Scaling-up HIV Prevention,Care and Antiretroviral Therapy

at Primary Health Centers

A WHO/PEPFAR Collaboration

Scaling-up HIV Prevention, Care and ART at Primary Health Centers

Adult Treatment Technical WorkgroupTedd Ellerbrock - CDCBob Ferris- USAID

Department of HIV/AIDS, WHOSandy GoveKJ Seung

Global AIDS Program, CDCMary Lou LindegrenLouise PerryTonia PoteatAlexandra Zuber

Organizing Committee

Scaling-up HIV PreventionCare and Antiretroviral Therapy

at Primary Health Centers:A WHO/PEPFAR Collaboration

The Rationale

Scaling-up HIV Prevention, Care and ART at Primary Health Centers

As of September 30, 2006, a total of 822,000 adults and children in the 15 focus countries were on antiretroviral therapy (ART) in programs supported by the Emergency Plan

The Emergency Plan treatment goal is to provide ART for 2 million persons by September 2009

Consequently, we need to initiate ART for about 1.2 million persons during the 36-month period, October 2006 – September 2009

Scaling-up HIV Prevention, Care and ART at Primary Health Centers

Most ART programs currently supported by the Emergency Plan are located at tertiary or large secondary medical facilities in urban areas

To expand access and assure long-term adherence to HIV care and treatment, services need to be provided at health centers and district hospitals in semi-urban and rural areas within walking distance of patients’ homes

Scaling-up HIV Prevention, Care and ART at Primary Health Centers

If we assume that we can provide ART for an average of about 300 persons at each of these health centers or district hospitals, we will need to provide support for about 4,000 facilities to initiate ART for 1.2 million persons

Thus, we need to help initiate HIV care and treatment programs at about 110 sites per month during the 36-month period, October 2006 - September 2009

Scaling-up HIV Prevention, Care and ART at Primary Health Centers

Initiating programs for 110 facilities per month appears achievable because an average of 93 sites initiated ART programs per month during FY2006

To support this scale-up, we have proposed a WHO/PEPFAR collaboration to standardize operational and clinical guidance and patient monitoring systems for delivery of HIV services at primary health centers

Scaling-up HIV PreventionCare and Antiretroviral Therapy

at Primary Health Centers:A WHO/PEPFAR Collaboration

The Proposal

Scaling-up HIV Prevention, Care and ART at Primary Health Centers

The collaboration is designed to achieve 4 objectives:

Development of an Operations Manual for Primary Health Centers

Development & updating of clinical & monitoring tools

Country adaptation of operational, clinical, and monitoring tools

Implementation of the operations manual and the updated tools

Scaling-up HIV Prevention, Care and ART at Primary Health Centers

The operations manual will include recommended clinical services, integration of services, physical infrastructure, drug and supply management, lab services, patient monitoring, human resources, quality management, and community services

The manual will be based on normative guidelines and use country-adapted clinical guidelines (e.g., IMAI and IMCI) and patient monitoring tools developed by WHO, USG, and other partners

Objective 1: Development of Operations Manual for Primary Health Centers

Scaling-up HIV Prevention, Care and ART at Primary Health Centers

IMAI/IMCI clinical guidelines and training for nurses and clinical officers at primary health centers will be updated to reflect current evidenceStandardized patient monitoring tools will be updated for ART and HIV care systems, including TB/HIV and PMTCT

Objective 2: Development and updating of clinical and monitoring toolsTo support decentralization to primary health centers, standardized clinical and monitoring tools will need to be developed, updated, and improved. For example,

Scaling-up HIV Prevention, Care and ART at Primary Health Centers

Development of a standardized adaptation guide

Sociocultural adaptation of patient education materials, including strengthening prevention messages

Providing support for country adaptation of operations manual, clinical tools, and patient monitoring systems

Objective 3: Country adaptation of operational, clinical and monitoring toolsThe goal is to update a customized set of tools for scale-up at primary health centers in each country, which are approved by MOH, WHO, and all partners, including:

Scaling-up HIV Prevention, Care and ART at Primary Health Centers

Training, mentoring, and supervision of health workers in clinical care and district coordinators in supervision

Providing staff in selected countries to support MOH and partners to adapt tools

Expanding the “South to South” technical network to share experiences and provide training in using toolsManagement support for technical assistance/oversight

Objective 4: Implementation of the operations manual and the updated toolsFunding will be needed for implementation activities, e.g.:

Scaling-up HIV Prevention, Care and ART at Primary Health Centers

The Adult Treatment Technical Workgroup was notified by the Office of the Global AIDS Coordinator (OGAC) on May 4, 2007, that the proposal for the collaboration was approved for $1.5 million during FY2007

USAID will be the funding agencyThe funding mechanism will be the USAID World Health Organization Umbrella Grant

Funding

Collaboration for HIV Prevention, Care and ART at Primary Health Centers

WHO (Headquarters, regional, and country offices) USG Agencies: CDC, USAID, HRSA, DOD, Peace Corps, Dept of State, Dept of Labor (Headquarters & country)USG-Implementing Partners: Columbia, AIDS Relief, EGPAF, Harvard, FHI, HAI, JSI, UMD, BASICS, MSHMinistries of Health

PLHIV client groups: ITPC, ICW, TAC, and othersOther Partners: Clinton Foundation, APCA, MSF, REACH, Engineers without borders, Anneca, DFID, GTZOther multilaterals: UNICEF, World Bank, GFATM, ILO

Selected Organizations of Participating Experts

Collaboration for HIV Prevention, Care cand ART at Primary Health Centers

During approximately the past 6 months, more than 250 experts were organized into 10 writing teams and 13 expert panelsThe second complete draft of the Operations Manual has been completed and will soon be disseminated for broader review and early country adaptation and usePatient monitoring and clinical tools are being updated

Progress to Date