The HIV Coverage, Quality, and Impact Network (CQUIN) is a multi-country learning network designed to accelerate the implementation of high-quality differentiated service delivery for HIV. CQUIN’s goal is to increase the number of people living with HIV initiating and sustaining highly effective HIV treatment with sustained viral suppression. Find out more at cquin.icap.columbia.edu

ICAP is conducting an evaluation of South Africa’s “surge” support for ward-based primary health care outreach teams.

ICAP worked through HRSA’s Quality Improvement Capacity for Impact (QICIP) mechanism on a plan for ongoing experience sharing and capacity building aimed at increasing retention of patients on ART at partner-supported sites. This Global TA (GTA) award supports follow-on activities including quarterly follow-up workshops and QI coaching site visits in collaboration with partners and other key stakeholders.

The ongoing South African Breast Cancer and HIV Outcomes (SABCHO) study aims to seek answers to several questions regarding the relationship between HIV and breast cancer in South Africa. However, historical information on ART use, CD4 cell count and VL are not currently being collected in the study. To better understand the association between HIV and breast cancer, examining HIV control in the time period preceding the diagnosis is important. To address these knowledge gaps, ICAP is studying: - association of HIV status with age and stage of breast cancer at diagnosis - whether HIV control (as measured by viral load) preceding breast cancer diagnosis is associated with age or stage of diagnosis - HIV control during breast cancer treatment and the association of HIV control (as measured by viral load) with breast cancer treatment outcomes 

The purpose of this follow-up study was to examine Long-term Adherence and Care Engagement (LACE) among women previously enrolled in the MCH-ART study. This study aimed to describe uptake and timing of ART and other health services including sexual and reproductive health, family planning and child health services through 36 months postpartum, and to examine a variety of infant health outcomes among HIV-uninfected infants exposed to TDF-FTC-EFV in utero and during breastfeeding at 36-48 months of age including, growth, morbidity, and health service utilization.

Optimizing Momentum Toward Sustainable Epidemic Control (OpCon) is a global initiative led by ICAP at Columbia University and funded by PEPFAR through HRSA. OpCon can assist countries in addressing the challenges they face in reaching epidemic control, sustaining achievements, and exploring innovations to measure progress.

ICAP is partnering with the University of Cape Town to conduct a study to examine the medical, psychological, and behavioral outcomes of children initiating ART in public health facilities. (funded by PEPFAR through the CDC)

To address the gap in HIV testing and linkage to care among youth in SA, ICAP will implement the Power of Peers Program, empowering nursing students—a largely female group aged approximately 19–24 years—to become champions who actively encourage their peers to self-test for HIV. The innovative program will be carried out in partnership with KZN College of Nursing, enrolling a cohort of 20 high-performing, second-year students at the Prince Mshyiyeni Memorial Campus in eThekweni to serve as youth champions. Program interventions will include: 1) empowering nursing students to become champions who expand access to HIV self-testing (HIVST), counseling, and linkage to care and treatment among their peers and social networks; 2) providing incentives to champions participating in the project; and 3) providing youth with access to a web-based platform using youth-friendly language to promote HIVST and sexual and reproductive health, follow-up support via WhatsApp for youth with a reactive self-test.

Recognizing that low retention rates limit the ability of HIV treatment programs in South Africa to successfully achieve patient outcomes and the “third 90”, ICAP will conduct a situational assessment of CDC-SA partner quality improvement (QI) activities in this domain. Working with HRSA and CDC, ICAP will design and implement a rapid scan of the QI methods, tools, systems and strategies use by Health Systems Trust (HST), the TB/HIV Care Association and the Aurum Institute. The output will include a plan for ongoing experience sharing and capacity building aimed at increasing retention of patients on ART at partner-supported sites. 

ICAP works with the MOH to strengthen health systems for HIV, providing technical assistance on the implementation of patient adherence and empowerment strategies and to improve nurse-initiated and managed antiretroviral treatment (NIMART). (funded by PEPFAR through the CDC)

ICAP collaborated with the University of Cape Town’s Desmond Tutu HIV Centre and the University of Pretoria to implement training courses for primary care and community-level clinicians on managing TB/HIV co-infected patients and implementing infection control measures in a primary health care setting. The courses are accredited as part of the continued professional development (CPD) requirements of the Health Professions Council of South Africa. Additional partners include the Medical Research Council (MRC) and Council for Scientific Industrial Research (CSIR). (funded by PEPFAR through the CDC)

The Global Nurse Capacity Building Program (GNCBP) is a global health initiative that was administered by the Health Resources and Services Administration (HRSA), under the U.S Department of Health and Human Services, with funding from the U.S. President’s Emergency Plan for AIDS Relief (PEPFAR). It was implemented by ICAP at Columbia University’s Mailman School of Public Health (ICAP) from 2009 to 2018. GNCBP’s goal was to advance the HIV response toward epidemic control and to improve population health in sub-Saharan Africa by fostering individuals, institutions, and networks to expand, enhance, and sustain the nursing and midwifery workforce. The program used a holistic approach to strengthen nursing and midwifery education and practice through two complementary sub-projects: the Nursing Education Partnership Initiative (NEPI), which expanded the health workforce by producing new nurses and midwives; and the General Nursing (GN) project, which supported the maintenance of a skilled health workforce through continuing professional development (CPD), in support of HIV care and treatment scale up and sustainability. Together, NEPI and GN interventions increased the quantity and quality of the nursing and midwifery workforce by addressing seven domains of health workforce development: infrastructure; curriculum; faculty; clinical skills; production; in-service training; and partnership for policy and regulation. Find the GNCBP final report here Find out more about NEPI View the End-of-Project Report for NEPI in South Africa

ICAP worked through HRSA’s Quality Improvement Capacity for Impact (QICIP) mechanism on a plan for ongoing experience sharing and capacity building aimed at increasing retention of patients on ART at partner-supported sites. This Global TA (GTA) award supports follow-on activities including quarterly follow-up workshops and QI coaching site visits in collaboration with partners and other key stakeholders.

ICAP contributed to South Africa’s National Strategic Plan on HIV/AIDS and sexually-transmitted infections (STIs) and tuberculosis (TB) by providing technical support for the implementation of comprehensive HIV prevention services for men who have sex with men (MSM). Implemented under the project name Mosaic Men’s Health Initiatives (MOSAIC), this project sought to increase coverage, access, and quality of HIV-related services for MSM in five provinces in South Africa by capacity building at the institutional, health facility, and community level to provide clinically-competent HIV care services to MSM. The project also delivered MSM services through mobile wellness clinics staffed by peer outreach workers, lay counselors and nurses who provide HIV counseling, testing, and screening for TB and STIs. (funded by PEPFAR through the CDC)

View the End-of-Project brief here

ICAP implemented a study to enhance services for non-communicable diseases (NCDs). This two-phase project aimed to expand diabetes and hypertension screening for people living with HIV in South Africa. Phase one included: a baseline needs assessment and situational analysis; selection of Zamdela Community Health Centre, in the Free State province, as the study site; provision of medical equipment; and development and delivery of NCD tools and training. Phase two included a study to determine the prevalence of these conditions in HIV-infected patients and the feasibility of screening methods to be integrated in HIV services. (funded by the Medtronic Foundation) South Africa ICAP

Columbia University’s role in implementing PEPFAR began in 2003, when it received funding from the Global AIDS Program of the Centers for Disease Control and Prevention (CDC) under the University Technical Assistance Projects (UTAP) to support the development of important components of national HIV programs, including treatment protocols and training. In 2004, ICAP was founded and was awarded a new cooperative agreement from CDC under the PEPFAR framework, the Track 1.0 funding mechanism, to provide comprehensive HIV care and treatment in five countries: Kenya, Mozambique, Rwanda, South Africa, and Tanzania, with programming in Côte d’Ivoire, Ethiopia, and Nigeria subsequently added. This initiative, the Multicountry Columbia Antiretroviral Program (MCAP), rapidly expanded programs for HIV care and ART by promoting early diagnosis of HIV infection, maintaining the health of those living with HIV, and preventing further transmission of HIV within the community. MCAP programming between 2004 and 2012, in addition to being focused on rapidly scaling up care and treatment in partnership with host-country governments, also emphasized the full continuum of HIV-related services, continued capacity building and health systems strengthening, and transition of operations to host governments and local nongovernmental organizations. Find the MCAP End-of-Project Reports here.

The MTCT-Plus Initiative, the world’s first multi-country HIV treatment program, aimed to demonstrate to a disbelieving world that it was possible to provide care and antiretroviral (ARV) treatment in resource-limited settings, using programs to prevent mother-to-child transmission of HIV (PMTCT) as an entry point. In December 2003, the MTCT-Plus Secretariat in New York (the precursor to ICAP, headed by ICAP’s Wafaa El-Sadr and Elaine Abrams) received its first grant from the new President’s Emergency Program For AIDS Relief (PEPFAR). Four years later, the MTCT-Plus Initiative of Columbia University’s Mailman School of Public Health was providing HIV care and treatment for nearly 17,000 people at 14 sites in nine countries. MTCT-Plus received expansion funding from USAID in 2003 and 2006. By 2010, ICAP had provided HIV care and treatment to more than one million people. Find the MTCT-Plus and MTCT-Plus Expansion reports here.

In partnership with the University of Cape Town, ICAP led a three-year randomized trial study to evaluate two strategies for delivering HIV care and treatment services to HIV-exposed infants. The goal of the study was to identify optimal strategies for postpartum antiretroviral therapy services for HIV-infected pregnant women and their exposed infants. (funded by the NIH)

In September 2002, the Mailman School of Public Health (MSPH) at Columbia University (CU) entered into a Cooperative Agreement with the Centers for Disease Control (CDC) for the University Technical Assistance Projects (UTAP) in Support of the Global HIV/AIDS Program. Situated within ICAP, UTAP was originally envisioned as a single-country program for the provision of technical assistance, but rapidly grew to include long-term and short-term technical and administrative assistance to the national responses to HIV/AIDS in five countries: Mozambique, Rwanda, South Africa, Tanzania, and Zambia. As the original UTAP project drew to a close and PEPFAR moved into its second phase—focused on sustainability—ICAP entered into several, follow-on Cooperative Agreements, called UTAP-2. Four were country-focused (in Côte d’Ivoire, Democratic Republic of Congo, Swaziland, and Tanzania) and the fifth—UTAP-2 Atlanta—became a flexible mechanism for providing a wide range of technical assistance and other support to PEPFAR countries. After beginning in 2009 as a means to help CDC conduct surveillance training more efficiently through distance education, UTAP-2 Atlanta grew over the next six and a half years to comprise 11 distinct projects addressing needs and gaps in the HIV response and answering important research questions to inform the response going forward. Find all UTAP and UTAP-2 resources here.