ICAP will build on its Year 2 work in supporting the PNLS, PNLT and LNR to expand the availability, quality and uptake of HIV-related services. ICAP-DRC will provide intensive technical support to build the capacity of provincial and health zone authorities and site-level health workers to deliver family-centered comprehensive HIV/AIDS services. ICAP will continue to strengthen the service capacity of 4 zonal hospitals and 30 TB clinics in Kinshasa to provide a sustainable, evidence-based model of comprehensive, evidence-based family-centered HIV prevention, care and treatment services; and will newly extend support to 1 provincial and 1 zonal hospitals in Lubumbashi. As components of this intervention, ICAP will support facilities to develop strong, integrated PMTCT and TB/HIV co-infection programs, to strengthen their laboratory networks for HIV-related diagnostics, and to develop comprehensive program monitoring and quality improvement systems. As part of support the elimination of pediatric HIV (acceleration plan), with COP11 additional funds, we will expand PMTCT activities in 97 sites in Kinshasa and 49 in Lubumbashi.

Overall project strategies will be guided by ICAPs experience establishing family-centered, comprehensive HIV services. Key strategies are family-centered care, multidisciplinary teams, community involvement and health systems strengthening.

ICAP will establish an overall project advisory committee in the two intervention cities composed of key representatives from CDC, provincial and zonal health authorities, NGO/CBO stakeholders, and PLHIV groups.

Two vehicles are already purchased, procurement of 3 is ongoing. In order to support PMTCT expansion to cover 129 supplementary sites, we will request 2 additional vehicles.

ICAP will support sites to increase use of comprehensive care services by HIV-infected individuals and families. ICAP will assist sites to provide high quality HIV care in accordance with national guidelines, supporting site staff to introduce the adapted Clinical Systems Mentoring tools, including Model of Care initial assessment and Standard of Care quality improvement tools, to initiate a standard package of care and support services and apply the standard of care tools to assess the quality of care provided. The package introduced at each site will include clinical and immunological monitoring and ART eligibility assessment, routine weight and nutritional assessment and support, OI prophylaxis and treatment, counseling, patient education, peer support, and food supplements as needed. Patients in HIV care not yet requiring ART will be monitored regularly so that ART eligibility is promptly identified and ART initiated accordingly. Routine TB screening using a simple symptom questionnaire will be offered to all patients and at each visit. PwP interventions will include counseling and education on serostatus disclosure, partner HIV testing, adherence support, support for alcohol reduction and condom use; diagnosis and management of STIs; and contraception and safer pregnancy counseling. ICAP will train and mentor MDTs, to shift from a traditional nonintegrated care model to a more effective integrated, chronic care model. Facilities will be supported to implement patient flow algorithms, appointment systems, national treatment protocols, adherence support, family testing chart and will develop patient tracking systems to support linkages and retention. HIV care and treatment will be integrated with other clinical services. ICAP will partner with Action Contre la Faim to provide nutritional support to patients at facilities in Kinshasa. ICAP will also provide TA to sites and PLHIV associations to recruit male community volunteers to be trained to disseminate messages about SGBV awareness and prevention. ICAP will work with site MDTs and health authorities to implement a system approach to integrate SGBV and HIV services for survivors.

In FY13 ICAP will add on its activities with support to orphan and vulnerable children as part of its family-centered care model. ICAP will build capacity of health care workers to Identify/select beneficiaries based on recognized tool such as USAID Child Status Index and will focus on reducing barriers to health care, linking to nutrition services, and psychosocial care and support. ICAP will work at its supported clinical sites to facilitate access to treatment for identified OVC for malaria, diarrhoea,malnutrition and others pediatric disease through medical supply and materials equipment. Collaboration will be promoted with PMTCT, care and treatment sites by etablishing linkage between care givers and families to ensure PLHIV remain connected to the continuum of care. Children family members will be linked to children support groups for pychosocial support--and these groups will be set up to refer children to exiting pediatric care and treatment services when needed. ICAP will support health care providers to link patients with OVC services provided by others PEPFAR partners.

During FY12, ICAP will continue support facilities to decrease the burden of TB in HIV-infected individuals and their family members through the provision of comprehensive HIV/TB services, including: technical assistance to improve TB diagnostic capacity and quality control at clinical laboratories; and palliative care and treatment for co-infected clients. ICAPs efforts will continue focus on three approaches: integrating TB services into HIV care and treatment; integrated HIV service into TB services at CSDT and improve TB infection control.

Integration of TB services into HIV care and treatment

ICAP will ensure that TB case finding among adults and children is consistently implemented at enrollment and at follow-up visits using a simple symptom checklist adapted from national guidelines and other ICAP programs, and that those who screen positive are assessed via sputum smear microscopy, chest X-ray and, where possible, TB culture, ensuring that those diagnosed with TB are treated at CSDT. TB screening will be extended to the families of HIV-infected patients, particularly children and other family members at risk of contracting latent TB infection and developing TB disease, TB screening will be introduced at all facilities.

Integration of HIV into TB services at CSDT

During FY11, with ICAP support, the supported TB clinics have improved the rate of tested TB patients from 54 to 85%.

ICAP will continue ensure that TB patients at CSDT are systematically offered PICT, and that those testing positive for HIV are given CPT, enrolled in care and promptly started on ART at health centers or zonal hospitals. Further, to protect HIV infected individuals and health care workers from nosocomial TB, ICAP will promote infection control measures that minimize the risk of TB transmission.

These activities will be extended to 10 additional TB clinics in Kinshasa and Lubumbashi. ICAP will also provide TA to sites and PLHIV associations to recruit male community volunteers to be trained so that they disseminate key messages about SGBV awareness and prevention. ICAP will work with site MDTs and health authorities to implement a system approach to integrate SGBV and HIV services for survivors.

ICAP will support health facilities to improve health outcomes of HIV-infected children and HIV exposed infants and adolescents through the provision of comprehensive medical care, including early identification of HIV infection, no-cost ART and psychosocial support to HIV-infected children and their nuclear family members. ICAP will support sites to ensure that care of HIV infected infants, children and adolescents form an integral part of maternal and child health, covering ANC, PMTCT, labor and delivery, postpartum and pediatric services. Most sites will need support to address gaps in equipment, supplies and medications. ICAP will train teams of providers at each site in pediatric HIV. The training will consist of a didactic training, followed by an in-service training during service initiation, and follow-up support until each site has mastered the necessary clinical skills. The training will address care of HIV-exposed and infected infants, children and adolescents, including provision of integrated clinical care for infants (vaccinations, nutritional support, and growth/developmental monitoring), ARV prophylaxis for exposed infants ensuring ARV protected breastfeeding, medications for prophylaxis and treatment of OI, and preventive therapy against TB in HIV exposed and infected children (TB screening and provision of IPT to children who are close contacts of TB cases),HAART for all children < 2y and timely determination of ART eligibility for older children. ICAP will work with peer educators and community relay teams to support facilities to provide psychosocial and adherence support and refer infants, children, and adolescents to the health services for ART. ICAP will coordinate activities with others implementing partners to avoid duplication of efforts. ICAP will partner with Action Contre la Faim to provide nutritional support to patients served at facilities throughout Kinshasa. ICAP will also provide TA to sites and PLHIV associations to recruit male community volunteers to be trained so that they disseminate key messages about SGBV awareness and prevention. ICAP will work with site MDTs and health authorities to implement a system approach to integrate SGBV and HIV services for survivors.

ICAP lab support in DRC will continue to tackle the deficits of skilled human resources, to address inadequate infrastructure, to equip labs for proper diagnostics, to improve lab supply chain management, and to strengthen lab leadership by improving management and operational mechanisms. Emphasis will continue to be put on development of quality assurance (QA) systems.

ICAP will continue to strengthen the HIV laboratory network in Kinshasa, increasing capacity of district and zonal labs to perform HIV rapid testing ensuring same day results, DNA PCR testing for early infant diagnosis, CD4 and other lab tests necessary for HIV care and treatment. In addition, 10 CSDT will be provided with LED microscopes for improving TB diagnosis.

The zonal lab networks and transportation systems will continue to be strengthened to enable facilities without hematology, biochemistry and CD4 capacity to access such services, for instance for PMTCT sites to determine ART eligibility of HIV-infected pregnant women. Funds will be provided to each health facility for sample transportation. Transporting results back to the facilities will use the same transportation system.

ICAP will provide TA in the use of CD4 PIMA machines, capacity for blood draw of DNA PCR samples and storage, centrifuge and solar panel in all PMTCT and TB sites with care and treatment services.

ICAP will continue to support the implementation of quality assurance measures, and will continue to use a lab system mentorship approach to improve the overall management and quality of the lab networks. Equipment will be installed by ICAP once planned renovations have been completed.

ICAP will continue assess lab system and provide ongoing training and mentoring in reagent forecasting and stock management to ECS and site lab staff. ICAP will also support systems and coordinate with the MOH, the Global Fund, KSPH and the Clinton Foundation to ensure that reagents are delivered in a timely manner to site in each health facility. ICAP will also continue to upgrade stock rooms and data management systems.

In FY13 ICAP will enable all supported sites to build capacity and train health care workers to assure safe injection practice in their daily work by applying universal precautions. This includes the provision of safe injection supplies (single-use needles and syringes, sharps containers, e.g.) ICAP will also apply behavior change communication (BCC) strategies aimed at both the community and health providers to promote safe injection practice and minimize demand for medically unnecessary injections. According to national health care waste managment strategies, ICAP will build provider and facility capacity to implement adequate waste management systems. This might include transport of waste to better-equiped sites by secured transportation for an appropriate disposal.

ICAP will support facilities to increase use of counseling and testing services to partners of pregnant women, newborns of HIV-infected women, TB patients, severely ill or chronically ill children, and family members through multiple methods, including facility- and community-based efforts and a special focus on SGBV victims. ICAP will help promote capacity for counseling and testing at all supported facilities and will ensure availability of test kits from SCMS and trained staff and the establishment of routine PICT for adults and children. Finger prick blood collection will be introduced to allow same-day results. HIV-infected patients will be systematically referred for care and treatment, and ICAPs field-tested family testing form will be introduced. PICT will be integrated at multiple points of service, including adult and pediatric inpatient clinics and with services for ANC, TB, STI, and SGBV, on adult and pediatric inpatient wards, in labor and delivery wards, and at immunization clinics. In addition, PICT for family members will be integrated into HIV care and treatment programs. Promotion of partner testing in ANC and couples counseling services will be implemented within antenatal and postpartum care settings. ICAP will work with the PNLS to ensure an uninterrupted test kit supply, coordinating efforts where possible with the GF and other USG partners, and will support sites and zonal health authorities to accurately forecast test kit needs. ICAP will continue also to support community counseling and testing promotion efforts through partnerships with local health committees, PLHIV groups, others PEPFAR partners and other local associations.

In FY13 ICAP will promote other prevention in all PMTCT, TB and care and treatment sites during group counseling and individual counseling sessions. Routine STI ( syphilis and other STI) assessment and treatment will be implemented in all PMTCT sites. ICAP will promote condom use during support group meeting among youth and discordant couples .Health care providers and peer educators will be trained to promote safer sexual behavior during support group meetings with certain target groups.

ICAP will continue support GODRC and health facilities to improve health outcomes of HIV-infected pregnant women through the provision of comprehensive PMTCT services at 17 sites in Kinshasa for COP12 while will expand to 80 new sites in Kinshasa and 49 in Lubumbashi regrouped in 33 hubs and their satellites, with PMTCT expansion funds both in public and private clinics. The package of services will include: counseling and testing services at ANC, delivery wards and post natal services; biological monitoring; and comprehensive medical care, including no-cost ART, psychosocial support and palliative care, to HIV-infected pregnant women and their first degree family members, HEI follow up, provision EID and nutritional support. We expect to test 140,000 pregnant women over 2 years.

In coordination with GODRC, ICAP will continue conduct site assessments and site-level supervision and mentoring. ICAP will continue support site staff, health zone and provincial PMTCT focal points to reorient and streamline services, ensuring the provision of more efficacious PMTCT regimens and HAART for eligible women throughout the PMTCT care spectrum. ICAP-supported sites will provide high-quality counseling to maximize the uptake of counseling and testing in the ANC setting and the uptake of and adherence to PMTCT services using peer educators. Within ANC, HIV-infected pregnant women will receive a complete package of services including same day blood draw for CD4 to rapidly determine ART eligibility, STI screening, OI and ART prophylaxis, HAART, TB screening, prophylaxis for malaria, family planning and insecticide-treated bed nets. To minimize loss to follow up, finger prick will be implemented in all sites to ensure same day result. To improve male partners involvement community mobilization activities will be carried out. ICAP will also provide TA to sites and PLHIV associations to recruit male community volunteers to be trained so that they disseminate key messages about SGBV awareness and prevention. ICAP will work with site MDTs and health authorities to implement a system approach to integrate SGBV and HIV services for survivors.

ICAP will expand support 58 care and treatment facilities to implement patient-flow algorithms, patient appointment systems, and national protocols for pre-ART and ART care. Capacity building of health care workers will be reinforced via workshop, on-site training and mentorship. Mentoring and supervision visits are conducted on weekly basis.

Stock management, forecasting, managerial and pharmacy operations will be enhanced, and appropriate medical records systems (appointment books, logs, patient files/forms) and data management and use will be introduced.

ICAP will support sites to implement the model of care through intensive hands-on support including provider-level mentorship, development of Multi-Disciplinary Teams (MDT), service integration and provision, and ongoing supportive supervision to ensure quality of care as described above

In the supported sites, ICAP will institute or strengthen on-site coordination meetings to identify and address care-system challenges and regular multidisciplinary team (MDT) meetings in facilities to share patient outcomes and experience. ICAP will train the zonal health team and hospital staff on mentorship and supervision.

Facilities will be supported to implement patient flow algorithms, appointment systems, national treatment protocols, adherence support, family testing chart and will develop patient tracking systems to support linkages and retention to minimize loss to follow-up. HIV care and treatment will be integrated with other clinical services, including ANC, adult outpatient departments.

ICAP will continue manage a security stock of ARVs ICAP will also provide TA to sites and PLHIV associations to recruit male community volunteers to be trained so that they disseminate key messages about SGBV awareness and prevention. ICAP will work with site MDTs and health authorities to implement a system approach to integrate SGBV and HIV services for survivors.

ICAP will target several entry points to increase access to HIV testing and treatment for HIV exposed and infected infants, children and adolescents ensuring pediatric provided initiated testing (PITC) including PMTCT services, and integrated into immunization services, pediatric wards, outpatient department, nutrition services and the nuclear family members enrolled into HIV care and treatment services. Capacity building of health care workers will be reinforced via workshop, on-site training and mentorship. Supervision visits will be conducted on weekly basis. For scaling up, ICAP will continue support site staff, health zone and provincial PMTCT/pediatric focal points to reorient and streamline services, ensuring effective PITC at all health sector levels, referral to care and treatment services and optimizing retention in care. These Focal points will supervise the program, routinely collect data, offer mentoring and monitor the quality of services. ICAP will work with peer educators and community relay teams to support facilities to provide needed psychosocial and adherence support and refer infants, children, and adolescents to the health services for ART when not possible to offer care and treatment services at same site. ICAP will make every effort to coordinate activities with others implementing partners to avoid duplication of efforts.

All supported facilities caring for HIV exposed and infected infants will be linked to ICAP lab network for HIV disease monitoring. For EID, ICAP will strengthen sample transportation system and result return between supported facilities and LNRS. ICAP will also provide TA to sites and PLHIV associations to recruit male community volunteers to be trained so that they disseminate key messages about SGBV awareness and prevention. ICAP will work with site MDTs and health authorities to implement a system approach to integrate SGBV and HIV services for survivors