The purpose of the CapacityPlus Project, implemented by IntraHealth, is to increase access to quality HIV/AIDS services for MARPs and PLHIVs. The project will contribute to the Partnership Framework and Guatemala GHI goals and aligns with the COMISCA Regional Strategy. The program will build the Continuum of Care (CoC) Strategy (that began in Guatemala under the Capacity Project) in Belize, Costa Rica, El Salvador and Panama and expand the CoC Strategy in Guatemala to improve quality of life for PLHIV and other vulnerable populations.

CoC is defined as linked and coordinated HIV care, treatment and support services for PLHIVs and MARPs provided by collaborating organizations or by other key stakeholders. The primary purpose of the CoC is to develop systems that provide humane, effective, high-quality comprehensive and continuous care to PLHIVs and their families. This package of services will be created and monitored by a multi-sectoral local network of community groups that proactively demand high-quality services. The project will continue to scale up its technical strategies by working closely with key stakeholders in Performance Improvement methodology which serves as an organizing framework for quality improvement of CoC implementation in the region.

Sustainability: Central to the project is the value it places on working collaboratively with the public sector, civil society, local communities, and other international, regional and national agencies to foster local solutions and ownership. The networks will generate funds through contributions made by members to support their work. At the end of the five years of the project, the networks should be self-sufficient and continue to support the CoC without the need of additional outside support.

The Continuum of Care (CoC) strategy, implemented in three regions/departments in four countries (Belize, Costa Rica, El Salvador, and Panama) and eight areas in Guatemala in collaboration with the Capacity Project aims to build a a sustainable HIV response in communities. The primary purpose of the CoC is to develop systems that provide humane, effective, high-quality comprehensive and continuous care to PLHIVs and their families. The CoC is a group of services for PLHIVs and MARPs delivered through the empowerment of a multi-sectoral local network, including community groups. A fully developed CoC brings together five major components of a response to HIV: care, treatment, support, counseling/testing (CT), and prevention. The activities to implement the CoC strategy include: (a) Training and Supportive Supervision of institutional and community health personnel in counseling on ART compliance, home care, stigma and discrimination reduction, and gender dimensions of HIV. (b)Prevention with Positives: Such training will ensure the systematic application of providing prevention recommendations to HIV-positive clients, assessing client adherence to ARVs and other medications, assessing clients for signs and symptoms of STI, integrating RH/FP services including condom counseling and condom provision at every visit, and referring for community-based support. (c) M-health technology (the use of mobile phones to share health information, send prevention messages, follow up with clients, provide text reminders for when it is time to take ARVs and/or other medications or come for medical appointments, and notify members of the hospital-community integration team of upcoming meetings, progress on implementation of activities, and other relevant issues) to improve community-facility partnerships. (d)Referral and counter-referral network to maximize integration of complementary services, ensure client satisfaction and ARV adherence and minimize client loss to follow up.

The CapacityPlus Project will improve use of strategic information at the local level. The multi-sectoral networks will each perform a CoC needs assessment utilizing available primary and secondary data sources as part of the community-based strategic planning process. The CapacityPlus project, will work with these networks in the collection, analysis and presentation of information to inform the planning, monitoring and evaluation of the community-based interventions. Although the CapacityPlus Project emphasizes the use of information at the local level, it will closely coordinate with other entities such as the MOH, PASCA and UNAIDS working at other levels. This coordination will ensure the harmonization of concepts and indicators (under the Three Ones); the reporting to other levels of the health system and the use and dissemination of the information for advocacy and decision-making. The project will strengthen the presentation and use of information through a series of structured local and national forums in collaboration with the MOH and other projects and agencies to present and discuss analyses, results, best practices, and lessons learned.

The CapacityPlus project will continue to scale up its technical strategies by working closely with key stakeholders, health facilities and institutions in: (a) In-service Performance Improvement (PI), a set of methods, procedures and strategies to find the root cause and soluation of performance problems; and (b) Learning for Performance (LFP), a systematic instructional design process with practical tools that retain only essential content relevant to a learners job performance for a specific responsibility and/or work environment.

The CapacityPlus project is working in OHSS only in Guatemala, as part of the expanded work of the Capacity Project. The project will increase demand and quality for HIV and STI services in the 30 health centers in the country in all eight regions in Guatemala. The project will work with national counterparts to develop and implement a Health Center PI strategy to identify performance standards adapted for that level of care. These will identify gaps in compliance with the standards for STI services including clinical and laboratory algorithms, surveillance and information systems. Although the PI process will cover all health center facilities, project staff will specifically follow up on gaps related to STI and HIV services (including VCT) with an emphasis on increasing the quality, access and use of these services by MARPs. Performance gaps identified through the PI process that involve medical supplies, technical capacity of personnel, and/or the availability of equipment will be brought to the attention of local and national authorities and to other projects and initiatives that could provide support or technical assistance for their resolution. The CapacityPlus project will initiate a training-of-trainers (TOT) activity beginning with the elaboration of a detailed training program, manuals and training guides as well as follow up methods to maintain staff informed and updated through supportive supervision. Through this process, skills will be transferred to the trained local team now competent to implement the PI strategy themselves.