1. HARVARD-BHP ASSESSMENT J OSE “R AFI ” M ORALES, MD, FACOG C HIEF M EDICAL O FFICER Clinical Assessment for Systems Strengthening (ClASS) HRSA, HIV/AIDS B UREAU, G LOBAL HIV/AIDS P ROGRAM January 26, 2010 Entrance Meeting

2. AGENDA 1. Introductions 2. Who is HRSA? 3. HRSA’s Role in PEPFAR 4. Assessment Overview 5. Today’s schedule 6. Questions and Answers

3. HHS/HRSA PEPFAR (Office of the Global AIDS Coordinator) Department of State US Agency for International Development (USAID) US Department of Health and Human Services Health Resources and Services Administration (HRSA) Center for Disease Control and Prevention (CDC) National Institute of Health (NIH) Others US Peace Corps Department of Defense Department of Labor Others

4. Funding Flow PEPFAR (Office of the Global AIDS Coordinator) US Department of Health and Human Services Health Resources and Services Administration (HRSA) Catholic Relief Services Harvard University Center for Disease Control and Prevention (CDC) Elizabeth Glaser Ped AIDS Ftn. Columbia University

5. Funding Flow US Department of Health and Human Services Health Resources and Services Administration (HRSA) Catholic Relief Services Harvard University BHP- PEPFAR APINMDH Center for Disease Control and Prevention (CDC)

6. Funding Flow US Department of Health and Human Services Center for Disease Control and Prevention (CDC)/Botswana BHP- PEPFAR

7. HRSA Global HIV/AIDS Portfolio Grantee:No. of CountriesNo. of SitesCum. No. of Individuals on ART Est. FY09 Funding Level Catholic Relief Services10187192,400$134.9 million Harvard University368106,500$58.8 million Care and Treatment Grantee:FunctionNo. of CountriesEst. FY09 Funding Level University of Washington (I-TECH)training capacity building 14$48.5 million American International Health Alliance (Twinning Center) twinning partnerships Mentoring/volunteering 11$10.6 million Columbia University (ICAP Nurse Capacity Initiative) nursing capacity building3*$0.89 million NY AIDS Institute (International HIVQUAL) quality improvement8$2.1 million NPI Grantees (5 grantees)local partner capacity development 5$4.9 million Capacity Building/Training * Grantee newly awarded in April, 2009. The grantees projects to work in 6 countries.

8. HRSA Global HIV/AIDS Program TRACK 1.0 Care and Treatment Catholic Relief Services Works in 10 countries (187 sites) Transition to Local Partners: Completed (FY2009): South Africa Anticipated (FY2010): Rwanda Zambia Harvard University Works in 3 countries (68 sites) Transition to Local Partners: Completed (FY2009): None Anticipated (FY2010): Botswana Nigeria

9. Clinical Assessment for Systems Strengthening (ClASS) Harvard/BHP-PEPFAR Assessment January 25-February 5, 2010

10. Purpose The purpose of the ClASS Harvard-BHP assessment is to conduct a comprehensive review of BHP’s organizational, programmatic, administrative & financial systems capacity to ensure readiness to become a directly funded USG partner. The assessment methodology has been developed in collaboration with Harvard, BHP, and CDC/Botswana.

11. WEEK ONE HRSA LEADRafi Morales, HRSA TRAINING REVIEWER Anjali Sharma REVIEW SUPPORTChristine Lim, HRSA PROJECT OFFICERRodrigo Boccanera, HRSA ADMINISTRATIVE REVIEWER N/A FINANCIAL REVIEWER N/A Assessment Team

12. Date(s)Site/Organization NameTime Mon. 1/25/10 Meeting with CDC/Botswana 8 AM Meeting Harvard/BHP, MOH & Ministry of Local Government (MLG) PM Tues. 1/26/10 Deborah Retief Memorial Hospital and Lab, Morwa Clinic All day Wed. 1/27/10 Drive to Tsabong All day Werda Clinic Thurs. 1/28/10 IDCC & Laboratory All day Fri. 1/29/10 Middlepits Clinic AM Bokspit Clinic and Strysendum Health Post PM Assessment Schedule: Week One

13. Date(s)Site/Organization NameTime Mon. 2/1/10 Meeting with CDC/Botswana AM Princess Marina IDCC & Pharmacy AM Meeting with BHP & MoH, and MLG PM Tues. 2/2/10 BHP All day Botswana-Harvard HIV Reference Lab PM Wed. 2/3/10 BHP All day M&E Unit PM Thurs. 2/4/10 BHP All day Tlokweng Clinic and Site Managers Meeting AM Failure Management Workshop/Training PM Fri. 2/5/10 Debrief meeting with CDC/Botswana AM Debrief meeting with Harvard/BHP, MOH and MLG PM Assessment Schedule: Week Two

14. Site Assessment Components  Entrance meeting: The assessments begin with an opportunity for the team to meet with the organization’s leadership, HIV clinical and laboratory Master Trainer Corps, and other key staff.  Facility tour (as appropriate): The team tours the facility to gain the perspective of the impact of clinical and laboratory training on quality of care and support to decentralization.  Information gathering: Team members conduct staff interviews and request follow‐up documents to clarify or confirm information collected.  Exit Conference: At the end of the site visit, the team meets with the organization’s leadership to share findings of the assessment, including strengths and areas for improvement.

15. Assessment Components: Training Support from:ToThrough Core Clinical Master Trainers: Six physicians, two pharmacists, and four nurse- midwives Site-level Master Trainers  Assessment of site-specific training and support needs  Immediate on-site practical support  Identification of site-level Physician and Nurse Master Trainers  On-site follow-up support  Support and evaluation visit  Telephone site support Site-level Master Trainers HCPs  Initial and on-going trainings  Direct supervision and support Clinical Master Trainer/ARV Site Support Component (CMT): Goal: Further develop and expand a sustainable training capacity in clinical care and treatment of HIV/AIDS patients that provides on-going training and mentoring to ARV sites

16. Assessment Components: Training Support from:ToThrough Core Lab Master Trainers Site Lab Master Trainers  Assessment of site-specific needs  Centralized training and mentoring in CD4, Viral Load, Chemistry, Hematology, and other lab testing  On-going site support  Periodic follow-up support and evaluation visits  Telephone site support HCPs  Provide on-site training and mentoring in labs  Evaluate Site Master Trainers in established labs and Nurses for Rapid HIV Testing and Dry Blood Spot Laboratory Master Trainer/ARV Site Support Program (LMT): Goal: Support the establishment of decentralized laboratories with CD4 and viral load testing capability by developing a sustainable training program in these tests at the local level.

17. Proposed Schedule  8:00-9:00Entrance Meeting  Welcome & Introductions  Site presentation  HRSA presentation  9:00-9:30Facility Tour  9:30-10:30Interviews with Clinic staff  10:30-12:00Interviews with Lab staff  12:00-12:15Team discussion  12:15-1:00Exit meeting

18. Staff Interviews  Executive Director  Clinic Director  Site Manager  Core Master Trainers  Physicians  Nurses  Pharmacy Staff  Laboratory Staff  Other relevant staff

19. On-Site Review  List of site Clinical and Laboratory Trainings  Telephone logs: CMTs, LMTs  Mentoring log  Site support log  Off-site and on-site training/re-training logs  Other relevant documents

20. Questions & Answers