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A consortium led by Columbia University's Mailman School of Public Health has received a $125 million, five-year grant from the Centers for Disease Control and Prevention (CDC) to provide comprehensive HIV care and treatment in Kenya, Mozambique, Rwanda, South Africa, and Tanzania – some of the countries hardest hit by AIDS worldwide. This represents the largest award ever granted to Columbia. The new funding is part of President Bush's Emergency Plan for AIDS Relief (PEPFAR). PEPFAR is a five-year global HIV/AIDS program that targets $9 billion in new funding to ramp up prevention, treatment, and care services in 15 of the most affected countries of the world.

The new project, the Multicountry Columbia Antiretroviral Program (MCAP), builds upon the Mailman School's existing MTCT-Plus initiative, which is funded by eight private foundations and USAID. MTCT-Plus provides HIV care and treatment to HIV-infected mothers, their partners and children at multiple sites in eight countries.

MCAP's goal is to broaden the population of patients by enrolling and offering HIV care and services to approximately 190,000 HIV-infected individuals in large geographic areas. The program's directors expect to provide antiretroviral therapy to 13,000 HIV-infected individuals in the first year and 116,000 people over a five-year period. Consistent with the national plans of each individual country, MCAP will use existing infrastructure and be fully integrated into local health-care systems.

"This funding enables us to establish a mosaic of programs that provide HIV care and treatment so that the needs of all HIV-infected individuals in a community can be met," says Dr. Wafaa El-Sadr, professor of clinical epidemiology at the Mailman School, principal investigator of MCAP, director of MTCT-Plus, and chief of infectious diseases at Harlem Hospital.

MCAP will reach a broader population than MTCT-Plus, which is focused on pregnant women who are found to have HIV and on reaching their family and household members. This expanded scope will require adapting the MTCT-Plus framework to identify other groups with HIV infection, to train health care workers to care for those with a wider spectrum of HIV disease stages and shape the program to new needs, Dr. El-Sadr says.

Like MTCT-Plus, MCAP will use multidisciplinary teams to provide a family-centered approach to HIV care and treatment, including antiretroviral management, clinical and psychosocial support, attention to adherence and long-term retention, empowerment of people with HIV/AIDS, central procurement of medicines and supplies, and careful monitoring and evaluation. It will also strive to establish linkages at program sites with local community-based organizations and other resources.

The goals of MCAP are to rapidly expand HIV care and antiretroviral programs, promote early identification of HIV infection, and prevent further spread of HIV. "We seek to build programs not solely focused on providing antiretroviral therapy but also on early identification of HIV, maintaining the health of those with HIV, and preventing the spread of HIV to others in the community," Dr. El-Sadr says.

Besides the Mailman School, the MCAP consortium members are Eastern Cape Department of Health and University of Transkei, South Africa; Ministry of Health and Health Alliance International, Mozambique; Ministry of Health and Muhimbili National Hospital, Tanzania; Moi Teaching and Referral Hospital and Indiana University, Kenya; and Treatment and Research AIDS Center of the Ministry of Health, Rwanda. The vast majority of the funds will be spent in Africa through local partners.

"Our host-country partners in sub-Saharan Africa have been caring for those with HIV since the disease first appeared and are intimately familiar with the programs that will serve them best," says Thomas Hardy, assistant clinical professor of population and family health, co-principal investigator of MCAP, and associate director of the MTCT-Plus initiative. "Drawing on the resources of the Mailman School and the experience and expertise of its staff and of our partners will ensure that appropriate technical support is provided to the programs."

"This CDC funding provides an extraordinary opportunity to save lives," says Dr. Allan Rosenfield, dean of the Mailman School. "It allows us to build on the experience gained from our pioneering MTCT-Plus initiative and to treat as many people as possible, as quickly as possible. We are committed to the global effort to provide HIV care and treatment to the millions who desperately need it."

The Mailman School now has more than $200 million in funding for its HIV/AIDS care and treatment programs in resource-poor countries – mainly in sub-Saharan Africa.

—Matthew Dougherty