University of Maryland (UOM) will continue to strengthen institutional capacity of key public institutions in Guyana in the training of medical students and residents in the diagnosis, evaluation and management of patients with HIV and other infectious diseases and their co-morbid conditions. In order to achieve this goal, the UOM will focus on the following key objectives: 1. Strengthening of the pre-service education institution through the professional development and training of University of Guyana (UG faculty); renovation and upgrading of laboratories; training and mentorship of medical students during their hospital rotations and lab practicums 2. Expansion of the post-graduate medical education program at UG and GPHC by implementation of a 3-year internal medicine/infectious disease residency program in collaboration with UG and GPHC and international faculty 3. Development of a national in-service training and mentorship program with technical consultation from international experts to ensure that practicing clinicians have opportunties to improve their skills and knowledge in the care and management of patients with HIV, TB and other opportunistic infections. The UOM's program will focus on public institutions with headquarters in Georgetown/Region 4. It is envisioned that the reliance on international faculty and consultants will decrease over time as host country nationals develop the knowledge, skills and tools to better educate and mentor medical students. In addition, the University of Maryland will be working closely with the MOH to ensure that there are mechanisms in place to retain promising Guyanese residents and promotional opportunities to increase the likelihood that they will not emgirate after completion of the program.

The University of Maryland will provide pre-service, in-service and mentorship of medical students, post-graduate residents and practicing physicians in clinical monitoring, evaluation and management of opportunistic infec*.75

tions in HIV infected patients.

University of Maryland will provide technical consultation and guidance to the staff at GPHC on the diagnosis, clinical monitoring and treatment of TB and HIV/TB co-infected patients hospitalized at GPHC. The University of Maryland will also provide enhanced pre-service, in-service and mentoring of medical students, post-graduate residents and practicing physicians in the prevention, diagnosis and management of TB in HIV infected patients. The University of Maryland will collaborate closely with the National TB Program to explore rotational opportunities for post-graduate residents at the chest clinics and to provide assistance in updating of national guidelines and strategic plans.

The University of Maryland will provide pre-service, in-service and mentorship of medical students and post-graduate residents and practicing physicians in the identification and clinical care of HIV-exposed infants and children.

The training of medical doctors to work within the health care system in Guyana has historically relied on scholarship arrangements between the Government of Guyana and foreign countries (Cuba, the former Soviet Union etc.). It was only in 1985 that the School of Medicine was established as a department of the Faculty of Health Sciences at the University of Guyana. The Bachelor of Medicine, Bachelor of Surgery degree offered by UG is a 5-year program which includes one year internship at the Georgetown Public Hospital Corporation (GPHC). The medical students and interns conduct clinical rotations at the hospital under the supervision of GPHC clinical mentors. Only two residency programs are currently recognized at University of Guyana/GPHC - one in surgery and the other in Emergency Medicine. An average of 25 medical students graduate per year from the University of Guyana, the majority though emigrate and enroll in residency programs abroad and do not return to Guyana afterwards. In response to this inability to train and retain physicians, the GoG established a partnership with the Cuban government to educate Guyanese medical students. Approximately 500 of these Cuban trained medical students will be returning to Guyana over the next few years but most of them have had little to no clinical exposure. Although the initial intent was to have these students work with Cuban specialists after returning to Guyana, the availability of these specialists is inconsistent.. Many of the returning Cuban trained physicians are sent to remote areas as medical directors of regional hospitals although they are inexperienced and ill-prepared to assume this significant responsibility. Historically, PEPFAR funding has provided high-level technical guidance, support, trainingand mentoring to the Ministry of Health (MOH) and those physicians who remain in country. Although individual capacity to provide high quality care has been built overtime, many of these physicians also emigrate or are reassigned. Currently there is very little institutional capacity that has been built and heavy reliance on international experts for updating of guidelines, consultation on complex cases, and even relatively routine program management activities continues. The University of Maryland will heavily focus on building the institutional capacity of the local government institutions (University of Guyana, GPHC and MOH) to ensure enhanced education and training for pre-clinical and postgraduate students and opportunities for continuing medical education for practicing clinicians. It is anticipated that 10 - 15 medical students per year will have received enhanced and intensive training on infectious diseases by the end of FY 13 and that 3 - 5 postgraduate students will be enrolled in the IM/infectious disease residency program during FY 13.

The University of Maryland will provide pre-service, in-service and mentorship of medical students, post-graduate residents and practicing physicians in clinical monitoring, evaluation and management of patients with HIV infection.

The University of Maryland will provide pre-service, in-service and mentorship of medical students, post-graduate residents and practicing physicians in clinical monitoring, evaluation and management of pediatric patients with HIV infection.