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: 2008 2009
ICAP-Cote d'Ivoire (ICAP-CI) supports the Ivorian Ministry of Health to expand the availability of a basic
package of HIV services at health facilities in five regions in the midwestern part of the country: Marahoue,
Sud Bandama, Fromager, Haut Sassandra and Worodougou.
ART services will be initiated at health facilities where there is at least one medical doctor, according to the
national guidelines. PMTCT services will be offered at antenatal clinics and CT at all health facilities,
including at the infirmary of prisons, and TB clinics.
By March 2009, ICAP anticipates initiating a full package of CT, PMTCT, palliative care, and ART services
at 28 facilities, and PMTCT services at an additional seven facilities (35 in total).
With FY09 funding, ICAP will continue to support all 35 facilities and expand to an additional 18 PMTCT
facilities for a total of 53 sites providing PMTCT services. In FY09, 34,000 pregnant women will be tested for
HIV and receive their results at ICAP-CI supported sites, and an estimated 1,360 HIV-infected pregnant
women (based on a 4% prevalence rate) will receive a complete course of ARV prophylaxis. All pregnant
women testing HIV positive will be offered CD4 testing and those who are eligible for HAART will initiate
their treatment during pregnancy.
ICAP will support sites to provide family-centered PMTCT services, using antenatal care (ANC) and other
maternal and child health (MCH) services as a key entry point. ICAP's capacity-building approach, focusing
on district- and facility-level systems strengthening and provider training and mentoring, will help ensure
long-term sustainability.
Interventions will include:
• Conducting initial assessments in collaboration with Ministry of Health and District authorities and
developing work plans for establishing and/or improving PMTCT Services according to national guidelines.
This will include developing a plan for reorienting services to ensure that the PMTCT cascade is effectively
implemented (e.g. ensuring CD4 testing the same day as HIV test results, coordinating ANC visits with care
and treatment visits for pregnant women initiated on ART , etc).
• Providing training and on-site clinical mentoring for 200 nurses, midwives, social workers, counselors, and
medical doctors on PMTCT and conducting on-site mentoring for initiation of services following
implementation:
60 trained in PMTCT, 70 in nutrition, and 70 in early infant diagnosis (DBS).
• Supporting sites to provide quality group and individual pre- and post-test counseling to maximize consent
for HIV testing, receipt of results, and enrollment in and adherence to the PMTCT program. A routine opt-
out testing approach will be adopted.
• Providing counseling and testing to pregnant women presenting to the facility for the first time during labor.
• Supporting sites to develop systems to ensure that HIV-infected pregnant women are promptly assessed
for ART eligibility, receive routine CD4 cell count testing, and are provided with the array of services
appropriate to their disease stage, including ART when indicated.
• Supporting sites to provide enhanced counseling on disclosure, couples counseling, prevention, family
planning, nutrition, infant feeding, and adherence. In line with a family-centered care model, women will be
strongly encouraged and supported to bring their children, their partners and other family members to the
facility for testing.
• Developing systems for linking PMTCT, care, and ART services to ensure that all pregnant women testing
HIV-positive are enrolled in care and treatment and receive ongoing care after delivery.
• Supporting facilities to establish systems for identifying and tracking women lost to follow-up and
supporting adherence to ARV prophylaxis and ART, including linkages to PLWHA organizations and
community-based support programs.
• Supporting sites to establish/strengthen links with community-based organizations to ensure community-
based
patient support to ensure adherence to the prescribed prophylactic regimen, nutritional support, and other
services; at each PMTCT site, at least one community-counselor will be identified, trained and will be
involved in follow up of pregnant women; ICAP will introduce a community resource mapping tool and
support sites to develop formal agreements and referral systems with relevant organizations.
• Ensuring effective exposed-infant follow-up, including initiating 90% of all exposed infants on
cotrimoxazole, growth monitoring, and early infant diagnosis using DNA PCR.
•Supporting sites to enroll HIV-positive infants into care and treatment services. Sites will also create
linkages with community based OVC services for all exposed and infected children.
• Collaborating with districts to support the initiation of PMTCT services and ongoing supervision and quality
improvement.
• Supporting sites to implement patient record-keeping systems and databases and to summarize and
analyze data for routine reporting, using national tools. A data quality assurance system will be
implemented, and ICAP technical advisers will assist sites to analyze data regularly to assess program
quality. This will include the introduction of registers that will allow sites to track mother/infant pairs
throughout the PMTCT cascade of services. ICAP will meet regularly with the MOH to provide feedback on
PMTCT-related M&E tools and approaches to help improve the national system of data collection and
reporting.
• Collaborating with SCMS and the National Public Health Pharmacy (PSP) to ensure effective forecasting
of
medications and test kits and to ensure timely delivery and management of drug and commodities stocks.
• Providing food and nutritional supplements to 600 mothers and children (a combination of nutritional
therapy, protein enriched foods, enriched flour, etc.)
At all PMTCT, ART, and CT sites, ICAP will contract with local organizations to ensure the participation of
community-based counselors dedicated to providing a comprehensive package of HIV prevention
interventions for all clients and effective referrals for PLWHA and their children.
All clients who test HIV-negative will be referred (on an opt-out basis) to a counselor for BCC interventions
focusing on ABC methods of risk reduction, as well as partner testing and STI prevention and care. HIV
Activity Narrative: positive
clients will be referred (on an opt-out basis) to a counselor for individual counseling that will include
ABC prevention interventions (including disclosure of HIV status, partner and family testing, and STI
prevention and care)
and referral to community-based OVC and palliative care services to address family and individual care
needs. Where possible, family-planning services will be provided through wraparound programming by non-
PEPFAR funded partners, and condoms will be provided free of charge.
All HIV-positive clients will be offered information about and referrals to specific community-based OVC
care and palliative care services tailored to their needs. ICAP will ensure that community-based services
capable of meeting these needs are identified, and ICAP will be responsible for monitoring and reporting on
referrals according to a nationally standardized referral system.
ICAP will continue its collaboration with nutritional partners (National Program of Nutrition, PATH) to
improve nutritional services for exposed infants, according to national guidelines. All HIV positive pregnant
women, before delivery, will receive individual counseling regarding infant feeding, according to national
and international (WHO) guidelines. Malnourished adults and children will receive nutritional support.
ICAP-CI is committed to ensuring long-term sustainability of its programs, and its main goal is to build and
strengthen capacity of Ivorian health systems, programs, and health-care workers to implement
comprehensive HIV services. At the district level, ICAP will support the district health management teams
(Equipe Cadre de District) to plan, implement, and supervise HIV services. ICAP will also provide
infrastructure and training support to key functions within the district critical to HIV service delivery, such as
the district pharmacy and the CSE (Charge de Surveillance et Epidemiologie). At the health facility level,
ICAP will improve infrastructure through the purchase of necessary medical equipment and supplies and
will support renovations to consultation rooms, labs, and pharmacies to better support HIV service delivery.
Strengthening human capacity is also a priority and will be accomplished through theoretical and practical
training of nurses, physicians, midwives, counselors, pharmacists, and other staff in HIV services provision.
Using a clinical mentorship approach, ICAP will also provide ongoing support to multidisciplinary teams at
sites to ensure continuous quality improvement, including the introduction of quality improvement tools that
staff themselves can use to assess the quality of services and develop quality improvement plans. As part
of this process, site staff will be mentored to use program data for clinical and program decision-making.
Over time, following clinical mentorship and participatory quality improvement processes, the need for
outside technical support will diminish. In addition, the mentorship role will be transferred to the district
health management teams. Finally, ICAP will be signing subcontracts for community-based services with
local NGOs and, in addition to enhancing their technical capacity, will strengthen their capacity in program
and financial management.
New/Continuing Activity: Continuing Activity
Continuing Activity: 16768
Continued Associated Activity Information
Activity Activity ID USG Agency Prime Partner Mechanism Mechanism ID Mechanism Planned Funds
System ID System ID
16768 16036.08 HHS/Centers for Columbia 7220 7220.08 International $654,000
Disease Control & University Center for AIDS,
Prevention Care and
Treatment
Program (ICAP)
16036 16036.07 HHS/Centers for Columbia 7319 7319.07 UTAP $400,000
Disease Control & University
Prevention
Emphasis Areas
Gender
* Increasing gender equity in HIV/AIDS programs
Health-related Wraparound Programs
* Child Survival Activities
* Family Planning
* Safe Motherhood
Human Capacity Development
Estimated amount of funding that is planned for Human Capacity Development $250,000
Public Health Evaluation
Food and Nutrition: Policy, Tools, and Service Delivery
Estimated amount of funding that is planned for Food and Nutrition: Policy, Tools $50,000
and Service Delivery
Food and Nutrition: Commodities
Economic Strengthening
Education
Water
Table 3.3.01:
Facility-based health services represent a critical opportunity to impact client behavior through clear,
authoritative health messages delivered in one-on-one or small-group settings, as well as to connect clients
effectively with community-based care services. To use the opportunity to reduce risk behavior and thus
HIV transmission, all ICAP supported sites will ensure that their package of services includes HIV
prevention behavior-change communication interventions promoting risk reduction through abstinence,
fidelity, correct and consistent condom use, status disclosure, partner testing, and STI prevention and care
targeting both HIV-positive and HIV-negative clients. In addition, they will ensure that all HIV-positive clients
are offered effective, monitored referrals to community-based OVC and palliative care services.
HIV-negative clients at PMTCT and CT sites:
All clients who test HIV-negative will be referred (on an opt-out basis) to a community counselor for
behavior change communication interventions, delivered individually or in small groups, focusing on risk
reduction through abstinence and fidelity, with correct and consistent condom use for those engaged in high
-risk behavior, as well as partner testing and STI prevention and care. For adolescents, messages about
delay of sexual debut and abstinence will be alongside messages about correct and consistent condom
use.
HIV-positive clients at PMTCT and ART sites:
Addressing prevention with HIV-positive patients is an important part of a comprehensive prevention
strategy. Through healthy living and reduction of risk behaviors, these prevention interventions can
substantially improve quality of life and reduce rates of HIV transmission. The goal of these interventions is
to prevent the spread of HIV to partners and infants born to HIV-infected mothers and to protect the health
infected individuals.
At all clinical visits, clients who are HIV-positive will be referred (on an opt-out basis) to a community
counselor for individual counseling that will include HIV prevention interventions and referral to community
OVC and palliative care services. Targeted HIV prevention counseling will focus on risk reduction
through abstinence, fidelity, correct and consistent condom use, disclosure, testing of partners and children,
and STI prevention and care. Family-planning counseling and services will be provided to patients and their
partners through wraparound programming by other non- PEPFAR funded partners. Condoms will be
provided free of charge.
In addition, all HIV-positive clients will be offered information about and referrals to specific community-
OVC care and palliative care services tailored to their individual needs. ICAP will ensure that
community-based services capable of meeting these needs are identified and will be responsible for
monitoring and reporting on referrals.
In collaboration with local organizations, ICAP will involve community-based counselors so that every site
provides this prevention and referral package to all clients.
ICAP will organize community sensitization and counseling and testing campaigns in the SSSU targeting
adolescents in middle and high schools and encouraging them to adopt safer sexual behavior: abstinence,
delay of sexual debut and fidelity for HIV prevention, alongside messages about correct and consistent
condom use. In addition, ICAP's adherence and community linkages team will assist and support schools
surrounding targeted health facilities to initiate or reinforce HIV/AIDS clubs. The clubs will be supported to
conduct HIV/AIDS awareness campaigns, HIV/AIDS conferences, and radio sensitization campaigns.
Counselors affiliated with the care and treatment sites will be trained to assess and address sexual risk
behavior and to deliver tailored AB messages using culturally appropriate visual aids. In each of these
interventions, patients are encouraged to remain abstinent to protect their own health and avoid
transmission to partners. Patients who are sexually active are also encouraged to remain faithful to one
partner. Abstinence is also promoted in the family planning and STI trainings as a method of preventing
pregnancy and STI transmission. Community counselors at sites will manage prevention-related community
awareness activities targeting community leaders, parents and other community members during routine
home visits, community outreach and support groups. The focus will be on messages to youth, especially
young women and girls, in order to reduce their vulnerability (reduce unwanted pregnancy, HIV infection,
and sexual violence). Parents will be sensitized to the need to enroll their daughters in school and the
benefits of delaying sexual debut and marriage.
ICAP will supervise, monitor and report on these activities in close collaboration with the health districts.
Activity Narrative: health management teams. Finally, ICAP will be signing subcontracts for community-based services with
Continuing Activity: 16525
16525 16525.08 HHS/Centers for Columbia 7220 7220.08 International $100,000
* Addressing male norms and behaviors
* Reducing violence and coercion
Estimated amount of funding that is planned for Human Capacity Development $75,000
Table 3.3.02:
-risk behavior, as well as partner testing and STI prevention and care.
to prevent the spread of HIV to partners and infants born to HIV-infected mothers and protect the health of
counselor or peer educator for individual counseling that will include HIV prevention interventions and
referral to community based OVC and palliative care services. Targeted HIV prevention counseling will
focus on risk reduction through abstinence, fidelity, correct and consistent condom use, disclosure, testing
of partners and children, and STI prevention and care. Family-planning counseling and services will be
provided to patients and their partners through wraparound programming by other non- PEPFAR funded
partners. Condoms will be provided free of charge.
OVC care and palliative care services tailored to their individual needs. ICAP will ensure that community-
based services capable of meeting these needs are identified and will be responsible for monitoring and
reporting on referrals.
In collaboration with local organizations, ICAP will involve counselors to allow every site to provide this
prevention and referral package to all clients. Counselors will be trained to assess and address sexual risk
pregnancy and STI transmission.
HIV risk reduction counseling, including counseling about the importance of condoms, condom distribution
and condom demonstrations will be integrated into all HIV services offered at the health facility, and at other
service delivery points including family planning. Condoms (female and male) will be offered free of charge
to all patients after counseling and testing, especially for those who test HIV positive. In addition, condoms
will be distributed during the support groups and community activities (e.g. outreach, meetings with
community leaders, prevention activities targeting young people and students)
Continuing Activity: 16770
16770 16770.08 HHS/Centers for Columbia 7220 7220.08 International $10,000
Estimated amount of funding that is planned for Human Capacity Development $25,000
Table 3.3.03:
package of HIV services at health facilities in 5 regions in the midwestern part of the country: Marahoue,
Sud Bandama, Fromager, Haut Sassandra, and Worodougou.
at 28 facilities, PMTCT services at an additional seven facilities, and CT services at another 15 facilities
(two prisons, three infirmaries, and 10 TB clinics).
With FY09 funding, ICAP will support this package of services at all FY08 sites and expand to an additional
15 facilities delivering palliative care and ART services, for a total of 43 sites providing care and support
services. By September 2009, the 43 facilities will have enrolled 8,900 HIV-infected adults into palliative
care services.
ICAP will also provide subgrant funding and technical assistance to several subpartners, including private
clinics, faith based clinics and PLWHIV association for HIV care and treatment services.
Adult care and support services for HIV-positive individuals will be provided by a multidisciplinary team of
providers,
will focus on caring for the whole family, and will be strongly integrated with CT (included routine provider-
initiated opt-out CT), PMTCT, and ARV services, as well as identification and referral to appropriate
services for orphans and vulnerable children (OVC).
ICAP's capacity-building approach, focusing on district and facility-level systems strengthening, and
provider training and mentoring, will help ensure long-term sustainability.
In FY09, adult care and support interventions will include:
•. ICAP will work with districts and facilities to identify staff needs, including materials and training. This may
include hiring certain staff, including data clerks, directly and detailing them to individual care and treatment
sites.
• Providing the necessary training, resources, and tools needed for staff to provide quality HIV care and
support
services will help motivate staff and encourage retention.
• Train in collaboration with PNPEC at least 112, nurses, social workers, counselors, and outreach workers
to deliver HIV care and support.
• ICAP will conduct intensive on-site mentoring during the initiation of services and regular follow-up
training and mentoring thereafter.
• Support sites to identify HIV-positive patients by strengthening HIV counseling and testing interventions,
including traditional VCT and routine provider-initiated CT (see Counseling and Testing section). ICAP will
also support sites to publicize the availability of HIV care and support services in the communities they
serve.
• Support sites to develop patient-flow algorithms, patient-appointment systems, and protocols related to
HIV care and support (e.g. CD4 schedule for pre-ARV patients, OI prophylaxis and treatment, etc).
• Support the formation and functioning of Multidisciplinary Team Meetings to discuss complicated cases,
including those failing treatment, and to coordinate individual patient care.
• Support District laboratories and pharmacies to improve their stock management procedures to avoid
stock outs of reagents and ARVs.
• Promote OI prophylaxis and treatment in accordance with MOH/National HIV/AIDS Care and Treatment
Program (PNPEC) guidelines: cotrimoxazole will be offered to HIV infected patients according to the
national guidelines. The USG remains an advocate for promoting universal (or at least expanded
qualification to include CD4 <500) cotrimoxazole for all HIV infected patients. Discussions with the MOH on
this issue are ongoing. Similarly, TB screening will be promoted for HIV infected adults and children.
• Ensure strong linkages between HIV care and support services and other services within the facility, such
as inpatient
wards, the outpatient department, VCT, PMTCT, TB, under-5 clinic, and family planning. Routine opt-out
HIV testing
will be offered to all patients in these services, and those testing HIV-positive will be immediately
enrolled in the care and treatment program and initiated on ART if eligible. HIV Program Management
Committees, including key staff representing various departments, will be established and will meet
regularly to coordinate services and cross-referrals.
•Ensure distribution of insecticide treated mosquito nets and water sterilization tablets to HIV infected
patients, especially for infants and pregnant women (in collaboration with SCMS and the Public Health
Pharmacy, PSP).
• Ensure routine weighing of patients enrolled in HIV care and treatment to better track weight loss and
signs of malnutrition. ICAP will purchase scales for each site and data managers will record each patients'
weight at each visit and document it in the patient chart. This will allow clinical staff to follow weight trends
for each patient, identify patients who are underweight, and provide nutritional counseling and food
supplements to those in need.
• Enhance adherence and psychosocial-support activities at care and treatment sites, including the
implementation of support groups and the use of peer educators. ICAP will work with RIP+ (the national
network of PLWHA
organizations) and local PLWHA organizations to replicate successful peer-education programs from other
countries (Rwanda, Swaziland, Ethiopia) to raise awareness about HIV testing and the availability of ARV
and care and support services, providing information and emotional support to patients receiving care and
support, and to conduct home visits to patients lost to follow-up.
• Work closely with SCMS and the Public Health Pharmacy (PSP) to ensure effective forecasting of needed
Activity Narrative: medications and test kits and to ensure timely delivery and accurate stock management.
• Work with health districts to support the initiation of HIV care and support services at sites and to provide
ongoing
supervision and quality-improvement monitoring.
• Support sites to implement patient record-keeping systems and databases and to summarize and analyze
data for routine reporting, using national tools. A data quality assurance system will be implemented, and
ICAP technical advisers will assist sites to analyze data regularly to assess program quality. ICAP will meet
regularly with the MOH at the central level to provide feedback on HIV care and support related M&E tools
and approaches to help improve the national system of data collection and reporting.
• Support sites to provide HIV prevention counseling for HIV-positive individuals enrolled in programs.
• Enhance counseling of HIV-infected individuals to promote secondary prevention, enhance adherence to
care and treatment, provide psychosocial support, link patients to community resources, and identify
household members in need of testing, treatment, and care, including children in need of OVC services.
ICAP will also ensure that patients have access to nutritional assessment and counseling.
• Support sites to establish and strengthen links with community-based organizations to ensure community
patient support for home-based care, OVC services, adherence support, nutritional support, and
other services. ICAP will introduce a community resource mapping tool and support care and treatment
sites to develop formal agreements and referral systems with relevant organizations.
ICAP will contract with local NGOs to hire and train peer counselors who will be assigned to all sites and
charged with ensuring effective referrals between services at the facility (i.e. from VCT to care), providing
emotional support, counseling clients about HIV prevention and adherence, and conducting home visits.
ICAP will develop a system at each site to reduce loss to follow up of patients receiving care and treatment
using the following strategies: first, ICAP will train community counselors at each site in adherence and
psychosocial support of patients and each patient will meet the counselor during their first visit; second,
ICAP will recruit an assistant data manager in each site who will be responsible for documenting patient
appointments, collecting detailed patient contact information, and identifying patients who do not return for
appointments and risk becoming lost to follow up; if a patient does not return for his appointment, the data
manager will alert the community counselor who will then attempt to trace the patient either by telephone or
a home visit; ICAP will furnish each site with motorcycles and bicycles to facilitate home visits; finally, other
services will be put implemented to support patient adherence, including bi-monthly support groups at each
site facilitated by the community counselors,
In order to ease access to HIV care and treatment services, ICAP will support sites and districts to sponsor
regular HIV/AIDS awareness campaigns with the aim of involving community leaders and reducing stigma
and discrimination. In addition, regular outreach by community counselors and peer educators will serve to
sensitize individuals, families and communities to the impact of stigma and discrimination. Finally, the
establishment of associations of PLWHA and support groups at sites will serve to reduce stigma in the
community and help HIV positive individuals cope with the daily stresses of living with HIV.
All HIV-positive clients will be offered information about and referrals to specific community based
OVC care and HIV care and support services tailored to their needs. With assistance from the National
OVC
Care Program (PNOEV) and the PEPFAR in-country team, ICAP will ensure that community-based services
referrals according to a nationally standardized referral system. Targeted HIV prevention counseling will
of partners and children,
and STI prevention and care. Where possible, family-planning counseling and services will be provided to
patients and their partners through wraparound programming by other non-PEPFAR funded partners, and
condoms will be provided free of charge. ICAP will emphasize involvement of districts in the planning,
implementation and evaluation of these services with the aim of capacity building and health systems
strengthening.
ICAP will report to the USG strategic information team quarterly program results and program data as
requested on an ad hoc basis. To participate in the building and strengthening of a single national M&E
system, ICAP will
participate in quarterly SI meetings and will implement decisions agreed upon during these meetings.
Continuing Activity: 16777
16777 16777.08 HHS/Centers for Columbia 7220 7220.08 International $350,000
* Malaria (PMI)
* TB
Estimated amount of funding that is planned for Human Capacity Development $200,000
Table 3.3.08:
In FY09, ICAP will support this package of services at all FY08 sites and expand to an additional 15
facilities delivering ART services, for a total of 43 sites providing ART services. ICAP-CU anticipates newly
initiating 3,800 adult patients on ART, for a total of 4,475 adult patients who ever received ART and at least
3,600 patients actively receiving ART by September 2009.
ICAP will contract with local community-based NGOs working on HIV/AIDS and PLWHA associations to
improve adherence and reduce rates of loss of follow-up, thereby improving outcomes of care and
treatment. ART services for HIV-positive individuals will be provided by a multidisciplinary team of providers,
who will focus on caring for the whole family, with referral to appropriate services for orphans and
vulnerable children (OVC). ICAP will also provide subgrant funding and technical assistance to several
subpartners, including private and faith based clinics for implementing HIV care services.
In FY09, ICAP-CU will continue to support sites to provide high-quality ART services following national
guidelines. The focus will be on treating families - not just the individual - to better meet patient needs and
to assure better adherence and clinical outcomes. Sites will be supported to shift the organization of their
facility from a traditional episodic model of care to a chronic model of care for HIV patients, using a
multidisciplinary team of providers. ICAP-CU will emphasize the involvement of PLWHA in programs
through peer-support interventions and strong linkages to community resources. ICAP-CU's capacity-
building approach, focusing on district- and facility-level systems strengthening and provider training and
mentoring, will help ensure long-term sustainability.
Key activities and approaches will include:
• Support sites to recruit and retain staff for ARV service provision. ICAP-CU will work with health districts
and
facilities to identify staff needs and, in collaboration with the Ministry of Health, find solutions for augmenting
staff. Providing the clinical training, resources, and tools needed for staff to provide quality ART services will
also help motivate staff and hopefully increase human resource retention.
• Train 112 doctors, to provide ART,
• Ensure intensive onsite mentoring to the multi-disciplinary team during the initiation of services, and
regularly scheduled follow-up training and mentoring thereafter.
• Support sites to identify HIV-positive patients by strengthening CT interventions, including routine provider-
initiated CT. ICAP-CU will support sites to publicize the availability of ART services in the communities they
• Support sites to develop patient-flow algorithms, patient-appointment systems, and protocols related to the
initiation of ART (e.g. number of appointments for pre- and post-ARV initiation, standard ARV prescriptions,
etc.).
• Develop protocols and systems (following international guidelines such as those recommended by the
WHO) for clinical staging of HIV patients and establishing eligibility for ART using national guidelines and
clinical staging, when appropriate.
• Support the formation and functioning of multidisciplinary team meetings to discuss complicated cases and
coordinate individual patient care.
• Help sites to provide effective support to patients prior to ARV initiation, such as counseling about HIV
status
disclosure, adherence, and peer support.
• Support sites to develop patient-tracking systems that will help to identify patients who have not returned
for pharmacy refill or other appointments. Protocols for patient home visits will be developed. ICAP-CU will
develop a program to train PLWHA as peer educators/counselors to support patients enrolled in ART
services and track patients who miss appointments or who are lost to follow-up. Peer educators will be
supervised by social workers or other staff.
• Ensure strong linkages within the facility and with community-based services. Referral mechanisms will be
developed between ART services and other services (inpatient and outpatient departments, CT, PMTCT,
TB, under-5 clinic, family planning). HIV testing will be routinely offered to all patients in these services. HIV
program management committees, including key staff representing various departments, will meet regularly
to coordinate services and cross-referrals.
• Support sites to establish/strengthen links with community-based organizations to ensure patient support
for home-based care, OVC services, adherence support, nutritional support, and other services. ICAP-CU
will introduce a community resource mapping tool and support sites to develop formal agreements and
referral systems with relevant organizations.
• Ensure availability of lab services for CD4 testing and to monitor drug toxicity. ICAP-CU plans to upgrade
all district hospital labs so they can provide CD4 testing for the entire district. ICAP-CU will support each
health district to develop an effective sample transportation system to ensure that patients at the health
center
receive CD4 results in a timely manner. Labs at all levels will have enhanced biochemistry and hematology
capacity.
• Work with SCMS and the Public Health Pharmacy (PSP) to support site pharmacies to establish systems
for ARV quantification, stock management, and patient appointments and to train pharmacists in counseling
patients about ART, including side effects and adherence. All ARV, OI drugs, and other commodities will be
Activity Narrative: procured by SCMS and distributed to sites via the PSP.
• Provide regular, supportive supervision, clinical updates, and refresher training to multidisciplinary care
teams and ART program managers, including the integration of M&E data into program planning and
data for routine reporting using national tools. A data quality-assurance system will be implemented, and
ICAP-CU technical advisers will assist sites to analyze data regularly to assess program quality. ICAP-CU
will meet regularly with the MOH at the central level to provide feedback on ART-related M&E tools and
approaches to help improve the national system of data collection and reporting. ICAP will continue to work
with URC on piloting quality improvement approaches.
ICAP will develop a system at each site to reduce loss to follow up of patients on treatment using the
following strategies. First, ICAP will train community counselors at each site in adherence and psychosocial
support of patients and each patient will meet the counselor during their first visit; second, ICAP will recruit
an assistant data manager in each site who will be responsible for documenting patient appointments,
collecting detailed patient contact information, and identifying patients who do not return for appointments; if
a patient does not return for his appointment, the data manager will alert the community counselor who will
then attempt to trace the patient either by telephone or a home visit; ICAP will furnish each site with
motorcycles and bicycles to facilitate home visits; finally, other services will be put implemented to support
patient adherence such as bi-monthly support groups at each site facilitated by the community counselors.
sensitize individual, families and communities to the impact of stigma and discrimination. Finally, the
establishment of associations of PLHA and support groups at sites will serve to reduce stigma in the
At all ART, PMTCT, and CT sites, ICAP-CU will provide - either through direct hire or by contracting with
individuals or local organizations - counselors dedicated to providing a comprehensive package of HIV
prevention interventions for all clients and effective referrals for PLWHA and their children. ICAP-CU will
engage enough counselors (funded in part through AB, Condoms and Other Prevention, OVC, and
palliative care funds) to allow every site to provide this prevention and referral package to all clients.
In collaboration with PNPEC, ICAP will also strengthen the capacity of its supported health districts to plan,
implement and supervise HIV related activities. This will include strengthening supervision and clinical
mentorship systems and skills, and enhancing district pharmacy capacity (training, IT, equipment, stock
management, transport to peripheral sites, etc.).
ICAP will also strengthen laboratory capacity at supported sites to enable them to perform recommended
laboratory monitoring tests for adult patients on ART. General Hospital laboratories with be equipped with a
complete package of HIV laboratory equipment (FacsCount, biochemistry and hematology). Selected urban
health care centers with important patient load will be equipped with hematology and biochemistry
machines and ICAP will support a blood sample transportation systems for CD4 count to the nearest
reference hospital.
All clients who test HIV-positive will be offered information about and referrals to specific services
appropriate to their needs. ICAP-CU will ensure that community-based services capable of meeting these
needs are identified, and ICAP-CU will be responsible for monitoring and reporting on referrals according to
a nationally standardized referral system.
Continuing Activity: 16992
16992 16042.08 HHS/Centers for Columbia 7220 7220.08 International $2,457,000
16042 16042.07 HHS/Centers for Columbia 7319 7319.07 UTAP $2,500,000
Estimated amount of funding that is planned for Human Capacity Development $800,000
Table 3.3.09:
package of HIV services at health facilities in 5 regions in the midwestern of the country: Marahoue, Sud
Bandama, Fromager, Haut Sassandra and Worodougou.
By the end of FY08, ICAP anticipates initiating a full package of CT, PMTCT, palliative care, and ART
services at 28 facilities, PMTCT services at an additional 7 facilities, and CT services at another 15 facilities
(2 prisons, 3 infirmaries, and 10 TB clinics).
facilities delivering ART services, for a total of 43 sites providing ART services. All 43 facilities will provide
pediatric care services and by September 2009, they will have enrolled 930 HIV-infected children into
palliative care services.
provider training and mentoring for providing pediatric care, will help ensure long-term sustainability
As part of this approach, ICAP will provide sub-grant funding and technical assistance to several partners,
including private clinics, faith based clinics and PLWHIV association for HIV care and treatment services.
Pediatric care services will include growth monitoring, immunization services, nutritional counseling, and
systematic cotrimoxazole prescription for exposed infants. Care and support services for HIV-positive
children will be provided by a multidisciplinary team of providers, will focus on caring for the whole family,
and will be strongly integrated with routine provider-initiated CT for the children of each enrolled HIV
positive woman, and all exposed children.
Specific interventions will include:
• Support districts and facilities to identify and augment staff necessary for provision of pediatric HIV care
and support services,
• Provide the training, resources, and tools needed for staff to provide quality pediatric HIV care and
support.
• In collaboration with PNPEC, train at least 112 doctors, nurses, social workers, counselors, and outreach
workers to deliver care and support.
• Conduct intensive on-site mentoring during the initiation of services and regular follow-up
training and mentoring.
• Support sites to identify HIV-positive children by strengthening HIV counseling and testing interventions,
including routine provider-initiated CT for children of each enrolled HIV positive woman and symptomatic
children, and offering early diagnosis for all exposed children.
palliative care for pediatric patients (e.g. CD4 schedule for pre-ARV patients, OI prophylaxis and treatment,
etc).
including those failing treatment, and to coordinate individual pediatric care.
Program (PNPEC) guidelines. Similarly, TB screening will be promoted for HIV-infected children.
•Support renovation at clinical care sites (clinics and hospitals) to create space for additional HIV/AIDS
services e.g. HIV testing and counseling for malnourished children.
• Ensure strong linkages between growth monitoring services, immunization services and nutritional
services where routine HIV testing will be offered to all children, and those testing HIV-positive will be
immediately enrolled in the care and treatment program and initiated on ART if eligible.
• Enhance adherence and psychosocial-support activities at clinical sites for mothers and their children and
ensure that
home visitsaresystematically conducted for patients who are lost to follow-up.
Pediatric medications and test kits and to ensure timely delivery and management of stocks.
• Work with health districts to support the initiation of pediatric care and support care services at sites and to
provide ongoing supervision and quality-improvement monitoring.
• Support sites to implement record-keeping systems and databases and to summarize and analyze
regularly with the MOH to provide feedback on HIV care and support -related M&E tools and approaches to
help
improve the national system of data collection and reporting.
• Enhance counseling of HIV-infected children and their guardians to promote secondary prevention,
enhance adherence to care and treatment, provide psychosocial support, link patients to community
resources, and identify household members in need of testing, treatment, and care, including children in
need of OVC services.
•Ensure that pediatric patients have access to nutritional assessment and counseling.
support and home-based care, OVC services, adherence support, nutritional support, and
other services.
• Contract with local organizations to engage counselors who will be place at each site to support pediatric
patients and their families.
• Implement procedures for early infant diagnosis at all sites, ensure that site staff are trained in early infant
diagnosis using DBS for DNA PCR, and set up a transportation system in collaboration with the district to
refer samples to the reference laboratories in Abidjan.
Activity Narrative: • Ensure that HIV-exposed infants are identified and maintained in care by setting up systems to identify
HIV-exposed children in PMTCT, Immunization, nutrition, and other care and treatment services.
• In collaboration with the PNPEC revise the maternal health card by incorporating information on maternal
HIV status to improve tracking of HIV-exposed children and those who are lost to follow up. Support sites to
provide cotrimoxazole to all HIV exposed infants at 6 weeks of age.
ICAP will collaborate closely with PATH and national partners (PNN, SASDE, PNCI, and PNOEV) to ensure
that nutritional services are available for HIV-exposed and HIV-infected children enrolled at all clinical sites
based on national guidelines. In addition, ICAP will provide counseling and nutritional support for all children
counseled and tested for HIV. HIV-positive children will be directly enrolled in HIV care and treatment
services.
ICAP will develop a system at each site to reduce loss to follow up of pediatric patients enrolled in care and
support using a range of strategies. First, ICAP will train community counselors at each site in adherence
and psychosocial support of patients and each patient will meet the counselor during their first visit; second,
ICAP will recruit an assistant data manager for each site who will be responsible for documenting patient
appointments; if a patient misses an appointment, the data manager will alert the community counselor
who will then attempt to trace the patient either by telephone or a home visit in an effort to reduce any loss
to follow up; ICAP will furnish each site with motorcycles and bicycles to facilitate home visits; finally, other
services will be put in place to support patient adherence such as bi-monthly support groups at each site
facilitated by the community counselors.
In collaboration with PNPEC, ICAP will also strengthen the capacity of its supported districts to plan,
mentorship systems and skills, and enhancing district pharmacy capacity (including training, IT, equipment,
stock management, transport to peripheral sites, etc).
New/Continuing Activity: New Activity
Continuing Activity:
Construction/Renovation
Estimated amount of funding that is planned for Food and Nutrition: Policy, Tools $10,000
Table 3.3.10:
package of HIV services at health facilities in 5 regions in the midwest of the country: Marahoue, Sud
Bandama, Fromager, Haut Sassandra, and Worodougou.
services at 28 facilities, PMTCT services at an additional seven facilities, and CT services at another 15
facilities (two prisons, three infirmaries, and 10 TB clinics).
pediatric treatment services and by September 2009, they will be providing ART services for at least 300
children.
ICAP has championed the cause of care and ART for pregnant women and children throughout the
programs it supports. It will continue to adapt and utilize well tested systems, tools, and procedures to
achieve this goal.
Pediatric support will focus on increasing availability of infant HIV diagnostics, enhancing pediatric case
finding and referral, ensuring comprehensive care and treatment services for HIV-exposed infants and for
HIV-infected infants and children, and increasing access to pediatric ART. Emphasis will be placed on full
involvement of families.
ICAP technical advisors will work closely with care and treatment sites to provide focused training and
clinical mentoring for pediatric care and treatment. Interventions will include:
• Assess lab services for pediatric diagnostics and design capacity-building plans. This will include assuring
the availability of dried blood spot diagnosis by DNA PCR via specimen referral to the regional or national
reference laboratory.
• Establish or strengthen HIV testing at entry points to pediatric services (inpatient wards, family-centered
care programs, CT programs, adult ART clinics, under-5 clinics).
• Strengthen referral mechanisms between ART clinic and entry points to pediatric services.
• Assess staff capacity for pediatric ART according national guidelines and provide targeted supplementary
training.
• Strengthen care services (including staging, cotrimoxazole prophylaxis, nutrition and growth monitoring,
parental counseling, social and adherence support) for all HIV-exposed and HIV-infected children.
• Assess feasibility of co-located services and/or coordinated appointment scheduling for HIV-infected
women and their children.
• Work closely with SCMS and PSP to ensure a seamless supply of pediatric ARV and OI drug formularies.
• Establish pediatric and family support groups.
• Establish or strengthen links to community-based services for infants and children, including nutritional
support and OVC services.
• Establish procedures for early infant diagnosis at all sites and ensure that site staff are trained in early
infant diagnosis using DBS for DNA PCR and set up a transportation system in collaboration with the district
to refer samples to the reference laboratories in Abidjan.
• Ensure that HIV-exposed infants are identified and maintained in care by setting up systems to identify
HIV-exposed children in PMTCT, immunization, nutrition, and other care and treatment services. In
collaboration with the PNPEC revise the maternal health card by incorporating information on maternal HIV
status to ease tracking of HIV-exposed children and those who are lost to follow up. Support sites to provide
cotrimoxazole to all HIV exposed infants at 6 weeks of age.
that nutritional services are available for HIV-exposed and HIV-infected children enrolled at all sites based
on national guidelines. In addition, ICAP will provide counseling and nutritional support for all children
an assistant data manager for each site who will be responsible for documenting patient appointments,
a patient misses an appointment, the data manager will alert the community counselor who will then attempt
to trace the patient either by telephone or a home visit in an effort to reduce any loss to follow up; ICAP will
furnish each site with motorcycles and bicycles to facilitate home visits; finally, other services will be put in
place to support patient adherence such as bi-monthly support groups at each site facilitated by the
community counselors,
mentorship systems and skills, and enhancing district pharmacy capacity.
Activity Narrative: will support renovations to consultation rooms, labs, and pharmacies to better support HIV service delivery.
Estimated amount of funding that is planned for Human Capacity Development $150,000
Table 3.3.11:
including at prison infirmaries and TB clinics.
services at 28 facilities and 10 TB clinics.
facilities delivering ART services, for a total of 43 sites providing ART services. Additionally, TB/HIV
services will be delivered at three new TB clinics for a total of 13 TB diagnosis and care clinics (CDT).
At all 43 sites, ICAP will ensure that intensified TB case finding is consistently done among all the patients
enrolled in HIV care and treatment at enrollment and follow up visits, and that those who screen positive by
symptoms are properly managed, including provision of or referral for smear microscopy, chest x-ray, and
TB culture according to national guidelines using appropriate interventions.
In addition, ICAP will ensure—either directly or in coordination with other implementing partners (PEPFAR
and GF)—that at least 80% of all TB suspects, either at the on-site TB clinic or at referring TB treatment
facilities (CAT and all CDTs in the supported area) are tested for HIV and that those testing positive are
enrolled in care and treatment.
Proven TB/HIV integration approaches and tools from ICAP such as a simple TB screening tool developed
in Rwanda and adapted for Côte d'Ivoire will be implemented. ICAP-CI will work closely with PNLT to
validate this tool at the national level. ICAP will also focus on promoting and supporting infection control
procedures that minimize risk of transmission of TB and that protect health care workers from nosocomial
TB infection. ICAP's capacity building approach, focusing on district and facility-level systems
strengthening, and provider training and mentoring, will help ensure long term sustainability.
An ICAP TB/HIV adviser will work closely with PNLT, the regional TB treatment center (CAT) and care and
treatment site teams to provide focused training and clinical mentoring for integration of TB/HIV care and
treatment.
• Ensuring that minor renovations are completed taking into account fundamental infection control principles
that are appropriate for resource-limited settings to prevent nosocomial transmission of TB reducing the risk
of infection of patients and health care workers.
• Support for laboratories to conduct appropriate diagnostics for TB in the context of HIV co-infected
patients, ensuring that all the 13 TB diagnostic sites have functional microscopes and that staff are
competent
in smear microscopy.
• Provide intensive training and on-site mentoring on TB/HIV integration activities with focus on provider-
initiated counseling and testing for all TB patients, 100% routine TB screening among all patients enrolled in
HIV
care and treatment, linkages and cross referrals between programs, and adherence and follow-up for co-
infected
patients.
• Sites will be supported to introduce and continue using a standardized TB screening questionnaire for
intensified TB case finding in HIV-infected patients and to providing routine TB screening, prevention, care,
and referrals for all patients enrolled in care and treatment.
• Sites will be supported to implement provider initiated HIV testing and counseling (moving toward an opt-
out
approach), prevention education, and referral for HIV care, if needed, for all TB patients. Staff at the TB
clinics will be trained in PITC using the training material developed by CDC/ WHO, which has been already
translated in French and adapted.
• Implement systematic, preventive cotrimoxazole therapy for all (100%) HIV co-infected TB patients at TB
clinics.
• For all children under 5 and all infected children, a screening algorithm will be adapted to include history of
tuberculosis related symptoms, clinical indicators suggestive of tuberculosis, and history of TB contacts
within and outside the household. The application of TST testing will be reviewed to determine the feasibility
efficacy of evaluating latent TB infection status in this population..
• In addition to direct evaluation of TB risks in the pediatric patient population, the routine TB screening
questionnaire mentioned above will be administered to the adult caregivers of all children testing HIV
positive. Most children are
exposed to TB through adult caregivers within the household and in child care settings. Adults with a
positive screening questionnaire will be referred for further evaluation. All pediatric household members will
be screened for HIV as well as TB.
• Ensure adherence with both TB and HIV treatment in order to achieve optimal patient outcomes.
ICAP will work with care and treatment sites to develop innovative approaches to adherence support such
as DOTs or using peer educators to conduct patient follow up. ICAP will also work closely with SAPHARM
and others NGOs and CBOs to ensure community based support for TB and HIV patients.
• Ensure the implementation of data collection instruments developed by the national TB program (PNLT) to
monitor and evaluate HIV/TB screening, diagnosis, and treatment activities at all ICAP supported sites.
• Ensure that linkages between HIV and TB clinics are established and strengthened at all ICAP supported
Activity Narrative: The multidisciplinary care teams in each facility will include representation from the TB service. Mechanisms
to facilitate referral will be introduced, supportive supervision will be provided, and activities will be closely
assisted and monitored by ICAP-CU technical experts.
Continuing Activity: 16778
16778 16040.08 HHS/Centers for Columbia 7220 7220.08 International $425,000
16040 16040.07 HHS/Centers for Columbia 7319 7319.07 UTAP $200,000
Table 3.3.12:
ICAP-Columbia University will develop strong mechanisms and services targeting OVC and their families in
the health districts they support. At each PMTCT and VCT site, peer educators will be trained and
supported to identify OVC in the surrounding community, including both in and out of school children and
youth. The peer educators and staff from care and treatment sites will identify and register OVC during
routine outreach and home visits, particularly visits to HIV positive patients enrolled in care and treatment
and PMTCT programs.
ICAP will introduce national OVC tools, such as registers and identification cards, at each site to ensure
proper documentation of OVC enrollment and services provision. ICAP anticipates enrolling approximately
800 OVC who will be referred for other community based services as available and appropriate.
Health personnel at ICAP supported sites will offer information to all enrolled patients about the availability
of OVC services for them or for their family members and will make referrals to specific community-based
OVC care services tailored to their individual needs. They will also inform patients that services are free for
those enrolled and with an enrollment card. In these individual sessions, the counselor will seek to obtain
contact information (e.g. address, telephone number) for the client and briefly assess the client's needs and
resources. The counselor will provide the client with a brochure or other illustrated materials showing what
the palliative care and OVC care services might include, such as clean water and bed nets for palliative
care and educational, medical, nutritional, legal, and psychosocial support for OVC. The counselor will then
ask the client whether she or he would like to provide the names of people in the household who might need
referral to such services.
ICAP will support each site to establish a list of services available to OVC and their families in the
surrounding community including, legal services, nutritional support, emotional support, micro-finance,
support for school fees, etc. In addition, through community sensitization campaigns and routine outreach
by peer educators and other site staff, sites will engage key religious and other opinion leaders to mobilize
community support for OVC. These efforts will also serve to address stigma and discrimination against
PLHA and OVC in the community. In collaboration with NGOs such as WPF and Caritas and local
associations of PLHA, ICAP-supported sites will distribute food supplements, school fees, and clothing to
OVC and vulnerable families. Finally, all OVC and family members will be encouraged to participate in
support groups at care and treatment sites.
OVC services will be integrated into all HIV services at each site. For instance, HIV counseling and testing
programs will refer HIV positive clients to OVC services, and counseling and referral for HIV testing will be
offered to all OVC and/or their guardians. Integrating HIV prevention into OVC services will be emphasized
for adolescent clients. To ensure that staff at sites are sensitive to the needs of OVC, health personnel from
all ICAP-supported sites, particularly physicians and pediatricians, will be trained in pediatric HIV care and
With assistance from the National OVC Care Program (PNOEV) and the PEPFAR in-country team, ICAP
will ensure that community-based services capable of meeting these needs are identified, and ICAP will be
responsible for monitoring and reporting on referrals according to a nationally standardized referral system.
Health workers will be trained in pediatric HIV/AIDS management and care and will be encouraged to
facilitate access to OCV services in ICAP assisted regions. In addition to the training, each facility will
receive a copy of the national pediatric care and treatment guide. ICAP will place particular emphasis on
early infant diagnosis and on the initiation of cotrimoxazole at 6 weeks of age for all exposed infants. In
addition, ICAP will continue to collaborate with PATH to provide nutritional support to exposed infants, in
compliance with national guidelines and recommendations.
In collaboration with PNOEV, ICAP will support the training of at least one community counselor from each
ARV treatment site, in addition to social workers. A total of 50 people will be trained in OVC care. These
trained staff will then work with PNOEV in each region to develop a plan for OEV services in their respective
Districts, in collaboration with District Health Authorities. All OVC activities will be reported monthly by the
community counselors and the data reviewed and approved by the district health officers (Directeurs
Departementaux) before being reported to ICAP.
Continuing Activity: 17122
17122 17122.08 HHS/Centers for Columbia 7220 7220.08 International $60,000
Estimated amount of funding that is planned for Human Capacity Development $50,000
Table 3.3.13:
services at 28 health facilities, two prisons, three infirmaries, and five rural health centers.
In FY09, ICAP will support this package of services at all 38 FY08 sites and expand to an additional 22
facilities delivering CT services, for a total of 60 sites providing CT services (excluding TB clinics). By
September 2009, ICAP anticipates counseling and testing 30,000 individuals.
Limited access to HIV counseling and testing remains a critical road block to the identification of HIV
individuals and to ensuring their early access to HIV prevention, care, and ART, if eligible. ICAP will
ensure that counseling and testing are available at all supported care and treatment sites through regularly
scheduled CT days, availability of trained counselors, and the establishment of routine, provider-initiated
testing throughout its supported
facilities.
CT will become part of the continuum of HIV care for patients at each of these sites. ICAP's capacity
building
approach, focusing on district- and facility-level systems strengthening, and provider training and
mentoring, will help ensure long-term sustainability. Interventions will include:
• Support for the operations of CT services at 60 designated facilities. As validated at the national level, a
new whole blood finger prick rapid-test algorithm will be introduced to improve turn-around time for test
results and limit dependence on laboratory staff, thus making point-of-services counseling and testing
easier.
• Support for facilities to expand counseling and testing access and improve quality and linkages to care
and ART services.
• Provide theoretical training and on-site mentoring to at least 70 nurses, social workers, and counselors on
CT, in collaboration with PNPEC.
• Provide on-site mentoring to nurses, social workers, and counselors related to the new rapid test algorithm
for CT.
Focus will be on strengthening providers' counseling skills, including for HIV prevention and couples
counseling.
•Introduce routine Provider Initiated Testing and Counseling (PICT) at all sites (60), and in multiple point of
service - ANC, TB, and STI-clinics.
• For adult and pediatric inpatients and outpatients, to facilitate enrollment and entry into treatment
programs.
ICAP will support sites to develop standard operating procedures related to routine testing within the facility
and will train appropriate staff.
• Development of tools, instruments, and databases to track HIV counseling and testing activities, including
linkages to HIV care and treatment.
• Support CT services in prisons and school infirmaries (SSSU) in the 5 supported regions, in order to reach
key vulnerable populations with prevention messages and to link those who are positive to care and
• Support for facilities to establish strong linkages with PLWHA organizations, OVC services, faith-based
groups and community-based NGOs to reduce stigma surrounding HIV testing, promote HIV counseling
and testing, and ensure that those who test HIV-positive access care and treatment services.
• Work with health districts to support the initiation of CT services and ongoing supervision and quality
• Work with SCMS and the Public Health Pharmacy (PSP) to ensure effective forecasting of test kits and to
ensure timely delivery and management of stock.
At all sites, ICAP will provide - either through direct hire or by contracting with individuals or local
organizations - counselors dedicated to providing a comprehensive package of HIV prevention
interventions for all clients and effective referrals for persons living with HIV/AIDS and their children. ICAP
will engage counselors (funded in part through AB, Condoms and Other Prevention, OVC, and
palliative care funds) to allow every site to provide this prevention and referral package to all clients. A rule
of thumb is that per day, one counselor might provide HIV prevention interventions in small-group sessions
for up to 80 HIV-negative clients or HIV prevention and OVC and palliative care referral services in
individual sessions for up to 10 HIV-positive clients.
All clients who test HIV-negative will be referred (on an opt-out basis) to a counselor for behavior-change
communication interventions, delivered individually or in small groups, focusing on risk reduction through
abstinence and fidelity, with correct and consistent condom use for those engaged in high-risk behavior, as
well as partner testing and STI prevention and care.
HIV-positive clients will be referred (on an opt-out basis) to a counselor for individual counseling that will
include HIV prevention interventions and referral to community-based OVC and HIV care and support
services to
address family and individual care needs. Targeted HIV prevention counseling will focus on risk reduction
condoms will be provided free of charge.
Activity Narrative: In addition, all HIV-positive clients will be offered information about and referrals to specific community
OVC care and palliative care services tailored to their needs. With assistance from the National OVC
Continuing Activity: 17080
17080 17080.08 HHS/Centers for Columbia 7220 7220.08 International $300,000
Table 3.3.14:
NOTE: With funding reprogrammed in April 2009, ICAP will also support deployment of the SIGVIH patient-
tracking system, working in conjunction with the Department of Information, Planning, and Evaluation
(DIPE) within the Ministry of Health (MOH) and with ACONDA. FY09 funds will be used to:
1) Assist electronic patient-monitoring system stakeholders (ACONDA, EGPAF, ICAP, DIPE, and Global
Fund principal recipient Care International) to harmonize and install a central-level data-management
system.
2) Ensure the technical governance and maintenance of the electronic patient-monitoring system.
3) Provide follow-up training of local data managers to develop local statistical capacities to analyze
program outcomes.
4) Continue to monitor the data quality through direct supervision and cross-matching of data. All data will
be analyzed at each site in order to monitor progress, and results will be summarized in a monthly report.
5) Ensure continuing communication among stakeholders, including non-PEPFAR partners.
6) Produce and submit publications to peer-review
The overarching goal of the M&E component of ICAP-Cote d'Ivoire program implementation is to develop
and conduct high-quality, timely, and sustainable monitoring and evaluation of ICAP-CU-CU supported
activities for program evaluation and improvement. This is a collaborative effort, with local, national,
and international partners to routinely collect, analyze, and disseminate data to assess program quality,
as well as program impact within and across sites and countries. In Côte d'Ivoire, ICAP-CU will implement
the nationally approved monitoring and evaluation system and tools, including the harmonized patient
monitoring tools. ICAP-CU will participate in PEPFAR or national committees to review and revise M&E
tools.
With FY08 funds, ICAP has achieved the following:
1) Hired and oriented three key M&E staff in Abidjan and three for the Daloa regional office;
2) Implemented the national patient monitoring and M&E tools at 21 new sites (including 10 care and
treatment
Sites)
3) Electronically recorded patient-level data for reporting, monitoring, and evaluation. At each of the 10 sites
data clerks have been recruited and trained in data collection, data entry, and reporting.
4) Developed and implemented a site-centered, Web-based reporting and dissemination tool called the
ICAP Unified Reporting System (URS). The URS captures and integrates diverse data, using the facility
as the primary unit to link indicators
In FY09 ICAP will continue to support routine data collection, management, use, and transmission at the
site
level. ICAP will also promote integration, analysis, use, and reporting of data at the country headquarters
level.
An M&E country team, based in Abidjan and reinforced by TA from ICAP headquarters, will participate in
the
building and strengthening of a national monitoring and evaluation system. More specifically, ICAP will
implement the following activities:
A- ICAP Country Team Activities
ICAP Strategic Information officers in collaboration with national counterparts and other PEPFAR partners
will:
1) Pilot and implement SIGVIH on ICAP-assisted ART treatment sites and support implementation of other
approved national data collection tools (paper and electronic) in the M&E strategy.
2) Provide ongoing technical support and training to data clerks.
3) Train multidisciplinary care teams in the use of program data to assess the quality of care at their sites.
4) Provide semi-annual and annual program results and ad hoc data sets as requested by the PEPFAR
USG team.
5) Participate in quarterly SI meetings organized by the USG strategic information branch.
6) Implement decisions agreed upon during these quarterly SI meetings.
7) Collaborate with the USG team on any publications submitted to peer-reviewed journals.
8) Participate in the national M&E Fellowship program by hosting fellows
B- Site Activities
1) Hire, orient, supervise and routinely train on an ongoing basis data clerks in each new site.
2) Provide SI related materials to each site including but not limited to (computer hardware, computer
software, printer, registers and forms, internet connection).
3) The ICAP field staff will attend workshops, conferences, and other training opportunities classes to
improve their technical capacities.
4) Support the SI capacity development of all personnel within the health facilities hosting ICAP sites.
C- Strengthening National SI Activities
1) District sites will be trained and responsible for ensuring data recording and transfer, electronic recording
and processing, and editing of reports for the district teams. ICAP 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 ICAP's program. Reports will be sent to the
regional level and to PNPEC for incorporation into national data-collection efforts.
2) Develop and execute a data quality improvement plan with technical assistance from external contractors
and in close collaboration with CDC-RETROCI SI team and district data managers.
3) Collaborate with the DIPE, PNPEC and other partners to use unique patient identifiers for improved
tracking of patients.
4) Submit commodities data to the national data-collection system for drug and supply-chain management.
The patient-management system being used at all sites will be interfaced with the Partnership for Supply
Chain Management Systems system which will be monitoring all care and treatment commodities data for
PEPFAR programs in Cote d'Ivoire in FY09.
Activity Narrative: 5) Participate in ongoing national efforts to maintain and improve a harmonized national longitudinal patient
monitoring system to track HIV seropositive patients.
To ensure sustainability, staff recruitment will be conducted in close collaboration with the MOH and health
district officials.
Continuing Activity: 17299
17299 17299.08 HHS/Centers for Columbia 7220 7220.08 International $200,000
Table 3.3.17:
