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
Integrated Activity Flag: This activity is linked to Activity IDs 17784.08, 4501.08, 18974.08, 9363.08,
10668.08 and 9673.08.
SUMMARY: The activities described below are carried out to provide comprehensive prevention of mother-
to-child transmission (PMTCT) services to HIV positive women. These PMTCT activities will be conducted
within PIH/ZL's "four pillars" model for implementing a comprehensive HIV program in the context of primary
care: 1) HIV prevention and care, including voluntary counseling and testing (VCT); 2) detection and
treatment of tuberculosis (TB) and other opportunistic infections; 3) detection and treatment of sexually
transmitted infections (STIs); and 4) women's health and prevention of mother-to-child transmission
(PMTCT) of HIV services. The primary emphasis areas for these PMTCT activities are human resources,
food/nutrition support, and training. The primary target populations for PMTCT activities are pregnant
women, HIV positive pregnant women, and HIV/AIDS-affected infants.
Activities will be carried out at eight sites in the Central department of Haiti (Belladère, Boucan Carré,
Cange, Cerca La Source, Hinche, Lascahobas, Thomonde, and Savanette) and three sites in the Artibonite
Department (Desdunes, Petite Rivière, and St. Marc). Activities in St. Marc will be carried out in
collaboration with the Hôpital St. Nicholas (HSN) and Services de Santé de Premier Echelon (SSPE).
Certain activities will also be carried out at health posts in Segur and Jean Denis.
PIH/ZL's HIV Equity Initiative has relied on sustained funding from the Global Fund for AIDSD, Malaria and
Tuberculosis (GFATM ), as well as PEPFAR, to operate over the past 5 years. Our GFATM Round 1 grant
is ending as of December 2007. We have recently submitted a Rolling Continuation Channel (RCC)
application to the Haiti HIV CCM. Among other critical costs, this application includes the ARV medications
for all the patients discussed herein. If this co-financing is not received, all targets listed here will need to be
adjusted, including a reduction in the number of service outlets.
BACKGROUND: PIH/ZL's PMTCT activities are part of a comprehensive HIV prevention and treatment
program started by PIH/ZL in 1998; expanded through the public sector beginning in 2002 in partnership
with the Haitian Ministry of Public Health and Population (MSPP) and with funds from the Global Fund to
Fight AIDS, Tuberculosis and Malaria (GFATM); and further expanded to Hinche, Cerca La Source, Petite
Rivière and St. Marc with the support of PEPFAR in the COP 05, 06, and 07. Since 2004 the program has
been a collaboration between these four key partners—PIH/ZL, MSPP, GFATM, and PEPFAR. Since 2005
work in the Artibonite region has been strengthened by involving several NGO partners in St. Marc (SSPE,
Promotion Objectif Zerosida (POZ), and La Fondation Esther Boucicault Stanislas (FEBS)) and in Petite
Rivière (Centre Medical Charles Colimon (CMCC), a Médecins Sans Frontières (MSF)-affiliated institution).
In August 2007, with the decrease in services provided by MSF, PIH/ZL will assume responsibility for all
services and supplies provided at CMCC.
PIH/ZL's PMTCT program was launched in the mid-1990s, soon after the efficacy of ART in reducing
mother-to-child transmission of HIV was proven. Since then, PMTCT activities have been a central
component of PIH/ZL's HIV efforts. Through a significant grant from the USAID Child Survival program,
PIH/ZL has been strengthening and broadening its maternal and child health activities in the clinic as well
as in the community—in particular, expanding and strengthening the network of ajan fanm (community
health workers trained in women's health) and traditional birth attendants.
PIH/ZL is committed to a long-term partnership with MSPP, and in all of the activities described, PIH/ZL is
dedicated to strengthening the public sector by training local staff, including MSPP health workers.
ACTIVITIES AND EXPECTED RESULTS:
ACTIVITY 1: VCT for Pregnant Women
The first activity is to perform VCT for all pregnant women. As part of PIH/ZL's provider-initiated VCT
strategy, pregnant women seen at PIH/ZL sites receive counseling that will include Family Planning and are
offered HIV testing during routine prenatal visits. PIH/ZL enlists " ajan fanm" to increase referrals of
pregnant women to clinics for testing and prevention education. In the last year, PIH/ZL provided counseling
and testing to more than 20,000 pregnant women. This funding will support the staff and infrastructure
necessary to provide VCT to pregnant women in the context of primary and prenatal care. It will also cover
expansion of staff and infrastructure at Segur and Jean Denis to ensure rapid-scale up of VCT activities for
pregnant women.
ACTIVITY 2: PMTCT in the Context of Prenatal, Perinatal, and Postnatal Care
The second activity is to provide prenatal, perinatal, and postnatal care to HIV-infected pregnant women at
each PIH/ZL site. In the prenatal period, HIV-positive pregnant women are enrolled in the PMTCT program
and receive counseling and education on transmission prevention. ART is offered to women with advanced
HIV infection and to all women in the third trimester of pregnancy to reduce the risk of HIV transmission.
Nutritional supplements, multivitamins, and STI screening and treatment are also routinely provided.
Mothers and infants receive comprehensive postnatal care involving ART for the infant, ongoing ART for the
mother (if required based on her stage of disease), education, and increased nutrition and home-based
support to enable best feeding practices In the last twelve months, PIH/ZL has provided this
comprehensive care to more than 190 HIV-positive pregnant women. This funding will provide salary
support and will allow for the ongoing training of clinicians in the detection and care of HIV-positive pregnant
women.
ACTIVITY 3: PMTCT in the Context of Social Support
The third activity is the provision of social support to all HIV-infected women enrolled in the PMTCT
program. Throughout her pregnancy and beyond, each woman is supported by an accompagnateur who
visits her at home once or twice a day to assess her needs as well as to assist with ART adherence and
other clinical care issues. During clinic visits, PMTCT program participants receive education and nutritional
support to decrease the likelihood of HIV transmission to infants during or following delivery. Post-partum,
new mothers receive nutritional supplementation, infant formula, and supplies for preparation of clean
water. Support groups, accompaniment, and medical supervision and care account for a low rate of MTCT
within PIH/ZL's program: less than 2%. This funding will ensure the continued success of PIH/ZL's PMTCT
services by supporting the hiring of additional accompagnateurs and the on-going training of all PIH/ZL
accompagnateurs and ajan fanm.
These PMTCT activities increase gender equity by supporting efforts to reach and treat an equitable
number of HIV-infected women and men, and by increasing access to information, services and care for
women and girls. By offering VCT to all pregnant women as part of routine prenatal visits, these activities
support linkages between HIV/AIDS and other sectors (reproductive health).
These activities contribute to the PEPFAR 2-7-10 goals by improving access to HIV testing and treatment,
enrolling individuals on ARV, and preventing the transmission of HIV to HIV-negative infants.
EMPHASIS AREAS:
- Human Resources 51-100%
- Food/Nutrition Support 10-50%
- Training 10-50%
Activity Narrative: TARGETS:
As indicated above, PIH/ZL considers our HIV Equity Initiative as a collaborative program. For this reason,
the targets listed in these sections are for the project as a whole, regardless of co-financing arrangements.
PIH/ZL defers to PEPFAR and GFATM to determine the most appropriate means to allocating these
accomplishments to the various donor agencies, if necessary to avoid duplication in reporting September
2009:
- Number of service outlets providing the minimum package of PMTCT services according to Haitian and/or
international standards: 13
- Number of pregnant women who received HIV counseling and testing for PMTCT and received their test
results: 20,000
- Number of pregnant women provided with a complete course of antiretroviral prophylaxis in a PMTCT
setting: 436
- Number of health workers trained in the provision of PMTCT services according to national and
international standards: 49
TARGET POPULATIONS: Pregnant women; HIV positive pregnant women; HIV/AIDS-affected infants
KEY LEGISLATIVE ISSUES: Gender; Wrap Around
COVERAGE AREAS: Central Department (Belladère, Boucan Carré, Cange, Cerca La Source, Hinche,
Lascahobas, Thomonde, and Savanette), and Artibonite Department (Desdunes, Petite Rivière and St.
Marc). Service outlets in St. Marc include HSN and SSPE.
The activities in this program seek to optimize quality of life for HIV-infected patients and their families and
to prevent the transmission of HIV and other sexually transmitted infections (STIs). Palliative care will be
conducted within PIH/ZL's "four pillars" model for implementing a comprehensive HIV program in the
context of primary care: 1) HIV prevention and care, including voluntary counseling and testing (VCT); 2)
detection and treatment of tuberculosis (TB) and other opportunistic infections; 3) detection and treatment of
sexually transmitted infections (STIs); and 4) women's health and prevention of mother-to-child
transmission (PMTCT) of HIV services. The primary emphasis areas for these activities are human
resources, infrastructure, and training, linkages with other sectors and initiatives, and community
mobilization/participation. The primary target population for palliative care is people affected by HIV/AIDS
and prevention activities for the general population.
Activities will be carried out at eight sites in the Central Department of Haiti (Belladère, Boucan Carré,
The PIH/ZL HIV Equity Initiative has relied on sustained funding from the Global Fund to fight AIDS,
Tuberculosis and Malaria (GFATM), as well as the President's Emergency Plan for AIDS Relief (PEPFAR),
to operate over the past five years. Our GFATM Round 1 grant ends December 2007. PIH/ZL has recently
submitted a rolling continuation channel (RCC) application to the Haiti HIV CCM (spell out). Among other
critical costs, this application includes the anti-retroviral (ARV) medications for all patients discussed herein.
If this co-financing is not received, PIH/ZL will have to readjust the targets listed in this narrative and to
reduce the number of service outlets.
BACKGROUND:
PIH/ZL's palliative care activities, including prevention, are part of a comprehensive HIV prevention and
treatment program started by PIH/ZL in 1998; expanded through the public sector beginning in 2002 in
partnership with the Haitian Ministry of Public Health and Population (MSPP) and with funds from the
GFATM and further expanded to Hinche, Cerca La Source, Petite Rivière and St. Marc with the support of
PEPFAR in the COP 2005, 2006, and 2007. Since 2004, the program has been a collaboration between
these four key partners—PIH/ZL, MSPP, GFATM, and PEPFAR. Since 2005, work in the Artibonite region
has been strengthened by involving several non-governmental organizations (NGO) partners in St. Marc—
SSPE, Promotion Objectif Zerosida (POZ), and La Fondation Esther Boucicault Stanislas (FEBS)—and in
Petite Rivière—Centre Medical Charles Colimon (CMCC), a Medécins Sans Frontières (MSF)-affiliated
institution. In August 2007, with the decrease in services provided by MSF, PIH/ZL will assume
responsibility for all services and supplies provided at CMCC.
For a decade, PIH/ZL's palliative care activities have been delivered by complementing a high standard of
clinical care with a strong community-based network of accompagnateurs. As a routine part of ARV
services, all patients are seen daily in their homes by their accompagnateur. These visits also serve as
opportunities to monitor outcomes and provide palliative services. If patients experience side effects,
advanced disease, or other barriers to positive outcomes, the accompagnateur addresses the situation
either directly or through a referral to a clinic. If the accompagnateur sees other health problems developing
in the household, such as a sudden weight loss of a family member, they will bring that individual in for
treatment.
Additionally, PIH/ZL oversees an extensive array of context-specific HIV prevention and general health
education activities. Such projects include outreach sessions at schools, churches, clinics, and community
gatherings, and at meetings for employees, community health workers, and TB and HIV patients.
PIH/ZL is committed to a long-term partnership with MSPP, and in all of the activities described; PIH/ZL is
ACTIVITY 1: General Clinical Care
The first activity is to provide general clinical care for HIV-infected adults and children and their families.
This care—provided in the health facility, at home, and through mobile clinics—is conducted within PIH/ZL's
"four pillars" model for implementing a comprehensive HIV program in the context of primary care, as
described above. This funding will support the infrastructure and human resources necessary for providing
clinical services to an increased number of HIV-infected patients. These funds will also support the ongoing
training of the clinical staff in effective palliative care strategies. Medical and laboratory commodities and
supplies needed to provide general clinical care for HIV-infected patients and their families are supported by
GFATM, PIH's unrestricted funds, and in-kind donations.
ACTIVITY 2: Accompagnateur Employment and Training
The second activity is employment and training of PIH/ZL's accompagnateurs. In 2008, we expect that more
than 200 new accompagnateurs will be hired to provide services to an increasing number of HIV-positive
patients. Accompagnateurs, through their provision of community-based supervision and monitoring, are the
backbone of PIH/ZL's ARV services. Funding will also be used to provide accompagnateurs with ongoing
trainings in the delivery of palliative care. Accompagnateurs will make the link between clinical services and
the community services.
ACTIVITY 3: Social and Psychological Support
The third activity involves providing social and psychological support to HIV patients and their families
based on needs assessments conducted by program doctors and social workers. This support includes
monthly patient meetings, support groups, and individual psychosocial support. This program will be
strengthened in 2008 with the hiring of additional social workers to support HIV-infected patients in the
Central and Artibonite Departments. A preventive package (safe water, condoms, and insecticide treated
nets in areas where malaria is endemic) will be provided. Access to family planning services will be
facilitated and food support will be provided for families in need. The program will also provide links to micro
credit and income generating activities.
ACTIVITY 4: Financial Assistance for Transportation
The fourth activity is to provide financial support to at HIV patients and their families. This support includes
assistance with school fees, housing, food, and transportation to/from the health facility. In the last year,
more than 40,000 social assistance stipends were provided to HIV-positive patients and their families. This
assistance was supported with funding from PEPFAR, PIH's unrestricted funds, and private donors.
The proposed activities address gender issues by mitigating the burden of care on women and girls by
linking care programs with resources such as psychosocial support groups and assistance with the
provision of school fees, food and transportation.
All palliative care activities and results contribute to the PEPFAR 2-7-10 goals by providing comprehensive
care to HIV-infected individuals.
Activity Narrative: ACTIVITY 5: Prevention
Noyeau Educatif Communitaire (NEC) specializes in community outreach and education, including radio
broadcasting of prevention and other health messages; the production and distribution of a variety of
educational materials (including pamphlets, calendars, etc.); and community gatherings at which prevention
and other health messages are emphasized. PIH/ZL promotes and provides condoms (provided by MSPP,
in-kind donations purchased with private funds) free of charge at all PIH clinical sites and at mobile clinics
and community events, and infection detection and treatment of STIs. Funding for this activity will
specifically be used for NEC activities, salary support of medical and administrative personnel who conduct
and supervise STI screening, treatment, and prophylactic ART, as well as the organization and execution of
community events (including World TB Day and World AIDS Day) where prevention messages are
emphasized. This activity addresses key legislative issues of stigma and discrimination.
By empowering both men and women to make informed choices about their sexual behavior, prevention
activities will address the following areas of legislative interest: increasing gender equity in HIV/AIDS
programs, male norms and behaviors, and reducing violence and coercion.
Prevention activities will contribute to the world-wide PEPFAR objective of averting seven million new
infections.
Human Resources 10-50%
Infrastructure 10-50%
Training 10-50%
Linkages with Other Sectors and Initiatives 10-50%
Community Mobilization/Participation 10-50%
INTEGRATED ACTIVITY FLAG: This activity is linked to Activity IDs 9682.08, 4501.08, 18974.08, 9363.08,
10668.08 and 17784.08.
SUMMARY: Tuberculosis (TB) is the most common and deadly opportunistic infection in Haiti and remains
rampant among HIV positive patients and their families due to chronic malnutrition, HIV, and overcrowded
living conditions. The proposed activities described below are aimed to strengthen and expand the Partners
In Health/Zanmi Lasante (PIH/ZL) capacity to detect, prevent, and treat TB infection for HIV positive
patients. The program will conduct TB/HIV activities within PIH/ZL's "four pillars" model for implementing a
comprehensive HIV program in the context of primary care: 1) HIV prevention and care, including voluntary
counseling and testing (CT); 2) detection and treatment of tuberculosis (TB) and other opportunistic
infections (OIs); 3) detection and treatment of sexually transmitted infections (STIs) and; 4) women's health
and prevention of mother-to-child transmission (PMTCT) of HIV services. The primary emphasis areas for
these palliative care TB/HIV activities are human resources, infrastructure, training, and quality assurance
and supportive supervision. The primary target populations for these TB activities are people living with
HIV/AIDS, including HIV positive infants and children.
The PIH/ZL HIV Equity Initiative has relied on sustained funding from the Global Fund to Fight AIDS,
Tuberculosis and Malaria (GFATM), as well as the President's Emergency Program For AIDS Relief
(PEPFAR), to operate over the past five years. Our GFATM Round 1 grant ends in December 2007. We
have recently submitted a Rolling Continuation Channel (RCC) application to the Haiti HIV Country
Coordination Mechanism (CCM). Among other critical costs, this application includes the antiretroviral
(ARV) medications for all patients discussed herein. If this co-financing is not received, we will need to
adjust all targets listed here, including a reduction in the number of service outlets.
PIH/ZL's TB prevention and treatment activities date back to the efforts of community health workers in the
early 1980s. Experience with directly observed therapy (DOT) in the context of TB treatment was
instrumental to the design of PIH/ZL's HIV treatment program. TB activities are fully integrated into the
comprehensive HIV prevention and treatment program started by PIH/ZL in 1998; expanded through the
public sector beginning in 2002 in partnership with the Ministry of Health (MOH) and with funds from
GFATM; and further expanded to Hinche, Cerca La Source, Petite Rivière and St. Marc with the support of
four key partners—PIH/ZL, MOH, GFATM, and PEPFAR. Since 2005 work in the Artibonite region has been
strengthened by involving several NGO partners in St. Marc—SSPE , Promotion Objectif Zerosida (POZ)
and, La Fondation Esther Boucicault Stanislas (FEBS))—and in Petite Rivière (Centre Medical Charles
Colimon (CMCC), a Medécins Sans Frontières (MSF)-affiliated institution). In August 2007, with the
decrease in services provided by MSF, PIH/ZL will assume responsibility for all services and supplies
provided at CMCC.
PIH/ZL is committed to a long-term partnership with MOH, and in all of the activities described, PIH/ZL is
dedicated to strengthening the public sector by training local staff, including MOH health workers.
ACTIVITY 1: Detection, Treatment, and Prophylaxis: The first activity is detection of treatment and
prophylaxis for TB among HIV-infected individuals served at PIH/ZL's sites. As HIV treatment in the context
of primary care is delivered at an increasing number of sites and locations, strengthening and expanding
PIH/ZL's capacity to detect, treat, and prevent TB/HIV co-infection will be essential to the well-being of our
patients. In the last year, PIH/ZL provided prophylactic TB therapy to more than 250 HIV-positive
individuals. The additional clinical human resources supported by this funding will allow for greater clinical
and programmatic focus on this essential component of HIV care. Funding will also support TB/HIV-related
laboratory capacity and the maintenance of necessary infrastructure.
ACTIVITY 2: Training: As PIH/ZL will be providing comprehensive HIV care to a significantly increased
number of patients in several new locations in 2008, the second activity is the training of providers in the
prevention and treatment of TB for HIV-infected individuals. Clinicians and accompagnateurs will receive
training on the management of TB/HIV co-infection during regularly held meetings. Moreover, selected
clinicians and community health workers from all PIH/ZL sites will participate in more formal classroom-
based trainings and clinic- and community-based practicums that address TB identification, treatment, and
prevention strategies for HIV-infected individuals.
ACTIVITY 3: HIV Testing for TB Patients: Tuberculosis is the leading HIV-associated OIs for patients in
resource-poor settings and the most common cause of death in HIV-positive persons worldwide. The
presence of TB increases HIV replication and hastens the progression of AIDS. In light of the interaction
between TB and HIV, the clinical guidelines adopted by PIH/ZL recommend that all patients with
tuberculosis be offered HIV testing and counseling.
As with all PIH/ZL palliative care, the above activities strive to ensure that an equitable number of women
and men receive treatment. In improving the health of HIV-infected patients, we strive to enable their full
participation in society at every level and to reduce the stigma and discrimination associated with HIV
status. The above activities and results contribute to the PEPFAR 2-7-10 goals by providing comprehensive
care to HIV+ individuals.
TARGETS:
As indicated above, the HIV Equity Initiative is a collaborative program. For this reason, the targets listed in
these sections are for the project as a whole, regardless of co-financing arrangements. PIH/ZL defers to
PEPFAR and GFATM to determine the most appropriate means to allocating these accomplishments to the
various donor agencies, if necessary to avoid duplication in reporting (This issue should be discuss and
resolved with the USG SI Advisor to determine the best way to avoid duplication but also to make sure that
PEPFAR funded targets are reported accurately).
September 2009:
Number of service outlets providing clinical prophylaxis and/or treatment for tuberculosis (TB) to HIV-
infected individuals (diagnosed or presumed) in a palliative care setting: 12
Number of HIV-infected clients attending HIV care/treatment services that are receiving treatment for TB
disease: 400
Number of HIV-infected clients given TB preventive therapy: 275
Number of TB patients tested for HIV: 1,775
Number of individuals trained to provide clinical prophylaxis and/or treatment for TB to HIV-infected
Activity Narrative: individuals (diagnosed or presumed): 100
Integrated Activity Flag: This activity is linked to Activity IDs 9682.08, 4501.08, 18974.08, 9363.08,
17784.08 and 9673.08.
The activities described below are carried out to support orphans and vulnerable children (OVC) through
four components: reinforcing existing primary/ambulatory care to increase capacity for identification of
children infected or affected by HIV; providing nutritional support; providing psychosocial support; and
providing social assistance. These OVC activities will be conducted within PIH/ZL's "four pillars" model for
implementing a comprehensive HIV program in the context of primary care: 1) HIV prevention and care,
including voluntary counseling and testing (VCT); 2) detection and treatment of tuberculosis (TB) and other
opportunistic infections; 3) detection and treatment of sexually transmitted infections (STIs) and; 4) women's
health and prevention of mother-to-child transmission (PMTCT) of HIV services. The primary emphasis
areas for these activities are linkages with other sectors and initiatives, human resources, and food/nutrition
support. Specific target populations include OVC, caregivers of OVC, and HIV/AIDS-affected families.
to operate over the past five years. Our GFATM Round 1 grant ends December 2007. We have recently
submitted a rolling continuation channel (RCC) application to the Haiti HIV Multisector Consultative Council
(CCM). Among other critical costs, this application includes the anti-retroviral (ARV) medications for all the
patients discussed herein. If PIH/ZL does not receive this co-financing, we will need to adjust all targets
listed here, including reducing the number of service outlets.
PIH/ZL's orphans and vulnerable children (OVC) activities are part of a comprehensive HIV prevention and
partnership with the Haitian Ministry of Public Health and Population (MSPP) and with funds from GFATM;
and further expanded to Hinche, Cerca La Source, Petite Rivière and St. Marc with the support of PEPFAR
in the COP 2005, 2006, and 2007. Since 2004, the program has been a collaboration among these four key
partners—PIH/ZL, MSPP, GFATM, and PEPFAR. Since 2005, work in the Artibonite region has been
strengthened by involving several NGO partners in St. Marc—SSPE, Promotion Objectif Zerosida (POZ), La
Fondation Esther Boucicault Stanislas (FEBS)—and in Petite Rivière—Centre Medical Charles Colimon
(CMCC), a Medécins Sans Frontières (MSF)-affiliated institution. In August 2007, with the decrease in
services provided by MSF, PIH/ZL will assume responsibility for all services and supplies provided at
CMCC.
PIH/ZL has long provided social assistance to vulnerable and HIV-affected children. In 2004, PIH/ZL
officially launched its Program on Social and Economic Rights (POSER) for HIV-infected patients and their
families. Similarly, educational assistance to OVC has been a component of the PIH/ZL project for over a
decade; in 2005 we expanded school fee assistance and formalized documentation and long-term follow-up
for this project in the Central Department.
Over the past two years, PIH/ZL has continued to strengthen our programming in the areas of nutritional
and psychosocial support, with a particular emphasis on OVC. PIH/ZL has initiated and scaled-up a
pediatric malnutrition program that includes the use of locally prepared Ready to Use Therapeutic Food
(RUTF). Additionally, a total of 500 OVC and their HIV-positive parents or caretakers have been enrolled in
a pilot psychosocial support intervention focused on coping strategies for dealing with stigma, grief and loss;
identification of depression; and disclosure of HIV status to family members.
In OVC activities and all others, PIH/ZL is committed to a long-term partnership with the Ministry of Health
(MSPP) and to strengthening the public sector by training local staff, including MSPP health workers.
ACTIVITY 1: Palliative Care to OVC
This activity aims to increase capacity at health centers to identify children infected or affected by HIV.
Significant numbers of children are seen at the clinics and rally posts and they are many lost opportunities
for identification of HIV infected children. PIH will emphasize on this entry door. Health services will be
reinforced for all children, thereby increasing the capability for identification of children infected with and
affected by HIV. Services include promotion of vaccination and well-child visits in the context of the
comprehensive care that is currently provided at each PIH/ZL site. This funding will support the personnel
and supplies necessary to serve an increasing number of children in general and OVC specifically.
ACTIVITY 2: Provision of Food
The second activity is to support social workers and companions in evaluating the nutritional needs of HIV-
affected children and their families. Identification of children at risk will be strengthened by training
companions to determine children's need for nutritional supplementation through nutritional assessment.
Companions will also ensure adequate follow-up and growth monitoring of at-risk children in order to
prevent relapse into malnutrition.
ACTIVITY 3: Provision of Psychosocial Support
The third activity is to employ and train social workers, thereby strengthening the provision of psychosocial
support services to OVC. Social workers will offer psychosocial support groups as well as individual
counseling for those who cannot benefit from group activities (specifically, those who have not disclosed
their HIV status) to children affected by HIV and their HIV-positive parents or caretakers. Moreover, the
social workers will promote a prevention curriculum as a means of reducing the chances of OVC
themselves becoming HIV-infected.
ACTIVITY 4: Social Assistance
The fourth activity seeks to provide social assistance to OVC and their families, including school fees (a
major barrier to school attendance). Scholarships of approximately $25 will be provided annually to more
than 2,000 HIV-positive parents to assist with the cost of their children's schooling, expanding upon the
social assistance provided by PIH/ZL in past years. The World Food Program and private funders have
partnered with PIH/ZL to provide these "wrap-around" services.
ACTIVITY 5: Expansion of OVC Services to the Artibonite department
The fifth activity is the provision of the full package of OVC services described above (palliative care, food,
psychosocial support, and social assistance) to three communities in the Artibonite: Desdunes, Petite
Rivière, and St. Marc. Last year, we provided comprehensive support to more than 5,000 OVC in the
Activity Narrative: Central Department. In 2008, we hope to support an additional 3,000 OVC at our sites in the Artibonite. This
will require hiring social workers and companions to ensure the development of OVC services at each site.
In addition to supporting the human resources and infrastructure required to provide such services in the
Artibonite, funding will be used to help establish a standardized system for tracking all OVC at all our sites
in the Artibonite and Central Departments.
These OVC activities mitigate the burden of care on women and girls by linking care programs with
resources such as psychosocial support groups, the school canteen program, and provision of school fees
and food. In paying school fees, we are ensuring that children and adolescents, especially girls, are able to
remain in school.
Linkages with Other Sectors and Initiatives 50-100%
Food/Nutrition Support 10-50%
As indicated above, PIH/ZL considers our HIV Equity Initiative as a collaborative program with a number of
partners. For this reason, the targets listed in these sections are for the project as a whole, regardless of co-
financing arrangements. PIH/ZL defers to PEPFAR and GFATM to determine the most appropriate means
to allocating these accomplishments to the various donor agencies, if necessary to avoid duplication.
September 2008
Orphans and vulnerable children served by OVC programs: 8,250
OVC referred to a treatment program: 50
Providers/caretakers trained in caring for OVC: 50
TARGET POPULATIONS:
Orphans and Vulnerable Children; Caregivers of OVC; HIV/AIDS-affected families
KEY LEGISLATIVE ISSUES:
Gender; Wrap Around; Stigma and Discrimination
Integrated Activity Flag: This activity is linked to Activity IDs 9682.08, 4501.08, 18974.08, 17784.08,
The activities described below are carried out to support comprehensive counseling and testing services,
and to ensure training and supervision for voluntary counseling and testing (VCT) and sexually transmitted
infection (STI) detection and management. PIH/ZL will conduct these counseling and testing activities
within its "four pillars" model for implementing a comprehensive HIV program in the context of primary care:
1) HIV prevention and care, including voluntary counseling and testing (VCT); 2) detection and treatment of
tuberculosis (TB) and other opportunistic infections; 3) detection and treatment of sexually transmitted
infections (STIs); and 4) women's health and prevention of mother-to-child transmission (PMTCT) of HIV
services. The primary emphasis areas for these activities are human resources, infrastructure, and training.
Specific target populations include adults and most at risk populations, particularly out-of-school youth,
street youth, and migrants, as well as orphans and vulnerable children and people living with HIV/AIDS
(PLWHA).
PIH/ZL will carry out activities at eight sites in the Central Department (Belladère, Boucan Carré, Cange,
Cerca La Source, Hinche, Lascahobas, Thomonde, and Savanette) and three sites in the Artibonite
Department (Desdunes, Petite Rivière, and St. Marc). PIH/ZL will collaborate with Hôpital St. Nicholas
(HSN) and Services de Santé de Premier Echelon (SSPE) to carry out activities in St. Marc. Certain
activities will also be carried out at health posts in Segur and Jean Denis.
Tuberculosis and Malaria (GFATM), as well as the President's Emergency Plan to Fight AIDS Relief
(PEPFAR), to operate over the past five years. Our GFATM Round 1 grant ends December 2007. We
have recently submitted a rolling continuation channel (RCC) application to the Haiti HIV CCM. Among
other critical costs, this application includes the anti-retroviral (ARV) medications for all patients discussed
herein. If this co-financing is not received, PIH/ZL will need to adjust all targets listed here and may include
a reduction in the number of service outlets.
PIH/ZL's VCT activities are part of a comprehensive HIV prevention and treatment program started by
PIH/ZL in 1998; expanded through the public sector beginning in 2002 in partnership with the Haitian
Ministry of Public Health and Population (MSPP) and with funds from the GFATM; and further expanded to
Hinche, Cerca La Source, Petite Rivière and St. Marc with the support of PEPFAR in the COP 2005, 2006,
and 2007. Since 2004, the program has been a collaboration between these four key partners—PIH/ZL,
MSPP, GFATM, and PEPFAR. Since 2005, work in the Artibonite region has been strengthened by
involving several NGO partners in St. Marc, Promotion Objectif Zerosida (POZ), and La Fondation Esther
Boucicault Stanislas (FEBS)—and in Petite Rivière, Centre Medical Charles Colimon (CMCC), a Medécins
Sans Frontières (MSF)-affiliated institution. In August 2007, with decreases in services provided by MSF,
PIH/ZL will assume responsibility for all services and supplies provided at CMCC.
One of the most daunting challenges facing HIV scale-up projects in impoverished rural settings is that of
case detection: identifying HIV-positive people for enrollment in treatment. Because the public sector has a
meager budget and is able to provide little in the way of primary health care services, many public clinics in
Haiti stand empty. In this context, there is minimal uptake of VCT for HIV. Without reinforcing primary health
care or integrating HIV casefinding and treatment within expanded services, initial efforts to find HIV cases
will be unsuccessful. For example, freestanding VCT was initiated in the capital of the Central Department,
Hinche, by the MSPP in January 2003; in the first year of the program, only 43 patients were tested. The
PEPFAR-backed ZL initiative in Hinche began in March 2004. In the first year of joint operations, 5,884
patients were tested; of these, 435 were positive, and 310 were started on ART.
ACTIVITY 1: VCT in the Central Department
The first activity is to continue providing comprehensive opt-out VCT services in PIH/ZL's health facilities
and via mobile clinics. This activity will build on last year's success in providing VCT to more than 55,000
individuals. With this renewed funding, PIH/ZL will increase and improve efforts to provide VCT to Haiti's
most marginalized groups, including migrants and vulnerable children. In order to reach these high-risk
groups, PIH/ZL will initiate a series of activities, including additional mobile clinics, a site-wide community
outreach campaign, and greater programmatic and staff focus on identifying and treating pediatric HIV
cases (including PCR HIV testing for all orphans less than 18 months of age).
ACTIVITY 2: Scale-up VCT in the Artibonite
The second activity is to continue to scale-up access to VCT in the Artibonite region. In 2008, PIH/ZL will
expand VCT services within a primary care setting at the public health centers in St. Marc, Desdunes, and
Petite Rivière, as well as at two health posts in the Petite Rivière health care network, Segur and Jean
Denis. HIV-positive individuals in Segur and Jean Denis will be referred to CMCC in Petite Rivière for
treatment, as needed. Funding for VCT scale-up will be used to renovate, equip, and supply the sites listed
above, as well as train clinicians in VCT practice.
Results of these two activities will contribute to the PEPFAR 2-7-10 goals by improving access to and
quality of VCT services in order to identify HIV-positive persons and increase the number of persons
receiving ARV services.
ACTIVITY 3: Detection, Prevention and Treatment of STIs
The third activity, detection, treatment and prevention of sexually-transmitted infections, is a core
component in PIH/ZL's comprehensive model of care. We will maintain the infrastructure to detect and
manage STIs at our sites in the Central Plateau and will grow this capacity at the health centers in Petite
Rivière, Desdunes, and St. Marc. This will require training of the clinical staff (both ZL and MSPP
employees) at these newer sites to ensure effective STI detection and treatment.
In these activities, PIH/ZL will strive to ensure that an equitable number of women and men receive
Human Resources 51-100%
accomplishments to the various donor agencies, if necessary to avoid duplication in reporting
Activity Narrative: Number of service outlets providing counseling and testing according to national and international
standards: 14
Number of individuals who received counseling and testing for HIV and received their test results: 56,000
Number of individuals trained in counseling and testing according to national and international standards:
220
Adults; Most at risk populations; OVC
Marc). Service outlets in St. Marc include HSN and SSPE. Additional service outlets for this activity include
health posts in Segur in Jean Denis.
Integrated Activity Flag: This activity is linked to Activity IDs 9682.08, 4501.08, 17784.08, 9363.08,
The activities described below are carried out to maintain access to antiretroviral therapy (ARV) for existing
patients, expand access to anti-retroviral (ARV) services to additional HIV-infected people in the Central
and Artibonite Departments of Haiti, and to train health workers in all aspects of HIV care and treatment.
PIH/ZL will conduct ARV treatment and training activities within its "four pillars" model for implementing a
counseling and testing (VCT); 2) detection and treatment of tuberculosis (TB) and other opportunistic
infections; 3) detection and treatment of sexually transmitted infections (STIs); and 4) women's health and
prevention of mother-to-child transmission (PMTCT) of HIV services. The primary emphasis areas for the
proposed activities are human resources, infrastructure, and training. The primary target populations for
these activities are people living with HIV/AIDS (including HIV-positive infants and children), health care
providers, community-based organizations and non-governmental organizations (NGO).
Activities will be carried out at eight sites in Haiti's Central Department (Belladère, Boucan Carré, Cange,
Cerca La Source, Hinche, Lascahobas, Thomonde, and Savanette) and two sites in the Artibonite
Department (Petite Rivière, and St. Marc). Activities in St. Marc will be carried out in collaboration with the
Hôpital St. Nicholas (HSN) and Services de Santé de Premier Echelon (SSPE). Certain activities will also
be carried out at health posts in Segur and Jean Denis.
Tuberculosis and Malaria (GFATM), as well as the President's Emergency Program for AIDS Relief
other critical costs, this application includes the ARV medications for all patients discussed herein. If this co
-financing is not received, PIH/ZL will need to adjust all targets listed here, including, perhaps, a reduction in
the number of service outlets.
PIH/ZL's ARV treatment and training activities are part of a comprehensive HIV prevention and treatment
with the Haitian Ministry of Public Health and Population (MSPP) and with funds from GFATM; and further
expanded to Hinche, Cerca La Source, Petite Rivière and St. Marc with the support of PEPFAR in the FY
2005, 2006, and 2007. Since 2004 the program has been a collaboration between these four key partners—
PIH/ZL, MSPP, GFATM, and PEPFAR. Since 2005, work in the Artibonite region has been strengthened by
involving several NGO partners in St. Marc (SSPE, Promotion Objectif Zerosida (POZ), and La Fondation
Esther Boucicault Stanislas (FEBS)) and in Petite Rivière (Centre Medical Charles Colimon (CMCC), a
Medécins Sans Frontières (MSF)-affiliated institution). In August 2007, with the decrease in services
provided by MSF, PIH/ZL will assume responsibility for all services and supplies provided at CMCC.
All symptomatic or at-risk individuals as well as all pregnant women seeking care at PIH/ZL clinics are
offered voluntary counseling and testing for HIV. Upon identification of HIV-positive status, a patient is
referred to the HIV public health nurse and HIV program nurse, who performs further post-test counseling,
assists the patient in identifying at-risk partners or family members, arranges for a CD4 count and other
laboratory tests, and schedules subsequent follow-up visits. All HIV-positive patients are followed monthly
by a trained HIV/TB physician. At each visit, patients are evaluated for HIV disease progression,
tuberculosis and other opportunistic infections, and general health and well-being. When indicated,
prophylaxis, treatment, and social services are provided; palliative care given; and antiretroviral therapy
(ART) initiated. All PIH/ZL patients who are placed on ART are assigned a community health worker, called
an accompagnateur, who provides essential psychosocial support to patients and their families in addition
to daily directly observed ART. The accompagnateur also notifies clinic staff if a patient experiences side
effects or new symptoms. All care and treatment is provided free of charge to the patient.
ACTIVITY 1: Patient Maintenance
The first activity is to maintain individuals currently on antiretroviral therapy (ART) by improving program
retention and enhancing clinical follow-up. Funding will be used to employ accompagnateurs and
accompagnateur supervisors and to support monthly trainings, ensuring a strong network of community lay
personnel trained in ARV management and adherence strategies. Funding will also support laboratory
capacity, supplies, and infrastructure required for ARV service delivery at each PIH/ZL site. Procurement of
ARV medications for HIV-infected individuals is supported by GFATM. As of May 2007, PIH/ZL has more
than 2,700 patients on ARV treatment and is actively scaling-up efforts to provide ARV services to
additional patients in the Artibonite sites.
ACTIVITY 2: Treatment of HIV-Positive Infants and Children
The second activity is to provide ART to pediatric patients in the appropriate formulations, including syrup
for infants. Support groups for HIV-positive mothers will be strengthened to improve treatment adherence
and program retention. This funding will also support staff resources and the supplies necessary to provide
care for an increasing number of pediatric patients.
ACTIVITY 3: Case Detection and Enrollment
The third activity is to enroll additional patients on ART. In 2008, with the support of GFATM, PIH/ZL plans
to begin providing comprehensive HIV care in two new sites (Savanette and Desdunes) as well as to
expand services at two health posts (Segur and Jean Denis in the Petite Rivière health care network). At
the same time, PIH/ZL will aggressively seek to increase enrollment among the most marginalized and high
-risk groups in its catchment area. PIH/ZL hopes to build upon the success of the past 12 months in which
approximately 900 patients were newly enrolled on ART. This funding will allow PIH/ZL to renovate and
equip public facilities at the expansion sites listed above and will also be used for comprehensive and on-
going training of clinical staff and accompagnateurs.
Activity Narrative: ACTIVITY 4: Training Healthcare Providers
In addition to providing direct services, PIH/ZL is committed to sharing and leveraging our experience by
providing ongoing training to healthcare workers across Haiti. PIH/ZL's efforts to train health workers in the
delivery of ARV services have expanded significantly in the past years. In 2004, with support from PEPFAR
and in collaboration with the International Training and Education Center on HIV/AIDS (I-TECH) and the
Caribbean HIV/AIDS Regional Training Initiative (CHART), PIH/ZL opened a National Training Center
(NTC) with facilities in Hinche and Cange. In the past year, PIH/ZL has trained hundreds of health workers
in Haiti in all aspects of HIV care and treatment. This funding will support personnel and infrastructure
requirements to strengthen the training program at Hinche as well as cover the direct costs of training
sessions: participant transport, trainer and participant per diems, and materials production.
treatment. These above activities will contribute to the PEPFAR 2-7-10 goals by increasing the number of
individuals on ARV treatment and by expanding the capacity of individuals and organizations in Haiti to
initiative and manage ART treatment, avert new HIV infection, and provide care for an increased number of
HIV+ patients.
Human Resources51-100%
Infrastructure10-50%
Training10-50%
This activity is a continuing activity, however, PIH performed this activity in a different program area--ARV
Services.
SUMMARY:
Funds will be used to provide sufficient laboratory bench space and purchase non-medical laboratory
equipment (such as furniture, sinks, etc) needed for improvement of laboratory infrastructure. A functional
laboratory is critical needed to support persons living with HIV/AIDS (PLWHA). Laboratory technicians will
also be hired and trained.
ACTIVITES AND EXPECTED RESULTS:
Partners in Health (PIH) proposes to carry out the following activities in this Program Area.
ACTIVITY 1: PIH will prepare 2 additional laboratories to provide ARV level laboratory services for PLWHAs
on ART. As sites upgrade from providing only Palliative Care level services to being able to follow patients
on ARVs certain laboratory systems requirements have to be met. While SCMS will procure medically
oriented equipment and supplies, this funding will enable PIH to procure basic items essential for improving
laboratory infrastructure. A laboratory will be refitted to provide laboratory bench space, working hand-wash
basin, office space for lab management, storage, and blood collection area. Using local companies, PIH will
procure, install and secure sets of inverters and batteries ensuring constant electrical supply to the
laboratoriesas well as procure and install a water tank and water pump to ensure constant water supply.
PIH will subcontract local companies to provide gas tanks, maintain and service gas refrigerators at the
laboratories to make sure that refrigerators are operating well in order to keep essential CD4 and other
laboratory test kits cold.
Activity 2: PIH will hire additional lab personnel for ARV laboratories (1 per site) in order to carry out extra
laboratory testing work load for people living with HIV/AIDS. The hired lab technicians will be trained by the
National Public Health Laboratory staff for laboratory testing, QA/QC, good lab practices and lab
management. There will be no cost for training since the NPHL will cover the expenses of training
These results contribute to the PEPFAR 2-7-10 goals by improving access to and quality of laboratory
services in order to identify HIV positive persons and increase the number of persons receiving ARV
services.
Infrastructure51%-100%
Human capacity development10%-50%
2 Lab technicians hired
2 laboratories to perform HIV-testing and CD4
2 laboratories improved its infrastructure
People living with HIV/AIDS
Laboratory Workers
COVERAGE AREAS: national
