PEPFAR's annual planning process is done either at the country (COP) or regional level (ROP).
PEPFAR's programs are implemented through implementing partners who apply for funding based on PEPFAR's published Requests for Applications.
Since 2010, PEPFAR COPs have grouped implementing partners according to an organizational type. We have retroactively applied these classifications to earlier years in the database as well.
Also called "Strategic Areas", these are general areas of HIV programming. Each program area has several corresponding budget codes.
Specific areas of HIV programming. Budget Codes are the lowest level of spending data available.
Expenditure Program Areas track general areas of PEPFAR expenditure.
Expenditure Sub-Program Areas track more specific PEPFAR expenditures.
Object classes provide highly specific ways that implementing partners are spending PEPFAR funds on programming.
Cross-cutting attributions are areas of PEPFAR programming that contribute across several program areas. They contain limited indicative information related to aspects such as human resources, health infrastructure, or key populations programming. However, they represent only a small proportion of the total funds that PEPFAR allocates through the COP process. Additionally, they have changed significantly over the years. As such, analysis and interpretation of these data should be approached carefully. Learn more
Beneficiary Expenditure data identify how PEPFAR programming is targeted at reaching different populations.
Sub-Beneficiary Expenditure data highlight more specific populations targeted for HIV prevention and treatment interventions.
PEPFAR sets targets using the Monitoring, Evaluation, and Reporting (MER) System - documentation for which can be found on PEPFAR's website at https://www.pepfar.gov/reports/guidance/. As with most data on this website, the targets here have been extracted from the COP documents. Targets are for the fiscal year following each COP year, such that selecting 2016 will access targets for FY2017. This feature is currently experimental and should be used for exploratory purposes only at present.
Years of mechanism: 2008 2009
This activity is linked to activity ID 17889.08, 18077.08, 18950.08, 4617.08, 3910.08, 3886.08, 5463.08,
12424.08, 12420.08.
SUMMARY:
I-TECH will establish a subcontract with the Institut Haitien de Santé Communautaire (INHSAC) to provide
training in PMTCT for 377 health workers in Haiti. I-TECH and INHSAC will collaborate to continue to
provide leadership on supervision and quality improvement of PMTCT services, in partnership with the
principle service delivery networks in Haiti (MSPP, CRS/AIDS Relief, GHESKIO, PIH/ZL, and MSH).
BACKGROUND: INHSAC is a Haitian non-governmental organization established in 1985 to provide post-
graduate training in public health issues for health care workers. Under COP06, INHSAC was funded
through partner JHPIEGO to provide initial training in PMTCT for 200 providers from 26 clinic sites.
Principle partners in this effort were MSH, MSPP, and CRS/AIDS Relief. Under COP07, INHSAC is funded
through I-TECH to provide the 2-week PMTCT course to 55 health care workers from approximately 15 new
VCT/PMTCT/palliative care scale-up sites throughout Haiti. Training participants will be primarily
physicians, nurses, and auxiliary nurses from these sites. I-TECH is assisting INHSAC to improve the
existing curriculum by adding a practical focus on lessons learned from successful interventions in Haiti, to
include updated material on infant feeding, and to address other improvements noted during previous
training sessions.
In 2007-08, I-TECH and INHSAC will convene a quality improvement process involving key leaders from the
5 principle service delivery networks in Haiti. This process will follow the "breakthrough collaborative" model
pioneered by the Institute for Healthcare Improvement (IHI). I-TECH will sponsor and facilitate quarterly
meetings of the Haiti PMTCT "breakthrough collaborative" to find new ways to address old problems and to
share best practices. The process will be one of organizational self-study and learning, where I-TECH will
convene leaders from the service networks to learn about the quality improvement (QI) framework, set QI
aims, establish measures to track progress, and select interventions. With coaching from I-TECH
facilitators and their "breakthrough collaborative" peers, the leaders will test the interventions within their
networks through Plan-Do-Study-Act QI cycles, document results, and scale-up successful interventions. In
its facilitation role, I-TECH will provide resources and tools to the "breakthrough collaborative," such as
standardized tools for PMTCT supervision, and will provide technical assistance on customizing these tools
for use in Haitian contexts.
ACTIVITIES AND EXPECTED RESULTS:
ACTIVITY 1: I-TECH will continue collaboration with INHSAC to plan, deliver, monitor and evaluate PMTCT
training for 377 personnel in VCT/PMTCT scale-up sites. I-TECH will provide technical assistance to
continue to modify the INHSAC PMTCT curriculum to address changes in international or national PMTCT
guidelines, the changing landscape for early diagnosis of pediatric HIV infection through DBS/PCR testing,
new infant feeding guidelines, integration of Family Planning with HIV prevention activities, and other
issues. I-TECH and INHSAC will support technical update TOT sessions for INSHAC's network of trainers
to stay current with changing guidelines and best practices. They will include two new components: the
elaboration for each pregnant woman of a comprehensive birth plan that will include a PMTCT adherence
plan, and the review of the counseling curriculum that will include information and messages on Family
Planning.
ACTIVITY 2: I-TECH and INHSAC will continue to facilitate quarterly "breakthrough collaborative" sessions
related to quality improvement of PMTCT services. At each meeting, leaders from the service delivery
networks will share their experiences over the past several months in testing quality improvement
strategies, and share their learning about which interventions worked and which interventions failed. I-
TECH will provide a quality improvement specialist who will provide skilled facilitation as participants
analyze the experiences and make decisions about what to do next to reach quality improvement aims. I-
TECH and INHSAC will also assist the network leaders to document their progress in relation to their
established quality measures, and to disseminate information on the results of the "breakthrough
collaborative" process.
This activity contributes to PEPFAR 2-7-10 goals by supporting workforce capacity to provide high-quality
HIV prevention, testing, and care services.
EMPHASIS AREAS:
Training (major area) 51%-100%
Quality assurance/quality improvement/supportive supervision 10%-50%
Development of network/linkages/referral systems 10%-50%
Information/education/communication 10%-50%
TARGETS:
1.Improved knowledge, skills, and attitudes in PMTCT for 377 health care workers.
2.Demonstrate improvements in established PMTCT quality measures across 5 service delivery networks.
TARGET POPULATIONS:
Health care workers
People affected by HIV/AIDS
HIV positive pregnant women
HIV positive infants and children
COVERAGE AREAS: All geographic regions receiving PEPFAR support for PMTCT services.
This activity is linked to activity ID 9725.08, 18077.08, 18950.08, 4617.08, 3910.08, 3886.08, 5463.08,
As a new activity in FY08, ITECH will implement CDC's training course "Prevention within the Care and
Treatment Setting" course. This will train counselors and social workers to utilizing CDC's module to
implement prevention with positives within the care and treatment facilities. ITECH will be responsible for
ensuring the materials are culturally appropriate for use in Haiti, will translate all materials, and will conduct
the trainings. CDC will give TA before and during the training. This program is split funded with OP funds.
BACKGROUND:
HIV prevention efforts have primarily focused on HIV-negative individuals; but in countries like Haiti, where
the main mode of transmission is heterosexual, it demands greater attention on prevention for HIV-positive
individuals. The HIV Prevention in Care and Treatment Settings was adapted by the CDC from Partnerships
in Health. This evidence-based intervention resulted in a decrease in reported sexual risk behaviors among
HIV-positive patients who received brief prevention messages from their healthcare providers.
Activity 1: ITECH will adopt, translate, and reproduce the training and program implementation toolkit
"Prevention within the Care and Treatment Setting". This toolkit was developed by CDC and field tested in
FY06 with select PEPFAR partners. ITECH will adopt each portion of the materials (training, implantation
tools, etc) to ensure they are culturally appropriate for use in Haiti, and will translate them into Haitian
Creole. They will reproduce the toolkit for use in 20 care and treatment centers.
Activity 2: ITECH will conduct the training module of the toolkit for counselors and social workers who work
within the selected care and treatment centers. Two counselors/social workers from 20 centers will be
trained for a total of 40 trained. The training course will take 2 days, and will end with a certification of
training and distribution of materials for implementation. ITECH will be responsible for oversight of the
counselors/social workers to ensure that they are implemented the course, and to provide feedback and
clarification on implementation. CDC will provide TA before and during the training course. As a result of
this activity, 40 counselors/social workers will be trained and will provide prevention within the care and
treatment setting, reaching 10,000 HIV positive individuals.
EMPHASIS AREA:
Training 10-50
Information, Education and Communication 10-50
# of targeted condom service outlets: N/A
# of individuals reached through community outreach that promotes HIV/AIDS prevention through other
behavior changes beyond Abstinence and/ or Being faithful: 10,000
# of individuals trained to promote HIV/AIDS prevention through other behavior changes beyond Abstinence
and/ or Being faithful: 40
Healthcare providers
PLWHA's
COVERAGE AREAS:
the trainings. CDC will give TA before and during the training.
This activity is linked to activity ID 9725.08, 17889.08, 18950.08, 4617.08, 3910.08, 3886.08, 5463.08,
Creole. They will reproduce the toolkit for use in 30 care and treatment centers.
within the selected care and treatment centers. Two counselors/social workers from 30 centers will be
trained for a total of 60 trained. The training course will take 2 days, and will end with a certification of
this activity, 60 counselors/social workers will be trained and will provide prevention within the care and
treatment setting, reaching 15,000 HIV positive individuals.
behavior changes beyond Abstinence and/ or Being faithful: 15,000
and/ or Being faithful: 60
PLWHA
Nationwide
I-TECH will develop a training package of palliative care, home-based care, nutrition services, as well as
management and leadership of community-based HIV/AIDS service organizations (ASOs). I-TECH will
collaborate with the non-governmental training center Institut Haitien de Santé Communautaire (INHSAC) to
provide training and technical assistance for institutional development of ASOs in all departments in Haiti.
Since 2004, I-TECH has supported INHSAC to develop an integrated HIV counseling curriculum. I-TECH
has produced a video drama on anti-retroviral therapy (ART) adherence issues (Chans), in partnership with
a local video production company (Agence des Jeunes Producteurs) formed and staffed by PLWHA. I-
TECH supported dissemination of this film through media television screenings, distribution to partner
organizations working in HIV/AIDS, and through 15 facilitated screening sessions for PLWHA and youth
groups. Working with local experts from several partner training institutions, I-TECH included a module on
psychosocial support, case management, and adherence support strategies within the national anti-
retroviral drugs/opportunistic infection (ARV)/(OI) curriculum, validated and disseminated in 2007. In 2007-
08, I-TECH plans to add modules on nutrition and palliative care for Version 2 of the national ARV/OI
curriculum.
ACTIVITY 1: In consultation with partners including MSPP, INHSAC, Partners in Health (PIH), Family
Health International (FHI), Foundation for Reproductive Health and Family Education (FOSREF), and
PLWHA associations and service organizations (ASON, POZ), I-TECH will inventory existing training
resources available in Haiti related to palliative care, home-based care, nutrition, and management and
leadership, and assess training needs of ASOs. I-TECH will work with these partners to define the desired
contents of a unified training package to support all aspects of institutional capacity development for ASOs,
including both programmatic/technical content and management domains. In this process, I-TECH will
bring to bear technical expertise on theoretically-grounded, innovative strategies for training, with methods
and materials that are appropriate to desired competencies. I-TECH will also share examples of related
materials from other resource-limited settings, for potential translation and adaptation to Haiti. I-TECH will
define a detailed work plan for development of the various elements of the training package, including plans
for further formative evaluation of certain elements of the training package. For example, for any video
products within the training package, I-TECH will review scripts and story boards with stakeholders
(focusing on the national MSPP technical advisory group on IEC (spell out), the Cluster CCC (spell out))
and/or focus groups prior to filming, to assure that the final materials produce appropriately emphasize key
messages, are culturally relevant, and are appropriate to the Haitian context.
I-TECH will provide external technical expertise for developing various elements of the training package, as
needed. Specifically, I-TECH will engage a specialist in HIV and nutrition to inform the content of material
on nutrition, according to international nutrition guidelines, as appropriate for Haiti. I-TECH will also engage
a specialist in management and leadership of community-based organizations.
ACTIVITY 2: I-TECH will contract with training partner INSHAC to conduct regional trainings using the
training package, for personnel from ASOs and other community-based organizations in each department. I
-TECH will complete a training of trainers (TOT) with INSHAC trainers, using I-TECH trainers and external
technical experts to deliver the TOT. INHSAC will deliver a pilot training in one department using the
completed training package, and I-TECH will use the findings from the pilot to refine the training package.
INSHAC will deliver the training package to the remaining departments. I-TECH and INHSAC will
collaborate to provide quarterly follow-up technical assistance visits to the primary ASO identified in each
department, with coaching in management and leadership and program domains. I-TECH and INHSAC will
also organize and sponsor an annual conference for the regional ASOs to share best practices and lessons
learned. The quarterly coaching visits and the annual conference will support the ASOs to develop as
strong regional organizations capable of fostering linkages between local initiatives in a variety of sectors
(microfinance, nutrition, agricultural development, etc.) and patient support initiatives that are capable of
building programmatic expertise in HIV/AIDS issues across these local networks and capable of advocacy
for PLWHA.
Information/education/communication (Major) 51%-100%
Training 10%-50%
Local Organization Capacity Development 10%-50%
Community Mobilization/Participation 10%-50%
Linkages with Other Sectors and Initiatives 10%-50%
1.Train at least 100 personnel from community-based AIDS service organizations in programmatic and
management excellence.
2.Capacity development for 10 AIDS service organizations in each department.
People affected by HIV/AIDS, including PLWHA and OVC
Special populations, including most at risk populations
Groups/organizations, including community-based organizations, faith-based organizations, and non-
governmental organizations
COVERAGE AREAS: All geographic regions receiving PEPFAR support for HIV care and treatment
services.
This activity is linked to activity ID 9725.08, 17889.08, 18950.08, 3910.08, 18077.08, 4617.08,3886.08,
5463.08, 12424.08.
I-TECH will add training on effectively working with orphans and vulnerable children (OVC) and their
caregivers to a standardized training package for clinic and community-based personnel. In partnership
with the non-governmental training center Institut Haitien de Santé Communautaire (INHSAC), I-TECH will
train at least 400 social workers, community health agents, community based organizations (CBO) and non-
governmental organization (NGO) staff, and community leaders from across Haiti's 10 departments, using
the standardized training package. I-TECH will also provide on-going technical assistance to 10 regional
HIV/AIDS service organizations (ASOs) for institutional development and leadership with respect to OVC
In 2007, I-TECH received "PlusUp" funding to develop a standardized training package related to OVC, and
to conduct training of training (TOT) sessions with partners intervening in this domain. To advance this
goal, I-TECH will use the "PlusUp" funds to fund technical assistance and training from two of its existing
partners in Haiti: the University of Medicine and Dentistry of New Jersey's Francois Xavier Bagnaud Center
(FXB), and INHSAC. FXB will develop a standardized training package focused on: community mobilization
to identify and refer OVC; psychosocial issues for OVC by age, gender, and caregiver status (covering
trauma, grief and loss, and self-esteem issues); effective programmatic strategies to meet basic OVC needs
(food/nutrition, shelter and care, protection and human rights, health care, education, and economic
support); creating effective community linkages with faith communities, small business/micro-credit,
schools, etc. and; empowering caregivers and OVC peer leaders. The training package will be targeted to
social workers and community agents, and will use culturally-relevant content and engaging adult learning
methodologies. FXB has long-standing experience in developing psychosocial training materials for
pediatric HIV care providers in the United States (US) and international settings, and for global pediatric
clinical trials training programs.
I-TECH, FXB, and INHSAC will collaborate to carry out two training of trainers sessions on the training
package, reaching at least 60 trainers from INHSAC, the Ministries of Health, Education and Social Affairs,
and from other organizations involved in OVC support, such as Family Health International, World Vision,
Care International, and the Association of Evangelical Relief and Development Organizations HIV/AIDS
Alliance.
With COP 2008 resources, I-TECH will build on this experience by adding to the training package and
extending training to clinic and community-based personnel who work with OVC and their caregivers.
ACTIVITY 1: I-TECH will partner with FXB to enhance the basic OVC training package by adding a fully-
developed module on nutrition for children and adolescents with HIV (age six months - 18 years). While
attention has been given to developing Haiti-specific infant feeding guidelines and training, there is a lack of
national HIV and nutrition guidelines for older children and adolescents. FXB has leading expertise in
nutrition across the pediatric age spectrum which they have used to shape US guidelines and have
provided technical assistance in settings in Africa and South America. I-TECH will link with the Food and
Nutrition Technical Assistance Project (FANTA) and the Infant and Young Child Nutrition Program (IYCN)
projects to avoid duplication.
I-TECH will also supplement the training package by producing a drama or set of trigger films on OVC
themes which can be used to shape attitudes and skills among professional and volunteer "helpers" and
caregivers. I-TECH will work with a local video production company, Agence des Jeunes Producteurs,
formed and staffed by young PLWHA, which helped I-TECH produce the Creole-language ARV drama
Chans. I-TECH will review scripts and story boards with stakeholders (including organizations working with
OVC) and target audience focus groups prior to filming, to ensure that the final materials produced
appropriately emphasize key messages, are culturally relevant, and are appropriate to the Haitian context.
training package, reaching social workers, community health agents, CBO and NGO staff, community
leaders, and OVC and caregiver peer educators in each department. I-TECH will recruit and hire an OVC
training specialist who will reinforce the INHSAC training team in planning, delivering, and evaluating the
trainings. This OVC training specialist will be based in the I-TECH office, and will be jointly supervised by I-
TECH and FXB. The training team will deliver one to two pilot trainings in one department, and use the
findings to refine the training package. The team will deliver the training package to the remaining
departments, reaching at least 40 participants per department.
The training team will also collaborate to provide quarterly follow-up technical assistance visits to the main
regional HIV/AIDS ASO in each department, with coaching in effective strategies to identify and serve OVC.
With other stakeholders, including various Ministries and UNICEF, I-TECH will co-sponsor an annual
conference on OVC issues to share best practices in serving this population. This strategy will link with I-
TECH's efforts in institutional development of community-based palliative care services. The departmental
training sessions, the quarterly coaching visits, and the annual conference will support departmental ASOs
to develop as strong regional organizations with programmatic expertise in OVC issues, capable of building
linkages with caregivers and community groups to nurture the healthy development, education, economic
support, and social support for this most vulnerable population.
Training 51%-100%
1.Training of at least 400 personnel from community-based AIDS service organizations, clinics, and
community-based organizations in caring for OVC.
Activity Narrative: governmental organizations
5463.08, 12420.08.
training in voluntary counseling and testing (VCT) (including rapid testing) and psychosocial support
services for 250 health workers throughout Haiti. With technical assistance from I-TECH on tools and
curriculum development, INHSAC will also train and support a network of personnel to provide supportive
supervision to VCT providers.
In 2004-05, I-TECH supported INHSAC to develop a HIV counseling curriculum covering VCT, anti-
retroviral therapy (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 (key
legislative interest areas). INHSAC completed a training of the trainer (TOT) session for 20 trainers, and
completed training 181 health workers. Under COP 2006, INHSAC received funding directly from the
United States Government (USG) to train 50 health care workers in HIV counseling, focusing on institutions
working with vulnerable populations such as community social workers, police, and truck drivers.
In 2007, I-TECH renewed its partnership with INHSAC to deliver three training courses: 1) a one-week
course on pre- and post-test counseling and rapid HIV testing for 150 health workers from VCT scale-up
sites; 2) a two-week in-depth course on integrated HIV counseling for 50 counselors, social workers, and
other personnel responsible for psychosocial support programs in clinic and community-based settings; and
3) a two-week preventing mother to child transmission (PMTCT) course for 55 providers at PMTCT scale-up
sites. INSHAC is continuing its collaboration with the National Public Health Reference Library (LNSP) for
experienced laboratory trainers to deliver the rapid testing portion of training during the one-week VCT
courses. At the same time, INHSAC is developing its capacity to directly provide rapid test training by hiring
two laboratory trainers and renovating a training room in their Port-au-Prince training center to support rapid
test training (adding sinks, counters, etc.). As INHSAC assumes responsibility for this portion of training,
the LNSP will continue to partner with INHSAC in a quality assurance role. I-TECH is providing technical
assistance to INHSAC in strengthening the content and presentation of its training materials, to address
areas of improvement noted in earlier use of the materials—such as including content on orphan and
vulnerable children (OVC) in the integrated HIV counseling curriculum, and improving organization of
participant manuals.
ACTIVITY 1: I-TECH will continue collaborating with INHSAC to plan, deliver, monitor, and evaluate VCT
training for 200 personnel in clinic and community-based VCT settings. INHSAC will advocate for the
recruitment and training of PLWHA as counselors. I-TECH will support INHSAC to customize the training
package for personnel from community-based confidential and anonymous test sites and/or for personnel
working in opt-out programs in clinic settings, if needed. I-TECH and INHSAC will also review the
curriculum package to be sure it reflects the best practices in service delivery to most at risk populations.
INHSAC will continue to collaborate with the LNSP as it provides quality oversight of rapid test training and
applies QA/QC protocols at trainee sites.
ACTIVITY 2: INHSAC will provide in-service training (a three week course) on in-depth psychosocial
support to PLWHA and their families for 100 counselors, social workers, and other key personnel from clinic
and community-based care and treatment programs. INHSAC will also provide advanced-skills update
training to 60 personnel who have already participated in a basic psychosocial support course. I-TECH will
provide technical assistance to INHSAC to further refine the curricula for the basic and update courses to
include newly-developed materials, in areas such as prevention for positives and working with victims of
sexual assault.
ACTIVITY 3: INHSAC will implement a supportive supervision program, focusing on reinforcing counseling
skills. The program will involve a group of approximately 30 VCT and HIV counseling trainees (three per
department), who demonstrated excellence and leadership during training. I-TECH will provide technical
assistance to INHSAC to develop standardized supervision tools and to design a curriculum on quality
standards, supervision skills, motivating staff, documenting feedback, handling stress and burn-out, and
other areas. Following training as supportive supervisors, these personnel will visit trainee sites, observe
their peers in practice, provide supportive feedback, and report to INHSAC on their findings. Prior to
including candidates in the supportive supervisor training, INHSAC will coordinate with employers to release
the relevant personnel during one week per quarter to provide supportive supervision to other trainees.
INHSAC will provide planning and coordination of supportive supervision visits, and will provide output-
based stipends and travel expenses for the supportive supervisors. INHSAC will make at least two site
visits per department to oversee the program, and will convene the group on a semi-annual basis to identify
commonly-observed problems and strategies for improvement. INHSAC will continue to link with the
National Public Health Reference Laboratory (LNSP), which is responsible for the HIV rapid testing QA/QC
protocol, to assure technical supervision on rapid testing for INHSAC trainees.
1.Improved knowledge, skills, and attitudes in VCT (pre- and post-test counseling and rapid testing) for 200
health care workers.
2.Improved knowledge, skills, and attitudes for in-depth psychosocial support services for 180 health care
workers.
3.Supportive supervision encounter to at least 200 trainees following training.
Activity Narrative: Special populations
I-TECH will provide clinical mentorship, training and technical assistance for high quality HIV care and
treatment across the network of PEPFAR-supported ART scale-up sites. I-TECH will also support staffing
and clinic operating costs at Hopital Nos Petits Freres et Soeurs (NPFS) in Port-au-Prince and Hôpital
Universitaire Justinien (HUJ) in Cap Haitien.
Since 2004, I-TECH has partnered with University of Miami and HUJ to extend HIV clinical care and to
serve as a regional center for training and technical assistance in the North Department. Also since 2004, I
-TECH has partnered with Cornell University to place full-time resident technical advisors at les Centres
GHESKIO, in support of its training and mobile supervision teams. Since 2005, I-TECH has supported 2 full
-time clinical mentors for the National University Hospital (HUEH), Haiti's largest facility and primary
teaching hospital, to support ARV scale-up. Since 2005, I-TECH has partnered with the University of
Medicine and Dentistry of New Jersey-Francois Xavier Bagnaud Center (FXB) to provide HIV pediatric
guidelines development and clinical training to 3 pediatric hospitals. I-TECH's contract with one pediatric
site, NPFS, for ARV service delivery, also began in 2005. I-TECH's ARV services extension involves both
public and NGO-sector facilities, and I-TECH has collaborated closely with National and Departmental
Ministry of Health (MSPP) counterparts in realizing these programs. Through these activities, as of May
2007, I-TECH has supported extension of HIV clinical services to approximately 600 patients (with 150 on
ART) at HUEH, approximately 1700 patients (with 600 on ART) at HUJ, and approximately 170 patients
(with 65 on ART) at NPFS.
ACTIVITY 1: I-TECH will continue its contract with University of Miami to extend HIV care and treatment
services in the North Department and to consolidate HUJ as a Regional Center of Excellence for HIV
Clinical Training. Through a subcontract with HUJ to support personnel, supplies and materials, and patient
support services, UM will extend HIV care and treatment to 2500 patients, with 1000 on ART. UM will
provide on-going supervision of within the Family Practice Center (FPC) at HUJ, the primary site for
outpatient HIV care, and will provide mentorship and leadership in coordinating program activities within
other units of HUJ, including the Preventive Medicine Service, which is responsible for community-based
care services and ART adherence support. UM will also plan, deliver, monitor, and evaluate HIV clinical
training for health care workers including: 12 family practice residents in a 3-year residency program; at
least 20 providers from VCT/PMTCT scale-up sites in 6-week intensive clinical courses; 15 advanced
nurses; and 175 students, interns, and North Department providers in basic HIV courses. Finally, UM will
provide on-site training and technical assistance for launch of at least 5 new VCT/PMTCT/palliative care
scale-up sites, and will supervise at least 15 sites within the North Department's HIV care referral network.
ACTIVITY 2: I-TECH will continue its contract with Cornell for placement of one HIV clinical specialist (MD)
and one senior laboratory specialist (MD, PhD) at GHESKIO. GHESKIO is responsible for training, on-site
technical assistance, and quality assurance to 14 ARV scale-up sites in Haiti. Cornell advisors will reinforce
GHESKIO in addressing advanced HIV care issues (resistance, adherence, chronic illnesses associated
with greater survival, integrated care spanning adult, pediatric and PMTCT services), and in implementing
new laboratory technologies for surveillance of drug resistance in Haiti. Cornell will assist GHESKIO
trainers to improve HIV clinical training courses, will carry out monthly site visits with mobile supervision
teams, and will provide monthly in-service sessions for GHESKIO colleagues. Finally, the Cornell advisors
will provide technical expertise to the MSPP in developing national care and treatment guidelines, protocols
and standard operating procedures (SOPs), and training curricula..
ACTIVITY 3: I-TECH will continue to lead improvements in quality of care and access to HIV services at
HUEH, through placement of 5 full- and part-time HIV clinical mentors. Mentors will complete patient
rounds, chart reviews, and case conferences with residents, interns, and medical students in the infectious
disease unit and the pediatric units of HUEH, with emphasis on ART management, TB/HIV co-infection, OI
prevention, etc. I-TECH will support French translation of the I-TECH Clinical Mentoring Toolkit and will
produce a trigger video on skills for quality clinical mentoring/practicum training. To support professional
development among lead trainers at HUEH, I-TECH will sponsor 6 people (I-TECH clinical mentors and
HUEH counterparts) to attend the annual I-TECH Clinical Summit or other external study tour.
I-TECH will also collaborate with the Center for Information and Training in Health Administration (CIFAS),
an MSPP training unit co-located at HUEH, to continue to provide 3-week theoretical and practical training
sessions for junior and mid-level providers from throughout Haiti. I-TECH will also assist CIFAS to launch a
3-, 6-and 12-month competitive fellowship programs for junior physicians (20 per year). Fellows will spend
mornings on the wards and in outpatient clinics managing HIV+ patients, including patients with TB/HIV co-
infection, and afternoons rotating through other services or in seminars related to best clinical practice,
management and leadership skills, quality improvement strategies, and other topics. I-TECH clinical
mentors and curriculum developers will collaborate to apply Version 2.0 of the national ARV/OI curriculum,
to expand the module on OI and TB management, and to adapt and apply other material from a successful
1-year fellowship program coordinated by the I-TECH India program. I-TECH will also cover living stipends
for the fellows.
ACTIVITY 4: I-TECH will continue its nursing initiative at HUEH, with the goals of enhancing the role of
nurses within HIV care team and of training advanced practice nurses capable of providing primary clinical
management of stable HIV patients. I-TECH will hire a second HIV nurse mentor, to join the one hired in
2007. Both will collaborate with nursing supervisors at HUEH to deliver theoretical training sessions on HIV
patient management, patient education, nutrition, and other topics for nurses from all service units at HUEH.
The nurse mentors will also supervise nursing students completing rotations in the HIV outpatient clinic. I-
TECH will work with the leadership of HUEH to continuously evaluate the role of nurses relative to care
protocols and patient flow patterns, to optimize the level of responsibility of nurses and improve patient care.
I-TECH will also initiate a training program for 15 nurse fellows to complete a 6-week course in advanced
Activity Narrative: nursing. Participants will be drawn from scale-up sites throughout Haiti, where health care human
resources are lacking, and where nurses must step into a lead role in managing HIV patients. The program
will include one-week of on-site mentoring for the nurses back at their clinic sites. I-TECH will fund partner
UM to conduct a parallel program at HUJ in Northern Haiti, and will support 2 annual exchange visits
between leads of the 2 programs to share experiences and lessons learned.
ACTIVITY 5: I-TECH will contract with FXB and NPFS for pediatric HIV clinical training and extension of
ARV services. FXB will support the MSPP to develop a national pediatric and PMTCT services scale-up
plan, to complement the National HIV Strategic Plan for 2007-11. FXB will also assist MSPP on update and
dissemination of the national pediatric care and treatment guidelines, with a new module on case finding
and other support tools such as a pocket reference guide. FXB will also continue a Haiti listserv and
newsletter for quarterly pediatric HIV updates. FXB will provide on-going quarterly clinical mentorship visits
in the pediatric and OB/GYN units of 4 public-sector hospitals in the South, Grand Anse, South East and
North Departments. These visits will focus pediatric case finding, linkages with PMTCT programs,
multidisciplinary team approaches, advanced issues in pediatric care, and quality improvement planning.
FXB will also provide technical assistance to NPFS to serve as a national Center of Excellence (COE) in
pediatric HIV clinical training. Finally, FXB will conduct a systematic evaluation of on-the-job practices of
clinicians who participated in clinical mentoring or study tour activities.
NPFS will expand its cohort of pediatric HIV patients to approximately 420 patients (with 210 on ART) by
March 2009, and will provide VCT services to approximately 2,500 children and family members. NPFS
services are offered without charge to patients, and include clinical monitoring of infants and children with
HIV, hospitalization, monthly home visits for infants and children on ART, and psychosocial support
services. As a national COE, NPFS will partner with I-TECH on a program to host up to 20 providers for
theoretical and clinical practicum training at NPFS and HUEH.
I-TECH will extend implementation of a laboratory information management system (LIMS) within the
network of United States Government-supported anti-retroviral therapy (ART) sites. I-TECH will also support
professional development for laboratory personnel through advanced training opportunities and through
capacity-building activities with the national Association of Laboratory Technicians.
In 2007, I-TECH initiated the process of identifying an appropriate LIMS for Haiti. In June, in collaboration
with a laboratory specialist from CDC's Global AIDS Program, I-TECH completed an initial visit to Haiti to
review with stakeholders the process of requirement gathering and LIMS selection. The process will
roughly follow the Association of Public Health Laboratories (APHL)/PEPFAR Guidebook for
Implementation of Laboratory Information Systems in Resource Poor Settings. I-TECH is planning a
detailed assessment of work- and information-flow at various levels of laboratories for August 2007,
followed by a national consensus meeting to validate requirements in September 2007. I-TECH will
evaluate existing commercial and non-commercial LIMS systems against the Haiti-specific requirements
and recommend a system for implementation. To meet COP 2007 deliverables, I-TECH will support
implementation of the LIMS in three to four sites through hardware and software installation and user
training. I-TECH will also develop an interface between the LIMS and the national Minister of Health and
Population's (MSPP) HIV Electronic Medical Record (EMR), a system in use in 24 sites with records for
approximately 8,000 patients as of June 2007. I-TECH has worked closely with CDC and MSPP since 2005
to develop and implement the EMR system.
In 2007, I-TECH hosted a 10-week course through the University of Washington's Laboratory Technologist
Training Program for four Haitian laboratory professionals, and will sponsor personnel from the LNSP to
attend training in use and maintenance of the PointCare automated CD4 analyzer, in Boston. I-TECH will
also provide external technical assistance to develop and deliver a lab equipment upkeep and maintenance
course to be integrated into the standardized pre-service lab curriculum.
ACTIVITY 1: I-TECH will continue collaboration with CDC/Haiti, CDC/GAP Atlanta, and Haiti MSPP to
extend the LIMS from the initial three to four sites to a total of 10 sites by March 2009. I-TECH will continue
to coordinate with the selected LIMS vendor or developer to address feedback from users at the initial sites
to improve the system for the Haiti context. I-TECH will procure and install necessary hardware (servers,
backup power supplies, local area networks, etc.) for new implementation sites, in collaboration with CDC's
Regional Information Officers (RIOs) and site personnel. I-TECH will deploy four in-country staff members
(one part-time Health Information Systems program manager, one part-time Laboratory Advisor, one IT
Technical Advisor, and one full-time LIMS trainer) in support of implementation. I-TECH will develop a
training module on the LIMS system and implement workshops for users at new sites. I-TECH staff will
then provide follow-up on-site training and technical assistance for successful use of the system. Training
and technical assistance will emphasize use of the LIMS tool to improve quality of lab services and to aid
decision-making for laboratory program management. Through an on-going partnership with the University
of Washington's Clinical Informatics Research Group and expert consultants, I-TECH will provide technical
support to Haiti staff and partners, coordinate with the system vendor or developer, assure reliable interface
between the LIMS and EMR system, and guide on-going system maintenance.
ACTIVITY 2: I-TECH will provide technical assistance to the MSPP National Public Health Reference
Laboratory (LNSP) in collaboration with CDC in the development of standardized paper-based tools for lab
information management. These tools will complement the LIMS in sites where resources or infrastructure
are not available to support use of an electronic LIMS. Such tools are needed to support best practices and
to improve the efficiency of information management at sites, which in many cases use improvised hand-
written laboratory order slips, laboratory results forms, results registers and logs, etc. I-TECH will
collaborate with the LNSP to print and disseminate standardized tools to all concerned sites, and to provide
training to laboratory personnel on their use.
ACTIVITY 3: I-TECH will support professional development of laboratory personnel in Haiti by offering
advanced training opportunities. These opportunities for professional growth and mastery of new skills
represent an important strategy for promoting job satisfaction and retention of personnel. Training activities
will include replication of three regional workshops on Laboratory Management and Leadership, in
partnership with APHL for 36 laboratory directors.
ACTIVITY 4: I-TECH will also promote the laboratory technician profession in Haiti through a partnership
with the Haitian Association of Laboratory Professionals. I-TECH will provide technical assistance and
funding to the Association to develop and disseminate a quarterly newsletter and to host an annual
conference. The goal of both activities will be to provide scientific updates, and to instill a culture of
professional excellence. I-TECH will assist the Association to sponsor an award for professional
excellence, with a structured application and selection process, and donations of laboratory equipment to be
made to the two national laboratory schools in honor of the awardees.
Strategic information/HMIS (Major)51%-100%
Infrastructure10%-50%
Development of network/linkages/referral systems10%-50%
Human resources10%-50%
Training10%-50%
•Extension of LIMS meeting Haiti's functional specifications at laboratories for 14 ARV sites, including
hardware and software installation.
•Workshop and on-site training of at least 10 people per site in use of the LIMS.
•Standardized paper-based tools for laboratory information management (order slips, individual patient
results records, testing, and results registries), for dissemination by NPHL.
•Laboratory Management and Leadership workshops reaching 36 lab directors
•Quarterly professional newsletter to reach 200 providers, and annual laboratory conference reaching 100
Activity Narrative: people.
General population
Health care providers, especially laboratory workers
MSPP staff
Groups/organizations which provide laboratory services
COVERAGE AREAS: All geographic regions receiving PEPFAR support for HIV testing and clinical
This activity is linked to activity ID 9725.08, 17889.08, 18950.08, 4617.08, 18077.08, 3886.08, 5463.08,
I-TECH will support extension of the MSPP electronic medical record (EMR) system for data management
and reporting on HIV care services. I-TECH will adapt the system to meet data needs at decentralized
sites. I-TECH will conduct targeted program evaluation on transfer of learning following in-service training
of physicians at HUEH, and on process and outcomes of a curriculum strengthening and faculty
development process at the four national nursing schools.
Beginning in 2005, I-TECH collaborated with MSPP, CDC, and other partners in the development of a
standardized set of paper-based adult and pediatric HIV medical records. I-TECH then launched a pilot
version of the electronic medical record system, and built enhancements to the application over time
through successive release versions. As of June 2007, 24 anti-retroviral therapy (ART) sites in Haiti had
begun to use the system, with data from approximately 8,000 patients captured. The system is designed for
flexible use depending on a site's IT infrastructure, with ability to use the system via the web or through
hosting on a local server. The system includes an automated replication function so that data from sites
hosting the system on local servers are regularly replicated to a central back-up server. The central back-
up server provides access to de-identified data for national program reporting. As of June 2007, four clinics
were using the system through local servers, meaning they could use the system without being dependent
upon sometimes slow or sporadic internet connections. I-TECH and CDC plan to support further
deployment of the system on local servers to improve usability.
By March 2008, I-TECH also plans to deploy a point-of-care version of the application with tabbed interface,
extensive drop-down menus, and embedded decision support features. I-TECH also plans to develop
interfaces between the EMR and several other information tools in Haiti: a laboratory information system
(LIS) to be selected for implementation; the pharmacy information tool supported by Supply Chain
Management Systems (SCMS); and the MESI system for presentation of aggregate health program data.
The interfaces will minimize duplication of effort by site personnel in managing patient information and
reporting.
Since 2005, I-TECH has collaborated extensively with local partners, such as CDC, Institut Haitien
d'Enfance (IHE), and HUEH to provide training on use of the EMR system to clinicians, data clerks, and
data managers. I-TECH's HIV clinical mentors train fellow clinicians on the relevance of complete patient
data for quality HIV care, on appropriate use of medical records, and on how to interact with the EMR
system to obtain summary information useful for patient care. I-TECH's EMR technical advisor provides
training to data management personnel through workshop-based and on-site training, supports
configuration and installation of local servers, and provides other computer maintenance support at sites
using the system.
With existing I-TECH staff and consultants and in partnership with CDC's Regional Information Officers
(RIOs), Tulane UTAP, and others, I-TECH is focusing on reinforcing data quality and data completeness
among users of the system, through training and on-site technical assistance. I-TECH will collaborate with
these partners to refine data quality protocols and implement systems for regular data quality audits. By
March 2008, I-TECH will support data analysis and dissemination of findings on key questions of interest.
For example, I-TECH is collaborating with MSPP and NASTAD to provide data from four departments in
southern Haiti for an epidemiologic profile, and is collaborating with MSPP and the World Health
Organization (WHO) to analyze early warning indicators for anti-retroviral (ARV) drug resistance.
ACTIVITY 1: I-TECH will provide technical assistance on the development of a minimum-data-set version
of the medical record and EMR application for HIV patient care. I-TECH will also add voluntary counseling
and testing (VCT) and preventing mother to child transmission (PMTCT) modules to the EMR system, to
support improved continuity of care for patients identified as HIV positive, as well as more efficient data
management and reporting for VCT and PMTCT programs. These enhancements will allow decentralized
satellite care sites to interact with the national network and patient data system. I-TECH will work with
MSPP and other partners to identify and implement cost-effective innovative technologies for incorporation
of these sites (e.g. through off-site data entry, use of mobile phone technology for relay of data, or use of
mobile computers to periodically capture data from sites).
ACTIVITY 2: I-TECH will continue to strengthen data management and data analysis capacity in Haiti
through work with counterparts within the MSPP. The I-TECH team will assist MSPP to refine protocols for
data quality assurance at site, regional, and national levels and provide technical assistance to MSPP and
key partners such as Institut Haitien de l'Enfance (IHE) to apply these protocols. I-TECH will also provide
leadership on using EMR data for patient- and program-level decision-making, through analysis of patient
health outcomes related to HIV treatment programs. I-TECH will also modify the EMR application to
improve automated reports based upon feedback from system users (clinicians, program managers,
administrators).
ACTIVITY 3: Through regular training site visits, I-TECH will orient clinic users on new system features and
optimal use of the system at their sites. I-TECH will also continue to collaborate with CDC, IHE, Tulane
University, and other partners to provide training to users at 30 new sites. To further transfer capacity for
system maintenance to partners in Haiti, I-TECH will contract with a local organization for complementary IT
support to the EMR system (support for hosting the application on local servers, assuring replication of data
to the central data repository, executing regular system maintenance functions, and making minor
modifications of the EMR application to meet changing local needs). 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).
This activity contributes to PEPFAR's goal of two million individuals on HIV treatment, by providing tools for
monitoring patients on treatment over time, assessing patient health outcomes, and evaluating transfer of
learning from in-service and pre-service training.
Strategic information/HMIS (Major) 51%-100%
Policy and guidelines 10%-50%
Targeted evaluation 10%-50%
1.System for national reporting of HIV patient care and health services data, implemented at 90 sites.
Activity Narrative: 2.Training of at least 250 health care personnel in EMR system.
3.Evaluation of transfer of learning among trainees from HUEH.
4.Evaluation of nursing curriculum reform initiative.
USG in-country staff
Health care providers
MSPP staff/country coordinating mechanism
Implementing organizations providing clinical services
Other organizations: national nursing schools
Coverage areas include all geographic regions receiving PEPFAR support for HIV testing and clinical
This activity is linked to activity ID 9725.08, 17889.08, 18950.08, 3910.08, 18077.08, 3886.08, 5463.08,
I-TECH will continue working with Haiti's public-sector schools for health professionals (medicine, nursing,
laboratory, social sciences, pharmacy, and dentistry) to integrate HIV/AIDS-related content into
standardized curricula, to build teaching capacity through faculty development activities, and to set
standardized student evaluation tools and processes based upon mastery of key competencies. I-TECH
will also develop the capacity of the Ministry of Health (MSPP) to guide for health worker training programs
in HIV care and treatment.
In 2005-2006, I-TECH launched curriculum development processes with Haiti's professional schools in
nursing, medicine, social sciences, and laboratory. This work involved close collaboration with the MSPP
Department of Human Resources (DDRH) and the relevant Dean/Administration for each school. I-TECH's
process for pre-service training involves: 1) needs assessment; 2) convening of academic leaders, faculty,
and experts to gain consensus on learning objectives and student evaluation standards; 3) gathering
content from existing curricula; 4) designing interactive and participatory learning activities; 5) producing
training materials to support teaching; 6) piloting and validation of these materials; and 7) carrying out
faculty development activities to improve teaching. In 2007, I-TECH completed a guide for integration of
HIV/AIDS into the nursing curriculum, designed and delivered a faculty TOT and specialized course in
HIV/AIDS for social work and psychology students, hosted a 10-week course through the University of
Washington's Laboratory Technologist Training Program for 4 faculty members from Haiti's 2 laboratory
technology schools, and completed a needs assessment for the faculty of medicine. In late 2007 through
early 2008, I-TECH will launch TOT sessions for nursing school faculty, continue with curriculum working
groups in medicine, social sciences, and laboratory, implement a series of faculty development workshops
to address key competencies for medical educators, and hold customized training sessions in HIV/AIDS for
20 final-year pharmacy students and 50 lab students.
In 2007, the MSPP validated the national ARV/OI curriculum, developed by I-TECH in partnership with
numerous local content experts. I-TECH supported its dissemination through distribution of print and CD-
Rom copies, and through a "Teachback" TOT course for trainers from key HIV clinical training institutions
throughout Haiti. I-TECH also continued to disseminate several Creole-language training videos in
partnership with the MSPP, including a 40-minute drama on ART (Chans).
The above-mentioned activities are part of I-TECH's global strategy of decentralization of curriculum
development capacity to country offices, health ministries, and other in-country partners. In 2007, I-TECH
hired an in-country training manager to be mentored by the Seattle-based Health Communications Team
and, in turn, to lead mentoring of MSPP counterparts. In 2008, I-TECH expects to hire 2 additional
curriculum developers to further transition capacity to Haiti, and expects to foster South-South collaboration
between I-TECH Haiti's curriculum team and other teams within I-TECH's global network for adaptation of
high quality training materials to Haiti's context.
ACTIVITY 1: I-TECH finalize the integration of HIV/AIDS into the medical school curriculum, through the
Faculté de Medecine curriculum working group. I-TECH will continue to host quarterly faculty development
workshops. I-TECH will also support the installation of an electronic resource library for medical school
faculty and students.
ACTIVITY 2: I-TECH will provide mentoring of nursing school faculty through three one- week visits to each
nursing school, to assure successful use of HIV curriculum material. I-TECH will facilitate a working group
to develop and validate standard student evaluation tools and processes, linked to graduation requirements.
The evaluation tools will use a competency-based framework and will be closely tied to learning objectives.
ACTIVITY 3: I-TECH will collaborate with the Faculté de Sciences Humaines (FSH) to incorporate culturally
-relevant materials on OVC into the required curriculum for psychology and social work students. I-TECH
will provide faculty mentoring, and assist to develop and validate student evaluation tools that include HIV-
related competencies. I-TECH will also assist FSH faculty to develop a required core course addressing
HIV/AIDS transmission, prevention, stigma, gender, and testing and treatment issues for all university social
sciences students. The goal of this core course will be to shape the knowledge and attitudes of opinion
leaders in Haitian society.
ACTIVITY 4: In partnership with the lab curriculum working group, I-TECH will finalize a revised,
standardized lab curriculum which harmonizes training programs and student evaluation standards of the 2
national laboratory schools for the basic-level laboratory professionals (techniciens médicales). I-TECH will
continue to host quarterly faculty development workshops to address key competencies for laboratory
educators.
ACTIVITY 5: In partnership with local universities and teaching institutions, I-TECH will develop a 4-year
bachelor degree curriculum for advanced laboratory professionals (technologistes médicales), to expand
the pool of highly skilled lab personnel in Haiti. The curriculum will include theoretical and practical
components, and is intended as a competitive one-year program for students who have already
successfully completed basic-level laboratory training. The bachelor program will be piloted at the national
laboratory school in Cap Haitien.
ACTIVITY 6: I-TECH will convene curriculum working groups in pharmacy and dentistry to launch the
process of integrating HIV content into their programs, and will provide faculty development activities to
support strong teaching.
ACTIVITY 7: I-TECH will continue to provide technical assistance to the Training Cluster within the MSPP's
Coordination Unit for AIDS/TB/Malaria on developing standardized HIV/AIDS clinical training materials,
training of trainers (TOT), and monitoring and evaluating training. I-TECH will support the MSPP to
organize and lead 4 TOT sessions, reaching at least 80 participants from key training institutions in Haiti,
Activity Narrative: using "Teachback" and other engaging methodologies to build fundamental skills for quality training. I-
TECH will provide training and TA to all PEPFAR-supported training partners in Haiti for adoption of a
national MSPP web-based training database, to facilitate planning, monitoring, and reporting on training
outputs. I-TECH will engage the MSPP in the formative development and final validation of all I-TECH
training products described in other sections of this proposal. Finally, I-TECH will assist the MSPP to plan,
carry out, and cover some logistics for a regional conference on innovations and best practices in HIV/AIDS
programs, in partnership with the Caribbean HIV/AIDS Regional Training Initiative CHART).
ACTIVITY 8: I-TECH will provide funding and technical assistance to establish a regional HIV clinical
training center in the South Department. Following I-TECH support to plan and launch the RTC, I-TECH
HIV Clinical Mentors will provide quarterly visits to mentor local trainers in delivery of high-quality didactic,
skills-building, and clinical practicum training.
Training (Major)51%-100%
Human resources:10%-50%
Local organization capacity development10%-50%
Information/Education/Communication10%-50%
Needs assessment10%-50%
Policy and guidelines10%-50%
