Detailed Mechanism Funding and Narrative

Years of mechanism: 2010 2011

Details for Mechanism ID: 10619
Country/Region: Lesotho
Year: 2010
Main Partner: Columbia University
Main Partner Program: NA
Organizational Type: University
Funding Agency: HHS/CDC
Total Funding: $1,850,000


ICAP will engage national-level MOHSW stakeholders and provide support to strategically plan,

implement, and evaluate TB and HIV prevention, diagnostic, care and treatment programs. Specifically,

ICAP will actively participate in and engage TWGs and planning bodies to support development,

dissemination, and implementation of TB/HIV and related policy, guidelines, registers, and tools.

Emphasis will mostly be placed on operationalization and implementation, as TB related plans and

strategies already exist at national level. ICAP will support the development of more advanced guidelines

such as latent TB infection and TB adherence and community follow-up as well as more general lab, IC

and ACSM plans and policies which do not exist. Priority focus areas will include fostering an enabling

and collaborative environment between the NTP and HIV/AIDS Directorate to ensure TB/HIV integration

and thus decrease the TB burden for PLHIV (through intensified case finding, IPT, and IC) and the HIV

burden for TB patients (through HIV prevention and testing, CPT, and HIVC&T services). Furthermore,

the MOHSW will be supported to implement a high-quality DOTS program as well as strengthened TB

lab networks and to sustainably expand M/XDR-TB services (DOTS-Plus), revitalizing IC implementation

at facility and community levels (especially as renovations are planned through MCC5 and other funding).

ICAP will work closely with the MOHSW to develop a comprehensive CME program to keep HCWs

updated on IC and TB/HIV clinical and diagnostic services.


Following MOHSW plans and guidelines, ICAP will support the DHMTs to strengthen TB/HIV service

delivery. Emphasis will be placed on providing TA and training to DHMTs to improve TB/HIV service

integration, with support for HIVC&T services to enhance intensified TB case finding, administer IPT for

all eligible PLHIV, ensure successful initiation and completion of TB treatment and implement IC

practices; and support to TB services to offer routine HIV testing to all TB cases, and enrollment of PLHIV

with TB on CPT and if eligible ART.

Furthermore, to ensure a sustainable and evidence-based approach to service scale-up, ICAP and the

MOHSW will identify one or two facilities to serve as settings for pursuing different models and

approaches for TB/HIV integration, delivering DOTS and DOTS-Plus, and VHWs TB screening.


ICAP will collaborate with the MOHSW and DHMT to conduct a rapid lab assessment of lab infrastructure

and staff capacity to develop a workplan for enhancing the TB lab network. The workplan will define lab

levels network-wide (i.e. reference, district, and HC levels); set a timeline for phased establishment of TB

lab components by lab; specify technology for tests at each level; develop a lab model for each network

level, based on lab space; address provisional lab space and services; and develop policies and SOPs

standard to each level. ICAP will support the NRL to develop an overall quality policy statement, QA/QC

manuals, SOPs, test methodologies for each level, and tools for a client satisfaction survey.


Meaningful involvement of the community in developing, implementing, and monitoring TB and HIV

activities is the cornerstone to reduce its burden and implement successful local TB- and HIV-related

services. Key activities will include emphasizing the value and modes of HIV and TB prevention;

enhancing TB and HIV literacy; promoting demand for high-quality TB and HIV health services;

destigmatizing TB and HIV and clarifying misinformation; and improving TB and HIV prevention skills and

self-efficacy. Key stakeholders will be engaged in these activities to assess priority needs and campaign

design as part of the larger ACSM strategy ICAP will support the MOHSW to develop.

VHWs, vital health facilities-community links, will be trained and supported regularly by ICAP and

MOHSW to follow up with high-risk patients in support of HIV and TB treatment, adherence, and care in

the household. They will also conduct community IEC activities and home visits for pregnant woman,

infants, newly diagnosed PLHIV with TB, those starting ART, and all TB and ART patients who miss

appointments. In addition, VHWs will assess homes of M/XDR-TB patients discharged to the community,

noting IC issues and vulnerabilities of household members (e.g. children, PLHIV); and will provide

education on TB transmission, signs and symptoms, and IC.

Funding for Care: TB/HIV (HVTB): $1,850,000

Columbia University-ICAP will aim to accelerate effective scale-up of TB- and HIV-health systems and will meet targets while sustainably building indigenous capacity. ICAP will support human resources, training, infrastructure, and the introduction of clinical, lab, community and M&E activities will be prioritized to strengthen TB-HIV actives.

In FY10, ICAP will support all 10 districts, however, at HF level, ICAP will provide support in a phased manner. Within the currently supported four districts and 31 HF, ICAP will broaden its ongoing HIV support to include TB and lab activities. In the new districts ICAP, will support eight hospitals, six labs, and 12 HCs, for a total 57 HFs (15 hospitals and 42 HCs).

ICAP will ensure delivery and uptake of appropriate, high-quality TB/HIV services; and to support the achievement of the GOL's National DOTS Expansion Strategic Plan (2008-2012), M/XDR-TB

Emergency Plan 2007-2009, and the National HIV and AIDS Strategic Plan (2008-2011). ICAP will also support the MOHSW on all related policy issues, including strategic decision making to improve the accelerated rollout of TB/HIV services.

ICAP will continue to strengthen collaborations with the following organizations in the areas of TB/HIV: PEPFAR-funded partners, Quality Assurance M2M, Human Capacity Project, Infant and Young Child Nutrition) and other stakeholders including Clinton Foundation, Baylor International Pediatric AIDS Initiative, Partners in Health, UNICEF and WHO.

ICAP will support the MOHSW to implement and institutionalize the electronic database to capture identifier-delinked patient-based information at district level directly from paper TB registers; to generate standard cohort reports, line listings, and data quality checks reflecting the DOTS strategy and enabling routine TB-program surveillance and M&E.

ICAP will work closely with the MOHSW to implement systems to routinely ensure and assess data quality. High-quality services will be achieved by intensively mentoring health facility (HF) staff and implementing SOC tools. Trainings and workshops will be conducted to enhance HF capacity to document, collect, analyze, report, and feedback data to improve services; supporting MOHSW establishment and enhancement of routine surveillance and M&E systems at facility, lab, and community level to track program outputs and implementation of systematic methods to gather strategic information for program planning, evaluation, and progress measurement. ICAP uses a Program and Facility Characteristics Tracking System (PFACTS) that systematically collects facility- , lab- and program-level information (e.g., location, provider-client ratio, specific services provided, etc.). The data will be used for strategic planning and program evaluation. ICAP-Lesotho will also support the MOHSW to implement a Data Quality Improvement Tool to identify and correct HF-level data problems. Finally, careful attention will be given to data confidentiality and security via the use of training, password-protected databases and locked files.

ICAP will conduct high-quality, timely, and sustainable monitoring and evaluation of project activities consistent with the Three Ones principles, ensuring that information is used for program improvement by supporting the routine collection, analysis, use, and dissemination of data using national registers and forms that assess program progress, quality, and impact.

Subpartners Total: $0
Yale University: NA
Cross Cutting Budget Categories and Known Amounts Total: $125,000
Construction/Renovation $25,000
Human Resources for Health $100,000