IMPACT: This mechanism is critical in directly contributing to the scale up of high quality HIV treatment, PMTCT (through the strategic placement of Technical Advisors and Fellows in MOH) and VMMC services in Malawi. Without this mechanism, Malawi would not have been able to effectively scale up PMTCT and HIV treatment services in the past 5 years. I-TECHs strategies, priorities, and areas of focus align with the PFIP, the Malawi GHI Strategy, and the Malawi Health Sector Strategic Plan 2011-2016. I-TECHs programming is responsive to the national agenda in part because of its central role in providing Technical Assistants, fellows and general program support to the MOH HIV and AIDS Department. These seconded staff bring technical expertise to MOH HSS initiatives (quarterly supervisory facility visits, clinical mentoring, tracking of in-service training data, electronic data systems, HMIS, operations research) and the roll out and scale up of important public health interventions, such as Option B+, integrated care (TB/HIV, PMTCT/HIV), and more rigorous quality assurance of HIV care and treatment. I-TECH is proposing in FY12 a gap analysis to inform the development of a capacity building strategy specific to the Department, with recommendations informing appropriate skills mix and adequate numbers of personnel to provide essential public health functions at the national level. I-TECH is also active pre-service technical assistance, and is working with other entire partners supporting the nurse midwife technician (NMT) program to build skills, knowledge, resiliency, process mechanisms and organizational capacity in CHAM colleges and the Nurses and Midwives Council of Malawi. ITECH will purchase 2 trucks for VMMC outreach and 2 vehicles to transport outreach teams.

Special support will be given to the implementation of 2011 national guidelines introducing Isoniazid preventive therapy in the pre-ART program and early ART initiation in co-infected patients using a new ART regimen. As a further measure of strengthening TB/HIV integration, I-TECH TAs and fellows will focus on strategies for improving effectiveness of routine TB screening of all patients in pre-ART and ART clinics. Also, additional numbers of TB officers will be trained and certified as integrated PMTCT/ART/TB providers.

I-TECH provides to the MOH Department of HIV & AIDS essential staffing and technical expertise, and IT-related operations and infrastructure for routine data collection. Activities align with Year 2 of the PFIP.

Devise national standard system and M&E tools for integrated follow-up for HIV exposed infants and pre-ART services for Family HIV Care and Under Five Clinics: The national HIV response lacks a standardized system to ensure effective identification and follow-up of HIV exposed infants and of pre-ART interventions for children and adults . I-TECH Technical Assistants (TAs) and fellows, with MOH HIV program officers, are scaling up and consolidating M&E and reporting systems for: pre-ART care, Option B+ for PMTCT, identification and enrolment for follow-up of HIV exposed infants, early infant diagnosis and treatment, and a revised Child Health Passport. These data will facilitate monitoring of access to HIV care and treatment and PMTCT program outcomes.

Roll-out of Point of Care Electronic Data Systems (EDS) at health facilities for ART and other HIV services: I-TECH staff will assist with coordination and supervision of the roll-out of EDS for ART through the provision of technical assistance to implementing partners to ensure adequate design of software and database architecture, and oversight of the integrated PMTCT/ART guidelines (i.e., modules for ANC, exposed child follow-up and pre-ART) into the existing EDS.

Implement national database for reporting in-service HIV trainings: I-TECH will provide technical guidance and on-going support to the Department and partners in customizing and maintaining TrainSMART, a specialised database application, as a central repository for participant registration and tracking of trainings, with support from the NAC and the MOH.

Establishment of a central M&E database for HIV programs integrated into the HMIS: I-TECH staff will assist with the establishment of a central health facility inventory linked to a GIS.

I-TECH directly funds salary and benefits of 1 M&E TA, two M&E fellows, two IT fellows, and M&E related costs for Department.

Indicators: M&E tools developed for integrated management of HIV; same tools captured in HMIS/EDS.

TA Positions: USG requested Logistics Technical Assistant: Develop supply chain systems to ensure accurate forecasting of Global Fund supported ART, drugs for opportunistic diseases and HIV test kits and mentor MOH logistician, pharmacy technicians and HIV fellows. Global Fund Technical Assistant: The Global Fund (GF) Liaison officer is seconded to the MOH Planning Department and provides grant management oversight of fund disbursements for HIV and AIDS, malaria, TB, and HSS. Lighthouse Trust requested Technical Assistant: LH proposes secondment of a clinician with research skills to conduct clinical and programmatic evaluations to improve quality care for public sector ART patients.

HIV Fellowship: The non-degree HIV fellowship programme builds leadership and technical competencies of exceptional Malawian professionals to support the national HIV program, including HIV treatment, care and support services, M&E, and HMIS.

Family Medicine: The College of Medicine proposes I-TECH TA to enhance implementation and success of its new Family Medicine module via: a training module for preceptors; a rapid needs assessment of attachment sites; curriculum review; and PBL self-study modules for students and preceptors.

Build Organizational Capacity of the Nursing and Midwifery Council of Malawi: I-TECH plans to: strengthen essential regulatory functions, e.g. accreditation, licensure and support for continuous professional development (CPD) activities; database development for accreditation and CPD; syllabus revision for RN cadres.

Baseline NMT Competency Assessment: In order to assess impact of its capacity building efforts with the NMT program at the CHAM colleges, I-TECH proposes conducting a baseline of recent graduates performance using knowledge and skills exams, and written case scenarios.

Gap Analysis: I-TECH plans a gap analysis to inform the development of a capacity building strategy for the MOH HIV and AIDS Department. The recommendations will help to routinize management systems, and describe appropriate skills mix and adequate numbers of personnel to staff essential public health functions at the national level.

ITECH will provide support to Malawi's newest HIV prevention strategy: Voluntary Medical Male Circumcision (VMMC). ITECH will provide direct service delivery support to scale up MC in Lilongwe District. This effort will utilize multiple service delivery models including high volume outreach sites, low volume static sites, and high volume static sites. These efforts will be in collaboration with other CDC partners including MOH, CHAM and MACRO.

Human capacity development in the management of HIV and PMTCT for adults and children: The I-TECH Technical Assistant for Care and Treatment (C&T TA) and fellows at the MOH Department of HIV and AIDS will guide and support the roll out of Malawis Option B+ for PMTCT through development of SOPs for the different levels of health facilities, and by supporting site supervision and the clinical mentorship program to ensure maximum access and retention of pregnant women to lifelong ART. Three prongs are essential to this effort: screening for HIV exposure at U1 clinics, enrolment for exposed children follow up to 24 months, and Option B+ follow up for mothers at ART sites. In collaboration with other partners, I-TECH will support planning, implementation, analysis and dissemination of evaluations of the implementation and impact of Option B+ in Malawi. This will provide an exciting opportunity for the Malawian I-TECH fellows to gain practical experience in conducting public health program evaluations while being directly involved in shaping the national program based on strategic information.

See HXTS for a description of the clinical mentoring program.

See HVSI for a description of FY2012 TrainSMART activities. The Department is currently utilizing TrainSMART to track the integrated HIV/PMTCT trainings conducted by the MOH and other implementing partners.

I-TECH directly funds salary and benefits of two TAs (C&T, M&E), two HIV fellows, two M&E fellows, and two IT fellows, all of whom sit at the MOH Department of HIV and AIDS.

Technical assistance to the MoH Department of HIV and AIDS in support of expansion of ART service delivery: The I-TECH Technical Assistant for Care and Treatment (C&T TA) will provide ongoing assistance to the Department in overall capacity building in HIV national clinical programming, encompassing expansion of integrated PMTCT/ART services and related HCW training, conducting quarterly supervision to support quality of service delivery, and mentoring of the senior management team and fellows seconded to the Department. In Q2 FY2011, CDC requested I-TECH to provide salary support for a new Logistics TA position who will guide forecasting, quantification, costing, procurement and distribution of ART/OI/STI drugs and HTC test kits; this set of responsibilities has to date been fulfilled by the C&T TA. Development of human capacity for the management of HIV and PMTCT in adults & children: I-TECH staff work from within the Department to provide oversight, coordination, and quality assurance support to the national clinical mentoring (CM) program for zonal and district scale up of new ART and PMTCT guidelines, and are active in the C&T TWG per CM development. I-TECH will contribute curriculum and M&E tools for Mentoring of Mentors (MoM) strategy, and will explore feasibility of developing distance learning based CPD units for HCWs to reinforce and expand clinical knowledge necessary for effective ART/PMTCT integration. Mentoring of fellows: I-TECH supported HIV fellows bolster the capacity of the Department to develop, maintain, and monitor HIV programming. The C&T TA will provide ongoing support to fellows to build their technical HIV clinical management and administrative skills (strategic planning, workplanning, report generation, operations research). I-TECH directly funds salary and benefits of 1 C&T TA, two HIV fellows, and some Department related training and clinical mentoring costs. Indicators: Per clinical mentoring, and dependent on C&T TWG stakeholders, consider one-year review of implementing partners specific to coverage, quality, and successful resolution of systems issues.

Treatment Scale-up: USD 400,000

ITECH will provide support to MOH in strengthing pediatric ART programs including the follow-up of HIV-exposed infants through preART care and scaling up early infant diagnosis (EID). ITECH will provide technical support for the monitoring of pediatric ART scale up at ART clinics, and ensure pediatric treatment is included in quarterly supervision visits coordinated by MOH with ITECH technical support

Treatment Scale-up: USD 100,000