With FY07 funds, USG technical staff will continue to work closely with program management staff and HQ technical staff to provide technical assistance for the design, implementation, and evaluation of PEPFAR-funded interventions aimed at preventing mother-to-child HIV transmission. These activities are conducted in consultation with relevant ministries (Family and Social Affairs, Health, Fight Against AIDS), non-governmental organizations, multinationals, and bilateral organizations.

Ongoing specific activities will include: 1. Supporting the implementation and coordination of PMTCT activities among donors and partners (e.g. UNICEF, UNAIDS, UNDP, and PEPFAR-funded partners including EGPAF, ACONDA-VS, and technical ministries) 2. Providing laboratory support at Projet RETRO-CI for quality point-of-service HIV testing with quality assurance at PMTCT sites, purchasing of laboratory commodities and supplies, training of peripheral-site staff, supervision, quality-assurance services, and targeted evaluations to assess simplified methods for infant HIV diagnosis 3. Participating in the PMTCT working group and assisting the MOH to develop innovative approaches for rapid scale-up, including: • A district approach with strengthening of PMTCT monitoring and evaluation at the district and site levels, in collaboration with RETRO-CI/SI, Measure, DIPE, and other key partners • Early infant HIV diagnosis by PCR, in collaboration with RETRO-CI/Lab and CDC HQ • Routine HIV counseling and testing in ANC services • Rapid testing in labor-and-delivery services • Linkages with care and treatment 4. Providing technical assistance to the MOH and national experts to complete the validation, dissemination, and regular updating of PMTCT policies and guidelines, with anticipated revisions related to couples counseling, HIV testing algorithms, infant feeding, and reaching women during and after labor 5. Establishing a formal monthly discussion involving EGPAF, the CDC/USAID country team , JHPIEGO, and other key partners to follow PMTCT activities, focusing on major points such as commodities management at the central and the district levels, longitudinal postnatal follow-up of mother/infant and linkages with pediatric care, and coordination with other partners (UNICEF, PATH, HIV/AIDS Alliance, UNFPA, WFP, ANADER, Care International, and PLWHA) 6. Assisting EGPAF to develop new partnerships with the public and private sectors, FBOs, and CBOs to expand PMTCT activities nationwide 7. Finalizing CDC's outsourcing of PMTCT technical assistance activities, in accordance with recommendations from CDC headquarters staff and core and country teams

This activity is linked to Activity#10346.

If plus-up funds are approved, RETRO-CI will provide technical assistance to support the integration and scale-up of routine HIV counseling and testing services at TB facilities, joint care of HIV and TB at joint-care facilities, improved monitoring and evaluation of integrated HIV-TB services, and a review of study and drug needs in relation to multi-drug-resistant TB. In addition, TA will support the finalization of a curriculum on HIV counseling and testing of TB patients and the systematic roll-out of a diagnostic counseling and testing training package. RETRO-CI will support the PNLT in its Green Light Committee (GLC) application for approval for access to second-line drugs.

Table 3.3.07:

With FY07 funds, USG technical staff will continue to work closely with the interagency country management team and HQ technical staff to provide technical assistance and coordination for EP-supported activities aimed at improving the lives of orphans and other vulnerable children (OVC) and families affected by HIV/AIDS. USG technical staff assists the host government and nongovernmental organizations with ongoing implementation and coordination of OVC-related activities. These efforts are conducted in consultation with the Ministry for the Fight Against AIDS, other technical ministries (Education, Health, Family and Social Affairs, Human Rights), multinationals, bilateral organizations (UNICEF and other UN agencies), and EP-funded partners such as FHI, HIV/AIDS Alliance, CARE International, ANADER, and JHPIEGO.

USG technical staff contributes to the development and implementation of policies and programs pertaining to OVC populations and ensures the ongoing development of programs to improve delivery systems of the public health sector of Cote d'Ivoire. USG staff provides technical support to partners to expand quality services for OVC and their families and provides technical assistance in program design, supervision, and monitoring and evaluation of EP-supported OVC activities.

In FY07, USG staff will complete and disseminate a national guidance document on OVC nutritional needs to help streamline and link partners' OVC activities.

Projet RETRO-CI, the CDC-MOH collaborative USG-funded project, will continue to support the MOH National Reference Public Health Laboratory, Public Health Pharmacy (PSP), and national HIV and TB programs to provide HIV reference laboratory functions and laboratory services in support of the national HIV program. Its support will focus on EP-funded HIV services as well as HIV-prevalence and resistance surveillance and other studies, including evaluation of adapted laboratory tests and techniques. A major and expanding activity is progressive transfer of competence to create a decentralized national laboratory network providing quality HIV services centered on the National Reference Laboratory. This activity will complement technical assistance from the EP-funded U.S. Association of Public Health Laboratories and HQ staff.

This support continues the multi-year process of building national capacity at central, decentralized, regional, district, and site levels to ensure good laboratory practices, provide quality diagnostic and follow-up HIV laboratory services, and support national surveillance, studies, and evaluations. Projet RETRO-CI has played a critical role in provision of laboratory services in support of the national PMTCT, CT, and HIV treatment programs since 1998. Thus the expanding capacity-building role has had to occur at the same time as expanding service delivery to accompany the rapid expansion and decentralization of HIV services.

With FY06 funds, Projet RETRO-CI has actively supported onsite quality laboratory services in EP-funded CT and PMTCT sites and more comprehensive services for clinical monitoring at district and regional hospital laboratories. Projet RETRO-CI staff have played a key role in the support of existing sites and the establishment of new sites through trainings, laboratory needs assessment, assistance in initial testing, external quality assessment by periodic onsite supervision and quality control. In order to ensure adequate material and reagent supplies at all CT and PMTCT sites, RETRO-CI has provided technical assistance to implementing partners and to PSP and SCMS for forecasting, procurement management, and management at sites.

RETRO-CI has supported the laboratory specimen collection, testing, and analysis from the 2005-2006 annual sentinel surveillance study (5,000 blood specimens) as well as the first-ever national AIDS Indicator Survey of 5,060 households (8,600 dried blood spot specimens). Together with APHL, the clinical laboratory has hosted and coordinated the national evaluation of compact flow cytometers and Pan-Leucogating strategy for the enumeration of CD4+ T lymphocyte cells. In order to simplify the national HIV testing algorithm to expand and decentralize CT and PMTCT services, a retrospective evaluation of the performance of simplified rapid HIV tests will be completed.

Building on previous work and consistent with the recommendations of the first EP Core Team consultation visit in Cote d'Ivoire (Feb 2006), substantial work is being done at the central level in collaboration with APHL to promote inter-laboratory partnership and networking within a national laboratory reference system, including organization and regulation of laboratory activities; definition of guidelines, norms, and standards in compliance with international standards (ISO); and integration of the 12 principal quality-system essentials in the overall laboratory management and evaluation.

With FY07 funds, in collaboration with CDC/HHS HQ staff and APHL, the RETRO-CI laboratory will: - Conduct an internal audit to revise and update its laboratory procedures in conformity with international quality standards (ISO) and advance in the laboratory-accreditation process, reinforcing areas needing improvement.

In collaboration with APHL and CDC/HHS HQ staff as well as MOH (LNSP, PNPEC, PNLT) and the laboratory network and EP partners, RETRO-CI will : - Provide technical assistance to update policies and strategies to assist the national program, regional and district officers, and CT and PMTCT site and laboratory managers to implement quality control and supervision, including standardized supervision guides and laboratory assessment checklists. - Collaborate closely with the MOH and EP -unded partners to assure good laboratory practices, quality assurance, and biosafety requirements at more than 100 PMTCT sites, 100 CT sites, and 33 laboratories linked to ARV treatment centers. This activity will be reorganized to support the expansion of sites with the creation of a pool of trained

decentralized supervisors at the regional and district levels. - Participate as part of the national pool of expert trainers in training of trainers and initial and continuing training of laboratory technicians and scientists. - Provide TA to the MOH to develop training materials and train health-care providers (nurses, physicians, midwives, laboratory technicians) on quality whole blood collection on filter paper dried blood spot (DBS) for infant HIV diagnosis. - Provide TA to build appropriate reference testing capabilities and facilities within the National Reference Laboratory (LNSP), including planning and implementation of the national external quality assessment scheme for HIV testing. - Provide TA to improve training capabilities and facilities at the national institute responsible for training laboratory technicians (INFAS). Preservice training materials will be revised and redesigned to integrate teaching to cover: HIV testing, biological monitoring of HIV-infected patients (CD4 count), commodities management, record-keeping, all aspects of the quality system, and biosafety.

RETRO-CI will also support the laboratory component of strategic information activities, including: - HIV testing and data analysis of the 2006 national antenatal sero-prevalence survey. - Sentinel surveillance of transmitted and emerging HIV drug resistance as part of the treatment program evaluation. - A pilot study to evaluate the feasibility and suitability of DBS for DNA PCR for early infant diagnosis. Subsequently the technology will be transferred to other central laboratories in order to decentralize and expand the national early infant screening capacity.

The following targeted operational studies with interest in programmatic activities will be carried out: - Onsite Phase I prospective evaluation of rapid HIV tests on finger-prick whole blood and Phase II studies of two test algorithms at selected sites with quality control using DBS. - Evaluation of adapted rapid tests for the detection of HIV and/or TB. - Evaluation of the suitability and accuracy of use of DBS for genotypic testing. - Field evaluation at EGPAF-supported treatment centers of the performance of Guava compact flow cytometer for the determination of CD4 percentages in children under 12 years.

All laboratory supplies will be purchased through SCMS, and RETRO-CI staff will provide assistance in ensuring that specifications and onsite management and forecasting are optimized.

The plus up funds will enable RETRO-CI to support 17 additional sites, train 30 additional individuals, adn perform 3,000 routine DNA PCR tests for early infant diagnosis of HIV in support of the national PMTCT program.

RETRO-CI provides concrete technical support for collecting, managing, analyzing, and disseminating strategic information for the National HIV/AIDS Program. If plus-up activities are approved, funding will be used to support planning and execution of a coordinated geographic-based health-information system. Coordination of activities will reduce duplication of work and will facilitate integration of data into a national health GIS system that will be used for strategic decision-making. In addition, funding will be used to evaluate ARV primary resistance in approximately 300 pregnant women (15-24 years old) in five sites. This survey will be implemented in conjunction with the 2007 ANC survey.

Targets

Target Target Value Not Applicable Number of local organizations provided with technical assistance for 0
strategic information activities Number of individuals trained in strategic information (includes 10
M&E, surveillance, and/or HMIS)

Table 3.3.13:

Despite the cost containment measures on the part of ICASS management as well as agency-specific efforts, Cote d'Ivoire has one of the highest ICASS cost in the African Region. This is partly due to the high cost of doing business in Abidjan, Cote d'Ivoire. The larger New Embassy Compound (NEC) inaugurated in 2005, has increased the overall budget for all ICASS subscribers compared to the costs associated with the previous embassy compound. The costs are associated with the much larger size coupled with a reduced number of agencies at post resulting in increased costs (utilities, security, etc) shared by fewer agencies. Due to the politico-military situation, agencies at post were significantly downsized after the NEC construction plans were in place. CDC joins other agencies in sharing the costs of operating one of the largest embassies in West Africa and the world. CDC will be joining other ICASS subscribers in sharing the high costs of building operations and paying for the actual space utilized in support of the interagency PEPFAR team.

The CDC portion of ICASS costs will increase as a direct result of the office space occupied at the NEC, shared with the PEPFAR coordinator and the USAID advisor. Currently, CDC supports the PEPFAR coordinator and five members of its management and support staff in the NEC space and anticipates an additional staff member (project management Officer) in FY07.

The additional OBO charges for CDC/HHS positions also add significantly to CDC M&S costs under the EP. Thus CDC EP programs, including Cote d'Ivoire need to incorporate OBO costs into their program budgets. Previously, GAP/CDC had paid for all OBO charges and provided partial support in FY06. However from FY 2007 costs must be paid from the country budget allocations. These charges apply to the total number of existing authorized positions for each US agency including both filled and unfilled positions (includes all "persons" employed by the agency, FTEs, LES, PSCs and temporary appointees). Each person is charged based on the type of office space allocated to each position. CDC will have six non-controlled access area office positions at the NEC. All other CDC personnel and contractors will continue to maintain office space with the Ministry of Health in Treichville.

Table 3.3.15:

USG Cote d'Ivoire continues to use innovative approaches to improve management and operations while minimizing costs. The CDC-funded Emergency Plan (EP) management, administrative, and motor pool staff support the USG (CDC-USAID) integrated project management team and technical assistance sections. This cost-sharing for USG EP operations reduces duplication of services and maximizes benefits for improved operations. If plus-up activities are approved, funding will be used to conduct an analysis of the overall management, technical, and administrative capabilities of EP implementing partners, including appropriate TA as needed to reinforce capacity in identified areas. In addition, funding will be used to increase the human resources capacities (specific trainings, HR, project management, administrative, and communications) of the in-country team to manage the rapid scale-up of EP activities in Cote d'Ivoire.

Table 5: Planned Data Collection

Is an AIDS indicator Survey(AIS) planned for fiscal year 2007?
Yes  No If yes, Will HIV testing be included?
Yes
No When will preliminary data be available? Is an Demographic and Health Survey(DHS) planned for fiscal year 2007?
Yes  No If yes, Will HIV testing be included?
Yes
No When will preliminary data be available? Is a Health Facility Survey planned for fiscal year 2007?
Yes  No When will preliminary data be available? 3/31/2007

Is an Anc Surveillance Study planned for fiscal year 2007?  Yes
No if yes, approximately how many service delivery sites will it cover? 42 When will preliminary data be available? 3/31/2008

Is an analysis or updating of information about the health care workforce or the  Yes
No workforce requirements corresponding to EP goals for your country planned for fiscal year 2007?

Other significant data collection activities

Name: Various targeted evaluations Brief description of the data collection activity: See targeted evaluations forms for individual study proposals in supporting documents corresponding to appendix 23. Preliminary data available: