Detailed Mechanism Funding and Narrative

Details for Mechanism ID: 10818
Country/Region: Zambia
Year: 2010
Main Partner: Columbia University
Main Partner Program: International Center for AIDS Care and Treatment Programs
Organizational Type: University
Funding Agency: HHS/CDC
Total Funding: $1,730,000

This activity relates closely to activities and the narrative described in the University Teaching Hospital Prime Partner FY 2010 narratives under budget code PDCS, PDTX and HVTB.

The International Center for AIDS Care and Treatment Programs (ICAP) at Columbia University's Mailman School of Public Health is proposing to continue to support the strengthening and implementation of pediatric HIV care and treatment services in Zambia through continued partnership with the University Teaching Hospital Center of Excellence (UTH PCOE) and the Zambia Ministry of Health (MOH). Since 2005, ICAP, via the CDC-funded University Technical Assistance Program (UTAP), has provided program, technical and operations support to develop, implement, manage and evaluate the University Teaching Hospital (UTH) and Livingstone General Hospital (LGH) Pediatric HIV Centers of Excellence (PCOEs) in partnership with the UTH Department of Pediatrics in Lusaka, and to support the expansion and decentralization of pediatric HIV services and capacity throughout the country. ICAP proposes to expand on this effort to ensure implementation of high-quality, decentralized pediatric HIV/AIDS care and treatment services.

ICAP activities and strategies are rooted in strong partnership with UTH PCOE, through the Department of Pediatrics that manages the PCOEs and the MOH. Together, objectives and program components for FY 2010 have been defined. ICAP aims to support the implementation of integrated and comprehensive pediatric and family-centered HIV support, care and treatment (HIVSC&T) services and reduce HIV-related morbidity and mortality among children and families. This will be accomplished by building national capacity to implement pediatric and family-focused HIVSC&T services to primary care facilities and by increasing the availability and implementation of quality comprehensive pediatric and family-centered HIVSC&T. This includes improving the quality and scope of pediatric and family-focused HIVSC&T services; by improving psychosocial, adherence and community support, and care programs for families; and by increasing patient follow-up, tracing, and tracking efforts for families engaged in HIV care.

Through partnership with UTH, ICAP will strengthen the health system by providing technical support at the national level to achieve the above noted activities. In turn, ICAP will support UTH through a sub-agreement to implement the above noted activities on the district and health facility level. ICAP will adopt a dynamic and contextualized strategy to support each level to operationalize these services. Innovative strategies will be implemented, including building the technical and program capacity of UTH COE team through skills building, knowledge transfer, supportive supervision, clinical mentoring and modeling in order to improve quality of care at the COE and to assist them to decentralize those skills. Finally, with UTH COE, ICAP will support the process of developing policies, performance tools and job aids, in addition to updating MOH guidelines, training materials and resources in line with changing WHO recommendations.

Funding for Care: Pediatric Care and Support (PDCS): $530,000

ICAP will continue to work closely with UTH PCOE to ensure continued strengthening of pediatric HIV care and treatment services. Priority activities include:

Integrated and comprehensive pediatric HIV care and treatment services at the PCOE- ICAP/UTH will support the implementation of the following program elements at the PCOE: Early infant diagnosis and follow up treatment for all positive infants Quality and continuous clinical care for all infected children Monitoring and assessment of all infected children for treatment eligibility Continuous assessment and retention of all children enrolled in care and treatment services for treatment complications, outcomes, and failure Increased linkage and coordination to support HIV needs of the family Implementation of comprehensive care package for the HIV-infected child at all ARV sites supported by the PCOE, including cotrimoxazole prophylaxis, management of opportunistic infections, palliative care, growth monitoring, and neuro-developmental and nutritional assessments Pediatric adherence and psychosocial programs, including support groups for HIV infected children and adolescents on treatment

Policies, Systems and Program- ICAP, in partnership with UTH, will support national level MOH stakeholders and provide support to strategically plan, disseminate and monitor key pediatric support, care and treatment programs. Specifically, ICAP will support the development of key advanced policy, guidelines, protocols and training resources. Emphasis will be placed on essential program areas that have not been comprehensively operationalized such as those for adolescents living with HIV. ICAP will work closely with UTH to develop a comprehensive support package to support implementation of services for adolescents living with HIV. Key topics will include clinical management, prevention for adolescents living with HIV, and psychosocial support addressing their specific needs.

Funding for Treatment: Pediatric Treatment (PDTX): $700,000

Supporting and strengthening UTH PCOE's Pediatric HIV Training Program: UTH PCOE has been designated by the GRZ to serve as the national Pediatric Training Center. ICAP will support UTH to develop and implement a training program whereby clinical staff at sites targeted to initiate pediatric HIV/AIDS related services visit the PCOE to receive on-the-job training and are followed-up regularly to ensure ongoing transfer of skills and learning. ICAP will work closely with UTH and the MOH to develop a model and approach that is best suited for the Zambia context and ensure a robust emphasis on providing post-training follow-up and systems support. A priority will be implementation of the pediatric HIV testing training program based on the revised guidelines and curriculum developed by UTH, ICAP and University of Medicine and Dentistry- Francois Xavier Bagnoud Center (FXB).

Sub-National (district) level: As appropriate and feasible, ICAP will support UTH PCOE to strengthen the capacity of the district level health authority to implement and manage pediatric HIV support, care and treatment plans to achieve saturation of pediatric services in their area. Initial targets would include the Livingstone, Siavonga, Monze, and Mazabuka District Health Management Teams (DHMT). As feasible, illustrative activities will include providing support to above noted DHMT to enhance the management and support they give to facilities implementing family-focused pediatric HIV services. Support will include providing the DHMT with the capacity to conduct site assessments, program quality evaluations, logistics management, supportive supervision visits, and work plans to ensure greater ownership and leadership of pediatric HIV services.

Funding for Care: TB/HIV (HVTB): $500,000

ICAP, in partnership with UTH, will engage national level MOH stakeholders and provide support to strategically build capacity to deliver pediatric TB/HIV care and treatment programs. Specifically, ICAP will actively support the development and adaptation of pediatric TB/HIV policy, guidelines, protocols and training resources in consultation with the National TB program:

Develop practical algorithms and guides for screening and diagnosis of TB in HIV-exposed and HIV-infected children and facilitate dissemination of these algorithms including adapting an adult TB screening questionnaire currently used in ICAP supported programs and pilot its use to assess the feasibility and efficacy of identifying TB in infants and children in consultation with the Ministry of Health National TB program.

Develop protocol and training materials in consultation with MOH NTP to:

o Ensure that all children and family members diagnosed with TB are routinely counseled and tested for HIV under the National TB and HIV program

o Ensure young children in the households of adults with active TB are screened and receive appropriate Isoniazid (INH) prophylaxis for prevention of TB infection.

ICAP and UTH PCOE will also continue to partner with FXB to provide support in the development of TB/HIV related training and performance related resources such as curriculums, job-aids, handbooks, and wall charts that support providers to read pediatric x-rays, screen and treat children for TB.

UTH PCOE has been designated by the GRZ to serve as the national Pediatric Training Center. ICAP will support UTH to develop and implement TB/HIV related training events and tools for implementation at the PCOEs and dissemination for other partner's training needs.

As appropriate and feasible, ICAP, through sub-agreement with UTH PCOE, will aim to strengthen the capacity of the district health authority to implement and manage pediatric TB/HIV care and treatment activities. Priority targets continue to include Livingstone, Siavonga, Monze, and Mazabuka DHMT. Activities will focus on enhancing the diagnosis and management of TB in children infected with and exposed to HIV at several large facilities.

All indicators will be reported by UTH.

Subpartners Total: $0
University Teaching Hospital - Zambia: NA
Key Issues Identified in Mechanism
Increasing gender equity in HIV/AIDS activities and services
Child Survival Activities