1.ICAP will support HIV integrated services at 32 sites in Sud Bandama and Worodougou, and will provide technical assistance to build capacitiesAt 7 district level in the 2 previous regions.At regional level: Marahoue, Sud Bandama, Worodougou, Haut Sassandra, Fromagerto local organizations including Sante Espoir Vie Cote dIvoire (local NGO created by ICAP)2.Innovative and evidence-based interventions will be implemented:Mobilizing and strengthening of existing networks and resources within the health system, including community health agents

Establish technical teams at regional level to reduce costs associated with travels to sites

3.SEV-CI staff technical capacity and familiarity with ICAPs programmatic approaches should ensure a smooth transfer of responsibilities within the dictated timeframe. ICAP current site support responsibilities will gradually be shifting to SEV-CI over the next 5 years. ICAP will reinforce regional teams, identify and train programmatic experts at district level and will conduct routine sites visit with districts/regions teams members4.The monitoring and evaluation plan will encompass strengthening of information systems to allow production and use of strategic information relevant to the piloting of programs across the following areas : data collection tools, training on data collection and management, data quality and validation5.Vehicules through COP11, none - in COP12, none- Through life of project , three (03).

Coverage in the geographic area and among the target population2 region and 7 districts and 23 C&Tx sitesActivities planned will target cumulatively 6930 patients including 1575 PLHIV newly enrolled on ART. Thus, ICAP will contribute to scaling up population in care and treatment program according to national recommendation.Describe the types of HIV care and support servicesoScreening for TB, STI, NutritionoMalaria prevention (provision of bed-net)oProvision of a water purification kit for families who do not have access to potable wateroPrescription for Cotrimoxazole for eligible patientsoStrengthening prevention with positive activitiesoPsychological supportoAvailability of condom and counseling for useoIntegrate HIV care in prisons at 2 regionsoDescribe specific strategies for improving quality of service deliveryoStrengthening appointment systemoTraining providers on care and support activities and management of kits stocks to avoid stock out in collaboration with PNPEC, PNN,oExpansion of nutrition support activities through PECNAP activities in collaboration with PNN and FANTAoRecruitment and training social workers to provide psychosocial support for PLHIVoInvolving nurses and midwives in HIV care and support activitiesoOrganization of meetings for best practices sharing at regional leveloSupervision of providers by districts teamoParticipating in URCs collaborative improvement programMechanisms to address client retention and referralsoRecruitment and training social workers to provide psychosocial support for PLHIVoInvolving community workers in HIV care at community level in collaboration with PNSI and DSC (Direction de la santé communautaire)oEstablishment of strong support group at site leveloStrengthening multidisciplinary meetings at site leveloEstablish internal (between services within a same facility) and external (between health facilities) referral and counter-referral systemoAwareness campaigns against stigma and HIV infection focusing small groupDescribe strategies for strengthening linkagesoSensitization providers on proper use of tools to refer patientoMapping services available at district level and dissemination information at all site levelStrategies for incorporating WASH Water, sanitation, hygieneoMinor reparation focusing on access to potable water within facilitiesoEducation PLHIV and their families on pure water kit use.Capacity building activitiesoIndividual/workforceTraining providers on nutrition, prevention with positive, care and support in collaboration with PNPEC, PNN and district teamsTraining provider on prevention : screening of STI and increasing PICT at hospitalization in collaboration with PNNCoaching personnel in charge of the management of dataTraining district teams on analysis and data use for decision makingoOrganizationalReinforcement of referral system within and between care services.Improvement system for managing appointments, active follows up of missed appointments.Support health structures and districts for blood samples transport within the districtoSystemEquip sites with computers to support deployment of national software.Quarterly feedback to districts and sites on reportsConducting quarterly analysis of individual SIGDEP data to re-orient program strategies.Strengthening

GoalsoIdentify OVCs and support them according their needsoStrengthen OVC platformoInvolved social center in OVC care and supportThe program will rich based on their needs: 1418 OVC for psychosocial support, 2441 OVC for nutritional support.Strategies/activities use to achieve their goalsoTraining providers, including community workers identification of OVC, completion of data collection tools and their orientation on platforms according to their needs.oAdoption national norms and directives related to OVCs supportoSensitization on identifying all children within families of PLWHA.oUse of cards for children identified as OVC.oOrganization medical care for the OVCs within supported health structures: counseling and testing, nutritional support, distribution of bed-nets and other care as needed.oImplementation of referral system and counter referral system between the points of identification of OVCs and social centers.oSupport social centers on managing platforms for support to OVCs.oAdvocate with community leaders to reduce stigmatization and discrimination faced by OVCs.oUse national data collection and reporting tools for OVCs activitiesCoverage in the geographic areao2 regions and 7 districts and 23 C&Tx sites, 28PMTCT sites and 7 CDT/CATSuccesses and challenges have you had in the pastoSuccess:- Support group for OVC at Hopital general ZuenoulaoChallengesAccess to OVCs platform: this activity is lead by PNOEV and expansion promised was not realized.ICAP will work with other partners and social centers in 2 region to address this challengeSet up other OVC support group in 2 regionsSupportive supervision and quality assuranceoParticipation in quality of care and treatment process for OVCs initiated by PNOEV in collaboration with URCDescribe your strategies for incorporating WASH in your activitiesoProvide water purification kits for OVC and their if neededoSensitize parents on use pur water, environment , food hygien for children and familiesCapacity building activitiesoTraining providers and social workers on support for OVC.oTrain providers in use of national data collection tools for OVCoEnsure availability of the national data collection toolsoHold quarterly meetings to analyze and share OVC data at regional level and with PNOEV in order to reduce the risks of duplicating data during the period of consolidation of aggregated data

?Coverage in the geographic area and among the target population.o2 region and 7 districts and 23 C&Tx sites and 7 CDT/CAToActivities planned will target 1092 TB patients among them 221 TB/VIH co-infected patients.?Alignment of Partner Activities with Country PolicyoExpansion TB/HIV activities planned according PNLT plan for scale upoInfant TB screening tool developed by ICAP is been piloted according to PNLT plan in collaboration with others implementers partners?Coordination across PartnersoParticipating to TB/HIV technical working group?Monitoring and Evaluation?Capacity building activitiesIn collaboration with the districts, the PNLT and PNPECoProvide technical assistance to providers for active TB screening at enrollment and during patient visitsoExpand use of infant TB screening tool after pilot process at site leveloAssure that HIV positive patient screened positive for TB are guaranteed follow up testing (microscopic, radiography, other exams) to confirm TB diagnosis.oIn collaboration with the PNLT/CAT, follow up sputum smear tests to corroborate TB diagnosisoStrengthen HIV counseling and testing at 7 CDT/CAToGuarantee availability of Cotrimoxazole in CDT.oEnsure that all TB patients testing HIV positive benefit from a nutritional evaluation and positive prevention outreach.oSupport supervision activities supporting at TB clinicsReinforce the referral system between TB and HIV care and treatment centers.Train community workers on recognizing symptomatic patient in the community and refer them at TB clinicParticipate in TB infection control activities at national level (pilot process) and at site levelOrganize semi-annual meetings to share experiences between the CDTs supported by ICAP.Develop indicators and tools for patients screened positive for TB follow up.Conduct quarterly data quality assessment

Target Population : Children between 0 and 15 years

Geographic Coverage : 2 regions, 7 health districts and 23 C&Tx sites.

Activities planned will target 2080 children. Among them, 316 (10%) will be on ART according to national guidelines. Thus, ICAP will contribute to scaling up the pediatric population in care and treatment program

Activities:oScreening for TB, NutritionoMalaria prevention (provision of bed-net)oProvision of a water purification kit for families who do not have access to potable wateroPrescription for Cotrimoxazole for eligible childrenoTracing and interpretation of growth chartoPsychological support to parents and children

Activities to support the needs of adolescents :oEstablishment of adolescent support groups focus on specific themes.oProviding services offering information adapted to youth: (contraceptives, condoms, prevention and treatment of STIs and HIV).oMessages on abstinence

Activities that integrate pediatric care, nutrition services and maternal health :

oImplementation of procedures to establish linkages between different service structures.

Strengthen referral linkages and synergies between mother/child health and family planning :oEstablishment system to identify and re-integrate exposed children and their mothers into entry point of Mother and Child care service and family planning services.

Nutrition :oTraining of service providers and community workers on screening of malnourished childrenoEquipment for the height and weight monitorringoNutritional care for malnourished children infected.oImplementation of tools for collection and reporting data

Water, Sanitation and Hygiene ::oSensitization of parents on benefit of general and food hygiene for the family.oProvision of a water purification kit for families who do not have access to potable wateroCreation of waters points in the pediatric consultation structures through minor renovations.

Capacity building :ProvidersTraining staff management of childhood illnesses.Improvement diagnostics of pediatric cases by reinforcement of PICT at pediatric entry points and hospitalizationTraining on tools to improve quality: SOCCoaching providers in the completion of data collection toolsCoaching personnel in charge of the management of dataTraining district teams on analysis and data use for decision making

From the organizational standpointReinforcement of referral system between different pediatric care services.Improvement system for managing appointments, active follow up of children who missed their appointments.Support health structures and districts for DBS samples transport to reference laboratories and results to sites.

At the structure/district levelSupport to the districts for supervision visits.Provide at district and regional level technical assistance in data analysis and use.Define and offer a complete package of pediatric care in 1 pediatric centre of excellenceMake available early infant diagnosis at supported sitesReproduce and make available tools for pediatric careEquip health structures with pediatric height and weight measuresProvide to Hopital general Sinfra and Issia equipment for nutritional demonstrations

Contribution to scaling up pediatric treatment for HIV infected children 0-15 years of ageoICAP will support 23 C&Tx sites and targeted to rich 2080 infected children of whom 316 (10%) will be on ART. This target is higher than number of children enrolled in care by September 2011. ICAP will made effort based on new strategies such as tracking and testing children of HIV positive adults enrolled in the programCoverage in the geographic area and among the target populationoICAP will support 23 C&Tx sites in 7 districts arising coverage level to 70% for Worodougou region and 75% for Sud Bandama region. In these regions, ICAP is working with other partners and this situation does not allow extension. ICAP will focus on improving the quality of care provided in supported facilities.oIn this 2 regions 717185 people are children (0-15 years of age), of whom 2710 (0, 3%) will be rich through this program including 630 exposed children.Activities to support adherence in pediatric populations,oRecruitment and training of social worker to work at site level on providing counseling prior ART initiationoIdentifying, training community workers to maintain contact HIV enrolled children and their families at community leveloTracing and tracking system for missed appointment children and their familiesActivities promoting integration of pediatric HIV treatment services into MCH platformsoTraining providers on providing HIV treatment including pediatric drug management to avoid stock outoIdentify exposed or infected children at entry points within the facility and establish strong links between the health structures and the community servicesoEducation and practice for parents of infected children on the use of color to identify ARVs and facilitate the proper doses for their children.Describe activities to expand capacity to provide early infant diagnostic servicesoTracking exposed infant with PCR positive for enrollment in careoReinforcement of PITC focusing on children of HIV positive adult enrolled in care.oOffer sexual and reproductive health services to adolescents infected by HIVCapacity building activities for this technical area includingoProviders. .Training providers on pediatric ARVs prescription, management of side effects, tools to improve qualityTraining district teams on analysis and data use for decision makingTrain two pharmacists (and the pharmacy managers) in adherence counseling and pediatric ARV treatment.oFrom the organizational standpointReinforcement of referral system between different PICT point of service and pediatric care and treatment services.Availability of national data collection toolsoAt the structure/district levelFinancial and technical support to the districts for supervision visits (Routine Data Assessment).Provide at the district and regional level a technical assistance in data analysis and use.Coordination meeting at regional level to share data and best practicesProviding feed back by bulletin information to regional and districtComputerizing and Implementation of national software SIGDEP

ICAP will build structural and operational capacity of health districts, in close collaboration with regional health boards, to further develop skills of the health workforce and improve the quality of service delivery. ICAP will take a systematic approach to health systems strengthening (HSS), addressing six essential areas of the health system framework as recommended by the WHO.

Human Resources (HR): Interventions will focus on building capacity of district health management teams (DHMTs) and training them to conduct periodic site assessments. This activity will be progressively integrated into the routine supervision process. The building of DHMT capacity will also involve the creation of budgeted work plans, supervision, data management, and quality of care. Ariel will strengthen HR of regional and district health boards, as well as the integration of social workers, to ensure, maintain, and sustain community activities at sites.

Service Delivery: ICAP will implement a basic package of care integrating clinical and community activities. Quality improvement (QI) activities will be incorporated into district and regional work plans. Joint supervision led by Ariel and DHMTs to ensure the progressive transfer of skills will take into account quality of care and data and will emphasize the feedback process through periodic QI follow-up meetings and a written report. ICAP will provide TA to health care workers through regular site visits and systematic integration of a district focal point into the joint supervision team to facilitate progressive transfer of skills. Tools and procedures will be developed for that purpose.

Leadership & Good Governance: ICAP will emphasize improving functionality of health regional teams and DHMTs to ensure good coordination of interventions through statutory meetings and those related to quarterly, semiannual, and annual follow-up of performance. Ariel will advocate for the adoption and integration of several available tools into the national process quality of care and capacity assessment.

Health System Financing: ICAP will build the capacity of national partners at the local level and will train them on resource mobilization and on the efficient use of funds for health service delivery.

Health Information System-Improving data collection: ICAP will build capacity of sites and districts to produce quality data through training sessions on the use of new tools, provision of computers, data management software, and internet connectivity in district and regional epidemiological surveillance centers.-Data quality improvement ICAP A will provide support to district and regional health boards when they implement data management procedures and will conduct routine data quality assessments with integrated improvement plans. This activity will be progressively integrated into the routine process of supervision.-Data use & analysis ICAP will support districts and regions in data analysis and use for decision making at the local level. Data validation meetings, follow-up on performance, and reports will ensure dissemination of data.

Technology: ICAP will deploy data management software at districts and sites. SEV-CI will facilitate the use of the PIMA CD4 test in labs to improve access to CD4 counts, reaching even remote sites. Lab activity supervision will be conducted by the QI staff of each region.

ICAP will conduct HTC activities at 31 sites already supported in the regions of Worodougou and Sud Bandama. ICAP will pursue these efforts to strengthen availability and quality of counseling and testing services at the health facility level.The following activities will be implemented :Initiate community mobilization meetings: debates and advice on local radio shows or by griots on market days; identify resource people to conduct the radio spots (doctors, nurses, community counselors, teachers, and administrative and religious authorities).Involve peer educators in the psychological support of patients testing HIV+.Make free HIV testing accessible at all levels of the health pyramid and in all health services/wards, including prenatal care and maternity wards.Support districts to reactivate village cases activities to bring services closer to populations that are having difficulty accessing care at health facilities.Offer patients HIV tests and report test results the same day ; for patients testing HIV+, assure that blood is drawn for biological testing that same day.Support districts to efficiently organize blood sample transport to reference laboratory for initial biological testing for patients testing HIV+, including for typing of HIV infection.Reproduce and systematically distribute card inviting the partners of tested clients to come get tested themselves.Assure the promotion of couples counseling and testing at health facilities.Identify and train a pool of regional trainers in techniques for couples testing.Organize coaching sessions for health care providers on couples testing at sites.Integrate couples testing with prenatal care and family planning services.Provide adequate psychological support to serodiscordant couples.Organize family testing activities beginning with index patients.Put in place a system to find exposed infants at all points of entry.Put in place a system to manage appointments and to restart care for children missing appointments.Strengthen the referral and counter-referral system between testing and care services.Facilitate medical care for patients testing positive at CSRs.Assure sensitization, testing and care for sex workers at 2 pilot sites.Support MSHP and DIPE to adapt data collection tools to the new HIV testing algorithm.Assure, with the district health team (ECD), that supportive supervision visits are held to improve the reporting process at health centers.Analyze, and share monthly with sites, the rate of HIV tests offered and accepted in counseling and testing centers.Together with sites, analyze process indicators such as proportion of patients testing HIV+ and having access to biological testing, the proportion of thèse receiving their test results, and finally, the proportion of HIV+ patients enrolling in care.

1-ICAP will support PMTCT activities at 28 existing sites in Worodougou and Sud Bandama regions. Estimated sizes of population are:Expected pregnancies: Sud Bandama: 39,311, Worodougou: 20,142Expected births: Sud Bandama: 38,572, Worodougou: 19,763The main objective will be to ensure that 100% of pregnant women attend ANC and 80% of those tested HIV positive and their children receive high quality of PMTCT services2-ICAP will continue its efforts to improve access to ANC services and to support high quality services for pregnant women tested HIV positive and their children. Proposed activities are;Promote and improve quality of ANC services and HIV diagnosis within exposed childrenStrengthen PMTCT activities performance, nutritional support for HIV pregnant women and their children, primary prevention activities at PMTCT sites, prevention with positives services for HIV-positive pregnant womenExpand access to HIV counseling testing for pregnant women,Ensure same day CD4 testing for pregnant women tested HIV positive, rapid determination of HAART eligibility, initiation of appropriate treatment at ANC sites and in maternity wardsInclude in the minimum package of services nutrition aspects including dietetic demonstrations and an assessment of progress of the childs growth.Implement strategies to involve partners in reproductive health servicesAssess quality of PMTCT services at all sites every 6 months.3-strategies to promote demand creation are:Work in close collaboration with community based NGO and others PEPFAR partnersInformation regarding availability of the service and its promotion at district, community and facility levelCouples counseling and testing will be provided if pregnant women attend clinic with her partnerAll pregnant women attending ANC will receive an invitation card systematically send to their partner for HIV testing. Couples CT will be provided if they come back together4-Specific strategies to reduce the lost to follow up rate are:Monitor patients appointments and initiate patients tracking and tracing for missed visitsimprove referral linkages between the different care and support services and establish formal linkages with the communityEstablish linkages with community based organizations to support HIV-infected women and help their families address stigmatization and provide them with psycho-social support to cope with their HIV status.Strengthen community mobilization services for PMTCT5-Improve referral and counter-referral services between ANC, labor and delivery, vaccination, family planning and HIV care and treatment services as well as exposed infant follow up.Follow up visits will be organized for the mother-infant pair with matched appointments for bothIntegrate HIV counseling and testing in family planning services6-activities and strategies aimed at building the capacity of health care providers and facilities areConduct on site coaching visit in collaboration with district teamThe plan for strengthening providers capacity will be based on a regional approach that will consist of identification, training and involving of a pool of regional coaches.7-activities and strategies to build capacity on data qualityStrengthen districts and regions capacity to carry out monitoring and supervision activities.Analyze, monitor progress on PMTCT output and impact indicators.

Coverage in the geographic area and among the target population

oICAP will support 23 C&Tx sites in 7 districts arising coverage level to 70% for Worodougou region and 75% for Sud Bandama region. In these regions, ICAP is working with other partners and this situation does not allow extension. ICAP will focus on improving the quality of care provided in supported facilities.oIn this 2 regions 717185 people are children (0-15 years of age), of whom 2710 (0, 3%) will be rich through this program including 630 exposed children.Level of on-site supervision provide

oPrescribing ARV and patients follow-up according to national guidelinesoManagement of side effects, therapeutic failures, and interruption of treatmentoTrain on tools completion (patient chart, registers), patients tracing and tracking system foQuality of care assessment : MOC / SOCoDistrict team involvement on activity follow up , data quality assessment, data analysis and utilization for decision makingTracking clinical outcomesoImplement data quality assurance procedures and help sites and districts to routinely analyze data to assess program quality.oEvaluate quality of service every 6 months by using SOC and make a plan to address challengesoUsing Routine data quality assessment every quarteroSupport district team supervisionoParticipating in URCs quality improvement collaborative program

Activities to improve retention of patients initiated on ARToRecruitment and training social worker to work at site level on providing counseling prior ART initiationoIdentifying, training community workers for home visit, community sensitizationoTracing and tracking system for missed appointment children and their familiesoStrengthen support group meeting and focus groupsoInvolving pharmacist in counseling while providing ART drug to patientsoTraining providers on cohort analysis tools for decision makingoAwareness campaigns focus on stigma in the community

Expected outcomesoPatients involved in their own care (follow up appointments)oProviders are working as multidisciplinary team at each siteoChallenges regarding retention identified at site level and strategies defined by providers themselves

Strategies for strengthening links and synergies with maternal/child health and family-planning servicesoPatients sensitization on advantages of access to contraceptives and dual protectionoTraining providers on integration of family planning activities in HIV careoStrengthen family planning services where available in collaboration with UNFPA

Strategies contributing to food and nutrition support for eligible clientsoExpand PECNAP program at all care and treatment site in collaboration with PNN and FANTAoEnsure availability of therapeutic food in collaboration with PNN

Strategies for incorporating WASHoMinor reparation focusing on access to potable water within facilitiesoEducation PLHIV and their families on pure water kit use.oMake available pur water kit for families in needs .

Contribution to scaling up pediatric treatment for HIV infected children 0-15 years of ageoICAP will support 23 C&Tx sites and targeted to rich 2080 infected children of whom 316 (10%) will be on ART. This target is higher than number of children enrolled in care by September 2011. ICAP will made effort based on new strategies such as tracking and testing children of HIV positive adults enrolled in the programCoverage in the geographic area and among the target populationoICAP will support 23 C&Tx sites in 7 districts arising coverage level to 70% for Worodougou region and 75% for Sud Bandama region. In these regions, ICAP is working with other partners and this situation does not allow extension. ICAP will focus on improving the quality of care provided in supported facilities.oIn this 2 regions 717185 people are children (0-15 years of age), of whom 2710 (0, 3%) will be rich through this program including 630 exposed children.Activities to support adherence in pediatric populations,oRecruitment and training of social worker to work at site level on providing counseling prior ART initiationoIdentifying, training community workers to maintain contact HIV enrolled children and their families at community leveloTracing and tracking system for missed appointment children and their familiesActivities promoting integration of pediatric HIV treatment services into MCH platformsoTraining providers on providing HIV treatment including pediatric drug management to avoid stock outoIdentify exposed or infected children at entry points within the facility and establish strong links between the health structures and the community servicesoEducation and practice for parents of infected children on the use of color to identify ARVs and facilitate the proper doses for their children.Describe activities to expand capacity to provide early infant diagnostic servicesoTracking exposed infant with PCR positive for enrollment in careoReinforcement of PITC focusing on children of HIV positive adult enrolled in care.oOffer sexual and reproductive health services to adolescents infected by HIVCapacity building activities for this technical area includingoProviders. .Training providers on pediatric ARVs prescription, management of side effects, tools to improve qualityTraining district teams on analysis and data use for decision makingTrain two pharmacists (and the pharmacy managers) in adherence counseling and pediatric ARV treatment.oFrom the organizational standpointReinforcement of referral system between different PICT point of service and pediatric care and treatment services.Availability of national data collection toolsoAt the structure/district levelFinancial and technical support to the districts for supervision visits (Routine Data Assessment).Provide at the district and regional level a technical assistance in data analysis and use.Coordination meeting at regional level to share data and best practicesProviding feed back by bulletin information to regional and districtComputerizing and Implementation of national software SIGDEP