Detailed Mechanism Funding and Narrative

Years of mechanism: 2008 2009

Details for Mechanism ID: 3315
Country/Region: Haiti
Year: 2009
Main Partner: GHESKIO
Main Partner Program: NA
Organizational Type: NGO
Funding Agency: HHS/CDC
Total Funding: $8,945,000

Funding for Biomedical Prevention: Prevention of Mother to Child Transmission (MTCT): $350,000

Summary:

GHESKIO will provide field support to 15 public and private sites for the provision of a full package of

PMTCT services to both mother and infant Activities are carried out to scale up interventions and support

the national program to prevent mother to child transmission (PMTCT) of HIV and syphilis. GHESKIO aimed

to provide a comprehensive and holistic approach for provision of PMTCT services. The ultimate goal is to

prevent mother to child transmission of those infections and to increase hospital delivery or assisted

delivery by a trained medical personnel for clinical follow up of mother and new born early diagnosis with

additional nutrition and social support. The primary emphasis areas for these activities are training, human

resources and infrastructure, logistics and community mobilizations. Specific target populations include

sexually active HIV positive women and partner, pregnant HIV+ women, pregnant women with syphilis and

partner, HIV+ women with their children seen during post partum period and after. The activities will be

carried out within the 16 (7 public/9 private) GHESKIO-PEPFAR health facilities.

Background:

The MOH-GHESKIO pilot project conducted at GHESKIO (1999-2005) aimed to PMTCT shows a rate

reduction from 27% to 9%, among children of mother who received Zidovudine as prophylaxis with infant

formula until the age of 6 months. ( Ref : Deschamps MM, Devieux J and al: .Prevention of Mother to child

transmission of HIV in Haiti. Pan Amer. Journal of Public Health. August 2008 ) In 2003, pregnant women

with AIDS were offered triple drug therapy. This conclusive protocol is being implemented nationwide.

However, there is a need to maximize results and effectiveness of intervention in order to increase access

to ARV to mother and new born, to increase number of infant and mother followed post delivery of infant, to

facilitate access to FP services and assist women and family during and after delivery. Excluding some

centers, majority of women continued to give birth outside of healthcare setting, or do not return for further

services after the test or after delivery. Since 2005, GHESKIO has developed new capacities to diagnose

early HIV infection in children (p24;PCR).DBS PCR has been initiated at 2 sites: GHESKIO, the National

Laboratory . Those methods of diagnostic will be progressively introduced at other sites for the early

diagnosis, treatment and follow up of HIV infected children and mother as well as integration of a PMTCT

case manager for interactive follow up of outcome of the intervention.

ACTIVITIES AND EXPECTED RESULTS:

PMTCT is an integrated activity for the diagnosis, prophylaxis and treatment of HIV infection in individuals of

reproductive age, including children born from HIV infected women.

Activity 1:

To offer counseling and testing using rapid test for both, HIV and syphilis to pregnant women attending the

collaborative sites. Counseling includes also referral of the sexual partner. HIV+ women will be informed

and counseled about the seropositivity, on the mode of HIV transmission and prevention and will be

encouraged to return with infant and partner on a regular basis for prophylaxis, treatment and care. Those

with positive serologic test for syphilis will start treatment the same day. HIV + women will be evaluated for

staging (WHO/CDC classification) and informed about a comprehensive PMTCT package of service: at

prenatal, during labor and at post partum, including circumcision for male infants, reinforcing the need for

follow up of children, the need for circumcision if a male infant, the choice of FP, and infant feeding issues.

Activity 2:

To provide assistance to the women to deliver in a hospital setting or to include the midwife or the matrone

in the delivery process, using the SOG program as an opportunity, to reinforce both programs the PMTCT

and the SOG which includes: the doctor, the nurse, the accompagnateur or facilitator, the matrone, the care

giver of the children, the midwife and develop with the HIV+ pregnant women (with or without her

accompagnateur or facilitateur) a "Plan of accouchement". Funding will support in each site: a PMTCT Case

manager who will create the link with the pediatrician or child care giver, the OBGYN etc., with development

and procurement of educational material, the transportation fee of the mother and children of the family.

Activity 3:

To assist the infected pregnant women and her new born for early diagnosis of HIV of infant, the choice of

infant feeding with the care giver ( the matrone, nurses or auxillary. OBGYN, pediatrician or

generalist).These interventions will be maintained and strengthened at the 15 identified sites, with the "

PMTCT" case manager" as coordinator who can be: a nurse, a physician, a midwife etc.

Activity 4:

To offer ARV prophylaxis or treatment to HIV + pregnant women before, during and after delivery, with the

infant, using the revised national guidelines to prevent MTCT. HIV + women will be counseled and receive

FP methods to prevent unwanted pregnancy. In cases where the site does not have access yet to ARV,

Women or children who require HAART will be referred to the closest "site of excellence".

Activity 5:

To continue the ongoing work established with the MOH regarding the early diagnosis of the HIV in children.

The HIV p24 assay will be conducted on site as first diagnosis of the status the HIV exposed infants.

GHESKIO and NPHL the only two laboratories equipped for DBS PCR will provide services for confirmatory

of the HIV status. This diagnosis is mandatory for HIV + children to receive the ARV treatment accordingly

as well as the one for syphilis.

Additionally, GHESKIO will provide assistance to women to deliver in a hospital setting or to include the

midwife or the matrone in the delivery process, using the SOG program as an opportunity, to reinforce both

programs the PMTCT and the SOG which includes: the doctor, the nurse, the accompagnateur or facilitator,

the matrone, the care giver of the children, the midwife and develop with the HIV+ pregnant women (with or

without her accompagnateur or facilitateur) a "Plan of accouchement".

Funding will support in each site: a PMTCT Case manager who will create the link with the pediatrician or

Activity Narrative: child care giver, the OBGYN etc.., with development and procurement of educational material, the

transportation fee of the mother and children of the family.

HIV + women will be evaluated for staging ( WHO/CDC classification) and informed about a comprehensive

PMTCT package of service : at prenatal, during labor and at post partum, including circumcision for male

infants, reinforcing the need for follow up of children, the need for circumcision if a male infant ,the choice of

FP, and infant feeding issues.

These results will contribute to PEPFAR goals by improving access to quality of care, decrease maternal

mortality and unwanted pregnancy and reduce significantly the PMTCT rate.

New/Continuing Activity: Continuing Activity

Continuing Activity: 17920

Continued Associated Activity Information

Activity Activity ID USG Agency Prime Partner Mechanism Mechanism ID Mechanism Planned Funds

System ID System ID

17920 17920.08 HHS/Centers for Groupe Haitien 7682 3315.08 $350,000

Disease Control & d'Etude du

Prevention Sarcome de

Kaposi et des

Infections

Opportunistes

Emphasis Areas

Gender

* Increasing gender equity in HIV/AIDS programs

* Increasing women's access to income and productive resources

* Increasing women's legal rights

Health-related Wraparound Programs

* Child Survival Activities

Human Capacity Development

Public Health Evaluation

Food and Nutrition: Policy, Tools, and Service Delivery

Food and Nutrition: Commodities

Economic Strengthening

Education

Water

Table 3.3.01:

Funding for Care: Adult Care and Support (HBHC): $200,000

The narrative will be modified in the following way:

New activities this year will aim to provide prophylactic and curative dental care. The dental clinic at

GHESKIO is a preventive dental clinic; the clinic will focus its efforts on HIV positive and at risk children and

adolescents frequenting the pediatric and adolescent clinics at GHESKIO. The main preventive treatments

that the clinic will offer are:

1. Prophylactic treatment

2. Sealants, fluorides rinses

3. Dental education

Funding will cover equipment, furniture, staffing and logistics for everyday functioning of a dental clinic at

GHESKIO.

Data review of GHESKIO file has shown that during the last 4 years the rate of cancer detection has

improved significantly. 25% of diagnosed cases were cervical cancer. Knowing the predictive role of HPV

infection in the development of cervical cancer, we plan to make available services for diagnostic and care

of treatable cancer.

Summary: Activities are carried out to support the effort of sites enrolling patients to be placed on highly

active antiretroviral therapy (HAART). The primary emphases of these activities include training, human

resources and (doing what to the infrastructure? Strengthening it, perhaps?)infrastructure. Specific target

populations include adults and children infected with HIV and not yet placed on anti-retroviral therapy

(ART.) The activities will be carried out in the Ministry of Health /GHESKIO/ President's Emergency Plan for

AIDS Relief (PEPFAR)'s network of 14 sites and will be linked with counseling and testing (CT), preventing

mother to child transmission (PMTCT), tuberculosis (TB)/HIV, anti-retroviral (ARV) services, and human

capacity building that is being also supported through this network

BACKGROUND:

GHESKIO is one of the two lead non-governmental organizations (NGOs)—the other one is Partners in

Health (PIH)—that have launched an integrated model of HIV services in Haiti. With PEPFAR, the United

States Government (USG) decided to build on its success to expand HIV services throughout the country.

Through GHESKIO, 12 sites, including four major departmental hospitals, have been reinforced to offer

integrated CT, PMTCT, TB/HIV, ARV as well as palliative care services. provided in conjunction with the

Global Fund to fight AIDS, Tuberculosis and Malaria (GFATM). GHESKIO has ensured that all HIV positive

patients detected through its CT network gain access to clinical, biological, nutritional, and psycho-social

assessments and services, as well as long term follow up to determine the optimal time for HAART. So far,

44,600 patients have been enrolled in palliative through the GHESKIO network. These activities are

essential to keeping active the cohort of HIV infected adults and children. Service providers will encourage

patients diagnosed with HIV to continue to attend regular clinic visits and maintain their link with the

community.

With Fiscal Year 2008 resources, GHESKIO will expand its network to 16 institutions and will continue to

strengthen palliative care services to reach about 10,000 additional patients with particular emphasis on

expanding nutrition services and building the capacity of nurses to play a greater role in the provision of

services.

ACTIVITES AND EXPECTED RESULTS:

GHESKIO will carry out four separate activities in this Program Area:

ACTIVITY 1: In integration with GFATM resources, GHESKIO will use PEPFAR funding to provide the non-

ART package of services including, diagnostic, treatment and prevention of opportunistic infections,

diagnostic and treatment of sexually transmitted infections, care of ART related illness (i.e., diabetes,

arterial hypertension), nutrition assessment and recuperation (if needed), psycho-social assessment and

support. All of the network's facilities will offer this package of care. Funding will support enhancement of

infrastructure, procurement of necessary drugs, diagnostic materials, hospital staff training in providing

specific care, and hospital supervisory staff training to ensure a minimum standard of quality of services.

ACTIVITY 2: Encourage building of support groups at each site and regrouping patients on ART and those

enrolled in palliative care. Meetings between these groups' members will serve as a forum for sharing

experiences and encouraging interactive communication between care providers and patients. Meetings will

be held once to twice a month depending on the number of patients enrolled at each site, Funding will be

used to provide patients with transportation fees, (I am not sure to whom these services are to be provided)

refreshing, collation, and education materials.

ACTIVITY 3: GHESKIO will increase the number of community health workers to accommodate scale-up at

each of its palliative care sites. 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, ORS, symptom and pain medications

according to the guidelines. Resources will be used to pay their (whose? Patients or community health

workers?)transportation fees.

ACTIVITY 4: Strengthening interventions to maintain patient's adherence to ART treatment. Funding will

help sites provide patients fees for transportation, phone cards, and educational materials. Patients will be

referred to community based organizations to gain access to a broader package of social support services

such as school fees for children, nutrition support, etc.

Activity Narrative:

New/Continuing Activity: Continuing Activity

Continuing Activity: 18948

Continued Associated Activity Information

Activity Activity ID USG Agency Prime Partner Mechanism Mechanism ID Mechanism Planned Funds

System ID System ID

18948 18948.08 HHS/Centers for Groupe Haitien 7682 3315.08 $200,000

Disease Control & d'Etude du

Prevention Sarcome de

Kaposi et des

Infections

Opportunistes

Program Budget Code: 09 - HTXS Treatment: Adult Treatment

Total Planned Funding for Program Budget Code: $25,577,679

Total Planned Funding for Program Budget Code: $0

Table 3.3.09:

Funding for Treatment: Adult Treatment (HTXS): $6,200,000

The narrative will be modified in the following way:

In addition to activities undertaken last year, thru COP 09, GHESKIO will:

1) Strengthen at departmental level the referral between CT, PMTCT, TB sites and ART centers to improve

the continuum of care between the different levels of the care system. Funding will be used to provide

reference and counter reference cards, transportation costs for patients and departmental coordination

meetings among partner etc.

2) Build capacity of the Jeremie public departmental hospital to become a Center of Excellence for the

Grand'Anse department. This new activity is necessary to continue the decentralization of ARV services

and serve as a model for extending services to peripheral sites. Funding requested will cover many items

including equipment, furniture, staffing, logistics for training and supervision and financial support for

peripherals sites.

3) Realize a national workshop with national and international experts to determine new regimen, new

costs, new strategies to improve follow up of patients placed on ART. Funding will cover elements for the

workshop: logistics, per diem for participants, lodging, invitation of experts.

4) Realize with the MOH and key stakeholders workshops in Haiti to establish cut-off of acceptable rate of

non-adherence, LTFU, and mortality. GHESKIO will use this cut-off to monitor thru the electronic data base

system put in place all sites the outcomes of the treatment program. This will allow to rapidly inform the

clinical team at each site on the performance at each site. An intervention plan will be developed to

improve quality of care at any site that is poorly performing. The GHESKIO mobile team will visit poorly

performing sites immediately and work with the staff to improve treatment outcomes.

5) GHESKIO will perform HIV-1 viral load and genotypic drug resistance testing for all patients receiving

ART who meet WHO criteria for ART failure in Haiti. We estimate that 10 to 20% of all patients receiving

ART will meet WHO criteria for failure and will need virologic monitoring. This evaluation will help better

define the demographic and clinical characteristics of patients who fail ART so that new better adapted

guidelines for monitoring patients on ART can be drafted. The drug resistance mutations identified will help

better tailor second-line antiretroviral drug regimens for patients failing ART in Haiti. Finally, this service will

allow us to increase capacity for virologic testing in Haiti and to train new technicians in the realization of

these tests.

SUMMARY:

Through activities listed in this project GHESKIO will contribute to the United States Government's (USG)

effort to provide treatment to people with HIV/AIDS (PLWHA) by maintaining and strengthening anti-

retroviral (ARV) services in a national network of public and private health facilities and by building human

capacity for the overall program. The major focus will be: 1) reinforcing technical, infrastructure, human and

administrative capacity of the 16 institutions in the GHESKIO network for the provision of ARV care; 2)

training providers; 3) supervising quality assurance (QA), quality control (QC) and quality improvement(QI)

of ARV services; 4) maintaining Immaculee Conception hospital, the South Regional Hospital as a Center of

Excellence; and 5) building capacity of St Michel Hospital, the South East Departmental Hospital to

become a center of excellence.

Areas of emphasis for these activities will include: community mobilization and participation; reinforcement

of existing network and referral systems; human resources; infrastructure development; development of

local organizations capacity; development of network/linkages/referral systems; information, education and

communication (IEC); linkage with other sectors and initiatives; development of guidelines; quality

assurance, quality improvement and supportive supervision; and strategic information and training.

Specific target population identified will be PLWA, HIV positive infants and adolescents from 0 to 14 years,

affected relatives, HIV positive pregnant women and different category of care providers.

BACKGROUND:

GHESKIO has been one of the two lead non-governmental organizations (NGO) that has an integrated

(integrated with STI, TB, CT, PMTCT) model of anti-retroviral (ARV) services and basic care. Over past last

three years, the USG has provided resources to GHESKIO to expand this integrated model in a network of

16 sites, including four of the largest departmental public hospitals and a large stand alone tuberculosis

(TB) facility. This program was built on previous efforts to implement CT, PMTCT and basic care services -

the entry point for enrolling patients on ARV—at the 16. All 16 sites have been reinforced with infrastructure,

laboratory equipment, and a multidisciplinary team of clinicians, nurses, counselors, pharmacists,

community and social workers as well as with medical equipment, electronic medical records, drug storage

capacity and SI tools to provide quality care. Based on the pilot experience of launching ARV pediatric care

in the main GHESKIO center in Port-au-Prince, efforts were since last year, to expand this program

throughout the network. Efforts are being made to strengthen one of the South's departmental hospitals,

Immaculee Conception Hospital, to become a center of excellence where training, supervision, and QA/QI

could be decentralized. Nearly 5000 patients have been placed on ARV through the GHESKIO network so

far.

The USG team has mandated GHESKIO to train healthcare providers nationwide for the ARV program and

to support the Minister of Health's (MOH) ARV certification process using national guidelines and updated

training. To date, GHESKIO has trained a total of 425 health professionals. As ARV services are expanded

and reinforced and because of a significant turnover of personnel, there is a continuous need to train and

provide refresher courses on ARV at GHESKIO. There is also a growing need to train nurses to play a

greater role in the provision of ARV services as well.

Activity Narrative: USG has also required GHESKIO to provide QA/QC/QI to 22 sites, some of which are outside of the

GHESKIO network. GHESKIO has formed three mobile multidisciplinary teams of clinicians, pharmacists,

and others to make regular supervision visits. There is a need to continue strengthening this activity to

implement a QA/QI system through which data could be generated and used to improve quality at the

patient, site, and program level.

With Fiscal Year 2008 funding GHESKIO will continue to strengthen its integrated model of ARV services in

its network of 16 sites, including its main site in Port-au-Prince, to continue enrolling new patients on ARV,

with the goal being to reach 10,000 patients by the end of September 2008 and 14,000 patients by the end

of September 2009. If obtained, these numbers will contribute to more than half of PEPFAR's targets for the

country. These sites will also focus on improving quality of care and adherence to treatment, and on

expanding pediatric treatment. GHESKIO will build the capacity at Hospital Saint Michel, the South East

departmental hospital to become a new center of excellence. GHESKIO will continue to train health care

professionals on ARV with an emphasis on training nurses. GHESKIO will work with MOH, CDC and other

stakeholders to improve the system of QA/QI with standardized indicators and with a focus on continuous

improvement of care for twenty-two (22) sites (14 in the MOH-GHESKIO network and eight in other

networks: Bethel, Gonaives, MARCH, Beraca, HAS, CBP, Grace Children's Hospital and Ouanaminthe).

This effort will be integrated with activities supported by the GFATM through GHESKIO.

ACTIVITES AND EXPECTED RESULTS:

ACTIVITY 1: Funding will be used to strengthen GHESKIO's headquarters to continue providing technical,

administrative, and accounting assistance to its network of 16 sites in integration with GFATM resources.

These sites are: GHESKIO-INLR, Les Cayes , Jeremie, Jacmel, Cap-Haitienne, Fame Pereo, IMIS,

Bombardopolis, Food for the Poor, Hopital de la Communaute Haitienne, Petit Goave, Hospital Bernard

Mews, La Gonave and Fermathe. GHESKIO's headquarters will provide oversight and monitoring of the

project.

Activity 2: GHESKIO will use funding to cover additional renovation, equipment, and personnel needed for

expansion of services at the 16 sites. Emphasis will be put next year on pediatric wards to ensure they have

adequate space, equipment, and personnel to enhance ARV pediatric services. Special attention will also

be given to improve laboratory services for ARV care to make available at all major sites automated

equipment for the dosage of CD4, hematology and blood chemistry (see laboratory narratives). Linkages

will be established with Supply Chain Management System to ensure adequate supply of drugs as well as

with CBOs and PLWA support group organization to provide community support to maintain patient

adherence to treatment.

Activity 3: GHESKIO will expand its training infrastructure, staff, and equipment to train and provide

refresher courses on ARV to close to 400 health professionals nationwide through all the networks. Funding

will be used to cover materials, per diem, and logistic costs for the trainees.

ACTIVITY 4: GHESKIO will maintain and expand supervision and on site training for ART services at 22

main sites supported by PEPFAR for QA/QC/QI using a national framework and tools that MOH, CDC, and

key stakeholders have started to develop. This will be supported through three mobile teams. The main

items covered by this funding will include: support for mobile teams, per diem, lodging, logistics for visits,

materials for supervision and training. A quality manager team will be created at GHESKIO to oversee the

QA/QI system.

ACTIVITY 5: Funding will be used to make St Michel Hospital, the South East departmental hospital a

center of excellence for the South East Department. This new activity is necessary to continue the

decentralization of ARV services and to serve as a model for extending services to peripheral sites. In this

capacity, St Michel Hospital will be a regional reference and training center, offering training sessions and

supervision for peripheral centers in their area of influence.

New/Continuing Activity: Continuing Activity

Continuing Activity: 17181

Continued Associated Activity Information

Activity Activity ID USG Agency Prime Partner Mechanism Mechanism ID Mechanism Planned Funds

System ID System ID

17181 4341.08 HHS/Centers for Groupe Haitien 7682 3315.08 $6,620,000

Disease Control & d'Etude du

Prevention Sarcome de

Kaposi et des

Infections

Opportunistes

9282 4341.07 HHS/Centers for Groupe Haitien 5124 3315.07 $5,150,000

Disease Control & d'Etude du

Prevention Sarcome de

Kaposi et des

Infections

Opportunistes

4341 4341.06 HHS/Centers for Groupe Haitien 3315 3315.06 $4,200,000

Disease Control & d'Etude du

Prevention Sarcome de

Kaposi et des

Infections

Opportunistes

Emphasis Areas

Construction/Renovation

Gender

* Addressing male norms and behaviors

* Increasing gender equity in HIV/AIDS programs

* Increasing women's access to income and productive resources

* Increasing women's legal rights

* Reducing violence and coercion

Health-related Wraparound Programs

* Child Survival Activities

* Family Planning

* Safe Motherhood

* TB

Human Capacity Development

Estimated amount of funding that is planned for Human Capacity Development $900,000

Public Health Evaluation

Food and Nutrition: Policy, Tools, and Service Delivery

Food and Nutrition: Commodities

Economic Strengthening

Education

Water

Table 3.3.09:

Funding for Care: Pediatric Care and Support (PDCS): $200,000

The narrative will be modified in the following way:

New activities this year will aim to provide prophylactic and curative dental care. The dental clinic at

GHESKIO is a preventive dental clinic; the clinic will focus its efforts on HIV positive and at risk children and

adolescents frequenting the pediatric and adolescent clinics at GHESKIO. The main preventive treatments

that the clinic will offer are:

1. Prophylactic treatment

2. Sealants, fluorides rinses

3. Dental education

Funding will cover equipment, furniture, staffing and logistics for everyday functioning of a dental clinic at

GHESKIO.

Data review of GHESKIO file has shown that during the last 4 years the rate of cancer detection has

improved significantly. 25% of diagnosed cases were cervical cancer. Knowing the predictive role of HPV

infection in the development of cervical cancer, we plan to make available services for diagnostic and care

of treatable cancer.

Summary: Activities are carried out to support the effort of sites enrolling patients to be placed on highly

active antiretroviral therapy (HAART). The primary emphases of these activities include training, human

resources and (doing what to the infrastructure? Strengthening it, perhaps?)infrastructure. Specific target

populations include adults and children infected with HIV and not yet placed on anti-retroviral therapy

(ART.) The activities will be carried out in the Ministry of Health /GHESKIO/ President's Emergency Plan for

AIDS Relief (PEPFAR)'s network of 14 sites and will be linked with counseling and testing (CT), preventing

mother to child transmission (PMTCT), tuberculosis (TB)/HIV, anti-retroviral (ARV) services, and human

capacity building that is being also supported through this network

BACKGROUND:

GHESKIO is one of the two lead non-governmental organizations (NGOs)—the other one is Partners in

Health (PIH)—that have launched an integrated model of HIV services in Haiti. With PEPFAR, the United

States Government (USG) decided to build on its success to expand HIV services throughout the country.

Through GHESKIO, 12 sites, including four major departmental hospitals, have been reinforced to offer

integrated CT, PMTCT, TB/HIV, ARV as well as palliative care services. provided in conjunction with the

Global Fund to fight AIDS, Tuberculosis and Malaria (GFATM). GHESKIO has ensured that all HIV positive

patients detected through its CT network gain access to clinical, biological, nutritional, and psycho-social

assessments and services, as well as long term follow up to determine the optimal time for HAART. So far,

44,600 patients have been enrolled in palliative through the GHESKIO network. These activities are

essential to keeping active the cohort of HIV infected adults and children. Service providers will encourage

patients diagnosed with HIV to continue to attend regular clinic visits and maintain their link with the

community.

With Fiscal Year 2008 resources, GHESKIO will expand its network to 16 institutions and will continue to

strengthen palliative care services to reach about 10,000 additional patients with particular emphasis on

expanding nutrition services and building the capacity of nurses to play a greater role in the provision of

services.

ACTIVITES AND EXPECTED RESULTS:

GHESKIO will carry out four separate activities in this Program Area:

ACTIVITY 1: In integration with GFATM resources, GHESKIO will use PEPFAR funding to provide the non-

ART package of services including, diagnostic, treatment and prevention of opportunistic infections,

diagnostic and treatment of sexually transmitted infections, care of ART related illness (i.e., diabetes,

arterial hypertension), nutrition assessment and recuperation (if needed), psycho-social assessment and

support. All of the network's facilities will offer this package of care. Funding will support enhancement of

infrastructure, procurement of necessary drugs, diagnostic materials, hospital staff training in providing

specific care, and hospital supervisory staff training to ensure a minimum standard of quality of services.

ACTIVITY 2: Encourage building of support groups at each site and regrouping patients on ART and those

enrolled in palliative care. Meetings between these groups' members will serve as a forum for sharing

experiences and encouraging interactive communication between care providers and patients. Meetings will

be held once to twice a month depending on the number of patients enrolled at each site, Funding will be

used to provide patients with transportation fees, (I am not sure to whom these services are to be provided)

refreshing, collation, and education materials.

ACTIVITY 3: GHESKIO will increase the number of community health workers to accommodate scale-up at

each of its palliative care sites. 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, ORS, symptom and pain medications

according to the guidelines. Resources will be used to pay their (whose? Patients or community health

workers?)transportation fees.

ACTIVITY 4: Strengthening interventions to maintain patient's adherence to ART treatment. Funding will

help sites provide patients fees for transportation, phone cards, and educational materials. Patients will be

referred to community based organizations to gain access to a broader package of social support services

such as school fees for children, nutrition support, etc.

Activity Narrative:

New/Continuing Activity: Continuing Activity

Continuing Activity: 18948

Continued Associated Activity Information

Activity Activity ID USG Agency Prime Partner Mechanism Mechanism ID Mechanism Planned Funds

System ID System ID

18948 18948.08 HHS/Centers for Groupe Haitien 7682 3315.08 $200,000

Disease Control & d'Etude du

Prevention Sarcome de

Kaposi et des

Infections

Opportunistes

Emphasis Areas

Human Capacity Development

Public Health Evaluation

Food and Nutrition: Policy, Tools, and Service Delivery

Estimated amount of funding that is planned for Food and Nutrition: Policy, Tools $50,000

and Service Delivery

Food and Nutrition: Commodities

Economic Strengthening

Education

Water

Table 3.3.10:

Funding for Treatment: Pediatric Treatment (PDTX): $525,000

The narrative will be modified in the following way:

The MOH/GHESKIO network with 16 sites (8 public and 8 private) including the 4 largest departmental

hospitals (Cayes, Cap, Jacmel, Jeremie) covers 50% of all patients receiving ARV nationwide. At the end of

COP08 in September 2009, we expect to have 14,000 patients (adults and children) on ARV in the network.

During the COP 09, we aim particularly to double the number of children receiving ART in the network.

SUMMARY:

Through activities listed in this project GHESKIO will contribute to the United States Government's (USG)

effort to provide treatment to people with HIV/AIDS (PLWHA) by maintaining and strengthening anti-

retroviral (ARV) services in a national network of public and private health facilities and by building human

capacity for the overall program. The major focus will be: 1) reinforcing technical, infrastructure, human and

administrative capacity of the 16 institutions in the GHESKIO network for the provision of ARV care; 2)

training providers; 3) supervising quality assurance (QA), quality control (QC) and quality improvement (QI)

of ARV services; 4) maintaining Immaculee Conception hospital, the South Regional Hospital as a Center of

Excellence; and 5) building capacity of St Michel Hospital, the South East Departmental Hospital to

become a center of excellence.

Areas of emphasis for these activities will include: community mobilization and participation; reinforcement

of existing network and referral systems; human resources; infrastructure development; development of

local organizations capacity; development of network/linkages/referral systems; information, education and

communication (IEC); linkage with other sectors and initiatives; development of guidelines; quality

assurance, quality improvement and supportive supervision; and strategic information and training.

Specific target population identified will be PLWA, HIV positive infants and adolescents from 0 to 14 years,

affected relatives, HIV positive pregnant women and different category of care providers.

BACKGROUND:

GHESKIO has been one of the two lead non-governmental organizations (NGO) that has an integrated

(integrated with STI, TB, CT, PMTCT) model of anti-retroviral (ARV) services and basic care. Over past last

three years, the USG has provided resources to GHESKIO to expand this integrated model in a network of

16 sites, including four of the largest departmental public hospitals and a large stand alone tuberculosis

(TB) facility. This program was built on previous efforts to implement CT, PMTCT and basic care services -

the entry point for enrolling patients on ARV—at the 16. All 16 sites have been reinforced with infrastructure,

laboratory equipment, and a multidisciplinary team of clinicians, nurses, counselors, pharmacists,

community and social workers as well as with medical equipment, electronic medical records, drug storage

capacity and SI tools to provide quality care. Based on the pilot experience of launching ARV pediatric care

in the main GHESKIO center in Port-au-Prince, efforts were since last year, to expand this program

throughout the network. Efforts are being made to strengthen one of the South's departmental hospitals,

Immaculee Conception Hospital, to become a center of excellence where training, supervision, and QA/QI

could be decentralized. Nearly 5000 patients have been placed on ARV through the GHESKIO network so

far.

The USG team has mandated GHESKIO to train healthcare providers nationwide for the ARV program and

to support the Minister of Health's (MOH) ARV certification process using national guidelines and updated

training. As ARV services are expanded and reinforced and because of a significant turnover of personnel,

there is a continuous need to train and provide refresher courses on ARV at GHESKIO. There is also a

growing need to train nurses to play a greater role in the provision of ARV services as well.

USG has also required GHESKIO to provide QA/QC/QI to 22 sites, some of which are outside of the

GHESKIO network. GHESKIO has formed three mobile multidisciplinary teams of clinicians, pharmacists,

and others to make regular supervision visits. There is a need to continue strengthening this activity to

implement a QA/QI system through which data could be generated and used to improve quality at the

patient, site, and program level.

With Fiscal Year 2009 funding GHESKIO will continue to strengthen its integrated model of ARV services in

its network, to continue enrolling new patients on ARV, with the goal being to reach 14,000 patients by the

end of September 2009. If obtained, these numbers will contribute to more than half of PEPFAR's targets

for the country. These sites will also focus on improving quality of care and adherence to treatment, and on

expanding pediatric treatment. GHESKIO will build the capacity at Hospital Saint Michel, the South East

departmental hospital to become a new center of excellence. GHESKIO will continue to train health care

professionals on ARV with an emphasis on training nurses. GHESKIO will work with MOH, CDC and other

stakeholders to improve the system of QA/QI with standardized indicators and with a focus on continuous

improvement of care for twenty-two (22) sites (14 in the MOH-GHESKIO network and eight in other

networks: Bethel, Gonaives, MARCH, Beraca, HAS, CBP, Grace Children's Hospital and Ouanaminthe).

This effort will be integrated with activities supported by the GFATM through GHESKIO.

ACTIVITES AND EXPECTED RESULTS:

ACTIVITY 1: Funding will be used to strengthen GHESKIO's headquarters to continue providing technical,

administrative, and accounting assistance to its network in integration with GFATM resources. These sites

are: GHESKIO-INLR, Les Cayes , Jeremie, Jacmel, Cap-Haitienne, Fame Pereo, IMIS, Bombardopolis,

Food for the Poor, Hopital de la Communaute Haitienne, Petit Goave, Hospital Bernard Mews, La Gonave

and Fermathe. GHESKIO's headquarters will provide oversight and monitoring of the project.

Activity 2: GHESKIO will use funding to cover additional renovation, equipment, and personnel needed for

expansion of services at the 16 sites. Emphasis will be put next year on pediatric wards to ensure they have

Activity Narrative: adequate space, equipment, and personnel to enhance ARV pediatric services. Special attention will also

be given to improve laboratory services for ARV care to make available at all major sites automated

equipment for the dosage of CD4, hematology and blood chemistry (see laboratory narratives). Linkages

will be established with Supply Chain Management System to ensure adequate supply of drugs as well as

with CBOs and PLWA support group organization to provide community support to maintain patient

adherence to treatment.

Activity 3: GHESKIO will expand its training infrastructure, staff, and equipment to train and provide

refresher courses on ARV to close to 400 health professionals nationwide through all the networks. Funding

will be used to cover materials, per diem, and logistic costs for the trainees.

ACTIVITY 4: GHESKIO will maintain and expand supervision and on site training for ART services at 22

main sites supported by PEPFAR for QA/QC/QI using a national framework and tools that MOH, CDC, and

key stakeholders have started to develop. This will be supported through three mobile teams. The main

items covered by this funding will include: support for mobile teams, per diem, lodging, logistics for visits,

materials for supervision and training. A quality manager team will be created at GHESKIO to oversee the

QA/QI system.

ACTIVITY 5: Funding will be used to make St Michel Hospital, the South East departmental hospital a

center of excellence for the South East Department. This new activity is necessary to continue the

decentralization of ARV services and to serve as a model for extending services to peripheral sites. In this

capacity, St Michel Hospital will be a regional reference and training center, offering training sessions and

supervision for peripheral centers in their area of influence.

New/Continuing Activity: Continuing Activity

Continuing Activity: 17181

Continued Associated Activity Information

Activity Activity ID USG Agency Prime Partner Mechanism Mechanism ID Mechanism Planned Funds

System ID System ID

17181 4341.08 HHS/Centers for Groupe Haitien 7682 3315.08 $6,620,000

Disease Control & d'Etude du

Prevention Sarcome de

Kaposi et des

Infections

Opportunistes

9282 4341.07 HHS/Centers for Groupe Haitien 5124 3315.07 $5,150,000

Disease Control & d'Etude du

Prevention Sarcome de

Kaposi et des

Infections

Opportunistes

4341 4341.06 HHS/Centers for Groupe Haitien 3315 3315.06 $4,200,000

Disease Control & d'Etude du

Prevention Sarcome de

Kaposi et des

Infections

Opportunistes

Table 3.3.11:

Funding for Care: TB/HIV (HVTB): $620,000

The narrative will be modified in the following way:

Activity 1

GHESKIO will implement tuberculosis (TB)/HIV services to the prisoners at the at the national prison at Port

au Prince in collaboration with the National TB Program. These resources will be linked to HIV resources to

ensure that all prisoners get HIV and TB screening. Infected patients will be provided appropriate TB and

HIV care and support within the prison health facility. GHESKIO ensure training and supervision of the

personnel of this facility to deliver these services. GHESKIO will also work with Partnership For Supply

Chain Management (PFSCM) to ensure the provision of necessary commodities and drugs for this program.

Activity 2

GHESKIO will collaborate with stakeholders to develop protocol and plan to treat patients with TB and HIV

co-infection at the HIV units. This will include building human capacity, tools and logistic at the HIV units to

deliver TB services.

Activity 3

As preliminary data from a national survey has shown a high prevalence rate of multi-drug resistant (MDR)-

TB (3%) in patients never treated before for TB, GHESKIO will work with MOH and stakeholders to develop

plan to monitor resistance among TB resistance among HIV patients and develop National guidelines to

standardize MDR /TB management.

SUMMARY:

With COP 09 resources, GHESKIO will continue to integrate TB screening, prophylaxis and treatment in its

network of HIV clinics and pursue the development of the Sigueneau public Hospital, a stand alone TB site,

to become a national center of excellence for the management of TB/HIV co-infection with the capacity to

offer antiretroviral therapy (ART) and TB treatment at a single site, and offer treatment for patients with

MDRTB. Siguenau Hospital will be the second site in Haiti capable of offering care to patients with MDRTB.

Emphasis areas for these activities will cover: community mobilization and participation, development of

network and referral center, human resources, logistics, infrastructure, needs assessment, policy and

guidelines, supervision for QA/QC/QI and training. Specific target population will be the HIV+ TB clients

attending Siguenau hospital and referred patients with TB/HIV requiring HAART and hospitalization. In

addition Siguenau will serve as a national training center for the management of TB/HIV co-infection and

MDRTB. These activities will be integrated with other HIV related activities (ART, Palliative care, CT and

PMTCT) supported by PEPFAR and the Global Funds thru GHESKIO and other lead HIV and TB partners.

BACKGROUND:

GHESKIO is one of the two lead NGOs that have implemented in Haiti integrated model of HIV services.

Actually with existing resources, GHESKIO is expanding its integrated model to 16 ART sites, including

seven major public hospitals. In this network, efforts were made to integrate TB/HIV activities focusing on

TB screening, prophylaxis and treatment for HIV patients.

Siguenau is a TB stand alone public hospital located in the West department. It offers, with support of

GFATM, CT services. This hospital is ideally located to serve as a referral center for HIV infected patients

with TB requiring HAART and for those with MDRTB. The treatment of patients co-infected with HIV and TB

is complicated and requires an experienced team. At present, there is no standardized treatment for such

patients. Studies done at GHESKIO centers showed that: 1) over one third of persons coming to VCT for

HIV testing who present with cough have active TB 2) Up to 50% of TB patients seen at our facility were

HIV infected and 3) in Port au Prince, up to 10% of HIV+ patients who were never treated for TB developed

associated MDRTB « AIDS 2006, Vol 20 No 3 ». The West Department, where Siguenau hospital is

located, is the most populated region in Haiti and has the highest prevalence of both HIV and TB in the

country. In Haiti at present, only GHESKIO offers a complete laboratory diagnosis for mycobacteria

including MDRTB, and only the PIH clinic in Cange located in the Center department offers care for patients

with MDRTB. Because the site in Cange is far from Port-au-Prince, most patients diagnosed with MDRTB in

the West Department do not want to go to the Center Department to receive inpatients therapy away from

their family for two years.

Strategies to diagnose and manage co-infection TB/HIV are an integral part of the National Strategic Plan.

Main project objective

The main intervention objective is to support the National Tuberculosis Program in order to reduce

morbidity ,mortality and transmission of Tuberculosis disease, to reduce the burden of TB/HIV coinfection

and to prevent the development of drug resistance

ACTIVITES AND EXPECTED RESULTS:

ACTIVITY 1: TB/HIV CARE AND TREATMENT INTEGRATION

In collaboration with the National TB Program, GHESKIO will help the MOH evaluate a National Plan to

Control HIV/TB in development with support from the GFATM.

1) Screen for HIV all patients with TB and screen for TB all patients with HIV.

2) Organize the treatment of both HIV and TB at ONE single site.

Since TB is the main OI in this setting it would make sense that both TB and HIV be treated at HIV centers

where ART is available. However, for practical reasons TB centers caring for 300 or more TB patients per

year should have the capacity of providing ART as well. For TB centers with less than 300 patients per year

a referral system will be set-up in each department to determine the closest place where both TB treatment

and ART are available.

ACTIVITY 2: IMPROVING TB/HIV CONTROL STRUCTURE INTEGRATON

GHESKIO TB specialists will participate in the MOH effort to establish national guidelines for the

management of TB/HIV co-infection.

Activity Narrative: ACTIVITY 3: REINFORCING TB PREVENTIVE THERAPY

GHESKIO 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. Resources will be used to build human capacity, reinforce

infrastructure and work with PEPFAR to ensure adequate provision of PPD tests and related commodities

including INH for prophylaxis. Based on needs assessment, IMIS will be reinforced with chest X-Ray

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

all the TB sites thru the TB/DOTS program financed by the Global Fund.

ACTIVITY 4: CAPACITY BUILDING

GHESKIO will reinforce Siguenau hospital with a multidisciplinary team of MDs, nurses, pharmacists, social

workers, laboratory technicians and field workers to maintain and expand ARV services to TB patients that

will be initiated this year with 09 resources.

ACTIVITY 5: TRAINING

GHESKIO will continue to reinforce Siguenau Hospital to become a training center. The resource capacity

of this facility will be improved by DOTS training staff, TB/HIV training and the management MDRTB(DOTS

PLUS). Resources will be allocated for training sessions including equipment and training materials as well

as logistic costs for participants. GHESKIO will coordinate this activity with other network of TB and HIV

clinics to offer comprehensive training in HIV and TB management to healthcare providers at HIV and TB

sites in collaboration with the TB National Program, the HIV national program and Partners in Health (PIH).

ACTIVITY 6: ENHANCING GHESKIO LAB CAPACITY

This activity will consist in the provision of support for the diagnosis of mycobacterium species including

MDRTB at GHESKIO. GHESKIO is the only site in Haiti capable of documenting the diagnosing of

mycobacterium tuberculosis and other mycobacteria by culture and, the only site in Haiti with the capacity to

diagnose MDRTB. GHESKIO will obtain the necessary reagents and supplies needed to diagnose MDRTB

in patients who fail conventional TB therapy. This will be integrated in the national plan for MDRTB

monitoring that will be developed. Actually 3 confirmed MDR patients has been placed under second line

treatment . Siguenau hospital's capacity will be reinforced to become a specialized and a national reference

center providing care to patients with MDRTB. Two GHESKIO clinicians recently trained at the New York

City Health Department in the management of patients with MDRTB will be assigned to the Siguenau

hospital.

ACTIVITY 7 : MDR/TB AND XDR

The magnitude of MDR problem is still unknown in Haiti. Therefore Gheskio is emphasizing partnership with

the National Tuberculosis Program by

1) Preliminary data from a national survey has shown a high prevalence rate of MDRTB (3%) in patients

never treated before for TB. It will be probably higher if we consider that only patients with positive smear

were enrolled, excluding most of HIV infected patients. Prior studies have already shown high association of

MDRTB with HIV. With COP09 funding, we will expand the survey enrolling all patients seen at the first visit

in a TB clinic.

2) Working closely with NTP to develop National guidelines to standardize MDR /TB management.

3) Increasing TB Program effectiveness in managing MDR patients and implementing infection control

steps to prevent XDR

4) Setting up an action plan to enroll on MDR treatment 12 patients per year. Three have already started

treatment at Sigueneau Hospital.

ACTIVITY 8: STRENGTHENING THE PENITENTIARY CENTERS

In collaboration with the Penitentiary health authorities Gheskio will participate in building capacity of the

centers and especially the main prison of the system located in Port-au-Prince. Thus GHESKIO will

participate in reinforcing the structure and provide the following services:

1) Penitentiary staffing

2) Training in co-infection TB/HIV and ART.

3) TB testing and treatment through DOTS strategy

4) HIV testing and ART

5) TB and HIV prevention package

6) Supervision at the National Penitentiary of Port-au-Prince. MDR inmates detected at Hinche prison will

be taken care and supervised in collaboration with Zanmi la Sante of Cange.

New/Continuing Activity: Continuing Activity

Continuing Activity: 17180

Continued Associated Activity Information

Activity Activity ID USG Agency Prime Partner Mechanism Mechanism ID Mechanism Planned Funds

System ID System ID

17180 9672.08 HHS/Centers for Groupe Haitien 7682 3315.08 $600,000

Disease Control & d'Etude du

Prevention Sarcome de

Kaposi et des

Infections

Opportunistes

9672 9672.07 HHS/Centers for Groupe Haitien 5124 3315.07 $500,000

Disease Control & d'Etude du

Prevention Sarcome de

Kaposi et des

Infections

Opportunistes

Table 3.3.12:

Funding for Care: Orphans and Vulnerable Children (HKID): $300,000

SUMMARY

Activities listed below are aimed at improving the quality of life of orphans and vulnerable

children/adolescents affected and infected by HIV/AIDS as well as preventing the HIV infection in

adolescents with risky behaviors to acquire it. Three levels of interventions are considered: child /adolescent

level, caregiver/family level, system level. All interventions are conceived to create opportunities for OVC to

grow, develop and meet their age - specific needs, to build capacity system for long term sustainability of

care while insuring Emergency Plan policies. Activities will be conducted at GHESKIO using the following

strategies: 1) continuous identification of OVC 2) Voluntary Counseling Testing 3) continuous training for

peer educators; 4) referral system implementation 5) educational sessions 6) therapeutic support groups 7)

STD's care 8) HIV/AIDS/TB care including ARV treatment 9) incentives to help increase adherence among

adolescents 10) nutritional support 11) shelter/home for children living in the streets 12) educational support

13) socio-cultural and recreational activities.

BACKGROUND

During the current year (2008), 4646 OVC have been identified and followed at GHESKIO Centers, among

those 639 are HIV infected. Besides this follow up activity, HIV preventing services targeted adolescents

specifically were given. Activities related to adolescents were funded by UNICEF. Strong collaboration has

been established between GHESKIO and other organizations working with OVC such as Lakay, Lakou,

CAFA (Centre d'Action Familiale), CAD (Centre d'Action pour le Développement), CARITAS, TIMTATEK (Ti

Moun Kap Teke Mab), Centre d'Accueil à Carrefour and Arc-en-ciel which were highly beneficiating from

GHESKIO's expertise to improve their institutional activities.

ACTIVITIES AND EXPECTED RESULTS

We will carry out seven (7) separate but linked activities in this Program Area

ACTIVITY 1: Food and Nutritional Support

- Nutritional assessment will be provided in order to identify malnourished children based on anthropometric

assessment and World Health Organization (WHO) guidelines

- Counseling on nutrition, weaning foods, water purification, and food preparation techniques will be

provided to families/guardians

- Children under 2 will benefit a complete nutritional package: supplementary and fortified weaning foods

(for example: medikamanba, fortified cereals blend) to prevent malnutrition will be provided; mothers /

guardians clubs will meet on a monthly basis for educational sessions

- Supplementary and therapeutic foods as well as multivitamins, micronutrients will be provided to children

identified as malnourished

- Older OVC will be linked to other organizations food providers collaborating with GHESKIO, food will be

delivered on site

- Technical guidelines, training curricula and job aids for nutrition assessment and counseling will be

developed for clinical providers and nutrition counselors.

Funds of this program will be used to support a nutritional coordinator and 2 counselors, to provide fortified

weaning food, therapeutic and supplementary feeding of malnourished children, to develop training and

counseling materials and to support training sessions for health care providers

ACTIVITY 2: Shelter and Care

- Identification of family members as caregivers to provide access to shelter for orphans at the parents'

death.

- Assistance and support to family members who provide access to shelter for orphans at the parents'

death.

- When family options are not available, HIV/AIDS children living in the streets who are followed actively in

the adolescent clinic at GHESKIO will be placed to live in a dormitory located in other collaborating

organizations (Lakou, Lakay, TIMTATEK, Centre d'Accueil, Arc en ciel for examples) that provide shelter for

this category of children.

Funds of this program will be used to provide family support, to cover the care for children through these

organizations

ACTIVITY 3: Protection

- On going identification of OVC through VCT, PMTCT, ARV programs. At least 1000 new OVC will be

identified during the year period.

- Facilitation of basic birth registration. Parents/guardians will be informed and motivated to legally register

their children and fees registration will be paid for them as needed.

- Estimation of the long term access to education, health care.

- Creation of a Community Advisory Board (CAB) formed of teachers, parents/guardians, health care givers,

adolescents that will serve as a Child / Adolescents Protection Committee. GHESKIO will be counseled on

the best way to help OVC meet their needs by the CAB, whose mission will be advocating and advising.

Funds of this program will support statistical system to identify OVC, transportation fees to referral places

for basic birth registration, the CAB Coordinator and support group meeting with the CAB.

ACTIVITY 4: Healthcare

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

Immunization, growth monitoring, parasitic treatment (as needed), HIV and syphilis testing will be provided.

Children/adolescents infected with HIV will be placed on HAART.

ACTIVITY 5: Psychosocial support

- Psychosocial support for adolescents with bad adherence to treatment and for those which HIV status is

being or will be revealed will be provided. Support groups held at the clinic, animated by psychologists and

social workers with the participation of the peer educators will be continued.

- Educative age - specific materials will be provided, aimed to: a) support families and caregivers to better

manage stress and improve parenting when they are in situations of chronic illness; b) create therapeutic

activities that would contribute to help adolescents to express themselves without words; c) help parents

make their children under ten aware of having an incurable disease with an adapted language; d) to support

Activity Narrative: parents/caregivers during this difficult first step of communication about HIV disclosure. This strategy will

help to prevent risk behaviors and non adherence during adolescence.

-Socio-cultural and recreational activities to maintain adherence rate at a respectable level, engaging youth

and encouraging their enthusiasm and talents in non health-related interests will be continued.

Funds will be used to cover the salary of 2 social workers and 1 field worker; to create and reproduce

communication materials; to organize recreational activities held at GHESKIO or at other places. At least 4

activities will be organized for the OVC during the year period.

ACTIVITY 6: Education and Vocational Training

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

- 600 children/adolescents in needed followed at the clinic have been identified this year Funds will cover

the purchase of school tools, books, school attendance fees and uniforms.

ACTIVITY 7: Economic Opportunity/ Strengthening

Parents/guardians, older HIV/AIDS OVC will be linked to Private Sector in order to promote income -

generating activities, small business development, entrepreneurial skills.

Funds will cover transportation fees to referral sites.

New/Continuing Activity: New Activity

Continuing Activity:

Emphasis Areas

Human Capacity Development

Public Health Evaluation

Food and Nutrition: Policy, Tools, and Service Delivery

Food and Nutrition: Commodities

Economic Strengthening

Education

Estimated amount of funding that is planned for Education $50,000

Water

Table 3.3.13:

Funding for Laboratory Infrastructure (HLAB): $400,000

SUMMARY: The goal of these activities is to strengthen National Public Health Laboratory (NPHL) capacity

by providing continuing technical assistance in the areas of Dried Plasma Spot (DPS) Quality Assurance for

HIV antibody testing, and whole blood syphilis testing. GHESKIO will also support laboratories at PMTCT,

VCT, ARV, and palliative care sites through training and technical assistance in diagnostic tests used for

diagnosis and follow up. The main emphasis for these activities is continued training, technical assistance

for quality assurance/quality control and equipment maintenance for GHESKIO laboratories. These

activities will involve NPHL, GHESKIO, and designated sites. The specific target population includes public

and private health care workers nationwide.

BACKGROUND: Many activities in COP09 are a follow up of activities conducted in 2007 and 2008 as part

of NPHL's objective to develop and provide QA/QC services to sites providing HIV-related testing in Haiti.

Through these activities, GHESKIO will continue to build the NPHL's capacity by mastering and transferring

to NPHL the capacity for HIV screening using DPS (re-testing activity). These activities will improve the

capacity of NPHL to provide quality control of laboratory results in healthcare facilities nationwide.

ACTIVITIES AND EXPECTED RESULTS

ACTIVITY I: This activity is to continue providing competency assessment yearly for 200 healthcare workers

with the collaboration of NPHL on DPS processing and HIV whole blood testing. It will build on the previous

year's activity to assist NPHL in the implementation of the DPS HIV testing. Corrective action and retraining

based on competency assessment results will be provided. GHESKIO mobile team will only be in charge of

the assessment of the healthcare workers of GHESKIO network. NPHL will be responsible for the MOH

network.

ACTIVITY II: GHESKIO will continue providing QA/QC assistance in whole blood rapid syphilis testing to

NPHL and the MOH lab network.

ACTIVITY III: GHESKIO will prepare a 1-week refresher workshop for the 10 trainers of the NPHL trained

during the COP08 activities. These trainers had previously been trained in CD4 T-cell count determination

by flow cytometry, ELISA, Western Blot, and p24 antigen assay. During this refresher workshop, the skills of

these trainers will be assessed and new recommendations will be made to the NPHL based on the trainers'

performance.

ACTIVITY IV: GHESKIO will follow up with the initial training to train all new national lab staff in diagnosis of

opportunistic infections, TB culture, TB drug resistance testing (4 weeks) in collaboration with American

Society of Microbiology (ASM) and Association of Public Health Laboratories (APHL) who will provide on-

site technical assistance to the national lab for TB, bacteriology, and parasitology. This joint effort is aimed

to enable the national lab to function in these laboratory areas in a timely manner.

ACTIVITY V: With the support of the CDC GAP International Lab Branch EID and PEPFAR LTWG,

GHESKIO will participate in performance evaluation of the 2 laboratories (GHESKIO/IMIS and NPHL)

previously trained in DBS-PCR for early infant diagnosis of HIV. Corrective action and troubleshooting will

be conducted. GHESKIO and NPHL will participate in a proficiency testing program provided by WHO and

CDC.

ACTIVITY VI: GHESKIO will develop drug resistance testing capacity to monitor HIV/AIDS patients

receiving ART by following the WHO/CDC criteria and monitoring treated patients. Based on preliminary

data at GHESKIO, we anticipate that 5% per year of the patients receiving antiretroviral therapy (ART) will

meet WHO eligibility criteria for ART failure. We will collect and freeze plasma specimens from an estimated

500 patients who meet WHO criteria for failure in order to perform HIV drug resistance testing. Funds are

requested for 2 laboratory technicians performing this technique. This activity will help better define the

demographic and clinical characteristics of patients who fail ART so that new better adapted guidelines for

monitoring patients on ART can be drafted. The drug resistance mutations identified will help better tailor

second-line antiretroviral drug regimens for patients failing ART in Haiti. Finally, this service will allow us to

increase capacity for virologic testing in Haiti and to train new technicians in these tests.

ACTIVITY VII: GHESKIO will provide laboratory support for four ART sites in its network. GHESKIO will play

an active role by improving laboratory infrastructure, upgrading the facility, and hiring additional lab staff to

make laboratories at these facilities ready for becoming ARV sites.

ACTIVITY VIII: GHESKIO will hire 1 biomedical engineer assisted by 1 electrician to increase its capacity of

the Biomedical Engineering Unit. Funds are also requested for the current personnel of this unit. This staff

will receive training on maintenance, repair and troubleshooting of mechanical and automated analyzers

used in the network (Point Care, Sysmex, Reflotron, ELISA plate reader, Facs Count).This staff will be

available to assist the national lab biomedical engineer unit providing services as deemed necessary.

ACTIVITY IX: GHESKIO will provide a refresher workshop to 2 laboratory technicians per site in the network

(total of 32 technicians) to perform instrument check and preventive maintenance. All public sites will be

covered by NPHL. GHESKIO will send its Biomedical engineering staff to assist the national lab with the

training of lab equipment maintenance at the national lab.

ACTIVITY X: NPHL will be in charge of equipment maintenance of the MOH Network. The GHESKIO

maintenance staff will serve as a backup for the National Laboratory and will be responsible for

maintenance and service of equipment in the GHESKIO network. Twice a year, GHESKIO staff will verify

the equipment maintenance activities in the GHESKIO laboratory network (16 sites: 8 private and 8 public)

including equipment cleaning, adjustment and replacement of parts, functional checks, temperature

recording, troubleshooting activities, calibration of equipment and record verification. This activity will be

introduced to other national laboratory networks in order to improve lab system quality.

ACTIVITY XI: GHESKIO will acquire one additional hematology instrument to increase the capacity of the

Activity Narrative: laboratory and for better follow up of patients receiving ART.

New/Continuing Activity: Continuing Activity

Continuing Activity: 17182

Continued Associated Activity Information

Activity Activity ID USG Agency Prime Partner Mechanism Mechanism ID Mechanism Planned Funds

System ID System ID

17182 4601.08 HHS/Centers for Groupe Haitien 7682 3315.08 $388,000

Disease Control & d'Etude du

Prevention Sarcome de

Kaposi et des

Infections

Opportunistes

9283 4601.07 HHS/Centers for Groupe Haitien 5124 3315.07 $400,000

Disease Control & d'Etude du

Prevention Sarcome de

Kaposi et des

Infections

Opportunistes

4601 4601.06 HHS/Centers for Groupe Haitien 3315 3315.06 $0

Disease Control & d'Etude du

Prevention Sarcome de

Kaposi et des

Infections

Opportunistes

Table 3.3.16:

Funding for Health Systems Strengthening (OHSS): $150,000

This project will support the national HIV prevention and care program by proposing a response to the

crucial shortage of physicians in some areas. Most of the graduate physicians leave the country after their

training. More than 75% of those remaining in the country leave in the metropolitan area. The nurses are by

far the best personnel available, capable to offer good care with a short and appropriate training. A twelve

months curriculum is ready allowing the selected nurses to work closely with patients at GHESKIO during

six months and to complete their academic skills during the next six months at Quisqueya. This program will

be certified by the national authorities. Particular attention will be paid to encouraging beneficiaries to go

back in their origin site.

We will carry out separate activities in this Program Area.

ACTIVITY 1: The first activity is to provide scholarship to selected nurses allowing them to be able to afford

the intensive twelve months curriculum. Most of them will come from cities away from the capital. This

funding will go specifically to support lodging and per diem fees during the training time.

ACTIVITY 2: The second activity is to assure the correct execution of the educational and training program.

GHESKIO and Universite Quisqueya will host the beneficiaries during twelve (12) months for a dynamic and

interactive curriculum aiming to offer them all the skills to be able to carrying HIV patients without

complications. This funding will go specifically to support training activities, teaching materials, salaries for

two job training mentors, teachers. This activity will be initiated in 2009, and the first graduates will be ready

to strengthen the national health program in 2010.

New/Continuing Activity: Continuing Activity

Continuing Activity: 17183

Continued Associated Activity Information

Activity Activity ID USG Agency Prime Partner Mechanism Mechanism ID Mechanism Planned Funds

System ID System ID

17183 15465.08 HHS/Centers for Groupe Haitien 7682 3315.08 $300,000

Disease Control & d'Etude du

Prevention Sarcome de

Kaposi et des

Infections

Opportunistes

15465 15465.07 HHS/Centers for Groupe Haitien 5124 3315.07 $150,000

Disease Control & d'Etude du

Prevention Sarcome de

Kaposi et des

Infections

Opportunistes

Table 3.3.18:

Subpartners Total: $0
Hôpital la Providence des Gonaïves: NA
Justinian University Hopital : NA
Justinian University Hopital : NA
Hospital Evang. Bompbardopolis: NA
Hospital Saint Antoine de Jeremie: NA
Hôpital Immaculée Conception des Cayes: NA
Hopital Saint Michel de Jacmel: NA
Centre Eliazair Germain: NA
Hopital Signueau: NA
Centre Bernard Mews: NA
Fame Pereo: NA
Hopital Communauté Haitienne: NA
Hopital de Fermathe: NA
Food for the Poor: NA
Cross Cutting Budget Categories and Known Amounts Total: $1,000,000
Human Resources for Health $900,000
Food and Nutrition: Policy, Tools, and Service Delivery $50,000
Education $50,000