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1
Partnering to Strengthen Local Efforts Can Help Us Get to Six Million on ART
Anja Giphart, MD MPHVice President, Program Implementation
Elizabeth Glaser Pediatric AIDS Foundation
July 25, 2012
Project HEART Countries and Number of Sites
Project HEART Care and Treatment Results, 2004-2011
Eligible Women for PMTCT ser-
vices
Women Received HIV Test Results
0
500,000
1,000,000
1,500,000
2,000,000
2,500,000
3,000,000
3,500,000
Num
ber o
f wom
en
N= 2.9m
N= 2.6m
Total HIV+ Pregnant W
omen
Women Rece
iving ARV Prophylaxis
0
50,000
100,000
150,000
200,000
250,000
300,000
350,000
400,000
Zambia South Africa Mozambique Cote d'Ivoire
N= 369,197N= 326,728
Project HEART PMTCT Results 2005-201162,000 pediatric
infections averted
Local Capacity Building Approach #1: District Approach to Expansion
of Services
District Approach
• An effective approach to rapidly scaling-up HIV services while building local financial, technical and management capacity
• Working “through” the districts: – Districts are responsible and accountable for
implementation, quality and scale-up of HIV services in their location
– EGPAF provided technical assistance and direct funding via subgrants
• EGPAF worked with a total of 159 districts across 5 countries
• In the final project year 96% of subaward funds were awarded to local partners, the majority being districts and community organizations
Tanzania Care and Treatment Scale-up
2004
Q4
2005
Q1
2005
Q2
2005
Q3
2005
Q4
2006
Q1
2006
Q2
2006
Q3
2006
Q4
2007
Q1
2007
Q2
2007
Q3
2007
Q4
2008
Q1
2008
Q2
2008
Q3
2008
Q4
2009
Q1
2009
Q2
2009
Q3
2009
Q4
2010
Q1
2010
Q2
2010
Q3
2010
Q4
2011
Q1
2011
Q2
2011
Q3
0
20,000
40,000
60,000
80,000
100,000
120,000
140,000
160,000
180,000
0tan28a566028
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0tan29a566029
0tan19a566019
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0tan30a566030
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0tan1a56601
Cumulative number of patients ever enrolled in HIV careCumulative number of patients ever started on ARTNumber of reporting sites
Num
ber o
f pati
ents
Num
ber o
f rep
ortin
g si
tesDistrict
Approach Expanded in
2007
Directly and Indirectly Supported Care and Treatment Sites, Tanzania
N=260
ART results for 5 Regions as of March, 2012
N=6,016 N=56,486
Sites New on ART Current on ART0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
37%29%
8%
IndirectDirect
Mozambique Subgrant Burn Rates Improvements over
Time
Maputo Gaza Nampula Cabo-Delgado Total
0tan4a56604
0tan9a56609 0tan4a56604
0tan19a566019
0tan29a566029
0tan24a566024
0tan14a566014
0tan24a5660240tan24a566024
0tan5a566050tan26a566026
0tan10a5660100tan10a5660100tan10a566010
Percent of Budget Spent by Subgrantees in 4 provinces
2008 -2011
July- December 2009 January-June 2010 July- December 2011
Local Capacity Building Approach #2: Decentralizing Training
Traditional In-Service Training
COUNTRY NAME
Physicians Trained: ART
Nurses Trained: ART
Other HCW Trained: ART
Côte d’Ivoire 3,069 2,571 655
Mozambique 278 916 687
South Africa 932 1,868 1,868
Tanzania 1,712 1,861 1,214
Zambia 926 4,047 2,638
TOTAL 6,917 11,724 6,962
Over 25,000 Healthcare Workers Trained in the provision of comprehensive HIV care and
treatment
Pre-Service Training in Cote d’Ivoire
Medicine69 doctors trained in care and treatment of HIV/AIDS, TB, and
malaria
* 12 employed by program site
* 14 awaiting assignment as civil servants
* 42 writing thesis* 1 working outside CI
Pharmacy25 pharmacists
trained in lab and strategic supply
management
* 4 employed by program site
* 19 writing thesis* 2 working outside CI
Social work151 social workers trained to provide
support and follow-up to PLWHA
* 131 employed as civil servants, mostly
in program sites* 20 awaiting assignment
245 health professionals trained, 2007-2011
Pre-Service Training in Mozambique
By June 2011, Project HEART supported a total of 9 courses for 259 medical officers, nurses, pharmacy agents, and assistant health officers.
Targeted Mentoring for Pediatric TreatmentCase Review of 348 Pediatric Patients
in 3 Referral Hospitals in Tanzania
Site# of records reviewed
# of children on ART
# eligible but not on ART
% eligible but not on ART
Maswa District
154 38 57 37%
Shinyanga Regional
130 49 47 36%
Bukombe District
64 41 18 28%
TOTALS 348 128 122 35%
“Systematic analysis of EID cascade and implementation of specific interventions: Lessons from Tanzania.” Schimana, W et al. IAS, 2011
Targeted mentoring to improve pediatric ART initiation -
Tanzania*
Eligible children not on ART
0%10%20%30%40%50%60%70%80%90%
100%
Baseline
Eligible children not on ART
0%10%20%30%40%50%60%70%80%90%
100%
After mentoring
* Data are from three referral hospitals in Tanzania
Local Capacity Building Approach #3: Transition
Services to Local Partners
Two Phases of Project HEART
Phase I: Emergency scale-up, 2004-2009
Phase II: Sustain & Transition, 2009-2012
Two Program Phases
Project HEART Transition Approach
Sustainable Health Outcomes: Clients have continuous high quality
HIV care and treatment delivered by local partners
Health Service Provision
(Quality & Access)
Management Capacity of
Government, NGOs & Private Sector managing health
system
Client and Community Engagement
(active civil society, high demand)
Enabling Environment Policies, political stability, human rights, gender equality, etc.
Transition Monitoring ToolsArea of
MeasurementDescription Monitoring Tool
Capacity Assess existence and scope of organizational systems and processes
H-CAT (for MOH Districts and Regions)
Organizational Capacity and Viability Assessment Tool (OCVAT)
Site Capacity Assessment Tool Affiliate Accreditation Tool
Transition Outcome indicators demonstrating an incremental increase in responsibility and ownership
Benchmark Matrix OCVAT Project workplans & budgets
Sustainability Performance indicators demonstrating sustained ownership and quality
Benchmark Matrix Affiliate Accreditation Tool Project workplans & budgets
Country Transition Approaches
• Health Systems Strengthening, capacity building and transition to local authorities -2 Provinces Directly Funded by CDC in Mozambique
• Transition to Existing NGO– Zambia: CIDRZ– South Africa: McCord Hospital and Health
Systems Trust, Aurum Institute• Enhanced health systems strengthening and
transition to a new independent NGO (EGPAF Affiliate) in– Cote d’Ivoire– Mozambique– Tanzania
Getting to Six Million: Our Future Depends on It
Acknowledgements
• PEPFAR and the US Government• Ministries of Health and the National, Regional and
Local Governments in Cote d’Ivoire, Mozambique, South Africa, Tanzania and Zambia
• International and local partners• CDC/Atlanta (from GH, PGO, Budget Office and ADS)• CDC in Cote d’Ivoire, Mozambique, South Africa,
Tanzania and Zambia• EGPAF staff in LA, DC and Cote d’Ivoire, Mozambique,
South Africa, Tanzania and Zambia• Other Track 1.0 partners for their collaboration• The patients, providers and communities for their
participation, engagement and courage