A new funding opportunity announcement from CDC for FY08 for the provision of technical assistance and

human-resource support for HIV care and treatment will replace the current University Technical Assistance

Program (UTAP) funding. The grantee (who is to be determined) will serve as the primary partner of the

Ministry of Health (MOH) in the expansion of adult and pediatric HIV care and treatment, including the

development of care and treatment guidelines and protocols, implementation of adherence monitoring and

provision of comprehensive palliative care, including clinical, psychological, social, spiritual and prevention

services at existing and future care and treatment sites and though linkages with community and home-

based care programs. The grantee will work with the MOH to develop and define a standard care package

appropriate for the Guyanese context and ensure this package is available at all treatment sites in the

country, both public and private. The grantee will enhance the care and treatment of opportunistic infections

(OIs), including TB, and improve STI management at the existing and future MOH HIV care and treatment

sites, including the hinterland areas in Guyana through a mobile unit. The grantee will improve access to

infant testing which will increase entry into care for pediatric patients and improve access to laboratory

monitoring of treatment. Additionally, the grantee will collaborate with other USG partners to integrate

prevention for positives strategies into care and treatment.

The grantee will strengthen linkages between the care/palliative care program and the treatment program

as well as other care sectors in Guyana, including PMTCT, home-based care, psychosocial support,

confidential counseling and testing, and TB diagnosis and treatment. This will include streamlining referral

processes and institutionalizing coordination between outpatient care and treatment and the new Infectious

Disease Ward at Georgetown Public Hospital.

The grantee will provide laboratory support to HIV care and treatment in Guyana, and increase the

coverage and scope of laboratory services available to people living with HIV. The grantee will assist the

MOH in training laboratory staff on technologies necessary for support of the care and treatment program

as well as introduce and oversee the implementation of appropriate testing and treatment for opportunistic

infections. Quality and accuracy of laboratory test results will be ensured through CQI initiatives and staff

training.

The grantee will create a plan for long-term sustainability of HIV care and treatment, and will specifically

emphasize activities that build capacity in the Guyanese MOH. These activities will include finding

innovative and creative approaches to address the human-resource shortages that threaten the

advancement and sustainability of the Guyanese treatment program, including the procurement of services

of physicians to provide complete clinical coverage for all care and treatment sites, the mentoring of

clinicians, and clinical training. The physicians contracted will assist in the development and implementation

of a standard curriculum on basic HIV care for all physicians working within the Guyanese MOH system.

The grantee will also establish a national Continuous Quality Improvement (CQI) Committee in Guyana 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 as part of the strategy for creating

sustainable health-care infrastructure in Guyana.

Financing for TB/HIV-related interventions will focus on providing expertise on the diagnosis, treatment, and

management of TB/HIV co-infected patients to the Guyana National TB Program. In TB/HIV co-

management particular emphasis will be placed on activities at the GUM and Chest Clinics in Georgetown.

The grantee will expand TB screening for HIV-infected patients and HIV testing for TB patients and the

Chest Clinic in Georgetown which will serve as the primary referral, consultation and treatment site for

management of TB/HIV coinfection. Screening activities will be focused on vulnerable populations from

local prisons and in-patient wards. Activities will include improving referral mechanisms between the clinics

and the purchase of a dedicated x-ray machine at GUM Clinic. The grantee 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. A physician will be identified to provide specialty TB/HIV care

at the GUM and Chest Clinics.

In collaboration with the Guyana National Continuous Quality Improvement Committee (CQI), the grantee

will facilitate the implementation of CQI measures at the Chest Clinic that will ensure that TB/HIV

management follows national standards. The grantee 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. The grantee will also emphasize referrals for patients to psychosocial services, home based care

and basic palliative care.

The grantee 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. In addition, the grantee will enhance MDR-TB management by assisting

MOH with improving systems of international specimen transfer for testing.

The grantee will collaborate with the various TB/HIV stakeholders. In particular, with both CDC Atlanta and

PAHO to coordinate training activities and ensure that there is not a duplication of services. The grantee'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.

A new funding opportunity announcement from CDC for FY08 for the provision of technical assistance and

human-resource support for HIV care and treatment will replace the current University Technical Assistance

Program (UTAP) funding. The grantee (who is to be determined) will serve as the primary partner of the

Ministry of Health in the development of a standard care package, the expansion of adult and pediatric HIV

care and treatment, the development of care and treatment guidelines and protocols, and the design and

implementation of adherence monitoring. The grantee will provide antiretrovirals at the existing and future

Ministry of Health HIV treatment sites, including coverage in hinterland areas in Guyana through a mobile

unit.

The grantee will create a plan for long-term sustainability of ART, and will specifically emphasize activities

that build capacity in the Guyanese Ministry of Health. These activities will include finding innovative and

creative approaches to address the human-resource shortages that threaten the advancement and

sustainability of the Guyanese treatment program, including by procuring the services of physicians to

provide complete clinical coverage for all treatment sites, the mentoring of clinicians, and clinical training.

The physicians contracted will assist in the development and implementation of a standard curriculum on

basic HIV care for all physicians working within the Guyanese Ministry of Health system.

The grantee will strengthen linkages between the treatment program and other care sectors in Guyana,

including PMTCT, home-based care, basic palliative care, psychosocial care, confidential counseling and

testing, and TB diagnosis and treatment. This will include streamlining referral processes and

institutionalizing coordination between outpatient antiretroviral treatment and the new Infectious Disease

Ward at Georgetown Public Hospital. The grantee will also establish a national Continuous Quality

Improvement (CQI) Committee in Guyana 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 as

part of the strategy for creating sustainable health-care infrastructure in Guyana.