The Caribbean HIV/AIDS Regional Training (CHART) Network Initiative was launched in 2003 by HRSA to address human capacity development needs for HIV service providers and HIV managers through the region. CHART was funded through HRSA's cooperative agreement with the University of Washington (I-TECH). I-TECH provides technical assistance to CHART. Starting FY 2012 HRSA developed a competitive RFA to fund CHART directly. The goal of CHART will be to improve HIV/AIDS related health service delivery outcomes in the 12 PF countries through the development of continuing education programs integrating pre-service and in-service training of the health workforce. In addition, CHART will provide TA to the 12 PF countries to strengthen their capacity for evidence based planning and budgeting. and assist in the development of strategies to strengthen the health workforce.CHART will provide TA to strengthen the capacity of relevant professional councils and associations.The review of the competitive proposals is scheduled for the first week in December 2011. CHART will offer a wide range of clinical and in-service courses through its national training centers and online to over 1500 physicians, nurses, clinical care providers and counselors each year.CHART will provide TA to the MOH to develop evidence based HRH training plans, as well as TA to develop strategies for staff recruitment and retention.CHART will strengthen the capacity of the CHART training centers to conduct outcome evaluation and provide TA to the 12 PF countries to support the development of HIV decentralization/integration implementation plans.

CHART will continue to provide training related to the basic health care of patients living with HIV and AIDS in support of the decentralization of care in each of the 12 PF countries. There continues to be a strong demand for aspects of HIV-related palliative care training in the Caribbean region including an expanded focus on nutrition along with topics such as HIV and STI co-infection, disease prgression, management of clinical disease, home-based care and oral manifestations. A variety of training modalities will be employed targeting physicians, nurses, pharmacists, laboratory staff, social workers, nutritionists, other ancillary health care providers and PLHIV. Additonal PITC trainings will be conducted leading to increased capacity of government and nongovernment health care workers to provide quality HIV/AIDS counseling and testing, and an increase in the number of persons in the twelve target countries who know their HIV serostatus. The aim is to ensure that all affected individuals access prevention, care, treatment and support services as early as possible. TB/HIV clinical consultation services will continue be provided to physicians along with a quarterly conference call for TB nurses in the region. Support for the implementation of the revised Caribbean TB Guidelines, use of related TB/HIV job aides and ongoing training on TB/HIV will continue to support the collaboratons previously developed between National AIDS Programs and National TB Programs. CHART will provide technical assistance to community service organizations in the care and support of persons living with HIV by providing skills development training in a number of areas including behavior change communicationsand positive prevention. These skills building workshops will be conducted to support national efforts in building stronger care and support systems for PLHIV.

HRH assessments and data collection have occurred in Antigua and Barbuda, Dominica, Grenada, St. Kitts and Nevis, St. Lucia, St. Vincent and the Grenadines, and Jamaica. HRH assessments, analysis or data gathering activities will continue in the Bahamas, Barbados, Trinidad and Tobago and Suriname. Analysis of assessments already conducted by CHART/I-TECH, PAHO or others will continue to be supported into FY 2012. CHART will support Ministries of Health to develop HRH plans as required, based on recently conducted HRH assessmnets and other available data. CHART, with support from I-TECH will introduce tools for forecasting future health worker needs and provide training and guidance on HR planning, performance management, and implementation of HRH plans. In countries where HR planning is predominantly overseen by a seperate personnel department or ministry, this support will also target those relevant local government agencies.CHART will provide TA related a Human Resource Information System (HRIS) to ensure evidence based HRH decision making at the country level. CHART will provide TA to adapt TrainSmart or other approrpiate training database as the national training database in twelve countries and link tracking of the training of health care workers to a HRIS for evidence based health workforce planning. CHART will provide TA to develop strategies for staff recruitment and retention. These atrategies may include: support for training of supervisors and managers in techniques of supportive supervision and performance management; scaling up involvement in HIV pre-service education and training in collaboration with selected Caribbean tertiary level institutions so that a larger number of persons with appropriate competencies will be availble to enter the workforce; liaising closely with national health services in order to identify categories of staff to be given priority in pre-service programs; supporting health care worker retention through provision of needed CMEs and other course certifications; advocating with relevant professional associations, accreditation councils and MOH for advancement or recognition for health care workers.

CHART will continue to provide training related to the antiretroviral management of patients living with HIV and AIDS in support of the decentralization of care in each of the 12 PF countries. As more primary health care providers begin to assume responsibility for HIV-infected patients the need for ART training will grow. Expanded use of distance learning training methodologies will assist the training centers in providing cost-effective and accessible ART training to a wider group of clinicians with varying levels of HIV knowledge and skill. This will complement the current use of didactic sessions, skill-building workshops, clinical mentoring and preceptorship training approaches. Technical assistance will continue to be provided to Ministries of Health in the twelve PF countries for national level adaptations to the Caribbean Regional Treatment Guidelines as needed and relevant. Training curricula will reflect these regional orcountry specific guidelines to ensure consistent messaging to health care workers and systems of care. Efforts will be made to strengthen linkages between core competency-based in-service training and updated job responsibilities with related measures.New National Training Centers in Belize and Suriname as well as at the OECS HAPU for the OECS sub-region will also be supported with these fundsas they scale up ART training in their respective countries.In addition, a Clinical mentoring Nurse trainer will be hired full time to work with the full time physician to lead the clinical mentoring thrust across the Caribbean