Cameroon (Total GHCS-State: $500,000)

HHS/CDC ($355,000): The FY2009 funding for CDC PEPFAR activities will support prevention of mother-to-child transmission (PMTCT) and strategic information (SI) activities. CDC will work to expand and improve the quality of infant follow-up and early infant diagnosis (EID) and will support the development of a national PMTCT facility listing that includes the level of service and capacity of each site. CDC will also contribute to the improvement of the Cameroon HIV/AIDS surveillance system, hold training sessions for national monitoring and evaluation (M&E) staff, and provide technical assistance to the Ministry of Public Health to enhance their ability to use strategic information for program and policy development.

Peace Corps ($50,000): The FY2009 PEPFAR funding for Peace Corps will further support and build upon Peace Corps's existing HIV/AIDS interventions and allow expansion of HIV/AIDS prevention activities (focusing on both abstinence and be faithful (AB) as well as other prevention messages) and care activities. Primary intervention areas include: training activities targeted at religious leaders and partner country nationals; Volunteer Activities Support and Training (VAST) grants; and educational material production and dissemination.

USAID ($95,000): The supplies will be used to support the National Early Infant Diagnostic (EID) Program, which provides the laboratory diagnostics for the following Regions in Cameroon: Northwest, Southwest, West, and Litorral. Supplies will also be used for proficiency testing and to support quality assurance in laboratories.

Djibouti (Total GHCS-State: $150,000)

DoD ($150,000): FY 2009 funds will be used to support the activities of the Office of Security Cooperation of the U.S. Embassy in Djibouti. These activities include: BCC campaigns; training of laboratory technicians and nurses on blood safety and best laboratory practices; purchasing of medical (diagnostic) material to improve clinical capability of treating infected people; female peer education sessions for military wives; HIV prevalence survey among members of the Djibouti Ministry of Defense (MoD); and a Knowledge, Attitude and Practices survey for members of the Djibouti MoD.

Liberia (Total GHCS-State: $800,000)

USAID ($450,000): USAID plans to develop and manage several sub-grants to implement HIV/AIDS prevention and care activities, focusing on women and youth as well as technical support for other organizations working in Liberia. In addition to supporting youth-friendly prevention programs, USAID will also contribute to programs that address the needs of OVCs. USAID plans to work with women's and community-based organizations, and to interact with government officials to promote women's health advocacy as well as the integration of family planning and reproductive health services with HIV/AIDS and other health service programming. USAID also plans to fund advocacy activities to fight the stigma surrounding HIV/AIDS and to promote both social cohesion on prevention, care and treatment as well as networking among HIV/AIDS providers and stakeholders. Finally, USAID plans to provide technical support to community and faith-based organizations, and church-supported health and social programs to improve the quality and accessibility of HIV/AIDS counseling, testing and outreach services, establish quality networks, and improve capacity for monitoring of performance, and for sustaining programs.

DoD ($350,000): The DoD HIV/AIDS Prevention, Care and Treatment Program for the Armed Forces of Liberia (AFL) plans activities including: conducting sensitization and prevention education and training, building laboratory capacity, and promoting the development of sound HIV/AIDS policy for the AFL. Resources will be used to expand the DoD and AFL HIV/AIDS Prevention Program, which targets AFL members as well as their spouses and adolescent children and works towards reducing sexual behaviors that increase the likelihood of the transmission of HIV and other sexually transmitted infections (STIs) by conducting sensitization and education activities and utilizes radio programs to air prevention messages. DoD also plans to strengthen the AFL's capacity by providing technical support and training to peer educators to promote positive sexual behavior and address stigma and discrimination. The Ministry of Health (MoH), in partnership with DoD, will train combat medics in prevention and management of STIs, provision condoms, referrals to voluntary counseling and testing (VCT) sites. Additionally, a laboratory with trained technicians and equipment to test for HIV/AIDS will be provided. Finally, DoD will also assist in the development of HIV/AIDS policies for the AFL by establishing a steering committee to include member organizations, collaborating with relevant national and multilateral stake-holders, consulting technical experts, and establishing the foundation for sustained partnership with local and international non-governmental organizations (NGOs).

Madagascar (Total GHCS-State: $500,000)2

USAID ($500,000): In collaboration with international NGOs working in Madagascar, USAID plans to continue to scale up innovative and successful behavior change communication (BCC) interventions that reach the population with HIV/AIDS information and services with appropriately tailored Abstinence, Be Faithful and correct and consistent Condom use (ABC) messages. Target audiences include youth, with attention given to rural populations, as well as other high-risk populations such as mobile men, commercial sex workers (CSWs), and men who have sex with men (MSM). Also, there will be work to expand a network of franchised private clinics providing quality youth-friendly services including HIV testing, peer education, and mass media campaigns, to a total of nine vulnerable cities.

Mali (Total GHCS-State: $1,450,000)

HHS/CDC ($1,450,000): In Mali, CDC funding will be used to cover the cost of one Resident Advisor who acts as both the Director and Deputy Director of the CDC Global AIDS Program in Mali, one (proposed) Senior Technical Advisor, and six locally-employed staff (LES), including two drivers, two administrative staff, an NGO liaison coordinator and a lab director. CDC will also provide technical assistance to local NGO partners as well as to the Government of Mali's National Institute of Public Health Research. All field-based technical assistance (TA) is in turn supported by centrally-funded TA, particularly in the Lab and Epidemiology/Strategic Information Branches of GAP. Though no national HIV-related surveys are planned for 2010, the program will continue supporting the 2009 sentinel and behavioral surveys through assistance with the validation and dissemination of survey results and any other TA and logistics associated with the completion of these studies in FY 2010. Further, PEPFAR funds will be utilized to undertake qualitative research which will inform the review/choice of high-risk target groups for the next round of Integrated STI Prevalence and Behavior Survey. This survey will provide essential data to prioritize HIV prevention and care interventions and informs effective HIV policymaking.

Senegal (Total GHCS-State: $1,535,000)

USAID ($1,168,607): PEPFAR funds will be used to strengthen the capacity of the health system and local NGOs to deliver quality prevention and treatment services targeting high-risk groups, including CSWs, MSM, military personnel and mine workers. Due to increased mining activities in Southeastern Senegal, USAID will direct HIV/AIDS prevention activities and capacity-building support to that region. USAID will support a second combined surveillance survey for high risk groups. Building on abstinence and fidelity messages, USAID will redouble efforts to reach individuals with prevention interventions focusing on condoms. In addition, USAID is a service provider for quality VCT, care, and supportive services to fight discrimination and stigmatization. In general, USAID continues to work towards the institutionalization of quality prevention, care and support services for people living with HIV/AIDS (PLWHA), and to strengthen information systems to achieve sustainability. Information system strengthening activities include capacity building for the M&E unit of the National AIDS Council and the HIV/AIDS division to plan, monitor, report and analyze data for decision making, and technical assistance to the support group for epidemiological surveillance.

HHS/CDC ($66,393): CDC will support the 2009 national sentinel survey in Senegal as part of a three-pronged strategy Senegal uses to accurately measure HIV prevalence in the country. In support of the survey, CDC plans to purchase laboratory equipment and consumables and to provide logistical support and training.

DoD ($300,000): The partnership between DHAPP and the Senegalese Armed Forces (SAF) will continue to focus on the testing and counseling of military personnel that are deployed on peace-keeping missions to countries that have higher prevalence rates. DHAPP and SAF will extend their cooperation to increase the number of service provider outlets, train peer educators, and continue to counsel and test military personnel as well as provide care and prevention messages to them and their families.

Sierra Leone (Total GHCS-State: $500,000)

HHS/CDC ($500,000): CDC is committed to strengthening Sierra Leone's health system by supporting effective and reliable diagnosis, treatment and surveillance for HIV/AIDS. CDC assistance will contribute to building laboratory capacity by facilitating the establishment of a national laboratory policy and strategic plan that will serve as a blueprint for strengthening laboratory services, and by providing TA to improve HIV laboratory services and HIV surveillance system. CDC will also take the lead in monitoring and supervising sentinel major surveillance survey and in the development of a standard check list for supervisory visits, which will improve diagnosis, testing, data collection and quality control and assurance measures. In addition, public health personnel and laboratory managers will be trained in laboratory management, including good management practices. Finally, CDC will also support senior officials of the MoH to attend international trainings and conferences to strengthen their leadership and technical capacity to enhance laboratory and surveillance services.

2 The proposed interventions focus entirely on providing services through non-governmental channels, thus taking into account the memo sent to Secretary Clinton regarding the need to invoke Section 7008 of the Department of State, Foreign Operations, and Related Programs Appropriations Act of 2009 in the case of assistance to Madagascar. US foreign assistance programs are still under review by State Department and a final decision could affect the program options proposed in this document.

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