serve as evidence-based advocacy.

  • Learn more about the biometrics system in Pakistan.

  • Interested in Nai Zindagi’s MIS or their biometric system? Feel free to contact them.  

  • Worried about privacy issues and the ethics around biometrics? It’s not as black and white a discussion as you might think. Read more here

2. ART Adherence Unit 

The ART Adherence Unit (AAU) is a residential rehabilitation facility for HIV positive persons who inject drugs (PWID) that combines treatment for opioid dependence with HIV treatment adherence support. It aims at stabilising the client so that HIV treatment becomes a realistic and achievable proposition for them.

The facility, operated by Nai Zindagi from 2014, was funded in its first two years by Mainline. After this successful pilot, Nai Zindagi received further support from the Global Fund to continue its operation until the end of 2017 with double capacity of 200 beds.

An external evaluation in 2016 shows that the AAU boosts adherence outcomes, despite relapses into drug use. Since relapse is part of the cycle of opioid dependence, the AAU poses an important alternative for other countries where few options exist for PLHIV who use drugs. Read the full evaluation here

Based on recommendations in this report, Mainline and Nai Zindagi moved to pilot additional interventions:

  • IN TOUCH: mobile phone support for AAU graduates

  • Self-help groups for former AAU clients and their spouses families

  • Mobile detox

  • Trauma Buster Technique (TBT)

3. IN TOUCH: mobile phone support

The IN TOUCH is a pilot to assess the effectiveness of follow-up and adherence support though mobile phones for AAU graduates.

AAU residents are referred from 28 districts across 3 provinces of Pakistan. For the AAU staff to physically follow up on AAU graduates would be not only difficult but also extremely costly due to distance, availability, travel, etc.

By keeping close contact through mobile phones, clients receive support from a distance and are being followed in their treatment progress. This pilot has not only been proved successful; it also delivers reliable data around adherence and relapse rates among AAU graduates. Read more about the IN TOUCH project 

4. Self-help groups for former AAU clients and their families

The evaluation of the AAU showed that short-term support immediately after graduation is needed. Because of this, self-support groups for ART Adherence Unit graduates and their families were established in four districts in 2016. The groups intend to support former AAU clients once they are back in their hometowns in Pakistan. Similar groups are established for female family members. The first results of this pilot look promising. Compared to AAU graduates who do not attend self-help groups:

  • Members build stronger relationships and support networks for psycho-social support;

  • ART adherence rate among group members range between 90 and 100%;

  • Relapse into drug use is reduced and people manage their drug use better when they do relapse;

  • Family relations are improved and employment rates are higher.

Due to the promising results, the pilot is expanded and extended into 2017. Read more details about this pilot

5. Mobile detox

The evaluation of the AAU pilot showed that relapse into drug use does not need to impact adherence to ARV treatment. However, when people relapse into chaotic drug use and end up back on the streets, the adherence rates may decrease over time. To ensure people get a second chance and adherence to ARVs is not endangered, this pilot envisioned a mobile detox unit for former AAU clients. The pilot was meant as a public-private partnership in four cities with a unit that could move after having supported local clients in one of the four districts. The realisations of the mobile component turned out to be too complicated.

Initially, public-private partnerships were established and successfully linked to local AIDS councils – a lobby platform initiated by Nai Zindagi. However, the locations that resulted were fixed and – due to high exploitation costs – only one materialised into an operational site. Read what lessons we learned during this pilot.

Want to know more?

Innovations in Pakistan

Our partners in Pakistan

News from Pakistan


Country Manager for Pakistan: Nick Veldwijk

Trauma Buster Technique (TBT)

The independent evaluation of the AAU recommended strengthening the relapse prevention component by introducing a sustainable, practical and affordable tool to provide psychosocial support to the clients of the AAU. 

Many drug users – estimates range up to over 30% – suffer from post-traumatic stress disorder. These psychological traumas may have preceded chronic drug use, or vice versa: PWUD suffered severe trauma while living on the street or when they found themselves in vulnerable circumstances caused by their drug use.  

Nai Zindagi hired Ms Rehana Webster who discovered a method - the Trauma Buster Technique (TBT) - to successfully neutralise the effects of trauma, regardless of its complexity.

In 2017, Mainline will explore whether TBT could be beneficial for other key populations reached by the Bridging the Gaps 2 programme. The commonalities that PWUD, sex workers and MSM have are the trauma they suffer on an individual level as a consequence of violence, marginalisation and isolation. TBT could be an example intervention that fits the needs of all three KPs. 

Read more about Trauma Buster Therapy and the experiences in Pakistan.

Innovation via meaningful involvement:

APLHIV and DUNE in Pakistan

The Association of People Living with HIV (APLHIV) in Pakistan is another Mainline innovation partner located in Pakistan. They are a Nationwide Network of People Living with HIV, affected by HIV and associated Key Populations.

Under the umbrella of The Association of People Living with HIV (APLHIV), People Who Use Drugs (PWUD) have united themselves in a semi-independent network called Drug User’s Network (DUNE). The innovative role DUNE plays in Pakistan will be used as an example to meaningfully include PWUD in service delivery and policy influencing.

Activities with APLHIV in 2017 vary between raising awareness on HCV, advocating for meaningful involvement in decision making, advocacy for increased harm reduction funding and OST and recording of human rights violation via the 24/7 helpline.

Under the Bridging the Gaps programme, ITPC, Mainline, APLHIV and Nai Zindagi initiated a participatory research that will start in 2017.

The goal of the research is to find the barriers that prevent access for those who use drugs who are diagnosed with HIV to ARVs. Furthermore, evidence will be collected on human rights violations of drug users regarding access to public health services.

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