Integrated Activity: This activity links to Activity IDs 18988.08, 17796.08, 5305.08, 17898.08, 18706.08, and

4496.08.

SUMMARY: PMTCT is an integral part of comprehensive HIV care and treatment of PLWH. Activities to

support PMTCT include: (1) provision of comprehensive PMTCT services at antenatal clinics (ANC); (2)

training and supervision of OBGYN, counselors in PMTCT as well as traditional birth attendants; (3)

community mobilization to support PMTCT and 4) and active linkage with Pediatric Services. The primary

emphasis areas for these activities are: community mobilization, training, human resources, food nutrition

support, ANC clinics, quality assurance, quality improvement and supportive supervision. The specific target

population will be pregnant women and children born from HIV+ mothers. The activities will be conducted in

the communes of Gros-Morne, Fond des Blancs, Fond des Nègres, Léogane, Pilate, Milot, Deschapelles,

Gonaives, Limbe, Ennery, Raboteau, K-Soleil and satellite health centers linked to these institutions.

BACKGROUND: PMTCT component is part of an initiative that began in 2002, funded by CMMB private

funds (Gros-Morne, Milot, Fond des Blancs, Limbe), CRS- UNICEF partnership (Pilate), MSH (Léogane and

Deschapelles), and through PEPFAR in 2005 (Fond des Nègres and Gonaives). PMTCT training activities

have been conducted in collaboration with Ministry of Health (MOH) and INHSAC, and will continue to be

conducted in collaboration with them in Year 5 AIDS Relief will continue to collaborate closely with the

MOH, Unité de Controle et de Lutte (UCC) and departmental direction, including regular supportive

supervision visits by the MOH. Pregnant women will be encouraged to attend ANC through community

mobilization activities.

ACTIVITIES AND EXPECTED RESULTS:

Activity 1: Provision of comprehensive PMTCT services at ANC and linked to Pediatric Services. Seven

mission hospitals and one public hospital will be supported to provide PMTCT in order to diagnose

HIV/AIDS and reduce HIV/AIDS transmission. All women attending ANC will be counseled and offered HIV

testing. . PMTCT services will be extended to at all satellite health centers attached to sites. The funds will

be used to support training, salaries for staff including physicians (OB/GYN's and pediatricians), counselors

and pediatric nurses, incentives for trained birth attendants and community health workers, supervision

visits, and community mobilization. The success of last year will build on this year's PMTCT activities.

Sustainability of this activity will be ensured through collaboration of AIDSRelief consortium members and

through collaboration with other stakeholders including Haiti's Ministry of Health, the US government team,

and other NGO's.

Activity 2: The second activity is to conduct training and supervision for OBGYN, pediatricians, counselors,

CHW and TBA in PMTCT. In collaboration with MOH and INHSAC, AIDS Relief will conduct this activity to

ensure that effective counseling that will include Family Planning messages and testing will be provided to

the population attending the ANC. Capacity of the staff will be built in order to deliver appropriate ARV

prophylaxis at different periods of pregnancy according to national guidelines. Staff will also acquire the skill

and knowledge necessary to provide effective counseling on infant feeding, and Family Planning services.

With the development of new curricula by the MOH and also with staff turnover at the different hospitals,

training and refresher courses will still take place again during Year 5.

Activity 3: The third activity is to support PMTCT/VCT activities at all AIDS Relief health facilities. This will

be done by providing full antenatal care, clinical services for HIV palliative care, subsidized labor and

delivery, and postnatal services, including complete prophylaxis for mothers and infants enrolled in the

AIDS Relief program. Linkages to wrap around services will be developed and will permit HIV+ pregnant

women access to reproductive health services, food/nutrition support, and micro-credit access in the sites

where such programs are being implemented through other programs (key legislative issue).

Activity 4: The fourth activity is community mobilization to increase attendance at the ANC by HIV+ pregnant

women, to reduce stigma, and facilitate access to PMTCT/VCT services, HIV treatment, care and support.

Effective community mobilization is an essential element of the project because the success of the program

relies heavily on the community. This activity will sensitize pregnant women and their communities about

HIV/AIDS and the transmission mode. At the same time they will be motivated to attend the ANC clinic and

be tested and counseled in order to reduce transmission of HIV. This activity was previously conducted and

funded with private funds at (Milot, Gros-Morne, Fond des Blancs, Pilate) and with PEPFAR funds at

Léogane and Fond des Nègres. The activity will continue this year at those sites and will be initiated in the

others.

TARGETS:

LPTF offering PMTCT programs 15

Pregnant women counseled and tested 20,000

Staff trained 45

HIV+ pregnant women receiving complete ARV prophylaxis 600

SUMMARY: AIDSRelief Consortium will expand palliative care to include comprehensive medical services,

psychosocial support, and follow-up for 15,000 patients by the end of year five. Development of networks

and linkages will be encouraged with other community-based clinical programs and with government-

supported programs in the geographic departments served by AIDSRelief. The target populations include

people living with HIV and AIDS and their families. The coverage area includes the communes of Gonaïves,

Gros Morne, and Deschapelles in the Artibonite; Fond-des-Nègres in the Nippes; Fond-des-Blancs in the

South; Léogane in the West; Pilate and Milot in the North, and all new sites to be assessed.

BACKGROUND: AIDSRelief has been providing palliative care and ARV drugs in Haiti since 2004, through

support from the President's Emergency Plan for AIDS Relief (PEPFAR). AIDSRelief recognized the need

to develop a comprehensive and public health approach to palliative care integrated with existing health

systems and the continuum of care for chronic, life threatening illnesses. HIV/AIDS has become a

manageable chronic disease. In the coming year, AIDSRelief will provide an integrative continuum of care

(including the need for improvements in pain and symptom management) according to the diverse settings,

clinical management strategies, and disease stages relevant to palliative care in HIV disease.

With existing resources, eight sites have been reinforced with integrated VCT, ARV, PMTCT and palliative

care services. So far 6,000 have been enrolled in clinical care. With Fiscal Year (FY) 2008 resources,

AIDSRelief will reinforce the existing eight sites and will expand palliative care services to three new sites

by September 2009 to reach a total of 11 palliative care sites in integration and/or in networking with the

ARV sites. AIDSRelief is committed to working with the government of Haiti (and other implementing

partners) and is an active member of the Ministry of Health's care and treatment cluster, which has

responsibility to define the national strategy for HIV/AIDS care.

ACTIVITIES AND EXPECTED RESULTS:

Activity 1: Service Organization:

AIDSRelief will ensure that all patients testing positive at any AIDSRelief hospital or at any of the satellite

health centers in their regional networks will be enrolled in clinical palliative care. As a result, they will

receive access to laboratory, clinical, nutrition, psycho-social assessment and follow up services. The

program will use FY 2008 funding 1) to staff each site with a multi-disciplinary health care team, including

physicians, nurses, psychologists, social workers, counselors, nutritionists, community health workers, and

laboratory technicians (see laboratory narrative); 2) to support the organization of health services,

including patient monitoring, laboratory for basic and CD4 testing, dispensation of opportunistic infection

treatment and prophylaxis, pain and symptom management, long-term patient follow-up and prescription of

food to malnourished PLWHAs, and; 3) to perform refurbishing at the sites to enhance laboratory capacity,

drug storage, and clinical management. This will be done in integration with Supply Chain Management

Services which is responsible for providing laboratory reagents, commodities, and OI drugs

Activity 2: Human capacity building:

The program will continue training to ensure the clinical staff maintains skills in the care and treatment of

people infected with HIV/AIDS. This year the focus will be on training health professionals in nutrition

assessment, follow-up and recuperation to make sure that all sites are integrated with nutrition services.

The capacity to provide quality health care at the local level will depend on the skills maintained by the

medical staff at each health center. To sustain a workforce of highest quality, AIDSRelief will provide on-

going training and technical support on a quarterly basis. Similar technical support will be available to

support staff including pharmacists, laboratory technicians, and monitoring and evaluation specialists.

Activity 3: Social support services:

Special attention will be given to the need for social support for patients enrolled in the palliative care

program. Funding will enable AIDSRelief to hire at each site a social work team led by a social worker that

will be in charge of assessing the social needs of all people living with HIV/AIDS (PLWHA) and help them

receive access to social support services. Direct support will be provided through the sites (e.g. fees for

services—delivery, hospitalization, x-ray etc) and for transportation to appointments. The program will also

refer patients to the PLWHA association and community based organization in charge to provide community

palliative care through a family centered approach. This will allow patients to gain access to a broader

package of social and economical support services (see AERDO, CRS, TBD, and Plan activity narratives

for palliative care). A social worker or psychologist who will focus on the counseling needs of staff at the

AIDSRelief hospitals and clinical satellites will be added to the AIDSRelief team.

Activity 4: Home based care

AIDSRelief will increase the number of community health workers to accommodate scale-up at each

AIDSRelief points of service. The community workers will be in charge of tracking patients (including

pregnant women enrolled in PMTCT and infected and exposed children), provide at home adherence

support, health education on best health and nutrition practices, counseling for positive behavior,

distribution of care, and preventive commodities such as condom, Oral Re-hydration Solution, pain

medications according to the guidelines and make appropriate referrals. The program will hire nursing

supervisors at each site to support the community workers with symptom recognition, and syndromic

treatment, particularly when they have patients experiencing health or psychosocial problems.

Activity 5: Psychological support

Funding will be used to hire, at minimum, a psychologist at each center of excellence to provide support to

PLWHA in order to reduce denial and assist in psychological assessment and follow up and on

preparedness for highly active antiretroviral therapy and chronic follow up and treatment. AIDSRelief will

continue to support each site PLWHA support groups to create a supportive environment for treatment

adherence and stigma reduction. In addition, local community leaders, traditional healers, and religious

leaders will be incorporated to encourage and enhance support of patients within the community.

AIDSRelief will continue to penetrate the religious sector in an effort to bring HIV/AIDS and treatment

awareness to churches and religious groups and to get them involved in providing spiritual care to patients.

INTEGRATED ACTIVITY FLAG: TB/HIV care is part of a comprehensive package of care and treatment

services for adults and children with HIV/AIDS. AIDSRelief will integrate this activity with its palliative care,

ARV services, OVC, PMTCT, and counseling and testing (CT) activities and narratives. This activity links to

Activity IDs 9671.08, 17796.08, 5305.08, 17898.08, 18988.08, and 4496.08.

SUMMARY: AIDSRelief will expand palliative care to include comprehensive medical services, psychosocial

support, and follow-up for 12,000 patients by the end of year five. It will ensure that all HIV patients get

access to TB screening, prophylaxis, and treatment through its network. AIDSRelief will encourage

development of networks and linkages with other HIV clinical and community-based programs supported by

the President's Emergency Program for AIDS Relief (PEPFAR) through AIDSRelief. The target populations

include people living with HIV/AIDS and their families. The coverage area includes the communes of

Gonaïves, Gros Morne, and Deschapelles in the Artibonite; Fond-des-Nègres in the Nippes; Fond-des-

Blancs in the South; Léogane in the West; Pilate and Milot in the North, and all new sites to be assessed.

BACKGROUND: AIDSRelief has been providing palliative care and ART in Haiti since 2004, through

support from PEPFAR (Track 1.0 and COP 2006). So far, a network of eight public and non-governmental

organization (NGO) hospitals has been reinforced to provide HIV care and treatment. This year and next

AIDSRelief will expand this network to provide care to 12,000 HIV patients. Many of these sites also offer

TB services with Global Fund and USAID support. Taking advantage of the co-location of HIV and TB

services thru its network of sites, AIDSRelief has taken steps to integrate TB/HIV in these sites focusing on

offering TB screening, prophylaxis to HIV positive patients, integrating CT in the TB wards at these sites

and making referrals between the HIV and TB services for continuum of care for co-infected individuals,

according to norms.

AIDSRelief recognized the need to continue expanding the TB/HIV program through its sites by improving

screening capacity, reinforcing linkages with TB services for TB treatment as needed, integrating this

program into pediatric care, reinforcing TB infection control measures, and by monitoring TB drug

resistance. AIDS/Relief will focus its effort on developing a comprehensive and public health approach for

TB/HIV and palliative care integrated with existing health systems and the continuum of care for HIV

patients. AIDSRelief is committed to working in collaboration with the government of Haiti and other key HIV

and TB implementing partners to define national policies and strategies for the program.

EXPECTED RESULTS AND ACTIVITIES

ACTIVITY 1:

AIDS/Relief (AR) will continue to reinforce its network of HIV sites to perform TB screening, prophylaxis,

and treatment for HIV positive individuals. Emphasis will be put next year on HIV positive children as

pediatric care is being expanded through this network. TB infection control measures as well as TB drug

resistance monitoring will be implemented in this network according to national norms and protocols. AR will

also reinforce CT services in TB wards at its sites. Resources will be used to build human capacity, to

reinforce infrastructure (including laboratory), and to ensure adequate provision of PPD test and related

commodities and INH for prophylaxis (see SCMS activity narrative). Based on needs assessment, the major

hospitals will be reinforced with chest x-ray capacity, including equipment and related materials and

commodities to improve TB screening. This will complement sputum smear diagnosis capacity

implemented at all TB sites through the TB/DOTS program financed by the Global Fund to Fight AIDS,

Tuberculosis and Malaria.

ACTIVITY 2: PEPFAR resources will be used to strengthen human resources and logistics of AIDSRelief's

Haiti headquarters, the QA/QI team to work with the Ministry of Health (MOH) at the central and

departmental levels, and other lead TB NGOs—International Child Care, CARE, Centre Pour Le

Développement et la Santé, and Groupe Haitien d'Etude du Darcome de Kaposi et des Infections

Opportunistes (GHESKIO)—to coordinate and monitor the TB/HIV program. In addition, health

professionals from AIDSRelief's network will be trained in TB/HIV at Siguenau Hospital. This hospital is

being reinforced by GHESKIO to become a center of excellence.

ACTIVITY 3: AIDSRelief will participate, along with the MOH and other lead TB NGOs, in developing and/or

updating norms, protocols, and guidelines and training tools for TB/HIV with an emphasis on TB infection

control, TB/HIV pediatric care, and on monitoring TB drug resistance. AIDSRelief will use PEPFAR

resources to disseminate these documents and implement TB/HIV activities in the AIDSRelief network.

Targets:

Number of service outlets providing treatment for tuberculosis (TB) TO HIV-infected individuals (diagnosed

or presumed) in a palliative care setting (a subset of all palliative care oulets) : 9

Number of HIV-infected clients attending HIV care/treatment services that are receiving treatment for TB

disease (a subset of all served with palliative care): 600

Number of HIV patients screened for TB: 10,000 (10% children)

Number of HIV patients on INH prophylaxis: 1,000

INTEGRATED ACTIVITY FLAG: This activity also relates to AIDSRelief activity narratives in voluntary

counseling and testing (VCT), prevention of mother to child transmission (PMTCT), palliative care, and HIV

services. It is linked to other institutional and community services, such as the child survival programs. This

activity links to Activity IDs 9671.08, 17796.08, 5305.08, 18988.08, 18706.08, and 4496.08.

SUMMARY: During the fourth funding year, AIDSRelief will pay particular attention to infants and children

infected with and affected by HIV and AIDS. AIDSRelief will also ensure that all local partner treatment

facilities (LPTFs) offer adequate pediatric palliative care to children. The primary emphasis areas for these

activities are community mobilization, commodity procurement, linkages with other sectors and activities,

training, human resources, and infrastructure. Specific target populations include HIV positive infants and

children, caregivers, and HIV affected families. The community support activities will be carried out in seven

AIDSRelief sites (St Boniface Hospital in the South department, Ste Croix Hospital and the Rosalie Rendue

Health center in the West department, HAS and Missionaries of Charity in the Artibonite, Hôpital Esperance

and Hôpital Sacre Cœur in the North Department); and accessed through other partners in the Haut

Artibonite (Gros Morne and Gonaives) and in Fond des Nègres.

BACKGROUND: AIDSRelief has been providing palliative care to children in Haiti since 2004, through

support from the President's Emergency Plan for AIDS Relief (PEPFAR). The AIDSRelief consortium is

currently providing anti-retroviral therapy (ART) services and HIV care to children in the eight supported

LPTFs. Catholic Relief Services, the lead agency in the consortium, has extensive experience in the care of

orphans and vulnerable children (OVC) and is also a grantee for OVC track 1 funds through PEPFAR.

CRS, with the Minister of Health (MOH) and the Minister of Social Affairs, was an active organizer of this

year's first national forum on OVC with the objective of defining a national framework for the support to OVC

from HIV. During year five, AIDSRelief will expand HIV pediatric care and support to the community. This

expansion of OVC services will take place in the eight current AIDSRelief sites and in two additional faith

based organizations (FBOs). Activities will be implemented directly by the AIDSRelief network and local

partners. Particular attention will be paid to vulnerable children and youth, particularly girls under the age of

14 years. At least 10% of AIDSRelief's care and treatment clients will be children.

ACTIVITES AND EXPECTED RESULTS:

There are four separate activities in this Program Area.

Activity 1:

Orphans and vulnerable children will be identified through the PMTCT programs, hospital-based pediatric

services, and community outreach programs. Using counseling techniques appropriate for children and

families, HIV testing will be offered to children at risk. Anti-retroviral (ARV) services will be offered to

seropositive children who are medically eligible for these services. HIV-infected and exposed children will

have special access to wrap-around services, such as nutrition support, immunizations, and integrated

management of childhood illness (IMCI), palliative care (prophylaxis and treatment of opportunistic

infections), and laboratory monitoring, through child survival programs at the LPTF. It is expected that 100%

of all seropositive infants and children and those exposed will be enrolled in care.

Activity 2 Caregivers, community health workers (CHWs) and PLWHAs will be trained to recognize medical

complications experienced by HIV infected children and refer them to the facility, if necessary. Periodic

trainings will be conducted for parents—and reinforced through post pharmacy counseling—to ensure that

they are properly providing correct doses to infants. AIDSRelief's adherence and support of OVC will

incorporate phased adherence trainings designed to address HIV from infant care, adolescence, and

through young adulthood. Psychosocial support will also be available for affected families. Home-based

care will be provided on a regular basis to children with HIV and AIDS, to improve children's access to

services. This care will focus on social support and the health needs of the entire family, and it will include

food and nutrition support, patient and family education.

Activity 3: Caregivers, CHWs and PLWHAs will be trained specifically to sensitize communities about

destigmatization through increased testing and treatment of children. Children infected with and affected by

HIV will be the main target population. The strategy will include linking with schools, churches, children's

home groups and community leaders through "Community Health Days." This initiative will help alleviate the

burden of stigma while including the community as the main host. Specific communities for enrolling this

strategy will be defined post the mapping exercise that AIDSRelief is currently conducting. AIDSRelief will

provide education on ways to spread prevention message in communities and schools. Each community

will have knowledge surveys conducted to properly quantify the need and later the impact community

mobilization has had. This is also an opportunity to disseminate prevention messages through peer to peer

contact.

Activity 4: Training for people living with HIV and AIDS as well as community health workers and clinical

staff will be provided to ensure high quality care and follow-up for children with HIV and AIDS. In Year five,

AIDSRelief will conduct a Pediatric HIV counseling workshop. This workshop will sensitize clinical staff to

the unique challenges of pediatric care and treatment. The skills they will gain will increase capacity among

hospital staff and improve services to children. During Year five, additional training will be required, as the

number of community health workers and counselors will increase significantly. Basic training for pediatric

HIV care will be provided for all new staff, and HIV and AIDS updates will be scheduled on a regular basis

for all AIDSRelief hospitals.

Activity Narrative:

TARGETS:

Targets Sept. 2009

OVC served by OVC Programs1,200

OVC Referred for ARV Services

400

Providers/caretakers trained in OVC Care3,500

Target Populations:

HIV infected and affected children

Caregivers (of OVC and PLWHAs)

HIV/AIDS affected families

Orphans and Vulnerable children

Community based organizations

Key Legislative issue:

Increasing gender equity in HIV AIDS

Stigma and discrimination

Food

Education

Microfinance/microcredit

Coverage areas

South, West, Artibonite, Nippes

Integrated Activity: This activity links to Activity IDs 9671.08, 17796.08, 18988.08, 17898.08, 18706.08, and

4496.08.

SUMMARY: Counseling and testing (CT) is provided at all AIDSRelief sites as part of a comprehensive

package for care, treatment and support for people living with HIV/AIDS (PLWHA). Activities to support CT

include: provision of comprehensive CT services at hospital clinics and satellite clinics; training and

supervision of counselors and community health workers (CHW's) in CT; support of CT activities at all

AIDSRelief health facilities; and, community mobilization. The primary emphasis areas for these activities

are: community mobilization, training, network development, human resource development, food nutrition

support, quality assurance, quality improvement, and supportive supervision. The specific target populations

will be: women of reproductive age, youth, truck drivers, sexual partners and children of seropositive

persons, tuberculosis (TB) patients, sexually transmitted infection (STI) patients, and adults and children

with clinical evidence of AIDS. The activities will be conducted in the communes of Gros-Morne, Fond des

Blancs, Fond des Négres, Leogane, Pilate, Milot, Deschapelles and Gonaives. People with high-risk

behaviors and sexually-active youth will be motivated to attend CT clinics during community mobilization. In

addition, AIDSRelief will conduct training in CT activities, in collaboration with Ministry of Health (MOH) and

the Haitian Institute for Community Health (INHSAC). The MOH, Unité de Coordination Central (UCC) and

Regional Health Departments are supportive of the project.

ACTIVITIES AND EXPECTED RESULTS: Activity 1: AIDSRelief will provide CT services at the 8 hospital

clinics and satellites clinics in its network, 7 Catholic mission hospitals and 1 public regional hospital, and

will establish 4 additional CT services at satellite health centers linked to these hospitals.

Activity 2: AIDSRelief will provide necessary training and will supervise counselors and CHW in CT. In

collaboration with MOH and the USG-supported CT training program at INHSAC (see I-TECH activity

narrative in CT), AIDSRelief will ensure that quality counseling and testing will be provided to the population

seeking care at its facilities. In November 2005, 25 nurses were trained in CT through PEPFAR funding.

Refresher trainings will be conducted during FY 2007 and follow-up will take place during technical

assistance visits. All training will emphasize counseling and referrals for family planning and other

reproductive health services.

Activity 3: AIDSRelief will support post-test activities (Post-test Clubs) at all of its health facilities to both

seropositive and seronegative persons. AIDSRelief will provide education, psychosocial and logistical

support to clients, clinic staff and CHWs in order to decrease stigmatization and discrimination experienced

by PLWHA. In addition, AIDSRelief will ensure that all seropositive persons are registered in HIV care

programs.

Activity 4: AIDSRelief will support community mobilization in order to decrease stigma and misinformation

regarding HIV and to increase the number of persons accessing CT centers. This activity will raise the

awareness of community leaders, CHWs, traditional birth attendants, health agents, teachers, pregnant

women, youth, people with risk behaviors, driver's syndicates and the general population about HIV/AIDS

and the importance of VCT. Particular emphasis will be placed on integrating traditional birth attendants and

community health agents into mobilization efforts. This activity was previously conducted and funded with

private funds at Milot, Gros-Morne, Fond des Blancs, and Pilate and with USG funds at Léogane and Fond

des Nègres.

Activity 5: AIDSRelief will strengthen the capacity of the regional hospital in Gonaïves to become a center of

excellence by supporting a working network of all CT sites around AIDSRelief-supported hospitals in the

Artibonite and Nippes Regional Departments.

SUMMARY: AIDSRelief Haiti is a comprehensive program currently providing anti-retroviral therapy (ART)

to 2029 people (May 2007) in eight treatment facilities. Target populations include adults, infants, children,

and youth infected with HIV, who seek medical services at any AIDSRelief hospital. Emphasis areas include

human resources, local organization capacity development, logistic support and training. Community

mobilization and the development of networks, linkages, and referral systems will also be critical

components of the AIDSRelief program. AIDSRelief will review its performance through the QA/QI process

to ensure implementation of best practices in each clinical program. The coverage area for this program

include the communes of Fond-des-Nègres (Nippes); Fond-des-Blancs (Sud); Léogane (Ouest);

Deschapelles, Gonaives, Gros Morne (Artibonite); Pilate, Milot (Nord).

BACKGROUND: AIDSRelief (AR) has provided ARV services in Haiti since 2004, through support from

Track 1.0 and funding from the President's Emergency Plan for AIDS Relief (PEPFAR). AIDSRelief is a five-

member consortium, led by Catholic Relief Services (CRS), and includes three faith-based organizations, a

medical institution that is recognized as a world leader in HIV/AIDS care, research and program

development, and an international development company that specializes in the design and implementation

of public health and social programs. All members of the AIDSRelief Consortium have a shared mission to

provide quality medical care to individuals living with HIV/AIDS. AIDSRelief Haiti works within seven faith-

based hospitals and one public hospital.

Since the launch of AR activities in Haiti, it has been able to implement eight ARV sites in four geographic

departments, including the main public departmental hospital in Gonaives. This program has built on CT,

PMTCT, TB and HIV basic care already implemented at these sites through PEPFAR, the Global Fund to

Fight AIDS, Tuberculosis and Malaria (GFATM), and core funds from members of the AR consortium. AR

has used funding to build infrastructure, logistic and human capacity to implement ARV services at these

sites. Through the consortium, technical assistance and QA/QI have been provided to ensure quality of

services.

A significant proportion of AIDSRelief patients are women; therefore this program will integrate with other

clinical programs that reach out to women including PMTCT, OB/GYN, and maternal and child health

(MCH) programs. Women and girls who are victims of sexual assault are a special target population for

AIDSRelief. AIDSRelief will work in close collaboration with the government of Haiti. AIDSRelief is an active

member of the Ministry of Health's (MOH) care and treatment cluster that has responsibility to define the

national strategy for HIV/AIDS care.

ACTIVITIES AND EXPECTED RESULTS:

Activity 1: AIDSRelief will continue its plan to provide durable, high-quality anti-retroviral therapy (ART),

according to Haiti's national guidelines. During COP 2008, each hospital will scale up the enrollment of anti-

retroviral (ARV) clients through expanded hospital-based and community-based VCT services that target

patients at highest risk for HIV, and through referrals from clinical programs such as TB treatment

programs. These activities will be accomplished through the development of an integrated approach to

services at each AIDSRelief hospital, and through collaboration with other stakeholders such as the MOH,

the Unites States Government (USG) team, and other PEPFAR awardees. AIDSRelief will strengthen its

regional approach to ART in the Artibonite by expanding its support for Gonaïves' Hôpital La Providence as

a regional center of excellence. Similar regional approaches will be maintained in the South and the North,

where AIDSRelief has multiple clinical sites that are strategically placed.

Activity 2: Training and capacity building in eight clinical centers will continue with support from COP 2008.

Continued clinical technical assistance and mentoring for in country caregivers will be expanded in Year

four to build capacity of in-country clinicians, and to strengthen the skills of other members of the multi-

disciplinary team, including counselors and treatment support staff, and technical staff (e.g. pharmacists, lab

technicians). This training will provide an opportunity for continued clinical technical assistance that will be

sustainable over time.

Upon receiving their training, these clinicians will provide strong leadership for AIDSRelief Haiti's eight

clinical centers. These clinicians will be responsible for monthly medical supervision and training for hospital

-based physicians, clinical officers, and nurses. AIDS seminars and updates will be held quarterly at each

hospital. These seminars will focus on treatment challenges and knowledge deficits identified by physicians

on the in-country team. In addition, training will present new approaches to care and treatment based upon

best practices and research findings in HIV/AIDS.

Activity 3: AIDSRelief partners will strengthen local organizational capacity in the areas of hospital

management, finance, and fund-raising in order to ensure long-term sustainability of ARV services.

AIDSRelief will collaborate with other stakeholders to provide critical linkages that ensure sustainable

quality ART.

Activity 4: AIDSRelief Haiti expects that at least 10% of the AIDSRelief patients will be within the pediatric

age group. Pediatric ART training will be provided for the eight AIDSRelief hospitals. Additional training and

support will be made available for pediatric counseling and treatment support. AIDSRelief will seek to

identify infected children through its expanded work with women enrolled in PMTCT and through close

collaboration with in-patient pediatric programs. Early diagnosis of HIV infection in HIV-exposed infants will

be provided in order to increase access to antiretroviral treatment. Infant feeding counseling will also be

provided to caregivers for an informed option and appropriateness choice of alimentation.

Activity 5: COP 2008 funding will support patient monitoring and management (PMM) tools at the

community and the institutional level to improve the program's ability to track patient care. At the community

level, treatment support teams will use these tools to ensure 95-100% patient adherence to ART. These

treatment teams will be lead by a nurse supervisor and/or a counselor at each hospital.

AIDSRelief will work with MOH, CDC and HIVQUAL to improve each hospital's QA/QI system during Year

four. QA/QI assessments will provide clinical, laboratory, and behavioral monitoring of the patient. The

QA/QI program and PMM will be used to improve patient care, and to identify areas within the ART program

that need strengthening.

Activity Narrative: AIDSRelief-Consella Futures will provide TA and training to build capacity of LPTF staff responsible for data

collection and analysis. Activities will include: complete adoption of government revised PMM systems; joint

supervision and TA with government M & E agency (IHE); analysis of required indicators requested by

LPTF, CCT and funding agencies; training on generation of programmatic indicators to produce the required

reports on an accurate and timely basis that meet data quality standards. Constella Futures will carry out

regular site visits and reviews to ensure quality data and data validation.

Activity 6: AIDSRelief will provide training for all members of its multi-disciplinary team in the management

of PEP (post-exposure prophylaxis). The team will develop skills in care, treatment, and support for women

following rape and services will be available at all times in each AIDSRelief hospital. Post-exposure

prophylaxis will be made available, in addition to HIV testing. Long-term follow-up for these women will

include psychological support, laboratory testing, and medical treatment. Similar services will be available at

all times for staff where there is the potential for occupational HIV exposure at an AIDSRelief hospital or at

one of AIDSRelief's satellite health centers.

TARGETS

Targets Sept.2008Targets Feb. 2009Targets Sept. 2009

LPTFs providing ART999

Adults on ART320040004400

Children receiving ARV375450500

Integrated Activity: This activity links to Activity IDs 9671.08, 18988.08, 5305.08, 17898.08, 18706.08, and

4496.08.

SUMMARY:

Funds will be used to provide sufficient laboratory working bench space and purchase equipment needed

for improvement of laboratory infrastructure,. A functional laboratory is critical to support persons living with

HIV/AIDS (PLWHA). Laboratory workers will be hired and trained to service the laboratory.

BACKGROUND:

ACTIVITES AND EXPECTED RESULTS:

AIDS Relief proposes to carry out the following activities activity in this Program Area.

ACTIVITY 1: AIDS Relief will prepare 2 laboratories within its network to provide ARV laboratory services

for PLWHAs under ART. With the availability of new testing such as automated CD4 counts, blood

chemistry and hematology certain laboratory systems requirements have to be met. Using local companies,

AIDS Relief will procure and install basic items essential for improving laboratory infrastructure including

laboratory bench space, working hand-wash basin, office space for lab management, storage, and blood

collection area. AIDS Relief will procure, install and secure sets of inverters and batteries ensuring constant

electrical supply to the laboratories as well as a water tank, pump and water to ensure constant water

supply. AIDS Relief will procure and install gas refrigerators and provide gas tanks, maintain and service

gas refrigerators at the laboratories to ensure that refrigerators are operating well, maintaining essential

laboratory test kits at recommended temperature.

ACTIVITY 2: Partner will hire additional lab for those ARV laboratories (1 per site) in order to carry out extra

laboratory testing work load for people living with HIV/AIDS. The hired lab technicians will be trained by the

AIDS Relief Laboratory specialist staff for laboratory testing, QA/QC, good lab practices and lab

management following the norms established by the National Public Health Laboratory.

These results contribute to the PEPFAR 2-7-10 goals by improving access to and quality of laboratory

services in order to identify HIV positive persons and increase the number of persons receiving ARV

services.

EMPHASIS AREAS:

Infrastructure51%-100%

Human capacity development10%-50%

TARGETS:

2 Lab technicians hired

2 laboratories to perform HIV-testing and CD4

2 laboratories improved its infrastructure

TARGET POPULATIONS:

People living with HIV/AIDS

Laboratory Workers

COVERAGE AREAS: national