Mechanism Narrative:

AIDSRelief is a consortium comprised of Catholic Relief Services (CRS), the University of Maryland School of Medicine's Institute of Human Virology (UMSOM-IHV), Futures Group, Catholic Medical Mission Board and Interchurch Medical Assistance. The program works primarily in faith-based institutions in 10 countries (Ethiopia, Kenya, Uganda, Rwanda, Tanzania, South Africa, Zambia, Nigeria, Haiti and Guyana). AIDSRelief began in Ethiopia in COP 2009 working with St. Luke Hospital, a faith-based institution and selected government-owned health centers to develop the network model of care and treatment. Consortium members providing HIV services in Ethiopia under AIDSRelief are CRS, UMSOM-IHV and Futures.

AIDSRelief brings six years multi-country experience in the successful rapid scale up of comprehensive quality HIV care and treatment. As of June 30th 2009, the program has successfully provided ART to 166,593 patients and care for more than 459,972 people working with 240 local partner treatment facilities (LPTFs) across 10 countries. AIDSRelief provides a continuum of comprehensive care extending from health institutions down into communities. It is based on a robust mentorship/preceptorship model with strong patient adherence preparation and a focus on capacity building.

In COP 2010, AIDSRelief Ethiopia will build upon lessons learned from its first year of implementation and plans to expand its model of care and treatment to additional government health centers around St. Luke Hospital and an additional hospital in the southern region. The program will have 2,731 patients on care, including 1,311 on treatment through its 10 health facilities. Most importantly, AIDSRelief will work on demonstrating the effect of the linked care model between the hospital and health centers on patient management, particularly addressing key issues such as lost to follow-up. It will also continue its work in building the capacity of St. Luke Hospital to provide technical assistance to the health centers, which will function as the satellite sites. This approach, once established, will enable health institutions such as St. Luke's to provide the necessary care and treatment support to their surrounding health institutions, with minimal technical inputs from external partners in the future; this is in line with AIDSRelief transition strategy.

AIDSRelief will concentrate its effort in South West Shoa zone in Oromiya region. This focused zonal approach, covering the majority of the catchment area of St. Luke Hospital and in line with government structures, will enable the program to better define strategies of the care and treatment network model, which could be replicated later in other parts of the region and across the country. St. Luke Hospital provides services to a population of more than 1.2 million people and serves as the referral hospital for 14 health centers. AIDSRelief will target nine of the 14 health centers in COP 2010.

In addition to successful care and treatment program implementation across its 10 country programs, AIDSRelief puts major effort in health systems development of partner institutions focusing in building capacity in supply chain management systems, information systems, human resource development, community mobilization, and grant management. In COP 2009, the program has identified the Ethiopian Catholic Secretariat (ECS) of the Ethiopian Catholic Bishops Conference, as its local partner for sustainability and transition in grant management. AIDSRelief has been working closely with ECS to identify areas to strengthen ECS' capacity in program and financial management for the latter to become a direct PEPFAR grant recipient.

Additional assessments were also conducted to identify local partners for the other technical components such as clinical and strategic information, and to clearly identify the technical transition strategy. In COP 2010, AIDSRelief will focus on finalizing these efforts while making sure that both its technical and programmatic components will be in strong alignment with Ministry of Health guidelines and policies and a close working relationship with MOH and its regional offices will assist shaping this transition process. AIDSRelief will also coordinate and work closely with other USG implementing partners such as Columbia University ICAP and Management Sciences for Health working in adjacent geographic areas. These approaches will enable more cost-effective approaches in program implementation.

AIDSRelief in Ethiopia will support PMTCT, ensuring integration into other ongoing services. The PMTCT program will be supported by strong community outreach and follow-up of all HIV positive mothers and their babies. This will include ensuring that all exposed babies receive ARV prophylaxis and that they are tested for HIV. In addition, targeted awareness campaign to women of child bearing age will be conducted to increase the uptake of PMTCT services.

AIDSRelief strategic information activities incorporate program-level reporting and setting up of both paper-based and computerized national Health Management Information Systems (HMIS). AIDSRelief sites will integrate into the National Strategic Information framework that is promoted and supported by the Ethiopian and US governments. Data collected by the facilities is used for informed clinical and programmatic decision-making at various levels including the facility level, the AIDSRelief consortium level, and the national level.

This is a new activity. In COP 2010, AIDSRelief in Ethiopia will start to work in partnership with the Ethiopian Catholic Secretariat (ECS) to provide comprehensive care and support services through two faith-based hospitals and six government health centers in the two hospitals' catchment areas.

AIDSRelief will support palliative care and support services for 4,000 HIV + patients. Services to be provided include clinical follow-up, treatment of opportunistic infections, psychosocial and spiritual support, laboratory testing, nutritional counseling, and provision of nutritional support. This program will support a model of clinical preceptorship for service providers with a special emphasis on maximizing the role of nurses, adherence counselors and community workers. Training to recognize and manage OIs and HIV related diseases for staff will be carried out in collaboration with the MOH and regional health bureaus. In addition, AIDSRelief will strengthen supply chain management systems to ensure uninterrupted supplies of OI drugs and other essential commodities. Pharmacy personnel will be trained in forecasting OI drugs, creating technical drug committees and participating in patient management.

AIDSRelief will assist health facilities to establish linkages with malaria prevention wraparound services through the Global Fund to provide insecticide-treated bed nets to children and adult PLWHAA in malaria-prevalent areas.

AIDSRelief will assist health facilities to work with community health teams such as health extension workers or other existing community groups led by case managers to support a family-centered model. A multi-disciplinary team will ensure comprehensive care delivery. A core component of the AIDSRelief intervention will be the training and mentoring of health care providers. This intervention will also include formation of support groups for caregivers of PLHIV and encouraging community staff to incorporate local community leaders in patient support. AIDSRelief will build upon existing faith-based networks and other community-based organizations that could support HIV patients at the community level. The partner being within PEPFAR will play its part in Global Health Initiative.

AIDSRelief has six years of experience in providing ART in resource-constrained settings. In COP10, AIDSRelief will continue to work in partnership with the Ethiopian Catholic Secretariat (ECS) to provide comprehensive ART services through two faith-based hospitals (St. Luke and Dubbo Hospitals) and eight government health centers in the two hospitals' catchment areas. Ten percent of those on treatment will be children.

AIDSRelief's clinical support package will include site assessment, training and clinical mentorship, and continuous site capacity evaluation and strengthening. AIDSRelief will actively support health facilities and community-based organizations to implement strong adherence programs and assist health facilities to mobilize their communities and create linkages with existing community programs. Increasing access to ART for children will include technical assistance for health workers to increase their skills in pediatric ART.

AIDSRelief will adapt existing, locally appropriate Information, Education and Communication and Behavior Change Communication materials, as well as identify gaps in these media and develop materials as needed. This work will be done in close collaboration with the AIDS Resource Center and other partners.

Many health facilities providing care and treatment services lack the necessary basic functions that are required for safe and efficient service delivery, such as consistent electricity, water supply and systems, waste water disposal, and waste management. Ensuring these basic functions is an urgent need and is critical for enabling the facilities to function as effective points of delivery for care and treatment services. Under this activity in COP 2010, the partner is allocated $50,000 in additional funds to carry out restoration of hospital basic functions in the care and treatment facilities it supports. The partner being within PEPFAR will play its part in Global Health Initiative (GHI).

In COP10, AIDSRelief will build on its achievements in COP09 to increase the number of people tested for HIV. AIDSRelief's program which builds upon a strong foundation of community links through faith based networks has the ability to initiate and expand innovative VCT in a variety of settings including the possibility of household level HIV testing. Building upon a family centered care; opportunities will also be explored for getting household members tested. There also exist possibilities of increasing pediatric HIV testing by increasing skills of health workers in pediatric care and treatment using a newly developed AIDSRelief/ANECCA pediatric counseling training curriculum. The program will also capitalize on the technical expertise and community linkages program of St. Luke's public health department to strengthen testing and counseling services. The program expects to have 40,000 people counseled and tested and receiving their results throughout the ten health facilities.

Community volunteers will also be trained to increase knowledge on HIV care and treatment and to reinforce their role in conducting community sensitization on CT services. AIDSRelief will further strengthen existing PLHA networks and will utilize them to sustain the active referral systems between communities and care and treatment services. PLHA will thus be empowered and serve as advocated for counseling and testing services.

In order to complement health facility based testing, alternatives and innovative approaches will be used to increase community and site level counseling and testing sites. Health facility staff will create a mobile site within the communities conducting outreach services once a week. AIDSRelief will also support and strengthen initiatives for facility based provider initiated testing and will encourage access to testing for all patients receiving health care services at facilities it supports. It will also encourage outreach and increased access to testing for high risk such as discordant couples.

CRS will contribute to the national effort to reach more people thorough HCT services and being within PEPFAR will play its part in Global Health Initiative (GHI).

This is a continuing activity from FY 2009. In FY 2009 ICAP, JHU and MSH have supported PMTCT in St. Luke and Dubbo hospitals and surrounding health centers in Oromia and SNNPR regions.

In COP 2010 AIDSRelief in Ethiopia will take over and continue to support the PMTCT program in the two hospitals and eight health centers. AIDSRelief will work in partnership with the Ethiopian Catholic Secretariat (ECS) to provide comprehensive PMTCT and ART services in the selected facilities. AIDSRelief will provide HCT for all pregnant women in the ten health facilities and through outreach activities. AIDSRelief will provide ART prophylaxis for eligible women, ensuring integration of PMTCT services into other ongoing services provided at the sites.

AIDSRelief will use ANC and labor and delivery as entry points for HIV care and treatment and will emphasize the importance of HCT for both the pregnant woman and her partner as part of the ANC service. AIDSRelief will also strengthen linkages for PMTCT with other services between and within the health facilities. Pregnant mothers will be referred from the satellite clinics to ANC-providing sites following the health network model.

Various community sensitizations for PMTCT will be conducted at site level and through community networks in order to increase women's awareness of the program. Community sensitizations specifically targeting men and opinion leaders will focus on the importance of ANC in general, as well as PMTCT services.

AIDSRelief will give emphasis to ensure:

Opt out Testing of pregnant women

CD4 testing and staging for ART;

Male and family involvement;

Use of PMTCT TC tool;

Use of combined prophylaxis;

Availability of PMTCT commodities and preventive care packages;

Distribution of job aids and IEC materials;

Training of service providers in PMTCT, patient-centered care, and infant feeding;

Strengthening of Mother Support groups (MSG) through training, materials, IGA linkages (i.e. urban gardening program), literacy schemes, mixed male-female groups, and IEC messages to increase male partner involvement;

Strengthen PMTCT M&E; ensure uninterrupted supply and utilization of national documentation tools; mentor staff for site-level ownership.

CRS/AIDSRelief is a new partner in HVTB. CRS will build on its experience to support TB/HIV services in ten health facilities. CRS will strengthen linkages and referrals between TB and HIV services, screening all HIV+ clients for TB at each visit, providing PICT for all TB patients, and referring patients into care. HIV+ clients without active TB will be provided IPT. All co-infected individuals will be given CPT and initiated on ART if eligible.

In COP 2010, CRS will provide TA to establish intensified TB case-finding at all sites by conducting needs assessment and screening of family members for co-infected patients. TA will promote good TB case management by following national guidelines; reconciling TB/HIV records to ensure patient tracking, effective case finding and referral; and monitoring of MDR-TB.

CRS will work with HEWs and existing community groups led by case managers to support an integrated HIV/TB co-infection services via a family-centered approach. This intervention will also include assessing the potential formation of support groups for PLHIV caregivers and encouraging health facility community staff to engage community leaders, religious leaders, and other community stakeholders in patient support.

CRS will pilot a community-based TB screening tool, identified as a best practice in Rwanda as a means of intensified case finding and to ensure referral to the nearest health center. Developing treatment preparation, support and community follow-up strategies will assist in promoting adherence to TB treatment and reducing the risk of MDR. To reinforce the linkages and assure the continuum of care, CRS will use existing faith-based networks and other CBOs to support HIV patients at the community level. Training will include TOT skills in order to build capacity of the health facilities to conduct step-down training. Moreover, the program will conduct community sensitizations focusing particularly on community and religious leaders as they will be essential in the success of community level support to PLHIV. CRS being within PEPFAR will play its part in Global Health Initiative (GHI).