ICAP News - December 2009

ICAP Hosts President Bill Clinton on World AIDS Day
Symposium examines impact of HIV/AIDS programs on health systems

To mark World AIDS Day on December 1, former U.S. President Bill Clinton, founder of the William J. Clinton Foundation, took part in a featured panel discussion titled “Awareness, Access, Action: The Global and Domestic State of AIDS,” co-hosted by ICAP and the Clinton Foundation at Columbia University. The panel, which was moderated by Stephen Lewis, Co-director of AIDS-Free World, was attended by more than 1,000 people and was part of an all-day symposium sponsored by ICAP on HIV and global health systems.

In addition to President Clinton and ICAP Director Wafaa El-Sadr, other panelists included C. Virginia Fields, President and CEO of the National Black Leadership Commission on AIDS, and Kali Lindsey, Senior Director for Federal Policy for the Harlem United Community AIDS Center, Inc. Columbia University President Lee Bollinger welcomed attendees and panelists, and Linda Fried, Dean of Columbia University’s Mailman School of Public Health, offered closing remarks.

Part of the panel discussion focused on continued support and funding for the President’s Emergency Plan for AIDS Relief (PEPFAR). “The last thing we need to do is back up,” said President Clinton. “We are only treating 42 percent of the people who need this [anti-HIV] medicine to stay alive and a smaller percentage of the children.” While noting the challenging federal budget situation, President Clinton said he would discuss the PEPFAR budget with President Obama’s administration.

In her comments, Dr. El-Sadr addressed the debate about whether too much money is being spent on the HIV epidemic at the expense of other global health initiatives, such as maternal-child health. “I think the pie has to grow bigger,” said Dr. El-Sadr. “It’s not a useful argument to take away from HIV and put the money into something else. I think there is more potential for synergies among various initiatives that will allow us all to achieve what we want and strengthen health systems overall.”

The featured panel with President Clinton was part of an all-day symposium sponsored by ICAP, which explored the rapid expansion of HIV/AIDS programs and their impacts on health systems in resource-limited countries. Topics included leveraging HIV programs to support other chronic disease initiatives, the impact of HIV scale-up on women’s health and rights, and the future of HIV funding. Panelists from government, academia, the World Bank, UNICEF, and Rockefeller Foundation took part in the daylong event.

The symposium was partially supported by the Rockefeller Foundation.

A video and transcript of the panel discussion with President Clinton may be accessed here. Symposium presentations may be accessed here.

Photo caption: President Bill Clinton and ICAP Director Wafaa El-Sadr at the special panel discussion on World AIDS Day.

Workshop Tackles Challenges to Sustainable Adherence and Psychosocial Support in HIV Programs

HIV programs in resource-limited settings face myriad challenges in retaining patients in care and treatment. It has been reported that approximately 40 percent of patients enrolled in some programs discontinue care and treatment for a variety of reasons. In an effort to address this challenge, nearly 100 staff from 10-supported ICAP country programs recently met in Kigali, Rwanda, to discuss these issues and develop strategies for fostering sustainable retention and adherence to HIV care and treatment. The workshop, which was also attended by representatives from the U.S. Centers for Disease Control and Prevention in Rwanda and the Rwandan Ministry of Health, examined evidence-based strategies for measuring and strengthening patient adherence, as well as the various types of psychosocial support that is provided across the continuum of care. 

The workshop provided opportunities for participants to share their achievements and challenges in strengthening patient adherence in their countries. A particular focus of discussion was the issue of adherence challenges related to prevention of mother-to-child transmission (PMTCT) of HIV.

“PMTCT complicates adherence issues, since there are so many visits that mothers and infants have to attend in such a short time,” explained Sara Riese, ICAP-New York PMTCT Officer. “Historically, adherence has only been addressed in HIV service sites, and we are trying to shift that thinking and implement adherence activities for pregnant HIV-positive women and HIV-exposed infants who need prophylaxis and consistent follow-up in the settings where they are seen, such as their homes.”

One of the innovations developed to address adherence in PMTCT programs was presented by the ICAP-Mozambique team. This multifaceted strategy uses peer educators, encourages partner involvement, and introduces tools to better monitor adherence of mother-infant pairs to the full spectrum of PMTCT services. After using the mother-infant pair tool, it was found that pregnant women were most likely to discontinue care after their first visits for PMTCT. This finding underscored the importance of delivering more focused adherence counseling and support during the first visit.

The workshop concluded with each country committing to a single adherence-related goal for 2010. These goals, combined with country-specific action plans, will form the basis of an ICAP adherence agenda. 

“Adherence is critical, and is impacted by every aspect of our programs,” said ICAP-Rwanda Country Director Ruben Sahabo. “While ICAP has had many successes in this area, we must continue to meet the challenges of supporting retention in care and sustainable adherence.”

Photo caption: In a breakout discussion at the workshop are (from left to right) Frida Njogu (ICAP-Kenya), Julius Kamwesiga (ICAP-Rwanda), Annemadelein Scherer (South-t0-South Partnership for Comprehensive Pediatric HIV/AIDS Care and Treatment), Mary Ashie (ICAP-Nigeria).

Public Health Professionals Take Part in New Surveillance Course Via the Internet

ICAP, through funding and collaboration with the U.S. Centers for Disease Control and Prevention (CDC), has launched a distance-learning program for public health surveillance professionals in Tanzania. The program is being piloted in two twelve-week courses. It is designed to build and reinforce surveillance skills for HIV/AIDS, sexually transmitted infections, and HIV risk behaviors.

Twice weekly, a total of 20 Tanzanian public health professionals from the Tanzania Ministry of Health and Social Welfare, Zanzibar Ministry of Health and Social Welfare, CDC-Tanzania, ICAP Tanzania, and other non-governmental organizations, log into a virtual classroom and participate in 90-minute interactive lectures and discussion sessions. Students complete weekly readings, written homework assignments, and a final project that requires students to utilize skills and knowledge gained throughout the course.

The courses are taught by Victoria Nankabirwa, a doctoral student in epidemiology at Columbia University’s Mailman School of Public Health, with guidance from Mailman School faculty Denis Nash, Marita Murrman, Mari Millery, and Ian Lapp.

“Strengthening in-country surveillance capacity is key to understanding and addressing the HIV epidemic in Africa,” said Jessica Justman, ICAP Senior Technical Director and Principal Investigator for the program. "We are excited about the possibility of offering a greater variety of public health courses for different types of audiences through distance learning.”

Photo caption: Victoria Nankabirwa (top left) leads a distance learning class on public health surveillance methods.

Palliative Care and Pain Management Program Introduced in Tanzania

For people living with HIV and cancer in resource-limited settings, palliative care, or care to ease suffering, receives little attention. With support from ICAP, the Ocean Road Cancer Institute and the U.S. Centers for Disease Control and Prevention, the Tanzania Permanent Secretary Ministry of Health and Social Welfare Blandina Nyoni recently inaugurated the National Palliative Care and Pain Management Program at Kilimanjaro Christian Medical Center.
The program is designed to improve quality of life for patients living with HIV and cancer by expanding comprehensive palliative care and pain management. Patients enrolled in the program can obtain free oral morphine for pain relief, as well as psychosocial, spiritual, and legal support.

By 2011, the palliative care and patient management program will be expanded to all four of Tanzania’s referral hospitals as well as 30 regional and district hospitals.

For more about ICAP-Tanzania, visit here.