APRIL 2009 REPROGRAMMING

TA provision from CDC to Amhara region to trinagulate existing data and provide training on rapid

assessment using this tool.

This activity will focus on TA support mainly on training for the International Rapid Response and Evaluation

(I-RARE) activity using Rapid Assessment Methodologies and Qualitative Analysis Techniques to

Understand and Respond to the HIV Epidemic in Vulnerable Populations in particular in Amhara region.

New/Continuing Activity: New Activity

Continuing Activity:

Table 3.3.02:

International Rapid Response and Evaluation (I-RARE)

This is a new activity for COP09.

Using Rapid Assessment Methodologies and Qualitative Analysis Techniques to Understand and Respond

to the HIV Epidemic in Vulnerable Populations

This training package is designed to provide public health researchers with the skills to conduct and analyse

qualitative data using the International Rapid Assessment, Response and Evaluation (I-RARE) technique

developed by the US Health and Human Service/Centers for Disease Control and Prevention (CDC)/Global

AIDS Program (GAP). Upon completion of the modules, researchers and field workers will understand how

to collect and analyze data to assess and respond to local health needs and how to evaluate existing

programs addressing those local health needs.

I-RARE is especially suited for gathering information from vulnerable populations such as drug users,

commercial sex workers and men who have sex with men. These groups are particularly vulnerable

because they engage in illegal or socially stigmatised behaviours and have less access to social and health

services than do members of the general population. Vulnerable populations are also more difficult for

researchers to access and understanding their risk behaviours and health needs require creative research

techniques such as I-RARE.

Rapid assessment involves gathering data from those who are directly part of or work closely with

populations of interest. Data can be collected from interviews, group meetings, and by mapping and

observing key locations where these populations spend time. Using many methods to gather qualitative

data is essential to understanding and highlighting the key health issues that exist in these groups. Rapid

assessment is a relatively quick and inexpensive method for collecting locally relevant data about emerging

patterns of risk behaviours.

Rapid assessment and response programs have a documented history of success in public health,

particularly in international settings. Methodologically sound rapid assessment methods have typically

provided timely data for addressing public health issues such as HIV/AIDS, substance abuse, family

planning, malaria, diarrhoeal disease, dengue fever, water sanitation, and disaster intervention.

Overview:

This I-RARE training curriculum package relies heavily on the content and guidelines that were already

developed by several international organizations (WHO, UNAIDS, UNODC). This is the first production of a

comprehensive training package for rapid assessment methods and qualitative data analysis that includes

training materials for principal investigators (PIs) and field team members. The PIs, field managers and

field coordinators will be managing the data collection and analysis process. The field team members will

be working in the community collecting data.

Goal:

The goal of the I-RARE training package is to provide rapid assessment teams with the skills necessary to:

1)plan, manage and conduct rapid assessments, and

2) analyze qualitative data in order to define and respond to the HIV epidemic (or other health issue) in drug

using (or other vulnerable) populations.

The I-RARE training curriculum package will guide participants through the actual implementation of a rapid

assessment. The first component focuses on data collection methods used in rapid assessment. The

second component focuses on data analysis. This training curriculum is designed to allow participants to

sequentially learn rapid assessment techniques in the following order:

?Understanding of qualitative methods

?Practicing data collection

?Analyzing data collected through qualitative methods.

Purpose:

The I-RARE training curriculum package is made up of two components: The I-RARE Methods Training

Curriculum and the I-RARE Analysis Training Curriculum.

In each component there are separate "Trainer" and "Participant" manuals.

The Trainer's manual provides "Tips for Trainers" in the introduction section. Each Trainer's unit contains

the following information:

?Unit overview

?Stated purpose of the unit

?Unit objectives

?Rrecommended duration of the unit

?Key messages

?Necessary preparation, and

?Corresponding materials.

Also included in each trainer's unit are:

?PowerPoint unit slides with extensive training notes, and

?Exercises encouraging hands-on participation

The Participant's manual consists of the PowerPoint slides with space available for taking notes.

Activity Narrative: The focus of the training package is on the assessment of drug users and their HIV risk behaviors.

However, the training package can be adapted for any vulnerable population and for use in different public

health contexts. The assessments can be modified in terms of the sample sizes, the mixture of methods

used, and the focus of the information collection to meet and accommodate local needs and conditions.

The curriculum contains comprehensive teaching notes and PowerPoint slides for each training unit. It is

important that the trainers using the curriculum package have experience with qualitative methods and

analysis and the skills to train others about these concepts.

New/Continuing Activity: New Activity

Continuing Activity:

Emphasis Areas

Gender

* Addressing male norms and behaviors

* Increasing gender equity in HIV/AIDS programs

* Increasing women's legal rights

* Reducing violence and coercion

Human Capacity Development

Public Health Evaluation

Food and Nutrition: Policy, Tools, and Service Delivery

Food and Nutrition: Commodities

Economic Strengthening

Education

Water

Table 3.3.03:

Laboratory infrastructure

ACTIVITY HAS BEEN MODIFIED IN THE FOLLOWING WAYS:

In FY09, CDC Ethiopia will support integrated laboratory services according to the national laboratory

strategic plan. CDC-Ethiopia will support the establishment of viral load testing at regional laboratories that

would serve as reference sites for their region. Support procurement of equipments and laboratory

furnitures for newly renovated laboratories. Also CDC Ethiopia will support procurement of biosafety,

diagnostics and monitoring equipments for medical laboratory technologist training schools. Furthermore,

collaborate with EHNRI and international laboratory branch to leverage resources to set up a regional

laboratory training center. Support expansion of DNA PCR for early infant diagnosis to 6 additional regional

laboratories.

PEPFAR Ethiopia, in collaboration with MOH, is strengthening regional, hospital and health center

laboratories to support HIV/AIDS prevention, care, and treatment programs. CDC Ethiopia coordinated and

led all laboratory related services implemented by PEPFAR implementing partners including training,

laboratory diagnosis and monitoring tests at hospital and health center level, referral diagnostic services

(CD4, infant diagnosis, and viral load tests).

In FY08, CDC Ethiopia supported the establishment of a national HIV referral laboratory at EHNRI to meet

National standards and in line with the national laboratory strategic plan. Furthermore, CDC Ethiopia will

work closely with EHNRI to support an integrated laboratory approach as well as implementation of the

"Maputo Declaration on Strengthening of Laboratory Systems" The national referral lab has been fully

networked with IT equipment and broadband internet connectivity. This national laboratory is used as a

model facility for training and coordinating laboratory quality assurance in the country. All ART monitoring

analyzers are installed and the referral lab was supporting the referral testing for ART program. Early infant

diagnosis (EID) equipment was provided and assisted the referral laboratory to provide referral infant

diagnosis of HIV. The new HIV rapid testing algorithm has been finalized for use and training of trainers on

HIV rapid testing using the new algorithm has been conducted.

In FY08, technical assistance was provided for regional roll out and decentralization of laboratory training in

HIV rapid testing, integrated laboratory training, laboratory management and lab quality system. A

standardized HIV rapid test log book to capture rapid test results at testing facilities has been developed

and piloted at five sites in Addis Ababa. DNA PCR testing for EID was successfully implemented at six

regional laboratories including all the six regional laboratories, and each was successfully enrolled into

external quality assurance programs for proficiency testing on DNA PCR. PEPFAR Ethiopia also supported

the national referral laboratory to conduct the following targeted evaluations: Implementation of HIV-1 drug

resistance genotyping assay including procurement of reagents, equipments and software; and

implementation of Dried Tube Spot (DTS) to support quality assurance for rapid HIV testing, defining the

reference ranges of hematology/chemistry profile.

All the activities started in FY08 will continue in FY09 with emphasis on sustainability and an integrated

laboratory approach to include sexually transmitted infections (STI), opportunistic infections (OI), malaria

and Avian influenza (AI). Collaboration with the President's Malaria Initiative (PMI) to improve quality of

malaria laboratory diagnosis has already started. The activities include to continuously support all laboratory

trainings, and implementation of national quality assurance program at all levels. CDC Ethiopia will lead and

coordinate all laboratory activities under PEPFAR support. Technical assistance will be provided to EHNRI

to strengthen the tiered quality laboratory services in the country and implement the national laboratory

strategic plan. The National HIV laboratory will be supported to upgrade the facility to Biosafety level three

(BSL3) to improve the containment for some specialized tests as referral center for country. Additionally,

support will be provided for the upgrade of 6 regional laboratories to support TB culture and molecular

diagnostics as well as evaluation of different filter papers for collection of infant specimens.

There will be support including furnishing with basic equipment provided to six additional regional

laboratories that will serve as regional referral hubs; as well as safety and equipments for establishment of

DNA PCR set ups at sub-regional or referral hospital laboratories renovated by University partners at

different regions. Support for the development, printing of laboratory guidelines, standard operating

procedures including standardization of logbooks and forms will continue.

CDC Ethiopia will facilitate and support national and regional laboratories review meeting for PEPFAR

supported program, and will coordinate periodic site level supportive supervision, mentoring and monitoring.

Furthermore, technical assistance will be provided to strengthen tiered laboratory services, referral

networking and expansion of Laboratory information system to hospital and health center facilities through

training and troubleshooting of difficulties experienced with the system.

There will also be support for the establishment of viral load testing for advanced clinical monitoring at

regional laboratories that would serve as reference sites for their regions. This will entail the preparation of a

standard training curriculum, training of trainers (TOT), purchase of reagents and other consumables for

training, development of materials to follow up and assess TOT post training.

CDC Ethiopia will support procurement of equipments and other laboratory furniture for newly renovated

regional laboratories that are expected to be completed in FY09 fiscal year.

CDC Ethiopia will support launching and implementation of laboratory management tools. This training

manual or curriculum developed by CDC Atlanta and covers all level of the lab tiered system will equip lab

directors, leaders or manager on how to properly direct, manage and supervise laboratory for quality

laboratory services.

CDC Ethiopia will work with EHNRI in collaboration with CDC Atlanta international laboratory branch to

leverage resources to set up a regional laboratory training center.

Activity Narrative: There will be support for strong monitoring and evaluation of laboratory service including standardization of

lab forms, recording keeping, reporting support tools to including laboratory test request, referral forms,

reporting forms and joint site supervision. Support the national and regional database system for laboratory

reporting system for laboratory based surveillance and detection, typing and drug susceptibility surveys.

New/Continuing Activity: Continuing Activity

Continuing Activity: 16615

Continued Associated Activity Information

Activity Activity ID USG Agency Prime Partner Mechanism Mechanism ID Mechanism Planned Funds

System ID System ID

16615 5628.08 HHS/Centers for US Centers for 7482 3792.08 Rapid expansion $898,000

Disease Control & Disease Control of successful

Prevention and Prevention and innovative

treatment

programs

10599 5628.07 HHS/Centers for US Centers for 5480 3792.07 $750,000

Disease Control & Disease Control

Prevention and Prevention

5628 5628.06 HHS/Centers for US Centers for 3792 3792.06 $700,000

Disease Control & Disease Control

Prevention and Prevention

Table 3.3.16:

Strengthening National HIV/AIDS/STI Surveillance Systems

ACTIVITY HAS BEEN MODIFIED IN THE FOLLOWING WAYS

The Ethiopian Health and Nutrition Research Institute (EHNRI) will continue to serve as the national lead

responsible for all HIV and related surveillance, and will continue to coordinate and finance the regional

Health Bureau's to help them support the related activities. In COP08, EHNRI produced and disseminated

the 7TH AIDS in Ethiopia report that was prepared mainly based on the results of the 2007 round of ANC

based HIV surveillance that involved the participation of ANC providing centers located in 108 of the health

facilities in the country. Support was also provided to all the preparatory works for the 2009 round of ANC

based HIV surveillance including for the selection of additional sites, capacity assessment of existing sites

and the conduct of national and regional review and planning meetings. Guidelines were developed,

finalized, and piloted for TB/HIV and HIV surveillance among blood donors and among commercial sex

workers. Sites for the conduct of TB/HIV and HIV surveillance among blood donors were selected by the

close collaboration between and among EHNRI regional health bureaus and the Ethiopian Red Cross

Society.

Data collection for the 2009 round ANC-based, sentinel- HIV surveillance activities will be supported in all

108 existing sites. Additional rural sites will be identified to increase the representativeness of the data and

assist in producing more valid local HIV estimates and improve the data quality. Over 1000 health workers

drawn from all sentinel sites for the ANC based HIV surveillance will be trained through regional trainers

that will be trained as trainers of trainee (TOT) at the national level. Support will also be continued to other

surveillance activities including: data collection, sample transport, provision of test kits, and other

supplies/equipments to be used by sites. Support will also be provided for supervisory visits and national

and regional review workshops. Dissemination of the ANC based HIV surveillance findings will also be

supported by PEPFAR.

]Support for non ANC-based HIV surveillance systems including TB/HIV surveillance and HIV surveillance

among blood donors will be continued. Activities related to review of the manuals; provision of relevant

trainings, data collection, processing and dissemination will be supported.

Preliminary findings of a study that was conducted to look at the prevalence of HIV and STIs and associated

risk behaviors among Most at Risk Population (MARPs) in Amhara region (official results to be released by

Amhara Health Bureau and HAPCO soon) has shown that some locally relevant MARPs may be driving the

HIV epidemic in the region. The importance of such surveillance programs/studies is now becoming

increasingly important. This is so because the low level generalized HIV epidemic in Ethiopia is more likely

to be driven by factors among locally relevant MARPs. The information currently available on MARPS is

very limited. As the trends of infection and behaviors in these population groups need to be more reliably

and consistently estimated, PEPFAR Ethiopia will continue its support for the design and implementation of

surveillance systems that consistently generate, analyze, and disseminate information that can be used for

making programmatic and policy decisions. In FY09, surveillance systems that monitor levels of HIV

infection and risk behaviors among commercial sex workers will be strengthened and implemented.

Moreover, surveillance systems that monitor levels of HIV infection and risk behaviors among mobile

population and uniformed services will be developed and piloted.

EHNRI will also undertake an HIV surveillance activity (BED assay) to estimate the extent of new HIV

infections in the country. Appropriate protocols related to this will be developed and stored blood samples

collected in previous ANC based HIV surveillance rounds as well as those collected in the 2009 round will

be used for the testing. The results of this assay will help to corroborate the data from other HIV

surveillance sources and to identify trends in new HIV infections.

PEPFAR Ethiopia will also support EHNRI to build the capacity of regions for undertaking surveillance

activities and enable them to better understand HIV surveillance data for decision making. Hence training of

regional and central staff in electronic data processing using EPI info, GIS and other analysis softwares will

be provided. Key surveillance staff will also participate in experience sharing workshops and trainings

abroad and in country to address the challenges and share best practices and lessons learned. (Eight staff

for abroad and 15-20 in country experience sharing events).

COP08 NARRATIVE

CDC-Ethiopia technical staff provides direct technical assistance to the Federal Ministry of Health (MOH) of

Ethiopia, as well its component parts, the Ethiopian Health and Nutrition Research Institute (EHNRI) and the

HIV/AIDS Prevention and Control Office (HAPCO) and the nongovernmental Ethiopian Public Health

Association (EPHA) in the areas of surveillance and blood safety.

In FY07, CDC Ethiopia completed several activities within the scope of technical assistance provision to

MOH, EHNRI, HAPCO and EPHA. CDC Ethiopia's main activities were:

1) Expanding antenatal care-based HIV surveillance through training of national and regional surveillance

officers, antenatal care (ANC) clinic and laboratory staffs, and supervision of data collection at sentinel ANC

sites

2) Conducting site assessments for AIDS Mortality surveillance

3) Technical assistance for the finalization of guidelines for HIV case, tuberculosis (TB)/HIV and sexually

transmitted infections (STI) surveillance

4) Technical assistance for HIV/STI and risk-behavior surveillance among most-at-risk population (MARPs)

and survey to identify the routes of spread of HIV from "hot spots" to rural areas. Findings from these

targeted evaluations will be used to design and implement effective interventions to MARPs and rural areas.

5) Sponsorship of technical assistance visits from international subject-matter experts related to leadership

for strategic information training, TB/HIV surveillance, and HIV case surveillance

These activities have helped PEPFAR Ethiopia and the Government of Ethiopia to generate, capture,

analyze, disseminate, and use quality strategic information to guide the planning, implementation, and

monitoring and evaluation of HIV/AID prevention, care, and treatment programs.

Activity Narrative: In FY08, CDC Ethiopia will focus on the provision of technical assistance to MOH, EHNRI, Federal HAPCO,

and EPHA in the areas of:

1) Implementing of HIV case surveillance

2) Expansion of the Leadership for Strategic Information Training and its development to the Field

Epidemiology and Laboratory Training (FELTP) and further implementation based on the needs of the MOH

3) Full implementation of TB/HIV surveillance

4) Implementation of ART drug-resistance surveillance

5) Successful completion of public health evaluations (PHE) that focus on all PEPFAR-supported

interventions

6) Capture, compilation, analysis, dissemination, and use of data generated from these surveillance

activities

7) Building the capacity of EHNRI and EPHA so that they can provide adequate technical support to

regional health bureaus (RHB), laboratories, and surveillance sites

Through these activities, PEPFAR Ethiopia will strengthen the leadership, technical, and managerial

capacity of EHNRI and RHB to absorb and respond to the increasing needs for evidence-informed

surveillance information for policy- and decision-making on HIV/AIDS in particular. and public health in

general.

Information Communications Technology (ICT) Support:

This is continuing activity from FY07. In FY07, PEPFAR Ethiopia has been supporting the development and

upgrade of the MOH and EHNRI comprehensive information technology (IT) network infrastructure,

including internet connectivity and human-capacity development for sustainable functioning of the system.

In FY07, PEPFAR Ethiopia conducted a system study for deploying a computer network within the RHB and

identified gaps.

In FY08, PEPFAR Ethiopia will deploy the computer network and establish the interconnection of five RHB.

PEPFAR will also continue to provide support for MOH and EHNRI on information and communications

technology to meet their new requirements, including expansion of their LAN/WAN system. With this

activity, all seven sites will be supported with the procurement of IT equipment, deployment of LAN/WAN

systems, provision of broadband connectivity, maintenance support, and advanced training for ICT staffs of

the partner organizations. This will ensure that the available communication technologies are sufficient to

enable the health sector to improve services, as well as enhancing the accuracy, quality, and timely flow of

health information (to the Health Management Information System, Human Resources, and Finance, among

others).

New/Continuing Activity: Continuing Activity

Continuing Activity: 16616

Continued Associated Activity Information

Activity Activity ID USG Agency Prime Partner Mechanism Mechanism ID Mechanism Planned Funds

System ID System ID

16616 10443.08 HHS/Centers for US Centers for 7482 3792.08 Rapid expansion $587,800

Disease Control & Disease Control of successful

Prevention and Prevention and innovative

treatment

programs

Emphasis Areas

Human Capacity Development

Estimated amount of funding that is planned for Human Capacity Development $100,000

Public Health Evaluation

Food and Nutrition: Policy, Tools, and Service Delivery

Food and Nutrition: Commodities

Economic Strengthening

Education

Water

Table 3.3.17:

Sustainable Management Development Program

ACTIVITY WITH ONLY MINOR CHANGES FROM FY2008

This is a continuation of activity from FY08. This is linked with PEPFAR Ethiopia-supported human capacity

development activities aimed at strengthening the implementation of the Sustainable Management

Development Program (SMDP) to improve the management and training skills of public health management

professionals, health service planners and managers in Ethiopia in HIV/AIDS program.

In FY07, CDC Ethiopia, with technical assistance from the SMDP program at CDC Global AIDS Program

(GAP) headquarters, conducted a needs assessment to design strategies for strengthening leadership and

management of HIV/AIDS prevention, care and treatment services at health facilities in support of the scale-

up of antiretroviral treatment (ART) in Ethiopia. Based on the result of the assessment, the first training was

conducted in March 2008 for 25 laboratory mangers from all regions on laboratory process improvement.

The participant will apply to their respective work to improve specific activities of laboratory management.

The result will be assessed in six months time.

In FY09, further trainings will be designed and provided for 60 public health management professionals

drawn from PEPFAR-supported hospitals, RHB, and HAPCO. CDC Ethiopia will also follow up on the main

SMDP components such as process improvement/problem solving, Total Quality management (TQM),

healthy planning, and strategic communications, all in collaboration with FMOH/HAPCO, health facilities,

US-based universities and agencies (Carter Center, Clinton Foundation), local universities, and health-

related training institutions in Ethiopia. In FY09, the focus will be on the regional HAPCO and Health Bureau

capacity building. In addition to health professionals trained in FY06 and FY07, in FY08, 3 professionals

received training on SMDP in Atlanta and this has increased the numbers of trainers' work force to scale up

the training.

The SMDP approach actively involves all local stakeholders, including health facilities, local universities and

training institutions in human capacity development, planning and management of public health services,

process improvements, and quality assurance mechanisms in an integrated and innovative approach. As

such, the SMDP trainings will be sustained and institutionalized at local health facilities and training

institutions. Accordingly, 20% of the required budget will be expended on training material design and

adaptation with technical assistance from CDC/GAP SMDP, 45% on training material production, delivery

and management, and 35% on follow up of the SMDP training program application at health facilities at

central, regional and local levels.

New/Continuing Activity: Continuing Activity

Continuing Activity: 18884

Continued Associated Activity Information

Activity Activity ID USG Agency Prime Partner Mechanism Mechanism ID Mechanism Planned Funds

System ID System ID

18884 18884.08 HHS/Centers for US Centers for 7482 3792.08 Rapid expansion $120,000

Disease Control & Disease Control of successful

Prevention and Prevention and innovative

treatment

programs

Table 3.3.18: