The GHESKIO centers are comprised of the national institute for laboratory and research (INLR) and the institute for infectious diseases and reproductive health (IMIS) and provide ART service to nearly 23% of patients on ART in the country and serve as national reference for HIV, TB, MDR TB and laboratory for the country. In FY12, GHESKIO will strengthen HIV/AIDS and TB services at both INLR and IMIS to increase its capacity to provide technical assistance to health institutions providing ART services as part of the GHESKIO network. GHESKIO will continue to provide training on HIV services, clinical mentoring and supervision to increase the numbers of health providers with capacity to provide high quality care to HIV patients. GHESKIO will also reinforce and strengthen HIV/AIDS and TB activities including MDRTB at the GHESKIO-IMIS HIV-TB-MDRTB hospital, the only facility of this kind in the West department, the GHESKIO-IMIS BSL3 laboratory, the Sigueneau Sanatorium (SS) and the National Penitentiary (NP). In FY12, GHESKIO plan to: 1) strengthen primary prevention of HIV through VCT and PMTCT at GHESKIO INLR, IMIS, Sigueneau (SS) and the National Penitentiary (NP); 2) Increase care and treatment of HIV/AIDS, STIs and other OIs a; 3) strengthen capacity of Haiti to collect and use surveillance data and manage national HIV/AIDS programs through ongoing mentoring and training and by expanding HIV/STI/TB surveillance programs; 4) strengthen lab support for surveillance, diagnosis, treatment, disease monitoring, and for HIV screening for blood safety; 5) develop, validate and evaluate public health programs to inform, improve and target appropriate interventions for prevention, care, treatment of HIV/AIDS, and TB/OIs; and 6) provide quality TB, TB/HIV and MDRTB services.

GHESKIO will provide care for all HIV infected clients through provision of clinical, psychosocial, preventing services. Clinical care will include prevention and treatment of OI, excluding TB, STI and other HIV-AIDS related complications. GHESKIO will also maintain and strengthen the HIV care unit, with a well trained multidisciplinary team composed of psycho-social workers, HIV infected trained individuals as counselors, pharmacists, clinicians, nurses and community workers at these facilities. We will strengthen our tracking as well in order to improve our retention rate. The HIV unit delivers quality services, supported by electronic medical records, good pharmacy and information systems, and strong linkages with community support services through our community unit. GHESKIO has developed a dedicated and sophisticated EMR that allows at all time complete patient tracking and available medication plan for each patient. A special attention is given to patient adherence by the use of pill count prior to seeing MD/RN. We plan to reinforce the EMR in collaboration with I-TECH and NASTAD. In order to improve patient adherence, incentives and strategies such as nutritional support by linkage with Espoir Anaize, transportation fees, micro credit by linkage with ACME, employment opportunities will be reinforced. The GHESKIO Centers Community Advisory Board (CAB) serves as a liaison between the GHESKIO Centers and the community.The CAB has been instrumental and will help us focus on vulnerable populations such as sex workers, street children and internally displaced persons. GHESKIO with the support of USAID has developed a project on Gender Based Violence to create linkages with the Haitian private sector for income- produced activities, vocational schools and provide educational services on human rights.

At the end of the year:

At least 80% of patients diagnosed with HIV will be enrolled in care

At least 80% of patients enrolled for follow-up care will attend clinic at least twice a year

90% of patients enrolled in care will remain active participants in the program.

Orphans and Vulnerable Children Program

Food and nutritional support

Identification of family members as caregivers to provide access to shelter for orphans at the parents death.

Ongoing identification of OVC through VCT, PMTCT, ARV programs.

Prevention and treatment activities will be continued in the children/adolescent clinics.

Psychosocial support for adolescents with poor adherence to treatment and for those made aware of their HIV status will be provided. Support groups will be held in the adolescent clinic.

Educational support by given school materials and scholarships for the OVC in needed will be provided.

Parents / OVC will be linked to private sector (Micro-credit) in order to promote income

Food and Nutrition activities:

Scale-up of preventative nutrition strategy for children 6-24 months

GHESKIO has scaled-up its infant feeding support (caregivers club + nutritional supplement) to cover all HIV-exposed infants 6-24 months of age. The program was based off a study in cooperation with Cornell University, which was completed in January 2010. The initial results of the study show a 57% reduction in stunting and a 68% reduction in wasting in intervention participants compared to a historical control group. Patients receive individual growth monitoring, well-baby care, group education, vaccinations, screening for severe acute malnutrition and a nutritional supplement (fortified peanut butter paste).

GHESKIO works closely with the National TB Program, the MOH and Partners in Health (PIH) to diagnose, treat and monitor MDR-TB and serve as a reference center to treat MDR TB. As the two TB sanatoria in the West Department (the Sigueneau Sanatorium in Leogane and the Sanatorium of Port-au-Prince) collapsed during the earthquake, GHESKIO set up a field hospital at IMIS for TB and MDR TB patients. In addition, the GHESKIO laboratory continues to perform TB diagnostic testing for other hospitals and tent cities.

During FY 2012, GHESKIO will continue to strengthen and expand IMIS facility to serve as a national reference center for TB multi-drug resistance testing and treatment, building on the efforts to provide a TB second line regimen and a national training and mentoring center for TB/HIV care and treatment.

GHESKIO will strengthen the HIV /TB care and treatment unit at Siguenea, with a well trained multidisciplinary team. While efforts are made to rebuild the infrastructure destroyed during the earthquake, GHESKIO will also focus on strengthening human resources, infrastructure and logistic capacity at Siguenau, to manage HIV/TB patients serving as an ART/TB site.

Haitis incarcerated persons have a disproportionately high burden of infectious diseases including HIV and TB. This is particularly true at the overcrowded National Penitentiary (NP) in Port-au-Prince. For the past 15 years, GHESKIO and many other institutions have intermittently contributed to improve the care of prisoners at the NP. For the past year, of the 792 inmates screened for HIV and syphilis, 39 (5%) were HIV infected, 80 (10%) had serologic syphilis and 29 were placed on ART. TB was diagnosed and treated in 23/334 (7%) screened. During FY 2012 GHESKIO will provide comprehensive infectious diseases screening and care for prisoners in collaboration with others partners including Health through Walls.

100% of HIV patients will be screened for TB according to norms

100% of HIV patients with TB infection will receive treatment

100% of TB patients will be screened for HIV

All diagnosed cases of MDR-TB at GHESKIO ILNR, IMIS, Sigueneau and the National Penitentiary will receive treatment.

During FY 2012 GHESKIO will reinforce pediatric care for HIV exposed and HIV infected children. At each pediatric patients will have access to a well trained multidisciplinary team comprised of physician, nurse, social worker, and community health workers to ensure continuous and quality care. Every site will do clinical follow up and a specific adherence plan including transportation fees, childhood immunizations, nutrition and psychosocial support for the family. The Pediatric Care and Support will be linked to counseling and testing (CT), and preventing mother to child transmission (PMTCT). All exposed newborn will be enrolled in care and placed on cotrmoxazole prophylaxis.All exposed newborn will be provided with EID and those tested positive will be enrolled on ART. The same level of support provided to adult will be provided to pediatric patients with a particular emphasis on nutrition support and immunization.

90% of patients enrolled in care will remain active participants in the program by the end of the year.

During FY 2012, GHESKIO will continue to strengthen and expand its laboratory capacity, all of which are centralized at IMIS. GHESKIO provides adequate and trained personnel, as well as equipment, materials, supplies and adequate space to perform routine testing, advanced HIV testing (CD4, PCR and viral load). In that manner, GHESKIO IMIS will serve as national reference center for HIV resistance testing. ART has been available countrywide in Haiti since 2003. Today, more than 55% of the estimated 60,000 HIV-infected persons eligible of ART in Haiti are receiving ARV. However, there are little data available on the drug resistance observed among patients initiating ART in Haiti. GHESKIO has established the only laboratory in Haiti capable of performing HIV-1 RNA level testing and genotyping. IMIS will also performed advanced bacteriology and Mycobacteriology testing including drug resistance testing. New technology such as the Cepheid GeneXpert MTB/RIF technology has been introduced. GHESKIO labs have developed standard operating procedures (SOPs) and other tools to ensure good standards of services, supported by a state of the art P3 bio-safety system. These labs are currently being strengthened and are using an electronic record system.

During FY 2012, GHESKIO will strengthen through PEPFAR and leveraging resources from other donors the following component of its health system strengthening activities.

1) As the main HIV referral training center, GHESKIO has a permanent multidisciplinary team in charge of HIV/AIDS training. With this application, new modules will specifically addressed challenges such as adherence and retention of patients, importance to diagnose and treat HIV/AIDS earlier, HIV/TB co-infection including sessions on chest X-Ray readings, PMTCT and importance to increase hospital deliveries and cervical cancer screening. This training has been essential for scaling rapidly the GHESKIO HIV model nationwide. In addition, GHESKIO provides 3 types of specialized training: a Masters in Public Health (MPH) Program, a Nurse Practionner Program (NPP) both in collaboration with Quisqueya University and a Laboratory training program in partnership with the National Laboratory of Public Health. This program provide one year advanced training (practical and theoretical) in well-equipped laboratories at GHESKIO/INLR, GHESKIO/IMIS, and NPHL and another one year internship training at GHESKIO/INLR and GHESKIO/IMIS laboratories and at the NLPH with rotations in different sections of the laboratories (Microbiology, Serology, Immuno-Hematology, Biochemistry, HIV molecular biology, and QA/QC program).

2) The MPH program aims at increasing capacity in integrated clinical, operational, and health services in support of the national scale-up of HIV prevention and care services. This is the first Public Health Training Program in Haiti. Human resources can be adequately trained in resource-limited countries to tackle specific public health problems and at a fraction of the cost of what it would take if this training was held in a developed country.

3) For the nurse practitioner (NP) Program, referred applicant nurses from rural hospitals are evaluated by a formal test at entry. This program is aimed in particular at large public hospitals. At present, six (6) NP, all from public hospital, are being trained at GHESKIO. They include three (3) from HUEH, 1 from Jacmel, 1 from Jeremie and 1 from Les Cayes.

Also, through collaboration with NASTAD, GHESKIO will strengthen the capacity to collect and use surveillance data for the national program and in the MOH- GHESKIO network. NASTADs approach work in Haiti is to work with the MOH and key implementing partners such as GHESKIO, to understand and use (where possible) systems and resources that are already in place; to focus on capacity building, knowledge and experience transfer; to plan for transition to local management from the start; and to provide mentoring, modeling, and technical assistance through transition. To further strengthen the capability of GHESKIO to reach system-wide implementation goals, we propose to develop within GHESKIO a Quality Improvement Team. This strategy will be developed through collaboration with the Institute of Health Improvement (IHI). The Quality Improvement Team will plan and execute health systems transformation at GHESKIO and throughout the GHESKIO HIV treatment network. In addition, the QI Team would study the effects of various systems strengthening tools and methods.

During the past fiscal year, 29,694 people were tested for HIV and 3,792 were positive (13%). 205 pregnant women were tested HIV positive among 2,734 tested (7%) at the GHESKIO centers INLR and IMIS.

GHESKIO will maintain and support a team of counselors and social assistant workers to provide high quality HIV counseling and testing services. HIV and Syphilis Voluntary Counseling and Testing (VCT) will be offered to all individuals and all pregnant women seeking services at GHESKIO. Using the national algorithm for VCT for HIV and syphilis, at least 70% of patients seen in GHESKIO-ILNR and GHESKIO- IMIS VCT wards, at SS and NP will be tested for both HIV and Syphilis by the end of the year.

GHESKIO will continue to expand PMTCT at the GHESKIO sites. During FY 2012 PMTCT activities recently introduced will be expanded at IMIS. At least 95% of pregnant women (PW) receiving prenatal services at GHESKIO- INLR and GHESKIO-IMIS will be tested for HIV and syphilis and 80% of those tested positive for HIV will be enrolled and receive appropriate interventions to reduce the risk of maternal child transmission of HIV by the end of the year.GHESKIO will make available a well trained team of nurse midewifes and counselors to care and manage each HIV positive pregnant woman according to her specific delivery plan. As GHESKIO INLR and IMIS do not offer maternity services established linkages will be reinforced with collaborating sites in our Network : Hospital Bernard Mevs, Hospital de Fermathe, Hospital de la Communaute Haitienne, Hospital Eliazar Germain and other institutions (HUEH, Hospital Isaie Jeanty, Hospital Judes Anne Maternity at Carrefour and Nos Petit Freres et Soeurs Pediatric Hospital) to provide a continuum of services to pregnant women. All HIV positive pregnant women will also receive access to a package of community services to ensure continuum of care and better traking of HIV exposed newborns. All HIV exposed newborns from mothers enrolled in PMTCT will receive timely and adequate prophylaxis and early infant diagnosis according to the national guidelines

Interventions to eradicate congenital syphilis will be continued and reinforced.

As per September 2011, nearly 23% of active patients were receiving HAART through the GHESKIO centers. The patients on HAART benefit from a comprehensive, continuous, patient-centered and community-oriented care. A well trained and dedicated multidisciplinary team (the same also provide care) is supported to provide 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.

IN FY 2012 GHESKIO will continue to strengthen ART services to ensure early initiation of ART. Strategies to speed the enrollment process of eligible patients without compromising adherence will be implemented. Patient enrolled in care will be prepared for ART starting the first clinical visit. Achieving these strategies will allow GHESKIO centers to enroll nearly 1500 new patients on ART by the end of the year. We will also capitalize on an aggressive detection of HIV -TB co infection as well as retention of women starting ART during their pregnancies.

We will strengthen our tracking as well in order to improve our retention rate. The HIV unit delivers quality services, supported by electronic medical records, good pharmacy and information systems, and strong linkages with community support services through our community unit. A special attention is given to patient adherence by the use of pill count prior to seeing MD/RN. GHESKIO has developed a dedicated and sophisticated EMR that allows at all time complete patient tracking and available medication plan for each patient.

GHESKIO will strengthen collaboration with Supply Chain Management System (SCMS) to ensure adequate supply of pediatric formulation of ARVs.

Lastly GHESKIO will provide onsite clinical mentoring and conduct chart reviews to continuously improve providers competencies in providing HIV treatment.

As of September 30, 2011, 524 children remained active on ART at GHESKIO INLR and IMIS.During FY 2012 GHESKIO will reinforce pediatric services for HIV exposed and HIV infected children. Each pediatric patient will have access to a well trained multidisciplinary team comprised of physician, nurse, social worker, and community health workers to ensure continuous and quality care. As for adult patient GHESKIO will ensure a package of care services including adequate support for high level adherence plan including efficient patient tracking, transportation fees, childhood immunizations, nutrition and psychosocial support for the family. Pediatric services will be linked to counseling and testing (CT), and PMTCT services. All exposed newborn will be enrolled in care and those identified as positive through EID enrolled on ART.

GHESKIO will strengthen collaboration with Supply Chain Management System (SCMS) to ensure adequate supply of pediatric formulation of ARVs.