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.
The new Contractor awarded through the AIDSTAR mechanism will replace the work of the Guyana
HIV/AIDS Reduction and Prevention Project (Prime: FHI) that ends in December 2008. The activities and
technical support previously offered through GHARP will be continued under AIDSTAR.
They will support the GoG's ongoing HIV prevention, care and treatment program by helping to establish
the necessary health infrastructure systems and improving provider skills so they can safely and effectively
provide PMTCT with appropriate links to follow-up services. FY09 will continue to focus on reaching male
partners, but will also seek to decrease the gap between those women tested and those that recieve their
results prior to delivery. This will be done by continuing the communication strategy that encourage women
to access services early in pregnancy, but also in staging health centers, and supporting those sites with
current capacity to provide on-site, rapid testing to do so. The management information system, developed
through GHARP, with the MOH is now fully managed by the MOH, but will require technical assistance to
ensure data quality, resolve any systems issues that may arise, and integrate with broader MOH HMIS
when operational.
The Contractor will suppor the technical assistance needs of the MOH and its MCH department as outlined:
Priorities:
•Provide technical assistance for MOH to promote quality assurance, ensure routine PMTCT data system
function in order to track service delivery/prevalence; and
•Provide support for training, equipment, transportation, and critical commodities needed to expand PMTCT
services nationally.
Illustrative Activities:
•Short and Long-term technical assistance, training and reporting/evaluation provided to the MOH in order
to expand programming, increase coverage, and strengthen the quality of services provided;
•Provide technical assistance to the Ministry of Health in updating and revising National Guidelines, service
standards, and curriculum as needed.
New/Continuing Activity: Continuing Activity
Continuing Activity: 13884
Continued Associated Activity Information
Activity Activity ID USG Agency Prime Partner Mechanism Mechanism ID Mechanism Planned Funds
System ID System ID
13884 3156.08 U.S. Agency for Family Health 6641 4.08 GHARP $200,000
International International
Development
7466 3156.07 U.S. Agency for Family Health 4612 4.07 GHARP $300,000
3156 3156.06 U.S. Agency for Family Health 2737 4.06 GHARP $700,000
Emphasis Areas
Gender
* Addressing male norms and behaviors
Health-related Wraparound Programs
* Child Survival Activities
* Family Planning
Human Capacity Development
Estimated amount of funding that is planned for Human Capacity Development
Public Health Evaluation
Food and Nutrition: Policy, Tools, and Service Delivery
Food and Nutrition: Commodities
Economic Strengthening
Education
Water
Program Budget Code: 02 - HVAB Sexual Prevention: AB
Total Planned Funding for Program Budget Code: $1,257,735
Total Planned Funding for Program Budget Code: $0
Program Area Narrative:
Guyana faces a low-level generalized HIV epidemic. A cumulative total of 4,502 AIDS cases had been officially reported to the
MOH by the end of 2004. At that time, UNAIDS estimated that the prevalence of HIV infection among adults in Guyana was
2.5%.
The 2005 Guyana AIDS Indicator Survey showed that 98% of adults in the general population have heard of AIDS and that 76%
of women and 81% of men know the two most important ways to avoid HIV transmission, using condoms and limiting sex to one
uninfected partner. Nine percent of men and 1% of women reported having had more than one sexual partner in the last 12
months. Only about 1% of Guyanese men and women who have ever had sex reported having an STI in the past 12 months.
A biological and behavioral survey of 334 men who have sex with men (MSM) was conducted in 2004. Twenty-four percent of
MSM agreed to provide blood samples, which were tested for HIV and syphilis. Among the participants who provided blood for
serologic testing, 21% tested positive for HIV and 10% for syphilis. The risk behaviors in the MSM population may also affect
levels of heterosexual transmission. Considering the high HIV prevalence and fluctuation of sexual partners, MSM are at high-risk
for HIV in Guyana. Like MSM, all female sex workers surveyed had heard of HIV and 76% knew someone infected with or dead of
HIV/AIDS. According to the latest sero-prevalence survey among FSW in Guyana, HIV prevalence for this group is 27%.
Guyana employs thousands of men in hundreds of mines in remote interior regions, so gold and diamond miners were surveyed.
Less than half (47%) were married or living maritally and 50% were migrant workers. Eighty-nine percent reported sexual activity
in the last year; 50% reported having had sex with only one partner and 15% had had sex with commercial sex partners. In 2004,
HIV prevalence was 4% among miners, down from 7% in 2002.
Tuberculosis is the most common opportunistic infection and the leading cause of death among people living with HIV/AIDS
(PLWHA). Only seventy-nine persons (31%) reported knowing their HIV-infection status before starting TB treatment and were not
retested for HIV. Of the 79 (84%) reported a positive HIV status. Of the remaining 174 patients with unknown HIV status before
diagnosis of TB, 73% were offered HIV counseling and testing, and 91% of those agreed to be tested. Ten percent of those tested
were HIV-positive. Guyana has a TB/HIV prevalence of 14%.
Drug users constitute an important risk group for HIV. The 2006 Canadian Society for International Health conducted a study
regarding the relationship between drug use behavior and HIV prevalence. The study was conducted among 172 cocaine users in
Georgetown during October and November 2006. Over half the participants (61%) reported a history of sexually transmitted
infections and 18.2% had previously had TB. Of the 172 participants, 17% tested positive for HIV. 79% of HIV+ drug users
already knew their HIV status before the study.
Collectively this strategic data has identified key Most-At-Risk Populations (MARP) as sex workers and their clients, men who
have sex with men, PLWHA, and "mobile" persons such as miners, loggers, sugar-cane workers, transport industry workers, and
those persons living with TB. These populations therefore continue to be the main target for focused interventions. In addition,
youth who are transitioning into sexual activity and women who often lack empowerment to control sexual relationships in the
familial structure will be reached as important populations.
Great strides have been made in the past five years of the PEPFAR/MOH collaboration. The USG program priorities continue to
be directly linked to and include the Guyana National HIV/AIDS Strategies for 2007-2011. Currently, the MoH and USAID
supported NGOs are directing efforts at risk elimination and risk reduction for MARPS. Female sex workers and MSM are also
being reached with combined targeted outreach and referrals to friendly clinical care and treatment services. This program is
implemented in Regions Four and Six with plans for expansion in Regions Two, Three, Seven and Eight. Interventions to reduce
the risk among miners and loggers have also commenced. Significant expansion of these programs, together with quality
assurance programming in FY09 and beyond are essential.
To date, the Private Sector Partnership Program developed in 2005 has evolved into a robust coalition of private sector
organizations that are actively engaged in helping the GoG reach its goals of preventing and reducing HIV in Guyana. Forty-six
(46) local private sector companies are currently collaborating with the Public/Private Sector Partnership Program in an effort to
protect the workforce against HIV and ensure the viability of private enterprise in Guyana.
Successes in the area of community outreach to promote behavior change include the large number of NGOs supported to
implement structured behavior change interventions and some progress was made to reach most at risk populations, especially
Female Sex Workers. Interventions to reach MSM remain a challenge. However, this sub-population will continue to be a priority
in FY 09. Non-traditional condom outlets were supported by the Condom Social Marketing Program through private sector
partnerships. The cost effectiveness of the CSM program in reaching places where high risk behaviors occur is a possible
success that should be evaluated further.
In addition, GHARP focused on creating an enabling environment for positive behavior change. Activities included promotion of
the benefits of partner reduction, increased family time, pre- and post marital counseling, and the promotion of individual, familial
and societal responsibilities. Training also focused on cultural norms, gender issues, substance abuse, human sexuality and
domestic violence. FBOs are integral partners in promoting this prevention strategy as well as counseling their members to
access pre-marital counseling and testing.
Specific Milestones Include:
•Over 11,000 persons were reached with other behavior change messages beyond abstinence and/or being faithful.
•More than 1400 Army recruits received Abstinence and Be Faithful messages and an additional 2400 Army Ranks received
abstinence/be faithful/safer sex messages from trained peer educators.
•The Modeling and Reinforcement to Combat HIV and AIDS (MARCH) radio serial drama, Merundoi, continues to broadcast twice
weekly plus weekend editions. The MARCH program has scaled up reinforcement activities in partnership with the Ministries of
Health and Education, and has transitioned from administration by the US-based Manila Consulting Company to a free-standing
NGO with administration and management through Community Support Development Services Inc, an indigenous organization.
•Mobile and fixed youth friendly services in several regions;
•USG/GOG supported jointly development of IEC materials following the National HIV/AIDS Communication Strategy and
disseminated nationally;
•NGO and MoH Peer educators actively working in all regions;
•Community awareness competition, HIV/STI Web game production;
•Over 2 million condoms per year were distributed via NAPS, maternal/child health clinics, and NGO sites.
•Condom sales in less than a year have exceeded over 100,000 pieces sold through non-traditional outlets regionally.
•Peace Corps Volunteers and community counterparts where able to complete 6 small projects that integrated literacy, information
technology and HIV/AIDS awareness.
•Peace Corps Response Volunteers have worked with local organizations including the Merundoi Project, Help & Shelter, and
Guyana Geology and Mines Commission on positive behavior change communication and HIV prevention education among
vulnerable populations.
In FY09, communication and public information programs that include the development of a comprehensive marketing strategy to
facilitate greater uptake of HIV/AIDS related prevention goods and services will be undertaken. These programs will target all
priority populations.
Development and implementation of a national condom distribution policy that includes and expands upon existing programs will
be a priority. Expansion of private sector condom sales model in conjunction with a free, national condom distribution system will
be supported; all under one umbrella social marketing campaign. Consideration will also be given for female condoms.
A continued increase of involvement of NGO, civil and private sectors will be fostered to increase coverage of all prevention
programming and as part of a sustainability strategy. These efforts should span all programs for at-risk populations. Special
consideration will be given to the reduction of gender-based sexual coercion and violence, including cross-generational sex.
Programs will also continue to address alcohol and substance abuse-related behavior as it contributes to HIV risk for all targeted
populations.
Individuals who are identified through AB outreach will continue to be referred to NGO and MoH VCT sites and other care,
support, and treatment services. One example is model built by the Guyana Defense Force project with the armed services,
where a mobile van provides GDF members and their families with AB, OP, VCT, and referral services. Sexually active youth are
reached through Life Skills and Peer Leader Education programs and Youth-Friendly Health Services. Referrals between
USG/Guyana's ABY and OVC program areas enable young persons engaging in risky behaviors to obtain needed HIV/STI
counseling and testing and other HIV prevention services. USG works with local partners such as the Salvation Army when
necessary to link HIV clients such as substance abusers to available services.
The program will work to finalize the prevention principles, standards and guidelines that will address prevention interventions.
Development of a condom policy that increases access for those at risk will be considered. Persons living with HIV will be
integrated further into prevention programs both at the national and community levels to reach more PLHIV as well as the general
population).
Table 3.3.02:
Technical assistance will be provided to NGOs and MOH with a focus on reinforcing the National
Communication Strategy and the Merundoi program as well as the continued Body Works peer education
program. Oversight and support will also be given to increase the quality of services provided and the
partners' ability to link clients with testing, support, and condom programs when needed.
•Provide technical assistance to develop strategies, training, and mentoring of MOH and NGO partners
implement AB programming;
•Provide training and technical guidance/mentoring to NGO and MOH partners as they continue to
implement Abstinence & Be Faithful programs and communication.
•Short and Long-term technical assistance provided to a team of colleagues from the National AIDS
Programme and NGOs working with high risk populations in order to expand programming, increase
coverage, and strengthen the quality of services provided; and
Programme and NGOs providing prevention programming that falls under AB in order to expand
programming, increase coverage, and strengthen the quality of services provided.
Continuing Activity: 13886
13886 3157.08 U.S. Agency for Family Health 6641 4.08 GHARP $400,000
7865 3157.07 U.S. Agency for Family Health 4612 4.07 GHARP $350,000
3157 3157.06 U.S. Agency for Family Health 2737 4.06 GHARP $450,000
* Reducing violence and coercion
Workplace Programs
•Provide technical assistance to develop strategies, training, and mentoring of MOH and NGO partners to
target MARP with programs that address prevention for positives, family planning, partner concurrency,
sexually transmitted illness (STI) treatment, condom use, fidelity, transactional sex, cross-generational sex,
and drug/alcohol use; and
•Maintain current condom distribution & sales strategy, expand further, and monitor condom sales and
distribution growth over time.
coverage, and strengthen the quality of services provided;
•Support sales promoters and maintain successes realized in the condom social marketing strategy;
•Work with businesses key to the condom distribution in order to support public-private partnerships with
each separately, but under a common strategy, in order to increase coverage and deliver both below and
above-line marketing;
•Provide technical assistance, upon request, from the Ministry of Health to assist in developing strategy,
guidelines, and curriculum as well as service delivery for high risk populations; and
•Provide technical assistance and on-the-ground long-term follow-up and advocacy in order to remove the
value-added tax on condoms in order to increase access and promote prevention.
Continuing Activity: 13888
13888 7877.08 U.S. Agency for Family Health 6641 4.08 GHARP $400,000
7877 7877.07 U.S. Agency for Family Health 4612 4.07 GHARP $300,000
* Increasing gender equity in HIV/AIDS programs
Estimated amount of funding that is planned for Education
Table 3.3.03:
The new Contractor awarded through the AIDSTAR mechanism will replace the work of the current Track
One Funded, Injection Safety Program (Prime: Initiatives) which is slated to end September, 2009, but may
have a period for no-cost extension.
Given the substantial level of resources that Track One funding has made available for safe medical
injection programming in Guyana, the current level of activities will not be sustainable. The Contractor will
however work along with the Guyana Safer Medical Injection Program (GSIP) to identify the most critical of
technical assistance needs and pursue those after the close of the GSIP project.
New/Continuing Activity: New Activity
Continuing Activity:
Program Budget Code: 06 - IDUP Biomedical Prevention: Injecting and non-Injecting Drug Use
Program Budget Code: 07 - CIRC Biomedical Prevention: Male Circumcision
Program Budget Code: 08 - HBHC Care: Adult Care and Support
Total Planned Funding for Program Budget Code: $1,598,458
This program area responds to the care and treatment section of Guyana's National Strategic Plan for HIV/AIDS 2007-2011 which
states that the objective is to "ensure access to care and treatment for all persons living with HIV/AIDS," including a supportive
environment and quality home-based care services. As of April 2008, free ARVs are available at a total of 16 sites, including a
mobile unit to provide service for the Hinterland regions (1, 7, 8, and 9). These sites are a mix of public and private faith-based
sites supported by MOH in partnership with FXB and AIDSRelief, with the capacity to treat adult and pediatric patients. There are
currently 2,185 persons on ART in Guyana, including 134 (8%) pediatric cases. A combined national cohort of all patients who
started ART in June 2007 showed that 79% were alive and on ART after 12 months. In FY09, the Guyana PEPFAR team will
transition more patients to treatment through linkages to PMTCT and VCT programs and provider-initiated counseling and testing
for infectious disease (e.g., TB, STIs) patients at facilities. Expansion of coverage to the Hinterlands through an additional mobile
unit, training mid-level providers in the basic care of non-complicated cases, and a new treatment and care initiative are planned.
In FY08, several initiatives supported enhanced treatment services. The National Public Health Reference Laboratory (NPHRL)
was completed. Once fully operational, in addition to basic laboratory monitoring, this laboratory will provide reference functions,
quality assurance, diagnostic capacity for OIs, STIs, and DNA PCR testing for early infant diagnosis (EID). WHO Patient
Monitoring System (PMS), including facility-based ART and pre-ART registers, was implemented in all treatment sites, including
private sites. This has resulted in better information for patient tracking, program management, and patient care. An initiative to
improve the quality of both pediatric and adult clinical services was launched by the MOH in partnership with UNICEF, HRSA, and
CDC through the HIVQUAL program, called "HealthQual." Selection of patient indicators was completed, and software
development has begun. HealthQual will be piloted in the GPHC ID ward, and the MOH MCH program. Other program highlights
from FY08, included strengthening the Partnership for Supply Chain Management (SCMS) for commodities management
including rapid test kits, ARVs, medications for OI, and laboratory reagents. This transition minimized stock outages and delays
that would have impeded the delivery of quality treatment services.
FXB continues to serve as the primary MOH partner in the provision of adult and pediatric HIV care and treatment services, the
development of guidelines and protocols, continuous quality improvement, and the design and implementation of adherence
monitoring. A full-time pediatric specialist was recruited to support multiple sites. FXB currently coordinates the clinical
assignments for the UN Volunteer (UNV) Physicians providing ARV services in-country. In addition, through mentoring of
clinicians, clinical training, and strong collaboration with MOH, CDC, and PAHO, FXB will seek innovative solutions to the human
resource shortages that threaten the advancement and sustainability of the Guyana treatment program. Significantly, FXB has
decreased the number of UNVs from 10 to 5 during FY08. PEPFAR Guyana and its partners will continue to explore creative
solutions to these shortages such as physician extenders, pre-service training, and alternative compensation strategies.
AIDS Relief will provide comprehensive ARV services at 3 sites, including two faith-based non-profit hospitals and one public
hospital. AIDS Relief uses a family-centered care model and ensures that families of patients on ART receive support services
and prevention messages. 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).
In FY09, the overarching goal is to begin the transition from scaling-up services to improving quality of services, transferring
technical capacity, promoting sustainability, and filling gaps in the treatment and care referral network. Specific program area
priorities include, but are not limited to: (1) implementing the HealthQual program at all 16 treatment sites, selected MCH sites,
and the ID ward for continual quality improvement of adult and pediatric care; (2) provide more focused TA to the ID ward,
including staff recruitment, training, and necessary renovations required to develop this into a center of excellence (COE) for
inpatient HIV care; (3) strengthening the National Treatment and Care Center (formerly GUM clinic) to develop into a COE for
outpatient care through onsite mentoring, training, and improved linkages with other treatment and care sites; (4) integrate the
national PEP program into general health sector programs (e.g., A&E departments) and non-health agencies (e.g., police
departments) for improved referral and management of patients with occupational and non-occupational exposures; (5) improve
services to the Hinterlands through expansion of mobile services, support task-shifting, and launching a partnership initiative to
promote better coordination and integration of more than 20 NGOs that currently provide services in these areas; (6) support
innovative strategies to address health worker shortages, including implementing the in-service curriculum for mid-level providers,
integrating new physicians from the Guyana-Cuba government exchange program, and exploring more cost effective models; (7)
broaden the national home based palliative care program to include basic care provisions such as safe water/hygiene, nutritional
assessments/food supplements, access to insecticide treated nets and opioid analgesics; and, (8) provide follow up treatment for
cervical cancer for HIV+ women identified in the cervical cancer screen and treat demonstration program.
Consistent with the PEPFAR guidance, the goals of the USG contribution to the National Strategy are to provide the five
categories of essential palliative care services to all people infected or affected by HIV: 1) Clinical Care; 2) Psychological Care; 3)
Social Services; 4) Spiritual Care; and 5) Prevention for persons living with HIV (PLHIV). These palliative care services are
provided in both facility and home-based settings. The CDC's 2006 Guyana Epidemiological Profile estimated that in 2007 there
would be 12,700 persons living with HIV (PLHIV) in Guyana. As of June 2008,3523 PLHIV were receiving one (clinical care) or
more of palliative care services in 22 clinical sites, of whom more than 929 clients were also receiving the full, home-based
palliative care package through 10 PEPFAR-supported NGOs. In addition, 188 providers of home-based care (HBC) were trained
in the first half of FY08. In FY09, the program will continue to support a comprehensive package of care services delivered in
facility and home-based care settings and will strengthen linkages to PMTCT, VCT, and provider-initiated testing in health care
facilities, formalize systems of referral between clinics and NGOs, monitor the delivery and quality of care services, and address
stigma and disclosure to enhance the uptake of HBC services. Support will continue for supervision and training of providers with
subsequent mentoring throughout service delivery by clinical partners, NGO and MOH outreach staff.
Services
Clinical care services that include preventive, asymptomatic, symptomatic, and end of life care (following WHO analgesic ladder)
are provided through the health sector and the St. Vincent de Paul Society hospice and rehabilitative care facility, with linkages to
community support organizations. At care and treatment sites, USG partners provide comprehensive, family-centered, palliative
care clinical services for adults and children that include routine clinical and CD4 monitoring, prevention and treatment of OIs,
including provision of co-trimoxazole, TB screening, support for adherence to ART, nutritional assessment and support, and
promotion of personal and household hygiene. Clinical sites are located in 21 health care facilities (15 of which also provide
treatment), including each regional facility (Regions 2,3,6,10) and the central treatment center of excellence (Region 4).
MOH Regional palliative care nurse coordinators, supported by the GFATM, are based within these facility-based settings.
Community based providers work along-side these regional palliative care nurse coordinators at the treatment sites to ensure a
continuum of care. Patients identified as positive through clinic-based counseling and testing and/or are receiving care at
treatment sites are accompanied to the nurse supervisor's office where they enroll in the HBC aspects of the program. HBC
nurse supervisors directly link patients to NGOs where they and their family can receive support in HIV palliative care services.
The referral systems and networking between the MOH Clinical/treatment sites were strengthened in FY08 with the institution of
monthly networking meetings that include quarterly reporting, discussion of active cases in HPC. In addition, NGOs that offer
community-based VCT also offer palliative care services and as such referrals are done internally. M&E tools for reporting and
referrals were standardized and are included in the National Reporting Guidelines for NGOs and Line Ministries. To increase the
number of persons in HIV care that also receive HBC and enter into a treatment and care program a novel initiative was
developed, the case navigator program. This program was piloted in four sites in Region 4. This program ensures that case
navigators are stationed at high volume VCT sites and are equipped to navigate persons tested positive into the treatment
program. A curriculum was developed and persons were trained and certified as case navigators. Forms for monitoring were
developed and a formal evaluation of the program conducted in FY08. Training, referrals, and monitoring are a collaborative effort
between the National AIDS Program Secretariat and PEPFAR..
Psychological care services will continue to address the non-physical suffering of the individual and their family and include
support groups linked to the care and treatment sites as well as those led by FBO and NGO partners. In FY08, support groups at
the various treatment sites as well as NGO sites function fully with a membership of more than four hundred and forty four
persons living with HIV Activities include the development and implementation of age-specific psychological care in collaboration
with the Ministry of Labour, Human Services and Social Security, and family care and support delivered by NGOs/FBOs. Family
centered approaches enable the program to identify and link OVC to specialized services, enable the children to receive
immunizations, provide home-based voluntary counseling and testing for family members, referral for family planning services,
links to legal services, support for disclosure of HIV status, bereavement care, as well as nutritional and hygiene counseling for
the family.
Spiritual care service supports FBOs to deal with basic issues related to HIV/AIDS through sensitization, training, and counseling
related to fears, guilt and forgiveness.
Prevention services for PLHIV includes case-management, age-appropriate prevention messages, partner testing, and
interventions for sero-discordant couples, including community and clinic-based support groups.
In FY08, the partnership for Supply Chain Management system with the MOH ensured a steady supply of HIV related
commodities through joint procurement planning for drugs for OI prophylaxis/treatment and STI treatment. In addition formation of
the joint procurement planning committee which met regularly in FY 08, enhanced the coordinated procurement needed at the
National Level. This process led by the Government of Guyana through the Ministry of Health and supported by SCMS, has
resulted in the transfer of skills from the HSDU Global Fund procurement officers to the MMU officers. In FY09, PEPFAR will
continue to work with MOH to support improved diagnostic capacity for OIs, including additional training and strengthening of
regional and central labs, build capacity for cervical cancer screening, utilizing the recently established national public health
reference laboratory. Additionally, PEPFAR will provide support to the HIV drug resistance monitoring in Guyana and to the
strengthening of the laboratory diagnosis for other sexually transmitted infections.
Referrals and Wraparounds
Social care services delivered primarily by the NGO/FBO sector, include an array of services not limited to adherence support,
nutritional and hygiene counseling, reproductive health counseling, creation of kitchen gardens, referrals to clinic care providers,
micro-credit loan opportunities, parenting skills and employment training, and, work place internships. Partnerships with the
private sector have facilitated the economic empowerment of PLHIV through establishment of their own businesses. PEPFAR will
continue to explore opportunities for new partnerships for the economic empowerment of PLHIV. Nutritional support will continue
to leverage other resources within the donor community, including the MOH Food Bank.
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.
Policy
In 2008, the MOH and the National AIDS Program Secretariat, in collaboration with implementing partners (FXB, CRS, and
GHARP), and CDC updated sections of the national guidelines for care and treatment for both adults and HIV-infected/exposed
children, on TB/HIV co-management and paediatric management. Recommendations included the earlier treatment of children
and treatment for all patients with TB/HIV co-infection. The guidelines for VCT were finalized. Currently, no official policies or
treatment guidelines exist for the treatment and management of pain. Opiods are only available through management by a
physician in hospital settings due to high costs that exist for importation of these drugs. GHARP will support the MOH in
partnership with FXB and SCMS to advocate for an enhanced legislative and policy framework so that there is increased access
to opioids in the home or hospice. GHARP and FXB will be working together with the MOH and the National AIDS Program
Secretariat to develop specific guidelines on pain management.
Table 3.3.08:
Continuing Activity
The Contractor will continue to provide technical assistance, training, and support for NGOs and the MOH in
its implementation and strengthening of home-based care services, case navigation throughout the
continuum of care, and monitoring and evaluation.
•Provide technical assistance to MOH and NGO partners in expanding the case navigation program
whereby treatment clients are actively navigated from clinical care to home based care and supported to
ensure continuity of care and treatment adherence;
•Provide technical assistance to the MOH in developing its standard package of care for PLHA, including
psychosocial support, counseling, and pain management for end of life care and for monitoring the
implementation of such to address quality of care;
•Provide technical assistance and training to NGO providers of adult and pediatric home-based care to
improve quality, ensure a standard package of care, and expand services to more PLHA; and
•Provide technical guidance and grant support for furthering the economic advancement of PLHA.
•Short and Long-term technical assistance and training provided to a team of colleagues from the National
AIDS Programme and NGOs providing care, support, and home-based care services to PLHA in order to
expand programming, increase coverage, and strengthen the quality of services provided;
•Provide technical assistance to the current micro-enterprise loan program to increase access (lower
interest rates, expand repayment period) etc for PLHIV, as well as exploring opportunities to engage other
micro-enterprise service providers;
•Collaborate with the economic growth portfolio at USAID in order to explore opportunities to increase the
economic status of PLHA; and
•Provide technical assistance to the MOH in updating and revising National Guidelines, care manuals, and
curriculum as needed as it relates to care, including psychosocial support and pain management.
Continuing Activity: 13890
13890 8200.08 U.S. Agency for Family Health 6641 4.08 GHARP $100,000
Estimated amount of funding that is planned for Economic Strengthening
UNICEF is the key partner in OVC work, but the Contractor will work closely with NGOs, line ministries, and
the current UNICEF program to fill in gaps, provide technical assistance and training.
•Provide technical assistance and training for NGOs in providing care, support the transition of those
reaching adulthood, support families caring for OVC, and link children to Government support
services/vouchers.
•Short-term technical assistance and training provided to NGOs providing support to OVC in order to
expand programming, increase coverage, strengthen the quality of services provided in public and NGO
sector, and strengthen the capacity of families and communities to provide care;
•Develop a standard package of services across NGO providers;
•Develop linkages to the UNICEF supported OVC work in order to increase their work's impact; and
•Build partnerships with the private sector to provide support for OVC and their families.
Continuing Activity: 13893
13893 3160.08 U.S. Agency for Family Health 6641 4.08 GHARP $50,000
7467 3160.07 U.S. Agency for Family Health 4612 4.07 GHARP $100,000
3160 3160.06 U.S. Agency for Family Health 2737 4.06 GHARP $310,000
Table 3.3.13:
In FY09, the Contractor will continue to provide the same level of technical guidance, quality assurance
support to both the MOH and the NGOs. Additionally, as an integrated activity with PMTCT, sites will be
staged according to capacity in order to increase the number of sites with rapid-tesing services. For those
sites that are not able to sustain such programs, support will be continued in order to increase the efficiency
of mobile team visits and/or sample transport so as to increase the coverage of CT services Nationally.
Technical guidance will also continue to focus on testing services for high risk populations and communities
including MSM and sex workers and their clients and targeting men who currently are consistenly under-
utilizing the services.
•Provide technical assistance to MOH and NGOs implementing counseling and testing (CT)to ensure quality
of service, expand coverage, and target those populations/communities most identified to be at highest risk
in order to identify those in need of clinical care;
•Provide technical training to MOH and NGO partners to increase capacity to support persons identified as
HIV+ in accessing the care continuum;
•Provide technical assistance to the MOH in updating and revising National Guidelines, service standards,
and curriculum as needed; and
AIDS Programme and NGOs providing CT in order to expand programming, increase coverage, and
strengthen the quality of services provided; and
•Provide technical assistance to MOH in order to adapt reporting structure/systems in order to ensure data
quality.
Continuing Activity: 13894
13894 3161.08 U.S. Agency for Family Health 6641 4.08 GHARP $200,000
8004 3161.07 U.S. Agency for Family Health 4612 4.07 GHARP $250,000
3161 3161.06 U.S. Agency for Family Health 2737 4.06 GHARP $840,000
Table 3.3.14:
technical support previously offered through GHARP will be continued under AIDSTAR and expanded upon
in coordination with those Health System Strengthening activities supported through PAHO. Support to the
workplace programs, publi-private partnerships and the Guyana Business Coalition business plan will
continue to be critical elements.
Important areas for improvement are quality improvement and systems strengthening. These areas were
supported during the rapid scale up, but can be strengthened in the next program period. The objective was
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. Concurrently PAHO is establishing a Human Resources Planning and Development Unit
within the MOH to address migration issues, as well as the retention and recruitment of health providers.
There are still large gaps in reaching the overall institutional strengthening and administrative support.
Human resources and workforce issues are much larger than the health sector or the HIV program.
However, short and interim plans for Human Capacity Development in this area can be addressed with
sustainability as the long term goal.
•Support to the Human Resource System at the MOH to assess recruitment, retention, and training needs
and work to address those needs;
•Support to the MOH to assess administrative inefficiencies, and assist in resolving or strengthening
identified weaknesses;
•Institutional Support to the GFATM CCM Secretariat;
•Technical assistance and training provided to NGO Grants Umbrella (Community Support & Development
Services) in order to build its capacity to meet NGO governance, transparency, advocacy, human resource
management, sustainability, budgeting and work plan development needs and direct training to NGOs on
said topics while CSDS capacity is being strengthened to deliver same in the futre;
•Technical and institutional assistance provided to the Guyana Business Coalition in order for them to
implement their business plan effectively, recruit new partners, retain current partners, track business
involvement, track businesses' success in upholding approved policies, and build work place programs
within partner businesses; and
•Provide assistance in drafting and gaining support at the community level for critical MOH policy changes
as needed/requested. (None identified for FY09).
•Long-term technical assistance in reviewing retention plans of the MOH and working with PS of MOH to
develop possible revisions;
•Support consultant staff, office costs, and CCM constituency meetings for the CCM Secretariat and its
activities;
•Provide short and long term technical assistance to the NGO Umbrella mechanism, building the capacity of
their own staff to deliver support to NGOS in governance, communication, human resource and
administrative management, and in building partnerships with Governmental Ministries;
•Support work plan, external technical guidance, and local consultant staff needed to implement the current
HIV/AIDS Business Coalition business plan; and
•Provide technical assistance to maintain the current private sector partners, and increase the membership
and their contributions to the community.
Continuing Activity: 13897
13897 3155.08 U.S. Agency for Family Health 6641 4.08 GHARP $50,000
8199 3155.07 U.S. Agency for Family Health 4612 4.07 GHARP $100,000
3155 3155.06 U.S. Agency for Family Health 2737 4.06 GHARP $450,000
Table 3.3.18:
