MOPH Implementing Mechanism Narrative

HHS/CDC funds the Thai MOPH through a five-year cooperative agreement (CoAg). Currently, CDC's Global AIDS Program (GAP) is entering the fourth year of the second five-year CoAg with MOPH. The goals of this collaboration are to provide technical support to the Thai MOPH for HIV prevention, care, and treatment programs as determined by MOPH leadership and GAP/ Thailand and in accordance with the national HIV/AIDS strategy. The expected outcomes of the collaboration include: 1) strengthening health systems, human capacity, guidelines and protocols, and quality systems in order for the government of Thailand to finance and manage in-country programs; 2) supporting replicable models for prevention and care; 3) improving the quality of prevention and care programs; 4) increasing the collection and use of strategic information; and, 5) sharing successful models and providing TA to other PEPFAR countries.

Models may include service delivery models, surveillance methodologies, or laboratory systems. Support for model development typically proceeds through phases: 1) model development, implementation, and evaluation; 2) scale-up through leveraging of other donor or government funds; 3) integration to routine services; and 4) technical support to ensure quality of national programs and for national-level program M&E.

Support through this implementing mechanism is national. Technical areas and target populations include HIV prevention, care, and support for FSW, IDU, MSM, and prisoners; PMTCT monitoring and early infant diagnosis; national HIV testing and counseling guidelines and monitoring systems; quality of adult and pediatric HIV care and laboratory systems, including EQA programs and laboratory accreditation; positive prevention for HIV-infected MSM, youth, and general population PLHA; surveillance for FSW, IDU, and MSM; and, ARV resistance monitoring, threshold surveys, and early warning indicators. In addition, experts in Thailand receive support through this implementing mechanism to provide TA to other PEPFAR programs (i.e., "Global TA" activity), building on the experience and expertise in Thailand.

Contributions to health systems strengthening are made through all aspects of USG Thailand's TA-based program. Health information systems, laboratory infrastructure, and human resources for health are all areas of emphasis in the Thailand PEPFAR program. USG provides technical support for a) existing surveillance systems in MOPH, b) the development of new surveillance methodologies that are subsequently integrated into routine systems, c) M&E of prevention, care, and treatment programs administered by MOPH, NHSO, or GFATM, and d) data management systems, data analysis, and reporting and use of data for program improvement.

The USG team supports laboratory accreditation programs and quality systems at a national and sub-national level by strengthening the existing organizational structure and the technical capacity of government partners. The USG team supports human resources for health through in-service training in specific technical areas, adoption of new concepts or programs as part of national curricula and guidelines, specific models for task-shifting in HIV care and support, and development of decentralized referral networks that allow patients to receive services at the community level. The USG team supports model and curriculum development with government partners, and provides training of trainers so that national curricula can be used by government staff to provide trainings at different regional, provincial, and district levels, thereby ensuring that programs and technical capacity are integrated into routine government programs.

All USG Thailand technical support to MOPH is for programs that are, or have a plan to be, fully integrated into routine public health programs. Technical support and capacity building are provided to MOPH staff for development, implementation, evaluation, and expansion of programs that are funded by the national government. If a new program, method, or service delivery strategy is developed, it is developed jointly with MOPH, and training and technical capacity building support are provided at all stages of the process, including for fully expanded national programs in the form of M&E and support for quality systems. M&E is conducted for new program models of service delivery and new quality systems, as well as for national programs or systems to identify gaps or areas that need strengthening. M&E serves to identify the effectiveness or success of a program, and build the M&E capacity of MOPH counterparts. USG heath systems strengthening support to MOPH includes development of M&E and database systems, increased technical knowledge and capacity, policy change, development and evaluation of quality systems and programs, and Global Fund technical support.

As a TA-based program, costs are low for this implementing mechanism, and will continue to be low. Model development and evaluation are supported for a time-limited period, and then other donor or government funding is leveraged for program expansion and integration. This CoAg may be a model for countries that are transitioning to reduced programmatic funding, or are moving to a TA-based system.

08-HBHC Care:

Adult Care and Support

Budget Code Narrative for MOPH

With USG assistance, MOPH will finalize and provide training on a comprehensive performance measurement system which integrates HIVQUAL-T and the NAP databases. MOPH will conduct a TOT on the QI curriculum for the HIV quality national committee, including representatives from all 12 regions. The USG team will provide TA for development of a post-scale-up program evaluation plan.

MOPH will support implementation and evaluation of advanced counseling tools for risk reduction counseling, HIV disclosure, and partner testing. The counseling modules will be tested at three hospitals. Results from the evaluation will be presented to MOPH stakeholders for possible use of the counseling materials in other settings.

Through MOPH, CDC will support model development of positive prevention for MSM in four provinces (Bangkok, Khon Kaen, Phuket, and Udon Thani). This will complement USAID support in two additional provinces. The model includes improved linkages for prevention through outreach activities, and promotion of HIV TC to increase early access to HIV care. Development of a network of MSM peers in the community, HIV-positive MSM, and ARV clinic staff, as well as a referral system, will be part of the model. Capacity building for both MSM peers and ARV clinic staff will be provided. Program monitoring tools have been developed, and linkages between HIV TC and comprehensive health care and health promotion among HIV-positive MSM (including prevention of transmission and behavioral risk assessments and counseling) will be monitored.

These activities will be developed and implemented with input from the MSM technical advisory board, which also serves as the technical advisory board for GFATM activities for MSM. Successful activities will be expanded to MSM sites in other GFATM-supported provinces, and technical support will be provided for similar activities in GFATM-supported sites and to GFATM partners.

12-HVCT Care:

Counseling and Testing

Budget Code Narrative for MOPH

With USG assistance, MOPH will pilot rapid HIV testing and counseling (TC) with same day results in six USG sites to increase the number of MSM accessing TC and learning about their HIV status and the number of HIV-positive MSM who access care. All USG sites are part of GFATM support for MSM prevention activities. MOPH will support development of an HIV counseling curriculum for MARPs, and provide training to all counselors working in MSM clinics under GFATM support.

MOPH will provide laboratory training, and establish a laboratory QA system for rapid HIV testing. USG will support HIV rapid test kits during this pilot, but the RTG will assume budgetary responsibility for this activity after 2011. M&E plans will be developed to demonstrate the feasibility of implementing rapid testing, and whether it increases the number of MSM accessing HIV TC services and learning about their HIV status.

With support from GFATM, HIV TC services will be scaled up to prisons in a few provinces. MOPH will continue to provide prison health care staff trainings, and develop referral systems between prisons, preventive medicine units, and ARV clinics at local hospitals. MOPH will work with participating prisons to ensure linkages between peer education and VCT services through referral of prisoners by peer educators. An HIV VCT reporting system will be implemented as part of the DoC prison health care monitoring system, and data will be used to inform DoC, MOPH, GFATM, and other stakeholders on the success of the HIV TC service model.

MOPH will provide TOT for HIV counseling for FSW based on the adapted training curriculum from FHI/UNICEF/WHO. This training will benefit counselors in the 41 provinces scaling up HIV TC services for FSW under GFATM. MOPH will expand STI-QUAL following the pilot phase to all GFATM-supported provinces. Key indicators in STI-QUAL are related to the uptake of HIV testing and receipt of results by FSW and clients with STIs.

MOPH will pilot the national guidelines for HIV TC, including counseling recommendations for MARPs, rapid testing algorithm recommendations, and M&E systems. MOPH will receive USG technical support to develop a monitoring system for HIV TC in Thailand.

14-PDCS Care:

Pediatric Care and Support

Budget Code Narrative for MOPH

With USG assistance, MOPH will monitor uptake of EID testing to evaluate whether strategies for promotion of DNA-PCR utilization are effective and useful for expansion to other provinces in Thailand that have low uptake of DNA-PCR for EID. By the end of FY 2011, provinces with low uptake will be identified, and additional training to promote utilization of DNA-PCR for EID will be conducted or planned. As a result of EID, infants should increasingly receive early treatment which will decrease mortality of HIV-infected infants during the first year of life.

MOPH and NHSO will fund the expansion of the community-based pediatric HIV network and pediatric HIVQUAL-T program. At least 27 tertiary care hospitals from 27 provinces are expected to implement the pediatric HIV network and pediatric HIVQUAL-T. This will help strengthen referral services from tertiary to community hospitals and increase data utilization at the local level, including pediatric HIVQUAL performance measurement data, EWI, and NAP reports for program improvement. To assist program expansion in the early phase, USG will provide support for coordination with MOPH and NHSO of expanded activities. USG will also support an annual meeting for various sites to share lessons learned and evaluation results from program expansion.

MOPH will evaluate the positive prevention for HIV-infected youth program, and disseminate evaluation results to stakeholders. As part of this project, USG will support meetings with stakeholders on ARV adherence promotion among HIV-infected youth. Guidance on promotion of ARV adherence in HIV-infected youth will be developed. Lessons learned from the Positive Prevention for Youth program will be shared with hospitals in the pediatric network and key stakeholders, including techniques for ARV adherence promotion among youth.

17-HVSI Strategic Information

Budget Code Narrative for MOPH

With USG assistance, MOPH has implemented the national HIV/AIDS information, monitoring, and surveillance systems. Key activities in FY 2010-FY 2011 include developing and evaluating replicable models for program monitoring and surveillance, building human resource capacity within the Thai government to integrate and expand these models, and using the results for program planning and improvement. Specifically, MOPH will undertake:

1) scaling-up of IBBS among non-venue-based FSW, IDU, and MSM by developing standardized operational procedures, and building capacity in surveillance implementation among key resource persons, including MOPH surveillance officers, provincial health offices, local NGOs, and outreach volunteers;

2) developing and piloting in the field monitoring tools to monitor HIV prevention service delivery and program outcomes among IDU and MSM;

3) evaluating and validating the measurement tools for monitoring HIVDR EWI, and organizing training workshops to implement EWI for HIVDR prevention;

4) field work and technical consultative workshops to explore the feasibility of establishing a single harmonized and integrated health management information system for national HIV and ART monitoring, which is currently managed by three governmental organizations (the Civil Servant Fund, NHSO, and SSO). It is expected that by the end of FY 2011, Thailand will have a harmonized HIV and ART monitoring system to monitor national ART program efficiency and effectiveness and integrate HIV case reporting surveillance; and,

5) consultative and training workshops to conduct in-depth analysis of SI, develop and implement local M&E plans, and increase the use of data for policy planning, resource mobilization, and action by health and non-health government organizations, NGOs, CBOs, and the private sector at national and sub-national levels.

03-HVOP Sexual Prevention:

Other Sexual Prevention

Budget Code Narrative for MOPH

With USG assistance, MOPH has supported provincial health offices in major areas of Thailand to implement peer outreach education for MSM since 2004. In FY 2010, MOPH will continue to support to MSM peer outreach activities, including capacity building, outreach trainings, and M&E activities.

Together with the USG team, MOPH has developed curricula for sensitivity training and health care management training for health care providers who will work with MSM. In FY 2010, MOPH will organize a Training of Trainers on sensitivity and health care management to be funded by GFATM. The USG team will support MOPH to monitor these trainers to ensure that quality trainings are provided.

To promote testing and counseling for MARPs, MOPH will work with GFATM and the USG team to develop work and budget plans to harmonize the work of MOPH and USG.

01-MTCT Prevention:

PMTCT

Budget Code Narrative for MOPH

USG supports the national PMTCT program through MOPH in specific technical areas, particularly in M&E and addressing gaps in program services. Otherwise, the national PMTCT program is fully funded and supported by the Government of Thailand.

With USG assistance, MOPH will support an evaluation of the couples counseling program at 17 public hospitals in five provinces including program uptake, feasibility and acceptability of couples counseling, and positive and negative consequences of couples counseling. Results from the evaluation will be presented to DOH for policy recommendations. Monitoring and supervision results of couples counseling will be shared as lessons learned and best practices from participating sites. The couples counseling manual and materials will be disseminated to hospitals, and recommended as part of the national PMTCT guidelines.

With USG assistance, MOPH will support meetings with key stakeholders to develop PMTCT reports that can be generated from the NAP database. The reports will be used at pilot sites to test for report validity and program improvement. By the end of FY 2011, it is expected that the NAP database will automatically generate PMTCT reports to use at hospital, provincial, regional, and national levels for program monitoring and improvement.

For USG reporting, the national outcome PMTCT indicators will be reported in line with data reported to UNGASS. Although USG does not provide direct support for PMTCT program services, the USG team will explore whether national-level data are available to report on the number of known positive pregnant women, what PMTCT regimens these women receive, proportion of infected women assessed for ART eligibility, and percent of infants born to HIV-infected mothers. As noted in the PMTCT Technical Area Narrative, these are potential program gaps identified through a national program evaluation, and USG will provide technical support to MOPH to increase the uptake of services. Improvement in uptake should be reflected in data from the NAP database. Furthermore, depending on the success of the couples counseling pilot, if this program is expanded nationally, systems may be instituted to monitor the uptake of partner testing.

16-HLAB Laboratory Infrastructure

Budget Code Narrative for MOPH

With USG assistance, MOPH will support software development, and provide technical and management support for the HIV DR EQA scheme. For OI diagnosis, MOPH will support program expansion of EQA schemes, and identify mechanisms for long-term sustainability. MOPH will support development of web-based technology for virtual microscopy for OI EQA schemes, and to harmonize more than 40 EQA schemes.

MOPH will implement an HIV rapid test algorithm at six USG-supported MSM clinics. This includes the development of SOPs, training, and establishment of rapid testing QA/QC programs. MOPH will help NIH roll out selected algorithms, and provide TOT for rapid HIV testing. MOPH will support post-marketing evaluation of HIV test kits by Thai NIH by developing a protocol and selecting appropriate panels for testing.

MOPH, in collaboration with USG, has provided training on laboratory QMS for local and regional laboratories. To harmonize all QMS training curricula, MOPH will support the development and evaluation of a generic laboratory QMS curriculum. To strengthen the national laboratory accreditation program, MOPH will continue to support the development of a training curriculum for trainers according to MT Council laboratory standards, as well as implementation of the training package.

MOPH will support the Chiang Rai laboratory network by providing training on QMS according to Thai MT Council standards. An estimated 60% to 80% of 44 hospitals in the network are expected to receive a quality score level 3. MOPH will leverage Thai government funds to expand support to another network for laboratory accreditation.

Thai MOPH staff will provide TA to a) Cambodia for OI diagnosis, auditor training, and QMS; b) Laos for HIV serology, OI diagnosis, STI diagnosis, and CD4 EQA programs; c) Papua New Guinea for HIV serology EQA programs and QMS; and, d) Vietnam for EID, ARV DR testing, OI diagnosis, STI diagnosis, HIV test kit pre-marketing evaluation, QMS, CD4 and HIV serology EQAS interpretation, and auditor training. MOPH laboratory experts will also provide TA to countries in Africa to develop and implement EQA programs, establish reference laboratories, and consult on implementation of laboratory accreditation.

10-HVTB Care:

TB/HIV

Budget Code Narrative for MOPH

With USG assistance, MOPH has developed, implemented, and evaluated model TB/ HIV interventions and a training curriculum for accelerating initiation of ART among TB/HIV patients. The evaluation during 2009 led to recommendations for revisions, and full rollout through the national TB program. In FY 2010, MOPH will add more case studies to the curriculum, and develop a more condensed handbook for clinicians.

In 2009, USG supported the introduction and validation of a new rapid molecular test (Hain MTBDR+) at the National TB Reference Laboratory. Routine implementation of this new test by MOPH, in parallel with conventional drug susceptibility testing methods, is being supported for one calendar year for TB patients from four provinces. The public health impact of the new assay will be evaluated. This process began mid-FY 2009, and will continue to be supported during FY 2010. The USG will support the cost of reagents and technician time, and the refresher training of clinicians in MDR TB management.

With USG assistance, MOPH will develop national TB infection control guidelines and training curriculum, pilot a facility/workplace practices assessment tool, and evaluate the efficacy of infection control interventions. USG technical support to MOPH will complement GFATM-supported infection control interventions, and enhance the evaluation of their implementation.