There are 2.1 million people living with HIV in India, with 0.3% adult prevalence, 80,000 new infections, 62,000 AIDS related deaths, 50% adults on antiretroviral therapy and 33% children on antiretroviral therapy as recent as 2016 (Joint United Nations Project on HIV/AIDS, 2017). India's first National AIDS Control Programme (NACP) was launched in 1992, and National AIDS Control Organization (NACO) as a division the Ministry of Health and Family Welfare (MoHFW) was constituted to provide leadership to HIV/AIDS control Project.

Over time, the focus has shifted from raising awareness on behavior change, from a national response to a more decentralized response and to increasing involvement of NGOs and networks of people living with HIV (PLHIV).

The key populations (KP) most affected by HIV in India are:

• Sex workers, with an HIV prevalence of 2.2%.
• Gay men and other men who have sex with men, with an HIV prevalence of 4.3%.
• People who inject drugs, with an HIV prevalence of 9.9%.
• Transgender people, with an HIV prevalence of 7.2%.

A growing evidence base has enabled the government and stakeholders to mount a well-informed and sharpened national HIV response. Various Projects have been undertaken in India to address the epidemic. A well planned and carefully executed evaluation reaps more benefits for all stakeholders.

Evaluation of Projects helps us to know:

• Strategy: are the right things being done? — Rationale or justification — Clear theory of change.
• Operations: are things being done right? — Effectiveness to achieve outcomes — Efficiency to optimize resources — Client satisfaction.
• Learning: are there better ways? — Alternatives — Best practices — Lessons learned.

This paper documents a comprehensive analysis on reduction of HIV/AIDS among the population being served, by analyzing various anti-HIV Project that will aid in producing best-practices on conducting community-wide various disease reduction and awareness interventions.

An exhaustive literature search of peer-reviewed articles, International/national and Government and Non-Government Organizations' (NGO) reports was conducted.

Inclusion Criteria: Major HIV Projects that have evolved over the timeline of last 25 years and that are multiyear projects with large funding and having availability of individual evaluation reports in the public domain. Selection of the projects was done keeping in mind the variety of key population targeted by these projects.

The methodologies of the evaluations used within various projects combined numerous instruments, such as analysis of documents, focus group discussions, in-depth interviews, group meetings, a review of project documents, media reports, police record, pre- and post-intervention cross-sectional survey design with retrospective analysis of programmed data reports review and mixed methods study, with key informant interviews.

Various HIV–AIDS projects have taught us the value of societal engagement: successful projects have actively drawn in the affected communities, stigma reduction, energized advocacy, and political support and will. These Projects have reflected that building the evidence for what works where, and for whom, in combination of HIV prevention strategies can guide the Project Managers, not only in designing projects but also in selecting appropriate methods to evaluate and constantly improving them. Table 1 below depicts a few of such successful projects which have been further discussed in detail.

Table 1. Successful Projects on HIV Prevention

Illustrating further, In Sonagachi project a distinctive method of engaging sex-workers to be peer educators who train other sex-workers all about safe-sex practices was adopted, which became the role model for sex-workers in other parts of the world to fight socio-economic health disparities. It involved participation based communication intervention at the community (re-defining the problem), group (peer outreach) and individual (empowering sex workers) level. The positive experiences from Sonagachi Project were inspiring and were used to guide Avahan Project in the design phase (Jana et al., 2004). It was sound prevention planning, considering the dynamics of local epidemic, the target populations in their context, the evidence base and “lessons learned from other projects”. And the intention was “learn as we go” (Laga & Vuylsteke, 2011).

Avahan should be commended for making learning by evaluation a crucial part of its effort. Avahan's evaluation design did not include the community mobilization from the start but later included community mobilization. Avahan in its very foundation, recognized that creating an enabling environment while working with the highly stigmatized and marginalized populations was indeed essential for project improvement.

Avahan's prospective and intended evaluation design incorporated at least two consecutive surveys, Integrated Behavior and Biologic Assessments (IBBA), various district population surveys, monitoring of project execution data and intervention uptake, also the cost analysis.

The project provided key evidence to NACO on the significance of community mobilization in HIV prevention intervention. Peer-led outreach and community mobilization approaches, cutting across all projects, were vital to Avahan's design. During Avahan's mid-term evaluation, Intervention Design of LDTD Project was refined.

The Avahan partner, TCIF, initially set up intervention sites at 36 locations by the sides of the major national highways. However, the project data indicated that despite a national presence, critical project gaps remained. A behavior-tracking survey in mid-2005 unfolded that project awareness was merely 12 percent and the service uptake was 7 percent. In response the project decided to: Focus interventions on the major impact locations & intelligent placement of services. These changes resulted in doubling of monthly communication reach and monthly clinic uptake as well as a 50 percent increase in monthly condom sales.

Another Project which emphasizes the importance of community involvement, provided the substantial evidence towards it; is Pehchan Project. The community-based, client-centric and gender-affirming methods exercised by it significantly raised the demand for and access to tailored health, HIV, psychological, social and legal services for the transgender people. Community participation and collectivization approaches reinforced self &collective efficacy of transgender communities and empowered them. Furthermore, structural changes in the legislative framework to decriminalize and legitimize sexual practices among transgender people were a priority (Shaikh et al., 2016).

Moving further, with community centric approaches such as peer counsellors involvement and mentorship, the Hridaya Project aims to increase community mobilisation and provide site specific support to harm reduction and HIV prevention strategies which have been extremely effective in bringing about substantial increase in the uptake of services and Female Outreach Workers (FORW) to address the issues related to spouses/regular sex partners of PWID and shown positive result. NACO included FORW in NACP IV after seeing the evidence of the importance of reaching out to spouses and partners of male PWID in national HIV Projects (Alliance India, 2016).

HIV Projects have impressively focused on the needed approaches for further improvement. Of such approach one project called PIPPSE (Impact through Prevention, Private Sector and Evidence-based Programming) to strengthen the institutional and human capacity in prevention projects and private sector engagements through innovative approaches to contribute to achieving the goal of accelerating the reversal of HIV epidemic. Two components of the project are: Social Protection and Financial Inclusion, National AIDS Helpline.

In PIPSE project District Network Model (DNM) approach was found to be effective in reaching KPs and PPs, linking them to services, and achieving saturation coverage targets.

Prevention of Parent-To-Child Transmission Project in India (PPTCT) and free ART Projects have made a laudable effort in reaching out to a huge number of HIV-infected women and their children. Incorporating unique approach Connect for Life Project supports the development of m- Maitri, an initiative to educate pregnant women on techniques to prevent mother-to-child HIV transmission. At the initial stage of their pregnancy, women receive tailored voice messages to their mobile phones imparting the general advice and support on pregnancy as well as peculiar information related to being pregnant and while HIV positive (Connect for Life, 2017).

Good surveillance systems for diseases and their risk factors are crucial for measuring the magnitude of the problem and its associated costs, identifying vulnerable subgroups, and evaluating the effects of policy and practice interventions.

“We have moved from despair to hope, from denial to acceptance, from stigma to reduction in stigma, from a death sentence to a chronic manageable disease and should now aim for donor funded to domestic funded project and standalone to more integrated projects". (Rewari, 2013).

The battle against HIV/AIDS is an excellent example of coordination between government and non-government agencies, diligence, dedication and scientific innovation. Figure 1 presents the key learnings.

Figure 1. Key Learnings

• Active participation/engagement of the private sectors needs to be encouraged to help in augmenting the sustainable funding in future projects.
• Our focus ought to be to strengthen systems for quality assurance, monitoring and evaluation. Also, it is vital to raise awareness of such issues through projects.
• In the routine management of many diseases, no systematic advice and counseling are provided to the patient that results in inappropriate management of compliance. For instance, a study revealed that in tuberculosis patients with DOTS, more than half of the households surveyed knew that primary health centers existed, but only 15% knew that free TB treatment was available there (Aamir et al., 2016). Further high-quality researches using evidence-based focused counseling techniques for the target populations should be a priority.
• The HIV–AIDS experience may guide the connection/ linking of detection, prevention, treatment and integration of behavioral and biomedical approaches that are just as applicable to others and more specifically to the prevailing non-communicable diseases as well. (Narayan et al., 2011).
• Peer counseling should to backed up by creating health-enabling social environments to support and enable health-enhancing attitude and behavior change.
• Partnership with government /NGOs, and international agencies should be promoted for effective sustainable Projects.
• Innovative approaches to the experiences of Aravind- Eye Care Hospitals in India are good examples of what can be achieved through innovative organization of low-cost human capital and technology in lowerincome countries.
• Community Participation is crucial for synergistic effect & communities as the beneficiaries of the projects deserve to be informed about the main evaluation results, because they are not only part of the problem, but also part of the solution. In the future projects, principles should embrace respect, transparency, inclusiveness and accountability.

A comprehensive inclusiveness and how various HIV Prevention & Control Projects were successful in disease control and raising the awareness, aided in identifying the key factors that are essential to create a significant impact. Learning these lessons from the HIV–AIDS projects and deploying them in future Projects would improve the learning curve for other diseases prevention and control.