The Francois-Xavier Bagnoud Center (FXB) provides expertise on the diagnosis, treatment, and management of TB/HIV co-infected patients to the Guyana National TB Program. In FY07, FXB will continue its involvement in TB/HIV co-management with emphasis on activities at the GUM and Chest Clinics in Georgetown.

FXB will expand TB screening for HIV-infected patients and HIV testing for TB patients. Screening activities will be focused on vulnerable populations from local prisons and in-patient wards. Particular emphasis will be placed on the Genitourinary Medicine (GUM) Clinic and Chest Clinic; activities will include improving referral mechanisms between the clinics and the purchase of a dedicated x-ray machine at GUM Clinic. FXB will also liaise with in-patient providers at Georgetown Public Hospital Corporation, where half of all TB and HIV-infected patients in Guyana are diagnosed and referred into care.

FXB will continue to build the Chest Clinic as the primary referral, consultation, and treatment site for management of TB/HIV co-infection. A United Nations Volunteer (UNV) physician will continue to provide specialty TB/HIV care at the GUM and Chest Clinics. In collaboration with the Guyana National Continuous Quality Improvement Committee (CQI), FXB will facilitate the implementation of CQI measures at the Chest Clinic that will ensure that TB/HIV management follows national standards.

FXB will strengthen the linkages between PMTCT sites, HIV treatment sites, and the Chest Clinic and regional hospitals performing TB screening and diagnosis to facilitate the referral of newly-diagnosed TB or HIV-infected patients into appropriate care and treatment services. FXB will also emphasize referrals for patients to psychosocial services.

FXB will provide specialized care to TB/HIV co-infected patients by following DOTS protocol and procedures. They will also assist with the roll-out of community-based modified DOT-HAART with DOTS-TB treatment throughout Guyana. DOTS workers funded by Global Fund and peer support networks in Regions 1, 7, 8, and 9 will expand regional access to services for TB/HIV co-infected individuals. In addition, FXB will enhance MDR-TB management by assisting MOH with improving systems of international specimen transfer for testing.

FXB will continue to collaborate with the various TB/HIV stakeholders. In particular, FXB will work with both CDC Atlanta and PAHO to coordinate training activities and ensure that there is not a duplication of services. FXB's efforts complement those of the Global Fund and World Bank programs and contribute to a comprehensive HIV response in Guyana. Efforts to minimize duplication include contributing to policy formulation and guidelines and protocol development in relation to HIV care and treatment and collaborating with MOH, USG partners, UN partners and other bilateral and multilateral organizations in HIV care and treatment efforts.

FXB, through funding from CDC, will continue to support 10 United Nations Volunteer Physicians (UNV) who are providing care in public treatment sites throughout Guyana. Guyana is the first and only country to utilize UNV specifically for HIV/AIDS care and treatment. Although their administrative support is provided through the United Nations Development Project, technical support and clinical assignments are managed by the Director of Care and Treatment Services at FXB. The National Care and Treatment Committee headed by the Chief Medical Officer supplies further coordination and assures integration of the UNV into the MOH system. These physicians are essential for scale up and maintenance of the treatment program due to severe shortages of trained HIV clinicians in Guyana. They provide ongoing care at major regional treatment sites and one UNV, based at the National AIDS Program Secretariat, provides coverage to the hinterland regions 1, 7, 8, and 9 with a mobile medical unit. In addition to the UNV at the main Georgetown treatment site, a UNV with particular expertise in TB/HIV care manages co-infected patients at the Georgetown Hospital Chest Clinic. UNV provide treatment services as well as mentoring of local clinicians. The UNV will complete their term in October 2007; the USG team and FXB are actively exploring alternative/additional sources of HIV clinicians and the future role of the UNV for FY08 and beyond.

The François-Xavier Bagnoud (FXB) Center of the University of Medicine and Dentistry of New Jersey, through funding by HHS/CDC, will continue to support US government PEPFAR goals in Guyana by providing treatment to1800 patients by 2008. FXB works within the structure of the MOH treatment sites; in FY07 focus areas will include support for human resources, laboratory activities for HIV treatment monitoring, and clinician training and mentoring. FXB provides or supports approximately 80% of treatment services and as such will continue to be a leader in the implementation of PEPFAR in Guyana.

FXB provides clinical staff to the MOH treatment program through its physician Director of Care and Treatment Services, technical staff including laboratory technologists, nurses and counselor-testers, and as a coordinator for the United Nations Volunteer physicians (UNV). (See Activity 8557). In FY08, technical staff working directly within the MOH program will transition to administrative control of the MOH. Funds from the CDC-MOH cooperative agreement will assist the Ministry with the financial transition. FXB together with USG agencies will coordinate with the Human Resources Unit at MOH, and, with support from PAHO develop a plan for sustaining this staff over the longer term. With assistance from its parent institution, UMDNJ, FXB will provide clinical mentoring and training on best practices and establish treatment SOPs that reflect those best practices in the Guyana context. With appropriate promotion and recruitment, clinicians from the diaspora and the Caribbean region could view Guyana's ARV program as a model for the region; this perception would open up opportunities for clinical rotations in Guyana. FXB will work closely with MOH and USG on this type of innovative solution to chronic shortages of trained clinical personnel.

FXB will emphasize clinical services and linkages to treatment from other service sectors including PMTCT, VCT, and TB. Activities to strengthen linkages will include streamlining referral processes, ongoing anti-discrimination campaigns, and institutionalized coordination between out patient ARV services and the new infectious disease ward at Georgetown Public Hospital. FXB will be integral to increased efforts to implement provider-initiated opt-out testing in the in-patient setting. FXB will continue its work on linkages between the treatment program the TB program to ensure that patients are tested both at the time of entry into HIV care and the time of TB diagnosis. One impediment to this testing has been the long waits for chest x-ray services for patients at the nations highest volume treatment site, GUM Clinic. In FY07 FXB will purchase a dedicated x-ray machine for the GUM Clinic so TB screening can be completed before these patients leave and are lost to follow up. FXB will assist MOH in the development of a standard care package which in FY07 will include access to infant testing to increase entry into care for pediatric patients an and improved access to laboratory monitoring of treatment. FXB will facilitate the establishment of a national continuous quality improvement (CQI) committee to help inform CQI strategies across sites. Implementation of CQI will dovetail with clinical mentoring and ongoing training for local clinicians and these efforts will intensify in FY07 as part of the strategy for sustainable healthcare infrastructure in country.

In 2007 FXB will continue to provide laboratory support to HIV care and treatment services in Guyana. This support will include ongoing activities with emphasis on increasing coverage and scope of laboratory services available to PLWHA, ensuring quality and accuracy of laboratory test results through continuous quality improvement initiatives and staff training, and ongoing provision of technical assistance for the construction, management and operational-ization of the National Public Health Reference Laboratory.

Over the last two years, FXB developed and implemented a testing protocol for CD4 count and provided technical support for the establishment of the NPHRL. In FY07 FXB will continue to manage the CD4 suite at CML and will build capacity in CD4 count at two regional hospitals. There will be ongoing staff training on these new tests.In addition, the implementation and monitoring of QA/QC/QI measures will further strengthen the laboratory support services of FXB. FXB Guyana will also continue with the external quality proficiency testing assessment with Health Canada, CAREC and UK NEQAS. These steps will help ensure continuity and sustainability of laboratory services in Guyana.

FXB will assist the MOH in training laboratory staff on technologies necessary for support of the care and treatment program. FXB will introduce and have oversight for the implementation of appropriate OI testing and treatment. Additionally, FXB will initiate discussions with the MOH and CDC to develop a long-term strategic plan for transfer of staff and technology to the MOH to ensure the sustainability of laboratory services in Guyana.