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Project HEART- Overview Track 1.0 Meeting 2008. Andrea Wahl, BSN, MPH Elizabeth Glaser Pediatric AIDS Foundation presenting for the Project HEART Team. Mission:

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project heart overview track 1 0 meeting 2008

Project HEART- OverviewTrack 1.0 Meeting 2008

Andrea Wahl, BSN, MPH

Elizabeth Glaser Pediatric AIDS Foundation

presenting for the Project HEART Team

slide2
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.

Elizabeth Glaser Pediatric AIDS Foundation

slide3
PMTCT “Call to Action” program initiated in 2000 with private funds, USAID started funding CTA in 2002.

CDC-funded HIV care and treatment program “Project HEART” initiated in 2004

Five countries, low-to-middle income, Sub-Saharan Africa

Cote d’Ivoire, South Africa, Tanzania, Zambia

Mozambique added in Program Year Three (PY3)

Goal for PY5: 257,475 patients ever on ART by Feb 28, 2009

79% of the target has been reached as of March 30, 2008

Total number ever enrolled into care as of March 30, 2008:

374,675 including 28,467 children under 15

Total number ever enrolled into ART program as of March 30, 2008:

204,264 including 15,316 children under 15

Program Overview

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.

Project HEART Strategic Framework
central sub grantees
Baylor University

Pediatric focus

Attachments, in country trainings

JSI

QI focus

Helps build capacity for QI at the country, district and site levels

UCSF

Training and mentoring

Central Sub-Grantees
slide6

Countries Involved in Project HEART

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

Côted’Ivoire

Tanzania

Mozambique

Zambia

South Africa

slide7

Côte d’Ivoire EGPAF-Supported Sites

Number of active ART sites in June 2007 = 77

mozambique egpaf supported sites
Mozambique EGPAF-Supported Sites

Number of active ART sites in June 2007 = 17

south africa egpaf supported sites
South Africa EGPAF-Supported Sites

Number of active ART sites in June 2007 = 11

tanzania egpaf supported sites
Tanzania EGPAF-Supported Sites

Number of active ART sites in June 2007 =38

zambia egpaf supported sites
Zambia EGPAF-Supported Sites

Number of active ART sites in June 2007 = 40

slide13

Project HEARTCumulative Patient Enrollment

CUMULATIVE data from March 1, 2004 through March 30, 2008

  • 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.
project heart current patient enrollment
Project HEART Current Patient Enrollment

All patients CURRENTLY on care and treatment on March 30, 2008

  • Number of HIV-positive patients who received care anytime January 1- March 30, 2008.
  • Number of patients on ART on March 30th 2008.
slide15
Percentage of patients ever started on ART who are children; as of September 2007, December 2007, and March 2008
slide17

Pediatric Treatment Frameworks

  • 1 Global and 11 country-specific strategic frameworks in development
  • Seven main objectives were identified for the country-specific frameworks, mirroring the seven key strategies of the WHO implementation document[1]:
    • Strengthen govt. leadership, ownership and accountability for peds C&T
    • Ensure integrated prevention care and treatment of infants and young children provided at all levels including primary health care facilities
    • Enhance identification of HIV-exposed and infected infants
    • Ensure reliable procurement and supply management
    • Expand lab capacity for pediatric HIV and AIDS needs
    • Strengthen community capacity to demand and utilize peds C&T
    • Strengthen M&E of pediatric C&T

[1] Meeting Report: Programming framework to support scale-up of HIV related diagnosis, care, support and treatment for HIV-exposed and HIV infected infants and children in resource-constrained settings. UNICEF-WHO, Draft date: December 16, 2007

slide18

Percentage of patients on ART who are on first line regimens at the end of Jan-Mar 2008, by age group

slide19

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

median attrition in the past year by site characteristics
Median attrition in the past year by site characteristics

by ownership

by location

by health care level

by length of support

egpaf pmtct sites project heart countries uptake counseling testing results hiv among tested
EGPAF PMTCT sites: Project HEART countries(Uptake %, counseling, testing, results; HIV+ among tested)
achievements and lessons learned
Close collaboration with host government is essential for sustainable programs

Staff training and mentoring is necessary; task shifting where appropriate is part of the solution

Increasing the pace of integration of program into primary health care system

Decentralization of services to lower levels is a current focus

Ex: Tanzania – approx 20 new sites each quarter for past two quarters, rolling out to primary health center and dispensary levels

Achievements and Lessons Learned
achievements and lessons learned cont
Development of sub-grantee capacity encourages sustainability

Transfer of experienced sites to local organizations necessitates adequate timeline, communication and identification (and attainment) of key readiness indicators

Strengthening linkages between HIV-related services such as counseling and testing, PMTCT, TB and ART aids in identification and provision of access to those in need of care and treatment

Achievements and Lessons Learned cont.
general program challenges
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

slide30
Focus even more on local capacity building and transition to local partners

Increase the number of children enrolled in care and treatment programs

Improve laboratory system

Improve quality of services

Strengthen linkages between services

Public health evaluation/operations research and documenting lessons learned

Future Goals

slide31
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

Stephen Lee

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

Acknowledgements

  • PARTNERS
  • Baylor
  • Mark Kline
  • Meg Ferris
  • John Snow International
  • Andrew Fullem
  • Lisa Hirschhorn
  • University of CA, San Francisco
  • Diane Havlir
  • Catherine Lyons
  • Royce Lin
  • CDC
  • 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
slide32
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.