This is a continuing activity. The HHS/CDC Office builds capacity through agreements with partners or via direct technical assistance (TA) implementation. The Laboratory and Strategic Information Branches are co-located with the Ethiopia Health and Nutrition Research Institute (EHNRI), enhancing HHS/CDCs ability to work government to government. HHS/CDCs largest investments in direct TA implementation and material support include: LAB SYSTEMS - TA, training, accreditation support and equipment and facilities investments strengthen the health system by improving infrastructure and human capacity. SI CAPACITY HHS/CDC collaborates with EHNRI and other partners on surveys and surveillance (including study design); use of information systems; data collection, analysis and use; and report writing and dissemination. SCIENCE - TA to health workers, updating of guidelines and policies, support to program managers and policymakers to improve their understanding and abilities in research methods, ethics and carrying out evidence-based projects. HHS/CDC assists with the establishment and continuation of Institutional Review Boards. HEALTH SYSTEMS STRENGTHENING support the FMOH to assess its management capabilities, address quality standards, and take action to rollout quality improvement focused on improving outcomes from work processes among national and regional managers and prevention of mother to child transmission (PMTCT). PREVENTION TA in formative evaluation, piloting of innovative program strategies, sexual networking studies, and cross-program evaluations.

This is a continuing activity with direct technical and material support to EHNRI for strengthening laboratories in line with the national laboratory master plan and provision of guidance and leadership for PEPFAR lab strengthening efforts. In FY2011, HHS/CDC assisted with the implementation of the national laboratory strategic plan. HHS/CDC provided technical support for implementation of the WHO/AFRO laboratory accreditation of 24 laboratories, all of which are currently in the final stage of assessment. Another 15 were enrolled in the second round. HHS/CDC also supported the WHO accreditation of the national reference laboratory for HIV drug resistance testing. In collaboration with the American Society of Microbiology, HHS/CDC is taking steps to strengthen microbiology services at selected national, regional and hospital laboratories. In all laboratories enrolled in accreditation, HHS/CDC provided training on laboratory quality management systems and worked with partners to implement the "Strengthening Laboratory Management Towards Accreditation" (SLMTA) program. To incorporate principles of laboratory quality systems into pre-service training curricula, HHS/CDC trained faculty of laboratory schools. HHS/CDC also supported local professional associations to develop strategic plans to facilitate laboratory strengthening efforts. Under COP2012, HHS/CDC will continue to work towards sustainability and integration of laboratory services, provide trainings and enhance national and regional quality assurance programs. Support will continue to strengthen microbiology services, laboratory information system, sample referral testing, early infant diagnosis, drug resistance testing, and surveys and surveillance. HHS/CDC will support WHO/AFRO accreditation of laboratories and implementation of SLMTA projects in selected laboratories. HHS/CDC will collaborate with the Ethiopian National Accreditation Office (ENAO), a recently established government accreditation body, and local professional associations. HHS/CDC will provide technical and material support for full functionality of three DNA PCR sites and four TB liquid culture facilities being established.

HHS/CDC will provide TA for surveys and surveillance and train partners in data generation and dissemination for evidence-based decision making. TA will improve timeliness and quality of national- and regional-level data collected by GOE and partners. HHS/CDC TA will focus on:

Surveillance for ANC, TB/HIV, STIs and AIDS mortality through Demographic Health Surveillance sites. Assist GOE and partners with guidelines revisions and updates, site readiness assessments, training of trainers for surveillance officers, and oversight of data collection, analysis, report writing, and dissemination;

Subject-matter experts for FELTP, HMIS and AIDS mortality and vital event registration program;

Initiation of HIV case surveillance, including pediatrics;

Data management and analysis training on statistical packages (e.g. EpiInfo, SPSS, STATA, SAS, EPP/Spectrum, GIS) as well as health informatics/ICT trainings for national and regional surveillance staff; and

TOT to improve use and management of national M&E system data by national and regional staff.

Secondly, HHS/CDC will expand capacity to interpret and conduct evidence-based research by providing TA and training on scientific writing, communication and ethics. HHS/CDC will support IRBs with training, capacity building, and obtaining federal-wide assurances. HHS/CDC will assist the National Ethics Board and the Ministry of Science and Technology with development and revision of guidelines, SOPs, and IRB accreditation documents, advanced research ethics training, and use of tracking systems. HHS/CDC will support experience-sharing visits by national committee members. HHS/CDC will specifically provide TA to:

Print and disseminate national guidelines and accreditation documents

Assist 7 RHB and 8 university IRBs to register and secure Federal Wide Assurances

Procure computers and materials for national and regional ethical committees

Assist with design of a graduate-level Ethics in Health Research course

Coordinate research methodology trainings for USG technical staff and health research methods/ethics trainings for IRBs and partners.

Under COP2012, continued activities will include the Sustainable Management Development Program (SMDP) and capacity building for partners in administrative management and media relations. PMTCT is a GOE priority given data showing that Ethiopia has the lowest HTC coverage among pregnant women. SMDP aims to strengthen the management and training skills of public health officials and improve PMTCT services and outcomes. SMDP's efforts have focused on training national and regional managers to improve processes and outcomes using SMDP process improvement tools. In collaboration with Oromia Regional Health Bureau and Addis Ababa City Administration, HHS/CDC conducted training workshops for PMTCT service providers. After training, HHS/CDC mentored the providers in carrying out and analyzing results from their applied management improvement projects. COP2012 funding will continue to support process improvement trainings, material production, delivery and management, as well as follow-up to ensure application at the national, regional and local level. The program will also replicate successful SMDP projects from Oromia and Addis Ababa within some worksites in Amhara Region.

HHS/CDC will provide partners with classroom and on-site TA in the administrative management of US Government awards. This TA will focus heavily on developing the capacity of local partners including the GOE. Some partners have never been funded directly by the USG, while others have several years of experience. This TA will include capacity assessments that will customize follow-on support based on findings.

Finally, HHS/CDC will provide TA to partners on systematic, proactive approaches to external communication with policymakers, partners and the general public. Such efforts seek to optimize performance and disseminate successes to meet USG PEPFAR goals. HHS/CDC will assist with the provision of media relations support services, including training in media and public relations, and will provide logistics support for media relations events.

HHS/CDC will provide TA and financial support for a range of activities specifically designed to inform prevention programs. These may include formative evaluation, piloting of innovative program strategies, sexual networking studies and cross-program program evaluations with the prevention portfolio. Specific activities include:

Improving collection, analysis and dissemination of routine program monitoring data for prevention programs. Examples include establishing a broader HTC monitoring platform covering national model testing sites, mobile, home-based, and facility-based testing, routinizing monitoring for confidential STI clinics for most at-risk populations, routine testing among university populations, and hotline calls and mobile phone outreach.

Establishing mechanisms to trace linkages between prevention and care-and-treatment programs, to demonstrate which programs are most effective at getting clients into care

Systematic comparisons of biomedical service platforms for most at-risk populations, comparing for-profit private sector, non-profit or NGO private sector, and public sector services.

Formative evaluation of STI treatment patterns among most at-risk and surrounding hotspot and how pre-packaged STI treatment kits are achieving prevention goals

Piloting interventions on alcohol and ART adherence conflict among most at-risk populations. Such information is important for establishing the feasibility of test-and-treat programs for most-at-risk populations

Small scale piloting of test-and-treat strategies for most-at-risk group

In addition, HHS/CDC will provide direct TA and work with local partners to selected local universities to improve the quality of training on formative and operations research and qualitative methods and mixed method research which have proven to be weak in African settings.