CHAMP aims to improve the health and quality of life of vulnerable families and PLHA in 10 geographical departments. The project adopts an innovative, integrated approach through a decentralized, department-based sub-grants program that mobilizes other NGOs and CBOs. CHAMP addresses challenges associated with the delivery of HIV care through a comprehensive strategy that builds on synergies between HIV/AIDS, TB, FP/RH, MCH, nutrition, and other basic health and social services including livelihood activities to provide a full spectrum of community-level services to vulnerable families. As part of a strengthened sustainability strategy, CHAMP conducted a needs assessment of updated services to identify gaps and scale key community services and will do a cost-benefit analysis this year. It will also strengthen the organizational, leadership, and technical capacity of CBOs to effectively implement integrated community care programs and facilitate their transition to local ownership once the project ends. CHAMP leverages HIV/AIDS resources and partnerships to provide a holistic minimum package of services; is developing a collaborative, multi-sectorial intervention to improve the well-being of PLHA and their families; and is building upon existing services to systematically strengthen and expand referrals. COP12 priorities include: 1) introduction of HIV/TB screening services at PDSCs; 2) introduction of TB diagnostics (Genexpert) in pilot sites (at the direction of the MOH); 3) introduction of long-term family planning methods at PDSCs); strengthening referral protocols to facility-based services through MOUs; and 4) expansion of livelihood services (in particular the mutuelles model of community-based savings cooperatives) to support OVC and their caregivers/families.

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? Neither3. What activities does this partner undertake to support global fund implementation or governance?

Budget Code Recipient(s) of Support Approximate Budget Brief Description of ActivitiesHBHC HIV+/TB individuals and families 4055699 Care and support servicesHVTB HIV+/TB individuals and families 250000 Screening, diagnostic and referralMTCT Pregnant women and infants 540800 Screening, diagnostic and treatment

CHAMP will provide community based Care and support services for PLHIV , including pregnant women and their families. A community based family-centered approach implemented at PDSC sites, with services to help meet most health, psychosocial nutrition , and even economic needs will be used. Recognizing the high vulnerability of youth, strategies to enhance youth-friendliness in all services will also be developed, including sensitizing community agents and CHBC providers on the special needs of youth. To expand the number of PLHIV receiving services, community agents and other community cadres will work closely with providers of VCT and ARV services, as well as post-test clubs and PLHIV associations, to facilitate their access to the full range of care and support services.Identified HIV infected individuals, including those referred to CHAMP by health care facilities will receive basic package of services which includes psychosocial support, support for adherence to antiretroviral therapy, distribution of commodities available (such as dlo la vi , bednets, SRO, condoms ), recreational and educational support, nutritional support including nutritional counseling, couples counseling, and referrals for health care services, including family planning and MCH, as well as access to mobile clinics that come directly to their communities.A key focal area within the services package will be the integration of Positive Prevention into routine community-based activities. The Positive Prevention approach encompasses three interrelated components: (1) preventing the onward transmission of HIV infection; (2) preventing illnesses including OIs, malaria, cholera and other diseases; and (3) ongoing practice of a healthy lifestyle. Community-based care and support services conducted by community agents, CHBC providers and local PLHIV support groups offer valuable opportunities for expanding and strengthening prevention and these community cadres will build capacity through training and mentoring to support and motivate HIV-infected clients and peers, and their family members, to incorporate healthy prevention practices into their daily life.Partnerships will also be built with local institutions to improve access to micro-credit and other livelihood opportunities to increase economic opportunities for PLHIV. Linkages will be made with vocational and job training opportunities, access to agricultural extension and agricultural programs, and savings and internal-lending community groups.Optimal access to services across the continuum of care requires that service providers, both community-based and health sector-based, must know who provides services within the spectrum of comprehensive care, where the services are located, and when and how to make a referral to facilitate the clients access. The development of a structured network of providers within target communes and departments will be supported to formalize linkages and promote coordination between services, entry points to care and referrals.

FHI360 is an international NGO working in Haiti from more than 10 years. According to CHAMP strategy FHI360 through PDSC identified Orphans and vulnerable children from, the community or health care institutions that are providing care and support to PLHA.Children leaving with HIV will be systematically enrolled. For each PLHA dependent and OVC will be systematically enrolled if birth certificate is provided by parents if not, home visit will be conducted to confirm family ties . For other vulnerable children, CHAMP will assess the economic situation of the family and enrolled them regarding the score obtained. CHAMP will conduct home visits to assess economic situation and determine the needs of each child enrolled in order to define the support that the child will receive.The basic package of services available through CHAMP for OVC will include psychosocial activities, educational support, legal support by providing birth certification, and referrals to prevention and curative health care services, including mobile clinics that may come directly to their communities.The educational support will be comprehensive and include different types of services: school fees and supply, establishment of vocational school, support to children who are not doing well in school, school visits to assure children attends school and progress well in class.Medical support to OVC will be done through the MCH services. OVC will be offered immunizations, growth monitoring and screening, micronutrients, Vitamin A, oral rehydration therapy, de-worming, iron pills, and participative health education. Sick children will be referred to the appropriate health facility for medical care management via the referral/counter-referral system. HIV-exposed and/or infected infants will be referred for accessing cotrimoxazole preventive therapy, early Polymerase Chain Reaction (PCR) testing (when/where available), and ART services according to national norms. HIV seropositive malnourished children under five years of age will be referred to the health facilities to receive ready-to-use therapeutic foods (RUTF) and other recuperative Title II foods where applicable.Legal support to OVC will be given to their guardian in term of accessing birth certification that will be important in their enrolment in school.Psychological support to OVC will vary from one place to another and will include provision of counseling, organizing and support activities for the OVC clubs, life skilss training, home visits, training for parents and guardians on Cummunity child care .Partnerships will be built with local institutions/ organization to improve access to vocational training for older children before they leave the age targetted by CHAMP. Through the livelihood aspect of CHAMP opportunities will be identified to increase economic opportunities (job training, savings groups, in kind grants, vocational training, etc...) for older OVC and/or care takers of orphans infected children.

CHAMP will improve the link between its community health agents and the Hospitals attending TB patients so a better tracking and accompaniment of those patients can be done. Suspected TB patients will also be diagnosed using the genexpert technology. This approach will be done both at the community level through the nine departments where CHAMP intervenes but also at the National Penitenciary (biggest prison in Port au Prince ) in coordination with a funded USAID project Health through Walls . CHAMP wil also be more proactive in identifying, screening and diagnosing HIV (Rapid testing ) and TB for the contacts of the index cases. This will be an important contribution as still many of the TB patients are not tested for HIV and the co infectin is about 20% CHAMP will work thtrough its sub grantee ICC in networking with GHESKIO and Partners In Health (PIH) the two leading local NGOs involved in treatment of MDR cases. This networking is critical in terms of referral of cases and use of the expertise of those partners . Besides CHAMP will also work in close colaboration with the National Public Health Laboratory (LNSP) and the Ministry of Health (MOH) TB Directorate in the coordination and approval of those activitites .

CHAMP will use its extensive community network to reach PLWHA contacts and do rapid HIV testing . This is critical as to fill a gap in outreach of siblings and partners of HIV positive individuals . Stigmatization has played an important role in difficulting disclosure and access of partners to HIV counseling and testing. Through its community-based network, CHAMP will reach families in home visits and identifuy and refer contacts. CHAMP staff will be trained soon in the use of rapid testing and this intervention is expected to be livered at the PDSCs. CHAMP will coordinate with PREVSIDA , MSH/SDSH and other PEPFAR partners involved in prevention and testing so a better coverage of the target population can be achieved . Mobile team doing counseling and testing at the community level from PREVSIDA and other NGOs will also collaborate with the community agents from CHAMP for a better impact of their interventions and to work in synergy. Social workers and psychologists already part of the FHI/CHAMP staff at the PDSC level will also be involved as a team effort in this activity.

CHAMP will contribute to the reduction of HIV transmission from the mother to the child through the identification of pregnant women in the community using three points of entry to service (PDSC, Rally post and home). At each one of these points of delivery services, community health care workers will educate community members about PMTCT and identify pregnant women who have not yet access ANC services including HIV point of HIV services. Using pre-established referral mechanisms between CHAMP and health care facilities, community health care workers will refer identified women to these health care facilities for HIV screening and ANC services. Through the counter referral mechanisms all HIV positive pregnant women identified within health care facilities will be referred to CHAMP community health care workers for their follow up. This follow up will include provision on psychological support to these women and their families, adherence support for those already put on ART, retention in care for those not yet eligible to start ART for PMTCT and/or HIV treatment, strengthening HIV prevention message ad practice to limit transmission and/or acquisition of HIV.CHAMP community health workers will establish partnership with identified HIV positive women that they are following in the community. Together with the women, they will make plan for delivery and identify facilities with safe motherhood practices and providing PMTCT services where she can deliver. Following the delivery community health care will ensure post partum follow up to guarantee access to ART for the baby and appropriate feeding options.CHAMP will assure involment of it community providers in PMTCT interventions. The involvement into PMTCT will include 1) sensitization of pregnant women on importance of PMTCT, 2) referral of pregnant women for HIV testing, 3) support to HIV+ pregnant women and breastfeeding mothers to health facilities for PMTCT prescription, 4) provision of FP to HIV+ women in postpartum.Finally in order to address the second prong of PMTCT (Prevention of un-intended pregnancies among HIV positive women) CHAMP will expand its community based family planning activities to include all HIV positive women, specially those in post partum, and their partners.

It is expected to serve 1791 HIV pregnant women for FY 12.