In FY12, ICC activities will be implemented in eight of the ten geographic departments of the country and across seven technical areas: Prevention of Mother to Child Transmission (MTCT); HIV Testing and Counseling (HVCT); Adult Care and Support (HBHC); TB/HIV (HVTB); Adult Treatment (HTXS); Strategic Information (HVSI); Abstinence/Be Faithful (HVAB). The main objectives are to ensure that: 1) 90% of patients with tuberculosis that are enrolled in treatment are tested for HIV; 2) 90% of TB patients co-infected with HIV are receiving ART; 3) 95% of co-infected patients with treatment failure will be evaluated for multi-drug resistance. The target population living in the geographic areas covered by the selected partner sites is of about 3,812,425 people of whom 8109 are expected to be tuberculous in 2012. To achieve these results in FY12, ICC will strengthen 10 TB sites that will become fully functional ARV sites and will support 15 new ones that will offer HIV testing and basic care services. The referral system will be strenghten at TB treatment sites that do not have the capacity to offer ARV treatment to co-infected patients. ICC will also focus on working the major ART sites on integrating HIV and TB services, with the end result being that providers at those sites are capable of treating both diseases. ICC will contribute to the expansion of the national electronic M&E system (MESI) by introducing M&E mechanisms and tools into the system focusing on HIV/TB, adapting the TB information system to integrate variables on co-infection and to generate surveillance and case notification of TB/HIV co-infection.

During FY 2012 ICC will continue to strengthen and expand HIV services at 10 major TB sites to ensure availability of comprehensive care and treatment services. At those technical and financial support for ICC will guarantee the provision of care and support to at least 80% of HIV positive persons. They will a complete package of services including OI prophylaxis and treatment, lab monitoring including CD4 count and psycho-social support. As recommended in country, ICC will work with the sites to ensure that patients newly tested positive for HIV have their first clinical visit and necessary lab tests the same day in order to reduce loss to follow up.

Services will be provided by a multidisciplinary team comprised of physician, nurses, psychologist/social workers, pharmacist, lab personnel and community health worker under the leadership and supervision of well experienced mentors from ICC.

ICC will work with other stakeholder such as CHAMP intervening at the community level to complete the package of services and ensure the continuum of care. Such collaboration will ensure that patients in need have access to nutritional support, transit house, home visit, spiritual support, etc...

ICC will also provide support to the site for systematic use of Medical records. Equipment and training will be made available to ensure the availability and proper use of the iSante EMR. This will facilitate the implementation of continuous quality improvement activities for the best possible care to be provided at these institutions.

ICC is working with a network of TB sites and in FY 2012 will continue to integrate HIV services whiling continuing the expansion and improvement of TB services. All TB patients within the ICC network will be tested for HIV and 100% co-infected identified will be place on ART either by TB providers trained on ART services or by active referral to ART sites. All co-infected patients experiencing treatment failure or in retreatment will be given proper investigation for TB drug resistance.

The primary focus in FY2012 will be to improve quality of HIV services provided at these TB sites and the following components will be emphasized:

Training and involvement of TB providers in HIV treatment: The network will guarantee the training for its staff by supporting the logistics of its participation to sessions offered, in case that the centrally managed mechanisms for this training could not provide the support. The network will make all possible arrangements to maintain TB providers involved in management of HIV treatment.

Hiring of key staff personal in order to rapidly put co-infected patient on ART: the ICC network will hire skilled clinicians that have experience in managing both HIV and TB. Skilled supervisors or care coordinators will also need to be hired to assure that proper care is given to all TB or HIV and with a great focus on co-infected patients.

ICC will also focus on support the ministry of health in strengthen the TB Infection Control Program through cross fertilization visits and sharing of experiences. ICC will ensure that all sites providing TB care and treatment will have an infection control committee that will effectively work to prevent the spread of TB. Training for health care workers for TB infection control will be conducted at all facilities.

The MSPP plan in FY12 is to move from 13 sites providing Care and Support to Children to 21 Care and treatment sites. Entry to the program, which is the Prevention of Mother-to-Child Transmission (PMTCT) will be strengthened through coordinated efforts of Case Managers who track babies born form pregnant mothers and make sure that they get their Early Infant Diagnosis (EID). The Orphans and Vulnerable Children (OVC) programs to be implemented this year will also reach out to children not captured by the PMTCT program. Children enrolled in the program will be received a package of services including: Post-partum prophylaxis for children within 72 hours after delivery, Cotrimoxazol prophylaxis, Integrated Management of Childhood Illnesses (IMCI) and basic pediatric care immunization, regular growth monitoring, routine vitamin A supplementation, oral rehydration therapy (ORT)/zinc supplementation for treatment of acute diarrhea and de worming, particularly for children under five. The PDSC activities will seek to integrate all these interventions to deliver an improved care and support for children at sites.

Sexual prevention/Abstinence-be faithful (HVAB) constitutes part of the visiting-nurses and educators on motorcycle activities in their communities. The target is to reach 114372 adolescents and young adults, men and women aged 18-30 in the catchman areas of the TB-HIV sites, with the appropriate themes during the health education sessions to be organized, eight meetings monthly by each community health workers (7128 meetings yearly), in secondary schools, churches' and other young groups. Voluntary counseling and testing will be promoted near to the beneficiaries of those sessions. The quality assurance will be promoted by the supervision system established by level, local regional and central, using a specific supervision grid to control the work of the health worker in this field. Aside the supervision, at the monthly meeting organized with the community health workers, they will have to report on this activity.

ICC is supporting testing and counseling services at 23 facilities. In FY11, 12886 individuals got tested from these facilities. In FY12 a growth of 20% has been projected for testing. The strategy is to reach and offer counseling and testing (CT) to all ambulatory and in-patient service users at these facilities. ICC will support the site in providing CT a multiple entry points, which will facilitate by using fingerprick recently adopted by the ministry of health. ICC will also work with the sites to improve enrollment. All patients newly tested positive for HIV will be given the opportunity to have the first clinical evaluation and laboratory testing the same day.

ICC will also work with community leaders and other stakeholders to sensitize the population of the targeted communities on the importance of knowing his/her HIV status in the fight for prevention of HIV transmission. ICC has a network of visiting auxiliary nurse that conduct home visits to trace TB contacts. These auxiliary nurses will be trained on HIV education and counseling in order to sensitize individuals during home visits on HIV.

To reach such objectives ICC will provide support to the sites for improving the CT facilities as well as adequate staffing.

In FY12 ICC will scale up PMTCT by using sevral strategies: 1- Expansion of Testing at ANC and Maternity wards. PMTCT will be thus extended to twelve new health centers and provide the opportunity to prevent MTCT in pregnant woman. The benefits of HIV testing among pregnant women will be actively promoted by the network of community health workers (visiting nurses and educators on motorcycle) during their public education activities in the community; 2-Availability of triple therapy regimens supported by the norms. The emphasis will be on: (i) working with SCMS to help the sites meet the criteria for HAART supply (ii) ensuring that drugs dispensation can be done within the maternal structures (ANC and maternity wards) including pediatric prophylaxis for children (iii) and making sure that personnel have the proper training; 3-Expansion of Case Manager (CM) approach: All sites will have at least one case manager; 4-Improvement of clinical and support services to women: Funding for that component will also support implementation at the supported sites of a series of interventions aimed at improving quality, appeal and effectiveness of maternal services such as : recruitment of qualified human resources; organization of community activities including womens clubs sensitization and education on reproductive health and training and collaboration with traditional birth attendants; 5-Improvement in monitoring and surveillance of pregnant women; ICC will support sites in using the new OBGYN patient chart that will facilitate follow up of pregnant women. ICC will also promote the use of the active surveillance of positive pregnant women feature on MESI. Al sites supported by ICC will implement an efficient system to generate timely reporting.

During the last fiscal year ICC is provided technical and financial support to 10 major TB sites to provide ART services. In FY 2012, ICC will continue to strengthen and expand HIV services at those sites enabling them to provide comprehensive ART services. Support will be provided to recruit and trained a multidisciplinary team to deliver high quality care to patients on ART according to national guidelines. New enrollment is expected to grow by at least 20%. Also, as these sites receive a high number of TB patients the focus will be on identify co-infected patients to be enrolled on ART as early as possible.

ICC will also support the sites in reducing loss to follow up. While adherence is highly important the success of ART, excessive majors may impede the enrollment. Providers will initiate ART adherence counseling as early as the first clinical visit to reduce the timeline for enrollment. Also, to reduce waiting sites will set up flexible appointment system for drug dispensation to adherent patients. By so doing, the ratio patient /providers will increase virtually allowing more time for first visits. In FY12 patients files will be classified according to adherence status and interval for visit appointment. ICC will work with LNSP to integrate the regional networks for automated CD4 testing. Manual testing will be the fall back option were the network is not yet functional. ICC will work with each site to assess the need in term lab personnel to ensure that adequate human resources are available according to patient load and the labor intensity of manual systems

ICC will also invest in supporting the sites to implement HIV continuous quality improvement activities using the electronic medical record. As such providers will immerse in culture of constantly reviewing charts and use data for decision making.

ICC will provide support for the monitoring of treatment patients as that function is shifted gradually to trained nurses in order to fill gaps where medical personnel are in short supply. Efforts to identify children in need of treatment will be stepped up by increasing site access to EID by Dried Blood Spot- Deoxyribonucleic acid-Polymerase Chain Reaction (DBS-DNA-PCR). The community health agent will be organized to play vital role in adherence monitoring.