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
PMTCT Services at Hospital and Health Center Level by Region - Columbia University
ACTIVITY HAS BEEN MODIFIED IN THE FOLLOWING WAYS:
This is a continuing activity from FY08. In FY08 the International Center for AIDS Care and Treatment,
Columbia University (ICAP-CU) supported PMTCT services in 42 hospital networks in Dire Dawa, Harari,
Oromiya, and Somali regions. The partner's achievement in meeting the targets set for all the selected
PMTCT indicators has been remarkable. It has provided ongoing site level implementation support to health
facilities providing PMTCT services to improve uptake and quality of services.
ICAP has been successful, particularly with regards to the provision of HIV counseling and testing services
at labor and delivery. The success in this regard has also encouraged other PMTCT partners to provide HIV
counseling and testing services at labor and delivery. Furthermore, it has introduced point of service testing
and early infant diagnosis using DBS at some health facilities, which has helped to improve the quality and
uptake of PMTCT services.
Furthermore, ICAP has actively participated in the national TWG and supported the rolling out of the revised
national PMTCT Guidelines.
While supporting the PMTCT program at facility level, ICAP has faced shortage and high staff turnover at
health facilities, lack of reporting on key PMTCT indicators, due to weak M&E system. There were
shortages of equipments, test kits and IP supplies at ANC, labor and delivery services. Furthermore, there
was low male involvement in PMTCT program.
In FY 09, ICAP will work to address the above challenges and will also build on FY 08 activities and
continue on expanding and strengthening the PMTCT program at 57 health facilities in Dire Dawa, Harari,
Oromia and Somali regions. In COP09 ICAP will scale up the PMTCT program in addition to the FY 08
planned activities by including the following:
1)Support the transitioning of the national PMTCT program from Federal HAPCO to the Family Health
Department (FHD) of the Federal MOH through active participation in the national PMTCT TWG and also
support integration of PMTCT with MCH services
2)Support regional health bureaus and PMTCT TWG to build PMTCT program management capacity at a
regional level and ensure sustainability. ICAP will second a PMTCT advisor to Oromia Regional Health
Bureau to assist in the scale-up, integration, coordination, quality assurance and oversight of PMTCT
program.
3)Promote the Testing and Counseling Support tools for PMTCT at all PMTCT sites.
4)Expand outreach PMTCT services focusing on higher prevalence areas to reach large number of women
not coming to health facilities for ANC or delivery
5)Support strategies and program plans to coordinate Prevention With Positives (PWP) with PMTCT
6)Expand Mothers' Support Group (MSG) to additional 10 sites
7)Assist to strengthen the PMTCT M&E system: ICAP will assist the national and regional PMTCT
program to improve data collection and reporting on key PMTCT indicators
COP08 ACTIVITY NARRATIVE
This is a continuing activity from FY07. In FY07, the International Center for AIDS Care and Treatment,
Columbia University (ICAP-CU) supported PMTCT services in 42 hospital networks in Operational Zone 3
(Dire Dawa, Harari, Oromiya, and Somali regions). Building on programs initiated by other implementing
partners in FY05-06, ICAP-CU expanded and enhanced interventions to prevent perinatal and postpartum
transmission, and to link HIV-positive pregnant women and their families to comprehensive HIV care and
treatment services.
In FY08, ICAP-CU will extend these services to a total of 52 facilities, working to dramatically reduce the
number of infants born with HIV in collaboration with the Federal Ministry of Health (MOH)and regional
health bureaus (RHB) of Dire Dawa, Harari, Oromiya, and Somali. It will provide PMTCT services at two
hospitals and six health centers in Dire Dawa, three hospitals and two health centers in Harari, 29 hospitals
in Oromiya, and six hospitals and four health centers in Somali. ICAP-CU utilizes antenatal care (ANC),
maternal-child health (MCH), and PMTCT programs as entry points to HIV care and treatment for women,
children, and families. Major areas of emphasis include: integration of PMTCT programs with HIV care and
treatment programs; implementation of more potent and complex PMTCT regimens; prompt clinical and
immunologic staging of HIV-positive pregnant women and rapid initiation of ART for eligible patients;
enhancing the quality of infant feeding initiatives; strengthening systems for PMTCT service delivery; and
supporting human resources by providing high-quality training and clinical mentoring.
The Government of Ethiopia issued new PMTCT guidelines in July 2007. ICAP-CU, in collaboration with
JHPIEGO, will support rollout of the new guidelines in these regions. Major areas of emphasis include:
integration of PMTCT with MCH services and HIV prevention, care, and treatment programs; provider-
initiated, routine, opt-out HIV testing and counseling at ANC and labor and delivery venues; implementation
of more potent and complex PMTCT regimens; prompt clinical and immunologic staging of HIV-positive
pregnant women and rapid initiation of ART for eligible patients; enhancing the quality of infant-feeding
initiatives; strengthening systems for PMTCT service delivery; and supporting human resources by
providing high-quality training and clinical mentoring.
ICAP-CU will work to support PMTCT programming at the national, regional, and site levels. At the national
level, as a member of the National Technical Working Group on PMTCT, ICAP-CU will contribute to the
development of training material, clinical support tools, guidelines, formats, and standards. ICAP-CU will
continue to provide technical input and guidance to the MOH and RHB, supporting initiatives to: expand
PMTCT beyond single-dose nevirapine (SD-NVP) where appropriate; enhancing PMTCT-Plus training; and
supporting links between PMTCT programs, HIV care and treatment programs, and pediatric services.
Activity Narrative: At the site level, the ICAP-CU-supported package of PMTCT Plus/family-focused care includes:
1) Support for linkages between healthcare facilities and community-based implementing partners, including
organizations for people living with HIV (PLWH). This will promote uptake of antenatal and PMTCT services
and support follow-up of infants enrolled in early infant diagnosis (EID) programs.
2) Enhanced linkages between ANC, MCH, PMTCT, family planning, sexually transmitted infections (STI)
and HIV care and treatment clinics at the facility level
3) Promotion of partner testing and a family-centered model of care, using PMTCT as an entry point to HIV
services for mothers, children, and families
4) Routine, opt-out HIV counseling and testing at ANC, family planning, and STI clinics (as well as
tuberculosis (TB) clinics and inpatient wards
5) Active case-finding within families and households using a simple validated tool (the Family Enrollment
Form)
6) Adherence and psychosocial support and enhanced follow-up and outreach services for pregnant women
testing positive for HIV, which will encourage retention in care. Implementation of peer-educator programs
and mothers' support groups at selected sites, to maximize adherence to care and treatment among
pregnant HIV-positive women, and to strengthen their links to psychosocial support and community
resources.
7) Provision of a basic care package for all HIV-positive pregnant women, including: patient education; TB
screening; prophylactic cotrimoxazole (CTX) when indicated; nutritional support (see below); insecticide-
treated bed nets; condoms; and safe water. This will be done in coordination with the Global Fund for AIDS,
Malaria, and Tuberculosis and other partners.
8) Routine assessment of all HIV-positive pregnant women for ART eligibility using clinical staging and CD4
testing, and provision of prophylaxis and treatment as appropriate, including ART when indicated
9) Nutritional education, micronutrient supplementation, and "therapeutic feeding" for pregnant and
breastfeeding women in the six-month postpartum period
10) Enhanced postnatal follow-up of HIV-positive mothers and HIV-exposed infants
11) Promotion of infant-feeding initiatives and healthy infant-feeding practices by facilitating on-site trainings
and mentoring of MCH staff (including traditional birth attendants) on safe infant-feeding practices in the
context of HIV. Developing infant-feeding support tools, and establishing mothers' support groups for infant
feeding.
12) Providing access to EID by DNA PCR/dried-blood-spot testing. Enhanced laboratory capacity for infant
diagnosis at selected facilities and strengthened linkages with regional labs at remaining facilities (see the
laboratory narrative). Initiation and expansion of the clinical and health-information management systems
needed to implement EID services.
13) Ensuring that HIV-exposed infants are enrolled in care and receive prophylactic CTX, immunizations,
nutritional support, careful clinical and immunologic monitoring, monitoring of growth and development, and
ongoing assessment of eligibility for ART
14) Determination of infection status at 18 months for HIV-exposed infants not found to be HIV-positive via
EID
15) Facilitate availability of supplies for PMTCT services
16) Support for site-level staff to implement national performance standards, the JHPIEGO-supported
Standards-Based Management Program, and ICAP-developed Standard of Care.
17) Providing PMTCT-Plus training to multidisciplinary teams at the facility level
18) Providing ongoing clinical mentoring and supportive supervision in partnership with RHB
19) Ongoing development and distribution of provider job aids and patient-education materials
20) Routine monitoring of PMTCT-Plus programs, reporting of progress against targets, and ongoing
assessment of linkages within facilities (from PMTCT to ART clinics, for example) and uptake of services by
family members
21) Support for the availability and correct usage of PMTCT registers and forms, HIV-exposed infant
registers and follow up cards, timely and complete transmission of monthly reports to regional and central
levels, and appropriate use of collected data
22) Minor renovation, refurbishment, and repair (as needed) of ANC, labor and delivery rooms, and
maternity wards at ICAP-CU supported sites.
23) Radio and TV outreach campaigns and use of information and education/behavior-change-
communication materials in local languages to enhance public awareness and use of ANC, MCH, PMTCT
and HIV care & treatment services
The funding level for FY08 has increased from FY07, in part because ICAP-CU has taken additional
responsibilities for continuing PMTCT implementation formerly carried out by IntraHealth at health centers in
emerging regions (Dire Dawa, Harari, and Somali regions), and in part because ICAP-CU will expand
services from 42 to 52 sites. In FY07, additional PMTCT funds ($75,000) reprogrammed from medical
transmission, are being applied to support social marketing and branding of PMTCT to improve knowledge
and create demand for ANC and PMTCT services, which will also continue in FY08. Therefore, the total
FY07 budget (including the additional PMTCT funds) should be considered as the base for the FY07 budget
to justify the increase in the FY08 budget request.
Additional narrative to existing COP narrative: This activity will provide support for outreach ANC/PMTCT
services. It will train health care workers to provide ANC and PMTCT services to the hard-to reach rural
communities. Trained nurses based at a hospital and health center and Health extension workers will be
involved to provide outreach PMTCT services. Community level PMTCT activities will be linked to the near-
by Hospital or Health center PMTCT programs through referral linkages and establishment of catchments
area networks. Experiences elsewhere and in Ethiopia (JHU and IntraHealth) have shown that outreach
PMTCT services can effectively be utilized to improve the uptake of PMTCT services. ICAP will be involved
in the expanding outreach PMTCT services in Oromia, Harreri, DireDawa, Somali regions.
New/Continuing Activity: Continuing Activity
Continuing Activity: 16667
Continued Associated Activity Information
Activity Activity ID USG Agency Prime Partner Mechanism Mechanism ID Mechanism Planned Funds
System ID System ID
16667 5637.08 HHS/Centers for Columbia 7498 3784.08 Rapid $1,100,000
Disease Control & University Expansion of
Prevention ART for HIV
Infected
Persons in
Selected
Countries
10451 5637.07 HHS/Centers for Columbia 5506 3784.07 $420,000
Disease Control & University
Prevention
5637 5637.06 HHS/Centers for Columbia 3784 3784.06 $160,000
Emphasis Areas
Gender
* Increasing gender equity in HIV/AIDS programs
Health-related Wraparound Programs
* Child Survival Activities
* Family Planning
* Malaria (PMI)
* Safe Motherhood
Human Capacity Development
Estimated amount of funding that is planned for Human Capacity Development $20,000
Public Health Evaluation
Food and Nutrition: Policy, Tools, and Service Delivery
Food and Nutrition: Commodities
Economic Strengthening
Education
Water
Table 3.3.01:
APRIL 2009 REPROGRAMMING
Strengthening STI services for MARPs
As a result of the Prevention Portfolio Review, we have determined this activity to have 20% AB component
from the previous 100% OP activity.
Expand access to PLHA and other MARPs to comprehensive STI care and treatment services at 52 sites in
Oromia, Somali, Harari and Dire Dawa regions.
Prevention of sexually transmitted infections (STI) among most-at-risk populations (MARPs) and people
living with HIV (PLWH) is a critical activity in preventing new HIV infections and slowing the pace of the
epidemic. During FY07& 08, Columbia University's International Center for AIDS Care and Treatment
Programs, (ICAPCU) has taken full responsibility for supporting STI activities at public and private health
facilities in Dire Dawa, Oromiya, Harari, and Somali regions. The support activities included: Training
healthcare providers on syndromic management of STI, and providing technical assistance to implement
the syndromic approach at hospital level. Coordination with Regional Health Bureaus (RHB) to help
facilitate and coordinate linkages between STI and HIV/AIDS services, and strengthen external referral
linkages between hospitals, health centers, and community service organizations, faith-based
organizations, and PLWH support groups and associations. A recent study by CDC/EPHA in selected
urban and rural areas identified a number of barriers that limit the utilization of STI services in the country,
operating at individual, community, health facility, and policy/program levels. These include: at facility level
space problems, shortage of basic functioning diagnostic equipment, failure to implement syndromic
management guidelines, lack of BCC/IEC materials, poor recordkeeping, lack of confidentiality. At provider
level lack of training; health workers lack basic patient counseling and education skills; health workers are
judgmental to patients with STDs. At patient level urban patients buy STI drugs to treat their disease without
consulting health care; government facilities seen as the last resort; fear of stigma, judgmental clinic staff,
breach of confidentiality, long waiting times seen as barriers to attending clinics. One of the major gaps
identified by the know your epidemic know your Ethiopian Episynthesis is lack of data on STIs with only few
cases being reported from health facilities throughout the country. Therefore, the major focus in FY09 shall
include support for sites for STI syndromic data documentation and reporting and support STI surveillance
program within the health-delivery structure in the specified Regions FY09 activities at the hospital/facility
level will include: 1), Continuation support of STI services for a total of 52 sites supported by ICAP-CU 2)
Providing on-site technical assistance to improve STI diagnosis and treatment following national syndromic
management guidelines 3) Training, supportive supervision, and mentorship of physicians, health officers,
and nurses on STI prevention, diagnosis, and treatment, with a focus on the linkages between STI and HIV
infection, as per national guidelines. 4) Have core T.O.T trained at the regional and Zonal health offices 5)
Developing linkages with the Global Fund for AIDS, Malaria, and Tuberculosis and other PEPFAR funded
partners to ensure adequate supplies of STI drugs at all facilities 5) Developing linkages to HIV counseling
and testing (HCT) services, promoting a provider-initiated, opt-out approach for all STI patients, and
developing linkages to care and treatment services for those who are HIV -positive 6) STI education
focused on risk reduction, screening, and treatment for patients enrolled in HIV/AIDS care and treatment at
the hospitals 7) Providing condoms and education on how to use them, to patients enrolled in care and
treatment, with a special focus on MARPs 8) Integration of STI services into antenatal and PMTCT services
to ensure that all pregnant women are educated about STI and given necessary treatment, and are
educated on STI prevention during pregnancy (according to national STI management and antenatal care
guidelines) 10) Development of linkages to community-based organizations that promote risk reduction and
HIV/STI prevention and early/complete treatment in communities surrounding ICAP-CU-supported ART
sites 11) More Strengthening of STI data recording and reporting system at all levels .Support for sites for
STI syndromic data documentation and reporting ICAP-CU will also focus on: 12) Continue targeted STI
prevention, diagnosis, and treatment services to MARPs, including commercial sex workers 13) In FY08,
ICAP was provided with supplemental funding to mainstream and strengthen IEC and BCC programs with
its existing care and treatment activities to conduct outreach activities and promote services with in and
outside the health facility areas in four regions of the country (Oromia, Dire Dawa, Harari and Somali
regions). In FY09, ICAP will strengthen and continue this activity by expanding sexual prevention outreach
activity using the ABC strategy in two local universities in Oromia region (Haromaya and Jimma
Universities). In FY09, ICAP will facilitate and coordinate linkages between STI and HIV/AIDS services.
One of the major gaps identified by the know your epidemic know your response of Ethiopian Episynthesis
is lack of data on STIs with only few cases being reported from health facilities throughout the country.
Therefore, the major focus of FY09 shall include support for sites for STI syndromic data documentation
and reporting and support STI surveillance program within the health-delivery structure. Others include
having core T.O.T trained at the regional and zonal health offices and providing on-site training.
New/Continuing Activity: New Activity
Continuing Activity:
Table 3.3.02:
Strengthening STI Services for MARPS
ACTIVITY MODIFIED IN THE FOLLOWING WAYS
epidemic.
During FY07& 08, Columbia University's International Center for AIDS Care and Treatment Programs,
(ICAPCU) has taken full responsibility for supporting STI activities at public and private health facilities in
Dire Dawa, Oromiya, Harari, and Somali regions.
The support activities included: Training healthcare providers on syndromic management of STI, and
providing technical assistance to implement the syndromic approach at hospital level. Coordination with
Regional Health Bureaus (RHB) to help facilitate and coordinate linkages between STI and HIV/AIDS
services, and strengthen external referral linkages between hospitals, health centers, and community
service organizations, faith-based organizations, and PLWH support groups and associations.
A recent study by CDC/EPHAin selected urban and rural areas identified a number of barriers that limit the
utilization of STI services in the country, operating at individual, community, health facility, and
policy/program levels. These include: at faclility level space problems, shortage of basic functioning
diagnostic equipment, failure to mplement syndromic management guidelines, lack of BCC/IEC materials,
poor recordkeeping, lack of confidentiality. At provider level lack of training; health workers lack basic
patient counseling and education skills; health workers are judgmental to patients with STDs. At patient
level urban patients buy STI drugs to treat their disease without consulting health care; government facilities
seen as the last resort; fear of stigma, judgmental clinic staff, breach of confidentiality, long waiting times
seen as barriers to attending clinics.
One of the major gaps identified by the know your epidemic know your Ethiopian Episynthesis is lack of
data on STIs with only few cases being reported from health facilities throughout the country. Therefore, the
major focus in FY09 shall include support for sites for STI syndromic data documentation and reporting and
support STI surveillance program within the health-delivery structure in the specified Regions
FY09 activities at the hospital/facility level will include:
1), Continuation support of STI services for a total of 52 sites supported by ICAP-CU
2) Providing on-site technical assistance to improve STI diagnosis and treatment following national
syndromic management guidelines
3) Training, supportive supervision, and mentorship of physicians, health officers, and nurses on STI
prevention, diagnosis, and treatment, with a focus on the linkages between STI and HIV infection, as per
national guidelines.
4) Have core T.O.T trained at the regional and Zonal health offices
5) Developing linkages with the Global Fund for AIDS, Malaria, and Tuberculosis and other PEPFAR funded
partners to ensure adequate supplies of STI drugs at all facilities
5) Developing linkages to HIV counseling and testing (HCT) services, promoting a provider-initiated, opt-out
approach for all STI patients, and developing linkages to care and treatment services for those who are HIV
-positive
6) STI education focused on risk reduction, screening, and treatment for patients enrolled in HIV/AIDS care
and treatment at the hospitals
7) Providing condoms and education on how to use them, to patients enrolled in care and treatment, with a
special focus on MARPs
8) Integration of STI services into antenatal and PMTCT services to ensure that all pregnant women are
educated about STI and given necessary treatment, and are educated on STI prevention during pregnancy
(according to national STI management and antenatal care guidelines)
10) Development of linkages to community-based organizations that promote risk reduction and HIV/STI
prevention and early/complete treatment in communities surrounding ICAP-CU-supported ART sites
11) More Strengthening of STI data recording and reporting system at all levels .Support for sites for STI
syndromic data documentation and reporting
ICAP-CU will also focus on:
12) Continue targeted STI prevention, diagnosis, and treatment services to MARPs, including commercial
sex workers
13) In FY08, ICAP was provided with supplemental funding to mainstream and strengthen IEC and BCC
programs with its existing care and treatment activities to conduct outreach activities and promote services
with in and outside the health facility areas in four regions of the country (Oromya, Dire Dawa, Harari and
Somali regions). In FY09, ICAP will strengthen and continue this activity by expanding sexual prevention
outreach activity using the ABC strategy in two local universities in Oromia region (Alemaya and Jimma
Universities).
In FY09, ICAP will facilitate and coordinate linkages between STI and HIV/AIDS services. One of the major
gaps identified by the know your epidemic know your response of Ethiopian Episynthesis is lack of data on
STIs with only few cases being reported from health facilities throughout the country. Therefore, the major
focus of FY09 shall include support for sites for STI syndromic data documentation and reporting and
support STI surveillance program within the health-delivery structure. Others include having core T.O.T
trained at the regional and zonal health offices and providing on-site training.
Continuing Activity: 16668
16668 10642.08 HHS/Centers for Columbia 7498 3784.08 Rapid $700,000
10642 10642.07 HHS/Centers for Columbia 5506 3784.07 $125,000
* Addressing male norms and behaviors
* Reducing violence and coercion
Table 3.3.03:
Pallative Care Support
ACTIVITY UNCHANGED FROM FY2008
COP 08 NARRATIVE:
Care and treatment of HIV is the centerpiece of the activities of the International Center for AIDS Care &
Treatment Programs-Columbia University (ICAP-CU). In FY07 and FY08, ICAP-CU supported basic
palliative care services at 52 facilities. These included: an initial assessment of site-level palliative care
activities, training of the multidisciplinary team, site-level clinical mentoring, enhancement of data collection
and reporting, minor renovations, and supportive supervision of palliative care activities. Training and
supervision focused on identifying and managing symptoms, pain, and discomfort among HIV-positive
patients, and on providing cotrimoxazole prophylaxis (pCTX), tuberculosis (TB) screening, and key
elements of the preventive-care package, such as multivitamins, nutritional assessments, and prevention for
positives. This program was introduced to the hospitals in Operational Zone 2 (Dire Dawa, Harari, Oromiya,
and Somali regions).
In FY09, ICAP-CU will continue to support palliative care and support activities at 52 facilities providing HIV
care and treatment via a multidisciplinary, family-focused approach for providing the preventive care
package for adults. This approach will incorporate best practices for health maintenance and the prevention
of opportunistic infections for people living with HIV (PLWH), slowing disease progression and reducing
morbidity and mortality.
ICAP-CU will continue to assist 52 facilities in Operational Zone 2 to provide the preventive care package,
complementing the Global Fund for Aids, Tuberculosis, and Malaria (Global Fund), the Federal Ministry of
Health, and other USG-funded activities when possible. ICAP-CU will focus on provision of the preventive
care package for adults, which includes: active TB screening; CTX; symptom management; micronutrient
(multivitamin) and nutrition supplementation and counseling; insecticide-treated mosquito nets (ITN) through
links with Global Fund; condoms; positive-living strategies; prevention with positives; counseling and testing
of family members and contacts; and home water disinfectant and vessels at all ICAP-CU-supported
hospitals.
ICAP-CU will continue to work closely with other PEPFAR Ethiopia US-based university partners (e.g.,
University of California, San Diego) to ensure complementarities of activities on implementation of national
pain management guidelines. As member of the National Technical Working Group on Palliative Care, ICAP
-CU will continue to contribute to the development of guidelines, formats, and standards. More details on
delivery of these aspects of the preventive care package are outlined below.
ICAP-CU support to facilities will be continued or expanded as follows. ICAP-CU will:
1) Strengthen the internal and external linkages required at facility level to identify HIV-positive individuals
and provide them with access to care. Internal linkages include referrals to the HIV/AIDS/ART clinic from
antenatal clinics, TB clinics, inpatient wards, out-patient departments, as well as voluntary counseling and
testing. External linkages include referrals to and from community-based resources providing counseling,
adherence support, home-based care, and financial/livelihood and nutritional support.
2) Provide on-site implementation assistance, including staff support, implementation of referral systems
and forms, and support for monthly HIV/AIDS team meetings to enhance linkages.
3) Provide training on palliative care and the preventive care package to multidisciplinary teams.
4) Provide clinical mentoring and supervision to multidisciplinary teams for care of PLWH, including those
who do not qualify for or choose not to be on treatment, in partnership with regional health bureaus in the
respective regions.
5) Continue to develop and distribute provider job aids and patient education materials related to palliative
care and positive living.
6) Identify and sensitize community-based groups to palliative care, to the importance of adherence to both
care and treatment for PLWH, and to the palliative care services available at the facility level.
7) Improve nutrition assessment at health facilities.
8) Promote interventions (pharmacologic and non-pharmacologic) to ease distressing pain or symptoms.
9) Continue patient management after hospital discharge if pain or symptoms are chronic.
10) Link patients with community resources after discharge.
11) Continue to provide safe water interventions like point of use water treatment by disinfectant and
general personal and environmental hygiene for people living with the virus and families.
ICAP-CU activities will promote prophylaxis and treatment for opportunistic infections in accordance with
national guidelines. Appropriate use of pCTX as essential elements of care for HIV-positive adults continue
to be an important component of ICAP-CU's implementation activities, especially at those sites not yet
providing ART. ICAP-CU will ensure that all supported sites have reliable stocks of CTX tablets, and will
provide emergency supplies at a time of absolutely necessary to ensure quality and continuity of care.
Similarly, TB screening and isoniazid prophylaxis (IPT) will be promoted and provided for HIV-positive
adults. Supportive supervision and the institution of standard operating procedures will improve the use of
CTX and IPT. Attention will be given to the issue of HIV/malaria co-infection and routine provision of ITN to
all HIV patients, in collaboration with Global Fund. Pregnant patients in HIV/AIDS and PMTCT programs will
have priority.
Health education and behavior-change communication for HIV-positive individuals continued to be provided
by facility and lay staff, complementing Global Fund and other USG-funded activities. Patients will have
access to nutritional counseling and multivitamins. At least five hospitals will provide "therapeutic feeding-by
prescription" for patients who qualify based upon criteria agreed upon by PEPFAR Ethiopia (i.e., HIV+
pregnant or breastfeeding women, HIV-exposed or infected infants who are no longer breastfeeding,
malnourished patients). Clear criteria will be established for patient selection, and an exit strategy
developed when therapeutic feeding support is initiated. Health education, counseling, and support will
encourage positive living to forestall disease progression and promote prevention among positives to
Activity Narrative: prevent further transmission of HIV.
Continuing Activity: 16669
16669 5772.08 HHS/Centers for Columbia 7498 3784.08 Rapid $372,000
10495 5772.07 HHS/Centers for Columbia 5506 3784.07 $333,000
5772 5772.06 HHS/Centers for Columbia 3784 3784.06 $850,000
Table 3.3.08:
April 2009 Reprogramming:
Expansion of HIV/AIDS Pre service Education Problem Statement Ethiopia's goals for expanding access to
HIV/AIDS prevention, care, and treatment services consistently face common and recurring challenges,
particularly when dealing with human resources. These include absolute shortages in terms of numbers, an
inadequate knowledge and skills base which require extensive and expensive in-service training, and poor
distribution and low motivation of those healthcare workers in the system. The crisis in human resources for
health is most severe in emerging regions, where vacancy and attrition rates are nearly double the national
average.
In FY06 and FY07, JPIEGO (PEPFAR partner) worked with seven health professional schools of three
major universities (Addis Ababa University, Gondar University, and Jimma University) to integrate and
strengthen the teaching of HIV/AIDS in pre-service education. Efforts included: consensus-building
workshops with stakeholders; an in-depth needs assessment; faculty updates in HIV/AIDS content areas,
effective teaching skills, infection prevention, etc.; and the development of educational standards specific to
this program and linked with the Higher Education Relevance and Quality Agency (HERQA) standards.
Also, the PEPFAR partner worked with instructors to develop relevant teaching materials for HIV/AIDS and
supported individual departments and schools in introducing these into relevant sections of the curriculum.
The PEPFAR partner also procured teaching equipment, including computers, LCD projectors, screens,
TVs and VCRs, printers, overhead projectors, clinical models, teaching charts, DVDs, videos, etc. for
distribution to each school. As of July 2007, 87 faculty attended training workshops (with many attending a
series involving both HIV/AIDS updates and effective teaching skills), and 349 students received pre-
placement training prior to graduation. The effective teaching skills component, in particular, has led
faculties to re-think and re-design how they deploy students to clinical practice sites (e.g., Jimma), and to
adopt the use of clinical preceptors as a way of maximizing mentoring of students in clinical areas.
In FY08, the PEPFAR partner consolidated its efforts in the three universities and expand to new cadres
within the university. These cadres included laboratory technicians, pharmacists and others. The partner
worked with PEPFAR partners—Strengthening Pharmaceutical Systems (SPS) and a CDC laboratory
partner. The partners worked to update faculty knowledge and skills and revise curricula, and provided
effective teaching-skills training and teaching equipment. The partner also applied the Standards Based
Education Management and Recognition (SBEM-R) approach for strengthening the quality of the pre-
service education. In addition, the partner applied the lessons learned in university settings to regional
health college for diploma-level nursing education. With the assumption that nurses recruited from and
trained in the regions of Gambella and Benishangul are more likely to stay in the regions for a longer
proportion of their career, the PEPFAR partner strengthened the nursing schools in Gambella and
Benishangul and prepared them to accept larger intakes of students. The focus was on HIV/AIDS content,
but the strengthening will include equipping classrooms and clinical skills labs, ensuring good scheduling of
clinical attachments/internships so that students learn by doing, upgrading faculty skills, etc, and testing
whether the SBEM-R methodology can be effectively applied in such a setting. Core groups of
faculty/tutors will also receive training in effective teaching skills and HIV/AIDS content support, working
with PEPFAR partners to carry out the latter as appropriate. Educational development centers will be
established in large universities and in all participating schools. The partner established a core team of
"Educational Mentors for Health" to build capacity for internal development of instructors and to overcome
the problem of teacher turnover. The PEPFAR partner continued to support the development of printed
materials, tools (question banks, learning resource packages for faculty, clinical attachment logbooks for
students, etc.) and support for other resources, such as teaching supplies/equipment, models, and other
supplies for clinical skills labs, as the curriculum development evolves. The partner shared other resources
that are available to school faculties and leadership, such as the virtual/distance leadership course
established by the Leadership and Management Support project, which is funded by the US Agency for
International Development.
In FY 09 these activities were reprogrammed from JHPIEGO to I-TECH (International Training & Education
Center on HIV, University of Washington) to implement the following activities.
• Ensure that one Academic Development and Resource Center (also known as educational development
centers) is established and strengthened at each of the two universities in the cities of Jimma and
Harayama
• Ensure that two skills laboratory are strengthened
• Ensure that competency-based education is promoted and strengthened at the universities in the cities of
Jimma and Harayama
• Educational quality is improved based on the increment in achievement of performance standards through
standards-based educational management and recognition
• 50 instructors will be trained on effective teaching skills
• 50 instructors will be trained on Instructional Design (ID)
• 50 instructors will be trained on student's performance assessment teaching and student performance
assessment will be improved.
• In collaboration with the Ministry of Education, Ministry of Health, the Higher Education Relevance and
Quality Agency, and professional associations, accreditation and licensure processes will be developed and
implemented
• Pre-service HIV/AIDS education strengthening support is expanded to other health science disciplines and
universities
• Practical training sites and their linkages with teaching institutions are strengthened; through training of
preceptors and strengthening the support to practical sites.
Table 3.3.09:
Technical Support for ART Scale-up
"ACTIVITY HAS BEEN MODIFIED IN THE FOLLOWING WAYS"
As of June 30, 2008, International Center for AIDS Care and Treatment Programs-Columbia University
(ICAP-CU) was supporting HIV treatment services in 40 ART sites in four regions of the country (Oromia
region, Dire-Dawa City Administration, Harari region and Somali). In these ICAP-CU supported sites, 31
649 patients were enrolled to Anti-Retroviral Treatment (ART), and 21 029 patients have been regularly
receiving ART by the end of June, 2008. These achievements far exceed the targets set for COP07 (ending
on September 30, 2008) with three more months left before the end of the reporting period. ICAP-CU
provides support to hospital ART sites in Oromia region, where as in the small and emerging regions of Dire
-Dawa City Administration, Harari region and Somali region, it supports comprehensive care and treatment
services at both hospital and health center ART sites.
The activities will continue in COP09 to maintain the care and treatment service to patients enrolled to
treatment, and to initiate new eligible patients on treatment. Emphasis will be given to improving quality of
service delivery and reduction of ART patient mortality. ICAP-CU will also work to improve the function of
the network and the referral system in collaboration with partners working at health center and community
level.
Establishing effective referral linkages between facilities (hospitals and health centers) and between
facilities and community services has been a challenge due to insufficient coordination among partners,
poor referral system and poorly developed community support services (particularly in remote sites).
Retention of patients to care and treatment services is an issue with high rate of ART patient mortality and a
significant proportion of patients being lost to follow-up.
Care and treatment of HIV in adults and children is the centerpiece of the ICAP-CU activities in Ethiopia. In
COP08, ICAP-CU supported full spectrum HIV prevention, care, and treatment services at these hospital
networks: ICAP-CU is the technical lead in pediatric HIV services, tuberculosis (TB)/HIV integration,
malaria/HIV integration, family-focused care and treatment, and involvement of people living with HIV/AIDS
(PLWH). ICAP-CU will continue its central- and regional-level support, and initiate additional clinical
mentoring and twinning projects as appropriate.
ICAP-CU will continue to provide technical support in the areas of family-centered HIV care and treatment,
and will work with the National ART Program to ensure that the growing Ethiopian PMTCT program is linked
to care and treatment services.
At the regional level, ICAP-CU will work with Dire Dawa, Harari, Oromia, and Somali Regional Health
Bureaus (RHB) and other partners to build their capacity to effectively design, implement, and evaluate
HIV/AIDS programs. ICAP-CU will formally partner with RHB and continue to support provision of quality
and comprehensive HIV services. ICAP-CU will work with RHB to assess, evaluate the clinical,
infrastructural, management, and informatics needs of facilities and develop implementation strategies to
enable each facility to meet required national standards, and to provide assistance to support the
implementation of national treatment guidelines. ICAP-CU will work with RHB to strengthen linkages across
the hospital-health center networks, and to assist partners as they assess health-center capacity. These
assessments and the strategies developed in conjunction with the health centers for appropriate "down
referral" will enable health centers to follow up on stable patients or initiate ART services in some cases.
"Up referral," in which health centers refer complex cases to hospitals, will also be facilitated.
ICAP-CU will continue to build the capacity of Jimma and Haramaya Universities to provide TA, supportive
supervision, and mentoring to their respective RHB and catchment health networks. These universities will
eventually assume the responsibilities of providing TA to the health networks in the four regions, enabling
external partners to exit smoothly.
At the facility level, following Ethiopian National Guidelines, ICAP-CU will support provision of
comprehensive high-quality HIV services, including ART, at public and private facilities in the four regions.
Specific activities include:
1) Support for hospital HIV/AIDS Committees and multidisciplinary ART Teams to ensure facility ownership
of service implementation
2) Training and quality improvement activities for physicians, nurses, and pharmacy personnel
3) Ongoing supportive supervision and clinical mentoring of facility staff (ICAP-CU will enhance clinical
mentoring skills and strategies by sending a team of clinical advisors to the Stephen Lewis Foundation
mentoring workshop in Uganda)
4) Linkages with entry points to care and treatment, including counseling and testing services, antenatal
clinics and PMTCT programs, TB clinics, Under-5 clinics, and adult and pediatric inpatient wards, as well as
support for staff at these entry points
5) Linkages to services for family planning, TB/HIV, sexually transmitted infections, and the full package of
palliative care services
6) On-site implementation assistance to strengthen systems, including: medical records; referral linkages;
patient follow-up and adherence support; ART clinic management; integration of prevention into care and
treatment; involvement of PLWH; appointment systems and defaulter tracing mechanisms; and facilitating
access to laboratory services and ARVs
7) Standardized health-management information systems and on-site assistance with data management
and monitoring and evaluation to guide quality improvement
8) Hiring of data clerks at all hospitals, in coordination with Tulane University and RPM+
9) Renovation of facilities, in coordination with RPSO and Crown Agents, as needed
10) Implementation of post-exposure prophylaxis (PEP) activity for occupational exposure of healthcare
providers and for victims of sexual assault in all the sites supported. This includes: establishing a functional
Infection Prevention/PEP committee in all facilities; organizing forums to create awareness in the facilities;
Activity Narrative: ensuring full availability of ARV drugs for PEP; developing and distributing standard operating procedures
(SOP), wall charts, and brochures that indicate steps to be taken after accidental occupational or sexual
assault exposures.
ICAP-CU will support ART training, according to national guidelines and curriculum. Additional training,
including training on program management skills, will be provided to all new sites initiating ART and to sites
already providing ART services to fill the gaps created by high staff turnover. This will be supplemented by
refresher trainings, focusing on an integrated multidisciplinary team approach to care and treatment.
Ongoing site-level clinical mentoring and supportive supervision will be carried out at all ART hospitals in
ICAP-CU supported regions.
ICAP-CU will support internet access for ART hospitals, enabling staff to use web-based resources,
including ICAP websites, and e-mail case consultation services, as well as to obtain information from the
national program. ICAP-CU will expand provider reference tools on ART, including pocket guides, ART
dosing cards, posters, and ART SOP, as well as client educational materials in local languages (i.e.
Amharic, Oromiffa, and Somali).
Under the ART health network, ICAP-CU will work to establish and strengthen links between hospital
services, different levels of facilities and PLWH groups, non-governmental and faith-based organizations,
and communities with other partners working at these levels. This will facilitate patient access to, and use
of, comprehensive care and support and continuity of care and treatment.
ICAP-CU will continue to support PLWH associations to involve their members in HIV/AIDS program
activities. ICAP-CU will:
1) Support and facilitate PLWH involvement at different levels
2) Work closely with the Network Association of Ethiopians Living with HIV/AIDS (NEP+) to foster their
greater involvement
3) Build the capacity of NEP+ in program management and implementation
4) Hold a PLWH involvement workshop and national peer educators' review meeting
5) Provide facility-level assistance to expand involvement of PLWH as peer educators. As part of
multidisciplinary ART teams, peer educators play a key role in patient education on prevention for positives,
positive living, adherence counseling and support, defaulter tracing, and linkages to community resources,
such as food and psychosocial support.
As part of its human capacity development scheme, ICAP-CU will collaborate with the International
Twinning Center to expand the voluntary healthcare corps by recruiting retirees with experience in clinical or
project management.
Continuing Activity: 16672
16672 10436.08 HHS/Centers for Columbia 7498 3784.08 Rapid $8,400,000
Palliative Care Support at Hospital Level
ACTIVITY IS REPLACED ENTIRELY AS FOLLOWS:
International Center for AIDS Care & Treatment Programs-Columbia University (ICAP-CU) is playing a lead
role in pediatric care and support. In FY07 and FY08, ICAP-CU supported basic pediatric care and support
services at 40 facilities. These included: an initial assessment of site-level palliative care activities, training
of the multidisciplinary team, site-level clinical mentoring, enhancement of data collection and reporting,
minor renovations, and supportive supervision pediatric care and support services. Other services included
training and supervision focused on identifying and managing symptoms, pain, and discomfort among HIV-
positive children, and on providing cotrimoxazole prophylaxis (pCTX), tuberculosis (TB) screening, and key
elements of the preventive-care package, such as multivitamins and nutritional assessments. This program
was introduced to the hospitals in Operational Zone 2 (Dire Dawa, Harari, Oromiya, and Somali regions).
ICAP-CU supported all health facilities in an effort to ensure facility-based care for HIV-exposed children
aimed at extending and optimizing quality of life for HIV-infected children and their families throughout the
continuum of illness. Clinical care includes
1) Supporting sites to perform early infant diagnosis, preventing and treating opportunistic infections (OI),
excluding TB, and other HIV/AIDS-related complications including malaria and diarrhea
2) Providing access to commodities such as pharmaceuticals, insecticide treated nets, safe water
interventions and related laboratory services
3) Providing pain and symptom relief
4) Providing nutritional assessment and support including the distribution of food.
In FY09, ICAP-CU will strengthen pediatric care and support in existing sites and expand activities to all
sites providing adult HIV care and treatment via a multidisciplinary, family-focused approach to providing the
preventive care package for children. This approach will incorporate best practices for health maintenance
and the prevention of opportunistic infections for children with HIV (PLWH), slowing disease progression
and reducing morbidity and mortality. ICAP-CU will continue to play the lead role in pediatric care and
treatment among PEPFAR Ethiopia's US university partners and will spearhead the revision of the
developed national pediatric guideline and standard operating procedures for pediatric HIV care as
appropriate. In the face of having a national guideline which adopts WHO recommendations for early
diagnosis and initiation of treatment, I-CAP will work to improve access to early infant HIV diagnostics using
dried-blood spot DNA PCR testing and networking to avail the service to hospitals and health centers.
ICAP-CU will continue to provide the preventive care package, complementing the Global Fund for AIDS,
Tuberculosis, and Malaria (Global Fund), the Federal Ministry of Health (MOH), and other USG-funded
activities when possible. ICAP-CU will focus on provisions of the preventive care package for children. The
package for children includes: appropriate prophylaxis and ITN to prevent serious illnesses like
pneumocystis carinii pneumonia, TB, and malaria; symptom management; prevention and treatment of
diarrhea; nutrition and micronutrient supplements; and linkage to national childhood immunization
programs. ICAP-CU will also ensure that all HIV-positive children receive careful and consistent clinical,
developmental, and immunologic monitoring to promptly identify those eligible for ART. Orphaned and other
vulnerable children (OVC) enrolled in care and treatment will be prioritized for palliative care services and
linked to community-based OVC care programs in order to receive a continuum of care.
1) Strengthen the internal and external linkages required at facility level to identify HIV-positive children and
provide them with access to care. Internal linkages include referrals to the HIV/AIDS/ART clinic from
antenatal clinics, TB clinics, under-5 clinics, inpatient wards, out-patient departments, as well as voluntary
counseling and testing. External linkages include referrals to and from community-based resources
providing counseling, adherence support, and financial/livelihood and nutritional support
and forms, and support for monthly pediatric team HIV/AIDS team meetings to enhance linkages
3) Provide training on pediatric care and support and the pediatric preventive care package to
multidisciplinary teams
4) Provide clinical mentoring and supervision to multidisciplinary teams for care of infected children,
including those who do not qualify for or choose not to be on treatment, in partnership with regional health
bureaus in the respective regions
5) Continue to develop and distribute pediatric provider job aids and patient education materials related to
pediatric care and support.
care and treatment services available at the facility level
7) Improve nutrition assessment of children at health facilities
8) Promote interventions (pharmacologic and non-pharmacologic) to ease distressing pain or symptoms
9) Continue patient management after hospital discharge if pain or symptoms are chronic
10) Link families with community resources after discharge
general personal and environmental hygiene for people and families living with the virus
ICAP-CU activities will promote prophylaxis (pCTX) and treatment for opportunistic infections in accordance
with national guidelines. Appropriate use of pCTX is an essential element of care for HIV-positive children,
and for HIV-exposed infants, and will be an important component of ICAP-CU's implementation activities,
especially at those sites not yet providing ART. ICAP-CU will ensure that all supported sites have reliable
stocks of CTX syrup and will provide emergency supplies when at a time of absolutely necessary to ensure
quality and continuity of care. Similarly, TB screening and isoniazid prophylaxis (IPT) will be promoted and
provided for HIV-positive children. (See TB/HIV narrative). Supportive supervision and the institution of
standard operating procedures (SOP) will improve the use of CTX and IPT.
Those sites with "therapeutic feeding-by prescription" will target HIV-exposed or infected infants who are no
longer breastfeeding along with HIV-positive pregnant or breastfeeding women and malnourished patients. I
Activity Narrative: -CAP will continue to work with Johns Hopkins University which is a leader for hospital-level nutrition
programs. The family of children graduating from therapeutic program will be linked to a food security
program as appropriate.
Table 3.3.10:
ACTIVITY HAS BEEN MODIFIED AS FOLLOWS
Pediatric treatment, previously included as a treatment/ARV service in FY06, FY07, and FY08 is the
centerpiece of the International Center for AIDS Care and Treatment Programs-Columbia University (ICAP-
CU) activities in Ethiopia. ICAP-CU is the technical lead in pediatric HIV services including early infant
diagnosis (EID), tuberculosis TB/HIV integration, malaria/HIV integration, family-focused care and
treatment, and involvement of people living with HIV/AIDS (PLWH). As a national leader in pediatric care
and treatment, ICAP-CU supported the Federal HIV /AIDS prevention and control office (HAPCO) in
updating and enhancing national policies, protocols, and guidelines on pediatric HIV as well as the
development of the national capacity-building plan for pediatric care and treatment. In FY08, ICAP-CU
supported full-spectrum pediatric HIV prevention, care, and treatment services at 40 facility networks
including hospitals and health centers and is currently on track in meeting targets for COP08. In FY08, ICAP
-CU-supported sites have initiated 1,683 children on ART; 1,231 children are currently on ART. ICAP-CU
has effectively supported the decentralization of ART services to health centers in Dire Dawa and Harari
regions by training staff from health centers, establishing catchment area meetings, providing ongoing
clinical mentoring, and developing standard operating procedures (SOP) to facilitate appropriate "down
referral". This enables health centers to follow stable patients or initiate ART services in some cases and
refer complex cases to hospitals (up-referral).
In FY09, ICAP-CU will expand pediatric care and treatment services to all health facilities providing adult
ART services, continue and expand its central- and regional-level support, and initiate additional clinical
mentoring and twinning projects. At the national level, ICAP-CU will continue to support the Ethiopian
Federal Ministry of Health's (MOH) National Pediatric HIV/AIDS Care and Treatment Program, by
continuing and expanding the following activities:
1) Assist the Government of Ethiopia (GOE) to update national policies and guidelines on pediatric HIV
2) Assist the GOE to develop a national capacity-building plan for pediatric care and treatment and support
to achieve national pediatric treatment targets
3) Provide technical support to National HIV Pediatric Care and Treatment Programme
4) Expand the national pediatric care and treatment training curriculum and continue widespread distribution
of pediatric support materials developed by ICAP-CU
5) Assist with the integration of pediatric monitoring and evaluation into existing care and treatment tracking
systems
6) Continue a partnership with the Ethiopian Pediatric Society to provide training on pediatric HIV/AIDS care
and treatment to every pediatrician in Ethiopia
7) Provide technical input into the development/revision and implementation of forms, registers, and
charting tools for pediatric care and treatment
8) Support radio and TV campaigns and the use of information, education and communication and behavior
change communication (IEC/BCC) materials in local languages to enhance public awareness of pediatric
HIV care & treatment services
9) Assist the GOE to establish a national system and support direct in four regions, and provide central-level
technical assistance to implementing partners working in other region
10) Expand the quality of service assessment (SOC) for pediatrics in its operational zone and support other
partners to implement quality of service assessment
and will work with the National ART Program to strengthen the growing Ethiopian PMTCT program and
linkage to pediatric care and treatment services. ICAP-CU will contribute its extensive experience with
treatment of HIV exposed and infected infants and children and assist with the expansion of national
pediatric treatment guidelines.
At the regional level, ICAP-CU will work with Dire Dawa, Harari, Oromiya, and Somali Regional Health
pediatric HIV/AIDS programs. ICAP-CU will formally partner with RHB and support provision of quality and
comprehensive pediatric HIV services. ICAP-CU will work with RHB to evaluate the clinical, infrastructural,
management, and informatics needs of facilities and develop implementation strategies to enable each
facility to meet required national standards for pediatric care and treatment services. Through intensive
collaboration, ICAP-CU works to build the capacity of the two regional Universities (Jimma and Haramaya)
to provide technical assistance, supportive supervision and mentoring to RHBs and catchment area health
networks.
In FY09, emphasis will be placed on increased pediatric ART service uptake at all sites through improved
entry points for children by supporting
1) Family focused care and family testing
2) PIHCT at under-5 clinic, pediatric inpatient, TB clinic and EPI clinic
3) Linkages with PMTCT service and improved infant follow-up
4) Strengthening linkages with OVC programs and orphanages
5) Advocacy to create better awareness among health professionals and the community to improve the
attitude towards pediatric care and treatment
6) Expansion of the service to private facilities
In FY09, on-site assistance will be provided to develop medical records for HIV-exposed and infected
children, referral linkages, patient follow-up and adherence support defaulter tracing mechanisms.
Moreover, more frequent ongoing site-level clinical mentoring and supportive supervision will be carried out
at all hospitals and health centers providing pediatric care and treatment service in ICAP-CU supported
regions.
ICAP-CU will emphasize strengthening the internal and external linkages including internal referrals to HIV
care clinics from various points of care and through external referrals to and from community-based
Activity Narrative: resources to identify HIV-infected children. Under the ART health network, ICAP-CU will work to establish
and strengthen links between hospital services, different levels of facilities and community-based services,
nongovernmental and faith-based organizations, and communities with other partners working at these
levels. Orphans and other vulnerable children (OVC) enrolled in care and treatment will be prioritized for
treatment services and linked to community-based OVC care programs in order to receive a continuum of
care.
ICAP-CU will support pediatric ART training, according to national guidelines and curriculum. Additional
training, including training on EID, will be provided to all sites initiating pediatric care and treatment service
in FY09 and to sites already providing ART services to fill the gaps created by high staff turnover. This will
be supplemented by refresher trainings, focusing on an integrated multidisciplinary team approach to care
and treatment. Through continued partnership with the Ethiopian Pediatric Society, ICAP-CU will continue
hosting annual CMEs to provide training on pediatric HIV/AIDS care and treatment to pediatricians in
Ethiopia.
ICAP-CU will continue to support the integration of pediatric monitoring and evaluation into existing care
and treatment tracking systems, updating and maintaining of a pediatric HIV website, including clinical and
training materials, frequently asked questions, illustrative case studies, and technical updates.
ICAP-CU will work closely with the MOH, the Global Fund for AIDS, Malaria, and Tuberculosis, the Supply
Chain Management System/ pediatric care and treatment services RPM+, and RHB to ensure drugs
purchased to treat opportunistic infections (OI) are distributed rationally, and to develop OI drug access for
all HIV-exposed and infected children. The availability of consistent and quality laboratory services including
EID at all these sites is critical to ensure quality comprehensive.
Table 3.3.11:
TB/HIV Linkage at Hospital Level
FY 08, ICAP has continued to support TB/HIV collaborative activities in 43 health facilities through providing
routine HIV counseling and testing for almost 95% of TB patients in the operational area, Screening of TB in
HIV positive clients and training of 165 health care providers in TB/HIV. In addition, ICAP has also provided
Technical and financial support provided in the revision, printing and distribution of the revised TB unit
register and TB/HIV reporting format as part of improving the national TB/HIV M&E system.
In FY 09, International Center for AIDS Care and Treatment Programs - Columbia University - (ICAP-CU)
will strengthen its support to MOH in the TB/HIV program implementation in line with Ethiopian Federal
Ministry of Health (MOH) and the Office of the Global AIDS Coordinator (OGAC) priorities.
TB infection control will be given more emphasis in all HIV care and treatment clinics and wards. Due
emphasis will be given at all facilities in improving early detection of infectious TB cases and timely initiation
of treatment and follow up till completion in order to render them non infectious. Ventilation and lighting will
be considered during renovations and refurbishment of patient examination and counseling rooms, wards,
and patient waiting areas. TB infection control measures will be incorporated as part of the hospitals'
comprehensive infection control plan. Due attention will be given to prevent the spread of TB to other
patients and health care workers at all HIV-related clinics through health education, cough triage in the
outpatient clinics, and isolation of admitted infectious TB patients in the wards.
MDR-TB: As an active member of the national MDR-TB technical working group, ICAP-CU will participate in
the development and revision of MDR-TB management guidelines, protocols, and tools. ICAP-CU will also
support MOH's MDR-TB management initiative through both the pilot program at St. Peter's Hospital and
the expansion plan to the regional referral hospitals.
TB/HIV M&E: Intensive training, supportive supervision, and mentorship will be provided to ICAP-supported
facilities to strengthen the TB/HIV information system to generate good quality data. ICAP-CU will also
assist national and regional TB/HIV review meetings and joint supportive supervisions.
Pediatric TB/HIV: In FY09, more emphasis will be given during the TB/HIV trainings and site level
mentorship in building the capacity and knowledge of health care workers in pediatric TB diagnosis and
TB/HIV co-management. Pediatric TB and IPT eligibility screening tools will be used to evaluate HIV-
exposed/infected children. All eligible TB/HIV co-infected children will be linked to HIV-related care and
treatment services through intra-facility and inter-facility referrals. The revised TB/HIV reporting format,
which includes age break down, enables reporting of pediatric TB/HIV activities separately and will be used
for TB/HIV activity reporting at all sites.
ICAP-CU has extensive experience strengthening linkages between TB and HIV programs in Ethiopia. In
FY08, ICAP-CU will expand its activities at the national, regional, and local levels to improve the vital
linkages between these closely related services. These activities will also establish programmatic
components that will enhance the diagnosis and management of TB/HIV co-infected patients.
At the national level, ICAP-CU will continue to give technical support to Ethiopia's Federal Ministry of Health
(MOH) and coordinate its TB/HIV activities. This will include maintaining ICAP-CU's clinical resources
website and assisting the MOH to update, reprint, and distribute national TB/HIV implementation guidelines,
registers, and reporting formats. ICAP-CU will also support the design and production of relevant
information, education, and communication (IEC) materials.
ICAP-CU is a member of the National TB/HIV Technical Working Group and, in that capacity, will continue
to support the MOH and Federal HIV/AIDS Prevention and Control Office (HAPCO) in the development and
revision of policies related to TB/HIV. ICAP-CU, together with CDC Ethiopia and MOH, will host a
symposium on updates on TB/HIV follow up and management, especially in the area of the ‘three I s'.
In COP09, ICAP-CU will continue to provide intensive training, supportive supervision, and mentorship to
coordinate activities between TB and HIV-related clinics, in patient wards, in patient referrals and in the
recording and reporting of TB/HIV activities. A standard operating procedure (SOP) will be introduced at the
facilities to generate timely reporting and good quality TB/HIV data to the national level. ICAP-CU will also
assist national and regional TB/HIV review meetings and joint supportive supervisions. The TB/HIV national
surveillance sites will be given due attention in strengthening their TB/HIV information system to be able to
report on the core TB/HIV activity indicators to the national level in a sustainable manner.
Tuberculosis is an important cause of morbidity and mortality among children in high TB and HIV burden
settings such as Ethiopia. However, TB diagnosis is challenging in the pediatric population and is often
under-reported. In 2006, the World Health Organization (WHO) published a guidance document on
childhood TB that included revised recommendations for the age groups for recording and reporting of
childhood TB. In order to gather information critical for ordering child-friendly formulations of anti-TB drugs,
and in order to monitor disease trends, pediatric TB should now be reported in two age groups: children 0-4
years old and children 5-14 years old.
In order to inform program planning to address TB/HIV among children, CDC-DTBE-IRPB will collaborate
with CDC-Ethiopia and Columbia University to enhance routine monitoring and evaluation through a
surveillance evaluation of new TB registers and recording and reporting by revised age categories (0-4
years old and 5-14 years old) at selected sites. This will help to characterize the epidemiology of childhood
TB as well as TB/HIV co-infection in Ethiopia, to describe the reach of TB/HIV collaborative activities to the
pediatric population, and to identify challenges in childhood TB diagnosis/treatment and recording and
reporting. Technical assistance will be provided by CDC Atlanta to assist in the implementation of this
activity.
Activity Narrative: In FY09, ICAP-CU will continue to second a TB/HIV integration expert on a full-time basis to MOH/HAPCO.
This advisor will have access to the expertise of ICAP-Ethiopia's TB/HIV advisors, to ICAP-CU regional
technical advisors, and to the extensive resources of the ICAP-CU Clinical Unit in New York. ICAP-CU will
also support MOH, HAPCO, and CDC efforts to improve the TB/HIV information system by hiring a TB/HIV
monitoring and evaluation expert who can work closely with MOH and CDC.
In addition to providing technical assistance with guidelines, conferences, and training materials, ICAP-CU
will provide systems-strengthening and implementation assistance in TB/HIV integration. Activities will
include:
1) Support to MOH in creating and expanding integrated TB/HIV programs for adults and children;
2) Development of standardized screening tools and diagnostic algorithms; and
3) Development of effective referral mechanisms among facilities providing TB and HIV services.
At the regional level (in Operational Zone 3), ICAP-CU will:
1) Support regional TB/HIV technical advisors to liaise with regional health bureaus (RHB) in Dire Dawa,
Harari, Oromiya, and Somali regions
2) Collaborate with Jimma and Haramaya Universities and with other partners (e.g., JHPIEGO) on pre-
service TB/HIV curricula and in-service training initiatives. This will develop local capacity to train healthcare
professionals
3) Assist RHB to establish regional TB/HIV coordinating bodies that will conduct joint supportive supervision
with regional TB/HIV focal persons
4) Develop tools and checklists to facilitate program management, supervision, and site visits.
5) Develop regionally-appropriate IEC materials in local languages
6) Support the initiative by MOH, CDC, and the Ethiopian Health and Nutrition Research Institute to
establish TB culture facilities at the regional level
At the facility level, ICAP-CU will:
1) Directly assist 52 health facilities in four regions (Dire Dawa, Harari, Oromiya, and Somali) to provide
integrated TB/HIV services as part of comprehensive HIV/AIDS service delivery
2) Support standardized TB screening and intensified TB detection in HIV-infected patients, with special
emphasis in children and pregnant women. The activity will focus on ICAP-CU supported Antiretroviral
Therapy (ART) sites, but will ensure that experiences are made available for nationwide adoption. This will
include training, supportive supervision, and other interventions that will ensure that TB screening (including
routine symptom checklists), prevention, care, and referrals are included as part of the basic package of
care for all HIV-positive individuals
3) Support the implementation of routine, provider-initiated HIV counseling and testing (with an opt-out
approach), prevention, education, and referral for HIV care (if needed) for all patients at TB clinics and TB
inpatient wards
4) Encourage all patients with TB to bring family members and household contacts to the clinic (particularly
children age 5 and younger) in order to promote early TB detection
5) Provide isoniazid preventive therapy to HIV-positive patients in whom active disease has been ruled out
6) Provide cotrimoxazole preventive therapy to all TB/HIV co-infected patients.
7) Design, implement, and evaluate systems for referral of HIV-infected TB patients to HIV care and
treatment services
8) Provide close clinical monitoring for TB/HIV patients who have started on ART to identify and manage
immune reconstitution reactions
9) Support strategies to engage families into care when TB patients are found to be HIV positive (e.g., home
visits to screen for HIV infection and disease in the household)
10) Work closely with sites on improving TB/HIV recording and reporting
11) Develop and share clinical support tools for TB/HIV management, including TB-symptom screening
questionnaires, job aids, posters, and clinical algorithms
12) Support TB/HIV refresher trainings and ongoing supportive supervision and clinical mentoring for site
staff
13) Support radiology services at TB and ART clinics to improve diagnosis and management of TB in HIV
infected patients
14) Renovate and refurbish TB and ART clinics as needed to minimize nosocomial transmission of TB
15) Introduce infection control and provide supplies required for infection control.
16) Support transport of TB culture specimens to regional labs, once capacity is available.
17) Support MOH, HAPCO and CDC efforts to purchase and install chest x-ray machines to hospitals in
ICAP- CU regions
18) Support feasibility studies and technical evaluations planned by CDC and other partners
Continuing Activity: 16670
16670 5750.08 HHS/Centers for Columbia 7498 3784.08 Rapid $528,000
10456 5750.07 HHS/Centers for Columbia 5506 3784.07 $440,000
5750 5750.06 HHS/Centers for Columbia 3784 3784.06 $250,000
Construction/Renovation
* TB
Table 3.3.12:
AActivity Narrative: HIV Counseling and testing support at hospital
ACTIVITY UNCHANGED FROM FY 2008
In FY07, the International Center for AIDS Care and Treatment Columbia University (ICAP-CU) supported
HIV counseling and testing services at 42 hospitals, providing comprehensive HIV services (including ART)
in the operational regions (Dire Dawa, Harari, Oromiya, and Somali). ICAP-CU's technical assistance and
implementation support included initial site assessments, site-level training in collaboration with JHPIEGO,
refurbishment of sites, enhancement of data collection and reporting, and supervision of counseling and
testing services. These activities assisted hospitals to deliver quality HIV counseling and testing services to
their patients and communities. In the last year 42 supported sites in four regions, trained more than 900
service providers and supported facilities provided HCT services to 250,000 people. In collaboration with
Somali Regional Health Bureau and HAPCO, ICAP-CU launched a mobile VCT services to reach the
pastoralist community.
In FY09, ICAP-CU will support voluntary counseling and testing (VCT) and provider initiated testing and
counseling (PICT) services sites in 52 sites (Public facility and NGO- mobile VCT), and the provision of
quality CT services and enhanced linkages between CT and care and treatment services. As a member of
the National Technical Working Group on HIV Counseling and Testing, ICAP-CU will contribute to the
development of guidelines, formats, and standards for CT services.
ICAP-CU will continue to promote the use of innovative testing strategies, including PITC, in inpatient wards
(adult and pediatric) and outpatient settings. It will offer a particular focus on TB, family planning, under-5,
sexually transmitted infections (STI), and other clinics, to identify HIV-positive patients and to facilitate their
enrollment into CT programs. Active case-finding within families and households will also be ICAP-CU
priority. CT cadres will be expanded and point-of-service testing models will be implemented—making it
possible to get same-day results. External referral linkages between hospitals and nongovernmental
organizations (NGO), faith-based organizations (FBO), and support groups/associations for people living
with HIV (PLWH) will be strengthened. ICAP-CU staff will work closely with PEPFAR Ethiopia partners and
USG agencies to develop and distribute promotional materials on PITC and VCT services.
ICAP-CU signed MOU with local NGO to implement mobile VCT service in Somali region. The program was
launched in FY08 to reach the underserved pastoralist population of the region. The mobile services will
also cater for the most -at- risk populations on the corridor along Hargessa route.
HIV Counseling and Testing activities will include:
1) In collaboration with regional health bureaus (RHB), the Federal Ministry of Health (MOH), CDC-Ethiopia,
and JHPIEGO, ICAP-CU will support training and deployment of lay counselors in the four ICAP-CU
supported regions. ICAP-CU will work closely with the MOH and RHB and other partners in the selection,
training, and supportive supervision of this new cadre to expand CT services.
2) ICAP-CU will continue to support the implementation of mobile CT service started in FY08. These
services are critically needed to serve hard-to-reach nomadic populations of Somali region
3) In collaboration with Jimma and Haromaya Universities and other institutions of higher learning, ICAP-CU
will support "Know Your Status" campaigns for students and staff. ICAP-CU will also support VCT services
for students and staff, as well as access to care and treatment.
4) Supported hospitals will expand the use of the Family Enrollment Form, a validated tool for active case
finding within families at multiple points of entry to HIV services.
5) ICAP-CU will play a major role in developing and implementing infant diagnostic strategies and services
at the national, regional, and facility level (see Lab and ART narratives).
6) ICAP-CU will support sites to extend CT services to the most vulnerable groups (e.g., prisoners) in
selected regions, providing education, CT, and linkages to prevention, care, and treatment services.
7) Strengthening stress- and burnout-management programs for service providers. This may be done by
establishing peer-support programs at site level, refresher trainings, and case conferences.
8) Supporting sites to provide outreach and weekend services in line with Millennium AIDS Campaign and
other local initiatives
Other specific activities include: ensuring establishment of quality-assurance systems for HIV counseling
and testing; supporting the development of tools and job-aids; and supporting refurbishment and minor
renovations to ensure privacy when needed. ICAP-CU will coordinate with relevant implementing partners
to help ensure the availability of counseling and testing supplies, such as test kits and laboratory supplies
and equipment.
ICAP-CU's CT activities will be harmonized with those of all PEPFAR Ethiopia partners operating in the
same regions. This will strengthen linkages for better program impact. All activities will be closely monitored
by ICAP-CU regional office staff and central office Clinical Advisors, who will provide technical assistance
and implementation support to strengthen service delivery and program management. This will help
PEPFAR Ethiopia and MOH reach FY08 targets for care and treatment.
Continuing Activity: 16671
16671 5722.08 HHS/Centers for Columbia 7498 3784.08 Rapid $450,000
10455 5722.07 HHS/Centers for Columbia 5506 3784.07 $375,000
5722 5722.06 HHS/Centers for Columbia 3784 3784.06 $200,000
Table 3.3.14:
Site-level Laboratory Support
ACTIVITY HAS BEEN MODIFIED IN THE FOLLOWING WAYS: (insert a maximum of 5000 character
narrative here):
Columbia University-ICAP in addition to the activities in FY08 will support the facilities to attain minimum
standards set by EHNRI. CU-ICAP will technically assist for the process improvement including
accreditation of regional laboratories. CU-ICAP will address integrated laboratory system and will also
provide support for establishment of regional laboratory in Somali, TB culture and viral load facilities in
regional laboratories and will work to develop capacity of regional laboratories for sustainability.
In FY08, International Center for AIDS Care and Treatment Programs, Columbia University (ICAP-CU) has
provided comprehensive high-quality HIV/AIDS services, including ART at 50 public and two private hospital
networks in the Oromia, Harari, Somali and Dire Dawa regions. Comprehensive technical assistance and
implementation support has strengthened essential elements of the laboratory system and improved service
quality and consistency. ICAP-CU has helped to: conduct assessment of laboratory services, train
laboratory staff (via offsite and onsite trainings on equipment operation, preventive maintenances and HIV-
related laboratory test procedures); establish and strengthen quality assurance (QA) programs via on-site
mentorship and by developing and implementing SOPs, developing log books and improving documentation
and recording; and provide technical and logistic support for specimen referral linkage between testing
hospitals and referring hospitals and health centers. ICAP-CU has been doing major infrastructure support
to hospital laboratories including improvement of space in the rooms with in the existing footage, epoxy
painting of floor and wall in the testing rooms, standard furnishing of the labs, and improving the electric line
and drainage system. ICAP-CU renovated two regional laboratories for establishment of DNA PCR for early
infant diagnosis. In collaboration with CDC and EHNRI, ICAP-CU has provided key technical and
implementation support to Early Infant Diagnosis (EID) program at national, regional, and site levels.
In FY09, ICAP-CU will provide its support to 52 hospital networks (50 government and two private) in the
Oromia, Harari, Somali and Afar regions, enabling each to provide comprehensive high-quality HIV/AIDS
services. In addition, ICAP-CU will continue supporting health centers in emerging regions. Intensive site-
level laboratory support is an essential component of ICAP-CU's plans, as the availability of consistent and
reliable laboratory services will ensure quality HIV prevention, care, and treatment services. Ongoing
training, supervision, and mentoring of laboratory staff and hands-on implementation support will be
provided to all 52 sites. ICAP-CU will work directly with the regional lab, hospital labs and health center
personnel to implement and monitor the quality assurance programs at the 52 sites so as to support the
facilities to attain the minimum standards set by EHNRI. ICAP-CU will provide technical support for process
improvement including accreditation of regional laboratories. ICAP-CU will continue to provide technical
assistance to the rollout of HIV-1 DNA PCR for infant diagnosis at regional levels.
ICAP-CU's laboratory support activities in FY09 will include:
(1) Strengthening of site-level laboratory quality systems, with emphasis on initiation and enhancement of
quality assurance programs in partnership with CDC, EHNRI and Oromia, Somali, Harari and Dire Dawa
regional reference laboratories. These activities will include the preparation, revision and implementation of
standard operational procedures (SOPs) for HIV disease monitoring (hematology, clinical chemistry, and
CD4), specimen management, laboratory safety, and QA/QC program. ICAP-CU will also support the
preparation and provision of standard documentation and recording formats including QC forms, lab request
forms and registers. ICAP-CU technical advisors will provide ongoing supportive supervision and
mentorship at all sites, ensuring the delivery of high-quality laboratory services as well as systems
strengthening, skills transfer, and capacity development. ICAP-CU in collaboration with CDC, EHNRI and
Somali Regional Health Bureau will support the establishment of the regional laboratory at Somali. In
addition, ICAP-CU will work closely with the regional laboratories at Oromia and Harari to build local
capacity as this is the exit strategy for partners.
(2) Technical support for uninterrupted laboratory services at all 52 ART site networks. This includes:
assisting with the development, implementation and enhancement of laboratory inventory systems in the
hospital networks and ensuring availability of continued and sufficient reagent supplies; supporting timely
preventive and troubleshooting maintenance services; building regional capacity for essential laboratory
equipment maintenance capability, and supporting human resources by facilitating the availability of
adequately trained laboratory personnel at all sites. These activities will be coordinated with supplies chain
management and regional laboratories. ICAP-CU regional laboratory advisors will work closely with the
regional lab associates of SCMS
(3) Capacity building and minor renovation of facility level laboratories:
ICAP-CU will provide regular mentorship of site-level staff focusing on improving laboratory management,
laboratory organization, layout and work flow, specimen management, testing procedures, standard
documentation, record keeping and reporting, and stock and inventory management. The mentorship will
address the integrated laboratory system with emphasis on HIV, TB, OIs and malaria. ICAP-CU will also
conduct periodic site assessments and will provide necessary and appropriate support including: minor
renovations and refurbishment of site labs; laboratory accessories needed for the day-to-day delivery of
integrated laboratory services. ICAP-CU will support preventive maintenance of essential integrated
laboratory service equipment and equipment care and management at the facilities and facilitate the major
equipment maintenance; and support for national laboratory reporting systems.
(4) ICAP-CU will technically support standardized trainings using nationally approved curricula with special
emphasis on onsite training and mentorship. These site-level and regional-level trainings will include: HIV
rapid test (point of care HIV rapid test training), HIV disease monitoring (hematology, clinical chemistry, and
CD4); laboratory training on integrated diseases including common OI diagnosis. ICAP-CU will provide
continued onsite training on the new HIV rapid testing algorithm and monitor and evaluate the utilization of
the algorithm at facilities. ICAP-CU will also support regional and onsite training on TB smear microscopy
and support the implementation of TB smear microscopy EQA manual.
Activity Narrative: (5) ICAP-CU will continue to provide technical assistance and implementation support to referral laboratory
services. This will strengthen the functioning of the reference labs as they supervise QA activities at lower
tier labs and provide access to more sophisticated diagnostic assays. ICAP-CU will also support
EHNRI/Regional labs to establish systems for specimen collection at health centers and/or peripheral
hospitals, transportation to appropriate hospital and regional laboratories, patient sample tracking, reporting
of results, and implementing and ensuring that standard guidelines and procedures are followed. ICAP-CU
will support the monitoring and evaluation activities in all laboratory program areas and will support the
expansion of LIS in the regions
(6) ICAP-CU will continue to provide key technical assistance to the early infant diagnosis program and viral
load test establishment nationally and in the region. Working at the national, regional, and site levels, ICAP-
CU will support not only HIV DNA PCR testing capacity in the laboratory, but the clinical systems, HMIS
systems, and linkages needed to provide high-quality services to infants and families. Based on need
assessment, ICAP-CU will support the establishment of HIV DNA PCR testing capacity at two more ICAP-
CU supported sub-regional and hospital laboratories (Nekemt regional laboratory and Jimma University
hospital laboratory). ICAP-CU will also support the establishment of viral load testing capacity at regional
laboratories as planned by EHNRI. These will include minor renovation, epoxy painting of floor and
furnishing with standard laboratory furniture.
(7). Integration of OI diagnosis in the HIV/AIDS laboratory support: ICAP-CU in collaboration with other
stakeholders working in the laboratory area will establish common OIs and STIs diagnostics testing services
at regional labs and hospitals. This includes training of lab personnel on common OIs and STI diagnosis,
providing TA in setting up of the test services and providing some critical reagents and diagnostic kits. ICAP
-CU will provide technical support for the establishment and functionality of TB culture at regional
laboratories.
Continuing Activity: 16673
16673 10619.08 HHS/Centers for Columbia 7498 3784.08 Rapid $1,100,000
10619 10619.07 HHS/Centers for Columbia 5506 3784.07 $400,000
Table 3.3.16:
Site-Level Data Support for Hospitals/Strengthen the HIV/AIDS Information System at Hospital level
ACTIVITY HAS BEEN MODIFIED IN THE FOLLOWING WAYS
In FY08, ICAP-CU supported 52 sites to collect, manage, analyze, and use HIV/AIDS-related data
generated at the site level for decision-making. ICAP-CU trained 150 health professionals in ART
monitoring, and data analysis and use, supported the documentation of pre-ART and ART patients by
conducting regular quality assessment exercises, ensured availability of adequate supplies of national M&E
forms for supported sites as well as availability of necessary equipment for the sites, and provided support
to document best practices and share experiences with other organizations.
In FY09, ICAP-CU will collaborate with other partners in rolling out and integrating the national HMIS at the
site level. Support to sites for the integration of the national HMIS will include:
•technical assistance with the collection, archiving, retrieval, and reporting of comprehensive HIV services
data on the new forms and the flow of data through the new integrated data system
•technical assistance with the collection and documentation of data on other HIV services in addition to
ART, such as paediatric ART, TB/HIV, PMTCT, VCT, PICT using the appropriate HMIS forms
•routine, data-quality assurance exercises to ensure completeness and accuracy of information on the
HMIS forms
•training on basic monitoring and evaluation
•training on basic computer skills, data management skills, including data entry, data analysis, and
tabulating and visualizing data using tables, charts, line and bar graphs and other standard methods, and in
technical paper writing and presenting. An emphasis will be placed on analyzing and using data at the site
level for local decision making and program improvement
•on-site supervision and mentorship to enhance the quality and use of data collected
In FY09, ICAP-CU will focus on building the capacity of sites to fully transition and integrate into the new
HMIS. In accordance with government plans, certain site-level support activities provided in FY08, such as
support for data technicians and managers and the printing and provision of the HMIS forms and tools, will
be phased out in FY09. ICAP-CU will work with its sites to build their capacity to fully support the HMIS
themselves.
COP08 NARRATIVE
This is a continuing activity from FY07. The major purpose of this activity is to strengthen the
implementation of the national Health Management Information System (HMIS) for comprehensive
HIV/AIDS services and to optimize the use of data for service and program strengthening in Dire Dawa,
Harari, Oromiya, and Somali regions.
In FY07, the International Center for AIDS Care and Treatment Program, Columbia University (ICAP-CU)
supported 42 sites in Operational Zone 3 to collect, manage, analyze, and use HIV/AIDS services-related
data generated at site level for decision-making to improve clinical and program management. Additionally,
ICAP-CU has trained 92 health professionals and data clerks in monitoring and evaluation (M&E) and
assisted regional health bureaus (RHB) to organize experience-sharing workshops.
In FY08, ICAP-CU will expand its site-level capacity building in M&E to further improve quality data
collection and maximize data use for continuous service quality improvements. ICAP-CU will:
1) Intensify support for efforts to fully document information for pre-ART and ART patients on the national
HIV care/ART follow-up by:
a) Continuing routine, data-quality assurance exercises to measure completeness and accuracy of
information on follow-up forms
b) Providing support to clinical teams for accurate completion of follow-up forms
c) Supporting efforts to fully document information for PMTCT, tuberculosis (TB)/HIV, voluntary counseling
and testing (VCT), and provider-initiated counseling and testing (PICT) clients on the appropriate national
d) Supporting the integration of HIV/AIDS care and treatment data with national comprehensive HMIS
through technical support at site level in archiving, retrieving, and report aggregation, supported by routine
data-quality assurance assessments
e) Train healthcare providers, data clerks, and HMIS personnel on database use, including how to enter
records, query the databases, and produce routine reports
2) Provide support for M&E support tools developed for the national M&E systems and equipment. ICAP-
CU will work to ensure availability of computers, computer peripherals, and storage equipment and an
uninterrupted supply of the national M&E tools at all the sites
3) Strengthen supportive supervision and mentorship. On-site supervision and mentorship will be provided
to enhance collection of accurate and complete data. ICAP-CU will also work with site-level staff to build
capacity in data analysis, and in the use of data to manage and improve program delivery.
4) Support institutions to manage and use data fully and effectively. Sites will continue to be assisted in
tabulating and visualizing their data using tables, charts, line and bar graphs and other standard methods;
optional tabulations will include aggregation of data by patient, clinic, and regional levels. Continued FY08
activities will expand the number of facility-based health providers with basic computer skills and data
management skills, including data entry, data analysis, technical paper writing, and presentations.
5) Support the national laboratory information systems to ensure communication of patient results in an
efficient manner. There will be particular emphasis on communicating results to patients whose specimens
were transported to the hospital from another facility, such as a health center. Furthermore, ICAP-CU will
assist sites in tracking specimens of patients who need more specialized tests, such as viral load, which are
Activity Narrative: currently performed only at regional labs.
6) Support biannual, regional review meetings to provide fora where facilities can present their data and
share lessons learned. This activity will also continue to support and strengthen the national HMIS
implementation, document best practices, and present findings and experiences at local and international
scientific and programmatic forums. Implementation mechanisms will consist of necessary modeling at site
and RHB levels.
Continuing Activity: 16674
16674 10437.08 HHS/Centers for Columbia 7498 3784.08 Rapid $300,000
10437 10437.07 HHS/Centers for Columbia 5506 3784.07 $150,000
Estimated amount of funding that is planned for Human Capacity Development $50,000
Table 3.3.17:
Strengthening Pre-Service Training for Medical Doctors This is a new activity in response to the critical
need and one of the highest priorities of the Ethiopian Federal Ministry of Health (FMOH) to scale up the
training of medical doctors. Problem statement Recent assessments suggest that the shortage of medical
doctors and other health professionals, poor performance, inequitable distribution of the available health
workforce among regions and health facilities are root causes for poor service delivery of health care. The
FMOH recognizes that with the existing levels of outputs from medical schools of medical doctors, surgical
specialists, anesthesia professionals, midwives, dentists and mental health professionals it will have
difficulties reaching the MDGs by 2020. While the FMOH recognizes the rapid need of medical specialties,
it stated that the existing level of output for health extension workers, health officers, nurses, pharmacists
and paramedics is sufficient and thus no major scale up is required.
The FMOH intends to scale up the number of medical doctors from the current 1,806 to 9,000 doctors in
public service thru a number of ambitious interventions. These are as follows: 1. To expand medical
training by increasing the number of medical schools from currently seven to twenty-one. Up to five teaching
facilities such as hospitals or other medical teaching centers will be attached to each new medical school.
Each of these teaching facilities will have an annual intake of 100 students. Thus, each new medical school
is expected to have an annual intake of up to 500 new students. 2. To introduce a 4 year medical training
program (for BSc holders) in addition to the existing six year program without compromising quality. 3. To
identify hospitals with adequate patient flow to be upgraded as teaching centers. 4. Utilize appropriate
Information Communication and Technology (ICT) to enhance the quality and efficiency of medical
education.
The FMOH has repeatedly requested PEPFAR Ethiopia, both informally and formally, to assist, thru US-
based universities, to scale up the training of medical doctors.
ICAP (Information Center for AIDS Care and Treatment Programs, Mailman School of Public Health at
Columbia University) is a major US-based university partner for PEPFAR-Ethiopia. The regions in which
ICAP is operational with PEPFAR funding have currently two medical schools located in the cities of Jimma
and Harayama.
Thus, in FY09, major activities for ICAP are to:
• Conduct needs assessment of Ethiopian public medical education institutions for implementing the
accelerated medical doctors training program.
• Provide technical, material and financial support to the FMOH, MOE, HERQA, and Universities at the
educational facility level in teaching materials development, review, publication and distribution activities as
well as in supply of essential teaching/training materials for medical education.
• Provide, based on needs assessment, limited support where feasible to faculty and infrastructure
development i.e. support to the establishment of training laboratories and learning centers, libraries and the
procurement of teaching materials to accommodate the large scale intake of new medical students.
• Monitor and evaluate the progress in the implementation of the medical doctors' education/training
programs.
• Assist in the development, local adaptation and review of curricular/training materials and modules for pre-
service education.
• Assist faculty and program managers in teaching and research, coordination, communication and
networking for medical education in the existing and upcoming public universities providing medical
education in Ethiopia.
• Assist Ethiopian medical education institutions in the development and effective application of different
models of education and training, including community-based team training and information technology for
distance learning-assisted approaches, standards-based education management and recognition, student
assessment and evaluation procedures, faculty development, establishment and/or reinforcement of
academic development centers in the universities/faculties.
• Coordinate all activities with all PEPFAR implementing partners on regional and central levels including
FMOH and HAPCO thru established mechanisms.
Table 3.3.18:
