This is a continuing activity. The University of Washington I-TECHs goal is to provide technical and financial assistance to the GOE to build human and organizational capacity and ensure sustainability in the scale-up of effective HIV services that are integrated within the general health structure. Specifically, I-TECH provides operational support, human resource development and quality improvement strategies. The geographic focus is three regions - Afar, Amhara and Tigray with a total population of over 23 million and accounts for 40% of the HIV burden in Ethiopia. Technical assistance is specifically targeted to all public hospitals in Amhara and Tigray regions and both public and private sector hospitals and health centers in Afar region. The I-TECH program supports the goals of the GOE's National Strategic Plan (SPMII). It is a key activity under the GOE's national Human Resources for Health (HRH) strategy as well as supports the goals of the GOE and USG HIV/AIDS Partnership Framework and Global Health Initiative. I-TECH has in place a comprehensive system to routinely monitor and evaluate its performance that is also aligned with the MOH's national HMIS and the USG PEPFAR indicators. To date, a total of 18 vehicles have already been purchased and/or leased by I-TECH with an additional three vehicles currently under the procurement process. Under COP2012, four additional vehicles will be procured to replace leased vehicles at an estimated total cost of ~$40,000 per vehicle. The new vehicles will be used by I-TECH's field-based monitoring and mentoring teams.

In prior years, I-TECH initiated tracing of lost-to-follow-up (LTFU) PLHIVs on pre-ART care and support. In COP2012, I-TECH will increase involvement of community-based organizations in multi-disciplinary and catchment area meetings to increase dialogue and active tracking of LTFU PLHIVs. Furthermore, I-TECH will support health facilities to develop community-based resource matrices and strengthen to and from referral/linkages to wrap-around programs. To increase PLHIVs retention in care, I-TECH will continue to ensure availability of nutrition assessment, counseling and support services at ART and PMTCT units in collaboration with USG partners working in the area. It will ensure the availability, distribution, proper training, utilization, and monitoring of the adult preventive care package in all facilities. In the absence of other USG partners, I-TECH will directly manage the delivery of the basic preventive care package. I-TECH will integrate mental health services into existing services in partnership with Johns Hopkins University. I-TECH will strengthen the provision of psychological and spiritual care including mental health counseling, family care and support for disclosure, support-group formation, future life planning, bereavement care, spiritual counseling, and referral and life completion tasks. It will strengthen site-level mentorship and supervision on CPT, use CPT as a quality indicator and assesses care providers compliance with the CPT guidelines. I-TECH will pilot a pain management monitoring tool and work with other USG partners to make available oral morphine in facilities. I-TECH will support the development of national Positive Health & Dignity Prevention (PHDP) within health facilities, care and support guidelines and curricula review, and rehabilitation and repatriation support for clients with HIV/VL in Humera and holy water sites. Mentoring support for orphanages will be included. Involvement of men as caregivers, reducing gender imbalance and domestic violence, and promoting access to HIV services for women and girls will be emphasized.

I-TECH supported TB/HIV services at 46 facilities on 3Is and linkage of HIV+ TB patients to care and treatment services, supported renovation of TB wards and TB clinics and waiting areas to improve TB Infection control in selected facilities. Capacity building support was given in relation to in-service and pre-service trainings to ensure sustainability and country ownership. I- TECH Ethiopia supported sample transportation to assist MDR-TB case finding and treatment monitoring for MDR TB treatment program at GUH( Gondar University Hospital )

Under COP 2012, I-TECH will:

1) Strengthen routine TB screening at the ART clinics; integrate TB screening to ANC, PMTCT and pediatric clinics;

2) Strengthen PITC to test TB patients and suspects for HIV and link TB/HIV co infected patients with HIV care and treatment services;

3) Strengthen IPT coverage in supported regions

4) Implement basic administrative and environmental TB infection control measures, and provide supplies.

5) Strengthen quality of care of TB/HIV co infected patients including CPT provision and early initiation of ART.

6) Improve the capacity for pediatric TB diagnosis at regional and referral hospitals, Support TB household contact screening

7) In collaboration with CDC-Ethiopia and CDC-Atlanta, evaluate the impact of TB/HIV care among co infected patients at ART clinics in I TECH supported sites.

8) Support national and regional efforts to scale up M/XDR-TB prevention, care and treatment.

9) Collaborate with EHNRI and RLAB to introduce improved TB diagnostic services including bleach concentration, fluorescent microscopy and other technologies as appropriate.

10) Support sample transport mechanism both at community and facility level to improve access to TB diagnostic services.

11) Collaborate with EHNRI to promote TB culture and DST diagnostic service expansion.

12) Collaborate with FMOH, the RHBs of the 3 regions and other partners to strengthen the TB/HIV HMIS at all levels.

13) Strengthen PPM TB DOTS and community TB care

14) Improve access to PWP services at the TB clinics.

15) Strengthen TB/HIV ACSM( Advocacy Communication & Social Mobilization)

In prior years, I-TECH supported implementation of basic pediatric care and support services at 46 sites in Amhara, Tigray, and Afar regions with the aim of extending and optimizing quality of life for HIV-exposed and HIV-infected children and their families. Under COP2012, I-TECH will continue to support pediatric care and support services within the same sites. Specific activities will include:

Participate at national level in the revision of pediatric guidelines, training curricula and standard operating procedures for pediatric HIV care as appropriate.

Implementation and scale up of EID for early identification of HEIs, prevention and treatment of OIs and other HIV/AIDS related complications including malaria and diarrhea, pain and symptom relief, nutritional assessment and counseling as well as integrating food provision in coordination with other partners.

Support training in coordination with local universities to ensure their provision of appropriate technical support to establish HIV treatment and care adherence support groups for children, adolescents, caregivers and families in an effort to address adherence and retention issues.

Provide technical support for the provision of preventive services including infant feeding counseling, multi-micronutrient supplement, CPT, enhanced TB case-finding and provision of IPT, malaria screening and distribution of ITNs to children under five years in endemic areas, point-of-use water sanitation, hand washing and personal and household hygiene.

Integrate services with existing child survival interventions, which include immunization, safe water and hygiene, micronutrient supplement, growth monitoring, improved infant and young child feeding, and treatment of life threatening childhood illnesses.

Enhance the documentation of all infants HIV exposure status and follow-up.

Provide on-site clinical mentorship to improve basic care and support provision.

Provide on-site care and support training and supportive supervision to strengthen and improve the quality of services.

In prior years, I-TECH has provided technical assistance to strengthen the laboratory system and improve service quality in over 40 laboratories in its operational area through on-site mentorship, strengthening quality assurance, renovating/furnishing laboratories, providing lab equipment and training on HIV, EID, TB and malaria laboratory diagnosis, and providing ART monitoring and supported EID service expansion. Under COP2012, specific activities include:

Provide high quality HIV/AIDS services and continue laboratory capacity strengthening through on-site embedded mentoring of lab technicians in the sites within its operational area.

Provide inservice training using nationally approved curricula and provision of technical assistance to strengthen and standardize laboratory policies, protocols and guidelines and program evaluations emphasizing WHO-AFRO step-wise accreditation.

Support the implementation of the laboratory information system (LIS) in selected hospitals and continue to scale-up ART intakes.

Build regional capacity for laboratory equipment maintenance and improve laboratory service quality through on-site mentorship on quality control and assurance.

Expand minor renovation activities to selected health facilities and provide standard laboratory furnishings to renovated laboratories.

Provide technical assistance on viral load, EID, POC testing and microbiology lab services in selected regional and hospital laboratories.

Provide technical assistance to the national / regional TB program through training on TB diagnosis and culturing in regional labs.

Provide technical assistance to regional labs to decentralize quality assurance programs for TB, HIV and Malaria and build regional lab capacity to serve as referral testing centers to support out break investigation and surveillance activities.

Support monitoring and evaluation of laboratory services and strengthen partnerships with stake holders like the Ethiopia Health and Nutrition Research Institute ( EHNRI), and USG partners.

I-TECH aims to strengthen the implementation of the national HMIS for comprehensive HIV/AIDS services and optimize the use of routine data for service and program strengthening. Under COP2012, in its operational area, I-TECH will:

Fully document information on pre-ART, ART, TB/HIV, PMTCT, VCT, and PICT clients.

Establish regular data quality assessment and feedback mechanisms.

Build capacity of site staff in data analysis and data use to improve service delivery.

Facilitate annual, regional review and planning meeting where facilities share experiences.

Strengthen sites with data clerks and availability of M&E tools to fill gaps.

Facilitate the implementation of HMIS in new health facilities by renovating and furnishing space and providing technical support in data archiving, retrieving, and report aggregation.

Work with Tulane University to facilitate the training of I-TECHs regional mentors and M&E officers so that they can mentor facility staff on HMIS.

Provide overall monitoring and evaluation support to 46 existing sites and collaborate with partners to scale up HMIS implementation and fully integrate HIV information in the national HMIS and EMR systems.

In line with the government plan, I-TECH will support sites to assess and address gaps in space, furniture, equipment and training to implement HMIS and EMR systems.

Prospectively collect, archive, retrieve, compile and report data for all HIV-related service using HMIS forms.

Provide data clerks, print and distribute HMIS tools, conduct data quality assessments and report validations through regular supportive supervision and mentoring.

Support catchment area and health facility multi-disciplinary teams meetings.

In recognition of the Human Resources for Health (HRH) crisis in Ethiopia, I-TECHs support addresses health workforce challenges through strengthening institutional capacity of medical institutions to deliver quality pre-service medical education. In prior years, as part of scaling up of pre-service medical education, I-TECH provided technical, material and financial support to Gondar, Bahir-Dar, and Mekelle Universities medical schools to deliver quality medical education, supported essential medical education teaching materials and equipment, and subscribed online updates of teaching materials. Under COP2012, I-TECH will build institutional capacity of the existing Gondar, Bahir-Dar, and Mekelle universities including the new medical institutions of Axum, Wollo, Debre-Berhan and Debre-Markos universities by providing technical, material and financial support, including infrastructure development; support the procurement of teaching materials and tool kits; and establish mini-libraries in affiliated hospitals. I-TECH will also continue its support in faculty development, cases development for problem based learning, ICT support, e-resources, and simulation production. I-TECH will support an Integrated Emergency Surgery and Obstetrics (IESO) training at the postgraduate program at Gondar and Mekelle Universities. I-TECH will continue to provide TA to medical schools of Gondar, Bahir-Dar, and Mekelle universities to deliver quality pre-service medical education and to training units to deliver HIV-related in-service trainings in their catchment area.

This is a new activity for I-TECH. The mission of the FMOH is the provision of safe and adequate blood and blood products to all patients who require blood transfusion as part of their treatment. The target of the FMOH is to collect 120,000 units per annum from voluntary blood donors, test all the blood in a quality assured manner in the regional blood banks and preposition stocks of blood for use at the health facilities. I-TECH will provide technical support to blood banks and health facilities in three regions (Tigrai, Amhara and Afar) in the implementation of blood safety program:

1. Strengthening of the clinical interface through training of clinicians and nurses on appropriate clinical use of blood as well its safe administration to patients as well as support the establishment of hospital transfusion committees in the regions of Afar, Tigray and Amhara

2. Support creation of linkages between blood banks and the hospitals in the respective areas of responsibility including transportation of blood and blood products, supplies as well maintenance of blood inventory at the hospitals

3. I-TECH will support the strengthening of data collection both from the blood banks and the regional blood banks and develop a comprehensive monitoring and evaluation plan as well as support reporting of blood bank activities to the RHB and the FMoH.

4. With the support and collaboration of WHO, conduct mentorship of 9 blood banks in the regions to ensure quality of services in the regions. This will be achieved through the mentors trained through WHO support

5. I-TECH will support the activities of the mobile collection teams in the regional blood through target setting and development of collection plans

6. Support blood donor education and mobilization through effective engagement with local radio stations, print media, and training of communication experts, blood donor mobilisers and blood bank staff.

In COP2011, I-TECH provided technical support to national TWG on revision of strategy, guidelines, and training material on IP/PS. Clinical mentoring by IP field team was provided to IP committees at health facilities, and TB committees cooperated with IP; 488 HCWs were trained with IP/injection safety training at semiannual performance. Under COP2012, I-TECH will:

Work closely with TWG at FMOH, Afar, Amhara and Tigray RHBs, and facility IP committees on proper management of IP/Injection safety program to decrease occupational exposure to blood borne pathogens aiming at promoting ownership and sustainability

Work in collaboration with GOs & NGOs partners to ensure availability of commodities of IP/Injection safety

Work to assess quality of IP program from commodity production and supplies to proper & frequent use of products by health care workers, paramedics and support staffs in collaboration with IP committees, federal & regional IP TWGs

Conduct outcome studies of IP program in facilities of I-TECH operation zone with strong collaboration of IP committees, regional & federal IP TWGs

Continue to provide clinical mentorship and ISS to health facilities in Afar, Amhara & Tigray regions

Design a strategy for ownership and sustainability of IP/Injection safety programs with series of consultation and sensitization of IP committees at health facilities, regional & federal TWGs

Strongly engage in integration of injection safety and waste management in HIV services such as Post Exposure Prophylaxis (PEP)

Provide on- site & off-site training to staff on injection safety to those facilities identified with training gaps

Continue to support medical universities to integrate IP and injection safety as pre- service training

Conduct HE, IEC/BCC to patients, health care workers and support staff at hospital and HCs to use the available injection safety and waste management procedures properly in a user-friendly way.

The primary goal of I-TECH support in the area of prevention is to strengthen STI/HIV prevention activities within I-TECH's operational area. The target population is STI patients at I-TECH -supported health facilities. In COP 2013, I-TECH activities that focuses on "abstinence and / be faithful" include:

Educating STI patients about the importance of secondary abstinence and promoting fidelity to reduce the risk of HIV/STI transmission.

Educating STI patients on reducing multiple and concurrence partners to prevent sexual transmission of HIV/STIs.

STI/HIV prevention information, education and behavior change and communication material will be adapted and used to educate STI patients at facility level.

Mini media and AIDS Resource Centers at the health facilities will be supported to deliver continuous messages about STI/HIV/RH.

Throughout I-TECH's program, linkages with community support services will be created and/or further enhanced.

Work on transition, build the capacity of the government to hand over AB activities.

In prior years, I-TECH supported HIV testing and counseling (HTC) services in 46 facilities in Amhara, Tigray and Afar. A total of 235,593 people received HTC services in FY2011. ITECH trained 179 health care workers on provider-initiated testing and counseling (PITC) and voluntary counseling and testing (VCT). In COP2012, I-TECH will support the implementation of VCT services including couples / partner and family testing and counseling and routine HIV testing at point-of-care (POC) in all service outlets. Pediatric PITC will be strengthened in all entry points at all I-TECH supported facilities such as pediatric inpatients, under five outpatient departments, therapeutic feeding units and immunization outlets. Implementation of family-centered care to address the whole family including children to ensure the referral of HIV positive clients to HIV care and treatment services will be emphasized where appropriate. Other activities will include:

1) Strengthen systems through regular mentorship and supportive supervision to ensure quality HTC service delivery.

2) Build human capacity through onsite training of health care workers on couple and individual HTC and PITC.

3) Work with partners implementing mobile VCT services in high risk corridor of Afar and Humera to improve referral and linkage.

4) Support HIV rapid testing quality assurance through regular supervision of labs.

5) Develop and translate IEC materials in support of HTC activities.

6) Provide monitoring and evaluation support through mentoring and regular supportive supervision and distribution of the new HTC HMIS materials to all sites.

7) Establish stronger HTC related partnerships at national and regional levels and provide technical and financial assistance to sites implementing HTC services in line with national VCT days other local promotional initiatives.

8) Work with the FMOH and national HTC technical working group, university partners and the National Counselors Association and provide technical support to partners involved in mentorship of community counselors.

In prior years, I-TECH has supported facility-based sexually transmitted infection (STI) management at 42 sites in Amhara, Tigrai and Afar regions. Support included training healthcare providers on STI syndromic management, provision of materials and supplies and site-level mentoring of facility staff. Under COP2012, I-TECH will continue its technical assistance to the same 45 health facilities. Specific activities include:

1) STI syndromic management training.

2) On-site clinical mentorship and supportive supervision.

3) Provide STI job aid materials.

4) Improving STI data recording/reporting.

5) Support integration of STI service package delivery into general health care services that include outpatient departments, antenatal care clinics, family planning services, and PMTCT and ART units.

6) Support the implementation of a comprehensive approach to STI management that includes STI syndromic management, sex partner notification and treatment, provision of sufficient information and risk reduction counseling on STIs, offering HIV testing and counseling (including provider-initiated counseling and testing), provision of condoms, and STI screening and treatment and referrals to HIV care and treatment of MARPs.

7) Provide technical support to the national STI technical working group and MOH regional health bureaus to enable their leadership and the eventual sustainability of the I-TECH program activities.

In prior years, I-TECH supported PMTCT activities in 46 sites in Amhara, Tigray, and Afar regions. Under COP2012, I-TECH will expand PMTCT services to 52 health facilities and support the USG PEPFAR PMTCT Acceleration Plan to improve uptake and quality of PMTCT services. I-TECH's goal is to provide comprehensive PMTCT services to pregnant women with known HIV status and ARV prophylaxis and treatment to HIV positive women. Activities include:

1) Support PMTCT services at public hospitals and health centers and expand outreach PMTCT services focusing on high prevalence and hotspot areas.

2) Support the MOH in revising the national PMTCT guidelines, training packages and implementation manual to adapt the new 2010 WHO PMTCT guidelines; support rolling out of the revised national PMTCT guidelines at health facilities.

3) Implement QI approaches to improve retention of HIV positive mothers and HEIs in care services and expand the role of Case Managers and Mother Support Groups(MSGs) to strengthen referral linkages.

4) Support the MOH RHBs to introduce a monitoring system for PMTCT along the PMTCT cascade.

5) Support training on safe pregnancy and FP counseling and promote integration of FP and HIV services.

6) Integrate TB Screening with PMTCT program

7) Scale-up couple counseling and partner testing, facilitate male friendly services, and establish monitoring system related to these services.

8) Expand counseling, prevention with positives (PWP) and treatment services for discordant couples.

9) Expand MSGs to 7 more sites and establish linkages with income generating activities.

10) Expand integrated MNCH/ART/PMTCT services.

11) Enhance postnatal follow-up of HIV-infected mothers and HIV-exposed infants.

12) Strengthen and expand Essential Newborn Care (ENC) services.

13) Provide minor renovation, refurbishment, and repair of ANC, labor and delivery rooms, and maternity wards.

14) Provide 80% of supported facilities with e-mobile phones and airtime cards to facilitate inter-facility communication including consultation requests for transport, referrals, lab test results and client tracing.

15) Work with the GOE to support research and evaluation of PMTCT programming.

University of Washington (I TECH) provides technical support to improve the delivery of comprehensive treatment services in its operational area. Comprehensive services includes TB screening, provision of IPT and the preventive care package, clinical and laboratory monitoring of all ART patients (and pre-ART patients) for ART eligibility and/or follow-up for progress on ART or development of side effects, inter-current illnesses, and ART failure. I-TECH provides comprehensive ART training to physicians, health officers, nurses and pharmacy personnel and site-level mentoring via field-based teams to continuously update provider knowledge and skills. Quality improvement activities have been initiated and technical assistance provided to strengthen Multi-Disciplinary ART Teams (MDT) at all sites. I-TECH collaborates with the MOH Regional Health Bureaus, zonal and district health departments, and other partners and stakeholders in its operational area to strengthen the health network and referral system to ensure the delivery of efficient quality continuum of care to ART patients. I-TECH also supports and participates in the catchment area meetings in the network areas it supports. I-TECH implements case management at all its supported facilities to improve ART adherence and retention in care and treatment services, which has led to a decrease in attrition of ART patients. To further address ART adherence, I-TECH also collaborates closely with faith-based organizations in its operational zone . These types of activities have led to stronger intra-facility linkages and linkages with community services for ART patients. I-TECH provides renovation, furnishings, maintenance and restoration of basic functions in the care and treatment facilities it supports. I-TECH works to build the capacity of local partners to promote local ownership and sustainability and supports the HMIS implementation in its operational area.

In prior years, I-TECH has supported full-spectrum pediatric HIV prevention, care, and treatment services at 46 ART sites in rural, urban & pastoralist communities including hospital-health center networks in the Afar region. Under COP2012, specific activities include:

Provide technical support to integrate the family-centered HIV care and treatment approach into the national ART program to strengthen the overall pediatric HIV program.

Provide technical support to increase pediatric ART service uptake at all sites by improving detection of HIV infected children at service entry points.

Strengthen internal and external linkages including internal referrals to HIV care clinics from various points of care and externally through referrals to and from community-based resources.

Support the development and implementation of strategies to integrate the pediatric HIV/AIDS treatment with child survival and MNCH services.

Support pediatric ART training, according to national guidelines and curriculum in collaboration with local universities.

Expand case management services to pre-ART and pediatric wards to decrease drop out.

Assess and improve quality of service for pediatric care and treatment by ensuring standardized approaches in all operating sites.

Build capacity of care providers on quality ART monitoring through in-service training, on-site mentoring, case-based discussion and distance learning.

Expand adherence support to in-patient wards and extend adherence support through home visits using outreach workers.

Assist RHBs to assure CD4 ART monitoring at all facilities.

Build capacity of HIV Committees and providers on quality assurance and monitoring for clinical and non-clinical ART outcomes and perform program evaluations.

Conduct integrated regular mentoring, supportive supervision and review meeting with stakeholders.

Support the use of Information, Education and Communication and Behavior Change Communication (IEC/BCC) materials in local languages to enhance public awareness of pediatric HIV care and treatment services.