Guyana FY 2006 Country Operational Plan (COP)


GUYANA

Project Title: Guyana FY 2006 Country Operational Plan (COP)

Budget Summary:

 
Field Programs Funding by Account
Central Programs Funding by Account
 
 
Notified as of May 2006
Current Notification August 2006
Current Notification August 2006
 
Implementing Agency

GAP

GHAI

Subtotal:
Field Programs Funding by Account

GHAI

GAP

New Subtotal: Field Programs Funding by Account

GHAI Central Programs

Total Dollars Allocated: Field & Central Funding

DOD

-

359,000

359,000

-

-

359,000

-

359,000

DOL

-

150,000

150,000

-

-

150,000

-

150,000

HHS

1,000,000

7,174,000

8,174,000

(175,000)

-

7,999,000

1,182,800

9,181,800

Peace Corps

-

267,000

267,000

-

-

267,000

-

267,000

State

-

50,000

50,000

-

-

50,000

-

50,000

USAID

-

10,000,000

10,000,000

175,000

-

10,175,000

1,544,316

11,719,316

TOTAL Approved

1,000,000

18,000,000

19,000,000

-

-

19,000,000

2,727,116

21,727,116

HIV/AIDS Epidemic in Guyana:

Adult HIV Prevalence Rate: 2.4% [1.0-4.9%] (UNAIDS 2006)
Estimated Number of HIV-infected People: 12,000 [4,700-23,000] (UNAIDS 2006)
Estimated Number of AIDS Orphans: N/A (UNAIDS 2006)

Country Results and Projections to Achieve 2-7-10 Goals:

Guyana Total # Individuals Receiving Care and Support Total # Individuals Receiving ART
End of FY 2004* 1,215 500
End of FY 2005** 6,200 800
End of FY 2006*** 1,695 1,200
End of FY 2007*** 2,000 1,500

*Results. "Engendering Bold Leadership: The President's Emergency Plan for AIDS Relief." First Annual Report to Congress submitted by the Office of the U.S. Global AIDS Coordinator, U. S. Department of State, March 2005
**Results. "Action Today, a Foundation for Tomorrow: The President's Emergency Plan for AIDS Relief." Second Annual Report to Congress submitted by the Office of the U.S. Global AIDS Coordinator, U. S. Department of State, February, 2006
***Projections from FY 2006 Country Operational Plan

Program Description:

Available evidence suggests that HIV/AIDS is a growing problem in Guyana, although the true extent of the problem is unknown because national sero-prevalence data and AIDS case reporting data is incomplete. By the end of 2001, the Ministry of Health (MOH) had recorded 2,185 cases (cumulative from 1987). The epidemic has become generalized, but the bulk of infections continue to be concentrated among high-risk groups. Females are increasingly affected by the disease, especially in the younger age groups. By 2001, the MOH reported that females made up 38 percent of all reported AIDS cases and, in the 15-24 age group, significantly more females than males have AIDS.

Prevention: $6,583,756 as of August 2006 ($4,013,000 Field and $2,570,756 Central) (37% of prevention, care, and treatment budget)

The Government of Guyana (GOG) has articulated a plan to offer prevention of mother to child transmission (PMTCT) services in 65 of a possible 118 national antenatal care (ANC) sites by December 2005 (USG contributing to 42 of these sites) and universal access for PMTCT by 2007. Currently, the PMTCT Labor & Delivery services are provided by five USG supported PMTCT sites and annually serve 80% of all deliveries. To contribute to these goals, the USG, in collaboration with the MOH, regional and district health authorities, health facility staff, people living with HIV/AIDS (PLWHA) and other community stakeholders, will utilize FY 2006 funding to facilitate expansion of PMTCT and follow-up services, and referral to antiretroviral therapy (ART) services offering a minimum package of services.

USG�s abstinence and be faithful (AB) activities directly support Guyana�s National Strategic Plan for HIV/AIDS. The results of the Emergency Plan (EP)-funded AIDS Indicator Survey (AIS) show that 74% of females and 64% of males between the ages of 15 and 19 never had a sexual encounter, but among the 20-24 year olds there is a sharp decline to 48% and 21% reporting the same behavior respectively. Conversely, 29% of youth aged 15-19 are sexually active.

Based on these findings, the President�s Emergency Plan (EP) in Guyana will use FY 2006 funds to support the MOH, faith-based and non governmental organizations (FBO, NGO) and a newly developing modeling and reinforcement program to encourage primary and secondary abstinence as well as the delay of sexual debut in schools, youth clubs, religious groups, and other organizations. FY 2006 funding will also support other prevention (OP) methods for high risk populations. While it is critical to educate women and young girls about safer sex practices, reproductive health, gender roles and the benefits of abstaining until marriage, it is equally critical to educate adult men and young boys so that the behaviors which fuel HIV transmission and other social and health challenges may be disrupted. �Be faithful� messages will complement abstinence messaging in groups of sexually active adults, encouraging mutual fidelity. Interventions will also discourage cross-generational sex and multiple partners among adult males, as studies have shown that cross-generational sex contributes to considerably higher rates of infection among girls and young women than among same-aged male peers.

Other prevention is critical in Guyana given that the bulk of existing and new infections continue to be concentrated among high-risk groups. A Behavioral Surveillance Survey and targeted prevalence surveys completed by USG/Guyana in 2005 identified key Most-At-Risk Populations (MARPS): sex workers, men who have sex with men (MSM), PLWHA, and �mobile� persons such as miners, loggers, sugar cane workers, transport industry workers, and migrants crossing the Brazil border. The USG team is supporting both risk elimination and risk reduction, and interventions with MARPS will follow the �ABC� model, with the emphasis on �BC� for these groups. High-risk populations will also be reached with combined targeted outreach and referrals to �friendly� clinical care and treatment services. An important component of Guyana�s EP prevention program is services for PLWHA and those affected by HIV/AIDS. Reinforcing �prevention for positives� and for sero-discordant couples helps PLWHA prevent secondary infection and further transmission of HIV.

An important aspect of the President�s Emergency Plan for AIDS Relief is to provide assistance to ensure a safe and adequate blood supply. Currently there are nine sites in Guyana (public and private) that perform blood collection and storage services in the country, and 10 that perform blood transfusions. A joint assessment by the CDC and MOH/National Blood Transfusion Service (NBTS) in December of 2003 showed that 14 percent of the population had no regional blood transfusion facility and there is a documented need in Georgetown. The USG will use FY 2006 funds to support development and management of an improved system.

Based on data from the AIS, health care workers have frequent potential exposures. The annual number of documented needle-stick injuries per injection provider is 38, and only 25 percent of facilities keep records of such injuries. Only 43% of injection providers have access to Post Exposure Prophylaxis drugs onsite. Finally, risks to waste handlers underscore the need for waste disposal site development with sustainable, appropriate technology. FY 2006 funding will support the Guyana Safe Injection Program (GSIP) project in order to help prevent the transmission of HIV and other blood borne diseases through accidental sharps injuries. The target populations are health care staff that prescribe, provide or dispose of injection equipment and clients from the general population. The three main components to be funded this year address commodity management, waste disposal and behavior change and advocacy. These strategies were informed by the results of a quantitative and qualitative national assessment.

In the May 2006 notification an additional $500,000 was allocated for prevention activities. The additional funds will support PMTCT in three ways: 1) increased support to the five major labor and delivery wards to increase their capacity to effectively serve their high patient load and also to explore extending at least one additional labor and delivery ward in coordination with MOH planning; 2) extension of care and treatment services to several PMTCT sites and program development to support the MOH with screening of newborns for HIV at well baby clinics and health centers; and 3) a comprehensive assessment of the PMTCT program in May-June 2006.

In August 2006, an additional $104,003 was allocated for prevention. Of the amount, $59,000 will be used to increase PMTCT services by USAID through GHARP, the World Bank, and UNICEF and to support field staff, supplies (including breast milk substitute) and program monitoring.

Principal Partners: Center for Disaster and Humanitarian Assistance Medicine, Comforce, Family Health International (FHI), Maurice Solomon Accounting, Oak Ridge Institute of Science and Education, The Guyana Red Cross Society, University of Michigan School of Public Health, Francois Xavier Bagnoud Center, Ministry of Health, Guyana, and Initiatives Inc.

Care: $4,185,000 as of August 2006 ($4,185,000 Field and $0 Central) (23.5% of prevention, care, and treatment budget)

It is estimated that there are over 3,500 persons living with HIV who are antiretroviral (ARV)-eligible. Last year, the Guyana HIV/AIDS Reduction and Prevention Program (GHARP) program referred 78 persons to treatment, and 400 more will need to be identified in FY 2006. Hence, the Plan�s funding in FY 2006 will focus largely on activities increasing the use and access to services including: expanding geographical coverage of counseling and testing, increasing coverage within high risk populations, increasing clients seen in some of the existing underutilized counseling and testing services, and promoting male access with focus on the workplace.

Palliative care responds to the treatment and support chapter of Guyana�s National Strategic Plan for HIV/AIDS 2002-2006. The goals under the USG contribution to the National Strategy are to provide the four categories of essential palliative care services that should be available to all people infected or affected by HIV/AIDS. In FY 2006, funds will support training providers as well as actual service delivery through NGO and MOH partners. Currently, there are eight EP-supported home-based care programs in place, with 127 trained providers caring for over 500 patients.

In addition to basic health palliative/care, the Plan�s FY 2006 funds will support care targeted towards tuberculosis (TB)/HIV patients. Guyana has been reported to have the fourth highest incidence of TB in the Americas, with 130 cases/100,000 or 900 new cases of TB per year (some of the increase in TB has been attributed to improved case identification and reporting). It is estimated that roughly 25-30% of all newly diagnosed cases are co-infected with HIV. HHS and its implementing organizations will support The Guyana National TB Control Program in FY 2006, which provides care and treatment for all TB cases in the country through six chest clinics operated in the more populous regions of the country. The Georgetown chest clinic serves as the central referral center and operates extension programs in two prisons.

In support of orphans and vulnerable children (OVC) and as defined in Guyana�s National Policy, the comprehensive response to OVC includes the following priority areas: socio-economic security, protection, care and support, education, health and nutrition, psycho-social support, legal support, conflict resolution, and education. UNICEF will be a strong partner in improving the policy and legislation, establishing mechanisms for monitoring and information exchange, and ensuring access to essential services. With FY 2006 funds, The Ministries of Labor, Human Services and Social Security and Education will be strengthened to coordinate and support preventative and care services to OVC, both in-school and out-of-school, and to enhance referral networks. A wide range of NGO and FBO partners will also be supported to continue their organizational capacity to deliver services, network with partners, ensure continuity of care, and responsibly report the support given to each OVC.

In the May 2006 notification, an additional $400,000 was allocated for care activities. The additional funds will be utilized to increase indigenous capacity to deliver counseling and testing. Furthermore, $150,000 of these funds will be used to establish a hospice/step-down care facility for patients with HIV/AIDS, in order to relieve the pressure on hospital wards and to ensure that patients get the transition care they need. In August 2006, $85,000 was reprogrammed from care activities to Management and Staffing to help cover the cost of a fellow position.

Principal Partners: Center for Disaster and Humanitarian Assistance Medicine, Comforce, Crown Agents, FHI, Maurice Solomon Accounting, Catholic Relief Services (CRS), United Nations Children�s Fund, Francois Xavier Bagnoud Center, and the Ministry of Health, Guyana.

Treatment: $7,020,360 as of August 2006 ($6,864,000 Field and $156,360 Central) (39.5% of prevention, care, and treatment budget)

The provision of quality HIV clinical care and access to free ART is at the core of the EP program. The Government of Guyana�s MOH initiated care and treatment in 2002 at a single site in Georgetown. By the end of September 2005, free care and ART will be available at six sites: five public and one private nonprofit. In addition, six additional MOH PMTCT sites have been selected to provide a family care approach to the provision of HIV counseling, testing and care, with one site providing ART. At the initiation of the EP program in October of 2004, there were approximately 230 patients on ART. As of August 2005 the number had increased to almost 800 and by September 2006 1,200 people are expected to be on treatment. To reach this goal, 12% of the total country budget in FY 2006 will be allocated for drug procurement. A satellite warehouse will be piloted to model best practices that can be transferred to the Government of Guyana. From its inception, the satellite will work hand in hand with the GOG and the Ministry of Health to transfer skills, develop distribution and information systems, revise standard operating procedures, and train staff. To support next years� procurement, processes have been identified to obtain and track clinical information. Information obtained will provide greater accuracy in quantification of the needs for the next procurement. These records will support the morbidity method to calculate items needed as well as support the clinical activities.

Prior to USG involvement, Guyana had limited capacity to conduct HIV surveillance, diagnose HIV infection, monitor patients on ART, and diagnose opportunistic infections and sexually transmitted infections. Since then a national algorithm for diagnosing HIV using rapid HIV tests has been implemented, CD4 testing essential for staging disease has become available, and a national HIV reference laboratory has been designed. FY 2006 funds will build on laboratory activities carried out last year and will rely on technical assistance from MOH, Fran�ois Xavier Bagnoud Center, CDC experts, and the American Society for Clinical Pathology (ASCP). With regard to the Reference Laboratory, the design process was completed in November 2005 and renovations at the Georgetown Public Hospital Corporation (GPHC) site are targeted to begin January 2006.

In the May 2006 notification, an additional $850,000 was being allocated for treatment activities. The additional funds will be used to procure drugs and strengthen the supply chain management system (SCMS) through technical assistance. This will address strengthening the standard operating procedures of SCMS and their information support systems. In addition, funds will be used to equip a 30-bed hospital ward for the Georgetown Public Hospital for the care of patients with opportunistic infections related to HIV. In August 2006, $20,000 was reprogrammed from treatment activities to PMTCT activities. Please note that pediatric AIDS funding that is attributed to OVC programs is included in the care program area total and is deducted from the treatment program area total.

Principal Partners: The Partnership for Supply Chain Management, Catholic Relief Services (CRS), Comforce, FHI, and Francois Xavier Bagnoud Center.

Other Costs: $3,938,000 as of August 2006

The USG will continue to work in close partnership with the Government of Guyana to ensure that the coordination of strategic information (SI) in Guyana�s HIV/AIDS sector is carefully and transparently monitored and assessed on a routine basis, and in full collaboration with all stakeholders. Utilizing FY 2006 funds, the USG team will build and expand upon existing SI activities, with an emphasis on creating sustainable capacity for SI. These activities will complement and support the strategic goals of the new national monitoring and evaluation (M&E) plan and national strategic plan for HIV/AIDS (2006-2010), and should be completed in early 2006. Also at the national level, USG will support two additional surveillance activities, including the first national prevalence study. In order to better guide SI activities, a revised SI addendum was submitted with the Country Operational Plan (COP) that frames the work planned in country.

The FY 2006 funded initiatives in policy and system strengthening will build on programs currently being implemented and will increase the support given in these cross-cutting issues, which will be the foundation upon which a sustainable response to HIV/AIDS will rely. In FY 2006 there is an ever-increasing priority to focus on policy and system strengthening across the workplace, private, public, and NGO/FBO sector in order to increase these sectors� capacity for leadership, administration, financial management and transparency, and technical strength.

These efforts influence policy and set the stage for a strong natural response need to focus on reducing stigma and discrimination. Currently, as reported in the AIS, only 20% of men and women expressed acceptance of HIV positive individuals in measures of stigma. Hence, a strong stigma and discrimination campaign as well as a sound policy environment are needed. Wherever possible, the program will build on USAID's additional mandate in Guyana to increase democracy and governance, and to gain support from our UN Family partners, which are both invested in sound legislation and the mitigation of the HIV/AIDS epidemic.

Several key policies exist that are of a broader influence, but directly affect the performance of the EP in Guyana. The USG EP Team in Guyana believes that several larger policy issues involving health legislation, human resources, and IMF/WB/IDB health sector reform initiatives must be addressed if EP efforts are to produce sustainable programs. Several underlying policy issues include age of consent, regulation and governance of the blood safety program, regulation and governance of the National Public Health Reference Laboratory, and legislation that will address funding needed to ensure future sustainability of the increased HIV/AIDS services being established.

In the May 2006 notification, an additional $150,000 was allocated for further strengthening of the National AIDS Program (NAPS). NAPS was re-established in August of 2005, and the new staff is still gaining experience. Therefore, support will focus on developing infrastructure, increasing the capacity of its technical officer, mentoring the program over time, and offering ongoing training opportunities. In August 2006, an additional $1,000 was allocated for other costs.

Other Donors, Global Fund Activities, Coordinating Mechanisms:

Many other organizations are involved in providing assistance in the fight against HIV/AIDS in Guyana. The largest donor is the Global Fund to Fight AIDS, Tuberculosis and Malaria (GFATM), providing approximately $27.2 million for the period of 2004-2008 to support prevention, treatment, care and support; strengthening of surveillance systems; enhanced laboratory capacity; and reduction of stigma and discrimination, among other activities. The World Bank, providing $10 million over the same four-year period, is focusing its support on institutional capacity strengthening, monitoring, evaluation and research. The Canadian International Development Agency is also a significant donor, funding $5 million over 2003 to 2007 for HIV/AIDS activities in Guyana. Various bodies of the United Nations, including UNAIDS, UNDP, UNICEF, UNFPA and WHO/PAHO are also providing significant assistance.

In addition, The Presidential AIDS Commission was initiated at the behest of President Bharrat Jagdeo in June 2004. It is chaired by the President and includes nine Sector Ministers, representatives from funding agencies and project staff from the Health Sector Development Unit. The Commission�s role is to support and supervise the implementation of the National Strategic Plan for HIV/AIDS 2002 � 2006. The Commission has been dormant since the floods experienced early in the calendar year 2005, but following a recent UNAIDS mission to Guyana, support has been offered to assist in facilitation.

Program Contact: Ambassador Roland W. Bullen and Julia Rehwinkel, USAID Guyana

Time Frame: FY 2006 � FY 2007

Approved Funding by Program Area: Guyana

August 2006 Operational Plan Main Page

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