Linked to Activities 10664, 8156, 10111, 10124, 10108, 10110, 10129.

SUMMARY: This program will provide people living with HIV/AIDS (PLWHA) in the South and Nippes Regional Departments with physical, psychosocial and legal support in order to live positively. When appropriate, it will provide end of life care to help individuals die with dignity. Major emphasis areas will be psychological, social, nutritional and preventive care support to PLWHA and local organization capacity development. CRS will encourage the establishment of networks and linkages with other community-based clinical programs and with government-supported programs in the geographic departments served by CRS. The target population is people living with HIV and AIDS and their families.

BACKGROUND: CRS has been providing palliative care and anti-retroviral treatment (ART) in Haiti since 2004 with its AIDSRelief partners and OVC care through a local cooperative agreement with USAID. CRS is committed to working in collaboration with the Government of Haiti and is an active member of the Ministry of Health (MOH)'s care and treatment cluster, which has responsibility to define the national strategy for HIV/AIDS care. In addition, CRS has been one of the major partners implementing the Title II Food Program in Haiti and has been engaged in palliative care in Haiti by providing food to PLWHA for several years. Through this new program, CRS will augment the current services by providing nutritional, psychosocial and spiritual support to PLWHA in the South and Nippes Departments of Haiti.

With PEPFAR and Global Fund resources, a public sector network of counseling and testing (CT), palliative clinical care, PMTCT and ARV treatment sites has been established in each of these two departments and PLWHAs have been receiving a continuum of counseling, clinical care ART services, but with very limited community support.

With 2007 resources, the United States Government (USG) will support the expansion of these services to target more people, placing emphasis on a more integrated package of psycho-social, nutrition and preventive care support. CRS will develop networks and linkages with these public sector sites as well as with other local community-based organizations (CBOs) providing services to ensure a continuum of care for PLWHAs from the clinics to the communities. This increased emphasis on a continuum of care should enhance the effectiveness of these sites as entry points for the program. The program will continue to wrap around the Title II Food Program resources and the OVC programs that CRS is implementing in these departments and promote a family-centered approach.

ACTIVITIES AND EXPECTED RESULTS: Activity 1: CRS will reinforce logistical and human capacity in each of these two departments by hiring social workers, adding community workers and expanding office space. CRS will also identify and expand the capacity of local CBOs, particularly faith-based organizations through which services can be provided. CRS will coordinate with Family Health International (FHI) and Haitian Institute for Community Health (INHSAC) to train the community workers and establish a supervisory structure using national guidelines and curricula. CRS will contribute to the implementation of a community-based information system to track PLWHAs and to monitor services.

Activity 2: In each department, CRS will develop linkages to and a referral system with the CT, PMTCT, clinical care and treatment sites which will continue to detect and enroll PLWHA. Linkages will also be created with local CBOs providing expanded community services. CRS will work with the Ministry of Health (MOH) departmental staff and other local stakeholders to develop tools for this referral system. CRS will encourage and support regular departmental meetings to implement and monitor the system.

Activity 3: CRS will coordinate with other local organizations to expand and reinforce PLWHA support groups. CRS will provide resources to structure these groups according to national guidelines and enhance their roles in PLWHA education on HIV, stigma reduction, best health practices and adherence to treatment. CRS will provide space and operational costs for these groups. CRS will train religious leaders and other community groups to engage them in providing end-of-life support for PLWHA.

Activity 4: CRS will distribute commodities for safe drinking water, e.g., water vessels, chlorine and hygiene kits, to PLWHA and their families. CRS will also work with Global Fund and MOH partners to distribute treated bed nets to PLWHA for malaria prevention

according to the national guidelines. The commodities for safe water and hygiene kits will be procured through the Partnership for Supply Chain Management (PFSCM) while the bed nets will be obtained through the Global Fund partners. CRS will assist in implementing the logistics system for distribution of these commodities.

Activity 5: CRS will provide funding in each department for a PLWHA transit house located near an ARV center. CRS will also support micro-credit activities in coordination with private or other NGOs involved in this activity. This support will complement other social support that is being provided through the OVC program and through the clinics, such as transportation and school fees.

Activity 6: Nutrition services. Nutritional support will also be provided by linking recipients to the USAID Title II food assistance program and to the World Food Program (WFP). Some of the resources will be used to buy local food for a limited time frame to address critical shortages. For this activity, the CRS team will work closely with the sites assessing and monitoring the nutritional status of PLWHA to identify those are in greatest need of food.

Please see Activity 10110 for additional text added February 2008.

SUMMARY: CARE International receives support from the USAID bilateral health program to support the National TB Control program and, with PEPFAR FY 05 and 06 funds, has integrated HIV/TB interventions into this network in the Grand'Anse, NorthWest, Artibonite and Nippes Regional Departments. FY 07 funds are planned for the expansion and scale-up of services and will address these overall objectives: 1) Increase integration in 16 Directly Observed Therapy (DOTS) clinics in 4 departments with HIV Counseling and Testing (CT) and referral of all positive patients to anti-retroviral treatment (ART) sites for further care and treatments 2) Increase to 52 the number of DOTS clinics in 4 departments and link them to the TB/HIV network 3) Improve health professionals skills in HIV/TB to provide clinical prophylaxis and or treatment for TB/HIV infected individuals according to the national and international standards.4) Assure jointly supervision and Quality Assurance / Quality Control (QA/QC) through mobile coordinating teams. Specific target populations include: 600 HIV-infected clients attending HIV care or treatment. BACKGROUND: CARE has the institutional capacity to adequately support communities within its working area through an integrated approach which strengthen existing as well as newly created community networks. In addition CARE has been one of the leading private voluntary organizations (PVOs) providing supports to strengthen and expand the DOTS strategy in 4 departments: Grand'Anse, Nippes, Artibonite and North West, using both United States Agency for International Development (USAID) central funds and PEPFAR resources. Remarkable gains were made in the Grand'Anse and Nippes departments, where all targeted TB health centers have adopted the DOTS strategy, but services still need to be expanded in the Artibonite, the second most crowded department, and also in the North West which is among the poorest. With USAID funds resources, CARE will continue to strengthen and expand the DOTS strategy in these four targeted departments and will offer integrated HIV/Tuberculosis testing and palliative care. ACTIVITIES AND EXPECTED RESULTS: CARE will carry out activities in this program area: Activity 1: Linking of TB DOTS clinics with CT services: This involves provision of prophylaxis for TB to HIV infected individuals in a palliative care setting. 52 CT health facilities in the GrandÁnse (19), North West (17), Upper Artibonite (8) and Nippes (8) Regional Departments will be linked to the TB DOTS network of clinics so that proper referral will take place to offer preventive and curative treatment TB services to 600 HIV infected clients according to national and international standards. Improved identification of TB cases: Continue surveillance systems at all Diagnosis and Treatment Centers (CDT). Monitor changes in detection rates with health service providers at quarterly meetings; ensure adoption of necessary corrective measures. Ensure proper transport of mucus specimens/smears to CDTs and test results back to Treatment Centers (CTs). Identify and refer suspect cases. Activity 2: Community Mobilization Participation: Funds will be also used to implement information, education and communication / community coalition care (IEC/CCC) IEC sessions for non-health care professionals (e.g. journalists, policeman etc.). Monthly radio programs in 28 stations.(Grand'Anse 7- North West 8, Artibonite 9 Nippes 4) 200 awareness sessions in schools or youth clubs. Quarterly meeting per department with 400 voluntary treatment peer supporters to update information and ensure follow-up. 24 Information/awareness raising sessions in addition of the International TB day. Activity 3: Quality Assurance and Supportive Supervision: Special attention will be given to supervisory visits to ensure they are used as opportunities for training and quality control. 416 supervisory visits at DOTS institutions Activity 4: Training: This activity is designed to strengthen capacity of institutions and communities (at their respective levels) to provide counseling, detection and diagnosis, treatment and monitoring of TB cases. Specific trainings include: 20 additional health providers will be trained in TB/HIV integration prophylaxis IEC training (3 days) for 100 providers in Nippes and North West Departments; training of 10 additional lab technicians to perform screening HIV/TB tests; continued training sessions for 800 members of community volunteer's network; and TB/HIV management training for 21 field staff in Artibonite and North West Departments.

Targets

Target Target Value Not Applicable Number of service outlets providing treatment for tuberculosis (TB) 52
to HIV-infected individuals (diagnosed or presumed) in a palliative care setting Number of HIV-infected clients given TB preventive therapy 850
Number of HIV-infected clients attending HIV care/treatment 600
services that are receiving treatment for TB disease Number of individuals trained to provide treatment for TB to 52
HIV-infected individuals (diagnosed or presumed)

Table 3.3.08: Program Planning Overview Program Area: Orphans and Vulnerable Children Budget Code: HKID Program Area Code: 08 Total Planned Funding for Program Area: $ 7,539,070.00

Program Area Context:

Poverty and socio-economic hardship have made a significant number of children vulnerable to HIV/AIDS in Haiti, a country with the highest HIV seroprevalence in the region and where 40% of the population is aged less than 15 years. According to the latest Demographic and Health Survey (DHS), 21% of children under 18 years are either orphans or vulnerable children (OVC) and of those an estimated 200,000 to 300,000 are orphaned due to HIV/AIDS. In FY 2004 only one organization, an orphanage, received Track 1 funding for OVC activities. In FY 2005, the USG Team engaged additional partners in OVC activities focused on community-based interventions rather than orphanages and other institutions. These activities included support to foster parents and a package of services for OVC of educational, nutritional, and psychosocial support. For FY 2006 an even larger number of partners are involved in community-based OVC activities, creating a need for better coordination between partners, networking opportunities and a mapping exercise to identify gaps in OVC services.

In FY 2007, the USG Team will expand support to pediatric AIDS clinics and nongovernmental organizations (NGOs) working with OVC to provide a complete package of educational, nutritional, psychosocial and medical care, including antiretroviral (ARV) treatment. [See discussion of pediatric ARV services under anti-retroviral (ARV) Services Program.] Health personnel will be trained in pediatric HIV/AIDS and the necessary lab equipment and training for pediatric testing will be provided to build the capacity of the regional departmental hospitals in Cape Haitian and Cayes to provide basic palliative care and follow-up for HIV positive babies and children. The USG Team currently supports two sites in the Center Regional Department, in Cange (with Partners In Health - PIH) and Mirebalais (with Management and Resources for Community Health - MARCH), and one at Fonds des Negres in the Nippes Department (with Catholic Relief Services - CRS AIDS Relief) to deliver palliative care for children with HIV/AIDS. Support for the pediatric AIDS sites will be coordinated with United Nations Children's Fund (UNICEF), who provides opportunistic infection (OI) drugs for children with HIV/AIDS while the USG provides ARV drugs. With this leveraged support, in FY 2007, the USG Team will expand pediatric palliative care services to five of Haiti's 10 regional departments.

In FY 207, the USG Team will address several legal issues related to OVC, such as inheritance rights for orphans, HIV testing of HIV/AIDS orphans, protection against stigma and discrimination, and formalizing the responsibilities of those with guardianship of HIV/AIDS orphans. The USG Team works in close collaboration with UNICEF, the Ministry of Social Affairs and the Ministry of Health (MOH) which took an important step by organizing a National Forum in June 2006 on children orphaned or made vulnerable by HIV/AIDS where all stakeholders participated. Gender inequalities will be addressed by providing access to education and vocational training to young girls and support will be provided to efforts to uphold the right to a birth certificate, which are not given automatically at birth as 75% of births in Haiti take place at home.

For FY 2007, the USG Team will expand its support for OVC to cover all 10 regional departments, with a selection of partners that ensures coverage while avoiding overlap. The USG will encourage strong coordination between all the partners across the departments to ensure common approaches and sharing of experiences and skills to establish a national program in support of the Ministry of Health. These are the same partners that will also be supported by the USG to carry out community based palliative care in each regional department, to ensure maximum integration of AIDS activities at the community level. The North East Regional Department, currently the department with the fewest OVC services and no sites delivering either pediatric or adult AIDS services, will receive special attention in FY 2007. In FY 2006 the USG Team is providing funding for TB/HIV activities and support for the opening of an HIV/AIDS care and treatment site in the Fort Liberte regional hospital. The location of this regional department at the Haiti/Dominican Republic border puts children in the department at increased risk for trafficking and prostitution.

To expand the number of OVC identified and served, the USG Team will work to strengthen linkages

between NGOs involved in OVC activities and the organizations and institutions where OVC can be found: associations of people living with HIV/AIDS (PLWHAs), prevention of mother-to-child HIV transmission (PMTCT) sites and health centers delivering pediatric ART. Efforts will be made to ensure that every child born of a seropositive mother identified through a PMTCT site is enrolled in an OVC program and followed closely for the first few years of its life, to address the extreme vulnerability of these children to malnourishment, illness and death. Basic child survival interventions for under-five OVC, following the OGAC/PEPFAR Preventive Package of Care for Children 0-14 will be applied in all programs, recognizing the mortality risk of all children born to HIV-positive women, even those who escape mother to child transmission, especially in a country with high infant and under-five mortality rates. Identified infants from PMTCT programs will be provided a continuum of services which includes educating mothers on infant feeding options [see Infant and Youth Child Feeding activity under the PMTCT program area for education of HIV positive mothers], linkages with health centers for comprehensive well child care, providing products for safe water use at household for the family, and bed nets. In addition, the USG Team will support HIV screening of older siblings in the household.

The USG Team will strengthen linkages to micro-credit activities for families or care takers of OVC in increase income generation potential for poor families. For children beyond age 5 years, the USG Team will increase support for improving access to education leading to completion of primary education and completion of vocational training for adolescents to help foster self-sufficiency.

Food insecurity is a major problem in Haiti. The USG Team has been working closely with Title II PL 480 partners to address the issue of food support to PLWHA including children and also with the World Food Program (WFP). The WFP is providing substantial food support to HIV and TB patients as well as OVCs; nevertheless their capacity to respond to the overwhelming demand is limited. For FY 2007, the USG Team is seeking opportunities to increase local production of suitable and appropriate fortified foods for PLWHA. Partners like PIH/Zanmi La Santé are experiencing good results with the use of a food supplement, Akamil, in their patient population. The USG Team will work with a local NGO that is developing local production capacity of a peanut-based food, under the local name of Medika Mamba. Access to adequate, fortified food for pediatric AIDS patients will greatly improve the outcome of and adherence to ART.

A new activity will be initiated in FY 2007 to address the issue of street children, a particularly vulnerable population to HIV/AIDS through sexual exploitation. In addressing this population, the USG Team will collaborate closely with UNICEF and a number of faith-based organizations (FBOs) that have identified HIV infected street youth to provide access to medical care, education, vocational training and HIV services such as ARV as appropriate.

Program Area Target: Number of OVC served by OVC programs 45,000 Number of providers/caregivers trained in caring for OVC 8,474

Table 3.3.08:

Linked to Activities 10123, 8156.

SUMMARY: These OVC activities will expand and scale-up services through four main activities: 1) Improve services to OVCs, including addressing psychosocial needs, human rights protection, and legal and economic support after the death of a parent; 2) Improve OVC's access to health services; 3) Improve community capacity to address the needs of OVCs and foster families; 4) Link institutions to communities. Major emphasis areas are community mobilization/partnership; information, education, and communication; and training. Specific target populations include orphans and vulnerable children and caregivers (especially families affected by HIV/AIDS). Catholic Relief Services/Haiti (CRS/Haiti), in partnership with other networks propose to support OVC interventions in the entire Nippes and South Department to complement and expand existing OVC programs.

BACKGROUND:

CRS currently supports OVCs through institutions such as orphanages and the clinical services provided in their points of service. 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 OVCs affected by HIV/AIDS. During FY 2007 funding period, CRS will expand community support for OVCs and ensure that children have access to comprehensive HIV/AIDS services and adequate follow-up from the institution to the community and vice-versa. Wrap around resources will give OVCs access to the Title II food program, and the AIDSRelief and other PEPFAR HIV programs at the MOH sites. (key legislative issue). This program will be executed through the CRS community network and through the Caritas/Haiti youth network, a faith-based organization. CRS through health agents, social workers or other human resources will provide the linkages between the sites offering the HIV/AIDS services and the community .Identifying and follow up of the OVC infected or affected by HIV/AIDS will be made easier by focusing around the sites and CRS will provide a comprehensive package of education, access to health care, psychosocial support, dietary assessment, nutrition and food support. Additionally, access to safe water and income generating activities will be offered to families of OVC.

ACTIVITIES AND EXPECTED RESULTS:

ACTIVITY 1: CRS will improve psychosocial services for OVCs. OVCs of ages 8 to18 will participate in discussion with staff experienced, receive counseling to help them manage and restore/build self-esteem, and develop social and coping skills. They will receive comprehensive and accurate STD and HIV/AIDS education. Prevention messages will address specific situations that these children face that make them more vulnerable than other children to becoming infected in order to help them address stigma and discrimination.

ACTIVITY 2: CRS will ensure that OVCs' access to education and health services is improved by increasing the capacity of community members, specially caregivers, to care for HIV infected and/or affected children and by enrolling OVCs in primary health care and Integrated Management of Childhood Illnesses (IMCI) services in MCHN clinics in the area, and in schools through support of school fees, uniforms and other school costs. CRS will also increase linkages to HIV facilities through its community network to help identify HIV/AIDS vulnerable children and refer them to these facilities. Access to micro-credit services will enable families to engage in increased income generataion activities. ACTIVITY 3: Community Health Workers (CHWs) will be trained to sensitize and educate the general population about HIV/AIDS to reduce discrimination and stigmatization and to promote the respect for the rights of PLWHAs and children. CHWs will also develop the skills and knowledge to provide psychosocial support using the CRS psychosocial support guide as a curriculum and home-base palliative care to HIV/AIDS infected children. Community leaders, teachers, service providers, and support group members (eg, PLWHAs) will also be trained in order to reduce stigma experienced by PLWHAs, especially children (key legislative issue). Community and foster care will be encouraged. Specific education materials about infant and childcare will be developed for the families caring for

OVCs.

ACTIVITY 4: Funds will also be used to help Caritas implement its new HIV/AIDS strategic plan through capacity-building support for priests, members of Catholic religious orders and program managers in the care and support of OVCs.

These results will contribute to reach the 2-7-10 PEPFAR objectives by preventing new infections in youth and providing care to infected, affected children and their families.

Targets include 320 OVCs ages 8 to 18 participating in meetings and counseling on coping with bereavement and HIV/AIDS, 1,920 OVCs will receive care, support, and services through expanded services and links, 90 health service providers, 90 directors and schoolteachers, 60 community health workers, 100 PLWHA support group members and 120 caregivers will be trained.

SUMMARY: These OVC activities will expand and scale-up services through four main activities: 1) Improve services to OVCs, including addressing psychosocial needs, human rights protection, and legal and economic support after the death of a parent; 2) Improve OVC's access to health services; 3) Improve community capacity to address the needs of OVCs and foster families; 4) Link institutions to communities. The OVC program will wrap around the PEPFAR supported sites and complement the palliative care component to be developed by CARE as well to offer a comprehensive family-oriented package of services to PLWA and their families identified at the sites. Major emphasis areas are community mobilization/partnership; information, education, and communication; and training. Specific target populations include orphans and vulnerable children and caregivers (especially families affected by HIV/AIDS). CARE International, in partnership with other networks propose to support OVC interventions in selected areas of the Nippes, the Grand Anse, the Artibonite, and Northwest to complement and expand existing OVC programs. BACKGROUND: CARE supports OVCs through its network of community-based programs in 4 departments. CARE, with the Ministry of Health (MOH) and the Minister of Social Affairs, were active organizers of this year's first national forum on OVC with the objective of defining a national framework for the support to OVCs affected by HIV/AIDS. During the country operating plan (COP) 07 funding period, CARE will expand community support for OVCs and ensure that its program wrap around the PEPFAR supported sites and that children and dependants of PLWA identified at those sites have access to comprehensive HIV/AIDS services and adequate follow-up from the institution to the community and vice-versa. Wrap around resources will give OVCs access to the Title II food program, and PEPFAR HIV programs at the MOH sites. (Key legislative issue). This program will be executed through the CARE community network.

(Could not add Expected Results paragraph--no space.)