Health through Walls (HTW) supports the provision of comprehensive HIV/TB care and treatment to key prisons throughout Haiti, with two key objectives: 1) identifying, diagnosing, and treating deadly and contagious diseases within the prison population, and 2) providing education on HIV/AIDS, sexual disease, and tuberculosis prevention, and water sanitation. HIV and TB screening and treatment are provided to all prisoners at supported sites, both upon entering the facilities and on an ongoing basis. PEPFAR support will ensure that prisoners receive messaging on improving knowledge, attitudes, and behavior related to HIV prevention, care, and treatment through participation in peer education programs. The project will encourage the prisoners and personnel to maintain a sanitary environment to reduce potential exposures of contagious disease, including support for implementation of infection-control measures. HTW will also intensify services related to TB screening and diagnostics. During the COP11 period, a mobile digital x-ray was installed at the national penitentiary. Active referral strategies are also being developed to ensure that released prisoners on ART or TB treatment are linked with USG-supported treatment networks. In COP12, HTW will expand to support 3 additional prisons. During the COP12 period, HTW will serve as a TB pilot partner, using the Genexpert TB diagnostic platform to identify active TB clients, including MDR clients (with active referral to the central plateau where incarcerated individuals can be properly isolated). This diagnostic will be used to support all sites within the HTW project.

The Project HTW has been supporting CARE services at 3 facilities. Three new sites will be upgraded to care status in FY12 to bring the total number of sites supported at 6. HtW also worked with the prison authorities to create a Discharge Planning Process to allow for planning and continuity of health care services for those released prisoners with HIV or TB. HtW recruited and trained a discharge planner, implemented an exit counseling and referral meeting process, identified appropriate follow-up medical care throughout Haiti to refer prisoners particularly those with HIV or TB, or those seeking testing or further information once released. We are expecting the number of patients receiving at least 1 clinical care service to increase but due to the fact that the project has not been implanted in the additional sites and due to the fact that little information on the health status of the prisoners is availlable at those sites.The project will establish a baseline in FY12 for the appropriate targets, even if the project already had a year of implementation during a previous grant but the normal course of the grant was profoundly disrupt due to several factors :earthquake, cholera outbreak and a riot.

At each of the supported prison facilities: 1) all prisoners will receive screening for HIV and TB, with postives enrolled in care and treatment services; (ii) TB+ will receive TB treatment, with MDR clients referred to the Central Plateau prison where isoluation can be ensured; (iii) all TB patients will be screened for HIV; and (iv) all TB patients tested positive for HIV will be put on immediate ART, regardless of CD4. Increased case finding of TB patients: with the introduction of a mobile digital x-ray and the future deploiement of the GeneXpert unit the project plans to greatly intensified their case finding in all sites,with the potential to diagnose MDR TB in the prisons an referral system is being put in place to refer the MDRTB+ to the central Plateau prison were they can be propely isolated.Fyurthermore CDC is procuring additional MDR drugs to ensure the continuity of care for the patients

Since the program is being implemented within the confines of the prisons walls, efforts will be deployed to screen (for HIV and TB) every new prisoner entering the target facilities. Additional efforts will be implemented to systematically screen current prisoners. The funding for VCT component will serve to provide periodic support for : (i) human resource capacity support for C&T, particularly related to phlebotomists and post-test counselors (ii) making space accommodation to expand on-site testing. Test kits will be procured through the SCMS mechanism.

Prisoners receive prevention messaging focused on improving knowledge, attitudes, and behavior related HIV prevention, care, and treatment. This is achieved through through participation in peer education programs at the selected sites. The project will encourage the prisoners and prison personnel at the selected prisons to maintain a sanitary environment to reduce potential exposures of contagious disease, including support for implementation of infection-control measures. Activities include a focus on dissemination of safer sex practices including reducting high-risk prison behaviors, through a peer-education model. Furthermore, HTW will support thematic approaches to prevention programming, including adoption of World AIDS Day activities, as well as support of other ongoing prevention campaign activities.

The project Is providing support currently to 3 ARV sites and is expected to launch services at 3 new in FY12 to bring the total number of sites offering ARV at 6 . New Enrollment is expected to grow during FY 12 because of a greater catchment area.The project will hire and train additional staff to implement their activities in the new sites. HTW plans to hire 2 doctors, 3 nurses and 1 phlebtomist to overcome the workload that will come with the activation of these 3 additional sites.