ICAP: Empowering Health for 15 Years

EMPOWERING
HEALTH FOR
15 YEARS

“
This is an organization of
tireless warriors who never
give up, endlessly striving for
better ways to solve problems,
more creative means to answer
questions, new approaches to
save lives.
Wafaa El-Sadr, MD, MPH, MPA
Founder and Global Director
ICAP at Columbia University

Empowering
In the mountains of Lesotho, ICAP gives support to nurses
who reach patients in remote areas on horseback.
Health
Since 2003, ICAP at Columbia
University has been dedicated
to improving the health of
families and communities around
the world. Together with its
partners—ministries of health, nongovernmental
and community-based
organizations, academic centers, the
private sector, civil society groups
and communities—ICAP applies
sustainable solutions to the world’s
most pressing health threats.
From its origins as a bold initiative
established to confront a raging
epidemic, ICAP has grown into
a global health leader bringing
innovative, effective, and ethical
research and programs to the most
challenging, resource-limited settings
across the globe.
Through its unparalleled experience
in strengthening health systems, its
deep investment in the power of
collaboration to effect change, and
its unwavering belief that every
person has the right to reach their
fullest potential, ICAP strives for
a world where every human being
has the means to live a healthy and
productive life.

The early years of the HIV
epidemic were marked by
relentless human loss. In the four
years between 1993 and 1997,
the number of people living with
HIV more than doubled, from 14
million to 30 million.
By the year 2000, an estimated 15
million people had lost their lives to
AIDS. Funerals became an everyday
part of life and the ranks of orphans
swelled. The HIV epidemic was
tearing at the fabric of communities
around the world.
HIV from a death sentence into a
manageable chronic disease. People
living with HIV who were fortunate
enough to get their hands on these
medicines were now able to live long
and productive lives.
In short order, death rates from
AIDS began to plummet in the U.S.,
but the suffering continued unabated
in Africa. By the year 2000, deaths in
the U.S. had decreased by 60 percent,
while in Africa an estimated 2.4
million people continued to die each
year from the epidemic.
As the global epidemic grew, the
scientific community responded. In
1987, the first antiretroviral drug for
treating HIV became available. Eight
years later, a remarkable combination
of HIV medicines transformed
As a global crisis
unfolded...
Clinic for prevention of mother
to child transmission of HIV.
Namicopo, Mozambique
HIV positive mother with her
HIV negative baby. Côte d’Ivoire

...A vision of
hope emerged
Inspired by the availability of
these miraculous treatment
options, a group of visionary
doctors in Harlem committed
themselves to bringing these
lifesaving treatments to their
disenfranchised patients.
Dr. Wafaa El-Sadr, then chief of the
Division of Infectious Diseases at
Harlem Hospital in New York City,
pioneered an integrated model of care
to address the medical, psychosocial,
and other needs of her stigmatized
patients and demonstrated the
success of a novel family-focused
approach. Meanwhile, her colleague,
Dr. Elaine Abrams, a pediatrician
who cared for some of the first
HIV-infected infants at Harlem
Hospital, was pioneering approaches
to prevent transmission of the HIV
virus from mother to child.
Based on their success in Harlem,
they became convinced that
treatment could be—and must be—
made a reality for those living in
resource-limited settings. Together,
and joining forces with Dr. Allan
Rosenfield, then dean of Columbia’s
Mailman School of Public Health
and longtime global champion for the
health of women, they challenged the
prevailing thinking. Countering the
many naysayers who believed it to be
impossible and inadvisable to bring
treatment to Africa, they brought
a revolutionary new paradigm to a
crisis that was causing incalculable
suffering.
In 2002 came the historic
announcement that they would lead
the world’s first-ever, multi-country
HIV treatment program.
With the goal of demonstrating
to a disbelieving world that quality
HIV care and treatment could be
provided in resource-limited settings,
the MTCT-Plus Initiative began
enrolling pregnant women living
with HIV at 13 demonstration sites
in eight countries.
The family-focused model that had
proven so successful in Harlem made
services to prevent mother-to-child
transmission of HIV the entry point
to lifelong HIV care and treatment
for women and their families. Within
four years, more than 14,000 women
and their family members were
accessing HIV care and treatment
at these sites, establishing a shining
precedent for the world and ushering
in a new era of response to HIV.

Scaling up
Bozi rural health center.
Côte d’Ivoire
From proof of concept
to global health leader
In 2003, under the leadership of
Dr. El-Sadr, ICAP was founded as
a center in the Columbia Mailman
School of Public Health to build
on the groundbreaking MTCT-Plus
model and work toward a vision of
a world where quality health care
is available to all families
and communities.
Contemporaneously, the launch of
the Global Fund in 2002 and the
U.S. President’s Emergency Plan
for AIDS Relief (PEPFAR) in 2003
signaled a new global commitment to
confronting the HIV epidemic. With
its already significant experience in
addressing the epidemic in numerous
countries around the world, ICAP
was well-positioned to contribute
to the effort to rapidly scale up
access to HIV treatment across sub-
Saharan Africa and quickly assumed
the mantle as one of PEPFAR’s key
implementing partners.
From its earliest days, ICAP engaged
the global HIV epidemic with
vigor and with a commitment to
an innovative model that combined
service, research, training, and
impact measurement to achieve
steadily improving outcomes.
ICAP’s unique model
achieves maximum impact

A worker in the testing lab at
a clinic. Kigali, Rwanda
A health care worker
examines a child. Cameroon
Staff workers test blood samples
at the laboratory at Muranga
District Hospital. Kenya
As the global response to the HIV
epidemic gathered steam, ICAP
launched major multi-year initiatives
to support government partners in a
dozen of countries as they wrestled
with the complex challenges of
scaling up specialized, ongoing care
and treatment services across health
facilities ranging from large hospitals
to remote health centers.
During this period, ICAP worked
with in-country partners in sub-
Saharan Africa to bring familyfocused
HIV care and treatment to
settings as diverse as the Tanzanian
coast and Lesotho highlands. For
the first time, pregnant women were
able to access HIV testing, care, and
treatment services for themselves
and their families under a single roof.
For the first time, children could be
born HIV-free. For the first time,
men and women with HIV could
regain their health and provide for
their families.
ICAP worked diligently to make
its ambitious vision a reality. It
engaged partners to renovate
facilities and laboratories, train
health workers, strengthen
monitoring and evaluation, put in
place supply management systems
for consistent supply of medicines,
launch peer education programs, and
better integrate community-based
organizations into the HIV response.
And ICAP provided technical
assistance to ministries of health
to develop national HIV clinical
guidelines, launch national training
programs, establish model centers for
clinical training and programmatic
innovation, conduct evaluations
to improve service quality—all in
support of building an effective HIV
response suited to the populations in
need.
By 2006, ICAP’s large-scale,
collaborative efforts had achieved
what had seemed impossible only
a few years before: 100,000 people
living with HIV had initiated
lifesaving treatment through ICAPsupported
programs.
By 2010, that number had jumped to
more than half a million.
And today it stands at nearly 1.5
million.

33,000,000
People tested for HIV
at ICAP-supported
facilities
2018

6,000
ICAP-supported
health facilities
2018
4,600,000
HIV patients screened for
TB at ICAP-supported
health facilities
1,500,000
People treated at
ICAP-supported
facilities
2018
2018
ICAP has provided HIV testing to over
8,000,000 pregnant women and initiated
640,000 on antiretroviral therapy (ART).
ICAP has supported more than 2,150
laboratories around the world, enabling
quality testing and rapid return of results.
All figures current as of September 2018

World-class, relevant
research adds up
to lives saved
It all begins with a question.
Research is a pillar of ICAP’s
dynamic approach to improving
the health of vulnerable
populations.
From the halls of its headquarters at
Columbia University to communitybased
research centers in Harlem and
the Bronx and out to the furthest
regions of the world, ICAP teams
passionately pursue an ethos of
inquiry.
To date, ICAP has conducted
more than 90 research studies in
25 countries. From drug trials to
implementation science to data
analyses, ICAP’s teams are always
asking questions and seeking
solutions. As they tackle one pressing
health challenge after another, the
questions they ask derive directly
from first-hand experience in the
field, caring for individuals, families
and communities impacted by HIV
and other health threats. The answers
they reach guide their own work and
inform the work of others.
In five countries severely affected
by the HIV epidemic—Ethiopia,
Kenya, Mozambique, Rwanda and
Tanzania—ICAP’s Optimal Models
Study enabled the analysis of
program data from health facilities
to measure patient outcomes and
identify what it takes to achieve
those.
In a pioneering study conducted in
Eswatini (formerly Swaziland), ICAP
researchers looked at key challenges
to integrating screening for risk of
heart disease into HIV clinic visits.
In Kyrgystan, where injection drug
use accounts for nearly 60 percent
of HIV infections, ICAP conducted
one of the first assessments of the
barriers and facilitators that affect
individuals’ participation in harm
reduction programs.
In Mozambique, a study explores
using a combination of interventions—
including peer support and new
digital communications technologies
—to connect adolescents with HIV
to care and keep them on treatment.
Through many more studies like
these, ICAP is asking powerful
questions that will point the way to a
healthier world.
“
Everyone at ICAP is consistently asking:
“Why?” “Who?” “What?” “Where?” “When?”
No matter what an individual’s role or focus,
all seek to understand how things work, why
they don’t work, and how to make them work
better.
A laboratorian examines a
specimen at Adama Hospital.
Ethiopia
Elaine Abrams, MD
Senior Research Director
ICAP at Columbia University

Seeking
answers
Support group for youth living
with HIV. Zambézia, Mozambique
A health care worker performs a blood
test in the Nicoadala district mobile
clinic. Mozambique
A technician tests samples at the
Bishkek City AIDS Center. Kyrgyzstan

Investing
in people
ICAP is building capacity
on the front lines of health
Nurses provide 90% of health care
in countries where ICAP works,
often serving as a person’s only
point of contact with the health
care system. Yet, until recently,
nurses have not been at the center
of investment in health globally.
ICAP is working to change this
and to demonstrate the profound
return on investment from focusing
on nurses and midwives—enabling
them to do what they know how to
do best and elevating the profession
by securing a seat at the table for
nurse leaders to influence policy.
ICAP has supported nearly 5,000
nursing school faculty, mentors, and
administrators to revamp nursing
school curricula in line with modern
practice and updated technology.
As a result, more than 13,000 new
nurses and midwives have graduated
into the workforce across sub-
Saharan Africa, more equipped and
knowledgeable than ever before.
But learning doesn’t stop at
graduation. Professional networks
and ongoing growth opportunities
are critical to support and retain
nurses where they are most needed.
To this end, ICAP has enabled
more than 5,500 working nurses and
midwives to improve their skills via
professional development courses
offered through innovative on-thejob
training programs as well as
online learning.
“
Our work has ensured that skilled nurses
are there where they are most needed, and
that the nursing profession’s unique patientcentered
approach is front and center in
shaping health services.
Susan Michaels-Strasser, PhD, MPH, RN, FAAN
Senior Implementation Director and
Associate Director for Nursing Programs
ICAP at Columbia University
Students studying e-learning modules at
the Roma School of Nursing. Lesotho

Students in auditorium, Lusaka School of Nursing. Zambia
Students practice inserting intravenous line on simulation
mannequin at Mzuzu University Nursing Facility. Malawi
“
ICAP’s collaboration with the Ministry of
Enabling front-line program managers,
policy makers and health workers
Health in building the capacity of health
to ask questions from their day-today
experiences and seek answers
professionals to implement and utilize
research will drive progress toward
through research is fundamental.
evidence-based clinical and public
ICAP’s Health Research Training
health programs in the country.
Program in Eswatini is investing
in the future of public health by
training professionals from diverse
Harriet Nuwagaba-Biribonwoha, MD, PhD
backgrounds in research methods
Research Director
ICAP in Eswatini
and enabling them to use data at
their fingertips to answer critically
important questions. The insights
from their research can drive policy,
programs, and resource allocation
within the country.

ICAP tackles tuberculosis, malaria,
non-communicable diseases, and
emerging threats
Tuberculosis is the number one
infectious disease killer globally
and the number one killer of
people living with HIV.
Malaria continues to threaten the
lives of people around the world,
particularly pregnant women and
young children. At the same time,
non-communicable diseases—like
heart disease, diabetes, cancer, and
mental illness—are the number
one cause of death globally and a
looming threat for low- and middleincome
countries.
ICAP’s work spans all these
conditions, investing in health
systems strengthening to position
countries to respond to a broad
array of issues. ICAP leaders have
highlighted how lessons learned
from the HIV response can go a
long way in addressing other chronic
conditions.
Across the countries where it works,
ICAP has screened nearly 4.6
million people living with HIV for
tuberculosis, in order to enable rapid
diagnosis and prompt initiation of
HIV treatment, thus preventing
unnecessary deaths.
In Ethiopia, ICAP works to improve
the quality of malaria diagnosis
and management throughout the
country.
In Lesotho, ICAP supports health
facilities that serve migrant miners
and their families to provide
integrated services for both HIV
and tuberculosis.
In Eswatini, ICAP supports cervical
cancer screening for women living
with HIV, enabling them to access
prevention and early treatment
services for this leading cancer killer
of women in Africa.
Over the past 15 years, ICAP
has supported more than 2,150
laboratories to provide essential
testing services. These laboratories
are able to accurately diagnose
multiple conditions, thus facilitating
access to necessary care.
In 2015, ICAP responded to the
unprecedented Ebola epidemic in
West Africa by sending a response
team to Sierra Leone. The team
conducted a three-week, rapid
assessment of Ebola community
care centers, a new model of care
that aimed to break the cycle of
household transmission of the
Ebola virus.
Ebola facility.
Sierra Leone
“
The care center is better because it’s in the
community. Many people died from Ebola before
the community care centers were established.
Now people are using these as a safe haven
where they can get the care they need.
Ebola Survivor
Sierra Leone
Malaria testing. Ethiopia
“
ICAP has a rare “big picture” view of the health
threats facing the communities that it serves.
As our knowledge and practice expand, we are
ever more able to work with our partners to
address these challenges.
Andrea Howard, MD, MS
Director, Clinical and Training Unit
ICAP at Columbia University

Going
beyond
HIV
A boy with malaria gets treatment at the
Fresco General Hospital. Côte d’Ivoire
Patient being treated for HIV, syphilis, malaria,
general fatigue, and coughing. Côte d’Ivoire

A nurse counsels a woman living with
HIV in Dushanbe, Tajikistan.

“
ICAP began as bold experiment
that changed the course of the HIV
epidemic response. From there it
has grown into an expansive and
powerful force for public health. In
15 years of transformative work,
ICAP has brought health and hope
to millions across the globe.
Lee Goldman, MD, MPH
Executive Vice President and Dean of the Faculties of
Health Sciences & Medicine, and Chief Executive
Columbia University Irving Medical Center

ICAP’s Portfolio
Expanding Depth
and Breadth
Since 2003, ICAP has steadily enhanced
its capabilities and added to its expertise
as it has forged its place among leading
providers of global health solutions
Human resources
for health
Key populations
Migrant health
Guidelines and tools
Distance learning
Strategic information
systems
Infection prevention
and control
Emerging infections
Non-communicable
diseases
Health management
and economics
Impact assessment
Quality improvement
Differentiated service delivery
Treatment optimization
Program optimization
Lab systems
HIV prevention
Tuberculosis
Malaria
PMTCT
Scale-up of HIV
treatment
Health systems
strengthening

ICAP’s Presence
Growing over
the years
ICAP Headquarters
(New York City)
ICAP is active worldwide, with more
than 1,800 staff in over 30 countries
2003
2004
2005
2010
2011
2012
2014
2015
2016
2017
Cameroon
Côte d’Ivoire
Rwanda
South Africa
Thailand
Uganda
Zambia
Kenya
Mozambique
Tanzania
Eswatini
Ethiopia
Lesotho
Nigeria
D.R. Congo
Kazakhstan
Kyrgyzstan
Tajikistan
Malawi
Mali
Uzbekistan
South Sudan
Burma
(Myanmar)
China
Sierra Leone
Angola
Jordan
Lebanon
Zimbabwe
Brazil
Guatemala
Ukraine
Georgia
Haiti
Namibia

Charting
progress
Gathering the data that
drive policy and programs
The scale-up of access to
treatment for people living with
HIV is a historic global health
achievement.
In order to make further progress,
countries and funders need to
understand how well they are faring
in responding to their national
epidemics and how best to focus
future resources and efforts.
Thanks to the Population-based HIV
Impact Assessment (PHIA) Project,
implemented by ICAP with funding
from the President’s Emergency
Plan for AIDS Relief (PEPFAR) and
in partnership with the U.S. Centers
for Disease Control and Prevention
(CDC) and ministries of health,
14 countries confronting the HIV
crisis will have access to a breadth
of population-level HIV data that
provide the most accurate measures
of the HIV epidemic to date.
The PHIA surveys involve
hundreds of trained staff who
conduct high-quality, householdbased
HIV counseling and testing
for all members of the household,
return the results, and refer HIVpositive
survey participants for care.
They also obtain blood samples
to determine HIV infection, how
well HIV is controlled, and also to
evaluate for other priority diseases
based on country priorities. To
date, more than 300,000 people
have participated in these nationally
representative surveys.
The surveys have been enormously
successful and are providing an
unprecedented understanding of
where countries stand in terms of
the HIV epidemic—yielding critical
information on HIV prevalence,
incidence, who is on treatment, and
how they are doing on treatment.
This information spotlights national
HIV program successes and points
to the gaps that remain.
Impressive declines in the rate of
new HIV infections have been
shown in countries such as Namibia
and Eswatini. At the same time,
the results provide a roadmap for
the future—recharging efforts to
confront the epidemic and guiding
adjustment of strategies.
Côte d’Ivoire Population-based HIV Impact Assessment
(CIPHIA) survey staff prepare for a day in the field. Staff
form clusters and use electronic tablets and printed materials
to identify survey households, check supplies, and coordinate
logistics.
“
Together with its remarkable partners, ICAP
brings ingenuity, expertise, and dedication
to these ambitious surveys. The findings will
continue to offer valuable insights for years
to come.
Jessica Justman, MD
PHIA Project Principal Investigator
and Senior Technical Director
ICAP at Columbia University

A KenPHIA survey team
on its way to conduct
interviews in rural Kenya.

Delivering
and using
data
A nurse scans patient records at the
East-Kazakhstan Oblast AIDS Center.
Ust-Kamenogorsk, Kazakhstan

Link4Health health care worker coming from Mankayane
Government Hospital to visit rural patients. Once the patients
are located, their addresses are entered into GPS systems so that
they can be easily located. Eswatini
Rural outreach teams test people for HIV in their homes and
counsel them on how to live healthy lives. Patients are registered
on computers and data about them is collected by the teams.
Tanzania
Patient information is recorded.
Democratic Republic of the Congo
Reliable information
makes the difference
Delivering quality services is the
ultimate goal guiding ICAP’s work.
Whether a health worker is making
a decision about a patient’s care, a
district health manager is deciding
which clinics need extra support, or
a policymaker is struggling to define
programmatic direction, having
readily accessible and accurate data
on which to base decisions is a must.
ICAP’s skilled staff around the world
are at the forefront of building the
systems needed to track progress and
measure outcomes.
ICAP provides the technical expertise
to build strong data systems, as well
as the on-the-ground training and
mentorship of the managers and
health workers who need to use the
systems confidently.
In Lesotho, ICAP spearheaded the
transition from an outdated and
cumbersome paper-based system to
one that is electronic, and used by
health managers across the country
to monitor all health programs.
In Kazakhstan, Kyrgyzstan, and
Tajikistan, ICAP helped reshape
national surveillance systems to enable
pinpointing which populations are at
increased risk for HIV and where
new infections are occurring.
In Tanzania, ICAP is developing data
systems that can reliably track HIV
services being delivered right in the
communities where people live.
“
ICAP believes in the value of data and, most
importantly, in using data to inform action.
Our goal is to put in place state-of-the-art
data systems and make this information
available to those who need to use it day-in
and day-out.
Tiffany G. Harris, PhD, MS
Director of Strategic Information
ICAP at Columbia University
In Cameroon, ICAP supported
the Ministry of Health to overhaul
its system for tracking data on the
prevention of mother-to-child
transmission of HIV and to assure
the quality of these data.

Making health
systems work
better
When quality improves,
lives are saved
Ensuring increased coverage
and enhanced quality of health
services for all people who need
them is essential.
Services need to be available and
accessible—but if they are not also
of high quality, impact will be limited
and resources wasted.
That is why ICAP is dedicated to
quality improvement, a systematic
approach that uses the scientific
method to analyze and improve
health system performance.
ICAP’s evidence-based, flexible
quality improvement approach has
helped improve turnaround time of
tests that determine whether a baby
has HIV infection in Cameroon,
increased coverage of HIV testing of
children in Tanzania, and improved
infection prevention and control in
Sierra Leone following the Ebola
epidemic.
Another strategy to enhance both
patient satisfaction and streamline
health services is the use of
differentiated service delivery, an
approach that adapts the services
to patient needs. Based on the
health status of the patient, clinic
visit frequency is adjusted and
services are relocated to be closer to
where patients reside. Moving the
services to the community also helps
unburden crowded health facilities
and overwhelmed health workers.
A leader of a monthly community ART refill
group (CARG) distributes life saving medication
to members. Outskirts of Harare, Zimbabwe

A physician training session at Muranga
District Hospital. Muranga, Kenya
ICAP works with ministries of
health from 11 African countries to
support the scale-up of these tailored
models of care. Through a learning
network that includes representatives
from various groups from these
countries, lessons can be shared on
how to implement and scale up these
tailored models of care.
living with HIV, assisted Zambia
in developing its scale-up plan for
differentiated service delivery, and
revealed complexities related to
connecting men to HIV services in
Zimbabwe.
A health care worker cares
for a patient. Cameroon
This network has helped the
Eswatini ministry of health revamp
its teen-club model for adolescents
“
We’re at a seminal moment in the global HIV
response. As more and more people access
services, ensuring quality is more important
than ever for achieving impact.
New technology
helps track patient data.
Quelimane, Mozambique
Miriam Rabkin, MD, MPH
Director, Health Systems Strategies
ICAP at Columbia University

Generating
new leaders
Empowering the next
generation of global
health champions
Global public health is constantly
presenting new challenges. But
the next wave of public health
champions are being well trained
to tackle them.
Through its Next Generation
program, ICAP provides a training
ground for the rising stars of global
public health.
Students from diverse backgrounds
and disciplines are welcomed at ICAP,
where they work on projects ranging
from research in HIV prevention at
ICAP’s centers in Harlem and the
Bronx to quality improvement of
laboratory systems in Eswatini.

“
This program was life-changing for
me, it pushed me to think beyond
what I thought were my limits.
Javier Cattle
ICAP Training Fellow
Contributing to the bigger picture
of global public health is a unique
educational experience for trainees—
nearly 200 to date—giving them a
foundation and direction for future
career growth.
“ICAP researchers are unique. They
work on real-world problems and
the application of public health
theory, and that matches well with
my experiences and where I want
to take my career next,” said Jorge
Soler, PhD, MPH, an ICAP Trainee.
“This training is one-of-a-kind,”
said Chioma Onuoha, who worked
on ICAP’s survey of men who have
sex with men in Zimbabwe. “The
ICAP team prepares you to make a
meaningful contribution to the work
in the field, so when you leave you
see that what you did is part of a
bigger picture. I really appreciated
that.”

ICAP’s commitment to
prevention is paying off
A community mobilizer encourages men
to get a voluntary medical circumcision,
which can help prevent HIV transmission.
Mocuba, Mozambique
HIV-positive or negative?
The moment a person tests
for HIV is a pivotal one.
For those who test HIV-positive—
whether they reside in sprawling
Nairobi or rural Mozambique—
ICAP supports stronger health care
systems to ensure that all have access
to quality, lifelong HIV care and
treatment. For those who test HIVnegative,
ICAP works diligently to
ensure that health care providers
can equip them with the most upto-date
information and prevention
methods to help them stay negative.
ICAP works at the cutting edge
of HIV prevention, conducting
research, small-scale pilots, and
evaluations, and supporting the
scale-up of prevention tools that
have been shown to work.
ICAP has been a leader in seeking
an end to HIV infection among
children around the world. Whether
establishing the first peer support
groups for pregnant women
living with HIV in Côte d’Ivoire,
conducting pioneering research
to evaluate a new combination
prevention approach in Eswatini,
or revamping Cameroon’s national
evaluation system for preventing
mother-to-child transmission of
HIV, ICAP’s teams are doing the
hard work needed to achieve an
HIV-free generation.
With definitive studies demonstrating
that medical circumcision helps
prevent HIV among men, ICAP
works to expand access to safe male
circumcision in Africa. In Tanzania,
Kenya, and Mozambique, ICAP
launched campaigns, trained health
workers, and equipped mobile
teams to offer the service, resulting
in more than 450,000 men and boys
benefiting from this prevention
method.
Most recently, ICAP has turned
its attention to pre-exposure
prophylaxis (PrEP)—the use of
HIV drugs to prevent individuals
from acquiring HIV. ICAP is
conducting research to understand
how to best use PrEP among young
sex workers in Kenya and wives of
migrant miners in Mozambique.
ICAP is also evaluating new and
exciting, long-acting drugs for PrEP
among men who have sex with men
in Harlem and the Bronx, as well as
among women at risk for HIV in
Eswatini.
An HIV support group counselor
conducts a condom demonstration.
Bouafle, Côte d’Ivoire
“
Whether pursuing a new prevention
approach or designing a novel way to
reach a forgotten group at risk for HIV,
ICAP brings a tradition of innovation and
ingenuity combined with sensitivity to the
contexts and settings where it works.
Community sensitization and drama groups help get
the word out about male circumcision. Tanzania
Mark Fussell, MPA
Deputy Director and Chief Operating Officer
ICAP at Columbia University

Stemming
the tide
Clinicians perfrom medical male circumcision in mobile
tent clinics near the Kagera Sugar Company. Tanzania
Patient counseling at ICAP’s Harlem
Prevention Center. New York City

Needle exchange program. Kyrgyzstan
A recovering user of opioids, who is now a peer counselor for
people who inject drugs and people living with HIV, takes a
dose of methadone. Dushanbe, Tajikistan

Finding the
Counseling session at ICAP’s
Harlem Prevention Center.
New York City
A speaker talks to the crowd about HIV testing and prevention
as part of a project known locally as “FIKIA,” which means “to
reach” in Swahili. Geita, Tanzania.
keys to the
puzzle
Bringing the needs of key
and vulnerable populations
to the forefront
“
HIV isn’t spoken about in the community. It’s
something that people would rather ignore
than face. I am known in this community
and it means a lot that I can contribute to an
environment where it’s okay to talk openly
about HIV.
Robert Gamboa
Peer Health Educator
ICAP’s Harlem Prevention Center
While the unprecedented global
effort to confront the HIV
epidemic has begun turning
the tide, it is clear that certain
population groups have been
left behind. Vulnerable and often
disenfranchised populations
are not fully benefitting from
advances in HIV prevention and
treatment.
Around the world, ICAP’s teams
work tirelessly to design, implement,
and evaluate approaches to meet
the complex needs of vulnerable
populations.
At its two research centers in New
York City—Harlem Prevention
Center and Bronx Prevention
Center—ICAP has spent the last
decade examining how to improve
services for those most deeply
impacted by HIV in the U.S. ICAP
conducts research on how to better
prevent HIV among men and
women of color and is evaluating
cutting-edge new prevention drugs.
In South Africa, ICAP trained a large
cohort of courageous peer outreach
workers to bring HIV testing and
prevention services to other men
who have sex with men in their
communities.
In Central Asia, where most new
HIV infections occur among
persons who inject drugs, ICAP has
worked with ministries of health and
partners in Kazakhstan, Kyrgyzstan,
and Tajikistan to support a holistic
approach to treat people who are
affected by the opioid crisis and to
expand access to integrated HIV and
TB services.
In Tanzania, ICAP is leading
ambitious efforts to provide vulnerable
groups—such as adolescent girls
and young women, men who have
sex with men, female sex workers,
and people who inject drugs—with
tailored HIV testing, prevention, and
treatment services right in their own
communities.

Envisioning
a healthier
tomorrow
Poised to meet the global health
challenges of the future
For 15 years, ICAP has addressed
some of the world’s most urgent
health challenges through a
commitment to advancing
research, training, health service
delivery, and impact measurement,
using a collaborative approach
that brings together diverse
partners.
Over this time, ICAP has grown
from a bold initiative into an
expansive and trusted global health
leader with a portfolio of projects
that have improved millions of lives
in dozens of countries.
Through the trajectory of this
growth, ICAP has gained invaluable
experience, forged deep connections
around the world, and positioned
itself to confront current and
future health challenges with
knowledge, expertise, experience,
and determination.
Today, the world is changing ever
more rapidly, provoking dramatic
new challenges to the health of
individuals, communities, and
nations. Economic development and
changing lifestyles are fueling the
risk of chronic non-communicable
diseases. The breakneck growth
in urbanization is creating new
health challenges stemming from
environmental pressures and
disconnection from cultural norms
as people leave traditional rural
homesteads for large cities. Concerns
have been raised for young people
who may be engaging in riskier
behaviors as a result of new digital
communications tools. Ease of travel
and encroachment of populations
on natural animal habitats make
the threat of emerging infections a
looming reality. Even as we cope with
these new and unknown health perils,
the world must continue to battle the
big killers: HIV, tuberculosis, and
malaria.
Against this volatile and uncertain
backdrop, ICAP is at the ready to
engage with the challenges that will
define the global health landscape
in the coming years. As it has done
for 15 years, ICAP is poised to face
the toughest challenges unflinchingly
and remains firmly committed to the
belief that a healthier world is within
reach.
Babies receiving care at
Bishoftu Hospital. Ethiopia

“
Through visionary commitment to a
healthier world, ICAP has empowered
communities to overcome whatever
stands between them and a brighter
future. Today, 15 years into its
remarkable journey, no organization
is better positioned to meet the
global health challenges of tomorrow
than ICAP.
Linda P. Fried, MD, MPH
Dean, Columbia Mailman School of Public Health
ICAP’s work during its
first 15 years has been
made possible by the
following funders
The President’s Emergency
Plan for AIDS Relief (PEPFAR)
The President’s Malaria
Initiative (PMI)
Centers for Disease Control
and Prevention (CDC)
Health Resources and Services
Administration (HRSA)
National Institutes
of Health (NIH)
United States Agency for
International Development
(USAID)
UK Department for International
Development (DFID)
The Global Fund to Fight AIDS,
TB and Malaria (GFATM)
World Health Organization
UNICEF
The World Bank
Bill & Melinda Gates Foundation
Open Society Foundations
Children’s Investment Fund
Foundation (CIFF)
The William and Flora
Hewlett Foundation
The Robert Wood
Johnson Foundation
The Henry J. Kaiser
Family Foundation
The John D. and Catherine T.
MacArthur Foundation
The David and Lucile
Packard Foundation
The Rockefeller Foundation
The Starr Foundation
Medtronic Foundation
Gilead Sciences
Janssen Pharmaceuticals
Merck
Columbia University

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