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:
GHESKIO will provide field support to 15 public and private sites for the provision of a full package of
PMTCT services to both mother and infant Activities are carried out to scale up interventions and support
the national program to prevent mother to child transmission (PMTCT) of HIV and syphilis. GHESKIO aimed
to provide a comprehensive and holistic approach for provision of PMTCT services. The ultimate goal is to
prevent mother to child transmission of those infections and to increase hospital delivery or assisted
delivery by a trained medical personnel for clinical follow up of mother and new born early diagnosis with
additional nutrition and social support. The primary emphasis areas for these activities are training, human
resources and infrastructure, logistics and community mobilizations. Specific target populations include
sexually active HIV positive women and partner, pregnant HIV+ women, pregnant women with syphilis and
partner, HIV+ women with their children seen during post partum period and after. The activities will be
carried out within the 16 (7 public/9 private) GHESKIO-PEPFAR health facilities.
Background:
The MOH-GHESKIO pilot project conducted at GHESKIO (1999-2005) aimed to PMTCT shows a rate
reduction from 27% to 9%, among children of mother who received Zidovudine as prophylaxis with infant
formula until the age of 6 months. ( Ref : Deschamps MM, Devieux J and al: .Prevention of Mother to child
transmission of HIV in Haiti. Pan Amer. Journal of Public Health. August 2008 ) In 2003, pregnant women
with AIDS were offered triple drug therapy. This conclusive protocol is being implemented nationwide.
However, there is a need to maximize results and effectiveness of intervention in order to increase access
to ARV to mother and new born, to increase number of infant and mother followed post delivery of infant, to
facilitate access to FP services and assist women and family during and after delivery. Excluding some
centers, majority of women continued to give birth outside of healthcare setting, or do not return for further
services after the test or after delivery. Since 2005, GHESKIO has developed new capacities to diagnose
early HIV infection in children (p24;PCR).DBS PCR has been initiated at 2 sites: GHESKIO, the National
Laboratory . Those methods of diagnostic will be progressively introduced at other sites for the early
diagnosis, treatment and follow up of HIV infected children and mother as well as integration of a PMTCT
case manager for interactive follow up of outcome of the intervention.
ACTIVITIES AND EXPECTED RESULTS:
PMTCT is an integrated activity for the diagnosis, prophylaxis and treatment of HIV infection in individuals of
reproductive age, including children born from HIV infected women.
Activity 1:
To offer counseling and testing using rapid test for both, HIV and syphilis to pregnant women attending the
collaborative sites. Counseling includes also referral of the sexual partner. HIV+ women will be informed
and counseled about the seropositivity, on the mode of HIV transmission and prevention and will be
encouraged to return with infant and partner on a regular basis for prophylaxis, treatment and care. Those
with positive serologic test for syphilis will start treatment the same day. HIV + women will be evaluated for
staging (WHO/CDC classification) and informed about a comprehensive PMTCT package of service: at
prenatal, during labor and at post partum, including circumcision for male infants, reinforcing the need for
follow up of children, the need for circumcision if a male infant, the choice of FP, and infant feeding issues.
Activity 2:
To provide assistance to the women to deliver in a hospital setting or to include the midwife or the matrone
in the delivery process, using the SOG program as an opportunity, to reinforce both programs the PMTCT
and the SOG which includes: the doctor, the nurse, the accompagnateur or facilitator, the matrone, the care
giver of the children, the midwife and develop with the HIV+ pregnant women (with or without her
accompagnateur or facilitateur) a "Plan of accouchement". Funding will support in each site: a PMTCT Case
manager who will create the link with the pediatrician or child care giver, the OBGYN etc., with development
and procurement of educational material, the transportation fee of the mother and children of the family.
Activity 3:
To assist the infected pregnant women and her new born for early diagnosis of HIV of infant, the choice of
infant feeding with the care giver ( the matrone, nurses or auxillary. OBGYN, pediatrician or
generalist).These interventions will be maintained and strengthened at the 15 identified sites, with the "
PMTCT" case manager" as coordinator who can be: a nurse, a physician, a midwife etc.
Activity 4:
To offer ARV prophylaxis or treatment to HIV + pregnant women before, during and after delivery, with the
infant, using the revised national guidelines to prevent MTCT. HIV + women will be counseled and receive
FP methods to prevent unwanted pregnancy. In cases where the site does not have access yet to ARV,
Women or children who require HAART will be referred to the closest "site of excellence".
Activity 5:
To continue the ongoing work established with the MOH regarding the early diagnosis of the HIV in children.
The HIV p24 assay will be conducted on site as first diagnosis of the status the HIV exposed infants.
GHESKIO and NPHL the only two laboratories equipped for DBS PCR will provide services for confirmatory
of the HIV status. This diagnosis is mandatory for HIV + children to receive the ARV treatment accordingly
as well as the one for syphilis.
Additionally, GHESKIO will provide assistance to women to deliver in a hospital setting or to include the
midwife or the matrone in the delivery process, using the SOG program as an opportunity, to reinforce both
programs the PMTCT and the SOG which includes: the doctor, the nurse, the accompagnateur or facilitator,
the matrone, the care giver of the children, the midwife and develop with the HIV+ pregnant women (with or
without her accompagnateur or facilitateur) a "Plan of accouchement".
Funding will support in each site: a PMTCT Case manager who will create the link with the pediatrician or
Activity Narrative: child care giver, the OBGYN etc.., with development and procurement of educational material, the
transportation fee of the mother and children of the family.
HIV + women will be evaluated for staging ( WHO/CDC classification) and informed about a comprehensive
PMTCT package of service : at prenatal, during labor and at post partum, including circumcision for male
infants, reinforcing the need for follow up of children, the need for circumcision if a male infant ,the choice of
FP, and infant feeding issues.
These results will contribute to PEPFAR goals by improving access to quality of care, decrease maternal
mortality and unwanted pregnancy and reduce significantly the PMTCT rate.
New/Continuing Activity: Continuing Activity
Continuing Activity: 17920
Continued Associated Activity Information
Activity Activity ID USG Agency Prime Partner Mechanism Mechanism ID Mechanism Planned Funds
System ID System ID
17920 17920.08 HHS/Centers for Groupe Haitien 7682 3315.08 $350,000
Disease Control & d'Etude du
Prevention Sarcome de
Kaposi et des
Infections
Opportunistes
Emphasis Areas
Gender
* Increasing gender equity in HIV/AIDS programs
* Increasing women's access to income and productive resources
* Increasing women's legal rights
Health-related Wraparound Programs
* Child Survival Activities
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:
The narrative will be modified in the following way:
New activities this year will aim to provide prophylactic and curative dental care. The dental clinic at
GHESKIO is a preventive dental clinic; the clinic will focus its efforts on HIV positive and at risk children and
adolescents frequenting the pediatric and adolescent clinics at GHESKIO. The main preventive treatments
that the clinic will offer are:
1. Prophylactic treatment
2. Sealants, fluorides rinses
3. Dental education
Funding will cover equipment, furniture, staffing and logistics for everyday functioning of a dental clinic at
GHESKIO.
Data review of GHESKIO file has shown that during the last 4 years the rate of cancer detection has
improved significantly. 25% of diagnosed cases were cervical cancer. Knowing the predictive role of HPV
infection in the development of cervical cancer, we plan to make available services for diagnostic and care
of treatable cancer.
Summary: Activities are carried out to support the effort of sites enrolling patients to be placed on highly
active antiretroviral therapy (HAART). The primary emphases of these activities include training, human
resources and (doing what to the infrastructure? Strengthening it, perhaps?)infrastructure. Specific target
populations include adults and children infected with HIV and not yet placed on anti-retroviral therapy
(ART.) The activities will be carried out in the Ministry of Health /GHESKIO/ President's Emergency Plan for
AIDS Relief (PEPFAR)'s network of 14 sites and will be linked with counseling and testing (CT), preventing
mother to child transmission (PMTCT), tuberculosis (TB)/HIV, anti-retroviral (ARV) services, and human
capacity building that is being also supported through this network
BACKGROUND:
GHESKIO is one of the two lead non-governmental organizations (NGOs)—the other one is Partners in
Health (PIH)—that have launched an integrated model of HIV services in Haiti. With PEPFAR, the United
States Government (USG) decided to build on its success to expand HIV services throughout the country.
Through GHESKIO, 12 sites, including four major departmental hospitals, have been reinforced to offer
integrated CT, PMTCT, TB/HIV, ARV as well as palliative care services. provided in conjunction with the
Global Fund to fight AIDS, Tuberculosis and Malaria (GFATM). GHESKIO has ensured that all HIV positive
patients detected through its CT network gain access to clinical, biological, nutritional, and psycho-social
assessments and services, as well as long term follow up to determine the optimal time for HAART. So far,
44,600 patients have been enrolled in palliative through the GHESKIO network. These activities are
essential to keeping active the cohort of HIV infected adults and children. Service providers will encourage
patients diagnosed with HIV to continue to attend regular clinic visits and maintain their link with the
community.
With Fiscal Year 2008 resources, GHESKIO will expand its network to 16 institutions and will continue to
strengthen palliative care services to reach about 10,000 additional patients with particular emphasis on
expanding nutrition services and building the capacity of nurses to play a greater role in the provision of
services.
ACTIVITES AND EXPECTED RESULTS:
GHESKIO will carry out four separate activities in this Program Area:
ACTIVITY 1: In integration with GFATM resources, GHESKIO will use PEPFAR funding to provide the non-
ART package of services including, diagnostic, treatment and prevention of opportunistic infections,
diagnostic and treatment of sexually transmitted infections, care of ART related illness (i.e., diabetes,
arterial hypertension), nutrition assessment and recuperation (if needed), psycho-social assessment and
support. All of the network's facilities will offer this package of care. Funding will support enhancement of
infrastructure, procurement of necessary drugs, diagnostic materials, hospital staff training in providing
specific care, and hospital supervisory staff training to ensure a minimum standard of quality of services.
ACTIVITY 2: Encourage building of support groups at each site and regrouping patients on ART and those
enrolled in palliative care. Meetings between these groups' members will serve as a forum for sharing
experiences and encouraging interactive communication between care providers and patients. Meetings will
be held once to twice a month depending on the number of patients enrolled at each site, Funding will be
used to provide patients with transportation fees, (I am not sure to whom these services are to be provided)
refreshing, collation, and education materials.
ACTIVITY 3: GHESKIO will increase the number of community health workers to accommodate scale-up at
each of its palliative care sites. 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, ORS, symptom and pain medications
according to the guidelines. Resources will be used to pay their (whose? Patients or community health
workers?)transportation fees.
ACTIVITY 4: Strengthening interventions to maintain patient's adherence to ART treatment. Funding will
help sites provide patients fees for transportation, phone cards, and educational materials. Patients will be
referred to community based organizations to gain access to a broader package of social support services
such as school fees for children, nutrition support, etc.
Activity Narrative:
Continuing Activity: 18948
18948 18948.08 HHS/Centers for Groupe Haitien 7682 3315.08 $200,000
Program Budget Code: 09 - HTXS Treatment: Adult Treatment
Total Planned Funding for Program Budget Code: $25,577,679
Total Planned Funding for Program Budget Code: $0
Table 3.3.09:
In addition to activities undertaken last year, thru COP 09, GHESKIO will:
1) Strengthen at departmental level the referral between CT, PMTCT, TB sites and ART centers to improve
the continuum of care between the different levels of the care system. Funding will be used to provide
reference and counter reference cards, transportation costs for patients and departmental coordination
meetings among partner etc.
2) Build capacity of the Jeremie public departmental hospital to become a Center of Excellence for the
Grand'Anse department. This new activity is necessary to continue the decentralization of ARV services
and serve as a model for extending services to peripheral sites. Funding requested will cover many items
including equipment, furniture, staffing, logistics for training and supervision and financial support for
peripherals sites.
3) Realize a national workshop with national and international experts to determine new regimen, new
costs, new strategies to improve follow up of patients placed on ART. Funding will cover elements for the
workshop: logistics, per diem for participants, lodging, invitation of experts.
4) Realize with the MOH and key stakeholders workshops in Haiti to establish cut-off of acceptable rate of
non-adherence, LTFU, and mortality. GHESKIO will use this cut-off to monitor thru the electronic data base
system put in place all sites the outcomes of the treatment program. This will allow to rapidly inform the
clinical team at each site on the performance at each site. An intervention plan will be developed to
improve quality of care at any site that is poorly performing. The GHESKIO mobile team will visit poorly
performing sites immediately and work with the staff to improve treatment outcomes.
5) GHESKIO will perform HIV-1 viral load and genotypic drug resistance testing for all patients receiving
ART who meet WHO criteria for ART failure in Haiti. We estimate that 10 to 20% of all patients receiving
ART will meet WHO criteria for failure and will need virologic monitoring. This evaluation will help better
define the demographic and clinical characteristics of patients who fail ART so that new better adapted
guidelines for monitoring patients on ART can be drafted. The drug resistance mutations identified will help
better tailor second-line antiretroviral drug regimens for patients failing ART in Haiti. Finally, this service will
allow us to increase capacity for virologic testing in Haiti and to train new technicians in the realization of
these tests.
SUMMARY:
Through activities listed in this project GHESKIO will contribute to the United States Government's (USG)
effort to provide treatment to people with HIV/AIDS (PLWHA) by maintaining and strengthening anti-
retroviral (ARV) services in a national network of public and private health facilities and by building human
capacity for the overall program. The major focus will be: 1) reinforcing technical, infrastructure, human and
administrative capacity of the 16 institutions in the GHESKIO network for the provision of ARV care; 2)
training providers; 3) supervising quality assurance (QA), quality control (QC) and quality improvement(QI)
of ARV services; 4) maintaining Immaculee Conception hospital, the South Regional Hospital as a Center of
Excellence; and 5) building capacity of St Michel Hospital, the South East Departmental Hospital to
become a center of excellence.
Areas of emphasis for these activities will include: community mobilization and participation; reinforcement
of existing network and referral systems; human resources; infrastructure development; development of
local organizations capacity; development of network/linkages/referral systems; information, education and
communication (IEC); linkage with other sectors and initiatives; development of guidelines; quality
assurance, quality improvement and supportive supervision; and strategic information and training.
Specific target population identified will be PLWA, HIV positive infants and adolescents from 0 to 14 years,
affected relatives, HIV positive pregnant women and different category of care providers.
GHESKIO has been one of the two lead non-governmental organizations (NGO) that has an integrated
(integrated with STI, TB, CT, PMTCT) model of anti-retroviral (ARV) services and basic care. Over past last
three years, the USG has provided resources to GHESKIO to expand this integrated model in a network of
16 sites, including four of the largest departmental public hospitals and a large stand alone tuberculosis
(TB) facility. This program was built on previous efforts to implement CT, PMTCT and basic care services -
the entry point for enrolling patients on ARV—at the 16. All 16 sites have been reinforced with infrastructure,
laboratory equipment, and a multidisciplinary team of clinicians, nurses, counselors, pharmacists,
community and social workers as well as with medical equipment, electronic medical records, drug storage
capacity and SI tools to provide quality care. Based on the pilot experience of launching ARV pediatric care
in the main GHESKIO center in Port-au-Prince, efforts were since last year, to expand this program
throughout the network. Efforts are being made to strengthen one of the South's departmental hospitals,
Immaculee Conception Hospital, to become a center of excellence where training, supervision, and QA/QI
could be decentralized. Nearly 5000 patients have been placed on ARV through the GHESKIO network so
far.
The USG team has mandated GHESKIO to train healthcare providers nationwide for the ARV program and
to support the Minister of Health's (MOH) ARV certification process using national guidelines and updated
training. To date, GHESKIO has trained a total of 425 health professionals. As ARV services are expanded
and reinforced and because of a significant turnover of personnel, there is a continuous need to train and
provide refresher courses on ARV at GHESKIO. There is also a growing need to train nurses to play a
greater role in the provision of ARV services as well.
Activity Narrative: USG has also required GHESKIO to provide QA/QC/QI to 22 sites, some of which are outside of the
GHESKIO network. GHESKIO has formed three mobile multidisciplinary teams of clinicians, pharmacists,
and others to make regular supervision visits. There is a need to continue strengthening this activity to
implement a QA/QI system through which data could be generated and used to improve quality at the
patient, site, and program level.
With Fiscal Year 2008 funding GHESKIO will continue to strengthen its integrated model of ARV services in
its network of 16 sites, including its main site in Port-au-Prince, to continue enrolling new patients on ARV,
with the goal being to reach 10,000 patients by the end of September 2008 and 14,000 patients by the end
of September 2009. If obtained, these numbers will contribute to more than half of PEPFAR's targets for the
country. These sites will also focus on improving quality of care and adherence to treatment, and on
expanding pediatric treatment. GHESKIO will build the capacity at Hospital Saint Michel, the South East
departmental hospital to become a new center of excellence. GHESKIO will continue to train health care
professionals on ARV with an emphasis on training nurses. GHESKIO will work with MOH, CDC and other
stakeholders to improve the system of QA/QI with standardized indicators and with a focus on continuous
improvement of care for twenty-two (22) sites (14 in the MOH-GHESKIO network and eight in other
networks: Bethel, Gonaives, MARCH, Beraca, HAS, CBP, Grace Children's Hospital and Ouanaminthe).
This effort will be integrated with activities supported by the GFATM through GHESKIO.
ACTIVITY 1: Funding will be used to strengthen GHESKIO's headquarters to continue providing technical,
administrative, and accounting assistance to its network of 16 sites in integration with GFATM resources.
These sites are: GHESKIO-INLR, Les Cayes , Jeremie, Jacmel, Cap-Haitienne, Fame Pereo, IMIS,
Bombardopolis, Food for the Poor, Hopital de la Communaute Haitienne, Petit Goave, Hospital Bernard
Mews, La Gonave and Fermathe. GHESKIO's headquarters will provide oversight and monitoring of the
project.
Activity 2: GHESKIO will use funding to cover additional renovation, equipment, and personnel needed for
expansion of services at the 16 sites. Emphasis will be put next year on pediatric wards to ensure they have
adequate space, equipment, and personnel to enhance ARV pediatric services. Special attention will also
be given to improve laboratory services for ARV care to make available at all major sites automated
equipment for the dosage of CD4, hematology and blood chemistry (see laboratory narratives). Linkages
will be established with Supply Chain Management System to ensure adequate supply of drugs as well as
with CBOs and PLWA support group organization to provide community support to maintain patient
adherence to treatment.
Activity 3: GHESKIO will expand its training infrastructure, staff, and equipment to train and provide
refresher courses on ARV to close to 400 health professionals nationwide through all the networks. Funding
will be used to cover materials, per diem, and logistic costs for the trainees.
ACTIVITY 4: GHESKIO will maintain and expand supervision and on site training for ART services at 22
main sites supported by PEPFAR for QA/QC/QI using a national framework and tools that MOH, CDC, and
key stakeholders have started to develop. This will be supported through three mobile teams. The main
items covered by this funding will include: support for mobile teams, per diem, lodging, logistics for visits,
materials for supervision and training. A quality manager team will be created at GHESKIO to oversee the
QA/QI system.
ACTIVITY 5: Funding will be used to make St Michel Hospital, the South East departmental hospital a
center of excellence for the South East Department. This new activity is necessary to continue the
decentralization of ARV services and to serve as a model for extending services to peripheral sites. In this
capacity, St Michel Hospital will be a regional reference and training center, offering training sessions and
supervision for peripheral centers in their area of influence.
Continuing Activity: 17181
17181 4341.08 HHS/Centers for Groupe Haitien 7682 3315.08 $6,620,000
9282 4341.07 HHS/Centers for Groupe Haitien 5124 3315.07 $5,150,000
4341 4341.06 HHS/Centers for Groupe Haitien 3315 3315.06 $4,200,000
Construction/Renovation
* Addressing male norms and behaviors
* Reducing violence and coercion
* Family Planning
* Safe Motherhood
* TB
Estimated amount of funding that is planned for Human Capacity Development $900,000
Estimated amount of funding that is planned for Food and Nutrition: Policy, Tools $50,000
and Service Delivery
Table 3.3.10:
The MOH/GHESKIO network with 16 sites (8 public and 8 private) including the 4 largest departmental
hospitals (Cayes, Cap, Jacmel, Jeremie) covers 50% of all patients receiving ARV nationwide. At the end of
COP08 in September 2009, we expect to have 14,000 patients (adults and children) on ARV in the network.
During the COP 09, we aim particularly to double the number of children receiving ART in the network.
training providers; 3) supervising quality assurance (QA), quality control (QC) and quality improvement (QI)
training. As ARV services are expanded and reinforced and because of a significant turnover of personnel,
there is a continuous need to train and provide refresher courses on ARV at GHESKIO. There is also a
growing need to train nurses to play a greater role in the provision of ARV services as well.
USG has also required GHESKIO to provide QA/QC/QI to 22 sites, some of which are outside of the
With Fiscal Year 2009 funding GHESKIO will continue to strengthen its integrated model of ARV services in
its network, to continue enrolling new patients on ARV, with the goal being to reach 14,000 patients by the
end of September 2009. If obtained, these numbers will contribute to more than half of PEPFAR's targets
for the country. These sites will also focus on improving quality of care and adherence to treatment, and on
administrative, and accounting assistance to its network in integration with GFATM resources. These sites
are: GHESKIO-INLR, Les Cayes , Jeremie, Jacmel, Cap-Haitienne, Fame Pereo, IMIS, Bombardopolis,
Food for the Poor, Hopital de la Communaute Haitienne, Petit Goave, Hospital Bernard Mews, La Gonave
and Fermathe. GHESKIO's headquarters will provide oversight and monitoring of the project.
Activity Narrative: adequate space, equipment, and personnel to enhance ARV pediatric services. Special attention will also
Table 3.3.11:
Activity 1
GHESKIO will implement tuberculosis (TB)/HIV services to the prisoners at the at the national prison at Port
au Prince in collaboration with the National TB Program. These resources will be linked to HIV resources to
ensure that all prisoners get HIV and TB screening. Infected patients will be provided appropriate TB and
HIV care and support within the prison health facility. GHESKIO ensure training and supervision of the
personnel of this facility to deliver these services. GHESKIO will also work with Partnership For Supply
Chain Management (PFSCM) to ensure the provision of necessary commodities and drugs for this program.
Activity 2
GHESKIO will collaborate with stakeholders to develop protocol and plan to treat patients with TB and HIV
co-infection at the HIV units. This will include building human capacity, tools and logistic at the HIV units to
deliver TB services.
Activity 3
As preliminary data from a national survey has shown a high prevalence rate of multi-drug resistant (MDR)-
TB (3%) in patients never treated before for TB, GHESKIO will work with MOH and stakeholders to develop
plan to monitor resistance among TB resistance among HIV patients and develop National guidelines to
standardize MDR /TB management.
With COP 09 resources, GHESKIO will continue to integrate TB screening, prophylaxis and treatment in its
network of HIV clinics and pursue the development of the Sigueneau public Hospital, a stand alone TB site,
to become a national center of excellence for the management of TB/HIV co-infection with the capacity to
offer antiretroviral therapy (ART) and TB treatment at a single site, and offer treatment for patients with
MDRTB. Siguenau Hospital will be the second site in Haiti capable of offering care to patients with MDRTB.
Emphasis areas for these activities will cover: community mobilization and participation, development of
network and referral center, human resources, logistics, infrastructure, needs assessment, policy and
guidelines, supervision for QA/QC/QI and training. Specific target population will be the HIV+ TB clients
attending Siguenau hospital and referred patients with TB/HIV requiring HAART and hospitalization. In
addition Siguenau will serve as a national training center for the management of TB/HIV co-infection and
MDRTB. These activities will be integrated with other HIV related activities (ART, Palliative care, CT and
PMTCT) supported by PEPFAR and the Global Funds thru GHESKIO and other lead HIV and TB partners.
GHESKIO is one of the two lead NGOs that have implemented in Haiti integrated model of HIV services.
Actually with existing resources, GHESKIO is expanding its integrated model to 16 ART sites, including
seven major public hospitals. In this network, efforts were made to integrate TB/HIV activities focusing on
TB screening, prophylaxis and treatment for HIV patients.
Siguenau is a TB stand alone public hospital located in the West department. It offers, with support of
GFATM, CT services. This hospital is ideally located to serve as a referral center for HIV infected patients
with TB requiring HAART and for those with MDRTB. The treatment of patients co-infected with HIV and TB
is complicated and requires an experienced team. At present, there is no standardized treatment for such
patients. Studies done at GHESKIO centers showed that: 1) over one third of persons coming to VCT for
HIV testing who present with cough have active TB 2) Up to 50% of TB patients seen at our facility were
HIV infected and 3) in Port au Prince, up to 10% of HIV+ patients who were never treated for TB developed
associated MDRTB « AIDS 2006, Vol 20 No 3 ». The West Department, where Siguenau hospital is
located, is the most populated region in Haiti and has the highest prevalence of both HIV and TB in the
country. In Haiti at present, only GHESKIO offers a complete laboratory diagnosis for mycobacteria
including MDRTB, and only the PIH clinic in Cange located in the Center department offers care for patients
with MDRTB. Because the site in Cange is far from Port-au-Prince, most patients diagnosed with MDRTB in
the West Department do not want to go to the Center Department to receive inpatients therapy away from
their family for two years.
Strategies to diagnose and manage co-infection TB/HIV are an integral part of the National Strategic Plan.
Main project objective
The main intervention objective is to support the National Tuberculosis Program in order to reduce
morbidity ,mortality and transmission of Tuberculosis disease, to reduce the burden of TB/HIV coinfection
and to prevent the development of drug resistance
ACTIVITY 1: TB/HIV CARE AND TREATMENT INTEGRATION
In collaboration with the National TB Program, GHESKIO will help the MOH evaluate a National Plan to
Control HIV/TB in development with support from the GFATM.
1) Screen for HIV all patients with TB and screen for TB all patients with HIV.
2) Organize the treatment of both HIV and TB at ONE single site.
Since TB is the main OI in this setting it would make sense that both TB and HIV be treated at HIV centers
where ART is available. However, for practical reasons TB centers caring for 300 or more TB patients per
year should have the capacity of providing ART as well. For TB centers with less than 300 patients per year
a referral system will be set-up in each department to determine the closest place where both TB treatment
and ART are available.
ACTIVITY 2: IMPROVING TB/HIV CONTROL STRUCTURE INTEGRATON
GHESKIO TB specialists will participate in the MOH effort to establish national guidelines for the
management of TB/HIV co-infection.
Activity Narrative: ACTIVITY 3: REINFORCING TB PREVENTIVE THERAPY
GHESKIO will continue to reinforce its network of HIV sites to perform TB screening, prophylaxis and
treatment for HIV positive individuals. Emphasis will be put next year on HIV positive children as pediatric
care is being expanded through this network. Resources will be used to build human capacity, reinforce
infrastructure and work with PEPFAR to ensure adequate provision of PPD tests and related commodities
including INH for prophylaxis. Based on needs assessment, IMIS will be reinforced with chest X-Ray
capacity to improve TB screening. This will complement sputum smear diagnosis capacity implemented at
all the TB sites thru the TB/DOTS program financed by the Global Fund.
ACTIVITY 4: CAPACITY BUILDING
GHESKIO will reinforce Siguenau hospital with a multidisciplinary team of MDs, nurses, pharmacists, social
workers, laboratory technicians and field workers to maintain and expand ARV services to TB patients that
will be initiated this year with 09 resources.
ACTIVITY 5: TRAINING
GHESKIO will continue to reinforce Siguenau Hospital to become a training center. The resource capacity
of this facility will be improved by DOTS training staff, TB/HIV training and the management MDRTB(DOTS
PLUS). Resources will be allocated for training sessions including equipment and training materials as well
as logistic costs for participants. GHESKIO will coordinate this activity with other network of TB and HIV
clinics to offer comprehensive training in HIV and TB management to healthcare providers at HIV and TB
sites in collaboration with the TB National Program, the HIV national program and Partners in Health (PIH).
ACTIVITY 6: ENHANCING GHESKIO LAB CAPACITY
This activity will consist in the provision of support for the diagnosis of mycobacterium species including
MDRTB at GHESKIO. GHESKIO is the only site in Haiti capable of documenting the diagnosing of
mycobacterium tuberculosis and other mycobacteria by culture and, the only site in Haiti with the capacity to
diagnose MDRTB. GHESKIO will obtain the necessary reagents and supplies needed to diagnose MDRTB
in patients who fail conventional TB therapy. This will be integrated in the national plan for MDRTB
monitoring that will be developed. Actually 3 confirmed MDR patients has been placed under second line
treatment . Siguenau hospital's capacity will be reinforced to become a specialized and a national reference
center providing care to patients with MDRTB. Two GHESKIO clinicians recently trained at the New York
City Health Department in the management of patients with MDRTB will be assigned to the Siguenau
hospital.
ACTIVITY 7 : MDR/TB AND XDR
The magnitude of MDR problem is still unknown in Haiti. Therefore Gheskio is emphasizing partnership with
the National Tuberculosis Program by
1) Preliminary data from a national survey has shown a high prevalence rate of MDRTB (3%) in patients
never treated before for TB. It will be probably higher if we consider that only patients with positive smear
were enrolled, excluding most of HIV infected patients. Prior studies have already shown high association of
MDRTB with HIV. With COP09 funding, we will expand the survey enrolling all patients seen at the first visit
in a TB clinic.
2) Working closely with NTP to develop National guidelines to standardize MDR /TB management.
3) Increasing TB Program effectiveness in managing MDR patients and implementing infection control
steps to prevent XDR
4) Setting up an action plan to enroll on MDR treatment 12 patients per year. Three have already started
treatment at Sigueneau Hospital.
ACTIVITY 8: STRENGTHENING THE PENITENTIARY CENTERS
In collaboration with the Penitentiary health authorities Gheskio will participate in building capacity of the
centers and especially the main prison of the system located in Port-au-Prince. Thus GHESKIO will
participate in reinforcing the structure and provide the following services:
1) Penitentiary staffing
2) Training in co-infection TB/HIV and ART.
3) TB testing and treatment through DOTS strategy
4) HIV testing and ART
5) TB and HIV prevention package
6) Supervision at the National Penitentiary of Port-au-Prince. MDR inmates detected at Hinche prison will
be taken care and supervised in collaboration with Zanmi la Sante of Cange.
Continuing Activity: 17180
17180 9672.08 HHS/Centers for Groupe Haitien 7682 3315.08 $600,000
9672 9672.07 HHS/Centers for Groupe Haitien 5124 3315.07 $500,000
Table 3.3.12:
SUMMARY
Activities listed below are aimed at improving the quality of life of orphans and vulnerable
children/adolescents affected and infected by HIV/AIDS as well as preventing the HIV infection in
adolescents with risky behaviors to acquire it. Three levels of interventions are considered: child /adolescent
level, caregiver/family level, system level. All interventions are conceived to create opportunities for OVC to
grow, develop and meet their age - specific needs, to build capacity system for long term sustainability of
care while insuring Emergency Plan policies. Activities will be conducted at GHESKIO using the following
strategies: 1) continuous identification of OVC 2) Voluntary Counseling Testing 3) continuous training for
peer educators; 4) referral system implementation 5) educational sessions 6) therapeutic support groups 7)
STD's care 8) HIV/AIDS/TB care including ARV treatment 9) incentives to help increase adherence among
adolescents 10) nutritional support 11) shelter/home for children living in the streets 12) educational support
13) socio-cultural and recreational activities.
BACKGROUND
During the current year (2008), 4646 OVC have been identified and followed at GHESKIO Centers, among
those 639 are HIV infected. Besides this follow up activity, HIV preventing services targeted adolescents
specifically were given. Activities related to adolescents were funded by UNICEF. Strong collaboration has
been established between GHESKIO and other organizations working with OVC such as Lakay, Lakou,
CAFA (Centre d'Action Familiale), CAD (Centre d'Action pour le Développement), CARITAS, TIMTATEK (Ti
Moun Kap Teke Mab), Centre d'Accueil à Carrefour and Arc-en-ciel which were highly beneficiating from
GHESKIO's expertise to improve their institutional activities.
ACTIVITIES AND EXPECTED RESULTS
We will carry out seven (7) separate but linked activities in this Program Area
ACTIVITY 1: Food and Nutritional Support
- Nutritional assessment will be provided in order to identify malnourished children based on anthropometric
assessment and World Health Organization (WHO) guidelines
- Counseling on nutrition, weaning foods, water purification, and food preparation techniques will be
provided to families/guardians
- Children under 2 will benefit a complete nutritional package: supplementary and fortified weaning foods
(for example: medikamanba, fortified cereals blend) to prevent malnutrition will be provided; mothers /
guardians clubs will meet on a monthly basis for educational sessions
- Supplementary and therapeutic foods as well as multivitamins, micronutrients will be provided to children
identified as malnourished
- Older OVC will be linked to other organizations food providers collaborating with GHESKIO, food will be
delivered on site
- Technical guidelines, training curricula and job aids for nutrition assessment and counseling will be
developed for clinical providers and nutrition counselors.
Funds of this program will be used to support a nutritional coordinator and 2 counselors, to provide fortified
weaning food, therapeutic and supplementary feeding of malnourished children, to develop training and
counseling materials and to support training sessions for health care providers
ACTIVITY 2: Shelter and Care
- Identification of family members as caregivers to provide access to shelter for orphans at the parents'
death.
- Assistance and support to family members who provide access to shelter for orphans at the parents'
- When family options are not available, HIV/AIDS children living in the streets who are followed actively in
the adolescent clinic at GHESKIO will be placed to live in a dormitory located in other collaborating
organizations (Lakou, Lakay, TIMTATEK, Centre d'Accueil, Arc en ciel for examples) that provide shelter for
this category of children.
Funds of this program will be used to provide family support, to cover the care for children through these
organizations
ACTIVITY 3: Protection
- On going identification of OVC through VCT, PMTCT, ARV programs. At least 1000 new OVC will be
identified during the year period.
- Facilitation of basic birth registration. Parents/guardians will be informed and motivated to legally register
their children and fees registration will be paid for them as needed.
- Estimation of the long term access to education, health care.
- Creation of a Community Advisory Board (CAB) formed of teachers, parents/guardians, health care givers,
adolescents that will serve as a Child / Adolescents Protection Committee. GHESKIO will be counseled on
the best way to help OVC meet their needs by the CAB, whose mission will be advocating and advising.
Funds of this program will support statistical system to identify OVC, transportation fees to referral places
for basic birth registration, the CAB Coordinator and support group meeting with the CAB.
ACTIVITY 4: Healthcare
- Prevention and treatment activities will be continued in the children/adolescent clinics.
Immunization, growth monitoring, parasitic treatment (as needed), HIV and syphilis testing will be provided.
Children/adolescents infected with HIV will be placed on HAART.
ACTIVITY 5: Psychosocial support
- Psychosocial support for adolescents with bad adherence to treatment and for those which HIV status is
being or will be revealed will be provided. Support groups held at the clinic, animated by psychologists and
social workers with the participation of the peer educators will be continued.
- Educative age - specific materials will be provided, aimed to: a) support families and caregivers to better
manage stress and improve parenting when they are in situations of chronic illness; b) create therapeutic
activities that would contribute to help adolescents to express themselves without words; c) help parents
make their children under ten aware of having an incurable disease with an adapted language; d) to support
Activity Narrative: parents/caregivers during this difficult first step of communication about HIV disclosure. This strategy will
help to prevent risk behaviors and non adherence during adolescence.
-Socio-cultural and recreational activities to maintain adherence rate at a respectable level, engaging youth
and encouraging their enthusiasm and talents in non health-related interests will be continued.
Funds will be used to cover the salary of 2 social workers and 1 field worker; to create and reproduce
communication materials; to organize recreational activities held at GHESKIO or at other places. At least 4
activities will be organized for the OVC during the year period.
ACTIVITY 6: Education and Vocational Training
Educational support by giving school materials and scholarships for the OVC in needed will be provided.
- 600 children/adolescents in needed followed at the clinic have been identified this year Funds will cover
the purchase of school tools, books, school attendance fees and uniforms.
ACTIVITY 7: Economic Opportunity/ Strengthening
Parents/guardians, older HIV/AIDS OVC will be linked to Private Sector in order to promote income -
generating activities, small business development, entrepreneurial skills.
Funds will cover transportation fees to referral sites.
New/Continuing Activity: New Activity
Continuing Activity:
Estimated amount of funding that is planned for Education $50,000
Table 3.3.13:
SUMMARY: The goal of these activities is to strengthen National Public Health Laboratory (NPHL) capacity
by providing continuing technical assistance in the areas of Dried Plasma Spot (DPS) Quality Assurance for
HIV antibody testing, and whole blood syphilis testing. GHESKIO will also support laboratories at PMTCT,
VCT, ARV, and palliative care sites through training and technical assistance in diagnostic tests used for
diagnosis and follow up. The main emphasis for these activities is continued training, technical assistance
for quality assurance/quality control and equipment maintenance for GHESKIO laboratories. These
activities will involve NPHL, GHESKIO, and designated sites. The specific target population includes public
and private health care workers nationwide.
BACKGROUND: Many activities in COP09 are a follow up of activities conducted in 2007 and 2008 as part
of NPHL's objective to develop and provide QA/QC services to sites providing HIV-related testing in Haiti.
Through these activities, GHESKIO will continue to build the NPHL's capacity by mastering and transferring
to NPHL the capacity for HIV screening using DPS (re-testing activity). These activities will improve the
capacity of NPHL to provide quality control of laboratory results in healthcare facilities nationwide.
ACTIVITY I: This activity is to continue providing competency assessment yearly for 200 healthcare workers
with the collaboration of NPHL on DPS processing and HIV whole blood testing. It will build on the previous
year's activity to assist NPHL in the implementation of the DPS HIV testing. Corrective action and retraining
based on competency assessment results will be provided. GHESKIO mobile team will only be in charge of
the assessment of the healthcare workers of GHESKIO network. NPHL will be responsible for the MOH
network.
ACTIVITY II: GHESKIO will continue providing QA/QC assistance in whole blood rapid syphilis testing to
NPHL and the MOH lab network.
ACTIVITY III: GHESKIO will prepare a 1-week refresher workshop for the 10 trainers of the NPHL trained
during the COP08 activities. These trainers had previously been trained in CD4 T-cell count determination
by flow cytometry, ELISA, Western Blot, and p24 antigen assay. During this refresher workshop, the skills of
these trainers will be assessed and new recommendations will be made to the NPHL based on the trainers'
performance.
ACTIVITY IV: GHESKIO will follow up with the initial training to train all new national lab staff in diagnosis of
opportunistic infections, TB culture, TB drug resistance testing (4 weeks) in collaboration with American
Society of Microbiology (ASM) and Association of Public Health Laboratories (APHL) who will provide on-
site technical assistance to the national lab for TB, bacteriology, and parasitology. This joint effort is aimed
to enable the national lab to function in these laboratory areas in a timely manner.
ACTIVITY V: With the support of the CDC GAP International Lab Branch EID and PEPFAR LTWG,
GHESKIO will participate in performance evaluation of the 2 laboratories (GHESKIO/IMIS and NPHL)
previously trained in DBS-PCR for early infant diagnosis of HIV. Corrective action and troubleshooting will
be conducted. GHESKIO and NPHL will participate in a proficiency testing program provided by WHO and
CDC.
ACTIVITY VI: GHESKIO will develop drug resistance testing capacity to monitor HIV/AIDS patients
receiving ART by following the WHO/CDC criteria and monitoring treated patients. Based on preliminary
data at GHESKIO, we anticipate that 5% per year of the patients receiving antiretroviral therapy (ART) will
meet WHO eligibility criteria for ART failure. We will collect and freeze plasma specimens from an estimated
500 patients who meet WHO criteria for failure in order to perform HIV drug resistance testing. Funds are
requested for 2 laboratory technicians performing this technique. This activity will help better define the
demographic and clinical characteristics of patients who fail ART so that new better adapted guidelines for
monitoring patients on ART can be drafted. The drug resistance mutations identified will help better tailor
second-line antiretroviral drug regimens for patients failing ART in Haiti. Finally, this service will allow us to
increase capacity for virologic testing in Haiti and to train new technicians in these tests.
ACTIVITY VII: GHESKIO will provide laboratory support for four ART sites in its network. GHESKIO will play
an active role by improving laboratory infrastructure, upgrading the facility, and hiring additional lab staff to
make laboratories at these facilities ready for becoming ARV sites.
ACTIVITY VIII: GHESKIO will hire 1 biomedical engineer assisted by 1 electrician to increase its capacity of
the Biomedical Engineering Unit. Funds are also requested for the current personnel of this unit. This staff
will receive training on maintenance, repair and troubleshooting of mechanical and automated analyzers
used in the network (Point Care, Sysmex, Reflotron, ELISA plate reader, Facs Count).This staff will be
available to assist the national lab biomedical engineer unit providing services as deemed necessary.
ACTIVITY IX: GHESKIO will provide a refresher workshop to 2 laboratory technicians per site in the network
(total of 32 technicians) to perform instrument check and preventive maintenance. All public sites will be
covered by NPHL. GHESKIO will send its Biomedical engineering staff to assist the national lab with the
training of lab equipment maintenance at the national lab.
ACTIVITY X: NPHL will be in charge of equipment maintenance of the MOH Network. The GHESKIO
maintenance staff will serve as a backup for the National Laboratory and will be responsible for
maintenance and service of equipment in the GHESKIO network. Twice a year, GHESKIO staff will verify
the equipment maintenance activities in the GHESKIO laboratory network (16 sites: 8 private and 8 public)
including equipment cleaning, adjustment and replacement of parts, functional checks, temperature
recording, troubleshooting activities, calibration of equipment and record verification. This activity will be
introduced to other national laboratory networks in order to improve lab system quality.
ACTIVITY XI: GHESKIO will acquire one additional hematology instrument to increase the capacity of the
Activity Narrative: laboratory and for better follow up of patients receiving ART.
Continuing Activity: 17182
17182 4601.08 HHS/Centers for Groupe Haitien 7682 3315.08 $388,000
9283 4601.07 HHS/Centers for Groupe Haitien 5124 3315.07 $400,000
4601 4601.06 HHS/Centers for Groupe Haitien 3315 3315.06 $0
Table 3.3.16:
This project will support the national HIV prevention and care program by proposing a response to the
crucial shortage of physicians in some areas. Most of the graduate physicians leave the country after their
training. More than 75% of those remaining in the country leave in the metropolitan area. The nurses are by
far the best personnel available, capable to offer good care with a short and appropriate training. A twelve
months curriculum is ready allowing the selected nurses to work closely with patients at GHESKIO during
six months and to complete their academic skills during the next six months at Quisqueya. This program will
be certified by the national authorities. Particular attention will be paid to encouraging beneficiaries to go
back in their origin site.
We will carry out separate activities in this Program Area.
ACTIVITY 1: The first activity is to provide scholarship to selected nurses allowing them to be able to afford
the intensive twelve months curriculum. Most of them will come from cities away from the capital. This
funding will go specifically to support lodging and per diem fees during the training time.
ACTIVITY 2: The second activity is to assure the correct execution of the educational and training program.
GHESKIO and Universite Quisqueya will host the beneficiaries during twelve (12) months for a dynamic and
interactive curriculum aiming to offer them all the skills to be able to carrying HIV patients without
complications. This funding will go specifically to support training activities, teaching materials, salaries for
two job training mentors, teachers. This activity will be initiated in 2009, and the first graduates will be ready
to strengthen the national health program in 2010.
Continuing Activity: 17183
17183 15465.08 HHS/Centers for Groupe Haitien 7682 3315.08 $300,000
15465 15465.07 HHS/Centers for Groupe Haitien 5124 3315.07 $150,000
Table 3.3.18:
