Emergency Plan For AIDS Relief and HRSA'S Role

The United States is engaged in major efforts to combat HIV/AIDS, tuberculosis, and malaria, targeting nations that are the hardest hit, the poorest, and most in need of international assistance. Initiatives include the President's Emergency Plan for AIDS Relief (PEPFAR), the largest commitment ever by any nation for an international health initiative dedicated to a single disease.

Multiple agencies within the U.S. Department of Health and Human Services (HHS) are taking part in PEPFAR activities, drawing upon their expertise with related domestic and international programs. HHS's Health Resources and Services Administration (HRSA) operates its Global HIV/AIDS Program through HRSA's HIV/AIDS Bureau. HRSA's Global HIV/AIDS program is the third largest provider of PEPFAR funds to organizations that implement its programs, exceeded only by the United States Agency for International Development and the Centers for Disease Control and Prevention. The Bureau draws upon over two decades of experience implementing some of the first HIV/AIDS care programs for the U.S. in the early days of the epidemic. These efforts include the Ryan White HIV/AIDS Program, the largest program in the U.S. focused solely on HIV/AIDS care first established in 1990 as the Ryan White CARE Act, whose foundations were based upon earlier HRSA initiatives crafted in the mid to late 1980s.

HRSA's Global HIV/AIDS strategy focuses on:

Health System Strengthening

• Strengthening clinical and administrative systems and services to build networks of comprehensive HIV/AIDS care and treatment
  
• Designing innovative care and support models to remove barriers to care and treatment
  
• Strengthening quality improvement integration to enhance clinical services

Human Resources for Health

• Supporting training activities and partnerships to develop human and organizational capacity
  
• Assessing the effectiveness of specific models of care to promote adaptation of best practices
  
• Enhancing the capacity of HRSA's partners to collect, monitor, and evaluate data for quality service
  

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.