The Centers for Development and Health (CDS) has a cooperative agreement with CDC to integrate HIV care into its primary care and reproductive health services supported by USAID. For the last three years CDS has strengthen and expand HIV prevention services including HIV counseling and testing (CT) and diagnosis and treatment of STIs. The project is implemented in four communes of the North East and one small community in the metropolitan area of the West Department in alignment with the objectives of the national HIV/AIDS program. HIV activities were initiated in the health centers at Mombin Crochu, Trou du Nord, and Terrier Rouge; they were improved and completed at Mont Organise (North East) and Petite Place Cazeau (West)

During FY 2012 will increase its support to allow all centers aforementioned to a comprehensive package of clinical care and treatment to HIV patients in integration with primary care and reproductive health; and become ART sites. CDS will ensure that all five centers have a well train multidisciplinary team clinicians, social and community workers to support the continuum of care. Linkages with community activities will contribute to increase the support accessible to HIV patients, allow better tracking and reinforce adherence.

As stated in HCTV, CDS will work on decreasing time to provide test results and facilitating patients tested positive for HIV in accessing care to reduce Loss to before enrollment (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 eligibility.

CDS will work with the sites to ensure that all patients enrolled in care receive a package of services at both institutional and community level to ensure continuum of care including diagnostic, prevention and treatment of opportunistic infections (OI), diagnostic and treatment of sexually transmitted infections (STI), psycho-social assessment and support. All HIV patients will receive cotrimoxazole prophylaxis according to the national guidelines and all HIV patients will be screened for TB and those negative will receive INH prophylaxis.

According to the national guidelines HIV/ TB co-infected patients are directly eligible for ART regardless of their CD4 count. CDS will work with the supported sites to ensure that all HIV patients are screened for TB; those tested negative will receive INH prophylaxis. Patients with a positive syndromic screening will be provided with smear microscopy and chest X-Ray to confirm diagnosis; they will receive TB treatment and be placed on ART according to national guidelines. All HIV clinicians will be trained on TB so that co-infected patients can be cared for by the same providers; such approach will reduce lost to follow up as it has been seen in a number of HIV patients refered for TB treatment. The Community Health Workers will be trained to conduct education and sensitization sessions on both TB and HIV. They will be prompt to refer all patients with respiratory symptoms to be examined for TB.

A special emphasis will be put on reinforcing the monitoring and evaluation system currently used within the network. This includes training sessions for newly recruited Data Report Officers and social workers. During FY 2012 CDS will reinforce it strategic information (SI) component. The focus will be placed on: 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 CDS supported Health facilities.

During FY 2012 CDS will work with the supported sites to improve primary care services to facilitate the integration of HIV. Leveraging resources from other donors, CDS will strengthen community health activities to ensure a continuum of services. Investments in strengthening the system will result in an overall improvement of services contributing to reaching our objectives. The component will support targeted measures aimed at improving services at the general ambulatory clinics, ANC clinics, maternity wards and TB clinics such as: reorganizing patient flow and recruitment of qualified and motivated health care providers. CDS will also reinforce community health programs through the hiring of community nurses to organize and supervise all community health activities including HIV sensitization and education sessions, home visit, community meeting on water, sanitation and hygiene, rally post ...etc.

Also, CDS will put a particular emphasis into improving financial and management capacity of health institutions in the network. Technical assistance will be provided develop/strengthen a cost recovery system. Meeting these objectives will allow sites to gradually increase their financial contribution in providing HIV services.

CDS has provided HIV counseling and testing for nearly 10,000 individual during the last fiscal year. During FY 2012, CDS will continue to expand availability of counseling and testing within supported health facilities. At least 15,000 people will be tested for HIV and syphilis. The recent adoption by the Ministry of Health (MOH) of fingerpick testing will decrease waiting and allow a greater number of patients to receive their result the same day; those tested positive will have their first clinical visit as well reducing the number of loss before enrollment.

In addition, education and sensitization o n HIV will be conducted to promote attitude and behavioral change, access to health services such as voluntary counseling and testing, palliative care and ART services; to help reduce stigma and social exclusion; and raised awareness about HIV/AIDS and STIs

The centers for development and health (CDS) support PMTCT services at four health facilities. During FY 2011 nearly 3000 pregnant women were tested for HIV and of those tested positive (68), 35% were enrolled and receive ARV prophylaxis or treatment. In FY12, all five sites will offer PMTCT services and CDS 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 CDS will reinforce PMTCT at all sites. Counseling and testing for HIV and syphilis will be performed at antenatal clinic as well as maternity wards. All pregnant women seeking services at these sites will know their HIV status by the time they deliver. Any pregnant women tested negative in 1st and 2nd trimester will have a second test in the third or during labor and delivery.

Providers at all sites will receive PMTCT refresher trainings to ensure the full implementation of the new PMTCT guidelines. Each site will recruit a case manager to ensure individualized care is provided to HIV positive pregnant women. Through formal linkages with community activities, we will ensure that every HIV pregnant woman receive a full package of services to support high level of adherence to treatment. Also, CDS 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).

During FY 2012, CDS will strengthen and expand HIV services all supported sites to provide comprehensive ART services. Support will be provided to recruit and trained a dedicated multidisciplinary team to deliver 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 services.

CDS will invest in organizing services to simply the enrollment process of eligible patients while working in collaboration with other partners such as CHAMP and WFP to provide a package of institutional and community services to support high level of adherence.

As all these health facilities will be new ART sites, CDS will work with the supply chain management system (SCMS) to improve their supply chain management capacity to avoid stock outs.

During FY 2012 at least 125 HIV patients will receive ARVs at these sites