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 Implementation Support at Uniformed Services Health Facilities
ACTIVITY HAS BEEN MODIFIED IN THE FOLLOWING WAYS
This is a continuing activity from FY08. In FY08 UCSD has provided support to PMTCT program in 24
uniformed health facilities. The SAPR indicates that the partner has achieved its target of two quarters in
terms of the number of women counseled and tested and those who received ARV prophylaxis. UCSD has
been working with JHPIEGO to expand MSG to new PMTCT sites and to strengthen those already
established groups. Moreover, it has played significant role in the rolling out of the revised PMTCT
Guidelines.
In FY08 UCSD faced several challenges while supporting PMTCT program at uniformed health facilities.
These challenges are considered for COP09 planning of PMTCT program. Many of the military health
facilities have inadequate infrastructure and the existing ones need major renovations. Like other PEPFAR
partners UCSD also faced high attrition of staff at PMTCT sites. Furthermore, the weak national and facility
level M&E system of PMTCT program has affected reporting system and resulted in the under reporting of
performances of the partner.
In FY 09, UCSD will work to address the above challenges and will also build on FY 08 activities and
continue strengthening the PMTCT program at 39uniformed health facilities nationally. The number of
service outlets have deceased from 45 in COP08 to 39 in COP09, because recent evaluation indicated that
the existing poor infrastructure and the very low patient load does not justify initiation of the program at 6 of
the military health facilities. In COP09 UCSD will scale up the PMTCT program in addition to the COP08
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 the uniformed health service departments to build PMTCT program management capacity and
ensure sustainability.
3)Promote the use Testing and Counseling Support Tools for PMTCT at all PMTCT sites.
4)Support strategies and program plans to coordinate Prevention With Positives (PWP) with PMTCT
5)Expand Mother Support Groups (MSG) to additional 10 sites
6)Assist to strengthen the PMTCT M&E system: UCSD will assist the national and uniformed services
PMTCT program to improve data collection and reporting on key PMTCT indicators
COP08 ACTIVITY NARRATIVE
This is a continuing activity from FY07. In FY07, UCSD supported PMTCT services in 24 health facilities
nationally. Building on programs initiated by JHPIEGO, UCSD 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, UCSD will extend these services to a total of 45 health facilities, working to dramatically reduce the
number of infants born with HIV in collaboration with the Defense Health Department and Command Health
Services. UCSD will provide PMTCT services at 38 hospitals and seven health centers. UCSD uses
antenatal care (ANC), maternal-child health (MCH), and PMTCT programs as entry points to HIV care and
treatment for women, children, and families.
In July 2007, the Government of Ethiopia issued new PMTCT guidelines. UCSD, in collaboration with
JHPIEGO, will support rollout of the new PMTCT guidelines in these health facilities. 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, labor and delivery;
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.
UCSD will work to support PMTCT programming at the national, regional, and facility levels. At the national
level, as a member of the National Technical Working Group on PMTCT, UCSD will contribute to the
development of training material, clinical support tools, guidelines, formats, and standards. UCSD will
continue to provide technical input and guidance to the Federal Ministry of Health (MOH) and Uniformed
Health Services, 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.
At the facility level, the UCSD-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/AIDS. 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 testing and counseling at ANC, labor and delivery according to national guidelines
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 to encourage retention in care. In collaboration with JHPIEGO, implementation of
peer-educator programs and mothers' support groups (MSG) at selected sites, to maximize adherence to
care and treatment among pregnant HIV-positive women, and to strengthen their links to psychosocial
Activity Narrative: support and community resources.
7) Providing 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, 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 providing 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-months postpartum period
10) Enhanced postnatal follow-up of HIV-positive mothers and HIV-exposed infants
11) Promoting 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 MSG for infant feeding
12) Linking all infants born to HIV-positive women to the HIV-exposed Infant Clinic to ensure early infant
diagnosis (EID) by DNA PCR using dried-blood spot (DBS). 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 management information 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) Determining infection status at 18 months for HIV-exposed infants not found to be HIV-positive via EID
15) Facilitating availability of supplies for PMTCT services
16) Support for site-level staff to implement national performance standards and the JHPIEGO-supported
Standards-Based Management Program
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) Conducting minor renovation, refurbishment, and repair (as needed) of ANC, labor and delivery rooms,
and maternity wards at UCSD-supported sites.
23) Supporting the Military Women's Anti-AIDS Coalition, an organization composed of military and civilian
women working on educating and increasing awareness about HIV/AIDS, with a focus on PMTCT. This
association will continue to do community mobilization, advocacy on safe infant feeding, and PMTCT-Plus
activities.
24) Linking the PMTCT service with the Modeling and Reinforcement to Combat HIV/AIDS (MARCH)
prevention interventions
25 Establish pre-service training through strengthening the curriculum of Defense Health Sciences College
and Police Nursing School
New/Continuing Activity: Continuing Activity
Continuing Activity: 16617
Continued Associated Activity Information
Activity Activity ID USG Agency Prime Partner Mechanism Mechanism ID Mechanism Planned Funds
System ID System ID
16617 5638.08 HHS/Centers for University of 7483 3785.08 Twinning of US- $400,000
Disease Control & California at San based
Prevention Diego Universities with
Institutions in
the Federal
Republic of
Ethiopia
10460 5638.07 HHS/Centers for University of 5481 3785.07 $130,000
Disease Control & California at San
Prevention Diego
5638 5638.06 HHS/Centers for University of 3785 3785.06 $40,000
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
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 10% AB component
from the previous 100% OP activity.
Include STI services at 76 facilities for police and military uniformed services through training of health care
workers on syndromic approach, provision of STI job aids. Also includes STI services to inmates in prison.
Prevention of STI among uniformed service members, prisoners, and people living with HIV (PLWH) is a
critical activity in preventing new HIV infections and slowing the pace of the epidemic among these
population groups. Complete and appropriate treatment of STI is also a key element of UCSD's
multidisciplinary, client- and partner-focused approach to prevention, care, and treatment. In FY07 USCD &
FY08, the University of California, San Diego (UCSD) supported the prevention and control of sexually
transmitted infections (STI) in the facilities of the military police and prison. Major accomplishments
included: expanded access to STI prevention and treatment services and improved quality of STI services
at 76 facilities. 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. In FY09, UCSD will work with commands and divisions of the
military to help facilitate and coordinate linkages between STI and HIV/AIDS services. One other major gap
identified by the 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 uniformed
services' health-delivery structure. FY09 activities at the hospital/facility level will include: 1) Continuation
of STI service support to the existing 76 sites supported by UCSD 2) Provision of on-site technical
assistance to improve STI diagnosis and treatment following national syndromic management guidelines 3)
Provide on-site training, supportive supervision, and mentorship of 300 providers, including 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 4) Development of 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)
Development of linkages to HIV counseling and testing services, promoting a provider-initiated, opt-out
approach, for all STI patients, and 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) Provision of condoms to patients enrolled in care and treatment and
education on how to use them. There will be a special focus on most at-risk patients/populations (MARPs).
8) Integration of STI services into antenatal and PMTCT services to ensure that all pregnant women are
educated about STI (including STI prevention during pregnancy) and provided with necessary treatment,
according to national STI management and antenatal care guidelines 9) Development of linkages to
community-based organizations that promote risk reduction and HIV/STI prevention and early/complete
treatment in communities surrounding UCSD-supported ART sites 10) More Strengthening of STI data
recording and reporting system at all levels. Support for sites for STI syndromic data documentation and
reporting.
New/Continuing Activity: New Activity
Continuing Activity:
Table 3.3.02:
Strengthening STI services for MARPS
ACTIVITY MODIFIED IN THE FOLLOWING WAYS
at 76 facilities.
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.
In FY09, UCSD will work with commands and divisions of the military to help facilitate and coordinate
linkages between STI and HIV/AIDS services. One other major gap identified by the 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 uniformed services' health-delivery structure.
FY09 activities at the hospital/facility level will include:
1) Continuation of STI service support to the existing 76 sites supported by UCSD
2) Provision of on-site technical assistance to improve STI diagnosis and treatment following national
syndromic management guidelines
3) Provide on-site training, supportive supervision, and mentorship of 300 providers, including physicians,
between STI and HIV infection, as per national guidelines.
4) Have core T.O.T trained at the regional and Zonal health offices
4) Development of 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) Development of linkages to HIV counseling and testing services, promoting a provider-initiated, opt-out
and treatment at the hospitals.
7) Provision of condoms to patients enrolled in care and treatment and education on how to use them.
There will be a special focus on most at-risk patients/populations (MARPs).
according to national STI management and antenatal care guidelines
9) Development of linkages to community-based organizations that promote risk reduction and HIV/STI
prevention and early/complete treatment in communities surrounding UCSD-supported ART sites
10) More Strengthening of STI data recording and reporting system at all levels.
Support for sites for STI syndromic data documentation and reportin
Continuing Activity: 16618
16618 10651.08 HHS/Centers for University of 7483 3785.08 Twinning of US- $300,000
10651 10651.07 HHS/Centers for University of 5481 3785.07 $50,000
* Addressing male norms and behaviors
* Reducing violence and coercion
Workplace Programs
Table 3.3.03:
Palliative Care Assistance at Uniformed Service Health Facilities
ACTIVITY UNCHANGED FROM FY2008
COP 08 ACTIVITY NARRATIVE:
This is a continuing activity from FY08. In FY07 and FY08, the University of California, San Diego (UCSD)
introduced basic palliative care and preventive care services to 33 more facilities, in addition to the 13 ART
facilities it supported in FYO6. This included: initial assessment of the palliative care activities at sites;
development of training modules in collaboration with I-TECH; training of trainers and providers; and
supervision and mentoring of palliative care activities. UCSD also introduced HIV counseling and testing of
family members and contacts, and prevention for positives. Relief of pain and discomfort among HIV
patients was also addressed through available analgesics, anti-motility, and anti-emetic drugs.
UCSD worked closely with other partners, ensuring the delivery of complementary activities, such as links to
services outside the facility and to community resources after discharge (e.g. OVC) through implementation
of referral systems, forms, staff support, and review meetings. UCSD also provided job aids and patient
Education materials related to palliative care and positive living.
UCSD is an active member of the National Palliative Care Task Force, which is working with other
stakeholders to facilitate the development of national palliative care guidelines, coordinate palliative care
program implementation at the national level, and advocate the integration of palliative care and
standardized pain management in the healthcare system with policy makers and health professionals.
In FY08, UCSD has continued to support palliative care activities via multidisciplinary, family-focused
approaches to providing the preventive care package, pain and symptom management, and end-of-life
care. In addition, UCSD will initiate palliative care activities at two new sites, bringing the total number of
sites to 48 uniformed services health facilities providing HIV/AIDS care and treatment. UCSD continue to
focus on provision of the preventive care package to adults, which includes: active tuberculosis (TB)
screening; cotrimoxazole prophylaxis; symptom management; micronutrient (multivitamin) and nutrition
supplementation and counseling (see below); insecticide-treated mosquito nets (ITN) through links to the
Global Fund; condoms; positive living strategies; prevention with positives; active TB screening; case
finding; counseling and testing of family members and contacts, and promoting safe water usage through
the provision of safe home water disinfectant vessels at all UCSD-supported hospitals. The preventive care
package for children includes: prevention of serious illnesses like Pneumocystis carinii pneumonia, TB, and
malaria via appropriate prophylaxis and use of ITN; symptom management; prevention and treatment of
diarrhea; and nutrition and micronutrient supplements and links to national childhood immunization
programs. 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.
In FY09, UCSD will continue to support facilities as follows:
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, and 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 related to the 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, the importance of adherence to both
care and treatment for PLWH, and 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.
UCSD will continue its national level support by assisting in the national policy review and participating in
the development of national strategies to ensure palliative care is well addressed in the overall HIV/AIDS
control program implementation plan. UCSD will continue to correspond with international partners to bring
in experiences and best practices in palliative care and support and pain management. UCSD is working
with key national palliative care partners like Ethiopian Pharmaceutical Company to import powder
morphine and formulate and distribute it as liquid morphine.
UCSD is finalizing the preparation to train pharmacist and physicians in pain management with a practical
attachment in international model palliative care centers. After getting approval from drug administration and
control authority, UCSD import powder morphine and sponsor trainings pharmacists and physicians as soon
as the stability study is completed. Based on the feedback collected from partners, UCSD will lead the
revision of the pain management guideline to promote the availability and access of opioids.
UCSD will mount its commitment, in collaboration with partners, to support the Federal Ministry of Health
and the national HIV/AIDS Prevention and Control Office (HAPCO) in efforts to implement a sustainable
national hospice care initiative through:
1) Initiating efforts to increase access, coverage, and integration of services to improve quality of life of
terminally-ill patients and their families via affordable and culturally appropriate "end-of-life" care or hospice
services.
Activity Narrative: 2) Initiating mental health and spiritual care services to PLWH at the facilities of the uniformed services and
using this as an experience to expand services nationally.
3) In collaboration with partners working at the community, coordinate the integration of currently ongoing
home based care activities at the community level with newly initiated hospice services at the facility level
4) Collaborate with HAPCO and other partners in organizing and sponsoring trainings at the national level
for physicians, nurses, and lay people as advocates and trainers of trainees abroad and within the country
to facilitate the capacity building efforts.
5) Establish within the uniformed services, a model center for ‘end of life'/hospice care so that it will be a
training and center of excellence for duplication nationally.
6) Partnering with the Ministry of Health and Education of Ethiopia and the Defense Health Sciences
College to introduce elements of palliative care in general, and end-of-life care in particular, into the national
curriculums of health professional training institutions of Ethiopia.
Continuing Activity: 16619
16619 5770.08 HHS/Centers for University of 7483 3785.08 Twinning of US- $373,200
10464 5770.07 HHS/Centers for University of 5481 3785.07 $311,000
5770 5770.06 HHS/Centers for University of 3785 3785.06 $75,000
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 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 the University of California in San Diego
(UCSD) to implement the following activities.
• Ensure that one Academic Development and Resource Center (also known as educational development
centers) is established and strengthened at the Medical School of the Ethiopian Defense University
• Ensure that one skills laboratory is strengthened
• Ensure that competency-based education is promoted and strengthened at the Medical School of the
Ethiopian Defense University
• Educational quality is improved based on the increment in achievement of performance standards through
standards-based educational management and recognition
• 25 instructors will be trained on effective teaching skills
• 25 instructors will be trained on Instructional Design (ID)
• 25 instructors will be trained on student's performance assessment teaching and student performance
assessment will be improved.
• In collaboration with the Ministry of Defense, Ministry of Education, Ministry of Health, the Higher
Education Relevance and Quality Agency, and professional associations, accreditation and licensure
processes will be explored and if feasible it will be developed and implemented
• Pre-service HIV/AIDS education strengthening support is expanded to other health science disciplines
• 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:
ART support for Uniformed Service Health Facilities
This is a continuation of activity from FY08.
UPDATE :
University of California San Diego (UCSD) has supported implementation of ART to the uniformed services
(Defense and Police and Prison Forces). The Ethiopian Ministries of National Defense and Health, the
National Defense Forces of Ethiopia (NDFE), the Federal Police of Ethiopia (FPE), and the Federal Prison
Administration (FPA) have committed to building capacity for care and treatment of their members, and to
provide free ART.
As of June 30, 2008, there were 6 833 HIV patients initiated on ART at 13 UCSD supported ART sites in the
uniformed services, and there were 4 300 ART patients regularly receiving their treatment at these sites.
This is more than 90 % of the target for patients started on ART, and almost 70 % of the target for patients
currently on ART, three months before the end of the reporting period for COP07.
The uniformed services sites supported by UCSD are scattered through out the country, and in many
instances are hard to reach for regular supervision and mentoring activities. Human resources constraints
and poorly developed infrastructure pose challenges to the successful implementation and expansion of the
ART program in the uniformed services. Lack of community support services for the uniformed services and
absence of formal linkage with the other public networks have been impediments to the service delivery.
UCSD will continue the care and treatment activities in COP 09 by maintaining quality services to patients
enrolled to ART, and also initiating new, eligible patients; and to work to improve quality of care and
treatment services, and ensure the continuum of care availed to these patients. UCSD will work to scale-up
and expand these services to more sites in COP 08.
PEPFAR Ethiopia provides the support to build on an on-going collaboration between NDFE and physicians
at USCD. Since 2005, UCSD, in cooperation with University of Washington (I-TECH), has assisted the
NDFE, FPE, and FPA with: (1) assessment of current capacity to support ART; (2) training and mentoring
for clinical, laboratory, and infection-control personnel through regular conferences in each facility and via
teleconferencing with UCSD experts; (3) support for physical space and equipment and reagents by
providing technical assistance and coordinating with other implementing partners; and (4) improvement in
medical informatics for health data management and information systems.
UCSD established a program of site assessments, training and mentoring of military health care workers to
support expansion of ART. UCSD has been training medical staff since 2005, and the ART program has
been systematically expanded to regional military hospitals and police and prison clinics. UCSD will
increase its technical support to 39 ART sites in COP 08. To ensure sufficient trained staff for expansion of
sites, UCSD has partnered with Defense University's Health Science and Police Nursing School to build
capacity through pre-service training. In 2006, UCSD assisted these colleges in revision of their curricula.
The support continued through 2007 to integrate major competencies of HIV/AIDS prevention, care, and
treatment programs into college curricula.
To improve coordination and integration of the program with the military and police administrations, UCSD
has provided workshops for high-ranking non-medical military, police, and prison administration leaders to
familiarize and involve them in prevention and treatment program. UCSD has worked with PEPFAR
partners to raise awareness of availability and utility of ARV services through uniformed-services media.
These sensitization workshops will continue.
Civil-military alliances were also strengthened through the training of more than 10 000 military reservists
who are respected community members and/or leaders. These trained reservists returned to their
communities to serve as community-based peer leaders for HIV/AIDS issues, and are having a wide
geographical impact. This activity will be continued in FY08 for an additional 20 000 military reserve recruits.
UCSD has also implemented educational programs on HIV/AIDS for more than 200 non-medical uniformed
trainees of Defense University College schools (non-medical), to help them protect themselves and become
effective leaders in the integration of HIV prevention and care program into their institutions.
UCSD also strengthened and continued the program aimed at protecting medical personnel from
occupational exposures by distributing infection prevention (IP) materials on a quarterly basis. Appropriate
post-exposure prophylaxis (PEP) was also implemented. Some activities of promoting PEP for women and
children who were victims of sexual assault were also carried out among the community of dependents of
military and police personnel.
Continuing activities in COP09 include:
(1) Continue the comprehensive technical support to the ART sites in the uniformed services (military,
police, and federal prison)
(2) Protection of medical personnel from occupational HIV exposure and PEP. UCSD will ensure
availability and use of basic IP materials to the HCWs of all supported sites and follow-up on the
implementation of the program at site level. PEP will be made available to those who have occupational
exposure to HIV infection and to victims of sexual assault, as outlined in the guidelines and protocols. All
the necessary trainings, protocols, and arrangements will be made to provide the service in all the sites that
are being supported by UCSD.
Activity Narrative: (3) Training for undergraduate and newly trained medical personnel. The support includes pre-placement
comprehensive HIV training for all health officer and nurse graduates of the Defense Health Sciences
College and Police Nursing School. UCSD also plans to support the Defense Junior Nurses Training
Institute, which is the only training center that trains nearly 400 junior nurses each year.
(4) Offer clinical mentoring activities to ensure program sustainability through capacity building of command
health departments, command referral hospitals, as well as the Defense Health Sciences College. This will
facilitate clinical mentoring within their commands and catchments by creating a pool of clinical mentors. As
most HCW in the defense forces are Health Officers, training this group of HCW to become capable
mentors would require the provision of intensive theoretical and practical trainings; this would have financial
implications.
(5) Work with teams of Central Defense Health Department, Command Health Departments, and Division
Health Departments of the NDFE to build their supportive supervisory capacity after training them in HIV
program management. Provide the necessary technical and logistical support to conduct regular and
sustainable supervisory site visits.
(6) Improve inter- and intra-facility referral linkages to minimize the number of patients lost to follow-up
between different service clinics of the hospital by printing and duplicating referral tools and following up to
ensure proper implementation. It will also work to improve adherence counseling, adherence support and
quality of service delivery to optimize ART patient out-comes. Involvement of People Living with HIV
(PLWH) in various activities will also be emphasized, including counseling and care and treatment support.
(7) Continue to collaborate with the Twinning Center to identify qualified professionals who can augment
local clinical and system mentoring activities at the uniformed-services health facilities.
(8) Address the human resource shortage by supporting the government's plan to shift tasks by level and to
highlight a nurse-centered care model. UCSD also plans to work on innovative retention plans to decrease
human resource attrition in the uniformed services; that attrition is becoming a continuing threat at all levels
of health facilities.
(9) Continue human capacity-building activities at the existing and new sites through building an HIV/AIDS
resource center. Expand TheraSim clinical simulator program to other sites as appropriate.
(10) Support the Military Women's Anti-AIDS Coalition, an organization comprised of military and civilian
women working to educate and increase awareness about HIV/AIDS.
(11) Promote ART via media campaigns.
(12) Support PLWH and others as peer advocates for ART: UCSD will help to organize and support military
unit- and hospital/clinic-based support groups to provide care, psychological support, and peer advocacy.
To provide technical support to the country, UCSD will assist the ART health networks to follow
standardized clinical procedures and use of tools that have been agreed upon by all partners.
Continuing Activity: 16622
16622 10426.08 HHS/Centers for University of 7483 3785.08 Twinning of US- $4,300,000
Military Populations
ACTIVITY IS REPLACED ENTIRELY AS FOLLOWS:
In FY07 and FY08, the University of California at San Diego (UCSD) is working in pediatric care and
support as part of the care and support activities, previously categorized as palliative care in Operation
Zone 4 (Defense and Police and Prison Forces).
In FY07 and FY08, UCSD supported basic pediatric care and support services at 13 facilities. These
services 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 include 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 uniformed force service facilities.
UCSD supported all facilities in a view toward ensuring 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 will include:
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, UCSD will continue to support pediatric care and expand activities in all facilities 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. UCSD will continue to participate in the revision of the developed national
pediatric guideline and standard operating procedures (SOP) 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, UCSD will work to improve access to early infant HIV diagnostics using dried-blood spot DNA
PCR testing and networking to avail the service to health centers.
UCSD 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. UCSD will focus on provision 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. UCSD will also ensure that all HIV-positive children receive careful and consistent clinical,
developmental, and immunologic monitoring to promptly identify those eligible for ART.
UCSD support to facilities will be continued or expanded as follows. UCSD will:
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
5) Continue to develop and distribute pediatric provider job aids and patient education materials related to
pediatric care and support
6) Identify and sensitize community-based groups to palliative care to the importance of adherence to both
care and treatment services available at the facility level
7) Improve nutrition assessment of children at health facilities
10) Link families 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
UCSD activities will promote prophylaxis 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 UCSD implementation activities, especially
at those sites not yet providing ART. UCSD 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 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.
Activity Narrative: UCSD continue to work with Johns Hopkins University (JHU) which is a lead 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:
Military ART Support
This is a continuing activity from FY06, FY07, and FY08 which has previously been included within
treatment/ARV services. University of California San Diego (UCSD) has played a critical role as the lead for
Military-Public Alliance and has supported implementation of pediatric ART in Operation Zone 4 (Defense
and Police and Prison Forces).
The Ethiopian Ministries of National Defense and Health, the National Defense Forces of Ethiopia (NDFE),
the Federal Police of Ethiopia (FPE), and the Federal Prison Administration (FPA) are committed to build
capacity to care for their members and families and to provide free ART. In FY08, UCSD actively
participated in the national pediatric care and treatment activities to update and enhance national policies,
protocols, and guidelines on pediatric HIV. In FY08, UCSD supported full-spectrum pediatric HIV
prevention, care, and treatment services at 13 health facilities and is currently on track in meeting targets for
COP08. In FY08 to date, UCSD supported sites have initiated 211 children on ART, and 174 children are
currently on ART.
At the national level, UCSD 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) Expand the national pediatric care and treatment training curriculum and continue widespread distribution
of pediatric support materials
3) Assist with the integration of pediatric monitoring and evaluation into existing care and treatment tracking
systems
4) Provide technical input into the development/revision and implementation of forms, registers, and
charting tools for pediatric care and treatment
5) 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
UCSD 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 strengthen the growing Ethiopian PMTCT program and linkage
to pediatric care and treatment services. UCSD will contribute its experience with treatment of HIV exposed
and infected infants and children and assist with the expansion of national pediatric treatment guidelines.
In FY09, UCSD has planned to focus on strengthening pediatric ART services in all sites currently providing
adult ART through continued collaboration with Columbia University's International Center for AIDS Care
and Treatment Programs. UCSD will have three major elements in improving the service uptake for
pediatric ART in the uniformed services: (1) Increasing access to pediatric ART, (2) ensuring
comprehensive care and treatment services for HIV-infected infants and children and (3) enhancing
pediatric case-finding and referral to care and treatment services.
In FY09, emphasis will be placed on increased pediatric ART service uptake at all sites. UCSD will focus on
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) 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
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 site-level clinical mentoring and supportive supervision will be carried out at all
hospitals and health centers providing pediatric care and treatment service in UCSD supported sites.
Assessing and improving quality of service for pediatric care and treatment through standardized approach
in all operating sites will be one of the core activities in FY09. The model pediatric ART center established
at one of the defense referral hospitals in FY07 will also be used as center of excellence and will be
replicated by phases at the other pediatric treatment centers.
UCSD will support pediatric ART training, according to national guidelines and curriculum. Additional
training, including training on early infant diagnosis (EID), will be provided to all new sites initiating Pediatric
ART 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.
UCSD will work closely with the MOH, the Global Fund for AIDS, Malaria, and Tuberculosis, the Supply
Chain Management System/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 pediatric care and treatment services.
To provide technical support to the country's pediatric care and treatment programme, UCSD will assist the
ART health networks to follow standardized clinical procedures and use of tools that have been agreed
upon by all partners. In its lead area of training, military-civil alliance in ART delivery, UCSD will coordinate
joint planning and implementation.
Table 3.3.11:
TB/HIV at the Uniformed-Services Health-Facility Level
ACTIVITY HAS BEEN MODIFIED IN THE FOLLOWING WAYS:
In FY 08, UCSD has continued to support TB/HIV collaborative activities in 15 uniformed services in
providing site level mentoring and supervision, training of 276 health care providers and organizing
awareness creation workshops on MDR TB. UCSD has also continued to strengthen TB/HIV collaborative
activities through integration of TB with other HIV related services. In addition, UCSD has piloted
Fluorescent microscopy and bleach techniques for TB diagnosis at limited facilities that have shown to
improve the sensitivity of TB smear microscopy.
In FY 09, UCSD will strengthen its support to MOH in the TB/HIV program implementation in line with
FMOH and 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 facilitating early detection of infectious TB cases and timely initiation
of treatment and follow up till completion 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 spread of TB to other patients
and health care workers at all HIV related clinics through health education, cough triage in the out patient
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, UCSD will participate in
the development and revision of MDR-TB management guideline, protocols and tools. UCSD will also
support MOH's MDR-TB management initiative 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 UCSD supported
facilities to strengthen the TB/HIV information system to generate good quality data. UCSD will also assist
national and regional TB/HIV review meetings and joint supportive supervisions. A standard operative
procedure will be introduced at the facilities to generate and timely report good quality TB/HIV data to the
national level. The TB/HIV national surveillance sites will 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.
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 and 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 with
age break down which enables reporting of pediatric TB/HIV activities separately will be used for TB/HIV
activity reporting at all sites.
Description of the Project:
The University of California San Diego (UCSD) has been providing tuberculosis (TB)/HIV support to the
National Defense Forces of Ethiopia (NDFE), Federal Police of Ethiopia (FPE) and the Federal Prison
Administration (FPA) since 2006. In FY08, that activity continued and the number of supported sites was
expanded from 13 to 46.
In FY08, working with other US universities, UCSD implemented a package of interventions, including: (1)
expansion of provider-initiated HIV counseling and testing for TB patients; (2) referrals of HIV-positive TB
patients for HIV-related care , including cotrimoxazole therapy and ART; (3) regular TB screening of HIV
patients in care and treatment; (4) isoniazid preventive therapy (IPT) for eligible, HIV-positive patients; (5)
improving TB diagnostic services; and (6) strengthening monitoring and evaluation (M&E) of the TB/HIV
collaborative activities.
As an active member of the national MDR-TB technical working group, I-TECH will participate in the
development and revision of MDR-TB management guideline, protocols and tools. I-TECH will also support
MOH's MDR-TB management initiative both the pilot program at St. Peter's Hospital and the expansion plan
to the regional referral Hospitals. UCSD will also advocate and closely work with MOH and EHNRI and CDC
-Ethiopia to establish TB culture facility and initiating MDR-TB management at the referral uniformed service
hospital in Addis Ababa.
Intensive training, supportive supervision and mentorship will be provided to I-TECH supported facilities to
strengthen the TB/HIV information system to generate good quality data. UCSD will also assist the national
and regional TB/HIV review meetings and joint supportive supervisions. A standard operative procedure will
be introduced at the facilities to generate and timely report good quality TB/HIV data to the national level.
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 and infected children.
All eligible TB/HIV co-infected children will be linked to HIV related care and treatment services through
Activity Narrative: intra-facility and inter-facility referrals. The revised TB/HIV reporting format with age break down which
enables reporting of pediatric TB/HIV activities separately will be used for TB/HIV activity reporting at all
sites.
UCSD initiated support to strengthen the TB diagnostic capacity of the uniformed-service laboratories in
several ways. The laboratory personnel were given on-site trainings on direct-smear microscopy and on the
new smear microscopy guidelines.
Moreover, concentration of sputum smears, which was proved to increase sensitivity of detection of
mycobacterium, was also introduced to all 46 sites using the simple, cheap, and less-contaminating step of
liquefying and decontaminating with bleach and concentrating through flotation in xylene. This was done
through on-site theoretical and practical trainings to the lab personnel and has proved to be effective in
increasing the yield of direct microscopy in all the sites.
Safety for laboratory personnel was also given due attention through supply of simple exhaust fans to
increase air flow and protect them from fumes. One of the hospitals was also supplied with dead air hoods
and a UV light for decontamination to allow for preparation of acid-fast bacilli smears.
A FY06 pilot project, in which fluorescent microscopy was introduced into one of the biggest military
hospitals, was scaled up to two more sites in FY07 through the supply of the objective lenses with built-in
barrier and excitation filters. These can be added to any microscope and widely available halogen bulbs
were used as a light source. This procedure was found to increase the sensitivity of detection of
mycobacteria without affecting the specificity.
In FY09, UCSD plans to strengthen activities that have already been initiated and implement the program in
the existing 46 sites, including the 15 regional prisons where the incidence of TB is high. A total of 76
uniformed-service sites will have TB/HIV collaborative services in FY09.
With the overall objectives of reducing the burden of TB in people with HIV and reducing HIV among people
with TB, UCSD will strengthen and continue activities initiated during FY07. The activities included were:
1) Intensified TB case-finding: This will be done through regular screening of all people with, or at-risk of,
HIV for symptoms and signs of TB, referring them for prompt diagnosis and treatment, and doing the same
for their household contacts. A simplified standardized checklist will be used to screen patients for TB
symptoms and identify the majority of the TB suspects. UCSD will continue to work on improving the TB
diagnostic capacity of laboratories and personnel through continuous on-and off-site trainings and regular
supportive supervision to give direct, technical, site-level support. The use of fluorescent microscopy to
diagnose TB will also be scaled up from three to six sites, as the relatively low cost and ease of use of these
microscopes has made fluorescent microscopy feasible. UCSD will also support the Federal Ministry of
Health (MOH), the Federal HIV/AIDS Prevention & Control Office (HAPCO), and CDC efforts to improve TB
diagnosis by purchasing and installing new chest x-ray machines. In addition, UCSD will support a venture
between the Ethiopian Health and Nutrition Research Institute (EHNRI) and CDC to establish culture
facilities at regional levels.
2) Treatment of latent TB infection with IPT. IPT will be given to both adult and pediatric patients with HIV
and TB latent infection, according to the national guideline to prevent progression to active disease.
3) Implementation of facility-level TB infection-control programs. UCSD will help sites establish infection
control strategies based on good work practices and administrative measures, which will include: a written
infection-control plan for each facility; technical and financial support for procedures in the plan including
quality assurance, staff training, education of patients, and increasing community awareness; and providing
supplies required for infection control. UCSD will work with prisons administration to introduce early TB case
detection and TB infection prevention measures in the central and regional prisons. UCSD will also work
with MOH, CDC and other partners on prevention and management of MDR -TB.
In FY09, UCSD will strengthen its support to the uniformed service facilities to reduce the burden of HIV
among people with TB. The following activities will be included:
1) HIV testing and counseling: UCSD will be expanding provider-initiated testing and counseling not only to
all TB patients, but also to all TB suspects, to increase the yield. This will be done through continuous onsite
training, and clinical, mentoring, and supportive supervision activities.
2) Implementing HIV preventive methods: UCSD will introduce and implement comprehensive HIV
prevention strategies for patients in TB clinics. This will be done through training and steady supply of
materials (e.g., information-education-communication materials, condoms).
3) Providing cotrimoxazole prophylaxis (CPT): CPT will be provided to all TB-HIV co-infected patients.
4) HIV/AIDS care and treatment, including ART: Ongoing support will be provided to co-infected patients
through counseling and other psychosocial support. Special attention will be given to the adherence status
of these patients, as they will have a high pill burden, which can greatly compromise adherence.
Continuing Activity: 16620
16620 5752.08 HHS/Centers for University of 7483 3785.08 Twinning of US- $120,000
10463 5752.07 HHS/Centers for University of 5481 3785.07 $100,000
5752 5752.06 HHS/Centers for University of 3785 3785.06 $50,000
Construction/Renovation
* TB
Table 3.3.12:
Counseling and Testing Support at Uniformed Services Health Facilities
COP 08 NARRATIVE:
This is a continuing activity and relates to activities in ART (ID10426), TB/HIV (ID 10463), Palliative care
(ID10464), PMTCT (ID 10460), laboratory (ID 10621 and 10622), other prevention (ID 10651), SI (ID10427),
During COP07 and COP08 UCSD-E supported the expansion and establishments of 91 HCT sites in the
uniformed services of Ethiopia. The increase from 58 (COP07) to 91 (COP08) sites includes military,
regional and federal police and prison health facilities in the country, all of which have HCT capacity
thereby facilitating the provision of counseling and testing services to remote peripheral regions.
This included an initial and follow-up site assessment, site-level training, refurbishment of sites, improving
data collection and reporting systems, and supervision of HCT services. The site-level support aimed at
improving performance to deliver quality HCT services for uniformed personnel, their families, prisoners,
and the community around military facilities ( civil-military alliance program).
Major HCT interventions by UCSD have been in:
1) Adopting PITC and opt-out strategies for CTR hospitals and outpatient clinic settings
2) Assessment of current capacity for care, laboratory testing, and nursing support of VCT
3) Support for the sites to provide same-hour HIV testing at VCT sites
4) Strengthening of the referral link between counseling and testing with post-test services
5) Support for site-level refresher trainings and mentoring for HCT personnel with UCSD experts
6) Support for minor renovation of physical space to ensure infrastructure which is consistent with the
standard
7) Providing necessary laboratory supplies for the VCT labs
8) Improved data management system of HCT and reporting
9) Establishing a quality-assurance system for HCT services for both client- and provider-initiated HCT.
In COP09, focus will be the expansion of HCT delivery sites from 91 to 115 to include most of the regional
prison facilities which were overlooked in previous COP08 and to strengthen site level HCT services
delivery in all previously existing and newly established VCT sites through monitoring program
implementation, quality assurance and referral linkage with other services. UCSD identified that most of the
prison facilities do not have HIV/AIDS facilities and COP09 will focus on working with and building the
regional prison health facilities and administration to provide HCT services for most of the prisoners in
corrections facility, and expand and consolidate HCT services for the communities around military health
facilities to strengthen civil-military alliance.
To expand and enhance this program in FY09, UCSD will establish regular trainings with special focus on
opt-out PITC, couples counseling, and provider training for non-health personnel. UCSD will also conduct
site assessments and regular supportive supervisions, mentoring of counselors to ensure quality of service
and supporting lab workers through training by both local staff and visiting UCSD experts.
UCSD will continue its support in FY09, increasing the reach of HCT at the regimental level, by supporting
the military's mobile VCT services as well as providing HCT at all prison sites (Federal and regional), prison
guards, and prisoners around the country. UCSD will continue to assist the regional prison clinics' efforts to
establish a strong referral linkage with the nearby civilian hospital to send all HIV-positive prisoners for
chronic care and support, including ART.
In FY09, UCSD plans to further expand the HCT program and strengthen the existing services through:
1) Conducting site-level basic and refresher training on VCT for service providers, and training non-health
professional uniformed personnel by following the standard protocol. Moreover, counselors at all sites will
be given training on counseling couples, so that they will be able to provide quality service. By placing
emphasis on discordant results, counselors will be supported to address the challenges clients face in
dealing with their results.
2) Consolidating the existing HCT services to increase the uptake of individuals receiving counseling and
testing in healthcare settings, while expanding the service to 115 new HCT sites. Child testing will be
promoted and supported at all sites by facilitating family-centered counseling
3) Collaborating with the CDC MARCH Program for outreach education, drama, and advertising, and
developing and disseminating military and police-specific information- education-communication/behavior
change communication (IEC/BCC) messages to promote HCT-seeking behavior among high-risk groups
and increase demand for the service
4) Supporting sites to provide outreach/community-based HCT services to uniformed personnel and their
families. In collaboration with PEPFAR, UCSD will organize a mobile service for hard-to-reach camps in the
periphery of the country
5) Involving people living with HIV (PLWH) as peer advocates for HCT and ART promotion and peer
support for positives. This will include peer support groups and experience-sharing through uniformed
services media.
6) Improving monitoring and evaluation system of the HCT service by using the UCSD-developed data
capturing software and timely reporting of data in all sites through training and mentoring of the staff.
7) Working with police forces at Federal and regional levels, UCSD will help strengthen and expand HCT
services in the 11 regional police clinics
8) Expanding HCT to customs services, fire-brigade clinics, and access refugee communities through
mobile VCT to strengthen civil-military alliance
9) Commemorating National Annual Testing Day in all sites, thereby disseminating HIV messages to
uniformed personnel and their families
10) Strengthening the referral network between HCT and other services such as ART, PMTCT, and other
services
Activity Narrative: 11) Strengthening the quality-assurance system of counseling services through refresher training,
mentoring, review meetings, and peer and group counseling supervision systems.
12) Consolidating and expanding civil-military alliance programs for communities around military facilities
13) Supporting burnout management programs for service providers
14) Developing a retention program for service providers. This will be done in collaboration with the Ministry
of Defense, the Police Commission, and prison administration.
All activities will be closely monitored by UCSD office staff and clinical advisors. The university will support
the administrative and technical coordination mechanism to improve the management system of the
service. The activity will help to reach PEPFAR Ethiopia targets for care and treatment.
Continuing Activity: 16621
16621 5737.08 HHS/Centers for University of 7483 3785.08 Twinning of US- $1,847,259
10462 5737.07 HHS/Centers for University of 5481 3785.07 $1,655,250
5737 5737.06 HHS/Centers for University of 3785 3785.06 $90,000
Table 3.3.14:
Site-Level Laboratory Support at Uniformed Service Health Facilities
University of California at San Diego (UCSD) in addition to the activities in FY08 will support the facilities to
attain minimum standards set by EHNRI. UCSD will technically assist for the process improvement
including accreditation of selected hospital laboratories. UCSD will address integrated laboratory system.
UCSD will support the establishment of TB culture and viral load testing facilities at Armed Force General
Hospital and will work to develop capacity of hospital laboratories for sustainability.
In FY08, University of California at San Diego (UCSD) has provided comprehensive high-quality HIV/AIDS
services, including ART at 39 facilities in uniformed services (Armed force, Police and Prison services)
nationwide. Comprehensive technical assistance and implementation support has strengthened essential
elements of the laboratory system, and improved service quality and consistency. UCSD 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.
UCSD has been doing major infrastructure support to hospital laboratories. UCSD has been working on
some selected sites to improve the TB diagnosis. UCSD supported early infant diagnosis through DBS
sample referral to the testing sites.
In FY09, UCSD will provide its support to 39 facilities in uniformed services nationwide, enabling each to
provide comprehensive high-quality HIV/AIDS services. Intensive site-level laboratory support is an
essential component of UCSD'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 39 sites. UCSD will work
directly with the facilities' personnel to implement and monitor the quality assurance programs at the 39
sites and will support the facilities to attain the minimum standards set by EHNRI. UCSD will provide
technical support for process improvement including accreditation of some laboratories. UCSD will continue
to provide technical assistance to the rollout of HIV-1 DNA PCR for infant diagnosis.
UCSD'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 other partners. 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. UCSD will also support the preparation and provision of standard documentation and
recording formats including QC forms, lab request forms and registers. UCSD 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.
(2) Technical support for uninterrupted laboratory services at all 39 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 and regular equipment calibration 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 and UCSD regional laboratory
advisors will work closely with the regional lab associates of SCMS
(3) Capacity building and minor renovation of facility level laboratories:
UCSD 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. UCSD will also
conduct periodic site assessments and will provide necessary and appropriate support including: minor
renovations and refurbishment of site labs; laboratory accessories including computers and printers needed
for the day-to-day delivery of integrated laboratory services. UCSD will support preventive maintenance of
essential integrated laboratory service equipment and equipment care and management at the facilities and
facilitate major equipment maintenance; and support for national laboratory reporting systems.
(4) UCSD 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. UCSD will provide
continued onsite training on the new HIV rapid testing algorithm and monitor and evaluate the utilization of
the algorithm at facilities. UCSD will also support regional and onsite training on TB smear microscopy and
support the implementation of TB smear microscopy EQA manual.
(5) UCSD will continue to provide technical assistance and implementation support to referral laboratory
services. UCSD 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. UCSD will support the monitoring and evaluation activities in all laboratory
program areas and will support the expansion of LIS in the regions
(6) UCSD will continue to provide key technical assistance to the early infant diagnosis program and viral
load test establishment in the facility. Working at the regional, and site levels, UCSD will support not only
Activity Narrative: HIV DNA PCR testing capacity in the laboratory, but also the clinical systems, HMIS systems, and linkages
needed to provide high-quality services to infants and families. Based on need assessment UCSD will
support the establishment of HIV DNA PCR testing capacity at armed force general hospital. UCSD will also
support the establishment of viral load testing capacity at selected facilities 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: UCSD 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.
Continuing Activity: 16623
16623 10622.08 HHS/Centers for University of 7483 3785.08 Twinning of US- $210,000
10622 10622.07 HHS/Centers for University of 5481 3785.07 $75,000
Table 3.3.16:
Site Level Data Support among Uniformed Services Health Facilities
ACTIVITY REMAINS THE SAME WITH FOLLOWING MINOR CHANGES FROM FY08
During FY08, the University of California San Diego (UCSD-E) expanded its program to support 91
uniformed services health facilities and supported their data recording and reporting activities, including the
roll out of the reformed HMIS into these facilities. Three hundred and fifty health care workers were
trained/updated on the newly developed recording and reporting forms by MOH/HAPCO as part of the
HMIS reform. In addition, data personnel (newly recruited for 33 facilities), health care workers (90), and
statistics officers (14) from commands, police and prison departments and health facilities were trained on
basic computer skills to facilitate site level data use and maintain the quality of data. About 40 people drawn
from the health facilities and teaching institutes were also trained on clinical research methodology. Thirty
three new sites were provided with computers and accessories and office furniture to be used for data
management and handling, and all sites received internet and telephone services, regular data, IT related
supervision, and mentoring through the active participation of the data managers and site level data
coordinators. 79 sites were able to utilize the database developed by UCSD-E to serve all HIV/AIDS
programs and facilitate site level data use, patient management and maintain data quality across all levels
of the uniformed services. A number of experience sharing events were organized where over 100 people
exchanged information about challenges and successes.
In FY09, UCSD-E will collaborate with other partners in integrating and rolling out the reformed national
HMIS within the uniformed services health facilities. Support will include site level capacity building in M&E
to further improve quality data collection and maximize data use for continuous service quality
improvements as described in the FY08 activity narrative. This will be accomplished mainly through well
planned and better organized supportive supervision, ensuring sustainability of the SI related support by
training relevant staff from within the system of the uniformed services, and creating a feeling of ownership
in data utilization. Support will also expand to include other HIV services in addition to ART.
The new activities proposed in FY09 to achieve the above focus area are:
•Develop collaborative partnerships between the uniformed services and the Federal Ministry of Health
(MOH) to facilitate integration of the national HMIS
•Ensure sustainability of the M&E related support by recruiting data personnel from within the system of the
uniformed services, such as those working as statistics officers or primary health workers, capable of
providing data-related support to the health facilities and commands/departments
COP08 NARRATIVE
The Federal Ministry of Health (MOH) has established a chronic-disease record-keeping system for the
national ART program. MOH has also developed standardized data collection and reporting tools for HIV
counseling and testing (HCT), PMTCT, tuberculosis (TB)/HIV, sexually transmitted infections (STI) and
Laboratory activities in a move to collect data in a standardized manner and put a national HMIS in place.
As such, this activity will strengthen the implementation of the national HMIS by harmonizing the data
collection and reporting system. The University of California at San Diego (UCSD) will also actively
collaborate with Tulane University in its effort to support the MOH/HAPCO in strengthening the HMIS and
M&E system.
As this activity was new in FY07, efforts were made during this year to establish a unit at UCSD with two
appropriate M&E personnel.
One of the major problems identified during FY07 was underused site-level data, and the following activities
were undertaken to improve the situation:
1) Appropriate data personnel were recruited for 24 health facilities, who provide support to all HIV/AIDS
programs including ART and PMTCT. This makes the total number of data personnel to be 38, together with
the 14 previously hired data personnel.
2) Eleven trainings were conducted for all the data personnel and more than 300 healthcare workers
actively involved in recording and reporting activities drawn from 58 health facilities. They were trained on
the basics of M&E, basic computer skills, PEPFAR and MOH indicators, data-collection and reporting tools
of the different programs, and site-level data use.
3) Support was provided through information technology (IT) infrastructure, data recording, and handling
materials for all the 58 uniformed-service health facilities. An electronic database was developed that serves
all levels of data handling and use for the uniformed services. The database encompasses program areas
for ART, PMTCT, HCT, TB/HIV, STI and information on Laboratory activities. The database was designed
to improve patient management, patient monitoring, site-level data use, and program monitoring, by
capturing core PEPFAR and MOH/HAPCO indicators.
In FY08, UCSD will provide technical support to 39 ART, PMTCT and Laboratory service sites, 76 STI,
TB/HIV and palliative care sites, 91 HCT sites (of which 33 are new ), and the Defense Health Science
College and Police Nursing School to assess and monitor HIV/AIDS services coverage, quality and
process. All the 91 health facilities will receive IS-related technical assistance and emphasis will be given to
the new sites through recruiting data personnel, trainings on basic M&E, data collection and reporting tools
of UCSD-supported programs, site-level data use, data quality, and other evidence-informed planning and
decision-making methods.
ART and other UCSD-supported programs will be strengthened further by increasing the capacity of health
facilities, health departments and health science colleges, and higher level decision-making departments
within the uniformed services, which provide treatment, care, and support to collect, store, analyze, and use
data generated at site level for decision-making to improve clinical and program management.
Despite the multiple efforts to expand sites, scale up services, and systematically collect, analyze, and use
data at different levels, insufficient attention is given to data and service quality, documentation and sharing
the information with stakeholders at all levels (i.e. healthcare personnel at facility level, health managers at
division and command level). Due to this, limited information is available on quality of services, barriers to
Activity Narrative: utilization of services, and documentations on best practices in PMTCT, HCT, TB/HIV, STI, palliative care
and ART services.
Therefore, in FY08 more emphasis will be given to data quality, ways to find information on service quality
and improve accordingly, and documentation of best practices and sharing information with all stakeholders.
Data use will be supported at all levels to enable service providers to manage data and use data. Sites will
be further enabled to appropriately tabulate and visualize their data through tables, charts, line and bar
graphs, and other standard methods. Appropriate options for tabulation include aggregation of data by
patient, clinic, and command levels.
Specific activities include: training and updating of data personnel and healthcare providers on the data
collection and reporting tools; training on basic computer skills; more frequent data-quality checks;
generation of more qualitative data through training and development of tools; training on documentation of
best practices: and presentations of findings and experiences both at local and international scientific and
programmatic forums for priority setting and decision making; assessment of service quality, barriers to
utilization of services; and tracking of lost-to-follow up clients and also strengthening the HIV drug-
resistance surveillance activities.
Implementation mechanisms for this activity will include providing the necessary modeling at site and
command levels within the uniformed services.
Continuing Activity: 16624
16624 10427.08 HHS/Centers for University of 7483 3785.08 Twinning of US- $300,000
10427 10427.07 HHS/Centers for University of 5481 3785.07 $150,000
Estimated amount of funding that is planned for Human Capacity Development $50,000
Table 3.3.17:
