G-105 Academic institutional impact on global HIV pandemic response: A decade of Implementing PEPFAR programs by University of Maryland Baltimore
Authors: Bazira Deus , Claassen Cassidy , Koech Emily , Marima Reson , Lavoie Marie-Claude 
Published: April 2019

Background:
The global HIV burden remains high with nearly 40 million persons living with HIV (PLWH) to date. Encouragingly HIV incidence and AIDS-related mortality have dropped significantly over the past 20 years due in part to availability of antiretroviral treatment in all parts of the world most especially in resource-limited countries. Global interventions such as U.S President's Emergency Plan for AIDS Relief (PEPFAR) and the Global Fund to Fight TB, Malaria and AIDS (GFATM) are credited for this unprecedented response. As a result, to date more than 22 million are receiving antiretroviral treatment. The Center for International Health, Education and Biosecurity (CIHEB) and its predecessors within the Institute of Human Virology (IHV) at the University of Maryland Baltimore (UMB) has played a key role in the global HIV response since PEPFAR inception.

Methods:
Under PEPFAR 1.0 which focused on decreasing the high mortality rate due to HIV our interventions aimed at enhancing provider competencies and health facility care processes to deliver quality HIV services. PEPFAR 2.0 placed emphasis on transition of health programs to local ownership for sustainability, and we shifted our focus to building technical stewardship capacity to sustain key programmatic interventions. PEPFAR 3.0 has focused on achievement of epidemic control and likewise our strategies have evolved to implementation of targeted health-systems strengthening and community-owned innovations for achievement and sustenance of HIV epidemic control. Our approaches have included: using data and evidence to inform decisions, policy and practice; ensuring effectiveness and competence of highly trained multi-disciplinary teams; building robust data and information systems; modeling care delivery; and institutionalization of continuous quality improvement to enhance service delivery. It is imperative that we assess the impact of these interventions in order to optimize future academic institutions' engagement in global health.

Results:
From 2004 to 2018, our programs have implemented models of care for delivering HIV/AIDS and related services for rural, peri-urban and the urban poor in 10 countries. These programs have resulted in: (1) provision of antiretroviral treatment to over 1 million PLWH including 285,000 who are enrolled in current programs; (2) reduced mother-to-child HIV transmission from 7.8% in 2010 to less than 2.5% by September 2016 in Kenya; (3) increased access to prevention of mother-to-child transmission (PMTCT) interventions, (4) trained more than 50,000 healthcare providers in resource-limited settings; (5) increased comprehensive combined prevention services to key and priority populations; (6) implementation of novel electronic health records solutions; (7) led HIV and health policy and guidelines development; and 8) institutionalized data and evidence use as part of continuous quality improvement initiatives in more than 1500 health facilities. Significantly, these programs have improved key patient and population health outcomes including achieving more than 90% virologic suppression among PLHIV receiving antiretroviral treatment in CIHEB programs.

Conclusions:
Currently, CIHEB implements programs in 7 countries as a key partner to local government health authorities. Working through local systems and with national institutions has been critical to our achievements, while the application of academic principles of inquiry to program interventions and adaptation of innovations to new settings has provide a template for success. We present the CIHEB model as an optimal framework for global health involvement that allows for integration of global best practices and local knowledge throughout the implementation process.