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
SUMMARY: PMTCT is an integral part of comprehensive HIV care and treatment of PLWHA. Activities to
support PMTCT include: (1) provision of comprehensive PMTCT services at antenatal clinics (ANC); (2)
training and supervision of OBGYN, counselors in PMTCT as well as traditional birth attendants; (3)
community mobilization to support PMTCT and 4) and active linkage with Pediatric Services. The primary
emphasis areas for these activities are: community mobilization, training, human resources, food nutrition
support, ANC clinics, quality assurance, quality improvement and supportive supervision. The specific target
population will be pregnant women and children born from HIV+ mothers. During the period of ten months
(October 2007 to July 2008), 7415 pregnant women were tested for HIV, and 190 of these women were
seropositive. Fifty-three (or 28%) of HIV infected women were placed on ARV prophylaxis. The coverage
area for this program include the communes of Fonds-des-Nègres (Nippes); Fonds-des-Blancs (South);
Port-au-Prince (West); Deschapelles, Ennery, Gros Morne (Artibonite); Pilate, Limbe, Milot (North) and all
new peripheral satellite sites.
BACKGROUND: In 2002, PMTCT component was initiated through Catholic Medical Mission Board in the
communes Gros-Morne, Milot, Fonds des Blancs and Limbe; CRS- UNICEF partnership in the commune
Pilate; Management Sciences for Health in the communes of Léogane and Deschapelles and; in 2005,
through President's Emergency Plan for AIDSRelief (PEPFAR) in Fonds des Nègres and Gonaives.
AIDSRelief is a five-member consortium, led by Catholic Relief Services (CRS), and includes three faith-
based organizations, a medical institution recognized as a world leader in HIV/AIDS care, research and
program development, and an international development company that specializes in the design and
implementation of public health and social programs. All AIDSRelief Consortium members have a shared
mission to provide quality medical care to individuals living with HIV/AIDS.
Since 2004, AIDSRelief has worked with eight ARV sites in five geographic departments, including the main
public departmental hospital in Gonaives. In year five, Hopital La Providence was accorded to the
Collaborative Agreement Partner of the Ministry of Health, Plan National. The community reference
hospital, Hopital Sainte Croix at Leogane was temporarily closed, and their patient population was offered
services at the GHESKIO-supported program at Signeau.
AIDSRelief has collaborated with Ministry of Health (MOH) and INHSAC in training activities. AIDSRelief
will continue its close collaboration with MOH, Unité de Controle et de Lutte (UCC) and departmental
direction to also conduct regular supervision visits. Pregnant women will be encouraged to attend ANC
through community mobilization activities.
ACTIVITIES AND EXPECTED RESULTS:
Activity 1: Provision of comprehensive PMTCT services at antenatal care (ANC) and linked to Pediatric
Services. AIDSRelief will support its sites and all new peripheral satellite sites to provide PMTCT in order to
diagnose HIV/AIDS and reduce HIV/AIDS transmission. All women attending ANC will be counseled and
offered HIV testing. AIDSRelief will support the extension of PMTCT services to all satellite health centers
attached to sites. The funds will be used to support training activities; salaries for staff including physicians
(OB/GYN's and pediatricians), counselors and pediatric nurses; incentives for trained birth attendants and
community health workers; supervision visits and; community mobilization. AIDSRelief will work in
collaboration with other stakeholders including the Ministry of Health (MOH), US government and other
NGOs to ensure sustainability of provision of PMTCT services.
Activity 2: AIDSRelief will support training and supervision for OBGYN, pediatricians, counselors, CHW and
TBA in PMTCT. In collaboration with MOH and INHSAC, AIDSRelief will ensure effective counseling to
include Family Planning messages and testing to women attending ANC. AIDSRelief will support increasing
staff capacity to deliver appropriate ARV prophylaxis at different periods of pregnancy according to national
guidelines. AIDSRelief will also help increase staff skills and knowledge necessary to provide effective
counseling on infant feeding and Family Planning services. With the development of new curricula by the
MOH and also given with staff turnover at the AIDSRelief sites, AIDSRelief will continue to provide training
and refresher courses in Year 6.
Activity 3: Nearly eighty percent of pregnant women in Haiti deliver at home. AIDSRelief will proffer an
integrated longitudinal package to minimize transmission of HIV from mother to infant. AIDSRelief will
establish community-wide identification of HIV-infected pregnant women; engage HIV-infected pregnant
women into comprehensive HIV care; provide effective antiretroviral treatment and prophylaxis for pregnant
and nursing women and their infants. AIDSRelief will adapt early HAART for all infected pregnant women
through evidenced-based and cost-effective strategy for prevention of intrauterine and intrapartum
transmission when transmission is most likely to happen. (The national guideline recommends at least bi-
therapy Antiretroviral treatment).
Activity 4: AIDSRelief will provide a package of support for HIV-exposed infants including continuous
nutritional counseling from pregnancy through infancy. All exposed infants will be monitored and receive a
package of services specific to their needs until 2 years of age. AIDSRelief will train clinical staff to provide
infant nutrition counseling; assess relative individual risks and; provide overall clinical care for both mothers
and infants from clinical facilities to community/homes level. Clinical outcomes such as infant feeding
patterns, late infection/sero-conversion and mortality will be monitored and evaluated.
Activity 5: In order to expand pediatrics care and case identification, AIDSRelief will move towards rapid
diagnosis of exposed infants and infected children. Through established MOH and the National Reference
Lab guidelines, AIDSRelief will ensure availability of early virologic diagnosis in infants through expanded
new technology such as Cavidi for VL capacity and rapid DBS. AIDSRelief will train clinical and laboratory
staff on the importance, rationale of early diagnosis; and in the use and interpretation of laboratory methods.
Exposure or infection status of all infants and children < 15 years of age should be determined with the use
of multiple entry points: children and siblings of patients, inpatients, children seen at MCH, well baby clinics,
community vaccination campaigns, orphanages, etc. Long-term health of exposed/infected children will be
monitored through preventive community follow-ups.
Activity Narrative: Activity 6: AIDSRelief will support PMTCT/VCT activities at all AIDSRelief hospitals and all new peripheral
satellite sites through the provision of full antenatal care, clinical services for HIV palliative care, subsidized
labor and delivery, and postnatal services. AIDSRelief will support a continuum of care for seamless
referral, coordination and communication between ART linkage of adults and maternal-child HIV services,
pediatrics, antenatal clinics and maternity services. To assure safe delivery of HIV pregnant women who
choose to deliver at home, AIDSRelief will support training, supervision and integration of traditional birth
attendants ("matronnes"). Over a period of ten months (October 1, 2007 to July 31, 2008), 85 pregnant
women infected with HIV delivered their babies at AIDSRelief hospitals. AIDSRelief will also guide its
hospitals in the leveraging of community staff to facilitate coordinated tracking, completion of ARV
prevention, and early infant prophylaxis and diagnosis. AIDSRelief will engage mothers and their families in
HIV care, group visits and family counseling. AIDSRelief will establish linkages to wrap-around services ¬to
provide HIV+ pregnant women with access to reproductive health services, food/nutrition support, and
microcredit opportunities..
Activity 7: Through community mobilization, AIDSRelief will seek to increase attendance at the ANC by
HIV+ pregnant women, to reduce stigma, and facilitate access to PMTCT/VCT services, HIV treatment, care
and support. A key element of the AIDSRelief program is the community and its involvement to support
access to services, transmission of accurate information, destigmatization of HIV for HIV+ patients.
Pregnant women will be motivated to attend ANC clinics for HIV/AIDS information, its modes of
transmission through counseling and testing in order to reduce HIV transmission.
New/Continuing Activity: Continuing Activity
Continuing Activity: 17165
Continued Associated Activity Information
Activity Activity ID USG Agency Prime Partner Mechanism Mechanism ID Mechanism Planned Funds
System ID System ID
17165 9671.08 HHS/Health Catholic Relief 7677 3314.08 AIDS Relief $500,000
Resources Services
Services
Administration
9671 9671.07 HHS/Health Catholic Relief 5117 3314.07 AIDS Relief $350,000
Emphasis Areas
Construction/Renovation
Gender
* Addressing male norms and behaviors
* Increasing gender equity in HIV/AIDS programs
Health-related Wraparound Programs
* Child Survival Activities
* Family Planning
* Malaria (PMI)
* Safe Motherhood
* TB
Human Capacity Development
Public Health Evaluation
Food and Nutrition: Policy, Tools, and Service Delivery
Food and Nutrition: Commodities
Economic Strengthening
Education
Water
Table 3.3.01:
SUMMARY: AIDSRelief Consortium will expand palliative care to include comprehensive medical services,
psychosocial support, and follow-up for 15,000 patients by the end of year five. Development of networks
and linkages will be encouraged with other community-based clinical programs and with government-
supported programs in the geographic departments served by AIDSRelief. The target populations include
people living with HIV and
AIDS and their families. The coverage area includes the communes of Gonaïves, Gros Morne, and
Deschapelles in the Artibonite; Fond-des-Nègres in the Nippes; Fond-des-Blancs in the South; Léogane in
the West; Pilate and Milot in the North, and all new sites to be assessed.
BACKGROUND: AIDSRelief has been providing palliative care and ARV drugs in Haiti since 2004, through
support from the President's Emergency Plan for AIDS Relief (PEPFAR). AIDSRelief recognized the need
to develop a comprehensive and public health approach to palliative care integrated with existing health
systems and the continuum of care for chronic, life threatening illnesses. HIV/AIDS has become a
manageable chronic disease. In the coming year, AIDSRelief will provide an integrative continuum of care
(including the need for improvements in pain and symptom management) according to the diverse settings,
clinical management strategies, and disease stages relevant to palliative care in HIV disease.
With existing resources, eight sites have been reinforced with integrated VCT, ARV, PMTCT and palliative
care services. So far 6,000 have been enrolled in clinical care. With Fiscal Year (FY) 2008 resources,
AIDSRelief will reinforce the existing eight sites and will expand palliative care services to three new sites
by September 2009 to reach a total of 11 palliative care sites in integration and/or in networking with the
ARV sites. AIDSRelief is committed to working with the government of Haiti (and other implementing
partners) and is an active member of the Ministry of Health's care and treatment cluster, which has
responsibility to define the national strategy for HIV/AIDS care.
Activity 1: Service Organization
AIDSRelief will ensure that all patients testing positive at any AIDSRelief hospital or at any of the satellite
health centers in their regional networks will be enrolled in clinical palliative care. As a result, they will
receive access to laboratory, clinical, nutrition, psycho-social assessment and follow up services. The
program will use FY 2008 funding 1) to staff each site with a multi-disciplinary health care team, including
physicians, nurses, psychologists, social workers, counselors, nutritionists, community health workers, and
laboratory technicians (see laboratory narrative); 2) to support the organization of health services,
including patient monitoring, laboratory for basic and CD4 testing, dispensation of opportunistic infection
treatment and prophylaxis, pain and symptom management, long-term patient follow-up and prescription of
food to malnourished PLWHAs, and; 3) to perform refurbishing at the sites to enhance laboratory capacity,
drug storage, and clinical management. This will be done in integration with Supply Chain Management
Services which is responsible for providing laboratory reagents, commodities, and OI drugs
Activity 2: Human capacity building
The program will continue training to ensure the clinical staff maintains skills in the care and treatment of
people infected with HIV/AIDS. This year the focus will be on training health professionals in nutrition
assessment, follow-up and recuperation to make sure that all sites are integrated with nutrition services.
The capacity to provide quality health care at the local level will depend on the skills maintained by the
medical staff at each health center. To sustain a workforce of highest quality, AIDSRelief will provide on-
going training and technical support on a quarterly basis. Similar technical support will be available to
support staff including pharmacists, laboratory technicians, and monitoring and evaluation specialists.
Activity 3: Social support services
Special attention will be given to the need for social support for patients enrolled in the palliative care
program. Funding will enable AIDSRelief to hire at each site a social work team led by a social worker that
will be in charge of assessing the social needs of all people living with HIV/AIDS (PLWHA) and help them
receive access to social support services. Direct support will be provided through the sites (e.g. fees for
services—delivery, hospitalization, x-ray etc) and for transportation to appointments. The program will also
refer patients to the PLWHA association and community based organization in charge to provide community
palliative care through a family centered approach. This will allow patients to gain access to a broader
package of social and economical support services (see AERDO, CRS, TBD, and Plan activity narratives
for palliative care). A social worker or psychologist who will focus on the counseling needs of staff at the
AIDSRelief hospitals and clinical satellites will be added to the AIDSRelief team.
Activity 4: Home based care
AIDSRelief will increase the number of community health workers to accommodate scale-up at each
AIDSRelief points of service. The community workers will be in charge of tracking patients (including
pregnant women enrolled in PMTCT and infected and exposed children), provide at home adherence
support, health education on best health and nutrition practices, counseling for positive behavior,
distribution of care, and preventive commodities such as condom, Oral Re-hydration Solution, pain
medications according to the guidelines and make appropriate referrals. The program will hire nursing
supervisors at each site to support the community workers with symptom recognition, and syndromic
treatment, particularly when they have patients experiencing health or psychosocial problems.
Activity 5: Psychological support
Funding will be used to hire, at minimum, a psychologist at each center of excellence to provide support to
PLWHA in order to reduce denial and assist in psychological assessment and follow up and on
preparedness for highly active antiretroviral therapy and chronic follow up and treatment. AIDSRelief will
continue to support each site PLWHA support groups to create a supportive environment for treatment
adherence and stigma reduction. In addition, local community leaders, traditional healers, and religious
leaders will be incorporated to encourage and enhance support of patients within the community.
AIDSRelief will continue to penetrate the religious sector in an effort to bring HIV/AIDS and treatment
awareness to churches and religious groups and to get them involved in providing spiritual care to patients.
Activity 6: Capacity building in Palliative Care Services
Activity Narrative: AIDSRelief will develop a program for integrated palliative care team-training. All home-based
care/community health workers will receive initial training in palliative care that includes: TB support, TB
screening through established algorithmic questionnaires and sputum sample, and TB treatment
adherence. Training on treatment support will focus on symptomatic triage, including identification of ARV
side effects; pain and referral to community health nurse or clinic for follow-up; documentation and
assessment of side effects and need for symptom management; communication skills; care for care-givers
in the home and; end-of-life issues.
Activity 7: Mentoring in Palliative Care Services
AIDSRelief will identify Palliative Care Leadership Team members from amongst its clinical staff and from
site providers. The team members will provide Trainer-of-Trainings (TOT) activities for home-based and
community care assessment; symptom management and facilitate and patient teaching. The Palliative
Care Leadership Teams will work in collaboration with National Community Care and Support implementing
organizations .
Activity 8: Staff Retention Activities
To better address the impacts on staff working in HIV and AIDS care and treatment services, (e.g., high
turnover, stress management and burn-out, etc.), AIDSRelief will work with each hospital to develop a site-
specific plan encouraging safe havens, peer support and resource centers and to initiate/evaluate other
activities for team support.
Continuing Activity: 17166
17166 4496.08 HHS/Health Catholic Relief 7677 3314.08 AIDS Relief $200,000
9269 4496.07 HHS/Health Catholic Relief 5117 3314.07 AIDS Relief $250,000
4496 4496.06 HHS/Health Catholic Relief 3314 3314.06 AIDS Relief $600,000
Table 3.3.08:
SUMMARY: AIDSRelief Haiti is a comprehensive program currently providing anti-retroviral therapy (ART)
to 2029 people (May 2007) in eight treatment facilities. Target populations include adults, infants, children,
and youth infected with HIV, who seek medical services at any AIDSRelief hospital. Emphasis areas include
human resources, local organization capacity development, logistic support and training. Community
mobilization and the development of networks, linkages, and referral systems will also be critical
components of the AIDSRelief program. AIDSRelief will review its performance through the QA/QI process
to ensure implementation of best practices in each clinical program. The coverage area for this program
include the communes of Fond-des-Nègres (Nippes); Fond-des-Blancs (Sud); Léogane (Ouest);
Deschapelles, Gonaives, Gros Morne (Artibonite); Pilate, Milot (Nord).
BACKGROUND: AIDSRelief (AR) has provided ARV services in Haiti since 2004, through support from
Track 1.0 and funding from the President's Emergency Plan for AIDS Relief (PEPFAR). AIDSRelief is a five-
member consortium, led by Catholic Relief Services (CRS), and includes three faith-based organizations, a
medical institution that is recognized as a world leader in HIV/AIDS care, research and program
development, and an international development company that specializes in the design and implementation
of public health and social programs. All members of the AIDSRelief Consortium have a shared mission to
provide quality medical care to individuals living with HIV/AIDS. AIDSRelief Haiti works within seven faith-
based hospitals and one public hospital.
Since the launch of AR activities in Haiti, it has been able to implement eight ARV sites in four geographic
departments, including the main public departmental hospital in Gonaives. This program has built on CT,
PMTCT, TB and HIV basic care already implemented at these sites through PEPFAR, the Global Fund to
Fight AIDS, Tuberculosis and Malaria (GFATM), and core funds from members of the AR consortium. AR
has used funding to build infrastructure, logistic and human capacity to implement ARV services at these
sites. Through the consortium, technical assistance and QA/QI have been provided to ensure quality of
services.
A significant proportion of AIDSRelief patients are women; therefore this program will integrate with other
clinical programs that reach out to women including PMTCT, OB/GYN, and maternal and child health
(MCH) programs. Women and girls who are victims of sexual assault are a special target population for
AIDSRelief. AIDSRelief will work in close collaboration with the government of Haiti. AIDSRelief is an active
member of the Ministry of Health's (MOH) care and treatment cluster that has responsibility to define the
national strategy for HIV/AIDS care.
Activity 1: AIDSRelief will continue its plan to provide durable, high-quality anti-retroviral therapy (ART),
according to Haiti's national guidelines. During COP 2008, each hospital will scale up the enrollment of anti-
retroviral (ARV) clients through expanded hospital-based and community-based VCT services that target
patients at highest risk for HIV, and through referrals from clinical programs such as TB treatment
programs. These activities will be accomplished through the development of an integrated approach to
services at each AIDSRelief hospital, and through collaboration with other stakeholders such as the MOH,
the Unites States Government (USG) team, and other PEPFAR awardees. AIDSRelief will strengthen its
regional approach to ART in the Artibonite by expanding its support for Gonaïves' Hôpital La Providence as
a regional center of excellence. Similar regional approaches will be maintained in the South and the North,
where AIDSRelief has multiple clinical sites that are strategically placed.
Activity 2: Training and capacity building in eight clinical centers will continue with support from COP 2008.
Continued clinical technical assistance and mentoring for in country caregivers will be expanded in Year
four to build capacity of in-country clinicians, and to strengthen the skills of other members of the multi-
disciplinary team, including counselors and treatment support staff, and technical staff (e.g. pharmacists, lab
technicians). This training will provide an opportunity for continued clinical technical assistance that will be
sustainable over time.
Upon receiving their training, these clinicians will provide strong leadership for AIDSRelief Haiti's eight
clinical centers. These clinicians will be responsible for monthly medical supervision and training for hospital
-based physicians, clinical officers, and nurses. AIDS seminars and updates will be held quarterly at each
hospital. These seminars will focus on treatment challenges and knowledge deficits identified by physicians
on the in-country team. In addition, training will present new approaches to care and treatment based upon
best practices and research findings in HIV/AIDS.
Activity 3: AIDSRelief partners will strengthen local organizational capacity in the areas of hospital
management, finance, and fund-raising in order to ensure long-term sustainability of ARV services.
AIDSRelief will collaborate with other stakeholders to provide critical linkages that ensure sustainable
quality ART.
Activity 4: AIDSRelief Haiti expects that at least 10% of the AIDSRelief patients will be within the pediatric
age group. Pediatric ART training will be provided for the eight AIDSRelief hospitals. Additional training and
support will be made available for pediatric counseling and treatment support. AIDSRelief will seek to
identify infected children through its expanded work with women enrolled in PMTCT and through close
collaboration with in-patient pediatric programs. Early diagnosis of HIV infection in HIV-exposed infants will
be provided in order to increase access to antiretroviral treatment. Infant feeding counseling will also be
provided to caregivers for an informed option and appropriateness choice of alimentation.
Activity 5: COP 2008 funding will support patient monitoring and management (PMM) tools at the
community and the institutional level to improve the program's ability to track patient care. At the community
level, treatment support teams will use these tools to ensure 95-100% patient adherence to ART. These
treatment teams will be lead by a nurse supervisor and/or a counselor at each hospital.
AIDSRelief will work with MOH, CDC and HIVQUAL to improve each hospital's QA/QI system during Year
Activity Narrative: four. QA/QI assessments will provide clinical, laboratory, and behavioral monitoring of the patient. The
QA/QI program and PMM will be used to improve patient care, and to identify areas within the ART program
that need strengthening.
AIDSRelief-Consella Futures will provide TA and training to build capacity of LPTF staff responsible for data
collection and analysis. Activities will include: complete adoption of government revised PMM systems; joint
supervision and TA with government M & E agency (IHE); analysis of required indicators requested by
LPTF, CCT and funding agencies; training on generation of programmatic indicators to produce the required
reports on an accurate and timely basis that meet data quality standards. Constella Futures will carry out
regular site visits and reviews to ensure quality data and data validation.
Activity 6: AIDSRelief will provide training for all members of its multi-disciplinary team in the management
of PEP (post-exposure prophylaxis). The team will develop skills in care, treatment, and support for women
following rape and services will be available at all times in each AIDSRelief hospital. Post-exposure
prophylaxis will be made available, in addition to HIV testing. Long-term follow-up for these women will
include psychological support, laboratory testing, and medical treatment. Similar services will be available at
all times for staff where there is the potential for occupational HIV exposure at an AIDSRelief hospital or at
one of AIDSRelief's satellite health centers.
TARGETS
Targets Sept.2008Targets Feb. 2009Targets Sept. 2009
LPTFs providing ART999
Adults on ART320040004400
Children receiving ARV375450500
Continuing Activity: 18988
18988 18988.08 HHS/Health Catholic Relief 7677 3314.08 AIDS Relief $3,065,000
Estimated amount of funding that is planned for Human Capacity Development $400,000
Table 3.3.09:
SUMMARY: AIDSRelief will expand palliative care to include comprehensive medical services,
psychosocial support, and follow-up for patients. AIDSRelief will encourage the development of networks
and linkages with other community-based clinical programs and with government-supported programs in the
geographic departments of its hospitals. AIDSRelief will review its performance through the Quality
Assurance/Quality Improvement (QA/QI) process to ensure implementation of best practices in each clinical
program. The coverage area for this program include the communes of Fonds-des-Nègres (Nippes); Fonds-
des-Blancs (South); Port-au-Prince (West); Deschapelles, Ennery, Gros Morne (Artibonite); Pilate, Limbe,
Milot (North).
BACKGROUND: AIDSRelief has provided ARV services in Haiti since 2004, through support from Track 1.0
and funding from the President's Emergency Plan for AIDS Relief (PEPFAR). AIDSRelief is a five-member
consortium, led by Catholic Relief Services (CRS), and includes three faith-based organizations, a medical
institution recognized as a world leader in HIV/AIDS care, research and program development, and an
international development company that specializes in the design and implementation of public health and
social programs. All members of the AIDSRelief Consortium have a shared mission to provide quality
medical care to individuals living with HIV/AIDS.
Since 2004, AIDSRelief has implemented eight ARV sites in five geographic departments, including the
main public departmental hospital in Gonaives. In year five, Hopital La Providence in Gonaives was
accorded to the Collaborative Agreement Partner of the Ministry of Health, Plan National. The community
reference hospital in Leogane was temporarily closed and as a result, their patient population was offered
service at the GHESKIO supported program at Signeau. The AIDSRelief Program has built on CT, PMTCT,
TB and HIV basic care already implemented at these sites through PEPFAR, the Global Fund to Fight
AIDS, Tuberculosis and Malaria (GFATM), and other funding sources. AIDSRelief built infrastructure,
logistic and human capacity to implement ARV services at these sites. Technical assistance and QA/QI
were also provided to ensure quality of services.
Activity 1: AIDSRelief Haiti projects at least 10% of the AIDSRelief patients will be within the pediatric age
group. As of July 2008, 6% of the active ART caseload (or 141 in total) were children under the age of 15.
AIDSRelief will identify infected children through an expansion of its PMTCT services for women and
through close collaboration with in-patient pediatric programs, well baby clinics and vaccination programs.
AIDSRelief will support the provision of a package of services for HIV-exposed infants including diagnostic
services and continuous evidence-based nutritional counseling from pregnancy through infancy. In order to
increase access to antiretroviral treatment, early diagnosis of HIV infection in HIV-exposed infants will be
provided. Caregivers will also be counseling on infant feeding for an informed option and appropriateness
choice of alimentation.
Activity 2: Pediatric case finding and outreach should be linked with the assurance of the long-term health of
infected children if the health outcomes are to be durable. AIDSRelief will support early identification of
children who require ART. AIDSRelief will work and collaborate with national guidelines committees
addressing pediatric needs in the selection of initial regimens that maximize prospect for long term viral
suppression with minimal toxicity; Child-friendly formulations (chewable/crushable tabs in several sizes and
with appropriate ratio of drugs) and; in the monitoring of treatment success and management of treatment
failure including 2nd-line options. The care will promote opportunistic infection prophylaxis and treatment;
better TB diagnostics and; nutritional counseling.
Activity 3: HIV-exposed infants should be enrolled into comprehensive HIV care clinics until they are
diagnosed as free of HIV, no longer exposed, and not at high risk for malnutrition - generally around 24
months of age. Bundling of HIV diagnostic, CTX prophylaxis, nutritional counseling, immunization, bednet
and oral rehydration service provision, and other services will be encouraged. AIDSRelief will support the
integration of Continum of Care into the care and treatment of children & adolescents living with HIV/AIDS.
AIDSRelief will support the hospital's Pediatric OI/ART team to administer the clinical management for
pediatric patients within the pediatric ward of the Referral Hospital. AIDSRelief will also support Child-
friendly environment equipped with age-appropriate IEC materials, toys, drawing materials and a play area.
Activity 4: In collaboration with national HIV programs and other entities, AIDSRelief will work to rapidly
diagnose infected and exposed infants and children for universal access to virologic diagnostics (e.g.
establishing lab, organizing logistics, etc).
Training on clinical diagnosis of HIV in infants by other means should be implemented immediately. In some
cases, there may be issues related to national guidelines on clinical diagnosis of infants; any such concerns
should be identified as soon as possible and a plan for addressing them implemented.
Activity 5: AIDSRelief will establish evidence-based identification of children who require ART and advocate
for appropriate guidelines for initiating treatment in children.
AIDSRelief will develop strategy for training clinical staff on revised treatment criteria, including the selection
of initial regimens that maximize prospect for long term viral suppression with minimal toxicity. AIDSRelief
will support the monitoring of treatment success and management of treatment failure, including recognition
of treatment failure, resistance consequences, and 2nd line options. AIDSRelief will seek to improve
opportunistic infection prophylaxis and treatment with the monitoring of clotrimazole usage. AIDSRelief will
also consider opportunities to evaluate potentially feasible and reliable TB diagnostic methods for children.
Activity 6: AIDSRelief will develop strategies and trainings for pediatric adherence preparation and support
and disclosure counseling. AIDSRelief will also support activities for children and adolescents to achieve
independent adherence.
Activity 7: AIDSRelief will engage mothers and families in HIV care by early testing of children and partners
of infected women; prevent vulnerable children from becoming orphans; create family-based tracking in the
Activity Narrative: community; make appointments (clinical and community based service centers) for parents and children at
same time and; engage parents in care, particularly fathers.
Activity 8: AIDSRelief will support the integration of nutrition activities into the care of all in-patient and out-
patient children regardless of HIV status. Given the link between nutritional status and HIV infection,
AIDSRelief will pay particular attention to nutritional assessment of infants and children who have been
exposed to HIV. Due to the fact that growth is a very sensitive indicator of HIV disease and disease
progression in children, the growth and development of all in and out-patient children will be carefully
assessed and monitored as per national nutritional guidelines.
Activity 9: AIDSRelief will develop materials, outcomes and evaluation tools, and procedures specific for
pediatrics. AIDSRelief will support efforts to assess counseling status; conduct refresher trainings on
modified counseling methods and; collect data on processes and outcomes.
Estimated amount of funding that is planned for Food and Nutrition: Policy, Tools $50,000
and Service Delivery
Table 3.3.10:
services and continuous nutritional counseling from pregnancy through infancy. In order to increase access
to antiretroviral treatment, early diagnosis of HIV infection in HIV-exposed infants will be provided.
Caregivers will also be counseling on infant feeding for an informed option and appropriateness choice of
alimentation.
Activity 4: In collaboration with national HIV programs and other entities, AIDSRelief will work with national
pilot program to rapidly diagnose infected and exposed infants and children for universal access to virologic
diagnostics (e.g. establishing lab, organizing logistics, etc). Training on clinical diagnosis of HIV in infants
will be implemented immediately.
Activity 5: AIDSRelief will establish identification of children who require ART and advocate for appropriate
guidelines for initiating treatment in children. AIDSRelief will continue training clinical staff on revised
treatment criteria, including the selection of initial regimens that maximize prospect for long term viral
suppression with minimal toxicity. AIDSRelief will support the monitoring of treatment success and
management of treatment failure, including recognition of treatment failure, resistance consequences, and
2nd line options. AIDSRelief will seek to improve opportunistic infection prophylaxis and treatment with the
monitoring of clotrimazole usage.
Activity 6: AIDSRelief will continue health education and trainings for pediatric adherence preparation and
support and disclosure counseling. AIDSRelief will also support activities for children and adolescents to
achieve independent adherence.
community; make appointments (clinical and community based service centers) for parents and children at
Activity 8: AIDSRelief will continue to collaborate with Care and Support Implementers for the integration of
nutrition activities into the care of all in-patient and out-patient children regardless of HIV status. Given the
Activity Narrative: link between nutritional status and HIV infection, AIDSRelief will pay particular attention to nutritional
assessment of infants and children who have been exposed to HIV. Due to the fact that growth is a very
sensitive indicator of HIV disease and disease progression in children, the growth and development of all in
and out-patient children will be carefully assessed and monitored as per national nutritional guidelines.
Activity 9: AIDSRelief will use its existing materials, outcomes and evaluation tools, and procedures specific
for pediatrics. AIDSRelief will support efforts to assess counseling status; conduct refresher trainings on
Table 3.3.11:
SUMMARY: AIDSRelief will expand palliative care to include comprehensive medical services, psychosocial
support, and follow-up for patients. AIDSRelief will ensure that all HIV patients get access to TB screening,
prophylaxis, and treatment through its network of hospitals. As of July 2008, 1965 active ART patients were
enrolled in TB care. AIDSRelief will encourage development of networks and linkages with other HIV clinical
and community-based programs supported by the President's Emergency Program for AIDSRelief
(PEPFAR). The target populations include people living with HIV/AIDS and their families. The coverage
area for this program include communes of Fonds-des-Nègres (Nippes); Fonds-des-Blancs (South); Port-au
-Prince (West); Deschapelles, Ennery, Gros Morne (Artibonite); Pilate, Limbe, Milot (North).
BACKGROUND: AIDSRelief has been providing palliative care and ART in Haiti since 2004, through
support from PEPFAR (Track 1.0 and COP 2006). AIDSRelief is a five-member consortium, led by Catholic
Relief Services (CRS), and includes three faith-based organizations, a medical institution recognized as a
world leader in HIV/AIDS care, research and program development, and an international development
company that specializes in the design and implementation of public health and social programs. All
AIDSRelief Consortium members have a shared mission to provide quality medical care to individuals living
with HIV/AIDS.
Since 2004, AIDSRelief has reinforced HIV care and treatment in eight sites in five geographic departments,
including the main public departmental hospital in Gonaives. In year five, Hopital La Providence was
reference hospital, Hopital Sainte Croix at Leogane was temporarily closed, and their patient population was
offered services at the GHESKIO-supported program at Signeau.
AIDSRelief has taken steps to integrate TB/HIV in its hospitals by offering TB screening, prophylaxis to HIV
positive patients; integrating Counseling and Testing (CT) in the TB wards at these sites and; making
referrals between the HIV and TB services for continuum of care for co-infected individuals, according to
norms. AIDSRelief recognized to expand the TB/HIV program through its sites by improving screening
capacity; reinforcing linkages with TB services for TB treatment as needed; integrating this program into
pediatric care; reinforcing TB infection control measures, and by monitoring TB drug resistance. AIDSRelief
will focus its effort on developing a comprehensive and public health approach for an integration of TB/HIV
and palliative care with existing health systems and the continuum of care for HIV patients. AIDSRelief will
collaborate with the government of Haiti and other key HIV and TB implementing partners to define national
policies and strategies for the program.
EXPECTED RESULTS AND ACTIVITIES
Activity 1: AIDSRelief will continue to reinforce its nine hospitals to perform TB screening, prophylaxis, and
treatment for HIV positive individuals. Emphasis will be put on HIV positive children as pediatric care is
being expanded through these sites. TB infection control measures and TB drug resistance monitoring will
be implemented in these sites according to national norms and protocols. AIDSRelief will also reinforce CT
services in TB wards at its sites through building capacity, reinforcing infrastructure (including laboratory),
and working with Supply Chain Management Systems (SCMS) to ensure adequate provision of PPD test
and related commodities and INH for prophylaxis. Based on needs assessment, the hospitals will be
reinforced with chest x-ray capacity, including equipment and related materials and commodities to improve
TB screening. This will complement sputum smear diagnosis capacity implemented at all TB sites through
the TB/DOTS program financed by the Global Fund to Fight AIDS, Tuberculosis and Malaria.
Activity 2: AIDSRelief and its Quality Assurance/Quality Improvement (QA/QI) will further its collaboration
with the Ministry of Health (MOH) at the central and departmental levels, and other lead TB NGOs—
International Child Care, CARE, Centre Pour Le Développement et la Santé, and Groupe Haitien d'Etude du
Sarcome de Kaposi et des Infections Opportunistes (GHESKIO)—to coordinate and monitor the national
TB/HIV program.
Activity 3: In collaboration with the MOH and other lead TB NGOs, AIDSRelief will share its expertise in
developing and/or updating norms, protocols, and guidelines and training tools for TB/HIV with an emphasis
on TB infection control, TB/HIV pediatric care, and on monitoring TB drug resistance. AIDSRelief will
disseminate these documents and implement TB/HIV activities in its sites.
Activity 4: AIDSRelief will continue to emphasize provider-initiated HIV counseling and testing of TB patients
with assuring referral to HIV care and treatment. AIDSRelief will ensure intensified TB case finding among
PLWHA with referrals for TB diagnosis and treatment; TB infection control; and if logistically feasible and
adequate TA, the initiation of isoniazid prevention therapy (IPT).
Activity 5: AIDSRelief will continue to utilize algorithms for clinical assessment of TB disease; maintain
integrated nursing staff in both TB and HIV care services with rotation between services and provide
integrated training for both staff. AIDSRelief will synchronizes TB cohort reporting system and HIV
outcomes reports with further integration of patient held records. Monitoring will facilitate the avoidance of
multiple drug resistant TB cases. AIDSRelief through its community adherence programs will expand
treatment literacy of both TB/HIV co-infections and use each other network and strategies of Directly
Observed Therapy (DOT) and family centered care. Both staff will be trained in the optimal time to start
antiretroviral therapy, identification of optimal antiretroviral regimens to use, proper dose of ARVs in the
presence of rifampicin. In pediatric cases, the staff will monitor and determine pediatric immune profiles
that influence progression of HIV and TB/HIV outcome.
Continuing Activity: 18706
18706 18706.08 HHS/Health Catholic Relief 7677 3314.08 AIDS Relief $50,000
Program Budget Code: 13 - HKID Care: OVC
Total Planned Funding for Program Budget Code: $9,137,346
Total Planned Funding for Program Budget Code: $0
Program Area Narrative:
Starting in Fiscal Year (FY) 2007 and increasingly in FY 2009, the United States Government's team has been working with
partners to offer a package of direct support to OVC with the goal of reaching at least three services or more per child, as
opposed to only one or two services as occurred in FY 2006. Children receiving multiple services, either primary or supplemental
direct support, will be counted once to avoid double-counting. Efforts will be made so that all children born to HIV-infected parents
are identified, tested, and enrolled as OVC and offered a full package of services whether infected or exposed. Wrap-around
activities at voluntary counseling and testing (VCT), prevention of mother-to-child transmission (PMTCT), anti-retroviral therapy
(ART), and tuberculosis TB/HIV sites are being provided by most non-governmental organizations (NGOs). These NGOs are
providing OVC services and community-based palliative care, including food assistance/security, making feasible an integrated
approach and delivery of a continuum of services including home-based visits.
The family-centered approach in community-based palliative care activities for people living with HIV/AIDS (PLWHA) enable OVC
to benefit from key interventions such as access to safe water at the household level, insecticide-treated nets in areas where
malaria is still endemic, and food support for OVC and caregivers, as well as linkages to micro-credit activities for families or
caregivers of OVC, providing income-generation potential for poor families.
Basic child survival interventions for OVC under five years of age, following the OGAC/President's Emergency Program for AIDS
Relief's (PEPFAR) Preventive Package of Care for Children 0-14 are being applied in all programs recognizing the mortality risk of
children born to HIV-positive parents in a country with a high infant and under-five years of age mortality rate. Access to IMCI
(Integrated Management of Childhood Illnesses) and basic pediatric care (immunizations, routine vitamin A supplementation,
ORT/zinc supplementation for acute diarrhea, de-worming, and growth monitoring) will be assured, as well as access to education
and vocational training, food and nutrition support, psychosocial support, shelter and income-generating activities. Because the
greatest health and nutritional vulnerability is among children under two years of age, their access to basic health services is
prioritized. Thus, the provision of basic preventive and clinical health care for OVC will be assured from birth through
adolescence.
Counseling and support of HIV-positive mothers regarding infant feeding options has been implemented since FY 2007 under
PMTCT and will continue as such in FY 2009 [see Infant and Young Child Feeding Activity under the PMTCT program]. These
activities are in line with World Health Organization (WHO) guidelines and PEPFAR guidance and have been endorsed by the
Ministry of Health. Lactating mothers will be counseled to exclusively breastfeed infants up to six months of age and to continue to
breastfeed, with the introduction of complementary foods, up to 24 months of age unless/until it is acceptable, feasible, affordable,
safe and sustainable (AFASS) to wean early. HIV-exposed infants should be PCR-DNA tested six weeks following weaning to
confirm HIV status. From weaning up to two years of age, clinics will provide, by prescription, a monthly supply of a blended,
enriched food for infants. It is recognized that this period of vulnerability requires strong preventive as well as curative approach
to nutrition and health. Food insecurity is a major problem in Haiti where, according to the last Demographic and Health Surveys
(DHS) (2005-2006), 24% of children less than five years of age suffer from chronic malnutrition. The USG Team has been
working closely with Title II PL-480 partners and the World Food Program to address the issue of food support to vulnerable
PLWHA families, including OVC older than 24 months, at the household level. The USG Team has led the promotion of ready-to-
use therapeutic feeding (RUTF) to care for severe malnutrition in the population of children less than five years old infected or
affected by HIV/AIDS.
With UNICEF collaboration, some NGOs have been using a peanut-based RUTF, Plumpy'Nut, in a pilot phase. A facsimile of
Plumpy'Nut, Medika Mamba, is currently produced in Haiti and has been tested for nutrient composition and food safety by
Cornell University. It has the endorsement of the Ministry of Health and is currently seeking UNICEF certification. Such RUTFs
have demonstrated effectiveness for community management of acute malnutrition (CMAM) of severely malnourished HIV-
infected and -exposed children, eliminating the costs of extended hospitalizations and allowing these children to return home to
continue nutritional rehabilitation with RUTF rather than traditional therapeutic milk (F100) within facilities.
In FY 2007, with the collaboration of I-TECH and FXB (François Xavier Bagnoud, University of New Jersey ), a curriculum on
training for OVC care is being developed. With FY 2008 funds, a training curriculum on nutrition for children and adolescents is
also being developed in collaboration with FANTA (Food and Nutrition Technical Assistance Project) and IYCN (Infant and Young
Child Nutrition Project). In FY 2009, IYCN is developing a training curriculum for health personnel for nutritional assessment.
With extensive training (TOT training of trainers )at the national level (all ten departments) it is expected to reach a significant
number of social workers, community health agents and nurses or auxiliary nurses who will be able to provide more quality care,
messages or early detection warning on the nutritional aspect for OVC.
In FY 2009, partners will continue the increase in their support to provide access to basic primary education for more OVC.
Opportunities for secondary and vocational training for youth will be emphasized. PEPFAR is leveraging with IDEJEN, an
organization funded by USAID education sector, for vocational training of the elder group of Orphans and Vulnerable children
starting at age fifteen (15). Education is a key element to assure that OVC will be able in the future to make a living for them.
28226 OVC are expected to register for this school year 2008- 2009 at an average cost of 136 $ per OVC.
Since FY 2007, services to OVC is available nationwide. A mapping exercise has been completed and regional gaps by
department in the distribution of services by NGOs have been identified. The NorthWest and GrandeAnse departments are the
ones with less intervention. Regular meetings aiming at avoiding duplication and overlap activities between partners working in
close location have been held.
In FY 2008, the USG Team, in close collaboration with UNICEF, the Ministry of Health (MOH), and the Ministry of Social Affairs
have worked to promote passing laws for inheritance rights of orphans, access to birth certificates, HIV testing of HIV/AIDS
orphans and formalizing the responsibilities of those with guardianship of HIV/AIDS orphans. Debates between stakeholders
started in 2006 regarding these issues but concrete steps need to be taken in order to provide legal protections to this vulnerable
group. The issue of birth certificates is critical in a country where 75% of deliveries are done at home and births are not reported
to local authorities and properly registered. OVC are made more vulnerable by precluding them from legal rights to inheritance. All
partners working on OVC activities have been taking this into account since FY 2007 and this effort will continue toward FY 2009.
Forty percent of the population is less than 15 years of age. According to the latest Demographic and Health Survey (DHS), 21%
of children fewer than 18 years of age are either orphans or vulnerable children, and of those, an estimated 200,000 to 300,000
are orphans due to HIV/AIDS.
Deterioration of the economic situation in Haiti has increased the number of street children which constitute a vulnerable group in
the cities particularly in Port- au -Prince. Efforts started in FY 2007 with World Concern and the Salesian Congregation in Port-au-
Prince will continue in FY 2009. The random violence that has prevailed in Haiti for the last two years has left a number of kids in
the streets making them vulnerable to unsafe sex and abuse.
Lastly, gender inequalities are another important issue that will be addressed by partners by providing young girls access to
education and vocational training.
Program area Target:
Number of OVC served by OVC programs: 60 000
Number of providers/caretakers trained in caring for OVC: 8500
Table 3.3.13:
SUMMARY: AIDSRelief will pay particular attention to infants and children infected with and affected by HIV
and AIDS. AIDSRelief will also ensure that all nine AIDSRelief hospitals offer adequate pediatric palliative
care to children. As of July 2008, AIDSRelief had 141 pediatric cases within its active ART patient caseload.
The primary emphasis areas for these activities are community mobilization, commodity procurement,
linkages with other sectors and activities, training, human resources, and infrastructure. Specific target
populations include HIV positive infants and children, caregivers, and HIV affected families. Particular
attention will be paid to vulnerable children and youth, particularly girls under the age of 14 years. The
coverage area for this program include communes of Fonds-des-Nègres (Nippes); Fonds-des-Blancs
(South); Port-au-Prince (West); Deschapelles, Ennery, Gros Morne (Artibonite); Pilate, Limbe, Milot (North).
BACKGROUND: AIDSRelief has been providing palliative care to children in Haiti since 2004, through
support from the President's Emergency Plan for AIDS Relief (PEPFAR). AIDSRelief is a five-member
social programs. All members AIDSRelief Consortium members have a shared mission to provide quality
Since 2004, AIDSRelief has been supporting comprehensive services in eight sites in five geographic
departments, including the main public departmental hospital in Gonaives. In year five, Hopital La
Providence was accorded to the Collaborative Agreement Partner of the Ministry of Health, Plan National.
The community reference hospital, Hopital Sainte Croix at Leogane was temporarily closed, and their
patient population was offered services at the GHESKIO-supported program at Signeau.
AIDSRelief currently provides anti-retroviral therapy (ART) services and HIV care to children in the eight
hospitals and will soon activate 3 additional sites. CRS has extensive experience in the care of orphans and
vulnerable children (OVC) and is also a grantee for OVC track 1 funds through PEPFAR. In the past, CRS,
with the Minister of Health (MOH) and the Minister of Social Affairs, actively organized the national forums
on OVC with the objective of defining a national framework for the support to OVC from HIV. AIDSRelief will
expand HIV pediatric care and support to the community to take place in nine clinical sites. At least 10% of
AIDSRelief's care and treatment patients will be children.
ACTIVITES AND EXPECTED RESULTS:
Activity 1: Orphans and vulnerable children will be identified through the PMTCT programs, hospital-based
pediatric services, and community outreach programs. Using counseling techniques appropriate for
children and families, HIV testing will be offered to children at risk. Anti-retroviral (ARV) services will be
offered to seropositive children who are medically eligible for these services. HIV-infected and exposed
children will have special access to wrap-around services, such as nutrition support, immunizations, and
integrated management of childhood illness (IMCI), palliative care (prophylaxis and treatment of
opportunistic infections), and laboratory monitoring, through child survival programs at the LPTF.
AIDSRelief projects to enroll 100% of all seropositive infants and children and those exposed in care.
Activity 2: Caregivers, community health workers (CHWs) and PLWHAs will be trained to recognize medical
complications experienced by HIV infected children and refer them to the facility, if necessary. Periodic
trainings will be conducted for parents—and reinforced through post pharmacy counseling—to ensure that
they are properly providing correct doses to infants. AIDSRelief's adherence and support of OVC will
incorporate phased adherence trainings designed to address HIV from infant care, adolescence, and
through young adulthood. Psychosocial support will also be available for affected families. To improve
children's access to services, home-based care will be provided on a regular basis to children with HIV and
AIDS,. This care will focus on social support and the health needs of the entire family and, will include food
and nutrition support, patient and family education.
Activity 3: Caregivers, CHWs and PLWHAs will be trained specifically to sensitize communities about
destigmatization through increased testing and treatment of children. Children infected with and affected by
HIV will be the main target population. The strategy will include linking with schools, churches, children's
home groups and community leaders through "Community Health Days." This initiative will help alleviate the
burden of stigma while including the community as the main host. Specific communities for enrolling this
strategy will be defined after a mapping strategy. AIDSRelief will provide education on ways to spread
prevention message in communities and schools. Each community will have knowledge surveys conducted
to properly quantify the need and later the impact community mobilization has had. This is also an
opportunity to disseminate prevention messages through peer to peer contact.
Activity 4: Training for people living with HIV and AIDS as well as CHWs and clinical staff will be provided to
ensure high quality care and follow-up for children with HIV and AIDS. AIDSRelief will conduct a Pediatric
HIV counseling workshop to sensitize clinical staff to the unique challenges of pediatric care and treatment.
Additional training will be conducted given that the number of community health workers and counselors will
increase significantly. Basic training for pediatric HIV care will be provided for all new staff, and HIV and
AIDS updates will be scheduled on a regular basis for all AIDSRelief hospitals.
The training and tools will incorporate recognition of symptoms and staging, particularly growth failure and
developmental impairment; Pediatric-specific adherence preparation and support; disclosure counseling;
support activities for children and; preparation for independent adherence.
Activity 5: Pediatric case finding and outreach should be linked with the assurance of the long-term health of
infected children if the health outcomes are to be durable. AIDSRelief will work towards early identification
of children who require ART. AIDSRelief will work and collaborate with national guidelines committees
Activity Narrative: with appropriate ratio of drugs); and the monitoring of treatment success and management of treatment
failure including 2nd-line options.
The care will promote opportunistic infection prophylaxis and treatment and better TB diagnostics, and
nutritional counseling.
Activity 6: AIDSRelief will engage mothers and families in HIV care by early testing of children and partners
Continuing Activity: 17898
17898 17898.08 HHS/Health Catholic Relief 7677 3314.08 AIDS Relief $600,000
Estimated amount of funding that is planned for Education $50,000
SUMMARY: Counseling and testing (CT) is provided at all AIDSRelief sites as part of a comprehensive
package for care, treatment and support for people living with HIV/AIDS (PLWHA). Activities to support CT
include: provision of comprehensive CT services at hospital clinics and satellite clinics; training and
supervision of counselors and community health workers (CHWs) in CT; support of CT activities at all
AIDSRelief health facilities; and, community mobilization. The primary emphasis areas for these activities
are: community mobilization, training, network development, human resource development, food nutrition
support, quality assurance, quality improvement, and supportive supervision. The specific target populations
will be: women of reproductive age, youth, sexual partners and children of seropositive persons,
tuberculosis (TB) patients, sexually transmitted infection (STI) patients, and adults and children with clinical
evidence of AIDS.
The coverage area for this program include the communes of Fonds-des-Nègres (Nippes); Fonds-des-
Blancs (South); Port-au-Prince (West); Deschapelles, Ennery, Gros Morne (Artibonite); Pilate, Limbe, Milot
(North). People with high-risk behaviors and sexually-active youth will be motivated to attend CT clinics
during community mobilization. In addition, AIDSRelief will conduct training in CT activities, in collaboration
with Ministry of Health (MOH) and the Haitian Institute for Community Health (INHSAC). The MOH, Unité
de Coordination Central (UCC) and Regional Health Departments are supportive of the project.
BACKGROUND:
AIDSRelief has supported counseling and testing services in Haiti since 2004, through support from Track
1.0 and funding from the President's Emergency Plan for AIDSRelief (PEPFAR). AIDSRelief is a five-
medical institution recognized as a world leader in HIV/AIDS care, research and program development, and
an international development company that specializes in the design and implementation of public health
and social programs. All AIDSRelief Consortium members have a shared mission to provide quality medical
care to individuals living with HIV/AIDS.
Since 2004, AIDSRelief has supported counseling and testing services in eight sites in five geographic
Activity 1: AIDSRelief will provide CT services at the 9 hospital clinics and satellites clinics in its network, 6
Catholic mission hospitals, 1 Protestant hospital, 1 Community Non-profit and 1 Public Community Referral
hospital, and will establish 4 additional CT services at satellite health centers linked to one of these
hospitals.
Activity 2: AIDSRelief will provide necessary training and will supervise clinical staff and CHW in CT. In
collaboration with MOH and the USG-supported CT training program at INHSAC, AIDSRelief will ensure
that quality counseling and testing will be provided to the population seeking care at its facilities. Refresher
trainings will be conducted during FY 2009 and follow-up will take place during technical assistance visits.
All training will emphasize counseling and referrals for family planning and other reproductive health
Activity 3: AIDSRelief will support post-test activities (Post-test Clubs) at all of its health facilities to both
seropositive and seronegative persons. AIDSRelief will provide education, psychosocial and logistical
support to clients, clinic staff and CHWs in order to decrease stigmatization and discrimination experienced
by PLWHA. In addition, AIDSRelief will ensure that all seropositive persons are registered in HIV care
programs.
Activity 4: AIDSRelief will support community mobilization in order to decrease stigma and misinformation
regarding HIV and to increase the number of persons accessing CT centers. This activity will raise the
awareness of community leaders, CHWs, traditional birth attendants, health agents, teachers, pregnant
women, youth, people with risk behaviors, driver syndicates and the general population about HIV/AIDS and
the importance of VCT. Particular emphasis will be placed on integrating traditional birth attendants and
community health agents into mobilization efforts.
Activity 5: AIDSRelief will implement expanded testing that is Family Centered and extended to the
satellite/peripheral clinic, mobile clinic and community service center level. AIDSRelief will train CHWs to
use patient as window into families; strengthen relationship with positive patients not yet on HAART and;
locate patients through the community mapping of each facility. AIDSRelief will undertake the community
based testing under the guidelines established for rapid tests from the Ministry of Health and National
Reference Lab.
Activity 6: AIDSRelief will reduce the likelihood of HIV transmission through identification and behavior
change. Technical assistance and training will be developed and monitored for prevention programs
through various health education and risk reduction activities, which include screening, testing, counseling,
other public health education training, etc.
Activity 7: Prevention with Positives will be organized such that with ARV treatment prevention is reinforced.
With prevention efforts on HIV transmission (slow transmission), reduced infectiousness ART is sustainable.
All efforts will be made to link all individual who test positive to care and treatment centers and community
support services. Peer support by other PLWHA, accompagnateurs, and CHWs will be integral for the
support and referral into care. Approaches to partner notification will include rapid HIV testing for partners
and using peers to conduct appropriate partner notification, prevention counseling, and referral. AIDSRelief
will continue to collaborate with Care and Support implementers to improve referral to prevention services,
medical care, and treatment. Health education will provide comprehensive risk counseling and services for
uninfected persons at very high risk for HIV and the infected persons with identified continued high risk
Activity Narrative: behaviors.
Continuing Activity: 17168
17168 5305.08 HHS/Health Catholic Relief 7677 3314.08 AIDS Relief $350,000
9267 5305.07 HHS/Health Catholic Relief 5117 3314.07 AIDS Relief $250,000
5305 5305.06 HHS/Centers for Catholic Relief 3434 1579.06 AIDS Relief $0
Disease Control & Services
Prevention
Program Budget Code: 15 - HTXD ARV Drugs
Total Planned Funding for Program Budget Code: $4,600,000
The President's Emergency Plan for AIDS Relief (PEPFAR) and the Global Fund (GF) have been supporting HIV/AIDS care and
treatment services in Haiti for the past 5 years through public, private and faith-based institutions. Although there are some
indications that HIV prevalence in Haiti in on a downward trend, Haiti remains the country with the highest HIV prevalence in Latin
America and the Caribbean. To date, over 17,000 Haitian patients are on antiretroviral (ARV) treatment.
By September 2009 (with FY 2008 funds) the USG, in collaboration with the GF, will supply long-term ART to 25,000 people and
to 33,000 by September 2010. In addition, antiretroviral prophylaxis will be provided to 2,500 pregnant women and drugs for
palliative care and opportunistic infection treatment to over 122,000 in FY 09. Of the 45 sites providing ARV treatment in the
country at the end of FY 08, the PEFPAR Program provided the drugs for 32 sites and the GF provided drugs for 17 sites. Four of
the sites receive ARV drugs from both PEFAR and GF programs. For these sites, GF supplies the first line regimens and
PEPFAR provides the second and third line regimens and pediatric AIDS drugs. The proportional split of ARV drug procurement
for Haiti is approximately 40% by the GF and 60% by the USG. The USG fraction includes a 10% buffer stock to be able to
respond to GF emergency needs of commodity loans. This proportional split is expected to gradually evolve to 50% USG and
50% GF as their procurement system improves and proves its capacity to efficiently cover program needs.There is careful
monitoring of drug procurement and distribution between the PEFAR team and the GF team to avoid duplication of resources and
reporting. The number of sites for which PEPFAR provides ARVS is expected to increase to 50 by September 2009 using FY
2008 funds, and to 60 by Sept 2009, using FY 2009 funds. In addition, plans are to reinforce as needed all previously established
sites. The focus on pediatric AIDS services, began in FY 2006, will continue through 2009 as the USG Team will increase supply
and access to pediatric drugs. Furthermore, as recommended, PEPFAR plans to procure adequate supplies of second line ARV
drugs for patients, as needed.
The Partnership for Supply Chain Management (PFSCM) is responsible for procurement, warehousing and distribution of the
PEFPAR provided drugs. Catholic Relief Services assists with the forecasting of ARVs for their seven sites funded under the
AIDS Relief Project.
With FY 2009 funds, the USG, through PFSCM, will ensure availability of ARV drugs at 45 sites in accordance with the Ministry of
Health (MOH) guidelines and the GF, through the Rolling Continuation Channel (RCC) of Round 1 and under Round 5, will
continue to supply drugs to their 17 sites. PEPFAR and GF drug logistics teams will continue to maintain close collaborative
planning and monitoring of drug distribution. The September 2009 targets for the country, as well as for PEFPAR, are 25,000
persons on ART and 2,500 pregnant women supplied with prophylactic ART. The focus of the USG efforts in drug procurement
and supply chain management with FY 2008 funds will be:
• continued coordinated commodity procurement and management system in support of the MOH's National AIDS Program,
integrating the GF procurement system.
• improving the quality of available information and the management of the supply chain;
• continued monitoring of adequate use of HIV commodities;
• periodic training in logistics and stock management with emphasis on HIV commodities, continuous onsite in-service training,
supervision and technical assistance on stock management;
• continuous active delivery of stock to sites;
• improving the provision of computerized reports of commodity needs projections for sites and for the national level including all
commodity sources; and
• providing appropriate technical assistance to the MOH on review of HIV/AIDS protocol and norms and continued reinforcement
of regional departmental and central warehouses to improve cold chain requirements and storage conditions.
Funding from FY 2008 is being used to reduce the redundancy of AIDS commodities procurement and logistics in the country by
working with the MOH to strengthen its procurement and distribution system and procedures. The USG is working toward this
goal, with PFSCM as the main partner. In FY 2009, the PFSCM will continue to be responsible for the warehousing and
distribution of HIV commodities.
The Essential Medicines Program (PROMESS), a World Health Organization and other United Nations stakeholders' project, was
established over 10 years ago. However, it has not been able to effectively and definitively address issues such as the lack of a
national entity responsible for warehousing and distribution of drugs and medical supplies to the whole health network. A major
drawback to the PROMESS system is that while its mandate is procurement and warehousing, it does not distribute commodities
to hospitals and other health delivery sites, nor does it undertake use assessments and forecasting exercises to establish future
needs. The establishment of a distribution system of drugs and laboratory supplies became a major challenge with the
increasingly difficult conditions of 2004 and a number of institutions established their own mini-networks to circumvent this
problem. The USG Team has taken the leadership in providing a single procurement and distribution agent for HIV-related
commodities, and is committed to working with the Government of Haiti to transfer these skills to the local partners.
The USG has played a leadership role in advocating for a national forecasting of ARV needs for the country. In the absence of a
national ART scale-up plan, the USG Team and the Global Fund, the two major providers of ARV drugs in the country, meet on a
regular basis with the MOH to exchange information and data to ensure that ARV drugs are available in the country for all existing
patients, taking also into account the scale up strategy as well as the national objectives and the individual project treatment
goals. The concerted effort includes all implementing partners receiving funds for ARV services through PEPFAR, Global Fund or
other donors.
According to the USG database, ARV patients nationally are on four first-line regimens: AZT/3TC/ EFV; AZT/3TC/NVP;
D4T/3TC/EFV and D4T/3TC/NVP, thus using the five drugs: AZT, 3TC, D4T, EFV and NVP. USG procurement efforts will
concentrate on these four drugs as well as some second line and alternate regimens to take into account the potential need for
changing treatment regimens as more patients may develop severe side effects or resistance to one or more drugs or class of
drugs. All purchased drugs will have to be approved or tentatively approved by the Food and Drug Administration.
Table 3.3.15:
