The U.S. President’sEmergency Plan for

AIDS Relief

HIV/AIDS and the U.S. Government’s Response: The Power of Partnerships

Better Information for Better Health andOpportunities for ICT-enhanced Solutions

Mark LandryOffice of the U.S. Global AIDS CoordinatorFebruary 2, 2009

Overview

• Next 5 years of PEPFAR: emergency plan to a sustainability plan

• Health management information systems (HMIS): better information for better health

• ICT-enhanced solutions: what’s a good fit and how will you know it when you see it?

Goal this week: Help identify community-specific potential opportunities and plan to leverage relationships and resources to take action.

Beyond 2008: 10-Year Program Goals

Working in partnership with host nations, PEPFAR will support:

– Treatment for at least 3 million people – Prevention of 12 million new infections – Care for 12 million people, including 5 million

orphans and vulnerable children

• To meet these goals, PEPFAR will support training of at least 140,000 new health care workers in HIV/AIDS prevention, treatment and care.

PEPFAR Worldwide Activities

• Mission is two-tiered, focused on both:– Information systems needed to implement

HIV services under PEPFAR (collect, store, transmit, analyze, and disseminate data)

– Information systems needed for monitoring and evaluation, to ensure accountability

Effective HMIS interventions influence the success of PEPFAR.

HMIS Technical Working Group

• Developing written five-year strategic plans for health information systems

• Assessment/evaluation of implemented systems   

• Improved data quality• Increase data use• Improved human capacity around HIS planning,

design, and implementation • Increased integration of separate information

systems

HMIS TWG Goals

• Automatic generation of indicators • Increased timelines and completeness of data • Improved sharing of technical expertise

(e.g., South-to-South technical assistance) • Use of IT to increase quality of service delivery • Fully functional implementations of systems for

clinics, labs, community interventions, program reporting, etc. 

• Assisting other TWGs in articulating their information systems strategies

HMIS TWG Goals (continued)

Program/project management systems (indicators)Clinical, patient-level information systems (electronic medical records)Community-based services information systemsPalliative care (e.g., HIV/TB)Prevention activities and indicatorsOrphans and vulnerable children programsBlood safety tracking systemsLaboratory information systemsGeographic information systems GIS)Supply chain/logistics management information systemsComprehensive training management

Component HMIS Sub-Systems

Origin of Primary Data

Many Registries of the Primary Health Worker

DATA SOURCE

Weekly Data, manually computed by the data entry operator

Burden of Data Aggregation

Data Storage and Retrieval

RWANDA’S TRACnet / Phones for Health

LocalApplications Cell

Phone

PCs/Internet

PDA/Smartphone

SAMPLE DATA

Phone

1234

Modified after: Eddie Karisa, CDC-Rwanda, 2007

Strategic use of ICTs in the next generation of PEPFAR

• HMIS capacity building– Cohesive strategy– National, regional, community ownership– Coordination, targeting, and follow up

• Reaching the hard to reach– Target populations (e.g., most at-risk, remote,

underserved, priority, OVCs)– Emphasis areas (e.g., prevention)– Continuity of care– Leveraging resources and existing

infrastructure

Some PEPFAR Challenges

• Prevention case studies– Behavior Change Communication (BCC)– Prevention of Mother to Child Transmission (PMTCT)

• Care case studies– Orphans & Vulnerable Children (OVC)– Continuity of Care: tracking individuals and their

personal medical records– Community-Based Systems– Data Management and Use – “Data for Decision-

making”• Treatment case studies

– Patient services: ARV adherence and monitoring– Health Worker training and referral/consultation

services

Prevention Case Study: BCC now

ICT-enhanced BCC in the future

• HIV Free Generation

www.hivfreegeneration.warnerbros.com

• Gaming: PC and cell phone

• New technology: Microsoft MultiPoint

Care Case Study: Continuity of Care

Data ExchangeStandard

ART Care

HIV Register

HIV SupportServices

VCT

TB Care

General Medical Care

PMTCT

OI Care

Care Case Study: OVC

OVCs In-Depth: Who are these children?

• Children who parents have died due to AIDS– Now living with grandparents, extended family, community

members, in orphanages, on the street.– May be treated as second class children, e.g. less to eat

• Children who have a parent who is sick and can no longer care for them– They drop out of school to care for parent, to work, beg

• Children who are stigmatized and grieving– By 2010, orphaned by AIDS globally is projected to exceed 20

million, with 80% in sub-Saharan Africa– The number of other children made vulnerable because of

HIV/AIDS is estimated by some to be more than double that number.

What these children need

• Psychosocial– Provide recreational, cultural, and spiritual

activities that support life skills and self-esteem

– Individual or group counseling– Develop memory books

• Health – HIV and AIDS prevention messages– Age appropriate health education– Immunizations– HIV screening– Referral and follow-up for treatment services

including HIV

• Education /Skill– Subsidizing school related costs– Provide bursaries to support vocational

training– Support after-school programs that assist with

homework– Link older youth to resources for setting up

small businesses or employment opportunities

• Economic Strengthening– Participation in economic strengthening

activities

• Food & Nutrition– Nutritional assessment and counseling– Nutritional supplementation– Staples for food insecure HH– Therapeutic feeding for malnourished children– Linkages and referrals to health and nutrition

interventions

• Shelter & Care– Identify short-term, protective shelter for children

living outside of family care. – Monitor and provide for material needs, i.e. clothing

• Protection– Facilitate birth registrations/ inheritance/succession

planning; guardianship and adoption– Support transfer of abused children to temporary

safe houses or permanent placements– Report and litigate abuse cases

Strategies for Caring for the OVC

• Strengthen families to protect and care for OVC

• Facilitate access to or provide basic social and protective services

• Build capacities of communities, local gov’t, provincial/district gov’t, national gov’t, to support families and care for orphans and vulnerable children.

• Advance policy and legal reforms in order to enable supportive environments for children’s growth and development.

OVC Programming Challenges

• Comprehensive programming– Multisectoral– Lack of referral systems– Weak social service systems

• Varying strategies for Identifying children in need– Generalized, high prevalence – Use of community

committees– Concentrated epidemics – Identify through affected

families, e.g. treatment, C&T, PMTCT, and PLWHA.

Treatment Case Study: ART

• Challenge: ARV adherence and loss to follow up

• ICT-enhanced solution: SMS services– Adherence Reminders– Patient Monitoring / Adverse Events – Patient Tracking – SMS Info Feeds – FAQs– SMS Question Box – SMS Support Clubs

SMS Solutions

Phones for Health

MDNet

Frontline SMS

Mobile for Life

Treatment Case Study: Health Worker Training

Training centers in urban areas

What about hard to reach areas?

OLPHW: One Laptop per Health Worker

Emerging Telecenter Ecosystem

• A telecenter is a public place where people can access computers, the Internet, and other digital technologies that enable people to gather information, create, learn, and communicate with others while they develop essential 21st-century digital skills.

• Where are telecenters in your area? Sponsors ready to multi-purpose them with HIV/AIDS content.– Cisco Network Academies– Microsoft Community Resource Centers– Intel World Ahead Learning Centers– Inveneo/Intel mobile clinics/IT labs

• Behavior change communication to impact youth through HIV/AIDS awareness campaigns using multimedia

• HIV/AIDS curriculum development/gaming at school• Home PCs “pay as you go” with FlexGo technology• Expanding role of Microsoft-funded community centres• Enabling kiosks with HIV/AIDS messaging• Earning credits for cell phone usage• ICT support for country information systems• Co-sponsorship of meetings or symposiums• Knowledge management - delivering individual journals

over analog dial-up connection

• Research and Development with Microsoft health experts

Public-Private Partnerships: Microsoft