As a part of global efforts to end the AIDS epidemic as a public health threat by 2030, the Bill & Melinda Gates Foundation has awarded ICAP at Columbia University $24.6 million over the next five years to expand the Coverage, Quality, and Impact Network (CQUIN), an initiative aimed at supporting novel person-centered HIV service delivery in Africa.
ICAP’s CQUIN network launched in 2017 with funding from the Foundation, and supports ministries of health and their partners to scale up high-quality differentiated service delivery (DSD) models for HIV treatment. Since its launch, CQUIN has grown from six to 21 countries, and the new funding will support an expanded focus that includes differentiated HIV testing and linkage services while continuing to advance efforts focused on optimizing the coverage and quality of HIV treatment.
“Differentiated service delivery models vary the ‘when, where, who, and what’ of HIV service delivery to respond to different needs of individuals and to the contexts in which they live,” said Wafaa El-Sadr, MD, MPH, MPA, global director of ICAP. “CQUIN has supported ministries of health to move beyond a ‘one size fits all’ approach to HIV service delivery by providing a platform to learn from each other and co-create tools and resources that serve recipients of services.”
CQUIN activities include webinars, workshops, meetings, country-to-country learning exchange visits, data use for decision-making, and technical assistance. In addition, CQUIN has established communities of practice for network members interested in focused areas relevant to DSD.
The “CQUIN 2.0” award will support an expanded portfolio of differentiated programming and launch a new stream of work focused on differentiated testing and linkage services. Early activities in this area include recent co-hosting of a satellite session on differentiated testing services at the International AIDS Conference and the inclusion of differentiated linkage services in the agenda of the recent CQUIN meeting that took place in Kigali, Rwanda from August 15-19.
In addition, CQUIN will continue to focus on shaping models of HIV treatment that meet the specific needs of people established on HIV treatment, and those with advanced HIV disease, tuberculosis and HIV, and HIV and non-communicable diseases. CQUIN 2.0 will also continue to support models of care for key and vulnerable populations, pregnant and breastfeeding women, migrant and mobile and displaced people, and other groups that have faced challenges in engaging with health services.
“The ICAP team has drawn upon our experience to design a learning network with a strong conceptual framework and a wide range of activities that connect ministries of health, practitioners, recipients of care, communities, funders, and other stakeholders in a way that facilitates the exchange of best practices and accelerates the scale-up of high-quality differentiated HIV services,” said Miriam Rabkin, MD, MPH, ICAP director for Health System Strategies and CQUIN principal investigator.
Evidence to date demonstrates the high impact of the CQUIN network’s knowledge-sharing approach. A 2021 assessment showed that CQUIN network participation improved the knowledge, skills, and attitudes toward DSD for 96 percent of participants.
“CQUIN’s rapid expansion highlights the interest of ministries of health in enhancing HIV programs and meeting community needs,” said Peter Preko, MBChB, MPH, CQUIN project director at ICAP. “We have worked to respond to diverse interests and priorities of ministries of health in CQUIN member countries. The continued support from the Gates Foundation allows for further efforts to make an even longer-lasting impact in the countries hit hardest by the HIV epidemic.”
As a multi-country learning network, CQUIN convenes health system leaders from 21 countries in Africa to participate in joint learning and exchange of innovations and best practices, with the goal of fostering scale-up and spread of these high-quality differentiated services. Representatives from ministries of health, implementing partners, civil society, associations of people living with HIV, and donor agencies work to scale up DSD relative to each country’s unique needs.
A major global health organization that has been improving public health in countries around the world for nearly two decades, ICAP works to transform the health of populations through innovation, science, and global collaboration. Based at Columbia Mailman School of Public Health, ICAP has projects in more than 40 countries and is working side-by-side with ministries of health and local governmental, non-governmental, academic, and community partners to confront some of the world’s greatest health challenges. Through evidence-informed programs, meaningful research, tailored technical assistance, effective training and education programs, and rigorous surveillance to measure and evaluate the impact of public health interventions, ICAP aims to realize a global vision of healthy people, empowered communities, and thriving societies.