ORGANISATION OF EASTERN ORGANISATION OF EASTERN CARIBBEAN STATES (OECS)CARIBBEAN STATES (OECS)

Report on the OECS GFATM HIV/AIDS Project Report on the OECS GFATM HIV/AIDS Project

FourFourteenth Meeting teenth Meeting of the of the

PANCAP Regional Coordinating Mechanism PANCAP Regional Coordinating Mechanism

BarbadosBarbadosMarch 24 – 25, 2010March 24 – 25, 2010

Content:Content:

• Introduction

• Programmatic performance and

planned Actions

• Achievements

• Financial performance

• Future Options

IntroductionIntroduction

The OECS GFATM HIV/AIDS Project • Aim: To scale up ‘Treatment and Care’ for PLH

in six OECS countries

• Duration: 5-years: March 2005 to Feb. 2010

• Costs: Total for Project US$17.2m; GFATM Grant US$10.2m

• Principal Recipient: OECS Secretariat• Sub-Recipients: Ministries of Finance & Health• National Implementing Agents: Ministries of Health

Performance - Programmatic

(June 30th 2009)

IndicatorsPhase 2 Targets

Actual

1. Number of PLWHA receiving antiretroviral combination therapy in accordance with Caribbean Guidelines

459 561 122%

2.1 Number of people receiving HIV counseling and testing including the provision of the test results

69836 11874 17%

2.2. Number and percent of HIV-positive pregnant women receiving a complete course of antiretroviral prophylaxis to reduce the risk of mother-to-child transmission

108 44 40%

3.1 Number of facilities carrying out comprehensive clinical staging of PLWHA as per Caribbean Guidelines

6 7 120%

Programmatic performance

(to June 30th 2009):

IndicatorsPhase 2 Targets

Actual

5.1 Number of countries with a system in place to receive and respond to complaints of discrimination by people living with and affected by HIV/AIDS

5 4 80%

6.1 Number of countries using standardized monitoring and evaluation patient tracking system 6 5 83%

7.1 Number of PLWHA receiving care and support 654 574 88%

8.1 Percent (%) of people (15-49) who both correctly identify ways of preventing the sexual transmission of HIV and reject major misconceptions around HIV transmission

90 (%) NA

Planned actions - Planned actions - Indicator 2.1Indicator 2.1

• Revisit of the working definition for the indicator

• Collaborate with Partners to: – Increase uptake and institutionalize HIV rapid testing to

facilitate ‘same session’ results

– Secure access to • HIV confirmatory testing services, • CD4 proficiency testing and • QA/QC for related laboratory services

– Pursue the Certification of national Laboratories

• Promote behaviour change initiatives

Planned actions - Planned actions - Indicator 2.2: Indicator 2.2:

• Maintain– The over 90% coverage of ante-natal clients at MCH

clinics, – The provision of antiretroviral medications and – Access to polymerase chain reaction (PCR) testing

(Clinton HIV/AIDS Initiative);

• Promote the uptake (almost 100%) of these services by pregnant women;

• Request studies to more accurately determine the numbers of HIV positive pregnant women; and

• Advocate for improved HIV surveillance

Planned actions - Planned actions - IIndicator 5.1ndicator 5.1

The PR has moved to: (a) Identify some funding for the operations of the

Human rights desks/mechanisms in the OECS;

(b) Joined the PANCAP Technical Advisory Group (TAG) to address Stigma and Discrimination; and

(c) Initiate planning at country level and to negotiate technical Assistance to strengthen the Human rights mechanisms for tackling acts related to HIV/AIDS stigma and discrimination.

ACHIEVEMENTSACHIEVEMENTS

To respond to the capacity building needs to meet the agreed goals and targets through the development and establishment of:

Standardised Monitoring & Evaluation systems and Data collection tools

Standardised Financial Management systems for the project; and

Standardised Patient Monitoring and Tracking System (PMTS)

SYSTEMS STRENGTHENING

ACHIEVEMENTS ACHIEVEMENTS cont’d…cont’d…

In the areas of : Clinical staging, Treatment and care - Clinical

Mentorship programs through CHART for Doctors, Nurses and Pharmacists

HIV related Testing and Diagnosis – Support from CAREC, CDC and CCAS

Leadership – CHILI program Behavioral Change Communication – COMBI Data Management – Collaboration with PAHO Monitoring and Evaluation – Support from CHRC

HUMAN RESOURCE DEVELOPMENT

Major ChallengesMajor Challenges

• Knowledge of HIV status– Individual

– Country

• Behavior impact– Consumers/Individuals

– Providers

– Planners

– Policy makers

ConsiderationsConsiderations

• Institutionalization of PITC and rapid testing

• Surveillance systems strengthening• OECS Regional and national

information networks (including Information standards & QA/QC)

• An OECS PLH representative organization

• R&D to generate Strategic Information

• Effective and coordinated Behavior impact programs as per target group

Major ChallengesMajor Challenges

• Capacity – Local Human

resource

– Laboratory

– Information systems

• Funding & the attending conditions

ConsiderationsConsiderations

• Strengthening OECS Training institutions e.g. establish a designated OECS CHART center

• Strengthening Leadership in OECS• Research on strategies for retention of

personnel• Development of a tiered Laboratory

system

• Negotiations for more flexible terms and conditions

• An OECS regional HIV/AIDS Frame work based on the “Three Ones”

• Coordination of the partners contributions

Future IssuesFuture Issues

• Managing HIV/AIDS as a Chronic disease

• Managing HIV/AIDS as a Public Health issue

• Managing HIV/AIDS using a Human Rights approach

Future Directions**Future Directions**

• Mainstreaming HIV/AIDS in the health sector

• Strengthening Health and social sectors using ‘best practices’

• Adopting a Prevention/‘Disease aversion’ strategy

• Reduction of the vulnerabilities

• Comprehensive health sector planning and adequate resource allocation for HR

• Promoting a Human Rights culture• Empowerment of the MARPS• Establishment of Human Rights Commission• Reduction in Stigma and discrimination

** Influenced by strategic information, leadership, resources, sensitivities, absorptive capacities, etc

Financial performanceFinancial performance (to June 30, 2009):(to June 30, 2009):

-

1,000,000

2,000,000

3,000,000

4,000,000

5,000,000

6,000,000

7,000,000

8,000,000

9,000,000U

S$

Series1

Series2

Series1 7,844,805 6,359,435 5,505,294

Series2 81% 87%

Budget Disbursement Expenditure

Financial ExecutionFinancial Execution

Financial performance cont’dFinancial performance cont’d.:.:

-

100,000

200,000

300,000

400,000

500,000

600,000

700,000

Antigua Dominica Grenada St. Kitts &Nevis

St. Lucia St. Vincent

DisbursementsExpenditure

Disbursement versus Expenditure by Sub-Recipient from inceptionDisbursement versus Expenditure by Sub-Recipient from inception

Financial SituationFinancial Situation

Phase II Funding:

Approved Project Budget for Phase II (to February 2010)

Cash received to June 2009

Project Funds held by GFATM as at June 30, 2009

Disbursement requested for July 2009 to Feb 2010 (based on Work plan and cash-in-hand)

Grant Funds forecasted to be ‘Unrequested’ at end of February 2010

US Dollars:

$6,860,183

$4,320,844

$2,539,339

$555,677

$1,983,662

FUTURE OPTIONSFUTURE OPTIONS

• NO COST EXTENSION – 6 Month extension up to August 2010 plus 3 months ‘wrap-up’

• ‘CLOSE OUT’ PLAN – To bridge gap until Round 9 proposal (September 2010 to …)

• OECS TREATMENT OBJECTIVE within PANCAP Round 9 Proposal – 5 year funding for treatment (Originally September 2010 to August 2014)

• PEPFAR 2 US Caribbean Initiative

• OECS REGIONAL ROUND 10 PROPOSAL (OECS HIV/AIDS Strategic Plan)

THANK YOUTHANK YOU

Thank you!