ICAP News - August 2008

ICAP Leadership Provide Perspectives on President’s Emergency Plan for AIDS Relief at the Crossroads
In a commentary published in the Aug. 7 issue of the New England Journal of Medicine (NEJM), Wafaa El-Sadr, MD, MPH, ICAP director, and David Hoos, MD, MPH, director of ICAP’s Track 1.0 Program, provide their perspectives on the President’s Emergency Plan for AIDS Relief (PEPFAR) at the time of its recent reauthorization for an additional five years. In the article titled “The President’s Emergency Plan for AIDS Relief – Is the Emergency Over?,” the authors argue that PEPFAR has made tremendous progress since its inception in providing care and treatment to millions of people with HIV. Some of the systems established in support of HIV programs can form the foundation for systems to help address other chronic conditions that are often overlooked in resource-limited countries. They contend that PEPFAR’s future course revolves around the debate over whether the program should be transformed from an emergency plan focused on HIV prevention and treatment to one that focuses on strengthening health care systems in general, and addresses social and economic factors that play a key role in fueling the epidemic.

The authors write, “The key choice for PEPFAR at the crossroads is between a “pull” strategy and a “push” strategy: Will a continued singular focus on HIV “pull” other components of national healthcare systems forward, so that they become more responsive to other health threats and can catalyze the necessary changes in social norms and policy? Or will a “push” strategy that is focused primarily on strengthening healthcare systems and tackling fundamental issues that define societal vulnerabilities to disease be more effective in achieving both HIV-specific and broader health and social goals?”

The full text of the NEJM perspective may be accessed here.

Photo caption: An ICAP laboratory advisor shows healthcare providers in Ethiopia how to collect blood for early infant diagnosis of HIV.

U.S. Ambassador to South Africa Visits ICAP-Supported Site in Eastern Cape
On July 17, U.S. Ambassador to South Africa Eric Bost visited ICAP-supported Flagstaff Primary Health Care Clinic in the Eastern Cape Province where he learned about progress in scaling up HIV services for children and adults. Bost, who was accompanied by ICAP leadership, U.S. Centers for Disease Control and Prevention officials in South Africa, and local department of health officials, observed facility operations and met with both staff and patients. Among the topics of discussion were the clinic’s infrastructure and resource challenges in delivering services to a large patient population and plans to relocate the clinic to a more spacious facility within a year. Currently, Flagstaff Clinic serves a population of more than 30,000 people and provides HIV care to 2,190 individuals, including antiretroviral therapy to more than 500 people.

Photo caption: Flagstaff personnel, department of health officials, and ICAP staff display a plaque marking the visit to the clinic by U.S. Ambassador to South Africa Eric Bost (center).

For more about ICAP South Africa , visit here.

Mozambique Mentorship Program Builds Nurses’ Skills to Deliver Multidisciplinary PMTCT Services
As part of efforts to scale up prevention of mother-to-child transmission of HIV (PMTCT) services in Mozambique, a multidisciplinary team of 20 maternal-child health (MCH) providers was trained in July in the principles of clinical mentorship. These “expert” nurses, representing each area of the multidisciplinary PMTCT model, will mentor nurses from Maputo and Nampula Province in counseling and testing, treatment, peer support, and adherence, during two-week rotations at ICAP-supported PMTCT Model Centers. The program is part of a larger ICAP-supported initiative to build capacity of MCH nurses to deliver multidisciplinary PMTCT care.

“This program represents a continuum of training complementary to the national pre-service PMTCT training curriculum for nurses,” said Fatima Tsiouris, MSc, senior ICAP PMTCT program officer. “It provides a unique opportunity for nurses to experience the holistic model of PMTCT through case-based studies and participatory learning at the model centers.”

ICAP collaborated with the International Training and Education Center for HIV (ITECH) in the development of the training curricula and learning modules for the mentorship program. Since 2006, ICAP has been actively supporting the development and implementation of strategies in Mozambique to enhance skills of health care workers, promote task-shifting, and empower non-traditional cadres of providers to deliver HIV/AIDS services.

Photo caption: 'Expert' nurse mentors completed their first training in July.

For more about ICAP Mozambique, visit here.

Newly Diagnosed HIV-Positive Pregnant Women in Tanzania Find Comfort and Acceptance in Family Support Groups
More than 150 pregnant women newly diagnosed with HIV are finding comfort and acceptance through 13 Family Support Groups at ICAP-supported sites in Kigoma, Pwani and Kagera Regions of Tanzania. The groups are based on a peer partnership model widely used in prevention of mother-to-child transmission (PMTCT) of HIV-specific support groups. HIV-positive pregnant women are recruited to the groups through antenatal clinics and labor wards. In bi-monthly meetings facilitated by clinic staff, participants learn from the experiences of their peers about issues such as disclosure, family planning and infant feeding.

In helping HIV-positive women cope with and accept their status, Family Support Groups have been instrumental in promoting adherence to care, safe infant feeding practices, partner disclosure, early enrollment of the exposed infant, and acceptance of PMTCT services. In addition to supporting the creation of an Implementer’s Guide and monitoring and evaluation tools for this initiative, ICAP is working with sites to develop a peer mentorship system for the Family Support Groups.

“Family Support Groups are a vital component of ongoing comprehensive care, a system by which women can support, teach, and guide each other,” said ICAP Tanzania Country Amy Cunningham. “In these groups, the seeds are planted for improved communication between partners, friendships, personal empowerment, and hopes for the future – while reducing HIV transmission from mothers to their children.”

For more about ICAP Tanzania, visit here.

Rural Swaziland Hospital Uses Cell Phones to Track Down Patients Who Miss Follow-up Appointments
Retaining patients in HIV/AIDS care and treatment is an ongoing challenge, particularly in rural areas where patients may be difficult to contact. At Mankayane Hospital, a rural HIV service site in Swaziland, ICAP has been working with the hospital to design and implement a cell phone-based patient follow-up system. In a recent pilot study of the system’s effectiveness, which was reported at this year’s HIV/AIDS Implementers’ Meeting, Mankayane Hospital staff used cell phones to contact nearly two-thirds of the 74 patients who had missed follow-up appointments after more than a week. Among this group, 44 percent had died during the first few months of initiating treatment, but more than quarter of the patients returned into care and treatment as a result of the phone contacts. In total, hospital staff made an average of 1.8 calls per patient at an average cost of 71 cents per call.

“The telephone system increased staff awareness of the importance of adherence support and follow up,” said Joris Vandelanotte, MD, senior clinical advisor for ICAP Swaziland. “Given the relatively low cost of implementing the system, cell phones should be available to more health facilities, especially in rural settings, as part of a broader package of adherence interventions.”

Photo caption: Thembie Dlamini, nurse in charge of the antiretroviral therapy
unit at Mankayane Hospital, uses a cell phone to follow up with a patient who has missed an appointment.

For more about ICAP Swaziland , visit here.