Linked to Activities 9269,8156,10667,9267,8162,9268, 9308, 9683, 9725.

SUMMARY: Prevention of mother to child transmission (PMTCT) is an integral part of comprehensive HIV care and treatment of persons living with HIV/AIDS (PLWHAs). Activities to support PMTCT include: (1) provision of a complete package of PMTCT services at medical facilities; (2) training and supervision of obstetrician/gynecologists (ob/gyn), as well as counselors in PMTCT; and, (3) community mobilization to support PMTCT. The primary emphasis areas for these activities are: community mobilization, training, human resources, food nutrition support, antenatal clinics (ANC), quality assurance (QA), quality improvement (QI) and supportive supervision. The specific target population will be pregnant women and children born from sero-positive mothers. The activities will be conducted in the communes of Gros-Morne, Fond des Blancs, Fond des Nègres, Léogane, Pilate, Milot, Deschapelles and Gonaives.

BACKGROUND: The PMTCT component is part of a CRS initiative that began in 2002, funded by Catholic Medical Mission Board (CMMB) private funds in Gros-Morne, Milot and Fond des Blancs), by a CRS - United Nations Children's Fund (UNICEF) partnership in Pilate, by United States Agency for International Development (USAID)'s Health Services 2007 (HS2007) Project in Léogane and Deschapelles, and through President's Emergency Plan for AIDS Relief (PEPFAR) in 2005 Fond des Nègres and Gonaives. PMTCT training activities have been conducted in collaboration with United States Government (USG) partners Ministry of Health (MOH), I-TECH/ Haitian Institute for Community Health (INHSAC) and JHPIEGO, and will continue to be conducted in collaboration with them in FY 2007. AIDSRelief will continue to collaborate closely with the MOH AIDS Coordination Unit (Unité de Coordination Centrale - UCC) and regional departmental directates, including regular supportive supervision visits by the MOH. Pregnant women will be encouraged to attend antenatal clinics (ANC) of the PMTCT sites through community mobilization activities.

ACTIVITES AND EXPECTED RESULTS: Activity 1: Provision of comprehensive counseling and testing at the ANC services of the eight CRS-supported medical facilities and their satellite clinics. Five mission hospitals and one public hospital will be supported to provide PMTCT in order to provide the full package of services for the reduction of HIV/AIDS transmission. All women attending ANC will be counseled and offered HIV testing every 3 months throughout pregnancy. Additionally counseling and testing (CT) centers will be established at all satellite health centers attached to the seven mission hospitals and to the one public hospital to identify HIV positive pregnant women who will then be referred directly to the PMTCT site. The funds will be used to support training, salaries for staff including physicians (ob/gyn's and pediatricians), counselors and pediatric nurses, incentives for trained birth attendants and community health workers (CHW) to accompany the pregnant and post-partum woman and her child, transportation support to the woman and her companion to the PMTCT site, supervision visits, and community mobilization. The success of last year will build on this year's PMTCT activities. Sustainability of this activity will be ensured through collaboration of AIDSRelief consortium members, and through collaboration with other stakeholders including Haiti's Ministry of Health, the USG Team, and other non-governmental organizations (NGO's).

Activity 2: Conduct training and supervision for ob/gyn, counselors and CHW in PMTCT. In collaboration with MOH, INHSAC and JHPIEGO, AIDSRelief will conduct this activity to ensure that effective counseling and testing will be provided to the population attending the ANC services in the hospitals and the satellite clincs. Capacity of the staff will be built in order to deliver appropriate ARV prophylaxis at different periods of pregnancy according to national guidelines. Staff will also improve their skills and knowledge necessary to provide effective counseling on infant and young child feeding, both in terms of an informed choice for the first six months, as well as during the weaning period and beyond. In FY 2005, twenty-five nurses and five ob/gyn in the CRS-supported hospitals were trained in PMTCT and CT with support from the USG. With the development of new PMTCT national guidelines and curricula by the MOH and also with staff turnover at the different hospitals, training will take place again during FY 2007.

Activity 3: Support PMTCT at five AIDSRelief-supported hospitals and and CT activities at all eight AIDSRelief-supported hospitals. This will be done by providing full antenatal care, clinical services for HIV palliative care, subsidized labor and delivery, and postnatal

services, including complete prophylaxis for mothers and infants enrolled in the AIDSRelief program. Linkages to wrap around nutritional, reproductive health, community support and orphan and vulnerable children (OVC) services will be developed and will permit seropositive pregnant women access to family planning and sexually transmitted infection (STI)services, food and nutrition support, and micro credit access in the sites where such programs are being implemented through other programs (key legislative issue). Using MOH approved registers and patient history forms, AIDSRelief will monitor PMTCT patients to ensure quality services and provide accurate reporting to the USG and MOH.

Activity 4: Community mobilization to increase attendance at the ANC by seropositive pregnant women, to reduce stigma, and facilitate access to PMTCT and CT services, HIV treatment, care and support. Effective community mobilization is an essential element of the project because the success of the program relies heavily on community involvement. Existing community groups will be engaged in this effort, such as mothers' clubs, traditional birth attendants (TBA) and CHWs. This activity will sensitize pregnant women and their communities about HIV/AIDS and the modes of transmission. At the same time all pregnant women will be motivated to attend the ANC clinic and be tested and counseled in order to reduce transmission of HIV. This activity was previously conducted and funded with private funds at (Milot, Gros-Morne, Fond des Blancs, Pilate) and with PEPFAR funds at Léogane and Fond des Nègres. The activity will continue this year at those sites and will be initiated in the others.

Linked to Activities 9671, 10667, 9267, 9268, 10123, 9333, 9314.

SUMMARY: The AIDSRelief Consortium will expand palliative care to include comprehensive clinical care, home-based care and clinical follow-up for 12,000 patients in 10 sites located in four departments: the South, the Nippes, the North and the Artibonite. This activity will build on the Catholic Relief Service's (CRS) Title II Food and OVC programs and will be integrated with the current AIDSRelief ARV program implemented in eight of these 10 targeted sites. Networks and linkages will be developed with community-based programs through which psycho-social, nutritional and preventive care support will be provided to PLWHAs and their families in these departments.

BACKGROUND: AIDSRelief has been providing palliative care and antiretroviral treatment (ART) in Haiti since 2004 with the United States Government (USG) support. AIDSRelief is a five-member consortium, led by CRS, and includes three faith-based organizations (FBOs), a medical institution recognized for its HIV/AIDS research and program development, and an international development company specializing in public health and social programs. AIDSRelief is an active member of the Ministry of Health's (MOH) care and treatment cluster, which has responsibility for defining the national strategy for HIV/AIDS care. AIDSRelief has implemented eight ARV sites in the country integrated with palliative care services which include clinical care as well as limited psycho-social and community support. To date, around 4,000 PLWAs have been enrolled in clinical care through the AIDS/Relief network of sites.

With 07 resources, AIDSRelief will continue to strengthen these 8 sites and expand to two new sites. These 10 sites will represent around 10% of all sites that will offer integrated clinical care and home based care. This program will be integrated with VCT, PMTCT and ARV services which AIDSRelief will be providing in its network of 10 sites. All HIV-positive patients at any AIDSRelief hospital or at any of the satellite health centers in its regional networks will be offered services in the AIDSRelief Palliative Care Program. It is expected that 90% of all HIV-positive patients tested at these sites will be enrolled in care.

ACTIVITIES AND EXPECTED RESULTS:

AIDSRelief will strengthen 10 sites to provide palliative clinical care to an anticipated 12,000 patients identified and enrolled through clinical based services at these sites.

Activity 1: Funding will be used to support service organizations and laboratory services for clinical assessments of patients, to provide opportunistic infection (OI) treatment and to provide OI prophylaxis with Isoniazid (INH) and cotrimoxazole according to the national norms and protocols. This funding will also support long-term patient follow-up to monitor the optimal time for ART. Ensuring that all palliative care sites have the capacity to assess and monitor the nutritional status of patients and to provide nutrition counseling will be emphasized this year. Efforts will be made to provide food by prescription to malnourished PLWHAs. Each site will be staffed with a multi-disciplinary health-care team, including physicians, nurses, counselors, lab technicians and community health workers. AIDSRelief will make resources available at each site to cover transportation fees for PLWHAs to attend clinics. OI drugs will be provided by the USG through SCMS. Dedicated staff will be hired at each site to adequately support monitoring and evaluation (M&E).

Activity 2: AIDSRelief will build on and expand its network of community workers hired at and around each site. These community workers will work under the supervision of managers and social workers of the sites and will conduct home visits in order to track patients and to provide counseling services regarding HIV prevention and best health practices, particularly related to safe drinking water, malaria prevention and nutrition. During home visits, these community workers will assess basic care needs of the patients and will provide, as needed, pain killer as well as other symptomatic medicine, oral rehydration solutions (ORS) and micronutrients according to the national guidelines. Commodities and drugs for this activity will be provided thru the Partnership For Supply Chain Management (PFSCM).

Activity 3: AIDSRelief will increase its technical and logistical capacity to implement this program, particularly to ensure supervision, quality assurance/quality improvement (QA/QI) and on-the-job training for ongoing activities. In addition, AIDSRelief will

coordinate with training institutions, such as Haitian Group for the Study of Kaposi's sarcoma and Opportunistic Infections (GHESKIO) and Partners in Health (PIH) to ensure that local staff receives appropriate training. All training institutions will be using national guidelines and tools for their training activity. AIDSRelief will participate in all efforts to update these national guidelines and training tools.

Linked to Activities 9671, 9269, 10667, 9267, 9268, 10664, 8156.

SUMMARY: In FY 2007, AIDSRelief will pay particular attention to infants and children infected with, and affected by, HIV and AIDS. AIDSRelief will also ensure that all local partner treatment facilities offer adequate pediatric palliative care. The community support activities will be carried out in seven AIDSRelief sites four of Haiti's Regional Departments and in two additional Regional Departments through partner sites.

AIDSRelief has been providing palliative care to children in Haiti since 2004 with the United States Government (USG) support. The AIDSRelief Consortium is currently providing antiretroviral treatment (ART) services and HIV care to children in its eight sites. CRS, the lead agency in the consortium, has extensive experience in the care of OVC and is also a grantee for President's Emergency Plan for AIDS Relief (PEPFAR) Track 1 funds. CRS, with the Ministry of Health (MOH) and the Minister of Social Affairs, was an active organizer of this year's first national forum on OVC with the objective of defining a national framework for the support to OVC from HIV. In FY 2007, AIDSRelief will expand HIV pediatric care and support to the community. This expansion of OVC services will take place in the eight current AIDSRelief sites and in two additional faith-based organizations (FBOs) and activities will be implemented directly by the AIDSRelief network and local partners. Particular attention will be paid to vulnerable children and youth, particularly girls under the age of 14 years. In addition, before the end of FY06, AIDSRelief will conduct a Pediatric HIV Counseling Workshop. This workshop will sensitize staff to the unique challenges of pediatric care and treatment. The skills gained will help increase capacity among hospital staff and improve services to children.

ACTIVITES AND EXPECTED RESULTS:

The activities described below will contribute to three principal PEPFAR objectives: placing the most vulnerable individuals in treatment; preventing new infections; and providing care for those who need it the most.

Activity 1: AIDSRelief will identify vulnerable children through the Prevention of Mother-to-Child Transmission (PMTCT) programs, hospital-based pediatric services, and community outreach programs. Using counseling techniques appropriate for children and families, HIV testing will be offered to children at risk. ARV services will be offered to medically eligible HIV-positive children. HIV-infected children will have special access to wrap-around services through child survival programs at the sites such as nutrition support, immunizations, and integrated management of childhood illness, palliative care (prophylaxis and treatment of opportunistic infections [OI]) and laboratory monitoring. It is expected that 100% of all HIV-positive infants and children will be enrolled in care.

Activity 2: AIDSRelief will train community health workers (CHWs) and caregivers to recognize medical complications experienced by HIV-infected children and refer them to the local facility, if necessary. Psychosocial support will also be available for affected families. Home-based care will be provided on a regular basis to children with HIV and AIDS, to improve children's access to services. This care will focus on social support and health needs of the entire family, and it will include food and nutrition support, patient and family education, sujpport for school fees for needy children and access to micro-crediti and micro finance support for increasing income generation opportunities for the mothers and other caregivers. Linkages and referral networks with the United States Agency for International Development (USAID)-funded Title II program and with the World Food Program (WFP) will be established to strengthen this comprehensive care model. The project manager will plan monthly group counseling for children, to promote positive self-esteem and to minimize the effects of stigma and discrimination. At the end of the year, focus groups consisting of families of infected children will be planned to measure the impact of this intervention. 400 OVC will be referred for ARV services.

Activity 3: AIDSRelief will train CHWs to sensitize the general population against discrimination and stigmatization and to promote respect for people living with HIV/AIDS (PLWHA) and children's rights. Community leaders, teachers, service providers and PLWHA support group members will also be trained in order to reduce stigma. Community and foster care will be encouraged. Specific communication materials about infant and

childcare will be developed for the families caring for OVC. The CHW program will ensure that at least 50% of the trained personnel are women in order to ensure gender equity in the program.

Activity 4: AIDSRelief will train CHWs and clinical staff to ensure high quality care and follow-up for children with HIV and AIDS. Basic training for pediatric HIV care will be provided for all new staff, and HIV and AIDS updates will be scheduled on a regular basis for staff at all AIDSRelief hospitals.

Lilnked to Activities 9671, 9269, 10667, 8162, 9268.

SUMMARY: Counseling and testing (CT) is provided at all AIDSRelief sites as part of a comprehensive package for care, treatment and support for people living with HIV/AIDS (PLWHA). Activities to support CT include: provision of comprehensive CT services at hospital clinics and satellite clinics; training and supervision of counselors and community health workers (CHW's) in CT; support of CT activities at all AIDSRelief health facilities; and, community mobilization. The primary emphasis areas for these activities are: community mobilization, training, network development, human resource development, food nutrition support, quality assurance, quality improvement, and supportive supervision. The specific target populations will be: women of reproductive age, youth, truck drivers, sexual partners and children of seropositive persons, tuberculosis (TB) patients, sexually transmitted infection (STI) patients, and adults and children with clinical evidence of AIDS. The activities will be conducted in the communes of Gros-Morne, Fond des Blancs, Fond des Négres, Leogane, Pilate, Milot, Deschapelles and Gonaives. People with high-risk behaviors and sexually-active youth will be motivated to attend CT clinics during community mobilization. In addition, AIDSRelief will conduct training in CT activities, in collaboration with Ministry of Health (MOH) and the Haitian Institute for Community Health (INHSAC). The MOH, Unité de Coordination Central (UCC) and Regional Health Departments are supportive of the project.

ACTIVITIES AND EXPECTED RESULTS: Activity 1: AIDSRelief will provide CT services at the 8 hospital clinics and satellites clinics in its network, 7 Catholic mission hospitals and 1 public regional hospital, and will establish 4 additional CT services at satellite health centers linked to these hospitals.

Activity 2: AIDSRelief will provide necessary training and will supervise counselors and CHW in CT. In collaboration with MOH and the USG-supported CT training program at INHSAC (see I-TECH activity narrative in CT), AIDSRelief will ensure that quality counseling and testing will be provided to the population seeking care at its facilities. In November 2005, 25 nurses were trained in CT through PEPFAR funding. Refresher trainings will be conducted during FY 2007 and follow-up will take place during technical assistance visits. All training will emphasize counseling and referrals for family planning and other reproductive health services.

Activity 3: AIDSRelief will support post-test activities (Post-test Clubs) at all of its health facilities to both seropositive and seronegative persons. AIDSRelief will provide education, psychosocial and logistical support to clients, clinic staff and CHWs in order to decrease stigmatization and discrimination experienced by PLWHA. In addition, AIDSRelief will ensure that all seropositive persons are registered in HIV care programs.

Activity 4: AIDSRelief will support community mobilization in order to decrease stigma and misinformation regarding HIV and to increase the number of persons accessing CT centers. This activity will raise the awareness of community leaders, CHWs, traditional birth attendants, health agents, teachers, pregnant women, youth, people with risk behaviors, driver's syndicates and the general population about HIV/AIDS and the importance of VCT. Particular emphasis will be placed on integrating traditional birth attendants and community health agents into mobilization efforts. This activity was previously conducted and funded with private funds at Milot, Gros-Morne, Fond des Blancs, and Pilate and with USG funds at Léogane and Fond des Nègres.

Activity 5: AIDSRelief will strengthen the capacity of the regional hospital in Gonaïves to become a center of excellence by supporting a working network of all CT sites around AIDSRelief-supported hospitals in the Artibonite and Nippes Regional Departments.

Need narrative.

Table 3.3.09:

Linked to Activities 9671, 9269, 10667, 9267, 8162, 9332.

SUMMARY: AIDSRelief Haiti is a comprehensive program, providing anti-retroviral therapy (ART) to 1,174 people in 8 treatment facilities in September 2006. Target populations include adults, infants, children, and youth infected with HIV seeking medical services at any AIDSRelief hospital. Health-care providers and victims of sexual abuse will also be targeted. Emphasis areas include human resources, local organization capacity development, logistical support and training. Community mobilization and the development of networks, linkages, and referral systems will also be critical components of the AIDSRelief program. AIDSRelief will review its performance through the quality assurance/quality improvement (QA/QI) process, to ensure implementation of best practices in each clinical program. The coverage area for this program includes the communes of Fond-des-Nègres (Nippes); Fond-des-Blancs (South); Léogane (West); Deschapelles, Gonaives, Gros Morne (Artibonite); Pilate, Milot (North).

BACKGROUND: AIDSRelief has provided ARV services in Haiti since 2004, through support from Track 1.0 and FY 06 of the President's Emergency Plan for AIDS Relief (PEPFAR). AIDSRelief is a five-member consortium, led by CRS, and includes 3 faith-based organizations (FBO), a medical institution that is well-recognized in HIV/AIDS care and research, and an international development company specializing in the design and implementation of public health and social programs. All members of the AIDSRelief Consortium work together to provide quality medical care to People living with HIV/AIDS (PLWHA). AIDSRelief Haiti works within 7 faith-based hospitals and one public hospital.

A significant proportion of AIDSRelief patients are women; therefore, this program will integrate with other clinical programs that serve women, including PMTCT, obstetric/gynecology (OB/GYN), and Maternal and Child Health (MCH) programs. Women and girls who are victims of sexual assault are a special target population for AIDSRelief. AIDSRelief will work in close collaboration with the Government of Haiti (GOH). AIDSRelief is an active member of the Ministry of Health's (MOH) care and treatment cluster, which has responsibility to define the national strategy for HIV/AIDS care.

ACTIVITIES AND EXPECTED RESULTS: Activity 1: AIDSRelief will continue its plan to provide durable, high-quality ART, according to Haiti's national guidelines. During the COP07 funding period, each hospital will scale up the enrollment of ARV clients through expanded hospital and community-based VCT services that target patients at highest risk for HIV, and through referrals from clinical programs such as tuberculosis (TB) treatment programs. These activities will be accomplished through the development of an integrated approach to services at each AIDSRelief hospital, and through collaboration with other stakeholders such as the MOH, USG team, and other PEPFAR awardees. AIDSRelief will strengthen its regional approach to ART in the Artibonite by expanding its support for the public sector Gonaïves' Hôpital La Providence as a regional center of excellence. With FY06 resources, hospital staff received training in ART and treatment support. Similar regional approaches will be maintained in the Nippes, the West, and the North, where AIDSRelief has multiple clinical sites that are strategically placed. Activity 2: Training and capacity building in eight clinical centers will continue with support from COP07. AIDSRelief physicians on the Country Technical Coordination Team (CTCT), in addtition to the training received at Haitian Group for the Study of Kaposi's sarcoma and Opportunistic Infections (GHESKIO), have been invited to the Institute of Human Virology for a "mini-fellowship" in infectious diseases. This activity will be expanded in FY07 to build capacity of the in-country physicians, and to strengthen the skills of other members of the multi-disciplinary team, including the counselors, treatment support staff, and technical staff (pharmacists, lab techs). This training will support the sustainability of clinical technical assistance. Following training, these physicians will provide strong leadership for AIDSRelief Haiti's eight clinical centers. The physicians will be responsible for monthly medical supervision and training for the hospital-based physicians and nurses. AIDS seminars and updates will be held quarterly at each hospital. The seminars will focus on treatment challenges and knowledge deficits identified by physicians on the in-country team. In addition, the training will present new approaches to care and treatment based upon best practices and research findings in HIV/AIDS. Activity 3: AIDSRelief partners will strengthen local organizational capacity in the areas of hospital management, finance, and fund-raising, in order to ensure long-term sustainability of ARV services. AIDSRelief will collaborate with other stakeholders to

provide critical linkages which support sustainable, quality ART. Activity 4: AIDSRelief Haiti expects that at least 10% of the AIDSRelief patients will be within the pediatric age group. Currently, 4% of patients are children; however, efforts are being made to increase enrollment of sero-positive children. In FY06, AIDSRelief held a conference on Pediatric ART for the 8 AIDSRelief hospitals. In November 2006, additional training and support will be made available for pediatric counseling and treatment support. AIDSRelief will seek to identify infected children through its expanded work with women enrolled in PMTCT and through close collaboration with in-patient pediatric programs. Activity 5: FY 07 funding will support patient monitoring and management (PMM) tools at the community and institutional levels, to improve the program's ability to track patient care. At the community level, treatment support teams will use these tools to ensure 95-100% patient adherence to ART. These treatment teams will be led by a nurse supervisor and/or a counselor at each hospital. AIDSRelief will work with GHESKIO, CDC and MOH to maintain a QA/QI Program at each hospital during Year 4. QA/QI assessments will provide clinical, lab, and behavioral monitoring of the patient. The QA/QI program and PMM tools will be used to improve patient care, and to identify areas within the ART program which need to be strengthened. AIDS\Relief will use standardized national QA/QI tools that MOH will implement with technical support from CDC. AIDSRelief-Consella Futures will provide technical assistance (TA) and training to build capacity of local partner treatment facility (LPTF) staff responsible for data collection and analysis. Activities will include: complete adoption of government-revised PMM systems; joint supervision and TA with the govt monitoring and evaluation (M&E) agency (Child Health Institute [IHE]); analysis of required indicators requested by LPTF, CTCT and funding agencies; training on generation of programmatic indicators to produce the required reports on an accurate and timely basis. Constella Futures will carry out regular site visits and reviews to ensure quality data and data validation. Activity 6: AIDSRelief will provide training for all members of the multi-disciplinary team in the management of post-exposure prophylaxis (PEP). The team will develop skills in care, treatment, and support for women following rape and the services will be available at all times in each AIDSRelief hospital. Post-exposure prophylaxis will be made available, in addition to HIV testing. Long-term follow-up for these women will include psychological support, lab testing, and medical treatment. Similar services will be available at all times for staff with a potential HIV exposure during their work at the AIDSRelief hospitals or at a satellite health center.