This mechanism supports CAR PEPFAR Strategy Objectives 2 and 3. The primary goals of this award are to provide technical assistance to increase the capacity of the MOH in Kazakhstan, Kyrgyzstan, and Tajikistan improve their Injection Safety (IS) strategy and practices in health care facilities, ensure adequate and appropriate injection practices, monitor and evaluate their programs, and sustain these program improvements over time. Sustainability of the program and country ownership will be fostered through training and capacity building of MOH and health care facility staff, and enhanced utility of their quality management and M&E systems, allowing the MOH to monitor and improve the quality and efficiency of their IS activities. Train the trainer methodology will be employed, allowing for cost efficiencies over time, as more local staff serve as trainers. Relevant indicators, such as number of people trained, as well as outcome data, will be tracked for monitoring and evaluation (M&E) of the program.

Global Fund / Programmatic Engagement Questions

1. Is the Prime Partner of this mechanism also a Global Fund principal or sub-recipient, and/or does this mechanism support Global Fund grant implementation? Yes2. Is this partner also a Global Fund principal or sub-recipient? Sub Recipient3. What activities does this partner undertake to support global fund implementation or governance?

Budget Code Recipient(s) of Support Approximate Budget Brief Description of ActivitiesHMIN MOH 15000 To provide TA with the development and implementation of curricula on Injection Safety into practice of pre-service and in-service trainings

This mechanism supports PEPFAR CAR Strategy Objectives 2 and 3. Nosocomial transmission of transfusion transmitted infections occur in CAR, with several outbreaks and clusters of HIV and HCV transmission reported among hospitalized children in Kazakhstan (KZ), Kyrgyzstan (KG), and Tajikistan (TJ) in recent years. Recently conducted assessments, with USG technical assistance (TA), of injection practices in health care facilities in KZ, KG, TJ, and Uzbekistan (UZ) revealed that, in general, sterile equipment was used for patient care, but stock-outs of needles/syringes and other commodities were common. The assessment revealed many deficiencies: gaps in injection safety (IS) practices and behavior such as two-handed needle recapping; use of multi-dose vials with needles left in for reconstitution; no reporting or follow-up of needle stick injuries; and improper healthcare waste management (HCWM) practices, such as open burning of waste, which is the main waste disposal method. There is also a lack of health-care worker knowledge relating to safety issues. Thus, adequate injection and injection practices in healthcare settings are important components of the PEPFAR prevention strategy to prevent health care related HIV transmision. The project will provide TA to KZ, KG, and TJ to improve the national strategies for Injection Safety (IS) based on the results of national assessments; help to establish a quality management system (QMS) for hospitals on Injection Safety; reduce non-evidence based clinical use of injections; improve information systems and standardize databases for needle stick injuries among health care workers; strengthen professional development of medical nurses and personnel responsible for health care waste management (HCWM); assist with the development and distribution of Information Education and Communication Campaigns on IS and HCWM to health care facilities; and provide TA to improve HCWM systems. Train the trainer methodology will be employed, and training curricula will include ensuring measurement and forecasting of sustained availability of single-use syringes and needles, lancets and blood drawing equipment, safety boxes, and gloves. M&E tools will be developed to track the number of distributed copies of the national strategies and other guidelines on IS, HCW Safety and HCWM; the number of medical staff trained; the number of reported needle-stick injuries, and resulting provision of post-exposure prophylaxis; number of health care facilities (HCFs) received IEC materialss on Injection Safety. In KG, the activities on the improvement of HCWM will be conducted in collaboration with Sweden's Red Cross Project. These activities will lead to country ownership and sustainablity by working with the national and regional governments to establish new guidelines for IS and HCWM improvement, implementation of QMS, particularly M&E of injection safety activities for hospitals on Injection Safety, health care worker safety, and HCWM. USG will train HCFs and MOH on how to monitor and evaluate their M&E data, and improve their systems in response to the evaluations. All of these activities will be integrated into HCFs at the national level in order to be integrated into HIV services. Particular attention will be paid to HIV service sites, such as treatment and care, HIV testing sites, and PMTCT programs.