Linked to Activities 9308,9682, 9671, 9670,9683.

SUMMARY: Activities are carried out to strengthen the capacity of the Haitian Institute for Community Health (INHSAC) to provide quality training and supervision of comprehensive PMTCT services. The primary emphasis areas for these activities are training new providers in PMTCT, supportive supervision and additional on-site strengthening of skills, and quality assurance of service delivery at PMTCT sites. Specific target populations include nurses, physicians, laboratory technologists, auxiliary nurses, psychologists, social workers, and community agents. The activities will be carried out in 40 PMTCT service outlets in all 10 regional departments.

BACKGROUND: The Haitian Institute for Community Health (INHSAC) is a Haitian nongovernmental organization (NGO) established in 1985 to provide training in community health, family planning and other health issues at a post graduate level. With USG support in FY 2006, INHSAC coordinated and provided training to USG partners in the area of PMTCT as well as counseling and testing (CT). INHSAC conducted trainings, as well as arranged logistics, travel and per diem, for 200 service providers from 26 PMTCT service sites. Major partners were Management Sciences for Health (MSH), the Ministry of Health (MOH), JHPIEGO, and Catholic Relief Services/Cooperative for American Relief Everywhere (CRS/CARE). In FY 2005, as a sub-partner to International Training and Education Center on HIV (I-TECH), INHSAC trained 218 healthcare staff in counseling skills for pre- and post HIV test counseling and in FY 2006 INHSAC trained 50 additional counselors and/or nurses. INHSAC collaborates ith the National Public Health Laboratory of the MOH for the rapid test training of the CT specialists

ACTIVITIES AND EXPECTED RESULTS: In FY 2007, I-TECH, through its sub-partner INHSAC, will carry out four separate activities in the PMTCT Program Area. Activity 1: Provide refresher courses in PMTCT to healthcare staff of existing USG-supported sites. I-TECH and INHSAC will collaborate with JHPIEGO and the MOH to identify the most appropriate staff members from each site to receive training prioritizing those sites with higher numbers of pregnant women. These training activities will also be coordinated with PMTCT provider training to be carried out by Partners in Health (PIH) and Catholic Relief Services (CRS) for the PMTCT sites under their supervision responsibility.

Activity 2: Train new providers from the 16 additional PMTCT that the USG will support in FY 2007 to ensure effective PMTCT services. Through this activity I-TECH will continue to build the capacity of INHSAC to design and carry out quality professional training programs and will also assist the USG-funded healthcare organizations and the MOH to increase their human capacity to meet the increasing demand for PMTCT services. INHSAC trainers will use the new PMTCT curriculum based on the revised national norms and standards for PMTCT developed by JHPIEGO in collaboration with the MOH in FY 2005.

Activity 3: Work with JHPIEGO to ensure quality assurance (QA) in the sites providing PMTCT services, applying the standards-based management and recognition (SBM-R) approach to service quality improvement developed by JHPIEGO and adapted to the Haitian context in coordination with the MOH. INHSAC will participate in the regular supervision visits in coordination with JHPIEGO in order to strengthen the skills of their training staff and expand their experience into service delivery quality assurance.

SUMMARY : This activity aims at strengthening the Haitian Institute for Community Health (INSHAC) capacity to provide quality training and supervision for OVC services. INSHAC will develop a comprehensive curricula and train providers in care and management of Orphans and Vulnerable Children . Target populations include physicians, nurses, auxiliary nurses, social workers, community agents.

BACKGROUND: The Haitian Institute for Community Health (INSHAC) is a Haitian nongovernmental organization (NGO) established in 1985 to provide training in community health, family planning and other health issues at post graduate level. Actually INSHAC supported by ITECH and PATH will conduct a training course on infant and young child feeding for health personnel. A standardized training course is much needed for providers in OVC programs .

ACTIVITIES AND EXPECTED RESULTS:

Activity 1. INSHAC will develop a comprehensive curriculum based on technical expertise and proven results. This curriculum will be adapted for training of health personnel at sites providing OVC services. INSHAC working with I-TECH will identify existing resources and seek technical assistance in order to develop this curriculum.

Activity 2. Train new providers and provide refresher courses to health personnel who carry out OVC activities. This aims at achieving standard quality training program and build human capacity for more effective OVC services. INSHAC will do supervision visits to ensure quality assurance of service delivery.

Linked to Activities 9725, 9343, 9340, 9341, 10240.

SUMMARY: I-TECH will establish a subcontract with the Haitian Institute for Community Health (INHSAC) to provide training and supportive supervision in HIV counseling for 300 health workers throughout Haiti. INHSAC will work with I-TECH to provide technical assistance to the social sciences faculty to integrate practical, skills-based training approaches into the counseling curriculum. The emphasis areas for this initiative include: training; quality assurance (QA), quality improvement (QI), and supportive supervision; development of network linkages and referral systems; and information/education/communication (IEC). Specific target populations include: health care workers, people affected by HIV/AIDS, HIV-positive pregnant women, HIV-positive infants and children, and special populations. Coverage areas include all geographic regions receiving USG support for counseling and testing. Final products of FY 2007 include icreased capacity among social sciences faculty to integrate practical, skills-based teaching into diploma program for social workers and psychologists and the INHSAC Training Center in Port-au-Prince strengthened with improved physical infrastructure, additional staff and increased capabilities to conduct training, supervision and QA/QI of counseling services on a national level.

BACKGROUND: In 2004-05, I-TECH supported INHSAC to develop an HIV counseling curriculum covering voluntary counseling and testing (VCT), antiretroviral treatment (ART) adherence, stigma and discrimination, changing male norms and behaviors for risk reduction, counseling victims of sexual abuse and violence, couples counseling, and other areas. INHSAC completed a Training of Trainers (TOT) session for 20 trainers, and completed training of 181 health workers. I-TECH provided technical assistance to INHSAC through sharing of curriculum resources and intensive joint work on the INHSAC curriculum, and supported implementation of a training database (TIMS) at INHSAC to track HIV counseling and other training. In late 2006, I-TECH will collaborate with INHSAC and the Ministry of Health (MOH) for national validation of the HIV counseling curriculum. In FY06, INHSAC received funding from the USG through Management Sciences for Health / Health Systems 2007 (MSH/HS2007) for a small-scale training program in HIV counseling (50 health workers).

ACTIVITIES AND EXPECTED RESULTS: Activity 1: I-TECH will renew collaboration with INHSAC to address unmet training needs in counseling and psychosocial support services in the context of VCT, Prevention of Mother-to-Child Transmission (PMTCT), palliative care, and ART services. Using its existing HIV counseling curriculum, INHSAC will carry out training sessions for HIV service providers at its campus in Port-au-Prince and in five other regions of Haiti. INSHAC will launch a practicum component to training sessions, to increase experiential learning and skills transfer. INHSAC will also add a supportive supervision function whereby trainers make site visits to observe and mentor trainees as they work in multidisciplinary care teams with HIV patients. Supportive supervision will reinforce learning, support professional development and quality services, and help to develop forums for health workers to discuss and diffuse stress and avoid burn-out. Finally, INHSAC will assist I-TECH to plan, carry out, and evaluate a faculty development workshop for the social sciences faculty, to meet a demonstrated need to shift the pre-service training of social workers and psychologists to integrate practical, skills-based teaching approaches (participatory training methods, supervised practicum experiences, etc.) to better prepare social workers and psychologists for professional practice in HIV care and treatment settings.

This activity has important implications for the sustainability of the President's Emergency Plan for AIDS Relief (PEPFAR) funded program in Haiti, in that a local organization is being strengthened to carry on training, supervision and QA/QI in counseling services after PEPFAR.

Resources required for this initiative include: staffing (administrators, 2 lead trainers, training coordinator, and support staff); supplies, furniture, and equipment for training classrooms; vehicle for transport of trainers to regional training sites and to supportive supervision visits; generator for back-up power supply; transportation and per diem costs for trainees and trainers; office rent, utilities, communications; improvements to INHSAC's Port-au-Prince training center, including the addition of one classroom to the upper story

and the procurement of a generator for backup power supply. These resources will provide INHSAC sufficient infrastructure to maintain its role in supporting USG training goals.

Need narrative.

Table 3.3.09:

Linked to Activities 9725, 9360, 9340, 9341, 10240, 9282, 9313.

SUMMARY: I-TECH will provide clinical mentoring, technical assistance and training for interns and residents on HIV/AIDS treatment in the largest University Teaching Hospitals (HUEH and Isaïe Jeanty). Through Cornell University, I-TECH will provide clinical mentoring and technical assistance (TA) at GHESKIO network ARV sites to support the scale up of on-going ARV services. Through the University of Miami (UM) which has been partnering with the North Departmental Hospital for many years to build a Family Practice Center (FPC) with integrated HIV services, I-TECH will support the upgrading of ARV services. Through the FPC, UM will create a regional training center to provide TA, in coordination with Global Fund, to establish ARV services in the North East Regional Department and supervise ARV services in the North and North East Regional Departments. I-TECH will also support extension of pediatric ARV services at Hopital Nos Petits Frères et Soeurs (NPFS) and will focus on supporting pre-service training for medical students at the Colleges of Medicine.

BACKGROUND: Over the last 3 years, the USG took steps to expand ARV services through Partners in Health (PIH) and GHESKIO, the 2 pioneers in HIV treatment in Haiti, through 2 new institutions, Catholic Relief Service Consortium (CRSC) and Management Science for Health/Health Serivces 2007 (MSH/HS2007) and through the largest University Teaching Hospital (HUEH) in Haiti. Although good models of care were developed in Haiti, there has been a need for technical assistance from US based universities for clinical mentoring to address critical treatment issues such as resistance, adherence, chronic illnesses associated with greater survival, integrated care spanning adult, pediatric services and to implement new laboratory technologies. There has been also a need to integrate HIV treatment as part of the training activities of interns and residents at the University Teaching Hospitals and as part of the training curriculum of medical and nursing students. The USG provided resources to I-TECH that established twinning relationships with different US based universities to address these different needs. As a result of this support, national HIV treatment guidelines and training tools were updated. Clinical mentor specialists in clinical care and lab from Cornell University were assigned to GHESKIO. Two Haitian infectious disease specialists were trained and assigned at HUEH to mentor intern and residents and other health professionals in HIV treatment. Pediatric treatment was expanded to 3 sites with technical support of University of New Jersey while ARV services were scaled up at the Family Practice Center of the North Departmental Hospital with support from UM in integration with other support from GHESKIO and the Ministry of Health (MOH).

It is critical for the success of the program that the USG continues to build on this mentoring and TA from I-TECH and US based universities to build human capacity, to improve program management, to address critical treatment issues, to implement new technologies and to expand ARV services in the North and North East Departmental Hospitals and pediatric treatment at Nos Petits Frères et Soeurs Hospital.

ACTIVITIES AND EXPECTED RESULTS: Activity 1: I-TECH will continue to support training activities and mentoring of HIV treatment at two University Teaching Hospitals (HUEH and Isaïe Jeanty) through 5 full-time clinical mentors. 2 were hired and trained in 2005. 3 more will be hired and trained. These mentors will conduct daily activities with residents, interns, and medical students, including patient rounds, chart reviews, and case conferences. I-TECH will organize and carry out U.S. study tours for residents and key service-providers to observe state-of-the-art HIV treatment services and will pursue the integration of HIV treatment in the training curriculum of medical students in 3 Colleges of Medicine through training of trainers and making available training tools and materials.

Activity 2: Through Cornell University, I-TECH will enhance training, on-site technical assistance, and quality assurance activities that GHESKIO will be carrying out in support of the scale up of ARV services. Cornell will provide 1 HIV clinical specialist (MD) and 1 senior laboratory specialist (MD, PhD) at GHESKIO. These advisors will reinforce GHESKIO in addressing advanced HIV treatment and lab issues and in providing leadership and technical assistance to implement in the South Regional Department a center of excellence at Les Cayes Departmental Hospital (Immaculate Conception) with the capacity to provide training and supervision at regional level. Finally, the Cornell advisors will provide technical expertise to the MOH in updating national adult HIV care and treatment

guidelines, protocols and standard operating procedures, and training curricula.

Activity 3: I-TECH will use its relationship with UM to extend ARV services in the North and North East Departmental Hospitals, building on the successful integration of HIV treatment into primary care services in the FPC, built by UM in the Cape Haitian Departmental Hospital and where approximately 1000 patients were enrolled on HIV treatment and 200 patients enrolled on ART by mid-2006. These activities are closely coordinated with GHESKIO interventions in the Cape Haitian Hosital. UM will provide on-going supervision to the FPC and guidance to the North (Cape Haitian) Departmental Hospital directors in the coordination of FPC HIV/AIDS services with other services, interventions, and partners working within the Hospital. UM will upgrade the capacity of the FPC to make it a center of excellence with the resources to provide in-service training on HIV treatment for at least 100 health workers in the North and North East departments, to supervise on-going and expanded ARV services, and to build referral networks among the different care and treatment sites in these two departments. UM will work with the MOH and other Global Fund supported partners to strengthen ARV services in the North East Departmental Hospital in Fort Liberte and in the Ouanaminthe Hospital, on the border with the Dominican Republic. An important component of the ARV services provided in the Ouanaminthe Hospital is cross-border coordination with USG-supported ARV services in the Dajabon Hospital in the Dominican Republic. These activities will require enhancement of infrastructure, reinforcement of logistical capacity(including a vehicle) reinforcement of human resources and a mobile team (including supervising physician, Disease Reporting Officer [DRO], and outreach nurse).

Activity 4: Through its contract with University of Medicine and Dentistry of New Jersey-Francois Xavier Bagnaud Center (FXB), I-TECH will support expanded pediatric HIV clinical training. FXB will continue to provide on-going clinical mentorship to 3 pediatric hospitals in Port-au-Prince (HUEH, NPFS, and Grace Children's Hospital), with a focus on advanced issues in pediatric care and development and oversight of CQI plans and U.S. study tours for key providers. FXB will support the MOH in completing an annual review and update of national pediatric care and treatment guidelines.

Activity 5: I-TECH will contract with Hopital Nos Petits Frères et Soeurs (NPFS), an NGO sub-partner, to expand with technical support from FXB HIV care to pediatric patients and their families, expanding on the pool of approximately 30 pediatric patients on ART in mid-2006 to 800 by September 2008. TARGETS: 1000 adults patients on ARV at Justinien Hospital (indirect support) 150 pediatric patients on ARV at Nos Petits et Soeurs Hospital (direct support) 300 interns and residents trained thru University Teaching Hospitals 30 health professionals trained (in service training)

Linked to Activities 9725, 9360, 9343, 9341, 10240, 9311, 9283.

SUMMARY: I-TECH will support implementation of a laboratory information management system (LIMS) at the national laboratory and within the network of the United States Government (USG)-supported anti-retroviral treatment (ART) sites. The emphasis areas for this initiative include: strategic information/ Health Management Information System (HMIS); infrastructure; development of network/linkages/referral systems; and training. Specific target populations include: general population, people affected by HIV/AIDS, special populations, health care providers, the Ministry of Health (MOH) staff, and groups/organizations which provide laboratory services. Coverage areas include all geographic regions receiving the President's Emergency Plan for AIDS Relief (PEPFAR) support for HIV testing and clinical services.

BACKGROUND: I-TECH has worked in Haiti since 2004. In 2005-06, I-TECH provided technical assistance to MOH and to the Centers for Disease Control and Prevention (CDC) to develop a standardized adult HIV medical record and corresponding application for electronic data management. As of June 2006, 18 sites in Haiti had access to this web-based application, and I-TECH has provided on-site training and technical assistance to 10 sites of these sites to routinely use the application for data management and reporting, and to reinforce data quality. I-TECH is proceeding with further development of the system to achieve: 1) disseminated (local) hosting of the application at ART sites, with regular replication of data to the MOH's central data repository; and 2) an interactive point-of-care electronic medical record (EMR) by clinicians at selected sites. The system tracks laboratory tests and a result for patients enrolled in HIV care, but does not represent a fully-functioning LIMS to manage the laboratory workflow for all types of laboratory tests.

ACTIVITIES AND EXPECTED RESULTS: Activity 1: I-TECH will work closely with CDC/Haiti, CDC/ Global AIDS Program (GAP) Atlanta and Haiti MOH to identify functional specifications for the LIMS at the National Reference Laboratory (NRL) and at ART sites, with reference to already-established frameworks for requirements for public health laboratories. I-TECH will provide technical assistance to identify Haiti-specific requirements, analyze costs and benefits of existing LIMS products according to the Haitian context, select and procure a LIMS product for use in Haiti. I-TECH will work with the vendor of the selected LIMS to adapt the system for specific laboratories in Haiti. I-TECH will also procure and install additional hardware (servers, backup power supplies, local area networks, etc.) to support the LIMS, in collaboration with CDC's Regional Information Officers (RIOs) and site personnel. The number of sites served will depend on the acquisition cost of the LIMS (including hardware and license fees for each site). Given the significance of these costs, it is anticipated that a phased implementation covering 3-4 sites under the country operational plan (COP) 07 will be required, with expansion to a total of 14 ART sites occurring during a second phase.

I-TECH will hire 2 full-time consultants to be based in Haiti (1 LIMS specialist/project manager and 1 trainer/ information technology [IT] specialist) to assure local collaboration on the selection of the LIMS and to interface with the LIMS vendor for appropriate adaptation. These consultants will also travel regularly to laboratory sites throughout Haiti to oversee implementation and to provide on-site training to laboratory personnel in use of the system. I-TECH consultants will also assist in developing and implementing a maintenance plan, and will plan and deliver training on system maintenance (including failure recovery strategies). I-TECH staff, affiliated with the University of Washington's Clinical Informatics Research Group, will provide technical oversight to the on-the-ground consultants. I-TECH staff will also program an interface between the LIMS and the national HIV EMR system for automated transmission of data on lab orders, pending labs, and results between the 2 systems

Activity 2: I-TECH will provide technical assistance to the MOH National Laboratory Director and other senior staff in the development of a national laboratory strategic plan, to increase responsiveness of laboratory services to the clinical and public health needs in Haiti. The strategic plan will identify recommended roles and responsibilities of the NRL and peripheral laboratories in both public and private sectors, including the infrastructure and test menu appropriate to each level of laboratory service. The strategic plan will take

into account Haiti's organization of health care services, demographic and geographic considerations (including climate, transport and communications infrastructure), existing laboratory capacity and organization, availability of laboratory technologies and facilities (including reagents, chemicals, medica, antisera, laboratory glassware and equipment as well as basic supplies such as safe water, electricity and gas), human resources available throughout the country, common health problems and the public health and clinical relevance of various laboratory procedures, and funding available for laboratory services. These considerations will inform the necessity for immediate laboratory test results or confirmation of presumptive laboratory diagnosis at each level of the health care system. In sum, the national strategic plan will identify the appropriate laboratory technology that should be employed in each type of facility (e.g. conventional methods, molecular, automation, and rapid diagnostic tests), as well as how facilities should inter-relate in support of timely, cost-effective, high quality diagnostic services. I-TECH will provide an international laboratory systems specialist, supported by a local laboratory consultant, to work over a 2-month period with the MOH on the development of the national laboratory strategic plan.

These activities contributes to PEPFAR 2-7-10 goals by strengthening information management within the national reference laboratory and selected ART sites, as well as national-level strategic planning. This will reinforce the quality assurance role of the national reference laboratory, and will improve the quality of patient care in other settings by supporting timely and accurate laboratory findings.

TARGETS: 1. Acquisition of a LIMS which meets Haiti's functional specifications and cost/benefit requirements, for ARV sites and the national reference laboratory. 2. Implementation of LIMS, with interface to HIV EMR, at selected sites. 3. Training of at least 3 persons per site in use of the LIMS, and of at least 5 people in maintenance of the LIMS. 4. National laboratory strategic plan developed and approved by MOH.

Linked to Activities 9725, 9360, 9343, 9340, 10240, 9310, 9284.

SUMMARY: I-TECH will: (i) support expansion of an electronic medical record (EMR) system for data management and reporting of adult and pediatric HIV care services, with point-of-care functionality at some sites and capacity to automatically generate the ARV facility-based report and HIV/AIDS case notification reports for the Ministry of Health; (ii) refine protocols for quality assurance (QA) of patient data captured through the medical record and assist in the creation of quality circles at the sites to handle data quality problems; (iii) support data analysis and dissemination of findings on key question of interest related to program service delivery, by incorporating automatic queries into the database or performing specific queries on behalf of stakeholders. The emphasis areas for this activity are the Health Management Information System (HMIS) and information technology (IT). The primary beneficiaries are HIV AIDS patients, who will benefit from better case management; field staff personnel, who will be trained in the use of the system; and the Ministry of Health (MOH).

BACKGROUND: In 2005-06, I-TECH collaborated with the MOH, the United States Government (USG) Team, and other partners in the development of a standardized set of paper HIV medical record forms. The adult medical record has been endorsed by the MOH and disseminated to many USG-supported sites providing HIV care and treatment services. In collaboration with USG Team information technology (IT) specialists, I-TECH developed an application for HIV patient data management, with retrospective entry of data from paper-based medical records. As of June 2006, 18 sites in Haiti had access to this web-based application, and 30 more will have access by December 2006. I-TECH has provided onsite training and technical assistance directly to the sites to enhance routine use of the application for data management and reporting. I-TECH is proceeding with planned application upgrades which will permit local hosting of the application at six clinic sites, with replication of data to a central data repository, and direct use of the application as a point-of-care EMR by clinicians at six selected sites. I-TECH will also produce a shortened version of the adult HIV medical record form as well as a standardized pediatric HIV medical record before the end of FY06.

In addition, I-TECH will support data analysis and dissemination of findings on key questions of interest related to program service delivery. While the application includes significant capacity for automated population-level reports, the level of missing data within patient records is significant; meaning that analysis using both automated reports and customized queries is less meaningful than desired. With existing I-TECH staff and consultants, in partnership with USG Regional Information Officers (RIOs), Tulane and others, I-TECH will focus on reinforcing data quality and data completeness among users of the system through training and on-site technical assistance.

While an ambitious agenda for completion of software development and dissemination to 50 sites within Haiti was developed for FY06, funding limitations and the need for intensive on-site technical assistance to support adoption of the system required that some parts of the agenda be deferred until FY07, as described below.

ACTIVITIES AND EXPECTED RESULTS: Activity 1: I-TECH will modify the EMR application to improve usability, based on work flow patterns in Haiti clinics and additional user feedback. I-TECH will ensure integration of the EMR system with laboratory data management, by automating transfer of some results (Complete Blood Count [CBC], chemistry, and Cluster of Differentiation 4 [CD4]) to the EMR system and by refining a pending lab order report function within the application. I-TECH will improve the system's interface with existing pharmacy data management tools and practices, and will improve strategies for handling data for patients moving between facilities by building in a records request function to the application. Finally, I-TECH will develop and apply an appropriate algorithm for identifying potential duplicate records at the national level, and improve strategies within the application for assuring uniqueness of patient identification (ID) and records.

Activity 2: To support improved continuity of care for all HIV patients at whatever points they come into contact with the health care system, I-TECH will add voluntary counseling and testing (VCT), prevention of mother-to-child transmission (PMTCT) and pediatric HIV modules to the EMR system. While the current EMR system already supports analysis of

care service delivery by gender, these additional modules will enhance the ability of stakeholders to analyze gender-related questions relative to an expanded array of HIV care services.

Activity 3: I-TECH will strengthen data management capacity in Haiti by recruiting, hiring, and training two National Data Managers (one international, one local) for placement within the MOH. These Data Managers will be responsible for refining protocols for data quality assurance at site, regional, and national levels (daily and weekly review of data quality reports, duplicate data entry, chart audits, etc.); providing training and technical assistance to system users at all levels to apply these protocols; and collaborating with the I-TECH University of Washington (UW) team and other stakeholders on data analysis. These Data Managers will have the mandate to create quality circles at the 68 sites where the system will be implemented and to address data quality issues by reviewing data quality reports and implementing adequate corrections into the database. I-TECH will also modify the EMR application to refine patient care reports, data quality reports, and population-level program reports, based upon feedback from system users (clinicians, program managers, administrators).

Activity 4: I-TECH will continue to collaborate with the USG RIOs and other partners to extend training and technical assistance to site-level EMR system users, through regional workshops and on-site workshops (at least 25 training sessions to be held). I-TECH will also provide on-site technical assistance for installation of the EMR application at 30 new sites (50 sites total). To further transfer capacity for system maintenance to partners in Haiti, I-TECH will contract with a local private contractor or local NGO specializing in information systems/IT services for on-going EMR system maintenance and for minor modification of the EMR application in the future. To facilitate this capacity transfer, I-TECH will sponsor an in-depth study tour to I-TECH/UW to learn the data model and system backup and maintenance procedures (how to rebuild servers, reinstall software reload data from backup, and other failure recovery strategies).

Linked to Activities 9341,9340,9343,9360,9725.

SUMMARY: I-TECH will work with Haiti's public-sector schools for health professionals (medicine, nursing, pharmacy, social sciences, laboratory, and dentistry) to fully integrate HIV/AIDS-related content into their curricula and enhance their training capacities. I-ITECH will provide technical assistance, training and support in the transformation of 4 departmental hospitals into centers of excellence. I-TECH will also develop the capacity of the Ministry of Health (MOH) to set standards for health-worker training programs in HIV care and treatment. The emphasis areas for this initiative include: training (major area); local organization capacity development; Information/Education/Communication; needs assessment; and policy and guidelines. Specific target populations include: national AIDS control program staff, other MOH staff, and health care providers. Coverage areas include Port-au-Prince/West Department, Les Cayes/South Department, Cap Haitian/North Department, and Jeremie/Grand Anse Department.

BACKGROUND: In 2005-2006, I-TECH, in collaboration with the MOH Department of Human Resources (DDRH) and the relevant Dean/Administration for each school, launched curriculum development processes with Haiti's professional schools in nursing, medicine, social sciences, and laboratory science. Curriculum development steps included: 1) needs assessment; 2) convening of academic leaders, faculty, and experts to gain consensus on learning objectives; 3) gathering content from existing curricula; 4) designing interactive and participatory learning activities; 5) producing a set of training materials to support teaching; 6) piloting and validation of these materials; and 7) faculty development to support integration of curriculum materials in teaching. In FY06, I-TECH began with thorough needs assessment of the schools' current curricula and readiness to teach HIV/AIDS content and the competencies needed in each HIV/AIDS-related discipline. I-TECH expects to complete the curriculum development process through step 4 in medicine, step 5 in nursing, social sciences, and laboratory. In addition to curriculum development work in 2006, I-TECH plans to host a 10-week course in the U.S. for 4 faculty members from Haiti's 2 laboratory technology schools. Funding in FY06 was insufficient to complete piloting and faculty development activities in all health professional schools.

In 2005-2006, I-TECH assisted the MOH to develop a standard national ARV/ Opportunistic Infection (OI) curriculum, in close consultation with well-known content experts within Haiti. I-TECH and the MOH will pilot and validate this national curriculum in 2006. I-TECH also produced and disseminated several Creole-language training videos for the MOH's Training Cluster

ACTIVITIES AND EXPECTED RESULTS: Activity 1: I-TECH will build on previous work to strengthen pre-service training and will pilot and validate standardized curricula, in collaboration with Human Resources Departments, School Administrations, and faculty work groups. I-TECH will also support full use of curriculum materials in actual teaching, by holding Training of Trainer (TOT) workshops and conducting supportive visits to observe and give feedback to faculty on their teaching. I-TECH will plan and carry out a minimum of 3 workshops for 30 faculty in Medicine, at least 4 workshops for 80 faculty in Nursing, 1 workshop for 8 faculty in Social Sciences, and 2 workshops for 12 faculties in Laboratory. I-TECH will also conduct at least 2 multi-day supportive supervision visits per professional school (16 visits). I-TECH will also sponsor 4 additional Laboratory faculty members from the 2 national Laboratory schools to attend a 10-week course on International Lab Technology at the University of Washington.

Activities in the schools of pharmacy and dentistry will include conducting a training needs assessment, convening a stakeholder curriculum work group to integrate and adapt HIV/AIDS curriculum, and developing curriculum materials integrating HIV/AIDS for piloting and validation. Within the social sciences school, I-TECH will contract with the Haitian Institute for Community Health (INHSAC) to support further integration of practical teaching methodologies into the curriculum for psychologists and social workers. I-TECH will also collaborate with the National University to develop a general course on HIV/AIDS for all students. The goals for such a course will be to influence University students, who represent future opinion leaders in Haitian society to increase knowledge of HIV transmission, prevention, and testing; to change male norms and behaviors leading to HIV risk; to mobilize to reduce violence and coercion; and to decrease stigma related to

HIV/AIDS (areas of key legislative interest). (Planned budget: $688,235).

ITECH will also enhance training capacity at those different schools by providing interactive multimedia equipment such as LCD projector, PCs and internet connection, to improve the quality of training.

Activity 2: I-TECH will provide technical assistance to the MOH to enhance its national leadership role in developing standardized HIV/AIDS clinical training materials, in TOT for regional HIV/AIDS training centers, and in monitoring and evaluating training. Training and technical assistance will focus on the reinforcement of a mentoring program, called "Centers of Excellence" at 4 departmental hospitals: Jacmel, Cap Haitian, Jeremy and Cayes. This concept of Centers of Excellence, adopted by the Ministry of Health as part of its HIV/AIDS service strategy, was initiated in 2006 but will need further support to institutionalize the approach. This support will enhance the capacity of these hospitals to support the development of services at peripheral sites surrounding them by tutoring their staff, helping in organization of services, providing hands-on technical assistance and regular oversight. The CDC regional officers will support the logistics for transporting teams to inter-institutional exchanges.

Technical assistance will also include a national workshop for the MOH and other partners on quality standards for curriculum and materials development. I-TECH will use a "teaching while doing" approach to transfer capacity to the MOH for planning, producing, and disseminating training materials. Specifically, I-TECH will assist the MOH to produce a 2008 update to the national ARV/OI curriculum in alignment with international guidelines; additional curriculum modules on treatment of opportunistic infections (including video case studies); job aides (posters, brochures) for health workers on HIV care and treatment standards; and an ART adherence education tool appropriate for health workers and low-literacy audiences.

I-TECH will also assist the MOH to establish a national-level database to track in-service training of health workers; to adapt and disseminate the Training Toolkit developed by I-TECH in collaboration with the Caribbean HIV/AIDS Regional Training Network (CHART); and to organize and facilitate TOT sessions (on adult learning and participatory training skills, HIV clinical mentoring, etc.) for key staff from training centers in Haiti (Haitian Group for the Study of Kaposi's sarcoma and Opportunistic Infections [GHESKIO], Partners in Health/Zanmi Lasanté [PIH/ZL], Justinien Hospital Regional Training Center, INHSAC, etc.).

These activities contribute to PEPFAR 2-7-10 goals by supporting workforce capacity in HIV prevention, testing, and care and treatment services.