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
ACTIVITY HAS BEEN MODIFIED IN THE FOLLOWING WAYS:
ACTIVITY 1: NACO HIV Specialists and MO Trainings
Since 2004, GHTM and I-TECH have conducted 40 NACO trainings for over 658 clinicians. In FY08, I-
TECH supported capacity development at GHTM, with the long-term goal of GHTM coordinating logistics as
well as monitoring and evaluation (M&E) for these trainings. In FY09, a primary goal for I-TECH will be
creating training systems models that can be institutionalized at the national level. This is in line with NACP-
III priorities to strengthen training systems as a function of capacity building. As the scale up of ART
Centers under NACP-III continues, there will be a need for evaluated, effective training and mentoring
models.
In FY09, 80 physicians from ART centers will receive training, including a PMTCT overview. A sub-set of
MOs will receive an in-depth PMTCT session and OB/GYN-focused field-visit. This will support NACO's
efforts to scale up and strengthen the quality of PMTCT services. I-TECH will: a) advocate with NACO to
develop a training curriculum for the Link and Community Care Centers' clinical and auxiliary staff; and b)
support GHTM in the roll-out of ART Refresher Trainings using the I-TECH-developed and WHO-supported,
ART Refresher Training Curriculum (RTC). Forty physicians will be trained using the RTC in FY09.
ACTIVITY 2: HIV Fellowship Program and ART Treatment Provision
In FY09, I-TECH will design, improve, systematize, and expand capacity development models for clinical
and auxiliary staff at training institutions and Centers of Excellence (COE). This will include the continuation
and evaluation of the one-year residential HIV/AIDS Clinical Fellowship Program. Besides the Fellowship
training, the Program also provides significant human and technical resources to support adult and pediatric
care and treatment services at GHTM, providing 60% of the GHTM physician workforce and direct clinical
care to approximately 30,000 PLHA annually.
In FY09, I-TECH will focus on creating a Fellowship Program model for clinical staff that can be expanded
and adapted at other national COEs, with a goal to institutionalize this model into the NACO-supported HIV
program. I-TECH will explore expansion into a second year and establish partnerships with local universities
for accreditation and long-term sustainability. I-TECH will also work on packaging the curriculum and on
national-level advocacy to identify suitable sites for replication.
ACTIVITY 3: Nursing Trainings and Roll Out of ENHANCE TOTs
In FY09, I-TECH will expand capacity development models for clinical and auxiliary staff at training
institutions and Centers of Excellence (COE). This will include ENHANCE (Empowering Nurses to deliver
HIV/AIDS Care and Education) Nurse Training. This is a thirteen-module interactive, case-based training for
hospital and ART Center nurses focusing on prevention, treatment, and care and support for PLHA. I-TECH
has used a TOT model to train close to 500 nurses at GHTM and other partner institutions. ENHANCE
training for nurses is especially suited as a complimentary component to a training package for physicians
in large training institutions and COEs. I-TECH will identify and collaborate with new partners, including
RDT and BelAir, to roll out ENHANCE. IN FY09, 100 nurses will be trained using this curriculum.
ACTIVITIES 4 and 5 rolled into other activities.
ACTIVITY 6: Clinical Consultation "Warmline"
I-TECH will provide long-term decision and TA support via distance consultation using our piloted and
evaluated clinical consultation telephone "Warmline" During the recent 3-month pilot phase, the "Warmline"
averaged 60 calls per month, predominately from ART MOs seeking guidance on HIV treatment issues like
peri-natal HIV transmission, ART prophylaxis, drug interactions, patient monitoring, and pediatric HIV
diagnosis.
ACTIVITY 7: Indian Nurse Specialist in HIV/AIDS and ART
Under GFATM Round 7, NACO is giving high priority to develop the capacity of nurses and other health
care providers. In FY09, I-TECH will support the Indian Nurse Specialist in HIV/AIDS and ART (INSHAA)
Program, whose primary target population is nurses in decentralized ART Centers and Community Care
and Support Centers. According to NACO's operational guidelines, task shifting of nurses' roles and
responsibilities can be introduced in these centers.
INSHAA is a four-week intensive training/clinical mentoring program with ongoing on-site mentoring; it
includes all six levels of I-TECH's framework for training. INSHAA addresses training gaps and needs of
nurses in decentralized ART Centers and Community Care and Support Centers in India in order to task
shift nurses roles and responsibilities. A rapid needs assessment and key informant interviews were carried
out in Andhra Pradesh (AP) and several collaborative training partners identified. The INSHAA curriculum
will be developed by I-TECH.
The training program will be piloted in AP. It will use 15 nurse mentors to train 50 nurses from 24 ART
Centers and 95 Community Care and Support Centers to serve as Indian Nurse Specialists in HIV/AIDS
and ART. I-TECH will use a TOT and Mentoring of Mentors model to train Indian School of Nursing faculty, I
-TECH nursing staff and nurse consultants, and local staff nurses showing leadership potential in order to
develop a pool of Indian nurse trainers and clinical mentors. Once the pilot is evaluated and revised, it can
be adapted for many similar settings. I-TECH is in a unique position to provide TA to other sites for
implementation of INSHAA. INSHAA will ultimately result in enhancing the role and status of nurses and
improving the quality of HIV care, treatment and support for PLHA in India.
FY 2008 NARRATIVE
SUMMARY
Since its inception, 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
Activity Narrative: following activities: 1) 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 FY08
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
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 FY08, 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 FY08, 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 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
counseling. 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
Activity Narrative: least 30 nurses with the goal to expand in FY09.
ACTIVITY 6: (new) Clinical Consultation Hotline
Healthcare providers in India have limited training on HIV/AIDS care and often do not have the resources or
time to keep up with cutting-edge clinical updates on HIV/AIDS. 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 (e.g. lack of advanced medical diagnostic facilities in rural settings where 70% of
Indian population lives). To address the need for accurate real-time clinical information on HIV, 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. This hotline will 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.
New/Continuing Activity: Continuing Activity
Continuing Activity: 16006
Continued Associated Activity Information
Activity Activity ID USG Agency Prime Partner Mechanism Mechanism ID Mechanism Planned Funds
System ID System ID
16006 11498.08 HHS/Health University of 6901 3962.08 I-TECH $30,000
Resources Washington (International
Services Training and
Administration
Education
Center on HIV)
11498 11498.07 HHS/Centers for MYRADA 5617 3964.07 $15,000
Disease Control &
Prevention
Emphasis Areas
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
Water
Table 3.3.01:
NEW ACTIVITY NARRATIVE
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 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
funds. GHTM is known for its high quality and stigma-free care for PLHAs.
Since 2004, GHTM and I-TECH have conducted a total of 40 NACO trainings, serving over 658 clinicians.
In FY09 80 Physicians from various ART centers will be trained. The topics include: appropriate disposal of
medical waste (including infection equipment), universal precautions, and developing standard operating
procedures related to infection safety in the medial workplace. I-TECH's will continue to develop the
capacity of GHTM to manage these trainings, to ensure sustainability.
In 2009, I-TECH will continue its systems strengthening efforts by a) advocating with NACO to develop
training curriculum for the Link and Community Care Centers' clinical and auxiliary staff and b) supporting
GHTM in the roll-out of ART Refresher Trainings using the I-TECH developed, and WHO supported, ART
Refresher Training curriculum. It is expected that 40 physicians will be trained using the Refresher Training
Curriculum in FY09.
ACTIVITY 2: HIV Fellowship Program
In 2009, I-TECH will continue and evaluate the one-year residential HIV/AIDS Clinical Fellowship Program.
The one-year curriculum includes specific training and practice in safe-injection practices, universal
precautions, infectious waste disposal, and post-HIV exposure prophylaxis. The Fellowship Program also
provides significant human and technical resources to support adult and paediatric treatment and care
services at GHTM by providing 60% of the GHTM physician workforce and direct clinical care to
approximately 30,000 PLHA annually.
In 2009, I-TECH will focus on creating a Fellowship Program model for clinical staff capacity development
which can be expanded and adapted at other COE sites coming on line at a national level, with a long-term
goal of institutionalizing this model into the national training program.
ACTIVITY 3: Nurses Infection Control Education (NICE) Nurses Training
The National AIDS Control Organization's third Strategy and Implementation Plan (NACP-III) highlights
workplace safety issues, including biomedical waste management and infection control measures, to be
practiced by healthcare workers involved in testing and treatment activities. The NICE training package will
comprehensively address this strategic plan. Given that infection control is largely the nurse's domain,
nurses can play a significant role in strengthening hospital infection control systems.
In 2009, I-TECH will disseminate an infection control training program for nurses called Nurses Infection
Control Education (NICE) to national institutions. The aim of NICE is to use nurses to facilitate the training
of other nurses and ancillary personnel in best infection control practices. A parallel aim is to empower
them to advocate for changes in their workplace that will ensure increased safety through implementing a
system of universal precaution for medical equipment and waste and developing policies on this issue.
In the first stage of NICE, 115 nurses will be trained in five batches. I-TECH will also provide technical
assistance to three training institutions using a Training of Trainers (TOT) model for sustainability. At least
six nurse leaders from each institution (18 total) will receive TOT training to use the NICE package to train
at least 50 staff nurses in each partner institution (150 total).
New/Continuing Activity: New Activity
Continuing Activity:
Program Budget Code: 06 - IDUP Biomedical Prevention: Injecting and non-Injecting Drug Use
Total Planned Funding for Program Budget Code: $153,076
Total Planned Funding for Program Budget Code: $0
Table 3.3.06:
CONTINUING ACTIVITY - NEW ACTIVITY NARRATIVE
The 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 (CT) for patients and family members, on-going follow-up
counseling focusing on living positively, TB screening and referral, opportunistic infection (OI) prophylaxis
treatment and referral, and counseling on nutrition and psychosocial support to improve the quality of life for
PLHA I-TECH will support USG-funded activities such as: 1) HIV Specialists and Medical Officers (MOs)
trainings, 2) HIV Fellowship Program for physicians, 3) Nurses' Trainings Programs, 4) Clinical Mentorship
Program, 5) Clinical Consultation Hotline, 6) HIV Fellowship Program for Nurses, and 7) Training of Trainers
on Follow-Up Counseling Toolkit. The target populations are physicians, nurses, medical and nursing
students, counselors, and dieticians.
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, known for its high quality stigma-free
care for PLHAs. Infrastructure at GHTM includes the Training Center, an ART Center, and a state-of-the-art
laboratory facilities supported by USG funds.
ACTIVITY 1: HIV Specialists and MOs Trainings
Funding from USG supports 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 MOs
and HIV Specialists with intensive training coordination support from I-TECH.
Since 2004, GHTM and I-TECH have jointly conducted a total of 40 NACO trainings, serving over 658
clinicians. In FY09, I-TECH will create training systems to serve as adaptable models that can be
institutionalized at the national level. A long-term goal of the program is for GHTM to be independently
responsible for coordinating logistics and monitoring and evaluation in order to support the sustainability of
the program.
As the scale up of ART centers under NACP-III continues, there will be a need to utilize evaluated, effective
training and mentoring models. In FY09, 80 physicians from various ART centers will be trained on OI
diagnosis and management, patient monitoring, drug interaction, and infection control. I-TECH will also
continue systems strengthening by: 1) advocating with NACO to develop training curriculum for the Link and
Community Care Centers' clinical and auxiliary staff, and 2) supporting GHTM in the roll-out of ART
Refresher Trainings using the I-TECH developed ART Refresher Training curriculum. In FY09, it is
expected that 40 physicians will be trained using this curriculum.
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, and
manage common OIs. The Fellowship Program provides significant human and technical resources to
support adult and pediatric treatment and care services at GHTM by providing 60% of the GHTM physician
workforce and direct clinical care to approximately 30,000 PLHAs annually. In FY09 the Fellows will provide
direct HIV treatment services (i.e. ART initiation and follow-up monitoring) to an estimated 6,200 adults at
GHTM.
and evaluation of the one-year residential HIV/AIDS Clinical Fellowship Program. I-TECH will also focus on
creating a Fellowship Program model for clinical staff capacity development that can be adapted at other
COE sites, with a long-term goal of institutionalizing the Fellowship in the national HIV/AIDS program. This
will include possible expansion into a second year and establishing partnerships with local universities for
accreditation and to ensure the long-term sustainability of the program.
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's ENHANCE (Empowering Nurses to deliver HIV/AIDS Care and Education) Nurse Training is a
comprehensive 13-module interactive, case-based training for hospital and ART Center nurses focusing on
prevention, treatment, care and support for PLHA. The course was developed by I-TECH in collaboration
with NACO, Indian Nursing Council, and Clinton Foundation in 2007. This Training of Trainers (TOT) model
has been used by I-TECH to train nearly 500 nurses at GHTM and other partner institutions. I-TECH will
continue to identify and collaborate with new partners to roll out ENHANCE. In FY09, 100 nurses will be
trained at RDT and BelAir using this curriculum.
Activity Narrative: ACTIVITY 4: Clinical Mentorship for Community Care Centers (CCCs) and Link ART Centers
Under the National AIDS Control Program Phase 3 (NACP-III), 350 government CCCs will be set up to
provide HIV care and support. Clinical staff at the CCCs will require training as well as on-site clinical
mentoring to enhance the quality of care to PLHAs. I-TECH will work with two new partners and TNSACs to
support this training in accordance with NACO guidelines
In Tamil Nadu, I-TECH, through its partnership with WHO, Solidarity and Action Against the HIV Infection in
India, and TNSACS, has also provided training and clinical mentoring for doctors and nurses at ART
Centers in ART service delivery, particularly in the management of treatment failure and initiating second-
line regimens and TB/HIV co-infection. In FY09, it is expected that I-TECH will reach 60 HIV clinicians for
clinical mentoring on comprehensive care services for PLHAs. I-TECH will work with regional partners to
identify a pool of 15 mentors who will be trained using the I-TECH Clinical Mentoring Toolkit. I-TECH will
advocate with GOI to scale up a national pool of mentors to support the national HIV program.
ACTIVITY 5: Clinical Consultation Warmline
Healthcare providers in India have limited HIV specific training and lack resources on HIV/AIDS care, but
confront complex questions about HIV treatment and care during their clinical practice. To address the need
for accurate and real time clinical information on HIV, I-TECH will provide technical support via distance
consultation using the piloted and evaluated clinical consultation telephone "Warmline" The Warmline gives
physicians easy and timely access to up-to-date HIV clinical information, and individualized expert case
consultation. The program is 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). Data from the Warmline will enable periodic knowledge, attitudes, and practices
assessments of clinicians trained under the NACO program.
During the recent 3-month pilot phase, the Warmline averaged 60 calls per month, predominately from ART
MOs seeking guidance on HIV treatment issues such as OI management, drug interactions, and patient
monitoring. Best practices will be documented carefully with the goal of replication at similar settings.
ACTIVITY 6: 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.
In order to increase access to HIV/AIDS services, NACO is giving high priority to develop the capacity of
available nurses and other health care providers. In FY09, I-TECH will implement the Indian Nurse
Specialist in HIV/AIDS and ART (INSHAA) Program, whose primary target population is nurses in
decentralized ART Centers and CCCs. INSHAA is a four-week intensive training/clinical mentoring program
with ongoing on-site mentoring; it includes all six levels of I-TECH's framework for training.
INSHAA addresses training gaps and needs of nurses in decentralized ART Centers and Community Care
and Support Centers in India in order to task shift nurses roles and responsibilities. The program will be
piloted in Andhra Pradesh (AP). It will use 15 nurse mentors to train 50 nurses from 24 ART Centers and
95 CCCs to serve as Indian Nurse Specialists in HIV/AIDS and ART (INSHAA). I-TECH will develop a
Training of Trainers and Mentoring of Mentors model to train Indian School of Nursing faculty, I-TECH
nursing staff and nurse consultants, and local staff nurses, resulting in a pool of Indian nurse trainers and
clinical mentors. Once the pilot is evaluated and revised, it can be adapted to many similar settings, for
which I-TECH is in a unique position to provide TA. INSHAA will ultimately result in enhancing the role and
status of nurses and improving the quality of HIV care, treatment and support for PLHA in India.
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.
In 2008, I-TECH developed the Follow up Counseling Toolkit Training 5-day curriculum and 7-day TOT
curriculum. The standardized counseling materials focus on advanced issues such as behavior change,
and improved quality of life (including TB screening and treatment adherence in PLHA). ITECH will
continue to provide capacity building and technical support for the roll out and implementation of the training
via the TOT model in AP. In addition, ITECH will train 25 master trainers in Tamil Nadu using the 7-day
TOT curriculum and will provide technical support to the master trainers in Tamil Nadu.
Continuing Activity: 14659
14659 HHS/Health University of 6901 3962.08 I-TECH $300,000
Estimated amount of funding that is planned for Human Capacity Development $228,370
Table 3.3.08:
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 (MO) and
HIV Specialist Trainings; 2) Government Hospital of Thoracic Medicine (GHTM)/I-TECH HIV Fellowship
Program; 3) nurse trainings for partner organizations; 4) implementation of a consultation hotline for HIV
clinicians in India; (5) 2-3 months' nurses training program on HIV; 6) FBO/NGO partnerships for ART
trainings and clinical mentoring; (7) 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.
Note that Activity 6 in FY08: HIV Fellowship for Nurses, has been deleted and replaced with Activity 8 in
FY09: Indian Nurse Specialist in HIV/AIDS and ART
The GHTM Training Center, a national Center of Excellence, hosts trainings on behalf of NACO for MOs
and HIV Specialists. Since 2004, GHTM and I-TECH have jointly conducted a total of 40 NACO trainings,
serving over 658 clinicians. The rapid scale-up of India's ART initiative under the National AIDS Control
Plan Phase III (NACP 3), required Medical Officers to be trained for the centers to become operational. The
ten regional ART Training Centers will be given staff (Logistics Coordinators) and funding to facilitate this
ongoing training. 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. 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. Trainings include didactic sessions and skill-based bedside teaching on HIV diagnosis,
management of common opportunistic infections in India, ART and palliative care. As the scale up of ART
centers under NACP-III continues, there will be a need to use evaluated, effective training and mentoring
models. In FY09, 80 physicians from various ART centers will be trained to provide high-quality ART
services. In FY09, I-TECH will continue its systems strengthening efforts by: a) advocating with NACO to
develop training curriculum for the Link and CCCs' clinical and auxiliary staff and b) supporting GHTM in the
roll-out of ART Refresher Trainings using the I-TECH developed, and WHO supported, ART Refresher
Training curriculum. It is expected that 40 physicians will be trained using the Refresher Training
Curriculum in FY09. A further goal for I-TECH will be creating training systems to serve as adaptable
models that can be institutionalized at the national level. In addition, I-TECH's continuing support and
capacity development at GHTM ensures the future sustainability of the ART trainings.
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, program
management, education, and research in India. Fellows gain 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 Fellowship Program provides significant human and technical resources to
workforce and direct clinical care to approximately 30,000 PLHAs annually.
creating a Fellowship Program model for clinical staff capacity development that can be expanded and
adapted at other COE sites, with a long-term goal of institutionalizing the Fellowship in the national
HIV/AIDS program. This will include possible expansion into a second year and establishing partnerships
with local universities for accreditation and to ensure the long-term sustainability of the program.
ACTIVITY 3: Nurse Trainings
I-TECH in collaboration with multiple partners will continue to conduct nurse trainings in three high
prevalence states, using I-TECH curricula, and 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.
with NACO, the Indian Nursing Council, and Clinton Foundation in 2007. The Training of Trainers (TOT)
model has been used by I-TECH to train nearly 500 nurses at GHTM and other partner institutions. I-TECH
Activity Narrative: will continue to identify and collaborate with new partners to roll out ENHANCE through this adaptable TOT
model, which enhances sustainability. In FY09, 100 nurses will be trained at RDT and BelAir using this
curriculum.
ACTIVITY 4: Clinical Mentoring for Community Care Centers and Link ART Centers
I-TECH, through its partnership with WHO, Solidarity and Action Against the HIV Infection in India, and
TNSACS, has provided training and clinical mentoring for doctors and nurses in Tamil Nadu ART Centers,
in ART service delivery, particularly in the management of treatment failure and initiating second-line
regimens and TB/HIV co-infection. The Government of India's third National AIDS Control Plan also
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, and ultimately to train other doctors in their region.
In FY09, it is expected that I-TECH will reach 60 HIV clinicians for clinical mentoring on comprehensive care
services for PLHAs. I-TECH will work with regional partners to identify a pool of 15 mentors who will be
trained using the three-module I-TECH Clinical Mentoring Toolkit. I-TECH will also engage in advocacy
efforts at that national level to scale up a national pool of mentors for support of GOI's national HIV
program.
ACTIVITY 5: Clinical Consultation "Warmline"
Healthcare providers in India have limited training on HIV/AIDS care and confront many complex questions
during their day-to-day clinical practice, ideally requiring the latest data on HIV treatment. Often, however,
they do not have the resources or time to keep up with clinical updates. Moreover, the best technical
information may not be applicable to specific patients with complex medical and social problems in the
Indian setting. I-TECH will provide long-term decision and TA support via distance consultation using our
piloted and evaluated clinical consultation telephone "Warmline." The service will provide physicians with
easy and timely access to up-to-date HIV clinical information, and individualized India specific expert case
consultation. It 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).
Medical Officers seeking guidance on HIV treatment issues such as ART, drug interactions, patient
monitoring, and adverse events due to HIV treatment. Best practices from the implementation of the
Warmline will be documented carefully with the goal of replication in similar settings.
ACTIVITY 6: HIV/AIDS Fellowship for Nurses: deleted and replaced with Activity 8 (see below).
ACTIVITY 7: Training of Trainer (TOT) for Follow-Up Counseling Toolkit: In 2008, I-TECH developed the
Follow up Counseling Toolkit Training 5-day curriculum and 7-day TOT curriculum. The standardized
counseling materials focus on advanced issues in care, support and treatment for adults and children with
HIV/AIDS such as: behavior change, and improved quality of life (including TB screening and treatment
adherence in PLHA). ITECH will continue to provide capacity building and technical support for the roll out
and implementation of the training via the TOT model in Andhra Pradesh. In addition, ITECH will train 25
master trainers in Tamil Nadu using the 7-day TOT curriculum and will provide technical support to the
master trainers.
ACTIVITY 8: Indian Nurse Specialists in HIV/AIDS and ART
In order to increase the accessibility of the HIV/AIDS services (NACP III) under GFATM Round 7, NACO is
giving high priority to develop the capacity of available nurses and other health care providers. In FY09, I-
TECH will work to design, systematize, and expand capacity development models for clinical and auxiliary
staff at training institutions and Centers of Excellence (COE). This will include the Indian Nurse Specialist in
HIV/AIDS and ART (INSHAA) Program, whose primary target population is nurses in decentralized ART
Centers and CCCs where, according to NACOs operational guidelines, task shifting of nurses' roles and
responsibilities can be introduced.
INSHAA is a four-week intensive training/clinical mentoring program with ongoing on-site mentoring after
training; it includes all six levels of I-TECH's framework for training. The INSHAA curriculum will be
developed by I-TECH using many existing materials and experiences. INSHAA addresses the training gaps
and needs of nurses in decentralized ART Centers and CCCs in order to task shift nurses' roles and
responsibilities. The program will be piloted in Andhra Pradesh. It will use 15 nurse mentors to train 50
nurses from 24 ART Centers and 95 CCCs to serve as Indian Nurse Specialists in HIV/AIDS and ART
(INSHAA). I-TECH will develop a Training of Trainers (TOT) curriculum and a Mentoring of Mentors model
to train Indian School of Nursing faculty, I-TECH nursing staff and nurse consultants, and local staff nurses,
resulting in a pool of Indian nurse trainers and clinical mentors. Once the pilot is evaluated and revised, it
can be adapted to many similar settings in India, for which I-TECH is in a unique position to provide TA.
INSHAA will ultimately result in enhancing the role and status of nurses and improving the quality of HIV
care, treatment and support for PLHA in India.
Continuing Activity: 14662
14662 HHS/Health University of 6901 3962.08 I-TECH $400,000
Health-related Wraparound Programs
* TB
Estimated amount of funding that is planned for Human Capacity Development $328,630
Table 3.3.09:
Note that the FY08 Activity 3: Nursing Training Programs and Activity 6: HIV Fellowship for Nurses have
been combined in a new FY09 Activity 8 (see below), with new elements.
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 for both adults and children, 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 USG-funded activities such as: 1) HIV Specialists and
Medical Officers (MOs) trainings, 2) HIV Fellowship Program for physicians, 3) Nurses' Trainings Programs;
4) Clinical Mentorship Program, 5) Clinical Consultation Hotline, 6) HIV Fellowship Program for Nurses, and
7) Training of Trainers on Follow-Up Counseling Toolkit. The target populations are physicians, nurses,
medical and nursing students, counselors, and dieticians.
annually and is also a NACO recognized ART and Training Center, known for its high quality and stigma-
free care for PLHAs. Infrastructure at GHTM includes the Training Center, an ART Center, and state-of-the-
art laboratory facilities supported by USG funds.
USG funding supports an international standard Training Center at GHTM. The GHTM Training Center, also
a national Center of Excellence, hosts trainings on behalf of NACO for MOs and HIV Specialists with
intensive training coordination support from I-TECH. GHTM is an ideal site for these trainings because of its
access to complex and varied clinical cases requiring a wide variety of services.
institutionalized at the national level. A long-term goal of the project is for GHTM to be independently
As the scale up of ART Centers under NACP-III continues, there will be a need to utilize evaluated, effective
training and mentoring models. In FY09, 80 physicians from various ART centers will be trained using the I-
TECH curriculum, which includes a pediatric module to build the capacity of ART MOs to provide high-
quality pediatric HIV/AIDS care and treatment. I-TECH will also continue systems strengthening by: 1)
advocating with NACO to develop a training curriculum for the Link and Community Care Centers' clinical
and auxiliary staff, and b) supporting GHTM in the roll-out of ART Refresher Trainings using the I-TECH
developed, and WHO supported, ART Refresher Training Curriculum. It is expected that 40 physicians will
be trained using the Refresher Training Curriculum in FY09.
support, education, and research in India. Fellows gain skills to provide a wide range of high-quality
Fellowship Program, Fellows manage pre-ART patients, screen and refer patients for TB therapy, manage
common OIs, and more. The Fellowship Program provides significant human and technical resources to
support adult and pediatric care and treatment services at GHTM by providing 60% of the GHTM physician
workforce and direct clinical care to approximately 30,000 PLHA annually (10% of which are children under
15 years old). In FY09 it is expected that the Fellows will provide direct HIV treatment services to 400 HIV
infected children seeking care at GHTM.
creating a Fellowship Program model for clinical staff capacity development, which can be expanded and
ACTIVITY 3: Nurse Training Programs: now included under Activity 8
ACTIVITY 4: Clinical Mentorship for Community Care Centers (CCCs) and Link ART Centers
Under the third phase of the National AIDS Control Program (NACP-III), 350 government CCCs will be
established to provide HIV care and support. Clinical staff at the 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 this training.
Activity Narrative: India, and TNSACS, has provided training and clinical mentoring at the ART Centers for doctors and nurses
regimens and TB/HIV co-infection. In FY09, it is expected that I-TECH will reach 60 HIV clinicians for
clinical mentoring on comprehensive care services for PLHAs, including pediatrics. I-TECH will work with
regional partners to identify a pool of 15 mentors who will be trained using the three-module I-TECH Clinical
Mentoring Toolkit. I-TECH will also advocate with NACO to scale up a national pool of mentors to support
the national HIV program.
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. During the recent 3-month pilot phase, the
"Warmline" averaged 60 calls per month, predominately from ART Medical Officers seeking guidance on
pediatric issues such as treatment formulations, HIV diagnosis, and prevention.
ACTIVITY 6: HIV Fellowship for Nurses: now included under Activity 8
In 2008, I-TECH developed the Follow up Counseling Toolkit Training 5-say curriculum and 7-day TOT
ACTIVITY 8: Indian Nurse Specialist in HIV/AIDS and ART (INSHAA) Program
In order to increase the accessibility of the HIV/AIDS services (NACP-III) under GFATM Round 7, NACO is
giving high priority to develop capacity of available nurses and other health care providers. Since the
traditional curriculum of nursing training does not have specific focus on care and treatment component for
HIV, NACO plans to strengthen the competence of nurses. In 2009, I-TECH will work to design,
systematize, and expand capacity development models for clinical and auxiliary staff at training institutions
and Centers of Excellence. This will include the Indian Nurse Specialist in HIV/AIDS and ART (INSHAA)
Program, whose primary target population is nurses in decentralized ART Centers and CCCs, where
according to NACO's operational guidelines, task shifting of nurses roles and responsibilities can take hold.
training. The program includes all six levels of I-TECH's framework for training. The INSHAA curriculum
will be developed by I-TECH using many existing materials and experiences. The program will be piloted in
Andhra Pradesh (AP). It will use 15 nurse mentors to train 50 nurses from 24 ART Centers and 95 CCCs to
serve as Indian Nurse Specialists in HIV/AIDS and ART (INSHAA). I-TECH will develop a Training of
Trainers and Mentoring of Mentors model to train Indian School of Nursing faculty, I-TECH nursing staff and
nurse consultants, and local staff nurses, resulting in a pool of Indian nurse trainers and clinical mentors.
Once the pilot is evaluated and revised, it can be adapted to many similar settings, for which I-TECH is in a
unique position to provide TA. INSHAA will ultimately result in enhancing the role and status of nurses and
Estimated amount of funding that is planned for Human Capacity Development $20,500
Table 3.3.10:
HIV Specialist Trainings, 2) Government Hospital of Thoracic Medicine (GHTM)/I-TECH HIV Fellowship
Program, 3) nurse trainings for partner organizations, 4) implementation of a consultation hotline for HIV
clinicians in India; (2) 2-3 months nurses training program on HIV, 5) FBO/NGO partnerships for ART
trainings and clinical mentoring; 6) partnership with Tamil Nadu State AIDS Control Society (TNSACS) for
Activities 3: Nursing Training and 6: HIV Fellowship for Nurses from the FY08 COP have now been
combined into a new Activity 7 (listed below): Indian Nurse Specialist in HIV/AIDS and ART (INSHAA)
Program
ACTIVITY 1: HIV Specialists and Medical Officers (MOs) Trainings
The GHTM Training Center, also a national Center of Excellence, hosts trainings on behalf of NACO for
MOs and HIV Specialists. Since 2004, GHTM and I-TECH have jointly conducted a total of 40 NACO
trainings, serving over 658 clinicians. I-TECH's role has been one of capacity development, with the long-
term goal of GHTM independently coordinating logistics as well as the monitoring and evaluation activities
of the NACO trainings to support program sustainability. In FY09, a primary goal for I-TECH is creating
training systems to serve as adaptable models that can be institutionalized at the national level.
quality pediatric HIV/AIDS care and treatment. In FY09, I-TECH will continue its systems strengthening
efforts by: 1) advocating with NACO to develop training curriculum for the Link and Community Care
Centers' clinical and auxiliary staff, and 2) supporting GHTM in the roll-out of ART Refresher Trainings
using the I-TECH developed, and WHO supported, ART Refresher Training Curriculum. It is expected that
40 physicians will be trained using the Refresher Training Curriculum in FY09.
The GHTM/I-TECH HIV Fellowship Program, which is supported 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,
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 Fellowship Program provides significant human and technical resources to
support adult and paediatric care and treatment services at GHTM by providing 60% of the GHTM physician
creating a Fellowship Program model for clinical staff capacity development, which can be adapted at other
ACTIVITY 3: Nurse Trainings: now included under Activity 7
ACTIVITY 4: Clinical Mentoring for Community Care Centers (CCCs) and Link ART Centers
The Government of India's third National AIDS Control Plan (NACP-III) 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 contain
the increasing loads in the existing ART centers.
In Tamil Nadu ART Centers, I-TECH, through its partnership with WHO, Solidarity and Action Against the
HIV Infection in India, and TNSACS, has provided training and clinical mentoring for doctors and nurses in
ART service delivery, particularly in the management of treatment failure and initiating second-line regimens
and TB/HIV co-infection. In FY09, it is expected that I-TECH will reach 60 HIV clinicians for clinical
mentoring on comprehensive care services for PLHAs, including pediatrics. I-TECH will work with regional
Activity Narrative: partners to identify a pool of 15 mentors who will be trained using the 3-module I-TECH Clinical Mentoring
Toolkit. I-TECH will also engage in advocacy efforts to scale up a national pool of mentors to support the
national HIV program.
Healthcare providers in India have limited training on HIV/AIDS care but confront many complex questions
during their clinical practice. Clinicians in India often do not have the resources or time to keep up with
clinical updates. Moreover, the best technical information may not be applicable to specific patients with
complex medical and social problems in the Indian setting. I-TECH will provide long-term decision and TA
support via distance consultation using our piloted and evaluated clinical consultation telephone "Warmline".
The program is 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
The Warmline will support the application of clinical skills learned in the NACO Specialist and MO Training
programs and will enable periodic assessments of clinicians trained under the NACO program. . During the
recent 3-month pilot phase, the "Warmline" averaged 60 calls per month, predominately from ART Medical
Officers seeking guidance on pediatric issues such as treatment formulations, HIV diagnosis, and
prevention. Best practices from the implementation of the warmline will be documented carefully with the
goal of replication in similar settings.
ACTIVITY 6: HIV Fellowship for Nurses: now included under Activity 7
ACTIVITY 7: Indian Nurse Specialist in HIV/AIDS and ART (INSHAA) Program
Program, whose primary target population is nurses in decentralized ART Centers and CCCs in India,
where according to NACO's operational guidelines, task shifting of nurses roles and responsibilities can
take hold.
training that addresses the training gaps and needs of nurses in decentralized ART Centers and CCCs. The
program includes all six levels of I-TECH's framework for training, including addressing paediatric care and
treatment. The INSHAA curriculum will be developed by I-TECH using many existing materials and
experiences. The program will be piloted in Andhra Pradesh (AP). It will use 15 nurse mentors to train 50
nurses from 24 ART Centers and 95 CCCs to serve as Indian Nurse Specialists in HIV/AIDS and ART. I-
TECH will develop a Training of Trainers and Mentoring of Mentors model will be used to train Indian
School of Nursing faculty, I-TECH nursing staff and nurse consultants, and local staff nurses, resulting in a
pool of Indian nurse trainers and clinical mentors. Once the pilot is evaluated and revised, it can be
adapted to many similar settings, for which I-TECH is in a unique position to provide TA. INSHAA will
ultimately result in enhancing the role and status of nurses and improving the quality of HIV care, treatment
and support for PLHA in India.
Program Budget Code: 12 - HVTB Care: TB/HIV
Total Planned Funding for Program Budget Code: $455,608
Program Area Narrative:
Overview: India has the highest TB burden of any country of the world, with 22% of the world's TB cases, but has a well designed
and implemented program for diagnosing and treating TB. The Directly Observed Treatment Short Course Chemotherapy (DOTS)
strategy was developed in India. The Government of India's (GOI) Revised National TB Control Program (RNTCP) has a network
of about 12,000 microscopy centers and 120,000 DOTS centers and providers throughout India. Based on HIV sentinel
surveillance data, the estimated burden of HIV-TB co-infection is 0.9 million cases and between 1-13% of TB patients are co-
infected with HIV depending on the setting.
The GOI began provider-initiated HIV testing of TB patients in April 2007 on a pilot basis in two districts: encouraging results have
led to a major policy change on testing and paved the way for scaling up this initiative. Until very recently, TB providers actively
resisted the referral of patients from HIV programs to TB clinics for DOTS because of concerns about the impact of stigma and
discrimination on TB programs and the lack of services for HIV in TB clinics. Referral and follow up is further complicated by the
lack of TB testing in settings for HIV care. HIV services are provided mostly at the district level (each district has approximately 2
million population) and TB services at the sub-district level. Cotrimoxazole for preventive treatment of patients co-infected with
HIV and TB has been added as a pilot initiative in DOT centers in three districts of Andhra Pradesh (AP), where there is a system
for sharing information between the HIV and TB programs under a joint agreement for "shared confidentiality." In this principle of
‘shared confidentiality' the HIV status of the individual is shared with the TB DOTS center after obtaining explicit approval from
patient for the purposes of providing CP and monitoring for TB.
Treatment regimens that combine TB and ARV drugs are complex and potentially hazardous. Efavirenz is part of the first-line
treatment of HIV /AIDS and accounts for about 15% of all ART drugs purchased. The cost of Efavirenz in the private sector is
often prohibitive and many People Living with HIV/AIDS (PLHAs) do not receive the recommended treatment or are taking two
drug regimens. The national government does not currently support isoniazid TB prophylaxis for PLHAs but there are ongoing
clinical trials to evaluate its effectiveness at the Tuberculosis Research Center of the Indian Council for Medical Research in
Chennai.
Coordination and Other Donor Support: A Joint GOI TB/HIV Working Group was established in 2001 to enhance the coordination
between the TB and HIV programs. Guidelines and cross training for managing TB and HIV co-infections have been developed
and national curricula now include modules on HIV-TB. Also, USG-funded, WHO-supported TB consultants are placed in all
states of India and have been instrumental in strengthening HIV-TB coordination at district, state and national levels.
The advantages of co-locating TB and HIV programs to improve treatment of both infections prompted the GOI to seek funding
from Global Fund Round Three to co-locate 329 TB microscopy centers with counseling and testing centers in high prevalence
districts. GOI is scaling up this important initiative in 200 high burden districts all over the country. Provider-initiated HIV
counseling and testing (‘opt out'), especially for patients with TB, is a priority in the third National AIDS Control Program (NACP-
III).
Current USG Support: TB-HIV services depend on effective linkage between the National AIDS Control Program (NACP) and
RNTCP. The USG has fostered this linkage through technical and resource support at all levels, especially at the national level
and in the high-prevalence states of Tamil Nadu, Andhra Pradesh, Maharashtra, Manipur and Nagaland. USG staff provide
technical assistance to the GOI for these activities via WHO.
USG provided technical assistance in the revision of the curriculum for TB-HIV providers to improve treatment in both national
programs. USG supports a WHO technical advisor to provide critical policy and technical inputs on TB-HIV issues at the national
level. This advisor works closely with the GOI on policy development and program implementation, especially in the areas of
TB/HIV surveillance, provider-initiated counseling and testing, and TB/HIV coordination.
By the end of FY08, 5,166 PLHAs had been diagnosed and put on TB treatment through 353 USG-supported outlets. The USG
also supported the training of over 500 health care providers on TB-HIV at different levels in six states in India. USG provides
direct support to the Government Hospital for Thoracic Medicine, Tambaram (GHTM), one of the largest TB and HIV care centers
in India. A DOTS center was opened at GHTM in June 2006, to which PLHAs receiving treatment and care at GHTM can be
referred for TB testing, diagnosis and treatment. A tracking system has been established to monitor referrals from GHTM to other
states. This is very important over 40% of new patients coming to GHTM are from the neighboring states of Andhra Pradesh,
Karnataka, Kerala and Maharashtra.
In remote rural areas mobile counseling and testing vans are being used for follow up of DOTS treatment for co-infected persons.
Counselors from various USG-supported projects are donating their time and expertise to government DOTS centers for smooth
referrals and counseling of TB-HIV patients. USG is also developing the capacities of a wide range of health providers in HIV
programs, including counselors, peer educators, HIV-positive network persons and men who have sex with men, to be DOTS
providers
USG FY09 Support: During FY09 there will be further consolidation of HIV-TB collaborative services and scale up of successful
model programs.
Support at national level:
• Members of the USG/India staff have considerable technical expertise in HIV-TB and technical officers will continue to provide
support to strengthen linkages between the TB and HIV programs in the USG focus states. The USG will continue to support the
WHO technical advisor
• USG technical support will also be provided to assist the RNTCP in the development of national TB infection control guidelines,
integrate principles of TB-HIV coordination into training programs and develop a realistic action plan with timelines for
implementation.
Support at state and district level:
• Four more USG-supported Community Care Centers (CCCs) (three in Karnataka and one in coastal AP) will be proposed as
Designated Microscopy Centers (DMCs) under the public-private partnership scheme of the national TB program for improving
access to TB diagnosis and treatment of PLHAs.
• USG will also advocate for and facilitate district level TB-HIV Coordination Committees, to improve linkages between Integrated
Counseling and Testing Centers and DMCs in USG focus states of AP, Tamilnadu, Karnataka and Maharashtra
• In Tamil Nadu, staff from 20 private hospitals will be engaged in treating TB-HIV patients and the counselors in these facilities
will refer patients between the two programs for HIV and TB testing.
• In Karnataka and AP, USG programs will strengthen linkages for TB referral and treatment at the workplace programs in the
private sector by collaborating with the Employee State Insurance Corporation (a parastatal organization providing health
services), and with empanelled hospitals. In Andhra Pradesh, USG will support the development of workplace policies for TB-
infected and HIV-positive employees and the reduction of stigma and discrimination.
Support at programmatic level:
• In FY09, all USG-supported HIV/AIDS care and treatment programs will implement systems to screen for TB and refer patients
for DOTS treatment. Community and home-based care programs will consolidate linkages with local RNTCP clinics and, wherever
feasible, become DOTS providers. The drop-in centers in the care and support projects for PLHAs in Pune and Salem, are
already acting as DOTS centers in the community. The DOTS program at GHTM will be enhanced and monitored and the lessons
learned about program integration will be shared nationally.
Overall, combined USG programs plan to provide TB-HIV care and support services to more than 6,400 patients in FY09 and
7,000 in FY10 and train over 1,800 health care workers in FY09 and 1,900 in FY10 in the provision of integrated services.
Table 3.3.12:
clinicians. In FY09, 80 Physicians from various ART centers will be trained on topics such as early
identification of signs and symptoms of TB, management of TB/HIV co-infection, and the latest advances in
TB therapy (including 2nd line treatment and MDR/XDR-TB management). I-TECH's capacity development
at GHTM ensures future sustainability of the trainings and supports NACO's efforts to scale up and
strengthen the quality of TB/HIV services.
ACTIVITY 2: Nurse Trainings
I-TECH's ENHANCE (Empowering Nurses to deliver HIV/AIDS Care and Education) Nurse Training is a 13-
module interactive, case based training for hospital and ART Center nurses focusing on prevention,
treatment, care and support for PLHA and TB/HIV topics (infection control, screening, diagnosis, and
treatment of TB in PLHA). The course was developed by I-TECH in collaboration with NACO, Indian
Nursing Council, and Clinton Foundation and has been used by I-TECH to train nearly 500 nurses at GHTM
and partner institutions. I-TECH will roll out ENHANCE and will train 100 nurses at RDT and BelAir using
this curriculum
ACTIVITY 3: HIV Fellowship Program
In FY 2009 the HIV Fellows will provide direct TB/HIV services, including TB screening, diagnosis and
treatment to an estimated 1800 PLHA at GHTM. I-TECH will also create a Fellowship Program model for
clinical staff capacity development that can be expanded and adapted at other COE sites, with a long-term
goal of institutionalizing it in the national program.
ACTIVITY 4: not continued
evaluated clinical consultation telephone "Warmline." During the recent 3-month pilot phase, the "Warmline"
averaged 60 calls per month, predominately from ART Medical Officers seeking guidance on diagnosis and
treatment (specifically TB and HIV treatment interactions) of TB in PLHA.
ACTIVITY 6: Clinical Mentoring
I-TECH, in partnership with WHO and TNSACS, provides training and clinical mentoring for doctors and
nurses in ART service delivery, including TB/HIV co-infection. In FY09, I-TECH will reach 60 HIV clinicians
for clinical mentoring on comprehensive care services for PLHA. I-TECH will work with regional partners to
identify a pool of 15 mentors who will be trained using the 3-module I-TECH Clinical Mentoring Toolkit. I-
TECH will also engage in advocacy efforts at that national level to scale up a national pool of mentors.
ACTIVITY 7: ToT for Follow-Up (FU) Counseling Toolkit
In 2008, I-TECH developed the Follow up Counselling Toolkit Training 5-day curriculum and 7-day Training
of Trainer (ToT) curriculum. The toolkit focuses on advanced counseling issues, including TB screening and
treatment adherence in PLHA. ITECH will provide technical support for the roll out this training in Andhra
Pradesh, and will train and provide technical support to 25 Master Trainers in Tamil Nadu.
ACTIVITY 8: Indian Nurse Specialist in HIV/AIDS and ART
In FY09, I-TECH will support the development of the Indian Nurse Specialist in HIV/AIDS and ART
(INSHAA) Program, whose primary target population is nurses in decentralized ART Centers and
Community Care Centers (CCCs). INSHAA is a four-week intensive training/clinical mentoring program that
addresses the training gaps and needs of nurses in decentralized ART Centers and CCCs in order to task
shift nurses roles and responsibilities. The curriculum will be developed by I-TECH and will include TB/HIV
co-infection treatment and care. The training program will be piloted in Andhra Pradesh, using 15 nurse
mentors to train 50 nurses from 24 ART Centers and 95 CCCs as Indian Nurse Specialists in HIV/AIDS and
ART. The pilot will use a TOT and Mentoring of Mentors model to train Indian School of Nursing faculty, I-
TECH nursing staff and nurse consultants, and local staff nurses to create a pool of nurse trainers and
clinical mentors. Once the pilot is evaluated and revised, it can be adapted in many similar settings in India.
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.
Activity Narrative: BACKGROUND
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.
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.
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.
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.
Activity Narrative: ACTIVITY 5: Clinical Consultation Hotline
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.
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.
Continuing Activity: 14660
14660 HHS/Health University of 6901 3962.08 I-TECH $150,000
Estimated amount of funding that is planned for Human Capacity Development $130,000
Update: $90,000 has been added to contact a national advisor on "Developing Centers of
Excellence" (COE) through I-TECH (International Training and Educatin Centers on HIV). CDC, with I-
TECH support, helped MOH to develop GHTM, Tamil Nadu, inot the first COE in India. There are an
additonal 12 institutions identified by NACO for developing into COEs by 2012. The contractor/advisor will
lead thsi process with support from I-TECH, CDC and otherse and in close collaboration with NACO's
Director of Care, Treatment and Support activities.
ACTIVITY 1: TB/HIV Information System (T/HIS)
I-TECH, in collaboration with the State of Tamil Nadu and Government of India will support the electronic
longitudinal medical records system at the Government Hospital of Thoracic Medicine (GHTM) Tambaram,
Tamil Nadu. The objective of this system is to improve the efficiency and effectiveness of care provided to
these patients and to routinely provide high-quality program level data to the facility, State, and National
HIV/AIDS Control Organizations; data which are both complex and rarely available in India. This
computerized record system also provides longitudinal patient data to more efficiently provide information
on follow-up patient care and outcomes. Data that is routinely collected as part of patient care is collected
and maintained in an electronic medical record system where it can be accessed by appropriate health care
staff for patient-level care, programmatic level advocacy, policy development and dissemination of findings
through mediums such as technical conferences and peer-reviewed journals.
I-TECH supports the Strategic Information services at GHTM by contracting with an epidemiologist to
oversee the technical and operational management of the T/HIS at GHTM. This contractor will also
collaborate with I-TECH and GHTM to ensure increased and appropriate utilization of this patient database
at the hospital by key stakeholders (GHTM clinical staff, I-TECH clinical fellows). In 2009, 40 GHTM and I-
TECH staff and other stakeholders will be trained on the use of the system. The objective of the training is
to increase use of the system to improve patient care and decision-making as well as analyzing,
interpreting, and dissemination of patient and population data from the system.
ACTIVITY 2: NACO HIV Specialists and Medical Officers' and Other Trainings
In FY09, ITECH will collaborate with NACO, TNSACS and other technical partners to ensure appropriate
basic program and impact evaluation of the NACO ART medical officer training and ART refresher training.
Using a cross-sectional assessment model, ITECH will assess at the point of service the quality of care
being provided by medical officers who have attended various NACO/ITECH HIV trainings. The objectives
of these assessments will be to: describe the quality of care provided to HIV-AIDS patients attending health
care facilities known to provide such care and assess training needs and the capacity of medical officers to
provide HIV-AIDS care post-training.
ACTIVITY 3: IATN Website
This activity will now be funded by the National AIDS Control Organization and WHO
ACTIVITY 4: Clinical Consultation Warmline
Optimizing I-TECH's training framework, which facilitates the transfer of learning from classroom to jobsite, I
-TECH will provide long-term decision support, guidance, and program monitoring and evaluation on an as-
needed basis through distance consultation using our piloted and evaluated clinical consultation Warmline.
The Warmline gives physicians easy and timely access to up-to-date HIV clinical information, and
individualized expert case consultation. Data from the Warmline will enable periodic knowledge, attitudes,
and practice assessments of clinicians trained under the NACO program.
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
Activity Narrative: 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.
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.
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.
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
approximately 2000 clinical consultations annually.
Continuing Activity: 14664
14664 HHS/Health University of 6901 3962.08 I-TECH $100,000
Estimated amount of funding that is planned for Human Capacity Development $87,000
Table 3.3.17:
ACTIVITY 1: HIV/AIDS Care Pocket Guide - Not continued in 2009
ACTIVITY 2: Training MIS Website - Continued as described in 2009
ACTIVITY 3: Nurse Trainings (ENHANCE)
To continue the FY08 activity, in FY09, I-TECH will work to design, systematize, and expand capacity
development models for clinical and auxiliary staff at training institutions and Centers of Excellence (COE).
I-TECH's Empowering Nurses to deliver HIV/AIDS Care and Education (ENHANCE) Nurse Training is a
with NACO, the Indian Nursing Council, and the Clinton Foundation in 2007. The Training of Trainers
(TOT) model has been used by I-TECH to train nearly 500 nurses at GHTM and other partner institutions
and partners are using curriculum to train many more. I-TECH will continue to support GHTM Nurse
Trainers in identifying other areas of nurse and ancillary staff training needs. In addition, the curriculum will
be packaged and rolled out to partners, including Bel-Air and RDT, potentially resulting in the training of one
hundred additional nurses in FY09.
ACTIVITY 4: Non-Clinical Trainings/Capacity Building Trainings
In FY09, I-TECH will work to design, systematize, and expand capacity development models for clinical and
auxiliary staff at training institutions and Centers of Excellence. This will include the development of
Capacity Building Trainings.
In FY08, I-TECH designed and piloted a series of short workshops on curriculum development to support
systems strengthening activities for its partners. These workshops will address topics such as Facilitation
Skills, the ADDIE model for Curriculum Development, Training Program Development and Implementation,
Monitoring and Evaluation of Training Programs (including I-TECH's use of Kirkpatrick's Four Levels of
Training Evaluation). In FY09, I-TECH will finalize and package the workshops, which will be extensively
promoted to partner organizations in India. I-TECH will develop a fixed training calendar to implement these
workshops throughout the year. Concurrently, a pool of trainers/coordinators will be hired to implement the
training workshops.
ACTIVITY 5: Infection Control and Clinical Society Meetings (Systems Strengthening at GHTM)
In FY09, a primary goal for I-TECH will be creating training and support systems which will serve as easily
adaptable models that can be institutionalized at the national level of GOI-supported HIV programs. I-
TECH's history of supporting health systems strengthening activities such as the regular Clinical Society
Meetings and Infection Control assessments and trainings at GHTM places I-TECH in the unique position of
being able to develop training standards, support systems, programs and resources that can be quickly
adapted to assist other COE and training institutions at the national level. This is directly in line with
NACPIII priorities of strengthening training systems as a function of capacity building.
I-TECH will continue to strengthen systems at GHTM by serving in an advisory role in the organization and
support of Hospital Infection Control Committee Meetings (HICC), weekly Clinical Society Meetings (CSMs),
and monthly Nursing Clinical Society Meetings (NCSMs). I-TECH will continue to support GHTM Nurse
Trainers in identifying other areas of nurse and ancillary staff training needs. By continuing its role in these
activities, I-TECH will be in a unique position to develop protocols and guidance for capacity building and
strengthening of systems within training institutions and Centers of Excellence that are grounded in years of
direct experience. I-TECH will be scaling up resources in order to best assess effectiveness of
interventions, determine best practices, lessons learned and challenges in order to optimize effective
protocols and guidance.
rapid scale-up of national and state-level HIV/AIDS services in India.. Significant training and mentoring
Counselors to support this scale-up of services.at these centers. I-TECH's strategy for institutional support
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
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
Activity Narrative: 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.
Continuing Activity: 14665
14665 HHS/Health University of 6901 3962.08 I-TECH $120,000
Estimated amount of funding that is planned for Human Capacity Development $103,000
Table 3.3.18:
