In 2005, GHESKIO developed the concept for Centers of Excellence (COE) and was asked by PEPFAR to implement this concept. Criteria for COE include the establishment of adequate space for VCT, PMTCT, care for HIV and syphilis, pharmacy and stock, a pharmacy plan, site-specific adherence plan, an Information Technology Unit, and a training strategy for staff.The purpose of this program is to provide technical and financial assistance to 11 sites throughout Haiti. The specific objectives of this project are to: 1) Achieve primary prevention of HIV; 2) Improve HIV/AIDS, STI, OIs including TB treatment/care, diagnostic capacity; 3) Mentor, train and supervise for the MOH GHESKIO network and strengthening the capacity of sites to collect and use surveillance data for the national program; and 4) Develop, validate and/or evaluate public health programs.These objectives will be reached by: 1) Continuing and strengthening provision of integrated Voluntary Counseling and Testing including high risk populations with improved comprehensive primary care and reinforced services for HIV/AIDS patients (adults, pregnant women and children); 2) Providing ongoing mentoring, training and supervision to the peripheral sites; 3) Reinforcing existing linkages with HIV community-based programs serving care and treatment sites that provide psycho-social, nutrition, and economic support to PLWHA and their families; and 4) Transfering administrative, fiscal, and managerial capacity to local organizations by focusing on making available the necessary equipment, tools and trained personnel to ensure the COE has sound administrative procedures to manage different sources of funding and all the goods provided.

Global Fund / Programmatic Engagement Questions

1. Is the Prime Partner of this mechanism also a Global Fund principal or sub-recipient, and/or does this mechanism support Global Fund grant implementation? Yes2. Is this partner also a Global Fund principal or sub-recipient? Sub Recipient3. What activities does this partner undertake to support global fund implementation or governance?(No data provided.)

Loss to before enrollment (LBE) has limited the number of HIV positive patients enrolled in palliative care. in FY 2012 GHESKIO will work with the site to reduce LBE. In addition to active referrals to the HIV care and treatment unit, better organization of patient flow will ensure that all patients tested positive for HIV have their first clinical visit and laboratory test the same day to determine their eligibilty. Such objective will require investments in recruiting and training health as well as in sterngthening health infrastructures.GHESKIO will ensure that all patients enrolled in care receive a package of services at both institutional and community level to ensure continuum of care. the package will include: diagnostic, prevention and treatment of opportunistic infections (OI), diagnostic and treatment of sexually transmitted infections (STI), care of ART related illness (i.e., diabetes, arterial hypertension), nutrition assessment and recuperation (if needed), psycho-social assessment and support. All HIV patients will receive cotrimoxazole prophylaxis. Also all HIV patients will be screened for TB and those eligible will receive INH prophylaxis.Through collaboration with POZ and PLWHA association, GHESKIO will support the organization of support groups at each site regrouping patients on HAART 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, refreshing, collation, and education materials.GHESKIO will increase the number of community health workers (field workers) to accommodate scale-up at each of its palliative care sites. The community workers will be in charge of tracking patients, providing at home adherence support, education on best health and nutrition practices, counseling for positive behavior, distribution of care, and preventive commodities such as condoms, Oral Rehydration Salt (ORS), symptom and pain medications according to the guidelines. Resources will be used to pay their transportation fees.GHESKIO will strengthen interventions to maintain patients adherence in Care. 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.

During FY 2012 GHESKIO will reinforce pediatric care for HIV exposed and HIV infected children. At each pediatric patients will have access to a well trained multidisciplinary team comprised of physician, nurse, social worker, and community health workers to ensure continuous and quality care. Every site will do clinical follow up and a specific adherence plan including transportation fees, childhood immunizations, nutrition and psychosocial support for the family. The Pediatric Care and Support will be linked to counseling and testing (CT), and preventing mother to child transmission (PMTCT). All exposed newborn will be enrolled in care and placed on cotrmoxazole prophylaxis. Through collaboration with CARIS foundation all exposed newborn will be provided with EID and those tested positive will be enrolled on ART. The same level of support provided to adult will be provided to pediatric patients with a particular emphasis on nutrition support and immunization. Also, GHESKIO will work with the sites to provide child friendly services and have designated area for children to interact with each other.

SI efforts will consist of 1) the development of the IT infrastructure for the expansion of the electronic medical records for primary health care activities; 2) help strengthen HIVQUAL activities; and 3) human resources for HIV case notification and surveillance system. Such investments will improve disease reporting in general in the GHESKIO supported Health facilities.

Strengthening HIV counseling and testing activities is essential to both HIV prevention and treatment. In FY 2012, GHESKIO will continue to expand availability of counseling and testing within supported health facilities. Support will be provided to improve patient flow and provider patient ratio to increase provider initiated counseling and testing at both out-patients and in-patients; HIV testing will be offered to all patients admitted to the hospital. The recent adoption by the Ministry of Health (MOH) of fingerpick testing will favor decentralizing testing at multiple points and making it more convenient for patients.GHESKIO will continue to work to increase access to high HIV prevalence target populations such as female commercial sex workers (CSW) through collaboration with FOSREF, men having sex with men through collaboration with POZ, prisoners, patients with active TB, and street children. A special emphasis will be placed on providing HIV CT service to incarcerated individuals during FY 2012.

The GHESKIO network supports PMTCT services at 10 facilities. In FY 11, of the 638 pregnant women diagnosed with HIV 405 (63%) receive ARVs either as prophylaxis or as treatment. In FY12, GHESKIO will significantly increase prophylaxis coverage to ensure that at least 80% of HIV positive pregnant women enrolled will receive appropriate interventions to reduce the risk of maternal child transmission of HIV. At least 95% of pregnant women (PW) will receive prenatal services and will be tested for HIV and syphilis by the end of the year.In order to reach those objectives GHESKIO will reinforce PMTCT at all sites. Counseling and testing for HIV and syphilis will be performed at antenatal clinic as well as maternity wards (24/7) to ensure that every the HIV status of every pregnant women is know during prenatal and labor & delivery. All pregnant women tested negative in 1st and 2nd trimester will have a second test in the third or during labor and delivery.GHESKIO will work with the sites to ensure that the new PMTCT norms are fully implemented and all pregnant women receive HAART. ARV drugs dispensation will be done within the maternal structures (ANC and maternity wards) including pediatric prophylaxis for children born at facilities. All health providers of maternal care services will receive full or refresher trainings on PMTCT. We continue to strengthen the case manager approach to ensure individualized care is provided to HIV positive pregnant women. Through formal linkages with community activities, we will ensure that every pregnant woman receive a full package of services (nutritional support through WFO, free labor and delivery services, transportation fees, home visits) to support high level of adherence to treatment. Also, GHESKIO will work with CARIS foundation to ensure that all HIV exposed newborns receive ARV prophylaxis within 72 hours as well as early infant diagnosis (EID) in collaboration with CARIS Foundation.GHEKIO will continue to strengthen the integration of PMTCT into maternal care. In FY 2012 support will be provided to improve overall maternal care service through the implementation of the women chart at all sites to improve follow up; improving family planning services to prevent unwanted pregnancies; improving emergency obstetric services; and establishing dedicated services for high risk pregnancies that include HIV-infected pregnant women. This will facilitate prenatal, delivery and post-natal care without stigmatization of HIV-infected patients and will reduce maternal mortality thereby contributing to the overall PEPFAR goals.

As per September 2011, 6050 active patients were receiving HAART through the GHESKIO network. The patients on HAART benefit from a comprehensive, continuous, patient-centered and community-oriented care. A well trained and dedicated multidisciplinary team (the same as describe in HBHC) is supported to provide high quality care to patients on HAART according to national guidelines. The package of services delivered includes ARV provision in addition to the standard package of Care and Support.IN FY 2012 GHESKIO will continue to strengthen ART services to ensure early initiation of ART. Strategies to speed the enrollment process of eligible patients without compromising adherence will be implemented. Patient enrolled in care will be prepared for ART starting the first clinical visit. Achieving these strategies will allow GHESKIO to enroll nearly 2000 new patients on ART by the end of the year. We will also capitalize on an aggressive detection of HIV -TB co infection as well as retention of women starting ART during their pregnancies.GHESKIO will ensure that all patients newly enrolled under ART receive appropriate intensified adherence counseling on a regular basis and are provided with close follow-up to support adherence. We will also work with the sites to leverage resources from other donors and formal linkages with community services to ensure continuous of care.GHESKIO will strengthen collaboration with Supply Chain Management System (SCMS) to ensure adequate supply of pediatric formulation of ARVs. Support will be provided to the sites to improve their supply chain management capacity to avoid stock outs.Lastly GHESKIO will provide onsite clinical mentoring using clinical rounds and chart reviews to continuously improve providers competencies in providing HIV treatment.

During FY 2012 GHESKIO will reinforce pediatric services for HIV exposed and HIV infected children. Each pediatric patient will have access to a well trained multidisciplinary team comprised of physician, nurse, social worker, and community health workers to ensure continuous and quality care. Every site will do clinical follow up and a specific adherence plan including transportation fees, childhood immunizations, nutrition and psychosocial support for the family. Pediatric services will be linked to counseling and testing (CT), and PMTCT services. All exposed newborn will be enrolled in care and those identified as positive through EID are enrolled on ART. The same level of support provided to adult will be provided to pediatric patients with a particular emphasis on nutrition support and immunization.GHESKIO will strengthen collaboration with Supply Chain Management System (SCMS) to ensure adequate supply of pediatric formulation of ARVs. Support will be provided to the sites to improve their supply chain management capacity to avoid stock outs.Lastly GHESKIO will provide onsite clinical mentoring using clinical rounds and chart reviews to continuously improve providers competencies in providing HIV treatment.