1. ORGANISATION OF EASTERN CARIBBEAN STATES (OECS) Report on the OECS GFATM HIV/AIDS Project Four teenth Meeting of the PANCAP Regional Coordinating Mechanism Barbados March 24 – 25, 2010

2. Content: Introduction Programmatic performance and planned Actions Achievements Financial performance Future Options

3. Introduction 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

4. Performance - Programmatic (June 30 th 2009) Indicators Phase 2 Targets Actual 1. Number of PLWHA receiving antiretroviral combination therapy in accordance with Caribbean Guidelines 459561122% 2.1 Number of people receiving HIV counseling and testing including the provision of the test results 698361187417% 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 1084440% 3.1 Number of facilities carrying out comprehensive clinical staging of PLWHA as per Caribbean Guidelines 67120%

5. Programmatic performance (to June 30 th 2009): Indicators Phase 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 5480% 6.1 Number of countries using standardized monitoring and evaluation patient tracking system 6583% 7.1 Number of PLWHA receiving care and support 65457488% 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

6. Planned actions - Indicator 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

7. Planned actions - 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

8. Planned actions - Indicator 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.

9. ACHIEVEMENTS 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

10. ACHIEVEMENTS 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

11. Major Challenges Knowledge of HIV status –Individual –Country Behavior impact –Consumers/Individuals –Providers –Planners –Policy makers Considerations 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

12. Major Challenges Capacity –Local Human resource –Laboratory –Information systems Funding & the attending conditions Considerations 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

13. Future 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** 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

14. Financial performance (to June 30, 2009):

15. Financial Execution

16. Financial performance cont’d.: Disbursement versus Expenditure by Sub-Recipient from inception

17. Financial 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

18. FUTURE 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)

19. THANK YOU Thank you!