Detailed Mechanism Funding and Narrative

Years of mechanism: 2008 2009

Details for Mechanism ID: 3787
Country/Region: Ethiopia
Year: 2009
Main Partner: Johns Hopkins University
Main Partner Program: Bloomberg School of Public Health
Organizational Type: University
Funding Agency: HHS/CDC
Total Funding: $12,408,436

Funding for Biomedical Prevention: Prevention of Mother to Child Transmission (MTCT): $1,300,000

PMTCT Services at Hospital and Health Center Level by Region - Johns Hopkins University

ACTIVITY HAS BEEN MODIFIED IN THE FOLLOWING WAYS:

This is a continuing activity from FY08. In FY08 JHU has supported PMTCT program at 34 health facilities

in Addis Ababa, Benshangul- Gumuz, Gambella and the Southern Nations, Nationalities, and Peoples

Regions (SNNPR). JHU TSEHAI expanded and enhanced interventions to prevent Mother-to-child

transmission and to link HIV-positive pregnant women and their families to comprehensive HIV care and

treatment services. The SAPR indicates that the partner has achieved all its PMTCT targets for the two

quarters. The partner has adopted innovative mechanisms like outreach ANC/PMTCT service delivery and

assignment of case managers to facilitate effective PMTCT service provision at facility level. It has also

played significant role in supporting FHAPCO to strengthen the national Program leadership. JHU TSEHAI

is still working to build PMTCT coordination capacity through secondment of a PMTCT advisor to the FHD

at the Ministry of Health. Furthermore, JHU has actively participated in the rolling out of the revised national

PMTCT Guidelines.

In FY08, JHU experienced high staff turn over at facility level and interruption in the supply of test kits. The

weak M&E system for PMTCT and PMTCT registers not capturing some important indicators on PMTCT

program has also affected the partner's performance. Very low ANC attendance rate, loss to follow up of

mothers and infants, low male involvement in PMTCT program and need for renovation of labor and

delivery at most PMTCT sites are some of the challenges that the partner faced in the last fiscal year.

In FY 09, JHU will work to address the above challenges and will also build on FY 08 activities and continue

strengthening the PMTCT program at 45 health facilities in Addis Ababa, SNNPR, Benshangul Gumuz and

Gambella regions. In FY 09 JHU 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. JHU will second a PMTCT advisor to SNNPR Regional Health

Bureau to assist in the scale-up, integration, coordination, quality assurance and oversight of PMTCT

program.

3)Promote the use of PMTCT TC Support tools 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: JHU 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, Johns Hopkins University/ Technical Support for the

Ethiopia HIV/AIDS ART Initiative (JHU TSEHAI) supported PMTCT services in 30 hospital networks in

Addis Ababa, Benshangul- Gumuz, Gambella and the Southern Nations, Nationalities, and Peoples

Regions (SNNPR). JHU TSEHAI expanded and enhanced interventions to prevent prenatal and

postpartum transmission, and to link HIV-positive pregnant women and their families to comprehensive HIV

care and treatment services. In FY08, JHU will extend these services to a total of 42 health 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 target areas.

Accordingly, JHU will provide PMTCT services at five hospitals in Addis Ababa, two hospitals and 11 health

centers in Benshangul-Gumuz, one hospital and six health centers in Gambella, and 17 hospitals in

SNNPR. JHU uses antenatal care (ANC), maternal/neonatal/child health (MNCH), and PMTCT programs as

entry points to HIV care and treatment for women, children, and families. The Government of Ethiopia has

recently issued revised national PMTCT guidelines, and JHU, in collaboration with JHPIEGO, will support

the rollout of the new PMTCT guidelines in these regions. Major areas of emphasis include: integration of

PMTCT with MNCH services and HIV prevention, care, and treatment programs; provider-initiated, routine,

opt-out HIV testing and counseling at ANC and 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.

JHU 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, JHU will contribute to the development

of training materials, clinical support tools, guidelines, formats, and standards. JHU 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. At the facility level,

the JHU-supported package of PMTCT Plus/family-focused care includes:

1) Support for linkages between healthcare facilities and community-based implementing partners, including

PLWH organizations, to promote uptake of antenatal and PMTCT services and to support follow up of

infants enrolled in early infant diagnosis (EID) programs

2) Enhanced linkages between ANC, MNCH, PMTCT, family planning (FP), 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

Activity Narrative: 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

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 in coordination with the Global Fund to Fight AIDS, Malaria, and

Tuberculosis (Global Fund) 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 (MVI) 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 MNCH staff (including traditional birth attendants) on safe infant-feeding practices in the

context of HIV, developing infant-feeding support tools, and establishing infant-feeding MSG

12) Linkages of all infants born to HIV-positive women to the HIV-Exposed Infant Clinic to ensure EID by

DNA PCR using dried-blood spot (DBS) 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-management information systems (HMIS)

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 of age 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 and the JHPIEGO-supported

Standard-based Management Program

17) Provision of PMTCT-Plus training to multidisciplinary teams at the facility level

18) Provision of 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, refurbishing, and repair (as needed) of ANC, labor and delivery rooms, and maternity

wards at JHU-supported sites

23) Radio and TV outreach campaigns and use of information-education-communication/behavior-change

communication (IEC/BCC) materials in local languages to enhance public awareness and use of ANC,

MNCH, PMTCT and HIV care & treatment services

In FY07, JHU-TSEHAI also implemented an initial pilot program to support infant-feeding practices in the

postpartum period. In FY08, this activity will continue as before, but will incorporate the following expanded

activities: (1) Expansion to SNNPR by linking with Intrahealth/JHPIEGO to introduce MSG at hospital level

for ongoing feeding support; (2) Supporting institutions to become baby friendly hospitals that promote

exclusive breastfeeding; (3) Training counselors and nurses in this activity; and (4) Training HIV-positive

mothers and family members in optimal feeding at all hospital sites.

JHU, in collaboration with Addis Ababa University, had followed more than 1,000 HIV-positive women and

their infants who were in a clinical trial for PMTCT. Review of feeding practices showed that although good

infant-feeding counseling was provided by trained healthcare staff, less than 50% of those who chose to

breastfeed were exclusively breastfeeding beyond three months. Appropriate ongoing counseling by

healthcare providers, mother-to-mother support groups, and involvement of family members would provide

a vehicle to promote and support optimal breastfeeding practices for mothers who are breastfeeding. The

proposed FY08 continuation activities include: (1)Assessment and improved current breastfeeding

counseling practices; (2) Targeting pregnant women in the antenatal period to counsel on infant-feeding ;

(3) Collaborating with partners on revising and updating current infant-feeding guidelines and manuals; (4)

Assessing and supporting factors that promote optimal breastfeeding such as maintaining breast health and

appropriate breastfeeding (positioning, attachment, etc.), developing IEC materials on exclusive

breastfeeding, ensuring maternal health and nutrition status, and family support; and (5) Training MSG to

ensure ongoing support for optimal infant-feeding and support for exclusive breastfeeding. JHU proposes

to train 150 counselors and nurses and 300 mothers and family members on optimal feeding options.

Additional narrative to COP08 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. JHU will be involved

in the expanding outreach PMTCT services in Addis Ababa, Gambella, Benishangul and SNNPR regions.

New/Continuing Activity: Continuing Activity

Continuing Activity: 16631

Continued Associated Activity Information

Activity Activity ID USG Agency Prime Partner Mechanism Mechanism ID Mechanism Planned Funds

System ID System ID

16631 5641.08 HHS/Centers for Johns Hopkins 7485 3787.08 Support for $1,100,000

Disease Control & University program

Prevention Bloomberg School implementation

of Public Health

through US-

based

universities in

the FDRE

10632 5641.07 HHS/Centers for Johns Hopkins 5484 3787.07 FMOH $482,760

Disease Control & University

Prevention Bloomberg School

of Public Health

5641 5641.06 HHS/National Johns Hopkins 3787 3787.06 $100,000

Institutes of Health University

Bloomberg School

of Public Health

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:

Funding for Sexual Prevention: Abstinence/Be Faithful (HVAB): $50,000

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 76 sites in

Addis Ababa, SNNPR, Benishangul and Gambella 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, Johns Hopkins University Bloomberg School of Public Health (JHU-BSPH)

supported STI activities to Addis Ababa, Benishangul-Gumuz, Gambella, and Southern Nations,

Nationalities, and Peoples (SNNPR) regions. The support included: training healthcare providers on

syndromic management of STI, and providing technical assistance to implement the syndromic approach at

hospital level. Development of a work plan and an assessment tool to identify the sources of STI treatment

and prevention activities at the 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 (CSO), faith-based

organizations (FBO) 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 of support on STI services of 76 sites

supported by JHU-BSPH (including hospitals and emerging region health centers) 2) Provision of on-site

technical assistance to improve STI diagnosis and treatment following national syndromic management

guidelines 3) 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 5) 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 (HCT) services, promoting a provider-initiated, opt-out approach for

all STI patients, and linkages to care and treatment services for those who are HIV-infected 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, 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. This will ensure that all pregnant women are educated on and/or treated for STI, and

receive education on STI prevention during pregnancy (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 ART sites

supported by Columbia 10) More Strengthening of STI data recording and reporting system at all

levels .Support for sites for STI syndromic data documentation and reporting 11) In FY08, Johns Hopkins

University Bloomberg School of Public Health (JHU) 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

(Addis Ababa, SNNPR, Gambella and Benishangul regions). In FY09, JHU will strengthen and continue this

activity by expanding sexual prevention outreach activity using the ABC strategy in universities in the region

(Hawassa University). The target populations are university students. The activity will be implemented in

collaboration with JHSPH Behavioral Sciences Department. In FY09, JHU 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 in FY 09 will be to include support to

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:

Funding for Sexual Prevention: Abstinence/Be Faithful (HVAB): $80,000

APRIL 2009 REPROGRAMMING

Confidential STI Clinics 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.

Establish new user-friendly confidential STI clinics including outreach for commercial sex workers and their

clients in urban areas. Partnering with local NGOs such as Family Guidance Association of Ethiopia

(FGAE).

In FY09 the following major activities will be undertaken to realize the project objectives: 1) Identification of

clinic sites and implementing partners and renovation and construction of the model clinics 2) Development

of training curricula, procurement of audio-visual educational equipment, training of clinic health and support

staff 3) Procurement and provision of condoms 4) Provision of STI medicines 5) Design of referral linkages

6) Promotion of clinics emphasizing their low cost/free services, confidentiality, and quality of service

(including hospitality) FY 2008 ACTIVITY NARRATIVE This is a continuation activity. The main objectives

of this activity are to establish comprehensive most-at-risk population (MARP)-friendly sexually transmitted

infections (STI) services and to link confidential clinics with other services like mobile counseling and

testing, ART, PMTCT, the Wegen Talkline, and ABC comprehensive prevention messages. In FY07, three

confidential STI clinics were to be renovated/constructed in Addis Ababa, Bahir Dar, and Nazareth to

provide comprehensive STI services. In FY08, four more clinics will be renovated /constructed to provide

comprehensive STI services, including reproductive health and post-exposure prophylaxis services for rape

survivors. Evidence suggests that STI are spreading widely in Ethiopia, particularly among MARPs, which

include commercial sex workers and their clients, long-distance truck drivers, low-income women,

substance abusers, street people, migrant workers, bar owners, and urban men with money, among others.

MARPs have the highest partner rates and are therefore critical targets for comprehensive STI prevention

and control. They are often socially marginalized, discriminated against and the last reached by traditional

health services. In recent years, increasing poverty in Ethiopia has lead to large-scale unemployment and

homelessness, which coupled with widespread commercial sex work, has increased STI prevalence. HIV

has spread between Ethiopian cities following the main trading routes. The sixth report on "AIDS in

Ethiopia" indicates that the 2005 HIV prevalence was 3.5% (urban 10.5%, rural 1.9%), and indicated the

national prevalence had stabilized. However prevalence remains high in MARPs and in rural Amhara. The

2005 STI regional report indicated 13,768 and 14,322 cases of urethral and vaginal discharge respectively;

and 5,582 cases of genital ulcer. The 2005 antenatal care survey indicated a general 2.7% syphilis

prevalence and a 4.9% prevalence of syphilis among HIV-positive clients, with higher incidence in rural

areas. Rates were higher in all settings than they were in 2003. Although it is widely acknowledged that STI

are rampant across the country, the number of cases seen at formal health service points is low. The

treatment-seeking behavior of STI patients, especially of MARPs with STI, remains poorly understood. They

tend to seek treatment from alternative sources, such as drug vendors, traditional healers, and open

marketplaces. Services provided there are inferior in terms of provider knowledge, availability of other

services like condom supply and voluntary counseling and testing (VCT), provision of

promotional/educational materials, etc. Among commercial sex workers, there is lack of knowledge of early

STI symptoms and thus lack of early care and treatment seeking; most commercial sex workers also lack

the skills to negotiate safer sex with their clients. Most MARPs do not seek STI treatment until it interferes

with their routine life, mainly due to stigma and lack of accessible affordable health services. There is also a

lack of staff trained in managing such marginalized populations. Therefore, confidential clinics, particularly

for MARPs, are essential to reach them. Strategies for this intervention will include: 1) Rapid assessment

to decide sites and services for the confidential MARPs clinics 2) Integration of MARPs clinics with partners'

clinics 3) STI diagnosis and treatment, including drug provision, condom promotion and provision,

establishment of peer-support groups, STI education and counseling, and referral linkages to VCT, ART

and PMTCT 4) Clients will receive messages and educational materials through linking clinics with AIDS

Resource Centers 5) Communications skill training will be provided to clinic staff to improve service delivery

and to make user-friendly The following major activities will be undertaken to realize the project objectives:

1) Communication/consultation with other PEPFAR partners on implementation of the clinic service 2)

Identification of clinic sites and implementing partners and renovation and construction of the model clinics

3) Development of training curricula, procurement of audio-visual educational equipment, training of clinic

health and support staff 4) Procurement and provision of condoms 5) Provision of STI medicines 6) Design

of referral linkages 7) Promotion of clinics emphasizing their low cost/free services, confidentiality, and

quality of service (including hospitality)

New/Continuing Activity: New Activity

Continuing Activity:

Table 3.3.02:

Funding for Sexual Prevention: Other Sexual Prevention (HVOP): $200,000

Strengthening STI Services for MARPs

ACTIVITY MODIFIED IN THE FOLLOWING WAYS:

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, Johns Hopkins University Bloomberg School of Public Health (JHU-BSPH) supported STI

activities to Addis Ababa, Benishangul-Gumuz, Gambella, and Southern Nations, Nationalities, and Peoples

(SNNPR) regions. The support included: training healthcare providers on syndromic management of STI,

and providing technical assistance to implement the syndromic approach at hospital level. Development of a

work plan and an assessment tool to identify the sources of STI treatment and prevention activities at the

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 (CSO), faith-based organizations (FBO) 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 of support on STI services of 76 sites supported by JHU-BSPH (including hospitals and

emerging region health centers)

2) Provision of on-site technical assistance to improve STI diagnosis and treatment following national

syndromic management guidelines

3) 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

5) 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 (HCT) services, promoting a provider-initiated,

opt-out approach for all STI patients, and linkages to care and treatment services for those who are HIV-

infected

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, 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. This will ensure that all pregnant women

are educated on and/or treated for STI, and receive education on STI prevention during pregnancy

(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 ART sites supported by Columbia

10) More Strengthening of STI data recording and reporting system at all levels .Support for sites for STI

syndromic data documentation and reporting

11) In FY08, Johns Hopkins University Bloomberg School of Public Health (JHU) 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 (Addis Ababa, SNNPR, Gambela and Benishangul regions). In FY09,

JHU will strengthen and continue this activity by expanding sexual prevention outreach activity using the

ABC strategy in universities in the region (Hawassa University). The target populations are university

students. The activity will be implemented in collaboration with JHSPH Behavioral Sciences Department

In FY09, JHU 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 in FY 09 will be to include support to 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: Continuing Activity

Continuing Activity: 16632

Continued Associated Activity Information

Activity Activity ID USG Agency Prime Partner Mechanism Mechanism ID Mechanism Planned Funds

System ID System ID

16632 10635.08 HHS/Centers for Johns Hopkins 7485 3787.08 Support for $550,000

Disease Control & University program

Prevention Bloomberg School implementation

of Public Health

through US-

based

universities in

the FDRE

10635 10635.07 HHS/Centers for Johns Hopkins 5484 3787.07 FMOH $100,000

Disease Control & University

Prevention Bloomberg School

of Public Health

Emphasis Areas

Gender

* Addressing male norms and behaviors

* Increasing gender equity in HIV/AIDS programs

* Reducing violence and coercion

Health-related Wraparound Programs

* Child Survival Activities

* Family Planning

* 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 3.3.03:

Funding for Care: Adult Care and Support (HBHC): $399,361

Support for Program Implementation

ACTIVITY UNCHANGED FROM FY2008

COP 08 ACTIVITY NARRATIVE:

In FY06, Johns Hopkins University - Bloomberg School of Public Health (JHU-BSPH) introduced a basic

care and support approach to 20 ART facilities and then in FY07 expanded this activity to 44 sites in

Operational Zone 2 (Addis Ababa, Benishangul-Gumuz, Gambella, and SNNP). Initial work included: a

baseline assessment of the palliative care and support activities at sites; development of site-level training

materials for palliative care and the prevention care package in cooperation with the national leadership;

development of national pain management guidelines and training materials; and supervision of palliative

care activities.

Training and supervision focused on identifying pain and discomfort among HIV patients, ensuring

cotrimoxazole (CTX) prophylaxis (pCTX)for all eligible patients, conducting tuberculosis (TB) screening for

HIV-positive patients, and targeting elements of the preventive care package (e.g., multivitamins, nutrition

assessments, condoms, and links to programs that distribute insecticide-treated bed nets (ITN) to HIV

positive patients. In FY07, this project has provided care and support services to 22 244 people, and has

distributed 22 000 condoms, 1.2 million CTX tablets, 33 000 bottles of cotrimoxazole and 630 000

multivitamins to ART sites. Four programs have linked ART clinics with the regional ITN distribution,

reserving 1 200 nets for HIV-positive persons of all ages.

As the lead for nutritional programs among university partners, JHU-BSPH has collaborated with the

HIV/AIDS Prevention and Control Office (HAPCO) and Food and Nutrition Technical Assistance (FANTA) to

facilitate the introduction of "food by prescription" programs at hospital level. To this end, National Guideline

on Nutritional and HIV/AIDS is being revised and Guide to Clinical Nutrition Care for Children 6 Months-14

Years Old and Adults Living with HIV training manual is being finalized. In the training manual section on

safe water system, hygiene and sanitation have been added to reflect the PEPFAR Ethiopia effort to

strengthen this service to PLWH and their families. The task force has standardized the national initial site

visits have been conducted at St. Peter's Hospital by JHU with FANTA.

In FY08, JHU plan to expand the services to total of 50 but to date it is only possible to support palliative

care and support activities at 45 sites providing HIV/AIDS care and treatment (hospital and emerging

regional health centers), via a multidisciplinary, family-focused approach to providing the preventive care

package for both adults and children. This approach will continue to 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.

In FY09, JHU will try to expand the services to 50 facilities that provide the preventive care package,

complementing the Global Fund for AIDS, Tuberculosis, and Malaria (Global Fund), the Federal Ministry of

Health, and other PEPFAR Ethiopia funded activities when possible. JHU will continue to focus on providing

the basic care package for adults, which includes: pCTX; micronutrient and nutrition supplements and

counseling; ITN (through linkage with the Global Fund malaria control program); water disinfectant and

ensuring personal and environmental hygiene for PLWH at community and hospital level; condoms and

education for prevention among positives; and TB screening and pain management for all patients. The

basic care package for children includes: pCTX to prevent serious illnesses like Pneumocystis carinii

pneumonia, TB, and malaria; prevention and treatment of diarrhea; nutrition and micronutrient supplement;

and links to national childhood immunization programs.

JHU will continue to work closely with other university partners to ensure complementary of activities with,

for example, the implementation of national pain management guidelines and implementation of the

Palliative Care Training curriculum.

JHU support to facilities will be continued or expanded 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, under-5 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, 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.

JHU will: ensure that all supported sites have reliable stocks of CTX tablets; provide emergency supplies

when needed for quality and continuity of care; promote TB screening; and provide and promote INH

prophylaxis for HIV positive adults and children. Supportive supervision and the institution of standard

operating procedures and national guidelines will improve the use of CTX and INH prophylaxis. Attention

Activity Narrative: will be given to the issue of HIV/malaria co-infection, and the routine provision of ITN in HIV/AIDS and

PMTCT programs in collaboration with Global Fund. Health education and behavior-change communication

for HIV-positive individuals will be provided by facility and lay staff, complementing Global Fund and other

USG-funded activities. Health education, counseling, and support will encourage positive living to forestall

disease progression and promote prevention among positives to prevent further HIV transmission.

In FY09, JHU will continue to support and expand nutritional activities to:

1) Assist in development of guidelines for nutrition assessment.

2) Improve dietary and nutrition assessment at the point of care and evaluate the effectiveness of the

assessment technique.

3) Improve nutrition counseling by assessing current practices and implementing identified best practices for

nutrition counseling.

4) Assess and address micronutrient supplement needs and examine and address therapeutic and

supplemental feeding needs.

5) Integrate therapeutic "food-by-prescription" with ART and PMTCT programs.

6) Support implementation of "food-by-prescription" in at least 20 hospitals, based on criteria agreed upon

by PEPFAR Ethiopia.

7) Evaluate therapeutic and supplementary feeding programs with adaptation of WHO criteria for eligibility

and exit criteria for programs.

8) Support dietary assessment and supplementation of micronutrients to pregnant and lactating women and

children.

9) Assess and recommend effective ways to improve dietary intake in patients with weight loss due to

appetite loss and inadequate intake.

10) Integrate infant feeding counseling and maternal nutrition in PMTCT programs.

11) Assess effect of ART in chronically malnourished populations.

12) Develop capacity and skill of hospital staff in nutritional assessment.

13) Examine the use of lay counselors (i.e., PLWH) to assist with nutritional counseling so that clinic staff is

not overburdened.

14) Share information regarding nutritional assessment guidelines and experiences gained through pilot

implementation programs with the other university partners.

New/Continuing Activity: Continuing Activity

Continuing Activity: 16633

Continued Associated Activity Information

Activity Activity ID USG Agency Prime Partner Mechanism Mechanism ID Mechanism Planned Funds

System ID System ID

16633 5618.08 HHS/Centers for Johns Hopkins 7485 3787.08 Support for $469,836

Disease Control & University program

Prevention Bloomberg School implementation

of Public Health

through US-

based

universities in

the FDRE

10497 5618.07 HHS/Centers for Johns Hopkins 5484 3787.07 FMOH $421,000

Disease Control & University

Prevention Bloomberg School

of Public Health

5618 5618.06 HHS/National Johns Hopkins 3787 3787.06 $675,000

Institutes of Health University

Bloomberg School

of Public Health

Table 3.3.08:

Funding for Treatment: Adult Treatment (HTXS): $380,800

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 John Hopkins University (JHU) 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 Awassa and Addis

Ababa

• Ensure that two skills laboratory are strengthened

• Ensure that competency-based education is promoted and strengthened at the universities in the cities of

Awassa and Addis Ababa.

• 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.

New/Continuing Activity: New Activity

Continuing Activity:

Table 3.3.09:

Funding for Treatment: Adult Treatment (HTXS): $1,053,000

Clinically Focused Record Systems

ACTIVITY UNCHANGED FROM FY2008

This is a continuing activity from FY 08.

This activity has been delayed from starting enrolling patients due to slow process of obtaining ethical

clearance from all concerned parties. Now, clearance has been obtained from Centers for Disease Control

and Prevention (CDC) and Johns Hopkins University (JHU). As of October 2008, the protocol had been

finally presented to the Science and Technology Commission of Ethiopia and is expected to get the required

clearance soon. Patient enrollment will start as soon as this process is finalized. Furthermore, coordination

among the different partners involved was a challenge, but, now things are going forward with better

coordination.

In FY 07, Advanced Clinical Monitoring (ACM) achievements included protocol submission and clearance,

initiation of cohort enrollment, ongoing support for the governing steering committee structure,

strengthening of clinic based activities at seven participating university hospitals, development and

implementation of facility based project management standard operating procedures to initiate cohort

enrollment and collect data from the targeted sample of HIV positive patients put on ART at the seven

universities and meet data transfer and specimen repository standards.

In FY 08, continuation activities include ongoing support for cohort enrollment, maintenance of implemented

standardization measures for data collection and patient records management, monitoring data quality

levels, data and specimen transfer to host institution, ongoing facility staff training to use national M&E

tools, monitoring electronic data management system at site and central levels and JHU will continue to

support collaborative targeted evaluations to meet project objectives, facilitate data and specimen requests

from daughter protocols as per steering committee approvals and increase university hospital capacity to

twin with local and international institutions.

Intensive monitoring and evaluation of approximately 3 000 patients on ART will provide critical information

on large scale ART distribution without piloting on a small scale. This activity will improve case management

of treatment services at the university hospitals and will enhance the universities' capacity to provide

technical assistance and training to clinicians, residents, and medical students. Data generated by this multi

-site project will inform and improve ART delivery in Ethiopia by providing important information on ART

associated toxicities and early mortality. The multi-site patient database and specimen repository will

facilitate operational research and scientific inquiry pertinent to HIV/AIDS, through in-depth monitoring of

treatment, acceptance and adherence, assessment of indicators of adherence, clinical and virologic efficacy

of treatment protocols, assessment of monitoring protocols (CD4), evaluation of drug toxicity, drug-

interactions and viral resistance, investigation of potential barriers to expanding ART access in Ethiopia.

The project will train staff required for collection of additional data to answer programmatic issues and

perform patient follow-up. JHU will also support capacity building of health providers and regional health

authorities to record, store and share information to support provision of appropriate services to individual

HIV patients and their families, across the continuum of care. These information systems will be flexible,

adaptable, and compatible with various existing health care information systems and will support program

monitoring and evaluation. JHU team of healthcare informatics experts will provide expert technical input in

developing a data model for HIV care and will work with the CDC informatics group and national committee

to develop an infrastructure for installation of electronic health records to support the longitudinal care

needed to combat HIV over the long-term. When an electronic patient record system for HIV care or for

overall hospital care is developed, the JHU team will guide its implementation for the hospitals in its four

regions. This activity will include provision of the CDC medical record folders if supported

New/Continuing Activity: Continuing Activity

Continuing Activity: 16637

Continued Associated Activity Information

Activity Activity ID USG Agency Prime Partner Mechanism Mechanism ID Mechanism Planned Funds

System ID System ID

16637 5685.08 HHS/Centers for Johns Hopkins 7485 3787.08 Support for $1,170,000

Disease Control & University program

Prevention Bloomberg School implementation

of Public Health

through US-

based

universities in

the FDRE

10598 5685.07 HHS/Centers for Johns Hopkins 5484 3787.07 FMOH $850,000

Disease Control & University

Prevention Bloomberg School

of Public Health

5685 5685.06 HHS/National Johns Hopkins 3787 3787.06 $700,000

Institutes of Health University

Bloomberg School

of Public Health

Table 3.3.09:

Funding for Treatment: Adult Treatment (HTXS): $5,595,000

Technical Support for ART Scale-up

ACTIVITY UNCHANGED FROM FY2008

This is a continuation of activity from FY08.

Johns Hopkins University - Bloomberg School of Public Health (JHU-BSPH) supported ART

implementation in Operational Zone 3 which includes Addis Ababa City Administration (region), Southern

Nations Nationalities and Peoples (SNNPR) region, Beni-shangul Gumuz region and Gambella region. By

the end of June, 2008, JHU was providing support for comprehensive HIV care and treatment services to 48

ART sites in the four regions. These ART sites included public and private hospitals in Addis Ababa City

Administration, public hospitals in the SNNPR, and public hospitals and health centers in the emerging

regions of Beni-shangul Gumuz region and Gambella region.

As of June 30, 2008, 31 917 persons were receiving ART, and 46 938 persons had been initiated on ART at

JHU supported ART sites in the four regions. These achievements exceed the targets set for COP07

(ending on September 30, 2008), three months before the end of the reporting period. Furthermore, training

has been provided to different cadres of ART providing healthcare workers, and JHU continues to lead with

advanced ART workshops and CME telemedicine case reviews.

In COP09, the care and treatment activities to HIV patients in these regions will continue through delivery of

the care and treatment services to those patients enrolled to care and initiated on ART, and also by

enrolling and initiating new patients. JHU will continue to support the ART facilities in its Operational Zone,

which includes public and private hospitals in Addis Ababa and SNNPR regions, and hospitals and health

centers in the emerging regions of Beni-shangul Gumuz region and Gambella region. Support will be

divided among several programmatic activities: direct site-level support, mentoring, human resources,

infrastructure, training, quality care, expansion of ART to the private sector, pediatric care, laboratory

diagnostics, site-level management, community-level support, and monitoring and evaluation of outcomes.

To increase capacity, JHU will invest in personnel to support ART technical assistance (TA) at sites and will

augment support by sponsoring regional meetings, collaborative activities, and by participating in the RHB

ART coordinating and implementation teams. JHU will address region specific challenges to scaling up,

while maintaining quality mentorship at established ART sites.

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.

In the preceding years, as the lead for the post-exposure prophylaxis (PEP) program amongst university

partners and health network, JHU focused on national-level activities in policy development, as well as on

regional-level facility-based training to implement an effective PEP guidelines, targeting healthcare

providers and victims of sexual assault at ten pilot facilities. Specific activities included: ensuring availability

of national guidelines and protocols; ensuring the availability of ARVs for PEP; implementation of

awareness programs to increase uptake of the program by exposed individuals; and training of trainers

(TOT) for health workers and Ministry of Health (MOH) and RHB staff to ensure decentralization of

activities to other regions and partners.

Phase I of this activity addressed the need to increase safety and protection of healthcare workers and the

need for a comprehensive plan of care for victims of sexual assault. Phase II focused on development of

guidelines, policy, and an implementation model for providing comprehensive care to both target

populations. These activities continued with a PEP expansion plan in the supported facilities within the four

regions, and continued to provide guidance to other university partners.

The ART technical support also included expansion of activities to the entire health network model in the

two emerging regions of Gambella and Benshangul Gumuz. JHU will further expand the comprehensive

HIV activities in the private sector —in particular TB/HIV, PMTCT, VCT, linkages to ART clinics in private

hospitals, increased coverage of pediatric ART and DNA testing for EID at all JHU-supported ART sites.

JHU will continue to work with the Ethiopian Orthodox Church and International Orthodox Church Charities,

and expand activities to other faith-based organizations. Using guidelines and training materials, JHU will

work closely with the MOH and RHB to address malaria and HIV co-infection and to provide linkages to

insecticide-treated nets for all HIV patients in malaria endemic areas. JHU will expand peer network

advocacy for people living with HIV/AIDS (PLWH) and tracking systems to improve adherence, follow-up for

care, and community-level support for ART.

JHU will continue to provide expertise at all levels of ART provision, ranging from multidisciplinary team

mentoring and supportive supervision to creation of a cadre of local university mentors. These mentors will

provide clinical stewardship and develop additional expertise in data processing and management at ART

sites. Recognizing the majority of patients are lost between CT and the ART clinic, JHU will continue to

invest resources to improve networking and inter and intra-service linkages with CT, TB, antenatal clinics

(ANC), sexually transmitted infections, PMTCT services, and community-based care, based on the "Referral

Network Model for Ethiopia" project completed by JHU in FY06. JHU will support hospital and RHB activities

in transferring patients from hospital ART clinics to locally networked health centers. JHU will offer TA with

transfer readiness, patient identification, development of standard operating procedures for mentoring, and

case review for difficult cases. JHU will support developing a cadre of nurse specialist mentors to provide on

-site follow-up and mentoring for ART nurses, as well as to train counselors, lay counselors, and peer

educators on adherence. JHU plans to train or identify persons affiliated with PLWH associations in an effort

to promote ownership, communication, policy drafting, and overall sustainability of ART programs. Through

these activities, it will work to improve quality of service delivery, improve patient out-come and retention of

Activity Narrative: patients to care and treatment services.

JHU will manage high demand at urban centers by: increasing site-capacity through renovation in

coordination with the Regional Procurement Support Office (RPSO) and Crown Agents; training and

innovative methods to improve human resource retention; and by strengthening referral linkages between

hospitals, health centers, and community-based organizations to improve service delivery. It will work with

partners working at health centers and community level to ensure transfer of stable patients from

congested, high-load ART sites to health centers closer to patients' residences and community services.

JHU will support linking treatment, care, and support services with PLWH associations. JHU will continue to

strengthen provider initiated counseling and testing (PICT), referrals for TB/HIV and malaria/HIV.

JHU will continue to expand the intensification of PMTCT to ART linkages and to increase the number of

pregnant women on ART. JHU will place PMTCT case managers and nurse assistants at sites to improve

overall screening for ART and to improve linkages to other programs (ART, pediatrics, TB/HIV).

JHU 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-positive patients, especially CTX for TB

patients, pregnant women, and HIV-exposed children.

JHU will expand MOH's basic ART Training activities within the hospitals, training inpatient healthcare

personnel, and new graduates so that ART services expand accordingly. JHU will continue to supplement

basic training through HIV telemedicine, case review sessions, TheraSim, and work with other partners to

expand services to distant regions through satellite connections and possible portable videoconference

capabilities.

In association with JPHIEGO, Standards Based Management and Recognition (SBMR) for all HIV activities

were introduced in FY07 and will be continued. These measures will assist measurement and improvement

of quality site services; performance on agreed indicators will be measured at facilities and district and

comparative reports produced. JHU will also continue to assess quality of reporting, recording, and clinical

services using Lot Quality Assurance Sampling techniques. These methods provide immediate feedback to

sites on areas requiring improvement and services management change.

Monitoring and evaluation (M&E) training for ART and laboratory technicians will continue to be provided as

part of the basic training package. JHU will work with the MOH to develop and distribute Information-

Education-Communication materials, reporting and recording formats, and all support for accurate

monitoring. M&E specialists will work closely with sites and RHB to analyze ART data and provide feedback

to clinicians. This will coordinate with the rollout of the health management information system and with

other PEPFAR partners.

Finally, JHU will continue to support the MOH in expanding free ART technical support to private sector

facilities in Addis Ababa. JHU will intensify its regional capacity building with greater emphasis on local

university and indigenous capacity. JHU will continue to build the capacity of Addis Ababa and Debub

Universities in knowledge-transfer, TA, supportive supervision, and mentoring to their respective RHB and

catchments health networks.

New/Continuing Activity: Continuing Activity

Continuing Activity: 16636

Continued Associated Activity Information

Activity Activity ID USG Agency Prime Partner Mechanism Mechanism ID Mechanism Planned Funds

System ID System ID

16636 10430.08 HHS/Centers for Johns Hopkins 7485 3787.08 Support for $7,000,000

Disease Control & University program

Prevention Bloomberg School implementation

of Public Health

through US-

based

universities in

the FDRE

Emphasis Areas

Gender

* Increasing gender equity in HIV/AIDS programs

Human Capacity Development

Public Health Evaluation

Food and Nutrition: Policy, Tools, and Service Delivery

Food and Nutrition: Commodities

Economic Strengthening

Education

Water

Table 3.3.09:

Funding for Care: Pediatric Care and Support (PDCS): $70,475

Palliative Care and Nutrition Support at Hospitals

ACTIVITY IS REPLACED ENTIRELY AS FOLLOWS:

In FY07 and FY08, the Johns Hopkins University Bloomberg School of Public Health (JHU-BSPH) is

working in pediatric care and support as part of the care and support activities, previously Palliative care. In

FY07 and FY08, JHU-BSPH supported basic pediatric care and support services at 30 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 (Addis Ababa, Benishangul-Gumuz, Gambella, and SNNP).

JHU-BSPH supported all 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 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, JHU-BSPH 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 OI for children with HIV, slowing disease progression and reducing morbidity and

mortality. JHU-BSPH will continue to participate in 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, JHU-BSPH

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.

JHU-BSPH 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. JHU-BSPH 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. JHU-BSPH 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.

JHU-BSPH support to facilities will be continued or expanded as follows. JHU-BSPH 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

2) Provide on-site implementation assistance, including staff support, implementation of referral systems

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

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

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

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

JHU-BSPH 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 JHU-BSPH

implementation activities, especially at those sites not yet providing ART. JHU-BSPH 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.

Activity Narrative: 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.

JHU-BSPH continues to be a leader for hospital-level nutrition programs and will continue to provide

guidance for other partners. The family of children graduating from therapeutic program will be linked to

food security program as appropriate.

New/Continuing Activity: Continuing Activity

Continuing Activity: 16633

Continued Associated Activity Information

Activity Activity ID USG Agency Prime Partner Mechanism Mechanism ID Mechanism Planned Funds

System ID System ID

16633 5618.08 HHS/Centers for Johns Hopkins 7485 3787.08 Support for $469,836

Disease Control & University program

Prevention Bloomberg School implementation

of Public Health

through US-

based

universities in

the FDRE

10497 5618.07 HHS/Centers for Johns Hopkins 5484 3787.07 FMOH $421,000

Disease Control & University

Prevention Bloomberg School

of Public Health

5618 5618.06 HHS/National Johns Hopkins 3787 3787.06 $675,000

Institutes of Health University

Bloomberg School

of Public Health

Emphasis Areas

Health-related Wraparound Programs

* Child Survival Activities

Human Capacity Development

Public Health Evaluation

Food and Nutrition: Policy, Tools, and Service Delivery

Food and Nutrition: Commodities

Economic Strengthening

Education

Water

Table 3.3.10:

Funding for Treatment: Pediatric Treatment (PDTX): $1,005,000

Technical Support for ART Scale-up

This is a continuing activity from FY05, FY06, FY07, and FY 08 which has previously been included within

treatment/ARV services. Johns Hopkins University (JHU) has supported the implementation of pediatric

ART in the two major regions of Addis Ababa and Oromiya, as well as the emerging regions of Benishangul

and Gambella.

In FY08, JHU actively participated in the national pediatric care and treatment activities to update and

enhance national policies, protocols, and guidelines on pediatric HIV. JHU supported full-spectrum pediatric

HIV prevention, care, and treatment services at 30 health facilities including hospitals and health centers

and is currently on track in meeting targets for COP08. In FY08 to date, JHU-supported sites have initiated

2069 children on ART, and 1585 children are currently on ART. JHU has effectively supported the

decentralization of ART services to health centers in Benishangul and Gambella 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, JHU will continue to support pediatric care and treatment services in the existing sites and expand

the services to private facilities.

At the national level, JHU 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

JHU 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. JHU will contribute its 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, JHU will work with Regional Health Bureaus (RHB) in its operational zone and other

partners to build their capacity to effectively design, implement, and evaluate Pediatric HIV/AIDS programs.

. JHU will work with RHB to evaluate the clinical, infrastructural, management and informatics needs of

facilities, develop implementation strategies to enable each facility to meet required national standards, and

to provide assistance to support the implementation of national treatment guidelines.

In FY09, emphasis will be placed on increased pediatric ART service uptake at all sites. JHU 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 orphans and other vulnerable children (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 sector

FY09 activities will also include expansion of activities to the entire health network model in the two

emerging regions of Gambella and Benshangul Gumuz. JHU will further expand the comprehensive

pediatric HIV care and treatment activities in the private sector in particular, linkages to ART clinics in

private hospitals, increased coverage of pediatric ART and DNA testing for early infant diagnosis (EID) at all

JHU-supported ART sites.

In FY09, JHU will continue to provide expertise at all levels of ART provision, ranging from multidisciplinary

team mentoring and supportive supervision to creation of a cadre of local university mentors. These

mentors will provide clinical stewardship and develop additional expertise in data processing and

management at ART sites. On-site assistance will be provided to develop medical records, 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 JHU supported regions.

Collaborating with I-CAP and other partners, JHU will continue support to all sites in pediatric care, by

training pediatricians and other health workers and integrating pediatric ART into current ART activities.

Assessing and improving the quality of service for pediatric care and treatment through standardized

approach in all operating sites will be one of the core activities in FY09.

JHU will emphasize strengthening the internal and external linkages including internal referrals to HIV care

clinics from various points of care and externally through referrals to and from community-based resources

to identify HIV-infected children and provide care and treatment services. Under the ART health network,

JHU 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

Activity Narrative: treatment will be prioritized for treatment services and linked to community based OVC care programs for

continued care.

JHU 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 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. JHU will expand MOH's basic ART Training activities within the hospitals, training inpatient

healthcare personnel, new graduates so that pediatric ART services expand accordingly. JHU will continue

to supplement basic training through HIV telemedicine, pediatric case review sessions, TheraSim, and work

with other partners to expand services to distant regions through satellite connections and possible portable

videoconference capabilities.

JHU 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 early infant diagnosis at all these sites is

critical to ensure quality comprehensive pediatric care and treatment services.

New/Continuing Activity: Continuing Activity

Continuing Activity: 16636

Continued Associated Activity Information

Activity Activity ID USG Agency Prime Partner Mechanism Mechanism ID Mechanism Planned Funds

System ID System ID

16636 10430.08 HHS/Centers for Johns Hopkins 7485 3787.08 Support for $7,000,000

Disease Control & University program

Prevention Bloomberg School implementation

of Public Health

through US-

based

universities in

the FDRE

Table 3.3.11:

Funding for Care: TB/HIV (HVTB): $336,800

TB/HIV Linkage Support at Hospital Level

ACTIVITY HAS BEEN MODIFIED IN THE FOLLOWING WAYS:

In FY 08, JHU has been expanding TB/HIV collaborative activities from 34 to 46 health facilities including

health centers in emerging regions and private hospitals to providing HIV counseling and testing of TB

patients in TB clinic, 3180 new HIV positive patients were screened for TB and 444 health care workers

were trained in TB/HIV. More over, JHU has participated in the national MDR-TB management working

group and have supported the development of proposal for second line anti TB treatment to the green light

committee and the MDR-TB management implementation guideline.

In FY09, Johns Hopkins University - Bloomberg School of Public Health (JHU-BSPH) 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, JHU-BSPH will participate

in the development and revision of MDR-TB management guidelines, protocols, and tools. JHU-BSPH 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 Monitoring and Evaluation (M&E): Intensive training, supportive supervision, and mentorship will be

provided to JHU-BSPH-supported facilities to strengthen the TB/HIV information system to generate good

quality data. JHU-BSPH will also assist national and regional TB/HIV review meetings and joint supportive

supervisions. 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. 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 Intermediate Presumptive Treatment (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, 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.

An integrated TB/HIV program is an essential component of the comprehensive HIV care preventive

package. With this program, JHUBSPH aims to strengthen the linkages between TB and HIV services in

hospitals of operational zone 2, which encompasses Addis Ababa, Benishangul-Gumuz, Gambella, and

Southern Nations, Nationalities, and Peoples Region (SNNPR).

Moreover, Tuberculosis infection control is a major concern in resource-limited settings. With the high

volume of TB patients seen in many health facilities in Ethiopia and the limited availability of infection control

practices, there is a concern for nosocomial TB transmission, including transmission to healthcare workers.

JHU will closely work with CDC-Ethiopia to establish a system for monitoring and evaluation of TB among

facility staff at the United States President's Emergency Plan for AIDS Relief (PEPFAR)-supported HIV care

& treatment sites. As a first step, CDC-DTBE-IRPB will collaborate with CDC-Ethiopia and JHU to conduct a

baseline assessment of nosocomial transmission of TB to healthcare workers at selected healthcare

facilities. Data will be gathered through interviews with hospital staff and administration to determine the

burden of TB among healthcare workers and to attempt to calculate rates of TB disease among workers.

This will help to determine the infection control needs for the country, as well as help to determine the

efficacy of planned interventions. This activity will be complementary with the infection control activities of

WHO, and technical assistance will be provided by CDC Atlanta to assist in the implementation of this

activity.

Support will be provided to St. Peter's TB Hospital in serving as a training and demonstration site, and plans

are underway to review the TB curriculum, conduct a review of multi-drug-resistant (MDR) TB cases,

establish culture activity at St. Peter's laboratory, and implement infection control measures in the inpatient

setting. On-site trainings are planned to be provided to the staff working at the hospital.

In FY09, JHU-BSPH will continue with all previous activities, supporting 50 sites in Operational Zone 2

(hospitals and emerging region health centers), and will focus on expanding activities to improve monitoring

and evaluation (M&E) and improved use of the current and revised TB/HIV recording system. Widespread

on-site training for TB/HIV activities will address the human resource attrition in the field. Improved TB

diagnostics (e.g., chest x-ray (CTX), concentrated acid-fast bacilli (AFB) staining methods, fluorescent

microscopy, fine-needle aspirations, culture and sensitivity, and—eventually—molecular diagnostics) will

improve site-level capacity to diagnose active TB. JHU-BSPH will support the phased implementation of

World Health Organization (WHO) guidelines on smear-negative disease and extra-pulmonary TB and will

assess TB relapse and failure rates as a proxy for resistance (MDR-TB).

JHU will further expand TB/HIV collaborative activities to those private-sector hospitals providing free

Activity Narrative: Antiretroviral Therapy (ART) and PPM-directly observed therapy services, in addition to expansion of IPT

and cotrimoxazole preventive therapy (CPT) to co-infected pediatric patients. In FY08, JHU-BSPH will work

with Columbia University and the MOH to assess training needs and curricula related to family-focused

TB/HIV activities, including provider-initiated counseling and testing (PICT) guidelines for children. With the

International Center for AIDS Care and Treatment Programs - Columbia University (ICAP-CU) as the lead

TB-implementing partner among university partners, current didactic materials will be modified to reflect

current needs.

In FY09, JHU-BSPH will continue to implement previous interventions, such as:

1)Expansion of PICT for TB patients

2)Referral of HIV/TB patients for HIV-related care including CTX and ART

3)TB screening in HIV care and treatment settings with improved documentation of these activities at the

HIV clinic

4)IPT for HIV-positive patients in whom active disease has been safely ruled out, and

5)Support at site level for improved ability to rule out active TB by providing CXR capacity in rural areas and

in network/referral hospitals.

These activities, implemented in FY08, will continue to be closely coordinated with the national TB and HIV

control programs and regional health bureaus (RHB) in the operational zone covered by JHU-BSPH. JHU-

BSPH will continue to work closely with the RHB in strengthening the TB/HIV working groups and review

meetings at regional level, along with providing strategies for: joint supportive supervision for TB/HIV

activities; M&E of TB/HIV activities; programs to improve prevention, diagnosis, and treatment advocacy for

MDR-TB; and human resources training and retention. JHU site-support teams will continue to provide

monthly supportive supervision and clinical mentoring in the field of TB/HIV, and teams will work closely

with the RHB to solve implementation road blocks.

In FY06, FY07, and FY08, JHU-BSPH initiated and continued its support to strengthen TB diagnostics

among HIV-positive patients through improvement of smear microscopy services, quality assurance of

laboratory networks, and support for regional referral. JHU-BSPH laboratory personnel assisted in the

review of new smear microscopy guidelines, trained on concentrated AFB methods, and disseminated this

information to JHU-supported TB/HIV sites. JHU-BSPH will continue to support improved smear microscopy

but will expand this laboratory support to labs providing culture and sensitivity testing at regional and federal

levels, in collaboration with the Plus-Up fund activities. The goal will be to increase ease of referral and

improve information feedback to patients and efforts to assess the situation of MDR-TB.

New/Continuing Activity: Continuing Activity

Continuing Activity: 16634

Continued Associated Activity Information

Activity Activity ID USG Agency Prime Partner Mechanism Mechanism ID Mechanism Planned Funds

System ID System ID

16634 5754.08 HHS/Centers for Johns Hopkins 7485 3787.08 Support for $316,800

Disease Control & University program

Prevention Bloomberg School implementation

of Public Health

through US-

based

universities in

the FDRE

10429 5754.07 HHS/Centers for Johns Hopkins 5484 3787.07 FMOH $264,000

Disease Control & University

Prevention Bloomberg School

of Public Health

5754 5754.06 HHS/National Johns Hopkins 3787 3787.06 $150,000

Institutes of Health University

Bloomberg School

of Public Health

Emphasis Areas

Construction/Renovation

Health-related Wraparound Programs

* TB

Human Capacity Development

Public Health Evaluation

Food and Nutrition: Policy, Tools, and Service Delivery

Food and Nutrition: Commodities

Economic Strengthening

Education

Water

Table 3.3.12:

Funding for Prevention: HIV Testing and Counseling (HVCT): $475,000

Creating Demand for Counseling and Testing through Promotional Activities

ACTIVITY UNCHANGED FROM FY2008

COP 08 NARRATIVE:

This continuing activity links to activities AB (ID10386, 10590, 10592 and 10605), Other Prevention (ID

10387 and 10388), Treatment (ID 10606 and 10623), Other Policy (ID 10422, 10423 and 10428) and all

HCT activities.

In view of expanding HIV counseling and testing (HCT) service availability, it is important that public

demand and utilization continue to increase. Since its inception, the Johns Hopkins University/Center for

Communication Programs AIDS Resource Center (CCP\ARC) has not only empowered people to access

voluntary counseling and testing (VCT), but also targeted service providers to provide quality VCT services.

JHU CCP/ARC produced print and multimedia materials encouraging use of VCT and distributed VCT

communication materials to service providers. CCP/ARC also conducted three national VCT Day promotion

campaigns in collaboration with partners. CCP/ARC played a major role in establishing the annual National

HCT Day on the eve of the Ethiopian New Year. As more people and organizations observe HCT Day, use

of services and efforts to improve quality will increase.

In FY08 JHU-CCP designed a communication strategy with participation of 30 prominent organizations

working on HCT in Ethiopia. In consultation with partners selected the theme of the year to focus on youth

between the ages of 18-24. The information was distributed to the regions.

On the VCT day (Sept 10 2008) a mass rally was organized involving 2,000 (two thousand) young people

from the various sub-cities. A huge billboard was unveiled at Public Square in Addis Ababa. Similarly the

regions have conducted events mostly related to community mobilization. Different educational materials

were produced and distributed.

In FY09, CCP/ARC plans to continue promotion via two approaches:

1) Implementation of HCT Day 2009 with local and international partners, in both Addis Ababa and in all of

the regions

2) Development of a long term HIV counseling and testing BCC campaign aimed at increasing quality and

uptake of services

3) Creation of synergy between its HCT promotion activities and those of the Millennium AIDS Campaign

through shared messaging, images, sponsorship, or events

4) Closely work with HAPCO to harmonize with the Ethiopian government's HIV/AIDS social mobilization

strategy

CCP/ARC will continue to support HAPCO and partners for HCT Day 2009 by producing campaign

materials (posters, flyers, radio/TV spots, and newspaper ads), creating web pages, organizing and

coordinating media coverage, and facilitating and providing information through its Wegen Talkline and

Warmline for service providers. CCP/ARC will support HCT Day activities at both the national and regional

levels.

In addition to the HCT Day communication strategy JHU CCP/ARC will support FHAPCO to development of

National HCT communication strategy for the longer-term campaign, which will likely target different

audiences than HCT Day activities (including youth and residents in rural areas) will serve as an important

entry point in HIV prevention and early access to treatment, care and support.

CCP/ARC will promote both VCT and provider-initiated counseling and testing to create demand and

reduce stigma against people living with HIV/AIDS.

The campaign will use traditional and modern channels to develop region-specific promotion messages,

support annual HIV-testing campaigns, lead development of an HCT communications strategy; and support

development of national HIV counseling and testing themes and logos. This campaign will complement

other CCP/ARC activities, including the Betengna Radio Diaries program and other prevention activities

carried out through CCP/ARC's website, as well as materials distribution and outreach at the regional

ARCs. These new mass media and community mobilization activities will be complemented by training

journalists and other partners in HCT reporting and communication. This expanded HCT campaign will be

supported through the addition of key staff.

New/Continuing Activity: Continuing Activity

Continuing Activity: 16635

Continued Associated Activity Information

Activity Activity ID USG Agency Prime Partner Mechanism Mechanism ID Mechanism Planned Funds

System ID System ID

16635 10545.08 HHS/Centers for Johns Hopkins 7485 3787.08 Support for $496,800

Disease Control & University program

Prevention Bloomberg School implementation

of Public Health

through US-

based

universities in

the FDRE

10545 10545.07 HHS/Centers for Johns Hopkins 5484 3787.07 FMOH $0

Disease Control & University

Prevention Bloomberg School

of Public Health

Table 3.3.14:

Funding for Laboratory Infrastructure (HLAB): $750,000

Site-level Laboratory Support

ACTIVITY HAS BEEN MODIFIED IN THE FOLLOWING WAYS:

John Hopkins University (JHU) in addition to the activities in FY08 will support the facilities to attain

minimum standards set by EHNRI. JHU will technically assist for the process improvement including

accreditation of regional laboratories. JHU will address integrated laboratory system and will also provide

support for establishment of regional laboratory in Gambela and Benshangul, TB culture and viral load

facilities in regional laboratories and will work to develop capacity of regional laboratories for sustainability.

In FY08, John Hopkins University (JHU) has provided comprehensive high-quality HIV/AIDS services,

including ART, at 50 hospital networks and health centers in Addis Ababa, SNNPR, Gambella and

Benshangul Gumuz regions. Comprehensive technical assistance and implementation support has

strengthened essential elements of the laboratory system, and improved service quality and consistency.

JHU 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, develop log books and improve documentation and recording; and provide technical

and logistic support for specimen referral linkage between testing hospitals and referring hospitals and

health centers. JHU has been doing major infrastructure support to hospital laboratories including

improvement of space in the rooms within 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. JHU renovated

two regional laboratories for establishment of DNA PCR for early infant diagnosis. In collaboration with CDC

and EHNRI, JHU has provided key technical and implementation support to Early Infant Diagnosis (EID)

program at regional, and site levels.

In FY09, JHU will provide its support to 50 hospital networks in Addis Ababa, SNNPR, Gambella and

Benshangul Gumuz regions, enabling each to provide comprehensive high-quality HIV/AIDS services. In

addition, JHU will continue supporting 9 health centers in emerging regions. Intensive site-level laboratory

support is an essential component of JHU'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 59 sites. JHU will

work directly with the regional lab; hospital labs and health center personnel to implement and monitor the

quality assurance programs at the 59 sites and will support the facilities to attain the minimum standards set

by EHNRI. JHU will provide technical support for process improvement including accreditation of regional

laboratories. JHU will continue to provide technical assistance to the rollout of HIV-1 DNA PCR for infant

diagnosis at regional levels.

JHU'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 Addis Ababa, SNNPR, Gambella and

Benshangul Gumuz 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. JHU will also

support the preparation and provision of standard documentation and recording formats including QC forms,

lab request forms and registers. JHU technical advisors will provide ongoing support supervision and

mentorship at all sites, ensuring the delivery of high-quality laboratory services as well as systems

strengthening, skills transfer, and capacity development. JHU in collaboration with CDC, EHNRI and

Gambella and Benshangul Regional Health Bureau will support the establishment of the regional laboratory

at Gambella and Benshangul Gumuz. In addition, JHU will work closely with the regional laboratories at

Addis Ababa and SNNPR to build local capacity as this is the exit strategy for partners and for sustainability

of programs.

(2) Technical support for uninterrupted laboratory services at all 59 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 supply chain

management and regional laboratories. JHU regional laboratory advisors will work closely with the regional

lab associates of SCMS

(3) Capacity building and minor renovation of facility level laboratories:

JHU 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. JHU 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. JHU 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) JHU 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. JHU will provide continued

onsite training on the new HIV rapid testing algorithm and monitor and evaluate the utilization of the

algorithm at facilities. JHU will also support regional and onsite training on TB smear microscopy and

support the implementation of TB smear microscopy EQA manual.

Activity Narrative: (5) JHU 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. JHU 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. JHU will

support the monitoring and evaluation activities in all laboratory program areas and will support the

expansion of LIS in the regions

(6) JHU will continue to provide key technical assistance to the early infant diagnosis program and viral load

test establishment in the regions. Working at the regional, and site levels, JHU 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 JHU will support the

establishment of HIV DNA PCR testing capacity at one sub-regional laboratory. JHU 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: JHU 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. JHU

will provide technical support for the establishment and functionality of TB culture at regional laboratories.

New/Continuing Activity: Continuing Activity

Continuing Activity: 16638

Continued Associated Activity Information

Activity Activity ID USG Agency Prime Partner Mechanism Mechanism ID Mechanism Planned Funds

System ID System ID

16638 10620.08 HHS/Centers for Johns Hopkins 7485 3787.08 Support for $800,000

Disease Control & University program

Prevention Bloomberg School implementation

of Public Health

through US-

based

universities in

the FDRE

10620 10620.07 HHS/Centers for Johns Hopkins 5484 3787.07 FMOH $300,000

Disease Control & University

Prevention Bloomberg School

of Public Health

Table 3.3.16:

Funding for Strategic Information (HVSI): $200,000

Site Level Data Support for Hospitals

ACTIVITY HAS BEEN MODIFIED IN THE FOLLOWING WAYS:

In FY08, JHU-BSPH supported 50 sites, trained two data personnel per site in basic computer skills, data

tabulation, and management, implemented electronic ART data management system (RDB) in 33 of 38

public ART sites, 10 private sites, and five additional regional sites, and trained all data clerks in RDB use,

continued to assess quality of ART care using Lot Quality Assurance Sampling, and facilitated sharing of

best practices and experiences within and between regions.

In FY09, JHU-BSPH 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 pediatric 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 on

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, JHU-BSPH 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. JHU-BSPH 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 Addis Ababa,

Benishangul-Gumuz, and Gambella regions, and the Southern Nations, Nationalities, and Peoples Region

(SNNPR).

In FY07, the International Johns Hopkins University-Bloomberg School of Public Health (JHU-BSPH)

supported 50 sites in Operational Zone 2 to collect, manage, analyze and use HIV/AIDS services-related

data generated at site level for decision-making to improve clinical and program management. In addition,

JHU-BSPH has trained more than 90 health professionals and data clerks in monitoring and evaluation

(M&E) and assisted regional health bureaus (RHB) to organize experience-sharing workshops.

In FY08, JHU-BSPH 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. JHU 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

HMIS forms

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. JHU-

BSPH 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. JHU- BSPH 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, JHU- BSPH will

assist sites in tracking specimens of patients who need more specialized tests, such as viral load, which are

currently performed only at regional labs.

Activity Narrative: 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.

New/Continuing Activity: Continuing Activity

Continuing Activity: 16640

Continued Associated Activity Information

Activity Activity ID USG Agency Prime Partner Mechanism Mechanism ID Mechanism Planned Funds

System ID System ID

16640 10433.08 HHS/Centers for Johns Hopkins 7485 3787.08 Support for $300,000

Disease Control & University program

Prevention Bloomberg School implementation

of Public Health

through US-

based

universities in

the FDRE

10433 10433.07 HHS/Centers for Johns Hopkins 5484 3787.07 FMOH $150,000

Disease Control & University

Prevention Bloomberg School

of Public Health

Emphasis Areas

Human Capacity Development

Estimated amount of funding that is planned for Human Capacity Development $50,000

Public Health Evaluation

Food and Nutrition: Policy, Tools, and Service Delivery

Food and Nutrition: Commodities

Economic Strengthening

Education

Water

Table 3.3.17:

Funding for Strategic Information (HVSI): $180,000

Clinical Simulation Technology (TheraSim) to support training on ART

ACTIVITY UNCHANGED FROM FY2008

COP08 NARRATIVE

In FY07, this was a new activity which links to various HIV treatment services activities supported by

PEPFAR. The capacity for rapid ART scale-up is severely limited by the rapid turnover of trained and

experienced HIV clinicians. To reduce this attrition and improve the knowledge-base of urban and rural

clinicians, JHU will introduce a continuing medical education and clinical-decision support tool via TheraSim

HIV clinical care simulator. To date, in FY07, TheraSim has been deployed to 38 sites, trained nearly 200

persons, and has been used to evaluate training outcomes for a basic ART training conducted by Johns

Hopkins University - Bloomberg School of Public Health (JHU-BSPH).

In FY08, JHU-BSPH will continue to work with TheraSim to provide support to 50 ART clinical sites (hospital

and health centers) to ensure all new physician and nursing staff are oriented to the case-learning program

and receive support to complete the training. The program will also be extended to all medical residents

enrolled in Addis Ababa University and Hawassa's training programs. TheraSim, under the guidance of JHU

-BSPH, will develop three new modules to expand the case learning approach to nurses, and to incorporate

new cases dealing with pediatric HIV care, tuberculosis (TB)/HIV, and advanced cases that deal with

treatment failure and other complications, for clinicians who have completed the basic training program.

Along with increasing the number of sites, the depth of the clinical complexity of cases and extent of the

personnel involved in the training program, JHU-BSPH will design an evaluation system to assess basic

ART training through the JHU-BSPH HIV telemedicine program. The modules will be used pre- and post-

training to assess training activities. A validation study will be developed to compare patient outcomes from

the simulator versus actual patient-outcome data in the clinics. In addition, TheraSim will provide

opportunities for clinicians to submit Ethiopian-based cases to be incorporated into the training program.

Clinicians will be compensated for their efforts, and TheraSim will act as an incentive and possible retention

program.

TheraSim was introduced because the success of the PEPFAR Ethiopia ART program depends on the

skills and stability of the ART team - doctor, nurse, pharmacist, and lab personnel. The stability of

healthcare workers in the Ethiopia HIV program has been challenged since trained clinicians often find

better-paying positions outside the public sector after graduating from medical school, and general

practitioners, who are expected to spend 2-4 years in public hospitals in isolated regions, often leave the

posts prior to completing their contracts. These clinicians report feeling cut off from learning, and they desire

increased clinical decision-making support, as consultations with more experienced clinicians are

impossible due to lack of communication technology. To improve the clinical skills of rural clinicians,

increase their capacity for appropriate decision-making, and address their desire for professional growth,

JHU-BSPH will continue its distance-learning program using TheraSim, a program for clinical-decision

support. For urban physicians, JHU-BSPH will continue to provide training centers and ART clinics with

access to the training programs via CDs or the Web. PEPFAR Ethiopia believes that improving information

transfer about HIV will reduce turnover of geographically isolated clinicians, as well as those from

overwhelmed urban clinics—thus improving HIV/AIDS care.

TheraSim, Inc. is a US-based company providing software and services internationally to measure and

improve the quality of clinical practice for HIV/AIDS and a variety of chronic and infectious diseases,

including malaria, tuberculosis (TB), hepatitis and diabetes. Capacity-building in Ethiopia faces several

challenges, including: a need for rapid scale-up of clinical capacity and expertise in treating patients with

HIV/AIDS; high cost and slow response of classroom-based learning; an ongoing need for clinically-based

mentoring following didactic training; and a general absence of empirical data after drug distribution.

TheraSim monitors and addresses gaps in clinical competence following existing classroom training and

helps improve patient outcomes in the ever-changing therapeutic environment. The TheraSim Clinical

Quality Assurance System has four key components: simulation-based assessment and intervention,

electronic medical records, decision support, and dashboard reports. The system is both Internet- and CD-

ROM-based, providing simulation of hypothetical patients in various stages of HIV/AIDS. The simulated

cases can be adapted for use by nurses, basic-level physicians (those who see few HIV/AIDS patients), and

expert-level clinicians. TheraSim uses guidelines approved by the World Health Organization (WHO) or

country-specific guidelines where they exist, and regionally-appropriate pharmacology and treatment

modalities with authentic "virtual" case studies for diagnosis and treatment of HIV/AIDS and co-morbidities.

It complements other methods, such as formal training, bedside teaching, and case discussions. Simulated

cases are used, for which diagnosis and treatment decisions must be made; the system then gives

feedback on these choices, referring to country and relevant international guidelines.

TheraSim can be adapted for training nurses and allied health professionals as needed. In the next phase

of support, TheraSim will advance existing capacity-building efforts efficiently by improving and measuring

the quality and outcome of clinical practice, including ART delivery for HIV/AIDS and the treatment of TB, in

compliance with published national treatment guidelines. TheraSim will seamlessly augment efforts begun

with CDC and other programs. For example, Washington University/I-TECH has developed training

curricula for ART, management of opportunistic infections (OI), and PMTCT with the support of international

partners and has organized numerous trainings. These training programs primarily reached health

professionals in the public sector. Various institutions have organized 2-5 day basic-training workshops on

HIV/AIDS management, one-day advanced courses for clinicians, and evening seminars on specific topics,

usually attended by clinicians from public and private sectors. However, no reliable and accessible system

exists to: assess individual health workers' skills; assess the overall effect of existing training activities;

provide ongoing mentoring and support; provide clinical support to reduce medical error; or to report clinical

skills and patient outcomes. TheraSim and JHU-BSPH will deploy TheraSim's field-tested Clinical

Performance Management computer-based decision support ("TheraSim CPM") system for rapid and

effective ongoing mentoring of healthcare workers throughout Ethiopia to support PEPFAR Ethiopia goals.

The system will continue to use regionally appropriate pharmacology and treatment modalities with

Activity Narrative: authentic case studies for diagnosis and treatment of HIV/AIDS and TB.

New/Continuing Activity: Continuing Activity

Continuing Activity: 16639

Continued Associated Activity Information

Activity Activity ID USG Agency Prime Partner Mechanism Mechanism ID Mechanism Planned Funds

System ID System ID

16639 10489.08 HHS/Centers for Johns Hopkins 7485 3787.08 Support for $180,000

Disease Control & University program

Prevention Bloomberg School implementation

of Public Health

through US-

based

universities in

the FDRE

10489 10489.07 HHS/Centers for Johns Hopkins 5484 3787.07 FMOH $150,000

Disease Control & University

Prevention Bloomberg School

of Public Health

Emphasis Areas

Human Capacity Development

Estimated amount of funding that is planned for Human Capacity Development $80,000

Public Health Evaluation

Food and Nutrition: Policy, Tools, and Service Delivery

Food and Nutrition: Commodities

Economic Strengthening

Education

Water

Table 3.3.17:

Funding for Health Systems Strengthening (OHSS): $333,000

April 2009 Reprogramming:

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.

John Hopkins University (JHU) is a major US-based university partner for PEPFAR-Ethiopia. The regions in

which JHU is operational with PEPFAR funding have currently two medical schools located in the cities of

Awasa and Addis Ababa.

Thus, in FY09, major activities for JHU 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.

New/Continuing Activity: New Activity

Continuing Activity:

Table 3.3.18:

Cross Cutting Budget Categories and Known Amounts Total: $150,000
Human Resources for Health $20,000
Human Resources for Health $50,000
Human Resources for Health $80,000