IMPACT: A Project that Made a Difference

JULY 2007 — The 10-year IMPACT (Implementing AIDS Prevention and Care) Project, funded by USAID and managed by FHI, made history and changed the world. This was a clear message of the all-day conference that marked the IMPACT closeout in Washington on June 28 at George Washington University.

Conference participants were told that IMPACT's primary focus was HIV prevention when it began in 1997; in four countries, innovative pilot projects tried to stem the global tide of HIV infection with a budget of a few million dollars. It was only four short years ago that IMPACT pioneered treatment as well as prevention, care and support, delivering safe and effective antiretroviral therapy in resource-poor settings—an achievement some considered unfeasible. Now, as the project closes out, IMPACT has worked in 75 countries, with more than 1,500 partner organizations and $441 million in support from USAID.

Over those years, IMPACT has been a programmatic bridge, noted Peter Lamptey, MD, DrPH, president of FHI's Public Health Programs. Its span encompasses demonstration prevention projects and continuum-of-care approaches that tackle nearly every aspect of the epidemic, including antiretroviral treatment, the care of orphans and other vulnerable children, and home-based and palliative care, as well as the strengthening of local organizations. From the beginning, IMPACT has partnered with a wide range of organizations ― including faith- and community-based organizations ― to develop locally owned and integrated programs and improve existing infrastructures. In the process, it constructed extensive, evidence-based platforms on which solid structures can stand.

One such organization that IMPACT helped bring into being was ANERELA+, a network of African religious leaders living with AIDS that is now on the threshold of becoming a global network. At the conference, the Reverend J.P. Heath, its general secretary and one of its founders, offered testimony on the importance of FHI's funding support and technical assistance; he declared the organization might otherwise have foundered.

Speakers offered other, abundant evidence that IMPACT provides a bridge to the future. For example, David Bukusi, MD, explained what IMPACT did to help establish the Kenyatta National Hospital's Comprehensive Care Center in Nairobi, developing it into an influential center of excellence. Beugré Kouassi, MD, PhD, outlined success in Côte d'Ivoire in home-based and palliative care training, and discussed ways IMPACT furthered comprehensive policy and plans in these areas for that country's estimated 1 million HIV-positive people. And Levina Kikoyo described the database developed in Tanzania under IMPACT's leadership that will help service providers and policymakers provide more effective and coordinated care for the country's 2.5 million orphans and other vulnerable children. This database is grounded in participatory processes in village and communities.

Reliable data have informed IMPACT's work every step of the way. FHI/Egypt Country Director Cherif Soliman, MS, BM, was among the speakers who talked about the development of IMPACT's pioneering behavioral surveillance surveys and monitoring and evaluation system. In Egypt, these data fed into the country's national surveillance plan, and the work undertaken has become a model for rest of the Middle East and North Africa.

Linkages with local partners have ensured that interventions are suited to local conditions and address social, economic and political factors that may increase risk and vulnerability, especially for people who are already vulnerable. Among many examples were those cited by Chawalit Natpratan, MD, MSc, who told of interventions in Cambodia that have been developed by sex workers, including a community-based clinic that offers care, counseling and supplementary skills-building activities for HIV-positive sex workers.

Over the years, as local capacity has increased, IMPACT's role has devolved to oversight, guidance and quality assurance; partner agencies remain responsible and accountable for activities in their communities. In this way, IMPACT's legacy and presence will be felt for years to come—when infection-free infants are born to HIV-positive mothers, when adolescents make life-saving choices, when HIV infection does not evoke a cascade of stigma and discrimination, and as antiretroviral treatments bring life and hope to thousands around the world, improving the lives of millions of people.

PHOTOS (all by Matt Dunham): (Top) At the IMPACT closeout session on HIV counseling and testing June 28, David Bukusi of the Kenyatti National Hospital in Nairobi (left) and Gloria Sangiwa, senior technical advisor in FHI's Care and Treatment Division (right), paid close attention to remarks by Jane Harriet Namwebya, FHI/Kenya senior technical officer.

(Center Left) Levina Apolinary Kikoyo, FHI/Tanzania senior technical officer, spoke at the IMPACT closeout conference session on strengthening local capacity to respond to children made vulnerable by HIV and AIDS.

(Center Right) Chawalit Natpratan, former FHI country director in Cambodia and now deputy director of technical support for FHI/Indonesia, presented at two conference sessions: on prevention programs for high-risk groups in Bangladesh, Cambodia and Nepal; and on starting and scaling up continuum of care in Cambodia.

(Bottom) Peter Lamptey, president of FHI's Public Health Programs, shares a laugh during a conference break with Ward Cates Jr, president of FHI's Research.

For more information, view the IMPACT Project final report.

― Hilary Russell