In FY2011, USAID will continue on-going support to AED to expand and strengthen HIV/AIDS prevention, treatment and care services for the most vulnerable population in provinces located in Region V, VI and VII, especially in those that are in the border with Haiti or that have Bateyes. In order to achieve this, AED will continue to support the Ministry of Education (MOE) to expand the implementation of the Life Skills Modules in the public education system; support the Ministry of Health at central, regional and local level in order to strengthen PMTCT, VCT, treatment and care services in public hospitals, and provide TA to the MOH reporting system in order to ensure full and accurate reporting, train health teams in service norms and protocols and in data analysis for decision making. AED will also fund NGOs, FBOs and CBOs which works with most-at-risk groups at the community level to link communities to PMTCT (including pediatric AIDS), VCT, treatment and care services. AED will also continue to support community mobilization through the ACCIONSIDA strategy. AED will provide TA to MOH to implement two pilot opt-out VCT services in public hospitals and plans to continue training and providing TA to the health teams responsible for thirteen primary health clinics (UNAPS) in order to provide basic follow-up and care PLWHs.

USAID/DR will continue on-going support to AED to fund NGOs, FBOs and CBOs which provide the basic package of home/community-based care for infected adults and their families in Region V and VII. The activities implemented by these NGOs include early detention and referral to clinical and laboratory services linking the health facility and the community, group and individual counseling in areas such as TB, nutrition, reproductive health, condom use, behavior change, human rights and stigma and discrimination. In Bateyes, where food availability is critical, NGOs have provided training and seed money so that beneficiaries will start food cooperatives that will provide infected individuals, their families and the community with much needed food AED will also continue to collaborate with MOH in order to integrate facility-based care in 13 primary care units (UNAPS) so that basic care services are located near to the communities NGOs are implementing home-based care. This activity is a pilot and may be expanded to more primare care units, if results are positive. AED will also continue to traing MOH health teams in the public hospitals and UNAPS and NGOs staff and community health workers in home-based care strategies, referral systems and supervision. AED will also continue to implement a strong monitoring system in order to ensure the quality of care and support activities and of the reporting system in order to minimize double counting.

USAID/DR will continue to fund AED on-going activities with orphans and vulnerable children in provinces located in Region V, VI and VII through NGOs, FBOs and CBOs. AED has trained NGOs to dentify, monitor and track children , providing services to affected and infected children and their families and or care-takers. NGOs strengths their capacity to take care of the infected and affected children, including accompanying them to the health care services that they may require, i.e.inmunization and/or treatment for OIs Family and Care-takers also make sure that these children have access to public education in their communities and link them to other services provided by other NGOs and Government institutions such as Solidarity program to ensure protection and legal aid in obtaining birth certificates, food and nutrition support.

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in Fy2011, USAID/DR will provide on-going support to AED to continue strengthening counseling and testing services in 35 MOH and NGO services in Region V and VII, including Provider Intiating Counseling and Testing (PIC). In order to achieve this this, AED will continue training counselors and providers in PMTCT, E.I.D., TB, Reproductive Health and Family Planning, Nutrition and prevention for positives. Also, AED will continue to fund NGOs, FBOs and CBOs to implement VCT services in the community in collaboration with the health team from the nearest public hospitals.

Duing FY2011, USAID/DR will continue to fund AED to support public service sites (hospitals and UNAPS), NGOs, FBOs and CBOs which provide pediatric care and support in order to strengthen early infant diagnosis, PITC, treatment of OIs and other health services, such as inmunization. AED will collaborate with other US Agencies to train health teams in the public and NGO sector in the DNA PCR

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USAID will continue to support AED to provide TA to MOH at the central and regional offices to improve and strengthen data collection systems in order to improve recording, reporting, analysis and decision-making both at the hospital and regional level with the aim of supporting an information system that is sustainable, responds to quality assurance tools and provides reliable and accurate data. AED will also provide NGOs, CBOs and FBOs with TA to continue with habilitation and accreditation process.

In FY2011, USAID/DR will continue to provide support to AED to address gaps in data collection systems in public hospitals in Region V and VII, collaborating very closely with MOH at the Regional and Central levels in order to improve recording, reporting and analysis both at the hospital and regional level with the aim of supporting an information system that is sustainable, responds to quality assurance tools and provides reliable and accurate data. AED will also support through its Continuing Quality Improvement Strategy (CQI) these hospitals to improve the quality and safety of services, identifying best practices in these hospitals and facilitating their application in other regions. In addition, AED will work very closely with NGOs, FBOs and CBOs to improve linkages between the communities and the HIV/AIDS services offered at the hospitals in order to improve access and referrals, and reduce loss to service and provide TA to continue with habilitation and accreditation process.

Continue to expand the Life Skills Program in grades 1-4 in Regions V, VI and VII public schools. In FY2010, AED collaborated with the Ministry of Education in the implementation of the Life Skills modules and trained 91,566 students in 700 primary public schools. It is expected through AED during FY2011, approximately 150,000 students will be trained in the life skills modules. In addition, the Ministry of Education has inserted the Life Skills curricula into the basic education curricula and it will be roll out to all public schools with the support of the World Bank Loan for education. USAID/DR will support the Ministry of Education in the expansion of Life Skills by providing TOT training and technical assistance to MOE to expand Life Skill Program to 1,000 more schools with World Bank and IDB support.

For FY2011, USAID/DR will provide on-going support to AED to fund NGOs, FBOs and CBOs which provide prevention and referral services to women with little or no education, people living in Bateyes, MSMs and CSWs living in Health Regions V and VII. NGOs will continue to provide information and education, through peer-to-peer and small groups to address human rights issues, stigma and discrimination, risk perception, reduction of sexual abuse, condom negotiation with partner(s), reproductive health, and STI prevention. Empowerment of girls/women is promoted to help them have a stronger voice in their sexual lives and thus prevent disease. Education activities targeting these groups addresses harmful social norms, partner reduction, gender-based violence, and transactional and cross-generational sex. The NGOs personnel which includes community based workers, supervisors and leaders have been trained on the DEBI methodology, behavior change strategy and peer education techniques. Educational activities at the community levels include health fairs, community CT, referral to services and door-to-door visits. USG will continue to fund NGOs to reach batey residents and migrants, especially men, in Region V and the border areas and to support PSI mass media campaign messages at the community level. AED will work very closely with PSI to make sure that the most at risk popultion in Region V and VII will have access to condoms. and continue to support the "100% Condom Strategy" carried out by partner NGOs targeting prostitutes, their clients and business owners in areas with commercial sex activity in Region V and the border areas. At these sites, they promote correct and consistent condom use, distribute condoms, encourage decreased use of alcohol and other drugs, promote HIV and STI screening, conduct education activities and distribute prevention information. These NGOs also train sex workers and other women in condom negotiation skills. NGOs also provide referrals to HIV counseling and testing, care and treatment services. In the geographic focus areas, USG will continue to support NGOs providing prevention outreach to MSM, including peer-to-peer counseling in gay bars and other outlets, and referrals to STI and HIV services.

Because of the challenges of reaching highly mobile populations, workplace behavior change activities (e.g. at tourist and bateyes) will help reach them effectively. USG will continue to solicit employer involvement to increase corporate social

AED has continue to provide technical assistance at MOH central level in the revision of the PMTCT and pediatric norms while at the same time continuing to train health teams in the actual norms and protocols in 35 municipal and provincial hospitals in Regions V and VII. During FY2010, AED has also trained health teams in the CQI methodology, supporting the development of quality improvement teams, in order to strengthen PMTCT and e.i.d. services in 35 public hospitals. AED has continued dialoguing with health authorities to obtain approval in order to test the opt-out strategy in two hospitals in Region V and VII.

Strengthening counseling and testing services in 35 hospital sites will include training lay counselors to integrate advice on partners testing, FP, nutrition, tuberculosis, STIs and prevention for positives, etc. and to link PLWHA to services provided in the community by NGOs and faith-based organizations. AED will also continue to strengthen HIV services at the primary level (UNAPS) to provide routine follow-up for pregnant women and their children. In order to do this, AED and MOH have selected 13 health posts and train health providers to provide follow-on care to PLWHA in the community level.

AED will also continue to provide T/A and funds to NGOs, FBOs and CBOs to create awareness in their respective communities, link communities to the health services available at the UNAPS and hospitals to increase the number of pregnant women accessing PMTCT services and reduce the loss of mothers and their infants to follow-up programs; provide emotional and psychological support to HIV positive women and their families.

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