Background: CDC has a direct cooperative agreement with the Ministry of Health through which support is provided to a broad range of Units and Programs within the MOH, including the National AIDS Program. The first year of this CoAg was FY05, and the first five year CoAg ended in August 2009. Starting in FY10, CDC will support another five year CoAg with the Ministry of Health that will carry on and build upon many of the activities that were implemented in the first five years, and will include new support to Units and Programs within the Ministry, such as the Environmental Health Unit and the National TB Program. The CoAg will be coordinated and managed by the Ministry of Health/National AIDS Program Secretariat and a CDC Project Coordinator based at the Ministry of Health, with technical and management support from the CDC Guyana office.

The scope of technical areas covered under the CDC-MOH cooperative agreement has evolved over time based on national priorities and availability of resources. In FY10 and beyond, CDC will focus on providing targeted and focused technical assistance to MOH in the various technical areas to improve services and programs. The technical assistance would be focused on strengthening the Ministry's capacity to lead, coordinate and implement activities supported under the CoAg.

Goals/Objectives: Since the CoAg supports a number of Units within the MOH for various program areas, there are a number of goals and objectives that are accomplished by activities implemented by various departments of the Ministry of Health.

Under the PMTCT program, the objective is to provide adequate care, treatment, and support to women, infants, and their families. Under the Abstinence and Be Faithful Program, the objectives are to strengthen to the capacity of the Adolescent Health Unit to provide HIV education, awareness, and prevention and to provide upgraded and quality training for Youth Friendly health care workers. Under the Condoms and Other Prevention Program, the objectives area to provide accurate information to the general public and stakeholders and to facilitate the effective functioning of the NAPS through capacity building of technical coordinators, and to ensure youth have access to information resources, resources persons, and youth friendly health services relating to transmission and prevention of STI/HIV/AIDS, and to provide precise and relevant information to adolescents and youths (in and out of school) in order for them to make healthy and informed choices. Under the Counseling and Testing program, the objectives are to provide VCT services, education, and IEC materials to 500 adolescents and young adults in all regions, and to provide support for human resources for the VCT program in the Adolescent Health Unit. Under the Treatment/ARV Services program, the objectives are to provide optimal treatment and care and support for PLHIVs. Under the TB/HIV program, objective is to expand and strengthen the quality of services and information related to the TB/HIV activities in-country, with coordination from CDC and their implementing partners. Under HIV Care and Support program, the objective is to provide a high quality of home-based care services to PLHIV. In the laboratory infrastructure program, the objectives are to strengthen staff members at NPHRL and enhancing the capacity of staff to provide quality lab services in support of HIV care and treatment, to enhance the range of lab services offered in support of HIV care and treatment at NPHRL to include HIV rapid and confirmatory testing, CD4 testing, EID, viral load monitoring and enhanced OI diagnostics and drug susceptibility testing, and to enable the provision of high quality lab services within the entire nation lab network and ensuring a safe working environment at the NPHRL. Under the Strategic Information program area, the objectives are to strengthen the national Surveillance Unit and improve monitoring and evaluation of all disease control activities, to establish a full IRB at MOH Guyana, to maintain adequate capacity among board members and that of the IRB office, to manage all applications for IRB review for studies done in Guyana and by Guyanese students doing research, to issue appropriate permits and directions for ethical standards in research and maintain high standard of accountability for all studies, monitor and evaluation IRB approved studies to ensure compliance with permission granted, to promote ethical research as an internal part of the development of health services, to improve connectivity and access to shared resources through increased use of networks, to support and strengthen ongoing E-Health initiatives across the public health sector, and to support the current HR capacity of MIS unit.

Through the CoAg, CDC in FY10 will support the National Home Based Care Program through this program area. The Guyana HIV/AIDS programme has over the years developed robust mechanisms to care for and support persons living with HIV. A home base care programme linked to the communities and executed through the Government Clinics and NGOs with volunteers has yielded results. These services and others such as nutritional support support for safe water and proper hygiene will result in better health outcomes and reduced morbidity and mortality. Through the CoAg, NAPS will conduct training for various categories of HBC and other health care workers in palliative care. The National Home Base Care Programme (HBC) is lead by the Ministry of Health and is collaboration with the Non Governmental Organizations supported primarily by the Government of Guyana and PEPFAR through CSDS. To effectively deliver a high quality of home base care services, ongoing training and retraining of volunteers, nurses and other health care workers is critical. Training curriculum for HBC and palliative trainings are defined and in use for all trainings. The duration of training based on these curriculums are four and five days respectively. This activity therefore seeks to expand on the number of persons trained and retrained in to deliver the services of home and palliative care in regions 3, 4 and 6 of Guyana.

Through its Cooperative Agreement with the Ministry of Health (MOH), CDC supports the National AIDS Program Secretariat (NAPS) for treatment services in Guyana. NAPS provides services at the National Care and Treatment Centre, the primary out-patient treatment facility in Guyana, and overseas the national treatment program through the 19 ART sites nationally. The Guyana National Treatment, Care and Support Programme has expanded to provide a wider geographical coverage as well as a more comprehensive service. Programmes such as the management of the dual infection of HIV and Tuberculosis and home and palliative care have expanded and seek the support of this agreement to further expand, consolidate and begin to explore the quality issues associated with the delivery of these services. The CoAg will support to the National Care and Treatment Center as the Center of Excellence for outpatient HIV management in Guyana.

In addition, a mobile unit services remote regions of Guyana for treatment, counseling and testing services (See separate activity under VCT). Since FY08 the mobile unit has been staffed by a physician supported through the Cooperative Agreement. The mobile unit provides ART services, phlebotomy services for treatment monitoring, and utilizes the national Patient Monitoring System so all patients are accounted for and treatment progress is well-documented. NAPS will coordinate all activities related to treatment services to ensure non-duplication of services between program areas and regional health authorities. The CDC Cooperative Agreement also supports NAPS in its role as the national authority for treatment guidelines and coordination of treatment linkages with other services.

In FY10, the mobile unit will continue to be staffed by one physician and his team. Therefore increased attention will be paid to linking the existing mobile treatment program with other prevention, counseling and testing, care and support programmes in the hinterland regions, especially through the CDC GAP's upcoming Hinterland Initiative (see separate narrative for Hinterland Initiative). There are a number of other initiatives that are supported through other mechanisms that provide services to the hinterland regions and coordination occurs at the level of the National AIDS Programme Secretariat.

In FY10, Regional Health Services of the Ministry of Health through support from the CDC CoAg will conduct a training workshop on clinical and facility management. Senior staff, supervisors and administrators at primary Health care facilities and HIV sites will be trained in management to enhance the functioning of their individual sites and clinics to include areas as identification of emergency cases, examining patient flow and other issues that are critical for a smooth flowing and effective functioning.

CDC supports counseling and testing (C&T) services in Guyana through its cooperative agreement with the Ministry of Health (MOH), specifically the Adolescent Health Unit. Support to this program area supports two primary objectives: to provide VCT services, education and IEC materials to adolescents and young adults in all Regions by August 2010, and to provide support for the human resources for the VCT programme in the Adolescent Health Unit. Specific activities include VCT outreaches to regions 1, 7, 8 (three of the four remote hinterland regions of Guyana), production and dissemination of IEC materials on VCT and HIV/AIDS, and salary support to two VCT technical officers at the Adolescent Health Unit of MOH.

In the period 2009 - 2014, the Ministry of health will continue to build and expand upon existing SI activities, with an emphasis on creating sustainable capacity for SI. Within the SI program area, the CDC CoAg supports three main activities: 1. Support to surveillance activities; 2. Support to the establishment and functioning of an Institutional Review Board (IRB) at the Ministry of the Health, and 3. Support to various information and technology activities carried out by the Management Information Systems (MIS) Unit at MOH.

Surveillance: In 2007 through the CDC cooperative agreement the National Surveillance Unit was established in the Department of Disease Control and the existing surveillance system was revised and upgraded. New forms were put in place to effectively and accurately capture health information from the ten administrative regions of Guyana. A surveillance manual, an SOP (Standard Operation Procedure) manual and a manual of case definitions were then produced in draft form and are currently under review before printing. An electronic system to facilitate collection and analysis of monitoring data was created by the MIS department, and is to be established in all regions for improved reporting. There is need to strengthen human resource capacity in SI and more contract staff are to be hired in SI priority areas through the CDC cooperative agreement to support training of regional staff in the correct use of the new forms and electronic system. The Goal for surveillance activities through this CoAg is to provide a functioning and sustainable Strategic Information System for the reliable, true, accurate and timely gathering of health information across the ten administrative regions that can be utilized for decision making in the Health Sector. This goal will be carried out by salary support to regional surveillance staff (EpiNurses), training of surveillance staff in case reporting and surveillance processes, expansion of the number of sites reporting through the national surveillance system, and supplying of surveillance forms at the site level. CDC Guyana will provide technical assistance and guidance in all these activities to ensure a well functioning surveillance system that meets the needs of health sector.

IRB: The Ministry of Health in an effort to improve the quality of Health Care in Guyana and to advance evidence based interventions in the health sector is expanding its research capacity. To meet this emerging need the Ministry of Health has established an IRB to regulate the conduct of Health research in Guyana. CDC has supported the establishment of the IRB through the CoAg and will continue to provide support to the IRB to ensure functionality at the maximum level. The IRB of the Ministry of Health would be responsible for reviewing and approving all health related research proposals including all on HIV, to ensure that human subjects are protected. Traditional authority for ethical review and issuance of permission for the study of any human subject lies with the Chief Medical Officer. More recently a small committee was established by the MOH under the chairmanship of the CMO to conduct more in depth ethical review. The Ministry proposes to establish a fully functioning IRB. The Board will operate under the principal of the Declaration of Helsinki and will seek to be listed and register with the authority. Specifically Objectives with regards to the goal of developing and sustaining a mechanism to ensure high quality ethical research in Guyana are: Establishment of full Institutional Review Board at the Ministry of Health, Guyana; Maintain adequate capacity among Board Members and that of the office of the IRB; Manage all applications for IRB review for studies done in Guyana and by Guyanese students doing research; Issue appropriate permits and directions for ethical standards in research and maintain high standard of accountability for all studies; Monitor and evaluate the IRB approved studies to ensure compliance with permission granted; Promote ethical research as an internal part of the development of health services

Information and Communication Technology Activities: The MISU was established within the overall MOH administrative structure during 2007 with its overall objective to design, implement, manage, evaluate and upgrade where applicable, the Ministry's Information and Communication Technology (ICT) framework and its data collection, analysis and dissemination procedures. Since its establishment, several ICT initiatives were planned and or executed with view to enhancing the planning and decision making capabilities of both managerial and operational tiers across the Health sector including that of the National AIDS Programme. There are a large number of MIS initiatives being undertaken throughout the MoH supporting several Health Information Systems (HIS) for the HIV programmes at all levels including the maintenance and development of applications for the National AIDS Programme Secretariat (NAPS), the National Public Health Reference Laboratory (NPHRL) along with the National Care and Treatment Center (GUM Clinic), to help organize some of the monthly reports produced by these facilities. There is also the technical support given to other related information system applications infrastructure such as the Warehouse Management System (WMS) which is an inventory management tool incorporated within the MoH Materials Management Unit (MMU) to support accurate quantifying and forecasting of antiretroviral (ARV) drugs and other commodities used in HIV/AIDS testing, care and treatment throughout the MMU supply chain system. There is also support to the HIV related information websites (www.hiv.gov.gy; www.health.gov.gy ), and also to the overall ICT infrastructure, hardware and equipment required to support the day-to-day communication activities of these and other administrative sites of the MoH. The objectives of the MIS unit under the CDC CoAg for FY10 are to Improve connectivity and access to shared resources through increasing use of networks, Support and strengthening ongoing E-Health initiatives across the Public Health Sector, and to Support to the current human resource (HR) capacity of the MIS Unit. These objectives will be carried out by the procurement of equipment to support communication, construction of a Virtual Health Library Infrastructure, Implementation of a Virtual Health Library area within the MoH, and employment of the MIS Unit Director, Information Technology Officer, a driver and an office assistant.

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

The Ministry will support the abstinence/be faithful program through its Adolescent Health Department, targeting youth in and out of schools. This is a continuation of the previous Cooperative Agreement and aims at increasing the knowledge of primary and secondary school children on HIV prevention, translating into delayed sexual debut. All five programmes within the Unit work together and in close collaboration with the National AIDS Programme Secretariat: the Youth Friendly Services, VCT, Drug Demand Reduction, Health Promotion and School Health. The settings are those such as primary and secondary schools, dormitory schools, school health clubs, Youth Friendly Health Centres, satellite tables at the main markets and the city mall, exhibitions, and outpatient clinics.

The first objective for this program area to be carried out by the Adolescent Health Department is to strengthen the capacity of the Adolescent Health Unit to provide HIV/AIDS Education, Awareness and Prevention by Retention of the Administrative and Technical Staff to the Adolescent Health Unit in order to ensure that the Unit is adequately and appropriately staffed and equipped, including an Administrative Assistant, two Youth Friendly Services Coordinators, a National Youth Health Organization Coordinator, and an Edutainment Officer; Retention of the nursing staff to Youth Friendly Sites (YFS) to operate on Friday evenings and weekends; and provision of operational and logistic support to the YFS.

The second objective of this program area is to provide upgraded and quality training for Youth Friendly health care workers, which will be carried out by youth-friendly training for Health Care workers on the topics such as Effective Communication, Youth Friendly Services, VCT and STI Syndromic Management Training, Sexual Orientation and Gender Issues and Advanced Counseling on Suicide, Bereavement, Sex & Relationship and Domestic Violence. This objective will also be met by training for Peer Educators in all ten regions across Guyana. The Peer Education Program within the YFS has expanded and as a result an increase in number of persons (there were over 8000 youth accessing services last year in the Youth Friendly Health Centres) accessing youth friendly health services. These young persons are spreading preventive messages such as abstinence, nutrition, physical activities etc to their peers within their schools and communities. The priority areas of focus for training would be: Nutrition and HIV, Abstinence and HIV/AIDS, Sexual and Reproductive Health, Physical Activities, Mental Health/Suicide Prevention and Drugs and Alcohol. The third activity through which this objective will be met is Training for Parents on Talking to Adolescents on Sex and Health Issues. Parents are the most important and often the first sexuality educators for their children. Talking on the topic of sex between parents and their children can be quite challenging. The provision of information to parents would be captured through PTA Meetings and Conferences/Workshops on how to talk to your teen about sex, STI, HIVAIDS and making healthy choices.

Through the cooperative agreement CDC will continue to provide contract support, at the central level and youth-friendly sites (YFS), technical guidance, development and production of educational and training materials to empower youth through the development of leadership skills, and staff training and travel.

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

The first objective within this program is to provide accurate information to the general public and stakeholders and to facilitate the effective functioning of the National AIDS Program through capacity building of technical coordinators, which will be accomplished through the production of quarterly newsletters for stakeholders.

The second objective of this program area is to ensure youth have access to information resources, resource persons and youth-friendly health services relating to transmission and prevention of STI/HIV/AIDS. This will be met by: the distribution of literature, posters, brochures, pamphlets and other relevant materials to schools to be placed in school libraries and at the Youth Friendly Health Centers; the execution of the edutainment programmes in secondary schools in regions 2, 3, 4, 5, 6 and 10 which will focus on HIV/AIDS education for youths using the arts ( poetry, drama, skits etc) in collaboration with the Phoenix Recovery Group; and the establishment of Satellite Tables with the dissemination of HIV messages. Through the 'Satellite Tables' programme, peer educators will be trained in STI/HIV//AIDS prevention, care and treatment, substance abuse prevention and pregnancy prevention. 'Satellite Tables' will operate in heavily trafficked areas providing IEC materials, female and male condoms, lubricants, etc. Permanent Peer educators and trained volunteers will conduct interpersonal communication.

The third objective of this program area is provide precise and relevant information to adolescents and youths (in and out of school) in order for them to make healthy and informed choices. Youth Friendly Services (YFS) program started in May 2005 in Regions 6 and 10 with the goal of making 60% of health centres "youth friendly" by 2010. The YFS is a comprehensive service offering health services and recreational opportunities, as well as a IEC materials for the youths accessing the health centres. This obecjtive will be met by Information, Education and Communication material development and dissemination and support for mobile youth-friendly outreaches in communities that address the following topics: Voluntary Counseling and Testing, STI Treatment, Health Screening, and Health Education.

Through the Cooperative agreement CDC will continue to provide contract support, at both the central level and youth-friendly sites (YFS), technical guidance, development and production of educational and training materials to empower youth through the development of leadership skills, and staff training and travel. An area of emphasis for FY10 is development and implementation of a monitoring and evaluation framework for activities carried out in this program area.

Context and Background: The national multisectoral AIDS response for Guyana was expanded to integrate injection and non injection drug use. With the support of Global Fund, the Ministry of Health Drug Demand Reduction Programme (DDRP) was launched in June, 2008 in region 4 (the capital). Formative work was undertaken by the Drug Demand Reduction Programme to recognize the impact of HIV risk behaviors which inform the development of interventions aimed at addressing drug and sexual HIV risk behaviors among the drug-using population in Guyana.

Goals and Strategies for the coming year: In FY10, the Ministry of Health has a very ambitious plan to expand the drug rehabilitation intervention to regions 1, 2, 3, 5, 7, 8, 9 and 10. The Ministry of Health will continue to be responsible for the management of the overall project and will continue to regularly monitor activities that the NGOs undertake. GHARP II a partner funded by PEPFAR will provide technical assistance and support to the Ministry of Health and will work with other stakeholders, to facilitate linkages with other programs which will address the unique needs of various subsets of the target populations .These populations included non-injecting and injecting drug users (NIDUs and IDUs), some of whom are also Commercial Sex Workers (CSWs) and Men who have Sex with Men (MSM). The drug-using populations will be then targeted with prevention interventions that address both sexual and drug-related HIV risk. Activities will include community outreach; HIV risk reduction counseling; expanded access to voluntary HIV counseling and testing (VCT); and referrals to drug treatment, HIV/STI care and treatment, and other social services. There will also be training opportunities for teachers, health care and social workers in the areas of: HIV risk reduction interventions, 40 additional persons are expected to be train in structured relapse prevention and motivational interviewing.

CDC through the CoAg with the Ministry of Health will support some on-going activities within the drug demand reduction program, filling in gaps where other donor funding is not available.

Under its cooperative agreement with the Ministry of Health, in FY10 the CDC will continue to support the strengthening of the Maternal and Child Health Department's PMTCT program to effectively screen patients and prevent the transmission of HIV, and provide adequate care and support. HIV screening is integrated into the ante-natal care system which also includes screening for other STIs. Currently there are 152 ANC sites that offer PMTCT services (public and private) and in FY10 it is expected for the number of sites with PMTCT services to increase until all ANC sites are covered.

Pregnant women who qualify by national guidelines receive HAART during their pregnancies and prophylaxis is offered to HIV+ pregnant women. The program will encourage partner testing for all STIs including HIV, discordant couple counseling and consistent family planning for HIV positive mothers. New initiatives are planned to reach such partners for testing outside the PMTCT program through targeted counseling and testing activities given low turnout of partners in the PMTCT setting.

The CDC CoAg supports three critical areas that are not supported by any other partner. These areas are (1) Continued salary support for key personnel; (2) support for appropriate infant feeding methods by the purchase of BMS and (3) Purchase of equipment. Through the cooperative agreement, CDC will continue to provide rapid test kits, laboratory supplies, counseling and referrals for family planning services, contract staff support, technical guidance, quality assurance and strong links to care and treatment. Supported areas will include MOH data collection and utilization, supervision of field implementation, educational materials and programs, and contract nurses for providing and supervising services, including counseling at health facilities.

CDC/GAP will also continue to support the MCH Unit and the MOH Strategic Information Unit for data collection and utilization (including data entry staff and computers), supervision of activities at the field level, and quality assurance. Specific activities include undertaking a rapid data quality assessment of site level PMTCT data, as well as assessing readiness to move to using routine PMTCT program data for HIV surveillance purposes.

CDC, through the Ministry of Health CoAg, supports strengthening of laboratory services and infrastructure in Guyana. Over the last five years, MOH has implemented HIV rapid testing at VCT sites, provided infrastructural support for CD4 testing, provided technical, policy, human resources, and equipment support for National Public Health Reference Laboratory (NPHRL), and in collaboration with the EU laboratory strengthening project has strengthened the Quality Assurance (QA) program at central, regional and district laboratories. In FY10, MOH laboratory activities will continue to be aligned to the objectives of the National Strategic Plan for Medical Laboratories 2008-2012. The main focus of MOH laboratory activities in FY10 will be to support laboratory services required for the delivery of HIV care and treatment programs at both the national and regional levels and to ensure that public sector laboratories are certified in compliance with the Health Facilities Licensing Act which came into effect in April 2008 which requires all laboratories to be certified by the Guyana National Bureau of Standards (GNBS).

The bulk of activities will be concentrated at the NPHRL and will include CD4 enumeration, chemistry and hematology for drug toxicity monitoring, HIV rapid testing (for PMTCT sites) and confirmatory testing (as required) for all public sector care and treatment sites. CD4 testing services extended to AIDSRelief funded private sector sites in FY09 will continue in FY10. In early FY08 CD4 enumeration for all public sector care and treatment sites was done at Central Medical Laboratory (CML), Georgetown Public Hospital Corporation. This function transitioned to NPHRL in FY09. HIV rapid/confirmatory testing and drug toxicity monitoring transitioned to NPHRL in late FY08 with the provision of laboratory equipment by MOH through Global Fund monies. In FY10 MOH will continue to ensure that the NPHRL and the care and treatment sites have the appropriate equipment required for the delivery of high quality laboratory services. In FY10 CDC will provided CD4 and chemistry and hematology reagents required for HIV care and treatment programs to NPHRL and 4 regional care and treatment sites through SCMS. MOH will ensure that these facilities are adequately equipped and have appropriate infrastructure in place for automated testing and ensure that appropriate equipment service contracts are in place at each site. In FY09 MOH, with technical assistance from CDC, developed laboratory services at NPHRL to include HIV early infant diagnosis (EID), and viral load monitoring. The provision of these services will continue in FY10. In FY 08 MOH in collaboration with the Clinton Foundation and CDC implemented a protocol for pediatric testing that included a system for shipping of specimens to an external reference lab until DNA PCR technology became available in Guyana. The procurement of DNA PCR equipment (Global Fund) occurred in FY08. In FY09, the MOH worked closely with CDC (installation, training and TA) and Clinton Foundation (reagents) to establish early infant diagnosis at NPHRL. Reagent support for EID from Clinton Foundation will continue in FY10.

The MOH will continue to support TB testing by provision of AFB smear microscopy at the NPHRL and national sites. In FY10 the MOH will work with the American Society of Microbiology (ASM) and PAHO to implement Mtb identification and drug susceptibility testing (DST) and expand this training as appropriate to other laboratories in the country. New diagnostic methods, such as Capillia and line probe assays will be implemented. The implementation of liquid culture techniques will be dependent on the completion of the biosafety level 3 upgrade to the NPHRL TB laboratory which was initiated by CDC in FY09.

In FY 10 the MOH will ensure that facility maintenance (cleaning, security, HVAC system, generator, plumbing etc) and equipment maintenance contracts are in place for the NPHRL. In FY10 MOH will continue to employ the NPHRL Director, 2 heads of department and 3 medical technologists who are essential for the delivery of HIV-related laboratory services. The MOH will continue to ensure that the NPHRL is also staffed by other mechanisms (e.g. HSDU) and will work with HSDU and other partners to make salaries uniform across grades and put in place mechanisms for future staff absorption by MOH.

In FY10 MOH will work closely with partners such as ASM, APHL, and ASCP, AIDSRelief, and FXB to identify training needs and conduct training for NPHRL and national laboratorians. In collaboration with CDC and ASCP MOH will continue to roll out training in hematology and chemistry to the regional laboratories. Additionally, MOH will be working closely with ASCP to establish local certifying board exams which will pave the way for local technologist to acquire the International ASCP certification. This will involve review of the Medical Technology curriculum at the University of Guyana which will be a continuous collaboration among ASCP, MOH and the University of Guyana.

In FY 08 MOH supported enrolment of CML, regional laboratories and VCT sites in an External Quality Assurance program. These activities will continue in FY10 with enrollment in EQA programs extended to a greater number of sites, including NPHRL. In FY10 MOH will continue to develop local EQA programs initiated in FY09 for VCT sites. In FY10 MOH will ensure thal all laboratories providing HIV-realted testing (e.g. CD4, viral load, EID) are enrolled in a international EQA program. In FY10MOH will support QA managers at NPHRL to travel to regional/district laboratories and VCT sites to provide oversight, training and assessment of compliance with QA programs. A key priority for FY10 is to continue with certification of public sector laboratories initiated in FY09. By the end of FY09, it is anticipated that the NPHRL and two regional hospital laboratories will be certified by the GNBS to GYS170:2003 (based on ISO17025). In FY10 all regional hospital laboratories will be certified by GNBS. In FY10 NPHRL will seek international accreditation to ISO15189 by continuing work initiated in FY09 with the Caribbean Laboratory Accreditation Service (CARICOM Regional Organisation for Standards and Quality).

In FY10 MOH will develop a sample transportation network including but not limited to HIV-related specimens (laboratory networking) with the assistance of CDC and APHL. This will ensure appropriate sample flow through the referral system and optimal utilization of limited laboratory resources, particularly in the area of high-complexity testing. This will be facilitated by the ongoing support for the driver hired through the MOH-CDC CoAg.

The focus in FY09 was to perfect paper based systems and to ensure monthly reporting to NPHRL from regional and district laboratories. By the end of FY09 preliminary investigations will take place into implementing LIS and suitable partners will be identified. LIS will be implemented by the MOH in FY10. CDC and APHL will provide TA on LIS.

In previous years PEPFAR's, support for TB/HIV was mainly through technical support provided by the local CDC office and funding through implementing partners such as PAHO and FXB. In FY2010 the NTP will receive direct funding as part of the Ministry of Health CoAg to "expand and strengthen the quality of services and information related to the TB/HIV activities in-country, with coordination from CDC and their implementing partners". The NTP will implement a modified DOT HAART initiative to improve the management of dually infected patients. This will include the supervision of the administration of TB medications as well as at least one dose of ARVs and ongoing monitoring of the clinical status of co-infected patients. The funding will support the recruitment of a DOT HAART supervisor and a social worker as well as facilitate the training of existing DOT workers. To address the challenge tuberculin skin testing (TST) and to increase access of PLHIV to TST, nurses from HIV treatment sites will be trained in the application and reading of TST. This will be done in tandem with incorporating isoniazide preventive therapy (IPT) into the services provided by ART clinics. The NTP with the lead role for surveillance, monitoring and evaluation of TB/HIV collaborative activities will improves its capacity to do so through the development of an M&E framework for TB/HIV as well as the training of the relevant health workers in M&E for TB/HIV.