1. Project HEART: Expanding Access, Extending Lives Presented by Denis Tindyebwa, MD; EGPAF Regional Director Pediatric Care and Treatment

2. Project HEART: Program update Expanded access – Geographical coverage – Increased enrollment Program outcomes Increasing focus on children PMTCT Linkages Hope for the future

3. Elizabeth Glaser Pediatric AIDS Foundation Mission: The Elizabeth Glaser Pediatric AIDS Foundation seeks to prevent pediatric HIV infection and to eradicate pediatric AIDS through research, advocacy, and prevention and treatment programs.

4. Project HEART supports activities in five countries Côte d’Ivoire Mozambique South Africa Tanzania Zambia Côte d’Ivoire Zambia Tanzania South Africa Mozambique Project HEART Countries

5. Sites in Project HEART Countries

6. Project HEART: Number of care and treatment sites reporting by quarter since the beginning of the program, by country Doubling expansion every year

7. Project HEART: Number of Persons Ever on Care and ART by quarter, over time Doubling ART Initiation every year

8. Patients New on ART during the quarter, over time

9. 1.Number of patients living with HIV, ever enrolled in long-term clinical care and support programs. 2.Of those enrolled, number of patients started on ARV therapy. CUMULATIVE data from March 1, 2004 through March 30, 2009 Project HEART Cumulative Patient Enrollment Country HIV Palliative Care 1 Antiretroviral Treatment 2 ChildrenAdultsTotalChildrenAdultsTotal Zambia 13,641 (7.3%)172,853186,494 8,387 (7.0%)111,109119,496 Cote d'Ivoire 4,755 (4.5%)100,447105,202 1,968 (3.9%)48,08450,052 South Africa 13,420 (9.4%)128,743142,163 8,926 (10.3%)77,33386,259 Tanzania7,862 (9.5%)75,24183,103 3,212 (8.5%)34,75737,969 Mozambique 3,457 (6.7%)47,96151,418 1,149 (7.0%)15,23816,387 Total 43,135 (7.6%)525,245568,380 23,642 (7.6%)286,521310,163

10. Project HEART Cumulative Patient Enrollment: End of Q1 2009

11. Project HEART Patients currently in Program All patients CURRENTLY on care and treatment on March 30, 2009 Country HIV Palliative Care 1 Antiretroviral Therapy 2 ChildrenAdultsTotalChildrenAdultsTotal Zambia 6,397 (7.1%)83,96290,359 4,898 (6.5%)70,44975,347 Cote d'Ivoire 1,753 (4.6%)36,10537,858 1,317 (3.9%)32,41033,727 South Africa 9,137 (10.5%)78,22787,364 8,146 (11.1%)65,42173,567 Tanzania 6,446 (9.7%)60,09366,539 2,593 (8.3%)28,77431,367 Mozambique 1,900 (7.8%)22,36824,268 917 (7.5%)11,29012,207 Total 25,633 (8.4%)280,755306,388 17,871 (7.9%)208,344226,215 1.Number of HIV-positive patients who received care anytime January 1- March 30, 2009. 2.Number of patients on ART on March 30 th 2009.

12. Project HEART Patients currently in Program: Q1 2009

13. 13 Reasons for Attrition All Patients and Among Adults, Q1 2009

14. Percent of Persons in Care Receiving Cotrimoxazole, Q1 2009

15. Percentage of patients on ART who are on first line regimens: End of Q1 2009, by age group

16. CD4 Cohort Data: Median CD4 at Baseline and 6 Mos, Q1 2009

17. Percentage of Patients in 6-month Cohort with CD4 Counts at Baseline and at the end of the Follow-Up Period, Q1 2009

18. Number of children currently on ART during Q3 2008, Q4 2008, and Q1 2009

19. Percentage of patients currently on ART who were children during Q3 2008, Q4 2008, and Q1 2009

20. Children newly started on ART during the quarter

21. Reasons for Attrition Among Children by Age Group, Q1 2009

22. Reasons for Attrition Among Children and Adults, Q1 2009

23. Percent distribution of children currently on ART end of March 2009, by age group* *not all sites in Mozambique and South Africa reported pediatric age breakdown information

24. Infant & Young Child (IYC) Strategy Target setting – site specific absolute numbers Implementation approaches Indicators for COC – PMTCT/C&T linkages and integration Emphasis on PMTCT More focused monitoring & feedback

25. IYC Strategy Indicators (Part 1), Q1 2009

26. IYC Strategy Indicators (Part 2), Q1 2009

27. 1.PMTCT is funded by CDC in CI, SA and Zambia. USAID funds PMTCT in TZ. In Mozambique, PMTCT funding is transitioning from USAID to CDC. 2.The above data is for all five PH countries to give a more thorough picture of services in PH countries Number of EGPAF PMTCT Sites, Project HEART countries (2004-2009)

28. 1.PMTCT is funded by CDC in CI, SA and Zambia. USAID funds PMTCT in TZ. In Mozambique, PMTCT funding is transitioning from USAID to CDC. 2.The above data is for all five PH countries to give a more thorough picture of services in PH countries PMTCT Cascade A for Five Project HEART Countries (Eligible, counseling, testing, results)

29. 1.PMTCT is funded by CDC in CI, SA and Zambia. USAID funds PMTCT in TZ. In Mozambique, PMTCT funding is transitioning from USAID to CDC. 2.The above data is for all five PH countries to give a more thorough picture of services in PH countries PMTCT Cascade B for Five Project HEART Countries (HIV+, Women ARV, Infant ARV)

30. Hope for the Future Greater focus by donors on health system strengthening Intensive work toward transition in each Project HEART country including local capacity building Increasing funding for increasing access to PMTCT and Improving the PMTCT cascade Increasing the identification, enrollment and retention of children in care and treatment Improving the quality of care in each supported site

31. CÔTE D’IVOIRE Anna Likos and CDC/CI MOH CI Joseph Essombo, Anthony Tanoh, Diby Brou Charles, Joseph Kouakou and the EGPAF/CI team EGPAF U.S. Georgette Adjorlolo-Johnson Nicole Buono Elizabeth Flanagan Nick Hellmann Trish Karlin Stephen Lee Richard Marlink Rose McCullough Sara Pacque-Margolis Mposo Ntumbanzondo Shobana Ramachandran Penny Smith Allison Spensley Tara Suntoke Andrea Wahl Cathy Wilfert Sue Willard MOZAMBIQUE Lisa Nelson and CDC/Moz MOH Moz Nancy Fitch, Cathrien Alons, Esmeralda Karajeanes, Alex Boon, Etelvina Mbalane and the EGPAF/Moz team SOUTH AFRICA Thurma Goldman, Celicia Serenata, and CDC/SA DOH SA Kuku Appiah, Marriam Mangochi, Pumla Lupondwana and the EGPAF/SA team TANZANIA John Vertifeuille and CDC/TZ MOH TZ Anja Giphart, Werner Schimana, Jeroen van Padt Bosch, Aisa Muya and the EGPAF/TZ team ZAMBIA Larry Marum and CDC/Zam MOH Zambia Susan Strasser and the EGPAF/Zambia team Jeff Stringer, Elizabeth Stringer, Carolyn Bolton, Stewart Reid and the entire CIDRZ team PARTNERS Baylor Mark Kline Meg Ferris John Snow International Andrew Fullem Lisa Hirschhorn University of CA, San Francisco Diane Havlir Royce Lin Oliver Bacon CDC Tedd Ellerbrock Louise Perry Diane Flournoy Bud Bowen Janna Brooks CDC Staff in Côte d’Ivoire Mozambique, South Africa Tanzania, Zambia ……..AND ALL OF OUR PATIENTS, PARTNERS, STAFF AND DONORS Acknowledgements