1. Scaling-up HIV Prevention, Care and Antiretroviral Therapy at Primary Health Centers A WHO/PEPFAR Collaboration

2. Scaling-up HIV Prevention, Care and ART at Primary Health Centers Adult Treatment Technical Workgroup Tedd Ellerbrock - CDC Bob Ferris- USAID Department of HIV/AIDS, WHO Sandy Gove KJ Seung Global AIDS Program, CDC Mary Lou Lindegren Louise Perry Tonia Poteat Alexandra Zuber Organizing Committee

3. Scaling-up HIV Prevention Care and Antiretroviral Therapy at Primary Health Centers: A WHO/PEPFAR Collaboration The Rationale

4. Scaling-up HIV Prevention, Care and ART at Primary Health Centers As of September 30, 2006, a total of 822,000 adults and children in the 15 focus countries were on antiretroviral therapy (ART) in programs supported by the Emergency Plan The Emergency Plan treatment goal is to provide ART for 2 million persons by September 2009 Consequently, we need to initiate ART for about 1.2 million persons during the 36-month period, October 2006 – September 2009

5. Scaling-up HIV Prevention, Care and ART at Primary Health Centers Most ART programs currently supported by the Emergency Plan are located at tertiary or large secondary medical facilities in urban areas To expand access and assure long-term adherence to HIV care and treatment, services need to be provided at health centers and district hospitals in semi-urban and rural areas within walking distance of patients’ homes

6. Scaling-up HIV Prevention, Care and ART at Primary Health Centers If we assume that we can provide ART for an average of about 300 persons at each of these health centers or district hospitals, we will need to provide support for about 4,000 facilities to initiate ART for 1.2 million persons Thus, we need to help initiate HIV care and treatment programs at about 110 sites per month during the 36-month period, October 2006 - September 2009

7. Scaling-up HIV Prevention, Care and ART at Primary Health Centers Initiating programs for 110 facilities per month appears achievable because an average of 93 sites initiated ART programs per month during FY2006 To support this scale-up, we have proposed a WHO/PEPFAR collaboration to standardize operational and clinical guidance and patient monitoring systems for delivery of HIV services at primary health centers

8. Scaling-up HIV Prevention Care and Antiretroviral Therapy at Primary Health Centers: A WHO/PEPFAR Collaboration The Proposal

9. Scaling-up HIV Prevention, Care and ART at Primary Health Centers The collaboration is designed to achieve 4 objectives: Development of an Operations Manual for Primary Health Centers Development & updating of clinical & monitoring tools Country adaptation of operational, clinical, and monitoring tools Implementation of the operations manual and the updated tools

10. Scaling-up HIV Prevention, Care and ART at Primary Health Centers The operations manual will include recommended clinical services, integration of services, physical infrastructure, drug and supply management, lab services, patient monitoring, human resources, quality management, and community services The manual will be based on normative guidelines and use country-adapted clinical guidelines (e.g., IMAI and IMCI) and patient monitoring tools developed by WHO, USG, and other partners Objective 1: Development of Operations Manual for Primary Health Centers

11. Scaling-up HIV Prevention, Care and ART at Primary Health Centers IMAI/IMCI clinical guidelines and training for nurses and clinical officers at primary health centers will be updated to reflect current evidence Standardized patient monitoring tools will be updated for ART and HIV care systems, including TB/HIV and PMTCT Objective 2: Development and updating of clinical and monitoring tools To support decentralization to primary health centers, standardized clinical and monitoring tools will need to be developed, updated, and improved. For example,

12. Scaling-up HIV Prevention, Care and ART at Primary Health Centers Development of a standardized adaptation guide Sociocultural adaptation of patient education materials, including strengthening prevention messages Providing support for country adaptation of operations manual, clinical tools, and patient monitoring systems Objective 3: Country adaptation of operational, clinical and monitoring tools The goal is to update a customized set of tools for scale-up at primary health centers in each country, which are approved by MOH, WHO, and all partners, including:

13. Scaling-up HIV Prevention, Care and ART at Primary Health Centers Training, mentoring, and supervision of health workers in clinical care and district coordinators in supervision Providing staff in selected countries to support MOH and partners to adapt tools Expanding the “South to South” technical network to share experiences and provide training in using tools Management support for technical assistance/oversight Objective 4: Implementation of the operations manual and the updated tools Funding will be needed for implementation activities, e.g.:

14. Scaling-up HIV Prevention, Care and ART at Primary Health Centers The Adult Treatment Technical Workgroup was notified by the Office of the Global AIDS Coordinator (OGAC) on May 4, 2007, that the proposal for the collaboration was approved for $1.5 million during FY2007 USAID will be the funding agency The funding mechanism will be the USAID World Health Organization Umbrella Grant Funding

15. Collaboration for HIV Prevention, Care and ART at Primary Health Centers WHO (Headquarters, regional, and country offices) USG Agencies: CDC, USAID, HRSA, DOD, Peace Corps, Dept of State, Dept of Labor (Headquarters & country) USG-Implementing Partners: Columbia, AIDS Relief, EGPAF, Harvard, FHI, HAI, JSI, UMD, BASICS, MSH Ministries of Health PLHIV client groups: ITPC, ICW, TAC, and others Other Partners: Clinton Foundation, APCA, MSF, REACH, Engineers without borders, Anneca, DFID, GTZ Other multilaterals: UNICEF, World Bank, GFATM, ILO Selected Organizations of Participating Experts

16. Collaboration for HIV Prevention, Care cand ART at Primary Health Centers During approximately the past 6 months, more than 250 experts were organized into 10 writing teams and 13 expert panels The second complete draft of the Operations Manual has been completed and will soon be disseminated for broader review and early country adaptation and use Patient monitoring and clinical tools are being updated Progress to Date