The AIDSRelief consortium provides comprehensive HIV care, treatment, and support services and HIV prevention services in Guyana. The care, treatment and support services are provided at three (3) local partner treatment facilities (LPTFs). Two of the LPTFs are faith based hospitals located in Georgetown (Region 4) and the third LPTF is a Ministry of Health Regional Hospital located in Bartica (Region 7). As part of our support services AIDSRelief supports Hospice Centre which is also located in Georgetown. AIDSRelief also provides a variety of prevention services through our local partners (PMTCT, VCT and Abstinence Education).

Goal and Objectives under the Award

The overall goal of the AIDSRelief program is to ensure people living with HIV and AIDS have access to ART and high quality medical care. To achieve this goal, AIDSRelief continues to focus on the following key strategic objectives:

1. Existing ART service providers rapidly scale up delivery of quality ART care; 2. Expand community level services providing quality ART to vulnerable and low income HIV infected people; and 3. Create and strengthen health care treatment networks to support capacity building within communities.

Geographic Coverage

The AIDSRelief care, treatment and support program primarily focuses on persons living in Region 4 and 7, however, some patients who enrolled in the program lives in Regions 2, 3, 5, 6 & 10. The abstinence program has been rolled out in all 10 administrative regions.

Key Issues

In the upcoming year, the AIDSRelief program is going to focus on the following key issues:

The low number of males utilizing VCT services; The disproportionate number of males (41%) enrolled in the care and treatment program compared to females (59%); The number of patients who are being lost to follow up; Adherence; and the increasing number adolescent clients.

Strategy towards costs efficiency

AIDSRelief continues to find innovative ways to provide high quality HIV care and treatment while trying to keep program costs at minimum. In the upcoming year AIDSRelief will continue to find ways to collaborate with local partners to maximize technical assistance offered to the clinical care and treatment staff at the Public and Private Care and treatment sites. AIDSRelief will also work with the Ministry of Health to look at ways of reducing care and treatment costs at SJMH and DMH, such as procuring OI medications through the MOH and centralizing CD4 tests at the National Reference Laboratory.

Monitoring and evaluation plans

AIDSRelief provides on-site technical assistance and training to facilitate the development and implementation of data management systems that respond to the needs of physicians, hospital administrators, MOH, USG donor, and project needs. Care and treatment sites receive strategic information capacity building and focuses: on improved data demand and information use; enhancing/implementing patient monitoring and management system that meet local requirements; and enhancing data quality for better service and clinical outcomes. AIDSRelief has three main objectives for strategic information:

1. LPTFs have skills to collect, manage, and analyze data; 2. Data demand increases for improved clinical and programmatic decision making; and 3. LPTFs share lessons learned and best practices for improved data quality.

AIDSRelief supports the care and treatment programs at Saint Joseph Mercy Hospital and Davis Memorial Hospital which are two faith based hospitals located in Georgetown (Region 4), Bartica Regional Hospital (Region 7) and 1 Hospice Centre (Region 4). AIDSRelief-supported sites provide the 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, cervical cancer screening, 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; 4) Spiritual Care; and 5) Psychological care. In FY2009, AIDSRelief provided comprehensive care to 1,204 clients enrolled at the three care and treatment sites and the hospice centre.

In FY2010, 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 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 has recruited an Adherence Specialist/ Community Outreach coordinator to oversee the integration of a comprehensive adherence model, which includes 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 FY 2010, AIDSRelief will begin to integrate psychological support with the adult, adolescent and children support groups. This service will strengthen the psychosocial support and behavioral interventions that are currently being offered to participants in the support groups. Due to the number of children in the AIDSRelief program that will mature into pre-adolescent hood and adolescent-hood, we will ensure that our counselors are fully trained by experts from the University of Maryland and are competent in providing psychological support to the needs of our adolescents and pre-adolescents.

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 Improvement (CQI) 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 will be able to use data to affect change in the quality of service provided.

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 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 psychological services to accommodate this population. With increasing numbers of OVCs, AIDSRelief and LPTFs recognized that there were unmet needs in providing psychological support to HIV infected/exposed/affected children. In FY09, 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 psychological issues unique to children with HIV and their families (e.g. coping, trauma and grief responses, disclosing status to children, stigma and discrimination). Particular emphasis was placed on tailoring ART adherence services to HIV positive OVC.

In FY 2010, AIDSRelief will continue to provide psychosocial support training to nurses, social workers and care takers serving pediatric and adolescent clients, and continue to further strengthen the capacity of our clinical and counseling staff to provide high quality care to Guyana's OVC population, including care and treatment support services for HIV affected children 5 years and under. AIDSRelief will continue to meet the psychosocial needs of the OVCs by actively involving them in the Kids Club and its activities.

CONTINUING ACTIVITY ACTIVITY UNCHANGED

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.

The clinical core team will continue to provide ongoing support and assistance to the LPTFs through didactic trainings and on-site mentoring, and additionally liaises with USG in-country and MOH partners on technical issues related to recognizing and managing ARV side effects, diagnosing and management of opportunistic infection as well as interpreting CD4 changes and viral load results. AIDSRelief will provide additional technical assistance in the areas of psychosocial support, pharmacy support, adherence, laboratory monitoring, and strategic information.

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 offsite adjuvant facility to SJMH and DMH. It will serve as a mechanism wherein AIDSRelief can collaborate with local in-country partners in building local technical capacity and promoting sustainability.

AIDSRelief provides a comprehensive care and treatment package at the three LPTF which includes clinical and laboratory monitoring, ARV treatment, OI prophylaxis and treatment, and adherence counseling and support.

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.

CONTINUING ACTIVITY

AIDSRelief continues to provide voluntary counseling and testing services through the three care and treatment sites located in Region 4 and Region 7. These sites provide onsite and community outreach counseling and testing (CT) services. The CT services provided through the sites comply with national and international standards.

In FY09, AIDSRelief sites tested 1,481 persons and out of those tested 95(6%) were tested positive.

In FY10, AIDSRelief will continue to 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 the out-patient department at St. Joseph Mercy Hospital and Davis Memorial Hospital. AIDSRelief would also like to focus on increasing the number of men who are being tested

AIDSRelief places a strong emphasis on high quality care and support to all HIV infected and affected children and their families through provision of clinical, psychological, spiritual, social, and prevention services.

In collaboration with the MOH, the AIDSRelief program will continue to provide DNA PCR testing for early infant diagnosis for all HIV-exposed infants at our local partner sites. These exposed infants will continue to be followed monthly by a physician and/or nurse until HIV serostatus is ascertained; thereafter, they will be followed up in our OVC clinic until five years of age.

In FY2010, AIDSRelief will continue to provide ARV treatment and management of OIs and other HIV/AIDS-related complications including malaria, and diarrheal diseases to all HIV infected children and adolescents. We will work with the MOH to help provide treated mosquito nets as a measure of home-based care to the affected children.

AIDSRelief will continue to place a strong emphasis on psychosocial support to HIV infected and affected children, adolescents and their families. Plans to implement secondary prevention interventions with emphasis on sexual risk behaviors, substance use, coping strategies, disclosure and domestic violence will be executed in FY 2010.

AIDSRelief will also provide specialized training to counseling staff at LPTFs government sites and local NGOs in addressing psychological issues unique to this patient population and their families (e.g., coping with trauma of death of parent, disclosing status to children, anxiety and fear). A pediatric psychologist from University of Maryland School of Medicine/IHV will provide this training. LPTF staff at Davis Memorial Hospital (DMH) and St. Joseph's Mercy Hospital (SJMH) will continue to strengthen the pediatric and adolescent support groups.

Additionally, AIDSRelief will continue mentorship to the adolescent and kids support groups that initiated in FY2009.

In the past year, LPTF staff at DMH and SJMH have recognized a growing need for nutritional counseling and support to HIV infected and affected children, adolescents and their families. In FY 2010 AIDSRelief will strengthen the nutrition counseling offered to the families and will collaborate with NGOs and the National AIDS Program Secretariat to supplement basic food supplies to the families.

In FY 2010 AIDSRelief will continue to strengthen the local programs' HIV pediatrician through mandatory CME training at IHV headquarters in Baltimore, MD. Furthermore, AIDSRelief will strengthen the capacity of our nursing staff to provide high quality care to Guyana's pediatric population. On-site technical assistance to the nursing staff will be provided by the AIDSRelief local pediatric consultant with support from visiting nurse specialists from the University of Maryland.

The counseling staff at LPTFs will also receive specific training in meeting the need of the chronically ill pediatric patient as well as adherence problems unique to the pediatric population. This training will be provided by a Child Physiologist from the University of Maryland.

The Pharmacy staff will also receive training on Pediatric ARVs, their side effects and toxicities and also on adherence issues peculiar to the pediatric patients. This training will be done on-site by the local Pediatrician.

In FY2010 AIDSRelief will place more emphasis on nutrition. Both counselors and the nursing staff will receive minimal training in Nutrition Counseling.

In FY2010 AIDSRelief will work closely with Adherence counselors, HBC workers, NGOs, SSVP to address adherence issues in the pediatric and young adult population. As well as training for the staff, AIDSRelief will work with the staff on how to teach and encourage better adherence. Staff will meet once a month with pediatricians to discuss the more problematic cases.

CONTINUING ACTIVITY

AIDSRelief continues to support local partner treatment facilities (LPTFs) in activities related to strategic information. Corresponding to AIDSRelief goal of providing high quality HIV care and treatment, AIDSRelief will continue to promote programmatic and operational decision making and planning based on quality data. In FY10, AIDSRelief will continue to build capacity and provide supportive supervision in using longitudinal medical record systems (electronic and paper based) so that the LPTFs can use data for quality improvement of their programs, patient management, and reporting to donors and MOH. AIDSRelief will provide technical assistance through trainings and site visits, and will continue to work collaboratively with donor and MOH to build sustainable monitoring and evaluation (M&E) units and health management information system (HMIS).

Information usage activities at LPTFs will continue to be a major focus to address and reduce drop -out rates and to improve ARV pick-up rates. AIDSRelief will coordinate 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.

Futures Group will continue to engage in the Transition to Local Partners, providing assessment, relative trainings and technical assistance. This will be done within the context of collaboration on Consortium Partners and promotion of activities put forth by the CTCT.

Proposed activities:

Data collection, management and reporting

Ensure collection and compilation of HIV patient data using the National Registers, longitudinal medical records, and electronic patient management and monitoring systems.

Ensure collection and analysis of required indicators requested by LPTFs, CTCT and funding agencies; provide feedback to LPTFs and stakeholders

Provide TA for LPTF to develop specific plans to enable them to easily review and analyze data (information) to enhance or improve their program, operations and patient care.

Data quality improvement workshops

In collaboration with the LPTFs AIDSRelief will establish a Continuous Quality Improvement (CQI) committee at the LPTFs

Building data use culture at the local site

Training workshops (on-site/off-site) on data usage

Training workshops (on-site/off-site) on defining indicators to measure quality and success of the local program

Promote sites developing custom reports to look at program and services

System strengthening and sustainability

Participate in regional workshops to share best practices and information for evidenced based decision making

Participation in workshops with other partners at national level for the implementation of the National M&E System

Programming responding to yellow-lit activities- Guyana PEPFAR Interagency team has adopted OGAC Prevention Technical Working Group recommendations for the sexual prevention portfolio.

AIDSRelief Guyana supports an abstinence and be-faithful program with the Roman Catholic Youth Office (RCYO) in Georgetown, Guyana. The abstinence program currently targets youths between the ages of 13 - 18 years in all 10 administrative regions.

In FY2009, RCYO provided abstinence messages to 1,081 youths in Regions 2, 3, 4, 5, 7 and 10. The youths were reached through organized sessions, community events, and outreach. RCYO also trained 62 peer educators in promoting abstinence as a healthy lifestyle choice. RCYO is currently in the process of updating their facilitator and student manual that promotes abstinence over 15 sessions. RCYO has also incorporated a monitoring and evaluation component to their abstinence program.

In FY2010, RCYO will provide a refresher training course and leadership training to all the peer educators and will train additional peer educators in various communities. RCYO will provide value-based HIV prevention activities through trainings, conventions, conferences, camps, and community outreach. RCYO will continue to work in collaboration with the Ministry of Health, Ministry of Education, the Catholic Church and other partners promoting abstinence

AIDSRelief Guyana PMTCT program targets mothers and fathers who see seek obstetric care at both St. Joseph Mercy Hospital (SJMH) and Davis Memorial Hospital (DMH), two faith based hospitals located in Georgetown, Guyana. The PMTCT program also targets mothers who are already enrolled in the SJMH and DMH Care and Treatment Program.

In FY2009 a total of 170 pregnant women attending ANC clinic at SJMH and DMH received an HIV test and were counseled on their results. Only 4 women had a positive HIV positive test result and 1 was put on multi-drug prophylaxis. 172 women delivered babies at the two facilities and all had received an HIV test before delivery. Out of these 172 women 9 were HIV positive and all 9 were on ARVs before delivery.

AIDSRelief strives to provide comprehensive family centered care which has been built upon our PMTCT program. All women who seek obstetric care at SJMH and DMH will be counseled on the importance of knowing their HIV status. For those pregnant women who want to know their status will receive VCT service at both sites. Pregnant HIV+ women are also counseled to have their partners/spouses tested as well as other children in the household. All pregnant HIV+ women will be enrolled in the facilities PMTCT program that provides clinical and lab monitoring, opportunistic medication as needed, and in keeping with Guyana's National Guidelines, all pregnant HIV+ women are counseled and started on ART for medical treatment or prophylaxis. All infants born into the PMTCT program receive close follow up care and monitoring, as well as free replacement feeding supplied to the 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 FY2010, AIDSRelief will continue to strengthen the PMTCT programs at our LPTFs by providing increasing training opportunities for physicians, nurses and counselors in collaboration with the Ministry of Health and provide on-site mentoring at the LPTFs. AIDSRelief will continue to encourage pregnant HIV+ mothers to have their husbands/spouses as well as other children in the household to be tested. 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 95% of HIV+ pregnant women started on ARV prophylaxis at a minimum and at least 90% 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 will also refer clients who need nutritional support, home base care, domestic violence counseling or substance abuse treatment to relevant organizations in Guyana. In the coming year, AIDSRelief will increase linkages with local NGOs and the MOH to ensure medical and psychosocial needs are met.

CONTINUING ACTIVITY

AIDSRelief laboratory personnel work with local partner treatment facilities (LPTF), the Ministry of Health (MOH), and the National Reference Laboratory (NRL) to strengthen the technical capacity of laboratory personnel working in Guyana and to improve laboratory infrastructure and procedures as needed. REDACTED

In FY2009, AIDSRelief successfully partnered with the MOH, NRL and CDC in providing a Microbiology Reference course to laboratory professionals from the NRL, Georgetown Public Hospital, regional public hospitals, and AIDSRelief LPTF sites. In FY2010 AIDSRelief will continue on-going collaborations with the MOH and CDC-Guyana to strengthen the NRL's capacity through training, professional development, and quality assurance. During the first half of FY2010 AIDSRelief together with the NRL, MOH, and CDC will conduct comprehensive opportunistic infection (OI) training. This training course will include both didactic and practical training sessions focusing on bacterial, fungal and viral OI diagnosis. Special focus will be concentrated on tuberculosis, cryptococcal meningitis, and OI quality assurance. During the second half of FY2010 AIDSRelief together with the NRL, MOH, and CDC will conduct comprehensive malaria training. This program will follow the same theoretical and applied approach focusing on species identification, diagnostic techniques, and quality assurance. Quality assurance collaboration will focus on pipette calibration training and implementation of a national pipette calibration program to ensure quality and accuracy in the laboratory.

In FY2010, AIDSRelief will continue to implement the following strategies and initiatives to build LPTF capacity: onsite technical assistance to maximize laboratory quality and efficiency, participation in external quality assurance programs, promoting professional laboratory development by developing and facilitating laboratory training sessions. AIDSRelief will also continue to collaborate with MOH, CDC, and other partners in supporting the NRL as a center of excellence for standardized laboratory training, as a sustainable mechanism for local laboratory professional development, and to strengthen and implement procedures as part of the national laboratory certification and accreditation

AIDSRelief will also continue to support the strengthening of linkages with the Chest Clinic for sites in Region 4 as well as support the Chest Clinic's activity at our site at Bartica Public Hospital. The technical team will also work with LPTF providers to implement better screening techniques of outpatient clients for TB at SJMH using the laboratory cytoscope equipment obtained in FY09.