BACKGROUND

This project, funded by PEPFAR through a cooperative agreement between the Centers for Disease Control

and Prevention (CDC) and IHE since September 2004, is ongoing. It will build upon accomplishments of

preceding years, taking into consideration progress made and lessons learned in tracking reports, validating

data, providing technical assistance to individual sites, supporting development of the Monitoring and

Evaluation Surveillance Interface (MESI) electronic system and supporting training sessions on the

HIV/AIDS information system.

This project is supported by the Haitian government. All activities will be implemented directly by IHE, but

particular attention will be paid to work more closely with MOH staff, reinforcing the existing working

relationship. However, there will be no major change in the strategic approach. We will focus on data

analysis and utilization of information.

ACTIVITIES AND EXPECTED RESULTS

Activity 1 - Submission of reports: IHE will ensure, through a close tracking, that the reports prepared by all

the sites in the PEPFAR network are posted on time every month on MESI and aggregated to be

incorporated progressively into the PEPFAR semiannual and annual reports. The funding will serve to

implement an organizational plan involving both central and site level personnel for monitoring timeliness of

report posting and for aggregating / processing data to prepare PEPFAR reports. An extended

communication channel reaching all data personnel will back up this process. We expect that the

application of the procedures during the precedent years and FY 2008 will be beneficial for the site

personnel, influencing their organizational culture in terms of respecting reporting submission deadlines.

This activity will be built on 2006 and 2007 experience. All monthly reports will be posted within a two week

delay after the end of each month and PEPFAR semiannual reports will be submitted by the 15th of October

2008 and by the 15th of April 2009, with at least 95% information coverage.

Activity 2 - Ongoing validation of data: Continuous implementation of QA/QC program focusing on new

sites, to ensure the quality of data collected and processed by all sites within the PEPFAR network.

Quality control of the data will be realized on a continuous basis through monthly desk validation at IHE

level and quarterly field validation during site visits. IHE personnel will verify coherence and completeness

of the reports and statistical likelihood of data, using MESI. Appropriate feedback will be sent to site

personnel. Field validation will consist in the control of the exactitude of the data and the respect of

procedures for collecting and processing the data. Each one of the ARV and PC site will receive an average

of three visits and the other sites, two visits. All new sites and those where weaknesses are identified will

receive an extra assistance visit. We plan to increase the number of Disease Reporting Officer

(DRO)/Regional supervisor involved in the process of field validation and to work more closely with the

departmental epidemiologist in order to ensure sustainability. By the end of March 2009, at least 90% of the

sites will produce reports, meeting the quality standard defined by IHE.

Activity 3 - Utilization of information to improve performance: IHE will ensure, through regular feedback by

internet and supervision visits, that the health provider systematically use the information generated at site

level to assess their performance. Special attention will be paid to the reference and counter reference of

patients from one service to another and also to follow the cohort of clients/patients into the CDV, PMTCT

and ARV services. An organizational plan based on best practices in use and taking profit of information

technology and communication infrastructure will be implemented. A one-day workshop to assess site

performance will be conducted on a quarterly basis at site level. A two-day workshop will be held in the

middle of the year at the regional/departmental level with the direct involvement of IHE staff, departmental

MOH staff and umbrella organizations. All the sites will achieve at least 90% of the objective set for the

period.

Activity 4 - Participating in training session on the HIV/AIDS information system: IHE will participate in the

training session organized under the umbrella of the MOH for monitoring of the PEPFAR project and will

participate with other partners to develop a module on monitoring VCT, PMTCT, PC, and ARV services

under a standard curriculum. The methodology of the training session will be task oriented and the skills for

the site personnel will be consolidated during site visits. The new sites will be visited more often. The

timeline for the training session will be decided thereafter. One hundred percent of the site personnel in

charge of data management will be knowledgeable about procedures to collect and process data and 90%

of these personnel will be able to generate reliable data for monitoring by the end of March 2008.

Activity 5 - Support to the development of MESI: IHE will continue to provide inputs for the development

and upgrade of MESI. IHE will ensure implementation of these specific activities: identification and

development by SOLUTIONS of new reports related to monitoring of site activities and site performance in

order to respond to the needs of strategic information, introduction in MESI of new tools that facilitate data

analysis and quality control, and train site and departmental personnel to be able to use MESI and ensure

sustainability. A revised version of MESI's web application with the new functionalities will be available by

December 2008 in all sites and used by 100% of the site personnel.

Activity 6 - Conduct a sixth round of the ANC sero survey in the existing network of sites. The

methodological approach used will be the same as in the preceding years with a complementary component

to compare classical ANC sero survey with usual PTME (spell out) monitoring system, in order to test the

possibility to use the regular PMTCT monitoring system as an instrument for trend analysis of HIV epidemic

among pregnant women. In-depth participation of the MOH staff will be sought at central and peripheral

levels to assure progressive transfer of this activity to MOH. At the end of December 2008, a report will be

available on trend analysis of HIV epidemic among pregnant women.

Activity 7: Collect data on Early Warning Indicators of Anti-retroviral Resistance per guidelines of the World

Health Organization. IHE, with the support of the Pan American Health Organization (PAHO) in Haiti,

began collection of non-laboratory data for Early Warning of Anti-Retroviral Resistance using the Early

Warning System of the WHO. Genotyping characterization, the laboratory component of this surveillance

system, will be performed this year using funding from PAHO. For 2008, however, continued collection of

data (including individuals lost to follow-up, no shows for appointments, etc) will be collected from ARV sites

during visits for the routine validation of data.

Activity 8: Support UCSF for the Triangulation. IHE (the local partner) will subcontract University of

California at San Francisco (UCSF) in the planning and implementation of the triangulation. They will

collaborate in the definition of questions, the gathering of data/reports, facilitation of meetings, analysis of

data and drafting of reports. They will recruit a high level local consultant specialized in modeling and

handling of data to lead that effort.

EMPHASIS AREAS

Health Management Information System: 51-100%, HIV Surveillance System: 10-50%, support to

information technology 10-50% and training 10-50%.

Activity Narrative: TARGETS

Target population: General population and people affected by HIV/AIDS attending the sites.

Target sites: All the sites of the PEPFAR network, approximately 154.

•Number of local organizations provided with technical assistance for strategic information activities = 160

•Number of individuals trained in strategic information (includes M&E, surveillance, and/or HMIS) = 500