ICAP News - March 2008

Programs Continue to Reach More People and Expand Breadth of Services Provided
A total of 431 ICAP-supported sites in 14 countries had enrolled more than 400,000 individuals in care and were providing antiretroviral therapy (ART) to nearly 190,000 people at the end of 2007. The enrollment figures are nearly double 2006 levels. Overall, an estimated one in eight of all HIV-infected people in sub-Saharan Africa who receive ART through the President’s Emergency Plan for AIDS Relief (PEPFAR) are obtaining their treatment at ICAP-supported sites.

In addition to care and treatment, ICAP-supported sites have provided HIV counseling and testing to more than half a million people, including nearly 208,000 pregnant women. More than 7,800 HIV-positive pregnant women have received prophylaxis for the prevention of mother-to-child transmission of HIV. At the end of 2007, ICAP also supported 237 laboratories in seven sub-Saharan African countries.

“This unprecedented scale-up of HIV services demonstrates a deep commitment by the countries and the teams on the ground to addressing the global AIDS emergency,” said ICAP Director Wafaa El-Sadr, MD. “Much has been accomplished, but much more needs to be done to achieve global goals.”

U.S. Global AIDS Coordinator Visits MTCT-Plus Services at ICAP-Supported Hospital in Lesotho
In January, Ambassador Mark Dybul, United States Global AIDS Coordinator, visited ICAP-supported Queen Elizabeth II Hospital in Lesotho. Ambassador Dybul, who was accompanied by the Lesotho Minister of Health and Social Welfare Mphu Ramatlapeng, MD, and U.S. Ambassador to Lesotho Robert Nolan, visited the hospital’s antenatal clinic where he observed MTCT-Plus services, including prevention of mother-to-child transmission of HIV, antiretroviral therapy, and counseling. He also viewed the dried blood spot sample collection system established for diagnosing HIV-infected infants and witnessed routine HIV testing for children in the Under 5 Clinic. ICAP Country Director Raphael Ntumy, MD, and ICAP Clinical Advisor Esayas Okubamichea, MD, helped guide the visit.

At Queen Elizabeth II Hospital, which serves as Lesotho’s National Referral Hospital, ICAP has supported facility renovations, the expansion of HIV services, and skills-building programs in family-focused HIV/AIDS care and treatment for healthcare providers. The hospital provides HIV care to 6,166 individuals, including antiretroviral therapy to 2,167 people.

Photo caption: From left to right, U.S. Global AIDS Coordinator Mark Dybul, U.S. Ambassador to Lesotho Robert Nolan (center), and ICAP-Lesotho Country Director Raphael Ntumy chat during the tour of Queen Elizabeth II Hospital.

For more about ICAP Lesotho, visit here.

ABC News Showcases ICAP-Supported Site in Tanzania
ABC News, in its coverage of United States President George Bush’s visit to five African countries in February, featured the success story of ICAP-supported Ocean Road Cancer Institute (ORCI) in Dar es Salaam, Tanzania. The Feb. 17 segment titled “Bush AIDS Fund Credited with Saving Lives” described how the President’s Emergency Plan for AIDS Relief (PEPFAR) has enabled ORCI to deliver HIV services. In addition to patient testimonials, the story featured an interview with ICAP-Tanzania Country Director Amy Cunningham. A full transcript of the story and the broadcasted segment may be accessed at http://abcnews.go.com/Health/story?id=4303636&page=1. ORCI provides HIV care to 645 individuals, including antiretroviral therapy to 463 people.

For more about ICAP Tanzania, visit here.

Multidisciplinary Teams Tackle Challenges of Implementing Family-Focused HIV Programs
In the second ICAP-supported Clinical Mentorship Workshop in Kampala, Uganda, multidisciplinary teams of healthcare providers from six ICAP-supported countries in sub-Saharan Africa met Feb. 11-15 to develop strategies for addressing the challenges in implementing family-focused HIV programs and building capacity at the site level. Topics explored at the workshop included quality improvement, team building, skills-building, and community engagement. Participants also discussed how to build mentorship cultures among peers within ICAP teams. Co-facilitating the workshop were multidisciplinary teams from Mulago Hospital and St. Francis Hospital Nsambya in Uganda, sites of the ICAP-supported MTCT-Plus Initiative. Addressing the workshop attendees at the opening session was Uganda’s Minister of State for Health Emmanuel Otaala, MD.

The workshop was held as part of the ICAP Clinical Systems Mentorship Initiative, a program supported by a grant from The Stephen Lewis Foundation for the development of multidisciplinary HIV programs in Africa, with a particular focus on women and children.

Photo caption: Participants in the second ICAP-supported Clinical Mentorship Workshop.

Valentine’s Day Event in South Africa Promotes HIV Testing,
Treatment Adherence

In collaboration with government and community partners in Port Elizabeth, South Africa, ICAP coordinated a community outreach activity on Valentine’s Day to raise awareness of HIV testing, the benefits of antiretroviral therapy (ART), and the importance of adherence to care and treatment. The Feb. 14 event, whose theme was “Love in the Age of HIV – Care + Support = Adherence,” featured a singing march of an estimated 500 people and HIV educational talks, songs, and drama. The event also highlighted the role of schools in addressing HIV/AIDS and the need to support HIV-positive students in continued engagement in HIV care and adherence to treatment.

The educational portion of the event featured testimonials from people living with HIV/AIDS who serve as peer educators. "It was particularly heartening to witness how the peer workers were able to reach out effectively to the students through sharing their own experiences," said ICAP-South Africa Country Director Doris Macharia, MD.

ICAP partners participating in the event included the Eastern Cape Departments of Education and Social Development.

Photo caption: Peer educators speak to school students about HIV at the Valentine's Day event.

For more about ICAP South Africa, visit here.

Prevention of Mother-to-Child Transmission of HIV Services Expand Rapidly in Rwanda
In 2007, 97 percent of the 15,000 women who sought antenatal services at 18 ICAP-supported facilities providing prevention of mother-to-child transmission (PMTCT) of HIV in Rwanda received HIV testing. During the same period, nearly all the 858 women testing HIV positive at these sites received multi-drug antiretroviral regimens, either AZT with single-dose nevirapine or highly active antiretroviral treatment (HAART). These successes were highlighted in a poster presented at the Fifteenth Conference on Retroviruses and Opportunistic Infections (CROI), Feb. 3-6, in Boston, MA.

In 2006, the Government of Rwanda revised its national PMTCT guidelines in favor of providing a multi-drug PMTCT regimen rather than single-dose nevirapine. In supporting the adoption of the revised protocol at the 18 PMTCT sites, ICAP worked with district health authorities and teams at the facilities to implement new procedures for rapidly evaluating immunological status of pregnant women newly diagnosed with HIV and enrolling them into care and treatment. District laboratories were also equipped with new CD4 cell count machines to facilitate timely access to CD4 cell testing. In addition, strong linkages were established between PMTCT sites and ART clinics to ensure that newly diagnosed women obtain prompt care and ART. ICAP PMTCT advisors also provided extensive training and mentorship on the new PMTCT protocol to healthcare providers at the 18 PMTCT sites.

"We applaud Rwanda's pioneering work in PMTCT," said Elaine Abrams, MD, director of ICAP's MTCT-Plus Initiative. "The program has been remarkably successful at expanding the breadth and depth of PMTCT services, particularly in delivering more effective interventions for both mothers and babies."

ICAP posters presented at CROI may be reviewed at http://www.columbia-icap.org/news/posters/CROI2008/index.html.

Photo caption: Landry Tsague, ICAP-Rwanda prevention of mother-to-child transmission of HIV program manager, during a clinical mentoring visit at an ICAP-supported PMTCT site.

For more about ICAP Rwanda, visit here.

Trial of Anti-HIV Microbicide Finds Tenofovir Gel Safe and Readily Accepted by Women
A vaginal microbicide that incorporates an antiretroviral drug normally used to treat people with HIV is safe for sexually active HIV-negative women to use every day over an extended period, suggest results of a multi-institutional clinical trial of tenofovir topical gel. Moreover, most of the women who participated in the study conducted in India and the United States said they would be willing to apply the gel, including daily, if it could help prevent getting HIV from their sexual partners. These findings were presented at the Microbicides 2008 conference Feb. 24-26, in New Delhi, India.

Jessica Justman, MD, director of ICAP’s University Technical Assistance Program, led the study of the tenofovir gel at a New York City site. She said the findings are an encouraging step forward in the search for an effective microbicide that women can use to protect themselves from HIV.

Additional studies are planned to further evaluate the safety of tenofovir gel, its effectiveness for preventing HIV, and the adherence profile among women.