APC is the follow-on mechanism to the Guyana HIV/AIDS Reduction and Prevention (GHARP II) project and Community Support and Development Services Incorporated project. Activities previously performed by both contractors will now be implemented by APC. APC will continue to provide institutional capacity building in the public and private sectors to sustain an effective response to HIV/AIDS. With CSOs accounting for over 90% of national prevention efforts targeted to MARPs, TA is needed to strengthen the current program in order to effectively promote behavior change and facilitate regular access to HIV prevention services and products. Organizational strengthening and technical capacity building will be provided to a network of NGOs undertaking activities designed to reduce the incidence and prevalence of HIV/AIDS transmission among MSM, female sex workers and their clients, and mitigate its impact on PLWHA and their families. Special focus will be on helping NGOs to reach key and other vulnerable populations and to sustain efforts over the long term. These include building NGO financial and organizational capacity, disbursing and managing grants, developing effective program approaches for MARPs, and developing a robust system for monitoring program quality and effectiveness. It also includes working closely with the MOH to develop a transition plan that delineates the specific steps to transition key services to the government and to other stakeholders to ensure the continuum of care for people infected and affected by HIV/AIDS, as well as building NGO skills to advocate for policy change. APC will also assist the MOH to develop a system that formally recognizes the role of NGOs so that community-based services can complement facility-based services.

APC will work closely with the National HIV/AIDS Program Secretariat (NAPS) and USAID-funded NGOs to strengthen the quality of services provided and to work towards sustainability. Emphasis will be placed on modified systems of community/home-based care that will focus on targeted prevention activities, linkage and adherence to care and treatment support and the broader issues of primary health care, targeting especially key and vulnerable populations. Hence to maximize USGs support to the national program in the provision of a comprehensive and integrated package of services, APC will implement the recommendations of the Care and Support Technical Working Group report (October 2012) which includes the following activities: Identify a standardized model of care aimed at addressing the needs of clients with a specific focus on concentrated key populations which are consistent with the Guyana setting; establish a formalized bi-directional linkage system to ensure consistency across partners with a national tracking system that allows for standardized monitoring of referrals and tracking of clients; support client level reporting systems to collect, manage, analyze, and report specific information on client status, use of services, and unmet needs at the monthly clinical review meetings between home-based care (professional health worker/s) and facility staff and encourage the use of data for decision making; conduct a community profile exercise to determine priority areas for targeting and budgeting future program activities, to include: HIV prevalence; population density; clinical status of the HIV-infected persons in the community as related to specific care and support service demands; types of service provided; and location of services related to HIV-infected persons; and address stigma and disclosure to enhance uptake of care and support services, particularly for key affected populations.

The community-based NGOs utilize a family centered approach to care for persons living with HIV, including OVC and their family members. NGOs provide an array of services including psychosocial support; social support, spiritual support; educational/vocational training support, and economic opportunity/strengthening support. In FY13, APC will continue to work closely with the USAID-funded NGOs and National AIDS Program Secretariat (NAPS) to strengthen the quality of services provided, and work towards sustainability. To this end, APC will provide mentoring and technical assistance to the participating NGOs to ensure adherence to guidelines and standards, as needed. Activities include strengthening the capacity of caregivers to support the emotional and social development of children/parenting skills training; strengthening the collaboration with NAPS to improve quality of services and promote networking and coordination; strengthening the referral system from the respective agencies/sites; and leveraging needed resources through the public and private sectors to strengthen and expand the existing OVC initiatives. Efforts will be made to strengthen linkages with existing Government of Guyana programs and agencies, and private sector companies for social support and educational opportunities to enhance economic empowerment. Emphasis will be placed on ensuring targeted interventions for OVC overlapping key populations sub-groups. APC will also provide financial and organizational assistance to NGO partners to implement comprehensive OVC programs.

APC will support the MOH and NGOs to implement a recently developed database to track clients and service uptake at the community and national levels, requiring NGOs to record data at the client encounter level, which will be reported monthly to NAPS. APC will utilize standardized data collection forms for each program area. Achievements reported by the NGOs will be compiled in one database and compared to program area targets. Quarterly data quality assessments will be conducted for each NGO, in order to monitor the utilization of the monitoring system and the accuracy of the data collected. APC contractor will monitor and report on progress against the total program area targets and those individually set by the NGOs, in their annual monitoring and evaluation plan. APC will prepare semi-annual and annual reports, and achievements for submission to USAID for PEPFAR reporting. In this process the following are expected: Develop a monitoring and evaluation (M&E) plan, to measure the results achieved individually and collectively by the NGOs as well as to track the progress of capacity building activities of the organization within the first month of project implementation. Develop a data quality assurance plan to monitor the NGOs program monitoring systems and ensure uniform M&E systems and processes across NGOs, and the generation of high quality data within the first month of project implementation. Conduct monthly supervisory visits and quarterly data quality assurance reviews at each NGO, in order to monitor the utilization of the monitoring system, provide on-site guidance and mentoring and validate the accuracy of the data collected. Conduct an annual M&E workshop to share current M&E guidance, receive feedback and ensure uniform understanding of guidance across NGOs. Ensure NGO utilization of standardized data collection forms for each program area during M&E monitoring visits. Compile the achievements reported by the NGOs in one database and compare to program area targets. Monitor and report on progress against the total program area targets and those individually set by the NGOs/FBOs, in their annual M&E Plans. Prepare quarterly, semi-annual and annual reports on achievements for submission to USAID. Disseminate and provide technical assistance for the use of a NGO level program database. Maintain central M&E database for management of program data in order to prepare program reports to USAID.

The Government of Guyana, donors and civil society have recognized that in order to scale up the HIV response and achieve Guyanas goals, non-governmental and faith-based organizations have become important partners in the national response. While the NGOs are essential to extending the delivery of HIV/AIDS prevention, care and support services throughout the country, many of them have demonstrated inadequate capacity to rapidly scale up services as a result of their limited administrative management and financial capacity. This requires working with the NGOs in the field and maintaining regular, even daily contact, to respond to emergency needs and monitor progress. Hence APC will meet the emerging needs of the NGOs by disbursing and monitoring grants to a network of USAID-supported non-governmental organizations (NGOs), and the NGO Coordinating Committee, while strengthening their financial and organizational management (including governance) capacity to enable them to expand HIV/AIDS services to key populations. Assistance will be provided in a targeted manner, focusing on direct management, onsite training and mentoring and other direct support, and when warranted, other formal training in the form of workshops to ensure long-term organizational sustainability. APC will also conduct the annual NGO work-plan development workshop, review all work-plans and provide technical comments to USAID.

Thus under the OHSS program area, APC will continue to build the capacity of the USAID-supported NGOs to fulfill critical governance and organizational tasks including: 1. Conducting organizational capacity assessment for each NGO and providing customized assistance. 2. Developing an accounting plan. 3. Developing action plans for each NGO with targets to meet capacity benchmarks.

On the policy front, the Guyana National Policy on HIV and AIDS emphasizes the rights of all HIV positive individuals, regardless of nationality, race, age, religion, disabilities, gender, sexual orientation and socio-economic status . . . to the best quality of health care available without being subjected to any form of discrimination. However, policy issues such as stigma and discrimination and unsupportive legislation for key populations remain major challenges. APC will provide the NGOs with the necessary skills to advocate for the enforcement of human rights policies so that all Guyanese can access HIV services, including key populations. APC will also explore policy initiatives to be taken to ensure sustainability of NGO programming based on best practices.

The Government of Guyana supports a mixed model of HTC. This mixed model includes both client initiated approaches such as mobile, home-based, and stand-alone counseling and testing, as well as provider-initiated approaches (PITC). In this context, home-based HTC is part of an existing community based service. Currently the program supports systematized links between HTC and HIV care, support and treatment services for clients who test HIV positive. Persons testing positive at NGO sites are enrolled in the care and support program and referred to or accompanied to the clinical site, and vice versa. However there are challenges with losses to follow up and tracking the outcomes of those referrals, especially since testing via HTC is primarily confidential, and there are no unique identifiers for each client tested. In addition, counseling and testing services need to be better targeted to those most at risk (MSM, FSWs and their clients). The MOH is leading efforts for HTC for the general population. Hence concerns related to this program area include limited testing among high risk and priority groups, including MSM and FSW, partners of PLHA; poor referrals and follow-up among HIV-positive clients; the use of the existing parallel testing algorithm which is extremely expensive; limited scope of counselor/tester skills that inhibit them from providing comprehensive counseling to clients; poor coverage and coordination with the Ministry of Health and the private sector in remote and geographically-isolated locations; and low uptake among men. The contractor will therefore be tasked with providing key technical inputs to support the national voluntary counseling and testing program and work closely with NAPS to ensure quality in counseling and testing. This will be done through the following activities: Provide technical assistance to the MOH and NGO partners to increase access to and uptake of HIV services by key affected populations (particularly MSM, FSWs and their clients). This will require Innovative efforts to reach MSM and CSW to get them into testing. Provide technical assistance to NGOs to identify key affected populations living with HIV and link those individuals to anti-retroviral treatment and appropriate care and support services. This activity will help to identify effective strategies to reach these populations, get them into appropriate care and treatment or link them to other support as needed. Provide technical assistance to the NGO partners to deliver high quality and comprehensive pre- and post-test counseling services as part of HTC service delivery. Regular visits to NGO sites are required to assess the quality of services and to provide mentoring and supportive supervision as staff work toward reaching those most at risk. Work with the MOH and NGO partners to develop innovative strategies to enhance timely linkages between diagnosis and HIV care and treatment by strengthening the use of the bidirectional referral/reporting forms as a means of tracking clients referred for enrollment into HIV clinical care and treatment; and strengthen the current GBV screening in the HTC programs.

Targeted approaches for key and other vulnerable affected populations, especially MSM, CSW and their clients, including counseling and testing will continue to be a major focus of our program. Significant attention will continue to be placed on providing appropriate services and products to this population. The contractor will work with the National HIV/AIDS Program and with the USAID-funded NGOs to refine strategies to reach this population with effective behavior change messages and with referrals for services including counseling and testing. The minimum package of services for both MSM and CSW will include: peer education and outreach, risk reduction counseling, condom and lubricant promotion and distribution, testing and counseling (HTC), support groups, and referrals for STI screening and treatment. In addition to these services, the comprehensive package of services for both MSM and CSW will include referrals for domestic violence, mental health, substance use treatment, other health, social, economic and legal services, and Positive Health Dignity and Prevention interventions. In addition, for female sex workers (FSW), linkages to economic strengthening programs, parenting skills training, and referrals for sexual and reproductive health services will be conducted. Emphasis will be placed on strengthening the referral system to HIV care and treatment, other health and social services and to ensure that the referrals occur. APC will promote and develop initiatives to provide alternatives to sex work. Linkages will be made to existing Ministry of Health Agencies for income generating activities. Activities to decrease stigma and discrimination in the health sector will continue, with NGO staff taking the lead. In collaboration with the Ministry of Health and NGOs, APC will advocate for an enabling environment of supportive laws, regulations, policies and social norms, in order to facilitate meaningful access to HIV services by key populations without discrimination or loss of confidentiality at both the facility and community level. APC will also collaborate with the MOH and NGOs to address violence among key affected populations that increase their risk for HIV. APC will also provide short-term technical assistance, upon request, to the MOH to assist in developing (where none exists) and implementing strategies and guidelines, as well as service delivery for key affected populations. Ensuring that key populations are involved in planning and implementing programs that affect their lives will be a major focus.