This is a continuing activity. JHU provides support to build in-country capacity of local, regional and federal entities, including local Universities, for the sustainable delivery of comprehensive HIV/AIDS services in support of the GOE's national goals to decrease new HIV infections, provide care and support to people living with HIV and expand ART services. Also, JHU supports for HMIS implementation and comprehensive HIV/AIDS service delivery in hospitals and health facilities, which includes training of physicians and emergency surgical officers, in Addis Ababa city and in three regional states-Gambella, Beni-Shangul Gumuz, and Southern Nations Nationalities and Peoples Regional (SNNPR). The target population is 18,760,540, both urban and rural populations and high risk and vulnerable populations (such as sex workers, long distance truck drivers, students and displaced persons). In support of USG efforts to build sustainability and country ownership, HHS/CDC has direct agreements with local partners, who also may receive technical assistance from another USG partner to build their capacity as a direct implementer. JHU capacity building of local partners (e.g. Hawassa University, Addis Ababa University) will decrease over time as these local partners assume greater responsibilities for direct implementation. JHU will purchase 6 new vehicles (~$50,000 each) to replace old ones. JHU collaborates closely with USG implementing partners to maximize resources and minimize duplication of effort. JHU activities are aligned with the goals of the GOE and USG HIV/AIDS Partnership Framework and Global Health Initiative. JHU has in place a comprehensive system for routine monitoring and regular progress reporting on program performance, which is aligned with the national HMIS.

In prior years, JHU integrated "food by prescription" and mental health services into HIV care and support services. Training guidelines and job aids were developed and mental health services were integrated as a pilot into four hospitals - ALERT and Zewditu Memorial in Addis Ababa and Arba Minch and Yirgalem in SNNPR. Under COP2012, JHU will expand mental health service integration into other hospitals. In collaboration with the Federal Ministry of Health (FMOH), JHU will also provide psychotropic drugs to each site where mental services are being made available. JHU will continue mentoring and providing supportive supervision to each site. A study is underway by JHU to better understand the types and magnitude of mental health disorders among PLHIVs as well as the prevalence of HIV among psychiatric patients in Ethiopia. JHU will also support FMOH efforts to develop national mental health / HIV integration guidelines. Other activities that focus on care and support include:Expansion of pain clinics and roll out of oral morphine from Tikur Anbessa Specialized hospital to other hospitals.Promotion of non-pharmacologic interventions to improve quality of life of PLHIVs and strengthen the evidence based practices through a study on the universal pain assessment tool.Support for the celebration of World Hospice and Palliative Care Day.Support for the revision of national pain management guideline.strengthen site-level mentorship and supervision on cotrimoxazole preventive therapy (CPT) and asses care providers compliance with CPT guidelines.Continue nutrition assessment, counseling and support services at ART and PMTCT units.Ensure the availability, distribution, utilization, and monitoring of the adult preventive care package.Facilitate the involvement of community-based organizations in multidisciplinary teams and catchment area meetings.Support health facilities to develop community-based resource mapping matrix to refer PLHIVs to community HIV and wrap-around services. Refer to indicators and targets for details on the magnitude and impact of JHU's program. These HBHC activities will be implemented in all ART sites including the additional health center sites that JHU is now assuming responsibility for after the USG PEPFAR program realignment.

In prior years, JHU expanded its TB/HIV support to 73 public and private health facilities focusing on implementation of the three Is. JHU conducted a situational analysis and infection control needs assessment in selected facilities and supplied material support, such as the N95 masks, to St Peters Hospital and other selected facilities. JHU assessed health care worker-related barriers for IPT implementation at supported facilities. Under COP2012, JHU will:Strengthen regional and facility-level TB/HIV program coordination.Support routine TB screening for HIV positives and promote integration into ANC, PMTCT, pediatric clinics and potentially high yield areas.Collaborate with EHNRI and regional laboratories to introduce improved TB diagnostic services (e.g., bleach concentration, fluorescent microscopy).Collaborate with EHNRI to assess feasibility of task shifting of FNA specimen collection and preparation of sample referral for histopathologic exam.Utilize evaluation findings to design evidence-based interventions to enhance IPT uptake.Strengthen PICT for TB patients and links between TB/HIV patients to HIV care and treatment services.Strengthen the family-based approach and contact investigation, particularly to improve pediatric TB diagnosis for HIV exposed and infected children.Support renovation to TB clinics, waiting areas and isolation wards to minimize nosocomial transmission.Implement basic administrative and environmental TB infection control measures at supported facilities, and provide supplies.Support the expansion of ambulatory MDR-TB treatment sites in collaboration with the Federal MOH, regional health bureaus, other partners.Strengthen TB/HIV monitoring and evaluation through training, supportive supervision, and mentorship.Expand community TB care in emerging regions and pilot and assess community sputum sample transportation mechanism for TB microscopy.Conduct evaluations to assess the impact of community TB care in TB case finding and treatment adherence.Strengthen and expand PPM-TB DOTS and TB/HIV activities.Improve access to PWP services at the TB clinics and strengthen TB/HIV ACSM. JHU has TB/HIV mentors who are well versed on MDR-TB and thus onsite mentorship and training will be integrated with ambulatory MDR-TB servicesRefer to indicators and targets for details on the magnitude and impact of JHU's program.

Previously, JHU supported pediatric care & support services in over 57 health facilities in its operational area. JHU aims to extend and optimize the quality of life for HIV exposed and infected children and their families throughout the continuum of illness. Under COP2012, JHU will expand these services to an additional 71 health facilities that were previously managed by MSH. JHU will identify other high case load sites and further expand services as appropriate. Activities include:Support national/regional health bureaus and assist with revision of guidelines according to the new WHO guidelines.Support local universities to establish training units and transition in-service training.Conduct site-level mentoring, minor renovations and provision of IEC materials/job aids and supplies.Ensure rollout, implementation and monitoring of pediatric preventive care package.Ensure availability of pediatric drug formulations, utilization of cotrimoxazole prophylaxis, TB screening, malaria prevention and treatment (including ITNs), prevention and treatment of diarrhea, linkages to immunization programs, and Isoniazid prophylaxis (IPT) for HIV positive children, and promote healthy hygiene & safe water interventions.Promote interventions for Psychosocial care and support for children and adolescents addressing Psychological and spiritual needs as well as support for end of life care.Ensure that sites implement early infant HIV diagnosis using appropriate techniques (e.g., dried blood spot) and all eligible HIV positive children are promptly referred for ART care;Ensure nutritional counseling/assessments are completed at all entry points targeting pediatric patients and HIV exposed/infected infants through training and site-level mentoring; liaise with partners to ensure availability of supplemental feeding products.Strengthen internal/external referral linkages to identify and link HIV positive children, orphans and vulnerable children with family, social & adherence support.Establish HIV positive adolescent support groups to promote adherence & positive living.Focus on quality improvement of Pediatric PC/Nutrition services including tool development, training & mentoring.

In prior years, JHU provided technical assistance to 77 hospitals and health centers in its operational area to provide comprehensive laboratory services. JHU conducted site assessments, provided training, established and strengthened quality assurance programs, supported specimen referral linkages between testing hospitals, referring hospitals and health centers, and assisted with the implementation of electronic laboratory information systems. JHU supported the integration of laboratory systems and has started the process of establishing regional laboratories in Gambella and Benshangul Gumuz regions. JHU in collaboration with Foundation of Innovative and New Diagnostics (FIND) and the Ethiopia Health and Nutrition Research Institute (EHNRI) supported the establishment of multi-drug resistance TB diagnostic laboratory in St. Peters Hospital and Hawassa regional laboratories. JHU supported WHO/AFRO accreditation of selected hospital and regional laboratories. Under COP2012, JHU will continue to provide comprehensive laboratory support in sites that have been previously supported as well as to 181 health center laboratories where support recently commenced. The activities will focus on strengthening of site-level laboratory quality systems, with emphasis on implementing the 12 quality essentials and ultimately accreditation. There will be site-level embedded mentorship, which is extended in duration and side by side bench-level coaching with the goal of attaining accreditation. Support will be provided in establishing and strengthening of microbiology and opportunistic infections (OIs) diagnostic services in selected hospitals through training, mentorship, minor renovation and procurement of equipments and supplies. JHU will continue developing, implementing and enhancing laboratory inventory systems in hospital networks and ensuring availability of reagents and consumable supplies and will also assist in the expansion and maintenance of electronic and paper-based laboratory information system and proper data collection, storage, analysis, and reporting systems. JHU will jointly plan and implement mechanisms with EHNRI and MOH Regional Health Bureaus.

Under COP2012, JHU will implement two distinct activities in support of strategic information. The first provides site-level monitoring and evaluation and HMIS support to 63 existing sites and 181 new sites within JHU's operational area. Specific support includes:Document pre-ART, ART, TB/HIV, PMTCT, VCT, and PICT information on HMIS forms.Establish data quality assessment and feedback mechanisms.Build capacity of site staff on data analysis and data use.Facilitate annual, regional and catchment area review and planning meeting.Strengthen sites by providing data clerks and M&E tools to fill gaps.Facilitate the integration of HIV/AIDS related data with the HMIS and support HMIS implementation in new health facilities.Facilitate the training of JHUs regional mentors to take the role of mentoring facility staff on HMIS.Collaborate with partners in HMIS implementation and integration of HIV information into the national systems.Assess and address gaps in space, furniture, equipment and training to implement HMIS and EMR systems.Collect, archive, retrieve, compile and report data for all HIV-related service.Support catchment area and health facility multi-disciplinary teams meetings.The second activity is a partnership with an international organization called TheraSim to implement a distance learning (DL) program using HIV-specific virtual clinical simulations in health facilities in Addis Ababa city and SNNPR, Benishangul Gumuz and Gambella regions. The DL program consists of 20 patient cases where learners make diagnosis and treatment decisions. The system gives feedback and records user choices in reference to respective HIV/AIDS guidelines and ART service providers complete case studies at their workplace. Specific support includes:Provide an orientation to the program for physicians and nurses in JHU sites.Conduct supervision, collect data on program performance and address technology issues.Conduct training sessions for Addis Ababa and Hawassa University residents and work with university faculty to integrate the DL program into pre-service education and update modules. Refer to indicators and targets for details on the magnitude and impact of JHU's program.

In recognition of the Human Resources for Health crisis in Ethiopia, under COP2012 JHU will address health workforce challenges by providing technical assistance (TA) to and strengthening institutional capacity of medical institutions to deliver quality pre-service medical education. JHU will continue strengthening institutional capacity of the Addis Ababa and Hawassa Medical Schools by providing technical, material and financial support to deliver quality medical education. It will support essential medical education teaching materials and equipment and purchase a variety of medical and other health sciences books for these schools. JHU will support institutional capacity of new medical institutions - Dilla, Wolayta-Sodo, and Arba Minch Universities as well as Yirgalem and Yekatit Hospitals by providing a similar level of technical, material and financial support. JHU will support the procurement of teaching materials and tool kits, establish mini-libraries in affiliation with these hospitals and teaching institutions. And, JHU will continue support for faculty development through case development for problem based learning, ICT support, e-resources, and simulation production. JHU will support an Integrated Emergency Surgery and Obstetrics (IESO) training at the postgraduate program at Hawassa University, Arba Minch, Dilla, and St. Paul's Health Science Colleges. JHU will provide technical assistance to these universities to establish training units and deliver HIV-related in-service trainings in their catchment area. Where applicable, throughout JHU's activities, gender issues have been incorporated, with a particular emphasis on reducing violence and coercion. Refer to indicators and targets for details on the magnitude and impact of JHU's program.

In prior years, JHU has been supporting voluntary medical male circumcision (VMMC) activities in eight sites in Gambella region and more than 35 health care providers have been trained in male circumcision surgical procedures. To date, 5945 clients have been circumcised. Under COP2012, JHU will focus VMMC activities at the facility-level and transition campaign outreach services to Gambella Regional Health Bureau (RHB) and the regional AIDS Resource Center (ARC). JHU will strengthen VMMC services in the current sites in Gambella and link these VMMC services to existing HIV/AIDS services, such as HTC, STI management and reproductive health services. Service providers will receive basic and refresher training. VMMC kits, consumable supplies and infection prevention equipment will be procured and distributed to the existing sites. In collaboration with members of the Surgical Society of Ethiopia, JHU will conduct quarterly coaching and supportive supervision visits to all sites. To ensure provision of safe and quality services, JHU will use WHO VMMC quality assurance guidelines. JHU will collaborate with the RHB and the ARC to design a regional VMMC communication strategy to increase awareness of and demand for VMMC. JHU will work with community and religious leaders to promote neonatal male circumcision. In addition, as part of these promotion efforts, health and agricultural extension workers will be provided with technical updates and orientation to adult and neonatal male circumcision to increase community awareness. JHU will conduct an annual regional review meeting on VMMC to review progress and improve program implementation. Refer to indicators and targets for details on the magnitude and impact of JHU's program.

The mission of the FMOH is the provision of safe and adequate blood and blood products to all patients who require blood transfusion as part of their treatment. The target of the FMoH is to collect 120,000 units per annum from voluntary blood donors, test all the blood in a quality assured manner in the regional blood banks and preposition stocks of blood for use at the health facilities. JHU will provide technical support to blood banks and health facilities in three regions (SNNP, Gambella and Benshangul Gumuz)) in the implementation blood safety program:1. Strengthening of the clinical interface through training of clinicians and nurses on appropriate clinical use of blood as well its safe administration to patients as well as support the establishment of hospital transfusion committees in the regions of SNNP, Gambella and BenShangul Gumuz2. JHU will support the creation of linkages between blood banks and the hospitals in the including transportation of blood and blood products, supplies as well maintenance of blood inventory at the hospitals3. JHU will support the strengthening of data collection both from the blood banks and the regional blood banks and develop a comprehensive monitoring and evaluation plan as well as support reporting of blood bank activities to the RHB and the FMOH.4. With the support and collaboration of WHO, conduct mentorship 6 blood banks in the regions to ensure quality of services in the regions. This will be achieved through the mentors trained through WHO support5. Improve the collection of blood through mobile collection teams. JHU will support the activities of the mobile collection teams in the regional blood through target setting and development of collection plans6. Support blood donor education and mobilization through effective engagement with local radio stations, print media, and training of communication experts, blood donor mobilisers and blood bank staff. Refer to indicators and targets for details on the magnitude and impact of JHU's program.

JHU supports the Federal MOH (FMOH) Medical Services Directorate to conduct a national Training of Trainers on infection prevention (IP) for 23 trainers, who have provided training for 204 health care workers (HCWs) in 8 health facilities in Addis Ababa and 50 HCWs in two health facilities in Gambella region. In addition, 61 support staff at Menilik II Hospital in Addis Ababa city have received the IP training. IP practices have been re-initiated in these facilities with updated terms of references and action plans developed in collaboration with hospital management teams. Under COP2012, JHU will:Continue to support national and regional IP working groups to update training manuals and guidelines.Support the integration of injection safety and waste management into HTC, ART, PMTC, and TB/HIV training curricula.Train 616 HCWs and support staff on IP/injection safety.Design a standard tool for capturing quality improvement assurance of IP/injection safety and integrate it into existing training modules.Set standard national indicators for IP/injection safety to improve monitoring and evaluation of IP programs.Secure IP commodities for health facilities of Addis Ababa, SNNPR, Gambella and Benishangul Gumuz in collaboration with RHBs and the FMOH.Strengthen TB and HIV programming of prevention of MDR/Extensive MDR TB and secure universal access to PEP in health facilities.Ensure that performance monitoring and data quality sampling techniques and data documentation tools and systems are in place.Continue to identify and support the production of locally produced, low-cost, personal protective equipment, antiseptic hand rubs and aprons, and customized basic IP supplies. Refer to indicators and targets for details on the magnitude and impact of JHU's program.

The primary goal of JHU support in the area of prevention is to strengthen STI / HIV prevention activities within JHU's operational area. The target population is STI patients at JHU-supported health facilities. Under COP2012, JHU assistance that focuses on "abstinence and / be faithful" includes:Educate STI patients about the importance of secondary abstinence to reduce the risk of HIV/STI transmission.Promote fidelity among STI patients to reduce the risk of HIV/STI transmission.Educate STI patients on reducing multiple and concurrence partners to prevent sexual transmission of HIV/STIs.STI/ HIV prevention information, education and behavior change and communication material will be adapted and used to educate STI patients at facility level.Mini media and AIDS resource at the health facilities will be supported to deliver continuous messages about STI/HIV/RH. In addition, throughout JHU's prevention activities, gender issues have been incorporated, with a particular emphasis on reducing violence and coercion. Refer to indicators and targets for details on the magnitude and impact of JHU's program.

JHU is supporting the implementation of provider and client initiated HTC services in 91 facilities in four regions. A total of 218,160 clients received HTC service in the first six months of FY2011. Under COP2012, JHU will continue to support provider and client initiated HTC in the existing 91 sites plus increase services to an additional 181 health centers in the region of SNNPR and Addis Ababa city. Intensive support will be provided to the newly added health centers in the areas of human resource development and material support. Specific activities will include:Conduct basic HTC training for health care workers and community counselors.Target provider initiated testing and counseling (PITC) trainings to at least 8-25 trainees per site.In collaboration with Family Guidance Association of Ethiopia via the confidential STI clinics, JHU targets HTC services to MARPs and hard-to-reach populations with outreach services.Increase efforts to identify more HIV positives and discordant couples by using patient expert and peer educators to promote partner testing in ART clinics and ANC outlets.Strengthen linkages HIV positives will be linked to care and treatment service and ensure referred clients reached and received the services through feedback mechanism.Promote HTC services using different media and events such as national HTC day and World AIDS Day as well as provide support to development of multi media materials in support of HTC and World AIDS Days.Collaborate with Ethiopia HIV/AIDS Counselors Association (EHACA) to conduct case review meetings to improve quality of HTC services in JHUs operational area.Improve data analysis and use to better guide implementation and management of activities.Work with Handicap international, regional HIV/AIDS Program Coordination Office, Ethiopian National Disability Action Network (ENDAN) and other stakeholders to reach the disabled people through four pilot sites in Addis Ababa. Refer to indicators and targets for details on the magnitude and impact of JHU's program.

In prior years, JHU has supported the implementation of facility-based sexually transmitted infection (STI) activities in 52 sites in Addis Ababa and Benishangul-Gumuz, Gambella, and SNNPR regions. This past year, JHU partnered with the Family Guidance Association of Ethiopia (FGAE) to establish one free standing confidential STI clinic in Addis Ababa. Under COP2012, JHU will provide the following areas of technical assistance in JHU-supported ART sites:Provide onsite mentoring for STI screening via questionnaire of all clients coming into clinic sites.Improve monitoring and evaluation, data recording and reporting of STI treatment and prevention activities and site- level STI data to improve service delivery.Actively participate on the national STI technical working group and provide technical assistance in the revision of national STI guidelines.Conduct training using innovative onsite or group-based approaches to ensure large numbers of workers are trained at the site level with a focus on ensuring HIV and STI linkages at facility level.Mentor healthcare providers to establish a good rapport with patients and give youth, adolescent, women and MARPS-friendly service.Ensure that adequate patient education and counseling is given to all patients diagnosed with STIs.Verify that all clients diagnosed with STIs are offered HIV testing and all clients found positive are enrolled in HIV care.Confirm that partner management is addressed for all STI cases according to guidelines.Collaborate with appropriate partners to ensure that all appropriate STI drugs and supplies are available at each site.Establish an adequate condom supply in all STI treatment sites.Transition confidential sex workers clinic in Addis Ababa and Hawassa to the FGAE. In addition, throughout JHU's prevention activities, gender issues have been incorporated, with a particular emphasis on reducing violence and coercion. Refer to indicators and targets for details on the magnitude and impact of JHU's program.

Previously, JHU supported PMTCT services in 59 health sites. Under COP2012, JHU will expand PMTCT to an additional 149 public hospitals and health centers for a total of 208 sites in its operational area. JHU PMTCT activities support the USG PEPFAR PMTCT Acceleration plan. JHUs goal is to provide comprehensive PMTCT services to pregnant women with known HIV status and ARV prophylaxis/treatment to HIV+ women. Activities include:Support PMTCT services and expand outreach PMTCT services focusing on high prevalence and hotspot areas.Support the FMOH in revising the national PMTCT guidelines, training packages and implementation manual to adapt to the new 2010 WHO PMTCT guidance; support rolling out of revised national PMTCT guidelines at health facilities.Implement quality improvement to improve retention of HIV positive mothers and HEIs in care, expand role of case managers and mother support groups (MSGs) and strengthen referral linkages.Support FMOH and regional health bureaus with the implementation of the monitoring system for PMTCT.Support training of safe pregnancy/family planning counseling and promote integration of family planning and HIV services.Scale up couple counseling / partner testing, facilitate male friendly services, and establish a monitoring system.Expand counseling, prevention with positives (PWP) and treatment services for discordant couples.Expand MSGs to at least 10 new sites, assess new sites for MSGs needs, and establish linkages with income generating activities.Expand integrated MNCH/ART/PMTCT services.Enhance postnatal follow-up of HIV-infected mothers and HIV-exposed infants.Strengthen and expand Essential Newborn Care (ENC) services.Support minor renovation, refurbishment, and repair of ANC, labor and delivery rooms, and maternity wards.Provide 80% of supported facilities with e-mobile phones and airtime cards to facilitate inter-facility communication including consultation requests for transport, referrals, lab test results and client tracing.Set the research/ evaluation agenda with the GOE and support PMTCT program evaluation.

JHU implements two distinct activities related to treatment: (1) support ART scale-up and (2) the Clinically Focused Record Systems (CFRS). With respect to ART, JHU provides technical support to ensure the delivery of quality comprehensive ART services in 218 ART sites in Addis Ababa and three regional states. This includes 147 sites in Addis Ababa and SNNPR, which were transferred to JHU as part of the 2012 USG interagency PEPFAR program reconfiguration. Specific areas of support include:ART training to health providers.Distance learning, teleconferencing and case discussion activities with ART providers.Mentorship at each ART site.Dissemination of appropriate educational information to ART patients, their care givers and the community to overcome the false beliefs and practices around HIV and ART and reduce stigma and discrimination of HIV patients.Support case management in collaboration with PLHIV associations to promote ART adherence and retention of patients in care and support programs.Improve health network systems by supporting catchment area meetings, inter-facility and facility-community linkages and the referral system as well as support the establishment and functioning of facility ART multi-disciplinary teams.Implement quality improvement approaches.Support ART monitoring and evaluation activities including support to the national HMIS.Furnish, maintain, renovate and restore basic functions of ART facilities.With respect to the CFRS activity, JHU supports clinical monitoring of ART patients in Ethiopia. Specific areas of support include:Cohort enrollmentProvide ongoing support for the governing steering committee structureStrengthen and maintain standardized data collection measures and patient records management of clinic-based activities at seven participating university hospitals.Develop and implement/maintain facility-based project management standard operating procedures.Maintain data transfer and specimen repository standards.Monitor data quality levels.Ongoing training of facility staff to use national M&E tools.Monitor electronic data management system at site and central levels.

Previously, JHU supported implementation of pediatric ART in 57 health facilities in its operational area. Under COP2012, JHU will expand pediatric ART to 71 additional health facilities previously managed by MSH and will identify other high case load sites to expand services. Activities include:Provide TA to national and regional working groups to update guidelines, protocols, training materials, IEC materials and build regional capacity to plan and monitor site level programs.Expand-ART uptake by maximizing entry points for children testing via PIHCT at under-five clinics, pediatric inpatient services, TB clinics, and EPI clinics.Strengthen family-focused HTC, care and treatment, and linkages to other services.Expand comprehensive pediatric HIV care and treatment in private sector.Strengthen management of HIV-exposed and infected infants and early treatment for HIV infants per national guidelines.Mentoring to improve service quality and provide onsite updates for providers.Training on Pediatric ART, advanced learning through telemedicine and case review sessions using local university trainers.Community involvement to support uptake and adherence of HIE and pediatric patients and link to OVC programs.Provide supplies, equipment, IEC materials/job aids and minor renovation.Collaborate with AAU and other universities to provide in-service/pre-service training and program supervision.Implement services for adolescent groups and camps designed to provide psychosocial support; incorporate family-focused elements to increase family involvement in pediatric HIV care and adherence.Integrate adherence Supporters into stand alone pediatric ART units to ensure, retention, tracking and referral for support services to available community based organizationsContinue monitoring and evaluation support to facilities as per national mandated standardsEnsure utilization of quality improvement tools (e.g., LQAS and SBMR) to identify and respond to gaps.Support the use of IEC/BCC materials in local languages to enhance public awareness of pediatric HIV care and treatment servicesEstablish strategies to integrate pediatric HIV services with other MNCH and child survival interventions.