The PMTCT national program continues to scale up to include regions. This scale up, as well as the need to provide the best technical support to the national program, will require expertise from the CDC/Atlanta and the PEPFAR technical working group for labor and delivery issues, as well as other issues as identified by the MoH. The comprehensive assessment of the PMTCT program planned by this group for FY06 has been postponed but is expected to occur in FY07. Additionally, to address the increased demands in M&E as the program is scaled up, the CDC will provide support for data entry and training in statistics and support for the senior program officer at CDC to oversee the PMTCT activities and the MOH agreement.

The PMTCT National Program is experiencing expansion during the same time that the MOH is working to establish a quality procurement system (with the technical assistance of SCMS). There are times when shortages of critical commodities do occur. In order to ensure that essential commodities are available as the MOH brings it procurement system in-line, CDC will provide, on an emergency basis, commodities for the PMTCT program. These include items such as gloves, BMS, and ensure that there is access to MOH-provided contraceptives for HIV+ mothers, etc.

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Table 3.3.02:

The role of the CDC GAP country office is understood to be ‘coordinating grant activity and consultants, to ensure utilization of available resources, and to provide feedback to OGAC on program design and need for reorientation.' In addition the CDC Office will continue to work to help implement priorities established in the national strategic plan and to ensure accurate data reporting. In-house program staff will work closely with TA provider, CDC Atlanta, NBTS, and other partners to support donor recruitment, data reporting, implementation of SOPs for NBTS, and advocacy on policy issues such as blood safety regulatory legislation for transfusion services and structure of the national transfusion system. CDC will also assist in the transition to SCMS to improve procurement systems at NBTS. CDC will liaise with the PEPFAR public affairs officer to highlight donation activities and promote a positive public image for voluntary blood donation and support a social marketing initiative.

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Table 3.3.06: Program Planning Overview Program Area: Palliative Care: Basic Health Care and Support Budget Code: HBHC Program Area Code: 06 Total Planned Funding for Program Area: $ 2,140,000.00

Program Area Context:

Although National Guidelines for palliative care exist, this program area responds to the treatment and support section of Guyana's National Strategic Plan for HIV/AIDS 2002-2006 which states that its purpose is to "improve the quality and length of life of persons infected and affected by HIV/AIDS in a supportive environment so they could achieve their maximum potential." The goals under the USG contribution to the National Strategy will be to provide the four categories of essential palliative care services that will be available to all people infected or affected by HIV/AIDS: 1.) Clinical Care; 2.) Psychological Care; 3.) Social Services; and 4.) Spiritual Care. There are an estimated 11,000 HIV+ individuals in Guyana, and currently 500 clients are receiving the full, home-based and palliative care package through eight PEPFAR-supported programs and over 2,100 ART non-eligible, HIV+ persons are receiving one (clinical care) or more of palliative care services. Definitions of home based care (HBC) and palliative care are those outlined by WHO, and reflected in the PEPFAR strategy. In addition, 127 providers of home-based care have now been trained. These community-based providers work along with the MOH Regional Palliative Care Coordinators, supported by GFATM, that are based within hospitals that offer ARV treatment. The referal service is being strengthened so that patients identified as positive through clinic-based counseling and testing and/or treatment sites will be directly accompanied to the Palliative Care Coordinator's office where they will enroll in the program. NGOs will be contacted in order to ensure their is a continuum of care. Finally, NGOs that offer community-based VCT also offer palliative care services and as such referalls can be done internally.

Support will continue to be given for training of providers with subsequent mentoring throughout service delivery by NGO and MOH outreach staff. Training, referrals,and monitoring are a collaborative effort between the National AIDS Program Secretariat, PEPFAR and the GFATM who support placement of palliative care officers in the regions. Clinical care services that include asymptomatic, symptomatic, and end of life bereavement services (following WHO analgesic ladder) will be provided through the health sector with linkages to community support organizations. These clinical sites located in each regional facility (Regions 2,3,6,10) and the central treatment center of excellence (Region 4), will use referral handbooks to directly link patient to a point of contact where they and their family can receive support in the other three palliative care aspects. The referral will also work in reverse when community outreach identifies a client in need of clinical services the nearest provider will be referred and when needed, accompaniment will also be provided to ensure a link is made.

Currently, no official policies or treatment guidelines exist for treatment of pain relief. Opiods are currently only provided at the Georgetown Public Hospital Corporation because of the the bueracracy and high costs that exists for the importation of these drugs. GHARP and FXB will be working together with the MOH and the National AIDS Program Secretariat to revise and adopt new treatment guidelines. SCMS and the MOH will also work from the supply chain management and logistical angle to facilitate the introduction and proper oversight of introducing these drugs into the system.

Psychological care services that address the non-physical suffering of the individual and their family include support groups linked to the health center as well as those led by FBO and NGO partners, development and implementation of age-specific psychological care in collaboration with the social workers union, and family care and support delivered by NGOs/FBOs. Families United, a young NGO, grew out of the PMTCT program when HIV+ mothers united in order to support one another through their delivery and after. The support group then continued to grow when the participation of families started to increase significantly. Family centered approaches enable the program to identify and link OVC to those specialized services available to them, enable the children to receive immunizations, provide home-based voluntary counseling and testing for family members, and offer nutritional and hygiene counseling for the family unit. Spiritual care service strengthening supports FBOs to deal with basic issues related to HIV/AIDS through sensitization, training, materials development, and continued technical assistance for their work.

Social care services are primarily delivered by the NGO/FBO sector and focus on a spectrum of support that includes but is not limited to adherence support, nutritional and hygiene counseling, reproductive health counseling, referrals to clinic care providers, safe-water programs, micro-credit loan opportunities, and employment training and work place internships such as the partnership with Liana Cane. Nutritional support will leverage other resources within the donor community and providing technical mentoring to establish and promote local government and community activism joining efforts to create village gardens and poultry rearing.

Existing PLWHA groups like G+, a local NGO supported by PEPFAR, that are interested in providing such care are integral to the effort, not only because of their experience of living with HIV/AIDS and/or working with PLHA, but also for the opportunity to build on the confidence of the community in existing groups. This relationship enables these HBC providers to naturally expand their work into areas of care and support in communities. Complementing these efforts are international technical assistance partnering with the UN Family, implementing initiatives to further strengthen referral systems for legal services, increasing access to government grants and small business loans, workforce skills-building, and continuing support for the development of an enabling environment free of stigma and discrimination.

Program Area Target: Total number of service outlets providing HIV-related palliative care (excluding 21 TB/HIV) Total number of individuals provided with HIV-related palliative care 2,305 (excluding TB/HIV) Total number of individuals trained to provide HIV-related palliative care 75 (excluding TB/HIV)

Table 3.3.06:

CDC will coordinate with CDC Atlanta to provide technical assistance for implementation of a safe water initiative as part of the package of services for basic palliative care. CDC headquarters staff with expertise in household level safe water interventions will visit Guyana in December 2006 to perform an assessment funded by Rotary International on implementation of the CDC/WHO Safe Water System (SWS) for Guyana on a national level. This system combines household-level chlorination, safe storage vessels, and a program of behavior change communication (BCC) regarding water and hygiene practices. The products are sold in country using a social marketing model. The Rotary-funded assessment will include water testing, identification of a local producer for the safe water vessels, disinfectant solution and bottles, and identification of a partner for social marketing of the SWS in the Guyanese context. Rotary International has funded start up and maintenance of SWS in multiple countries throughout the world. The production and BCC are sustained by continued funds from Rotary combined with cost-recovery through social marketing of the SWS in the general population.

While in Guyana the consultant will develop a plan for adding the SWS to the palliative care services package provided by the PEPFAR program. The SWS team will work with USG Guyana and its partners to develop a distribution plan for SWS that is appropriate for PLWHA in Guyana. The estimated cost to provide services is $12 per household per year. The requested funding of $65,000 includes SWS for 5000 households affected by HIV/AIDS plus start up costs and consultant travel for program monitoring. CDC Atlanta will continue to coordinate with CDC Guyana for establishment and implementation of the service program. All efforts will be closely coordinated with MOH, NAPS and USAID/GHARP.

The CDC Division of Tuberculosis Elimination (International Branch) in collaboration with the CDC Guyana office provides technical assistance to the National TB Control Program. The main focus of activities in FY07 will be training and facility-based assessments of practices that impact cross-referrals and coordinated care for TB/HIV co-infected patients. Given pervasive human resource shortages in Guyana, investments in training are key to providing continuity to programs, encouraging staff retention, and improving institutional memory. Training investments will also improve the quality of care for HIV-infected persons with TB by exposing staff to new information, techniques, and strategies. This type of training is an essential strategy in a setting like Guyana where continuing medical education for nurses and doctors is not a requirement for retention. Specific activities will include: 1. Ensuring TB patients receive HIV testing through staff training and supervisory outreach to clinics 2. Increasing the number of TB patients referred to and receiving HIV care by strengthening referral systems 3. Expanding systems for TB screening in HIV care and treatment settings 4. Implementing facility assessment tools for quality of care for TB/HIV co-infected patients 5. Performing register and chart reviews for TB/HIV co-infection management 6. Providing training on TB/HIV surveillance and strengthening reporting activities to improve the quality of national TB/HIV surveillance data 7. Providing training on best practices for the unique challenges of care for TB/HIV co-infected patients 8. Explore method to define burden of multi-drug resistant TB in Guyana and contribution to AIDS mortality

All above activities will be coordinated with the MOH, FXB, and PAHO to ensure that key areas receive emphasis and that activities do not overlap.

Over the last two years CDC provided HIV rapid test kits and consumables to all VCT and PMTCT sites, QA oversight to all HIV rapid testing sites, leadership, technical assistance, and policy support for the establishment of the NPHRL, and technical and reagent support to referral and regional laboratories. In FY06 CDC will continue to provide HIV rapid test kits, consumables, and reagents to the HIV program, but will transition the process to the SCMS. CDC will be working closely with SCMS on reagents forecasting, procurement orders, and audits of distribution of these items at program sites during this transition. CDC will review current Quality Assurance (QA) plans for HIV rapid testing and will develop a laboratory assessment tool for the referral and regional hospital laboratories that support the HIV program in collaboration with MOH and FXB. CDC will provide in- country liaison for RPSO during the NPHRL construction project and will assist the MOH to create staffing, maintenance and equipment plans for the NPHRL while the construction is in progress. The CDC consultant report on OI provides recommendations on the implementation of OI testing will be shared with MOH. The office will provide coordination and support for special studies such as the ante-natal clinic survey (ANC) and serosurveys involving MARPS as well as assistance with planning the laboratory processes for the DHS Plus proposed for 2008. All CDC activities are coordinated by a physician-laboratory specialist working from the CDC office and serving as liaison to MOH on all issues related to laboratory infrastructure.

This activity was funded in FY06 but due to delays, implementation will commence in October 2006. The American Society of Clinical Pathologists (ASCP), the world's largest laboratory professional society providing training and education, will collaborate with MOH and FXB to support chemistry and hematology laboratory training and quality assurance. Laboratory workers will require substantial training in use of new tests, use of automated procedures, and all aspects of laboratory functions such as inventory management, quality assurance and quality control, documents and records management, information management, trouble shooting and problem resolution, safety, laboratory management, and customer service. ASCP will collaborate with partners in Guyana to develop its courses for training Guyanese pathologists, laboratory personnel, and other health workers. ASCP will apply its expertise and resources to educational design and evaluation; training course development; competency assessment development; technical assistance with training delivery; and development of the training capacity of the National Public Health Laboratory. In 2006 the initial training audience will be those laboratory specialists who supervise and provide training. ASCP will also focus on developing more laboratory task specific training materials (e.g., troubleshooting and quality control for chemistry and hematology) and incorporate educational design elements that are tailored for Guyana.

CDC will continue to work in close collaboration with the MOH and all Emergency Plan (EP) partners to strengthen and support strategic information activities including HMIS, surveillance, M&E, and research. Surveillance is a strategic information priority in FY07. CDC will work in close collaboration with the MOH and in-country partners to help create sustainable systems for the accurate and timely collection and reporting of data for disease control and the utilization of surveillance data for programs and policy. CDC will work with the MOH to integrate routine HIV/AIDS surveillance data with the existing population data (e.g., census and vital statistics) and population-based studies (e.g., AIS, BSS, and MICS) into a single, comprehensive HIV/AIDS epidemiological country profile. This activity will be supported with technical assistance (TA) for workshops on data utility for program management and decision-making. Initial planning for this activity was conducted in FY06; however, this activity will be implemented with FY07 funds. CDC will also work closely with the MOH and GHARP to strengthen routine PMTCT program data for surveillance needs as the PMTCT program in Guyana continues to expand to universal coverage (expected in 2008). Specific support to the MOH will be short-term TA and targeted trainings in data management and surveillance, in addition to long-term financial and technical support to PAHO to assist the MOH implement a sustainable and harmonized surveillance system to monitor and measure all health care priorities. In FY07, migrant populations in Guyana have been identified as HIV/AIDS surveillance priority given their significant presence in some MARPS. A needs assessment will be planned with the aim of characterizing this population (size, temporal and spatial patterns) and identifying their HIV/AIDS care and treatment needs. The needs assessment will provide the baseline for further work with this at-risk population in 2008 and beyond. In FY07, CDC will also collaborate with USAID and GHARP on assisting the GOG with operationalizing the National HIV/AIDS M&E Plan and National Strategic Plan (NSP) on HIV/AIDS (2006-10). Lastly, CDC will continue to work with all partners to strengthen routine program reporting with more standardize and feasible reporting systems, and stronger agency-relevant guidelines for the EP.

In FY07, CDC will recruit a short-term consultant to plan and implement a study to evaluate the impact of EP supported trainings on systems for the management and delivery of HIV/AIDS programs. Training for health care providers, facility managers, and program staff increases the skills and knowledge of health care providers, managers, and personnel, and enables those persons to develop, manage, expand, and monitor programs and interventions for HIV/AIDS. This study will compliment the PAHO human resources for health assessment by providing baseline data on previous training practices and gaps, and defining clear strategies for improving and prioritizing training efforts in Guyana. Moreover, the results of this study will also be used to inform the assessment and implementation of the TIMS coordination system.

CDC will work closely with the MOH to design and implement a study to examine the coverage and completeness of vital registration in Guyana. This study will provide data to strengthen EP reporting on HIV/AIDS-related mortality and inform planning and implementing of future population-based surveys and/or surveillance events.

ACTIVITY DELETED.

In order to measure and compare the financial resources required for the rapid scale-up of ART in PEPFAR-supported countries, CDC will plan for a cost-effectiveness study of ART in FY07 with a focus on facility-level program costs. CDC is developing a standardized costing model for ART with linkages to clinical outcomes to determine appropriate program functioning and to develop the cost implications of different program models. Dissemination of this study is planned for FY08 with FY07 funding.

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Table 3.3.14: Program Planning Overview Program Area: Other/Policy Analysis and System Strengthening Budget Code: OHPS Program Area Code: 14 Total Planned Funding for Program Area: $ 2,005,000.00

Program Area Context:

The initiatives in policy and system strengthening will build on programs currently being implemented, as well as to increase the support given to cross-cutting issues which will be the foundation for a sustainable response to HIV/AIDS in Guyana. In FY06 there was an ever-increasing focus on policy and system strengthening across the workplace, private, public, and NGO/FBO sector in order to increase these sector's capacity in leadership, administration, financial management and transparency; as well as technical strength.

Guyana has no restrictions on migration and accepts this phenomenon as a positive value shared widely throughout society. The country is thus faced with a dilemma: on the one hand the need to provide quality health services with sufficient staff and on the other hand, the individual's right to move to different shores as a positive value. Second to this is the phenomenon of internal migration. The global initiatives (addressing specific disease oriented programs) have led to internal migration from the public to the NGO and private sectors, competing for already scarce human resources. When hiring with additional incentives occurs in service settings, this usually leads to motivation of a small number of staff and de-motivation of those not benefiting from access to additional incentives.

The most recent report by World Bank of human resource depletion globally, noted that Guyana suffers from the highest rates of out-migration or "brain drain" of any other country. The challenges cannot be solely solved by a massive scaling up of the training programs. Guyana has a small population base from which to recruit and train the health workforce and any single qualified professional leaving the public sector potentially takes years to replace, particularly in specialized treatment categories and the upper echelons of management and administration. There is thus a need to coordinate the staffing needs of various local, national and international initiatives in order to avoid throwing the total delivery system into imbalance and possibly adversely affect the epidemiological profile.

The overarching objective of PEPFAR's support to MOH, PAHO, ITECH, and Management Science for Health (MSH) will be to strengthen the HIV/AIDS human resource system (within the broader ministries of the GOG and civil society organizations) and create conditions that foster retention, effective performance, and supportive supervision. MSH has a clear mandate to deliver technical assistance to the Health Sector Development Unit, responsible for the implementation of WB and GFATM awards, in order to leverage their funding already allocated to GOG Ministries and civil society, in order to ensure the effectiveness and timeliness of those programs. FHI/GHARP will be continuing to facilitate the annual work and M&E plans for each of the PEPFAR supported NGOs as well as continue on-site technical assistance and supervisory visits on a quarterly basis. The International Labor Organization and Howard Delafield will be supporting the policy and work place program development within the private sector and work place settings. The goal will be to develop and implement on-site performance improvement and monitoring systems that improve specific performance outcomes, implement local solutions, strengthen relationships between supervisors and clinic managers, improve the consistency of supervisory visits and motivate clinic staff as essential partners in the monitoring and feedback mechanism. Finally, Maurice Solomon, Pramaser and Company will continue to support the NGO and FBO community with the contracting of entities to provide targeted assistance in developing sound governance and administrative processes. This will continue to support civil society to take on an incrementally deeper responsibility, currently held by international organizations, of providing institutional capacity building assistance that will continue to be needed in Guyana in the future.

In relation to both policy and setting a stage for a strong National response, is the need to focus on reduction of stigma and discrimination. Currently, as reported in the Guyana AIDS Indicator Survey of 2005 (GAIS), only 20% of men and women expressed acceptance on all four measures stigma. Hence, a strong stigma and discrimination campaign as well as a sound policy environment are needed. Wherever possible, the program will build on USAID's additional mandate in Guyana for increased democracy and

governance, as well as gain support from our UN Family partners that are both invested in sound legislation as well as mitigation of the HIV/AIDS epidemic.

Several other key policies exist that are of a broader influence, but directly affect the performance of PEPFAR in Guyana. We believe that issues involving health legislation, human resources, and IMF/WB/IDB health sector reform initiatives must be addressed if our efforts are to produce sustainable programs. Some of these issues are under review; others will need more background investigation, in country discussion, and review by OGAC. Several underlying policy issues include age of consent, violence against women, regulation and governance of the blood safety program, regulation and governance of the National Public Health Reference Lab, and legislation that will address funding needed to ensure future sustainability of the increased HIV/AIDS services being established. External influences also play a critical role in determining the future sustainability of the program. This includes the IMF caps on civil service for key health professionals. As part of the process for fiscal restructuring, the GOG agreed to caps on civil service (number, salary). In many countries these caps have been rescinded to facilitate staffing in critical sectors (health and education). To date the MOH holds to the position that it can not increase salaries or staffing in the MOH because of IMF caps. To meet current shortages, the MOH uses Cuban and Chinese physicians provided by their respective governments as a part of bilateral programs. Finally, a large proportion of HIV related health care in Guyana occurs in the private sector. We need to find ways to encourage the private sector to adhere to good practice and to comply with public health reporting requirements.

CDC will support activities and advocate for progress to be made on several of these key legislative issues. Not specifically or financially supported by PEPFAR, the USAID Mission Director can also play a key role through his close collaboration with other UN bodies such as the United Nations Development Program and the donor coordinating committee to advocate for change on key issues. USAID is also responsible, through its Democracy and Governance Program, to assist in the reduction of violence and coercion of women and continues to strengthen the GOG's response to trafficking in persons. The first case in Guyana was identified by the president of one of the PEPFAR-supported NGOs working in Region 8 and the woman's case in now being tried. UNICEF, along with financial support from the GFATM will be addressing two policies/draft legislation: the Child Protection Law and the establishment of a foster care system from within the Ministry of Labor, Human Services, and Social Security. The Department of Defense will use its own HIV/AIDS policies to work with the Guyana Defense Force to adopt the principles and translate them into policy.

Program Area Target: Number of local organizations provided with technical assistance for 35 HIV-related policy development Number of local organizations provided with technical assistance for 20 HIV-related institutional capacity building Number of individuals trained in HIV-related policy development 40 Number of individuals trained in HIV-related institutional capacity building 120 Number of individuals trained in HIV-related stigma and discrimination 115 reduction Number of individuals trained in HIV-related community mobilization for 125 prevention, care and/or treatment

Table 3.3.14:

CDC will provide financial support for repair of the Lilliendal MOH building that will house ITECH and the HSEC. Repairs will be mostly cosmetic and will include an electrical and telecommunications system upgrade. This minor work will allow the GYNTCC to share physical space with their counterpart in the MOH and facilitate collaboration between these entities. The site also contains the MOH library for health worker for training materials and ITECH will be actively involved in strengthening this resource with the HSEC. The renovation will be accomplished through small contract/s managed out of the US Embassy.

Table 3.3.14:

Activity Deletion

Table 3.3.15: Program Planning Overview Program Area: Management and Staffing Budget Code: HVMS Program Area Code: 15 Total Planned Funding for Program Area: $ 2,519,401.00

Program Area Context:

In FY07 the total Emergency Plan commitment to Guyana will be nearly $30 million with the inclusion of Track One funding. The Management and Staffing costs are close to the soft earmark of 7%, but exceed this earmark by 1.5%. The Emergency Plan is nearly entirely staffed now, as outlined in the staffing matrix. The PEPFAR program in Guyana is managed and staffed by an experienced group of experts in health and development. Under the leadership of the US Ambassador, the USG team meets on a bi-weekly basis to facilitate the plan's design, implementation, and monitoring and evaluation. In addition, the full USG team and all its implementing partners, meets on a monthly basis with key officials from the Ministry of Health and institutional contractors to review progress and coordinate efforts.

There are four USG implementing agencies making up the Country Team for Guyana's Emergency Plan: USAID, DHHS/CDC Global AIDS Program, Peace Corps and DOD. Each agency within this initiative operates from a different technical expertise and administrative system, but is committed to coordinating their efforts. The overall costs for management and staffing run at less than 9% of the total Emergency Plan budget.

DOS In FY07, the PEPFAR program in Guyana will follow the leadership of the newly- arrived Ambassador Robinson. The staffing for DOS will add a true PEPFAR Coordinator, transition a current public affairs part-time position to a full-time foreign-service national position, and maintain the second part-time PEPFAR public affairs writer.

USAID In FY07, the USAID will oversee $13 million in Emergency Plan-funded programming in the following COP Program areas: 1) PMTCT; 2) AB; 3) Other Prevention; 4) Palliative Care; 5.) Counseling and Testing; 6) OVC; 7) ARV Drugs; 8) Strategic Information; and 9) System Strengthening. In addition, USAID will provide in-country support and oversight for the Track 1 Injection Safety initiative ($1,289,832) and which is managed out of USAID Washington.

The USAID Mission is led by the Mission Director and includes program portfolios in Health, Democracy and Governance, and Economic Growth, where expanded teams collaborate across development sectors to increase cross-fertilization. USAID operates out of the US Embassy and relies on the USAID Regional Contracting and Controller Officers from Santo Domingo. The health portfolio follows a five-year strategic objective (2004-2008) and signs annual, bilateral strategic objective agreements with the Government of Guyana. The programmatic portfolio also follows guidance approved in the Mission Performance Plan as well as tracks program implementation and impact through the Mission Management Plan. A cognizant technical officer is assigned to each contract, and a technical lead is also assigned for each USAID-Washington contract or field support mechanism that USAID/Guyana utilizes.

CDC In FY07, the CDC Guyana office will oversee $12 million in Emergency Plan-funded programming in the following COP Program Areas: 1) HIV/AIDS Treatment: ARV Services (including $156,360 of Track 1 funding for AIDSRelief); 2) Palliative Care: Basic Health Care and Support; 3) Strategic Information; 4) Laboratory Infrastructure; 5) Abstinence and Be Faithful Programs; 6) Condoms and Other Prevention Activities; 7) Palliative Care: TB/HIV. In addition, the CDC Guyana office will provide oversight for the Track 1 Blood Safety initiative ($1,250,000) which is managed out of CDC Atlanta. CDC Guyana will also continue its direct technical support, where appropriate, to USAID, the Peace Corps and the Military Liaison Office (MLO).

Peace Corps After returning to Guyana in 1995, Peace Corps has played an active role in providing volunteers for

Education and Health sector. Every Peace Corps volunteer in Guyana has been trained in combating HIV/AIDS. Peace Corps has a distinctive advantage since most volunteers are in small villages and can provide one-on-one service. Currently, 67 Peace Corps volunteers are involved in ABC program, PCMTCT, OVC, and palliative care. In order to support these volunteers, it will be imperative for Peace Corps to have a core of four positions focused on facilitating efficient program implementation and oversight.

DOD The Department of Defense does not have an in-country presence, but the Military Liaison Officer at the US Embassy serves as a point of contact for the DOD technical liaison for PEPFAR located in Florida at Southern Command. DOD therefore, works directly through the Guyana Defense Force (GDF) which lacks human capacity, an organizational structure or written policy to run HIV/AIDS programs. It is in the process of developing an HIV/AIDS policy and is working incrementally to develop an HIV/AIDS prevention program. The GDF has expressed a preference for having an individual with a military background coordinate its HIV/AIDS programs.

DOL The Department of Labor does not have an in-country presence, but the Department of State Economic Officer in collaboration with the PEPFAR coordinator serve as the point of contact for the involvement of DOL.

Table 3.3.15:

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

Table 3.3.15:

ICASS The CDC Guyana office will pay ICASS fees to US Embassy Georgetown according to standard charges for services agreed to in the ICASS agreement. See Activity #8086 for details of CDC Office.

Table 3.3.15:

Overseas Building Office (OBO), US Deptment of State The CDC Office will pay OBO charges per standard rates as part of cost of doing business. For CDC Office details see Activity #8086

Table 5: Planned Data Collection

Is an AIDS indicator Survey(AIS) planned for fiscal year 2007?
Yes  No If yes, Will HIV testing be included?
Yes
No When will preliminary data be available? Is an Demographic and Health Survey(DHS) planned for fiscal year 2007?  Yes
No If yes, Will HIV testing be included?  Yes
No When will preliminary data be available? 10/1/2008

Is a Health Facility Survey planned for fiscal year 2007?
Yes  No When will preliminary data be available? Is an Anc Surveillance Study planned for fiscal year 2007?  Yes
No if yes, approximately how many service delivery sites will it cover? 110 When will preliminary data be available? 2/1/2008

Is an analysis or updating of information about the health care workforce or the  Yes
No workforce requirements corresponding to EP goals for your country planned for fiscal year 2007?

Other significant data collection activities

Name: Behavioral Surveillance Survey Brief description of the data collection activity: In FY 07 GHARP will begin evaluating the impact of some of the PEPFAR-supported targeted interventions through implementation of behavioral surveillance surveys (BSS) in two target populations and will lay the groundwork for the implementation of the BSS in the other populations that were surveyed in the first round of the BSS. The first round of the BSS was conducted in 2003/2004 before the inception of the GHARP project and serves as the project baseline for interventions in at-risk populations. The first round of the BSS was conducted among female commercial sex workers (CSW), men who have sex with men (MSM), youths (in and out of school), the uniformed services and employees of the sugar industry. The BSS in CSW and MSM were combined with a biological component, which included testing for HIV and other sexually transmitted infections. The data from these surveys were used to guide the development of interventions that targeted the various populations. As the end of the project approaches, this is the ideal opportunity for GHARP to measure any changes that may have resulted from the various activities that were supported by PEPFAR. Moreover, sufficient time has elapsed for the interventions to work and for changes to reach measurable levels. As such, GHARP will conduct a second round of BSS in target populations beginning in FY07. In FY07, GHARP will map and estimate the size of the CSW population in the gold mining and logging areas in Guyana, and conduct a combined biological and behavioral surveillance survey (BBSS) in the entire CSW population. This data will document any effect of the current intervention targeting CSW, as well as provide data for guiding the expansion of this project to ensure national coverage of this project. The BSS will also examine an additional at-risk population in FY07: Despite evidence from some surveys that there may be a close association between drug use and HIV risk, the exact role which this population plays in driving the epidemic is not clearly understood. In the beginning of FY 07, GHARP will map and estimate the size of this population and assess the behaviors among them which may be driving the epidemic. Subsequently, the project will conduct a BSS among this population in the latter part of the year. The foundation will also be laid in FY07 to repeat the BSS in FY08 among MSM, youths (in and out of school), the uniformed services and employees of the sugar industry. Preliminary data available: August 01, 2007

Name: Basic needs assessment of migratory populations Brief description of the data collection activity: In FY07, migrant populations in Guyana have been identified as HIV/AIDS surveillance priority given their significant presence in some MARPS. A needs assessment will be planned with the aim of characterizing this population (size, temporal and spatial patterns) and identifying their potential HIV/AIDS care and treatment needs. The needs assessment will provide the baseline for further work with this at-risk population. Preliminary data available: February 01, 2007

Name: Human Capacity Development through Training Special Study Brief description of the data collection activity: Please see uploaded document in supporing documents Preliminary data available: March 01, 2007

Name: Special study on coverage and completeness of vital registration Brief description of the data collection activity: Please see uploaded document in supporting documents Preliminary data available: June 01, 2007