With FY 07 funds, USG technical staff will be supported and will continue to work closely with the interagency management country team and HQ technical staff to provide technical assistance for the design, implementation, and evaluation of PEPFAR-funded behavioral interventions designed to influence HIV prevention behaviors, with primary emphasis on efforts to promote abstinence, fidelity, delay of sexual debut, partner reduction, and related social norms. These are conducted in consultation with the Ministry for the Fight Against AIDS, other technical ministries (Education, Health, Social Affairs, Human Rights, Youth and Sport, etc.), non-governmental organizations (NGOs), multinationals, and bilateral organizations.

Ongoing specific activities will include: -Participation in the behavior change communication (BCC) technical group and assistance, in collaboration with JHU/CCP and the IEC/CCC unit of the DMS, in the mapping of AB activities implemented by PEPFAR partners and the harmonization and standardization of BCC tools. -Support for implementation of the life-skills curricula and coordination of the national BCC working group -Identification of opportunities for targeted BCC. -Supervision of official needs assessments. -Coordination of activities among donors and partners, including UNICEF, UNAIDS, UNDP and PEPFAR-funded partners Care International, FHI, PSI, JHPIEGO, ANADER, International HIV/AIDS Alliance, JHU-CCP, and the ministries responsible for Education, Social Affairs, Health, and AIDS coordination). -Develop a communications strategy, in coordination with JHU/CCP and REPMASCI (network of media professionals and artists against AIDS in Cote d'Ivoire), to promote all PEPFAR activities.

PEPFAR CI will continue to support RIP+ (network of CBOs of people living with HIV/AIDS), REPMASCI, and COS-CI (NGO collective against HIV, representing more than 400 organizations). PEPFAR CI will also continue to support faith-based organizations (ARSIP, a recently created interfaith alliance of religious leaders), youth organizations, and other community activists and leaders in mobilizing their communities for the promotion of abstinence, fidelity, delay of sexual debut, and partner reduction in their communities.

With fiscal year 2007 funds, USG CI team will request technical assistance from CDC headquarters to support targeted assistance in support of the country program in the following areas: HIV-TB, sexual prevention, PMTCT, ARV Services, Laboratory services, SI, and operations and management.

This technical assistance will strengthen the Emergency Plan's (EP) country team's ability to manage the overall and specific technical portfolios and projects as part of PEPFAR as well as to provide assistance to the Government of Cote d'Ivoire and to our implementing partners.

In the area of Other Prevention, the country team requests ongoing technical assistance from CDC HQ staff to support the ongoing review of the country portfolio of projects and interventions targeting most at risk populations including transactional sex workers, uniformed services and ex-combatants, truckers, prisoners and other populations made vulnerable due to the prolonged politico-military crisis.

USG CI will support the travel and logistics for all requested technical assistance from HQ.

Targets

Target Target Value Not Applicable Number of targeted condom service outlets  Number of individuals reached through community outreach that  promotes HIV/AIDS prevention through other behavior change beyond abstinence and/or being faithful Number of individuals trained to promote HIV/AIDS prevention  through other behavior change beyond abstinence and/or being faithful

Table 3.3.05:

With fiscal year 2007 funds, USG CI team will request technical assistance from CDC headquarters to support targeted assistance in support of the country program in the following areas: HIV-TB, sexual prevention, PMTCT, ARV Services, Laboratory services, SI, and operations and management.

This technical assistance will strengthen the Emergency Plan's (EP) country team's ability to manage the overall and specific technical portfolios and projects as part of PEPFAR as well as to provide assistance to the Government of Cote d'Ivoire and to our implementing partners.

In the area of HIV-TB, the country team requests ongoing technical assistance from CDC HQ staff to support the integration and scale up of routine counseling and testing services at TB facilities, joint care of HIV and TB at joint-care facilities and improve monitoring and evaluation of integrated HIV-TB services, and review study and drug needs in relation to multi-drug resistant TB.

USG CI will support the travel and logistics for all requested technical assistance from HQ.

If plus-up funds are approved, RETRO-CI will provide technical assistance to support the integration and scale-up of routine HIV counseling and testing services at TB facilities, joint care of HIV and TB at joint-care facilities, improved monitoring and evaluation of integrated HIV-TB services, and a review of study and drug needs in relation to multi-drug-resistant TB. In addition, TA will support the finalization of a curriculum on HIV counseling and testing of TB patients and the systematic roll-out of a diagnostic counseling and testing training package. RETRO-CI will support the PNLT in its Green Light Committee (GLC) application for approval for access to second-line drugs.

Targets

Target Target Value Not Applicable Number of clinic sites with associated CBO/FBOs providing  community based services to persons coninfected with HIV/TB. Number of service outlets providing treatment for tuberculosis (TB)  to HIV-infected individuals (diagnosed or presumed) in a palliative care setting Number of HIV-infected clients given TB preventive therapy  Number of HIV-infected clients attending HIV care/treatment  services that are receiving treatment for TB disease Number of individuals trained to provide treatment for TB to  HIV-infected individuals (diagnosed or presumed)

Target Populations: National Health program and staff Local government bodies Project staff Host country government workers Laboratory workers Laboratory workers Implementing organizations (not listed above)

Coverage Areas: National

Table 3.3.07:

With FY07 funds, the USG technical staff will continue to work closely with the interagency management team and HQ technical staff to provide technical assistance for the design, implementation, and evaluation of HIV counseling and testing interventions. USG technical assistance contributes to the strengthening of national guidelines and adoption of routine testing policies at health facilities. USG staff consults with the national VCT technical working group, expert HIV laboratory committee, and other technical forums to assure the quality of decentralized HIV counseling and testing services. USG staff are providing ongoing technical assistance for the inspection and supervision of HIV testing services performed at peripheral sites. Specifically, USG staff will provide assistance in implementing the simple rapid testing algorithm and introduce a new approach based on t whole blood finger-prick. These efforts are conducted in consultation with the Ministry for the Fight Against AIDS; other technical ministries (Health, Education, Family and Social Affairs); nongovernmental organizations, multinationals, bilateral organizations (UNAIDS and other UN agencies); and PEPFAR-funded partners (such as EGPAF, Care International, FHI, International HIV/AIDS Alliance, JHPIEGO, and ANADER).

Ongoing specific activities will include technical assistance to the MOH and other partners to improve the quality and monitoring of counseling and testing through evaluation of existing counseling and testing services. In conjunction with Liverpool, JHPIEGO and other partners, USG staff will provide technical assistance for the integration of HIV testing at health-care service sites. USG staff will provide technical assistance to strengthen training for professional health workers, professional counselors, lay counselors, and labs technicians. This training will improve linkages to care and treatment services for people who test HIV-positive

These activities complement direct USG laboratory and other donor contributions to support the expansion and reinforcement of a national network of laboratories involved in the development and implementation of laboratory plans and resources for training, inspection, supervision, and monitoring and evaluation of laboratory personnel and facilities.

With fiscal year 2007 funds, USG technical staff will provide technical assistance, laboratory services and HIV reference laboratory functions in support of all prevention, care and treatment services with direct Emergency Plan (EP) support and will continue to work closely with integrated management team and HQ technical staff to provide technical assistance and coordination in the area of HIV/AIDS care and treatment, including assisting national programs with the development, implementation and evaluation of care and treatment services in Cote d'Ivoire. These efforts are conducted in consultation with the Ministry for the fight against AIDS, other technical ministries (Health, Education, Solidarity), non-governmental organizations (NGOs), multinationals, and bilateral organizations.

Laboratory services provided by USG technical staff include provision of comprehensive biologic monitoring for screening and follow-up of persons receiving ART, technical assistance to the MOH (PSP and national HIV and TB care programs) to improve laboratories' commodities management system, procurement and distribution of substantial laboratory and other supplies to support laboratory services, and management of the national database of persons screened and taking ART at public sites, with progressive transfer of service-delivery functions to the national laboratory system.

In addition, USG assists host government, non-governmental organizations and donor partners (e.g. UNICEF, UNAIDS, UNDP), and EP-funded partners (CARE, FHI, JHPIEGO, ANADER, HOPE Worldwide, Alliance CI, the Ministry responsible for the fight against AIDS, and other technical Ministries) in continued cooperation and coordination of care and treatment. USG staff provides direction to collaborators on USG policies, strategies, priorities, guidelines, and reporting requirements related to ART services.

USG staff provides advice to country partners on the matters of medical and scientific policy and practices associated with program management and operational support for care and treatment services. USG staff substantially contributes to the planning and implementation of policies to ensure the ongoing development of programs to improve health care management and delivery systems of the national public health activities of Cote d'Ivoire. USG staff provides advice and guidance regarding internal and external public health programmatic design, procedures, protocols, and studies as well as technical and administrative policies among various levels of stakeholders. USG staff supports coordination and provides technical assistance to reinforce public-private partnerships efforts to expend an effective and comprehensive HIV/AIDS response in the workplace, including facilitating the coordination and jointed actions related to HIV/AIDS among and between companies, between public and private sectors. In coordination with UNAIDS, ILO, and other bilateral technical cooperation institutions, this activity will support innovative public/private/NGO partnerships to promote HIV/AIDS sustainable and quality health services with expanded coverage, including care and treatment to family members of workers and surrounding communities.

The government of Cote d'Ivoire is improving national capacity to respond to the HIV/AIDS epidemic throughout the country. Through the Emergency Plan, the USG is an important contributor to that effort. Its contributions are both financial and in technical expertise. Projet RETRO-CI, a collaborative organization created jointly by the Ministry of Health (MOH) and the CDC, is a critical partner in the development of the unified national vision for monitoring and evaluation, information technologies, and information management systems, and for HIV surveillance. RETRO-CI provides concrete technical support for collecting, managing, analyzing, and disseminating strategic information. With FY07 funds, the SI team at Projet Retro-CI will contribute to national SI efforts by:

1. Providing technical and logistic assistance to the MOH to complete the annual 2005 national antenatal HIV surveillance survey. With FY 06 funds, 88 health staff were trained, blood samples were collected at 30 urban and rural sites and tested at Projet RETRO-CI laboratory, and data was stored. FY 07 funds will enable RETRO-CI staff to assist the MOH with data analysis and results dissemination through written reports, a CD-ROM, workshops, and a national conference.

2. Providing technical and logistic assistance to the MOH to conduct the annual 2007 national antenatal HIV surveillance survey. RETRO-CI staff will procure laboratory and study supplies, supervise data and sample collection at peripheral sites and testing at the Projet RETRO-CI laboratory, and assist with data entry, analysis, and data dissemination through written reports and oral presentations. Progressive capacity building and transfer of skills to national counterparts, started in FY 06, will be strongly promoted during FY 07 at both central and decentralized levels. In addition, with CDC headquarter technical assistance, further analysis will be conducted with ANC, AIDS Indicator Survey, and PMTCT programmatic data to describe the patterns that drive the HIV epidemic in Cote d'Ivoire.

3. Providing technical and logistic assistance to the Ministry of the Fight Against AIDS (MLS) and the National Institute of Statistics to complete the National AIDS Indicator Survey with the elaboration and implementation of a comprehensive communications plan. This plan will include broadcasts, workshops, and training on data use for planning and advocacy, as well as dissemination of findings through written reports and a CD-ROM.

4. Providing technical and logistic assistance to the MOH and to PHR, in collaboration with WHO and other partners, to disseminate Service Provision Assessment (SPA) findings through a workshop, training, written reports, and a CD-ROM.

5. Providing technical assistance to the MOH to implement longitudinal surveillance of patients in ARV treatment and to support a variety of in-country partners with the implementation of targeted evaluations, including evaluation and surveillance of HIV resistance, incidence, and prevalence in accordance with WHO/CDC standards. This support includes procuring laboratory and study supplies, collecting samples at peripheral sites, transporting specimens for testing at the RETRO-CI laboratory, data entry, analysis, and data dissemination through written reports and oral presentations. Technical assistance will also be provided by CDC HQ to conduct the initial assessment, development of protocol and guidelines, and planning of activities.

6. Providing continual technical assistance to the MLS and other PEPFAR-funded partners (among them the MOH, the Ministry of National Education, and the Ministry of Family and Social Affairs) to develop, disseminate, and implement the national strategy and an overall M&E plan, and to develop a national HIV/AIDS information system and database. With technical assistance from CDC HQ, Projet Retro-CI informatics staff will assist in: - Implementing a national ART patient monitoring system, including adapted WHO ART patient monitoring forms and an electronic ART monitoring tool - Designing or adapting software, databases, and computer applications that support HIV/AIDS program activities (VCT, PMTCT, OVC, etc.) - Designing a national database on HIV/AIDS at the MLS (customizing CRIS to meet national needs and developing an interface to allow other ministries to access the CRIS data or designing a data warehouse) - Supporting adaptation and installation of TIMS at the national MOH level and providing appropriate training support to use the system properly - Addressing confidentiality, privacy, and security and ART patient ID issues

7. Upgrading and maintaining Projet RETRO-CI IT infrastructure. The infrastructure will provide improvements to office automation equipment (including workstations) and software, as well as improved Internet connectivity. All of these improvements will support PEPFAR information capacity building, provide for more rapid data analysis, and support the procurement of commodities such as computer equipment, laboratory reagents, and other expendables.

8. Providing assistance in the areas of informatics and information systems to a wide variety of governmental, non-governmental, and other partner organizations. Specific activities include: - Providing training in the use of data-management software such as Epi Info, CRIS, and PMS, and in statistical analysis - Assisting the MOH/DIPE with their next-generation national health management information system (HMIS), which integrates HIV indicators with other health-outcome measures - Assisting with the development and implementation of a national M&E system in support of PEPFAR prevention, care, and treatment goals. This assistance includes but is not limited to the translation of software programs and training materials and training, supervision, and quality-assurance guidelines. - Developing with the national SI group recommendations for the integration of software to reinforce the linkages between services in support of the network model of HIV-related health services at different levels of the health pyramid. This technical assistance will complement SI activities funded through cooperative agreements with the MLS, the MOH, and other partners to create a functional national M&E system.

9. Developing the national SI strategy for Cote d'Ivoire and providing technical assistance to PEPFAR-funded partners to ensure they are aware of PEPFAR reporting requirements. This activity includes providing materials and training in French, preparing required reports describing PEPFAR results, and providing written and oral reports for national partners and stakeholders for the USG. With Measure Evaluation technical assistance, the USG team will provide all PEPFAR-funded partners with data-management software (CIPMS) for data storage and decision-making. The USG will also start the Data Quality Audit (DQA) process, including onsite supervision and partner performance evaluation.

10. Participating in key regional or international meetings or training to remain up to date on PEPFAR and international requirements and best practices in support of the third of the "Three Ones," namely having one integrated national M&E system.

USG Cote d'Ivoire continues to use innovative approaches to improve management and operations while minimizing costs. The CDC funded Emergency Plan (EP) management, administrative and motor pool staff support the USG (CDC-USAID) integrated project management team and technical assistance sections, as well as the RETRO-CI laboratory and strategic information infrastructure. This cost sharing for USG EP operations reduces duplication of services and maximizes benefits for improved operations. CDC M&S costs must be evaluated in light of support to the overall platform and the absence of a USAID bilateral mission.

USG CI continues to implement innovative approaches to include: 1) capacity building and outsourcing technical expertise to partner organizations; 2) linking partner organizations into USG technical expertise (capitalizing on laboratory and informatics expertise at Projet RETRO-CI); 3) providing joint CDC-USAID technical assistance to all EP funded partners including operational and financial management aspects; 4) proposing joint agency staffing positions (such as the proposed new FY07 positions: a project management specialist and a community liaison specialist); 5) providing for bilingual (French/English) assistance in the translation and/or interpretation of USG requirements; and 6) hosting joint Ivorian partners meetings for program monitoring and management.

These steps will facilitate optimal coordination, performance and management of EP activities and will result in a decrease in the number of USG directly supported staff, a reduction in redundancies, a capitalization of technical strengths, improvements in coordination and greater compliance with USG financial requirements.

Despite the aforementioned approaches, the human capital cost for USG Cote d'Ivoire's management and operations continues to increase. This is driven by the large New Embassy Compound (NEC) associated costs, enhanced security protections and communications equipment required due to the critical threat post, as well as shifts in international currency exchange rates. The great majority of the management and operations budget is driven by ICASS and OBO charges associated with NEC construction and operating costs (discussed in a separate narrative). The crisis and other factors also increase transactional costs and drive up costs of goods and services. General operations for the USG have also resulted in some increased costs for communication and security measures.

Salary costs have increased due to expanded international staff (PEPFAR coordinator and filling of previously approved international positions), coupled with a marginal increase in local staff and regular step/performance increases.

Disproportionate time continues to be required for security and HR related actions. Challenges with recruiting senior local staff continue to persist mainly due to challenges with CAJE classifications not always resulting in a competitive salary level for technical and management positions. Due to the on-going politico-military crisis and security situation, post remains a critical threat post and is currently "adult only" with minor dependents not permitted. This coupled with French language requirements also create additional challenges in filling international positions. On a positive note, multiple management and technical positions have recently been filled and key strategic information and medical advisor positions are in process drawing in senior francophone experts from the region. In addition, appropriate preventive "mental health" strategies need to be implemented to protect staff from burn-out associated with operating in a chronic crisis situation. Simple measures such as taking regular R&R with adequate staff coverage and ongoing training are in the process of being implemented.

Table 3.3.15: