In FY2007, AIDS Relief and the Roman Catholic Youth Office (RCYO) of the Diocese of Georgetown will capitalize on the foundation laid in the previous year to expand the Guyana Abstinence Program by training 300 peer educators, who will promote value-based HIV prevention activities in each of the ten regions of Guyana. A youth club will also be established in each Region in order to coordinate future initiatives to promote value-based HIV prevention activities targeting local youth in the area. It is envisaged that 5,000 youths will be reached through the youth clubs.

Targets

Target Target Value Not Applicable Number of individuals reached through community outreach that  promotes HIV/AIDS prevention through abstinence (a subset of total reached with AB) Number of individuals reached through community outreach that 5,000
promotes HIV/AIDS prevention through abstinence and/or being faithful Number of individuals trained to promote HIV/AIDS prevention 300
programs through abstinence and/or being faithful

Target Populations: Children and youth (non-OVC) Out-of-school youth

Table 3.3.02:

AIDSRelief will continue to strengthen its comprehensive palliative care program in order to enhance the well-being of their clients. AIDSRelief provides a basic package of care which follows OGAC guidance and includes: 1) Clinical Care (routine clinical monitoring and assessments of non-ART patients including follow-up to assist in determining the optimal time to initiate ART, including laboratory and clinical evaluations; prevention and treatment of OIs; support for adherence to ART; nutritional counseling; promotion of good personal and household hygiene); 2) Psychological Care (counseling, home visits, peer support); 3); Social Services (home-based care and CRS-privately funded assistance programs); and 4) Spiritual Care. AIDSRelief will build the capacity of clinical staff at its three existing local partner treatment facilities (LPTF) through focused technical assistance (e.g. clinical preceptorships, tutorials, didactics and clinical updates) in order to conduct routine clinical and laboratory monitoring, including assistance in determining the optimal time to initiate ART, and to effectively prevent and treat opportunistic infections (OIs). AIDSRelief will also support comprehensive adherence models to provide treatment preparation and continuous psychosocial support for its clients through individual counseling and support groups. In addition to being integrated within its treatment program, AIDSRelief palliative care will be linked with other clinical programs such as VCT, OVC and prevention activities as well as with complementary social support programs available at LPTFs (e.g. nutritional support funded by CRS-private funds) and in the community (e.g. legal support, housing). AIDSRelief will continue to liaise with GHARP, MOH and local community-based organizations to provide a seamless interface between care in the health facility and in the home/community.

In addition to further strengthen the palliative care program at its existing LPTFs, AIDSRelief will capitalize on its strong linkages with public & private treatment sites, the MOH and the faith-based community to oversee the introduction of step-down and hospice care service for HIV+ patients. As quality and access to hospital care for AIDS patients improves, the inpatient population will increase and hospital wards will quickly exceed their already limited capacity. AIDSRelief will introduce transitional and hospice care to HIV+ patients through a step-down unit run by the St. Vincent de Paul Society of the Catholic Diocese of Georgetown. This group has been providing charitable services to the poor and marginalized in Guyana since 1858, and they currently support similar step-down facilities in Trinidad & Tobago. While St Vincent de Paul Society will help administer the center, the Georgetown Public Hospital Corporation (GPHC) has agreed to staff this new clinical program. AIDSRelief will ensure that this facility is closely linked with both hospital-based and community-based providers. A particular emphasis will be placed on the training of caregivers to ensure a timely and smooth transition of the client into the home. Technical experts in the field of palliative care from the Institute for Human Virology (IHV) will also work with clinical providers to build their capacity to care for these patients. Those involved with planning patient care need to ensure that patients discharged from these facilities receive supervised care and support until they are able to transition to their homes/places of origin. This approach to patient care will ensure increased adherence to treatment rates. Hospice services are also needed to allow those with late-stage disease to end life in comfort and dignity. In September-November 2006, AIDSRelief will develop an integrated step-down service delivery model addressing such factors as inclusion criteria, technical staffing, administrative management, sustainability, stigma, and reintegration of patients into the home, in coordination with beneficiaries and other stakeholders including AIDSRelief treatment sites, MOH Palliative Care Coordinators supported with GFATM funds, technical partners (e.g. FXB, GHARP), and the NGO/FBO partners already delivery palliative care in the communities.

As one component of its comprehensive care and treatment activities in Guyana, AIDSRelief will focus on inter-agency collaboration and training in regards to TB/HIV co-infection diagnosis and treatment.

To ensure effective co-management of HIV and TB, AIDSRelief will continue to strengthen the relationship between the Chest Clinic and the Local Treatment Partner Hospitals (LTPH) in Georgetown (St. Joseph Mercy Hospital and Davis Memorial Hospital). AIDSRelief will also continue to work with the Ministry of Health and the Chest Clinic to ensure treatment and follow-up of TB/HIV co-infected patients at Bartica Public Hospital. Beginning in October 2006, AIDSRelief will provide direct oversight of monthly visits to Bartica Public Hospital by Chest Clinic staff.

AIDSRelief, in collaboration with the Chest Clinic and Ministry of Health, will provide training for all health staff and DOTS workers at Bartica Public Hospital, Mazaruni Prison, and regional health posts in Region 7 so that there is sufficient human capacity to manage patients on-site and in the surrounding areas. Clinician training on managing TB/HIV co-infection, in accordance with Guyana's national guidelines, will include: diagnosis of TB in the HIV-infected person, selection of an ART regimen for patients starting therapy for tuberculosis, and initiation of ART in a patient who is currently on anti-TB therapy. In addition, AIDSRelief will support the laboratory infrastructure at Bartica Public Hospital to ensure proper diagnosis and management of TB and HIV. AIDSRelief will avoid duplication of services by coordinating with the Global Fund and other PEPFAR partners.

Targets

Target Target Value Not Applicable Number of service outlets providing treatment for tuberculosis (TB) 1
to HIV-infected individuals (diagnosed or presumed) in a palliative care setting Number of HIV-infected clients given TB preventive therapy 25
Number of HIV-infected clients attending HIV care/treatment 25
services that are receiving treatment for TB disease Number of individuals trained to provide treatment for TB to  HIV-infected individuals (diagnosed or presumed)

Target Populations: Adults Faith-based organizations Doctors Nurses People living with HIV/AIDS Prisoners Public health care workers Laboratory workers Other Health Care Worker Private health care workers Doctors Laboratory workers Nurses Other Health Care Workers HIV positive children (5 - 14 years)

Coverage Areas Cuyuni-Mazaruni (7)

Demerara-Mahaica (4)

Table 3.3.07:

AIDSRelief places an emphasis on high quality care for OVC as part of its family-centered approach to care and treatment. Of the 625 patients currently enrolled in care (ART and non-ART), eighty-two (13%) are under the age of fourteen. Through continued dialogue with the pediatrician, counseling staff, and discussions with other treatment partners, AIDSRelief has come to recognize the need for targeted technical assistance tailored to the needs of our pediatric population. AIDSRelief will focus clinical technical assistance to strengthen clinical and laboratory monitoring of pediatric patients enrolled in pediatric care and/or ART programs. A pediatric psychologist from IHV will provide specialized training to counseling staff at local partner treatment facilities (LPTFs) in addressing psychosocial issues unique to children with AIDS and their families (e.g. coping with trauma of death of parent, disclosing status to children, anxiety & fear). Additionally, providers and counselors from the community and USG partner treatment sites will be invited to attend continuing education seminars on issue related to counseling children and adolescents infected with HIV. Particular emphasis will be placed on tailoring ART adherence services specifically for HIV positive OVC, as clinicians have reported that many caregivers have challenges understanding the dosages of ARV oral solutions. In addition, AIDSRelief will coordinate with USG and MOH to explore the possibility of introducing technology to enable pediatric diagnosis open to both public & private treatment sites in the interim until PCR testing is available at the National Reference Laboratory.

As part of its family-centered approach, AIDSRelief will strengthen linkages with ongoing care, treatment and prevention programs. Strong linkages with PMTCT programs will ensure that children have timely access to treatment services. AIDSRelief will also facilitate linkages with complimentary support services available at the LPTFs and in the community to offer a greater continuum of care for OVC.

NOTE: Funds are not requsted as this will be incorporated into our treatment and palliative care activities funding request.

In FY06 AIDSRelief will continue to promote its model of family-centered HIV care by ensuring that at least 15% of its palliative care and treatment targets are children. AIDSRelief will also continue to train the pediatrician at St. Joseph Mercy Hospital (SJMH) in pediatric HIV care and will build the capacity of an additional pediatrician to provide ART and non-ART care to children as the pediatric caseload continues to increase. In addition, the SJMH pediatrician has volunteered her time to travel to Bartica on a montly basis to treat the HIV+ children identified at that POS. AIDSRelief will also continue to procure pediatric ARVs for its patients, and will facilitate access to pediatric formulations of medicines for common opportunistic infections (e..g. fluconazole oral solution for oral/esophageal candidiasis). Lastly, AIDSRelief will strengthen linkages with services funded with CRS private funds targeted at children affected by HIV/AIDS at its POS (i.e. nutritional support, educational supplies), as well as with organizations that provide care to children in the community (e.g. UNICEF, Red Cross).

AIDSRelief will continue to ensure that HIV counseling and testing services at the three treatment sites it supports comply with national and international standards. As HIV testing will remain the major limiting factor to the expansion of HIV treatment in Guyana, AIDSRelief will support the rapid scale up of VCT services in existing health and community facilities. In coordination with NAPS and the USG, AIDSRelief will support the integration of fixed VCT services in five riverain health posts in the Lower Mazaruni (Region 7) as well as in seven Adventist church structures in the Georgetown Area (Region 4). AIDSRelief will also support free HIV testing in accordance with national standards at four private hospitals in Georgetown (Balwan Singh, Woodlands, Prasad's, Medical Arts Center) as these facilities have the potential to capture a large segment of the population due to their high out-patient and ANC populations. AIDSRelief will ensure that counseling and testing adhere to national standards as anecdotal evidence from HIV treatment providers indicates that these hospitals do not currently provide adequate post-test counseling or prepare the positive client to receive care or treatment. AIDSRelief will also ensure that these newly established VCT services are linked with other clinical programs, and HIV care & treatment programs in the public and private sector.

Targets

Target Target Value Not Applicable Number of service outlets providing counseling and testing 19
according to national and international standards Number of individuals who received counseling and testing for HIV 7,000
and received their test results (including TB) Number of individuals trained in counseling and testing according to  national and international standards

Target Populations: Adults Faith-based organizations HIV/AIDS-affected families People living with HIV/AIDS Migrants/migrant workers Religious leaders

Coverage Areas Cuyuni-Mazaruni (7)

Demerara-Mahaica (4)

Table 3.3.09:

In FY07, AIDSRelief will begin to utilize the Partnership for Supply Chain Management (SCMS) for supplying antiretroviral medications for its treatment program. AIDSRelief must maintain a stock of essential medications for current treatment regimens to ensure there are no stock outages during the transition from an existing independent commodities management system to SCMS. AIDSRelief's current funding for drugs will end in February of 2007 and replacement stocks of medications must be ordered four months in advance. This activity provides contingency funds for a buffer stock of antiretroviral medications for AIDSRelief, so as to compensate for any delays or difficulties that might arise in the transition to SCMS and cause a break in service delivery.

AIDSRelief is a consortium of three faith-based, non-governmental organizations with experience in international development, a leading research institution in the care and treatment of HIV, and a consulting firm with expertise in monitoring and evaluation. AIDSRelief is committed to working in close collaboration with the government of Guyana and the in-country US government (USG) team to help strengthen existing networks of HIV care and treatment. Catholic Relief Services is the ARV services provider.

In FY 2007, AIDSRelief will continue to provide ARV treatment services at St. Joseph Mercy Hospital (SJMH) and further expand services both in the private and public sector. In the public sector, AIDSRelief provides technical assistance to Bartica Public Hospital, helps ensure that PLWHA receive quality care at that site, and facilitates linkages between the Bartica treatment program and the Mazaruni Prison. Additionally, AIDSRelief's full-time physician provides frequent on-site visits in order to work with Bartica Public Hospital's clinical staff and maintains close contact with the adherence nurse coordinator in order to discuss any problems that arise. In an effort to avoid duplication of services, SJMH clinicians refer TB and TB/HIV co-infected patients to the Chest Clinic for treatment. The treatment team also facilitates linkages with complementary HIV services (e.g. PMTCT).

AIDSRelief has begun to expand services to Davis Memorial Hospital, which is located in Region 4 (SJMH and Davis Memorial Hospital are the only two faith-based hospitals in Guyana). The addition of Davis Memorial Hospital as a treatment site further expands the options for those wishing to access care and treatment services for HIV. In preparation for site activation in August 2006, local AIDSRelief staff and Institute of Human Virology (IHV) physicians and laboratory specialists helped build the clinical and laboratory capacity of staff at Davis Memorial Hospital for HIV diagnosis and management. Patient enrollment began in September 2006.

The in-country IHV physician provides ongoing support and assistance to the local partner treatment facilities (LPTFs), and liaises with USG in-country and Ministry of Health (MOH) partners on technical issues related to HIV care and treatment. IHV provides support and assistance on a national scale through the continued revisions of the National Guidelines, ongoing HIV-related Continuing Medical Education (CME) for clinical staff, and lectures and discussions with medical staff at both public and private treatment sites in Georgetown. AIDSRelief's QA/QI initiative identifies best practices through analysis of facility-based data and is critical to providing the highest quality care at each of the treatment sites. This ongoing initiative will continue to promote efficient and sustainable care by enabling AIDSRelief to effectively implement and scale-up successful programs, as well as target technical assistance resources more efficiently to the LPTFs. AIDSRelief also builds the capacity of the laboratories at its three LPTFs through trainings, ongoing technical assistance, and the provision of equipment, supplies, and reagents. AIDSRelief will adopt the national patient tracking system and will coordinate with MOH and USG to assure that data formatting and reporting is consistent with the national program.

In FY 2007, AIDSRelief will scale-up the number of patients receiving care and treatment services in the private faith-based sector by substantially increasing HIV testing and intensifying technical assistance. AIDSRelief anticipates that up to 30% of all patients in Guyana will access HIV treatment services in the private sector (currently 18% receive care in the private sector); thus, scale-up in the private sector is vital to maximize the sustainability of ART services in Guyana. For this reason, in addition to improving clinical practice to promote viral suppression and ensure the timely initiation of quality ART, AIDSRelief will focus on strengthening health systems at its private-sector sites to improve their operational and financial sustainability and ensure that this sector is thoroughly integrated into the national network of treatment services (e.g. drug and reagent procurement, trainings, development of guidelines and protocols). Through the Constella Futures group, AIDSRelief will build the capacity of LPTFs to effectively collect and validate data as part of an adaptive management strategy to further reinforce efficiency and promote sustainability.

In FY 2007, AIDSRelief will also continue to augment capacity and services at Bartica Public Hospital and strengthen its linkages with the Mazaruni Prison and the regional health posts in order to provide greater access to care and treatment services to Bartica and the surrounding communities. AIDSRelief, through IHV, will collaborate with in-country partners to provide trainings, lectures, and workshops for local HIV treatment

providers, in both the public and private sectors, in order to build the confidence and capacity of Guyanese clinicians so that they may inform future HIV-related policy and standards.

AIDSRelief will avoid duplication of services by coordinating with the Global Fund and other PEPFAR partners.

AIDS Relief provides support of HIV-related laboratory services including equipment, reagents, staffing, and training at CRS supported Mercy Hospital and CRS supported Bartica (MOH) Hospital and Davis Memorial Hospitals.