I-TECH's activities occur primarily in the following technical areas: health system strengthening, health workforce development, operations research and evaluation, prevention, care, and treatment of infectious diseases.In September 2011, I-TECH received a 5-year CDC award to provide technical assistance and capacity building support to improve integrated HIV/AIDS services at Hôpital St. Michel of Jacmel and Hôpital St. Antoine of Jérémie, and support the facilities and their associated periphery sites to become Centers of Excellence. The geographic coverage and target population is the people living in the GrandAnse and Sud-Est Departments of Haiti. The priority for I-TECH in FY2012 is to capitalize on achievements of last fiscal year and to continue to build local capacity (site level) to provide high quality HIV services including primary prevention of HIV, prevention care and treatment of OIs, STIs and TB as well as ART services. I-TECH will also ensure that each site has administrative and managerial capacity to efficiently use PEPFAR funds. I-TECH will also help the site to look for ways to enhance their cost recovery system and use these resources to self finance health activities. I-TECH will also provide support to Hôpital Saint Damien/Nos Petits Freres et Soeurs (NPFS), a pediatric hospital in Port-au-Prince, to strengthen and improve its PMTCT services to become a center of excellence for PMTCT and Pediatric HIV providing the highest standard of services. During FY12, I-TECH plans to acquire two vehicles to support project activities.

In COP12, I-TECH will continue to provide technical assistance and build the capacity of Hôpital St. Antoine (HAS) of Jérémie and associated periphery sites in the GrandAnse department, and Hôpital St. Michel (HSM) of Jacmel and associated periphery sites in the Sud-Est department in adult care and support to ensure that all patients enrolled in care receive a package of services at both institutional and community level to ensure continuum of care will including prophylaxis and treatment of opportunistic infections (OI), and prevention services such as risk reduction counseling (see HVOP for more information on the Positive Prevention program), adherence counseling and support, family planning, psychosocial support and care for ART related illness. All HIV patients will receive cotrimoxazole prophylaxis. Also all HIV patients will be screened for TB and those eligible will receive INH prophylaxis.As mentioned in HVCT, I-TECH will provide support to the supported sites to reduce lost before enrollment by ensuring that HIV test results are given the same day and patients tested positive for HIV have their first clinical visit as well during that day.I-TECH will continue to provide technical assistance to support HSA and HSM to collaborate and strengthen referral networks with NGOs (examples include CHAMPS in Jacmel and Haitian Health Foundation in Jérémie) and indigenous health organizations providing community-based adult care and support.

In COP12, I-TECH will continue to provide technical assistance to HSA in the GrandAnse Department, and HSM in the Sud-Est Department to integrate HIV and TB services and increase quality and coverage of TB testing and treatment. I-TECH will continue to build capacity in facility based-testing and treatment and outreach/mobile clinic screening and treatment, including mobile clinics that provide TB, screening and treatment services to inmates at penitentiaries in both Jacmel and Jérémie.I-TECHs approach to strengthening TB screening and treatment services at HSA and HSM relies on improving the quality of health services provided, and closely linking TB and HIV services. In COP11, I-TECH began providing technical assistance to COE sites in the following areas:Training HSA and HSM staff on TB infection control, management of TB using the national curriculum, and fast-tracking HIV-positive patients into HIV care and treatment.Equipping waiting rooms with UV light and culturally and linguistically appropriate IEC TB prevention materials.Posting TB care algorithm and TB standards of care in HIV and TB clinics at both HSM and HSA.Organizing weekly education sessions on TB prevention and signs/symptoms in the outpatient waiting room at both HSM and HSA.Implementing TB mobile screening and treatment program for inmates at penitentiaries in both Jacmel and Jérémie.Collaborate with GHESKIO and Partners in Health/Zanmi Lasante to offer multidrug resistant TB testing and treatment for patients with suspected MDR-TB.Test 100% of TB patients for HIV, and fast-track HIV-positive patients into care and/or treatment.Strengthen referral networks and establish mechanisms to increase the number of TB patients completing treatment.

In COP12, I-TECH will continue providing TB technical assistance to HSA, HSM, periphery sites and penitentiaries in the areas listed above.

In COP12, I-TECH will provide trainings for clinical laboratory personnel at HSA, HSM, and periphery sites to support performance and operations improvement. Trainings will focus on quality system essentials, including health management information systems (including OpenELIS lab system), Phlebotomy, documents and archives, and evaluation. I-TECH will provide all necessary equipments for the full implementation of the laboratory information system in both HSA and HSM. I-TECH will provide technical assistance to HSA and HSM to ensure that the standards for good laboratory practices are in place and equipement for biosafety including autoclave, safety box, and other materials are available.

During FY2012 I-TECH will provide financial and technical assistance to Hospital St Antoine and Hospital St Michel to improve their technologic infrastructure (hardware and software) supporting the electronic medical record (isante) the laboratory information system (Open Elis) and the training information system (TrainSMART). A particular emphasis will be place on restructuring the archives as iSante is being expanded to cover primary care services. I-TECH will also focus on data quality, data analysis, and use of data for program monitoring and management. Activities include: Ensure the stability and availability of electricity at HSA and HSM. I-TECH will provide technical assistance to evaluate the electric charge, evaluate the electric power generating equipment, check the electrical circuits, and update the electrical system according to the energy needs.Ensure optimal functioning of iSanté and OpenELIS. I-TECH will provide technical assistance to support COE sites to implement routine maintenance of computers and servers on a monthly basis, routine use of a back-up system, and update anti-virus software on a weekly basis.Install a highly secure internet connection including installation of security updates, a firewall to block network connections from the internet, and installment and updating of antivirus software.Support the Archives to develop an effective filling system and support development and implementation of a training on the new filling system.User training on iSanté, OpenELIS, and TrainSMART.Trainings on data management and reporting.iSanté data quality analyses.

I-TECH will use a health systems strengthening approach to build the capacity of the COEs and peripheral sites. This approach ensures integration across domains including leadership and management, finance, human resources for health (clinical mentoring and other training), strategic information (iSanté, OpenELIS, and TrainSMART), technology and delivery systems. This integrated multi-pronged approach is designed to directly impact health outputs and outcomes.I-TECH will provide technical assistance to COE sites to develop a consolidated annual budget, develop and implement financial, administrative, and operations policy and procedure manuals, develop and implement internal financial regulations, and develop a schedule for the preparation and submission of financial reports.I-TECH will provide technical assistance to COE sites to develop mission and vision statements, prepare and implement a code of ethics, organize weekly management meetings, and standardize roles and job descriptions.To improve integration of PMTCT into maternal care and pediatric ARV into outpatient and pediatric I-TECH plans to support HSAS and HSM to rehabilitate antenatal and pediatric outpatients services including painting, equipments for consultation rooms as well as material for counseling and testing. I-TECH will also support the integration of family planning into both antenatal and outpatients care reinforcing the concept of one stop shop.I-TECH will also provide support to HSA and HSM to reinforce their capacity to manage funds. Adequate finanncial traning and accounting software will be provided. I-TECH will support the sites in implementing a cost recovery system to generate fund to address cross cutting issues.

In COP12, I-TECH will continue to provide technical assistance to HSA in the GrandAnse Department, and HSM in the Sud-Est Department to improve quality and increase coverage of HIV testing and counseling services. I-TECH will continue to build capacity in facility based-testing and outreach/mobile clinic testing, including mobile clinics that provide HIV testing and counseling services to inmates at penitentiaries in both Jacmel and Jérémie.I-TECHs approach to strengthening HIV/AIDS services in the GrandAnse and Sud-Est Departments relies on strengthening the quality of health services provided at HSA and HSM, and integrating HIV testing and counseling into antenatal clinics, maternity child and reproductive services, TB clinics, and outpatient departments . The strengthening of routine services and the integration of HIV testing and counseling will increase the volume of patients, increase testing and identification of patients who are positive, and increase the number of clients initiated on care and treatment.

The recent adoption by the Ministry of Health (MOH) of fingerpick testing will reduce waiting time before results and favor decentralizing testing at multiple points and making it more convenient for patients. During FY 2012, I-TECH will assist the supported sites in expanding availability of counseling and testing and training on fingerpick testing. Also, I-TECH will increase the provider /patients ratio to reduce waiting time and ensure that all patient tested get their results the same day; those with a positive result will also get their first clinical visit. I-TECH expects that such strategies will reduce lost to follow up before enrollment. During FY 2012 the objective is to provide counseling and testing to at least 50% of people seeking care at these supported sites.

During FY 2012, I-TECH will continue to provide technical assistance and build the capacity of the supported sites to reinforce their prevention activities including positive prevention, cervical cancer, cervical cancer and STIs screening and treatment.

During last fiscal year, I-TECH in collaboration with the University of San Franscisco adapted a positive prevention (PP) model to the Haitian context and subsequently a curriculum on PP. During FY 2012, I-TECH will provide training on PP for all HIV service providers to further integrate positive health dignity and prevention program into the HIV clinical services at the supported sites.

During FY 2011, I-TECH has provided technical assistance to implement a pilot cervical cancer screening program at HSA using VIA and cryotherapy. I-TECH has distributed standards for screening of precancerous lesions using VIA, and train two midwives and 2 gynecologists in screening for per-cancerous cells using VIA methodology. In COP 12, 50% of women aged 30-45 seen in the HSA outpatient clinic will be screened and 100% with abnormal lesions will be treated.]

I-TECH will also assist Hopital St Antoine and Hopital St Michel in improving their capacity to screen, diagnose and treat STIs particularly syphilis for which a prevalence greater than 4% is being observed. I-TECH will ensure that providers are trained and sites have the supplies needed to fully implement the new algorithm adopted by the ministry of health.

I-TECH will provide technical assistance to Hôpital St. Antoine (HAS) in Jérémie in the GrandAnse department, and Hôpital St. Michel (HSM) in the Sud-Est department to scale-up and decentralize quality PMTCT services. The mid to long term goal over the course of the 5-year cooperative agreement is to decrease PMTCT to less than 2% transmission rate in the catchment areas. Due to limited space, targets are not outlined in this narrative, but are available on the Mechanism Indicators Targets spreadsheet.I-TECHs approach to strengthening PMTCT services in the GrandAnse and Sud-Est Departments relies on strengthening the quality of maternal child health care at HAS and HSM, and integrating PMTCT with routine maternal child health and reproductive services. Specific activities include:Improve physical infrastructure of maternity services at HSA.Ensure the operating room and maternity services at both facilities have equipment necessary to conduct cesarean sections and the equipment for newborn resuscitation and routine newborn care. I-TECH will need to secure addition funds for the sites to implement this activity.Provide retention support and continuing education for at least one full-time OBGYN and one mid-wife at both facilities.Provide refresher training in PMTCT care and counseling and management of OIs to maternal & child health and reproductive health personnel at both facilities.Ensure updated PMTCT, family planning, malaria, diarrhea, and malnutrition national guidelines and algorithms are posted in in-patient and out-patient maternal child health and reproductive health areas.Offer HIV testing to all pregnant women seen at antenatal clinic, and enroll 100% of HIV positive pregnant women into PMTCT.Review memorandum of understanding with other community partners involved in PMTCT care and treatment to improve PMTCT linkages and referral networks.

In COP12, I-TECH will continue to provide technical assistance to Hopital St Antoine (HSA) and Hopital St Michel H(SM to improve the quality and coverage of adult HIV/AIDS treatment services. Specific activities include HIV/AIDS training and refresher training for providers, clinical mentoring, continuous quality improvement (CQI) activities, and building capacity of COE sites to provide practical clinical training opportunities for providers working at surrounding small health facilities.I-TECH will provide technical assistance to HAS and HSM to design and implement to reduce the timeline for enrolling eligible patients on ART without compromising adherence. Preparation for ART will starts at the first clinical visit. As regimens are more effective and number of pills per day are decreasing patient are more likely to achieve adherence, however appropriate adherence counseling on a regular basis and close follow-up are to be provided. Such strategies will ensure that at least 70% of eligible patients are enrolled on ART. I-TECH will also ensure that all patients with HIV -TB co infection are enrolled on ART and on women starting ART during their pregnancies continues their treatment for life.To reach these objectives, staff at the COE and peripheral sites will receive the following trainings or refresher training in-person: a)Three-week theoretical and practical training sessions using the Infectious diseases curriculum curriculum for junior and mid-level providers; b) One week theoretical and practical training sessions using the new national TB curriculum for junior and mid-level providers.COE staff will also have the opportunity to participate in web-based e-learning courses on HIV care and treatment, leadership and management, supervision, and improving quality of care. Distance eLearning training options include: (1) HIV Care, Treatment and Prevention (UW Department of Global Health (2) HIV web-based study (solely for individual use).In COP12, I-TECH will continue to provide technical assistance in CQI, and build capacity of COE sites to develop expertise in the CQI process. Clinical rounds, chart reviews in addition to in-person clinical mentoring built on I-TECH Haitis existing model will contribute to improve quality of care provided to ART patients.

I-TECH will also reinforce pediatric HIV services at both HSA and HSM to ensure that all HIV exposed newborns are enrolled in care and those HIV positive (EID) are provided with ART. I-TECH will strengthen pediatric care and support at the supported sites to maintain the continuum of care for children on ART. A particular emphasis will be placed on completing immunization.

As part of the subcontract with I-TECH, NPFS will provide in-service training for health professionals in Haiti on prevention and treatment of pediatric HIV. The scientific community and programmatic implementers have the knowledge and capacity to eradicate pediatric AIDS. One strategy for a better response is to have enough well trained health professionals able to conduct the program and apply the national protocol in preventing and treating pediatric AIDS.In COP11, the NPFS training program will train 20 Haitian health professionals in PMTCT and pediatric HIV care and treatment. CDC, I-TECH, and NPFS will collaborate to identify these 20 health professionals. In COP12, NPFS will provide training to 20 Haitian health professionals. The training program will be based on the Haitian National Pediatric HIV Guidelines and will include theoretical and practical components. The first two weeks will be devoted to theoretical teaching, followed by a practicum whereby trainees shadow experienced staff caring for HIV-exposed and infected children in both in-patient and out-patient settings.Participants will learn all aspects related to care of exposed infants and HIV infected children, including initiation of HAART, monitoring children, how to diagnose failures, how to change regimens , how to treat and prevent the opportunistic infections, TB/HIV, adherence principles, the disclosure of status to children, and the special challenges for adolescents. While completing the training program at NPFS trainees will also participate in academic activities such as morbidity and mortality review, regular conferences, and journal clubs.