1. Project HEART: Rapid Scale-up of HIV Care and Treatment in Five African Countries
Dr. Richard Marlink Vice President, International Program Implementation Elizabeth Glaser Pediatric AIDS Foundation

2. Countries Involved in Project HEART
Project HEART supports activities in five countries
Côte d’Ivoire
Mozambique
South Africa
Tanzania
Zambia
Côte d’Ivoire
Tanzania
Zambia: Lusaka District
South Africa: 2 major sites in KwaZulu-Natal Province (McCord- Durban; Africa Centre/Hlabisa Hospital and new PortShepstone, Muchison Hospital)
Tanzania: Muhumbili, Morogru, Mawenzi,KCMC in Moshi; Village of Hope in Dadoma Region,Kibong'oto TB Hospital in Arusha Region,
Kitete Regional Hospital in Tabora Region,Tumbi Regional Hospital in Coast Region
Cote d’Ivoire: Abidjan and Hopital General in Sassandra
Mozambique
Zambia
South Africa

3. Project HEART Strategic Framework
Family-centered comprehensive health approach that includes:
Engaging local leadership
Collaboration with host governments
Adherence to national treatment guidelines
Decentralization to district and primary health center levels
Innovative human resource approaches such as “task shifting”
Decentralization and integration of services within primary care systems are key strategies to improve access and coverage and to ensure local ownership and sustainability.

4. Number of active care and treatment sites
supported by EGPAF under Project HEART

5. Antiretroviral Treatment2
Project HEART Cumulative Patient Enrollment
CUMULATIVE data from March 1, 2004 through March 30, 2008
Country
HIV Palliative Care1
Antiretroviral Treatment2
Children
Adults
Total
Zambia
9,876 (7%)
129,937
139,813
5,953 (7%)
82,031
87,984
Cote d'Ivoire
3,957 (5%)
76,389
80,346
1,428 (4%)
35,584
37,012
South Africa
7,991 (10%)
71,813
79,804
5,401 (11%)
43,016
48,417
Tanzania
4,973 (10%)
42,988
47,961
2,036 (9%)
20,268
22,304
Mozambique
1,671 (6%)
25,080
26,571
498 (6%)
8,049
8,547
28,468 (8%)
346,207
374,675
11,525 (8%)
188,948
204,264
All sites report on pediatric care and ART in Zambia, South Africa and Mozambique
In Cote d’Ivoire 21/77 sites report pediatric care.
Number of patients living with HIV, ever enrolled in long-term clinical care and support programs.
Of those enrolled, number of patients started on ARV therapy.

6. Project HEART Current Patient Enrollment
All patients CURRENTLY on care and treatment on March 30, 2008
Country
HIV Palliative Care1
Antiretroviral Therapy2
Children
Adults
Total
Zambia
7,034 (7%)
101,089
108,123
4,671 (7%)
67,034
71,705
Cote d'Ivoire
1,662 (6%)
27,603
29,265
976 (4%)
24,408
25,384
South Africa
5,371 (13%)
37,423
42,794
4,950(12%)
36,366
41,316
Tanzania
4,160 (10%)
35,659
39,819
1,635 (9%)
16,514
18,149
Mozambique
831 (6%)
12,675
13,506
454 (6%)
7,393
7,847
19,058 (8%)
214,449
233,507
12,686 (8%)
151,715
164,401
All sites report pediatric care and ART in Zambia, South Africa and Mozambique
In Cote d’Ivoire 21/77 sites report on pediatric care.
Number of HIV-positive patients who received care anytime January 1- March 30, 2008.
Number of patients on ART on March 30th 2008.

7. Percentage of patients on ART who are on first line regimens at the end of Jan-Mar 2008, by age group
Invite Anna to describe last two bullets if questions.

8. PERCENTAGE DISTRIBUTION OF CHILDREN (0-14 YEARS OLD) ON FIRST-LINE REGIMENS AT THE END OF THE QUARTER, JAN-MAR 2008

9. PERCENTAGE DISTRIBUTION OF ADULTS ON FIRST-LINE REGIMENS AT THE END OF THE QUARTER, JAN-MAR 2008

10. Percent distribution of children ever started on ART, by age group
%: CI: 3.3%; Moz: 5.2%; SA: 12.0%; TZ: 9.4%; Zam: 6.5%; DRC: 69.8%; Rwanda: 10.1%; Swazi: 11.0%
If you are interested in more pediatric numbers, please visit the poster Scale Up of Pediatric Care and Treatment in resource limited settings (# 6142) in Hall D from 12:30-2:30 today.

11. % change in 6 Mo CD4 cohorts
suspect that data for SA and MOZ aren't of good quality and they don't have many sites reporting CD4 data. CI: ACONDA graduation

12. Rate of Patients attrition over the Past Year April – March (Males, Females and Total)
Females
Males
Total
The graph is called box and whiskers. It has the advantage of showing not only the median but the range of the indicator. The line in the middle of the box is the median, the top of the box is the 75% quartile (75% of sites are below this value) and the bottom of the box is the 25% quartile (25% of sites are below this value). The whiskers present the range of the data. the dots on the top of some of the whiskers are outliers (or extreme values not considered in the estimation of the median value).
Using Routine Monitoring and Evaluation Data to Assess Patient Retention and Outcome on ART Program: A multi-country analysis, Marlink R, Amouzou A, Lee S, McCullough R, Willard S, Bulterys M, Ellerbrock T, Struminger B, Serenata C, Wiktor S, Project HEART partners and team

13. Median attrition in the past year by site characteristics
by ownership
by location
Highest attrition is happening in sites that are private FBO, among other urban populations, at tertiary sites and at older sites.
by health care level
by length of support

14. General Program Challenges
Pediatric access and enrollment
Limiting loss to follow up
Inadequate public health infrastructure
Limited trained human resources
Occasional drug, laboratory reagent and supply stock-outs
Integration with PMTCT, TB, MCH programs
Vast geographic territory and distances
Potential for civil unrest

15. Some Lessons Learned Close collaboration with host government
Staff training and mentoring. Encourage task shifting where appropriate.
Decentralization of services to lower levels
Strengthen linkages between HIV-related services such as counseling and testing, PMTCT, TB and ART, to better identify and provide access to those in need of care and treatment
Infants and Children need to be targeted with specific plans and staffing to achieve goals

16. Advantages of a Large, Multi-country Program
Learning from M&E of large numbers of sites and approaches
Able to see trends on a broader scale to improve programs at the site level
Able to monitor barriers to access
Learning from and across multiple countries/programs/sites
Technical exchanges, learning and documentation
“From the Ground Up: Building Comprehensive HIV/AIDS Care Programs in Resource-Limited Settings” 16

17. Volume III: Developing Pathways and Partnerships
Volume I: Laying a Strong Foundation
Volume II: Establishing a Framework for Success
Volume III: Developing Pathways and Partnerships

18. “From the Ground Up: Building Comprehensive HIV/AIDS Care Programs in Resource-Limited Settings”
A compilation of chapters written by over 230 authors from a range of institutions
Book consists of 3 softcover volumes inside of a hardcover slipcase
A proposed Internet delivery platform for information and resources
Slipcase Cover

19. Acknowledgements
CÔTE D’IVOIRE
Bruce Struminger
Joseph Essombo
Anthony Tanoh
Siaka Toure
Joseph Sylvain N'dah Kouakou
Charles Diby Brou
EGPAF
Georgette Adjorlolo-Johnson
Agbessi Amouzou
Lisa Bohmer
Nicole Buono
Elizabeth Flanagan
Christophe Grundmann
Nick Hellmann
Trish Karlin
Richard Marlink
Rose McCullough
Lulu Oguda
Sara Pacque-Margolis
Mposo Ntumbanzondo
Penny Smith
Allison Spensley
Andrea Wahl
Cathy Wilfert
Lee Yerkes
EGPAF Staff in Côte d’Ivoire,
Mozambique, South Africa, Tanzania, Zambia
MOZAMBIQUE
Lisa Nelson
Cathrien Alons
Cameron Garrett
Alexandre Boon
Caroline de Schacht
SOUTH AFRICA
Okey Nwanyanwu
Celicia Serenata
Tshi Neluheni
Marriam Mangochi
TANZANIA
Stefan Wiktor
Anja Giphart
Denis Tindyebwa
Werner Schimana
Mark Swai
Aisa Muya
ZAMBIA
Marc Bulterys
Deborah Conner
Carolyn Bolton
Susan Strasser
Moses Sinkala
Elizabeth Stringer
Jefferey Stringer
Stewart Reid
Mary Morris
PARTNERS
Baylor
Mark Kline
Meg Ferris
John Snow International
Andrew Fullem
Lisa Hirschhorn
University of CA, San Francisco
Diane Havlir
Catherine Lyons
Royce Lin
USG
Tedd Ellerbrock
Louise Perry
Vivian Walker
Bud Bowen
CDC Staff in Côte d’Ivoire
Mozambique, South Africa
Tanzania, Zambia
……..AND ALL OF OUR PATIENTS, PARTNERS, STAFF AND DONORS
What to do with USG – make it CDC? Anyone else that needs to go in there?

20. This presentation was made possible through support provided by the U
This presentation was made possible through support provided by the U.S. Centers for Disease Control and Prevention (CDC), through the President’s Emergency Plan for AIDS Relief (PEPFAR), as part of the Elizabeth Glaser Pediatric AIDS Foundation's International Family AIDS Initiatives (“Project HEART”/Cooperative Agreement No. U62/CCU123451). The opinions expressed herein are those of the authors and do not necessarily reflect the views of CDC.