The Elizabeth Glaser Pediatric AIDS Foundation (EGPAF) celebrated the success of their eight-year project to scale up HIV prevention, care and treatment services in five countries at an all-day event Thursday. Helping put more than 500,000 people living with HIV on lifesaving antiretroviral therapy (ART), the “Help Expand Antiretroviral Therapy to children and families” (HEART) program was one of four funded by the U.S. President’s Emergency Plan for AIDS Relief (PEPFAR) “Track 1” program to expand global access to ART.
Building on the successes of their prevention of mother-to-child transmission (PMTCT) programs in Africa, EGPAF launched Project Heart in 2004 in Cote d’Ivoire, South Africa, Tanzania and Zambia, adding Mozambique in 2006. Throughout Project HEART’s duration, more than 1 million men, women and children received HIV care and support; and more than 2.5 million pregnant women received HIV counseling and testing, averting more than 66,000 pediatric HIV infections. Project HEART supported HIV/AIDS services at more than 510 ART sites and 1,053 PMTCT sites.
“In 2010, one out of 10 PEPFAR-supported ART patients in sub-Saharan Africa received treatment through Project HEART,” according to the report.
Thursday’s event also featured the debut of the new EGPAF video highlighting the successes of the program.
Their efforts helped to change the face of the AIDS pandemic, said Debbie Birx, director of Center for Disease Control and Prevention’s (CDC’s) global health HIV program. She joined U.S. Global AIDS Ambassador Eric Goosby in lauding the program, calling Project Heart, “A weather vane of what works and doesn’t work, looking at data collected at your level, enabling us to truly understand where our impact has been, why it has been there, and what we need to do to continue our impact and increase it,” he said.
The EGPAF team released an end-of-project report highlighting the successes of the program, lessons learned, and detailing the process of transitioning ownership of these programs to in-country teams – “helping move projects into the hands of those we have been working with in-country – expanding the impacts we have started… [which] allows us to take on more of a technical assistance role,” according to Dr. Goosby.
Addressing Pregnant Women and TB Co-infection
In terms of specific populations, the program achieved successes and noted areas for improvement. For example, “All Project HEART countries institutionalized HIV counseling, testing and recording status of TB patients,” reaching an average 75 percent of TB patients with these services in 2010, according to the HEART report. An example of high and consistent TB screening rates, about 70 percent of HIV patients in Tanzania consistently were screened for TB in 2010 and 2011. “However, less than 30 percent of eligible co-infected patients received ART in 2010, pointing to the need for more effective follow-up and integration of services.”
Also of note, PMTCT treatment programs also made a dramatic shift to more efficacious combination regimens and ART over time, with less than five percent of pregnant women still being treated with single-dose nevirapine at the end of 2011
Tedd Ellerbrock, head of the Adult HIV Treatment and Project Office at CDC, took a moment to highlight the collective successes of the four PEPFAR Track 1 partners – to include AIDSRelief (Catholic Relief Services Consortium), the Harvard School of Public Health, and Columbia University’s ICAP program in addition to Project HEART. The $2.2 billion spent on the project since 2004 has helped expand the 119 treatment facilities to 1,307 in 2011 through 25 programs in 13 countries.
Transitioning to Local Partners
Key to following PEPFAR’s goal of transitioning from an emergency response to a sustained response, the Project HEART team followed a three-pronged transition strategy:
- Strengthening the health system through investments in infrastructure, logistics systems, human resources, and innovative and sustainable financing mechanisms;
- Strengthening the technical and organizational capacity of existing governments, NGOs, and CBOs to provide quality HIV services; and
- Establishing local NGOs affiliated with the Foundation where needed, in order to serve as technical leaders around pediatric HIV and partners to support MOHs for health systems strengthening and service delivery activities in host countries.
While dramatic strides were made in the transition process, the EGPAF report notes that the short period of time given to strengthen in-country health systems did not allow for fully addressing the time-consuming nature of the policy change process, human resource capacity development, not to mention budget limitations, and contending with centralized health financing at the government level.
Despite these challenges, Project HEART successfully: supports 154 labs in the five countries; equipped 105 treatment sites with CD4 count machines; trained nearly 26,000 doctors, nurses and other healthcare workers to provide ART services; supports 1,053 PMTCT sites; and renovated 141 clinical sites. Moreover, 96 percent of these Project HEART partners are local organizations.
In terms of strengthening existing local organizations, the report listed successful methodologies such as offering performance-based financing mechanisms for community-based organizations providing HIV care and treatment services in Cote d’Ivoire – “transform[ing] clinics from small sites serving a handful of patients into strong service-delivery centers providing a variety of HIV prevention, care and treatment services to the community.”
This transition process is ongoing, and PEPFAR and EGPAF hope the lessons learned throughout Project HEART will inform locally-drive program planning and implementation. To that end, EGPAF developed three text books about how to build comprehensive HIV/AIDS care programs in resource-limited settings. Nevertheless, “there was and continues to be a crucial need to augment the financial, operational and administrative management capacity of public health authorities to maintain the current scale of services,” according to the report’s executive summary.