Guyana Fiscal Year 2008 Country PEPFAR Operational Plan (COP)

GUYANA

Project Title: Guyana Fiscal Year 2008 Country PEPFAR Operational Plan (COP)

Budget Summary:

	Field Programs Funding by Account						Total Funding
	Allocated as of February 2008			Allocated June 2008			Allocated as of June 2008
Implementing Agency	GAP	GHCS - State	Subtotal: Field Programs Funding	GAP	GHCS - State	Subtotal: Field Programs Funding	New Subtotal: Field Programs Funding	Subtotal: GHCS Central Programs	Grand Total:  Field & Central Funding
DOD	-	-	-	-	-	-	-	-	-
DOL	-	400,000	400,000	-	-	-	400,000	-	400,000
HHS	1,000,000	7,127,535	8,127,535	-	(65,000)	(65,000)	8,062,535	756,360	8,818,895
Peace Corps	-	-	-	-	-	-	-	-	-
State	-	70,000	70,000	-	34,400	34,400	104,400	-	104,400
USAID	-	12,053,065	12,053,065	-	380,000	380,000	12,433,065	2,042,948	14,476,013
TOTAL	1,000,000	19,650,600	20,650,600	-	349,400	349,400	21,000,000	2,799,308	23,799,308

HIV/AIDS Epidemic in Guyana:
Adult HIV Prevalence Rate: 2.75% (2007 Guyana Epidemiologic Profile)
Estimated number of People Living with HIV: 12,710 (2007 Guyana Epidemiologic Profile)
Estimated number of Orphans due to AIDS: 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***	3,700	1,600
End of FY 2007****	5,300	2,100
End of FY 2008*****	5,550	2,300
End of FY 2009*****	7,295	2,805

^* "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.
^** “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.
^*** "The Power of Partnerships: The President’s Emergency Plan for AIDS Relief.” Third Annual Report to Congress submitted by the Office of the U.S. Global AIDS Coordinator, U.S. Department of State, February 2007.
^**** "The Power of Partnerships: The President's Emergency Plan for AIDS Relief." 2008 Annual Report to Congress submitted by the Office of the U.S. Global AIDS Coordinator, U.S. Department of State, January 2008.
^***** Projections from FY 2008 Country Operational Plan

Program Description/Country Context:

Available evidence suggests that HIV/AIDS is a major public health problem in Guyana. The HIV/AIDS epidemic is generalized, with HIV prevalence of 1.55% found among pregnant women attending antenatal care (ANC) clinics in 2006 and a national prevalence of 2.75% (2007 Guyana Epidemiologic Profile). The major exposure category for HIV infection in Guyana is heterosexual contact, accounting for more than 80% of all cases. Overall, the number of AIDS cases in males outnumbers the number of cases in females, except within the younger age groups (15-24), where there are more female than male cases. The most current data show an annual increase in HIV/AIDS-related deaths, and HIV-related illness is currently among the leading causes of death among persons 25-34 years old. Although the HIV/AIDS epidemic is generalized, select high-risk subpopulations in Guyana are disproportionately affected. For instance, the overall prevalence of HIV among women in prostitution was found to be 26.6 percent, with a higher prevalence among those who work in downtown Georgetown. The prevalence of HIV among men who have sex with men (MSM) in one region was 21.2 percent. Miners were also at high risk for HIV infection, with a prevalence of 4% found in 2004 among miners residing in 45 camps in three regions of Guyana. UNAIDS estimates (2005) for Guyana suggest that at the end of 2005, there were approximately 12,000 people living with HIV/AIDS (PLWHA) and 1,200 AIDS-attributable deaths annually.

Prevention: $6,738,393 ($4,095,445 Field; $2,642,948 Central) (36.6% of prevention, care and treatment budget)

The Government of Guyana (GOG) has prioritized national coverage of prevention of mother-to-child transmission (PMTCT) services, using a network system. Currently, there is access to PMTCT services at more than half of the 118 national antenatal care (ANC) sites supported by PEPFAR. The Ministry of Health (MOH) has adopted “opt-out” testing at six public hospitals, which combined provide services to 85% of the women at delivery facilities. To support these goals, PEPFAR will utilize FY 2008 funding to facilitate expansion of PMTCT and follow-up services, monitor and evaluate the PMTCT program, and facilitate referral from the PMTCT program to antiretroviral therapy (ART) services.

USG abstinence and be faithful activities directly support Guyana’s National Strategic Plan for HIV/AIDS. The results of the AIDS Indicator Survey (AIS), funded by PEPFAR, show that 74% of females and 64% of males between the ages of 15 and 19 have never had a sexual encounter. 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, PEPFAR in Guyana will use FY 2008 funds to encourage primary and secondary abstinence as well as the delay of sexual debut in schools, youth clubs, religious groups, and other organizations. “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.

An important aspect of PEPFAR 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. All of the blood collected by public sites is tested at the National Blood Transfusion Service (NBTS) laboratory in the capital or at regional laboratories. USG will support a new technical assistance provider to upgrade and expand the NBTS.

Based on data from the AIS, health care workers have frequent potential exposures. Only 43% of injection providers have access to post-exposure prophylaxis drugs onsite. Risks to waste handlers underscore the need for waste-disposal site development with sustainable, appropriate technology. FY 2008 funding will support a safe injection program to help prevent the transmission of HIV and other blood-borne diseases through accidental sharps injuries.

Other prevention is critical in Guyana, given that the bulk of existing and new infections continue to be concentrated among high-risk and vulnerable groups. A Behavioral Surveillance Survey and targeted prevalence surveys completed by the USG team in 2003/2004 identified key persons engaged in high risk behavior (PEHRBs): people in prostitution, 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 PEHRBs will follow the ABC model, with emphasis on faithfulness and correct and consistent condom use and other prevention activities for these groups.

The USG will continue to work through local non-governmental organizations (NGOs) and other partners to train the ranks of the Guyana Defense Forces. In FY 2008, high-risk populations will continue to be reached with combined targeted outreach and referrals to “friendly” clinical care and treatment services. An important component of PEPFAR prevention program is the provision of 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.

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: $4,644,199 ($4,644,199 Field; $0 Central) (25.2% of prevention, care and treatment budget)

The goal of the PEPFAR contribution to the Guyana National Strategy will be to provide the four categories of essential palliative care services to all people infected or affected by HIV/AIDS: clinical care, psychological care, social services, and spiritual care. Currently, there are eight USG-supported, home-based care programs in place. In FY 2008, funds will support training of providers as well as service delivery through NGO and MOH partners.

In addition to basic health/palliative care, FY 2008 funding will support care for tuberculosis (TB)/HIV patients. Guyana has one of the highest TB incidence rates in the Americas; roughly 25-30% of all newly-diagnosed TB cases are co-infected with HIV. The USG will support the Guyana National TB Control Program, which provides care and treatment for all TB cases in the country.

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, psychosocial support, legal support, conflict resolution, and education. With FY 2008 funds, the USG will help strengthen the Ministries of Labor, Human Services, Social Security, and Education to coordinate and support preventive and care services to OVC, both in-school and out-of-school, and to enhance referral networks.

PEPFAR’s FY 2008 activities will focus on further mobilizing people to access counseling and testing (CT), with a strong emphasis on PEHRBs and males, to boost prevention efforts and to identify those who need treatment. Currently, the USG program includes labor and delivery sites supported through the PMTCT program, which have begun to implement provider-initiated counseling and testing. The USG also supports public-sector CT sites; additional fixed Voluntary Counseling and Testing (VCT) sites operated by NGOs and faith-based organizations (FBOs); and mobile VCT teams that focus on workplace and hard-to-reach communities. PEPFAR’s FY 2008 strategy includes the continual integration of provider-initiated CT into the formal health sector, which will be critical for the sustainability of the program and for the most efficient identification of infection.

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, and the Ministry of Labor Human Services and Social Security, Guyana.

Treatment: $7,017,706 ($6,861,346 Field; $156,360 Central) (38.1% of prevention, care and treatment budget)

The provision of high quality HIV clinical care and ART access is at the core of the PEPFAR program. Enrolling patients on ART treatment is now limited only by outreach, counseling, and testing. Thus, funding in FY 2008 will focus largely on activities that increase the use of and access to services, including: opt-out HIV testing in labor and delivery of pregnant women; provider-initiated testing in the hospital setting; and expanding geographic coverage and reach of VCT to vulnerable and migratory populations and in workplace settings.

The USG, along with the MOH and other donors, will build on early successes in order to strengthen a single national system of forecasting, procurement, transport, and monitoring of drugs and commodities. In FY 2008, all partners will adopt a long-term strategy establishing the parameters of warehousing, procurement, and final storage and management at point-of-service. Furthermore, the USG will support the development of a single, national information system to monitor and inform forecasting and procurement. These records will support the morbidity method in order to calculate items needed as well as to support clinical activities. Throughout FY 2008, the USG will address skills transfer through on-site training, as well as local, regional, and South to South training opportunities.

Prior to USG involvement, Guyana had limited capacity to conduct HIV surveillance, diagnose HIV infection, monitor patients on ART, and diagnose opportunistic and sexually transmitted infections. Since PEPFAR began work in Guyana, a national algorithm for diagnosing HIV using rapid HIV tests has been implemented, and CD4 testing essential for staging disease has become available. In fiscal year 2007, the USG will help define the appropriate location and site for testing for opportunistic infections.

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

Other Costs: $5,399,010

Cross-cutting PEPFAR activities in Guyana include strategic information, policy development, systems strengthening, and management and staffing. Strategic information is crucial to measuring the progress made in reaching PEPFAR's 2-7-10 goals. The USG team will continue to work in close partnership with the GOG to support the development of strategic information systems for Guyana’s HIV/AIDS sector. 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). The USG team also will work with the GOG in FY 2008 to implement a national sero-prevalence study, the Demographic and Health Survey Plus.

In fiscal year 2006, efforts in Guyana focused 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. With fiscal year 2007 funds, the USG team will strengthen the HIV/AIDS human resource system and create conditions that foster retention, improve performance, and facilitate supervision (i.e., through leadership development workshops).

Other Donors, Global Fund Activities, Coordinating Mechanism:

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 (Global Fund), which has provided 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, will focus its support on institutional capacity strengthening, monitoring, evaluation, and research. The Canadian International Development Agency (CIDA) completed its HIV/AIDS activity in 2007 with a grant that has provided US $5 million since 2003. Various bodies of the United Nations, including UNAIDS, UNDP, UNICEF, UNFPA, and WHO/PAHO also provide important assistance. Lastly, the Caribbean Epidemiological Center (CAREC) and Caribbean Community (CARICOM) play a major role in laboratory support and drafting of legislation.

In addition, Guyana’s Presidential AIDS Commission was initiated at the behest of President Bharrat Jagdeo in June 2004. It is chaired by the President of Guyana 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 2007-2011.

Program Contact: Ambassador David Robinson; Julia Roberts, USAID Guyana; La Mar Hasbrouke, US Centers for Disease Control; Jim Geenen, US Peace Corps; Steven Stanley, MLO/DOD

Time Frame: Fiscal year 2008 – Fiscal year 2009

Approved Funding by Program Area: Guyana