1.In collaboration with Ministry of Health of Cote dIvoire, SEV-CI will carry out a range of HIV interventions in three regions of Cote dIvoire (estimate population 3 271 025): HIV prevention through AB activities, adult and pediatric care and support, ARV dispensing, counseling and testing, laboratory, HIV/TB, PMTCT services, strategic information, renovations and procurement of commodities.2.SEV-CI will implement innovative and evidence-based interventions that maximize resources through:Setting of clear and meaningful benchmarks for capacity at site and district levelIntegrating interventions to strengthen service delivery and quality of careMobilizing and strengthening of existing networks and resources within the health system, including Community Health Agents and TBAs3.Partnership and close collaboration with ICAP-CI is critical to SEV-CIs strategy for meeting service delivery targets SEV-CI staff members technical capacity and familiarity with ICAPs programmatic approaches should ensure a smooth transfer of programmatic responsibilities within the dictated timeframe. SEV-CI Will support all district and site supported by ICAP4.In collaboration with ICAP, SEV-CI will develop and implement streamlined capacity-building M&E tools to measure and monitor individual and organizational competencies. SEV-CI will also develop a set of indicators to measure relevant project outcomes and will devise a process for providing performance-improvement feedback to facilities, DHTs and local organizations.5.New requests in COP12: 2Total planned vehicles for life of mechanism:New request justification:Two vehicles will be needed for site visits by the SEV-CI staff and also for general office operations.

During the 2012 fiscal year, SEV-CI activities will target 3 regions and 10 districts and 45 ART sites. Activities planned will target cumulatively 12 086 patients including 4 445 PLHIV newly enrolled on care. Thus, SEV-CI will contribute to scaling up population in care and treatment program according to national recommendation. HIV care and support services will focus onScreening for TB, STI, NutritionMalaria prevention (provision of bed-net) Provision of a water purification kit for families who do not have access to potable water and educate PLHIV and their families about simple and low-cost water filtration/ purification techniques to reduce the incidence of water-borne diseases.Prescription for Cotrimoxazole for eligible patientsStrengthening prevention with positive activitiesPsychological supportAvailability of condom and counseling for useIntegrate HIV care in prisons at 3 regionsSEV-CI will develop activities to :1.improve quality of service deliveryStrengthening appointment systemProviding ongoing support to health providers and regional trainers with the roll out and adoption of national policies and guidelines for clinical and biological surveillance of patients.Training providers on care and support activities and management of kits stocks to avoid stock out in collaboration with PNPEC, PNN,Expansion of nutrition support activities through PECNAP activities in collaboration with PNN and FANTAImproving the quality of HIV services by involving nurses and midwives in provinding care and treatment

Strengthening site providers capacity to respond to exposure to infected blood (AES) and distribute posters and leaflets on proper guidelines to follow in the event of exposure to infected blood, in collaboration with PNPEC and FHI 360.Participating in URCs collaborative improvement program

2.address client retention

Recruitment and training social workers to provide psychosocial support for PLHIV in collaboration with Human Resource Direction of MOHInvolving community workers in HIV care at community level in collaboration with PNSI and DSC (Direction de la santé communautaire)Establishment of strong support group at site levelAwareness campaigns against stigma and HIV infection focusing small group

3.strengthen linkages and referralEstablishment internal and external referral and counter-referral systemTraining health providers including Social workers on carrying out primary prevention activities, strengthening linkages between HIV care and support services and family planning servicesSensitization providers on proper use of tools to refer patient and strengthening linkages /supporting the continuum of services between health centers and the communityMapping services available at district level and dissemination information at all site levelMinor reparation will be held focusing on access to potable water within facilities and Education PLHIV and their families on pure water kit use.Bring up to speed and provide technical assistance to health providers to use data collection tools correctly.Continue to participate in URCs collaborative improvement program and train and mentor providers on data quality.Organize and improve the quality of biological surveillance of patients enrolled in care.Put in place data quality assurance systems and assist sites and districts with routine data analysis

During the 2012 fiscal year, SEV-CI activities will target 3 regions (Haut Sassandra, Fromager, Marahoue) 10 districts, and 87 heath facilities. Goals are :Identify OVCs and support them according their needsStrengthen OVC platformInvolved social center in OVC care and supportSEV-CI will focus activities onTraining providers, including community workers identification of OVC, completion of data collection tools and their orientation on platforms according to their needs.Adoption national norms and directives related to OVCs supportSensitization on identifying all children within families of PLWHA.Use of cards for children identified as OVC.Discuss data related to OVCs at MDT meeting.Organization medical care for the OVCs within supported health structures: counseling and testing, nutritional support, distribution of bed-nets and other care as needed.Implementation of referral system and counter referral system between the points of identification of OVCs and social centers.Support social centers on managing platforms for support to OVCs.Advocate with community leaders to reduce stigmatization and discrimination faced by OVCs.Use national data collection and reporting tools for OVCs activities

Supportive supervision and quality assuranceoParticipation in quality of care and treatment process for OVCs initiated by PNOEV in collaboration with URCSEV-CI will provide water purification kits for OVC and their if needed and sensitize parents on use pur water, environment , food hygien for children and families

Capacity building activitiesTraining providers and social workers on support for OVC.Train providers in use of national data collection tools for OVCEnsure availability of the national data collection toolsHold quarterly meetings to analyze and share OVC data at regional level and with PNOEV in order to reduce the risks of duplicating data during the period of consolidation of aggregated data

During the 2012 fiscal year, SEV-CI activities will target 3 regions (Haut Sassandra, Fromager, Marahoue) 10 districts, 45 care & treatment sites and 10 CDT.In collaboration with the districts, the PNLT and PNPEC, the strategies envisioned are :

To pursue the scaling up of TB screening in HIV services:Make available to service providers in the 45 supported cares and treatment structures the child TB screening tool and reproduce the TB treatment algorithms validated by PNLT and PNPEC and distribute them to sites.Assure that the active screening of TB is carried out among pregnant women found to be HIV positive and enrolled in care.Assure that HIV positive patient who screen positive for TB are guaranteed follow up testing (microscopic, radiography, other exams) to confirm the diagnosis of TB.In collaboration with the PNLT/CAT, follow up sputum smear tests to corroborate the diagnosis of TB.In collaboration with the PNLT/CAT extend the diagnostics and treatment of TB to level 1 CDT.Pursue the screening for HIV among patients tested positive for TB at Day 1 and guarantee the treatment of patients co-infected with TB/HIV.Maintain the integration of counseling and testing for HIV in the 10 CDTIn collaboration with the district pharmacists, guarantee the availability of Cotrimoxazole in the CDT.Ensure that all TB patients testing HIV positive benefit from a nutritional evaluation and positive prevention outreach.In collaboration with the PNLT and the CAT, provide a financial support to two coordination zones for CAT for the supervision of activities supporting the fight against TB/HIV coinfection.

Reinforce the referral system between TB and HIV care and treatment centers.Make accessible and truly offer TB treatment for the incarcerated population.Organize the care of incarcerated patients co-infected with TB/HIV, in collaboration with the reference CDT/CATStrengthen linkages with communityImprove community health workers and peer educators in the active research of TB,Disseminate positive prevention message during home visitcontrol TB infectionPut in place activities to control TB infection in 5 pilot sites, identified in collaboration with the PNLTInform and sensitize service providers in measures for controlling infection in order to reduce the transmission of TB.Build capacities building, Monitor and evaluate activitiesProvide technical assistance to service providers for the active diagnosing of TB at enrollment and during patient visits in the 45 structures providing care and treatment of HIV.Organize semi-annual meetings to share experiences between supported CDT.Develop indicators and tools for the following of patients screened positive for TB. Hold semi-annual meetings to validate the data with all supported site (Care and treatment, PTMCT, CAT/CDT) in collaboration with the districts. Put in place a system to access the active file of coinfected TB/HIV patients who continue TB treatment.Conduct quarterly controls of the data reported for patients co-infected in the CDT/CAT with the coinfected patients under TB treatment, followed by the SIGDEP database.Share the TB data quarterly with the PNLT in order reconcile the data with that of the PNLT.

During the 2012 fiscal year, SEV-CI activities will target 3 regions and 10 districts and 45 care & treatment sites arising coverage level to 82%for Haut sassandra, 81% for fromager and 87% for Marahoue. In this 3 regions 1 518 152 people are children (0-15 years of age), of whom 3356 (0, 3%) will be rich through this program including exposed children. SEV-CI will contribute to scaling up the pediatric population in care and treatment program. pediatric care and support services will focus on :Screening for TB, NutritionMalaria prevention (provision of bed-net)Provision of a water purification kit for families who do not have access to potable waterPrescription for Cotrimoxazole for eligible childrenTracing and interpretation of growth chartPsychological support to parents and childrenSEV-CI will develop activities to :

1.support the needs of adolescents :Establishment of adolescent support groups focus on specific themes.Providing services offering information adapted to youth: (contraceptives, condoms, prevention and treatment of STIs and HIV).Messages on abstinence

2.integrate pediatric care, nutrition services and maternal health :

oImplementation of procedures to establish linkages between different service structures.

3.Strengthen referral linkages and synergies between mother/child health and family planning :Establishment system to identify and re-integrate exposed children and their mothers into entry point of Mother and Child care service and family planning services.Identify children exposed or infected by HIV in mother/child health and family planning services and refer them to HIV care and treatment services

4.integrate nutrition :Nutritional care for malnourished children infected.Implementation of tools for collection and reporting dataTraining of service providers and community workers on screening of malnourished childrenEquipment for the height and weight surveillance of children in the health structure (baby scale, height measure)Systematic de-worming of exposed or infected children (in accordance with the regulations in place).The organization of nutritional care for malnourished children infected/exposed to HIV and provision of therapeutic feedingInitiation of screening for malnutrition in the community during home visits.

SEV-CI will sensitize parents on benefit of general and food hygiene for the family; provide water purification kit for families who do not have access to potable water, Create waters points in the pediatric consultation structures through minor renovations.

SEV-CI will build structural and operational capacity of health districts, in close collaboration with regional health boards, to further develop skills of the health workforce and improve the quality of service delivery. SEV-CI will take a systematic approach to health systems strengthening (HSS), addressing six essential areas of the health system framework as recommended by the WHO.

Human Resources (HR): Interventions will focus on building capacity of district health management teams (DHMTs) and training them to conduct periodic site assessments. This activity will be progressively integrated into the routine supervision process. The building of DHMT capacity will also involve the creation of budgeted work plans, supervision, data management, and quality of care. Ariel will strengthen HR of regional and district health boards, as well as the integration of social workers, to ensure, maintain, and sustain community activities at sites.

Service Delivery: SEV-CI will implement a basic package of care integrating clinical and community activities. Quality improvement (QI) activities will be incorporated into district and regional work plans. Joint supervision led by Ariel and DHMTs to ensure the progressive transfer of skills will take into account quality of care and data and will emphasize the feedback process through periodic QI follow-up meetings and a written report. SEV-CI will provide TA to health care workers through regular site visits and systematic integration of a district focal point into the joint supervision team to facilitate progressive transfer of skills. Tools and procedures will be developed for that purpose.

Leadership & Good Governance: SEV-CI will emphasize improving functionality of health regional teams and DHMTs to ensure good coordination of interventions through statutory meetings and those related to quarterly, semiannual, and annual follow-up of performance. Ariel will advocate for the adoption and integration of several available tools into the national process quality of care and capacity assessment.

Health System Financing: SEV-CI will build the capacity of national partners at the local level and will train them on resource mobilization and on the efficient use of funds for health service delivery.

Health Information System-Improving data collection: SEV-CI will build capacity of sites and districts to produce quality data through training sessions on the use of new tools, provision of computers, data management software, and internet connectivity in district and regional epidemiological surveillance centers.-Data quality improvement: SEV-CI will provide support to district and regional health boards when they implement data management procedures and will conduct routine data quality assessments with integrated improvement plans. This activity will be progressively integrated into the routine process of supervision.-Data use & analysis: SEV-CI will support districts and regions in data analysis and use for decision making at the local level. Data validation meetings, follow-up on performance, and reports will ensure dissemination of data.

Technology: SEV-CI will deploy data management software at districts and sites. SEV-CI will facilitate the use of the PIMA CD4 test in labs to improve access to CD4 counts, reaching even remote sites. Lab activity supervision will be conducted by the QI staff of each region.

SEV-CI will conduct HTC activities at 87 sites supported in the 3 supported regions SEV-CI will pursue these efforts to strengthen availability and quality of counseling and testing services at the health facility level.

The following activities will be implemented :Initiate community mobilization meetings: debates and advice on local radio shows or by griots on market days; identify resource people to conduct the radio spots (doctors, nurses, community counselors, teachers, and administrative and religious authorities).Involve peer educators in the psychological support of patients testing HIV+.Make free HIV testing accessible at all levels of the health pyramid and in all health services/wards, including prenatal care and maternity wards.Support districts to reactivate village cases activities to bring services closer to populations that are having difficulty accessing care at health facilities.Offer patients HIV tests and report test results the same day ; for patients testing HIV+, assure that blood is drawn for biological testing that same day.Support districts to efficiently organize blood sample transport to reference laboratory for initial biological testing for patients testing HIV+, including for typing of HIV infection.Reproduce and systematically distribute card inviting the partners of tested clients to come get tested themselves.Assure the promotion of couples counseling and testing at health facilities.Identify and train a pool of regional trainers in techniques for couples testing.Organize coaching sessions for health care providers on couples testing at sites.Integrate couples testing with prenatal care and family planning services.Provide adequate psychological support to sero-discordant couples.Organize family testing activities beginning with index patients.Put in place a system to find exposed infants at all points of entry.Put in place a system to manage appointments and to restart care for children missing appointments.Strengthen the referral and counter-referral system between testing and care services.Facilitate medical care for patients testing positive at CSRs.Assure sensitization, testing and care for sex workers at 2 pilot sites.Support MSLS and DIPE to adapt data collection tools to the new HIV testing algorithm.Assure, with the district health team (ECD), that supportive supervision visits are held to improve the reporting process at health centers.Analyze, and share monthly with sites, the rate of HIV tests offered and accepted in counseling and testing centers.Together with sites, analyze process indicators such as proportion of patients testing HIV+ and having access to biological testing, the proportion of thèse receiving their test results, and finally, the proportion of HIV+ patients enrolling in care.Analyze the évolution of HIV prévalence among people ages 15-24.

SEV-CI will carry out these activities at 80 sites in the 3 regions., SEV-CI will continue its efforts to improve referral linkages between different care and support services and will establish formal linkages with the community and strengthen districts and regions capacity to carry out monitoring and supervision activities.. The proposed activities are:oStrengthen primary prevention activities at the PMTCT sitesoSensitize and mentor health providers to expand IEC group sessions to include partner or persons that accompanied women to ANC servicesoStrengthen prevention with positives services for HIV-positive pregnant womenoStrengthen integration of PMTCT services with existing MCH services.oImprove referral and counter-referral services between ANC, labor and delivery, vaccination, family planning and HIV care and treatment services.oDevelop and make available a minimum package of services - taking care not to cause stigmatization - in sites where pregnant women access HIV counseling and testing services to maximize their enrollment and adherence to care and treatment. When pregnant women receive their test results, those testing positive will receive a free kit which will consists of iron and parasite medication. They will also receive a second kit containing an insecticide treated net, anti-malaria pills, water purification tablets, and condomsoImprove the dispensation rate of prophylaxis to HIV + pregnant women by putting in place an appointment system - or by strengthening the existing one and actively follow-up on women who have missed an appointment to obtain ARV, in accordance with national protocols.oOffer nutritional support (Nutritional assessment and advices) to HIV positive pregnant women including access to therapeutic feeding for malnourished women.oInclude in the minimum package of services for HIV-positive women (pregnant or breastfeeding) a module on infant nutrition including dietetic demonstrations if necessary, and an assessment of progress of the childs growth.oIn collaboration with UNICEF and PNN, ensure vitamin A availabilitys in maternity services and encourage midwives to administer the recommended dose vitamin A in labor and delivery wards during the immediate postpartum period.oDevelop a strategy to mobilize mothers who regularly frequent ANC and postpartum care services.oSensitize Traditional Birth Attendants and Community Health Agents to refer pregnant women and children to health facilities. They will also raise awareness and invite the partners of pregnant women 's involvement in maternal and child careoStrengthen community mobilization services for PMTCT (sensitize community and religious leaders about PMTCT activities, prevent stigmatization and discrimination of HIV positive pregnant women, and organize radio broadcasts and community meetings to discuss PMTCT).oEstablish linkages with community based organizations to support HIV-infected women and help their families address stigmatization and provide them with psycho-social support to cope with their HIV status.oImprove mother and child tracking through actions in the community (monitoring of child and the mother appointment by CHA during the home visit, awareness of the interests of appointment complianceoEnsure and improve data quality PMTCT services control at all sites every 6 months

During the 2012 fiscal year, SEV-CI activities will target 3 regions (Haut Sassandra, Fromager, Marahoue) and 10 districts and 45 ART sites. Activities planned will target cumulatively 12 086 patients including 2 225 PLHIV newly enrolled on ART. The focus of SEV-CI activities will be on providing quality care and ARV to all HIV + patients.SEV-CI will develop activities to :

1.Provide supervision on site level

Prescribing ARV and patients follow-up according to national guidelinesManagement of side effects, therapeutic failures, and interruption of treatmentTrain on tools completion (patient chart, registers)Dissemination and adoption of ARV national protocolesPatients tracing and tracking systemQuality of care assessment : MOC / SOCDistrict team involvement on activity follow up , data quality assessment, data analysis and utilization for decision making

2.Track et evaluate clinical outcomesPut in place data quality assurance procedures and help sites and districts to routinely analyze data to assess program quality.Evaluate quality of service every 6 months by using SOC and make a plan to address challengesUsing Routine data quality assessment every quarterSupport district team supervisionParticipating in URCs quality improvement collaborative program

3.improve retention of patients initiated on ARTRecruitment and training social worker to work at site level on providing counseling prior ART initiationIdentifying, training community workers for home visit, community sensitizationTracing and tracking system for missed appointment children and their familiesStrengthen support group meeting and focus groupsInvolving pharmacist in counseling while providing ART drug to patientsEnsure that sites without medical doctors can provide ARV treatment by supporting « traveling doctors » at these sites to initiate patients on ARVsTraining providers on cohort analysis tools for decision makingAwareness campaigns focus on stigma in the community

The expected outcomes are:Patients involved in their own care (follow up appointments)Providers worked as multidisciplinary team at each siteChallenges regarding retention identified at site level and strategies defined by providers themselves

4.strengthen links and synergies with maternal/child health and family-planning servicesPatients sensitization on advantages of access to contraceptives and dual protectionTraining providers on integration of family planning activities in HIV careStrengthen family planning services where available in collaboration with UNFPA, AIBEF and PNSR/PFStrengthen linkages between HIV C&Tx services and reproductive health (RH) services to provide RH services to ARV patients, including access to contraceptives and dual protection

5.contribute to food and nutrition support for eligible clientsExpand PECNAP program at all care and treatment site in collaboration with PNN and FANTAInitiate nutritional support services for PLHIV on ARV in OP facilitiesEnsure availability of therapeutic food in collaboration with PNN

SEV-CI will also realize minor reparation focusing on access to potable water within facilitieseducation PLHIV and their families on pure water kit use and Make available pur water kit for families in needs

During the 2012 fiscal year, SEV-CI activities will target 3 regions and 10 districts and 45 care & treatment sites arising coverage level to 82%for Haut sassandra, 81% for fromager and 87% for Marahoue. In this 3 regions 1 518 152 people are children (0-15 years of age), of whom 3356 (0, 3%) will be rich through this program including exposed children. SEV-CI will contribute to scaling up the pediatric population in care and treatment program

SEV-CI will develop activities to :1.support adherence in pediatric populations,

Recruitment and training of social worker to work at site level on providing counseling prior ART initiationIdentifying, training community workers to maintain contact HIV enrolled children and their families at community levelTracing and tracking system for missed appointment children and their families

2.promote integration of pediatric HIV treatment services into MCH platforms

Training providers on providing HIV treatment including pediatric drug management to avoid stock outIdentify exposed or infected children at entry points within the facility and establish strong links between the health structures and the community servicesEducation and practice for parents of infected children on the use of color to identify ARVs and facilitate the proper doses for their children.

3.to expand capacity to provide early infant diagnostic services and roll out PITC HIV testing in infants, children and adolescents,

Tracking exposed infant with PCR positive for enrollment in careReinforcement of PITC focusing on children of HIV positive adult enrolled in care.Offer sexual and reproductive health services to adolescents infected by HIVImprove the diagnostics of pediatric cases through the reinforcement of provider initiated counseling and testing in consultations, hospitalization and in vaccination services by the PECP sites. Active recruitment and enrollment of all exposed children with positive DBS test into care. Offer early diagnostics to all children exposed between 2-9 monthsCapacity building activities for this technical area including

oProviders. .Training providers on pediatric ARVs prescription, management of side effects, tools to improve qualityTraining district teams on analysis and data use for decision makingTrain two pharmacists per district (and the pharmacy managers) in adherence counseling and pediatric ARV treatment.

oorganizational stand pointReinforcement of referral system between different PICT point of service and pediatric care and treatment services.Availability of national data collection toolsOrganization of multidisciplinary team meetings to discuss complicated cases and coordinate care

oAt the structure/district levelFinancial and technical support to the districts for supervision and monitoring visits (Routine Data Assessment).Provide at the district and site level a technical assistance in data analysis and use.Coordination meeting at district level to share data and best practices with site teamsFinancial and technical support to the districts for organize sensitization meetings for community leaders on pediatric HIV challengesComputerizing and Implementation of national software SIGDEP