This is a continuing activity. UCSD provides support for implementation of comprehensive HIV services to Uniformed Services of Ethiopia (USE) to prevent new infections, scale-up ART services, and create access to care and support services. UCSD serves a large most-at-risk population (MARPS) that includes the military and their dependents, the federal police and their families, and federal prisoners. Its important to strengthen the health system capacity of the USE in human resources and infrastructure to enable a smooth transition of specific program activities, strengthen ownership and ensure sustainability. UCSD provides support to USE facilities located in nine administrative regions of Ethiopia. UCSD is supporting mobile ART units to improve access, enrollment, compliance and quality of ART services to mobile populations in hard-to-reach areas. The Armed Forces are often deployed to different parts of the country and by the nature of their military duties, they are frequently required to more from one area to another. UCSD works to align the monitoring and evaluation activities within USE with the national HMIS. UCSD has leased but not purchased eight vehicles. It plans to procure two vehicles under COP2011 at $64,584 per unit and two more vehicles in COP2012 at $71,042 per unit cost. Total planned/purchased/leased vehicles for the life of this mechanism is 10. The vehicles will be used for supporting program activities centrally and at the sites spread across the 9 regions, many of which are in hard-to-reach locations. The UCSD program supports the goals of the GOE's National Strategic Plan II as well as the GOE and USG HIV/AIDS Partnership Framework and Global Health Initiative. UCSD has a system in place for routine performance monitoring and reporting.

Under COP2012, UCSD will revise and standardize the national pain management and training guidelines in support of overall HIV care and support services. UCSD will conduct awareness sessions among policy makers, training institutions, and other stakeholders on the national guideline for palliative care. It will work closely with the FMOH to establish the national TWG on palliative care and will conduct a series of stakeholders meetings on the national pain management guidelines. It will strengthen its training programs in palliative care and pain management for health care providers in order to increase the pool of trained and skilled USE human resources. It will also continue to strengthen the availability and accessibility of morphine. To increase the access of pain management, UCSD will establish pain clinics and strengthen internal and external linkages at the USE and harmonize referrals to and from HIV clinics. It will also update the service directory of community based resources. UCSD will strengthen the positive living strategies through prevention with positives activities with the help of case managers and lay counselors. UCSD will support health facilities to implement the minimum preventive care package provision of nutritional assessment, counseling and supports. UCSD will work on mental health service integration in partnership with JHU-TSEAHI in order to enhance patient compliance to treatment. It strengthens site level mentorship and supervision on CPT and will consider CPT as one of the quality improvement indicators and will assess healthcare providers compliance with the national CPT guideline. UCSD will strengthen and utilize the palliative care model center to expand its psychological and spiritual care services and improve the quality of life of terminally-ill patients and their families. UCSD will continue to advocate for palliative care through USE media. To increase the psychological services, USCD will train nurses on psychological support, prepare guidelines and job aids for distribution. USCD will open a cervical cancer prevention center in one of its referral hospitals. Where applicable, prevention of gender-based violence and coercion will be integrated into UCSD's activities. Refer to the indicators and targets for magnitude and impact of UCSD's program.

In FY2011, UCSD supported the implementation of TB/HIV programs at 35 uniformed service facilities focusing on the 3 Is including minor renovations to improve quality of TB/HIV care and infection control. UCSD is working with the Military Health Command to establish MDR-TB treatment center and TB culture diagnostic services at the Armed forces referral teaching hospital. UCSD introduced TB/HIV activity recording and reporting tools at the USE to ensure proper documentation and timely reporting of program data. In FY 2011, UCSD conducted a survey at the central prison to determine baseline prevalence of TB, HIV, and STI.

Under COP2012, UCSD will:

Support routine TB screening for HIV positive patients.

Promote integration of routine TB screening to ANC, PMTCT and pediatric clinics.

Promote HIV testing of TB patients and linkage of HIV co-infected TB patients to HIV care and treatment services.

Improve uptake of IPT and work with the prisons administration and WHO country office to expand the pilot disease screening program to other major regional prisons.

Undertake TB screening campaigns at military barracks and police training camps.

Support renovation of TB clinics, waiting areas, isolation wards and temporary isolation rooms at the prisons to minimize nosocomial transmission.

Implement basic administrative and environmental TB infection control measures at supported facilities and prisons, and provide supplies as appropriate.

Promote the scale up of bleach concentration technique and fluorescent microscopy as well as the introduction of other technologies for TB diagnosis as appropriate.

Undertake program evaluation to assess the impact of the disease screening pilot project at Kality central prison.

Strengthen TB/HIV M&E through training, mentorship and supportive supervision to ensure data quality.

Support TB DOTS expansion at the USE through assessing the gap and intervening in its supported sites in line with the GHI.

Introduce outreach TB and TB/HIV control activities at remote military camps.

Improve access to PWP services.

Strengthen TB/HIV ACSM activities.

In FY2010, UCSD supported USEs basic pediatric care and support program for HIV exposed and infected infants and children at 15 facilities. In FY 2012, key activities in the facilities include: participation in development of guidelines and training materials at national level, initial assessment of site-level palliative care activities, training of the multidisciplinary team on palliative care and the preventive care package for children, site-level clinical mentoring, enhancement of data collection and reporting, minor renovations, and supportive supervision pediatric care and support services.

Under COP2012, UCSD will continue to support pediatric care in the supported facilities and expand the service in all facilities providing adult HIV care and treatment via a multidisciplinary, family-focused approach. UCSD will improve the skills of human resources at the facilities with training in collaboration with local universities. Moreover, UCSD will work to ensure provision of nutritional assessment and counseling services for HIV exposed/infected children and infant, supplying of job aids, and collaboration with other partners to ensure provision of micronutrients and nutrition supplementation. In addition to supporting sites to perform early infant diagnosis, UCSD will promote prophylaxis and treatment for opportunistic infections in accordance with national guidelines. Appropriate use of pediatric treatment for HIV-positive children and for HIV-exposed infants will be an important component of UCSD implementation activities, especially at those sites not yet providing ART. Similarly, TB screening and IPT will be promoted and provided for HIV-positive children.

With case managers deployment, UCSD will strengthen referral and linkages with community based support groups for adherence counseling and psychosocial support. UCSD will ensure regular supply of drugs for OI and pain management, malaria prevention and de-worming, as well as sensitize its community to PC care through preparation and distribution of IEC/BCC on pediatric care and support materials targeting children. Where applicable, prevention of gender-based violence and coercion will be integrated into UCSD's activities. Refer to the indicators and targets for magnitude and impact of UCSD's program.

UCSD provided comprehensive site-level laboratory technical support at facilities of uniformed services (police, defense and prison health services). This includes off-site and on-site training, mentorship and coaching, support to strengthen quality assurance and sample referral linkage, strengthening TB and other OIs diagnostics and implementation of 12 laboratory quality essentials and accreditation of laboratories.

Under COP2012, UCSD will focus on strengthening site-level laboratory quality systems, with the overall goal of implementing the 12 quality system essentials and ultimately attaining accreditation. UCSD will provide embedded mentorship which is extended and side-by-side bench level coaching to ensure the delivery of high-quality laboratory services as well as systems strengthening. UCSD will support a tiered laboratory network within the uniformed services for referrals and EQA program. UCSD will provide support to strengthen microbiology and OI diagnostic services in selected hospitals through training, mentorship, minor renovation and procurement of equipment and supplies.

UCSD will continue to build capacity and carrying out minor renovation and refurbishment of facility-level laboratories to improve laboratory organization, layout, work flow and to support the WHO-AFRO accreditation effort. Technical assistance will be provided for specimen management, testing procedures, standard documentation, record keeping and reporting and inventory management. UCSD will also conduct standardized trainings using nationally-approved curricula. UCSD will continue strengthening 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. Technical assistance will be provided 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.

This activity will strengthen the national HMIS and optimize the use of routine data for service and program improvements. Under COP2012, UCSD site-level M&E support will be maintained at 114 facilities and expanded into new health facilities to support data quality and to maximize data use for continuous quality improvement.

UCSD will:

Fully document information on pre-ART, ART, TB/HIV, STI, PMTCT, VCT, and PICT clients.

Establish regular data quality assessment and feedback mechanisms.

Build capacity of site staff in data analysis and data use to improve service delivery.

Facilitate semiannual review and planning meeting for regional commands to share experiences.

Strengthen sites with data clerks and provide M&E tools.

Facilitate the implementation of HMIS in new health facilities by renovating and furnishing space and providing technical support in data archiving, retrieving, and report aggregation.

Work with the Ministry of Defense, Ministry of Health and Tulane University to facilitate the implementation of HMIS and EMR by the uniformed services.

Prospectively collect, archive, retrieve, compile and report data for all HIV-related service using adopted HMIS forms.

In addition, UCSD will continue ongoing support for supportive supervision related to SI, internet and telephone services, IT supervision and mentoring, review meetings and experience sharing visits among the data personnel, and training on clinical research methodology for health care providers. It will also support health facility multi-disciplinary team meetings.

This is an ongoing activity and is linked with PEPFAR/Es support for HRH activities. In recognition of the HRH deficiencies in Ethiopia, UCSD will be addressing health workforce challenges by providing technical assistance (TA) to and strengthening institutional capacity of medical school and health science colleges of the Uniformed Services in Ethiopia to deliver quality pre-service medical and health science education. In FY2011, as part of scaling up of the pre-service medical education, UCSD provided technical, material and financial support to the Defense University and Health Science College (DUHSC). UCSD also provided trainings on effective teaching skills, student assessment and clinical skills to the academic faculty members of DUHSC. Under COP2012, UCSD will continue to build institutional capacity of the DUHSC by providing technical, material and financial support, as well as infrastructure development; support the procurement of teaching materials; and equip classrooms and clinical skills labs. To ensure the sustainability of the pre-service training efforts, UCSD will establish an academic development and resource center for designing, developing, implementing, and monitoring pre-service training programs for the DUHSC. UCSD will provide TA to DUHSC to deliver quality pre-service medical and health science education. Moreover, it will provide TA to establish a training unit to deliver HIV-related in-service trainings within the USE.

Medical Injection/Infection Prevention (IP) procedures are important components for providing quality health care services and to prevent the transmission of HIV and other diseases. UCSD has been implementing various activities since 2009 such as technical support through training; provision of basic IP/personal safety equipment; ISS and clinical mentoring to all USCD supported facilities. In FY2011, TOTs was organized for 17 HCWs by UCSD resulting in the cascade of training on IP/HMIN principles to 817 health care workers. IP committees were established in each facility to bring ownership and sustainability.

Under COP2012 USCD will focus on distribution of IP materials to 115 health facilities that are found in military, police and correction areas. Integrate injection safety and waste management practices into all OPD/IPDs under UCSD. Incorporate injection safety into mid-level health care professional curriculum as a standard practice. Regarding capacity building on the HMIN, USCD will train 1103 medical, paramedical and support staffs working within the defense health units on IP/injection safety.

UCSD will closely work with the defense disease prevention and control unit and the IP committee at all health facilities to build the capacity through mentoring, ISS and providing IP support materials. This support will include assistance with planning for cost effective, appropriate, and environmentally friendly waste management technologies. The organization will continue to work on ventilation of TB wards and complete the MDR/XDR TB prevention activities. A continuous quality improvement assessment on the injection safety activities will be conducted to identify and close gaps in close collaboration with the IP committees at health facilities, regional and national TWGs. Biannual stakeholder meetings will be held to share best practices.

UCSD supported the expansion and establishments of 115 HTC fixed and mobile Uniform Service health facilities at the national level and prisons. This facilitated testing and counseling services for over 200,000 uniform persons and general population. Under COP2012 major interventions will continue strengthening HTC services down to the regiment level as well as for mobile and hard-to-reach communities around military camps through the support of the mobile services. The organization will continue to assist the regional prison clinic efforts to establish a strong referral linkage with the nearby public health facilities. UCSD also plans to strengthen the existing services and ensure their quality by conducting trainings on partner and couple counseling with emphasis on discordant results. The Civil Military Alliances initiative will continue to build the HTC outreach services for marginalized civilian communities. Child testing will be supported at all sites through family-centered counseling. UCSD will strengthen the collaborative activities by using the Uniform Service media, MARCH programs, developing and dissemination of IEC/BCC materials and involving PLHIV as peer educators in promoting partners testing. UCSD, MOH/HAPCO and National Defense Force will work together to plan events around the National Annual Testing Day and WAD to promote HIV testing. UCSD and the National Defense Force will improve the quality of M&E tool (HMIS) for data capturing and timely reporting through training and mentoring of staff. This will include working with facilities and mobile units to improve the quality-assurance system through refresher training, mentoring, case review meetings, and peer and group supervision. UCSD will assist facilities in documenting and sharing best practices for increasing couple/partner testing. UCSD will also continue to support the National HTC program by contributing to the policy and training manual development. Where applicable, prevention of gender-based violence and coercion will be integrated into UCSD's activities. Refer to the indicators and targets for magnitude and impact of UCSD's program.

Since FY2007, UCSD supported the prevention and control of sexually transmitted infections (STI) in the 76 health facilities of the military, police and prisons.

The major focus of FY2012 shall include:

Continuation of STI service support to the existing 76 sites supported by UCSD.

Provision of on-site technical assistance to improve STI diagnosis and treatment.

Providing on-site training, supportive supervision, and mentorship for health providers on STI prevention, diagnosis, and treatment.

Strengthening the pool of core training of trainers (TOT) at the UCSD supported sites and departments.

Promoting PICT for all STI patients, and linkages to care and treatment services for PLHIV.

Scaling up and sustaining STI education focused on risk reduction, screening, and treatment for patients enrolled in HIV/AIDS care and treatment at the hospitals.

Strengthening provision of condoms to patients enrolled in care and treatment and education on how to use them.

Strengthening integration of STI services into antenatal and PMTCT services.

Strengthening of STI data recording and reporting system at all levels and site level data use. Where applicable, prevention of gender-based violence and coercion will be integrated into UCSD's activities. Refer to the indicators and targets for magnitude and impact of UCSD's program.

In FY2011, UCSD supported PMTCT in 20 USE health facilities. In COP 2012, UCSD will strengthen and expand PMTCT services at uniformed services health facilities nationally. UCSD will support FMOH and PEPFAR/E PMTCT acceleration plan to improve uptake and quality of these services. Under COP2012, UCSD will:

Support PMTCT services at health facilities and expand outreach services focusing on high prevalence and hotspot areas.

Support the FMOH in revising the national PMTCT guidelines, training packages and implementation manual, to adapt the new 2010 WHO PMTCT guidelines. This will include rolling out the revised national PMTCT guidelines at health facilities.

Implement quality improvement approaches, expand the role of case managers and Mother Support Groups (MSGs) and strengthen referral linkages to improve retention of HIV positive mothers and HEIs in care.

Support the Uniformed Health Services/FMOH to introduce a monitoring system for PMTCT program along the PMTCT cascade.

Support training on safe pregnancy/FP counseling and promote integration of FP/HIV services.

Scale up couple counseling and partner testing, facilitate male friendly services, and establish a monitoring system.

Expand counseling, PWP and treatment services for discordant couples.

Support improved maternal and neonatal emergency services through training, minor renovation, refurbishment of ANC, labor and delivery rooms and maternity wards and support the establishment of MNCH services where these services are non-existent to increase demand for ANC and delivery and thereby improve PMTCT uptake.

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.

Strengthen the pre-service training in the uniformed services training institutes.

Set the research/ evaluation agenda with the GOE and support PMTCT program evaluation.

Provide comprehensive PMTCT services to pregnant women with known HIV status and ARV prophylaxis and treatment to HIV+ women. Where applicable, prevention of gender-based violence and coercion will be integrated into UCSD's activities. Refer to the indicators and targets for magnitude and impact of UCSD's program.

UCSD has been providing support for comprehensive ART service delivery at Uniformed Services of Ethiopia (USE) health facilities and their respective health governing bodies. UCSD provides in-service training to health officers, nurses and pharmacy personnel from the USE health facilities.

UCSD conducts regular on-site supportive supervision and mentoring to ART providing facilities. It conducts Integrated Supportive Supervision (ISS) with health workers from the National Defense Forces, Federal Police and Federal Prison Administration of Ethiopia. The partner uses a cascade mentoring approach to provide mentoring support to remote and hard-to-reach sites that are difficult to visit regularly. USE facilities clinicians provide mentoring to other ART providers of the remaining ART sites in their area.

The ART service delivery in most of the USE facilities is provided by health officers and nurses due to shortage of physicians among the USE. This requires intensive support through continued training, supervision and mentoring. USCD supports and builds the capacity of the USE health governing departments in leadership and coordination of HIV care and treatment activities.

UCSD supports case management activities for improving adherence and retention of ART patients. Specifically, it trains and deploys case managers to the ART sites and provides mentoring support to the case managers. The partner supports the provision of integrated comprehensive care and treatment services to ART patients. All ART patients are screened for TB disease and isoniazid prophylaxis (IPT) provided according to the national guidelines. It also supports the preventive care package services. UCSD works to align the USE ART monitoring and evaluation activities with that of the national HMIS. It works to track and evaluate clinical outcomes and other performance data for site level use and quality improvement.

UCSD supports the USE facilities to strengthen civil-military alliance so that civilians in remote hard to reach areas can access HIV services at USE facilities. The partner works in renovation, furnishing, maintenance and restoration of basic functions in USE care and treatment facilities. Where applicable, prevention of gender-based violence and corecion will be integrated into UCSD's activities. Refer to the indicators and targets for magnitude and impact of UCSD's program.

UCSD has played a critical role to support implementation of pediatric ART services in its Operation Zone.

Under COP2012, UCSD will:

Provide technical support to national and regional working groups in the area of guideline development, training curricula and other job aids.

Work to improving pediatric case-finding and referral to care and treatment services with strong linkages with PMTCT and strengthen implementation of PICT at under-5 clinics, pediatric inpatient, TB clinics and EPI clinics

Ensure the implementation of family-focused care and family testing in all sites

Provide trainings for health workers in uniformed service facilities on comprehensive pediatric HIV care/ART in collaboration with the Defense University.

Promote advocacy to improve the attitude among health professionals as well as creating awareness in the community on the importance and benefit of pediatric ART services.

Improve the quality of service (growth monitoring, TB screening, cotrimoxazole prophylactic treatment (CPT), determination of infection status) provided for HIV exposed infants in the follow-up clinic with on job refresher training and regular mentorship as well as thru the provision of job aids to all the facilities.

Focus on regular site level support thru clinical mentoring, on job refresher trainings and supportive supervision.

Continue to work closely with the MOH, the Global Fund for AIDS, Malaria, and Tuberculosis, the Supply Chain Management System/RPM+, to ensure drugs purchased and distributed rationally.

Assess and improve quality of service for pediatric care and treatment through standardized QI approach.

Assist the ART health networks to follow standardized clinical procedures and use of tools that have been agreed upon by all partners.

Work to establish and strengthen strategies to integrate pediatric HIV services with MNCH and other child survival program interventions.

Identify potential challenges in implementing the program related to the peculiar administrative structure in uniformed services and work with the uniformed forces to implement appropriate solutions. Where applicable, prevention of gender-based violence and coercion will be integrated into UCSD's activities. Refer to the indicators and targets for magnitude and impact of UCSD's program.