avenida hotel maputo, mozambique august 10-12, 2010 the 8th annual track 1.0 art program meeting

Avenida HotelMaputo, MozambiqueAugust 10-12, 2010

The 8th Annual Track 1.0 ART Program Meeting

The Latest Treatment Numbersand Transition Highlights

Tedd V. Ellerbrock, MD, FACOGCo-Chair, Adult Treatment Technical Workgroup

Team Leader, HIV Care and TreatmentGlobal AIDS Program, NCHHSTP

U.S. Centers for Disease Control and Prevention

Track 1.0 ART Program

The Track 1.0 ART Program is funded & administered by the Division of Global HIV/AIDS at CDC and Global AIDS Program at Health Resources and Services Administration (HRSA)

Four partners received Track 1.0 ART awards AIDSRelief (Catholic Relief Services Consortium)Elizabeth Glaser Pediatric AIDS Foundation (EGPAF)Harvard School of Public Health (Harvard)Mailman School of Public Health of Columbia University (Columbia)

The program was funded in February 2004

Program Year

Annual Funding

(millions)No. of

Countries

No. of Partner

Programs

No. of Treatment Facilities

1 (2004-05) $92 11 21 119

2 (2005-06) $172 13 24 279

3 (2006-07) $206 13 24 478

4 (2007-08) $320 13 25 652

5 (2008-09) $443 13 25 1,030

6 (2009-10) $413 13 25 1,235

7 (2010-11) $372 13 25

Track 1.0 ART Program Funding, Countries, Partner Programs, and Facilities, by Program Year

Total Funding since February 2004 = US $2 billion

Track 1.0 ART ProgramThe Emergency Plan for AIDS

Relief

Program Totals

Countries where Partners have Implemented Track 1.0 ART Programs, as of March 31, 2010

Countryby Partner AIDSRELIEF EGPAF HARVARD COLUMBIA TOTAL

Botswana X 1

Cote d’Ivoire X X 2

Ethiopia X X 2

Guyana X 1

Haiti X 1

Kenya X X 2

Mozambique X X 2

Nigeria X X X 3

Rwanda X X 2

South AfricaProgram

Transitioned X X 2

Tanzania X X X X 4

Uganda X 1

Zambia X X 2

TOTAL 9 5 3 8 25

Number of Track 1.0 Treatment Sitesby Country and Partner, as of March 31, 2010


Botswana 1* 1

Cote d’Ivoire 129 58 187

Ethiopia 1 51 52

Guyana 3 3

Haiti 8 8

Kenya 31 51 82

Mozambique 42 57 99

Nigeria 34 25 32 91

Rwanda 16 47 63

South Africa 49 65 114

Tanzania 98 165 42 127 432

Uganda 19 19

Zambia 19 65 84

TOTAL 229 450 68 488 1,235

*Indirect Support

Number of Persons Currently on ARTby Country and Partner, as of March 31, 2010


Botswana 8,498* 8,498

Cote d’Ivoire 37,011 2,954 39,965

Ethiopia 605 31,567 32,172

Guyana 855 855

Haiti 3,140 3,140

Kenya 39,757 13,335 53,092

Mozambique 20,159 58,353 78,512

Nigeria 35,418 43,651 32,884 111,953

Rwanda 4,092 19,406 23,498

South Africa 97,763 55,325 153,088

Tanzania 31,910 33,903 33,950 18,927 118,690

Uganda 26,176 26,176

Zambia 33,009 88,480 121,489

TOTAL 174,962 277,316 86,099 232,751 771,128

*Indirect Support

Number of Children (<15 years) Currently on ARTby Country and Partner, as of March 31, 2010


Botswana n/a* 0

Cote d’Ivoire 1,699 150 1,849

Ethiopia 107 2,717 2,824

Guyana 60 60

Haiti 217 217

Kenya 4,975 1,752 6,727

Mozambique 1,657 5,449 7,106

Nigeria 1,914 1,997 2,055 5,966

Rwanda 599 2,156 2,755

South Africa 11,370 5,231 16,601

Tanzania 2,446 3,092 3,101 1,517 10,156

Uganda 2,327 2,327

Zambia 2,292 5,662 7,954

TOTAL 14,937 23,480 5,098 21,027 64,542

*Indirect Support

Track 1.0 ART Program

As of March 31, 2010: 2,116,203 ever enrolled in palliative care1,129,590 (53%) currently in palliative care1,133,027 ever started on ART771,128 (68%) currently on ART

Of those on ART, 64,542 (8%) were children

Of adults on ART, 66% were females

Of children on ART, 50% were females


Relief

Number of Persons on ARTby Partner and Quarter

Number of Persons on ART by Partner and Quarter, as of March 31, 2010

0

40,000

80,000

120,000

160,000

200,000

240,000

FY04Q

4

FY05Q

1

FY05Q

2

FY05Q

3

FY05Q

4

FY06Q

1

FY06Q

2

FY06Q

3

FY06Q

4

FY07Q

1

FY07Q

2

FY07Q

3

FY07Q

4

FY08Q

1

FY08Q

2

FY08Q

3

FY08Q

4

FY09Q

1

FY09Q

2

FY09Q

3

FY09Q

4

FY10Q

1

FY10Q

2

Ever Started Current Started in Quarter

AIDSRelief

246,378 Ever StartedOn ART

71% on ART

10,712 patients/quarter


040,00080,000

120,000160,000200,000240,000280,000320,000360,000400,000440,000

FY04Q

4

FY05Q

1

FY05Q

2

FY05Q

3

FY05Q

4

FY06Q

1

FY06Q

2

FY06Q

3

FY06Q

4

FY07Q

1

FY07Q

2

FY07Q

3

FY07Q

4

FY08Q

1

FY08Q

2

FY08Q

3

FY08Q

4

FY09Q

1

FY09Q

2

FY09Q

3

FY09Q

4

FY10Q

1

FY10Q

2


EGPAF



66% on ART


0

20,000

40,000

60,000

80,000

100,000

120,000

140,000

FY04Q

4

FY05Q

1

FY05Q

2

FY05Q

3

FY05Q

4

FY06Q

1

FY06Q

2

FY06Q

3

FY06Q

4

FY07Q

1

FY07Q

2

FY07Q

3

FY07Q

4

FY08Q

1

FY08Q

2

FY08Q

3

FY08Q

4

FY09Q

1

FY09Q

2

FY09Q

3

FY09Q

4

FY10Q

1

FY10Q

2


Harvard

66% on ART




0

40,000

80,000

120,000

160,000

200,000

240,000

280,000

320,000

FY04Q

4

FY05Q

1

FY05Q

2

FY05Q

3

FY05Q

4

FY06Q

1

FY06Q

2

FY06Q

3

FY06Q

4

FY07Q

1

FY07Q

2

FY07Q

3

FY07Q

4

FY08Q

1

FY08Q

2

FY08Q

3

FY08Q

4

FY09Q

1

FY09Q

2

FY09Q

3

FY09Q

4

FY10Q

1

FY10Q

2


Columbia

70% on ART




0

200,000

400,000

600,000

800,000

1,000,000

1,200,000

FY04Q

4

FY05Q

1

FY05Q

2

FY05Q

3

FY05Q

4

FY06Q

1

FY06Q

2

FY06Q

3

FY06Q

4

FY07Q

1

FY07Q

2

FY07Q

3

FY07Q

4

FY08Q

1

FY08Q

2

FY08Q

3

FY08Q

4

FY09Q

1

FY09Q

2

FY09Q

3

FY09Q

4

FY10Q

1

FY10Q

2


Program Totals

68% on ART


1,133,027 Ever StartedOn ART


Relief

CDC Transition Approach

Our Vision ofTrack 1.0 ART Program Transition

Focus on strengthening the Ministry of Health (MOH), especially Regional and District health systems, to support HIV care and treatment services

Build the capacity of local partners and civil society institutions (NGOs and FBOs) to support the MOH in response to HIV/AIDS

Strengthen ability of MOH and partners to compete for and manage direct USG and other international funding

Gradually transition administrative and clinical responsibilities to the MOH and local partners, while continuing to provide quality care and treatment

Essential Elements ofTrack 1.0 ART Program Transition

Shared vision of what we plan to achieve

Leadership of participating parties at all levels

Commitment of time and effort, despite competing priorities

Collaboration to develop a local strategy and processes that will work

Willingness to transcend ownership issues

Flexibility to encourage and support in-country perspectives, solutions, and thus ownership

How We Need to Work Togetherto Achieve Transition

Track 1.0 ART Program Transition to MOH & Local Partners

CDC Head-

quarters

CDC Country Office

Track 1.0 Partner Head-

quarters

Track 1.0 Country Program

Ministry of Health

Local Partners

ART Treatment

Sites

Aligning Track 1.0 Transition Plans with In-Country Strategies

Harmonize transition plans with Partnership Framework strategies

Provide a role for MOH in transition decision-making

Integrate transition activities into the processes of in-country CDC and national MOH systems

Communicate the vision of the Track 1.0 transition to all levels of the MOH and other local partners

Because transition plans were not initially fully aligned with in-country strategies, we found a need to help:

The Transition Process

Stages of Track 1.0 ART Program Transition

Benchmarks

1 Plan Transition Strategy 1.1 International partner (IP) has organizational strategy for transitioning significant portion of Track 1.0 HIV program functions to sustainable local capacity.

1.2 Local partners that can meet OGAC criteria are identified to take over specific program functions.

1.3 MOH and/or potential local partners participate in transition planning decision-making.

1.4 IP submits written transition plan strategy that includes detailed 3-year work plan and measurable benchmarks.

1.5 CDC country team and CDC or HRSA HQ team approves the transition plan and updates.

2 Build Local Partner Capacity

2.1 IP has operational plan/approach to develop local partner capacity to provide and manage HIV specific program services.

2.2 IP conducts baseline assessment of local partners’ technical and organizational capacity that includes core competency areas

2.3 Local partner engages with IP in capacity-building work plan that includes human resources and organizational systems development.

2.4 IP validates and documents local partner capacity to begin to manage technical and administrative requirements of specific program areas.

3 Supportive Transition of Functions and Funding to Local Partners

3.1 IP begins transition of key program functions and resources to local partner management responsibility through sub-grants and/or transfers to existing local partner USG awards.

3.2 IP transitions increasing amounts of resources and functional responsibilities to local partner through sub-grants or transfers to local partner USG awards during transition period.

3.3 IP continues to provide quality assurance support to local partner programmatic and financial management and implementation during transition period.

3.4 Local partners successfully apply for a USG funding opportunity announcement (FOA) in-country for local partners.

4 Implementation by Local Partners

4.1 Local partners successfully manage key program functions as transferred by IP through sub-grants and/or transitions to existing local partner prime awards.

4.2 Local partner maintains and improves organizational capacity in core competency areas.

4.3 Local partner provides effective program service support to ART treatment sites in specific functional area.

4.4 Local partners successfully manage USG funding awards to support care and treatment sites and programs as a USG prime partner.

5 Monitor Results 5.1 Program functions and associated funding of Track 1.0 ART program has transitioned to direct implementation and management by local partners as prime USG grantee.

5.2 All ART treatment sites in Track 1.0 program as continue to provide ART treatment services.

5.3 Uninterrupted supply of ARV medicines at site level is assured (in absence of national stock-outs).

5.4 Quality of service core indicators for ART treatment services are monitored through site assessments and supportive supervision on a scheduled basis.

5.5 Treatment sites implement a quality management system to sustain and improve quality of care,

5.6 Key program performance indicators remain level or improve for sites in Track 1.0 program during and after transition to local partners.

Organizational domains(All domains apply for potential MOH and local partners

that may become USG prime partners.)

Technical program domains(Specific domains to be selected/defined according to

program area(s) the local partner will implement.)

Governance/Leadership

Strategic planning & execution

Human resource management

Performance measurement, analysis and improvement systems/CQI

External relationships, networks, and partnerships

Financial management

Ability to apply for and manage USG grants

Strategic resource mobilization (other than USG)

Clinical HIV service delivery

Routine supervision of HIV services

Training (clinical and other in-service) for HIV program/service delivery

Clinical mentoring

Laboratory services

Infrastructure rehabilitation

Supply chain support/management

Community and patient services

Monitoring and evaluation

Technical assistance to MOH

Core Capacity Domains

Strategic Guidance for a Standards-based Approach to National ART Program Supervision

to Assure Quality Care and Sustainability of U.S. Government Support to National ART Program

This system would implement and/or maintain the following standards:

There is a regular schedule of joint (USG-MOH) supportive supervisory site visits

There is a reliable results monitoring system for oversight of partners and programs

All ART sites have a functional and sustainable patient monitoring system

There is a regular schedule and reporting of ART data quality assessment activities

All ART sites have QM/PI processes in place


Relief

The Way Forward

Early Lessons Learned

Transition of program responsibilities to MOH and local partners must be accompanied by new program approaches designed to progressively increase leadership and decision-making roles of MOH and local partners during the transition period

Engaging MOH leaders at sub-national levels (e.g., at Regions, Provinces, and Districts) to provide transition leadership and support is essential


We need increased emphasis on measurable benchmarks for USG partners to support increasing health system capacity at district and provincial levels to sustain integrated HIV services

Transition can gain momentum by focusing on early wins, transitioning functions that can be readily absorbed by existing systems in the country, if adequate external funding and assistance is provided (e.g., human resources)


Learning-by-doing is an effective method for strengthening MOH and local partners’ capacity to manage increasing fiscal responsibilities through direct funding of activities

The rate of transition to the Ministry of Health and other local partners in resource-limited settings depends upon the capacity of the local entities to absorb the administrative, fiscal, and clinical responsibilities of the programs (i.e., the rate of transition is determined by the local absorptive capacity)

What Is Neededto Support Track 1.0 Transition

Reasonable timeline to ensure MOH or local partner has capacity to assume transition responsibilities

Flexibility to re-program Track 1.0 funds into new awards to be fully operational post-February 2012

Recognition that international partners will be needed for selected activities beyond 2012 in some countries

Flexibility to define success as what is reasonable to achieve in a country, given existing limitations

Ability to monitor transition of leadership, program functions, responsibilities, performance, and results

The Track 1.0 cooperative agreement for the 4 grantees that supports 26 programs in 13 countries will end on February 28, 2012

New funding opportunities will be announced to support continuous HIV care and treatment programs by CDC country teams, and will be in place, prior to February 2012

New funding opportunities will emphasize goals for continuing the transition to sustainability in PEPFAR II, including increased support for Ministries of Health and local partners

Track 1.0 Close-Out: February 2012

avenida hotel maputo, mozambique august 10-12, 2010 the 8th annual track 1.0 art program meeting

Documents