This is a new Implementing Mechanism which will replace the "track 1.0" mechanism which is planned to terminate in February 2012. This mechanism will continue the provision of comprehensive HIV prevention, care and support, and treatment services that have been initiated under the PEPFAR-funded HHS/CDC and HHS/HRSA HIV clinical services and antiretroviral treatment programs. This implementing mechanism will allow successful transition of the "track 1.0" activities to local partner(s) with close support and mentoring by an external international implementing partner (IP) so that the quality of service delivery will not be compromised and there will not be any untoward disruption of services during the transition process.

The international partner will continue to implement activities at site, regional and national levels that cannot be currently transitioned to local partner(s) until the local partner(s) reach the capacity to take over these responsibilities. The partner will develop an operational plan to implement transition of organizational and technical functions in all program activities to its counterpart local partner(s). It will support its local partner counterpart(s) in building their financial management, administrative and technical capacity to assume more responsibilities and activities progressively.

The International IP will provide technical assistance and support implementation of innovative, effective, and ethical programs to ensure provision of comprehensive, family-focused and quality HIV services, while also building the capacity of local institutions and transitioning responsibilities in a phased and incremental manner. The International IP will support the full continuum of HIV-related services. The IP provides intensive support to HIV counseling and testing; adult and pediatric HIV care and support, and antiretroviral therapy (ART); PMTCT; TB/HIV integration; STI/HIV integration; laboratory systems and infrastructure; strategic information; peer workers program; outreach services and community mobilization; PLHIV associations; capacity building to enhance local ownership, smooth transition and program sustainability.

The International IP will:

Establish strong strategic relationship with the Federal Ministry of Health (FMOH), federal HIV Prevention and Control Office (FHAPCO), Ethiopian Health and Nutrition Research Institute (EHNRI), Regional Health Bureaus (RHB), local universities, the Network of Associations of HIV Positive Ethiopians (NEP+), and other partners;

In line with the overarching goal of PEPFAR in Ethiopia, develop scopes of work and implementation strategies that are fully integrated and consistent with the national HIV program;

Respond to changes in the national HIV program orientation and evolving standards of care;

Address critical health system issues related to human resource challenges, logistical concerns and infrastructure limitations;

Build the capacity of its key partners and in particular augment the ability of RHB to plan and manage key aspects of HIV related service programming;

The International IP will work to strengthen the health system by supporting the FMOH/FHAPCO, the four RHB, the two Regional Laboratories, and 70 care and treatment facilities in its operational zone. It will support system strengthening and transfer of skills and competencies to FMOH departments, RHB and regional teams, and care providers. National level support will focus on capacity building and technical assistance in key areas including pediatric care and treatment, TB/HIV integration, malaria/HIV integration, and support to PLHIV associations.

The International IP will support the Government of Ethiopia (GOE) in its efforts to alleviate the shortages in human resources for health. It will support task shifting, non-monetary incentives for clinicians and staffing for program management at all levels. The partner will support Jimma and Haramaya universities to enable them to mainstream HIV into their training programs and serve as regional hubs for training and technical assistance for HIV programs.

In collaboration with WFP, UNICEF and other partners, the partner will continue expanding nutritional counseling, assessment and support at all service delivery sites as well as linking sites with organizations providing food support and "food by prescription".

The partner will work with the GOE and WHO/UNICEF to promote harmonization of HIV activities with child survival initiatives and support relevant MNCH interventions to reduce maternal and neonatal mortality. In collaboration with RHB, ITN will be made available to all HIV infected individuals living in malaria endemic areas. It will work with the PMI project to enhance malaria diagnosis and treatment. It will partner with PSI to expand provision of safe drinking water to clients. It will also support expansion of mobile counseling and testing services to nomadic, hard-to-reach and underserved populations.

The International IP will provide support to strengthen the monitoring and evaluation (M&E) systems at national, regional and site levels in accordance with the "three ones" principle. The partner will support sites to implement the nationally approved health management information system. It will focus on regional and site level capacity building to enhance the utilization of self assessment tools and to build further site-level capacity for data analysis and evidence-based program monitoring and improvement, and integration of HIV information to the national HMIS. It will support health care delivery sites and RHB to further strengthen recording and reporting systems to improve on data quality and information flow. Through its monitoring and evaluation teams, the partner will provide direct technical direction, supervision, and support implementation of the M & E activities. The partner will monitor the transition of responsibilities to RHB and other relevant local partners based on joint work plans. The partner will support improved maternal and neonatal emergency services to increase demand for ANC and delivery and thereby improve PMTCT uptake.

In COP09 and 10, ICAP-CU supported basic palliative care services via a multidisciplinary family-focused approach at 55 facilities and will increase the number of facilities supported to 60 in COP11. A new FOA will be developed as a Track One transition mechanism. In COP11, the partner will collaborate with FMOH and other USG and Non-USG funded organizations to complement its activities. The activities included: an initial site assessment; training of the multidisciplinary team; site-level clinical mentoring; supportive supervision; minor renovations; identifying and managing symptoms, pain, and discomfort; provision of CPT, tuberculosis screening and IPT; provision of multivitamins; nutritional assessments; and linkage to nutritional support providing organizations and the complete package of prevention with positives (PwP).

The PwP package includes: health education on positive living; ITN distribution and utilization through links with Global Fund; condom promotion, demonstration and distribution; and linkages to family planning service and integration of family planning service in the ART clinic.

Data collection and reporting will be emphasized to monitor and evaluate the activities. Mechanisms of implementation of the activities at facility level are as follows:

1. Strengthen internal and external linkages.

2. Provide training on palliative care and the preventive care package for multi-disciplinary teams.

3. Train health providers with Ethiopian Five HIV prevention Steps for People Living with HIV/AIDS materials. The partner would also translate, duplicate and distribute posters, pocket cards and other job aids to be used for PwP efforts in all supported facilities. The partner would ensure that PwP activities are properly monitored and reported periodically.

4. Strengthen routine nutritional assessment at health facilities

5. Promote pharmacologic and non-pharmacologic interventions to ease distressing pain and symptoms.

6. Continue patient management after hospital discharge through linkages with community support organizations.

As a member of the National and Regional Technical Working Group on Palliative Care, the partner will also continue to contribute to the development and updating of national palliative care guidelines, procedures, and standards. The partner being within PEPFAR will play its part in Global Health Initiative

This is a new "track 1.0 follow-on" activity which will start under a new mechanism which is planned to replace the track 1 mechanism which will come to an end after February 2012. This activity will continue and build on the achievements of the activities implemented by the track 1.0 partners currently operating in Ethiopia while transitioning specific, selected activities to local partner(s). The transition of activities should be smooth, and will be facilitated by the close support and mentoring of this implementing partner so that quality of service delivery will not be compromised and there will not be any untoward disruption of services. The partner will develop an operational plan to implement transition of organizational and technical functions in all program activities to local partners. It will support its local partner counterpart(s) in building their financial management, administrative and technical capacity to assume more responsibilities and activities in the regions.

The partner will continue to implement those activities at site, regional and federal levels that cannot be currently transitioned to local partner(s). The geographic area and supported facilities consist of hospitals in Oromia administrative region, and both health centers and hospitals in Harari and Somali administrative regions and Dire-Dawa City administration. The activities include technical support in comprehensive care and treatment, prevention, data and information systems, and health systems strengthening. The partner will support these activities at the care and treatment facilities, the respective Regional Health Bureau (RHB) and Federal Ministry of Health (FMOH)/Federal HAPCO. It will provide site level support through training, clinical mentoring, supportive supervision, strengthening the multi-disciplinary team, minor renovations etc&. It will work closely with other PEPFAR implementing partners, federal and regional governmental institutions, other relevant local partners and community level services to strengthen the health network and referral linkages in its operational zone. It will support care and treatment facilities to have and maintain optimal working space and basic functions for provision of quality care and treatment services. The partner will provide technical support and build capacity of local universities in its area to maximize their engagement and contribution to the HIV program activities in their university communities, affiliated and catchment health facilities, and regional and national levels as appropriate. It will undertake and support regular review and planning meetings to evaluate, monitor and improve program implementation and coordination. It will put in place systems to improve quality of service delivery for optimal outcomes.

The partner being within PEPFAR will play its part in Global Health Initiative (GHI).

In COP10, ICAP-CU supported HIV testing and counseling (HTC) services at 65 facilities in 4 regions of Ethiopia. ICAP-CU trained more than 500 service providers and supported provision of HTC services to more than 500,000 clients in the first semiannual period. In collaboration with Somali RHBs, ICAP-CU provided mobile HCT services to nomadic, pastoralist population.

In COP11, a new FOA will be developed as a track one transition mechanism. The partner will support HTC services at 60 health facilities in Dire Dawa, Harari, Oromiya, and Somali Regions, where it is providing comprehensive HIV services. Technical assistance will be provided to reach the population of the 4 regions, to extend TC services to the most vulnerable groups such as prisoners & construction project; to reach the underserved pastoralist population; for the most -at-risk populations in the corridor along Hargessa route in the Somali region, and students and the university community of Jimma and Haramaya Universities. The partner will work in collaboration with radio stations on mass education on HTC in 3 local languages, develop and distribute promotional materials such as leaflets and posters to reach the target population with the services.

The partner will support client-initiated HTC and, provider initiated HTC (including for married couples), Clients will be provided with HTC services in the in-inpatient wards (adult and pediatric) and the outpatient settings, and TB & STI clinics. National HTC campaigns will be supported and outreach and weekend HCT services provided in line with the national AIDS Campaign and other local initiatives. In collaboration with partners, the partner will ensure availability of HTC supplies, test kits and equipment, the quality HCT services through supporting refurbishment and minor renovations. The partner will contribute in the development of policy & guidelines, formats, standards for HCT services, training aids, and provision of seminars, onsite trainings, case presentations and updates to health providers.

The partner will support partners to strengthen HTC service delivery and program management in implementing supportive supervision, analysis of standard of care (SOC) and use of monthly, quarterly, bi-annual and annual reports. The partner will establish and strengthen external referral linkages between hospitals and NGO, FBO, and support groups/associations for PLHIV and strengthen exchange of reports on referral and linkages.

The budget for this activity Redacted. ICAP-CU is playing a lead role in pediatric care and support (C&S) programs. In FY 2009, ICAP-CU supported basic pediatric C&S services at 40 facilities. Activities included initial assessment of site-level palliative care services, training of the multidisciplinary teams, clinical mentoring, data collection and reporting, and supportive supervision. Quality of pediatric HIV care and treatment service was assessed and monitored using ICAP SOC. Other activities included training and supervision on providing CTX, TB screening, and nutritional assessments. Pediatric services were successfully decentralized to four health centers.

In COP 2011, a new FOA will be developed as a Track One transition mechanism. The partner will implement the following activities in COP11:

1. Strengthening the intra-facility and intra-facility linkages required to identify HIV-positive children and provide them with access to care and treatment.

2. Ensuring that all HIV-positive children receive careful and consistent clinical, developmental, and immunologic monitoring to promptly identify those eligible for ART.

3. Providing on-site implementation assistance, including staff support, implementing referral systems, and supporting monthly pediatric HIV/AIDS team meetings.

4. Providing training in pediatric C&S and pediatric preventive care package including nutrition.

5. Providing clinical mentoring and supervision to multidisciplinary teams for care of HIV-exposed and infected children.

6. Developing and distributing pediatric provider job aids and patient education materials related to pediatric C&S.

7. Identifying and sensitizing community-based groups to palliative care and the importance of adherence to both care and treatment services.

8. Improving nutritional assessment of children at health facilities.

9. Promoting interventions to ease distressing pain or symptoms and continuing patient management after hospital discharge if pain or symptoms are chronic.

10. Linking families with community resources after discharge.

11. Providing safe water interventions like point of use water treatment by disinfectant.

The partner being within PEPFAR will play its part in Global Health Initiative (GHI).

As the PEPFAR lead implementing partner for pediatric care and treatment, ICAP-CU supported the FMOH in developing national policies, protocols and guidelines on pediatric HIV. ICAP-CU supported the full spectrum of pediatric HIV services at ICAP-CU supported facilities and is on track in meeting targets.

In COP11, a new FOA will be developed as a follow on for the ICAP-CU Co-ag that will be part of the track one transition mechanism. The partner will expand pediatric care and treatment services to all health facilities that are providing adult ART services, and continue to initiate additional clinical mentoring and twinning projects. At the national level, the partner will continue to support the FMOH to: update national policies and guidelines; develop a national capacity-building plan; integrate pediatric monitoring and evaluation into existing care and treatment tracking systems; and to update and implement forms, registers, and charting tools for pediatric care and treatment. The partner will continue its partnership with the Ethiopian Pediatric Society to provide training on pediatric HIV/AIDS care and treatment and organize national pediatric HIV conferences. The partner will support radio and TV campaigns and IEC/BCC materials to enhance public awareness of pediatric HIV care and treatment services.

At the regional level, the partner will work with RHBs to build their capacity to effectively design, implement and evaluate programs. The partner will continue to build the capacity of the two regional universities to provide technical assistance, supportive supervision and mentoring to RHBs.

At facility level, the partner will continue to provide technical support with due emphasis on family-centered services. Emphasis will also be placed on increased pediatric ART service uptake at all sites through improved entry points for children. SOC assessment will be expanded in the four regions and other partners supported to implement quality of service assessment. On-site assistance will be provided to improve medical records keeping, referral linkages and patient follow-up. ART training will be provided based on national guidelines supplemented by refresher trainings. The partner will continue hosting annual CMEs to provide training to pediatricians in Ethiopia. The partner being within PEPFAR will play its part in Global Health Initiative (GHI) by supporting relevant MNCH interventions to reduce maternal and neonatal mortality.

CU/ICAP SI BCN Final COP 2011 This activity aims at strengthening the implementation of the national HMIS for comprehensive HIV/AIDS services and optimizing the use of routine data for service and program strengthening.

In COP 2011, a new FOA will be developed as part of the Track One transition mechansim. The partner will provide site-level M&E support to maintain at 60 facilities to support data quality and maximize data use for continuous quality improvement. ICAP-CU intensified support to:

1) Fully document information on pre-ART, ART, TB/HIV, PMTCT, VCT, and PICT clients;

2) Establish regular data quality assessment and feedback mechanisms;

3) Build capacity of site staff in data analysis and data use to improve service delivery;

4) Facilitate annual, regional review and planning meeting where facilities share experiences;

5) Strengthen sites with data clerks and availability of M&E tools to fill gaps; and

6) Facilitate the integration of HIV/AIDS-related data into the national HMIS in all HMIS implementing sites by renovating and furnishing space and providing technical support in data archiving, retrieving, and report aggregation.

In COP11,the partner will maintain its M&E support to 60 sites, collaborate with partners to scale up HMIS implementation and fully integrate HIV information in the national HMIS and EMR systems. In line with the government plan, the partner will support sites to assess and address gaps in space, furniture, equipment and training to implement HMIS and EMR systems; to relocate care and treatment folders from ART clinics to integrated card rooms; and to prospectively collect, archive, retrieve, compile, and report data for all HIV-related service using HMIS forms.

Support will continue to sites through provision of data clerks (temporarily), printing and distribution of HMIS tools as a gap filling measure, and conducting of data quality assessments and report validations. Assessments and validations will be carried out through regular quarterly supportive supervisions where completeness and accuracy of data in registers will be reviewed and assistance in lot quality assurance will be provided. The partner will also support annual regional review and planning meetings, as well as clinical and M&E teams to review data along with health facility multi-disciplinary teams.

The GOE has prioritized to scale-up training of medical doctors, midwives, anesthetists, emergency surgeons, and others for expansion, as Ethiopia faces the challenge of human resource shortage in the health sector. The physician-to-population ratio has worsened over the last two decades due to increased attrition of doctors, fast population growth, expansion of governmental- and non-governmental health institutions, and low production of doctors. Retention strategies and expansion of medical education programs are viewed as viable long-term solutions by the Government of Ethiopia.

In COP 10, ICAP-CU provides TOTs in the different HIV service areas for the faculty of Jimma and Haramaya Universities and involves them in the in-service training of health care providers and pre-placement training of graduating classes. ICAP-CU contributes to the provision of quality education by providing standard medical textbooks.

In COP 11, a new FOA will be developed for track one transition as a follow on for the ICAP-CU expiring Co-ag. The partner will utilize its in-country and US-based expertise to strengthen its technical, material and financial support to JU and HU medical schools to increase their enrollment capacity and provide quality medical education. The activities will include: conducting needs assessments to ascertain the capacity of JU and HU medical schools to expand and deliver quality medical education; strengthening institutional capacity to deliver quality pre-service medical education whilst specifically integrating HIV, TB and Malaria modules originating from national and international guidelines; exposing faculty of JU and HU medical schools to different models of education delivery by arranging experience-sharing visits; contributing to FMOH efforts to meet HRH requirements for medical doctors as articulated in the HRH strategy and implementation plan and the new FMOH BPR documents by supporting the harmonization of FMOH strategies with the partner efforts at JU and HU; providing technical, material and financial support in teaching materials development, review, publication, and distribution as well as supplying essential medical education teaching materials and equipment; providing support where feasible to infrastructure development; 7. Monitoring and evaluating the progress of the program; and supporting local medical universities in Health Officer obstetric emergency training.

Moreover, in COP 11 the partner will strengthen support to Haramaya and Jimma Universities and extend support to other health science colleges to integrate HIV into pre-service training and increase the production of new health workers. In addition to the above, activities will include: provide limited renovation support to increase institutional capacity, including use of information technology and e-learning approaches; equip classrooms and clinical skill labs; facilitate clinical attachments/internships; provision of technical, material and financial support in teaching materials development, review, publication, and distribution activities as well as in supply of essential teaching/training materials for medical education; and monitor and evaluate the progress of the program.

Targets: By the end of FY2011, 400 new health care workers will graduate from pre-service training institutions specifically from Jimma and Haramaya Universities. On top of this, around 1,630 health care workers will successfully complete an in-service training program.

One of the critical challenges to Ethiopia's program to expand access to HIV/AIDS services is human resource shortages mainly due to low production and attrition. Scarce HR resources need to be protected from occupational hazards by effective work-related infection prevention (IP) initiatives. The Ethiopian MOH is collaborating with partners to undertake a number of IP activities, including establishing an IP Technical Working Group, development of national IP guidelines and procurement and distribution of IP materials. ICAP-CU has also supported an initiative to incorporate IP service into Post Exposure Prophylaxis (PEP) activities at facilities.

To support this initiative, the partner collaborates with Ethiopian MOH and other USG-funded partners, especially JHPIEGO. Activities in previous years included: active membership in the national TWG, support for IP implementation at health facilities through sponsorship of on-site IP trainings and facility level IP working groups.

In COP 2011, a new FOA will be developed as a transition mechansim for Track One activities. The partner will continue to be an active member of the national IP TWG and to strengthen activities at Regional Health Bureaus and facilities. The partner will carry out the following activities:

1. Building the capacity of the RHBs to coordinate IP activities at facilities by organizing IP trainings for RHBs staff and involving them in supportive supervision and on-site IP trainings for facility staff.

2. Organizing off-site IP trainings for RHBs staff and members of the working groups.

3. In collaboration with JHPIEGO, conducting HR inventory related to IP training.

4. Organizing on-site IP trainings for facility and non-health staff of public, private and NGO hospitals based on need assessments; non-health staffs include cleaners, porters, guards, etc.

5. Providing limited infrastructure support to strengthen IP activities in the facilities.

6. Working in collaboration with MOH, RHBs and other partners to facilitate provision of IP materials to health facilities.

7. Developing, adopting, distributing, and encouraging utilization of IP materials targeting providers.

8. Strengthening IP working groups at facilities and implementing IP activities including PEP.

9. Closely monitoring and evaluating IP implementation at RHBs and facilities.

Starting in COP07, ICAP supported the implementation of facility based STI activities in 65 sites in Oromia, Harere, Diredewa and Somali Regions . The support included: training healthcare providers on syndromic management of STI, provision of materials and supplies and mentoring site level staff to implement the syndromic approach at hospital level. ICAP was also providing of technical assistance to Health Facilities, RHBs and Local Universities implementing STI related activities; coordination with (RHBs) to facilitate integration of STIs related activities in to and HIV care and treatment, ANC, FP and other services and strengthening referral linkages within and between health facilities and CBOs, FBOs and PLHIV associations. In FY10 ICAP has supported the FGAE in the opening of confidential STI clinic for sex workers in Adama.In FY11 this activity will be more strengthened.

In FY11 a follow on FOA will be published as a mechanism for Track One transition. The partner will expand the number of their operational sites to 78. Supporting local universities and colleges in all the above regions (including the Haromaya and Jima Universities) on STI program area is other priority area in COP11 to maximize local ownership and sustainability of the program.

1) Support the implementation of a comprehensive approach to STI management that include syndromic management of STIs, sex partner notification and treatment; provision of sufficient information and risk reduction counseling on STIs ; offering of PICT and provision of condoms and assurance of confidentiality . 2) In collaboration with CBO/NGOs, avail the basic information, resources and services to reduce risk of STIs/ HIV for MARPs. These encompass peer education and outreach, risk reduction counseling, condom promotion and provision, HIV counseling and testing, STI screening and treatment and referrals to HIV care and treatment of MARPs. 3) Provide technical and material assistance to Family Guidance Association of Ethiopia (FGAE) to establish confidential STI clinics at FGAE sites to develop and implement innovative outreach clinical service strategies targeting MARPs. 4) Support advocacy and social mobilization for better health-seeking behavior to reduce barriers to healthy sexual and health care seeking behaviors, with a special focus on MARPs.

Starting in COP07, ICAP supported the implementation of facility based STI activities in 65 sites in Oromia, Harere, Diredewa and Somali Regions . The support included: training healthcare providers on syndromic management of STI, provision of materials and supplies and mentoring site level staff to implement the syndromic approach at hospital level. ICAP was also providing of technical assistance to Health Facilities, RHBs and Local Universities implementing STI related activities; coordination with (RHBs) to facilitate integration of STIs related activities in to and HIV care and treatment, ANC, FP and other services and strengthening referral linkages within and between health facilities and CBOs, FBOs and PLHIV associations. In FY10 ICAP has supported the FGAE in the opening of confidential STI clinic for sex workers in Adama.In FY11 this activity will be more strengthened.

In FY11 a new FOA will be published as a mechanims for Track One transition. The partner will also expand the number of their operational sites to 78. Supporting local universities and colleges in all the above regions (including the Haromaya and Jima Universities) on STI program area is other priority area in COP11 to maximize local ownership and sustainability of the program.

In COP 11, the partner will focus on the following major activities:

1. Providing on-site technical assistance and support to improve STI diagnosis and treatment;

2. Organizing and conducting training, supportive supervisions and clinical mentorship on STI;

3. In collaboration with RHBs and responsible partners avail adequate supplies of STI drugs within the health facilities;

4. Strengthening PITC service to counsel and test all STI clients coming to the facility;

5. Providing education on STI risk reduction, HIV screening, and treatment for all patients;

6. Promoting and providing condoms to all patients with special focus on MARPs;

7. Integrating STI services in to ANC and PMTCT services to ensure education of women on STI prevention during pregnancy;

8. Developing and strengthening linkages to CBOs that promote risk reduction and HIV / STI prevention and early / complete treatment at community level;

9. Supporting targeted STI prevention, diagnosis, and treatment services to MARPs, including commercial sex workers;

10. Build the capacity of health care providers in diagnosing, treating and screening STI;

11. Strengthening of STI data recording and reporting systems at all levels.

The partners staff at the Regional and Country Office levels in collaboration with staff from health facilities and regional health bureaus will be actively involved in monitoring of activities performed, provision of technical assistance and support to strengthen service delivery and overall program management.

In FY2010 ICAP-CU supported PMTCT services in 64 health facilities and has provided ongoing mentorship and supportive supervision. ICAP-CU has successfully implemented PMTCT SOC in many of the sites and initiated integrated MCH/ART/PMTCT services in selected hospitals.

In COP 11, a follow on FAO will be published as a mechansim for Track One transition. The partner will build on COP10 activities and will scale up the PMTCT program at 74 health facilities. It will continue to provide technical support to FMOH initiatives.The partner will support RHBs to build PMTCT program management capacity at a regional level and expand outreach PMTCT services in Dire Dawa and other regions. The partner will support improved maternal and neonatal emergency services to increase demand for ANC and delivery and thereby improve PMTCT uptake. At facility level partner will facilitate and support:

1. Within facility and external referral linkages;

2. Couple counseling and partner testing at ANC and maternity wards;

3. Routine, opt-out HIV counseling at all service outlets;

4. Expansion of Mothers' Support Group (MSG) to 10 more sites and organization of training on Income Generating Activity (IGA) for graduating MSG members;

5. Provision of adherence and psychosocial support for HIV positive pregnant women;

6. Provision of basic care package for all HIV-positive pregnant women, including: health education, TB screening; CTX when indicated, nutritional support, insecticide-treated bed nets, condoms, and safe water;

7. Routine assessment and management of all HIV-infected pregnant women for ART eligibility;

8. Nutritional education, micronutrient supplementation, and "therapeutic feeding" for pregnant and breastfeeding women in the six-month postpartum period;

9. Expansion of integrated MNCH/ART/PMTCT services to selected ICAP supported sites;

10. Enhanced postnatal follow-up of HIV-infected mothers and HIV-exposed infants;

11. Promotion of infant-feeding initiatives and healthy infant-feeding practices

12. Availability of supplies for PMTCT services;

13. Site-level staff to implement standards of care assessment;

14. PMTCT trainings, ongoing clinical mentoring and supportive supervision;

15. Ongoing development and distribution of provider job aids and patient-education materials

16. Minor renovation, refurbishment, and repair (as needed) of ANC, labor and delivery rooms, and maternity wards at ICAP-CU supported sites; and

17. Provision of a mass sensitization program on PMTCT.

In FY 2010, ICAP-CU continued to second a full-time TB/HIV integration expert to FMOH/FHAPCO. At national level, ICAP-CU supported expansion of integrated TB/HIV programs; development of screening tools and diagnostic algorithms, including MDR-TB guidelines, protocols and tools; and promote effective referrals among TB/HIV service sites. ICAP-CU has also supported regional TAs to liaise with RHBs, Jimma and Haramaya Universities to build capacity, develop IEC materials in local languages, and strengthen MOH, CDC, and EHNRI initiatives to establish TB culture facilities at the regions.

In FY 2011, a new FOA will be developed as a Track One transition mechanism. The partner will continue to support and build the regional health bureaus and continue to support 60 sites in four regions to provide integrated TB/HIV services.

The partner will

1) Support TB screening and intensified TB case detection in HIV patients;

2) Expand implementation of PITC and care referrals;

3) Strengthen family based approach and contact investigation; improve pediatric TB diagnosis for HIV exposed and infected children.

4) Provide IPT to HIV patients in whom active TB is ruled out and have no contraindications;

5) Provide pCTX to all TB/HIV co infected patients;

6) Implement systems for referral of HIV+ TB patients to care and treatment;

7) Provide clinical mentorship on the identifying and managing immune reconstitution reactions in TB patients on ART;

8) Support to enroll families of co-infected patients in care;

9) Improve recording and reporting; coordinate with EHNRI in TB/HIV surveillance in the selected sites.

10) Develop and share clinical support tools for TB/HIV management, including symptom screening tools, job aids, posters, and clinical algorithms;

11) Provide TB/HIV refresher trainings, ongoing supportive supervision and clinical mentoring;

12) Support radiology services to improve diagnosis of TB in HIV-infected patients;

13) Do minor renovation to TB clinics to minimize nosocomial transmission of TB;

14) Introduce infection control and provide supplies;

15) Continue to Support establishment of TB culture diagnosis and sample transportation system at regional labs,

16) Support feasibility studies and technical program evaluations;

17) Support establishment of MDR-TB treatment and demonstration model site for the Eastern Ethiopia regions at Harar;

18) Continue to support community DOTS through health extension workers at Diredawa, Harari and Somali regions.

19) Support the TB program through assessing the gap and intervening to fill the break in its operational zones in line with the Global health initiative