Detailed Mechanism Funding and Narrative

Years of mechanism: 2010 2011 2012 2013 2014

Details for Mechanism ID: 10516
Country/Region: Ethiopia
Year: 2010
Main Partner: Columbia University
Main Partner Program: NA
Organizational Type: University
Funding Agency: HHS/CDC
Total Funding: $12,422,861

The International Center for AIDS Care and Treatment Programs (ICAP) at Columbia University is one of the world's largest multi-country HIV/AIDS programs and a global leader in HIV programming. Rooted in comprehensive, family-focused services, ICAP-CU provides TA and supports site implementation of innovative approaches in resource-limited settings. ICAP is part of a consortium of US-based universities supported by CDC to support specified regions that accounted for approximately 69% of PEPFAR-supported patients on ART in Ethiopia as of October 2009.

ICAP-CU's strategy aims at supporting the full continuum of HIV-related services including counseling and testing; adult and pediatric care and treatment; nursing capacity initiative; PMTCT; injection safety; STI/TB/HIV integration; integration of prevention with care and treatment; lab support; safe water interventions; peer worker support; community mobilization; outreach; and SI.

ICAP-CU has been able to:

Establish strong relationships with Federal Ministry of Health (MOH), Federal HIV Prevention and Control Office (FHAPCO), Ethiopia Health and Nutrition Research Institute (EHNRI), Regional Health Bureaus (RHBs), and other partners;

Develop scopes of work that are fully integrated and consistent with the national program;

Respond to changes in national program orientation, funding, policies, and evolving standards of care;

Work effectively with RHBs to decentralize services;

Expand the scope of services to encompass the full prevention and care continuum while fostering coordination and integration with other program components;

Increase government and local partner capacity to manage key aspects of service programming, including financial management;

Respond to health systems challenges including HR, logistics and infrastructure;

ICAP-CU works in Oromia, Somali and Harari Regions, Dire Dawa Administrative Council, and nationally. Combined, these regions include 93,000 PLHWA in need of ART, or 28% of the national projected need as of 2009. ICAP will target 65 health facilities in the four regions will a catchment population of over 32 million.

ICAP's program now includes a range of comprehensive support to MOH, four RHBs and 55 service delivery sites, including initiating services, developing mentoring approaches, strengthening lab services, expanding pediatric care and treatment services, involving PLHWA, and building multi-disciplinary teams to implement the ICAP-CU model of care. ICAP-CU's approach emphasizes skills transfer to government to ensure long-term sustainability.

ICAP-CU will also continue national-level TA to the MOH in key areas such as PMTCT, pediatric care/ART, early infant diagnosis, TB/HIV, safe water, sanitation and hygiene integration, PLWHAA involvement, and adherence. At regional and sites level, ICAP-CU's own multi-disciplinary teams will provide TA to RHBs and site staff to enhance knowledge and skills in standard of care assessments for quality improvement, clinical supervision and mentoring.

ICAP-CU strengthens quality laboratory services following the health network model through which services are delivered. Quality laboratory services are as described by strategic objectives in the lab master plan and implementation strategies devised through joint planning with EHNRI and RHBs. Training and WHO accreditation of laboratories constitute key strategies for health system strengthening and ensuring sustainability.

ICAP-CU supports task shifting, non-monetary incentives, and program management staffing to support HRH. Pre-service training programs, especially in medicine, receive support, as do Jimma and Haramaya Universities to mainstream HIV into pre-service training and serve as regional hubs for HIV training and TA. In collaboration with WFP, UNICEF, and others, ICAP-CU will expand nutritional counseling, assessment and support at facilities and link the facilities with organizations providing food support and food by prescription. ICAP-CU will work with the GOE and WHO/UNICEF to harmonize activities with child survival initiatives like IMCI and EPI. In collaboration with RHBs, ITNs will be made available to all PLWHAA living in malaria endemic areas; malaria diagnosis and treatment will be enhanced through the ICAP-CU/PMI Project. In partnership with PSI, ICAP-CU will expand provision of safe drinking water to clients. ICAP will support expansion of mobile CT services to the nomadic, hard-to-reach populations in Somali Region. The ICAP-CU approach includes:

TA to MOH regarding program planning and development, and development of guidelines, training materials and provider support tools.

Regional level assistance in program development, implementation, supervision, and M&E.

Facility-level TA for implementation of high quality prevention, care, and treatment services.

Assistance to PLWHAA associations, private facilities and civil societies in program development and service delivery.

ICAP-CU innovations include the family enrollment form; intra-partum CT for mothers and partners; point-of care rapid HIV testing; family screening of TB contacts, and prevention of in-facility TB transmission. ICAP-CU will continue to support M&E systems at national, regional and site levels, giving attention to site-level capacity to utilize assessment tools, analyze and use data, and improve integration with the national HMIS. ICAP-CU's experienced M&E teams will provide TA and supervision to support implementation of activities.

Funding for Care: Adult Care and Support (HBHC): $598,519


Funding for Treatment: Adult Treatment (HTXS): $6,318,481


Funding for Testing: HIV Testing and Counseling (HVCT): $468,834


Funding for Care: Pediatric Care and Support (PDCS): $182,400

The budget for this activity was increased by more than 20% because of the need to expand to new facilities and to improve care and support services. ICAP-CU is playing a lead role in pediatric care and support (C&S) programs. In FY 2009, ICAP-CU supported basic pediatric C&S services at 40 facilities. Activities included initial assessment of site-level palliative care services, training of the multidisciplinary teams, clinical mentoring, data collection and reporting, and supportive supervision. Quality of pediatric HIV care and treatment service was assessed and monitored using ICAP SOC. Other activities included training and supervision on providing CTX, TB screening, and nutritional assessments. Pediatric services were successfully decentralized to four health centers.

In COP 2010, ICAP will build on COP 2009 by:

1. Strengthening the intra-facility and intra-facility linkages required to identify HIV-positive children and provide them with access to care and treatment.

2. Ensuring that all HIV-positive children receive careful and consistent clinical, developmental, and immunologic monitoring to promptly identify those eligible for ART.

3. Providing on-site implementation assistance, including staff support, implementing referral systems, and supporting monthly pediatric HIV/AIDS team meetings.

4. Providing training in pediatric C&S and pediatric preventive care package including nutrition.

5. Providing clinical mentoring and supervision to multidisciplinary teams for care of HIV-exposed and infected children.

6. Developing and distributing pediatric provider job aids and patient education materials related to pediatric C&S.

7. Identifying and sensitizing community-based groups to palliative care and the importance of adherence to both care and treatment services.

8. Improving nutritional assessment of children at health facilities.

9. Promoting interventions to ease distressing pain or symptoms and continuing patient management after hospital discharge if pain or symptoms are chronic.

10. Linking families with community resources after discharge.

11. Providing safe water interventions like point of use water treatment by disinfectant.

The partner being within PEPFAR will play its part in Global Health Initiative (GHI).

Funding for Treatment: Pediatric Treatment (PDTX): $1,230,927


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


Funding for Health Systems Strengthening (OHSS): $458,000


Funding for Biomedical Prevention: Injection Safety (HMIN): $100,000

One of the critical challenges to Ethiopia's program to expand access to HIV/AIDS services is human resource shortages mainly due to low production and attrition. Scarce HR resources need to be protected from occupational hazards by effective work-related infection prevention (IP) initiatives. The Ethiopian MOH is collaborating with partners to undertake a number of IP activities, including establishing an IP Technical Working Group, development of national IP guidelines and procurement and distribution of IP materials.

To support this initiative, ICAP-CU collaborates with Ethiopian MOH and other USG-funded partners, especially JHPIEGO. Activities in previous years included: active membership in the national TWG, support for IP implementation at health facilities through sponsorship of on-site IP trainings and facility level IP working groups. ICAP-CU has also supported an initiative to incorporate IP service into Post Exposure Prophylaxis (PEP) activities at facilities.

In COP 2010, ICAP-CU will continue to be an active member of the national IP TWG and to strengthen activities at Regional Health Bureaus and facilities. ICAP-CU will carry out the following activities:

1. Building the capacity of the RHBs to coordinate IP activities at facilities by organizing IP trainings for RHBs staff and involving them in supportive supervision and on-site IP trainings for facility staff.

2. Organizing off-site IP trainings for RHBs staff and members of the working groups.

3. In collaboration with JHPIEGO, conducting HR inventory related to IP training.

4. Organizing on-site IP trainings for facility and non-health staff of public, private and NGO hospitals based on need assessments; non-health staffs include cleaners, porters, guards, etc.

5. Providing limited infrastructure support to strengthen IP activities in the facilities.

6. Working in collaboration with MOH, RHBs and other partners to facilitate provision of IP materials to health facilities.

7. Developing, adopting, distributing, and encouraging utilization of IP materials targeting providers.

8. Strengthening IP working groups at facilities and implementing IP activities including PEP.

9. Closely monitoring and evaluating IP implementation at RHBs and facilities.

Funding for Sexual Prevention: Abstinence/Be Faithful (HVAB): $50,000


Funding for Sexual Prevention: Other Sexual Prevention (HVOP): $200,000


Funding for Biomedical Prevention: Prevention of Mother to Child Transmission (MTCT): $1,200,000


Funding for Laboratory Infrastructure (HLAB): $672,000

This activity has a significant change in scope and should be part of a streamlined COP10 submission.

In COP09, ICAP provided integrated laboratory service support to 55 health facilities and three regional laboratories. ICAP also provided technical and logistics support in the roll-out of the early infant diagnosis program at national, regional, and site levels. ICAP's laboratory support activities in FY10 will include:

Providing site-level laboratory support to 60 health facilities and three regional laboratories for high-quality integrated laboratory services. ICAP will provide ongoing supportive supervision, coaching and mentoring of laboratory staffs at all sites to ensure strong referral linkages, improved inventory systems, preventive maintenance, and troubleshooting of equipment failures.

Availing and use of SOPs at sites for integrated laboratory tests, specimen management, safety manuals, documentation, and recording. ICAP will provide technical and logistics support for participating tier-level laboratories and points of testing in EQA programs.

Supporting the establishment of a regional laboratory in Somali in collaboration with CDC, EHNRI and the Somali Regional Health Bureau. Five hospital laboratories will be renovated, furnished and equipped to improve quality of services

Supporting the establishment of HIV DNA PCR testing capacity at Nekemte Regional and Jimma University Hospital Laboratories.

Facilitating the establishment of viral load testing capacity at regional laboratories.

Providing technical and logistic support towards establishing TB culture facility.

Supporting the establishment of clinical bacteriology diagnostic capacity at selected hospitals.

Supporting and providing trainings on different thematic areas that include POSRHT, ART laboratory monitoring, TB smear microscopy, OI and STI diagnosis, EID and HEI care, HIV DNA PCR, quality assurance, laboratory management, and accreditation of five laboratories using WHO-AFRO scheme.

Ensuring sustainability by building capacity of regional laboratories to independently evaluate and monitor their respective sites and to follow operational plans for accrediting laboratories.

Facilitating training of university staffs on ART laboratory monitoring; strengthening pre-service training of graduating students.

Funding for Care: TB/HIV (HVTB): $743,700


Subpartners Total: $0
Adama Life Saving Association: NA
Dire Dawa Regional Health Bureau: NA
Family Guidance Association of Ethiopia: NA
Harari Regional Health Bureau: NA
Mekdim Ethiopia National Association: NA
Network of Networks of Ethiopian Living with HIV/AIDS: NA
Oromiya Regional Health Bureau: NA
Somali Regional Health Bureau: NA
To Be Determined: NA
Yetesfay Bisrat Misrak Association: NA
Cross Cutting Budget Categories and Known Amounts Total: $5,560,000
Construction/Renovation $550,000
Food and Nutrition: Policy, Tools, and Service Delivery $250,000
Human Resources for Health $4,500,000
Water $260,000
Key Issues Identified in Mechanism