The purpose of the Cooperative Agreement with the Trinidad and Tobago Ministry of Health (MOH) is to assist the Government of Trinidad and Tobago in fully implementing strategic-information (SI) activities for HIV/AIDS, including behavioral and biological surveillance among Most At Risk Populations (MARPs) and People Living with HIV/AIDS (PLWHA); to improve coordination of the expansion of confidential Voluntary Counseling and Testing (VCT), including laboratory training and the implementation of HIV rapid testing.

This implementing mechanism will support the laboratory management framework that will train personnel to scale up point of care HIV rapid testing to various VCT sites. Training of both new and in-service laboratory personnel to cover key testing areas and quality systems essential components will also be supported.

For strategic information, the USG will support the implementation of systems for HIV/AIDS Surveillance and M&E to assist Trinidad and Tobago in generating high quality, reliable data to characterize the epidemic and plan appropriate responses. Specific activities include: 1. Implementation of systems for HIV Case Reporting; 2. Implementation of behavioral surveys for selected Most-At Risk-Populations; and 3. Support for improvements in M&E data collection, analysis, and use for program improvement. The Government of Trinidad and Tobago has prioritized MARP surveillance as a core component of its national response. Funds from this Cooperative Agreement will support the planning and implementation of MARP surveillance activities in Years 1, 2 and 3.

Support will be given to strengthen the ability of the MOH to identify, adapt and implement applicable evidence-based prevention interventions. The proposed goals and activities are priorities agreed upon by collaborating partners. These activities will build capacity for the national health system to accurately characterize the epidemic, provide high-quality and targeted prevention, treatment and care services for the general population and specifically for most at risk populations.

This implementing mechanism supports the USG Caribbean Regional Partnership Framework Goals for Prevention (Goal 1) Strategic Information (Goal 2), and Laboratory Support (Goal 3). This mechanism is national in scope, with emphasis on lab systems strengthening, the collection of surveillance and program monitoring data at national (MOH), health center and community-levels. Laboratory personnel, Surveillance Officers, M&E staff, Community Health Nursing staff and community health providers are the main target audience for this Cooperative Agreement.

This Cooperative Agreement will contribute to strengthening the health systems in Trinidad and Tobago. The partnership will add value to the delivery of laboratory services, and 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 work in close collaboration with the Government of Trinidad and Tobago to ensure the efficient use of USG resources in achieving the programmatic priorities for the 3-year cooperative agreement. The Ministry of Health will be asked to develop an annual workplan with agreed-upon performance benchmarks, starting in Year 1. The MOH will be required to report on progress towards the essential and additional outcome indicators on a semi-annual and annual basis via SAPR reporting.

CDC will support the National AIDS Program to build capacity and strengthen integration of prevention and support services into the routine care of PLHIV in facility and community-based services. These services will be linked with efforts to scale up counseling and testing to increase the number of HIV positive persons who learn their status and get linked to prevention, care, and treatment services.

M&E: No. of people living with HIV and AIDS (PLHIV) reached with a minimum package of prevention with PLHIV (PwP) interventions

CDC will support the Government of Trinidad and Tobago to enhance it's capacity to provide VCT 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 Government's ability to build human, technical and institutional capacity in Trinidad and Tobago OPM-NACC to effectively develop, scale-up and sustain comprehensive "combination" prevention strategies. The CoAg will be monitored annually through technical reviews and country visits.

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 trained

New/continuing activity: Continuing activity