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: The activities described below are carried out to provide comprehensive prevention of mother-
to-child transmission (PMTCT) services to HIV-positive women. These PMTCT activities will be conducted
within PIH/ZL's "four pillars" model for implementing a comprehensive HIV program in the context of primary
care: 1) HIV prevention and care, including voluntary counseling and testing (VCT); 2) detection and
treatment of tuberculosis (TB) and other opportunistic infections; 3) detection and treatment of sexually
transmitted infections (STIs); and 4) women's health and prevention of mother-to-child transmission
(PMTCT). The primary emphasis areas for these PMTCT activities are Gender: Increasing gender equity in
HIV/AIDS programs; Wraparound programss: Child Survival Activities, Family Planning, and Safe
motherhood. The primary target populations for PMTCT activities are pregnant women, HIV positive
pregnant women, and HIV/AIDS-affected infants.
Activities will be carried out at 10 sites in Haiti's Central Department (Belladère, Boucan Carré, Cange,
Cerca La Source, Hinche, Lascahobas, Thomonde, as well as the new expansion sites of Mirebalais, Saut
d'Eau, and Savanette) and 4 sites in the Artibonite Department (Petite Rivière, St. Marc, Project ZeroSIDA
(POZ), and the new expansion site of Desdunes). Activities in St. Marc will be carried out in collaboration
with the Hôpital St. Nicholas (HSN) and Services de Santé de Premier Echelon (SSPE) as well as at La
Fondation Esther Boucicault Stanislas (FEBS) and Brocozel. Certain activities will also be carried out at
health posts in Segur and Jean Denis, which report their numbers through Petite Riviere.
The PIH/ZL HIV Equity Initiative has relied on sustained funding from the Global Fund to Fight AIDS,
Tuberculosis and Malaria (GFATM), as well as the President's Emergency Program for AIDS Relief
(PEPFAR), to operate over the past six years. Our GFATM Round 1 grant ended in December 2007. In
2008 we received Bridge Year funding and expect to receive renewed funding through the rolling
continuation channel (RCC) in 2009, but this is not enough to sustain current services. This specific
application does not include budget lines for ARVs. However, we are expecting, for new patients enrolled
after December 31, 2008, to receive ARVs through PEPFAR's Supply Chain Management System (SCMS)
beginning in 2009. If this co-financing is not received, PIH/ZL will need to adjust all targets listed here,
including, perhaps, a reduction in the number of service outlets.
BACKGROUND: PIH/ZL's PMTCT activities are part of a comprehensive HIV prevention and treatment
program started by PIH/ZL in 1998; expanded through the public sector beginning in 2002 in partnership
with the Haitian Ministry of Public Health and Population (MSPP) and with funds from the Global Fund to
Fight AIDS, Tuberculosis and Malaria (GFATM); and further expanded to Hinche, Cerca La Source, Petite
Rivière and St. Marc with the support of PEPFAR in the COP 2005, 2006, 2007 and 2008.Since 2004 the
program has been a collaboration between these four key partners—PIH/ZL, MSPP, GFATM, and
PEPFAR. Since 2005 work in the Artibonite region has been strengthened by involving several NGO
partners in St. Marc—SSPE, Promotion Objectif Zerosida (POZ), and La Fondation Esther Boucicault
Stanislas (FEBS)—and in Petite Rivière—Centre Medical Charles Colimon (CMCC).
PIH/ZL's PMTCT program was launched in the mid-1990s, soon after the efficacy of ART in reducing
mother-to-child transmission of HIV was proven. Since then, PMTCT activities have been a central
component of PIH/ZL's HIV efforts. Through a significant grant from the USAID Child Survival program,
PIH/ZL has strengthened and broadened its maternal and child health activities in the clinic as well as in the
community—in particular, expanding and strengthening the network of ajan fanm (community health
workers trained in women's health) and traditional birth attendants.
The PMTCT services provided through PIH/ZL increase gender equity by supporting efforts to reach and
treat an equitable number of HIV-infected women and men, and by increasing access to information,
services and care for women and girls. By offering VCT to all pregnant women as part of routine prenatal
visits, these activities support linkages between HIV/AIDS and other sectors (reproductive health).
PIH/ZL is committed to a long-term partnership with MSPP, and in all of the activities described, PIH/ZL is
dedicated to strengthening the public sector by training local staff, including MSPP health workers, to
ensure sustainability.
ACTIVITIES AND EXPECTED RESULTS:
ACTIVITY 1: VCT for Pregnant Women
The first activity is to perform VCT for all pregnant women. As part of PIH/ZL's provider-initiated VCT
strategy, pregnant women seen at PIH/ZL sites receive counseling (including family planning) and are
offered HIV testing during routine prenatal visits. PIH/ZL enlists "ajan fanm" to increase referrals of pregnant
women to clinics for testing and prevention education. In the last year, PIH/ZL provided counseling and
testing to more than 20,000 pregnant women. In 2009, PIH/ZL expects to provide testing and counseling to
an additional 22,500 pregnant women. This funding will support the staff and infrastructure necessary to
provide VCT to pregnant women in the context of primary and prenatal care. It will also cover expansion of
staff and infrastructure at Desdunes, Brocozel, Mirebalais, Savanette, and Saut d'Eau to ensure rapid-scale
up of VCT activities for pregnant women.
ACTIVITY 2: PMTCT in the Context of Prenatal, Perinatal, and Postnatal Care
The second activity is to provide prenatal, perinatal, and postnatal care to HIV-infected pregnant women at
each PIH/ZL site. In the prenatal period, HIV-positive pregnant women are enrolled in the PMTCT program
and receive counseling and education on transmission prevention. ART is offered to women with advanced
HIV infection and to all women in the third trimester of pregnancy to reduce the risk of HIV transmission.
Nutritional supplements, multivitamins, and STI screening and treatment are also routinely provided.
Mothers and infants receive comprehensive postnatal care involving ART for the infant, ongoing ART for the
mother (if required based on her stage of disease), education, and increased nutrition and home-based
support to enable best feeding practices. In the last six months leading up to April 2008, PIH/ZL provided
this comprehensive care to more than 145 new HIV-positive pregnant women and plans to provide care for
an additional 400 HIV-positive pregnant women in 2009. This funding will provide salary support and will
allow for the ongoing training of clinicians in the detection and care of HIV-positive pregnant women.
Activity Narrative: ACTIVITY 3: PMTCT in the Context of Social Support
The third activity is the provision of social support to all HIV-infected women enrolled in the PMTCT
program. Throughout her pregnancy and beyond, each woman is supported by an accompagnateur who
visits her at home once or twice a day to assess her needs as well as to assist with ART adherence and
other clinical care issues. During clinic visits, PMTCT program participants receive education and nutritional
support to decrease the likelihood of HIV transmission to infants during or following delivery. Post-partum,
new mothers receive nutritional supplementation, infant formula, and supplies for preparation of clean
water. Support groups, accompaniment, and medical supervision and care account for a low rate of MTCT
within PIH/ZL's program: less than 2%. It is expected that 400 new HIV-infected pregnant women will
receive these services in 2009. This funding will ensure the continued success of PIH/ZL's PMTCT services
by supporting the hiring of additional accompagnateurs and the on-going training of all PIH/ZL
accompagnateurs and ajan fanm.
New/Continuing Activity: Continuing Activity
Continuing Activity: 17208
Continued Associated Activity Information
Activity Activity ID USG Agency Prime Partner Mechanism Mechanism ID Mechanism Planned Funds
System ID System ID
17208 9682.08 HHS/Centers for Partners in Health 7691 3337.08 PIH $400,000
Disease Control &
Prevention
9682 9682.07 HHS/Centers for Partners in Health 5137 3337.07 PIH $320,000
Emphasis Areas
Gender
* Increasing gender equity in HIV/AIDS programs
Health-related Wraparound Programs
* Child Survival Activities
* Family Planning
* Safe Motherhood
Human Capacity Development
Estimated amount of funding that is planned for Human Capacity Development $377,777
Public Health Evaluation
Food and Nutrition: Policy, Tools, and Service Delivery
Estimated amount of funding that is planned for Food and Nutrition: Policy, Tools $5,511
and Service Delivery
Food and Nutrition: Commodities
Estimated amount of funding that is planned for Food and Nutrition: Commodities $15,656
Economic Strengthening
Education
Water
Table 3.3.01:
SUMMARY:
The activities described below are carried out to support HIV prevention efforts through four components:
education and outreach; radio-messages and large scale community-wide events; production and
distribution of educational materials; and screening and treatment for sexually transmitted infections (STIs).
These prevention activities will be conducted within PIH/ZL's "four pillars" model for implementing a
comprehensive HIV program in the context of primary care: 1) HIV prevention and care, including voluntary
counseling and testing (VCT); 2) detection and treatment of tuberculosis (TB) and other opportunistic
infections; 3) detection and treatment of STIs and; 4) women's health and prevention of mother-to-child
transmission (PMTCT). The primary emphasis areas for these activities are Gender: Addressing male
norms and behaviors, Increasing gender equity in HIV/AIDS programs, and Reducing violence and
coercion, as well as Wraparound programs: Family Planning. Specific target populations include
marginalized populations including OVC, men who have sex with men (MSM), commercial sex workers, and
women.
Fondation Esther Boucicault Stanislas (FEBS) and Brocozel . Certain activities will also be carried out at
BACKGROUND:
PIH/ZL's prevention activities are part of a comprehensive HIV prevention and treatment program started by
PIH/ZL in 1998; expanded through the public sector beginning in 2002 in partnership with the Haitian
Ministry of Public Health and Population (MSPP) and with funds from GFATM; and further expanded to
Hinche, Cerca La Source, Petite Rivière and St. Marc with the support of PEPFAR in the COP 2005, 2006,
2007, and 2008. Since 2004, the program has been a collaboration among these four key partners—
PIH/ZL, MSPP, GFATM, and PEPFAR. Since 2005, work in the Artibonite region has been strengthened by
involving several NGO partners in St. Marc—SSPE, Promotion Objectif Zerosida (POZ), La Fondation
Esther Boucicault Stanislas (FEBS)—and in Petite Rivière—Centre Medical Charles Colimon (CMCC). FY
09 will be the first year that PIH will receive prevention AB and OP funds from PEPFER.
PIH/ZL has long worked to prevent the spread of HIV and other STIs. In a six month period alone this past
year, members of PIH/ZL's prevention team, Noyeau Educatif Communautaire (NEC), estimate that they
reached over 300,000 people with prevention messages via a variety of different avenues including mass
media campaigns and local community-based projects. PIH/ZL does not differentiate between sexual
prevention messages, rather they provide ABC programming, hence the reason this narrative is the same
for HVAB and HVOP. Last year, PIH/ZL screened more than 88,000 people for STIs as a means of
providing early detection and treatment to reduce patients' risk of acquiring HIV.
By empowering both men and women to make informed choices about their sexual behavior, PIH/ZL sexual
prevention activities will work to increase gender equity in HIV/AIDS programs, address male norms and
behaviors, and place an emphasis on the reduction of violence and coercion. By offering ABC messages to
women as part of routine women's health visits, these activities support linkages between HIV/AIDS and
other sectors (family planning).
In prevention activities and all others, PIH/ZL is committed to a long-term partnership with the Ministry of
Health (MSPP) and to strengthening the public sector by training local staff, including MSPP health workers,
to ensure sustainability.
ACTIVITIES AND EXPECTED RESULTS
ACTIVITY 1: Prevention Education and Outreach
Currently 40 NEC specialize in community outreach and prevention education, working in schools,
churches, market places, health centers, organized community meetings, public plazas, mobile clinics,
people's homes, soccer games, brothels, traditional healers' homes, and cock fighting arenas with people of
a variety of ages. In addition, NEC provide prevention messages and training in meetings for employees,
community health workers, and TB and HIV patients. Funding for this activity will support the current human
resources and materials necessary for providing education and outreach in a multitude of settings each
month. In addition, PIH/ZL plans to hire and train NEC to work in the communities of Savanette, Saut d'Eau,
Mirebalais, and St. Marc in the upcoming year, for a total of 8 new NEC. It is expected that the NEC will
reach 550,000 people in the Central and Artibonite Departments with their education and outreach efforts.
ACTIVITY 2: Mass-media Campaigns—Radio Messages and Community-wide Events
Radio broadcasts of prevention and health messages play throughout the Central and Artibonite
departments with frequency. As the main source of news and entertainment for Haiti, short radio spots are
the easiest way to get a public health message across to a variety of people. This funding will make more
prevention messages possible on major radio stations throughout the communities where PIH/ZL works.
PEPFAR funding will also help make possible the annual World TB Day and World AIDS Day community
events where prevention messages are promoted to the thousands upon thousands of people who attend.
The team NEC and street theater actors involved in mass-media efforts with PIH/ZL expect to reach
550,000 people with their sexual prevention messages of "abstinence, be faithful, and use condoms."
ACTIVITY 3: Production and Distribution of Prevention Education Materials
PIH/ZL promotes and provides condoms (provided by MSPP, in-kind donations purchased with private
funds) free of charge at all PIH clinical sites and at mobile clinics and community events. In addition to
condom distribution, the NEC have distributed pamphlets and calendars in the past. This year PIH/ZL hopes
to develop and distribute more prevention education materials, focusing on images as a way to easily
convey public health messages. Funding for this activity will support the distribution of condoms,
Activity Narrative: development of educational materials, and space and equipment needed for the creation of such materials.
Specific efforts will be made to distribute prevention materials in the lower Artibonite as a variety of high risk
groups can be found in St. Marc and its surrounding communities.
New/Continuing Activity: New Activity
Continuing Activity:
Table 3.3.02:
for HVAB and HVOP.
other sectors (family planning). In prevention activities and all others, PIH/ZL is committed to a long-term
partnership with the Ministry of Health (MSPP) and to strengthening the public sector by training local staff,
including MSPP health workers, to ensure sustainability.
development of educational materials, and space and equipment needed for the creation of such materials.
* Addressing male norms and behaviors
* Reducing violence and coercion
Table 3.3.03:
The activities in this program seek to optimize quality of life for HIV-infected patients and their families and
to prevent the transmission of HIV and other sexually transmitted infections (STIs). Community-based care
and support will be conducted within PIH/ZL's "four pillars" model for implementing a comprehensive HIV
program in the context of primary care: 1) HIV prevention and care, including voluntary counseling and
testing (VCT); 2) detection and treatment of tuberculosis (TB) and other opportunistic infections; 3)
detection and treatment of sexually transmitted infections (STIs); and 4) women's health and prevention of
mother-to-child transmission (PMTCT). The primary emphasis areas for these activities are Gender:
Increasing women's access to income and productive resources and Wraparounds programs: Child Survival
Activities, TB, Safe motherhood. The primary target population for community based care and support is
people affected by HIV/AIDS and prevention activities for the general population.
PIH/ZL's community-based care and support activities are part of a comprehensive HIV prevention and
treatment program started by PIH/ZL in 1998; expanded through the public sector beginning in 2002 in
partnership with the Haitian Ministry of Public Health and Population (MSPP) and with funds from the
GFATM and further expanded to Hinche, Cerca La Source, Petite Rivière and St. Marc with the support of
PEPFAR in the COP 2005, 2006, 2007, and 2008. Since 2004, the program has been a collaboration
between these four key partners—PIH/ZL, MSPP, GFATM, and PEPFAR. Since 2005, work in the
Artibonite region has been strengthened by involving several non-governmental organizations (NGO)
Stanislas (FEBS)—and in Petite Rivière—Centre Medical Charles Colimon (CMCC)).
For a decade, PIH/ZL's community-based care and support activities have been delivered by
complementing a high standard of clinical care with a strong community-based network of
accompagnateurs. As a routine part of ARV services, all patients are seen daily in their homes by their
accompagnateur. These visits also serve as opportunities to monitor outcomes and provide palliative
services. If patients experience side effects, advanced disease, or other barriers to positive outcomes, the
accompagnateur addresses the situation either directly or through a referral to a clinic. If the
accompagnateur sees other health problems developing in the household, such as a sudden weight loss of
a family member, they will bring that individual in for treatment.
The proposed community care and support activities address gender issues by mitigating the burden of
care on women and girls by linking care programs with resources such as psychosocial support groups and
assistance with the provision of school fees as well as income-generating resources.
ACTIVITY 1: Accompagnateur Employment and Training
The first activity is employment and training of PIH/ZL's accompagnateurs. In 2009, we expect that
approximately 250 new accompagnateurs will be hired to provide services to an increasing number of HIV-
positive patients. Accompagnateurs, through their provision of community-based supervision and
monitoring, are the backbone of PIH/ZL's ARV services. Funding will also be used to provide
accompagnateurs with ongoing trainings in the delivery of palliative care. Accompagnateurs will continue to
make the link between clinical services and community services possible.
ACTIVITY 2: Social and Psychological Support
The second activity involves providing social and psychological support to HIV patients and their families
based on needs assessments conducted by program doctors and social workers. This support includes
monthly patient meetings, support groups, and individual psychosocial support led by the social work team.
This program will be strengthened in 2009-2010 with the hiring of 4 additional social workers and 14
assistants to support HIV-infected patients in the Central and Artibonite Departments. A preventive package
(safe water, condoms, and insecticide-treated nets in areas where malaria is endemic) will be provided.
Access to family planning services will be facilitated and food support will be provided for families in need.
The program will also provide links to microenterprise activities.
ACTIVITY 3: Social Assistance
The third activity is to provide financial support to HIV patients and their families. This support includes
assistance with school fees, housing, food, and transportation to/from the health facility. In the last year,
Activity Narrative: more than 40,000 social assistance stipends were provided to HIV-positive patients and their families. In
2009-2010, PIH/ZL expects to provide ongoing social assistance to close to 13,000 HIV-positive patients
and their families. This assistance is supported with funding from PEPFAR and PIH's private donors.
Continuing Activity: 17209
17209 4501.08 HHS/Centers for Partners in Health 7691 3337.08 PIH $250,000
9318 4501.07 HHS/Centers for Partners in Health 5137 3337.07 PIH $300,000
4501 4501.06 HHS/Centers for Partners in Health 3337 3337.06 PIH $900,000
* Increasing women's access to income and productive resources
* TB
Estimated amount of funding that is planned for Food and Nutrition: Policy, Tools $30,015
Estimated amount of funding that is planned for Economic Strengthening $25,000
Estimated amount of funding that is planned for Water $1,698
Table 3.3.08:
The activities described below are carried out to maintain access to antiretroviral therapy (ARV) for existing
patients, expand access to anti-retroviral (ARV) services to additional HIV-infected people in the Central
and Artibonite Departments of Haiti, and to train health workers in all aspects of HIV care and treatment.
PIH/ZL will conduct ARV treatment and training activities within its "four pillars" model for implementing a
infections; 3) detection and treatment of sexually transmitted infections (STIs); and 4) women's health and
prevention of mother-to-child transmission (PMTCT). The primary emphasis areas for the proposed
activities are Gender: Increasing gender equity in HIV/AIDS programs, Construction/renovation, and
Wraparound programs: Safe motherhood, Child Survival Activities and TB. The primary target populations
for these activities are people living with HIV/AIDS, health care providers, community-based organizations
and non-governmental organizations (NGO).
PIH/ZL's ARV treatment and training activities are part of a comprehensive HIV prevention and treatment
with the Haitian Ministry of Public Health and Population (MSPP) and with funds from GFATM; and further
expanded to Hinche, Cerca La Source, Petite Rivière and St. Marc with the support of PEPFAR in the FY
2005, 2006, 2007, and 2008. Since 2004 the program has been a collaboration between these four key
partners—PIH/ZL, MSPP, GFATM, and PEPFAR. Since 2005, work in the Artibonite region has been
strengthened by involving several partners in St. Marc--SSPE, Promotion Objectif Zerosida (POZ), and La
Fondation Esther Boucicault Stanislas (FEBS)--and in Petite Rivière--Centre Medical Charles Colimon
(CMCC).
All symptomatic or at-risk individuals as well as all pregnant women seeking care at PIH/ZL clinics are
offered voluntary counseling and testing for HIV. Upon identification of HIV-positive status, a patient is
referred to the HIV public health nurse and HIV program nurse, who performs further post-test counseling,
assists the patient in identifying at-risk partners or family members, arranges for a CD4 count and other
laboratory tests, and schedules subsequent follow-up visits. All HIV-positive patients are followed monthly
by a trained HIV/TB physician. At each visit, patients are evaluated for HIV disease progression,
tuberculosis and other opportunistic infections, and general health and well-being. When indicated,
prophylaxis, treatment, and social services are provided; palliative care given; and antiretroviral therapy
(ART) initiated. All PIH/ZL patients who are placed on ART are assigned a community health worker, called
an accompagnateur, who provides essential psychosocial support to patients and their families in addition
to daily directly observed ART. The accompagnateur also notifies clinic staff if a patient experiences side
effects or new symptoms. All care and treatment is provided free of charge to the patient.
In following activities outlined below, PIH/ZL will strive to ensure that an equitable number of women and
men receive treatment. By offering general clinical care to all HIV infected adults and their families, these
activities support linkages between HIV/AIDS and other services (safe motherhood and child survival).
ACTIVITY 1: General Clinical Care
The first activity is to provide general clinical care for HIV-infected adults and their families. This care—
provided in the health facility, at home, and through mobile clinics—is conducted within PIH/ZL's "four
pillars" model for implementing a comprehensive HIV program in the context of primary care, as described
above. By September 30, 2010, PIH/ZL expects to be providing clinical care to 18,000 patients. This funding
will support the infrastructure and human resources necessary for providing clinical services to an increased
number of HIV-infected patients as PIH/ZL expands to work in more communities. These funds will also
support the ongoing training of the clinical staff in effective palliative care strategies. Medical and laboratory
commodities and supplies needed to provide general clinical care for HIV-infected patients and their families
are supported by GFATM, PIH's unrestricted funds, and in-kind donations.
ACTIVITY 2: Patient Maintenance
The second activity is to maintain individuals currently on antiretroviral therapy (ART) by improving program
retention and enhancing clinical follow-up. Funding will be used to employ accompagnateurs and
accompagnateur supervisors and to support monthly trainings, ensuring a strong network of community lay
Activity Narrative: personnel trained in ARV management and adherence strategies. Funding will also support laboratory
capacity, supplies, and infrastructure required for ARV service delivery at each PIH/ZL site. As of January 1,
2009, PIH/ZL expects to be receiving ARVs through PEPFAR's SCMS. With 3,455 adult patients on ARV
treatment at the end of June 2008, PIH/ZL proposes to ensure that these current patients remain active on
treatment while initiating services for more than 2000 new HIV patients in need of ARVs, for a total of 6000
patients. An additional 500 accompagnateurs will be employed to ensure daily management of patients'
treatment.
ACTIVITY 3: Case Detection and Enrollment
The third activity is to enroll additional patients on ART. In 2009, with the support of PEPFAR, PIH/ZL plans
to begin providing comprehensive HIV care in 4 new sites (Mirebalais, Saut D'eau, Savanette and
Desdunes) as well as to expand services at 2 health posts (Brocozel and FEBS in the St. Marc health care
network). At the same time, PIH/ZL will seek to increase enrollment among the most marginalized and high-
risk groups in its catchment area. PIH/ZL hopes to build upon the success of the past 6 months leading up
to April 2008, in which 685 patients were newly enrolled on ART to arrive at 6000 patients on ART by
September 30, 2010; an aggressive target of more than 2000 patients in 2 years. This funding will allow
PIH/ZL to renovate and equip public facilities at the expansion sites listed above and will also be used for
comprehensive and on-going training of clinical staff and accompagnateurs.
ACTIVITY 4: Training Healthcare Providers
In addition to providing direct services, PIH/ZL is committed to sharing and leveraging our experience by
providing ongoing training to healthcare workers across Haiti. PIH/ZL's efforts to train health workers in the
delivery of ARV services have expanded significantly in the past years. In 2004, with support from PEPFAR
and in collaboration with the International Training and Education Center on HIV/AIDS (I-TECH) and the
Caribbean HIV/AIDS Regional Training Initiative (CHART), PIH/ZL opened a National Training Center
(NTC) with facilities in Hinche and Cange. In the past year, PIH/ZL has trained hundreds of health workers
in Haiti in all aspects of HIV care and treatment. This funding will support personnel and infrastructure
requirements to strengthen the training program at Hinche as well as cover the direct costs of training
sessions: participant transport, trainer and participant per diems, and materials production.
These above activities will contribute to the PEPFAR 2-7-10 goals by increasing the number of individuals
on ARV treatment and by expanding the capacity of individuals and organizations in Haiti to initiative and
manage ART treatment, avert new HIV infection, and provide care for an increased number of HIV+
patients.
Continuing Activity: 18974
18974 18974.08 HHS/Centers for Partners in Health 7691 3337.08 PIH $5,375,000
Estimated amount of funding that is planned for Human Capacity Development $2,628,265
Estimated amount of funding that is planned for Food and Nutrition: Policy, Tools $52,477
Estimated amount of funding that is planned for Food and Nutrition: Commodities $693,696
Estimated amount of funding that is planned for Economic Strengthening $70,560
Table 3.3.09:
The activities in this program seek to optimize quality of life for HIV-infected pediatric patients and their
families and to prevent the transmission of HIV and other sexually transmitted infections (STIs). Community-
based care and support will be conducted within PIH/ZL's "four pillars" model for implementing a
prevention of mother-to-child transmission (PMTCT) of HIV services. The primary emphasis areas for these
activities are Gender: increasing women's access to income and productive resources and Wraparound
programs: Child Survival Activities, TB, safe motherhood. The primary target population for community
based care and support is people affected by HIV/AIDS and prevention activities for the general population.
PIH/ZL's pediatric community-based care and support activities are part of a comprehensive HIV prevention
and treatment program started by PIH/ZL in 1998; expanded through the public sector beginning in 2002 in
PEPFAR in the COP 2005, 2006,2007, and 2008. Since 2004, the program has been a collaboration
For a decade, PIH/ZL's pediatric community-based care and support activities have been delivered by
accompagnateurs. As a routine part of ARV services, all pediatric patients are seen daily in their homes by
their accompagnateur. These visits also serve as opportunities to monitor outcomes and provide palliative
The proposed pediatric community care and support activities address gender issues by mitigating the
burden of care on women and girls by linking pediatric care programs with resources such as psychosocial
support groups and assistance with the provision of school fees as well as income-generating resources.
approximately 16 new accompagnateurs will be hired to provide services to additional pediatric HIV-positive
patients. Accompagnateurs, through their provision of community-based supervision and monitoring, are the
backbone of PIH/ZL's ARV services. Funding will also be used to provide accompagnateurs with ongoing
trainings in the delivery of palliative care. Accompagnateurs will continue to make the link between clinical
services and community services possible.
The second activity involves providing social and psychological support to pediatric HIV patients and their
families based on needs assessments conducted by program doctors and social workers. This support
includes monthly patient meetings, support groups, and individual psychosocial support led by the social
work team. A preventive package (safe water, condoms, and insecticide-treated nets in areas where
malaria is endemic) will be provided. Access to food support will be provided for children in need. The
program will also provide links to microenterprise activities.
The third activity is to provide financial support to pediatric HIV patients and their families. This support
includes assistance with school fees, housing, food, and transportation to/from the health facility. In the last
year, more than 40,000 social assistance stipends were provided to HIV-positive patients and their families.
In 2009-2010, PIH/ZL expects to continue to provide social assistance to the approximately 180 pediatric
Activity Narrative: HIV patients on treatment.
Estimated amount of funding that is planned for Human Capacity Development $158,577
Estimated amount of funding that is planned for Food and Nutrition: Policy, Tools $8,973
Estimated amount of funding that is planned for Food and Nutrition: Commodities $7,206
Estimated amount of funding that is planned for Water $507
Table 3.3.10:
pediatric patients, expand access to anti-retroviral (ARV) services to additional HIV-infected children in the
Central and Artibonite Departments of Haiti, and to train health workers in all aspects of HIV care and
treatment. PIH/ZL will conduct ARV treatment and training activities within its "four pillars" model for
implementing a comprehensive HIV program in the context of primary care: 1) HIV prevention and care,
including voluntary counseling and testing (VCT); 2) detection and treatment of tuberculosis (TB) and other
opportunistic infections; 3) detection and treatment of sexually transmitted infections (STIs); and 4) women's
health and prevention of mother-to-child transmission (PMTCT). The primary emphasis areas for the
proposed activities are Gender: Increasing gender equity in access to services and Wraparound programs:
Child Survival Activities. The primary target populations for these activities are children living with HIV/AIDS,
health care providers, community-based organizations and non-governmental organizations (NGO).
PIH/ZL's pediatric ARV treatment and training activities are part of a comprehensive HIV prevention and
partnership with the Haitian Ministry of Public Health and Population (MSPP) and with funds from GFATM;
and further expanded to Hinche, Cerca La Source, Petite Rivière and St. Marc with the support of PEPFAR
in the FY 2005, 2006, 2007, and 2008. Since 2004 the program has been a collaboration between these
four key partners—PIH/ZL, MSPP, GFATM, and PEPFAR. Since 2005, work in the Artibonite region has
been strengthened by involving several partners in St. Marc--SSPE, Promotion Objectif Zerosida (POZ),
and La Fondation Esther Boucicault Stanislas (FEBS)--and in Petite Rivière--Centre Medical Charles
Colimon (CMCC).
All symptomatic or at-risk children as well as all pregnant women seeking care at PIH/ZL clinics are offered
voluntary counseling and testing for HIV. Upon identification of HIV-positive status, a patient is referred to
the HIV public health nurse and HIV program nurse, who performs further post-test counseling, assists the
patient in identifying at-risk partners or family members, arranges for a CD4 count and other laboratory
tests, and schedules subsequent follow-up visits. All HIV-positive pediatric patients are followed monthly by
a trained HIV/TB physician. At each visit, pediatric patients are evaluated for HIV disease progression,
(ART) initiated. All PIH/ZL pediatric patients who are placed on ART are assigned a community health
worker, called an accompagnateur, who provides essential psychosocial support to patients and their
families in addition to daily directly observed ART. The accompagnateur also notifies clinic staff if a patient
experiences side effects or new symptoms. All care and treatment is provided free of charge to the patient.
In these activities, PIH/ZL will strive to ensure that an equitable number of girls and boys receive treatment.
The first activity is to provide general clinical care for HIV-infected children and their families. This care—
above. This funding will support the infrastructure and human resources necessary for providing clinical
services to an increased number of HIV-infected pediatric patients. These funds will also support the
ongoing training of the clinical staff in effective palliative care strategies specifically focused on children.
PIH's unrestricted funds, and in-kind donations.
The second activity is to maintain children currently on antiretroviral therapy (ART) by improving program
personnel trained in ARV management and adherence strategies. Funding will also support laboratory
capacity, supplies, and infrastructure required for ARV service delivery at each PIH/ZL site. As of June
2008, PIH/ZL had 107 pediatric patients on ARV treatment. In 2009, PIH/ZL plans to scale-up efforts to
provide ARV services to 50 additional pediatric patients in the Artibonite sites and three new sites in the
Activity Narrative: Central Plateau.
The third activity is to enroll additional pediatric patients on ART. In 2009, with the support of PEPFAR,
PIH/ZL plans to begin providing comprehensive HIV care in 4 new sites (Mirebalais, Saut D'eau, Savanette
and Desdunes) as well as to expand services at 2 health posts (Brocozel and FEBS in the St. Marc health
care network). At the same time, PIH/ZL will aggressively seek to increase enrollment among the most
marginalized and high-risk groups in its catchment area. PIH/ZL hopes to build upon the success of the 6
months leading up to April 2008, in which 685 patients were newly enrolled on ART. This funding will allow
comprehensive and on-going training of clinical staff and accompagnateurs on care and treatment for
pediatric HIV.
ACTIVITY 4: PCR laboratory capabilities
Early detection of HIV in a child is important in assuring the child receives proper treatment and nutrition as
quickly as possible. Currently the ability to analyze PCR tests is not available on a national level in Haiti,
and PIH/ZL has been sending tests to a US laboratory for analysis. The ability to have on-site analysis for
PCR in PIH/ZL's catchment area, which we expect to be implemented by the laboratory services team at
PEPFAR in COP 08, will greatly improve laboratory capacity in the PMTCT program. Funding for this
activity in COP 09 will pay for laboratory technicians' trained in reading PCR tests salaries as well as
materials and equipment needed for providing the tests to infants. Every child in PIH/ZL's PMTCT program
receives 2 PCR tests along with rapid tests at 0,3,6,9,12 and 18 months to confirm a child's HIV status. It is
expected that 400 children of mothers in PIH/ZL's PMTCT program will need to be tested in 2009-2010.
manage ART treatment, avert new HIV infection, and provide care for an increased number of pediatric HIV
Estimated amount of funding that is planned for Human Capacity Development $350,000
Estimated amount of funding that is planned for Food and Nutrition: Policy, Tools $11,021
Estimated amount of funding that is planned for Food and Nutrition: Commodities $31,312
Table 3.3.11:
Sustainability narrative:
Over the past twenty-five years, PIH/ZL in collaboration with the Haitian Ministry of Health (MOH), has
successfully established itself as the primary provider of comprehensive health care in the Central
Department of Haiti, including prevention, care, and treatment services for AIDS and tuberculosis (TB). With
support from the Global Funds (GF) and the President's Emergency Plan for AIDS Relief (PEPFAR), and
working in collaboration with the MOH, we have been able to expand our HIV Equity Initiative to the nine
sites we serve today-- 7 in the Central Department (Belladère, Boucan Carré, Cange, Cerca La Source,
Hinche, Lascahobas, Thomonde) and 2 in the Artibonite Department (Petite Rivière and St. Marc). Again in
collaboration with the MOH, through this year's funding support from PEPFAR, PIH/ZL hopes to expand to
Mirebalais, Saut d'Eau, and Savanette and strengthen health services in Desdunes and Brocozel in the
Artibonite. Through this strong and growing partnership with the MOH, PIH/ZL has worked hard to enhance
the capacity of Haiti's health system, both at the community and institutional level, striving to provide the
highest standard of care possible with the resources available and plans to continue to train health care
workers and make infrastructure improvements in areas in need of improved health services.
SUMMARY: TB is the most common and deadly opportunistic infection (OI) in Haiti and remains rampant
among HIV positive patients and their families due to chronic malnutrition, HIV, and overcrowded living
conditions. The proposed activities described below are aimed to strengthen and expand the PIH/ZL
capacity to detect, prevent, and treat TB infection for HIV positive patients. The program will conduct
TB/HIV activities within PIH/ZL's "four pillars" model for implementing a comprehensive HIV program in the
context of primary care: 1) HIV prevention and care, including voluntary counseling and testing (VCT); 2)
detection and treatment of TB and other OIs; 3) detection and treatment of sexually transmitted infections
(STIs) and; 4) women's health and prevention of mother-to-child transmission (PMTCT). The primary
emphasis areas for these palliative care TB/HIV activities are Wraparound programs: TB and gender:
gender equity. The primary target populations for these TB activities are people living with HIV/AIDS
(PLWHAs), including HIV-positive infants and children.
d'Eau, and Savanette) and 4 sites in the Artibonite Department (Petite Rivière, St. Marc, Promoteurs
Objectif ZéroSida [POZ], and the new expansion site of Desdunes). Activities in St. Marc will be carried out
in collaboration with the Hôpital St. Nicholas (HSN) and Services de Santé de Premier Echelon (SSPE) as
well as at La Fondation Esther Boucicault Stanislas (FEBS) and Brocozel . Certain activities will also be
carried out at health posts in Segur and Jean Denis, which report their numbers through Petite Riviere.
The PIH/ZL HIV Equity Initiative has relied on sustained funding from the Global Fund for AIDS,
Tuberculosis and Malaria (GFATM) and PEPFAR, to operate over the past six years. Our GFATM Round 1
grant ended in December 2007. In 2008 we received Bridge Year funding and expect to receive renewed
funding through the rolling continuation channel (RCC) in 2009, but this is not enough to sustain current
services. This specific application does not include budget lines for ARVs. However, we are expecting, for
new patients enrolled after December 31, 2008, to receive ARVs through Partnership For Supply Chain
Management (PFSCM) beginning in 2009. If this co-financing is not received, PIH/ZL will need to adjust all
targets listed here, including, perhaps, a reduction in the number of service outlets.
PIH/ZL's TB prevention and treatment activities date back to the efforts of community health workers in the
early 1980s. Experience with directly observed therapy (DOT) in the context of TB treatment was
instrumental to the design of PIH/ZL's HIV treatment program. TB activities are fully integrated into the
comprehensive HIV prevention and treatment program started by PIH/ZL in 1998; expanded through the
public sector beginning in 2002 in partnership with the MOH and with funds from GFATM; and further
expanded to Hinche, Cerca La Source, Petite Rivière and St. Marc with the support of PEPFAR in the
country operational plan (COP) 2005, 2006, 2007 and 2008. Since 2004, the program has been a
collaboration between four key partners—PIH/ZL, MOH, GFATM, and PEPFAR. Since 2005 work in the
Artibonite region has been strengthened by involving several non-governmental (NGO) partners in St.
Marc—SSPE, POZ and, FEBS)—and in Petite Rivière (Centre Medical Charles Colimon [CMCC]).
As with all PIH/ZL care and support, the activities outlined below strive to ensure that an equitable number
of women and men receive treatment. In improving the health of HIV-infected patients, PIH/ZL strives to
enable their full participation in society at every level and to reduce the stigma and discrimination associated
with HIV status.
PIH/ZL is committed to a long-term partnership with MOH, and in all of the activities described; PIH/ZL is
dedicated to strengthening the public sector by training local staff, including MOH health workers, to ensure
sustainability.
ACTIVITY 1: Detection, Treatment, and Prophylaxis: The first activity is detection of, treatment and
prophylaxis for TB among HIV-infected individuals served at PIH/ZL's sites. As HIV treatment in the context
of primary care is delivered at an increasing number of sites and locations, strengthening and expanding
PIH/ZL's capacity to detect, treat, and prevent TB/HIV co-infection will be essential to the well-being of our
patients. In the last six months leading up to April 2008, PIH/ZL provided prophylactic TB therapy to more
than 300 HIV-positive individuals. The additional clinical human resources supported by this funding will
allow for greater clinical and programmatic focus on this essential component of HIV care. Funding will also
support TB/HIV-related laboratory capacity and the maintenance of necessary infrastructure.
ACTIVITY 2: Training: As PIH/ZL will be providing comprehensive HIV care to a significantly increased
number of patients in several new locations in 2009; the second activity is the training of providers in the
prevention and treatment of TB for HIV-infected individuals. Clinicians and accompagnateurs will receive
Activity Narrative: training on the management of TB/HIV co-infection during regularly held meetings. Moreover, selected
clinicians and community health workers from all PIH/ZL sites will participate in more formal classroom-
based trainings and clinic- and community-based practicum that address TB identification, treatment, and
prevention strategies for HIV-infected individuals.
ACTIVITY 3: HIV Testing for TB Patients: TB is the leading HIV-associated OIs for patients in resource-
poor settings and the most common cause of death in HIV-positive persons worldwide. The presence of TB
increases HIV replication and hastens the progression of AIDS. In light of the interaction between TB and
HIV, the clinical guidelines adopted by PIH/ZL recommend that all patients with tuberculosis be offered HIV
testing and counseling. In 2009, PIH/ZL estimates it will test 1900 TB patients for HIV.
Continuing Activity: 17210
17210 9673.08 HHS/Centers for Partners in Health 7691 3337.08 PIH $200,000
9673 9673.07 HHS/Centers for Partners in Health 5137 3337.07 PIH $450,000
Table 3.3.12:
The activities described below are carried out to support orphans and vulnerable children (OVC) through
four components: reinforcing existing primary/ambulatory care to increase capacity for identification of
children infected or affected by HIV; providing nutritional support; providing psychosocial support; and
providing social assistance. These OVC activities will be conducted within PIH/ZL's "four pillars" model for
opportunistic infections; 3) detection and treatment of sexually transmitted infections (STIs) and; 4) women's
health and prevention of mother-to-child transmission (PMTCT). The primary emphasis areas for these
activities are: Gender: Increasing gender equity in HIV/AIDS programs and Wraparound programs: Child
Survival Activities, Malaria and Family Planning. Specific target populations include OVC, caregivers of
OVC, and HIV/AIDS-affected families.
PIH/ZL's orphans and vulnerable children (OVC) activities are part of a comprehensive HIV prevention and
in the COP 2005, 2006, 2007, and 2008. Since 2004, the program has been a collaboration among these
been strengthened by involving several NGO partners in St. Marc—SSPE, Promotion Objectif Zerosida
(POZ), La Fondation Esther Boucicault Stanislas (FEBS)—and in Petite Rivière—Centre Medical Charles
PIH/ZL has long provided social assistance to vulnerable and HIV-affected children. In 2004, PIH/ZL
officially launched its Program on Social and Economic Rights (POSER) for HIV-infected patients and their
families. Similarly, educational assistance to OVC has been a component of the PIH/ZL project for over a
decade. In 2005 we expanded school fee assistance and formalized documentation and long-term follow-up
for this project in the Central Department, and, with special funds from PEPFAR in March of 2008, we were
able to provide school assistance to over 1500 OVC in the lower Artibonite alone.
Over the past two years, PIH/ZL has continued to strengthen our programming in the areas of nutritional
and psychosocial support, with a particular emphasis on OVC. PIH/ZL has initiated and scaled-up a
pediatric malnutrition program that includes the use of locally prepared Ready to Use Therapeutic Food
(RUTF). Additionally, a total of 500 OVC and their HIV-positive parents or caretakers have been enrolled in
a pilot psychosocial support intervention focused on coping strategies for dealing with stigma, grief and loss;
identification of depression; and disclosure of HIV status to family members.
The proposed OVC activities address gender issues by mitigating the burden of care on women and girls by
linking care programs with resources such as psychosocial support groups and assistance with the
provision of school fees as well as income-generating resources to ensure that girls have the same
opportunities to receive an education and learn a trade so that they can better support themselves later in
life.
In OVC activities and all others, PIH/ZL is committed to a long-term partnership with the Ministry of Health
(MSPP) and to strengthening the public sector by training local staff, including MSPP health workers, to
ACTIVITY 1: Palliative Care to OVC
This activity aims to increase capacity at health centers to identify children infected or affected by HIV.
Significant numbers of children are seen at the clinics and rally posts and there are many lost opportunities
for identification of HIV infected children. Health services will be reinforced for all children, thereby
increasing the capability for identification of children infected with and affected by HIV. Services include
promotion of vaccination and well-child visits in the context of the comprehensive care that is currently
provided at each PIH/ZL site. Dlo Lavi, bednets, ORS, and vitamins will be provided both in community-
based home visits and clinic visits, as available. It is expected that by September 30, 2010, 10,000 OVC will
have received health care through the OVC program. This funding will support the personnel and supplies
necessary to serve an increasing number of children in general and OVC specifically. Specifically, 1 nurse
case manager for the Artibonite and 1 for the Central Department will be hired to oversee OVC services at
each site.
Activity Narrative: ACTIVITY 2: Provision of Food
The second activity is to support ajan sante (health agents) and ajan agrikol (community agriculture
workers) nutritional needs of HIV-affected children and their families in their homes. Identification of children
at risk will be strengthened by training community-based staff to determine children's need for nutritional
supplementation through nutritional assessment. Community-based staff will also ensure adequate follow-
up and growth monitoring of at-risk children in order to prevent relapse into malnutrition. Children identified
as malnourished and severely malnourished will be placed in PIH/ZL's nutrition program, where they will be
prescribed locally produced ready to use therapeutic food (RUTF), Nourimanba, or a food supplement,
Nourimil. It is expected that 7000 OVC will receive food and nutritional support in 2009-2010.
ACTIVITY 3: Provision of Psychosocial Support
The third activity is to employ and train social workers, thereby strengthening the provision of psychosocial
support services to OVC. Social workers will offer psychosocial support groups as well as individual
counseling for those who cannot benefit from group activities (specifically, those who have not disclosed
their HIV status) to children affected by HIV and their HIV-positive parents or caretakers. Moreover, the
social workers will promote a prevention curriculum as a means of reducing the chances of OVC
themselves becoming HIV-infected. Social worker assistants will be provided for the lower Artibonite, and
social workers will be trained at new sites in the Central Plateau to aid in providing services to OVC. In total
4 new social workers and 14 assistants will be trained and hired to oversee psychosocial support to OVC.
ACTIVITY 4: Social Assistance
The fourth activity seeks to provide social assistance to OVC and their families, including school fees (a
major barrier to school attendance) and nutritional support. PIH/ZL will provide 9,000 OVC with school aid
and vocational training, expanding upon the social assistance provided by PIH/ZL in past years. The World
Food Program and private funders have partnered with PIH/ZL to provide these "wrap-around" services in
the past.
ACTIVITY 5: Expansion of OVC Services in the Central and Artibonite Departments
The fifth activity is the provision of the full package of OVC services described above (palliative care, food,
psychosocial support, and social assistance) to three communities in the Artibonite: Desdunes, Petite
Rivière, and St. Marc as well as three communities in the Plateau: Mirebalais, Savanette, and Saut D'eau.
Last year PIH/ZL provided comprehensive support to more than 6,000 OVC, mostly in the Central
Department. In 2009, we hope to support an additional 4,000 OVC at our sites in the Artibonite and Central
Departments. This will require hiring social workers and accompagnateurs to ensure the development of
OVC services at each site. In addition to supporting the human resources and infrastructure required to
provide such services in the Artibonite and Central Departments, funding will be used for ongoing
monitoring and evaluation of OVC at all our sites.
Continuing Activity: 17211
17211 10668.08 HHS/Centers for Partners in Health 7691 3337.08 PIH $900,000
10668 10668.07 HHS/Centers for Partners in Health 5137 3337.07 PIH $550,000
* Malaria (PMI)
Estimated amount of funding that is planned for Education $50,000
Table 3.3.13:
The activities described below are carried out to support comprehensive counseling and testing services,
and to ensure training and supervision for voluntary counseling and testing (VCT) and sexually transmitted
infection (STI) detection and management. These counseling and testing activities will be conducted within
PIH/ZL's "four pillars" model for implementing a comprehensive HIV program in the context of primary care:
1) HIV prevention and care, including voluntary counseling and testing (VCT); 2) detection and treatment of
tuberculosis (TB) and other opportunistic infections; 3) detection and treatment of sexually transmitted
infections (STIs); and 4) women's health and prevention of mother-to-child transmission (PMTCT) of HIV
services. The primary emphasis areas for these activities are Gender: increasing gender equity in HIV/AIDS
programs and Wraparund programs: Family Planning, Safe motherhood, and TB. Specific target
populations include adults and most at risk populations, particularly out-of-school youth, street youth, and
migrants, as well as orphans and vulnerable children and people living with HIV/AIDS.
PIH/ZL's VCT activities are part of a comprehensive HIV prevention and treatment program started by
Ministry of Public Health and Population (MSPP) and with funds from the Global Fund to Fight AIDS,
Tuberculosis and Malaria (GFATM); and further expanded to Hinche, Cerca La Source, Petite Rivière and
St. Marc with the support of PEPFAR in the COP 05, 06, 07 and 08. Since 2004 the program has been a
collaboration between these four key partners—PIH/ZL, MSPP, GFATM, and PEPFAR. Since 2005 work in
the Artibonite region has been strengthened by involving several NGO partners in St. Marc (SSPE,
Promotion Objectif Zerosida (POZ), and La Fondation Esther Boucicault Stanislas (FEBS)) and in Petite
Rivière (Centre Medical Charles Colimon (CMCC)).
One of the most daunting challenges facing HIV scale-up projects in impoverished rural settings is that of
case detection: identifying HIV-positive people for enrollment in treatment. Because the public sector has a
meager budget and is able to provide little in the way of primary health care services, many public clinics in
Haiti stand empty. In this context, there is minimal uptake of VCT for HIV. Without reinforcing primary health
care or integrating HIV case finding and treatment within expanded services, initial efforts to find HIV cases
will be unsuccessful. For example, freestanding VCT was initiated in the capital of the Central Department,
Hinche, by the MSPP in January 2003; in the first year of the program, only 43 patients were tested. The
PEPFAR-backed ZL initiative in Hinche began in March 2004. In the first year of joint operations, 5884
patients were tested; of these, 435 were positive, and 310 were started on ART.
The VCT services provided through PIH/ZL increase gender equity by supporting efforts to reach and test
an equitable number of women and men. By offering VCT to all pregnant women as part of routine prenatal
visits, these activities support linkages between HIV/AIDS and other sectors (family planning and safe
motherhood).
ACTIVITY 1: VCT in the Central Department
The first activity is to continue providing comprehensive opt-out VCT services in PIH/ZL's health facilities
and via mobile clinics. This activity will build on last year's success in providing VCT to more than 55,000
individuals by testing 65,000 people in 2009-2010. With this renewed funding, PIH/ZL will increase and
improve efforts to provide VCT to Haiti's most marginalized groups, including migrants and vulnerable
children. In order to reach these high-risk groups, PIH/ZL will initiate a series of activities, including
additional mobile clinics, a site-wide community outreach campaign, and greater programmatic and staff
focus on identifying and treating pediatric HIV cases (including PCR HIV testing for all orphans less than 18
months of age). Special emphasis will be placed on the communities of Savanette, Saut D'eau, and
Mirebalais.
ACTIVITY 2: Scale-up VCT in the Artibonite
The second activity is to continue to scale-up access to VCT in the Artibonite region. In 2009, PIH/ZL will
expand VCT services within a primary care setting at the public health centers in Desdunes and at POZ, as
well as at two health posts in the Petite Rivière health care network, Segur and Jean Denis and one in the
St. Marc health care network, Brocozel. HIV-positive individuals in Segur and Jean Denis will be referred to
CMCC in Petite Rivière for treatment and individuals in Brocozel will be referred to St. Marc's facilities at
Activity Narrative: SSPE and HSN. Funding for VCT scale-up will be used to renovate, equip, and supply the sites listed
above, as well as train clinicians in VCT practice.
Results of these two activities will contribute to the PEPFAR 2-7-10 goals by improving access to and
quality of VCT services in order to identify HIV-positive persons and increase the number of persons
receiving ARV services.
Continuing Activity: 17212
17212 9363.08 HHS/Centers for Partners in Health 7691 3337.08 PIH $350,000
9363 9363.07 HHS/Centers for Partners in Health 5137 3337.07 PIH $250,000
Table 3.3.14:
