GOAL 1: STRENGTHENED NATIONAL CAPACITY

ICAP will engage national-level MOHSW stakeholders and provide support to strategically plan, implement, and evaluate TB and HIV prevention, diagnostic, care and treatment programs. Specifically, ICAP will actively participate in and engage TWGs and planning bodies to support development, dissemination, and implementation of TB/HIV and related policy, guidelines, registers, and tools. Emphasis will mostly be placed on operationalization and implementation, as TB related plans and strategies already exist at national level. ICAP will support the development of more advanced guidelines such as latent TB infection and TB adherence and community follow-up as well as more general lab, IC and ACSM plans and policies which do not exist. Priority focus areas will include fostering an enabling and collaborative environment between the NTP and HIV/AIDS Directorate to ensure TB/HIV integration and thus decrease the TB burden for PLHIV (through intensified case finding, IPT, and IC) and the HIV burden for TB patients (through HIV prevention and testing, CPT, and HIVC&T services). Furthermore, the MOHSW will be supported to implement a high-quality DOTS program as well as strengthened TB lab networks and to sustainably expand M/XDR-TB services (DOTS-Plus), revitalizing IC implementation at facility and community levels (especially as renovations are planned through MCC5 and other funding).

GOAL 2: COMPREHENSIVE AND QUALITY DISTRICT-WIDE TB SERVICE

Following MOHSW plans and guidelines, ICAP will support the DHMTs to strengthen TB/HIV service delivery. Emphasis will be placed on providing TA and training to DHMTs to improve TB/HIV service integration, with support for HIVC&T services to enhance intensified TB case finding, administer IPT for all eligible PLHIV, ensure successful initiation and completion of TB treatment and implement IC practices; and support to TB services to offer routine HIV testing to all TB cases, and enrollment of PLHIV with TB on CPT and if eligible ART. Under the guidance of the MOHSW, ICAP will collaborate with other partners to build DHMT management capacity and skills through training, mentoring, modeling, and district twinning.

GOAL 3: EFFECTIVE TB LABORATORY NETWORK

ICAP will support the MOHSW to implement the Laboratory Services Strategic Plan in collaboration with CDC, Association of Public Health Laboratories (APHL), FIND, PIH and other partners. Specifically, ICAP will provide support to strengthen microscopy services in high TB case load district hospitals and enhance the facilitynetwork sample transportation system.

GOAL 4: COMMUNITY MOBILIZATION

Meaningful involvement of the community in developing, implementing, and monitoring TB and HIV activities is the cornerstone to reduce its burden and implement successful local TB- and HIV-related services. Key activities will include emphasizing the value and modes of HIV and TB prevention; enhancing TB and HIV literacy; promoting demand for high-quality TB and HIV health services; destigmatizing TB and HIV and clarifying misinformation; and improving TB and HIV prevention skills and self-efficacy. Key stakeholders will be engaged in these activities to assess priority needs and campaign design as part of the larger ACSM strategy ICAP will support the MOHSW to develop.

VHWs, vital health facilitiescommunity links, will be trained and supported regularly by ICAP and MOHSW to follow up with high-risk patients in support of HIV and TB treatment, adherence, and care in the household. They will also conduct community IEC activities and home visits for pregnant woman, infants, newly diagnosed PLHIV with TB, those starting ART, and all TB and ART patients who miss appointments. In addition, VHWs will assess homes of M/XDR-TB patients discharged to the community, noting IC issues and vulnerabilities of household members (e.g. children, PLHIV); and will provide education on TB transmission, signs and symptoms, and IC.

Strategic Information

ICAP will conduct high-quality, timely, and sustainable monitoring and evaluation of project activities consistent with the Three Ones principles, ensuring that information is used for program improvement by supporting the routine collection, analysis, use, and dissemination of data using national registers and forms that assess program progress, quality, and impact. ICAP will support the MOHSW to implement and institutionalize the ETR.net electronic database to capture identifier-delinked patient-based information at district level directly from paper TB registers; to generate standard cohort reports, line listings, and data quality checks reflecting the DOTS strategy and enabling routine TB-program surveillance and M&E.

With FY11 funds, ICAP will build on the already established relationship with MOHSW to assist in strengthening human resource capacity and information systems in order to improve TB/HIV integration data quality, and the data flow from health facility or community to district and national level in a timely manner for use and decision making at all levels. Additionally, by leveraging other Development Partners investments and working in close collaboration with MOHSW, Ministry of Local Government and Chieftainship and other relevant key ministries and local organizations, ICAP will contribute to the monitoring and evaluation of the Partnership Framework's TB/HIV objective and to the transition from PEPFAR-specific reporting systems to strengthened, GOL-owned systems.

ICAP will work closely with the MOHSW to implement systems to routinely ensure and assess data quality. High-quality services will be achieved by intensively mentoring health facility (HF) staff and implementing SOC tools. Trainings and workshops will be conducted to enhance HF capacity to document, collect, analyze, report, and feedback data to improve services; supporting MOHSW establishment and enhancement of routine surveillance and M&E systems at facility, lab, and community level to track program outputs and implementation of systematic methods to gather strategic information for program planning, evaluation, and progress measurement. ICAP uses a Program and Facility Characteristics Tracking System (PFACTS) that systematically collects facility- , lab- and program-level information (e.g., location, provider-client ratio, specific services provided, etc.). The data will be used for strategic planning and program evaluation. ICAP-Lesotho will also support the MOHSW to implement a Data Quality Improvement Tool to identify and correct HF-level data problems. Finally, careful attention will be given to data confidentiality and security via the use of training, password-protected databases and locked files.

Human Resource capacity and Sustainability

ICAP's concept of TA is built upon the process of Clinical Systems Mentorship (CSM), a re-conceptualization of traditional clinical mentorship aimed at establishing a model for high-quality care, which is characterized by comprehensive continuity care, a focus on the family and community, attention to high-quality patient follow-up, and coordination of services within/between a health facility CSM strengthens the individual health care worker (HCW), the MDT, district supervisory bodies, and health-care systems. Grounded in continuous data-driven assessment to ensure the effectiveness of support activities, the approach explicitly targets health-service delivery challenges. ICAP's portfolio of CSM support tools ranges from participatory site assessments, standards of care (SOCs) toolkits, job aids, patient-flow analysis materials, questionnaires, and checklists. ICAP will support the INCI in Lesotho to improve in service nurse training and mentorship.

ICAP will support the MOHSW to implement the Laboratory Services Strategic Plan in collaboration with CDC, Association of Public Health Laboratories (APHL), FIND, PIH and other partners. Specifically, ICAP will provide support to strengthen microscopy services in high TB case load district hospitals and enhance the facilitynetwork sample transportation system. The MOHSW will be supported to implement a high-quality DOTS program as well as strengthened TB lab networks.

ICAP will work closely with the MOHSW to develop a comprehensive CME program to keep HCWs updated on IC and TB/HIV clinical and diagnostic services

Columbia University-ICAP will aim to accelerate effective scale-up of TB- and HIV-health systems and will meet targets while sustainably building indigenous capacity. ICAP will support human resources, training, infrastructure, and the introduction of clinical, lab, community and M&E activities will be prioritized to strengthen TB-HIV actives.

In FY10, ICAP will support all 10 districts, however, at HF level; ICAP will provide support in a phased manner. Within the currently supported four districts and 31 HF, ICAP will broaden its ongoing HIV support to include TB and lab activities. In the new districts ICAP, will support eight hospitals, six labs, and 12 HCs, for a total 57 HFs (15 hospitals and 42 HCs).

ICAP will pay special attention to TB/HIV co-infected migrant workers. It will support the MOHSW at national, district, facility as well as community level with the implementation of routine TB screening among miners and their family. Adherence and psychosocial support (APS) in migrant workers on TB and/or HIV treatment will be strengthened in order to reduce defaulter rates. Other APS activities include strengthening the continuum of TB/HIV care for mine workers in their communities in Lesotho by training and supporting community health workers. As mine workers enter Lesotho through various border posts throughout the country, generally during month-end and holiday seasons, community health workers and APS Officers will provide TB-related information and referrals to health facilities within their respective communities. At national level ICAP will support MOHSW of Lesotho with the establishment of bi-national information and administrative system (including standardized paper-based medical records) to support continuity in TB prevention, diagnosis, treatment and care for migrant workers and their families.

ICAP will ensure delivery and uptake of appropriate, high-quality TB/HIV services; and to support the achievement of the GOL's National DOTS Expansion Strategic Plan (20082012), and the National HIV and AIDS Strategic Plan (20082011). ICAP will also support the MOHSW on all related policy issues, including strategic decision making to improve the accelerated rollout of TB/HIV services.

ICAP will continue to strengthen collaborations with the following organizations in the areas of TB/HIV: PEPFAR-funded partners, Quality Assurance M2M, Human Capacity Project, Infant and Young Child Nutrition) and other stakeholders including Clinton Foundation, Baylor International Pediatric AIDS Initiative, Partners in Health, UNICEF and WHO.

ICAP will support the MOHSW to implement and institutionalize the ETR.net electronic database to capture identifier-delinked patient-based information at district level directly from paper TB registers; to generate standard cohort reports, line listings, and data quality checks reflecting the DOTS strategy and enabling routine TB-program surveillance and M&E.