Detailed Mechanism Funding and Narrative

Years of mechanism: 2008 2009

Details for Mechanism ID: 3786
Country/Region: Ethiopia
Year: 2009
Main Partner: University of Washington
Main Partner Program: NA
Organizational Type: University
Funding Agency: HHS/HRSA
Total Funding: $13,443,150

Funding for Biomedical Prevention: Prevention of Mother to Child Transmission (MTCT): $1,300,000

PMTCT Services at Hospital and Health Center Level by Region

ACTIVITY HAS BEEN MODIFIED IN THE FOLLOWING WAYS:

This is a continuing activity from FY08. In FY08, ITECH has supported 35 health facilities to provide PMTCT

services in Afar, Tigray and Amhara regions. The partner has been successful in promoting PMTCT

services in these regions. Furthermore, ITECH has been actively involved in the national TWG and

supported the rolling out of the revised national PMTCT Guidelines.

ITECH has faced challenges of underutilization of PMTCT services due to low ANC uptake and low

institutional delivery. There was underreporting of key PMTCT indicators, because the PMTCT registration

books at facility level do not capture data on PMTCT program performance at labor and delivery. High staff

turnover at facility level is another challenge that the partner faced. Deteriorating labor and delivery rooms

that need major renovation and shortage of IP supplies at labor and delivery rooms were also other

challenges in FY08.

In FY 09, ITECH will work to address the above challenges and will also build on FY 08 activities and

continue strengthening the PMTCT program at 42 health facilities in Amhara, Tigray and Afar regions. The

number of service outlets has decreased from the planned COP08 targets, because further assessment

revealed that there were logistic problems, poor infrastructure and low patient load, which does not justify

initiation of the program at these health facilities.

In FY 09 ITECH will scale up the PMTCT program in addition to the FY 08 planned activities by including

the following:

1)Support the transitioning of the national PMTCT program from Federal HAPCO to the Family Health

Department (FHD) of the Federal MOH through active participation in the national PMTCT TWG and also

support integration of PMTCT with MCH services

2)Support regional health bureaus and PMTCT TWG to build PMTCT program management capacity at a

regional level and ensure sustainability. ITECH will second a PMTCT advisor to Amhara Regional Health

Bureau to assist in the scale-up, integration, coordination, quality assurance and oversight of PMTCT

program.

3)Promote the Testing and Counseling Support tools for PMTCT at all PMTCT sites.

4)Expand outreach PMTCT services focusing on higher prevalence areas to reach large number of women

not coming to health facilities for ANC or delivery

5)Support strategies and program plans to coordinate Prevention With Positives (PWP) with PMTCT

6)Expand Mothers' Support Group (MSG) to additional 10 sites

7)Assist to strengthen the PMTCT M&E system: ITECH will assist the national and regional PMTCT

program to improve data collection and reporting on key PMTCT indicators

COP08 ACTIVITY NARRATIVE

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

Activity Narrative: 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

Form

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

family members

21) Support for the availability and correct usage of PMTCT registers and forms, HIV-exposed infant

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.

New/Continuing Activity: Continuing Activity

Continuing Activity: 16656

Continued Associated Activity Information

Activity Activity ID USG Agency Prime Partner Mechanism Mechanism ID Mechanism Planned Funds

System ID System ID

16656 5639.08 HHS/Health University of 7487 3786.08 Rapid expansion $1,100,000

Resources Washington of successful

Services and innovative

Administration

treatment

programs

10465 5639.07 HHS/Health University of 5495 3786.07 aa $310,000

Resources Washington

Services

Administration

5639 5639.06 HHS/Health University of 3786 3786.06 $160,000

Resources Washington

Services

Administration

Emphasis Areas

Gender

* Increasing gender equity in HIV/AIDS programs

Health-related Wraparound Programs

* Child Survival Activities

* Family Planning

* Malaria (PMI)

* Safe Motherhood

Human Capacity Development

Estimated amount of funding that is planned for Human Capacity Development $20,000

Public Health Evaluation

Food and Nutrition: Policy, Tools, and Service Delivery

Food and Nutrition: Commodities

Economic Strengthening

Education

Water

Table 3.3.01:

Funding for Sexual Prevention: Abstinence/Be Faithful (HVAB): $55,000

APRIL 2009 REPROGRAMMING

Strengthening STI services for MARPs

As a result of the Prevention Portfolio Review, we have determined this activity to have 20% AB component

from the previous 100% OP activity.

Expand access to PLHA and other MARPs to comprehensive STI care and treatment services at 38 sites in

Amhara, Tigray and Afar regions.

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

epidemic. During FY07 & FYO8 I-TECH supported STI prevention and control activities at 35 sites in Afar,

Amhara, and Tigray regions. The support included training healthcare providers on 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. A recent study by CDC/EPHA in selected urban and rural

areas identified a number of barriers that limit the utilization of STI services in the country, operating at

individual, community, health facility, and policy/program levels. These include: at facility level space

problems, shortage of basic functioning diagnostic equipment, failure to implement syndromic management

guidelines, lack of BCC/IEC materials, poor recordkeeping, lack of confidentiality. At provider level lack of

training; health workers lack basic patient counseling and education skills; health workers are judgmental to

patients with STDs. At patient level urban patients buy STI drugs to treat their disease without consulting

health care; government facilities seen as the last resort; fear of stigma, judgmental clinic staff, breach of

confidentiality, long waiting times seen as barriers to attending clinics. One of the major gaps identified by

the ‘Know your epidemic Know your Ethiopian Episynthesis' is lack of data on STIs with only few cases

being reported from health facilities throughout the country. Therefore, the major focus of FY09 shall include

support for sites for STI syndromic data documentation and reporting and support STI surveillance program

within the health-delivery structure in the specified Regions FY09 activities at the hospital/facility level will

include: 1) Continuation support of STI services for a total of 38 sites supported by I-TECH (including 30

public hospitals, two private hospitals, and six health centers) 2) Providing on-site technical assistance to

improve STI diagnosis and treatment following national syndromic management guidelines 3) Onsite

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. 4) Have core T.O.T trained at the regional and Zonal health offices 5) 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 5) 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 positive 6) Providing STI education focused on risk-reduction,

screening, and treatment for patients enrolled in HIV/AIDS care and treatment at the hospitals 7) Providing

condoms and education on how to use them, to patients enrolled in care and treatment. There will be a

special focus on MARPs. 8) 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 9)

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 10) More

Strengthening of STI data recording and reporting system at all levels .Support sites in documenting and

reporting STI syndromic 11) In FY08, I-TECH was provided with supplemental funding to mainstream and

strengthen IEC and BCC programs with its existing care and treatment activities to conduct outreach

activities and promote services with in and outside the health facility areas in three regions of the country

(Amhara, Tigray and Afar). In FY09, I-TECH will strengthen and continue this activity by expanding the

sexual prevention outreach activity using the ABC strategy in two local universities-Mekelle and Gonder

Universities. In FY09, ITECH will facilitate and coordinate linkages between STI and HIV/AIDS services.

One of the major gaps identified by the ‘Know your epidemic Know your response of Ethiopian Episynthesis'

is lack of data on STIs with only few cases being reported from health facilities throughout the country.

Therefore, the major focus of FY09 shall include support for sites for STI syndromic data documentation

and reporting and support STI surveillance program within health-delivery structure. Others include having

core T.O.T trained at the regional and zonal health offices and providing on-site training.

New/Continuing Activity: New Activity

Continuing Activity:

Table 3.3.02:

Funding for Sexual Prevention: Other Sexual Prevention (HVOP): $220,000

Strengthening STI services for MARPS

ACTIVITY MODIFIED IN THE FOLLOWING WAYS

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

epidemic.

During FY07 & FYO8 I-TECH supported STI prevention and control activities at 35 sites in Afar, Amhara,

and Tigray regions. The support included training healthcare providers on 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.

A recent study by CDC/EPHAin selected urban and rural areas identified a number of barriers that limit the

utilization of STI services in the country, operating at individual, community, health facility, and

policy/program levels. These include: at faclility level space problems, shortage of basic functioning

diagnostic equipment, failure to mplement syndromic management guidelines, lack of BCC/IEC materials,

poor recordkeeping, lack of confidentiality. At provider level lack of training; health workers lack basic

patient counseling and education skills; health workers are judgmental to patients with STDs. At patient

level urban patients buy STI drugs to treat their disease without consulting health care; government facilities

seen as the last resort; fear of stigma, judgmental clinic staff, breach of confidentiality, long waiting times

seen as barriers to attending clinics.

One of the major gaps identified by the ‘Know your epidemic Know your Ethiopian Episynthesis' is lack of

data on STIs with only few cases being reported from health facilities throughout the country. Therefore, the

major focus of FY09 shall include support for sites for STI syndromic data documentation and reporting and

support STI surveillance program within the health-delivery structure in the specified Regions

FY09 activities at the hospital/facility level will include:

1) Continuation support of STI services for a total of 38 sites supported by I-TECH (including

30 public hospitals, two private hospitals, and six health centers)

2) Providing on-site technical assistance to improve STI diagnosis and treatment following national

syndromic management guidelines

3) Onsite 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.

4) Have core T.O.T trained at the regional and Zonal health offices

5) 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

5) 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

positive

6) Providing STI education focused on risk-reduction, screening, and treatment for patients enrolled in

HIV/AIDS care and treatment at the hospitals

7) Providing condoms and education on how to use them, to patients enrolled in care and treatment. There

will be a special focus on MARPs.

8) 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

9) 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

10) More Strengthening of STI data recording and reporting system at all levels .Support sites in

documenting and reporting STI syndromic

11) In FY08, I-TECH was provided with supplemental funding to mainstream and strengthen IEC and BCC

programs with its existing care and treatment activities to conduct outreach activities and promote services

with in and outside the health facility areas in three regions of the country (Amhara, Tigray and Afar). In

FY09, I-TECH will strengthen and continue this activity by expanding the sexual prevention outreach activity

using the ABC strategy in two local universities-Mekele and Gonder Universities.

In FY09, ITECH will facilitate and coordinate linkages between STI and HIV/AIDS services. One of the

major gaps identified by the ‘Know your epidemic Know your response of Ethiopian Episynthesis' is lack of

data on STIs with only few cases being reported from health facilities throughout the country. Therefore, the

major focus of FY09 shall include support for sites for STI syndromic data documentation and reporting and

support STI surveillance program within health-delivery structure. Others include having core T.O.T trained

at the regional and zonal health offices and providing on-site training.

New/Continuing Activity: Continuing Activity

Continuing Activity: 16642

Continued Associated Activity Information

Activity Activity ID USG Agency Prime Partner Mechanism Mechanism ID Mechanism Planned Funds

System ID System ID

16642 10648.08 HHS/Health University of 7487 3786.08 Rapid expansion $420,000

Resources Washington of successful

Services and innovative

Administration

treatment

programs

10648 10648.07 HHS/Health University of 5488 3786.07 $100,000

Resources Washington

Services

Administration

Emphasis Areas

Gender

* Addressing male norms and behaviors

* Increasing gender equity in HIV/AIDS programs

* Reducing violence and coercion

Health-related Wraparound Programs

* Child Survival Activities

* Family Planning

* Safe Motherhood

Human Capacity Development

Public Health Evaluation

Food and Nutrition: Policy, Tools, and Service Delivery

Food and Nutrition: Commodities

Economic Strengthening

Education

Water

Table 3.3.03:

Funding for Care: Adult Care and Support (HBHC): $467,500

Rapid expansion of successful and innovative treatment programs

ACTIVITY HAS BEEN MODIFIED IN THE FOLLOWING WAYS:

In FY09, I-TECH will strengthen the prevention with positive efforts by further standardizing healthy living

promotion efforts and encouraging involvement of people living with HIV. For the later, I-TECH will work

closely with Addis Ababa HIV/AIDS Prevention and Control Offices and its sub-partner Organization for

Social Services for AIDS. I-TECH will use its experience of developing prevention with positives training

manual for health workers in further adopting the material for training a PLWH in social support group.

Trained PLWH will facilitate discussion in PLWH support group and mobilize the community in a view

toward creating conducive environment for disclosure of HIV status. I-TECH will also support the

development of a strategic framework on positive prevention through a participatory process with key

stakeholders. I-TECH will also continue its lead in positive prevention roll out and integration of positive

prevention and in the national comprehensive prevention strategy

COP 08 ACTIVITY NARRATIVE:

In FY07 and FY08, the University of Washington/I-TECH is working on palliative care and prevention with

positives activities. In FY06, 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. I-TECH 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 received palliative care, and 60 000 tablets of cotrimoxazole (CTX) and 1 000

bottles of CTX were provided to ART sites in the Afar region as emergency support.

In FY08, I-TECH is supporting care and support activities at 46 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 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 is assisting hospitals in Afar, Amhara, and Tigray to provide the preventive care package,

complementing the Global Fund for Aids, Tuberculosis and Malaria (GFATM), 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 isoniazid (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

programs.

In FY09 I-TECH will continue to work closely with PEPFAR Ethiopia's other US-based university partners to

ensure complementarily of activities in the implementation of national pain management guidelines and the

palliative care training curriculum.

In FY09, I-Techs' 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

Activity Narrative: 9) Continue patient management after hospital discharge if pain or symptoms are chronic

10) Link patients with community resources after discharge

11) Continue to provide safe water interventions like point of use water treatment by disinfectant and

general personal and environmental hygiene for people living with the virus and families.

I-TECH will ensure that all supported sites have reliable stocks of CTX tablets and 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. 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 human resource issue by increasing healthcare

worker training through the standardized palliative care curriculum.

In FY08, I-TECH spearheaded the establishment of a Federal HIV/AIDS prevention and Control Office

(FHAPCO) lead prevention with positives core team. The team is working toward standardizing and scaling

up prevention effort targeting PLWH at care and treatment setting. The core team develops strategic

framework outlining activities like training for health workers at different levels; sensitization workshop at

national and regional levels, addressing reproductive health rights and needs of PLWH; harmonizing

behavioral change message at health facility, community and mass media level to maximize the synergistic

effect. I-TECH led the adoption of well piloted prevention with positive training material to be used by health

care providers in care and treatment settings in Ethiopia. The training material was reviewed by experts

drawn from government of Ethiopia, other USG partners and different UN agencies. In FY09, I-TECH will

strengthen the prevention with positive efforts by further standardizing healthy living promotion efforts and

encouraging involvement of people living with HIV. For the later, I-TECH will work closely with Addis Ababa

HIV/AIDS Prevention and Control Offices and its sub-partner Organization for Social Services for AIDS. I-

TECH will use its experience of developing prevention with positive training manual for health workers in

further adopting the material for training a PLWH in social support group. Trained PLWH will facilitate

discussion in PLWH support group and mobilize the community to create a conducive environment for

disclosure of HIV status. At most effort will be exercised to ensure that disclosing status will not incite

violence. The following strategies will be further promoted and implemented to: create enabling

environments for the empowerment of people with HIV; protect and promote human rights and ethical

principles, including the right to privacy, confidentiality, informed consent and the duty to do no harm; and

work with all partners to prevent the stigmatization of PLWH while focusing on their specific needs and

rights. The meaningful involvement of PLWH is instrumental and will be promoted in all prevention-with-

positives activities throughout PEPFAR Ethiopia's care and treatment programs. I-TECH will continue to

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.

New/Continuing Activity: Continuing Activity

Continuing Activity: 16643

Continued Associated Activity Information

Activity Activity ID USG Agency Prime Partner Mechanism Mechanism ID Mechanism Planned Funds

System ID System ID

16643 5767.08 HHS/Health University of 7487 3786.08 Rapid expansion $550,000

Resources Washington of successful

Services and innovative

Administration

treatment

programs

10501 5767.07 HHS/Health University of 5488 3786.07 $333,000

Resources Washington

Services

Administration

5767 5767.06 HHS/Health University of 3786 3786.06 $400,000

Resources Washington

Services

Administration

Table 3.3.08:

Funding for Treatment: Adult Treatment (HTXS): $125,000

April 2009 Reprogramming:

Expansion of HIV/AIDS Pre service Education Problem Statement Ethiopia's goals for expanding access to

HIV/AIDS prevention, care, and treatment services consistently face common and recurring challenges,

particularly when dealing with human resources. These include absolute shortages in terms of numbers, an

inadequate knowledge and skills base which require extensive and expensive in-service training, and poor

distribution and low motivation of those healthcare workers in the system. The crisis in human resources for

health is most severe in emerging regions, where vacancy and attrition rates are nearly double the national

average.

In FY06 and FY07, JPIEGO (PEPFAR partner) worked with seven health professional schools of three

major universities (Addis Ababa University, Gondar University, and Jimma University) to integrate and

strengthen the teaching of HIV/AIDS in pre-service education. Efforts included: consensus-building

workshops with stakeholders; an in-depth needs assessment; faculty updates in HIV/AIDS content areas,

effective teaching skills, infection prevention, etc.; and the development of educational standards specific to

this program and linked with the Higher Education Relevance and Quality Agency (HERQA) standards.

Also, the PEPFAR partner worked with instructors to develop relevant teaching materials for HIV/AIDS and

supported individual departments and schools in introducing these into relevant sections of the curriculum.

The PEPFAR partner also procured teaching equipment, including computers, LCD projectors, screens,

TVs and VCRs, printers, overhead projectors, clinical models, teaching charts, DVDs, videos, etc. for

distribution to each school. As of July 2007, 87 faculty attended training workshops (with many attending a

series involving both HIV/AIDS updates and effective teaching skills), and 349 students received pre-

placement training prior to graduation. The effective teaching skills component, in particular, has led

faculties to re-think and re-design how they deploy students to clinical practice sites (e.g., Jimma), and to

adopt the use of clinical preceptors as a way of maximizing mentoring of students in clinical areas.

In FY08, the PEPFAR partner consolidated its efforts in the three universities and expand to new cadres

within the university. These cadres included laboratory technicians, pharmacists and others. The partner

worked with PEPFAR partners—Strengthening Pharmaceutical Systems (SPS) and a CDC laboratory

partner. The partners worked to update faculty knowledge and skills and revise curricula, and provided

effective teaching-skills training and teaching equipment. The partner also applied the Standards Based

Education Management and Recognition (SBEM-R) approach for strengthening the quality of the pre-

service education. In addition, the partner applied the lessons learned in university settings to regional

health college for diploma-level nursing education. With the assumption that nurses recruited from and

trained in the regions of Gambella and Benishangul are more likely to stay in in the regions for a longer

proportion of their career, the PEPFAR partner strengthened the nursing schools in Gambella and

Benishangul and prepared them to accept larger intakes of students. The focus was on HIV/AIDS content,

but the strengthening will include equipping classrooms and clinical skills labs, ensuring good scheduling of

clinical attachments/internships so that students learn by doing, upgrading faculty skills, etc, and testing

whether the SBEM-R methodology can be effectively applied in such a setting. Core groups of

faculty/tutors will also receive training in effective teaching skills and HIV/AIDS content support, working

with PEPFAR partners to carry out the latter as appropriate. Educational development centers will be

established in large universities and in all participating schools. The partner established a core team of

"Educational Mentors for Health" to build capacity for internal development of instructors and to overcome

the problem of teacher turnover. The PEPFAR partner continued to support the development of printed

materials, tools (question banks, learning resource packages for faculty, clinical attachment logbooks for

students, etc.) and support for other resources, such as teaching supplies/equipment, models, and other

supplies for clinical skills labs, as the curriculum development evolves. The partner shared other resources

that are available to school faculties and leadership, such as the virtual/distance leadership course

established by the Leadership and Management Support project, which is funded by the US Agency for

International Development.

In FY 09 these activities were reprogrammed from JHPIEGO to I-TECH (International Training & Education

Center on HIV, University of Washington) to implement the following activities.

• Ensure that one Academic Development and Resource Center (also known as educational development

centers) is established and strengthened at each of the two universities in the cities of Gonder and Mekele

• Ensure that two skills laboratory are strengthened

• Ensure that competency-based education is promoted and strengthened at the universities in the cities of

Gonder and Mekele

• Educational quality is improved based on the increment in achievement of performance standards through

standards-based educational management and recognition

• 50 instructors will be trained on effective teaching skills

• 50 instructors will be trained on Instructional Design (ID)

• 50 instructors will be trained on student's performance assessment teaching and student performance

assessment will be improved.

• In collaboration with the Ministry of Education, Ministry of Health, the Higher Education Relevance and

Quality Agency, and professional associations, accreditation and licensure processes will be developed and

implemented

• Pre-service HIV/AIDS education strengthening support is expanded to other health science disciplines and

universities

• Practical training sites and their linkages with teaching institutions are strengthened; through training of

preceptors and strengthening the support to practical sites.

New/Continuing Activity: New Activity

Continuing Activity:

Table 3.3.09:

Funding for Treatment: Adult Treatment (HTXS): $7,393,770

Rapid expansion of successful and innovative treatment programs

ACTIVITY UNCHANGED FROM FY2008

This is a continuation of activity from FY08.

UPDATE

As of March 31, 2008, 38,146 HIV patients initiated on ART, and 26,353 ART patients were regularly

receiving their treatment from 35 I-TECH supported facilities in three regions of the country (Amhara region,

Tigray region and Afar region). These achievements already exceed the targets set for the reporting period,

with six more months to go before the end of the reporting period for COP 07.

This activity will continue in COP 09, and I-TECH will support the enrollment of new patients and maintain

quality care and treatment of those already taking ART.

I-TECH will provide intensive comprehensive technical support to ART hospitals in Amhara and Tigray

regions, and to ART hospitals and ART health centers in Afar region in partnership with the regions. This

will be done through established regional and field-based teams.

The expanded regional ART teams include a physician coordinator, pediatrician, a lab technician, a

program assistant, 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 ART sites in the I-TECH supported regions.

I-TECH will work with partners working at health center and community levels to improve the referral system

and the function of the network in its operation zone, so that stable patients will be transferred from

congested, high load ART sites to health center ART sites near to patients' residencies. It will also ensure

delivery of comprehensive, quality care and treatment services to HIV patients through better linkage to

community services. I-TECH will work with partners at health center and community level to coordinate the

different services to HIV patients in order to ensure the continuum of care.

This will contribute to improved patient out-come and retention to care and treatment services. In addition, I-

TECH will continue its support for case management in order to optimize linkages between the different

programs within the facilities, between the facilities in the network, and between the facilities and community

services. It will also involve People Living with HIV (PLWH) and their associations in different activities,

including adherence counseling, patient tracking, and care and support.

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.

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.

2) Trainings of trainers (TOT) will continue to be used for multi-disciplinary 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. 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 area.

3) 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, nurse practice training and certification, and

development of new or innovative ART team members.

4) As the demand for ART provider nurses has increased, as a continuation of this activity and to conduct

this training on a broader scale, I-TECH will train & offer TOT for nurse ART providers, and work with US

uiversities throughout the country to prepare them to mentor their own nurse ART providers. I-TECH will

also work with Management Sciences for Health (MSH) to ensure that the 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 ensure that standardized site visits to all regions through mentoring of

mentors are conducted in collaboration with MOH, HIV/AIDS Prevention and Control Offices, and US

universities.

5) I-TECH has started and piloted an ART case-management model. In FY07, the National ART Case

Management Model was finalized, 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, and will work with the MOH, HAPCO

and US universities to expand this activity. It will also provide the training curricula and TOT to MSH in order

to ensure that a standard model of case management exists at both hospitals and health centers supported

by USG.

6) I-TECH will continue to support MOH and Federal 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.

Site level:

Activity Narrative: I-TECH site mentors, consisting of a physician for ART support, lab technologist, nurse, and monitoring and

evaluation staff teams, will regularly visit all 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

appropriate.

I-TECH will 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. 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.

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 trainings.

Local Universities Support:

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. 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.

New/Continuing Activity: Continuing Activity

Continuing Activity: 16644

Continued Associated Activity Information

Activity Activity ID USG Agency Prime Partner Mechanism Mechanism ID Mechanism Planned Funds

System ID System ID

16644 10439.08 HHS/Health University of 7487 3786.08 Rapid expansion $9,633,980

Resources Washington of successful

Services and innovative

Administration

treatment

programs

Emphasis Areas

Gender

* Increasing gender equity in HIV/AIDS programs

Human Capacity Development

Public Health Evaluation

Food and Nutrition: Policy, Tools, and Service Delivery

Food and Nutrition: Commodities

Economic Strengthening

Education

Water

Table 3.3.09:

Funding for Care: Pediatric Care and Support (PDCS): $82,500

Palliative Care

ACTIVITY IS REPLACED ENTIRELY AS FOLLOWS:

In FY07 and FY08, the International Training and Education Center on HIV-University of Washington (I-

TECH) supported the implementation of pediatric care and support as part of the care and support activities,

previously categorized as palliative care. In FY07 and FY08, I-TECH supported basic pediatric care and

support services at 37 facilities. These included: an initial assessment of site-level palliative care activities,

training of the multidisciplinary team, site-level clinical mentoring, enhancement of data collection and

reporting, minor renovations, and supportive supervision pediatric care and support services. Other services

included training and supervision focused on identifying and managing symptoms, pain, and discomfort

among HIV-positive children, and on providing cotrimoxazole prophylaxis (pCTX), tuberculosis (TB)

screening, and key elements of the preventive-care package, such as multivitamins and nutritional

assessments. This program was introduced to the hospitals in Operational Zone 1 (Afar, Amhara, and

Tigray regions).

I-TECH supported all facilities in an effort to ensure facility-based care for HIV-exposed children aimed at

extending and optimizing quality of life for HIV-infected children and their families throughout the continuum

of illness. Clinical care includes

1) Supporting sites to perform early infant diagnosis, preventing and treating opportunistic infections (OI),

excluding TB, and other HIV/AIDS-related complications including malaria and diarrhea

2) Providing access to commodities such as pharmaceuticals, insecticide treated nets, safe water

interventions and related laboratory services

3) Providing pain and symptom relief

4) Providing nutritional assessment and support including the distribution of food.

In FY09, I-TECH will continue to support pediatric care and expand activities in all facilities providing adult

HIV care and treatment via a multidisciplinary, family-focused approach to providing the preventive care

package for children. This approach will incorporate best practices for health maintenance and the

prevention of opportunistic infections for children with HIV slowing disease progression and reducing

morbidity and mortality. I-TECH will continue to participate in the revision of the developed national pediatric

guideline and standard operating procedures for pediatric HIV care as appropriate. In the face of having a

national guideline which adopts WHO recommendations for early diagnosis and initiation of treatment, I-

TECH will work to improve access to early infant HIV diagnostics using Dried-blood spot DNA PCR testing

and networking to avail the service to hospitals and health centers.

I-TECH will continue to provide the preventive care package, complementing the Global Fund for AIDS,

Tuberculosis, and Malaria (Global Fund), the Federal Ministry of Health, and other USG-funded activities

when possible. I-TECH will focus on provisions of the preventive care package for children. The package for

children includes: appropriate prophylaxis and ITN to prevent serious illnesses like Pneumocystis carinii

pneumonia, TB, and malaria; symptom management; prevention and treatment of diarrhea; nutrition and

micronutrient supplements; and linkage to national childhood immunization programs. I-TECH will also

ensure that all HIV-positive children receive careful and consistent clinical, developmental, and immunologic

monitoring to promptly identify those eligible for ART. Orphans and other vulnerable children (OVC) enrolled

in care and treatment will be prioritized for palliative care services and linked to community-based OVC care

programs in order to receive a continuum of care.

I-TECH and the International Center for AIDS Care & Treatment Programs-Columbia University (ICAP-CU)

support to facilities will be continued or expanded as follows. ICAP-CU will:

1) Strengthen the internal and external linkages required at facility level to identify HIV-positive children and

provide them with access to care. Internal linkages include referrals to the HIV/AIDS/ART clinic from

antenatal clinics, TB clinics, under-5 clinics, inpatient wards, out-patient departments, as well as voluntary

counseling and testing. External linkages include referrals to and from community-based resources

providing counseling, adherence support, 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 pediatric team HIV/AIDS team meetings to enhance linkages

3) Provide training on pediatric care and support and the pediatric preventive care package to

multidisciplinary teams

4) Provide clinical mentoring and supervision to multidisciplinary teams for care of infected children,

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 pediatric provider job aids and patient education materials related to

pediatric care and support

6) Identify and sensitize community-based groups to palliative care to increase awareness of importance of

adherence to both care and treatment services available at the facility level

7) Improve nutrition assessment of children 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 families with community resources after discharge

11) Continue to provide safe water interventions like point of use water treatment by disinfectant and

general personal and environmental hygiene for people living with the virus and families.

I-TECH activities will promote prophylaxis (pCTX) and treatment for opportunistic infections in accordance

with national guidelines. Appropriate use of pCTX is an essential element of care for HIV-positive children,

and for HIV-exposed infants, and will be an important component of I-TECH implementation activities,

especially at those sites not yet providing ART. I-TECH will ensure that all supported sites have reliable

stocks of CTX syrup, and will provide emergency supplies when at a time of absolutely necessary to ensure

quality and continuity of care. Similarly, TB screening and isoniazid prophylaxis (IPT) will be promoted and

provided for HIV-positive children. (See TB/HIV narrative). Supportive supervision and the institution of

standard operating procedures (SOP) will improve the use of CTX and IPT.

Activity Narrative: Those sites with "therapeutic feeding-by prescription" will target HIV-exposed or infected infants who are no

longer breastfeeding along with HIV-positive pregnant or breastfeeding women and malnourished patients. I

-TECH will continue to work with Johns Hopkins University which is a leader in hospital-level nutrition

programs. The family of children graduating from therapeutic program will be linked to a food security

program as appropriate.

New/Continuing Activity: Continuing Activity

Continuing Activity: 16643

Continued Associated Activity Information

Activity Activity ID USG Agency Prime Partner Mechanism Mechanism ID Mechanism Planned Funds

System ID System ID

16643 5767.08 HHS/Health University of 7487 3786.08 Rapid expansion $550,000

Resources Washington of successful

Services and innovative

Administration

treatment

programs

10501 5767.07 HHS/Health University of 5488 3786.07 $333,000

Resources Washington

Services

Administration

5767 5767.06 HHS/Health University of 3786 3786.06 $400,000

Resources Washington

Services

Administration

Emphasis Areas

Health-related Wraparound Programs

* Child Survival Activities

Human Capacity Development

Public Health Evaluation

Food and Nutrition: Policy, Tools, and Service Delivery

Food and Nutrition: Commodities

Economic Strengthening

Education

Water

Table 3.3.10:

Funding for Treatment: Pediatric Treatment (PDTX): $1,322,430

ITECH Pediatric Treatment

This is a continuing activity from FY05, FY06, FY07, and FY 08 which has previously been included as a

treatment/ARV services. I-TECH has played the vital role of implementing pediatric ART in Afar, Amhara,

and Tigray, in partnership with the regions. In FY08, JHU-supported sites have initiated 1929 children on

ART, 1530 are currently on ART.

In FY08, I-TECH actively participated in the national pediatric care and treatment activities to update and

enhance national policies, protocols, and guidelines on pediatric HIV. As a national technical lead on

training, I-TECH supported Ethiopia's Ministry of Health (MOH) and Ethiopia's Federal HIV/AIDS

Prevention, Care, and Support Organization (HAPCO) in the development and harmonization of training

materials on pediatric care and treatment for primary healthcare providers working at health centers, and

assisted in the development of different guidelines. I-TECH supported full-spectrum pediatric HIV

prevention, care, and treatment services at 32 hospital and 5 health center networks and is currently on

track in meeting targets for COP08. I-TECH has effectively supported the decentralization of ART services

to health centers in Afar region through training staff from health centers, establishing catchment area

meetings, providing ongoing clinical mentoring, and developing SOPs to facilitate appropriate "down

referral". This enables health centers to follow stable patients or initiate ART services in some cases and

refer complex cases to hospitals (up-referral).

In FY09, I-TECH will strengthen and expand the implementation of pediatric care and treatment at all

facilities providing adult ART services. At the national level, I-TECH will continue to support the Ethiopian

Federal Ministry of Health's (MOH) National Pediatric HIV/AIDS Care and Treatment Program, by

continuing and expanding the following activities:

1) Assist the Government of Ethiopia (GOE) in updating national policies and guidelines on pediatric HIV

2) Expand the national pediatric care and treatment training curriculum and continue widespread distribution

of pediatric support materials

3) Assist with the integration of pediatric monitoring and evaluation into existing care and treatment tracking

systems

4) Provide technical input into the development/revision and implementation of forms, registers, and

charting tools for pediatric care and treatment

5) Support radio and TV campaigns and the use of Information, Education and Communication and

Behavior Change Communication (IEC/BCC) materials in local languages to enhance public awareness of

pediatric HIV care & treatment services

I-TECH will continue to provide technical support in the areas of family-centered HIV care and treatment

and will work with the National ART Program to strengthen the growing Ethiopian PMTCT program and

linkages to pediatric care and treatment services. I-TECH will contribute its experience with treatment of HIV

-exposed and infected infants and children and assist with the expansion of national pediatric treatment

guidelines.

At the regional level, I-TECH will work with Regional Health Bureaus (RHB) in its operational zone and other

partners to build their capacity to effectively design, implement, and evaluate pediatric HIV/AIDS programs.

I-TECH will also work with RHBs to evaluate the clinical, infrastructural, management and informatics needs

of facilities and develop implementation strategies to enable each facility to meet required national

standards for pediatric HIV care and treatment. The need to expand routine treatment of children, which

was a focus point in FY08 and addressed by the hiring of three pediatricians, will be further expanded in

FY09 through working with the sites RHB and MSH to assure referral from health centers to hospitals as

appropriate.

In FY09, emphasis will be placed on increased pediatric ART services at all sites. I-TECH will focus on

improved entry points for children by supporting

1) Family-focused care and family testing

2) PIHCT at under-5 clinic, pediatric inpatient, TB clinic and EPI clinic

3) Linkages with PMTCT service and improved infant follow-up

4) Linkages with orphan and other vulnerable children programs and orphanages

5) Advocacy to create better awareness among health professionals and the community to improve the

attitude towards pediatric care and treatment

In FY09, on-site assistance will be provided to develop medical records for HIV-exposed and infected

children, referral linkages, patient follow-up and adherence support defaulter tracing mechanisms.

Moreover, more frequent site-level clinical mentoring and supportive supervision will be carried out at all

hospitals and health centers providing pediatric care and treatment service in I-TECH supported regions. I-

TECH site mentors, consisting of a pediatrician for ART support, lab technologist, nurse, and monitoring

and evaluation staff teams, will regularly visit all regional pediatric ART sites to

1) Provide system support for clinics, laboratories, and pharmacies

2) Provide regular mentoring and case consultation to physicians and nurses

3) Address issues that are identified as barriers to the efficient and effective care of children on care and

treatment

Collaborating with the International Center for AIDS Care and Treatment Programs-Columbia University

(ICAP-CU) and other partners, I-TECH will continue support to all sites in pediatric care, by training

pediatricians and other health workers and integrating pediatric ART into current ART activities. Assessing

and improving quality of service for pediatric care and treatment through a standardized approach in all

operating sites will be one of the core activities in FY09. Through coaching and mentoring visits to hospitals,

I-TECH's field-based clinical teams would work to ensure quality of pediatric care and treatment services in

pediatric service outlets.

I-TECH will emphasize strengthening the internal and external linkages including internal referrals to HIV

care clinics from various points of care and through external referrals to and from community-based

Activity Narrative: resources to identify HIV-infected children. Under the ART health network, ICAP-CU will work to establish

and strengthen links between hospital services, different levels of facilities and community based services,

nongovernmental and faith-based organizations, and communities with other partners working at these

levels. OVC enrolled in care and treatment will be prioritized for treatment services and linked to community

-based OVC care programs in order to receive a continuum of care.

I-TECH will support pediatric ART training, according to national guidelines and curriculum. Additional

training, including training on EID, will be provided to all new sites initiating ART in FY09 and to sites

already providing ART services to fill the gaps created by high staff turnover. This will be supplemented by

refresher trainings, focusing on an integrated multidisciplinary team approach to care and treatment.

Advanced training for clinicians working on pediatric care and treatment will continue to be provided through

an ongoing relationship with Hadassah Medical Center in Jerusalem.

I-TECH will work closely with the MOH, the Global Fund for AIDS, Malaria, and Tuberculosis, the Supply

Chain Management System/RPM+, and RHB to ensure drugs purchased to treat opportunistic infections

(OI) are distributed rationally, and to develop OI drug access for all HIV-exposed and infected children. The

availability of consistent and quality laboratory services including early infant diagnosis at all these sites is

critical to ensure quality comprehensive pediatric care and treatment services.

New/Continuing Activity: Continuing Activity

Continuing Activity: 16644

Continued Associated Activity Information

Activity Activity ID USG Agency Prime Partner Mechanism Mechanism ID Mechanism Planned Funds

System ID System ID

16644 10439.08 HHS/Health University of 7487 3786.08 Rapid expansion $9,633,980

Resources Washington of successful

Services and innovative

Administration

treatment

programs

Table 3.3.11:

Funding for Care: TB/HIV (HVTB): $560,000

TB/HIV Linkage at Hospital Level

ACTIVITY HAS BEEN MODIFIED IN THE FOLLOWING WAYS:

FY 08, I TECH has supported TB/HIV collaborative activities in 35 health facilities through providing training

for 189 health care providers, routine HIV counseling and testing at TB clinic, intensified case detection in

ART clinic and provision of IPT and CPT in Operational Zone 1 (Afar, Amhara, and Tigray regions). I TECH

has also supported the establishment of THAC in Tigray region to coordinate the implementation of full

package of TB/HIV activities. More over, I TECH is an active member of national TB/HIV and MDR TB

Technical Working Groups.

In FY09, I-TECH will strengthen its support to MOH in the TB/HIV program implementation in line with

FMOH and OGAC priorities.

TB infection control will be given more emphasis in all HIV care and treatment clinics and wards. Due

emphasis will be given at all facilities in facilitating early detection of infectious TB cases and timely initiation

of treatment and follow up till completion to render them non infectious. Ventilation and lighting will be

considered during renovations and refurbishment of patient examination and counseling rooms, wards and

patient waiting areas. TB infection control measures will be incorporated as part of the hospitals

comprehensive infection control plan. Due attention will be given to prevent spread of TB to other patients

and health care workers at all HIV related clinics through health education, cough triage in the out patient

clinics and isolation of admitted infectious TB patients in the wards.

MDR-TB: As an active member of the national MDR-TB technical working group, I-TECH will participate in

the development and revision of MDR-TB management guideline, protocols and tools. I-TECH will also

support MOH's MDR-TB management initiative both the pilot program at St. Peter's Hospital and the

expansion plan to the regional referral Hospitals.

TB/HIV M&E: Intensive training, supportive supervision and mentorship will be provided to I-TECH

supported facilities to strengthen the TB/HIV information system to generate good quality data. I-TECH will

also assist national and regional TB/HIV review meetings and joint supportive supervisions. A standard

operative procedure will be introduced at the facilities to generate and timely report good quality TB/HIV

data to the national level. The TB/HIV national surveillance sites will given due attention in strengthening

their TB/HIV information system to be able to report on the core TB/HIV activity indicators to the national

level in a sustainable manner.

Pediatric TB/HIV: In FY09, more emphasis will be given during the TB/HIV trainings and site level

mentorship in building the capacity and knowledge of health care workers in pediatric TB diagnosis and

TB/HIV co-management. Pediatric TB and IPT eligibility screening tools will be used to evaluate HIV

exposed and infected children. All eligible TB/HIV co-infected children will be linked to HIV related care and

treatment services through intra-facility and inter-facility referrals. The revised TB/HIV reporting format with

age break down which enables reporting of pediatric TB/HIV activities separately will be used for TB/HIV

activity reporting at all sites.

TB infection control will be given more emphasis in all HIV care and treatment clinics and wards. Due

emphasis will be given at all facilities in facilitating early detection of infectious TB cases and timely initiation

of treatment and follow up till completion to render them non infectious. Ventilation and lighting will be

considered during renovations and refurbishment of patient examination and counseling rooms, wards and

patient waiting areas. TB infection control measures will be incorporated as part of the hospitals

comprehensive infection control plan. Due attention will be given to prevent spread of TB to other patients

and health care workers at all HIV related clinics through health education, cough triage in the out patient

clinics and isolation of admitted infectious TB patients in the wards.

In FY09, I-TECH will continue to strengthen and expand TB/HIV activities in Operational Zone 1 at the 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 strengthen 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.

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.

Activity Narrative: 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. And in FY08, capacity building was provided in the area of human resource

development and establishing TB/HIV information system. TB/HIV collaborative activity has been initiated at

5 facilities in the Afar region. In FY09 continuous support will be provided to the facilities in the pastoralist

area which have initiated TB/HIV activities through capacity building and close follow up to strengthen and

further scale up TB/HIV services to improve quality of care, information system and service access.

I-TECH will support the MOH, HAPCO, and CDC efforts to purchase and install chest x-ray machines for

hospitals in I-TECH supported 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.

New/Continuing Activity: Continuing Activity

Continuing Activity: 16657

Continued Associated Activity Information

Activity Activity ID USG Agency Prime Partner Mechanism Mechanism ID Mechanism Planned Funds

System ID System ID

16657 5751.08 HHS/Health University of 7487 3786.08 Rapid expansion $441,750

Resources Washington of successful

Services and innovative

Administration

treatment

programs

10469 5751.07 HHS/Health University of 5495 3786.07 aa $396,000

Resources Washington

Services

Administration

5751 5751.06 HHS/Health University of 3786 3786.06 $150,000

Resources Washington

Services

Administration

Emphasis Areas

Construction/Renovation

Health-related Wraparound Programs

* Child Survival Activities

* TB

Human Capacity Development

Public Health Evaluation

Food and Nutrition: Policy, Tools, and Service Delivery

Food and Nutrition: Commodities

Economic Strengthening

Education

Water

Table 3.3.12:

Funding for Testing: HIV Testing and Counseling (HVCT): $532,950

Rapid expansion of successful and innovative treatment programs

ACTIVITY UNCHANGED FROM FY2008

COP 08 ACTIVITY NARRATIVE:

Activity Narrative: HIV Counseling and Testing Support at hospital

This is a continuing activity and relates to activities in ART (ID 10439 and 10628), TB/HIV (ID 10469 and

10472), Palliative Care (ID 10501), Laboratory (ID10613), SI (ID 10440) , Other Prevention (ID 10629 and

10648) and all HCT activities.

In FY08, the University of Washington/I-TECH provided 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).

Midway into 2008, 183 healthcare professionals had been trained on HIV counseling and testing (HCT)—

both client and provider initiated—according to national and international standards. In addition, 35 sites are

providing voluntary counseling and testing (VCT) and 30 sites are providing provider-initiated counseling

and testing (PICT) services.

In FY09 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 encouraging testing of the untested partner.

Appropriate child counseling and testing 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 FY09, 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. I-TECH will continue to expand

counseling and testing cadres and same hour result models through HIV testing points. All I-TECH sites will

offer routine HIV testing for sexually transmitted infections (STI), tuberculosis (TB), and family planning (FP)

to clients and patients in the inpatient and outpatient departments. Appropriate intra facility referral tools will

be implemented to ensure functional linkage between 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

immunization outlets.

I-TECH will fully assume responsibility for training healthcare providers as fulltime counselors and in the use

of HIV rapid 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

Through coaching and mentoring visits to hospitals, I-TECH's field-based clinical teams would make sure

that quality 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

private-sector facilities.

Efforts will be made to collaborate with PEPFAR partners to provide 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.

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 the establishing of peer-support groups at site level for burnout management and skills

building, and also organizes other burnout-management programs in collaboration with partners.

Activity Narrative: Furthermore, I-TECH will give technical assistance support to the Regional Health Bureaus and sites when

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.

New/Continuing Activity: Continuing Activity

Continuing Activity: 16658

Continued Associated Activity Information

Activity Activity ID USG Agency Prime Partner Mechanism Mechanism ID Mechanism Planned Funds

System ID System ID

16658 5725.08 HHS/Health University of 7487 3786.08 Rapid expansion $561,000

Resources Washington of successful

Services and innovative

Administration

treatment

programs

10468 5725.07 HHS/Health University of 5495 3786.07 aa $468,000

Resources Washington

Services

Administration

5725 5725.06 HHS/Health University of 3786 3786.06 $200,000

Resources Washington

Services

Administration

Table 3.3.14:

Funding for Laboratory Infrastructure (HLAB): $850,000

Site-level Laboratory Support

ACTIVITY HAS BEEN MODIFIED IN THE FOLLOWING WAYS:

University of Washington I-TECH in addition to the activities in FY08 will support the facilities to attain

minimum standards set by EHNRI. I-TECH will technically assist for the process improvement including

accreditation of regional laboratories. I-TECH will address integrated laboratory system and will also provide

support for establishment of regional laboratory in Afar, TB culture and viral load testing facilities in regional

laboratories and will work to develop capacity of regional laboratories for sustainability.

In FY08, I-TECH (University of Washington) has provided comprehensive high-quality HIV/AIDS services,

including ART, at 30 public and two private hospital networks in the Amhara, Tigray and Afar regions.

Comprehensive technical assistance 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, train laboratory staff (via offsite and onsite trainings on equipment

operation, preventive maintenances, and HIV-related laboratory test procedures); establish and strengthen

quality assurance (QA) programs via on-site mentorship and by developing and implementing SOPs,

developing log books and improving documentation and recording; and providing technical and logistic

support for specimen referral linkage between testing hospitals and referring hospitals and health centers. I-

TECH has been doing major infrastructure support to hospital laboratories including improvement of space

in the rooms with in the existing footage, epoxy painting of floor and wall in the testing rooms, standard

furnishing of the labs, and improving the electric line and drainage system. I-TECH renovated two regional

laboratories for establishment of DNA PCR for early infant diagnosis. In collaboration with CU-ICAP, CDC

and EHNRI, I-TECH has provided key technical and implementation support to Early Infant Diagnosis (EID)

program at regional, and site levels.

In FY09, I-TECH will provide its support to 32 hospital networks (30 governments 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 continue supporting 6 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, hospital and health center laboratory personnel to implement and monitor

the quality assurance programs at the 38 sites and will support facilities to attain minimum standards set by

EHNRI. I-TECH will provide technical support for process improvement including accreditation of regional

laboratories. I-TECH will continue to provide technical assistance to the rollout of HIV-1 DNA PCR for infant

diagnosis at regional levels.

I-TECH's laboratory support activities in FY09 will include:

(1) Strengthening of site-level laboratory quality systems, with emphasis on initiation and enhancement of

quality assurance programs in partnership with CDC, EHNRI and Amhara, Tigray and Afar regional

reference laboratories. These activities will include the preparation, revision and implementation of standard

operational procedures (SOPs) for HIV disease monitoring (hematology, clinical chemistry, and CD4),

specimen management, laboratory safety, and QA/QC program. 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 capacity development. I-TECH in collaboration with CDC, EHNRI and Afar Regional Health Bureau will

support the establishment of the regional laboratory at Afar. In addition, I-TECH will work closely with the

regional laboratories at Amhara and Tigray to build local capacity as this is the exit strategy for partners.

(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 supplies chain

management 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. The mentorship will

address the integrated laboratory system with emphasis on HIV, TB, OIs and malaria. I-TECH will conduct

periodic site assessments and will provide necessary and appropriate support including: minor renovations

and refurbishment of site labs; laboratory accessories needed for the day-to-day delivery of integrated

laboratory services. I-TECH will also support preventive maintenance of essential integrated laboratory

service equipment and equipment care and management at the facilities and will facilitate the major

equipment maintenance; and support for national laboratory reporting systems.

(4) I-TECH will technically support standardized trainings using nationally approved curricula with special

emphasis on onsite training and mentorship. These site-level and regional-level trainings will include: HIV

rapid test (point of care HIV rapid test training), HIV disease monitoring (hematology, clinical chemistry, and

CD4); laboratory training on integrated diseases including common OI diagnosis. I-TECH will provide

continued onsite training on the new HIV rapid testing algorithm and monitor and evaluate the utilization of

the algorithm at facilities. I-TECH will also support regional and onsite training on TB smear microscopy and

support the implementation of TB smear microscopy EQA manual.

(5) I-TECH will continue to provide technical assistance and implementation support to referral laboratory

Activity Narrative: 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, patient sample tracking, reporting

of results, and implementing and ensuring that standard guidelines and procedures are followed. I-TECH

will support the monitoring and evaluation activities in all laboratory program areas and will support the

expansion of LIS in the regions

(6) I-TECH will continue to provide key technical assistance to the early infant diagnosis program in the

region. Working at the national, regional, and site levels, I-TECH will support not only HIV DNA PCR testing

capacity in the laboratory, but the clinical systems, HMIS systems, and linkages needed to provide high-

quality services to infants and families. Based on need assessment I-TECH will support the establishment

of HIV DNA PCR testing capacity at two more I-TECH supported sub-regional and hospital laboratories

(Dessie and Gondar University hospital laboratory). I-TECH will also support the establishment of viral load

testing capacity at regional laboratories as planned by EHNRI. These will include minor renovation, epoxy

painting of floor 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 OIs and STIs diagnostics testing services

at regional labs and hospitals. This includes training of lab personnel on common OIs and STI diagnosis,

providing TA in setting up of the test services and providing some critical reagents and diagnostic kits. I-

TECH will provide technical support for the establishment and functionality of TB culture at regional

laboratories.

New/Continuing Activity: Continuing Activity

Continuing Activity: 16645

Continued Associated Activity Information

Activity Activity ID USG Agency Prime Partner Mechanism Mechanism ID Mechanism Planned Funds

System ID System ID

16645 10613.08 HHS/Health University of 7487 3786.08 Rapid expansion $1,000,000

Resources Washington of successful

Services and innovative

Administration

treatment

programs

10613 10613.07 HHS/Health University of 5488 3786.07 $300,000

Resources Washington

Services

Administration

Table 3.3.16:

Funding for Strategic Information (HVSI): $200,000

Support for Site-Level Use of Data

ACTIVITY HAS BEEN MODIFIED IN THE FOLLOWING WAYS:

In FY08, I-TECH provided technical support to 43 sites, including assignment of 1-4 data

technicians/managers, distribution of computers, printers, accessories, and facilitating telephone and

internet connections. In addition, I-TECH trained 67 data and health care workers in basic computer skills

and in M&E.

In FY09, ITECH will collaborate with other partners in rolling out and integrating the national HMIS at the

site level. Support to sites for the integration of the national HMIS will include:

• technical assistance with the collection, archiving, retrieval, and reporting of comprehensive HIV services

data on the new forms and the flow of data through the new integrated data system

• technical assistance with the collection and documentation of data on other HIV services in addition to

ART, such as pediatric ART, TB/HIV, PMTCT, VCT, PICT using the appropriate HMIS forms

• routine, data-quality assurance exercises to ensure completeness and accuracy of information on the

HMIS forms

• training on basic monitoring and evaluation

• training on basic computer skills, data management skills, including data entry, data analysis, and on

tabulating and visualizing data using tables, charts, line and bar graphs and other standard methods, and in

technical paper writing and presenting. An emphasis will be placed on analyzing and using data at the site

level for local decision making and program improvement

• on-site supervision and mentorship to enhance the quality and use of data collected

In FY09, I-TECH will focus on building the capacity of sites to fully transition and integrate into the new

HMIS. In accordance with government plans, certain site-level support activities provided in FY08, such as

support for data technicians and managers, and the printing and provision of the HMIS forms and tools, will

be phased out in FY09. I-TECH will work with its sites to build their capacity to fully support the HMIS

themselves.

COP08 NARRATIVE

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-

sharing workshops.

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

HMIS forms

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

Activity Narrative: 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.

New/Continuing Activity: Continuing Activity

Continuing Activity: 16646

Continued Associated Activity Information

Activity Activity ID USG Agency Prime Partner Mechanism Mechanism ID Mechanism Planned Funds

System ID System ID

16646 10440.08 HHS/Health University of 7487 3786.08 Rapid expansion $300,000

Resources Washington of successful

Services and innovative

Administration

treatment

programs

10440 10440.07 HHS/Health University of 5488 3786.07 $150,000

Resources Washington

Services

Administration

Emphasis Areas

Human Capacity Development

Estimated amount of funding that is planned for Human Capacity Development $50,000

Public Health Evaluation

Food and Nutrition: Policy, Tools, and Service Delivery

Food and Nutrition: Commodities

Economic Strengthening

Education

Water

Table 3.3.17:

Funding for Health Systems Strengthening (OHSS): $334,000

April 2009 Reprogramming:

Strengthening Pre-Service Training for Medical Doctors This is a new activity in response to the critical

need and one of the highest priorities of the Ethiopian Federal Ministry of Health (FMOH) to scale up the

training of medical doctors. Problem statement Recent assessments suggest that the shortage of medical

doctors and other health professionals, poor performance, inequitable distribution of the available health

workforce among regions and health facilities are root causes for poor service delivery of health care. The

FMOH recognizes that with the existing levels of outputs from medical schools of medical doctors, surgical

specialists, anesthesia professionals, midwives, dentists and mental health professionals it will have

difficulties reaching the MDGs by 2020. While the FMOH recognizes the rapid need of medical specialties,

it stated that the existing level of output for health extension workers, health officers, nurses, pharmacists

and paramedics is sufficient and thus no major scale up is required.

The FMOH intends to scale up the number of medical doctors from the current 1,806 to 9,000 doctors in

public service thru a number of ambitious interventions. These are as follows: 1. To expand medical

training by increasing the number of medical schools from currently seven to twenty-one. Up to five teaching

facilities such as hospitals or other medical teaching centers will be attached to each new medical school.

Each of these teaching facilities will have an annual intake of 100 students. Thus, each new medical school

is expected to have an annual intake of up to 500 new students. 2. To introduce a 4 year medical training

program (for BSc holders) in addition to the existing six year program without compromising quality. 3. To

identify hospitals with adequate patient flow to be upgraded as teaching centers. 4. Utilize appropriate

Information Communication and Technology (ICT) to enhance the quality and efficiency of medical

education.

The FMOH has repeatedly requested PEPFAR Ethiopia, both informally and formally, to assist, thru US-

based universities, to scale up the training of medical doctors.

I-TECH (International Training & Education Center on HIV, University of Washington) is a major US-based

university partner for PEPFAR-Ethiopia. The regions in which I-TECH is operational with PEPFAR funding

have currently two medical schools located in the cities of Gondar and Mekele.

Thus, in FY09, major activities for I-TECH are to:

• Conduct needs assessment of Ethiopian public medical education institutions for implementing the

accelerated medical doctors training program.

• Provide technical, material and financial support to the FMOH, MOE, HERQA, and Universities at the

educational facility level in teaching materials development, review, publication and distribution activities as

well as in supply of essential teaching/training materials for medical education.

• Provide, based on needs assessment, limited support where feasible to faculty and infrastructure

development i.e. support to the establishment of training laboratories and learning centers, libraries and the

procurement of teaching materials to accommodate the large scale intake of new medical students.

• Monitor and evaluate the progress in the implementation of the medical doctors' education/training

programs.

• Assist in the development, local adaptation and review of curricular/training materials and modules for pre-

service education.

• Assist faculty and program managers in teaching and research, coordination, communication and

networking for medical education in the existing and upcoming public universities providing medical

education in Ethiopia.

• Assist Ethiopian medical education institutions in the development and effective application of different

models of education and training, including community-based team training and information technology for

distance learning-assisted approaches, standards-based education management and recognition, student

assessment and evaluation procedures, faculty development, establishment and/or reinforcement of

academic development centers in the universities/faculties.

• Coordinate all activities with all PEPFAR implementing partners on regional and central levels including

FMOH and HAPCO thru established mechanisms.

New/Continuing Activity: New Activity

Continuing Activity:

Table 3.3.18:

Subpartners Total: $0
Ethiopian Nurses Association: NA
Cross Cutting Budget Categories and Known Amounts Total: $70,000
Human Resources for Health $20,000
Human Resources for Health $50,000