AIDSRelief strives to provide comprehensive family centered care which has been built upon our PMTCT

program. In keeping with Guyana's National Guidelines, all pregnant HIV+ women are counseled and

started on ART- for medical treatment or prophylaxis. AIDSRelief's sites have had 27 pregnant women on

combination ART (since the changes in Guyana's National Guidelines) for both prophylaxis and treatment.

Additionally patients are counseled and strongly encouraged to have any other children in the household

tested as well as their spouse/partners. All infants born into the PMTCT program receive close follow up

care and monitoring, as well as free replacement feeding supplied to sites by the Maternal Child Health

department of the Ministry of Health. Moreover, children born into our PMTCT program that are diagnosed

HIV negative at 18 months continue to receive a minimum package of care until the age of five. In the

coming year, AIDSRelief will continue to strengthen the PMTCT programs at our LPTFs. We will continue

to monitor the number of pregnant patients being referred and those that enroll into our sites' care and

treatment programs. Our goal will be to have at least 80% of HIV+ pregnant women started on ARV

prophylaxis at a minimum and at least 80% of HIV exposed children in regular follow up care.

In addition to providing general counseling, counselors and clinicians must also address issues such as of

domestic violence and substance abuse. In the coming year, AIDSRelief will increase linkages with local

NGOs (such as Help & Shelter) that support survivors of gender based violence in order to ensure that both

medical and psychosocial needs are met.

In FY2008, AIDSRelief will continue to provide on-site technical assistance to clinicians and counselors in

addressing the needs of pregnant HIV+ women.

In FY2008 AIDSRelief and the Roman Catholic Youth Office (RCYO) will continue to provide follow-up

support to the activities of the youth clubs established in all ten regions throughout Guyana. In addition to

training an additional 100 peer educators, RCYO will provide leadership training to active youth club

participants. RCYO will also directly conduct value-based HIV prevention activities through conventions,

conferences, a summer camp, and an STI awareness day. RCYO will incorporate a gendered approach to

HIV prevention and life skills promotion by addressing male norms and behaviors and by supporting the

empowerment of women in interpersonal situations.

In FY2008 AIDSRelief will continue to strengthen its comprehensive palliative care program at its three ART

sites and the step-down/hospice centre in order to achieve optimal quality of life for its clients and their

families. AIDSRelief-supported sites will provide 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; screening and referral for

latent TB infection and active TB; nutritional counseling; pain management, promotion of good personal

and household hygiene); 2) Psychological Care (counseling, home visits, disclosure support, peer support,

bereavement care); 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 four palliative care service outlets through focused

technical assistance (e.g. clinical preceptorships, tutorials, didactics and clinical updates) in palliative care

issues. AIDSRelief will recruit a local staff as an adherence specialist to oversee the integration of a

comprehensive adherence model, which will include individual counseling, community support groups, the

empowerment of PLHIV to serve as treatment partners, support for disclosure, and the integration of family

members affected by HIV as care supporters.

AIDSRelief-supported palliative care services will be integrated with other clinical programs at its local

partner treatment facilities such as PMTCT, CT, OVC and prevention activities as well as with

complementary social support programs available at these sites (e.g. nutritional support funded by CRS-

private funds). AIDSRelief will also 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. AIDSRelief will strengthen linkages between the step-down/hospice center and

treatment facilities, community-based care providers and other potential sources of support (e.g. night

shelter, Amerindian Hostel). AIDSRelief will also facilitate linkages to substance abuse treatment by

training social workers in recognizing symptoms of substance abuse and by strengthening referrals for

substance abuse treatment.

In FY2008 AIDSRelief will integrate a gendered approach to its palliative care services to address some of

the issues that may affect a woman's access to and use of PEPFAR-supported services. AIDSRelief will

continue to strengthen its family-centered model of care to ensure equitable access for women to HIV care

services (currently 61% of clients accessing care at AIDSRelief-supported sites are women). AIDSRelief

will ensure that all women enrolled in its program have access to annual cervical cancer screening.

AIDSRelief will also address gender-based violence by training health care staff in recognizing the signs of

gender-based violence, counseling and referral for appropriate follow-up. AIDSRelief will also strengthen

linkages with complementary social services to increase women's access to income and productive

resources (e.g. education, vocational training, access to credit).

AIDSRelief places a strong emphasis on high quality care for HIV infected and affected children. In the

coming years, we will continue to strengthen our OVC program and increase the numbers of OVCs

accessing these services by continuing to identify patients through our sites' PMTCT programs, community

networks, provider-initiated testing in the pediatric inpatient wards and pediatric outpatient clinic, and by

encouraging patients to have their children tested.

As sites scale up the number of OVCs in their care, AIDSRelief will continue to strengthen both clinical and

psychosocial services to accommodate this population. In this past year, AIDSRelief and LPTFs recognized

that there were unmet needs in providing psychosocial support to HIV infected/exposed/affected children.

In order to fill this need, a pediatric psychologist from University of Maryland School of Medicine/IHV

provided specialized training to counseling staff at LPTFs and members from local NGOs in addressing

psychosocial issues unique to children with HIV and their families (e.g. coping with trauma of death of

parent, disclosing status to children, anxiety & fear). Particular emphasis was placed on tailoring ART

adherence services to HIV + OVC. In FY2008, AIDSRelief will continue to further strengthen the capacity of

our clinical and counseling staff to provide high quality care to Guyana's OVC population. Continued on-site

technical assistance will be provided by a local pediatric HIV consultant, as well as, additional support from

IHV. Additionally, staff from LPTF will be sent to IHV for further training and preceptorship.

AIDSRelief will continue to ensure that HIV counseling and testing (CT) services at the three treatment sites

it supports comply with national and international standards. As the national numbers of HIV+ persons

enrolled in care continues to lag behind the numbers that test positive for HIV, AIDSRelief will also work

with facility- and community-based CT providers to strengthen the referral linkage between CT and

enrollment into HIV care for HIV+ clients, and between CT and prevention services for HIV- clients.

AIDSRelief will increase CT outreach from its LPTFs by forging linkages with mobilized counselor/testers in

community structures (e.g. churches, health posts, prisons). AIDSRelief will also target CT to higher-risk

groups by introducing routine provider-initiated CT in private hospital in-patient wards and by facilitating

access to CT through services targeting high-risk populations (e.g. substance abusers, prisoners).

AIDSRelief continues to support HIV care and treatment services in both the private and public sector. In

the public sector AIDSRelief continues to support Bartica Public Hospital, and continues to facilitate

linkages with Mazaruni Prison and complementary HIV services (e.g. PMTCT). Frequent onsite visits are

made regularly by both the AIDSRelief physician and also the Pediatric HIV consultant. AIDSRelief

maintains close contact with the adherence nurse coordinator in order to discuss any problems that may

have arisen.

In the private sector AIDSRelief continues to support St. Joseph Mercy Hospital (SJMH) and has expanded

services to Davis Memorial Hospital, which is located in Region 4 and is the only other faith-based hospital

in Guyana. The addition of Davis Memorial Hospital as a treatment site further expands the options and

choices for those wishing to access care and treatment services for HIV in the private sector, as evidenced

by the rapid scale-up at this site since October 2006.

In FY2008, AIDSRelief will continue to build local HIV technical capacity with increasing attention to

pediatric and adolescent HIV treatment. AIDSRelief will support the newly formed adolescent clinic at St.

Joseph Mercy Hospital with onsite didactics and mentoring, as well as, providing off site training at

University of Maryland's School of Medicine Adolescent HIV clinic. In supporting the adolescent HIV clinic

at SJMH, AIDSRelief is increasing the quality and spectrum of care that is provided to a very vulnerable

population, those caught between childhood and adulthood. SJMH will also integrate a registered nurse

into the HIV program to provide follow-up care and facilitate patient-flow and linkages with other programs

(e.g. OVC, PMTCT). Additionally, to further support pediatric treatment at our LPTFs, AIDSRelief will recruit

a local pediatric HIV specialist to mentor staff at all sites.

In FY2008, the in-country IHV physician will continue to provide ongoing support and assistance to the

LPTFs through didactics and on-site mentoring, and additionally liaises with USG in-country and MOH

partners on technical issues related to HIV care and treatment. AIDSRelief will provide additional technical

assistance in the areas of psychosocial support, pharmacy support, adherence, laboratory monitoring,

strategic information and financial management.

In order to ensure that high quality care is being delivered, AIDSRelief will continue to monitor for unmet

needs in the health care delivery system through the AIDSRelief Continuous Quality Assurance/Quality

Improvement program. This will be implemented with six fundamental components: 1) continuous

observation and measurement of standards of care delivery and program management, 2) measuring

success of treatment outcomes through viral suppression, immune reconstitution, morbidity, mortality, and

lost to follow up over time, 3) linking available patient health information and program characteristics as a

predictor of treatment outcomes, 4) collecting information on adherence to treatment and treatment support,

5) comprehensive and useful feedback of the information, and 6) utilization of outcomes analysis to design

site specific improvement activities. Through this continuous quality improvement plan, sites (with technical

assistance from IHV and Constella Futures) will be able to use data to affect change in the quality of service

provided.

In FY2008, AIDSRelief will also continue to augment capacity and services at its LPTFs and strengthen

linkages with complementary services (i.e. home based care, nutritional support, family planning services)

in order to provide greater access to care and treatment services. AIDSRelief, through IHV, will also

enhance its role to collaborate with in-country partners in providing training opportunities, lectures, and

workshops for local HIV treatment providers, in both the public and private sector, to build the technical

capacity of local clinicians and other members of the healthcare team to promote sustainability and to

empower them to inform future policy and standards related to HIV care.

AIDSRelief laboratory personnel work with local partner treatment facilities to strengthen the capacity of

laboratory personnel and to improve infrastructure as needed. The AIDSRelief laboratory capacity building

program seeks to assist local care delivery systems with the following areas: appropriate technology

selection, comprehensive training, comprehensive quality systems, integration of laboratory services, and

knowledge transfer and sustainability. During COP '08, AIDSRelief's laboratory capacity building program

will engage in the following activities: Technical Assistance and Technical Bulletins, Laboratory Quality, OI

Diagnostics, Training Sessions and Curriculum Development, and Sustainability Activities.

In FY08, AIDSRelief will provide intensive technical assistance to laboratories to ensure their capacity for

sustainability. Technical assistance will include quarterly quality monitoring visits to all sites, continued

development of forecasting and procurement systems, implementation of new technologies to upgrade

laboratory capacity, training sessions to focus on quality and laboratory management, and dissemination of

routine technical updates to laboratories. AIDSRelief will also enhance quality assurance at its three sites by

implementing a monthly quality assurance program and by networking laboratories for best practice sharing.

AIDSRelief continues to support PEPFAR and local partner treatment facilities (LPTFs) in monitoring and

evaluation (M&E) of ART services. AIDSRelief is committed to providing high quality HIV care and treatment

based on quality data. Fulfilling this commitment requires well integrated and efficient facility based strategic

information systems and a strong M&E team. In FY08, AIDSRelief through Constella Futures and the

Institute for Human Virology (IHV) will build capacity and provide supportive supervision to LPTFs in the use

of longitudinal medical record systems (electronic and paper based) for quality improvement, patient

management, and reporting. Constella Futures will continue to provide technical assistance through training

to treatment sites in collaboration with all stakeholders to build sustainable M&E units and health

management information system (HMIS). AIDSRelief will continue to work closely with the National AIDS

Program to implement the national patient monitoring system reporting format for all its treatment sites.