Strategies to Build Capacity for Prevention, Treatment,

and Care of HIV/AIDS in Africa: Recommendations

from the IOM

Carmen Portillo, RN, PhD, FAAN

Professor & Chair

Community Health Systems, SON

University of California, San Francisco

Background

In 2010 an ad hoc committee “Preparing for the Future of HIV/AIDS in Africa” was convened by the IOM to answer 5 specific questions

12 members were appointed who worked in HIV/AIDS in Africa or the US

Two nurses served on the taskforce: Dr. Marla Salmon and myself

Background

The drafted recommendations were independently reviewed by 14 individuals (i.e. Jason Farley)

Two IOM members were responsible for the independent review and followed IOM proceduresDr. William HolzemerDr. Ronald Brookmeyer

Statement of Task 1. What is the best projection for global

incidence and burden of HIV/AIDS? 2. What are the long term implications of the

global HIV prevalence on U.S. (broadly)? 3. What are the implications of the global

HIV prevalence from the perspective of African governments?

4. What are the implications of the projected HIV incidence and burden of HIV/AIDS for capacity constrained countries to make ethical decisions?

Statement of Task

5. What should be the strategies for the U.S. and highly affected nations to develop now in order to ensure domestic and international capacities for highly effective HIV prevention, treatment, and care efforts in the 2018-2023 timeframe? What structures, systems, and professions would be necessary to implement these strategies?

Statement of Taskand Study Scope

Overall, the task was ENORMOUS Innovative strategies that can be used by the United

States and other donor countries to respond to the challenge of HIV/AIDS in the coming decades through institutional and human resource capacity building

How can the US be smarter about the investment in addressing the AIDS epidemic – and how can Africa address the same issue

Focus solely on the domain of health care systems

Assumption

Social determinants of health, such as the conditions in which people live and work such as access to education, women’s status, and poverty are critical factors that would help mitigate the global pandemic

Twinning Effective Partnerships Task Sharing Utilization of Local African Institutions Supporting US Public-Private Partnerships

Highlights of Strategies to Build Capacity

Concept: Twinning

Twinning: a bilateral, mutually beneficial capacity-building partnership formed to mitigate the effect of HIV/AIDS in Africa. Examples: Facilitate the introduction of new, cutting-edge

technologies for laboratories, informatics, logistics, communications, and teaching through training by partners

Provide access to professional development to improve the teaching ability of faculty

Assist in developing grant management; training in operations research, etc

Effective Partnerships

Effective partnerships require the engagement within the cultural and contextual reality but also the governmental and national planning framework of the host country. This partnership should be guided by the host country.Types of Partnerships:

Short-term consultative/technical assistanceIndividual to individualInstitution to institution

Task Sharing – Not Task Shifting

Task sharing

- is needs based; not hierarchical or territorial; allows roles to expand/contract according to need

- implies a realignment of roles & responsibilities Task shifting (WHO)

- specific task are transferred to workers with less training and qualifications

- does not imply realignment of roles & responsibilities

Sustainability of Task Sharing

Policy development to enable task sharing Remuneration of packages Clear job descriptions Professional boundaries/responsibilities Governments, international, bilateral

organizations prepare health systems National governments to garner stakeholders’

support (i.e. professional bodies and associations, MOH, MOE, MOF, public service

Utilization of African Institutions

South-South partnerships and regional collaborations

- Partners in Health model to build human capacity African science academies

- Academy of Science of South Africa National public health institutes

- International Association of National Public Health Institutes

Partnerships with country health resources

- Advocacy groups, regional networks, interregional networks

Supporting U.S. Public-Private Partnerships

PEPFAR defines a public-private partnership as a “collaborative endeavor that combines resources from the public sector with resources from the private sector to accomplish the goals of HIV/AIDS prevention, treatment and care”

Types of Public – Private Partnerships

PEPFAR – through CDC and Becton, Dickinson and Company (BD)

Faith-based partnerships made unique contributions primarily because of their position in country before the AIDS crisis In South Africa, the Catholic Church has been present since

1849, where they have build 2 hospitals, 31 clinics, 16 hospices, 10 multipurpose health centers, and hundreds of HIV projects across the country

Military partnerships Academic twinning

Launched a 5-yr public-private partnership to improve overall laboratory systems and services in African countries

Types of Public – Private Partnerships

Military partnershipsU.S. DOD developed a partnership with

militaries in Kenya, Nigeria and Tanzania – U.S. Military HIV Research Program

Academic twinningAcademic Model for Providing Access to

Healthcare (AMPATH) International Training and Education Center on

Health (I-TECH)

IOM Report: Preparing for the Future of

HIV/AIDS in Africa www.nap.edu or www.iom.edu Other resources:

Strategic Approach to the Evaluation of Programs Implemented Under the Tom Lantos and Henry J. Hyde U.S. Global Leadership Against HIV/AIDS, Tuberculosis, and Malaria Reauthorization Act of 2008 (2010)

Healers Abroad: Americans Responding to the Human Resource Crisis in HIV/AIDS (2005)

Public Financing and Delivery of HIV/AIDS Care: Securing the Legacy of Ryan White (2004)