PEPFAR's annual planning process is done either at the country (COP) or regional level (ROP).
PEPFAR's programs are implemented through implementing partners who apply for funding based on PEPFAR's published Requests for Applications.
Since 2010, PEPFAR COPs have grouped implementing partners according to an organizational type. We have retroactively applied these classifications to earlier years in the database as well.
Also called "Strategic Areas", these are general areas of HIV programming. Each program area has several corresponding budget codes.
Specific areas of HIV programming. Budget Codes are the lowest level of spending data available.
Expenditure Program Areas track general areas of PEPFAR expenditure.
Expenditure Sub-Program Areas track more specific PEPFAR expenditures.
Object classes provide highly specific ways that implementing partners are spending PEPFAR funds on programming.
Cross-cutting attributions are areas of PEPFAR programming that contribute across several program areas. They contain limited indicative information related to aspects such as human resources, health infrastructure, or key populations programming. However, they represent only a small proportion of the total funds that PEPFAR allocates through the COP process. Additionally, they have changed significantly over the years. As such, analysis and interpretation of these data should be approached carefully. Learn more
Beneficiary Expenditure data identify how PEPFAR programming is targeted at reaching different populations.
Sub-Beneficiary Expenditure data highlight more specific populations targeted for HIV prevention and treatment interventions.
PEPFAR sets targets using the Monitoring, Evaluation, and Reporting (MER) System - documentation for which can be found on PEPFAR's website at https://www.pepfar.gov/reports/guidance/. As with most data on this website, the targets here have been extracted from the COP documents. Targets are for the fiscal year following each COP year, such that selecting 2016 will access targets for FY2017. This feature is currently experimental and should be used for exploratory purposes only at present.
Years of mechanism: 2008 2009
SUMMARY:
Since its inception, the International Training and Education Center on HIV (I-TECH), has recognized the
importance of addressing PMTCT in its training activities including counseling, testing, and prevention
messages as well as ARV treatment and prophylaxis. As such, I-TECH has incorporated national standards
-based comprehensive PMTCT service components in the following activities: (1) National AIDS Control
Organization (NACO) Medical Officer and HIV Specialist Trainings, (2) Government Hospital of Thoracic
Medicine (GHTM)/I-TECH HIV Fellowship Program, (3) nurse trainings for partner and (4) trainings using
WHO's Integrated Management of Adult and Adolescent Illnesses (IMAI). New initiatives for FY 2008
include: (1) 2-3 month nurses training program on HIV (2) implementation of a consultation hotline for HIV
clinicians in India. These activities also link to Palliative Care, ARV Services, and Systems Strengthening
Program Areas and cover in-service training, task shifting, and local organization capacity building efforts.
Primary target populations include nurses and physicians.
BACKGROUND:
I-TECH is a collaboration between the University of Washington Seattle and the University of California San
Francisco. It supports the development of HIV/AIDS treatment, care and support training initiatives in more
than a dozen developing countries impacted by the global AIDS pandemic, and incorporates a holistic
approach to care for PLHAs. Established in 2003, I-TECH partnered with CDC/GAP to create a Center of
Excellence in training, treatment and care services at the Government Hospital of Thoracic Medicine
(GHTM), Tambaram, Chennai in Tamil Nadu. GHTM is India's largest TB/HIV care center providing care to
30,000 PLHAs annually and is also a NACO recognized ART and Training Center. Infrastructure at GHTM
includes the Training Center, an ART Center, and state-of-the-art laboratory facilities supported by USG
funds. GHTM is known for its high quality and stigma free care to PLHAs. I-TECH at GHTM has the
capacity, knowledge and experience to execute high impact programs.
ACTIVITIES AND EXPECTED RESULTS:
ACTIVITY 1: (on-going) HIV Specialists and Medical Officers' Trainings
Funding from USG supported the development of an international standard Training Center at GHTM. The
GHTM Training Center, also a national Center of Excellence, hosts trainings on behalf of NACO for Medical
Officers and HIV Specialists with intensive training coordination support from I-TECH. GHTM is an ideal site
for these trainings because of the involvement of the I-TECH Fellowship Faculty as well as the access to
complex and varied clinical cases. Since the first NACO training in 2004, GHTM and I-TECH have jointly
conducted a total of 22 NACO trainings, serving 450 clinicians. In FY08, it is expected that an additional 100
ART Centers will be established, each requiring Medical Officers to be trained for the centers to be
operational.
I-TECH in collaboration with NACO and support from WHO India revised the national HIV Specialists and
Medical Officers curricula, which is now being used by all ten regional ART Training Centers for the HIV
Specialists and Medical Officers Trainings and will continue to be used to train physicians from all new ART
Centers. The Trainings include a general PMTCT overview and for some participants include an in-depth
PMTCT session with a field visit to Government Institute of Obstetrics/Gynecology. Continuing these
trainings will support NACO in efforts to scale-up and strengthen the quality of PMTCT services.
This activity also supports ARV, Palliative Care, and TB/HIV program areas.
ACTIVITY 2: (on-going) HIV Fellowship Program
The ongoing GHTM/I-TECH HIV Fellowship Program funded by PEPFAR is an innovative year-long training
program preparing junior and mid-level physicians to be leaders in HIV-related care, support, education,
and research thereby building long term capacities for India to manage the HIV epidemic in the coming
years. Through this USG supported program, Fellows gain critical skills to provide a wide range of high
quality HIV/AIDS patient care services including comprehensive PMTCT services such as ARV treatment
and prophylaxis, safer delivery practices, and infant-feeding practices for mothers who are HIV-exposed.
These skills are gained through a variety of participatory training activities, including daily hands-on clinical
training and experiential learning through didactic and case-based sessions. The first cohort of 11 Fellows
graduated in November 2006, with 14 more Fellows graduating by November 2007. Recruitment for the
third cohort of 18 Fellows for FY08 is currently underway. The Fellowship Program also supports Palliative
Care, ARV, TB/HIV, Prevention, Strategic Information as well as System Strengthening.
ACTIVITY 3 (on-going): Nursing Trainings Program
I-TECH in collaboration with multiple partners will continue to conduct nursing trainings in high prevalence
states such as Andhra Pradesh, Maharashtra, and Tamil Nadu, with the goal of advancing the role of
nurses in HIV services. The trainings include PMTCT topics such as testing and prevention messages for
women of childbearing age as well as counseling HIV positive pregnant women on the risks of perinatal
transmission. I-TECH, working with the Indian Nursing Council (INC), NACO and with support from the
William J. Clinton Foundation developed a 14 module nursing training curriculum which once approved by
NACO will be used as the national HIV/AIDS nursing curriculum in India. With continued support in FY
2008, 1000 nurses will be trained, including nurse trainers.
ACTIVITY 4 (on-going): WHO's IMAI Trainings
I-TECH's Clinical Team has been trained on WHO's Integrated Management of Adult and Adolescent
Illnesses and facilitates trainings using this curriculum for doctors, nurses, and counselors in one high
prevalence district in Tamil Nadu. This curriculum covers PMTCT topics with an emphasis on prevention
and counseling. In FY 2008, I-TECH will facilitate scale-up of PMTCT services by expanding these trainings
to multi-disciplinary teams through local NGO partnerships and the network mission hospitals in high
prevalence areas in India. This scale-up will train an additional 120 nurses and 60 physicians and support
the sustainability of high quality PMTCT services throughout India.
Activity Narrative: ACTIVITY 5: (new) HIV Fellowship for Nurses - 2-3 Months Nurses' Training
While there are a limited number of trained doctors able to provide ART in India, there is a vast pool of
nurses who are not trained in HIV/AIDS and are therefore underutilized. I-TECH proposes to develop a 2-3
month training program for nurses to address this need to be established in early FY08. This program will
develop a pool of advanced trained nurses in HIV/AIDS topics, including PMTCT prevention and
counselling. A key component of this program will include advanced training on prevention strategies and
methods including the opportunity to pilot prevention interventions through exposure visits to local NGOs.
Best practices will be documented with the aim to replicate this program in other similar settings. This
activity also supports Palliative Care, TB/HIV, Prevention, and Systems Strengthening Program Areas. It is
expected that in FY 2008, I-TECH will conduct two batches of the Nursing Fellowship Program reaching at
least 30 nurses with the goal to expand in FY 2009.
ACTIVITY 6: (new) Clinical Consultation Hotline
Healthcare providers in India have limited training on HIV/AIDS care and confront many complex questions
in their routine day-to-day clinical practice, requiring the latest data on HIV treatment. Clinicians in India
often do not have the resources or time to keep up with cutting-edge clinical updates. Moreover, the best
technical information is often not applicable to specific patients with complex medical and social problems in
the Indian setting with resource constraints that include e.g. availability of advanced medical diagnostic
facilities in rural settings that constitute almost 70% of the Indian population. To address the need for
accurate real-time clinical information on HIV, I-TECH proposes establishing a clinical consultation hotline to
provide physicians with easy and timely access to up-to-date HIV clinical information, and individualized
India specific and India relevant expert case consultation. This hotline will serve to support sustainability in
HIV care and services by providing long-term follow-up support to clinicians trained under the NACO ART
Training Program. Specifically, this hotline will support application of clinical skills learned in NACO
Specialist and Medical Officer Training programs which includes comprehensive PMTCT services. It is
expected that clinical technical assistance will be provided through approximately 2000 clinical consultations
annually.This program will be implemented by I-TECH with clinical support from GHTM and technical
support from the National HIV/AIDS Clinicians' Consultation Center, based at the University of California,
San Francisco (UCSF).This activity also supports Palliative Care, TB/HIV, Strategic Information, and
Systems Strengthening Program Areas.
SUMMARY
The recently revised National AIDS Control Organization (NACO) estimates that 2.5 million people in India
are living with HIV; the need for care and support for these PLHA is an acute problem in India. To address
this, the International Training and Education Center on HIV (I-TECH) aims to train clinicians on key aspects
of Palliative Care, including counseling and testing for patients and family members, on-going follow-up
counseling focusing on living positively, TB screening and referral, OI prophylaxis treatment and referral,
and counseling on nutrition and psychosocial support to improve the quality of life for PLHA This program
area will support on-going USG-funded activities such as the (1) HIV Specialists and Medical Officers
trainings, (2) HIV Fellowship Program for physicians, (3) Nurses' Trainings Programs; as well as new
initiatives in FY08 (4) Clinical Mentorship Program, (5) Clinical Consultation Hotline, (6) HIV Fellowship
Program for Nurses, and (7) Training of Trainers on Follow-Up Counseling Toolkit. These activities also link
to ARV Services, PMTCT, TB/HIV, and Policy and System Strengthening. The target populations are
physicians, nurses, medical and nursing students, counselors, and dieticians.
BACKGROUND
Francisco. It supports the development of HIV/AIDS treatment, care and training initiatives in more than a
dozen developing countries impacted by the global AIDS epidemic, and incorporates a holistic approach to
care for PLHAs. Established in 2003, I-TECH partnered with CDC/GAP to create a Center of Excellence in
training, treatment and care services at the Government Hospital of Thoracic Medicine (GHTM), Tambaram,
Chennai in Tamil Nadu. GHTM is India's largest TB/HIV care center providing care to 30,000 PLHAs
annually and is also a NACO recognized ART and Training Center. Infrastructure at GHTM includes the
Training Center, an ART Center, and state-of-the-art laboratory facilities supported by USG funds. GHTM is
known for its high quality and stigma-free care for PLHAs. I-TECH at GHTM has the capacity, knowledge
and experience to execute high impact programs.
ACTIVITY 1: HIV Specialists and Medical Officers Trainings
Funding from USG supports the development of an international standard Training Center at GHTM. The
for these trainings because of its access to complex and varied clinical cases requiring a wide variety of
services. Since the first NACO training in 2004, GHTM and I-TECH have jointly conducted a total of 22
NACO trainings, serving 450 clinicians. In collaboration with WHO India, I-TECH revised curricula now
being used by all 10 ART Training Centers. In FY ‘08, it is expected that an additional 100 ART Centers will
be established. There is urgent need for additional training of Medical Officers and HIV Specialists before
the new ART centers become operational.
It is expected that the doctors trained will provide care and support to at least 18,000 patients annually. The
continuation of this activity also supports ARV, PMTCT, and TB/HIV program areas.
ACTIVITY 2: HIV Fellowship Program
The ongoing GHTM/I-TECH HIV Fellowship Program funded by the USG is an innovative year-long USG
supported, training program preparing junior and mid-level physicians to be leaders in HIV-related care,
support, education, and research in India. Fellows gain skills to provide a wide range of high quality
HIV/AIDS patient care services through a variety of participatory training activities, including daily hands-on
clinical training, and experiential learning through didactic and case-based sessions. Four months into the
Fellowship Program, Fellows manage pre-ART patients, screen and refer patients for TB therapy, manage
common OIs, and more. The first cohort of 11 Fellows graduated in November 2006: 14 more will graduate
by November 2007. Recruitment for the third cohort of 18 Fellows for FY08 is currently underway. 30,000
HIV-infected patients seek care at GHTM annually, with 6800 getting ART. The Fellows supports these
services by providing direct clinical care to PLHAs.
In FY08 it is expected that the Fellows will provide direct care to over 9,000 PLHAs at GHTM.
ACTIVITY 3 Nursing Trainings Program
I-TECH in collaboration with multiple partners like Rural Development Trust, Bel-Air Hospital, GHTM,
Clinton Foundation, Christian Medical Association of India (CMAI), and Catholic Health Association of India
(CHAI) will continue to conduct nursing trainings in high prevalence states such as Andhra Pradesh,
Maharashtra, and Tamil Nadu. The goal is to advance the role of nurses in diagnosis of HIV and clinical
staging, clinical management of OIs, counseling and testing, nutrition and treatment adherence counseling.
I-TECH in collaboration with the Indian Nursing Council (INC), NACO and support from the William J.
Clinton Foundation developed a 14 module nursing training curriculum. Once approved by NACO it will be
used as the national HIV/AIDS nursing curriculum in India. In FY08, the William J. Clinton Foundation will
support I-TECH to train Master Trainers to support this national initiative to train 10,000 nurses in India.
In FY08 is expected that with PEPFAR support 1000 nurses will be trained including nurse trainers.
ACTIVITY 4: Clinical Mentorship for Community Care Centers and Link ART Centers
Under the third phase of the National AIDS Control Program (NACP-3), 350 government Community Care
Centers (CCC) will be established to provide HIV care and support. Clinical staff at these CCCs will require
training as well as on-site clinical mentoring to enhance the quality of comprehensive care to PLHAs. I-
TECH will work with two new partners and TNSACs to support training of health care providers. Enhanced
training will assist these centers to reach more PLHA requiring comprehensive services as per NACO
treatment guidelines. This partnership also supports ARV, TB/HIV, Systems Strengthening, and PMTCT
Program Areas.
In FY 2008, I-TECH expects to reach 100 HIV clinicians for clinical mentoring on comprehensive care
services for PLHAs.
Activity Narrative:
ACTIVITY 5: Clinical Consultation Hotline
Healthcare providers in India have limited HIV specific training and therefore lack resources on HIV/AIDS
care, but confront many complex questions about the latest in HIV treatment and care during their day-to-
day clinical practice. To address the need for accurate and real time clinical information on HIV, I-TECH
proposes establishing a Clinical Consultation Hotline to provide physicians easy and timely access to up-to-
date HIV clinical information, and individualized expert case consultation. This program will be implemented
by I-TECH with clinical support from GHTM and technical support from the National HIV/AIDS Clinicians'
Consultation Center, based at the University of California, San Francisco (UCSF). The hotline will support
application of clinical skills learned in NACO Specialist and Medical Officer Training programs and will
enable periodic knowledge, attitudes, and practices assessments of clinicians trained under the NACO
program. Best practices from the implementation of this hotline will be documented carefully with the goal of
replication at similar settings. This activity also supports ARV, TB/HIV, PMTCT, and Systems Strengthening
Program Areas as well.
ACTIVITY 6 (New): HIV Fellowship for Nurses
While the number of trained doctors able to provide ART in India is limited, a vast pool of nurses is
available. Unfortunately, many of them do not have adequate training on HIV/AIDS, and are under utilized. I
-TECH will develop a 2-3 month training program for nurses to address this need, and to create a pool of
advanced trained nurses in HIV/AIDS care. I-TECH's experience of managing a year-long HIV Fellowship
Program for physicians will enable quick establishment of this program building on documented I-TECH
best practices. The aim is to replicate this program in other similar settings. This activity also supports ARV,
TB/HIV, PMTCT, and Systems Strengthening Program Areas.
In FY 2008, I-TECH expects to conduct two batches of the Nursing Fellowship Program reaching 30 nurses
with the goal to expand in FY 2009.
ACTIVITY 7: Training of Trainers for Follow-up Counseling Toolkit
Counselors are often the first point of contact with the health care system and play a critical role in linking
PLHA to critical services. The complex physical, psychological and social vulnerabilities associated with
being a PLHA necessitate the integration of follow-up counseling into the existing counseling infrastructure.
The Follow up Counseling Toolkit, prepared by the Indian Clinical Epidemiology Network (IndiaCLEN) with
financial and technical support of HHS/CDC, leverages the potential value of counselors in linking PLHAs to
palliative care by training the counselors in patient screening and referral to such services. Complementary
to the currently available HIV counseling materials, these tools provide practical guidance for counselors to
use during client sessions. However, to maximize the potential of this phase of counseling, a more
comprehensive infrastructure needs to be developed, including formal training on the advanced counseling
issues addressed in the Follow-up Counseling Toolkit. I-TECH India will train and observe counselors at
GHTM in the use of the Toolkit. Based on this evaluation, I- TECH will develop a Training of Trainers
curriculum including facilitator's guide to train a core group of master trainers.
Tuberculosis (TB) is a serious public health problem in India with an estimated 40% of the population
infected with Mycobacterium tuberculosis. Over 1 million cases of TB disease are reported annually,
accounting for nearly one third of the global TB burden. In India, as in other high TB and HIV settings, there
is considerable overlap of the TB and HIV epidemics. Active TB disease is the most common opportunistic
infection in HIV-infected individuals. Amongst reported AIDS cases, 55-60% had TB. Controlling this dual
epidemic remains a major challenge for the country, and requires capacity building among health care
workers. Thus the International Training and Education Center on HIV (I-TECH) has highlighted TB-HIV co-
infection in all its training programs. Early recognition of signs and symptoms of TB followed by diagnosis
and prompt treatment in PLHA are key components of the TB/HIV curricula for on-going programs such as:
(1) HIV Specialists and Medical Officers Trainings, (2) Nurses Trainings, and (3) HIV Fellowship Program.
New initiatives for FY08 which will also address TB-HIV include: (1) 2-3 month nurse trainings, (2)
Consultation hotline for HIV clinicians, and (3) Clinical mentoring at government and non-government
community care centers. The activities discussed below also support Palliative Care and ARV Services.
Specific target populations include physicians and nurses.
30,000 PLHAs annually and is also a NACO recognized ART and Training Center. GHTM provides a unique
opportunity to explore TB/HIV co-infection due to the high volume of cases diagnosed each year. Clinicians
can observe a range of complicated cases, as well as various diagnostic and treatment approaches.
Infrastructure at GHTM includes the Training Center, an ART Center, and state-of-the-art laboratory
facilities supported by USG funds. GHTM is known for its high quality and stigma free care to PLHAs. I-
TECH at GHTM has the capacity, knowledge and experience to execute high impact programs.
ACTIVITIES AND EXPECTED RESULTS
ACTIVITY 1: HIV Specialists and Medical Officers' Trainings
Early identification of signs and symptoms of TB, management of TB/HIV co-infection, and the latest
advances in TB therapy and ART will continue to be key components of sessions on TB/HIV and bed-side
clinical case discussions for the NACO-sponsored HIV Specialists and Medical Officers trainings conducted
at GHTM supported by I-TECH. This activity will reach 250 physicians in FY08.
ACTIVITY 2: Nurse Trainings
I-TECH in collaboration with multiple partners including GHTM, Rural Development Trust, FBOs, and the
Clinton Foundation will continue to conduct nurse training activities with a focus on advancing the role of
nurses in early diagnosis of TB, referral for HIV and TB diagnosis and treatment, providing treatment
adherence support for TB/HIV patients, and clinical staging for co-infected patients. These trainings consist
of didactic and hands-on clinical mentoring sessions. In FY08, I-TECH will continue to conduct nursing
trainings in high prevalence states such as: Andhra Pradesh; Maharashtra; Karur district in Tamil Nadu; and
two new partner FBO/NGO sites using the WHO Integrated Management of Adult and Adolescent Illnesses
(IMAI) and I-TECH curricula. I-TECH in collaboration with the Indian Nursing Council (INC), NACO and
support from the Clinton Foundation developed a 14 module nursing training curriculum which once
approved by NACO will be used as the national nursing curriculum in India. This curriculum includes
specific modules dedicated to addressing the diagnosis and treatment of TB in HIV-infected persons and
the clinical and programmatic issues of TB/HIV. In FY08, the Clinton Foundation will support I-TECH to
train Master Trainers to support this national initiative, which will train 10,000 nurses in India: with USG
support I-TECH, will train 1000 nurses with this curriculum in FY08.
ACTIVITY 3: HIV Fellowship Program
The GHTM/I-TECH HIV Fellowship Program funded by USG is an innovative year-long training program
that aims to prepare junior and mid-level physicians to be leaders in HIV-related care and support,
education, and research in India. Fellows gain necessary skills to provide a wide range of high quality
HIV/AIDS patient care services including management of TB/HIV co-infection through a variety of
participatory training activities, including: daily hands-on clinical training; experiential learning; didactic and
case-based sessions; mentoring by local and international experts and faculty; management and leadership
skills development; and clinical or community health project opportunities. Fellows undergo rigorous training
on the complexities of TB/HIV co-infection in out-patient and in-patient wards. Being at GHTM the Fellows
are exposed to a myriad of complex TB/HIV cases. The first cohort of 11 Fellows graduated in November
2006, with 14 more graduating by November 2007. Recruitment for the third cohort of 18 Fellows for FY08
is currently underway.
This USG supported Fellowship Program significantly supports treatment and care services at GHTM by
providing 50% of the GHTM physician workforce and direct clinical care to approximately 6,000 PLHAs
annually. Fellows manage over 2000 TB/HIV patients annually including complex multiple drug resistant TB
cases.
HIV counselling and testing is routinely offered to TB patients at GHTM; in 2006, 3003 (94% of all TB cases)
were tested for HIV with 202 (6.7% of those tested) testing HIV-positive. In FY08 I-TECH clinical fellows will
provide human resource support for HIV counselling and testing to TB patients diagnosed at GHTM. In
FY08 it is expected that 4000 TB patients will be provided with HIV counselling and testing and be provided
with the results through this support and that over 2,000 HIV/TB patients will be treated by GHTM fellows
directly supported by USG funds. TB/HIV patients will be referred to either GHTM (see above described
activities) or appropriate facility for care and treatment.
ACTIVITY 4: HIV Fellowship for Nurses (2-3 Months Training)
nurses who are not trained in HIV/AIDS and ART, and therefore, a significant human resource is
underutilized. In FY08, I-TECH will develop a 2-3 month training program for nurses to address this need.
This program will create a pool of advanced trained nurses in HIV/AIDS care with expertise in early
identification of TB and management of TB/HIV co-infected patients. I-TECH's experience of managing long
-term HIV Fellowship Program for physicians will facilitate establishing this program early on in FY ‘08. Best
practices will be documented with the aim to replicate this program in other similar settings. This activity
also supports Palliative Care, TB/HIV, PMTCT, and Systems Strengthening Program Areas. It is expected
that in FY08, I-TECH will conduct two batches of the Nursing Fellowship Program reaching at least 30
nurses with the goal to expand coverage in FY09.
ideally requiring the latest data on HIV treatment. Clinicians in India often do not have the resources or time
to keep up with cutting-edge clinical updates. Moreover, the best technical information is often not
applicable to specific patients with complex medical and social problems in the Indian setting. To address
the need for accurate clinical information on HIV in real time, I-TECH proposes establishing a clinical
consultation hotline to provide physicians with easy and timely access to up-to-date HIV clinical information,
and individualized, India specific expert case consultation. This hotline will be unique in India. This program
will be implemented by I-TECH with clinical support from GHTM and technical support from the National
HIV/AIDS Clinicians' Consultation Center, based at the University of California, San Francisco (UCSF). Best
practices from the implementation of this hotline will be documented carefully with the goal of replicating this
hotline at similar settings. This activity also supports Palliative Care, ARV, PMTCT, and Systems
Strengthening Program Areas. Clinical technical assistance will be provided through about 2000 clinical
consultations annually of which 40% are expected to be related to TB/HIV co-infection.
ACTIVITY 6: Clinical Mentoring
To enhance the TB/HIV services of other hospitals, especially management of TB/HIV co-infection, in FY08,
I-TECH will work with two new FBO/NGO partners: Catholic Hospital Association of India and the Catholic
Medical Mission Board and their affiliated hospitals. I-TECH will also support the TNSACS Community Care
Centers in FY08 for clinical mentoring of TB/HIV. I-TECH's primary responsibility will be on-site and
telephonic mentoring of doctors and nurses on complexities of TB/HIV co-infection. In FY 2008, it is
expected that I-TECH will reach 100 HIV clinicians for clinical mentoring on ARV services, treatment failure
and second line regimens. This partnership also supports Palliative Care, TB/HIV, Systems Strengthening,
and PMTCT Program Areas.
The International Training and Education Center on HIV (I-TECH)'s program in ARV Services provides
comprehensive patient-centered training, mentoring, and clinical consultation on HIV care and treatment
through the following activities: (1) National AIDS Control Organization (NACO) Medical Officer and HIV
Specialist Trainings, (2) Government Hospital of Thoracic Medicine (GHTM)/I-TECH HIV Fellowship
Program, and (3) nurse trainings for partner organizations. New initiatives for FY 2008 include: (1)
implementation of a consultation hotline for HIV clinicians in India; (2) 2-3 months nurses training program
on HIV; (3) FBO/NGO partnerships for ART trainings and clinical mentoring; (4) partnership with Tamil Nadu
State AIDS Control Society (TNSACS) for clinical mentoring of clinicians to support ART scale-up in Tamil
Nadu (TN). The specific target populations are physicians and nurses.
Francisco. It supports the development of HIV/AIDS treatment, care and support training initiatives in
developing countries impacted by the global AIDS pandemic, and incorporates a holistic approach to care
for PLHAs. Established in 2003, I-TECH partnered with CDC/GAP to create a Center of Excellence in
Chennai in Tamil Nadu. GHTM is India's largest TB/HIV care center known for its high quality stigma-free
care to 30,000 PLHAs annually. It is a NACO recognized ART and Training Center. The infrastructure at
GHTM includes the Training Center, an ART Center, and state-of-the-art laboratory facilities supported by
USG funds. I-TECH at GHTM has the capacity, knowledge and experience to execute high impact
programs.
The GHTM Training Center, also a national Center of Excellence, hosts trainings on behalf of NACO for
Medical Officers and HIV Specialists. Over 3 years, GHTM and I-TECH have jointly trained 450 clinicians in
22 NACO trainings. In FY08, an additional 100 ART Centers will open, each requiring Medical Officers to be
trained for the centers to become operational. These clinicians will be trained at regional training centers
including GHTM with continued support from I-TECH. In collaboration with NACO and with support from
WHO India, I-TECH revised the national HIV Specialists and Medical Officers curricula, which is now being
used by all ten regional ART Training Centers and will be used for FY08 trainings. Trainings include didactic
sessions and skill-based bedside teaching on HIV diagnosis, management of common opportunistic
infections in India, ART and palliative care.
Under the National AIDS Control Plan Phase III (NACP 3), all regional ART Training Centers will be given
staff (Logistics Coordinators) and funding to facilitate ongoing trainings in order to support India's rapid ART
scale-up initiative. I-TECH's role will expand to support a few of these ten regional Training Centers and
Logistics Coordinators with hands-on mentoring on coordinating and conducting a high quality national
training. It is expected that the doctors trained will provide ARV, TB/HIV, and palliative care and treatment to
at least 18,000 patients annually at ART Centers throughout India.
ACTIVITY 2: HIV Fellowship Program and ART Treatment Provision
The GHTM/I-TECH HIV Fellowship Program, which is supported by the USG, is an innovative year-long
training program that aims to prepare junior and mid-level physicians to be leaders in HIV-related care and
support, program management, education, and research in India. Fellows gain necessary skills by caring
for a wide range of HIV/AIDS patients as well as through a variety of participatory training activities,
including daily hands-on clinical training, experiential learning, didactic and case-based sessions, mentoring
by local and international experts and faculty, management and leadership skills development, and clinical
or community health project opportunities. The first cohort of 11 Fellows graduated in November 2006, with
14 more graduating by November 2007. Recruitment for the third cohort (estimated class size of 18) for
FY08 is currently underway. This program is also directly building capacity for India to manage its growing
HIV epidemic by developing leaders and experts in HIV.
The Fellowship Program significantly supports treatment and care services at GHTM by providing 50% of
the GHTM physician workforce and direct clinical care to approximately 30,000 PLHAs, 6,000 of whom
receive ART, annually. In FY ‘08 it is expected that the Fellows will provide direct ART care to about 2500
PLHAs at GHTM.
ACTIVITY 3: Nurse Trainings
I-TECH in collaboration with multiple partners will continue to conduct nurse trainings focusing on advancing
the role of nurses in diagnosis of HIV and clinical staging, clinical management of OIs, and of patients
receiving ART, including treatment adherence support. These trainings consist of didactic sessions and
hands-on clinical mentoring sessions. I-TECH believes in long-term capacity building and always works
towards developing a group of trainers at partner institutions and supports them with Training of Trainers
(TOTs) to become the local pool of trainers for on-going capacity building training activities.
In FY ‘08, I-TECH will continue to conduct nursing trainings in three high prevalence states using I-TECH
curricula and the WHO Integrated Management of Adult and Adolescent Illnesses (IMAI) curriculum. I-
TECH in collaboration with the Indian Nursing Council (INC), NACO and support from the William J. Clinton
Foundation developed a 14 module nursing training curriculum which once approved by NACO will be used
as the national nursing curriculum in India. In FY ‘08, the William J. Clinton Foundation will support I-TECH
to train Master Trainers to support this national initiative to train 10,000 nurses in India. In FY ‘08 is
expected that with PEPFAR support 1000 nurses will be trained including nurse trainers.
ACTIVITY 4: Clinical Mentoring for Community Care Centers and Link ART Centers
To enhance the HIV services of other hospitals and Community Care Centers (CCCs) I-TECH will work with
two new FBO/NGO partners and with GOI-supported CCCs in FY08. I-TECH's main role in these
Activity Narrative: partnerships will be in training and clinical mentoring of doctors and nurses in ART service delivery,
particularly in the management of treatment failure and initiating second line regimens. This is of significant
relevance as the Government of India's third National AIDS Control Plan envisages a more direct role for
CCCs in the ART program by making them peripheral drug distribution centers designated as "Link ART
centers" that will ensure more accessible and convenient services to PLHAs, better adherence and also
contain the increasing loads in the existing ART centers. Enhanced training will allow these centers to
reach more patients with appropriate ARV initiation and follow-up, as well as address treatment failure
properly, and ultimately to train other doctors in their region. In FY08, it is expected that I-TECH will reach
100 HIV clinicians for clinical mentoring on ARV services, treatment failure and second line regimen.
during their day-to-day clinical practice, ideally requiring the latest data on HIV treatment. Clinicians in India
technical information may not be applicable to specific patients with complex medical and social problems in
the Indian setting. I-TECH will establish a clinical consultation hotline to provide physicians with easy and
timely access to up-to-date HIV clinical information, and individualized India specific expert case
consultation. The program will be implemented by I-TECH with clinical support from GHTM and technical
San Francisco (UCSF). This hotline will support the application of clinical skills learned in NACO Specialist
and Medical Officer Training programs and will enable periodic assessments of clinicians trained under the
NACO program. Best practices from the implementation of this hotline will be documented carefully with the
goal of replication in similar settings. It is expected that clinical technical assistance will be provided through
approximately 2000 clinical consultations annually.
ACTIVITY 6: HIV Fellowship for Nurses (2-3 months training for nurses)
There is a vast pool of nurses who are not trained in HIV/AIDS and ART and therefore, under utilized. I-
TECH proposes to develop a 2-3 month training program for nurses to address this need that will be
established in early FY08. The program will meet multiple objectives. It will create a long-term pool of
advanced trained nurses in HIV/AIDS care, and in the short-term will support I-TECH's partner institutions
by providing additional nursing staff working either in the wards as part of the clinical mentoring programme
or at visiting partner institutions as part of clinical exposure visits. Best practices will be documented with
the aim to replicate this program in other similar settings. This activity also supports the Palliative Care,
TB/HIV, PMTCT, and Systems Strengthening Program Areas. It is expected that in FY08, I-TECH will
conduct two batches of the Nursing Fellowship Program reaching at least 30 nurses with the goal to expand
in FY09.
The International Training and Education Center on HIV (I-TECH) aims to monitor and evaluate its trainings,
training tools and training Management Information Systems (MIS) databases while building local capacity
in the area of public health evaluation. I-TECH will continue to support USG funded TB/HIV Information
System (T/HIS) database for system-strengthening data output to improve patient care at GHTM. I-TECH
will also pilot a database to support a national clinical consultation hotline, and support the continued
development of a partially PEPFAR funded national training MIS which will link all 10 National AIDS Control
Organization (NACO) Training Centers. This MIS will be a clearing house for all NACO training related
information including data collection, analyses, and evaluation reports. I-TECH's goal is to ensure that
NACO takes on the long-term maintenance and support of the training MIS to ensure sustainability of this
project. The primary target populations include physicians, administrators, State AIDS Control Societies
(SACS), and NACO.
approach to care for PLHAs. Established in 2003, I-TECH partnered with HHS/CDC to create a Center of
30,000 PLHAs annually and is also a NACO recognized ART and Training Centre. Infrastructure at GHTM
includes the Training Centre, an ART Centre, and state-of-the-art Laboratory facilities supported by USG
Since 2004, I-TECH has utilized JHPIEGO's Training Information Monitoring System (TIMS), a Microsoft
Access database application used to track and monitor trainings, to complement its monitoring and
evaluation activities. I-TECH plans to replace TIMS with an improved web-enabled training database in
FY08.
ACTIVITY 1: TB/HIV Information System (T/HIS)
I-TECH supports the Strategic Information services at GHTM by contracting with an epidemiologist to
oversee the management of the T/HIS at GHTM. I-TECH collaborates with GHTM to ensure increased and
appropriate utilization of this patient database at the hospital. A key expected result of this activity is the
dissemination of data and findings from patient records. A presentation at the Kigali-based PEPFAR
Conference (June 2007) highlighted the ART scale-up experience of GHTM using patient data records.
Utilization of the system by providers to document, track, and improve patient care over the time is another
goal of this SI support. In FY08, it is expected that 50% of the GHTM physician workforce will be trained to
use the database.
ACTIVITY 2: NACO HIV Specialists and Medical Officers' and Other Trainings
All training programs conducted by I-TECH, such as the NACO Specialists and Medical Officer Trainings
and Nursing trainings are evaluated with tools such as pre/post test questionnaires, daily evaluations and
overall course evaluations to assess reactions to the training, and changes in participants' skills, knowledge
and attitudes. In addition, I-TECH plans to assess longer term impacts of the training through follow-up
three- and six-month surveys conducted with training participants. A separate follow up schedule for the
Training of Trainers participants will also be implemented. Templates for data entry and analysis are
created and adapted accordingly. These evaluation activities facilitate continuous quality improvement and
enhancement of our training activities to facilitate high quality clinical care.
It is expected that in FY08 long term evaluation will be conducted for all NACO trainings reaching at least
100 physicians.
ACTIVITY 3: India AIDS Training Network (IATN) Database
USG is partially funding the IATN website project which will link all 10 NACO ART Training Centers in India
and will have a database/intranet component which will compile HIV training MIS reports. In the future this
website will be a platform for online CME courses for HIV clinicians in India. This project is described in
greater detail under the Policy and Systems Strengthening program area. This project will support NACO's
public health evaluation needs to develop effective training strategies under the National AIDS Control
Program Phase III (NACP 3) for HIV clinicians, nurses, and counselors. It is expected that all 10 Logistics
Coordinator hired under the NACP 3 for the 10 Regional Training Centers will be trained by I-TECH on the
use of this database by FY08.
ACTIVITY 4: Clinical Consultation Hotline
which require the latest data on HIV treatment. Clinicians in India do not have the resources or time to keep
up with cutting-edge clinical updates. Moreover, the best technical information is often not applicable to
specific patients with complex medical and social problems in the Indian setting.
To address the need for accurate real time clinical information on HIV, I-TECH proposes establishing a
clinical consultation hotline to provide physicians with easy and timely access to up-to-date HIV clinical
information, and individualized India specific expert case consultation. This hotline will be unique in India. A
database will be developed to support clinicians manning the hotline to record calls and track trends in HIV
clinical care. We can analyse gaps in knowledge, assessment of attitudes and practices of clinicians
towards providing stigma free HIV care. Long-term follow-up support to clinicians trained under the NACO
ART Training Program can then be provided.
Activity Narrative: The clinical consultation hotline and supporting database ensure transfer of learning from didactic to skills-
based to clinical consultation and long-term decision support all of which are I-TECH's guiding principles for
trainings. This program will be implemented by I-TECH with clinical support from GHTM and technical
San Francisco (UCSF). Specifically, this hotline will support application of clinical skills learned in NACO
Specialist and Medical Officer Training programs and will enable public health evaluations through periodic
knowledge, attitudes, and practices assessments of clinicians trained under the NACO program. Best
hotline at other similar settings. This activity also supports Palliative Care, TB/HIV, PMTCT, and Systems
Strengthening Program Areas. It is expected that clinical technical assistance will be provided through
The International Training and Education Center on HIV (I-TECH)'s overarching philosophy has been to
create systems, infrastructure, and resources to scale up and support a network of health care institutions,
the National AIDS Control Organization and its recognized Training Centers across the nation to support the
rapid scale-up of national and state-level HIV/AIDS services in India.. Significant training and mentoring
support on clinical and non-clinical topics are required for HIV Specialists, Medical Officers, Nurses, and
Counselors to support this scale-up of services.at these centers. I-TECH's strategy for institutional support
combines training in HIV/AIDS, on-going mentoring, and a well-developed system for monitoring and
evaluation and quality assurance. I-TECH uses databases to facilitate data collection and reporting and has
the capacity to store and analyze data at the country level. I-TECH's the areas of emphasis also include
local organization capacity building, in-service training, and task shifting. Primary target populations include
NACO, ART Training Center Logistics Coordinators, Nurses, Counselors, and Doctors.
than a dozen developing countries impacted by the global AIDS epidemic, and incorporates a holistic
includes the Training Center, an ART Center, and state-of-the-art Laboratory facilities supported by USG
funds. GHTM is known for its high quality and stigma free care to PLHAs.
ACTIVITY 1: The Standard Procedures of HIV/AIDS Care Pocket Guide
This brief guide was developed to provide technical support to those involved in the care of HIV-infected
patients. It is geared specifically to government hospitals in India and integrates guidelines from NACO and
the World Health Organization (WHO). I-TECH revised the Standards of HIV Care Pocket Guide for
physician (a user-friendly reference guide on HIV treatmen) to include the updated NACO Guidelines. I-
TECH will continue to provide this resource to new ART Centers to help support overall system
strengthening for new ART Centers. This resource will be also be used by national training centers, medical
colleges, and other training organizations. This pocket-sized booklet focuses on practical information about
antiretroviral therapy and prophylaxis and treatment of common opportunistic infections in both adults and
children.
ACTIVITY 2: Training MIS Website
With partial PEPFAR funding, I-TECH is developing an umbrella Training MIS website which will link all the
NACO Training Centers. The primary goals of this website are: link all NACO Training Centers; act as a
clearing house for HIV/AIDS training resources; and reduce administrative time and cost burden by
streamlining collection of participant registration information and data on pre-and post-test evaluations. A
key purpose of the Training MIS will be to provide evaluation reports on the impact of trainings and the need
for additional Continued Medical Education (CME), planned by the GOI to be mandatory from 2008. This
can be offered on-line as self-study modules in the second phase of the development of this website. This
website will be linked to the NACO website with overall maintenance and support provided by NACO in a
phased manner to ensure sustainability of this project.
ACTIVITY 3: 2-3 Month Training for Nurses
I-TECH plans on expanding its partnership base to work with the Christian Medical Association of India, an
organization of 20 faith-based private hospitals and the Catholic Hospital Association of India, which
comprises 47 nursing schools, which train the majority of India's nurses. In response to requests from
these schools, I-TECH, assist them to develop two-three month pre-service and in-service training for
nurses on HIV/AIDS I-TECH will also assist develop nursing curricula. These additional activities will
address task shifting and also strengthen clinical and administrative systems at partner sites.
ACTIVITY 4: Non-Clinical Trainings
Non-clinical trainings focusing on curriculum development, training skills, public health evaluation methods
have been requested by many of I-TECH's partners. I-TECH will develop a series of short workshops on
these topics to support systems strengthening activities for its partners. These trainings will support task
shifting and retention.
ACTIVITY 5: Infection Control and Clinical Society Meetings
I-TECH will also strengthen health systems in regard to infection control. It will continue to organize
Hospital Infection Control Committee (HICC) meetings in collaboration with GHTM to discuss issues
surrounding the hospital's infection control measures. Topics addressed during the meeting include tracking
of vaccinated GHTM staff against Hepatitis B, regular infection control rounds with an infection control
checklist, personal protective equipment, and biomedical waste management. Additionally, I-TECH will
support the GHTM Nurse Trainers to roll out an Infection Control curriculum with practical training in the
wards for nurses. Monthly nursing and weekly doctors' clinical society meetings (CSMs) are conducted at
GHTM with I-TECH's support. These CSMs provide a forum for clinical case discussions, hospital systems
strengthening needs, and support enhancement of clinical skills of doctors and nurses.
