To promote the above strategy, HRSA coordinates
in-country implementation; facilitates governmental
relations with host country and U.S. governmental
representatives, and manages the grants/cooperative
agreements. Described below are funded activities,
which focus on improving HIV/AIDS care and
treatment, increasing health manpower and
institutional capacity, and enhancing data
collection and evaluation.
As of 2009, the bulk of funds are focused
on care/treatment improvement. In the coming
years, indigenous agencies in targeted nations
will be directly funded and HRSA's activities
will increasingly focus on development of
health manpower and institutional capacity.
Activity Area
1: Improving HIV/AIDS Care and Treatment
Resources are provided to organizations
delivering HIV care and treatment programs
to rapidly expand ART for low income HIV-infected
persons in a matter that is consistent with
national plans. Activities are underway
in 10 countries: Botswana, Guyana, Haiti,
Kenya, Nigeria, Rwanda, South Africa, Tanzania,
Uganda, and Zambia.
As of June 30, 2008 our program has funded
care to 477,436 individuals and is providing
180,753 individuals with ART. This rapid
expansion occurred as a result of funding
new local, faith based, and community based
partners. Key results include enhanced sustainability;
cheaper drugs, due in great part to the
FDA approved generic ARV formulations; better
infrastructure; and enhanced capacity for
rapid growth. Grantees: AIDSRelief Consortium,
Harvard University - School of Public Health
Activity Area
2: Increasing Health Manpower and Institutional
Capacity
Efforts to build international capacity
to respond to HIV/AIDS are in the areas
of quality improvement, training including
nursing capacity, and twinning, as follows:
Quality Improvement Capacity Development.
The mission is to build diverse portfolio
of international programs that manage quality
programs and strengthen human capacity for
HIV/AIDS care. One tested program being
used is HIVQUAL International, a quality
improvement program that provides a systematic
methodology for measuring quality of care
in clinical settings. It has been used in
different geographic countries and cultural
settings where HIV/AIDS services are provided.
It enables efficient use of limited resources,
facilitates capacity building at the facility
and national level, and improves quality
of HIV care based on national guideline
indicators. Grantee: New York AIDS Institute.
Training Capacity Development. The
goal is to create capacity for training
and technical assistance to improve local
human and institutional capacity for prevention,
care and treatment. The systems are to be
locally-determined, optimally resourced,
highly responsive, and self-sustaining in
countries and regions hardest hit by the
AIDS epidemic. The program was modeled after
HRSA's domestic AIDS Education and Training
Center (AETC), and aims to develop capacity
in the field offices to comprise a Global
Network of non-governmental organizations
specializing in human capacity development
in resource poor settings. The program provides
technical assistance in planning, design,
and management of training programs; disseminates
new treatment information and new curricula,
and mentors physicians, nurses, and other
healthcare professionals. The program currently
operates in Botswana, Ethiopia, Haiti, India,
Malawi, Mozambique, Namibia, South Africa,
Tanzania, Vietnam, Cote D'Ivoire, and China.
Grantee: International -Training and Education
Center on HIV (I-TECH), University of Washington
and University of California at San Francisco.
Nursing Capacity Building. The
goal is to strengthen the clinical and professional
leadership capacity of nurses. The program
increases the number of nurses trained and
prepared to work with HIV/AIDS, and develops
training and education tools adapted to
local needs. The program produced an ART
training curriculum focused on the role
of nurses. The program currently operates
in South Africa and Swaziland and is expected
to expand to other countries. Grantee: Georgetown
University.
Twinning Partnerships. The goal
is to create partnerships between organizations
and programs in the US and programs in developing
countries (East to West) as well as programs
within and among developing countries (North
to South) to create an open exchange of
knowledge, information, and professional
experience. These partnerships are referred
to as "twinning partnerships".
The program coordinates twinning partnerships
and creates an effective framework for building
sustainable institutional and human-resource
capacity. Twinning activities are currently
occurring or being negotiated in eight countries:
Ethiopia, Kenya, Mozambique, South Africa,
Tanzania, Zambia, Botswana, and Cote d'Ivoire.
Grantee: The Twinning Center, American International
Health Alliance.
New Partners Initiatives. Announced
on World AIDS Day 2005, the New Partners
Initiative (NPI) is part of a broader effort
within the U.S. President's Emergency Plan
for AIDS Relief to work with new partners,
including community- and faith-based organizations,
enhancing their technical and organizational
capacity and ensuring the quality and sustainability
of HIV/AIDS programs by building community
ownership.
Many organizations have the capability
to reach people who need HIV/AIDS services,
but lack experience in working with the
U.S. Government and its processes. Community-
and faith-based organizations, in particular,
represent vital but underutilized resources.
Many such organizations are well-established
within communities and well-placed to reach
out to those infected and affected by HIV/AIDS.
Building the capacity of organizations
at the community level also helps to build
local ownership of HIV/AIDS responses for
the long term. In some countries, such organizations
provide as much as 40 to 50 percent of all
care for people living with HIV/AIDS with
little support from the U.S. Government.
In some cases, existing U.S.-based organizations
can serve as a bridge due to their relationships
with these entities in host countries.
The alliance between PEPFAR and new partners
will promote better care for people living
with and affected by HIV/AIDS, and give
hope to stronger families and healthier
communities. Grantees: Visions in Action,
Universidad Catolica De Mocambique, Handicap
International Rwanda, World Conference of
Religions for Peace, and Christian Blind
Mission Tanzania.
Activity Area
3: Enhancing Data Collection and Evaluation
CAREWare: CAREWare,
the electronic health information system
developed by HRSA to track information on
clients receiving care under the Ryan White
HIV/AIDS Program, has gone global.
First implemented in 2000, CAREWare provides
a free, easy to use, standardized tool for
HIV/AIDS service providers to collect client
information. It can monitor quality of care
at clinics, maintain schedules, track how
clients use medications, and produce required
reports. Today more than 350 Ryan White
Program grantees and providers use CAREWare
to manage more than 100,000 patient records.
With that domestic experience as a base
- and with funds from the President's Emergency
Plan for AIDS Relief (PEPFAR) and support
from HRSA's Global AIDS Program - the software
is being used increasingly in countries
around the world to improve the way they
treat and track their own citizens living
with HIV/AIDS.
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