Partnering to Strengthen Local Efforts Can Help Us Get to Six Million on ART Anja Giphart, MD MPH Vice President, Program Implementation Elizabeth Glaser Pediatric.
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Partnering to Strengthen Local Efforts Can Help Us Get to Six Million on ART Anja Giphart, MD MPH Vice President, Program Implementation Elizabeth Glaser Pediatric AIDS Foundation July 25, 2012 1 Project HEART Countries and Number of Sites Project HEART Care and Treatment Results, 2004-2011 Project HEART PMTCT Results 62,000 pediatric 2005-2011 infections averted 400,000 N= 369,197 3,500,000 N= 2.9m Number of women 3,000,000 N= 326,728 350,000 N= 2.6m 300,000 2,500,000 250,000 2,000,000 200,000 Zambia South Africa Mozambique 150,000 1,500,000 Cote d'Ivoire 100,000 1,000,000 50,000 500,000 0 0 Eligible Women for Women Received PMTCT services HIV Test Results Total HIV+ Pregnant Women Women Receiving ARV Prophylaxis 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 180 160,000 160 140,000 140 District Approach Expanded in 2007 120,000 100,000 80,000 120 100 80 60,000 60 40,000 40 20,000 20 Cumulative number of patients ever enrolled in HIV care Cumulative number of patients ever started on ART Number of reporting sites 2011 Q3 2011 Q2 2011 Q1 2010 Q4 2010 Q3 2010 Q2 2010 Q1 2009 Q4 2009 Q3 2009 Q2 2009 Q1 2008 Q4 2008 Q3 2008 Q2 2008 Q1 2007 Q4 2007 Q3 2007 Q2 2007 Q1 2006 Q4 2006 Q3 2006 Q2 2006 Q1 2005 Q4 2005 Q3 2005 Q2 0 2005 Q1 0 Number of reporting sites 180,000 2004 Q4 Number of patients Tanzania Care and Treatment Scale-up Directly and Indirectly Supported Care and Treatment Sites, Tanzania N=260 N=6,016 100% ART results for 5 Regions as of March, 2012 N=56,486 8% 90% 80% 37% 29% 70% 60% Indirect 50% Direct 40% 30% 20% 10% 0% Sites New on ART Current on ART Mozambique Subgrant Burn Rates Improvements over Time Percent of Budget Spent by Subgrantees in 4 provinces 2008 -2011 July- December 2009 90 January-June 2010 July- December 2011 100 95 100 100 87 65 55 55 20 15 10 Maputo 55 5 Gaza Nampula Cabo-Delgado Total Local Capacity Building Approach #2: Decentralizing Training Traditional In-Service Training COUNTRY NAME Côte d’Ivoire Physicians Nurses Other HCW Trained: Trained: Trained: ART ART ART 3,069 2,571 655 Mozambique 278 916 687 South Africa 932 1,868 1,868 1,712 1,861 1,214 Zambia 926 4,047 2,638 TOTAL 6,917 11,724 6,962 Tanzania Over 25,000 Healthcare Workers Trained in the provision of comprehensive HIV care and treatment Pre-Service Training in Cote d’Ivoire 245 health professionals trained, 2007-2011 Medicine Pharmacy Social work 69 doctors trained in care and treatment of HIV/AIDS, TB, and malaria 25 pharmacists trained in lab and strategic supply management 151 social workers trained to provide support and followup to PLWHA * 12 employed by program site * 14 awaiting assignment as civil servants * 42 writing thesis * 1 working outside CI * 4 employed by program site * 19 writing thesis * 2 working outside CI * 131 employed as civil servants, mostly in program sites * 20 awaiting assignment 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 Treatment Case Review of 348 Pediatric Patients in 3 Referral Hospitals in Tanzania Site # of records # of reviewed 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* Baseline 100% 90% 80% 70% 60% 50% 40% 30% 20% 10% 0% After mentoring 100% 90% 80% 70% 60% 50% 40% 30% 20% 10% 0% Eligible children not on ART Eligible children not on ART * Data are from three referral hospitals in Tanzania Local Capacity Building Approach #3: Transition Services to Local Partners Two Phases of Project HEART Two Program Phases Phase I: Emergency scale-up, 2004-2009 Phase II: Sustain & Transition, 2009-2012 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 Tools Area of Measurement Capacity Description Assess existence and scope of organizational systems and processes Monitoring Tool 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