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: 2008
PMTCT Services at Hospital and Health Center Level by Region
This is a continuing activity from FY07. In FY07, the University of Washington/I-TECH-supported PMTCT
services in 35 health facilities in Afar, Amhara, and Tigray regions. Building on programs initiated by other
implementing partners in FY05-FY06, I-TECH expanded and enhanced interventions to prevent perinatal
and postpartum transmission, and to link HIV-positive pregnant women and their families to comprehensive
HIV care and treatment services.
In FY08, I-TECH will extend these services to a total of 50 health facilities, working to dramatically reduce
the number of infants born with HIV in collaboration with the Federal Ministry of Health (MOH) and regional
health bureaus (RHB) of Afar, Amhara, and Tigray. I-TECH will provide PMTCT services at two hospitals
and 16 health centers in Afar, 17 hospitals in Amhara, and 12 hospitals and three health centers in Tigray. I-
TECH uses antenatal care (ANC), maternal/neonatal/child health (MNCH), and PMTCT programs as entry
points to HIV care and treatment for women, children, and families. The Government of Ethiopia has revised
the National PMTCT Guidelines that was published in 2001, and issued the new PMTCT Guidelines in July,
2007. I-TECH in collaboration with JHPIEGO will support roll out of the new PMTCT Guidelines in these
regions. Major areas of emphasis include: integration of PMTCT with MNCH services and HIV prevention,
care and treatment programs; provider-initiated routine opt-out HIV testing and counseling at ANC, labor
and delivery; implementation of more potent and complex PMTCT regimens; prompt clinical and
immunologic staging of HIV-positive pregnant women and rapid initiation of ART for eligible patients;
enhancing the quality of infant feeding initiatives; strengthening systems for PMTCT service delivery; and
supporting human resources by providing high-quality training and clinical mentoring.
I-TECH will work to support PMTCT programming at the national, regional, and site levels. At the national
level, as a member of the National Technical Working Group on PMTCT, I-TECH will contribute to the
development of training material, clinical support tools, guidelines, formats and standards. I-TECH will
continue to provide technical input and guidance to the FMOH and Regional Health Bureaus (RHB),
supporting initiatives to expand PMTCT beyond single-dose nevirapine (SD-NVP) where appropriate,
enhancing PMTCT-plus training, and supporting links between PMTCT programs, HIV care and treatment
programs, and pediatric services.
At the facility level, the I-TECH supported package of PMTCT Plus/family-focused care includes:
1) Support for linkages between healthcare facilities and community-based implementing partners, including
PLWH organizations, to promote uptake of antenatal and PMTCT services and to support follow up of
infants enrolled in early infant diagnosis (EID) programs. I-TECH will continue to work on referral linkages
by using case managers at hospitals, and enhance this system through partnership with other USG
partners. It will continue to strengthen the patient referral/linkage network through the development of tools,
training of health professionals, and on-site mentorship
2) Enhanced linkages between ANC, MNCH, PMTCT, family planning (FP), STI, and HIV care and
treatment clinics at the facility level
3) Promotion of partner testing and a family-centered model of care, using PMTCT as an entry point to HIV
services for mothers, children, and families
4) Routine, opt-out HIV testing and counseling at ANC, labor and delivery according to national guidelines
5) Active case-finding within families and households using a simple, validated tool—the Family Enrollment
6) Adherence and psychosocial support and enhanced follow-up and outreach services for pregnant women
testing positive for HIV to encourage retention in care. In collaboration with JHPIEGO, implementation of
peer-educator programs and Mothers' Support Groups (MSG) at selected sites, to maximize adherence to
care and treatment among pregnant HIV-positive women, and to strengthen their links to psychosocial
support and community resources.
7) Provision of a basic care package for all HIV-positive pregnant women, including patient education, TB
screening, prophylactic cotrimoxazole (CTX) when indicated, nutritional support (see below), insecticide-
treated bed nets, condoms, and safe water in coordination with the Global Fund to Fight AIDS, Malaria, and
Tuberculosis (Global Fund) and other partners
8) Routine assessment of all HIV-positive pregnant women for ART eligibility using clinical staging and CD4
testing, and provision of prophylaxis and treatment as appropriate, including ART when indicated
9) Nutritional education, micronutrient (MVI) supplementation, and "therapeutic feeding" for pregnant and
breastfeeding women in the six-month postpartum period
10) Enhanced postnatal follow-up of HIV-positive mothers and HIV-exposed infants
11) Promotion of infant-feeding initiatives and healthy infant-feeding practices by facilitating on-site trainings
and mentoring of MNCH staff (including traditional birth attendants) on safe infant-feeding practices in the
context of HIV, developing infant-feeding support tools, and establishing infant-feeding MSG
12) Linkages of all infants born to HIV-positive women to the HIV-Exposed Infant Clinic to ensure EID by
DNA PCR using dried-blood spot (DBS) testing. Enhanced laboratory capacity for infant diagnosis at
selected facilities and strengthened linkages with regional labs at remaining facilities (see the laboratory
narrative). Initiation and expansion of the clinical and health-management information systems (HMIS)
needed to implement EID services
13) Ensuring that HIV-exposed infants are enrolled in care and receive prophylactic CTX, immunizations,
nutritional support, careful clinical and immunologic monitoring, monitoring of growth and development, and
ongoing assessment of eligibility for ART
14) Determination of infection status at 18 months of age for HIV-exposed infants not found to be HIV-
positive via EID
15) Facilitate availability of supplies for PMTCT services
16) Support for site-level staff to implement national performance standards and the JHPIEGO-supported
Standard-based Management Program
17) Provision of PMTCT-Plus training to multidisciplinary teams at the facility level
18) Provision of ongoing clinical mentoring and supportive supervision in partnership with RHB
19) Ongoing development and distribution of provider job aids and patient-education materials
20) Routine monitoring of PMTCT-plus programs, reporting of progress against targets, and ongoing
assessment of linkages within facilities (from PMTCT to ART clinics, for example) and uptake of services by
21) Support for the availability and correct usage of PMTCT registers and forms, HIV-exposed infant
Activity Narrative: registers and follow up cards, timely and complete transmission of monthly reports to regional and central
levels, and appropriate use of collected data
22) Minor renovation, refurbishing, and repair (as needed) of ANC, labor and delivery rooms, and maternity
wards at JHU-supported sites
23) Radio and TV outreach campaigns and use of information-education-communication/behavior-change
communication (IEC/BCC) materials in local languages to enhance public awareness and use of ANC,
MNCH, PMTCT and HIV care & treatment services.
Additional narrative to COP08 narrative: This activity will provide support for outreach ANC/PMTCT
services. It will train health care workers to provide ANC and PMTCT services to the hard-to reach rural
communities. Trained nurses based at a hospital and health center and Health extension workers will be
involved to provide outreach PMTCT services. Community level PMTCT activities will be linked to the near-
by Hospital or Health center PMTCT programs through referral linkages and establishment of catchments
area networks. Experiences elsewhere and in Ethiopia (JHU and IntraHealth) have shown that outreach
PMTCT services can effectively be utilized to improve the uptake of PMTCT services. ITECH will be
involved in the expanding outreach PMTCT services in Amhara, Tigray and Afar regions.
This funding will be used to strengthen the existing prevention intervention by University of Washington.
Mainly the program will focus on mainstreaming IEC and Behavioral Change Communication programs with
care and treatment programs.
University of Washington in collaboration with regional health bureaus, regional HAPCO's, US University
partners and CDC-Ethiopia will establish a national and respective regional taskforce to research, design
and develop, produce and mounting billboards centrally and regionally on new thematic areas that will be
endorsed by the task force. These billboards will replace the central and regional billboards which were
mounted in 2004 and 2005 under the theme "the Role of Leadership in the fight against HIV/AIDS". JHU-
CCP will provide the necessary technical assistance in the production processes of the educational
billboard. University of Washington will mainly work with three regional health bureaus in this regard.
Prevention of sexually transmitted infections (STI) among most-at-risk populations (MARPs) and people
living with HIV (PLWH) is a critical activity in preventing new HIV infections and slowing the pace of the
During FY07, I-TECH has taken full responsibility for supporting STI activities at 35 sites found in
Operational Zone 1 (Afar, Amhara, and Tigray regions). The support includes training healthcare providers
in prevention and syndromic management of STI, and providing technical assistance to implement the
syndromic approach at hospital level. I-TECH has hired an STI technical officer to spearhead this effort and
begin the developing an action plan to initiate the training and assistance that will be needed to affect
heightened awareness and treatment of STI by clinical practitioners at all I-TECH hospital sites.
FY08 activities at the regional level will include:
Coordination with regional health bureaus (RHB) will help facilitate and coordinate linkages between STI
and HIV/AIDS services, and strengthen external referral linkages between hospitals, health centers, and
community service organizations (CSO), faith-based organizations (FBO) and PLWH support groups and
associations. Regional linkages will be supported so that patients who do not respond to syndromic
management of STI symptoms at the health-center level are referred to appropriate care at the hospital
FY08 activities at the hospital/facility level will include:
1) Expansion of STI services to three additional sites, for a total of 38 sites supported by I-TECH (including
30 public hospitals, two private hospitals, and six health centers)
2) Continuing needs assessments of the capabilities of hospital-based STI services, followed by joint action-
planning with facility staff to improve STI services and linkages between STI and other services (counseling
and testing, care and treatment, antenatal care, etc.)
3) Providing on-site technical assistance to improve STI diagnosis and treatment following national
syndromic management guidelines
4) Training, supportive supervision, and mentorship of physicians, health officers, and nurses, on STI
prevention, diagnosis, and treatment. The focus will be on the linkages between STI and HIV infection, as
per national guidelines.
5) Training of facility-based peer educators on STI prevention and treatment for PLWH and their partners,
as well as community education on the symptoms of STI and the need to seek care
6) Developing linkages with the Global Fund for AIDS, Malaria, and Tuberculosis and other PEPFAR-
funded partners to ensure adequate supplies of STI drugs at all facilities
7) Developing linkages to HIV counseling and testing services, promoting a provider-initiated, opt-out
approach for all STI patients, and providing linkages to care and treatment services for those who are HIV-
8) Providing STI education focused on risk-reduction, screening, and treatment for patients enrolled in
HIV/AIDS care and treatment at the hospitals
9) Providing condoms and education on how to use them, to patients enrolled in care and treatment. There
will be a special focus on MARPs.
10) Integrating STI services into antenatal and PMTCT services to ensure that all pregnant women are
educated about STIs (including education on preventing STI during pregnancy) and provided with
necessary, according to national STI management and antenatal care guidelines
11) Developing linkages to community-based organizations that promote risk-reduction and HIV/STI
prevention and early/complete treatment in communities surrounding I-TECH-supported ART sites
I-TECH will also focus on:
12) Establishing criteria to ensure that follow-up of patients on treatment is successful
13) Close collaboration with the RHB to ensure that those persons at highest risk of STIs from all publicly
supported STI clinics are included in the protocols for HIV testing
14) Developing appropriate protocols and tools at each site to ensure that all partners of those persons
testing positive for any STI are notified of their exposure and of the need for STI evaluation, treatment, and
HIV screening, as per the national guidelines
15) Evaluating STI/HIV referral services that will be provided quarterly to both hospital staff as well as the
16) Providing appropriate training and support for hospital staff to routinely evaluate patients for STI at
antenatal, family planning, and ART units and out-patient departments, as well as to offer routine HIV
17) Support sites in documenting and reporting STI syndromic
In this continuing FY08 activity, two I-TECH FY07 palliative care programs (i.e. basic care and support-
10501) and prevention with positives (10629), are merged into one activity.
In FY06, the University of Washington/I-TECH introduced a basic palliative care approach to 31 ART
facilities. In FY07, they expanded this activity to 35 sites in Operational Zone 1 (Afar, Amhara, and Tigray
regions). Initial work included baseline assessment of the palliative care activities at sites, development of
pain management guidelines, and development of palliative care training curriculum in collaboration with
relevant government stakeholders. They also conducted regular supervision of palliative care activities at
site level. The palliative care curriculum developed by I-TECH was integrated as part of the basic
comprehensive HIV training, including ART. Training and supervision focused on identification of pain and
discomfort among HIV patients, ensuring cotrimoxazole prophylaxis (pCTX) for all eligible patients,
tuberculosis (TB) screening for HIV-positive patients, and targeted elements of the preventive care package
(e.g., multivitamins, nutrition assessments, condoms, and links to programs that distribute insecticide-
treated bed nets (ITN).)
As a lead partner in palliative care among US-based university partners, I-TECH, in collaboration with the
Ethiopian Drug Administration and Control Authority and PEPFAR partner organizations, has developed the
National Pain Management guideline to aid proper assessment and management of pain at all levels of
healthcare. As an active member of the National Palliative Care Task Force, I-TECH is working with other
stakeholders in the development of the National Palliative Care Guideline and coordination of palliative care
program implementation at the national level.
In FY07, 5,417 persons have received palliative care, and 60,000 tablets of cotrimoxazole (CTX) and 1,000
bottles of CTX have been provided to ART sites in the Afar region as emergency support.
In FY08, I-TECH will support palliative care activities at 38 sites that provide HIV/AIDS care and treatment
(hospitals and emerging region health centers), via a multidisciplinary, family-focused approach to providing
the preventive care package for both adults and children. This approach will incorporate best practices for
health maintenance and prevention of opportunistic infections for people living with HIV (PLWH), slowing
disease progression and reducing morbidity and mortality.
I-TECH will assist hospitals in Afar, Amhara, and Tigray to provide the preventive care package,
complementing the Global Fund for Aids, Tuberculosis and Malaria (Global Fund), federal Ministry of
Health, and other PEPFAR Ethiopia-funded activities when possible. I-TECH will focus on provision of the
preventive care package, which for adults includes: pCTX; micronutrient (multivitamin) and nutrition
supplements and counseling; ITN, through links with the Global Fund malaria control program; point-of-use
water disinfectant (wuha agar) at hospital level and health education about safe water use; condoms and
education for prevention among positives; and screening of partners and family members of PLWH, as well
as TB screening and isoniazed (INH) preventive therapy. The preventive care package for children includes:
pCTX to prevent serious illnesses like Pneumocystis carinii pneumonia, TB, and malaria; prevention and
treatment of diarrhea; nutrition and micronutrient supplements; and links to national childhood immunization
I-TECH will work closely with PEPFAR Ethiopia's other US-based university partners to ensure
complementarity of activities in the implementation of national pain management guidelines and the
palliative care training curriculum.
I-TECH's support to facilities will be continued or expanded as follows:
1) Strengthen the internal and external linkages required at facility level to identify HIV-positive individuals
and provide them with access to care. Internal linkages include referrals to the HIV/AIDS/ART clinic from
the antenatal clinics, TB clinics, under-5 clinics, inpatient wards, out-patient departments, and voluntary
counseling and testing. External linkages include referrals to and from community-based resources
providing counseling, adherence support, home-based care, and financial/livelihood and nutritional support.
2) Provide on-site implementation assistance, including staff support, implementation of referral systems
and forms, and support for monthly HIV/AIDS team meetings to enhance linkages.
3) Provide training on palliative care and the preventive care package to multidisciplinary teams.
4) Provide clinical mentoring and supervision to multidisciplinary teams related to the care of PLWH,
including those who do not qualify for or choose not to be on treatment, in partnership with regional health
bureaus in the respective regions.
5) Continue to develop and distribute provider job aids and patient education materials related to palliative
care and positive living.
6) Identify and sensitize community-based groups to palliative care, to the importance of adherence to both
care and treatment for PLWH, and to the palliative care services available at the facility level.
7) Improve nutrition assessment at health facilities.
8) Promote interventions (pharmacologic and non-pharmacologic) to ease distressing pain or symptoms.
9) Continue patient management after hospital discharge if pain or symptoms are chronic.
10) Link patients with community resources after discharge.
I-TECH will ensure that all supported sites have reliable stocks of CTX tablets and syrups as well as
promote TB screening and provide INH prophylaxis for HIV-positive adults and children. (See also the
activity section on TB/HIV activities.) Supportive supervision and mentorship will be strengthened to ensure
that standard operating procedures and national guidelines for the provision of CTX and INH prophylaxis
are being followed. Attention will be given to the issue of HIV/malaria co-infection, and the routine provision
of ITN in HIV/AIDS and PMTCT programs in collaboration with the Global Fund. Facility and lay staff will
provide health education and behavior-change communication for HIV-positive individuals, complementing
Global Fund and other USG-funded activities. Health education, counseling, and support will encourage
positive living to forestall disease progression, and promote prevention among positives to prevent further
In FY08, I-TECH will continue its national-level support through active participation in the National Palliative
Care Task Force and through organizing workshops to advocate for the integration of palliative care
(including the preventive care package) in the overall healthcare system. I-TECH will also address the
Activity Narrative: human resource issue by increasing healthcare worker training through the standardized palliative care
I-TECH will implement prevention-with-positives activities which include: promotion and education on the
use of condoms; partner and family screening; education and counseling on positive living; and addressing
the full spectrum of transactional sex, particularly in urban settings. Along with these efforts, some
opportunities may exist for more strategic access to condoms, condom distribution and condom education.
In addition to standardized training, coordination, and evaluation, strategies will include peer education and
outreach programs through the case managers and outreach workers at each facility (given the human
resource constraints in Ethiopian health facilities). Many of those programs will include PLWH. In addition,
the lessons learned from FY07 prevention-with-positives activities will be used to enhance and refine the
approach to this intervention, as well as to strengthen prevention-with-positives activities throughout
PEPFAR Ethiopia's palliative care programs.
TB/HIV Support at Hospital Level
In FY07, Washington University/I-TECH has been supporting tuberculosis (TB)/HIV collaborative activities
in 35 hospitals in Operational Zone 1 (Afar, Amhara, and Tigray regions). I-TECH has been providing
technical assistance to sites through: on-site clinical mentorship for counseling and testing TB patients for
HIV; linkage to care and treatment services; routine screening of HIV patients for TB; isoniazid preventive
therapy (IPT); cotrimoxazole preventive therapy (CPT); monitoring and evaluation (M&E) of TB/HIV
activities; and TB infection control. In addition, during the first quarter of FY07, 30 healthcare providers were
trained and certified on TB/HIV collaborative activities.
In FY08, I-TECH will continue to strengthen and expand TB/HIV activities in Operational Zone 1 at a total of
38 sites. I-TECH will support improved access to high-quality HIV counseling and testing services among
patients at TB clinics by training both providers and on-site lay counselors, as well as providing support for
on-site, rapid HIV testing. In addition, I-TECH will continue to support sites to implement routine, provider-
initiated HIV counseling and testing (with an opt-out approach) for all TB patients in I-TECH-supported
hospital and health-center settings. I-TECH will also offer prevention counseling, education, and referral to
HIV care and treatment services.
I-TECH will introduce intensified, active case-finding for TB in HIV-positive clients by incorporating
screening for TB symptoms into post-test counseling in a number of venues: voluntary counseling and
testing (VCT) centers, sexually transmitted infections (STI) clinics, and antenatal clinics (ANC). Clients with
symptoms will be linked to the newly trained case managers and peer educators to ensure proper TB
diagnosis and treatment. Case managers and peer educators will also encourage family members of their
HIV-positive clients to be tested for HIV and screened for TB, and will offer home visits to do screenings. In
addition, I-TECH will support efforts to improve adherence to TB therapy through case managers and peer
educators. Through its region-based, clinical mentoring teams, I-TECH will sensitize ART-adherence nurses
to the importance of adherence to TB treatment. I-TECH will collaborate in regional and national
interventions related to multidrug-resistant TB (MDR-TB) treatment and containment.
As part of their routine activities, region-based ART clinical mentoring teams will continue working with sites
on appropriate diagnosis and treatment of active TB in HIV-positive persons. I-TECH will also ensure that
HIV-positive patients are appropriately provided with isoniazid preventive therapy (IPT), through regular
supportive supervisory visits by field-based clinical mentoring teams to all 38 hospital sites. ITECH will
support sites in the provision of cotrimoxazole preventive therapy (CPT) for all TB/HIV co-infected patients.
I-TECH will establish and strengthen the multidisciplinary care teams in each facility, with representation
from the TB service to facilitate referral and linkage to care and treatment services. I-TECH's M&E unit
(both field- and Addis-based) will support facilities in monitoring the referral system for co-infected patients,
and regularly evaluate/analyze referral data to inform efforts to improve the current system. As part of its
M&E activities, I-TECH will also offer supportive supervision of ART-clinic-based data clerks and data
managers, and on-site training and mentoring in data collection using TB/HIV data-collection forms. I-TECH
will also support the Federal Ministry of Health (MOH), the HIV/AIDS Prevention and Control Office
(HAPCO), and CDC efforts to improve the TB/HIV information system by hiring a TB/HIV M&E expert who
can work closely with CDC and MOH.
I-TECH will support laboratory TB diagnosis through regular mentoring visits to TB clinics and labs by
laboratory technicians and quality-assurance experts who have experience in TB diagnosis with smear
microscopy. These laboratory-mentors will provide on-site troubleshooting and training, as well as a link to
the regional referral laboratories. I-TECH will support the initiative by MOH, CDC and EHNRI to establish
TB culture facilities at regional levels and facilitate the transport of specimens to regional labs for TB culture
once capacity is available.
I-TECH will also work on developing information, education, and communications materials, and/or reprint
and distribute existing materials on TB prevention and symptom screening at the hospital level.
In 2007, I-TECH assessed the feasibility of TB/HIV collaboration and the prevalence of HIV in TB patients in
pastoralist areas of the country. In FY08, the result of the assessment will be used to improve the
implementation of TB/HIV collaboration in those areas.
I-TECH will introduce infection control and provide supplies required for infection control, work closely with
regional health bureaus (RHB), MOH, implementing sites, and CDC on prevention and management of
MDR-TB, and on improving the recording and reporting of TB/HIV data. I-TECH will support the MOH,
HAPCO, and CDC efforts to purchase and install chest x-ray machines for hospitals in ICAP- CU regions.
Finally, I-TECH will support feasibility studies (targeted evaluations) planned by CDC and other partners
and will work closely with RHB, hospital ART committees, regional TB/HIV working groups, and MOH in its
focus regions to ensure that TB program representatives are included in program-planning activities and
policy development that addresses the co-morbidity of HIV/AIDS and TB.
This is a continuing activity.
In FY07, the University of Washington/I-TECH has been providing technical assistance for the
implementation of both client-initiated and provider-initiated HIV testing and counseling services, as well as
training of healthcare providers in the same area for 35 hospitals found in Operational Zone 1 (Afar,
Amhara, and Tigray regions). So far, during the first quarter of 2007, 57 healthcare professionals have been
trained on HIV counseling and testing (HCT)—both client and provider initiated—according to national and
international standards. In addition, 34 sites are providing voluntary counseling and testing (VCT) and 30
sites are providing provider-initiated counseling and testing (PICT) services. In the same quarter, we have
provided HCT services to 16,965 and PICT services to 1,901 individuals.
In FY08 the following activities will be supported by I-TECH :
Considering that HCT is the entry through which the general population can access appropriate HIV
prevention, care, and treatment services, I-TECH would intensify complementary interventions to ensure
quality, client HCT services at 38 health facilities (30 public hospitals, two private hospitals and six health
centers in Afar) within Operational Zone 1 (Afar, Amhara, and Tigray), including referrals of HIV-positive
clients from community-based VCT programs.
In line with the family-centered care approach, which includes testing pediatric age groups, couples would
be encouraged to be counseled, tested, and receive test results together. The notification of partners will be
encouraged in cases where one partner receives positive test results, regardless of the setting in which the
person was tested. Efforts will be made to ensure privacy and autonomy of both individuals and couples.
Informed decisions shall be encouraged among discordant couples to protect the HIV-negative partner and
support the HIV-positive partner, while, at the same time, trying to assure testing of the untested partner.
Appropriate child counseling and testing, as appropriate, would be assured as part of diagnostic testing, and
family and couples' counseling.
Considering the high prevalence of HIV among youth and women, efforts also would be made to promote
routine premarital and preconception HCT to family-planning clients.
In FY08, I-TECH will consolidate ongoing efforts to ensure that both client-initiated and PICT services are
readily available at all 35 hospitals in the three I-TECH operation regions. We will continue to expand
counseling and testing cadres and same-hour result models through HIV testing points. It will be the norm at
all I-TECH sites to offer routine HIV testing for sexually transmitted infections (STI), tuberculosis (TB), and
family planning (FP) clients and to patients in the inpatient and outpatient departments. Appropriate intra-
facility referral tools will be implemented to ensure functional linkage among the different units within a
hospital: VCT, ART, STI, TB, FP, inpatient, and out-patient.
In addition, PICT will be expanded in pediatric inpatient and outpatient departments, as well as in
I-TECH will fully assume responsibility for training healthcare providers as fulltime counselors and in the use
of rapid HIV testing in the three operational regions. Gondar and Mekele Universities will continue to be
supported as training sites for counselors. A pool of trainer-of-trainers for healthcare provider training in
HCT techniques would be ensured to sustain local needs to include Health Center staffs as necessary and
to assure regional ownership of the program.
Furthermore, taking into account that the nation suffers most from a severe shortage of trained healthcare
providers, I-TECH will fully support and complement the national effort in scaling up the lay counselors
initiative. I-TECH will also involve people living with HIV/AIDS (PLWH) in this effort throughout the three
operation regions (based on the piloting of lay counselors by JHPIEGO in 2006).
Through coaching and mentoring visits to hospitals, I-TECH's field-based clinical teams would make sure
that quality of HCT services (client- and provider-initiated) are in place in both adult and pediatric service
outlets. Functional hospital HIV committees would be encouraged to foster adherence to quality HCT
standards and enhance the formation of multidisciplinary care teams for all testing sites within the facility.
Hospitals and health centers will be supported to establish functional referral mechanisms and linkages with
efforts will be made to launch outreach and mobile VCT services in high-risk corridor areas like the Addis
Ababa - Djibouti route in Afar area and the Humera region in western Tigray where there are migrant
mobile work forces and commercial sex workers are found. This will be done in close partnership with
PEPFAR implementing partners in the area.
Since there is limited space for HCT, and a shortage of human resource because of high turnover of
hospital staff (especially trained counselors), it is important to increase timely access to HIV care and
treatment services. I-TECH will continue to expand counseling and testing services by supporting weekend
VCT services in all of the major hospitals within the regions.
I-TECH provides support to sites implementing outreach services as necessary, in line with the Millennium
AIDS Campaign and local initiatives.
I-TECH supports establishing peer-support groups at site level for burnout management and skill building,
and also organizes other burnout-management programs in collaboration with partners.
Furthermore, I-TECH will give support to the Regional Health Bureaus and sites in terms of technical
assistance in launching National HIV Testing days.
I-TECH will also continue to work closely with national and regional partners and USG agencies to promote
HCT services, training of healthcare providers, and sharing of best practices.
In FY06, I-TECH-supported facilities enrolled over 15,000 new patients on ART (96% of target) and enrolled
2,560 new patients in the first two months of FY07, ensuring it would meet its target for new patients in
2007. This activity continues in FY08 and will enroll a projected total of 18,000 new patients on ART, with a
better quality of care.
I-TECH will provide intensive technical support to all 30 public hospitals and two private hospitals in Afar,
Amhara, and Tigray regions, in partnership with the regions. This support will also extend to up to six health
centers in Afar region for comprehensive support through established regional and field-based teams. To
meet 2008 targets in Afar, I-TECH anticipates continuing comprehensive support of the six health centers.
The expanded regional ART teams include a physician coordinator, pediatrician, a lab technician, a
program assistant, and a monitoring and evaluation coordinator and a data manager for each of the three
regions. These teams will continue to work in close collaboration with the Regional Health Bureaus (RHB).
There will also be an enhanced focus on the quality of all services in our continuing efforts to strengthen
and focus on positive clinical outcomes. The teams will identify the training needs of the multidisciplinary
teams at the 38 sites in the I-TECH supported regions.
I-TECH will provide periodic entry-level training on: providing ART; tuberculosis (TB)/HIV collaborative
activities; and voluntary counseling and testing (VCT), PMTCT and sexually transmitted infections services.
(This will also extend to the post-basic nurse training under the I-TECH Nursing Initiative). In addition to this
training, HIV/ART modules for pre-service training, begun in FY07, will be completed in FY08 in
collaboration with major university sites within the I-TECH regions (i.e., Gondar and Mekele) and will
continue to be supported.
Advanced training for ART clinicians will continue to be provided through an ongoing relationship with
Hadassah Medical Center in Jerusalem, Israel. Ten healthcare providers have completed this advanced
training and we will be sending another 11 healthcare providers in FY07. The advanced training has proved
very valuable for Ethiopian ART practice and the development of ART expertise. In 2008, I-TECH will
design an evaluation tool to assess the performance of the trainees on site and try to measure the impact.
1) In addition to developing "Centers of Excellence" for HIV and infectious disease training at Gondar and
Mekele Universities, I-TECH will continue to support and give technical assistance in upgrading ALERT
Hospital as a demonstration training center by assisting with training curriculum development and modeling
the HIV practice set-up. The establishment of these three centers of excellence in FY08 will provide the
framework for shifting advanced ART clinical training currently conducted in Israel to Ethiopia.
2) In FY08, I-TECH, in collaboration with Hadassah University, will conduct advanced training in Israel for
nurses working in health centers supported by I-TECH and other USG universities.
3) Trainings of trainers (TOT) will continue to be used for multidisciplinary training and their roles will be
expanded for training and mentoring at all levels of practice within the hospital setting, including the ART
clinic and the key programs including the VCT, PMTCT and TB programs. During FY08, each health facility
in I-TECH-supported regions will have at least one skilled trainer who would be able to train on at least one
4) In collaboration with the Ethiopian Ministry of Health (MOH) and USG partners, I-TECH is already in the
process of developing revised training curricula for comprehensive ART training and refresher courses for
ART practice that will be piloted and evaluated to address the major changes in treatment.
5) In FY08, I-TECH will continue to work with its USG partners and the MOH in the primary role of ART
training-related activities, including curriculum review and development, advanced nurse practice training
and certification, and development of new or innovative ART team members. I-TECH will train and certify 60
additional TOT and train 300 health providers (physicians, nurses and pharmacists) on comprehensive HIV
6) As the demand for HIV Advanced Nurse Specialists (HANS) has increased, I-TECH will train 200 HANS
in FY07. In the first quarter of 2007, 80 nurses received this training. As a continuation of this activity and to
conduct this training on a broader scale, I-TECH will train offer TOT for HANS in 2008, and work with USG
universities throughout the country to prepare them to mentor their own HANS in 2008. I-TECH will also
work with Management Sciences for Health (MSH) to ensure that the advanced-practice nurse trainings and
curricula are made available to the nurse cadre seeing patients at health centers including the development
of TOT for that segment. In addition I-TECH will assure that standardized site visits to all regions through
mentoring of mentors will be conducted in collaboration with MOH, HIV/AIDS Prevention and Control
Offices, and USG universities.
7) I-TECH has a national mandate to develop an ART case-management model. In FY07, the National ART
Case Management Model was finalized, an ART case-management curriculum was developed, and six
case managers were hired in order to pilot case-management services at six major hospitals in Amhara,
Tigray, and Afar regions. I-TECH will be training more ART case managers before the end of FY07, and will
work in FY08 with the MOH, HAPCO and USG universities on TOT to ensure that it is endorsed as a
national program. I-TECH will train case managers for all the facilities it supports in FY08 and will conduct
targeted evaluations to see the impact of their activity. It will also provide the training curricula and TOT to
MSH in order to assure that a standard model of case management exists at both hospitals and health
centers supported by USG.
8) In FY08 I-TECH will continue to support MOH and Federal HAPCO in the development and
harmonization of training materials for primary healthcare providers working at health centers, and will
assist HAPCO in the development of different guidelines and mentoring training manuals in response to
HAPCO's request to lead these activities. As a national technical lead on training, I-TECH will continue to
give TA to organizations that implement the ART program at health centers, particularly in development of
curricula and TOT.
I-TECH site mentors, consisting of a physician for ART support, lab technologist, nurse, and monitoring and
evaluation staff teams, will regularly visit all 38 regional ART sites to: provide system support for clinics,
laboratories, and pharmacies; identify and provide multidisciplinary team training; provide regular mentoring
and case consultation to physicians and nurses; and address issues that are identified as barriers to the
efficient and effective care of ART patients. These mentors will be part of a regional ART team for each of
the three regions and each team will be assigned to assist 3-4 health facilities per team. The ART team will
work in close collaboration with the RHB but will report to the I-TECH medical and country director as
Activity Narrative: 1) An I-TECH laboratory technician will routinely visit the ART laboratory staff to provide additional
resources and capacity by addressing issues of training, equipment maintenance, and reagent
procurement. The technician will work closely with the RHB and the national agency for laboratory support
for ART (through the Ethiopian Health and Nutrition Research Institute). This expert will link with the CDC
and other university partners in order to standardize laboratory practices and capacity, and work closely
with other laboratory trainers, agencies, and suppliers to strengthen support and capacity in the hospital
2) In addition to adult ART support and training, I-TECH will concentrate on the support for pediatric
treatment and expand to other major sites including Dupti Hospital in Afar. The need to expand routine
treatment of children, which was a focus point in FY07 and addressed by the hiring of three pediatricians,
will be further expanded in FY08 through working with the sites, RHB, and MSH to assure referral from
health centers to hospitals as appropriate.
I-TECH will also integrate a post-exposure prophylaxis (PEP) protocol and approach for both government-
employed clinicians, as well as its own staff at all I-TECH sites in FY08. I-TECH will also provide protocols
and training for victims of sexual assault, and ensure that PEP-related drugs are in place in all of its sites in
2008. Victims have virtually no access to information on HIV/AIDS or the preventive services such as PEP;
the need for information, services, and trained practitioners will be met both by site-level training and by
including the training in I-TECH's basic ART and HANS trainings.
Local Universities Support: As part of its continuation of the FY07 plan, in FY08, I-TECH will further
strengthen the two demonstration sites at Gondar and Mekele Universities as venues for training and
clinical preceptorship for health providers in the Amhara, Tigray and Afar regions. To strengthen human
resource capacity of these two universities, their staff will be recruited and enrolled as TOT, and given
advanced ART trainings in Israel. These demonstration centers will also provide the continuum of care for
ART services beyond the hospital, extending to the community through case managers, palliative care
providers, and linkages to health centers in the major hospital catchments. I-TECH will also strengthen their
laboratory capacities, including resistance testing, in collaboration with the ongoing laboratory training with
Hadassah Medical Center and the University of California, San Diego.
Site-level laboratory Support
In FY07, I-TECH (Washington University) provided comprehensive high-quality HIV/AIDS services,
including ART, at public and private hospital networks in the Amhara, Tigray, and Afar regions.
Comprehensive technical assistance (TA) and implementation support has strengthened essential elements
of the laboratory system, and improved service quality and consistency. I-TECH has helped to conduct
assessment of laboratory services and train laboratory staff (via offsite and on-site trainings on equipment
operation, preventive maintenance, and HIV-related laboratory test procedures). I-TECH has also helped to
establish and strengthen quality assurance (QA) programs via on-site mentorship and by developing and
implementing standard operating procedures (SOP), developing log books and improving documentation
and recording; and providing technical and logistic support for specimen referral linkages between testing
hospitals and referring hospitals and health centers.
In FY07, I-TECH provided major infrastructure support to hospital laboratories, including: improving space in
the rooms within existing footage; epoxy painting of floors and walls in testing rooms; standard furnishing of
labs; and improving electric lines and drainage systems. In addition, I-TECH, in collaboration with the
International Center for AIDS Care and Treatment Programs at Columbia University, has provided key
technical and implementation support to Early Infant Diagnosis (EID) programs at regional and site levels. I-
TECH supported 393 blood sample transfers from health centers to nearby hospitals in Tigray and 1,643
samples in Amhara regions in FY07.
In FY08, I-TECH will expand its support to 32 hospital networks (30 government and two private) in the
Amhara, Tigray, and Afar regions, enabling each to provide comprehensive, high-quality HIV/AIDS services.
In addition, I-TECH will support six health centers in Afar region. Intensive site-level laboratory support is an
essential component of I-TECH's plans, as the availability of consistent and reliable laboratory services will
ensure quality HIV prevention, care, and treatment services. Ongoing training, supervision, and mentoring
of laboratory staff and hands-on implementation support will be provided to all 38 sites. I-TECH will work
directly with the regional labs, hospital labs, and health center personnel to implement and monitor QA
programs at the 38 sites. Procurement and distribution of laboratory equipment and supplies for these sites
will be handled by the CDC, the Ethiopian Ministry of Health, the Ethiopian Health and Nutrition Research
Institute (EHNRI), and the Supply Chain Management System (SCMS), as will equipment maintenance. I-
TECH will continue to provide TA for the rollout of HIV-1 DNA PCR tests for infant diagnosis at regional
I-TECH's laboratory support activities in FY08 will include:
(1) Strengthening site-level laboratory quality systems, with emphasis on initiating and enhancing QA
programs in partnership with EHNRI and Amhara, Tigray, and Afar regional reference laboratories. These
activities will include: the preparation, revision, and implementation of standard operating procedures (SOP)
for HIV disease monitoring (hematology, clinical chemistry, and CD4); specimen management; laboratory
safety; and QA and Quality Control (QC) programs. I-TECH will also support the preparation and provision
of standard documentation and recording formats, including QC forms, lab request forms, and registers. I-
TECH technical advisors will provide ongoing supportive supervision and mentorship at all sites, ensuring
the delivery of high-quality laboratory services, as well as systems strengthening, skills transfer, and
(2) Technical support for uninterrupted laboratory services at all 38 ART site networks. This includes:
assisting with the development, implementation, and enhancement of laboratory inventory systems in the
hospital networks and ensuring availability of continued and sufficient reagent supplies; supporting timely
preventive and troubleshooting maintenance services; building regional capacity for essential laboratory
equipment maintenance capability, and supporting human resources by facilitating the availability of
adequately trained laboratory personnel at all sites. These activities will be coordinated with SCMS and
regional laboratories, and I-TECH regional laboratory advisors will work closely with the regional lab
associates of SCMS.
(3) Capacity building and minor renovation of facility-level laboratories:
I-TECH will provide regular mentorship of site-level staff, focusing on improving laboratory management,
laboratory organization, layout and work flow, specimen management, testing procedures, standard
documentation, record keeping and reporting, and stock and inventory management. I-TECH will also
conduct periodic site assessments and will provide necessary and appropriate support ,including minor
renovations and refurbishing of site labs and laboratory accessories needed for the day-to-day delivery of
HIV-related laboratory services. I-TECH will support preventive maintenance of essential HIV-related
equipment and equipment care and management at the facilities and facilitate the major equipment
maintenance; and support for national laboratory reporting systems. In FY08, I-TECH will continue to
facilitate upgrading laboratory infrastructure to improve the service in ten selected high-patient-burden
hospital laboratories. This will help to improve the capacity to support more patients, to maintain quality, and
to provide standard laboratory service at ART facility laboratories supported by PEPFAR.
(4) Providing standardized trainings using nationally approved curricula, in collaboration with CDC, PEPFAR
implementing partners, EHNRI, and regional laboratories. These site-level and regional-level trainings will
include: HIV diagnostics (HIV serology testing, rapid testing); HIV disease monitoring (hematology, clinical
chemistry, and CD4); and laboratory training on integrated diseases, including diagnosis of common
opportunistic infections (OI). I-TECH will provide continued on-site training on the new HIV rapid-testing
algorithm and monitor and evaluate the use of the algorithm at facilities. A total of 300 laboratory personnel
will be trained, and I-TECH, in collaboration with regional labs, will evaluate the quality of services rendered
by lab personnel after training in different disciplines.
(5) I-TECH will continue to provide TA and implementation support to referral laboratory services. This will
strengthen the functioning of the reference labs as they supervise QA activities at lower-tier labs and
provide access to more sophisticated diagnostic assays. I-TECH will also support: EHNRI/regional labs to
establish systems for specimen collection at health centers and/or peripheral hospitals; transportation to
appropriate hospital and regional laboratories; tracking of patient samples; reporting of results; and
implementing and ensuring that standard guidelines and procedures are followed. I-TECH will facilitate
EHNRI's expansion of the Laboratory Information System (LIS) to the sites.
Activity Narrative: (6) I-TECH will continue to provide key TA to EID programs in the region. Working at the national, regional,
and site levels, I-TECH will support not only HIV DNA PCR testing capacity in laboratories, but the clinical
systems, health management information systems, and linkages needed to provide high-quality services to
infants and families. Support will be given to establish HIV DNA PCR testing capacity at three more I-TECH-
supported sub-regional and hospital laboratories (Dessie and Afar regional labs and Gondar University
hospital laboratory). This will include minor renovations, epoxy painting of floors, and furnishing with
standard laboratory furniture.
(7). Integration of OI diagnosis in the HIV/AIDS laboratory support: I-TECH, in collaboration with other
stakeholders working in the laboratory area, will establish common OI and sexually transmitted infection
(STI) diagnostic testing services at regional labs and hospitals. This includes training of lab personnel on
common OI and STI diagnosis, providing TA in setting up of the test services, and providing some critical
reagents and diagnostic kits.
The significant increase of budget was necessary to support: upgrading of the three regional laboratories
and hospital laboratories for EID; support for health center laboratories in emerging regions; and integration
of OI diagnosis.
Support for site-level use of data
This is a continuing activity from FY07. The major purpose of this activity is to strengthen the
implementation of the national Health Management Information System (HMIS) for comprehensive
HIV/AIDS services and to optimize the use of data for service and program strengthening in Afar, Amhara,
and Tigray regions.
In FY07, University of Washington/I-TECH supported 26 sites in Operational Zone 1 to collect, manage,
analyze, and use HIV/AIDS services-related data generated at site level for decision-making to improve
clinical and program management. In addition, I-TECH has trained 45 health professionals and data clerks
in monitoring and evaluation (M&E) and assisted regional health bureaus (RHB) to organize experience-
In FY08, I-TECH will expand its site-level capacity building in M&E to further improve quality data collection
and maximize data use for continuous service quality improvements I-TECH will:
1) Intensify support for efforts to fully document information for pre-ART and ART patients on the national
HIV care/ART follow-up by:
a) Continuing routine, data-quality assurance exercises to measure completeness and accuracy of
information on follow-up forms
b) Providing support to clinical teams for accurate completion of follow-up forms
c) Supporting efforts to fully document information for PMTCT, tuberculosis (TB)/HIV, voluntary counseling
and testing (VCT), and provider-initiated counseling and testing (PICT) clients on the appropriate national
d) Supporting the integration of HIV/AIDS care and treatment data with national comprehensive HMIS
through technical support at site level in archiving, retrieving, and report aggregation, supported by routine
data-quality assurance assessments
e) Train healthcare providers, data clerks, and HMIS personnel on database use, including how to enter
records, query the databases, and produce routine reports
2) Provide support for M&E support tools developed for the national M&E systems and equipment. I-TECH
will work to ensure availability of computers, computer peripherals, and storage equipment and an
uninterrupted supply of the national M&E tools at all the sites
3) 3) Strengthen supportive supervision and mentorship. On-site supervision and mentorship will be
provided to enhance collection of accurate and complete data. I-TECH will also work with site-level staff to
build capacity in data analysis, and in the use of data to manage and improve program delivery.
4) Support institutions to manage and use data fully and effectively. Sites will continue to be assisted in
tabulating and visualizing their data using tables, charts, line and bar graphs and other standard methods;
optional tabulations will include aggregation of data by patient, clinic, and regional levels. Continued FY08
activities will expand the number of facility-based health providers with basic computer skills and data
management skills, including data entry, data analysis, technical paper writing, and presentations.
5) Support the national laboratory information systems to ensure communication of patient results in an
efficient manner. There will be particular emphasis on communicating results to patients whose specimens
were transported to the hospital from another facility, such as a health center. Furthermore, I-TECH will
assist sites in tracking specimens of patients who need more specialized tests, such as viral load, which are
currently performed only at regional labs.
6) Support biannual, regional review meetings to provide fora where facilities can present their data and
share lessons learned. This activity will also continue to support and strengthen the national HMIS
implementation, document best practices, and present findings and experiences at local and international
scientific and programmatic forums. Implementation mechanisms will consist of necessary modeling at site
and RHB levels.