Carmen Portillo, RN, PhD, FAAN Professor & Chair Community Health Systems, SON

1. 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

2. 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

3. 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 procedures • Dr. William Holzemer • Dr. Ronald Brookmeyer

4. 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?

5. 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?

6. 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

7. 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

8. Highlights of Strategies to Build Capacity • Twinning • Effective Partnerships • Task Sharing • Utilization of Local African Institutions • Supporting US Public-Private Partnerships

9. 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

10. 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 assistance • Individual to individual • Institution to institution

11. 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

12. 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

13. 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

14. 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”

15. 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

16. Types of Public – Private Partnerships • Military partnerships • U.S. DOD developed a partnership with militaries in Kenya, Nigeria and Tanzania – U.S. Military HIV Research Program • Academic twinning • Academic Model for Providing Access to Healthcare (AMPATH) • International Training and Education Center on Health (I-TECH)

17. 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)