The University of California San Diego (UCSD) provides technical assistance in HIV prevention, care and treatment to the Uniformed Services of Ethiopia (USE), including the National Defense Forces of Ethiopia (NDFE), the Federal and Regional Police of Ethiopia, and the Federal and Regional Prison Administration.

UCSD signed a Memoranda of Understanding with the National Defense Forces of Ethiopia and the Federal Police of Ethiopia to support the coordination of its activities within the USE.

UCSD implements its program through collaboration with the Centers of Disease Control and Prevention Global AIDS Program (CDC-GAP), the Federal Ministry of Defense, Defense Health Department, the Federal Police and Prison Health Institutions, the Federal Ministry of Health, and the HIV/AIDS Prevention and Control Office (HAPCO).

UCSD's geographic coverage is country-wide since USE populations are deployed throughout the country, and currently supports 115 sites, of which 35 provide ART and comprehensive services, and 80 are HCT sites. Of those, 57 are defense sites, 17 are Police Hospitals/Clinics, and 41 are prison health centers. In addition to training of clinicians, UCSD partners with USE Colleges/schools and builds capacity through pre-graduate and postgraduate pre-service training. UCSD also provides technical assistance to these colleges to revise their curricula for health officers and nurses and the integration of major competencies of HIV/AIDS prevention, care and treatment programs into curricula.

UCSD's mission is to assist in establishing and strengthening sustainable programs for HIV prevention, treatment, and care for the USE by:

- Building human capacity for supporting HIV/AIDS care, prevention, treatment and support,

- Improving clinical and laboratory infrastructure,

- Providing technical assistance for the accelerated access of ART by those who need it, in a safe and sustainable manner, and

- Creating and strengthening a civil-military alliance in the areas of HIV prevention, control, care and treatment.

UCSD aims to achieve its goals through strengthening existing institutions, as well as helping create sustainable health services systems by focusing in select program areas. Program areas include ART scale-up activities (adult and pediatric), TB/HIV activities, PMTCT implementation, counseling & testing, palliative care activities (adults and pediatric), site-level data and laboratory support, strengthening STI and other prevention activities, pre-service education support and infection prevention activities.

UCSD's focus has been toward sustainability and fostering ownership of the program by the respective Uniformed Service sectors. To this end, the program has emphasized creating better integration and coordination among partners by providing familiarization workshops, training, review meetings for high-ranking medical and non-medical defense, police and prison administration leaders and involving them in the programs. security issues and the sensitive nature of the military require training of trainers and material support rather than direct interaction with those medical personnel in sensitive locations.

The overall strategy for the next phase will be to strengthen the program that has been created thus far by increasing their size, efficiency, quality, and independence from UCSD-E. UCSD will have emphasize program quality by creating capacity within the respective sectors so as to enable them to carry forth the program with decreasing intervention.

Specifically, strengthening USE educational institutions such as the Defense Health Science Colleges (DHSC) and the Police Nursing School will produce larger numbers of better trained providers. For example, "upgrading" programs such as NDFE's Health Officer to MD; Nurse to Heath Officer; and Junior to Upgrading Nurse courses are initiatives aimed at creating new and improved medical providers at multiple levels. UCSD will continue to improve the skills and confidence of our nurse/providers of ART who have begun to carry a large share of ART care through "task-shifting," but need continuing mentoring and support.

Local systems strengthening by supporting institutions is another such initiative, such as the Federal Police creating a regulatory body which would be responsible for all health-related decision-making; supporting the defense in formulating and implementing their long-term HIV/AIDS policy and strategy; and integrating UCSD- supported technical areas in each of the uniformed service institutions.

UCSD strengthens quality laboratory services within the different uniformed services through which services are delivered. Quality laboratory services are as described by strategic objectives in the lab master plan and implementation strategies devised through joint planning with EHNRI and RHBs. Training and WHO accreditation of laboratories will constitute key strategies for health system strengthening and ensuring sustainability.

In addition, cross cutting issues such as gender are an important aspect of UCSD's work.

UCSD has supported the creation of software which will better enable the uniformed service health institutions by better tracking patients as well as making qualitative information available for better assessment of the treatment program. In addition, a functional M&E structure with data flow and feedback mechanism is in place.

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This is a continuing activity. The University of California at San Diego (UCSD) has supported implementation of ART to the uniformed services at 36 ART sites and three mobile ART units. Activities in COP10 include:

(1) Maintaining technical support to the ART sites in the uniformed services;

(2) Training healthcare workers from health facilities as a gap filling measure;

(3) Training undergraduate and newly trained medical personnel;

(4) Offering clinical mentoring activities to ensure program sustainability through ongoing capacity building;

(5) Working with teams of Defense Health Department, Command Health Services sections, and Division Health Services sections of the NDFE to build their supportive supervisory capacity;

(6) Improving referral linkages to minimize the number of patients lost to follow-up and improving adherence counseling, adherence support and quality of service delivery to optimize ART patient outcomes;

(7) Continuing to collaborate with the Twinning Center to identify qualified professionals who can augment local clinical and system mentoring activities at the uniformed services health facilities;

(8) Addressing the human resource shortage by supporting the government's plan to taskshift and to promote a nurse-centered care model;

(9) Continuing human capacity-building activities by building an HIV/AIDS Resource Center;

(10) Promoting ART via media campaigns;

(11) Supporting PLHIV and others as peer advocates for ART;

(12) Strengthening the case management program;

(13) Supporting the full integration of Prevention with Positives Program in all ART clinics through ongoing training and supportive supervision;

(14) Supporting Continuing Medical Education (CME);

(15) Improving quality of care and treatment at inpatient departments;

(16) Strengthening the collaboration with MARCH projects of defense and police to address barriers to ART initiation, adherence and also promote ART service delivery sites.

Also under this activity in COP10, the partner will undertake basic function restoration (including ensuring consistent supplies of water and electricity) in selected USE care and treatment facilities. The partner being within PEPFAR will play its part in Global Health Initiative (GHI).

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UCSD has been carrying out various activities to make IP part of routine facility level activity, including training for HCWs and non HCWs, awareness raising and advocacy, as well as developing IP hospital management and SOPs in collaboration with the national TWG. UCSD has also focused on TB ward ventilation and MDR/XDR TB prevention activities.

In COP 10, UCSD will continue its support focusing on capacity building, sustainability and quality improvement of IP practices. Activities will include:

Support National Defense Force of Ethiopia (NDFE) industry department for local production of some IP materials;

Purchase and distribute IP materials to 115 health facilities and ensure their proper usage;

Conduct pre-service training for medical students of the USE colleges with special emphasis for environmental health students;

Organize onsite and offsite trainings for health care workers and non-health professionals working in the health facilities;

Create pools of IP trainers in USE by providing ToTs for health professionals working within the defense health department, referral and command hospitals;

Closely work with defense disease prevention and control unit to build their capacity through trainings, mentoring, supportive supervision, and provision of office and supervision materials. The defense disease prevention and control unit together with sanitation departments of the hospitals will be the focus area of technical and material support to make IP activities sustainable;

Conduct regular supportive supervision and support IP committees at health facility level;

Conduct regular review and experience sharing meetings on IP program implementation;

Update and distribute various IEC/BCC materials;

Continue to work on ventilation of TB wards and complement the MDR/XDR TB prevention activities of TB/HIV program;

Continue local capacity building on maintenance of laundry machines and autoclaves by training technicians and responsible workers.

Expand UCSD comprehensive IP activities to 76 sites.

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The University of California at San Diego will support the facilities in its charge to attain and maintain minimum standards set by EHNRI. In FY10, UCSD's laboratory support will include:

Strengthening site-level laboratory quality systems, including EQA/PT panel distribution, standard operational procedures (SOPs) preparation and revision, implementation of standard documentation and recording formats.

Providing supportive supervision, coaching and mentorship to ensure the delivery of high-quality laboratory services as well as systems strengthening, skills transfer, capacity development, and process improvement for accreditation of hospital laboratories.

Providing technical support for uninterrupted laboratory services at all ART sites which entails assisting with the development, implementation and enhancement of laboratory inventory systems in the hospital networks and ensuring availability of reagent supplies at all sites.

Building capacity and carrying out minor renovation and refurbishment of facility-level laboratories to improve laboratory organization, layout and work flow, specimen management, testing procedures, standard documentation, record keeping and reporting, stock and inventory management.

Conducting Standardized trainings using nationally-approved curricula which will include HIV rapid testing, HIV disease monitoring (hematology, clinical chemistry, and CD4), TB smear microscopy, and common OI and STIs diagnosis.

Establishing systems for specimen collection and referral linkages at health centers and/or peripheral hospitals, transportation to nearby laboratories, sample tracking, result reporting and expansion, and sustainability and quality of LIS in UCSD-supported sites.

Providing TA to the early infant diagnosis program and establishing viral load testing facilities, establishing HIV DNA PCR testing capacity at Armed Forces General Teaching Hospital and viral load and TB culture testing at selected facilities as planned by EHNRI.

Supporting three laboratories for accreditation using the WHO-AFRO accreditation scheme.

UCSD will implement its TB/HIV program in line with MOH and OGAC priorities. UCSD will emphasize TB infection prevention (IP), intensified TB case finding and IPT implementation. TB IP will be factored into renovations and refurbishments of health facilities. As a member of the national MDR-TB TWG, UCSD will support MOH's MDR management initiative, both the pilot program at St. Peter's Hospital and the regional expansion plan. To strengthen facilities' TB/HIV HMIS, UCSD will provide training, supportive supervision and mentorship. UCSD will also assist with national and regional review meetings.

UCSD will give more emphasis to pediatric TB diagnosis and TB/HIV co-management. The pediatric TB screening tool and IPT algorithm will be used to evaluate HIV exposed and infected children. UCSD will strengthen PITC for TB patients and refer of eligible co-infected children and adults to HIV services. UCSD will also collaborate with MOH, EHNRI and CDC to establish and strengthen TB culture capacity and initiate MDR-TB management at a uniformed services hospital in Addis Ababa.

UCSD will improve and enhance programs in the existing 35 sites, including prison health facilities with the objectives of reducing the TB burden in people with HIV and vice versa. UCSD will strengthen intensified TB case-finding through screening of people at-risk of HIV and referrals to prompt diagnosis and treatment. TB screening will be established at four regional prisons based on experience from the pilot program at the Central prison. Outreach TB case finding activity will occur at remote police and military camps using mobile teams of clinical and laboratory staff.

TB diagnostic capacity of labs and personnel will be improved through training and supportive supervision. Fluorescent microscopy to diagnose TB will be expanded from four to eight sites. UCSD will support the efforts of MOH, FHAPCO, and CDC to improve TB diagnosis; IPT will be given to eligible adult and pediatric HIV patients. UCSD will help sites establish IP strategies including QA, training, health education, and provision of supplies. UCSD being within PEPFAR will play its part in Global Health Initiative.