IM 49 is designed to assist The Bahamas in strengthening lab services and prevention activities to enhance strategic information (SI) for HIV/AIDS. During the first year, lab strengthening included the recruitment of a Lab Strengthening Manager; the purchase of rapid HIV tests and other lab supplies; and the provision of training in QA and accreditation. In Prevention, support involved the creation of strategic and implementation plans. Further work supported PITC and rapid HIV testing training for decentralization of HIV services. SI activities entailed the identification of data sources, and data use. An ICT Consultant was engaged to review and strengthening of data collecting activities. Other SI activities included the finalizing of job scopes for an epidemiologist and M&E specialist.In ensuing years, IM49 will support the lab management framework to recruit and train new and in-service lab persons, consolidate gains in SI to generate high quality surveillance reports and improve programs, and strengthen high quality and targeted prevention, treatment and care services for the general population. IM49 has been tailored the work to build capacity among its existing staff while looking to increase technical expertise in-house through in-service mechanisms with a further view to absorb key personnel into the Ministrys complement. During FY12, a mobile testing van will be purchased to provide a confidential location for counseling and delivery of testing results in the field thereby adding value to the delivery of prevention services. CDC continues to work with the Ministry to ensure the efficient use of USG resources in achieving the outlined priorities for the 5-year CoAg. The Ministry is required to formally report through semiannual and annual submissions.

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

During the first year of the agreement, these laboratory strengthening activities included the recruitment of a Laboratory Strengthening Manager; the procurement of rapid HIV testing and other general laboratory supplies; and the provision of technical training in quality assurance and accreditation exercises along with targeted technical skills. In ensuing years, implementing mechanism will support the laboratory management framework to recruit and train both new and in-service laboratory personnel to scale up quality assurance measures and tracking at the National HIV Reference laboratory, including monitoring of point of care HIV rapid testing, as well as the procurement of reagents for molecular testing. In addition, this mechanism will continue to cover training in key testing areas and essential components of a quality system such as quality assurance and quality control procedures.

M&E: Number of laboratory personnel trainedNew/continuing activity: Continuing activity

CDC CRO will maintain support for the implementation of systems for HIV/AIDS Surveillance and M&E to assist the government 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 the general population and selected Most-At Risk-Populations; and 3. Support for improvements in M&E data collection, analysis, and use for program improvement. The Government of the Bahamas has prioritized MARP surveillance as a core component of its national response, and during Year 2 will embark on formative assessment and survey activities among the men who have sex with men sub-population. Funds from this Cooperative Agreement will support the planning and implementation of additional MARPs as well as high risk population surveillance activities in out-years.This implementing mechanism supports capacity building efforts and the strengthening of country-led processes aimed at establishing standard data collection, analysis, reporting and dissemination methods for HIV/AIDS behavioral and biological surveillance and monitoring to better inform local decision making and action.M&E: The availability of high quality Surveillance and M&E reports

This Cooperative Agreement will contribute to strengthening the health systems in Bahamas, adding value to the delivery of laboratory services, and integrating high quality HIV/AIDS data with the collection and reporting of surveillance and program monitoring data within the wider health sector.

In crafting this Cooperative Agreement, The Bahamas government tailored the work to build capacity among its existing staff while looking to increase technical expertise in-house through in-service mechanisms. As the latter process became more challenging in the present economic situation, discussions are underway to absorb key personnel into the Ministry of Healths staff complement, namely, Epidemiologist and M&E Specialist. The activities that have been increased will gradually become routine activities of existing staff with expanded numbers to support the execution of duties. Additional support is anticipated through the strengthening of NGOs and CSOs.

CDC will support the Government of Bahamas to enhance its capacity to provide VCT and PITC client centered, couples testing and provider initiated testing 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 the Bahamas MOH to effectively develop, scale-up and sustain comprehensive combination prevention strategies.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 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. The available resources will be used to support implementation, scale up and monitoring of PwP as well as increasing access to services for MARPs in the Bahamas, through an implementing partner, and in collaboration with the Ministries of Health. Selection of appropriate strategies and activities will be based on evidence from MARPS surveys which are currently in the planning stages in the Bahamas. 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