Cote d’Ivoire – FY 2010 Approved Funding by Program Area, Agency and Funding Source*
*Only appropriations from the GHCS (State) fund account are notified by the Global AIDS Coordinator.
Within the fragile and evolving context of this country, PEPFAR investments are designed to build the capacity of the government of Côte d’Ivoire (GoCI), civil society, and private sector to plan, implement, and monitor a continuum of comprehensive HIV/AIDS prevention, care, and treatment services. While a mid-term review of the HIV/AIDS National Strategic Plan (2006-2010) indicated greatly expanded access to prevention, care, and treatment services, the national HIV/AIDS response is limited by poorly equipped and under-staffed health and social services. The PEPFAR team continues to work closely with the GoCI towards developing a Partnership Framework, with the intent of drafting one in 2010. The progress on this collaboration continues to be quite dependent upon the political situation in country. Important gains in HIV counseling and testing (HCT), PMTCT, and care for orphans and vulnerable children (OVC) are being secured through an emphasis on policy development, task shifting, building national capacity, standardizing approaches, and improving coordination.
Côte d’Ivoire has the highest adult HIV prevalence in West Africa, estimated at 3.9%. Among the 480,000 adults and children living with HIV, about 190,000 are estimated to be in need of ART. The national HIV/AIDS response is limited by poorly equipped and under-staffed health and social services at decentralized levels. Despite challenges, national HIV testing and ART programs have grown substantially. Monthly ART enrollment rates have increased from 1,800 in May 2009 to 2,900 in May 2010. Resources will also be used to significantly reduce the national gap and enable the GoCI to have greater ownership of their treatment programs.
HIV prevention efforts focus on evidence-based approaches to improve life-skills training for in- and out-of-school youth, better targeting of MARPs, efforts to define peer education standards, a growing focus on addressing gender-based vulnerabilities and stigma, and the integration of prevention into every aspect of care and treatment, most notably prevention with positives (PwP). All PEPFAR-supported health facilities will integrate HIV prevention through paid counselors, who will also provide follow-up care, support for ART and tuberculosis (TB) treatment adherence, and referrals to community-based care and OVC services. The PEPFAR program plans to moderately increase the number of people tested for HIV through the implementation of routine HCT in all health facilities.
Efficiency of home-based care and OVC service delivery will continue to be improved by ensuring that OVC partners cross-train their community caregivers to provide palliative care and support, and vice versa. OVC support will emphasize sustainability by building the capacity of local organizations to assess, address, and monitor the vulnerabilities of children. The National OVC Program will continue to lead a quality-assurance initiative and reinforce and expand its coordination platforms at social centers.
PEPFAR care and support and adult and pediatric treatment support will focus on targeted expansion of services, mainly to extend access at lower levels of the health pyramid in already-supported districts; the pursuit of efficiencies through costing and task-shifting; scale-up of quality-assurance activities; strengthened nutritional services; capacity-building for central and district-level coordination; and better M&E systems.
PEPFAR efforts will focus on reinforcing health systems that provide a continuum of comprehensive care and treatment services through a family-centered approach, with a comprehensive treatment package that includes laboratory services, early infant diagnosis (EID), adherence and psychosocial support, palliative care, treatment of OIs and STIs, and prevention services for HIV-affected families. Links to community- and home-based care and support, including OVC support, will be provided by full-time, trained counselors at all sites. PEPFAR will strengthen key ART monitoring systems (including ARV resistance) through a health management information system (HMIS) and program evaluations; advocacy and capacity-building for decentralized health authorities; and the strengthening of a laboratory network supported by technical assistance (including training and quality assurance).
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