Summary

With FY 2008 funding, the International Training and Education Center on HIV (I-TECH) Technical Advisor

for Training, in collaboration with Lighthouse (LH), will play a key role in the development of systems of

training, supervision, and mentoring of CT staff at both Lighthouse and Ministry of Health (MoH). Activities

of the Training Advisor also relate to activities in PMTCT, Other Health Policy/Systems Strengthening, and

HIV Treatment/ARV services. Activities are identified and driven by the Lighthouse Trust and in

collaboration with the MoH. I-TECH provides technical assistance (TA) to Lighthouse through the placement

of the Technical Advisor for Training.

In 2007, the I-TECH Training Advisor played a major role in revising a 5-week HIV Counseling and Testing

training to a 3-week training on behalf of the MoH. The training advisor was responsible for leading a Work

Group through this intensive process, including pilot testing and evaluation of the revised CT curriculum. In

2008, monitoring and evaluation (M and E) of this curriculum will continue using FY 2007 Emergency Plan

funds. Minor updates are also expected before the curriculum is finalized in early 2008. The curriculum

includes key components of TB screening for HIV+ individuals and PMTCT protocols and referral. The

primary target populations are nurses, counselors, home-based care nurses, and other health care staff.

The I-TECH Training Advisor provides TA to Lighthouse nurses, counselors, home-based care nurses, and

other health care staff assisting them to improve group education skills. The Advisor also responds to the

training needs of the MoH and provides training and curriculum revision on behalf of the MoH. Activities

include: mentoring, training, curriculum revision, quality improvement, and supportive supervision.

In 2007, Lighthouse and the I-TECH Training Advisor were charged with the task of leading the revision of

Malawi's national counseling and testing curriculum alongside the Ministry of Health. The central

accomplishments were facilitating a successful curriculum re-design workshop in February and re-designing

the curriculum in preparation for the pilot in March. The positive feedback from MoH, participants in the

workshop suggested that the workshop and subsequent revisions were successful. These two outputs

were accomplished within 4 weeks time. In early April, results from the pilot training were compiled and

revisions to the curriculum were made based on feedback from: participants, facilitators, observers, and

outcome indicators (i.e. pre and post test). Revisions were completed in May and a 2.5 day TOT workshop

was conducted with 60 HTC trainers (30 in Lilongwe and 30 in Blantyre). I-TECH Training Advisor planned

and facilitated the TOT in Lilongwe.

Activity 1: Human Capacity Development in Training for Counseling and Testing

In collaboration with Lighthouse, the I-TECH training advisor will contribute to the development and revision

of sustainable systems and materials to improve national HIV Testing and Counseling (HTC) mentoring and

supervision at 300 HTC sites throughout Malawi. The I-TECH Training Advisor works with Lighthouse staff

to build overall training capacity of the institution. Therefore, when projects are implemented, it is difficult to

separate Lighthouse contributions from I-TECH's contributions, as the Advisor coaches, encourages and

supports Lighthouse counterparts to build the capacity of other Lighthouse and MoH staff.

This will include the development of a mentoring skills curriculum, review of monitoring systems, and focus

on outputs of the mentoring. In 2008, the I-TECH Training Advisor and Lighthouse counterparts will make

significant improvements to the "cascade" approach, where LH mentors outstanding site counselors how to

mentor others at their site. The Training Advisor also contributes to planning and scale-up through a

National-level HTC mentoring Work Group. LH will build the understanding that sharing counseling skills

and experience through observed practice and mentorship is a natural and essential part of a counseling

service. Both mentoring and supervision programs will focus on 1) developing capacity for provider initiated

counseling and testing; 2) working with TB Officers and clinicians to ensure that appropriate routine referrals

for CT are made; and 3) refining counseling protocols to improve consistency of message and efficiency.

Mentoring/training may include curriculum update and revision, training of HCT trainers, and leading and

evaluating training of trainers (TOT's) workshops. The primary target populations are nurses, counselors,

home-based care nurses, and other health care staff. The outcome of this activity will be of benefit and

relevance to both men and women in the general population.

Summary

In FY 2008, the USG proposes to fully fund a new clinical support team to assist the HIV Unit of the MoH

with the expansion of HIV/AIDS treatment services in the country. The team will comprise of an expatriate

Senior Technical Assistant (TA) and two Malawian Staff Fellows as counterparts. The team will be housed

at the MoH. The Staff Fellowship program is intended to attract Malawians into a mentorship program to

help address concerns of the MoH regarding sustainability of this very successful HIV/AIDS treatment

program. The new team will directly support the MoH's aspiration of expanding ARV treatment services

from the current 114,375 patients started on ARV treatment as of June 2007 to 250,000 patients by 2010.

Specifically, their functions will involve, but not be limited to coordinating: provider-initiated HIV counseling

and testing in the context of care; ARV treatment for adults, pregnant women, and children; adverse drug

effects monitoring; drug regimen changes and switching to second line drugs; management of TB/HIV co-

infection; OI management (including prophylaxis); palliative care (including home-based care); and

monitoring and evaluation (M&E) of the clinical outcomes of care and treatment. Additional details of the

new model in terms of the duration of support and remuneration of the Staff Fellows is being negotiated.

The new clinical team will be working very closely with the USG Medical Officer (HTXS ID# 15422) to

ensure appropriate and timely support from the EP team.

Background

Over the past four years, the USG recruited and placed a Senior Technical Assistant (TA) within the HIV

Unit of the Ministry of Health (MoH). This TA has overseen the expansion of HIV/AIDS treatment services

from a mere 4000 patients at nine sites in December 2003 to more than 114,375 patients ever started on

ART in 146 public and private sector facilities by June 2007. Currently, 69.4% of the patients who ever

started treatment are alive and continuing their treatment. The TA has coordinated the training of service

providers in all treatment sites, led a team of on-site supervisors on a regular quarterly basis, collated data

from all the sites, and produced a comprehensive report of progress every three months. This is a

remarkable achievement considering that patient identification was based on WHO clinical staging and

patient monitoring was based on clinical presentation. In spite of these successes, the MoH has expressed

some concerns about the lack of adequate complementary Malawian staff in leadership roles to ensure

sustainability of this effort. The current contract for the TA expires in March 2008 and a new model for

providing assistance is being considered.

Activity 1. Recruitment and placement of an Expatriate Senior Technical Assistant to assist the MoH with

the expansion of ART Services

USG will work with MoH and HHS/HRSA/I-TECH to identify a suitable candidate for the senior Technical

Advisor position. This Senior Technical Assistant will be placed within the HIV Unit of the MoH and report

directly to the HIV Unit Director. The responsibilities of the Senior Technical Assistant will be divided equally

between oversight for the expansion of ART services and training, supervision, as well as mentoring the

senior leadership team of the HIV Unit including the Malawian Staff Fellow counterparts.

Activity 2. Recruitment and Placement of Malawian Staff Fellow Counterparts

USG will work with MoH to identify two suitably qualified Malawian counterparts that will be recruited under

a newly proposed Staff Fellowship program and placed in the HIV Unit of the MoH. The Staff Fellows will be

supervised by the Senior Technical Assistant under the overall leadership and direction of the HIV Unit

Director. The plan is for these positions to transition into MoH permanent staff within two years. The

Ministry anticipates that length of time is needed to obtain permanent positions for the fellows.

Activity 3. Resource and on-site Support Supervision

This new clinical team will bring additional technical expertise and expand the capabilities of the HIV Unit.

Additionally, they will be a resource to all other ARV service providers through training and on-site support

supervision. They will oversee the collection and collation of valuable data on the expansion of ARV

services and ensure the quality of the services as programs expand. The team will work with others in the

HIV Unit to prepare long-term plans, annual work-plans, 6-monthly reports, and other ad hoc reports on the

state of scaling up and performance of the ART support services and operations research. The Unit will

ensure timely dissemination of reports and updated guidance.

Summary

In FY 2008, Lighthouse plans to continue its work on building the capacity of clinicians, nurses, and others

in ART management. Special emphasis will be placed on training key Lighthouse staff and trainers on

training curriculum development and dissemination for care givers. The initial beneficiaries will be students

of the clinical attachment program and new Lighthouse staff. Lighthouse will expand the curriculum to

include pediatric treatment and care as well as the management of TB/HIV co-infection.

Background

Since 2005, I-TECH using USG resources has provided a full-time Training Advisor to the Lighthouse Trust

to support ARV scale-up and increase capacity of clinical staff in the provision of HIV services. In

collaboration with the Lighthouse staff and the I-TECH M&E Advisor, the Training Advisor has played an

important role in building capacity for HIV treatment care and support. Training of Lighthouse healthcare

workers (HCW) has included various strategies ranging from formal classroom training to learner-driven

mentoring. In previous years, the Training Advisor provided direct support to the training attachment

program for ART management. After formal training of nurses and clinical officers, graduates were sent to

Lighthouse on a clinical attachment. For a period of 2 weeks nurses and clinical officers from different parts

of the country work with, and are mentored by Lighthouse staff who have experience managing AIDS

patients. This program was developed at the Lighthouse and rolled out nationwide. It emphasized the

importance of management of OIs especially TB in parallel with building skills in ART delivery.

In the new role of Lighthouse as an MoH designated Center-of-Excellence for AIDS patient management it

was important that staff acquire the skills of scientific information dissemination. This involved developing

staff skills at distilling complex scientific information into communication messages for academics, clinical

and nursing staff, and the general public. In 2006/7, the Training Advisor worked with the Lighthouse nurses

to write and submit 4 abstracts centering on findings associated with the various departments of Lighthouse,

including Home Based Care, Day Care Ward, the Nursing Empowerment Project, and Adherence to the

National Conference for the Association of Nurses in AIDS Care.

The priority activities for FY 2008 will include :

Activity 1: Human Capacity Development in ART Management and Distribution (Continuation Activity and

Expansion).

This training activity will support the implementation of the revised ART guidelines and efforts to increase

pediatric treatment. In FY 2008, Lighthouse will continue its work to build the capacity of clinicians, nurses,

and others in ART management and distribution. The Training Advisor will assist in planning and support

for the ART mentoring program for both newly recruited Lighthouse staff and staff sent on attachment

programs to Lighthouse. The training advisor will design, pilot, and evaluate training of healthcare workers

in the treatment of HIV/AIDS. The Training Advisor will contribute to the appropriate design and

implementation of new programs that are intended to scale up the provision of HIV treatment services at the

Lighthouse. Capacity development in this area includes effective communication and dissemination of

information and best practices to other Health Care Workers (HCWs), the MoH, and the public. Also,

ongoing support is provided to build capacity of the nurses and counselors at Lighthouse to provide high

quality ART for adults and children.

If funds are available, opportunities will be sought for Lighthouse staff to share their knowledge and

expertise in ART delivery as well as learn new skills from their peers through participation in international

and domestic meetings and conferences.

Activity 2: National Capacity Development: HIV/TB (Expansion Activity)

This activity is to develop ways to harmonize TB and HIV services for co-infected clients at Lighthouse

clinics for treatment. The I-TECH Training Advisor will work with other Lighthouse staff to assist the MoH in

integrating training strategies as they develop a national TB/HIV 5-year scale-up plan. This should include

classroom training, attachments, mentoring, and supervision as appropriate. The Lighthouse will provide the

venue for piloting this effort.

Summary

This activity will support national Monitoring and Evaluation efforts through the recruitment, placement, and

training of an M and E Unit within the Ministry of Health's HIV and AIDS Unit. The proposed M and E Unit

will comprise a senior M and E Technical Advisor and two local counterparts.

Background

HIV services are rapidly scaling up in Malawi and with the scale-up in services, the need for strong

monitoring and evaluation of the response is critical. Data are needed to monitor site performance, guide

policy development, and for quantification and forecasting of drug and commodity needs.

Though the Health Management Information Unit (HMIU) has the overall mandate for monitoring of the

SWAp and Program of Work within MoH, the HIV/AIDS Unit currently has considerable M and E needs that

the HMIU does not have capacity in place to support.

Placement of additional staff and resources for M and E within the Ministry of Health would greatly

strengthen coordination and leadership for M and E within the HIV/AIDS Unit as well as HMIU to more

actively work with implementing partners on M and E issues. The team would have the capacity to take on

limited but focused M and E implementation roles, e.g. routine data collection and reporting, monitoring HIV-

related training programs in the Unit, and drug and commodity quantification and forecasting.

Key M and E related needs were identified through discussions with various programs within the Ministry of

Health. Placement of additional M and E resources within the various Units could begin to address the

following:

• Provide overall leadership and coordination to M and E activities

• Development and Revision of M and E Tools (e.g. registers)

• Data Management and Reporting of Routine Service Delivery Data

• Supervision of Service Delivery Sites (Data Collection and Quality Assurance)

• Data Management of Routine Training Data

• Quantification and Forecasting of drugs and other commodities

• Design, Conduct and/or Disseminate Operational Research

• Informatics/Serve as internal point person for the ART EDS.

• Liaise with programs within MoH and provide technical assistance on M and E and operations research

activities

• Serve as the point person on M and E issues for the Unit for other Units within MoH (HMIU), NAC, and

external technical and development partners

Activity 1: National Monitoring and Evaluation of HIV Services

I-TECH will support national monitoring and evaluation of HIV services by providing technical assistance to

the Ministry of Health through the recruitment and placement of a senior M and E Technical Advisor and two

locally recruited M and E Officers at the HIV/AIDS Unit at the MoH. This is a new activity for 2008. Although

the Health Management Information Unit (HMIU) has the overall mandate for monitoring of the SWAp

(Health Sector Wide Approach) and Program of Work within MoH, the HIV/AIDS Unit currently has

considerable M and E needs that the HMIU does not have capacity in place to support. This newly formed

Unit will be responsible for monitoring site performance, and disseminating information relevant to policy

development, quantification and forecasting of drug and commodity needs, and other areas. The team will

support limited and focused M and E implementation roles, e.g. routine data collection and reporting,

monitoring HIV-related training programs in the Unit, operational research and drug and commodity

quantification and forecasting. I-TECH will collaborate with other implementing partners, including the LH,

to continue to support the MoH, but with greater coordination and leadership provided from the Unit.

I-TECH is prepared to provide the necessary support, professional development opportunities, and IT-

related operations and infrastructure for routine data collection. Resources will be offered including

networking, database development, long-distance consultation, and other necessary resources such as

computers, software, communication technologies, sponsorship of the senior Technical Advisor and his/her

local counterparts at major conferences and meetings, and a vehicle for meetings and quarterly ARV site

supervision. As part of I-TECH's global team of M and E Technical Advisors, the MoH M and E Advisor will

have extensive tested resources to draw from in heath services monitoring and quality improvement.

Summary

I-TECH will work in Human Capacity Development in Monitoring and Evaluation (M and E) of Clinical

Services by placing a Technical Advisor at the Lighthouse Clinic. I-TECH will work at developing an

effective referral system for HIV-positive TB patients and pregnant women with low CD4-counts to ART, and

will provide mentoring support in M and E to 104 ARV clinics. I-TECH will provide technical expertise to the

Electronic Data System Task Force on the development and launch of a pilot electronic data system for

monitoring the national ART program, and will provide technical assistance in establishing M and E

functions in the MoH's HIV/AIDS Unit.

Background

Since 2005, I-TECH has supported M and E activities of Lighthouse clinical services through technical

assistance, human capacity development, and systems strengthening. Lighthouse has assumed a unique

role in Malawi as the model centre for integrated HIV-care in the public sector. To fully realize this potential,

the M and E Technical Advisor will further strengthen the Lighthouse in-house capacity to conduct

operational research and to disseminate findings that are expected to influence national policy and

practices.

Within the past year, with guidance and technical assistance from the I-TECH M and E Technical Advisor,

Lighthouse has built a robust M and E unit including, 2 M and E officers, 3 IT officers and 4 data clerks. In

2008, the M and E Technical Advisor will continue to build the capacity of this 9-member team to carry out

M and E of Lighthouse clinical services. Technical assistance is provided to ensure that Lighthouse has the

means to effectively evaluate its work, to better inform national and international policy, and to

collaboratively collect, validate and compile national data along with the Ministry of Health (MoH).

Additionally, I-TECH will support the national M and E efforts through the recruitment, placement, and

training of a senior M and E Technical Advisor and two local M and E counterparts within the MoH. The

primary target populations are clinical (doctors, medical officers, nurses) and technical (IT, administrative,

and other support staff) healthcare workers.

I-TECH supports the Lighthouse Clinic's capacity development goals in Monitoring and Evaluation (M and

E) of its clinical services and ART program. In 2008, I-TECH proposes to provide technical assistance in

systems strengthening and capacity building of the Ministry of Health (MoH) M and E Unit. Activities include:

human capacity development, systems strengthening, operational research, dissemination of information,

and M and E of PMTCT activities.

Activity 1: Human Capacity Development in Monitoring and Evaluation of Clinical Services

In 2008, I-TECH will continue supporting an M and E Technical Advisor at the Lighthouse (Lighthouse)

Clinic. This activity focuses on the development of human capacity and program sustainability through

continued on-the-job training of the Lighthouse Monitoring and Evaluation team. It covers work begun in FY

2006, which is consolidated and expanded for continuation in FY 2008. The I-TECH M and E Technical

Advisor will continue to develop monitoring and evaluation systems with the Lighthouse M and E team to

provide strategic information on the expanding HIV-services offered at Lighthouse and its new Centre. The

core services now include: HIV testing and counseling, family-centered ARV clinic, integrated TB/HIV

management, integration of PMTCT, home based care, community support group for PLWHA, therapeutic

feeding, and training centre

Activity 2: System Strengthening and Quality Assurance

This is a continuing activity in Systems Strengthening and Quality Assurance. Lighthouse opened the new

‘Martin-Preuss-Centre (MPC) Tithandizane-Clinic' on the Bwaila-Hospital campus in Lilongwe in December

2006. This clinic is Malawi's first center dedicated to the integration of TB and ARV services. In 2007, the I-

TECH M and E Technical Advisor assisted with the design and implementation of aspects of the clinic

operations (patient registration, patient flow, filing system for clinical records, management of lab-samples

and results, referral protocols, etc.). In 2008, the M and E Technical Advisor will continue to guide the

Lighthouse M and E team in the refinement of tools for routine data collection at the new centre. The

effective referral of HIV-positive TB patients and pregnant women with low CD4-counts to ART has been

identified as a new key challenge. The M and E team will continue to develop systems for monitoring of

referrals and conduct research into the causes for failed referrals.

Activity 3: Local Organization Capacity Building

This is a continuing activity in Local Organization Capacity Building. In the past two years, the Lighthouse

M and E team has assumed a growing role in providing services directly to the Ministry of Health, such as

designing tools for M and E, national surveys, data entry and analysis, writing of reports. The I-TECH M

and E Technical Advisor supports the HIV Unit directly through participation in the quarterly supervision and

clinical mentoring of the 104 ARV clinics currently in the public sector. The model of direct provision of M

and E services to the MoH has proven very successful and in 2008 the M and E team will continue their

collaboration with the MoH. Activities will include: revision of the HIV Counseling and Testing Register and

revision of the reporting of indicators from the approximately 360 HTC-sites; review of the national PMTCT

activities and assistance with the HIV Unit in revising PMTCT M and E methods; conducting the 2008-round

of the National Situation Analysis of HIV and TB Services with the teams from HIV Unit and CDC Malawi,

and providing other technical assistance to the MoH.

Activity 4: HMIS, Survey/Surveillance, Reporting

Through his technical expertise and in-country clinical experience, the I-TECH M and E Technical Advisor

has been able to make a significant contribution to the development of an electronic data system for the M

and E of the national ART program (implemented by Baobab Health Partnership and Taiwanese Medical

Mission in Mzuzu). The MoH has recognized this project as a key for the sustainability of the national M and

E system for ART. A pilot of this system will be launched at 4 public ART clinics in July 2007 and the I-

TECH M and E Technical Advisor will continue to support this project in the evaluation process and through

technical support in FY 2008.

Activity Narrative: Summary

Summary

I-TECH in Malawi supports the ongoing development of healthcare worker training systems that are locally-

determined, optimally resourced, highly responsive and self-sustaining. The activity described here

supports the activities of the Lighthouse. The targets are ascribed to Lighthouse, and not the training

advisor who supports the implementation of services and the training done by Lighthouse.

Background

Since 2005, I-TECH has partnered with the Lighthouse Trust to increase the capacity of the Lighthouse

Training Department, including the Lighthouse Training Officer, to conduct training for Lighthouse staff and

select other participants. The Training Department provides oversight to the design and dissemination of

information, education and communication (IEC) materials by the Ministry of Health (MoH) to the Districts,

monitors and evaluates clinical and training services, and provides trainings on behalf of the MoH. In the

next two years, Lighthouse plans to formally transition the training department and establish Lighthouse as

a general training institution. This will lend support to the larger human resources issues being addressed

with the GFATM Round 5 Health Systems Strengthening (HSS) Grant to the MoH implemented through the

larger Sector Wide Approach (SWAp) in Health.

In 2007, I-TECH sponsored the training team to attend the Monitoring and Evaluation of Training Programs

Workshop—an intensive weeklong workshop in Seattle, Washington. Participants were able to adapt and

integrate the newly gained evaluation methodologies and tools from this workshop into their training

activities at the Lighthouse and elsewhere. In 2008, I-TECH will continue to provide a full-time Training

Advisor to Lighthouse, with the primary goal of developing a sustainable, quality-driven Training Department

within the institution.

The International Training and Education Center on HIV (I-TECH) will continue to support Lighthouse's

goals in national capacity development and program sustainability through training of healthcare workers in

Malawi. Activities include clinical training, mentoring, quality assurance, quality improvement, and

supportive supervision with the aim of supporting the expansion of HIV and AIDS, TB and STI care and

treatment in Lilongwe. These services are provided to MoH and CHAM (private hospitals) staff and will

involve 2000 health care workers trained in the classroom, with about 450 ART and VCT sites receiving

quality assurance visits. The primary target populations are nurses, counselors, home-based care nurses,

and other health care staff.

The I-TECH Training Advisor provides technical assistance (TA) to the Lighthouse implementing partners,

to improve the quality of the training programs conducted. In 2007, Lighthouse created 3 new positions

(known as "lead facilitators") and began to monitor all training sessions, focusing on the Training Officer and

Advisor giving regular improvement feedback to facilitators. Lighthouse Departments appointed lead

facilitators, and a formal orientation for the lead facilitators was conducted in April. The benifits of this

structural change include: decreased workload for coordinators, improved monitoring of trainings (as one

person will be clearly responsible for paperwork and other pre-training preparations), and more focused

attention from the training office (Lighthouse advisors coach the 3 lead facilitators on how to train other

facilitators at Lighthouse. Currently the Lighthouse Training Officer and I-TECH Training Advisor coach

around 25 facilitators).

This activity also relates to activities in Strategic Information, Counseling and Testing, and Palliative

Care/TB/HIV. Activities are linked to those at the Lighthouse Clinic.

Activity 1: Capacity Development in Training

In 2008, the I-TECH Training Advisor will continue to provide mentorship to the Lighthouse Training Officer

in training methodologies, curriculum design and revision, and training evaluation. This activity, which

focuses on the development of human capacity and program sustainability, is a continuation of work started

in 2005, and an expansion on the activities implemented in 2007. The Training Advisor will continue to build

the capacity of the Lighthouse training department to conduct new trainings and deliver refresher courses to

Lighthouse staff, to integrate HIV/AIDS-related content into standardized curricula, and to utilize

standardized evaluation tools and processes based upon mastery of key competencies. The training team

will provide technical assistance to key trainers in each Lighthouse department: Clinic, CT and Home based

Care. In 2008, the Training Advisor will work with the Training Officer to conduct a needs assessment and

quarterly skills update trainings in the departments of Lighthouse and continue to train HBC volunteers.

The I-TECH Training Advisor will also strengthen the capacity of the MoH to provide health worker training

programs related to HIV. In collaboration with staff at Lighthouse, the Training Advisor will assist in the

revision and development of key national HIV trainings, as these needs are identified by MoH.

Activity 2: Training Program Development

In line with the Lighthouse vision for a multi-year HIV training program, the I-TECH Training Advisor and

Lighthouse will develop a strategic training plan consistent with MoH goals, to meet the growing demand for

quality HIV training that support the MoH HSS goals. In 2007, the Training Advisor participated in the

Lighthouse strategic planning retreats and contributed to ideas for expansion of training through the

Lighthouse Training Department. In 2008, the Training Advisor will assess how an organization like

Lighthouse can better meet national training needs while supporting MoH, and involve appropriate partners,

both in-country and internationally.

New FY 2008 funding will support the continuation of human capacity development in training programs at

the Lighthouse. Activities are expected to lead to improved training and improved care clinic-wide.

Summary

This activity is funded through an IAA to CDC from USAID Child Survial and Health HIV/AIDS funds.

Background

One of the critical success factors for the national ARV treatment program in Malawi is the central

coordination of all services. This coordination has led to the development and adoption of national policies

with very impressive timelines. It has also led to the standardized approach to service delivery using

nationally accredited guidelines. Because HIV/AIDS care and treatment interventions are dynamic, these

standards, policies, and guidelines need to be constantly updated. Currently there is only one individual

within the HIV Unit with responsibility for coordinating the scale-up of treatment services nationally. With the

increasing number of patients on treatment and the growing complexity of the management of AIDS as a

chronic disease, having a single individual take responsibility is becoming untenable. This is further

compounded by the concerns about ARV drug resistance, treatment in pregnant women, TB/HIV co-

infection, and treatment of children.

In FY 2008, the USG plans to fund a clinical team comprising of a Senior Technical Advisor and two Staff

Fellows to assist the HIV Unit (see ARV Services activity# 26527). A part of the team's responsibility will be

to assist with the coordination of the ARV treatment scale-up plan, updating policies, standards, and

guidelines, and ensuring that treatment targets are met while maintaining the quality of the service.

Activities associated with this program area include:

Activity 1: Expansion of Treatment Services

USG will support the newly formed clinical team of the HIV/AIDS Unit to strengthen the Ministry's

coordination role in the implementation of health services that make up the continuum of care. The team will

work with all stakeholders to facilitate standardized training for the implementation of provider-initiated

counseling and testing services, management of opportunistic infections, ARV delivery, palliative care,

home care, and caring for careers.

In conjunction with expansion of treatment services is the need to monitor and track patients. The clinical

team will work with others in the HIV Unit to establish and maintain a monitoring system that tracks,

documents and disseminates key data on operations research and health service delivery at intervention,

service and program levels.

The HIV Unit will facilitate the development and implementation of management systems and standards for

technical support services on such aspects as drug security and safety, laboratory support, referral

systems, facility and equipment specifications and monitoring and evaluation.

Activity 2: HIV Policy and Systems Strengthening

As scale-up activities continue, policies need to be developed or constantly updated. The clinical care team

will work with others in the HIV Unit to develop and implement HIV/AIDS care and support policies,

guidelines, and standards that are responsive to the changing HIV/AIDS service environment in the country.

The clinical team will ensure that policies, guidelines, and standards are sensitive to critical issues such as

gender and equity. The clinical team will work very closely with the HIV team and others within and outside

the MoH to develop the capacity of the staff to design, and implement operations research to address

critical problems encountered in the delivery of ARV services. They will be trained and mentored to evaluate

such projects, write reports and disseminate findings which may have an impact on relevant aspects of

HIV/AIDS care and support activities in Malawi.

In FY 2008, the USG will support the HIV Unit to work effectively with all stakeholders, at policy and

implementation level, within and outside the MoH, and within and outside Malawi. Through information

sharing, the team would strengthen the MoH and her contribution to inter-sectoral, regional, international

policies, and guidelines for HIV/AIDS treatment and care.