PEPFAR's annual planning process is done either at the country (COP) or regional level (ROP).
PEPFAR's programs are implemented through implementing partners who apply for funding based on PEPFAR's published Requests for Applications.
Since 2010, PEPFAR COPs have grouped implementing partners according to an organizational type. We have retroactively applied these classifications to earlier years in the database as well.
Also called "Strategic Areas", these are general areas of HIV programming. Each program area has several corresponding budget codes.
Specific areas of HIV programming. Budget Codes are the lowest level of spending data available.
Expenditure Program Areas track general areas of PEPFAR expenditure.
Expenditure Sub-Program Areas track more specific PEPFAR expenditures.
Object classes provide highly specific ways that implementing partners are spending PEPFAR funds on programming.
Cross-cutting attributions are areas of PEPFAR programming that contribute across several program areas. They contain limited indicative information related to aspects such as human resources, health infrastructure, or key populations programming. However, they represent only a small proportion of the total funds that PEPFAR allocates through the COP process. Additionally, they have changed significantly over the years. As such, analysis and interpretation of these data should be approached carefully. Learn more
Beneficiary Expenditure data identify how PEPFAR programming is targeted at reaching different populations.
Sub-Beneficiary Expenditure data highlight more specific populations targeted for HIV prevention and treatment interventions.
PEPFAR sets targets using the Monitoring, Evaluation, and Reporting (MER) System - documentation for which can be found on PEPFAR's website at https://www.pepfar.gov/reports/guidance/. As with most data on this website, the targets here have been extracted from the COP documents. Targets are for the fiscal year following each COP year, such that selecting 2016 will access targets for FY2017. This feature is currently experimental and should be used for exploratory purposes only at present.
Years of mechanism: 2007 2008 2009
Other ACONDA activities on which this PMTCT component builds are described in Counseling and Testing (#10063), Basic Health Care and Support (#10053), HIV-TB (#10338), ARV Services (#10070), and Strategic Information (#10075).
Since its creation in 2002, the Ivorian NGO of health professionals called ACONDA has provided innovative, comprehensive, family-based care services in support of the Ministry of Health PMTCT and HIV treatment programs. ACONDA's personnel has more than a decade of experience in HIV clinical and applied research, with a sustained focus on PMTCT and mother-child care and treatment. ACONDA defines a holistic approach to care and seeks to provide a complete and integrated package of quality services that includes prevention (CT, PMTCT, secondary sexual prevention); adult, child, and family care (with provision of ART, OI prevention and treatment, and promotion of "positive living"); and psychosocial support and a continuum of care through links with local PLWHA and community organizations. ACONDA is also committed to improving the management of information to improve service delivery and promote sustainable quality services to reduce HIV-related morbidity and mortality in Cote d'Ivoire.
ACONDA has been successful in mobilizing resources and developing its own organization to support expanded service delivery and research activities. ACONDA has created numerous technical and financial partnerships (with the MOH, ISPED/University of Bordeaux, GIP-ESTHER, Columbia University, GlaxoSmithKline Foundation, NGO Sidaction, and the Clinton Foundation). Since 2004, ACONDA has been a sub-partner under the five-year EP cooperative agreement called Project HEART, led by the Elisabeth Glaser Pediatric AIDS Foundation (EGPAF) and the University of Bordeaux/ISPED.
ACONDA is rapidly expanding its comprehensive family-based model and will provide ART to approximately 12,500 patients, including 1,375 children (11%), by March 2007. With ACONDA's contributions, Project HEART exceeded its five-year service-delivery goals in the first 18 months. This substantial growth not only led to rapid growth in ACONDA's organizational capacity for service delivery but was also accompanied by reinforced capacity in management and financial systems, with substantial assistance from U Bordeaux/ISPED. In September 2006, ACONDA graduated to become an EP prime partner by winning a competitive EP/CDC award to provide comprehensive family care and PMTCT services. ACONDA will use FY06 funds to further strengthen its financial and management systems to ensure that it has the capacity to manage EP funds directly while maintaining strong partnerships with technical partner ISPED, EGPAF, and other collaborating partners.
In addition to Project HEART funding, ACONDA has also successfully competed to become a sub-partner to EGPAF under the EP-funded Call to Action project to provide PMTCT services. At present (September 2006), ACONDA provides direct support to 17 PMTCT sites and 20 comprehensive HIV care and treatment sites. ACONDA receives EP funding through EGPAF for 12 PMTCT sites, and non-EP funding (Columbia University, Global Fund) for five PMTCT sites. To date, with EP funds, ACONDA has assisted the national Ministry of Health program to train 71 health providers to provide PMTCT services and has provided 5,981 pregnant women with HIV counseling and testing with receipt of test results. Of these, 653 were HIV-infected, and 498 (76%) were provided with ARV prophylaxis. In addition, 65 women identified through PMTCT services were initiated on ART (with 55 of them identified as eligible during pregnancy). By the end of March 2007, ACONDA projects that it will support 38 EP-funded PMTCT sites (41 sites total) and 38 comprehensive HIV care and treatment sites (including 35 under EGPAF/Project HEART and three under this new EP award as a prime partner).
In FY07, ACONDA will continue its PMTCT activities while contributing to the scale-up and decentralization of PMTCT and linked HIV care and treatment services. ACONDA aims to improve access to underserved and rural populations, enhance uptake of services, improve population coverage, promote quality and evidence-based practices, and integrate PMTCT and HIV care into routine health services with district health team involvement. ACONDA will adhere to national standards, will remain an active member of the PMTCT and other technical consultative forums, and will provide input to improve national policies according to evidence-based practices. ACONDA will also remain an active member of the national commodities coordination committee for HIV-related commodities. EGPAF and ACONDA will coordinate as the ACONDA program splits off to become an independent prime partner under the EP, and they will coordinate the scale-up of their programs with the MOH in
strategic geographic areas.
With FY07 funds, ACONDA will support the 38 PMTCT sites under its new award and expand PMTCT activities to 10 new sites. At its 48 sites, ACONDA will reach at least 50,000 pregnant women with HIV counseling and testing results and will provide ARV prophylaxis to at least 2,857 HIV-infected pregnant women. To support its sites, ACONDA will train 328 health providers involved in preventing mother-to-child transmission of HIV, using previously developed national PMTCT training materials. To meet human resource needs in areas that lack laboratory technicians, ACONDA will also train 40 nurses and midwives from rural areas to perform HIV testing using approved methods and will monitor their performance. To ensure that all sites adhere to national standards, ACONDA will conduct site assessments, onsite training, supportive supervision, and laboratory QA, and it will provide other ongoing technical support. It will improve the quality of data gathered at sites through supervision and ongoing participatory training for data managers. ACONDA will help each site develop and implement a comprehensive M&E plan that will also identify collaborations with key partners. PMTCT commodities will be monitored but will be procured through the Partnership for Supply Chain Management Systems (SCMS)
ACONDA and its partners will link HIV care and treatment services with systematic referrals to enable all identified HIV-infected pregnant women to access clinical and home-based services. Women eligible for ART will start treatment according to national guidelines and receive ongoing care through HIV treatment clinics or community-based sites. ACONDA will provide joint care for HIV-infected women and their babies during postnatal care, as well as infant follow-up with early infant diagnosis and clinical monitoring. It will subsequently link mothers and children to community-based care services. The program will also encourage HIV-positive women to bring their family members in for CT. Finally, ACONDA will support MOH staff in each district to integrate PMTCT with other services, such as family planning and nutritional support. This MOH staff member will also provide supervision, training, supportive supervision, and M&E assistance to aid the progressive transfer of capacity to the district health team. ACONDA will work to strengthen its monitoring and evaluation system and to support an integrated national M&E system.
This activity complements ACONDA activities in CT (#10063 ), Basic Health Care and Support (#10053 ), HIV/TB (#10338), ARV Services (#10070 ), and SI (#10075).
Since its creation in 2002, the Ivorian NGO of health professionals called ACONDA has provided innovative, comprehensive, family-based care services in support of the Ministry of Health PMTCT and HIV treatment programs. ACONDA's personnel has more than a decade of experience in HIV clinical and applied research, with a sustained focus on palliative care. ACONDA defines a holistic approach to care and seeks to provide a complete and integrated package of quality services that includes prevention (CT, PMTCT, secondary sexual prevention); adult, child, and family care (with provision of ART, OI prevention and treatment, and promotion of "positive living"); and psychosocial support and a continuum of care through links with local PLWHA and community organizations. ACONDA is also committed to improving the management of information to improve service delivery and promote sustainable quality services to reduce HIV-related morbidity and mortality in Cote d'Ivoire.
ACONDA has been successful in mobilizing resources and developing its own organization to support expanded service delivery and research activities. ACONDA has created numerous technical and financial partnerships (with the MOH, ISPED/University of Bordeaux, GIP-ESTHER, Columbia University, GlaxoSmithKline Foundation, NGO Sidaction, and the Clinton Foundation). Since 2004, ACONDA has been a sub-partner under the five-year EP cooperative agreement called Project HEART, led by the Elisabeth Glaser Paediatric AIDS Foundation (EGPAF) and the University of Bordeaux/ISPED.
ACONDA's FY07 palliative-care activities will work mainly in the emphasis areas of training and development of network/linkages/referral system, and on the key legislative issue of wraparounds.
Health clinic-centered care: Through its holistic program, ACONDA provides palliative-care services at its 38 ART treatment sites (with 10 more to open in FY07) and at 48 community-level service points. With EP support, ACONDA has provided palliative-care services for 27,700 people. It continues to bring patients into its program for the full range of comprehensive care, treatment, and prevention services. In FY07, ACONDA will provide palliative care to approximately 49,310 patients and will train 282 physicians, paramedics, social workers, and community advisers in prevention and treatment of OIs, adherence to ARV treatment, and provision of psychosocial support.
For new patients, ACONDA ensures that HIV-positive people undergo clinical and biological assessments (CD4 count measurement) to determine clinical staging and eligibility for ART initiation. Patients who are eligible are put on ART according to national ART guidelines. They are followed up after three months and then every six months to monitor side-effects and assess adherence and efficiency of treatment (using CD4 count increase).
Symptomatic patients are cared for according to symptom type: Pain is treated with opiates or non-opiates (according to WHO guidelines); patients with fever, diarrhea, or anemia are managed using pre-defined algorithms with specific and appropriate drugs (anti-diarrhea, antipyretic, blood transfusion, and intravenous solutions). Asymptomatic patients are assessed every six months for clinical staging and ART eligibility. Based on national guidelines, all patients with a CD4 count of less than 500 (symptomatic or not, on ART or not) receive cotrimoxazole. These patients are also referred to counselors for
adherence support and for prevention-for-positives counseling sessions. Advice and help for disclosure of HIV status to their partners and family are provided by trained peer counselors, with a specific focus given to sero-discordant couples. Patients also undergo a systematic psychosocial assessment to identify barriers and obstacles to adherence and are then referred to the support groups.
Infants who are diagnosed early with HIV infection are also assessed for ART initiation and are provided with a complete package of care. ACONDA will also identify local foods that can be substituted in the diets of pediatric patients who are being weaned off breast milk, and counselors will provide information to patients on diet changes.
Nutritional support will be provided through non-USG support to patients and their families, wrapping around ACONDA's efforts to provide HIV-infected families with cooking kits and cooking classes at health centers. Classes will be geared toward improving patient health through proper nutrition for people receiving palliative care or ART. ACONDA will provide malnourished patients with targeted nutritional support. A series of trainings on this care will be given to care providers and will comply with OGAC policy.
Community-Centered Care: CBOs, NGOs, and other institutions providing specific interventions will be identified and given grants, in conjunction with Alliance CI, to help ACONDA support patients in their communities. These sub-grantees will make home visits to provide palliative care, psychological support, adherence support, nutritional counseling, mosquito bed nets, and even some micro financial support through income-generating activities. These sub-partner organizations will also help develop community mobilization activities, work to reduce HIV-related stigma and discrimination, and will network with health-center teams to provide linkages among clinical HIV care, community support, and wraparound services.
ACONDA will work to strengthen its monitoring and evaluation system and to support an integrated national M&E system. It will adhere to national palliative-care standards and contribute to the national dialogue on policy issues, drug lists, and a minimum package of palliative-care services as part of the palliative-care and other technical consultative forums. ACONDA.will also remain an active member of the national commodities coordination committee for HIV-related commodities.
This activity complements ACONDA activities in CT (#10063 ), Basic Health Care and Support (#10053 ), ARV Services (#10070 ), and SI (#10075).
Since its creation in 2002, the Ivorian NGO of health professionals called ACONDA has provided innovative, comprehensive, family-based care services in support of the Ministry of Health PMTCT and HIV treatment programs. ACONDA's personnel has more than a decade of experience in HIV clinical and applied research, with a sustained focus on TB and HIV co-infection care and treatment. ACONDA defines a holistic approach to care and seeks to provide a complete and integrated package of quality services that includes prevention (CT, PMTCT, secondary sexual prevention); adult, child, and family care (with provision of ART, OI prevention and treatment, and promotion of "positive living"); and psychosocial support and a continuum of care through links with local PLWHA and community organizations. ACONDA is also committed to ongoing applied research to improve service delivery and promote sustainable quality services to reduce HIV-related morbidity and mortality in Cote d'Ivoire.
ACONDA has been successful in mobilizing resources and developing its own organization to support expanded service delivery and research activities. ACONDA has created numerous technical and financial partnerships (with the MOH, ISPED/University of Bordeaux, GIP-ESTHER, Columbia University, GlaxoSmithKline Foundation, NGO Sidaction, and the Clinton Foundation). Since 2004, ACONDA has been a sub-partner under the five-year EP cooperative agreement called Project HEART, led by the Elizabeth Glaser Pediatric AIDS Foundation (EGPAF) and the University of Bordeaux/ISPED.
Integrated HIV/AIDS care and treatment at TB sites: Despite the politico-military crisis in Cote d'Ivoire, the National TB Program has continued to decentralize its services to more than 60 sites. With USG support, the National TB Program has integrated and expanded routine, provider-initiated HIV counseling and testing and cotrimoxazole prophylaxis at nine specialized centers. In line with its holistic approach, ACONDA has linked HIV care and treatment services at its 38 sites with TB services. As the National TB Program decentralizes further, ACONDA will provide HIV/AIDS care and treatment services linked to TB services at the 10 new sites it will open in FY07.
During FY07, ACONDA expects to increase the coverage of its HIV/AIDS care and treatment services to 2,466 patients in TB clinics (an estimated 5% of all TB patients at each clinic). To accomplish this, ACONDA will ensure that health professionals at the new sites are trained to clinically manage HIV and common opportunistic infections. In addition, professionals from TB clinics will attend training on the holistic case management of TB/HIV co-infected patients, using materials validated by the national HIV/AIDS care and treatment program (PNPEC).
ACONDA will benefit in 2007 from the newly established TB drug supply, which will provide first-line TB drugs to the National Public Pharmacy (PSP) for national distribution. If Cote d'Ivoire's Green Light Committee provides approval, second-line and pediatric TB drugs will also be procured and stored at the PSP.
Integrated TB care and treatment at HIV/AIDS sites: In FY07, providers at ACONDA's 38 HIV/AIDS sites will systematically screen HIV/AIDS patients for TB based on their clinical symptoms, sputum smear, and X-ray performance. Patients infected with TB will be referred to the nearest TB reference clinic (CAT) or to the
TB facility on the same site. ACONDA expects that approximately 10% of HIV/AIDS clinic patients will have sputum tests; 20% of adult patients will have culture and anapath exams; and 100% of children will have culture and anapath exams. Prophylaxis will be prescribed for all eligible patients, and ACONDA will provide follow-up until the end of the TB treatment.
A seminar for physicians at existing sites will be provided to improve program implementation, data management, and linkages to community services. A total of 144 staff members from both existing and new sites will be trained onsite to diagnose TB in HIV-positive patients using specific guidelines from the National TB program. Other professionals will attend training in holistic case management of TB/HIV co-infected patients (the same training listed above for TB clinic staff). About 50 paramedics from the various sites will receive refresher training in TB care.
Community management of patients co-infected with TB/HIV will be linked to services at both the TB clinic and the HIV/AIDS clinic. CBOs and NGOs will receive sub-grants, in conjunction with Alliance CI, to guarantee DOTS and to follow up with patients lost to treatment. ACONDA will improve referral forms and counter-referral forms to establish stronger links between clinics, to improve the ability of clinics and CBO/NGOs to follow up with patients, and to improve monitoring and data analysis.
ACONDA will work to strengthen its monitoring and evaluation system and to support an integrated national M&E system. ACONDA will adhere to national standards, will remain an active member of relevant technical consultative forums, and will provide input to improve national policies according to evidence-based practices. ACONDA will also remain an active member of the national commodities coordination committee for HIV-related commodities.
Targets
Target Target Value Not Applicable Number of clinic sites with associated CBO/FBOs providing community based services to persons coninfected with HIV/TB. Number of service outlets providing treatment for tuberculosis (TB) 48 to HIV-infected individuals (diagnosed or presumed) in a palliative care setting Number of HIV-infected clients given TB preventive therapy Number of HIV-infected clients attending HIV care/treatment 2,466 services that are receiving treatment for TB disease Number of individuals trained to provide treatment for TB to 282 HIV-infected individuals (diagnosed or presumed)
Target Populations: Community-based organizations Faith-based organizations Doctors Nurses HIV/AIDS-affected families Non-governmental organizations/private voluntary organizations People living with HIV/AIDS National Health program and staff Laboratory workers Other Health Care Worker Doctors Laboratory workers Other Health Care Workers HIV positive infants (0-4 years) HIV positive children (5 - 14 years)
Table 3.3.07:
This activity complements ACONDA activities in Basic Health Care and Support (#10053 ), HIV/TB (#10338), ARV Services (#10070 ), and SI (#10075).
Since its creation in 2002, the Ivorian NGO of health professionals called ACONDA has provided innovative, comprehensive, family-based care services in support of the Ministry of Health PMTCT and HIV treatment programs. ACONDA's personnel has more than a decade of experience in HIV clinical and applied research, with a sustained focus on counseling and testing. ACONDA defines a holistic approach to care and seeks to provide a complete and integrated package of quality services that includes prevention (CT, PMTCT, secondary sexual prevention); adult, child, and family care (with provision of ART, OI prevention and treatment, and promotion of "positive living"); and psychosocial support and a continuum of care through links with local PLWHA and community organizations. ACONDA is also committed to improving the management of information to improve service delivery and promote sustainable quality services to reduce HIV-related morbidity and mortality in Cote d'Ivoire.
ACONDA is rapidly expanding its comprehensive family-based model and will provide ART to approximately 12,500 patients, including 1,365 children (11%), by March 2007. With ACONDA's contributions, Project HEART's five-year service-delivery goals were exceeded in the first 18 months. This substantial growth not only led to rapid growth in ACONDA's organizational capacity for service delivery but was also accompanied by reinforced capacity in management and financial systems, with substantial assistance from U Bordeaux/ISPED. In September 2006, ACONDA graduated to become an EP prime partner by winning a competitive EP/CDC award to provide comprehensive family care and PMTCT services. ACONDA will use FY06 funds to further strengthen its financial and management systems to ensure that it has the capacity to manage EP funds directly while maintaining strong partnerships with technical partner ISPED, EGPAF, and other collaborating partners.
Counseling and testing services are the doorway for HIV-infected individuals into ACONDA's comprehensive service program. In Cote d'Ivoire, approximately 29% of routine CT clinic patients are infected with HIV.
In FY06, ACONDA integrated CT services at 42 clinics, where it provided counseling and testing to 18,894 people. In FY07, ACONDA expects to expand the number of people who are counseled and tested, because it will provide CT services at 10 additional sites, and testing will be provider-initiated. Furthermore, each HIV-positive adult receiving a test will be counseled and asked whether their children or families can also be tested, and when a child tests positive, the parents will be asked to have tests done for all siblings. In collaboration with the rural development agency ANADER, ACONDA will also pilot community-based counseling services that are delivered via mobile testing units in rural areas. In all, ACONDA expects to provide counseling and test results for 35,784 people and to direct approximately 10,368 people who are seropositive to the appropriate services within its program.
Most of ACONDA's 42 CT sites were operated in FY06 in collaboration with EGPAF (two were operated with non-USG partners). With direct funding in FY07, ACONDA will establish 10 new programs in district hospitals, possibly including some in the northern part of the country. ACONDA will furnish the new sites with the appropriate equipment and will hire two counselors for each site. Counselors will be trained to provide peer-to-peer counseling to HIV-positive and HIV-negative individuals. The counselors will be able to provide effective education on the benefits of abstinence, fidelity and condom usage. The counselors will also play a key role in having people bring in their family members for testing.
ACONDA will also provide training to 215 community advisers and health providers within
the community and will work closely with CBOs and NGOs to provide them with technical assistance. Local NGOs and CBOs will be given sub-grants, in conjunction with Alliance CI, to provide psychosocial support and community-based C&T. This will generate innovative ways of reaching out to greater numbers of people with CT services in communities. These organizations also help ACONDA leverage additional funding, because the reach that ACONDA has through these partnerships is attractive to many donors.
New sites will be provided with tools for record-keeping, and the staff will receive training to use these tools. Staff at the new sites, and new staff at existing sites, will be brought up to speed on national guidelines. After these 10 new district hospitals are fully functional, CT services will be expanded to local health centers.
This program will also be linked with stand-alone CT services operated by other organizations or the government. ACONDA will accept all referrals for counseling, psychosocial support, clinical prevention, prevention education, care, and treatment services.
ACONDA and EGPAF will coordinate as the ACONDA program splits off to become an independent prime partner under the EP, and they will coordinate the scale-up of their programs with the MOH in strategic geographic areas.
ACONDA will work to strengthen its monitoring and evaluation system and to support an integrated national M&E system. It will adhere to national standards, will remain an active member of the CT and other technical consultative forums, and will provide input to improve national policies according to evidence-based practices. ACONDA will also remain an active member of the national commodities coordination committee for HIV-related commodities.
This activity complements ACONDA activities in CT (#10063 ), Basic Health Care and Support (#10053 ), HIV/TB (#10338), and SI (#10075).
Since its creation in 2002, the Ivorian NGO of health professionals called ACONDA has provided innovative, comprehensive, family-based care services in support of the Ministry of Health PMTCT and HIV treatment programs. ACONDA's personnel has more than a decade of experience in HIV clinical and applied research, with a sustained focus on antiretroviral treatment. ACONDA defines a holistic approach to care and seeks to provide a complete and integrated package of quality services that includes prevention (CT, PMTCT, secondary sexual prevention); adult, child, and family care (with provision of ART, OI prevention and treatment, and promotion of "positive living"); and psychosocial support and a continuum of care through links with local PLWHA and community organizations. ACONDA is also committed to ongoing applied research to improve service delivery and promote sustainable quality services to reduce HIV-related morbidity and mortality in Cote d'Ivoire.
Through its holistic program, ACONDA has cared for 12,500 people on ART with EP support. It continues to bring patients into its program for the full range of comprehensive care, treatment, and prevention services. In FY07, ACONDA will provide ART to approximately 22,800 patients, including 2,280 pediatric patients. These patients will be able to access services at any one of ACONDA's 38 sites supported with FY06 funds, along with 10 new sites that will be supported with FY07 funds.
ACONDA will ensure that HIV-positive individuals undergo clinical and biological assessments (CD4 count measurement) to determine clinical staging and eligibility for ART initiation. Patients who are eligible will be put on ART according to the national ART guidelines. The patients will be followed up after three months and then every six months to monitor side-effects and assess adherence and efficiency of treatment (using CD4 count increase).
ACONDA's treatment program will build on its holistic model while focusing on treatment eligibility, efficacy, and adherence issues. Treatment support will begin with short educational courses at clinical sites for patients who have been prescribed ARV treatment. Next, a pharmacist or drug dispenser will provide informal case management and treatment adherence counseling. In addition, children will be provided special child-friendly treatment adherence counseling by trained specialists. ACONDA's home-based care program will provide additional adherence support for patients in their homes and through community-based family-support programs. Finally, patients will be able to join support groups that will meet regularly and provide an additional means to support treatment adherence.
Infants who are diagnosed early with HIV infection will also be assessed for ART initiation and will be provided with a complete package of care. ACONDA will identify local foods
that can be substituted in the diets of pediatric patients who are being weaned off breast milk, and counselors will provide information to patients on diet changes.
CBOs, NGOs, and other institutions providing specific interventions will be identified and given grants, in conjunction with Alliance CI, to help ACONDA support patients in their communities. During home visits, these sub-grantees will provide palliative care, psychological support, adherence support, nutritional counseling, mosquito bed nets, and even some micro financial support through income-generating activities. These sub-partner organizations will also help develop community-mobilization activities and will network with health-center teams to provide linkages among clinical HIV care, community support, and wraparound services.
ACONDA will work to strengthen its monitoring and evaluation system and to support an integrated national M&E system. ACONDA's software, MONISTAC, will be adapted for use as the national patient monitoring and management system. ACONDA will adhere to national treatment standards, will remain an active member of treatment and other technical consultative forums, and will provide input to improve national policies according to evidence-based practices.. ACONDA will also remain an active member of the national commodities coordination committee for HIV-related commodities.
Additional Background on ART-Related Training In FY07, ACONDA will train 282 providers in ART. It will strengthen the expertise of its clinicians with the following: 1. Training for new clinicians to provide a solid foundation of knowledge, followed by adherence and treatment regimen training. After this, weekly training will be offered to the clinicians during the first month. The training will transition to monthly follow-up and training until the clinicians are fully trained on all treatment regimens. 2. Clinical specialists will provide technical assistance monthly to the newly trained clinicians for case follow-up and monitoring of treatment complications. 3. Monthly meetings will be organized to provide clinicians and other staff the opportunity to exchange information on the services they are providing. This will provide clinicians an opportunity to air their concerns. 4. ACONDA will train staff on early diagnosis of pediatric HIV through PCR. 5. Practical training on ART will be done at CEPREF (ACONDA's health center). Methodological support will be included to follow up on procedures and other recommendations.
ACONDA will also be working with the government of Cote d'Ivoire on national guidelines on ART management.
This activity complements ACONDA activities in CT (#10063 ), Basic Health Care and Support (#10053 ), HIV/TB (#10338), and ARV Services (#10070).
Since its creation in 2002, the Ivorian NGO of health professionals called ACONDA has provided innovative, comprehensive, family-based care services in support of the Ministry of Health PMTCT and HIV treatment programs. ACONDA's personnel has more than a decade of experience in HIV clinical and applied research, with a sustained focus on monitoring and evaluating its program. ACONDA defines a holistic approach to care and seeks to provide a complete and integrated package of quality services that includes prevention (CT, PMTCT, secondary sexual prevention); adult, child, and family care (with provision of ART, OI prevention and treatment, and promotion of "positive living"); and psychosocial support and a continuum of care through links with local PLWHA and community organizations. ACONDA is also committed to improving the management of information to improve service delivery and promote sustainable quality services to reduce HIV-related morbidity and mortality in Cote d'Ivoire.
ACONDA is rapidly expanding its comprehensive family-based model and will provide ART to approximately 12500 patients, including 1,375 children (11%), by March 2007. With ACONDA's contributions, Project HEART's five-year service-delivery goals were exceeded in the first 18 months. This substantial growth not only led to rapid growth in ACONDA's organizational capacity for service delivery but was also accompanied by reinforced capacity in management and financial systems, with substantial assistance from U Bordeaux/ISPED. In September 2006, ACONDA graduated to become an EP prime partner by winning a competitive EP/CDC award to provide comprehensive family care and PMTCT services. ACONDA will use FY06 funds to further strengthen its financial and management systems to ensure that it has the capacity to manage EP funds directly while maintaining strong partnerships with technical partner ISPED, EGPAF, and other collaborating partners.
The main objective of ACONDA's M&E strategy is to use all relevant tools and procedures to ensure that patients can be effectively managed within the comprehensive-care system. ACONDA has been using a data-management system at all of its sites for the past three years. The system, based on a 10-year history of providing services and doing research in Cote d'Ivoire, was designed to optimize the capability of sites to follow patients closely. ACONDA assigns one focal point to each of the district hospitals where it works, who in turn trains others and provides regular supportive supervision to keep checks on the data that is recorded. In FY06, ACONDA trained 36 data clerks (called AMDs), three focal points, and three nurses who specialize in epidemiology (called CSEs). Through its data-management system, ACONDA monitors patient tracking information as well as information that is needed by the EP, EGPAF, ISPED, the national care and treatment program (PNPEC) and the MOH (DIPE).
The data-management system will be made available to the 10 district hospitals in which in which ACONDA will add HIV/AIDS activities in FY07. In many cases, this will require ACONDA to provide computers, other equipment, and training that will allow the new sites to use the system. In addition to rolling this system out to the new sites, ACONDA will strengthen monitoring activities at its 38 existing ART sites by providing refresher training and monthly supervision. In all, ACONDA's FY07 activities will train 480 people in strategic information and provide 48 local organizations with technical assistance for strategic-information activities. ACONDA will also implement the following activities: 1. Other management tools will be designed or modified for each district based on data-management needs. These tools will allow service sites to better monitor patients and manage registers, forms, and drug stocks. 2. District teams will be formed and will be responsible for ensuring data recording, data transfer to the district team location, electronic recording and processing, and reports editing. ACONDA will provide strong support to the district teams to enable them to
supervise this effort. The district teams will prepare monthly reports that include information related to all aspects (quantitative and qualitative) of ACONDA's program. Reports will be sent to the regional level and to PNPEC, to feed into national data-collection efforts. 3. A network will be set up between ACONDA and the district teams. 4. Technical support for data analysis will be provided by the University of Bordeaux. 5. A team (made of AMD-CSE focal points, who serve on the district teams) will be trained to better manage data. The training will be provided by the ACONDA M&E team in a five-day session followed by a 10-day practicum. 6. A quarterly workshop will be held with the M&E team and field staff to talk about practical issues in the field and appropriate solutions. 7. An annual meeting will be organized to review M&E activities at all sites. 8. The ACONDA SI team will attend specific workshops, conferences, or classes that bolster their technical capacity.
ACONDA will feed into national data-collection systems for drug and supply-chain management. The patient-management system that is currently used at its sites will be interfaced with the system that the Partnership for Supply Chain Management Systems will be sharing with all care and treatment programs in Cote d'Ivoire in FY07. In addition, the PMMS ACONDA software has been selected for use at the national level, and ACONDA will assist the national program to develop additional measures as necessary.
