PEPFAR's annual planning process is done either at the country (COP) or regional level (ROP).
PEPFAR's programs are implemented through implementing partners who apply for funding based on PEPFAR's published Requests for Applications.
Since 2010, PEPFAR COPs have grouped implementing partners according to an organizational type. We have retroactively applied these classifications to earlier years in the database as well.
Also called "Strategic Areas", these are general areas of HIV programming. Each program area has several corresponding budget codes.
Specific areas of HIV programming. Budget Codes are the lowest level of spending data available.
Expenditure Program Areas track general areas of PEPFAR expenditure.
Expenditure Sub-Program Areas track more specific PEPFAR expenditures.
Object classes provide highly specific ways that implementing partners are spending PEPFAR funds on programming.
Cross-cutting attributions are areas of PEPFAR programming that contribute across several program areas. They contain limited indicative information related to aspects such as human resources, health infrastructure, or key populations programming. However, they represent only a small proportion of the total funds that PEPFAR allocates through the COP process. Additionally, they have changed significantly over the years. As such, analysis and interpretation of these data should be approached carefully. Learn more
Beneficiary Expenditure data identify how PEPFAR programming is targeted at reaching different populations.
Sub-Beneficiary Expenditure data highlight more specific populations targeted for HIV prevention and treatment interventions.
PEPFAR sets targets using the Monitoring, Evaluation, and Reporting (MER) System - documentation for which can be found on PEPFAR's website at https://www.pepfar.gov/reports/guidance/. As with most data on this website, the targets here have been extracted from the COP documents. Targets are for the fiscal year following each COP year, such that selecting 2016 will access targets for FY2017. This feature is currently experimental and should be used for exploratory purposes only at present.
Years of mechanism: 2008 2009
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 51 pregnant women on
combination ART (since the changes in Guyana's National Guidelines) for both prophylaxis and treatment.
Patients are counseled to have their partners/spouses tested as well as other children in the household. 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 will continue to receive a
minimum package of primary care until the age of five. In the coming year, AIDSRelief will continue to
strengthen the PMTCT programs at our LPTFs by providing increasing training opportunities for physicians
at our private 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 we will continue to work closely with MOH in tracking infants born to HIV+
women and providing early testing with dried blood spot testing.
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 FY2009, AIDSRelief will continue to provide on-site technical assistance to clinicians and counselors in
addressing the needs of pregnant HIV+ women.
Targets:
•2 service outlets providing the minimum package of PMTCT services according to national and
international standards
•400 pregnant women who received HIV counseling and testing for PMTCT and received their results
•30 pregnant women provided with a complete course of antiretroviral prophylaxis in a PMTCT setting.
•10 health care workers trained in the provision of PMTCT according to international standards
New/Continuing Activity: Continuing Activity
Continuing Activity: 12740
Continued Associated Activity Information
Activity Activity ID USG Agency Prime Partner Mechanism Mechanism ID Mechanism Planned Funds
System ID System ID
12740 12740.08 HHS/Health Catholic Relief 6266 2765.08 AIDSRelief $2,000
Resources Services
Services
Administration
Emphasis Areas
Health-related Wraparound Programs
* Child Survival Activities
Human Capacity Development
Public Health Evaluation
Food and Nutrition: Policy, Tools, and Service Delivery
Food and Nutrition: Commodities
Economic Strengthening
Education
Water
Table 3.3.01:
In FY2009 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 120 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.
•1200 individuals reached through community outreach that promotes HIV/AIDS prevention through
abstinence and/or be being faithful
•120 individuals trained to promote HIV/AIDS prevention through abstinence and/or being faithful
Continuing Activity: 12713
12713 7982.08 HHS/Health Catholic Relief 6266 2765.08 AIDSRelief $22,721
7982 7982.07 HHS/Health Catholic Relief 4450 2765.07 AIDSRelief $20,000
Gender
* Addressing male norms and behaviors
* Increasing gender equity in HIV/AIDS programs
Estimated amount of funding that is planned for Human Capacity Development $10,000
Estimated amount of funding that is planned for Food and Nutrition: Policy, Tools $1,000
and Service Delivery
Table 3.3.02:
In FY2009 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);
4) Spiritual Care; and 5) Psychological care for caregivers.
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 an Adherence Specialist/ Community Outreach coordinator 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 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 FY2009 AIDSRelief will continue to 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 57% 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 strengthen linkages with complementary social services to increase
women's access to income and productive resources (e.g. education, vocational training, access to credit).
In FY2009, AIDSRelief will liaise with in-country partners to procure safe water solutions, which will aid in
reducing the amount of diarrheal diseases. AIDSRelief will provide training to LPTF adherence staff and
HBC staff to promote safe water and hygiene practices so that may communicate these messages to clients
at LPTFs . Additionally, LPTF staff and HBC workers will distribute safe water solution initially to most
vulnerable clients & households (i.e those with co-infected patients. Infants/children<5, and stage 3 & 4)
•4 service outlets providing HIV-related palliative care (excluding TB/HIV)
•2400 individuals provided with HIV-related palliative care (excluding TB/HIV)
•30 individuals trained to provide HIV palliative care (excluding TB/HIV)
Continuing Activity: 12753
12753 12753.08 HHS/Health Catholic Relief 6266 2765.08 AIDSRelief $269,147
Estimated amount of funding that is planned for Human Capacity Development $113,000
Estimated amount of funding that is planned for Education $1,000
Table 3.3.08:
AIDSRelief continues to support HIV care and treatment services in both the private and public sector
through its clinical core team composed of an Infectious Disease specialist and a Community
Outreach/Adherence Specialist from IHV, and clinical and counseling staff at the LPTF. 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 supported HIV physicians. 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 Davis
Memorial Hospital, which are both located in Region 4 and are the only faith-based hospitals in Guyana.
AIDSRelief through University of Maryland's Institute of Human Virology (UMSOM-IHV) will continue to build
local HIV technical capacity with increasing attention to pediatric and adolescent HIV treatment, palliative
care and diagnosing and management of opportunistic infections (OIs).
The clinical core team 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.
Enhanced clinical and didactic training will be conducted at UMSOM-IHV's Clinical Training Site. Providers
will have access to video conferencing CME lectures and will also have the opportunity to receive direct
preceptorship in the management of more complicated HIV+ patients. The clinical site will serve as an off
site adjuvant facility to SJMH and DMH. It was serve as a mechanism wherein AIDSRelief can collaborate
with local in-country partners in building local technical capacity and promoting sustainability.
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.
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.
•3 service outlets providing antiretroviral therapy.
•273 individuals newly initiating antiretroviral therapy during the reporting period
•1200 individual who ever received antiretroviral therapy by the end of the reporting period
•1020 individuals receiving antiretroviral therapy at the end of the reporting period
•60 health workers trained to deliver ART services according to national and/or international standards.
Continuing Activity: 12716
12716 3191.08 HHS/Health Catholic Relief 6266 2765.08 AIDSRelief $1,415,612
8067 3191.07 HHS/Health Catholic Relief 4450 2765.07 AIDSRelief $870,000
3191 3191.06 HHS/Health Catholic Relief 2765 2765.06 AIDSRelief $870,000
Estimated amount of funding that is planned for Human Capacity Development $636,750
Estimated amount of funding that is planned for Food and Nutrition: Policy, Tools $5,000
Table 3.3.09:
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 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.
Program Budget Code: 12 - HVTB Care: TB/HIV
Total Planned Funding for Program Budget Code: $338,885
Total Planned Funding for Program Budget Code: $0
Program Area Narrative:
Guyana has one of the highest tuberculosis (TB) incidence rates in the Americas. In 2006 WHO estimated that Guyana has 164
cases per 100,000 population, the third highest in the region (after Haiti and Bolivia). A 2006 study demonstrated high rates of
HIV testing, HIV-related care, and co-trimoxazole preventive therapy (CPT) use among patients utilizing Guyana's MOH chest
clinics. The coordination of TB and HIV care has been facilitated by the TB clinics' universal use of on-site HIV rapid testing, their
geographical proximity to HIV clinics, and when possible, their utilization of clinicians trained in both TB and HIV patient care.
While Guyana lacks the technology to test for multi-drug resistant (MDR) TB, at least 11 cases of MDR TB have been confirmed
since 2006 and it is estimated that many more undetected cases exist.
The Guyana National Tuberculosis Control Program (NTCP) provides care and treatment for all TB cases applying the WHO
recommended DOTS strategy in the country through six formal clinics operating in the more populous regions of the country, 4 of
the 5 prisons and some sites in primary health care centers. All regions now have DOTS coverage through these clinics and
outreach workers in more remote areas. A few patients are managed at private sites by choice and the national program supports
these sites with standard guidelines and essential medication. The Georgetown Chest Clinic serves as the central referral center
and operates extension programs in two prisons. ART services are now being offered to TB/HIV co-infected patients at the
Georgetown Chest Clinic. Case detection of HIV/TB co-infected patients is estimated to be close to 100%.
CDC Atlanta, previously in collaboration with the Canadian Society for International Health (CSIH), has been actively engaged in
support of the Ministry of Health initiative to improve TB and TB/HIV care. CSIH activities focused on improvement in TB
laboratory capacity, TB diagnosis, and clinical care, but CSIH support for TB has now ended. CDC Guyana has made linkages
with MOH and FXB in order to support both TB/HIV surveillance activities and stronger infection control mechanisms at outlying
hospitals. A TB/HIV co-infection committee has been established and meetings are regularly held with TB/HIV programs and
other stakeholders. In addition, the Global Fund continues to support TB services in Guyana and in FY07 hired laboratory
technologists and DOTS-TB workers, who will also provide DOT-HAART to co-infected individuals.
Guyana continues to face several priority challenges and barriers to the provision of comprehensive HIV/TB diagnosis and care in
Guyana. These challenges include: 1) human resource shortages; 2) persistence of diagnostic challenges; and 3) infection
control, especially in light of MDR cases.
While FXB provides TB/HIV technical assistance, the lack of a TB/HIV coordinator represents a large gap and the USG team will
plan to address this issue in FY09. An USG supported TB/HIV nurse through FXB is also recently vacant and filling this position
will be a priority. In addition the human resource shortages, current and future staff need continued training in TB/HIV co-
management, including MDR TB, and this will be included in FY09 PEPFAR support.
While there have been improvements in the local support of sputum smear and culture, diagnostic challenges remain, especially
in the area of drug susceptibility testing (DST). Currently samples are gathered centrally and sent to the CAREC facility in
Trinidad, but results have not been received in a timely manner and it is unclear if some collected samples are sent at all. To
address this problem in FY09, the USG and MOH plan to send samples to the new National Public Health Reference Laboratory
and explore the possibility of utilizing existing relationships with CDC Atlanta to send samples there for testing. The USG team will
also look into coordinating with PEPFAR Haiti program in consolidating samples for testing.
The existence of MDR TB in Guyana presents special challenges and exacerbates the infection control problems that have
resulted due to the lack of adequate infectious disease (ID) wards and isolation wards. Currently all ID patients are together
including smear positive TB patients together with smear-negative TB HIVpositive patients. There is a continuing need to improve
infrastructure and create separate space for TB patients.
In FY09, the USG will continue to strengthen the quality of services and information related to the TB/HIV activities in-country, with
a special focus on monitoring and assessing the quality of care at regional sites. CDC will continue to fund TB/HIV activities
through FXB, AIDS Relief, MOH, and provide technical assistance through the CDC Guyana Office. PAHO will continue to carry
out specific activities related to in-country collaboration and training of health staff, and in partnership with FXB and MOH will
promote sustainable solutions for issues related to TB/HIV programming in-country including support of contractor staff to
supplement MOH staff at Georgetown Chest Clinic. This proposal is in line with the current MOH plan for TB and is part of
PEPFAR Guyana's ongoing coordination with Global Fund and World Bank to find integrated solutions to strengthen diagnostics,
laboratory services, and referral systems.
Table 3.3.12:
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. With increasing numbers of OVCs, 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 FY2009, AIDSRelief will continue to
further strengthen the capacity of our clinical and counseling staff to provide high quality care to Guyana's
OVC population. AIDRelief/IHV's local pediatric HIV consultant will continue on-site technical assistance
with support from specialists from IHV.
In the past year, LPTF staff at SJMH recognized that there was a growing number of adolescent patients,
and have established an adolescent focused clinic. Additionally, staff at SJMH has presently been working
to implement pediatric and adolescent support groups. In FY2009, AIDSRelief will support the adolescent
clinic by providing mentorship in adolescent medicine to staff at LPTF and will also collaborate with the
Ministry of Health's Adolescent Unit in providing trainings to other providers. 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.
• 76 OVC served by OVC programs (primary direct an supplemental direct support).
Continuing Activity: 12714
12714 7514.08 HHS/Health Catholic Relief 6266 2765.08 AIDSRelief $41,700
Estimated amount of funding that is planned for Human Capacity Development $18,000
Estimated amount of funding that is planned for Food and Nutrition: Policy, Tools $200
Program Budget Code: 14 - HVCT Prevention: Counseling and Testing
Total Planned Funding for Program Budget Code: $1,140,524
Results of the PEPFAR-funded Guyana HIV/AIDS Indicator Survey (GAIS) indicate that as of 2005, only 11.3% of women and
10.3% of men had been tested and received their results in the last 12 months. Over the past two years, the counseling and
testing program has expanded its reach from 10,546 persons who received counseling and testing in FY05 to 48,578 nationally at
the end of 2007. In FY09, PEPFAR will reach 43,000 individuals indirectly with counseling and testing. Our activities will focus on
further mobilizing people to access counseling and testing (C&T), with a strong emphasis on most at-risk populations (MARP) and
males, to boost prevention efforts and to identify those who need treatment. The second round of PEPFAR-funded Behavioral
Surveillance Surveys (BSS) for female commercial sex workers (CSW), men having sex with men, and uniformed services to be
finalized early in calendar year 2009, will serve to inform the targeted counseling and testing interventions.
Currently, our program includes ANC and labor and delivery sites supported through the PMTCT program that have begun to
operationalize provider-initiated counseling and testing. Currently there is national access through 60 fixed CT public sites, and
two private hospital sites with the caveat that regions 1, 7, 8, and 9 are also served through mobile teams. All services are
supported by a community mobilization strategy that utilizes both interpersonal and multi-media interventions. In 2007, over 4,504
persons were tested on the National Day of Testing, so it is planned that in November 17-21st, this special day will be extended to
a one-week period.
It is estimated that there are over 3,300 persons living with HIV that are ARV-eligible. In FY07, the target of providing treatment to
1,500 was exceeded with 1,949 persons on treatment at the end of FY07. To reach and exceed our FY08 target of providing ARV
treatment to 2,300 persons, we will focus on continuing to increase use and access to prevention, testing, and referral services
through continuing expansion of geographical coverage of C&T in clinical settings using provider-initiated protocol, VCT mobile
services to hinterland areas in Regions 1, 7, 8, and 9; continued promotion for male access through targeted programs such as
sports clubs, interventions for minibus drivers, male-centered group and community discussions, male clinics, and male-centered
BCC messages; providing targeted services for MARP through the CSW and MSM projects, with increased focus on targeting
populations based on risk-factor data; and broadening the range of services provided at VCT sites. Additionally, the DoD will
support the expansion of C&T for uniformed services and their families within the Guyana Defense Force (GDF), with an
emphasis on reduction of stigma and discrimination.
Community organizations that are strategically placed in hinterland areas with the largest mining and timber industry sites will
operate mobile VCT and link those persons in need of care to the regional health care facility for follow-up. Cultural sensitization
for mobile staff working in new communities will take place to raise the level of consciousness to tailor delivery of messages for
different groups. Staff members at sites providing STI and HIV testing will be trained and monitored to ensure that these high-risk
populations are able to access services in a supportive and respectful environment. Couples counseling will also continue to be
emphasized in FY09 in an effort to increase the number of males who access C&T, to reduce transmission between sero-
discordant couples, and to encourage faithfulness in concordant negative couples. In FY09 a common goal for USG/GOG efforts
will be to expand on the currently limited implementation of home-based VCT for families of orphans and vulnerable children,
persons on treatment, persons identified through the PMTCT program, and those communities mapped as most affected by the
epidemic. (Using PMTCT routine program data). Careful planning and oversight will be built for this activity in both the public and
civil society sector.
All training for counseling for HIV testing is implemented in collaboration with the MoH according to established national
curriculum and guidelines and includes critical components on PMTCT, family planning, disclosure, domestic violence, prevention
counseling on abstinence, condoms, and partner reduction. A USG/GOG common goal is for the complete integration of all
counselor/tester training and curricula. Such cross-training would develop personnel with the capability to implement
comprehensive counseling and testing (including provider-initiated) with no differentiation between a VCT, PMTCT, or youth-
friendly setting as well as include approaches for couples counseling, home-based testing, etc. This will call for a revision in
curriculum as well as refresher training for all current employees. A shared, longer-term vision is for the revision of MOH Job
Descriptions where each tier of health worker has HIV/AIDS services incorporated as base responsibilities rather than being
classified or viewed as special/extra duties.
All counseling and testing sites, both community and facility based, use standardized forms to routinely report HIV testing
information to the national level. These forms were developed in a collaborative process between the GoG and USAID/GHARP in
FY06 and have since been used at all counseling and testing sites. In FY09, a review of the reporting form will be undertaken
since currently the forms are also collecting critical death and disease notification data and according to WHO recommendations
such data should be reported disaggregated.
Over the last two years, the number of HIV+ clients identified was substantially higher than those entering the care and treatment
program. In order to ensure the continuum of care, a pilot was initiated to serve the four highest volume treatment sites whereby
case navigators were trained and hired. In the first six months of programming, over 90% of all persons testing positive accessed
the care and treatment program through this case navigation program. The other treatment sites currently rely on referral cards
and follow-up between tester and the treatment site. This process seldom works and when it does, it is usually at a much later
date. Hence, in FY09 a common USG/GOG goal will be for the staged expansion of the case navigation program to additional
facilities with the next highest client volumes.
Finally, our FY09 strategy includes the promotion and training of providers to expand the integration of provider-initiated C&T into
the formal health sector, which will be critical for the sustainability of the program and for the most efficient infection identification.
To that end, and with the encouragement and support of the USG, the MOH will maintain provider-initiated C&T at sites delivering
diagnosis and treatment for TB, STIs, Male and Female Wards, and the Infectious Disease Ward at Georgetown Public Hospital.
In FY09, the common goal of USG/GOG is to expand provider initiated testing at critical wards at our private hospital partner sites.
Additionally, there will be continued support for the referral networks for prevention, care and treatment within and between public
and private service points.
The CDC cooperative agreement will support the MOH to lead the quality assurance programs to track rapid testing proficiency
and training needs and offer support for the MOH VCT program in gap areas not provided for in WB/GFATM funding.
Commodities management, procurement, and storage of test kits and related supplies will be implemented by SCMS and
overseen by MMU and CDC/GAP. USAID will support the NGO/FBO sector for service delivery and community mobilization, as
well as MOH curricula development, training, information management, and monitoring and evaluation.
Table 3.3.14:
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).
•3 service outlets providing counseling and testing according to national and international standards.
•3300 individuals who received counseling and testing for HIV and received their results.
Continuing Activity: 12715
12715 8046.08 HHS/Health Catholic Relief 6266 2765.08 AIDSRelief $15,395
8046 8046.07 HHS/Health Catholic Relief 4450 2765.07 AIDSRelief $60,000
Estimated amount of funding that is planned for Human Capacity Development $7,000
AIDSRelief laboratory personnel will work with three local treatment facilities (two private hospitals - St.
Joseph Mercy Hospital, and Davis Memorial Hospital and one government owned hospital in Bartica) and
the Ministry of Health's Laboratory division to strengthen the capacity of laboratory personnel and to
improve infrastructure as needed. In the past, AIDSRelief has worked with the three local hospitals to
increase the capacity of the laboratories, assisted in the design of new laboratory space to ensure highest
functionality, implemented new technologies and provided educational opportunities both onsite and
centralized for all hospital laboratory staff and non-AIDSRelief laboratory staff.
In FY2009, AIDSRelief will continue to implement the following strategies and initiatives in building local
capacity: identification and training of appropriate staff; collaborating with MOH, CDC and local partners in
supporting the NPHRL as a centers of excellence for standardized laboratory training and as a sustainable
mechanism for continued training of local staff; collaborating with MOH, CDC and other partners to in
strengthening the current certification and accreditation process as a part of external quality assurance
level; and most importantly promoting professional development by participating in or facilitating local
laboratory training sessions.
AIDSRelief will also continue strengthen the three hospitals capacity in forecast and procure reagents for
HIV. For the two private hospitals AIDSRelief will continue support the cost of these tests. The IHV
specialists will also continue to provide ongoing mentoring of all lab staff at the three treatment facilities and
ensure that the following tests are being done on a routine basis or as needed CRAG, Creatinine, Liver
Function Test, Hematology and CD4.
•3 laboratories with capacity to perform 1) HIV tests and 2) CD4 tests and/or lymphocyte tests
•10 individuals trained in the provision of laboratory-related activities
•12,000 HIV related laboratory tests performed
Continuing Activity: 12744
12744 12744.08 HHS/Health Catholic Relief 6266 2765.08 AIDSRelief $139,566
Estimated amount of funding that is planned for Human Capacity Development $60,000
Program Budget Code: 17 - HVSI Strategic Information
Total Planned Funding for Program Budget Code: $1,245,743
USG will continue to work in close partnership with the Government of Guyana (GoG) to ensure a coordinated approach to
strategic information (SI) in Guyana's HIV/AIDS sector. The major challenges for strategic information in Guyana are insufficient
human resource capacity, a lack of a centralized strategic information unit within the Ministry of Health (MoH) with a clear
mandate and technical capacity and lack of integration and compatibility for various information systems in country. GoG's
priorities for SI are to increase human resources, enhance technical skills, improve data quality, facilitate access to and use of
accurate program monitoring and evaluation data to promote evidence-based program planning and policy development, and
identify and implement sustainable strategies for SI activities.
USG will continue assisting GoG in establishing functional, integrated systems and institutions for data collection, analysis and
reporting, and building human capacity to sustain these systems. All USG efforts will be executed in keeping with its strategic
vision and approach of promoting SI systems strengthening that facilitates a deeper integration of HIV/AIDS SI into the wider
health information system (HIS). The role of the USG team, in conjunction with prime implementing partners, is to work closely
with the National AIDS Program Secretariat (NAPS), the Ministry of Health's (MoH) SI Unit, when it is established, and NGO
partners, for M&E, development of HMIS, population-based surveys, surveillance activities, and public health evaluations.
Through the joint efforts of USG, MoH, and implementing partners, achievements in FY08 include: completion of phase I
(planning and logistics) of Guyana's first DHS survey; implementation of the Patient Monitoring System (PMS) in all 16 national
treatment sites; completion of the round two BSS among CSWs; development of National M&E Guidelines for NGOs and Line
Ministries (LMs) implementing HIV/AIDS programs; training of NGOs and LMs in the National M&E Guidelines; development and
finalization of the Operational Plan for the National M&E Plan; establishment of the NAPS M&E unit within the MOH; and training
of NAPS M&E unit staff in M&E fundamentals.
Challenges in FY08 included the delay in getting the CDC Medical Epidemiologist in place due to administrative challenges,
contractual issues related to implementation of DHS, insufficient staff to address competing SI priorities at the national level and
delays in establishment of an SI unit within the MoH. In FY09, USG will support: completion of the DHS and the behavioral
surveillance surveys among MSM, youth, and uniformed services; provide technical assistance to NAPS in addressing priority SI
activities such as revision of data collection and reporting systems; development of an evaluation agenda for HIV/AIDS programs;
and development of a centralized HIV/AIDS database housed at NAPS.
STRATEGIC INFORMATION TEAM: The USG SI Team is jointly coordinated by a USAID SI Officer and the CDC Medical
Epidemiologist, who is anticipated to join the country office during November 2008. Although one agency is the nominal technical
lead for a given specific activity activities are collaborative. In-country target setting is a collaborative process led by the USAID SI
Officer (SI Liaison) with all partners. The process consists of a systematic review of past fiscal year targets and results, with a
strategic examination of programmatic trends and opportunities for scaling up or down, when appropriate. In FY08, GoG
established annual national targets (2007-2011) for the National M&E Plan for HIV/AIDS; these national targets will be used as
point of reference in establishing targets for the partnership compact.
All USG partners report on OGAC indicators on a semi-annual and annual basis; however, individual partners also provide regular
monthly and/or quarterly updates on results to USAID and CDC. USG works with all partners to ensure the compatibility of
monitoring and reporting systems with both national and OGAC requirements/systems. During FY09, the USAID SI officer will
work with USG partners to revise their M&E systems to facilitate PEPFAR II reporting. To ensure adequacy of monitoring and
reporting systems and assess their compatibility with the national system, assessments of partner data management systems
were conducted by USAID in FY08. Plans are in place for FY09, to conduct a second round of Data Quality Assessments using
standardized MEASURE Evaluation tools.
In FY09, the CDC Office will continue to serve as the lead for two Public Health Evaluations (ART Adherence and Blood Safety)
that were funded in FY08. All USG agencies work closely with the CDC-based SI Advisor who is a member of the Core Team and
provides support for SI planning and implementation in country.
INFORMATION SYSTEMS: Currently, at the national level, a number of information systems are being used for HIV data
collection and reporting. Data presently flows by program area from the community and facility levels to the NAPS and other units
within the MoH. At these points, information is compiled and reported by program area using a number of unlinked databases. For
HIV treatment, all treatment sites are using the ARV Dispensing Tool (ADT) for consumption and forecasting needs, whereas the
WHO Patient Monitoring System, adapted to country needs, is being used, in its paper based form, at facilities to monitor and
report to NAPS on patients receiving HIV care and treatment.
Community-based information is collected using paper-based standardized frontline tools and reporting forms, which were revised
in FY08 to reflect the National M&E Guidelines for NGOs and Line Ministries implementing HIV/AIDS programs. Currently, an
electronic system tailored to these guidelines is being piloted at a few USG supported NGOs. At the community level during FY09,
the Community Support and Development Services (CSDS), a local NGO, will assume responsibility for the monitoring and
evaluation of all USAID- supported NGOs. USAID will support capacity building for their newly established M&E unit to equip them
with the necessary skills to ensure high quality data continues to be generated by these NGOs and to promote data use for
program planning and improvement at the NGO level. The community-based information system currently being piloted will be
rolled out to all USG supported NGOs during FY09 with the support of the M&E Unit at the Community Support and Development
Services (CSDS).
In FY09, USG will emphasize creating sustainable capacity for SI. The current structure for HIV/AIDS strategic information is not
well-defined; an electronic system to facilitate central collection and analysis of required HIV/AIDS data elements does not exist;
and there is insufficient human capacity in all areas of SI. At the national level, USG will continue to work with PAHO in
collaboration with MoH to strengthen the Patient Monitoring System which provides both individual patient tracking and the ability
to perform facility-level and national cohort and cross-sectional analysis. In FY09, USG will support NAPS in the development of a
central database that will integrate separate HIV/AIDS information systems. The process of development will include a
comprehensive review of existing information systems, gaps, current needs, including staffing needs, and compatibility with the
MoH HIS, and will culminate in the drafting of a database implementation plan. This system will be compatible with the MOH HIS
and will improve the timeliness and quality of data available to the NAPS M&E unit. This database will be used so that all
HIV/AIDS program area coordinators will be able to input data into a single database which can be managed by NAPS to view
and analyze data and provide reports on all national and other indicators. A priority in the development of this database will be
training all relevant parties in the use of the centralized database. Future plans need to include identifying staff to ensure routine
and timely data entry.
SURVEILLANCE AND SURVEYS: USG will continue to support the GoG in conducting two population-based surveys in FY09.
Planning for the first Demographic and Health Survey (DHS) in Guyana took place in FY08, and the implementation of the survey
will be completed in FY09 and will provide information on critical health indicators. The DHS will take the place of the second
round of the AIS which was conducted in 2004 and will provide information required for meeting HIV/AIDS program reporting and
provide data to inform policy decisions, ensuring comparability on standard HIV/AIDS indicators across countries and over time.
In FY08, biological and behavioral surveillance surveys (BBS) were completed among CSWs. In FY09, similar surveys will be
conducted among MSM, youth, and uniformed services to measure any changes in the population resulting from targeted
interventions. The BSS will provide national level data on these target populations.
In past years, ANC surveillance has been the basis for tracking HIV prevalence trends through unlinked anonymous testing (UAT)
of left-over blood collected during routine care for pregnant women. ANC surveys were conducted in 2004 and most recently in
2006. During the 2006 survey, HIV prevalence among pregnant women was 1.5%, surveillance guidance advises countries with
HIV prevalence greater than 1% to conduct ANC surveys every two years. During FY09, USG will opt out of supporting ANC
surveillance and instead use routine PMTCT program data to estimate antenatal HIV prevalence, and, by proxy HIV prevalence
among the general population. The decision was made in light of the high cost of antenatal surveys coupled with high ANC
attendance rates and very good HIV testing acceptance rates among pregnant women of 97.8%. Additionally, PMTCT services
are offered at 110 of the 379 health facilities across the country. USG will support efforts to strengthen the quality of PMTCT data
during FY09 to ensure that high quality data is collected at all sites offering PMTCT services.
M&E: Enhancing data quality in routine program monitoring will be central to USG support in FY09. Currently, a number of data
collection and reporting systems are unable to properly measure progress made in reaching the objectives and targets of the
National M&E Plan for HIV/AIDS, 2007-2011. USG will facilitate a comprehensive review of existing HIV program monitoring
systems to identify strengths and weaknesses in data collection and reporting systems, including risks to data quality. This review
will result in revision and streamlining of data collection and reporting formats. Relevant stakeholders will be trained in the revised
data collection and reporting systems.
A priority of the MOH is to make NAPS the central location for HIV/AIDS-related data. The systematic and coordinated flow of
data to NAPS will ensure proper data collection and usage. Currently, data collection at NAPS is not centralized in the M&E unit
and responsibility lies with each individual coordinator. MOH will ensure to make NAPS M&E unit the central repository of
HIV/AIDS data. In FY08, data quality assurance and supportive supervision began at the PMS sites. In FY09, this activity will be
expanded to include additional program areas; findings from these site visits will inform data quality improvement efforts within
these program areas.
CSDS M&E staff will also provide ongoing support to NGOs to ensure that community based information from their data collection
and reporting systems flow to the national level via the HSDU which will then provide data to the NAPS.
Program monitoring will also be strengthened through targeted capacity building, including mentoring and supervision, for NAPS
M&E staff, regional M&E officers and CSDS M&E staff, in data quality assessment, data utilization and dissemination, strategic
planning, program evaluation and leadership. Additionally, to ensure routine and comprehensive reviews of the national M&E
system to allow timely and relevant improvements, USG will support an M&E systems assessment.
PROGRAM EVALUATION: In FY09, NAPS will develop an evaluation agenda to identify and prioritize the schedule of HIV/AIDS
program evaluations. USG will support this effort in addition to one program evaluation based on identified priorities. This program
evaluation will be conducted along with the HIV care and treatment patient satisfaction evaluation planned by NAPS. USG will
also support the development of guidelines for documenting lessons learned and best practices, these guidelines will be used by
NAPS program coordinators to chronicle program successes and failures that will inform future implementation.
HUMAN CAPACITY DEVELOPMENT: The paucity of trained personnel to execute SI responsibilities is a significant challenge
faced by the national program. The NAPS M&E unit, and when established the MoH SI unit, will need to focus on recruiting and
retaining skilled persons to support SI system strengthening activities. This will include identifying feeding sources, and
establishing training and capacity building in key aspects of SI. Though there is no single solution, actions can be taken now to
come up with both short term and long term solutions.
To strengthen human resource capacity in SI in FY09, contract staff will be hired in SI priority areas, including regional M&E
officers, through the CDC cooperative agreement as a short-term solution to the problem. To complement these initiatives and
strengthen systems in the long term, USG will support the establishment of a human resource planning unit at MOH to achieve
staffing recruitment goals for SI and other activities. Additionally, the GoG will work with the University of Guyana to develop a
training program in M&E so that a direct feeding mechanism can be established to the MOH. In addition to this, MOH will identify
training programs in the region.
LINKAGES: Success in donor collaboration for SI systems strengthening through USG support during FY08 was the development
of a National Operational Plan for the National M&E plan. In FY09, this plan will serve as a blueprint for the steps to be taken to
monitor the national response. A monitoring and evaluation technical work group exists that brings together all donor agencies,
including the GoG and USG, however it is currently dormant. In FY09, USG will support the revival of this group and promote
donor collaboration on SI matters nationally. This group will also be responsible for monitoring progress of the Operational Plan.
Table 3.3.17:
AIDSRelief continues to support PEPFAR and local partner treatment facilities (LPTFs) in activities related
to strategic information. Corresponding to AIDSRelief goal of providing high quality HIV care and treatment,
Futures will continue to promote programmatic and operational decision making and planning based on
quality data usage and dissemination. Systems will be integrated efficiently into facility based systems. In
FY09, AIDSRelief through Futures will build capacity and provide supportive supervision in using
longitudinal medical record system (electronic and paper based) so that the LPTFs can use information for
quality improvement of their programs, patient management, and reporting to donors and MOH. Futures will
provide technical assistance through training to treatment sites in collaboration with donor and MOH to build
sustainable monitoring and evaluation (M&E) units and health management information system (HMIS).
Site data quality improvement activities will continue to be a major effort needed to sustain systems,
address and reduce drop out rates and drug pick-up rates. Futures will continue to coordinated SI activities
that are integrated in daily clinical care and support the QI activities to improve the quality of care and build
the capacity of the LPTFs.
Proposed activities:
Data collection, management and reporting
•Ensure collection and compilation of HIV patient data using the National Registers and longitudinal medical
records.
•Ensure collection and analysis of required indicators requested by LPTFs, CTCT and other stakeholders
and funding agencies.
•Provide TA for LPTF to develop specific plans to enable sites to easily look at data (information) to
enhance or improve program and operations.
•Data quality improvement workshops
•In collaboration with CRS and IHV, establishment of Continuous Quality Improvement (CQI) committee at
LPTFs
Building data use culture at the local site
•Training workshops (on-site/regional) on data usage
•Training workshops (on-site/regional) on defining indicators to measure quality and success of the local
program
System strengthening and sustainability
•Participate in regional workshops to share experience and information
•Participation in workshops with other partners at district level for the implementation of the National M&E
System
•4 local organizations provided with technical assistance for strategic information activities.
•15 individuals trained in strategic information (national systems, data usage and dissemination, and
IQChart spread as indicated)
Continuing Activity: 12754
12754 12754.08 HHS/Health Catholic Relief 6266 2765.08 AIDSRelief $140,592
