DOD will identify a TBD partner to strengthen the capacity of the Dominican Armed Forces (DAF) to plan, manage, and implement HIV programs. Activities will build on previous HSS efforts to develop a military-specific strategic plans, policies and capacity building.

Referral networks and service integration will be strengthened for HIV/STI/TB prevention, care, and treatment. Gender norms, substance abuse and confidentiality currently are not approved military policies. DOD policy dialogue will seek to secure the endorsement of military leadership to include these areas in their training program.

Opportunities to strengthen pre-service and in-service training will be expanded and improved for military health care providers in multidisciplinary fields, including STIs, ART management, psychosocial counseling. Military personnel will be trained on how to use HIV surveillance to improve HIV prevention programming.

The DOD will continue to support the provision of quality HIV care for DAF personnel, their partners and families, and in select circumstances, community members who live in the surrounding areas. Basic care provided by military health services to HIV-positive personnel will include clinical staging and baseline CD4 counts, immunologic (i.e. CD4 cell count) and clinical monitoring, prevention, diagnosis and treatment of OIs, psychosocial counseling, and referrals for PLWHA to community-based care and support services based on individual needs.

This activity will enhance the capacity of the health workforce by training military health providers to diagnosis and treat STIs, OIs, and mental health disorders. Training will also include prevention with positives, activities to improve health care providers' abilities to effectively counsel military members on healthy living, reduction of risk behaviors, partner notification and adherence to ART. Efforts will be made to address stigma and discrimination by promoting accepting attitudes towards PLWHA.

Basic care and support activities are implemented in conjunction with other services such as VCT, ART, TB/HIV, OIs, and/or STIs in military delivery settings. TA will be provided to the DAF to strengthen linkages to community-based HIV care and support groups

The DOD will continue to support the provision of quality HIV care for DAF personnel, their partners and families, and in select circumstances, community members who live in the surrounding areas. Basic care provided by military health services to HIV-positive personnel will include clinical staging and baseline CD4 counts, immunologic (i.e. CD4 cell count) and clinical monitoring, prevention, diagnosis and treatment of OIs, psychosocial counseling, and referrals for PLWHA to community-based care and support services based on individual needs.

This activity will enhance the capacity of the health workforce by training military health providers to diagnosis and treat STIs, OIs, and mental health disorders. Training will also include prevention with positives, activities to improve health care providers' abilities to effectively counsel military members on healthy living, reduction of risk behaviors, partner notification and adherence to ART. Efforts will be made to address stigma and discrimination by promoting accepting attitudes towards PLWHA.

Using PF FY2010 funds, DOD and a TBD partner will continue to strengthen the capacity of DAF to provide accessible, confidential, and quality testing and counseling services. Activities will build on previously funded initiatives to expand testing and counseling services for military personnel, their families, and communities in close proximity to military installations. DOD will continue to work with DAF to integrate VCT services into existing medical health services and routine medical care through provider-initiated testing and counseling (PITC). VCT opportunities for military personnel will be further expanded to include four new VCT sites. A referral system to ensure appropriate linkages to prevention, treatment, and care and other health services will be reinforced.

DOD will continue to partner with the DAF to assist in the procurement of rapid HIV test kits and work with national supply chain mechanisms to ensure sites have sufficient supply, adequate and secure storage facilities, as well as inventory monitoring and tracking systems for HIV test kits. Activities will build on the previously established monitoring and evaluation system implemented through standardized logbooks, client data forms, monthly reporting forms, and other methods that comply with the national reporting systems and requirements.

Using the findings from a BSS with biological markers which will be conducted in 2010 (funded with FY2008 dollars), the DAF will conduct data dissemination seminars and undertake a critical review of the armed forces training curriculum. This review will ensure that BSS results and conclusions are appropriately incorporated into the armed forces training program, policies and prevention interventions.

Program monitoring and evaluation will be supported in a culture of informed decision making. Data collection systems in the clinical and prevention settings will be assessed. Recommendations will be provided for strengthening data collection and its appropriate use.

DOD will work with DAF to ensure the updated military strategic plan is properly implemented and reinforced across service components (strategic plan developed by a TBD partner using FY 2009 funding). DOD will continue efforts to strengthen military protocols that reduce stigma and discrimination and strengthen the commitment of the military leadership to support HIV-positive members and HIV programs.

2. DOD will continue to emphasize the importance of good storage practices and inventory systems in central and peripheral military warehouses. This activity will also provide human capacity assistance to the DAF in epidemiology, M&E, blood safety, and laboratory. DOD will also continue supporting the development of physical space and equipment in DAF health centers in order to adequately manage STI/HIV/AIDS and TB related programs

DOD will identify TBD partners to provide training and technical assistance in evidence based intervention areas (i.e. improving knowledge and attitudes about testing and decreasing HIV-related stigma). DOD will continue to implement troop level HIV prevention education and behavior change communication activities. DOD will identify TBD partners to implement the IEC strategy developed by USG PEPFAR for MARPs. The IEC strategy will be implemented throughout the DAF. DOD will also evaluate the DAF master trainer/peer educator HIV prevention training program to identify areas in need of strengthening and to develop tailored refresher training for DAF training cadre.

DOD will continue to support the training of DAF lab personnel and provide necessary support for equipment and commodities to develop and strengthen laboratory systems and facilities. Continued support will also be provided for laboratory specimen collection and transport. DAF laboratory personnel will be continue to receive training in laboratory SOP development, logistics management, QA/QC activities, utilization of laboratory equipment, and data management. Military laboratories will be further strengthened to provide referral systems to civilian sector labs where resources limit diagnostic and treatment service provision within the military health system. DOD will also establish basic laboratory testing capability at (6) VCT sites (established with FY09[h1] HVCT).