Detailed Mechanism Funding and Narrative

Details for Mechanism ID: 5001
Country/Region: Zambia
Year: 2007
Main Partner: Columbia University
Main Partner Program: Mailman School of Public Health
Organizational Type: University
Funding Agency: HHS/CDC
Total Funding: $1,400,000

Funding for Treatment: Adult Treatment (HTXS): $1,400,000

This activity relates to: Lab (#9015), UTH FSU (#9044), UTH Pediatrics (#9717)

The primary goal of the program is to provide state-of-the-art care to infants, children, and adolescents with HIV infection. This will be accomplished through 1) enhancing counseling and testing (CT) at pediatric entry points such as inpatient wards and outpatient services, 2) improving neonatal and inpatient pediatric wards by supporting and training counselors and medical staff to provide CT in inpatient settings, 3) enhancing human capacity resources to support a multi-disciplinary team of HIV pediatric and family care providers, 4) supporting preceptoring and clinical mentoring on comprehensive service delivery to pediatric and adolescent HIV-infected patients and 5) supporting efficient and effective comprehensive monitoring and evaluation systems.

The program began implementation of activities at the UTH Department of Pediatrics in September 2005. Some of the achievements to date includes, identifying management and leadership staff to incorporate into the Pediatric and Family Center of Excellence (COE), setting up computer data systems and logistics, information and referral flow between the in-patient wards, out-patient clinics, the Family Support Counseling Unit and the laboratory, training and establishment of the infant diagnostic protocols and guidelines. Between September 2005 and March 2006, the number of children admitted to the pediatric wards who were counseled (guardians give consent), increased from an initial 37% to 67%. More than 80% of those counseled were tested. To date, (August 2006) 1,063 children are accessing antiretroviral therapy and approximately 353 staff have received training and skills building in a range of pediatric areas including neurodevelopmental considerations for the HIV-infected child, pediatric counseling and disclosure.

In fiscal year (FY) 2007, this program will continue to support the development and operation of a COE for HIV/AIDS care at the University Teaching Hospital (UTH) in Lusaka and scale-up by duplicating the development of a similar center at the provincial hospital in Livingstone. In FY 2007 the Arthur Davison Children's Hospital in Ndola will receive initial technical support for the establishment of a similar center in FY 2008. This will be done in close collaboration with the United States Agency for International Development supported partner, Zambia HIV/AIDS prevention, care, and treatment (ZPCT) / Family Health International. The Pediatric Center at Livingstone hospital will be supported to serve as an additional Regional COE of HIV care and treatment through capacity-building, training, and infrastructure improvements. UTH will provide training to multi-disciplinary teams in pediatric and family HIV care and treatment. Using the lessons learned, UTH will provide technical assistance to both Livingstone and Ndola Hospitals as they develop their own COE.

In FY 2007, a priority activity for Columbia will be to explore innovative approaches to identify, engage, and manage adolescents with HIV. Programs for routine infant diagnosis using DNA/RNA polymerase chain reaction dried blood spot technology will be expanded through training of staff at service delivery points, and the development of infant diagnostic testing protocols and systems, in close collaboration with CDC and the University of Nebraska-Lincoln laboratory at UTH (#9015).

Capacity building will be supported by instituting a clinical fellowship program for advanced-level pediatric infectious disease fellows. Fellows will be supported to rotate in Zambia at UTH, Livingstone, and other related sites, where they will engage in supporting clinical care, teaching, and research activities. Each fellowship will bring specific expertise to the COEs through applied study projects and cross-training activities (see prevention of mother to child transmission activity #8784). To promote sustainability, fellows from the US will partner with Master of Medicine in Pediatrics fellows at the UTH to ensure exchange of knowledge and local building capacity.

Boston University (BU) staff will continue to provide short-term technical assistance to the program specifically targeting pediatric clinical and neurodevelopment issues.

Columbia University in collaboration with UTH and BU will also support a key public heath evaluation activity to inform comprehensive pediatric HIV/AIDS programs. A pediatric ART efficacy and resistance evaluation will also inform the pediatric program elements and interventions that should be enhanced to ensure successful uptake and management of

comprehensive pediatric care and treatment services.

Subpartners Total: $553,803
Boston University: NA
University Teaching Hospital - Zambia: $288,344
Livingstone General Hospital: $265,459