See activity 8773

Table 3.3.11: Program Planning Overview Program Area: HIV/AIDS Treatment/ARV Services Budget Code: HTXS Program Area Code: 11 Total Planned Funding for Program Area: $ 3,138,058.00

Program Area Context:

Quality HIV clinical care and access to free ART is the quintessential element of the PEPFAR program. As of September 2006, free antiretroviral treatment services are available at 10 sites including seven MOH sites and three sites administered by the AIDSRelief Consortium. All sites have capacity to treat adult and pediatric patients. There are currently 1,546 persons on ART in Guyana. Of the 326 children in care, 123 (38%) are on ART. In FY07, the Guyana PEPFAR team will transition more patients to treatment by emphasizing linkages to PMTCT and VCT programs as well as provider-initiated counseling and testing for infectious disease patients at healthcare facilities. Service coverage in hinterland areas will continue through a mobile unit due to prohibitive resource demands for establishing treatment sites in the remote regions of Guyana.

In FY07, several initiatives will support and enhance treatment services. The National HIV Laboratory will provide reference functions, quality assurance, diagnostic capacity for opportunistic infections (OI), and a site for advanced technologies such as DNA polymerase chain reaction (PCR) testing. In addition, laboratory support for treatment monitoring including CD4 count, hematology, and chemistry will be available at two additional sites in Guyana and will thus reduce the burden on specimen transport systems from regional treatment sites. The building that will house the new laboratory will also include a modern HIV clinic facility. In FY07, commodities management for rapid test kits, ARVs, medications for OI, and laboratory reagents will all be transitioned to the Partnership for Supply Chain Management (SCMS). This transition will minimize stock outages and delays that impede delivery of quality treatment services and will ensure accurate drug forecasting. The implementation of a modified WHO patient tracking system, including facility-based ART and pre-ART registers, will further improve drug forecasting and improve patient care and monitoring. Also in FY07, PEPFAR funding will support infant diagnosis in Guyana to allow expansion of pediatric treatment. A multi-agency working group has nearly completed a clinical protocol and budget plan for infant testing using DNA PCR. USG will work closely with the Ministry of Health (MOH) and other partners on the logistics of international specimen transfer for DNA PCR testing, including obtaining prompt results of such testing in Guyana. When the HIV laboratory is operational, USG will assist the MOH in establishing this technology in-country.

The Genitourinary Medicine (GUM) Clinic will eventually share a new structure on the campus with the National HIV Laboratory. The GUM Clinic currently resides in an old wooden building on the Georgetown Public Hospital Corporation (GPHC) campus and carries the largest patient cohort in Guyana. The new facility will provide a modern, comfortable venue for treatment with enhanced patient flow in clinic areas and space for pharmacy services and adherence counseling that will ensure patient confidentiality. Operated by the MOH with the support of the Francois-Xavier Bagnoud Center (FXB), the GUM Clinic serves as the referral center for other clinics providing HIV care; core functions include providing clinical consultations on hospitalization, resistance to first-line medications, TB/HIV co-infection, management of opportunistic infections, medication side effects, and referrals to specialized social services. Physicians at GUM Clinic use a pocket directory developed by FXB that provides contact information for a comprehensive range of social support services available in Georgetown and some outlying areas. Increasing referrals into these services is a key focus area for USG and its partners in FY07.

With FY06 funds, CDC is supporting the refurbishment of a medical ward at GPHC to serve as a committed infectious disease ward. The physician who will manage this ward will provide training to hospital staff on infection control practices and to medical residents and hospital staff on management of HIV-infected patients. As the only tertiary hospital in Guyana, GPHC is a key point-of-entry for treatment; the new ward will both fill a gap in service provision and provide an opportunity for identifying HIV-positive individuals and referring them to treatment and other services. Furthermore, the opportunity to acquire special skills and specialty training will serve as an incentive for staff retention. The operational HIV/AIDS ward will also serve as a venue for bringing in physicians from the Guyanese diaspora for mentoring and twinning programs.

FXB will continue to serve as the primary MOH partner in the expansion of adult and pediatric HIV care and treatment services, the development of care and treatment guidelines and protocols, and the design and implementation of adherence monitoring. FXB provides staff, technical assistance, equipment, upgrades for clinic facilities, laboratory support, and clinical training. In addition, FXB coordinates the clinical assignments for the 10 United Nations Volunteer (UNV) Physicians providing ARV services in-country. FXB will work with MOH to define a standard care package appropriate for the Guyana context and ensure that these services are available at all treatment sites. FXB will collaborate with CDC, USAID/GHARP and UNICEF on the integration of prevention for positives strategies into treatment services. FXB will build upon initiatives begun in FY06 including Continuous Quality Improvement (CQI) and client outreach. In FY07, FXB will emphasize linkages to maximize numbers of persons transitioned from PMTCT, VCT, and provider-initiated counseling and testing in healthcare facilities. Through mentoring of clinicians, clinical training, and strong collaboration with MOH, CDC, and PAHO, FXB will seek innovative solutions to the human resource shortages that threaten the advancement and sustainability of the Guyana treatment program.

AIDSRelief will provide comprehensive ARV services at three sites, including two faith-based non-profit hospitals and one public hospital. AIDSRelief uses a family-centered care model and ensures that families of patients on ART receive support services and prevention messages. Through wraparound activities with GHARP and UNICEF, AIDSRelief coordinates a full package of services for patients and those affected by HIV/AIDS.

In FY07 PEPFAR Guyana will add PAHO as a treatment partner. PAHO will provide supportive supervision to the MOH ARV treatment program based on a decentralized network model. Regional Health Coordinators who currently supervise TB, malaria and other health programs will receive training regarding ARV services, including information on the new patient tracking and registry system. These coordinators will provide oversight, guidance and reinforcement training in their respective regions. Through this system the regional coordinators serve as clinical mentors and provide key linkages to other health sectors and assist with the integration of ARV treatment into the overall health system.

Program Area Target: Number of service outlets providing antiretroviral therapy 10 Number of individuals who ever received antiretroviral therapy by the end of 1,500 the reporting period Number of individuals receiving antiretroviral therapy by the end of the 1,500 reporting period Number of individuals newly initiating antiretroviral therapy during the 400 reporting period Total number of health workers trained to deliver ART services, according to 40 national and/or international standards

Table 3.3.11:

AIDSRelief is a consortium of three faith-based, non-governmental organizations with experience in international development, a leading research institution in the care and treatment of HIV, and a consulting firm with expertise in monitoring and evaluation. AIDSRelief is committed to working in close collaboration with the government of Guyana and the in-country US government (USG) team to help strengthen existing networks of HIV care and treatment. Catholic Relief Services is the ARV services provider.

In FY 2007, AIDSRelief will continue to provide ARV treatment services at St. Joseph Mercy Hospital (SJMH) and further expand services both in the private and public sector. In the public sector, AIDSRelief provides technical assistance to Bartica Public Hospital, helps ensure that PLWHA receive quality care at that site, and facilitates linkages between the Bartica treatment program and the Mazaruni Prison. Additionally, AIDSRelief's full-time physician provides frequent on-site visits in order to work with Bartica Public Hospital's clinical staff and maintains close contact with the adherence nurse coordinator in order to discuss any problems that arise. In an effort to avoid duplication of services, SJMH clinicians refer TB and TB/HIV co-infected patients to the Chest Clinic for treatment. The treatment team also facilitates linkages with complementary HIV services (e.g. PMTCT).

AIDSRelief has begun to expand services to Davis Memorial Hospital, which is located in Region 4 (SJMH and Davis Memorial Hospital are the only two faith-based hospitals in Guyana). The addition of Davis Memorial Hospital as a treatment site further expands the options for those wishing to access care and treatment services for HIV. In preparation for site activation in August 2006, local AIDSRelief staff and Institute of Human Virology (IHV) physicians and laboratory specialists helped build the clinical and laboratory capacity of staff at Davis Memorial Hospital for HIV diagnosis and management. Patient enrollment began in September 2006.

The in-country IHV physician provides ongoing support and assistance to the local partner treatment facilities (LPTFs), and liaises with USG in-country and Ministry of Health (MOH) partners on technical issues related to HIV care and treatment. IHV provides support and assistance on a national scale through the continued revisions of the National Guidelines, ongoing HIV-related Continuing Medical Education (CME) for clinical staff, and lectures and discussions with medical staff at both public and private treatment sites in Georgetown. AIDSRelief's QA/QI initiative identifies best practices through analysis of facility-based data and is critical to providing the highest quality care at each of the treatment sites. This ongoing initiative will continue to promote efficient and sustainable care by enabling AIDSRelief to effectively implement and scale-up successful programs, as well as target technical assistance resources more efficiently to the LPTFs. AIDSRelief also builds the capacity of the laboratories at its three LPTFs through trainings, ongoing technical assistance, and the provision of equipment, supplies, and reagents. AIDSRelief will adopt the national patient tracking system and will coordinate with MOH and USG to assure that data formatting and reporting is consistent with the national program.

In FY 2007, AIDSRelief will scale-up the number of patients receiving care and treatment services in the private faith-based sector by substantially increasing HIV testing and intensifying technical assistance. AIDSRelief anticipates that up to 30% of all patients in Guyana will access HIV treatment services in the private sector (currently 18% receive care in the private sector); thus, scale-up in the private sector is vital to maximize the sustainability of ART services in Guyana. For this reason, in addition to improving clinical practice to promote viral suppression and ensure the timely initiation of quality ART, AIDSRelief will focus on strengthening health systems at its private-sector sites to improve their operational and financial sustainability and ensure that this sector is thoroughly integrated into the national network of treatment services (e.g. drug and reagent procurement, trainings, development of guidelines and protocols). Through the Constella Futures group, AIDSRelief will build the capacity of LPTFs to effectively collect and validate data as part of an adaptive management strategy to further reinforce efficiency and promote sustainability.

In FY 2007, AIDSRelief will also continue to augment capacity and services at Bartica Public Hospital and strengthen its linkages with the Mazaruni Prison and the regional health posts in order to provide greater access to care and treatment services to Bartica and the surrounding communities. AIDSRelief, through IHV, will collaborate with in-country partners to provide trainings, lectures, and workshops for local HIV treatment

providers, in both the public and private sectors, in order to build the confidence and capacity of Guyanese clinicians so that they may inform future HIV-related policy and standards.

AIDSRelief will avoid duplication of services by coordinating with the Global Fund and other PEPFAR partners.

Table 3.3.11: