This IM will assist the Government of Trinidad and Tobago to implement strategic-information activities, strengthen laboratory management and diagnostic services for HIV, and develop targeted combination (i.e. biomedical, behavioral and structural) prevention interventions for key populations at high risk for HIV and people living with HIV (PLHIV). This IM is national in scope and supports the USG Caribbean Regional Partnership Framework Goals for Prevention (Goal 1) Strategic Information (Goal 2), and Laboratory Support (Goal 3). For laboratory strengthening, this mechanism will continue to support the training of new and existing personnel to scale up point of care HIV Rapid Testing at VCT sites and support quality lab systems. For strategic information, a revised case report form was developed and plans are on the way to implement case reporting using this form. MARP surveillance was prioritized as a core component of its national response and the planning and implementation of MARP surveillance activities is also in progress. For prevention, this IM will strengthen the MOHs ability to identify, adapt and implement applicable evidence-based prevention interventions. Overall, this mechanism strengthens the human resource capacity of the MOH through training of Laboratory personnel, and the hiring of Surveillance and M&E staff. CDC will continue to work in close collaboration with the MOH to ensure the efficient use of USG resources in achieving program priorities and in delivering results more cost effectively. The MOH has been asked to develop a work plan with agreed-upon performance benchmarks, as well as a plan to transition programs and staff funded under this mechanism to local ownership.

One of the challenges in addressing the magnitude of the epidemic among the MARPs is the capacity of non-governmental organizations to provide combination HIV prevention related services needed by these populations. These services include addressing biomedical interventions including HIV testing, condom provision and sexually transmitted infection diagnosis and treatment ; social interventions of providing psychosocial support and social welfare services to these groups; and structural interventions by being an advocate for policy, legislative and human rights reform to have less stigma and discrimination meted out to these groups. CDC will support the National AIDS Program to build capacity and strengthen integration of prevention and support services into the routine care of PLHIVcommunity-based services and Non Governmental Organizations. These services will be linked with efforts to scale up counseling and testing in the NGO sector to increase access to prevention services to populations at high risk for HIV as well as increase the number of HIV positive persons who learn their status and get linked to prevention, care, and treatment services.

The Trinidad and Tobago Ministry of Health will utilize the cooperative agreement funds to support the capacity building of laboratory staff through regional and international trainings. Training workshop content areas will be: 1) TB diagnosis and EQA for AFB smear microscopy; 2) Good Clinical Laboratory practices (GCLP); 3) HIV rapid testing (including algorithm development, quality testing and use of logbooks); 4) and other areas of wet laboratory training.Furthermore, selected laboratory staff will be sent to the International Laboratory Branch at CDC Atlanta to be trained on the use of both manual and automated Roche Amplicor methods for early infant HIV diagnosis (EID) to support PMTCT programs within the region. Other international trainings involving lab staff from these countries will include advanced trainings in CD4, clinical chemistry, hematology, Bio-safety and laboratory management as they prepare for accreditation.These activities will greatly enhance and support the current cross cutting goal of training, capacity building and ensuring long term sustainability of in-country systems for testing, diagnosis, and patient monitoring.M&E: Number of laboratory personnel trainedNew/continuing activity: Continuing activity

The focus of this implementing mechanism will be: Surveillance and M&E systems strengthening, including support for the completion of an epidemiological profile, strengthening of systems for HIV/AISS Case reporting, and the collection, analysis and use of routine M&E data for program improvement. Funds under this cooperative agreement will also support the completion of special studies for MARPs in Trinidad and Tobago.M&E: The availability of one high quality Surveillance and M&E report after the first 12 months of the award

One of the barriers to the successful implementation of activities is insufficient human resources across the goal areas of prevention, strategic information and laboratory strengthening for HIV and across the wider health sector. Activities under this Cooperative Agreement contributes to health systems strengthening, to include building human resource capacity of Laboratory personnel, Surveillance and M&E staff, Community Health Nursing staff and community health providers. The partnership will continue to add value to the delivery of laboratory services, and support the integration of high quality HIV/AIDS data with the collection and reporting of surveillance and program monitoring data within the wider health sector.

CDC will support the Government of Trinidad and Tobago to enhance its capacity to provide VCT and PITC client centered, couples testing and provider initiated testing throughout the island and identify, adapt and implement appropriate evidence-based prevention interventions, which will support the Partnership Framework Prevention Goal and target persons engaged in high risk behaviors (PEHRB). The PwP is cross-cutting target population with this group. Cost effectiveness will be achieved through coordinating service delivery with other partners in the region. This will improve the Governments ability to build human, technical and institutional capacity in Trinidad and Tobago MOH to effectively develop, scale-up and sustain comprehensive combination prevention strategies. The CoAg will be monitored annually through technical reviews and country visits.M&E: Total number adults tested for HIV in the past 12 months and know their results

Funding will be provided to support the implementation of a package of prevention services for MARPs. This package will include outreach to hard to reach populations, HIV counseling and testing, risk reduction counseling and the provision of condoms, STI diagnosis and treatment and linkages to care and treatment for persons newly diagnosed with HIV. The target population reached will be MSM in year one and CSW in year two of this cooperative agreement. These target populations are also being studied through the HVSI code for special studies for MARPs. Funding will be provided to support the implementation of a package of prevention services for MARPs. This package will include outreach to hard to reach populations, HIV counseling and testing, risk reduction counseling and the provision of condoms, STI diagnosis and treatment and linkages to care and treatment for persons newly diagnosed with HIV. The articulated goals and activities will build capacity for the national health system to accurately characterize the epidemic, strengthening its provision of high quality and targeted prevention, treatment and care services for the general population, and focusing its ability to do the same for targeted most at risk and high risk populations. This population is also being studied through the HVSI code for special studies for MARPs. M&E:Number of MARP reached with individual and/or small group level interventions that are based on evidence and/or meet the minimum standards