This is new award / mechanism with limited eligibility to facilitate transition of programs to local ownership. Addis Ababa City Administration Health Bureau and the South Nations and Nationalities People Regional (SNNPR) health bureau are government entities established by law and mandated to plan, manage, administer and coordinate all health related activities including HIV/AIDS activities within their designated geographic area. The purpose of the program(s) is to develop and strengthen the support and implementation of HIV prevention, care and treatment services delivered by each of these Regional Health Bureaus. The program will help to build the capacity of the overall health care system in Ethiopia to provide high-quality comprehensive health services to the Ethiopian population in line with government strategies and policies and the overarching USG global health goals outlined in GHI. The TBD partner(s) will work in collaboration with HHS/CDC Ethiopia and Federal MOH in Ethiopia to achieve program outcomes. All activities implemented under this program will follow national and local policies and guidelines for HIV service delivery. The TBD partner(s) will work to improve the breadth, scale, and quality of HIV services available within each of these regions and conduct supportive supervision visits and provide mentoring to health facilities. This will also include facilitating and participating in USG joint supportive supervision programs in the region. The partner(s) will document its activities, share best practices and undertake monitoring and evaluation of the program. The partner being within PEPFAR will play its part in the implementation of GHI.

The Addis Ababa City administration Health Bureau will recruit or assign a care and support focal person who will oversee the implementation of care and support related activities and take over the adult care and support activities being implemented by the international TA partner. In COP 2013, the bureau will undertake the following activities:

Strengthen the intra-facility and two way referrals and linkages between health facilities and the community.

Coordinate and harmonize work with community-based organizations (CBOs) working on HIV/AIDS care and support services, and facilitate their involvement in health facilities multi-disciplinary team and catchment area meetings; use CBOs and urban health extension workers to trace and link lost to follow-up PLHIV.

Intensify prescription of co-trimoxazole prophylactic therapy (CPT) for eligible PLHIV; consider CPT as one of the quality monitoring indicators and review its performance regularly

Provide nutritional assessment and counseling services and provide nutritional support to malnourished PLHIV in collaboration with partners working on nutritional support.

Integrate mental health services into the chronic care unit or link PLHIV who need mental health service to psychiatric clinics.

Strengthen PwP prevention messages and services

Strengthen pain assessment and management services for PLHIV, and improve access to pain medication for PLHIV, including morphine.

Ensure training, distribution and utilization of basic preventive care package components.

Oversee implementation of cervical cancer prevention service at Zewditu Hospital

In COP 2013, AACARHB will strengthen its capacity to support and monitor TB/HIV program and service integration in a sustainable manner through training and integrated mentorship activities and ensuring quality of TB/HIV care.

In COP 2013 the AACARHB will:

Develop a costed strategic plan for TB/HIV program support as part of the comprehensive HIV/AIDS program plan.

Strengthen TB and HIV control program coordination and integration at regional and sub-regional health care structure levels.

Undertake assessment of the TB and TB/HIV program to identify key program gaps and focus areas for the regional TB control program.

Strengthen TB program management and human resource capacity at regional and sub-regional levels through training of TB and TB/HIV control program staff.

Undertake regular supportive supervision and review meetings to monitor the TB/HIV programs.

Organize a pool of a core team of trainers for comprehensive TB-Leprosy, TB/HIV and MDR-TB training at the regional level.

Organize regional TOTs and in-service trainings on comprehensive TB, TB/HIV TOTs in collaboration with local universities and partners.

Organize mentorship teams composed of RHB, health facility and local university staff; in collaboration with partners, undertake mentorship of the comprehensive TB and TB/HIV control programs in health facilities in the region

Undertake TB and TB/HIV related program evaluations.

Strengthen TB diagnostic services and EQA in collaboration with EHNRI, regional laboratories, and partners.

Strengthen patient referral networks across TB/HIV delivery sites; print and distribute TB/HIV guidance documents and job aids.

Support TB and TB/HIV Advocacy Communication and Social Mobilization (ACSM) activities.

In COP 13, the core activities that will be undertaken by the Addis Ababa City Administration Health Bureau will be to build its managerial and technical capacity to take over the pediatric care and treatment program in preparation for a full transition of support by 2015. In COP 2013, the AACAHB will identify other high case load sites and further expand services as appropriate. In COP 2013, the AACAHB will:

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, prevention and treatment of diarrhea, linkages to immunization programs, and Isoniazid prophylaxis (IPT) for HIV positive children. The partner will also 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 that 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 the availability of supplemental feeding products.

Strengthen internal/external referral linkages to identify and link HIV positive children, orphans and vulnerable children with family, social, and adherence support.

In COP 2013, the AACAHB Regional Laboratory will closely work with the TBD international TA partner to facilitate the transition of laboratory program activities in the region. The AACAHB Regional Laboratory will:

Conduct baseline assessments of laboratories to be enrolled in Stepwise Laboratory Improvement Process Towards Accreditation(SLIPTA), participate in SLIPTA training, and mentor participating laboratories.

Procure ancillary laboratory equipments and safety materials to support laboratory accreditation through SLIPTA.

Collaborate with Addis Ababa University and the TBD partner to conduct training on laboratory quality management systems, laboratory management, HIV rapid testing, safety, and ART monitoring.

Establish central equipment maintenance capacity through employment of equipment maintenance engineers, training of the maintenance engineers, and procurement of preventive maintenance tool kits and calibration equipments. The workshop will have the capacity to maintain ancillary equipments, conduct calibration, and provide preventive maintenance for larger equipment.

Strengthen the Regional EQAS program and increase coverage of facilities in the region. The Regional Laboratory will implement process improvement informed by REQAS performance. The Regional Laboratory will procure equipment and supplies required for regional EQAS.

The Regional Laboratory will organize regional laboratory program review meetings.

The Regional Laboratory will collaborate with EHNRI to establish data management capacity (data base) for major laboratory program areas such as training, sample referral networks, EQA, SLIPTA, and equipment maintenance.

Work closely with EHNRI, the postal service, and the TBD partner to strengthen sample referral networks. The AACAHB Regional Laboratory will train laboratory personnel on sample referral networks, and monitor network performance. The Regional Laboratory will procure sample transportation and storage materials to strengthen the sample referral networks.

Strengthen the microbiology laboratory services at the Regional Laboratory to support referral testing, disease surveillance, and outbreak investigations in the region.

Strengthen the referral system between different levels of facilities, including referrals to available community-based services.

The Addis Ababa City Administration Health Bureau is a local government entity that is responsible for all health care and related activities in the Addis Ababa City Administration. The Health Bureau entered into a cooperative agreement with CDC in COP 12 and has become a direct recipient of PEPFAR funds to implement HIV/AIDS program activities in its region. Starting from FY 2013, in the SI program area, the partner will support and strengthen monitoring and evaluation of HIV program activities in order to be report PEPFAR indicators for the region and to utilize data at the site and regional levels to inform evidence-based planning and quality improvement. The partner will transition key technical and managerial activities away from the international TA partner to the local Regional Health Bureau (RHB). Technical and management support includes, but is not limited to, on-site mentoring and supportive supervision, coordination of in-service training through collaboration with local universities, and implementation of a monitoring system that will build the capacity of the AACAHB to report on PEPFAR performance indicators. In COP 2013, to the partner will:

Facilitate a smooth transition of key technical and managerial activities to the AACAHB.

Ensure M&E/HMIS staff and HIT/Data clerks will be trained in HMIS and HIV/AIDS data management, and take over full responsibility for this activity from the existing international TA partner working on this.

Use site level performance data for informed decision making, performance data, and quality improvement.

Work together with the international TA partner to ensure a smooth transition of responsibility for reporting on PEPFAR performance indicators.

Document its activities, share best practices, undertake monitoring and evaluation of the program, and site supportive supervision.

Conduct regular regional review meetings.

Collaborate with the international TA partner and local universities to strengthen the M&E unit of the RHB through SI specific in-service trainings.

This is a new activity to be implemented by regional health bureaus.

Health system strengthening remains a priority for the Government of Ethiopia (GOE) and all stakeholders in the health sector as weaknesses in the health system are critical barriers to achieving country capacity to sustain the response to HIV/AIDS over time.

The goal of this program is to build the technical and managerial capacity of the regional health bureaus to successfully transition technical and management support for the implementation of comprehensive HIV prevention, care, and treatment services. In particular, this program will be geared toward supporting the implementation of strategic objective 5 (improve quality of health care), strategic objective 6 (enhance harmonization and alignment), and strategic objective 13 (improve human capital and leadership) of the GOEs Health Sector Development Program IV (HSDP IV).

In COP2013, AACAHB will work closely with local universities to coordinate the implementation of pre- and in-service training, support the deployment and implementation of human resources information system (HRIS) at the RHB, support and coordinate the implementation of hospital reform and quality improvement programs, conduct regional joint supportive supervision with implementing partners, support regular health sector review meetings;,disseminate policy documents, implementation guidelines, best practices, and evaluation findings. The AACAHB will work closely with the USG and other partners to avoid programmatic duplication and to enhance synergy for optimal use of resources.

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. The international TA partner has been implementing various activities in health facilities under the management of the Addis Ababa City Administration Health Bureau, which includes technical support through training, provision of basic IP/personal safety equipment, ISS, and clinical mentoring..

In COP 2013, some of the IP and patient safety activities will be transitioned to the Addis Ababa City Administration Health Bureau, to support health facilities under AACAHB focusing on building IP management capacity through providing trainings, printing and distribution of IPPS guidelines, integrating injection safety and waste management practices into all OPD/IPDs in the facilities, and procuring and distributing selected standard IP commodities.

The Addis Ababa City Administration Health Bureau will work closely with the health facilities under its management, other implementing agencies, and the IP committee in all health facilities, to build capacity through mentoring of clinical staff and waste handlers, ISS, and providing IP support materials. This support will include assistance with planning for cost effective, appropriate, and environmentally friendly waste management techniques at the facility level. The Addis Ababa City Administration Health Bureau will also assist the health facilities to continue work on ventilation of TB wards and complete the MDR/XDR TB prevention activities. It will also assist with implementation of a continuous quality improvement assessment on the injection safety activities and closely monitor Infection Prevention and waste management activities at the facility level to identify and close gaps in collaboration with the IP committees at health facilities.

In previous years, HIV testing and counseling (HTC) services at health facilities in Addis Ababa were supported by JHU TSEHAI. In COP 2013, some activities of the HCT program will be transitioned to the Addis Ababa City Administration Health Bureau. In COP 2013, the AACAHB HCT program will:

Support the implementation of VCT services including couples/partner and family testing and counseling, and routine HIV testing at point-of-care (POC) in all health facilities.

Strengthen pediatric PITC in all entry points to at all health facilities. This includes pediatric inpatients, under five outpatient departments, therapeutic feeding units, and immunization outlets.

Work with partners to implement index case testing in hospitals and health centers.

Build human capacity through onsite training of health care workers on couple and individual HTC and PITC.

Strengthen systems through regular mentorship and supportive supervision to ensure quality HTC service delivery.

Support HIV rapid testing quality assurance through regular supervision of labs.

Develop an SOP for HTC activities.

Establish stronger HTC-related partnerships at national and regional levels and provide technical and logistic support to sites implementing HTC services.

Work with the international transition TBD partner and other university partners. The Addis Ababa City Administration Health Bureau will be provided with technical support by the TBD transition partner to carry out these activities.

The Addis Ababa City Administrative Region has a population of 2, 738, 248 , and HIV prevalence of 4.4%.

Since 2005, JHU-TSEHAI has been supporting the Addis Ababa City Administration Health Bureau to strengthen STI/HIV service and program activities in all Addis Ababa hospitals.

In COP 13, the following STI program support activities will be transitioned to the Addis Ababa City Administration Health Bureau to ensure sustainability and local ownership of the STI/HIV program by the GOE.

Strengthening the capacity of HCWs in Addis Ababa to diagnose and treat STIs/HIV. Health care providers from 20 public health hospitals and health centers in Addis Ababa will be trained on syndromic management of STIs.

Improving the linkage of STI/HIV / AIDS services through provision of PICT for STI clients at public hospitals and health centers in Addis Ababa. At least 80 percent of STI patients will be tested for HIV and linked to care and treatment services .

Strengthen STI screening for PLWHAs at ART clinics, and also HCT , family planning, and ANC clients in public hospitals and health centers Addis Ababa.

Strengthen condom demonstrations and access at the public health facilities in Addis Ababa, particularly for STI patients and PLWHAs at the ART clinics.

Strengthen risk reduction counseling and health education for STI patients at the public health facilities in Addis Ababa.

Support the capacity of public health facilities in Addis Ababa to print and distribute STI job aid materials, (national STI guidelines, wall charts, and flipcharts)and IEC/BCC materials on STI/HIV prevention.

Improve access to prepackaged STI treatment kits in the public health hospitals and health centers in the region in collaboration with other partners(PFSA &PSI).

The Addis Ababa City Administration Health Bureau (AACAHB) will work closely with the respective CDC/PEPFAR international partner to build its capacity, and will gradually transition PMTCT activities to strengthen local ownership and ensure sustainability of the program. It will enhance the capacity of the Zonal/Woreda Health Offices to support the transition of PMTCT services.

In COP13, AACAHB will:

Support the transition of PMTCT services to public hospitals and health centers in the Addis Ababa City Administration.

Support rolling out of Option B+ through training and mentoring of health care providers at facilities providing PMTCT services.

Conduct site supportive supervision, use site level performance data, and implement quality improvement approaches to improve retention of HIV positive mother and HEIs in care services.

Strengthen the capacity of Case Mangers and MSGs to improve retention of HIV+ women and family members in care and treatment services.

Support implementation of the updated PMTCT monitoring system in line with the Option B+ strategy..

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

Support Integration of TB Screening with PMTCT program.

Scale-up couples counseling and partner testing, facilitate male friendly services, and establish a monitoring system related to these services.

Support minor renovations, refurbishment, and repairs of ANC, labor and delivery rooms, and maternity wards.

Improve the referral system to ensure continuum of PMTCT care.

Support the catchment area meetings and conduct regular regional review meetings.

Under COP2012, the TBD partner(s) will strengthen the capacity of the health care system to plan, manage, and support the provision of HIV/AIDS services within the respective geographic target areas of the Addis Ababa city administration health bureau and the SNNPR health bureau. This includes human resources, training, supervision, financial management, quality improvement, laboratory, infrastructure maintenance, and commodity support. The HHS/CDC will provide additional technical assistance and oversite to the TBD partner(s). Specific activities will include: Conduct supportive supervision visits and provide mentoring to health facilities and facilitate and actively participate in USG joint supportive supervision programs in the city administration. Reproduce and distribute, as needed, HIV-related training materials, monitoring tools, supervision tools, job aides, and clinical guidelines. Collaborate with the HHS/CDC and other USG partners in the training of site level mentors recruited from the sites. Conduct in-service training and support pre-service trainings of health care providers in the provision and monitoring of HIV prevention, care, and treatment services, in accordance with national HIV/AIDS policies, guidelines, and training materials. Conduct program M&E activities including provision of support for implementation of Health Management Information System (HMIS) at regional and facility levels, and regular data quality verification exercises. Provide program oversight for all HIV/AIDS prevention, care and support and treatment services in the region including holding regional ART committee meetings, reviewing program and service delivery performance data, and addressing implementation issues.

In COP 13, the core activities to be undertaken by the Addis Ababa City Administration Health Bureau will be to build its managerial and technical capacity to manage the pediatric care and treatment program in preparation for a full transition of the support by 2015. In COP2013, the AACAHB will identify other high case load sites and further expand services as appropriate. In COP 2013, the AACAHB will:

Provide TA to national and regional working groups to update guidelines, protocols, training materials, and IEC materials; 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.

Mentor health care providersto improve service quality and provide onsite updates.

Provide training on pediatric ART, advanced learning through telemedicine, and case review sessions using local university trainers.

Involve the community in supporting uptake and adherence of HIE and pediatric patients, and link to OVC programs.

Provide supplies, equipment, IEC materials/job aids and minor renovations.

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 pediatric ART units to ensure retention, tracking, and referral tor support services at available community-based organizations.

Continue monitoring and evaluation support to facilities as per national mandated standards.

Ensure utilization of quality improvement tools 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 services

Establish strategies to integrate pediatric HIV services with other MNCH and child survival interventions.