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: 2010 2011 2012 2013 2014 2015 2016
The I-TECH India program is located in Chennai and is affiliated with the University of Washington, Seattle and the University of California, San Francisco. I-TECH India has received PEPFAR funding since 2003 to support work in India to halt and reverse the HIV/AIDS epidemic. I-TECH aims to enhance the quality of HIV training activities in India, particularly in high-prevalence states, through: capacity building and systems strengthening with national, regional, and local training centers; and clinical mentoring visits at hospitals, anti-retroviral treatment centers, non-governmental organizations, and other health centers.
Key Ongoing Activities:
I-TECH India is co-located at the Government Hospital of Thoracic Medicine (GHTM) in Chennai. I-TECH is implementing and supporting activities in Tamil Nadu (TN), Andhra Pradesh (AP), and Maharashtra; all of which are high HIV-burden states in India. All current and planned activities are developed and implemented in collaboration with key government and non-government of India entities and other stakeholders with emphasis placed on evidence-based and sustainable programming. I-TECH employs 24 staff, broken down as: clinicians; curriculum and training specialists; monitoring and evaluation experts; and program managers. They are engaged in delivering the following programs:
Clinical training and technical assistance in partnership with the National AIDS Control Organization NACO. This includes supporting NACO's rollout of Centers of Excellence (COE) in HIV care, treatment, and support. I-TECH supports establishing and integrating quality HIV human capacity development activities into clinical training programs at COEs.
Supporting GHTM as a national COE through its HIV clinical fellowship and other system support including the health management information system (HMIS) since 2004.
NACO ART medical officer (MO) and specialist training (since 2004)
Clinical mentorship program with Tamil Nadu State AIDS Control Society (TNSACS) (since 2007)
Empowering Nurses to Deliver HIV/AIDS Nursing Care and Education (ENHANCE) (since 2007)
Follow-up counseling training toolkit training curriculum ( 2007)
Nurse Infection Control Education (NICE) (since 2008)
Indian Nurse Specialist in HIV/AIDS and ART (INSHAA) (since 2008)
Clinician consultation warmline (since May 2008)
Training program development workshop series (since June 2008)
Project Achievements and Innovations:
I-TECH developed and implemented an innovative and comprehensive one-year HIV clinical fellowship program to prepare junior and mid-level physicians to be leaders in HIV-related care, support, education, and research. To date, 42 fellows (three batches) have graduated. Currently, seven fellows are undergoing advanced training on HIV/AIDS care, treatment, and support. I-TECH conducts continuous quality improvement approaches to ensure programmatic improvement and to assess program outputs and outcomes.
I-TECH conducted clinical training and consultations for ART MO. These trainings, which use I-TECH developed curricula, have trained 527 MOs and specialists including: 129 MOs, 52 link ART center MOs and 335 specialists. In addition, 11 MOs underwent HIV care and treatment refresher training where I-TECH provided technical support.
I-TECH developed and implemented an innovative telephone consultation 'Warmline' service for HIV clinicians to provide rapid and expert consultation to HIV/AIDS care and treatment health workers. To date, 337 calls have been received from HIV care and treatment centers.
I-TECH developed three curricula to expand the role of nurses and promote task-shifting, a key area of focus in PEPFAR II: a 13-module training for nurses on HIV/AIDS care, ENHANCE, and a hands-on infection-control curriculum, NICE. The trainings serve to enhance HIV care and treatment knowledge and skills and encourage greater involvement of nurses in HIV care and treatment. To date, 441 nurses at four tertiary care centers were trained using the ENHANCE curricula and 114 nurses were trained through the NICE program. The INSHAA is a four week intensive training and clinical mentoring program to address training gaps and needs of nurses in ART centers and Community Care Centers (CCCs) according to NACO operational guidelines. An outcome evaluation of the pilot training activity is planned for FY2010.
I-TECH designed and piloted a series of short workshops to support systems strengthening activities that address topics such as facilitation skills, ADDIE model for curriculum development, training program development and implementation, and monitoring and evaluation (M&E) of training programs. To date, 40 people have been trained in with these workshops.
I-TECH will continue to leverage its domestic and international technical expertise in human capacity development to support India to build sustainable workforce capacity to deliver HIV/AIDS prevention, care and treatment that include pre-service and in-service training and training for task-shifting; management and leadership development. Special emphasis is placed on developing evidence-based and sustainable programs that can be adopted and replicated throughout the country, both key priorities under PEPFAR II. I-TECH will look to expand its role in NACO and SACs as a technical expert in human capacity development (clinical and non-clinical) to ensure cost effective expansion of the above described programs.
SUMMARY
The National AIDS Control Organization (NACO) estimates that there are 2.3 million people living with HIV (PLHIV) in India, all of which require care and support services. Under the National AIDS Control Program Phase III (NACP III), NACO is enhancing the role of Community Care Centers (CCCs) to provide monitoring, follow-up, and counseling support to those who are initiated on ART, positive prevention, drug adherence, and nutrition counseling. NACO is also creating Link antiretroviral therapy (ART) Centers (LACs) to provide expanded access to HIV care and treatment services, in addition to services provided through the 217 ART Centers. By 2011, NACO plans to have 350 CCCs, 250 ART centers and approximately 500 LACs.
To support the need for increased capacity among health care providers (HCP) at these care and treatment centers and to build the capacity of leaders in the field of HIV, I-TECH India aims to train clinicians on key aspects of palliative care, including prevention with positives, opportunistic infection (OI) prophylaxis, treatment, and referral, nutrition counseling and psychosocial support. I-TECH India will support the following USG-funded activities: 1) NACO Trainings for HIV Specialists and ART Center, LAC and CCC medical officers (MOs), 2) Clinical mentorship for CCC and LAC MOs, 3) the Indian nurse specialists in HIV/AIDS and ART (INSHAA) training program, and 4) an HIV fellowship program for physicians.
ACTIVITIES AND EXPECTED RESULTS
ACTIVITY 1: NACO TRAININGS
The Government Hospital of Thoracic Medicine (GHTM) training center, which is housed at national Center of Excellence (COE), hosts trainings on behalf of NACO for HIV specialists and ART, LAC, and CCC MOs, with technical support from I-TECH. Since 2004, GHTM and I-TECH have jointly conducted a total of 32 NACO trainings for 720 clinicians including: 20 HIV specialist trainings (546 participants), seven ART MO trainings (104 participants), one ART MO Refresher training (11 participants), two LACO MO trainings (52 participants) and one CCC MO training (7 participants).
Curriculum Development: I-TECH has already developed the NACO ART MO and HIV Specialist training curricula, which is now implemented at training centers and COEs nationwide. In FY09, I-TECH developed, piloted and finalized the ART MO refresher course, with support from WHO and USG. In FY10, I-TECH will advocate with NACO to disseminate the ART MO refresher course nationally. As HIV care and treatment is being scaled-up by creating LACs and expanding the role of CCCs, MOs at these facilities will require additional training in diagnosis and treatment of opportunistic infections (OIs), including TB, provision of psychosocial support and nutrition counseling, and referral for treatment and social services.
At present the four day LAC and CCC MO trainings are being conducted using a modified version of the two week ART MO curriculum. To ensure that LAC and CCC MOs have the knowledge and skills necessary to carry out their responsibilities and as per PEPFAR II guidelines for human resources for health (HRH) in-service trainings, these trainings should be linked to the core competencies of the MOs' job description and the resources available at their sites. In FY09, the NACO COE consultant drafted an outline for the LAC and CCC MO courses. I-TECH will continue to advocate for these courses throughout the year during monthly visits with NACO. In FY11, I-TECH will provide technical assistance to six training centers/centers of excellence (TC/COE) in implementing the LAC and CCC MO curricula.
Training: Over time, I-TECH has helped develop capacity of GHTM in organizing NACO trainings by mentoring the GHTM Training Coordinator, who is now handling all training logistics. In FY10, I-TECH will continue to build the capacity of the GHTM training coordinator to monitor and evaluate the trainings. I-TECH will also provide resource faculty, including the fellows, for the NACO trainings at GHTM. During FY10, I-TECH plans to support GHTM in conducting six NACO trainings (120 participants). In FY11, I-TECH will continue to support GHTM by providing resource faculty, but will no longer support the GHTM training coordinator in monitoring and evaluating the trainings, as the necessary capacity will have been built.
Warmline: In May 2008, I-TECH launched Warmline, a phone line devoted to expert, up-to-date HIV care and treatment clinical consultations. Since inception, the Warmline has received 337 calls from 48 different ART centers and two CCCs, with 79% of callers being ART and CCC MOs. The Warmline is advertised at all NACO trainings and is a key activity in providing on-going support (identified as priority for in-service trainings per PEPFAR II) to MOs after they complete their training course. In FY10, I-TECH will continue to provide on-going support to MOs and others through continued implementation of the Warmline. In FY10 I-TECH will conduct a rapid distance learning (DL) needs assessment to explore the possibility of implementing DL activities, such as the Warmline, at TC/COEs. Depending on the results of the assessment, the Warmline may then be scaled-up nationally in FY2011.
ACTIVITY 2: CLINICAL MENTORSHIP FOR LAC & CCC MOs
To enhance the quality of comprehensive care to PLHIVs, LAC and CCC MOs will require on-site clinical mentoring in addition to training. In FY10, I-TECH will continue to conduct computerized management (CM) activities for LAC and CCC MOs as a follow on to the four-day training. In FY11, I-TECH will continue these activities, and look to expand CM activities to other COE sites.
ACTIVITY 3: INDIAN NURSE SPECIALISTS IN HIV/AIDS AND ART (INSHAA)
INSHAA is a four-week intensive training program which has didactic, practicum and on-site mentoring components. The course is designed to task shift nurses' roles and responsibilities in ART Centers and CCCs. In FY09, I-TECH developed a draft curriculum for the didactic training and practicum components which are currently under review by NACO, the Indian Nursing Council (INC) and the US Center for Disease Control and Prevention Global AIDS Program (CDC-GAP).
In FY10, I-TECH will conduct a pilot training in Andhra Pradesh. This pilot will include a Training of Trainers model to train potential nurses as INSHAA trainers and mentors in order to support sustainability of the INSHAA program. I-TECH will conduct a comprehensive pilot evaluation to inform future scale-up and determine the effectiveness of training in task-shifting care of HIV patients to INSHAA-trained nurses. After completion of the evaluation the materials will be revised and finalized for dissemination. In FY11, INSHAA will be rolled-out in several high prevalence states. While I-TECH will not be leading this roll-out process, I-TECH is in a unique position to provide TA for implementation of INSHAA.
ACTIVITY 4: HIV FELLOWSHIP PROGRAM
The GHTM/I-TECH HIV Fellowship Program, which was launched in 2005, is an innovative one-year residential clinical and leadership training program jointly sponsored by the Government of Tamil Nadu and CDC-GAP. The program includes daily hands-on HIV patient care at GHTM, didactic afternoon sessions, weekly hospital case presentations, and exposure visits to public health programs, among other diverse training experiences.
Fellowship Year 5: In FY10, I-TECH will continue the fellowship program into year five by recruiting up to 12 physicians. To date, 42 Fellows (three batches) have graduated and seven Fellows are currently in the program. As of May 2008, 62% of fellows from years one and two of the fellowship program were working in HIV/AIDS in various capacities as clinicians, researchers, and managers, contributing to the HRH goals and NACP III priorities. In FY11, I-TECH plans to implement Year 6 of the Fellowship, continuing to optimize the program through ongoing evaluations and continuous quality improvement activities.
Fellowship Accreditation : Lack of accreditation is a major barrier in attracting applicants and ensuring that fellows are able to obtain appropriate placements in HIV programs after completion of the fellowship program. In addition, accreditation of programs has been recognized in PEPFAR II as critical to assure consistency of training, improve the quality of training, and serve as retention initiative for HCPs. In FY10, I-TECH will continue to establish partnerships with local universities, such as Tamil Nadu Dr. MGR Medical University, to obtain university accreditation. If accreditation is obtained in FY2010, this activity will not be continued in FY2011.
Fellowship Program Second Track : In FY2010, I-TECH will conduct a needs assessment for a modified fellowship track. The target cadre for the second track will be physicians who, due to distance or professional obligations, are unable to participate in the year-long fellowship program. The assessment will include collaboration with NACO, COE leadership, and stakeholders to determine identification of training objectives, appropriate program models, and geographic locations for piloting and roll-out of the program. Based on the assessment I-TECH will develop a concept paper for the second track model and advocate for implementation. In FY2011, I-TECH will pilot the second track fellowship at two locations, which would be either TC/COEs or medical colleges.
ACTIVITY 5: HIV/AIDS POCKET GUIDE
In 2005, I-TECH developed the HIV/AIDS Pocket Guide for Physicians that contains the NACO and WHO HIV/AIDS care and treatment guidelines and information on ART, prophylaxis and treatment of common OIs. In FY09, I-TECH began revision of the guide to include the updated NACO guidelines on second line ART. In FY10, I- TECH plans to complete the revision of the HIV/AIDS Pocket Guide, devise a dissemination plan, print 1,000 copies, and release the new version nationally. In FY11, I-TECH will continue to reprint the guide as needed to ensure adequate supply.
The National AIDS Control Organization (NACO) estimates that there are 2.3 million people living with HIV (PLHIV) in India, all of which require care and support services. Under the National AIDS Control Program Phase III (NACP III), NACO is enhancing the role of Community Care Centers (CCCs) to provide monitoring, follow-up, and counseling support to those who are initiated on antiretroviral therapy (ART), positive prevention, drug adherence, and nutrition counseling. NACO is also creating Link ART Centers (LACs) to provide expanded access to HIV care and treatment services, in addition to services provided through the 217 ART Centers. By 2011, NACO plans to have 350 CCCs, 250 ART Centers and approximately 500 LACs.
To support the need for increased capacity among health care providers (HCPs) at these care and treatment centers and to build the capacity of leaders in the field of HIV, I-TECH India aims to train clinicians on key aspects of palliative care, including prevention with positives, opportunistic infection (OI) prophylaxis, treatment, referral, nutrition counseling and psychosocial support. I-TECH India will support the following USG-funded activities: 1) NACO Trainings for HIV and ART center specialists, LAC and CCC medical officers (MOs); 2) clinical mentorship for CCC and LAC MOs; 3) the Indian Nurse Specialists in HIV/AIDS and ART (INSHAA) training program; and 4) an HIV Fellowship Program for physicians.
The Government Hospital of Thoracic Medicine (GHTM) Training Center, which is housed at national Center of Excellence (COE), hosts trainings on behalf of NACO for HIV specialists and ART, LAC, and CCC MOs, with technical support from I-TECH. Since 2004, GHTM and I-TECH have jointly conducted a total of 32 NACO trainings for 720 clinicians including: 20 HIV specialist trainings (546 participants), seven ART MO trainings (104 participants), one ART MO refresher training (11 participants), two LACO MO trainings (52 participants) and one CCC MO training (7 participants).
Curriculum Development: I-TECH developed the NACO ART MO and HIV specialist training curricula, which is now implemented at training centers and COEs nationwide. In FY09, I-TECH developed, piloted and finalized the ART MO refresher course, with support from WHO and USG. In FY10, I-TECH will advocate with NACO to disseminate the ART MO refresher course nationally. As HIV care and treatment is being scaled-up by creating LACs and expanding the role of CCCs, MOs at these facilities will require additional training in monitoring patients on ART, dispensing ART drugs, recognition of side effects identification of drug interactions, ART adherence counseling and referral of complicated cases to ART centers, in addition to care and support topics.
At present the four day LAC and CCC MO trainings are being conducted using a modified version of the two week ART MO curriculum. To ensure that LAC and CCC MOs have the knowledge and skills necessary to carry out their responsibilities and as per PEPFAR II guidelines for HRH in-service trainings, these trainings should be linked to the core competencies of these MO's job description and the resources available at their sites. In FY2009, the NACO COE consultant drafted an outline for the LAC and CCC MO courses. I-TECH will continue to advocate for these courses throughout the year during monthly visits with NACO. In FY2011, I-TECH will provide technical assistance to six TC/COEs in implementing the LAC and CCC MO curricula.
Training : Over time, I-TECH has helped develop the capacity of GHTM in organizing NACO trainings by mentoring the GHTM training coordinator, who is now handling all training logistics. In FY10, I-TECH will continue to build the capacity of the GHTM training coordinator to monitor and evaluate the trainings. I-TECH will also provide resource faculty, including the Fellows, for the NACO trainings at GHTM. During FY10, I-TECH plans to support GHTM in conducting six NACO trainings (120 participants). In FY11, I-TECH will continue to support GHTM by providing resource faculty, but will no longer support the GHTM training coordinator in monitoring and evaluating the trainings, as the necessary capacity will have been built.
Warmline : In May 2008, I-TECH launched the Warmline, a phone line devoted to expert, up-to-date HIV care and treatment clinical consultations. Since inception, the Warmline has received 337 calls from 48 different ART centers and 2 CCCs, with 79% of callers being ART and CCC MOs. The Warmline is advertised at all NACO trainings and is a key activity in providing on-going support (identified as priority for in-service trainings per PEPFAR II) to MOs after they complete their training course. In FY2010, I-TECH will continue to provide on-going support to MOs and others through continued implementation of the Warmline. In FY2010 I-TECH will conduct a rapid distance learning (DL) needs assessment to explore the possibility of implementing DL activities, such as the Warmline, at TC/COEs. Depending on the results of the assessment, the Warmline may then be scaled-up nationally in FY2011.
To enhance the quality of comprehensive care to PLHIVs, LAC and CCC MOs will require on-site clinical mentoring in addition to training. In FY2010, I-TECH will continue to conduct CM activities for LAC and CCC MOs as follow-on to the four-day training. In FY2011, I-TECH will continue these activities, and look to expand CM activities to other COE sites.
INSHAA is a four week intensive training program which has didactic, practicum and on-site mentoring components. The course is designed to task shift nurses' roles and responsibilities in ART centers and CCCs. In FY09, I-TECH developed a draft curriculum for the didactic training and practicum components which is currently under review by NACO, the Indian Nursing Council (INC) and the US Center for Disease Control and Prevention Global AIDS Program (CDC-GAP).
In FY10, I-TECH will conduct a pilot training in Andhra Pradesh. This pilot will include a Training of Trainers model to train potential nurses as INSHAA trainers and mentors in order to support sustainability of the INSHAA program. I-TECH will conduct a comprehensive pilot evaluation to inform future scale-up and determine the effectiveness of training in task-shifting care of HIV patients to INSHAA-trained nurses. After completion of the evaluation the materials will be revised and finalized for dissemination. In FY11, INSHAA will be rolled-out in several high prevalence states. While I-TECH will not be leading this roll-out process, I-TECH is in a unique position to provide technical assistance (TA) for implementation of INSHAA.
Fellowship Year 5: In FY10, I-TECH will continue the fellowship program into year five by recruiting up to 12 physicians. To date, 42 fellows (three batches) have graduated and seven fellows are currently in the program. As of May 2008, 62% of fellows from years one and two of the fellowship program were working in the HIV/AIDS field as clinicians, researchers, and managers, contributing to the human resources for health (HRH) goals and NACP III priorities. In FY11, I-TECH plans to implement year six of the fellowship, continuing to optimize the program through ongoing evaluations and quality improvement activities.
Fellowship Accreditation : Lack of accreditation is a major barrier in attracting applicants and ensuring that fellows are able to obtain appropriate placements in HIV programs after completion of the fellowship program. In addition, accreditation of programs has been recognized in PEPFAR II as critical to assuring consistency of training, improve the quality of training, and serve as retention initiative for HCPs. In FY2010, I-TECH will continue to establish partnerships with local universities, such as Tamil Nadu Dr. MGR Medical University, to obtain university accreditation. If accreditation is obtained in FY2010, this activity will not be continued in FY2011.
Fellowship Program Second Track :In FY2010, I-TECH will conduct an assessment for a modified fellowship track. The target cadre for the second track will be physicians who, due to distance or professional obligations, are unable to participate in the year-long fellowship program. The assessment will include collaboration with NACO, COE leadership, and stakeholders to determine identification of training objectives, appropriate program models, and geographic locations for piloting and roll-out of the program. Based on the findings, I-TECH will develop a concept paper for the second track model and advocate for implementation. In FY2011, I-TECH will pilot the second track fellowship at two locations, which would be either TC/COEs or medical colleges.
In 2005, I-TECH developed the HIV/AIDS Pocket Guide for Physicians that contains the NACO and WHO HIV/AIDS care and treatment guidelines and information on ART, prophylaxis and treatment of common opportunistic infections (OIs). In FY09, I-TECH began revision of the guide to include the updated NACO guidelines on second line ART. In FY10, I- TECH plans to complete the revision of the HIV/AIDS Pocket Guide, devise a dissemination plan, print 1000 copies, and release the new version nationally. In FY11, I-TECH will continue to reprint the guide as needed to ensure adequate supply.he guide as needed to ensure adequate supply.
SUMMARY The National AIDS Control Organization (NACO) estimates that there are 2.3 million people living with HIV (PLHIV) in India, all of which require care and support services. Under the National AIDS Control Program Phase III (NACP III), NACO is enhancing the role of Community Care Centers (CCCs) to provide monitoring, follow-up, and counseling support to those who are initiated on antiretroviral therapy (ART), positive prevention, drug adherence, and nutrition counseling. NACO is also creating Link ART Centers (LACs) to provide expanded access to HIV care and treatment services, in addition to services provided through the 217 ART Centers. By 2011, NACO plans to have 350 CCCs, 250 ART Centers and approximately 500 LACs.
Curriculum Development : I-TECH developed the NACO ART MO and HIV specialist training curricula, which is now implemented at training centers and COEs nationwide. In FY09, I-TECH developed, piloted and finalized the ART MO refresher course, with support from WHO and USG. In FY10, I-TECH will advocate with NACO to disseminate the ART MO refresher course nationally. As HIV care and treatment is being scaled-up by creating LACs and expanding the role of CCCs, MOs at these facilities will require additional training in monitoring patients on ART, dispensing ART drugs, recognition of side effects identification of drug interactions, ART adherence counseling and referral of complicated cases to ART centers, in addition to care and support topics.
Fellowship Year 5 : In FY10, I-TECH will continue the fellowship program into year five by recruiting up to 12 physicians. To date, 42 fellows (three batches) have graduated and seven fellows are currently in the program. As of May 2008, 62% of fellows from years one and two of the fellowship program were working in the HIV/AIDS field as clinicians, researchers, and managers, contributing to the human resources for health (HRH) goals and NACP III priorities. In FY11, I-TECH plans to implement year six of the fellowship, continuing to optimize the program through ongoing evaluations and quality improvement activities.
Fellowship Program Second Track : In FY2010, I-TECH will conduct an assessment for a modified fellowship track. The target cadre for the second track will be physicians who, due to distance or professional obligations, are unable to participate in the year-long fellowship program. The assessment will include collaboration with NACO, COE leadership, and stakeholders to determine identification of training objectives, appropriate program models, and geographic locations for piloting and roll-out of the program. Based on the findings, I-TECH will develop a concept paper for the second track model and advocate for implementation. In FY2011, I-TECH will pilot the second track fellowship at two locations, which would be either TC/COEs or medical colleges.
In 2005, I-TECH developed the HIV/AIDS Pocket Guide for physicians that contains the NACO and WHO HIV/AIDS care and treatment guidelines and information on ART, prophylaxis and treatment of common opportunistic infections (OIs). In FY09, I-TECH began revision of the guide to include the updated NACO guidelines on second line ART. In FY10, I- TECH plans to complete the revision of the HIV/AIDS Pocket Guide, devise a dissemination plan, print 1000 copies, and release the new version nationally. In FY11, I-TECH will continue to reprint the guide as needed to ensure adequate supply.
To support the need for increased capacity among health care providers (HCPs) at these care and treatment centers and to build the capacity of leaders in the field of HIV, I-TECH India aims to train clinicians on key aspects of palliative care, including prevention with positives, opportunistic infection (OI) prophylaxis, treatment, referral, nutrition counseling and psychosocial support. I-TECH India will support the following USG-funded activities: 1) NACO Trainings for HIV and ART center specialists, LAC and CCC medical officers (MOs); 2) clinical mentorship for CCC and LAC MOs; 3) the Indian Nurse Specialists in HIV/AIDS and ART (INSHAA) training program; and 4) an HIV Fellowship Program for physicians
The Government Hospital of Thoracic Medicine (GHTM) Training Center, which is housed at national Center of Excellence (COE), hosts trainings on behalf of NACO for HIV Specialists and ART, LAC, and CCC medical officers (MOs), with technical support from I-TECH. Since 2004, GHTM and I-TECH have jointly conducted a total of 32 NACO trainings for 720 clinicians including: 20 HIV specialist trainings (546 participants), seven ART MO trainings (104 participants), one ART MO refresher training (11 participants), two LACO MO trainings (52 participants) and one CCC MO training (7 participants).
Curriculum Development : I-TECH has already developed the NACO ART MO and HIV specialist training curricula, which is now implemented at training centers and COEs nationwide. In FY2009, I-TECH developed, piloted and finalized the ART MO refresher course, with support from WHO and USG. In FY2010, I-TECH will advocate with NACO to disseminate the ART MO Refresher course nationally. As HIV care and treatment is being scaled-up by creating LACs and expanding the role of CCCs, MOs at these facilities will require additional training in diagnosis and treatment of opportunistic infections (OIs), including TB, provision of psycho-social support and nutrition counseling, and referral for treatment and social services.
At present the four day LAC and CCC MO trainings are being conducted using a modified version of the two week ART MO curriculum. To ensure that LAC and CCC MOs have the knowledge and skills necessary to carry out their responsibilities and as per PEPFAR II guidelines for HRH in-service trainings, these trainings should be linked to the core competencies of these MOs' job description and the resources available at their sites. In FY09, the NACO COE consultant drafted an outline for the LAC and CCC MO courses. I-TECH will continue to advocate for these courses throughout the year during monthly visits with NACO. In FY11, I-TECH will provide technical assistance to six TC/COEs in implementing the LAC and CCC MO curricula.
Training: Over time, I-TECH has helped develop the capacity of GHTM in organizing NACO trainings by mentoring the GHTM training coordinator, who is now handling all training logistics. In FY10, I-TECH will continue to build the capacity of the GHTM training coordinator to monitor and evaluate the trainings. I-TECH will also provide resource faculty, including the Fellows, for the NACO trainings at GHTM. During FY10, I-TECH plans to support GHTM in conducting six NACO trainings (120 participants). In FY11, I-TECH will continue to support GHTM by providing resource faculty, but will no longer support the GHTM training coordinator in monitoring and evaluating the trainings, as the necessary capacity will have been built.
Warmline: In May 2008, I-TECH launched the Warmline, a phone line devoted to expert, up-to-date HIV care and treatment clinical consultations. Since inception, the Warmline has received 337 calls from 48 different ART centers and 2 CCCs, with 79% of callers being ART and CCC MOs. The Warmline is advertised at all NACO trainings and is a key activity in providing on-going support (identified as priority for in-service trainings per PEPFAR II) to MOs after they complete their training course. In FY2010, I-TECH will continue to provide on-going support to MOs and others through continued implementation of the Warmline. In FY2010 I-TECH will conduct a rapid distance learning (DL) needs assessment to explore the possibility of implementing DL activities, such as the Warmline, at TC/COEs. Depending on the results of the assessment, the Warmline may then be scaled-up nationally in FY2011.
Fellowship Accreditation :Lack of accreditation is a major barrier in attracting applicants and ensuring that fellows are able to obtain appropriate placements in HIV programs after completion of the fellowship program. In addition, accreditation of programs has been recognized in PEPFAR II as critical to assuring consistency of training, improve the quality of training, and serve as retention initiative for HCPs. In FY2010, I-TECH will continue to establish partnerships with local universities, such as Tamil Nadu Dr. MGR Medical University, to obtain university accreditation. If accreditation is obtained in FY2010, this activity will not be continued in FY2011.
In 2005, I-TECH developed the HIV/AIDS Pocket Guide for Physicians that contains the NACO and WHO HIV/AIDS care and treatment guidelines and information on ART, prophylaxis and treatment of common opportunistic infections (OIs). In FY09, I-TECH began revision of the guide to include the updated NACO guidelines on second line ART. In FY10, I- TECH plans to complete the revision of the HIV/AIDS Pocket Guide, devise a dissemination plan, print 1000 copies, and release the new version nationally. In FY11, I-TECH will continue to reprint the guide as needed to ensure adequate supply.
To support the National AIDS Control Organization (NACO) priority area of increased capacity on monitoring and evaluation, surveillance and research, the International Training and Education Center on HIV (I-TECH) will continue its collaboration with the Government Hospital of Thoracic Medicine (GHTM) and increase its technical support of the Tamil Nadu State AIDS Control Society (TANSACS). These activities will serve to improve the quality of data provided to state and national HIV/AIDS control organizations requested through the National AIDS Control Program III (NACP III) Evaluation Plan, in addition to providing increased effectiveness of data systems that support patient monitoring, program monitoring and evaluation, programmatic level advocacy, policy development as well as dissemination of findings through mediums such as technical conferences and peer-reviewed journals.
ACTIVITY 1: TB/HIV Information System (T/HIS) Management, Quality Improvement and Operations Research Support to GHTM
In FY10, I-TECH, in collaboration with the State of Tamil Nadu and Government of India, will continue to support and develop the T/HIS, the electronic health management information system at GHTM, India's largest HIV care and treatment facility. 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 T/HIS provides comprehensive, longitudinal patient data to more efficiently provide information on follow-up patient care and outcomes. Collectively, I-TECH's activities ensure high quality data management and ongoing use of the data to improve the quality of care at GHTM, as well as use of the data to inform state and national policies and practices to improve quality of HIV/AIDS care on a larger scale.
In FY2010, I-TECH will provide technical assistance (TA) to oversee the technical and operational management of the T/HIS at GHTM. This TA will be provided through key technical staff (epidemiologist, data-base administer (DBA), statistician). I-TECH, in collaboration with the GHTM management team, will coordinate and supervise these technical personnel to ensure appropriate data collection, analysis, and utilization of this patient database at the hospital by key stakeholders as well as continued system development as per the need of the program.
To facilitate T/HIS quality assurance, as well as data use and dissemination, in FY2010, I-TECH will conduct monthly data quality audits and provide training for 27 T/HIS data entry operators related to accurate data collection and entry into the T/HIS system. I-TECH will also train 20 GHTM clinical staff, 12 I-TECH clinical fellows, and 12 state and national program staff, in utilizing and accessing the T/HIS to develop their skills in data analysis and technical writing. An additional objective of this training is the increased use of the system to improve patient care and decision-making through the analysis, interpretation, and dissemination of patient and population data from the system. To further increase data use and subsequent sustainability of the T/HIS system, I-TECH will facilitate appropriate access to the system for approved analysis that can be used for quality improvement of service provision at GHTM as well as to disseminate programmatically relevant findings.
In FY2010, I-TECH will continue to support the development of on-going operations research and quality improvement activities utilizing the T/HIS by participating in the GHTM Institutional Review Board (IRB), which it successfully helped to develop in FY2008, as well as begin participation with the newly-developed Quality Improvement Technical Working Group at GHTM, which guides operations research and quality improvement activities within GHTM.
These training and technical assistance activities will result in at least two technical papers of publishable quality are being developed in FY2010.
In FY2011, I-TECH will continue its efforts in supporting the GHTM to ensure high quality T/HIS data management and on-going use of the T/HIS data to improve the quality of care at GHTM, as well as use of the data to inform state and national policies and practices to improve quality of HIV/AIDS care on a larger scale.
ACTIVITY 2: Targeted support to Tamil Nadu State AIDS Control Society (TANSACS)
Strategic Information Technical Assistance
TANSACS has requested I-TECH's assistance in building its capacity in strategic information and in conducting training. TANSACS is the nodal agency for HIV program strategic information (i.e. monitoring and evaluation, HMIS, surveillance) in the state of Tamil Nadu. In order to operationalize this mandate, I-TECH has contributed TA to TANSACS for collecting, analyzing, and interpreting program data in the state. Despite significant improvement, several factors have limited the optimal utilization of TANSACS program data. These factors include: limited human resources, limited technical capacity, and the collection of increasingly larger and more complex program data. To date, I-TECH has supported specific activities to address these factors including: technical support to the newly established Strategic Information Management Unit (SIMU) and ongoing TA to their monitoring and evaluation (M&E) officer, TA to establish an operational research funding and coordinating committee (TORCH), and development and implementation of a web-based computerized management information system (CMIS).
In FY2010, I-TECH staff will continue to provide TA to TANSACS to improve appropriate use of program data, including continuation of the above activities. Additional specific activities as requested by TANSACS will include TA to the SIMU to build institutional capacity in: program data management, analysis, and interpretation; statistical support; and program evaluation design and implementation. It is expected that such support will result in a sustained culture of appropriate data use and dissemination by TANSACS, a key priority area under NACPIII. In FY2011, I-TECH will continue support and technical assistance to TANSACS and SIMU as requested. In FY2011, I-TECH will continue to provide TA to TANSACS, increasingly building capacity of staff to ensure sustainability.
Under the National AIDS Control Program Phase III (NACP III), the National AIDS Control Organization (NACO) is expanding provision of care, support and treatment by increasing the number antiretroviral (ART) Centers and Community Care Centers (CCCs); enhancing the role of CCCs in providing monitoring, follow-up, and counseling support to ART patients; creating a new type of facility called Link ART Centers (LACs). By 2011, NACO plans to have 350 CCCs, 250 ART Centers and approximately 500 LACs.
To develop the human resources for health (HRH) needed to support this expansion, NACO plans to designate seven additional Training Centers and Centers of Excellence (TC/COEs) to complement the existing 13. To support the current TC/COEs and the expansion of new TC/COEs, I-TECH will support the following USG-funded activities: 1) COE development and 2) support to GHTM and other partner organizations on: a) infection control, b) coordination and implementation of training programs, and c) quality improvement and evaluation.
ACTIVITY 1: Center of Excellence Development
In FY2009, I-TECH supported 13 existing TC/COEs through provision of a NACO Consultant who, by the end of FY2009, will have developed TC/COE core capacities based on NACO guidelines and completed an overall needs assessment at the 13 TC/COEs. Based on I-TECH's experience supporting GHTM as a COE, I-TECH will develop a comprehensive plan to build the capacity of the TC/COEs in India and to improve infrastructure to increase training capacity.
Training TC/COE Staff: In FY2010, I-TECH will conduct a training needs assessment (TNA) for each TC/COE. As the TNAs for each COE are completed, I-TECH will work closely with each TC/COE to develop a comprehensive training plan for TC/COE staff and begin HIV trainings with the goal of making each institution a more effective support mechanism for the ART, LAC and CCCs in the region. In FY2011, I-TECH will complete the TNAs for the 13 existing TC/COEs and conduct additional assessments for TC/COEs as they are established. I-TECH will also continue to develop training plans with TC/COEs as the TNAs are completed, finalize plans for the 13 TC/COEs by the end of FY11 and begin training of staff.
Distance Learning (DL) Assessment: DL is a powerful tool in providing ongoing training and support to improve the HIV-related knowledge and skills of the healthcare providers (HCPs). Globally, I-TECH supports DL activities in nine countries and is implementing a biweekly web-based HIV/AIDS Clinical Seminar Series (www.globalhivlearning.org) with an average of 86 participants from around the world. I-TECH previously conducted similar DL needs assessments in Tanzania, Mozambique and Trinidad and Tobago. I-TECH will conduct a rapid DL needs assessment at the TC/COEs in FY2010 which will: 1) Explore various DL methods (web-based seminar and courses, telemedicine, and Warmline) to determine which method(s) provide the type of support needed by HCPs and 2) assess capacity of the TC/COEs to create, implement and support DL programs. I-TECH will disseminate findings and hold discussions with stakeholders to determine a plan for DL. At the request of NACO, I-TECH will also explore implementation of a clinical seminar series similar to the I-TECH HIV/AIDS Clinical Seminar Series. In FY11, I-TECH plans to provide technical assistance (TA) to NACO in implementing additional DL technologies as identified by the assessment.
NACO Consultants: In FY2010 and FY2011, I-TECH will support three NACO consultants: a lead clinical consultant, a deputy clinical consultant, and a training coordinator. In FY2010, the lead and deputy clinical consultants will utilize the findings of the TC/COE overall needs assessments in FY2009 to develop a capacity building plan for the TC/COEs. The lead clinical consultant will also coordinate with national and local stakeholders, including NACO, state AIDS control societies (SACS), Center for Disease Control Global AIDS Program (CDC-GAP), TC/COE leadership, and people living with HIV/AIDS (PLHIV) networks to create a research agenda for the 13 TC/COEs and document best practices of the national ART program, and serve as a resource person for NACO trainings at the TC/COEs. The deputy clinical consultant will primarily be responsible for providing on-going TA for the TC/COEs in implementing their capacity building plans.
Based on the NACP III guidance and the capacity building plans, the training coordinator will work with SACS and TC/COE training coordinators to develop a national training schedule and provide TA as trainings are implemented. This TA will include assistance in: training schedule preparation, identification of resource persons, review of training reports, and sharing of best practices/lessons learned. The training coordinator will also provide national-level monitoring of progress towards NACP III goals in ensuring that HCPs are adequately trained to provide high quality clinical care.
In FY2011, the lead clinical consultant will continue to support TC/COEs in creating research agendas, documenting the best practices and study results, and publication; the deputy clinical consultant will continue to provide on-going TA for the TC/COEs, and the training coordinator will continue to support the implementation of the national training schedule by providing TA to SACS and TC/COE training coordinators.
ACTIVITY 2: GHTM SYSTEMS STRENGTHENING
Clinical Support: At GHTM I-TECH's strategy has been to develop innovative approaches for strengthening health systems and directly contribute in improved quality of care for HIV patients. I-TECH India has initiated Clinical Society Meetings (CSMs) for physicians and nurses, a Hospital Infection Control Committee (HICC) and sanitary rounds which have become institutionalized at GHTM. In FY2010, I-TECH will continue to support GHTM in these activities and continue to be an active member of the State AIDS Clinical Expert Panel (SACEP) which determines patient qualification for second line ART.
T/HIS Management, Quality Improvement, and Operations Research : In FY2010, I-TECH, in collaboration with the State of Tamil Nadu and Government of India, will continue to support the electronic TB/HIV Information System (T/HIS) health management information system at GHTM. I-TECH's activities will ensure high quality data management and on-going data use to improve the quality of care at GHTM, and use of the data to inform state and national policies and practices to improve the quality of HIV/AIDS care.
To further support the development of operations research (OR) and quality improvement (QI) activities utilizing the T/HIS, I-TECH will continue to support the GHTM Institutional Review Board and participate in the new QI Technical Working Group at GHTM. These activities will result in at least two technical papers of publishable quality in FY2010. In FY2011, I-TECH will continue its efforts in supporting the GHTM to ensure high quality T/HIS data management and ongoing data use.
ACTIVITY 3: TA TO TAMIL NADU STATE AIDS CONTROL SOCIETY (TANSACS)
Secundment of Training Manager : In coordination with TANSACS, in FY2010, I-TECH India will help to recruit and second a Training Manager to TANSACS who will coordinate training for ART, CCC, and Drop-In Center teams; prepare training schedules; design training programs for ORWs; conduct needs assessments and evaluations; and assess the quality of the training programs conducted. It is envisioned that I-TECH will provide the coordinating mechanism for the second, but the Training Manager will be report programmatically to TNSACS. I-TECH will continue to provide this level of support in FY2011.
ACTIVITY 4: Nurses Infection Control and Education (NICE)
The NICE training package addresses biomedical waste management and infection control measures as described in NACP III. It is designed to train nurses in infection control practices and empower them to advocate for changes that increase workplace safety through consistent implementation of standard precautions.
In FY09, I-TECH completed and disseminated the NICE training package and conducted trainings for 114 nurses at GHTM. In FY10, I-TECH will provide TA in rolling out NICE at Rural Development Trust (RDT) and Bel Air hospitals using a Training of Trainers (TOT) model for sustainability. At least 12 nurse leaders will receive TOT training and will train at least 50 staff nurses at their institutions (100 total). In FYII both organizations will assume responsibility after full capacity development and thus this will be a discontinued activity.
ACTIVITY 5: Infection Control Training for RDT support staff
NACP III recognizes that IC policies and standard precautions play a vital role in preventing hospital-acquired infections. It is imperative that all HCPs are oriented and trained in these areas. In FY2010, I-TECH will carry out a needs assessment at RDT to study the current IC systems and practices and to understand the knowledge and attitudes of support staff concerning IC practices and policies. The data collected in this assessment will be used to develop recommendations for improving IC at the facility, including a capacity building plan for support staff which I-TECH will then implement.
ACTIVITY 6: Organizational Capacity Building
As the HIV epidemic and response to it matures, there is increasing recognition by NACO, SACs, and NGOs for the need to support capacity development in non-clinical HIV/AIDS program areas and systems such as: program monitoring and evaluation, training development, and program management.
FY10 I-TECH will be responsive to requests for a series of non-clinical workshops to support health systems strengthening activities. The primary target for these workshops will be government partners with subsequent consideration for key NGOs. Some specific workshop topic areas that have been developed to date include: curriculum development, training program development and implementation, scientific writing and communication, and practical and appropriate monitoring and evaluation of training programs. Additional topic areas may be developed based on the needs of partner agencies. In FY2010, I-TECH will focus these activities in Tamil Nadu and Andhra Pradesh, two of the high HIV-burden states in India. In FY11, I-TECH will expand these activities to additional high-burden states.
Tuberculosis (TB) is a serious public health problem in India with over 1 million cases of TB reported annually, accounting for nearly one third of the global TB burden. There is considerable overlap of the TB and HIV epidemics in India. Active TB disease is the most common opportunistic infection (OI) in people living with HIV/AIDS (PLHIV). Each year, 230,000 PLHIVs (10%) will have an episode of TB. Controlling this dual epidemic remains a major challenge for the country, and requires capacity building among health care providers (HCPs). Under the National AIDS Control Program Phase III (NACP III) the National AIDS Control Program (NACO) is expanding the number of facilities that will provide HIV related services, which include TB screening, diagnosis and treatment. In addition to expanding the number of Community Care Centers (CCCs) and antiretroviral therapy (ART) Centers, NACO is creating Link ART Centers (LACs) to decentralize provision of ART. By 2011, NACO plans to have 350 CCCs, 250 ART Centers and approximately 500 LACs.
In order to support the scale-up of TB services, as part of a comprehensive HIV care and treatment package, I-TECH will provide training and mentoring for HCPs in early recognition of signs and symptoms, diagnosis and treatment of TB. The specific target populations are physicians and nurses.
Curriculum Development: I-TECH has already developed the NACO ART MO and HIV specialist training curricula, which is now implemented at training centers and COEs nationwide. In FY2009, I-TECH developed, piloted and finalized the ART MO refresher course, with support from WHO and USG. In FY2010, I-TECH will advocate with NACO to disseminate the ART MO Refresher course nationally. As HIV care and treatment is being scaled-up by creating LACs and expanding the role of CCCs, MOs at these facilities will require additional training in diagnosis and treatment of opportunistic infections (OIs), including TB, provision of psycho-social support and nutrition counseling, and referral for treatment and social services.
INSHAA is a four week intensive training program which has didactic, practicum and on-site mentoring components. The course is designed to task shift nurses' roles and responsibilities in
ART centers and CCCs. In FY09, I-TECH developed a draft curriculum for the didactic training and practicum components which is currently under review by NACO, the Indian Nursing Council (INC) and the US Center for Disease Control and Prevention Global AIDS Program (CDC-GAP).
Fellowship Accreditation: Lack of accreditation is a major barrier in attracting applicants and ensuring that fellows are able to obtain appropriate placements in HIV programs after completion of the fellowship program. In addition, accreditation of programs has been recognized in PEPFAR II as critical to assuring consistency of training, improve the quality of training, and serve as retention initiative for HCPs. In FY2010, I-TECH will continue to establish partnerships with local universities, such as Tamil Nadu Dr. MGR Medical University, to obtain university accreditation. If accreditation is obtained in FY2010, this activity will not be continued in FY2011.
