Twinning Partnership to Strengthen the Quality of VCT Services

The American International Health Alliance (AIHA), through a Cooperative Agreement with the Health

Resources and Services Administration (HRSA), has established an "HIV/AIDS Twinning Center" to support

partnership and volunteer activities as part of the implementation of PEPFAR. Through twinning

partnerships, volunteers, and supportive assistance programs, the Twinning Center will contribute

significantly to building human and organizational capacity by: a) training and mentoring caregivers; b)

strengthening existing and new training and educational institutions; and c) developing models of care for

improved organization and delivery of services. This will allow rapid scale-up of interventions to help meet

the goals of PEPFAR in Ethiopia to prevent, treat, and care for HIV-positive individuals and AIDS orphans.

To strengthen the provision of voluntary counseling and testing (VCT) services in Ethiopia in FY07, AIHA is

initiating a South-South twinning partnership between the Liverpool VCT Program (LVCT—an indigenous

Kenyan organization) and Ethiopian national institutions responsible for VCT. The partnership assists in

quality assurance, policy development, and materials development to increase capacity of the Federal

Ministry of Health (MOH) and regional health offices to develop and support VCT sites throughout Ethiopia.

In FY07, LVCT support to the MOH and regional health bureaus (RHB) included:

1) Assessment of selected sites and definition of quality assurance and review of lessons learned from

implementation at national and regional demonstration sites

2) LVCT-developed strategies to improve VCT service quality at the site level, based on the experiences

gained in-country and elsewhere

3) Developing a National Quality Assurance (QA) tool and organizing a training-of-trainers (TOT) for field

testing

In FY08, LVCT support will further expand through training of counselors to assure quality of service at the

site level. Twenty-two sites will be identified for piloting the QA system in collaboration with PEPFAR

partners. Documented "best practices" and lessons learned will be replicated to other sites. Furthermore,

LVCT will revise the QA tool based on lessons learned from site-level implementation.

AIHA is requesting additional funding in 2008 to ensure the robust progress of this South-South partnership.

As the partnership transitions out of the first year/initiation phase, they will require increased funding levels

to support a greater level of activities and allow for an adequate number of professional exchanges,

trainings, and technical assistance to accomplish their goals and objectives. Further, in the first three years

of the Twinning Center cooperative agreement, HRSA provided central funding (received from

PEPFAR/Office of the Global AID Coordinator headquarters) to AIHA to subsidize the initiation of programs

and cover in-country office and headquarters operations. Now, HRSA is phasing out its central funding to its

cooperative agreement partners; therefore, these costs are now included in this country funding request.

The Twinning Center will operate as a traditional US government partner, receiving all its programmatic

funding, including operations for the in-country office and headquarters, from the US government country

programs (through the Country Operational Plans) and will cease to receive central funding from HRSA.

The country office and headquarters will continue to operate in a streamlined fashion without addition of

new staff or office costs.

Since this partnership focuses on building capacity and developing local institutions' abilities to provide

quality VCT services, it works with other USG implementing partners. USG partners implementing VCT

services will report on the number of individuals who were counseled, tested, and received results; thus, this

twinning partnership will report on numbers of institutions providing services and numbers of service

providers trained, to measure the effect of the Twinning Center Program on sustainable strengthening of

HIV/AIDS VCT services in Ethiopia. The targets represent institutions and individuals we expect the

partnership to reach in FY08 to strengthen both human resources and institutional ability to provide HIV

VCT services.

The American International Health Alliance (AIHA), through a cooperative agreement with the US

Department of Health and Human Services' Health Resources and Services Administration (HRSA/DHHS),

has established an "HIV/AIDS Twinning Center" to support partnership and volunteer activities as part of the

implementation of PEPFAR. Through twinning partnerships, volunteers, and supportive assistance

programs, the Twinning Center (TC) will contribute significantly to building human and organizational

capacity by: training and mentoring HIV caregivers; strengthening existing and new training and educational

institutions; and developing models of care for improved organization and delivery of services for rapid scale

-up of interventions to help meet the goals of PEPFAR.

Components of the AIHA TC are: institutional partnerships based on AIHA's Twinning Methodology; and a

volunteer Healthcare Corps to recruit, select, place, and support volunteers with professional expertise for a

period of six weeks to one year.

The AIHA Twinning Center is supported by PEPFAR Ethiopia to achieve two main objectives:

The TC's first objective is to increase human and organizational capacity to prevent and treat HIV/AIDS by

engaging professionals, primarily from the Ethiopian diaspora, in volunteer assignments at ARV clinics and

HIV/AIDS service organizations.

The TC's Volunteer Initiative is a continuing activity from FY07. As of July 31, the TC has placed seven

qualified volunteers from the Ethiopian diaspora at multiple sites. Their expertise includes information

technology, laboratory science, health policy, social work, palliative care, and mental health. The volunteers

have made extensive accomplishments at their respective placement sites, as is evident from their monthly

reports and the positive feedback received from the placement site supervisors.

The TC has identified eight qualified volunteers to be placed in August and September 2007. Their

expertise includes medicine, tuberculosis (TB)/HIV laboratories, information technology, and social work. In

addition, the TC has developed seven Scopes of Work, based on identified needs at placement sites

throughout Ethiopia, and these are being used to recruit qualified volunteers.

The TC's second objective is to increase human and organizational capacity to prevent and treat HIV/AIDS

through institutional twinning partnerships. The identification and management of institutional partnerships is

a continuing activity from FYO7. As of July 2007 the TC has initiated the following partnerships:

AIDS Resource Center (ARC-Ethiopia)/AIDS Treatment Information Center (ATIC-Uganda) Partnership:

This south-south twinning relationship facilitates knowledge and skills transfer between two organizations

that share the similar experience of working in a resource-constrained environment. The objectives of this

partnership are to increase the capacity of the ARC to strategically plan for and implement a call center that

provides a clinical "warmline" and HIV/AIDS pharmaceutical and laboratory service-delivery system, monitor

and evaluate the call center's warmline, and analyze the logistical, educational, and infrastructural need to

disseminate the information to appropriate partners. As of July 31, the partners have participated in two

professional exchanges to collaborate on developing the partnership workplan and to conduct a needs

assessment. The partners have also been actively communicating via e-mail and telephone to develop, test,

and review a survey tool.

Addis Ababa University School of Pharmacy (AAU), the Drug Administration and Control Authority (DACA),

and Howard University School of Pharmacy and Continuing Education:

The objectives of this partnership are to strengthen pharmacy services within the healthcare system by

establishing two drug information centers, one at DACA of Ethiopia and another at AAU's School of

Pharmacy. The drug information centers will support the expansion and provision of quality ART and

strengthen the clinical capacity of pharmacists to provide quality ART through continuing education. As of

July 31, the partners have participated in two professional exchanges, including an initial assessment visit

to Ethiopia by members of the Howard team, and an exchange that enabled partners from AAU and DACA

to develop a workplan and participate in professional development at Howard. In August, representatives

from Howard will travel to Ethiopia to work with AAU and DACA on a survey to identify the education levels,

work experiences, and attitudes on drug information of Ethiopian pharmacists and other pharmacy

professionals, as well as to identify continuing education opportunities and patient-oriented pharmacy

services in Ethiopia.

Hospital to Hospital Partnerships: Through an open solicitation process, the TC has identified two US-based

hospitals to partner with Debre Berhan and Ambo hospitals to increase human and institutional capacity in

hospital management and the provision of clinical care. The partnerships will create professional

development opportunities for hospital staff and managers through training and mentoring. Elmhurst

Hospital in New York is partnering with Debra Berhan Hospital and Jersey Shore University Medical Center

in Neptune, NJ, is partnering with Ambo Hospital. The first exchange takes place in July, with partnership

teams of doctors, nurses, and social workers from both US hospitals traveling to Ethiopia to conduct a

needs assessment and to begin jointly developing the partnership workplans.

Addis Ababa University School of Social Work (AAU)/Jane Addams College of Social Work (JACSW),

Chicago USA/Institute of Social Work (ISW)-Tanzania: As of July 31, initial meetings have taken place with

participating stakeholders to discuss available resources and guide partnership development. This

triangular partnership between the AAU School of Social Work, JACSW, and the ISW in Tanzania will focus

on training facility-based case managers at the pre-service level, in close collaboration with in-service

efforts of Washington University/I-TECH and Management Sciences for Health, and the overall efforts of the

Ethiopian government and PEPFAR partners. Partners will use the existing relationship between JACSW

and ISW to provide south-south professional exchanges and resource sharing for the Ethiopian partners.

AIHA is requesting additional funding in 2008 to ensure the robust progress of these five current treatment

partnerships and the diaspora volunteer initiative. As the five active partnerships transition out of their Year

1 initiation phase, they will require greatly increased funding levels to support a greater level of activities

and allow for an adequate number of professional exchanges, trainings, and technical assistance to

accomplish their goals and objectives. The FY08 request will allow partners to more than double their

activities accomplished in the first year of the partnerships. In the first three years of the TC cooperative

agreement, HRSA provided central funding (received from PEPFAR/Office of the Global AIDS Coordinator)

Activity Narrative: to AIHA to subsidize the initiation of programs and cover in-country office and headquarters operations.

Now, HRSA is phasing out its central funding to its cooperative agreement partners; therefore, these costs

are now included in this country funding request. The TC will operate as a traditional USG partner, receiving

all its programmatic funding, including operations for the in-country office and headquarters, from the USG

country programs (through the Country Operational Plan) and will cease to receive central funding from

HRSA. The country office and headquarters will continue to operate in a streamlined fashion without

addition of new staff or office costs. The TC can also provide training to individual Ethiopian organizations

on financial administration and subgrant management to further strengthen organizational capacity.

These partnerships and the volunteer program focus on building capacity and developing the local

institutions' abilities to provide quality ART services, in collaboration with other USG implementing partners.

USG partners implementing the ART services will report on the number of individuals receiving HIV clinical

services, such as ART and treatment for opportunistic infections; thus, these twinning partnerships and

volunteer program will report on the number of institutions providing services and number of service

providers trained, to measure the effect of the TC Program on sustainable strengthening of HIV/AIDS ART

services in Ethiopia. Targets represent individuals and institutions expected to be strengthened through

these programs and were derived by counting five institutional partnerships and 28 volunteers for

institutional strengthening, with partnership and volunteer-initiative training for over 1,200 individuals.

AIHA requests a budget of $2,710,000 in FY08 to support the following Care and Treatment activities:

1) Fielding 28 volunteers (primarily from the Ethiopian Diaspora)

2) Expansion and management and technical support to the five active treatment partnerships established

in 2007.