ICAP News - September 2007

ICAP-Supported Sites Showcased in Africa Tour by United States Health and Human Services Secretary
As part of a four-country African tour to visit programs funded by the President’s Emergency Plan for AIDS Relief (PEPFAR), United States Health and Human Services Secretary Mike Leavitt and a delegation of senior U.S. health officials visited three ICAP-supported HIV/AIDS sites in Rwanda and Mozambique.

At Rubengera Health Center in Rwanda’s Central Province, Secretary Leavitt learned from patients how they had benefited from the initiation of HIV/AIDS services at the facility. Members of associations of persons living with HIV/AIDS (PLWHA) also described their experiences as peer educators who work in their communities to promote HIV counseling and testing and treatment adherence.

Secretary Leavitt’s visit to Rubengera Health Center also included a tour of the facility’s prevention of mother-to-child transmission (PMTCT) of HIV unit, where he observed and later praised the full integration of PMTCT, antenatal, family planning and care and treatment services. An important focus of ICAP’s work in Africa is promoting the integration of HIV/AIDS services with other healthcare services. The Secretary capped off his visit to the Rwandan site with a donation of 50 goats to two associations of PLWHA.

In Mozambique, Secretary Leavitt visited Jose Macamo Health Center in Maputo, another ICAP-supported site, where he learned from staff and patients about PMTCT services and an innovative patient-support program called PositHIVe Teas. A unique feature of the program is the use of art to provide HIV-positive children and adults with an outlet for expressing their feelings. Secretary Leavitt concluded his visit at the health center’s treatment area where he undertook an HIV rapid test. Later, he visited another ICAP-supported site in Quelimane, Zambezia, in the northern part of the country.

“The ICAP teams in Rwanda and Mozambique, as well as site teams, were delighted to showcase their hard work and their remarkable achievements,” said ICAP Director Wafaa El-Sadr, MD, MPH. “Building on the resilience and courage of people living with HIV will ensure that these programs endure and continue to thrive.”  

In Rwanda, ICAP support has enabled enrollment of more than 26,000 patients in care and 13,000 have started treatment. In Mozambique, more than 85,000 patients have been enrolled in care and 26,000 have started treatment. In addition, nearly 20,000 pregnant women in Rwanda and Mozambique have received HIV counseling and testing.

Photo caption: Secretary Leavitt undertakes an HIV rapid test at Jose Macamo Health Center in Maputo, Mozambique.
For more about ICAP Rwanda, visit here. And for more about ICAP Mozambique, visit here.

ICAP Launches New Activities in Cote d’Ivoire
ICAP is expanding its support for HIV/AIDS prevention, care, and treatment services in West Africa with the launch of new activities in Cote d’Ivoire through support from the U.S. Centers for Disease Control and Prevention under the President’s Emergency Plan for AIDS Relief. Among West African nations, Cote d’Ivoire has the highest seroprevalence at 4.7 percent and has recently emerged from several years of civil unrest.

ICAP will initially support comprehensive, family-focused HIV/AIDS services at 10 sites in five regions. Supported services will include HIV counseling and testing, prevention of mother-to-child transmission of HIV, pediatric and adult HIV/AIDS care and treatment, and integrated tuberculosis/HIV care and treatment.

“Since 2002, ICAP’s MTCT-Plus Initiative has been supporting family-focused HIV/AIDS programs in Cote d’Ivoire,” said Program Director David Hoos, MD, MPH. “Building on this strong foundation, we look forward to working with our in-country partners to help expand HIV programs for more people who so desperately need them.”

Photo caption: Cote d'Ivoire (shown in red) is among 13 African countries in which ICAP supports HIV/AIDS programs.
For more about ICAP Cote d'Ivoire, visit here.

Tanzania’s First Lady Pledges Greater Collaboration to Expand Access to PMTCT Services
In a Sept. 14 meeting, Tanzania’s First Lady and women’s health advocate Mama Salma Kikwete and ICAP-Tanzania Country Director Amy Cunningham discussed ways to work together to expand access to prevention of mother-to-child transmission (PMTCT) of HIV programs in Tanzania.

The First Lady is chairperson of the Women in Development Foundation, a non-governmental health education organization which is leading a national campaign to promote HIV testing, and PMTCT services for pregnant women. For its part, ICAP has been working with the Tanzania Ministry of Health to strengthen PMTCT services in four regions of the country. Currently, ICAP supports 37 PMTCT sites, which have provided HIV testing to more than 28,000 women. By next year, ICAP plans to expand its support for PMTCT services to 60 sites in Tanzania.

“If we agree to work together,” said Mama Kikwete, “I am confident that your
PMTCT campaign will be bolstered since we have strength in advocacy. After all, there are no achievements without partnerships.”

Photo caption: First Lady Mama Salma Kikwete (right) meets with ICAP Country Director Amy Cunningham.
For more about ICAP Tanzania , visit here.

ICAP Expands Support for HIV/AIDS Programs to Three Additional States in Nigeria
ICAP has expanded its support for comprehensive HIV/AIDS services to three additional states in Nigeria: Gombe, Kogi, and Akwa Ibom States (shown in green on map). Following needs assessments, ICAP has begun facility renovations, training and mentoring of healthcare providers, establishing monitoring and evaluation systems, and stocking laboratories. In the three states, ICAP is planning to support 59 sites, which will provide either comprehensive HIV/AIDS services, prevention of mother-to-child transmission of HIV, or tuberculosis care and treatment. ICAP also supports HIV/AIDS programs in Nigeria’s Cross River, Benue, and Kaduna States (shown in yellow on map).

For more about ICAP Nigeria, visit here.

Clinical Mentorship Initiative Launched
On Aug. 26, Dr. Richard Nduhuura, Ugandan Minister of State for General Duties, inaugurated the MTCT-Plus HIV/AIDS Clinical Mentorship Intensive Workshop in Kampala. The one-week workshop, organized by ICAP in collaboration with Mulago Hospital and St. Francis Hospital Nsambya in Uganda, focused on building skills of healthcare providers and peer educators in leading multidisciplinary, family-focused HIV/AIDS programs in sub-Saharan Africa.

"Sustainability of HIV programs is of utmost importance,” said Dr. Nduhuura, at the
inauguration of the initiative. “This workshop will foster capacity building through training in mentorship approaches at the local level, while building a cross-continent HIV/AIDS clinical mentorship network in Africa.”

Attending the workshop were multidisciplinary country teams from Rwanda, Tanzania, Mozambique, Uganda, and South Africa. The workshop and the mentorship initiative are supported by the foundation named after Stephen Lewis, the former United Nations Special Envoy for HIV/AIDS in Africa.

Swaziland Expert Clients Take More Active Role in Care and Treatment Programs
People living with HIV/AIDS are taking a more active role in care and treatment programs in Swaziland under an innovative Ministry of Health and Social Welfare (MOHSW) peer educator program supported by ICAP that trains “expert clients” to provide practical and emotional support to fellow clients at HIV/AIDS healthcare facilities throughout the country. Among other roles, expert clients promote adherence–a major challenge to HIV/AIDS care and treatment programs–and help pregnant women to better understand and access HIV/AIDS services. Expert clients themselves are enrolled in care and treatment programs and/or prevention of mother-to-child transmission of HIV programs at the sites where they will work. After completing trainings this month, the MOHSW expects to deploy more than 50 expert clients to HIV/AIDS hospitals and clinics throughout the country.

Photo caption: An expert client prepares a role play for the group.
For more about ICAP Swaziland , visit here.

Training Program Helps Address Shortage of Pharmacists in Eastern Cape, South Africa
To address the severe shortage of pharmacists in the Eastern Cape, South Africa, ICAP has partnered with local and provincial health departments to develop a pharmacy assistants training program. The two-year program consists of paid apprenticeships directed by South Africa Pharmacy Council tutors at ICAP-supported sites in Port Elizabeth. The program’s first class consists of seven students who will be trained to perform most of the functions of public health clinic pharmacists, including dispensing HIV/AIDS medicines. After graduation, the pharmacy assistants will work at their training sites, which currently lack qualified pharmacists. This shortage is highlighted by the presence of only a single pharmacist to dispense medicines for the nine ICAP-supported primary health clinics in Port Elizabeth. Plans are in place to expand the program in the Eastern Cape, where ICAP supports a total of 42 healthcare facilities.

For more about ICAP South Africa, visit here.

Nurse Mentors Tackle Improving Quality of Post-Partum Care for HIV-Infected Women
Improving quality of care for HIV-infected pregnant women was the focus of the second ICAP-supported mentorship workshop for professional nurses held in August in Durban, South Africa. The week-long workshop highlighted the importance of early post-partum follow-up of HIV-infected women with the goal of reducing maternal morbidity and mortality. In addition, nurses continued to practice their clinical skills, including history taking and physical examinations.

"It was an extremely thought-provoking experience to be part of a group of faculty from the major schools of nursing in the Eastern Cape, nurse managers from the Department of Health, and professional nurses training to be mentors, all working together to address the challenges of providing prompt pre-natal and early post-partum care for HIV-infected women," said workshop co-facilitator Marita Murrman, EdD, a Columbia University Mailman School of Public Health faculty member working with ICAP.

The mentorship workshop is part of a year-long program to train nurses as mentors and “advanced practitioners” who can guide their colleagues in HIV/AIDS management. The third and final mentorship workshop will be held in early December in Durban. Increasing the number of healthcare providers who can deliver HIV/AIDS care and treatment is an ICAP priority in South Africa.

Photo caption: Nurse mentor Nombulelo Bandezi practices a newborn physical examination at the workshop.
For more about ICAP South Africa, visit here.

South-to-South Partnership Plans Nurse Training Component
With the completion of its eleventh workshop this summer, the South-to-South Partnership for Comprehensive Pediatric HIV/AIDS Care and Treatment (S2S Program) has trained 106 healthcare providers from ICAP-supported country programs in the family-focused model of pediatric HIV/AIDS care and treatment.

A collaborative endeavor between ICAP and Stellenbosch University in South Africa, the S2S Program enters its second year with plans to host 16 new teams of multidisciplinary providers and to launch a new nursing component that will focus on building cadre-specific skills and knowledge for delivering pediatric HIV/AIDS care and treatment. In addition, a new partnership between the S2S Program and the Michael Mapongwana Clinic in Khayelitsha Township will provide new precepting opportunities for program participants at primary care centers.
“The success of the S2S Program is a testament to the strong partnership between Stellenbosch University and ICAP,” said Elaine Abrams, MD, director of ICAP’s MTCT-Plus Initiative. “We are excited that the program continues to grow and look forward to the participation of many more multidisciplinary teams committed to the care of children.”

For more about the S2S Program, visit here.

AJOG Commentary: Success of MTCT-Plus Demonstrates Need for Strengthened Ties Between PMTCT and HIV/AIDS Care and Treatment Programs
In a supplement to the September issue of the American Journal of Obstetrics & Gynecology, ICAP authors, led by MTCT-Plus Initiative Director Elaine Abrams, MD, argue for strengthened ties between prevention of mother-to-child transmission (PMTCT) of HIV services and HIV/AIDS care and treatment programs in resource-limited settings. According to Abrams and her co-authors, PMTCT programs can be used as gateways to family-based HIV/AIDS care and treatment. They conclude that the successful experiences of the MTCT-Plus Initiative demonstrate the feasibility of close ties between PMTCT and care and treatment programs, which can lead to significant advances in reducing vertical transmission of HIV and promote the health of HIV-infected women, children, and families.