Building Sustainable Public Health Capacity and Infrastructure

Strengthening National Laboratory Systems
A strong national public-health laboratory network is the cornerstone of a strong response to HIV/AIDS. Through PEPFAR, CDC is building capacity for high-quality laboratory services to assist with the rapid expansion of HIV treatment, and the accompanying need for HIV diagnosis and associated care. In 2007, CDC provided the technical assistance needed to establish the African Centre for Integrated Laboratory Training in South Africa that will serve as a reference lab for TB and other diseases and will significantly expand the number of laboratorians and other health care workers trained in TB/HIV throughout Africa.

Building Integrated Treatment Services
Tuberculosis (TB) is the leading cause of death among HIV-infected individuals, and one of the most common opportunistic infections. The prevalence of HIV infection among patients in TB clinical settings is high-up to 80 percent in some countries. In many countries, including Botswana, Ethiopia, Kenya, Rwanda, and Tanzania, CDC has worked with partners to support the expansion of provider-initiated testing and counseling among TB patients and collaborated with international partners to develop and disseminate protocols, training, and policy to improve the integration of HIV and TB service care through PEPFAR.

Strengthening Capacity to Prevent New Infections
"Prevention with Positives” (PwP) involves working with HIV-positive people and their partners to prevent further HIV transmission. CDC spearheaded a new, provider-initiated intervention for HIV-infected individuals in Kenya, and is now implementing it in countries throughout Africa. This technique gives providers the tools and skills to deliver tailored prevention messages to HIV-infected persons at the end of every routine clinic visit. Messages focus on the disclosure of HIV status, partner testing, the reduction of transmission to others, and the prevention of other sexually transmitted infections.

Helping Nations to Collect Information for Program Improvement
CDC is at the forefront in developing new surveillance and reporting tools to track and fight the global HIV/AIDS epidemic. Working with Ministries of Health and international partners, CDC is building capacity of resource-constrained nations to design and implement HIV/AIDS surveillance systems and surveys, and to monitor and evaluate the process, outcomes, and impact of HIV programs.

Ensuring Scientifically Sound Interventions through Public Health Evaluation
CDC helps to lead public-health evaluations (PHE) under PEPFAR to ensure all interventions are scientifically sound and delivered as effectively and efficiently as possible. Common areas of evaluation include adult and pediatric treatment; TB/HIV; infant diagnostics; and prevention of mother-to-child transmission. CDC recently led a PHE antiretroviral costing study designed to provide an estimation of resource needs and an understanding of how these needs change over time. Preliminary analysis of data indicates treatment costs vary widely across facilities and that spending changes markedly as programs mature. This ongoing study will strengthen knowledge about the costs of comprehensive HIV treatment to inform efficient and cost-effective policy and planning.

Building Capacity for and Access to Treatment for HIV-infected Children
Left unidentified and untreated, studies show that 50-60% of HIV-infected infants die by age two. Early Infant Diagnosis (EID) by dried blood spot (DBS) gives HIV-infected infants early access to appropriate care and treatment. With the simple prick of an infant’s heel, toe, or finger, whole blood is placed onto a card to dry, creating samples which are stable for relatively long periods without refrigeration, and are light and simple to transport. With CDC’s leadership, EID is now being implemented in 13 African countries and two countries in the Caribbean.