In developing our vision for CDC programs and activities for the five-year PEPFAR program and beyond, we have kept in mind the goal to help Guyana become a model for the Caribbean. Today Guyana is a leader in the region in surveillance, care, and treatment, and the integration of the rapid test into the public health system. As projects and programs mature over the next few years, Guyana should be able to demonstrate that it is possible, in a resource-constrained Caribbean nation, to stem the tide of the epidemic, prevent nearly all HIV-positive mothers from passing HIV to their newborns, and ensure that life-saving ART treatment is available to all those in need. If we do our job well, PEPFAR can contribute to Guyana's leadership in training for physicians and public health practitioners, particularly lab practitioners, in HIV/AIDS care, surveillance, program design/implementation, and services.

The current and short term (2 year) staff for the CDC GAP office is a total of 22 positions, 12 under Management and Staffing and 10 working in or supporting specific program areas. In addition to the skill sets required for operating an office, the current level and mix of staff are needed to provide technical assistance and guidance to local and international partners as they develop their own capacity and reach. Partners include the Ministry of Health, the National Blood Transfusion Service, the AIDSRelief Consortium (Mercy and Affiliate Public Nonprofit Hospitals), UMDNJ/FXB and ITECH. During the current and expected near-term, the CDC will continue to assist the MOH and others in the development and implementation of national strategic plans as well as with strengthening internal systems to implement and monitor program activities. The current staffing mix includes three US direct hire FTEs, two contractors, one fellow, and 16 locally engaged staff (LES) on personal service agreements (PSAs). The vision for the projects and program is set by the US FTE country director (physician epidemiologist) and the US FTE deputy director for programs (physician epidemiologist), who are supported by the US FTE deputy for administration. The deputy for programs is supported by two senior program advisors, one a Guyanese physician epidemiologist who has a generalist program support role and the other a Guyanese MPH who provides overall structure and guidance to program areas and supports the MARCH project. Two junior program officers will focus on laboratory quality assurance and Blood Safety respectively. Support staff include an IT specialist, a data entry clerk, a chief financial officer, an office manager, an administrative assistant, two secretarial staff and a receptionist.

In addition, the office will be supported by one janitor and three drivers. In order to support the vision of serving as a regional example of successful response and management of the epidemic in the Caribbean, given the limited technical capacity in country and the constant drain of young professional staff, the CDC will need to remain at its current size for at least the next two to three years. As policies are developed and programs come on line to ensure retention of key staff for the public sector (MOH and NBTS) and the public non-profit sector (Mercy, Adventist Hospital etc.), the CDC will be able to scale back programmatic and administrative staff. A premature scale back or departure would be a lost opportunity to help Guyana move away from their growing dependence on Cuba and China for physician and technical staff.

The M&S activity supports 12 positions at the CDC GAP office in Guyana that include 3 US direct hire FTEs and 9 LES/PSAs. The estimated cost of doing business will total $400,000 to $600,000 in 2007 and 2008, this to cover ICASS, CSCS and Non-ICASS Security). In addition to the salary, benefits and business charges, funds within the M&S for FY07 include costs associated with office expansion ($80,000), office rent, utilities, security for the office and US FTE residencies. Other costs associated with US FTE staff include rent, utilities, and moving expenses for staff. Other costs will include office equipment supplies, training and travel. Travel will include periodic administrative support from Atlanta, and attendance at international and regional conferences and CDC meetings. Funding will be used to support some program activities, consultants, and special activities such as the Ambassador's Fund for HIV/AIDS ($20,000/yr).

Budget Overview 3 US FTEs ($225,000/ea total package) $ 675,000 Local Non Program Staff $ 130,000 Office Space/yr $ 50,000 Local Transportation (4 vehicle op costs) $ 60,000 ICASS and OBO $ 500,000 Travel $ 75,000 Admin support ATL $ 75,000 Office Expansion $ 80,000 Discretionary Program Support $ 200,000 Total $1,845,000