May 2012

Event Recap:
Video of ICAP Director Wafaa El-Sadr’s University Lecture, "The HIV/AIDS Epidemic: Global Tragedy, Lasting Triumphs” is now posted. View Video.

ICAP Webinar Grand Rounds:
June 21, 2012, 8:30 am ET: Infection Control for TB with Andrea Howard, MD, MS, director of the ICAP Clinical and Training Unit and associate professor of clinical epidemiology at Columbia University. JOIN WEBINAR 

ICAP Webinar Grand Rounds Recap:
HIV and Infant Feeding with Louise Kuhn, PhD, professor of epidemiology at Columbia University. VIEW WEBINAR 

ICAP was founded in 2004 at Columbia University’s Mailman School of Public Health. Now a global leader in HIV/AIDS services, ICAP has supported work at more than 2,000 sites across 20 countries. More than one million people have received HIV services through ICAP-supported programs.

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Harlem Prevention Center Initiates Studies in Critical Population

ICAP’s Harlem Prevention Center (HPC) is launching two studies that address the HIV epidemic in the population most deeply affected in the US—men who have sex with men (MSM).  More than half of new HIV infections in the US occur in MSM, and black MSM are disproportionately impacted, with an HIV prevalence in some studies of 28 percent as compared to 19 percent in MSM overall. 

The STAR Study—short for “Seek, Test, and Retain: Linkages for Black HIV+, Substance-Using Men Who Have Sex with Men”—is a randomized controlled trial led byICAP Director Wafaa El-Sadr, and Sharon Mannheimer, Chief of Infectious Diseases at Harlem Hospital. STAR sets out to test innovative methods to engage Black MSM in HIV testing and, for those found to be HIV-infected, to assess two methods for linking them to HIV primary care. STAR plans to recruit an estimated 2,200 men through a method called respondent-driven sampling, in which participants receive an incentive to refer a limited number of other men for possible enrollment in the study. “This strategy mobilizes the power of social influence to engage people who would benefit from HIV counseling and testing, but are not reached by conventional recruitment methods,” explained Dr. El-Sadr.

Two hundred STAR participants identified as HIV-infected will then be randomly assigned to one of two interventions—peer navigation and financial incentives—to link and retain them in HIV primary care. Both interventions have been shown to improve patient engagement at different points along the continuum of HIV primary care, but neither has been evaluated as a linkage and retention strategy for Black MSM. STAR will compare the relative effectiveness of the two interventions and their cost effectiveness.

The second study at the Harlem Prevention Center aims to further the understanding and best practices of a pre-exposure prophylaxis (PrEP) regimen to prevent HIV infection. On May 10, the Antiviral Drug Advisory Committee to the US Federal Drug Administration recommended that the antiretroviral Truvuda® be approved in the US as a pre-exposure prohphylaxix (PrEP) that prevents HIV infection in adults at high risk for sexual acquisition of HIV including at-risk MSM. The promise of an effective biomedical tool to strengthen approaches to HIV prevention raises the persistent question of how best to support medication adherence, upon which the effectiveness of PrEP depends. 

In the HPTN 067 ADAPT Study (“Alternative Dosing to Augment PrEP pill-Taking”), supported by the NIH-funded HIV Prevention Trials Network (HPTN), researchers at the Harlem Prevention Center will evaluate the pharmacokinetics and feasibility of different dosing schedules of Truvada® for PrEP to prevent HIV infection. As an important step towards answering questions about supporting medication adherence, the HPTN 067 ADAPT Study will evaluate PrEP coverage in instances of possible exposure to HIV; reported symptoms and side effects of PrEP; medication adherence; and HIV-risk behaviors under three different dosing schedules: daily, twice-weekly, and around the time of sex. The study will also provide important new information about how tests for drug in the blood may be used to monitor use of PrEP, and how to improve the reliability of self-reporting of pill taking. The Harlem Prevention Center aims to enroll 180 MSM from New York City in this study.

“ADAPT presents a unique opportunity to gain a deeper understanding of the complexities and barriers to remain adherent to PrEP. We hope this study will shed light on ways to address adherence challenges in this critical population,” said Dr. Sharon Mannheimer, the primary site investigator.

Both the HPTN ADAPT and STAR Studies are conducted in partnership with community-based organizations in Harlem, and will take place over the next year. 


ICAP Expands Prevention of Mother to Child Transmission Programs in Cameroon and the Democratic Republic of the Congo

Responding to the UNAIDS call for the virtual elimination of mother-to-child HIV transmission (MTCT), ICAP has partnered with ministries of health in Cameroon and the Democratic Republic of Congo to expand prevention of mother to child transmission (PMTCT) of HIV programs.

In Cameroon, nearly half of pregnant women who are HIV infected receive the necessary treatment to ensure that HIV infection is not transmitted to their child. Once born, about a quarter of the HIV exposed infants receive treatment to prevent the infection. In an effort to support the Cameroon Ministry of Health in the elimination of pediatric infections, ICAP will conduct training programs and infrastructure support to enhance data management and reporting systems, and conduct evaluations of the national PMTCT program.

Funded by the US Centers for Disease Control and Prevention (CDC), ICAP’s program in Cameroon will provide intensive technical support at the national level to ensure a comprehensive monitoring and evaluation system of PMTCT services is in place.  The system will be rolled out in collaboration with the Cameroon Ministry of Health and PMTCT implementing partners through rigorous training programs and periodic joint supervision visits to district health teams and facilities. The strengthened monitoring and evaluation system will be a cornerstone of the national PMTCT elimination agenda and provide stakeholders with high-quality data for critical decision-making.

“ICAP will build on its expertise as well as the experience and inputs of national stakeholders, PEPFAR implementing partners, and others to support the national program as it works towards the critical goal of eliminating pediatric HIV infections,” said Batya Elul, director of strategic information at ICAP.

The Democratic Republic of the Congo has also prioritized the elimination of pediatric infections, putting in place a National Strategic Plan for the Fight against HIV/AIDS, which aims, among other objectives, to reduce the rate of mother to child transmission below 2 percent by 2014. In the DRC, currently only 11 percent of pregnant women receive HIV counseling and testing, and an estimated 37 percent of HIV-infected pregnant women transmit the virus to their children.

With funding from CDC, ICAP is helping to improve access to PMTCT services in Kinshasa and Lubumbashi. ICAP has assisted in national trainings of providers in PMTCT and has begun supporting PMTCT services at 10 main sites and seven satellite sites.

Looking ahead, ICAP is focusing on an ambitious expansion of PMTCT service sites and will support more than 100 such facilities in Kinshasa and Lubumbashi to improve the health outcomes of HIV-infected pregnant women through the provision of comprehensive PMTCT services.  These services include counseling and testing at antenatal clinics, as well as the integration of PMTCT services and comprehensive medical care to all HIV-infected pregnant women and their first-degree family members.

While several challenges associated with the expansion of PMTCT programs exist, including fragile infrastructure and challenges in referral and tracking of patients, ICAP is drawing upon its extensive experience in supporting the implementation of PMTCT programs in 11 countries to support Cameroon and the Democratic Republic of Congo in their efforts to eliminate mother to child transmission of HIV in their countries.


Launch of Nursing Education Partnership in Zambia

In Zambia, like in many countries around the world, nurses and midwives form the backbone of the health workforce and serve at every level of the health care system, but their skills are often uneven, underutilized, and unrecognized. ICAP is addressing these challenges through efforts to transform nursing and midwifery education and training using innovative approaches aimed at strengthening the health systems in 11 countries in sub-Saharan Africa.

On May 3, ICAP in Zambia, in partnership with the Zambia Ministry of Health, sponsored the launch of the Nursing Education Partnership Initiative (NEPI) at the University Teaching Hospital in Lusaka. Supported by the US Department of Health and Human Services/Health Resources and Services Administration (HRSA) and the US President’s Emergency Plan for AIDS Relief (PEPFAR), NEPI aims to enhance nursing and midwifery educational institutions. In Zambia, ICAP through NEPI will work in harmony with national plans to improve the availability and distribution of qualified healthcare workers to overcome the dire shortage of medical doctors, nurses, and midwives, to increase the percentage of health workers that are absorbed into the public health workforce, and to support innovative retention strategies to decrease the annual attrition rate. 

Together, the two partners aim to support three nursing schools, equipping the schools with innovative teaching and learning tools and infrastructure enhancements. For the development of nursing tutors and other faculty members, for example, ICAP through NEPI will facilitate exchanges and best practice visits among schools, provide scholarships, and a select number of Master’s degrees, and facilitate needs-based short courses and workshops.

More than 150 individuals, including the guests of honor, the Zambian Minister of Health, Honorable Dr. Joseph Kasonde, and the US Ambassador, Mr. Mark Storella attended the launch of NEPI in Zambia. Also in attendance were senior officials from the Ministry of Health, US Health Resources and Service Administration (HRSA), US Centers for Disease Control and Prevention (CDC), the General Nursing Council, Zambia Nurses Union Organization (ZUNO), the Medical Education Partnership Initiative (MEPI), and representatives from the three selected nurse training institutions supported by NEPI—Monze School of Nursing, Lusaka School of Nursing of the UTH, and the Department of Nursing Sciences, School of Medicine at the University of Zambia.

During the launch, the Hon. Dr. Kasonde noted that Zambia has succeeded in reducing maternal and child mortality, but further progress is necessary if the country is to meet the Millennium Development goals. Meeting these goals is dependent upon the alleviation of the human resource shortage within the health sector. “The help from the American government through NEPI could not have come at a better time than this,” said Dr. Kasonde.

UNICEF and ICAP Host Global Meeting

ICAP partnered with UNICEF to host the 2012 Annual Meeting of the Interagency Task Team (IATT) on Prevention and Treatment of HIV Infection in Pregnant Women, Mothers, and Children. The meeting, held on April 26-27, 2012 at Columbia University in New York City, reviewed the progress of the Interagency Task Team, which is designed to support the Global Plan Towards the Elimination of Pediatric HIV Infection Among Children by 2015 and Keeping their Mothers Alive—and effort launched at the June 2011 UN High Level Meeting on HIV/AIDS.

The IATT meeting included nearly 100 participants from more than 20 member organizations as well as several observers, and served as an opportunity for member agencies to review progress and planning on the elimination of mother to child transmission (eMTCT). Some of the meeting’s primary objectives included assessing structures, progress, and challenges associated with eMTCT goals, as well as determining how to leverage the Task Team’s capacity and resources to best support the health of mothers and MTCT elimination. Partners at the meeting emphasized the need to prioritize eMTCT as the first step in ending AIDS and develop an overall strategy to identify gaps and solutions to advance the 2015 Global Plan.