Extramural Branch: CDC provides technical, administrative, and financial support to local and international partners to implement high quality health programming and conduct public health research.
Through the President’s Emergency Plan for AIDS Relief (PEPFAR) CDC manages ten cooperative agreements with eight partners. These agreements work to increase access to and expand the provision of HIV/AIDS and TB services including HIV and TB testing and counseling, prevention of mother-to-child transmission of HIV, HIV and TB care and treatment, support for orphans and vulnerable children, laboratory services including viral load testing, and health information systems management. The Extramural Branch collaborates closely with the implementing partners to monitor and track project deliverables and targets, ensure the timely and accurate submission of program data and reports, develop tools and build partner capacity through trainings, and provide overall technical and administrative support. In FY18 CDC’s cooperative agreements supported 88 health facilities through the PEPFAR Haiti partner network, strengthened and expanded health information systems, and provided over 100,000 PLHIV with treatment.
- Catholic Medical Mission Board (CMMB): CMMB has partnered with CDC through PEPFAR since 2012 to reduce HIV-related morbidity and mortality in Haiti. CMMB is currently implementing the five-year ALESIDA project (ALESIDA translates to “Go away AIDS!” in Haitian Creole) at 13 faith-based facilities and three public health facilities across five departments. Key services provided through ALESIDA include HIV testing and counseling, prevention of mother-to-child transmission, HIV care and treatment, TB screening and treatment, laboratory services, strategic information and surveillance support, and community-support services. Under ALESIDA, CMMB sites achieved sustained clinical outcomes well above national averages—with a 76% adjusted patient retention rate, the nation’s highest, in FY16. CMMB achieved high patient retention by implementing innovative programs like multi-month scripting of antiretroviral therapy (ART) and community distribution of drugs which delivers ART at a fixed point in the community or at the patient’s home. CMMB also led the initial development of a community of practice, gathering the country’s technical experts and health facilities to share best practices.
- Centres pour le Développement et la Santé (CDS): CDS is a Haitian nongovernmental organization providing integrated health and development services in Haiti since 1974. CDS became a CDC/PEPFAR partner in 2009 and delivers TB screenings and HIV/AIDS prevention, care and treatment services at four health facilities in the Northeast and West departments. The CDS network reached nearly 25,000 individuals with HIV testing and counseling services (including pregnant women) in FY18 and enrolled 497 new patients on treatment – bringing the total number of patients enrolled on ART to 1,949.
- Fondation pour la Santé Reporductrice et l’Education Familiale (FOSREF): FOSREF is a Haitian NGO founded in 1988 that promotes and delivers sexual and reproductive health, maternal health, family planning, HIV/AIDS and other infectious disease prevention services to the Haitian population with a particular focus on vulnerable and high-risk groups. FOSREF has a national network of sites and community networks located in large cities throughout Haiti’s ten geographical departments ensuring adequate access to quality and integrated HIV/AIDS and sexual health services. Through a partnership with CDC and PEPFAR, FOSREF has provided an integrated package of HIV/AIDS prevention, screening, and care and treatment services to key populations (KP) since 2005. This partnership has served more than 1.7 million vulnerable and high risk people throughout the country including commercial sex workers (CSWs) and their clients, youth involved in transactional sex, men who have sex with men (MSM), and transgender. With CDC/PEPFAR support, FOSREF operates a network of ten sites that deliver services at both the site and community levels across the West, North, and Artibonite departments.
- GHESKIO: Established in 1982, Groupe Haïtien d’Étude du Sarcome de Kaposi et des Infections Opportunistes (GHESKIO) provides clinical services and conducts research and training in HIV/AIDS prevention and treatment. In 2000, the Haitian Government designated GHESKIO a “public utility,” a status reserved for institutions deemed essential to the welfare of the Haitian people. CDC/PEPFAR has provided direct funding to GHESKIO since 2005 for HIV care and treatment services and TB/HIV work. Through the CDC/PEPFAR grant GHESKIO has continued scaling up antiretroviral therapy to nearly 30,000 patients at all 18 sites within its network while also providing supervision and training to staff. This network is the largest in the country, accounting for 28% of all patients on ART nationwide. In addition to providing technical and financial support to HIV and HIV/TB services through PEPFAR, CDC also provides direct support to GHESKIO to improve TB and MDR-TB case detection. GHESKIO is one of the largest providers of TB screening and treatment in the Americas and one of two providers in Haiti equipped to treat MDR-TB. In FY2018, GHESKIO diagnosed and treated 1,503 new TB cases and 116 cases of MDR-TB.
- The International Training and Education Center for Health (I-TECH): The International Training and Education Center for Health (I-TECH) is a global network working with local partners to develop skilled health care workers and strong national health systems in resource-limited countries. I-TECH is based in the University of Washington’s Department of Global Health with staff in Africa, Asia, the Caribbean, Eastern Europe, and the United States. In Haiti, through a partnership with CDC/PEPFAR, I-TECH works with the Ministère de la Santé Publique et de la Population (MSPP) to implement health systems strengthening programs to improve service delivery via a trained health workforce, robust health information systems (HIS) and leadership and governance. I-TECH’s team of physicians, nurses and psychologists provide technical assistance to 40 sites in the MOH’s care and services network to help strengthen HIV/AIDs related services. Additionally, I-TECH helped to develop and rollout iSanté, an electronic medical record (EMR) system used at 155 hospitals and clinics around Haiti which includes more than 1.3 million patient records. The system includes patient care summaries, population-level data dashboards, automated program reports, epidemiological monitoring, indicator reporting, and is linked to computerized lab results. iSanté functions at 21 sites interoperably with the open-source lab information system OpenELIS which I-TECH developed in Haiti in partnership with the National Public Health Laboratory.
- National Association of State and Territorial AIDS Directors (NASTAD): NASTAD has been a CDC partner through PEPFAR since 2009 working closely with the Haitian MOH to provide technical and implementation assistance for strategic information and health systems strengthening activities. NASTAD has collaborated with the MOH to implement national HIV case-based surveillance in Haiti; and in recent years, NASTAD’s support to the MOH has expanded to include related strategic information activities including enhanced perinatal HIV surveillance and implementation of a community-level patient linkage and retention (PLR) toolkit. Haiti’s case-based surveillance system allows the MOH to track care continuum outcomes at all levels. In fiscal year 2018 the PLR platform facilitated outreach to almost 37,033 patients who had missed appointments or dropped out of care. Of these, 51% returned to clinics to resume treatment.
- Partners in Health (PIH): PIH is an international non-profit organization that provides comprehensive, high-quality health care, including treatment for HIV/AIDS and drug-resistant TB, in mainly rural, underserved settings. PIH and its local sister organization Zanmi Lasante (ZL) have operated together in Haiti since 1987 to build health systems capacity in the Central Plateau and the lower Artibonite Departments of Haiti. In FY2006, CDC began providing financial and technical support through PEPFAR to PIH/ZL to provide HIV and TB clinical services. CDC has supported emergency obstetric care activities, cholera, Zika virus research, and meningitis surveillance. As a CDC/PEPFAR partner PIH/ZL provides a comprehensive package of HIV and TB services across 12 facilities in two departments. Additionally, to ensure patient adherence to treatment, PIH/ZL uses community health workers as part of the patient linkage to and retention in care (PLR) program to actively track patients using mobile technology. In FY18 the PIH/ZL network reached nearly 100,000 people with HIV testing services, initiated 2,000 new patients on HIV treatment, and identified over 1,500 new cases of TB. In addition to providing HIV/AIDs and TB services through PEPFAR, CDC has provided direct support to PIH/ZL for emergency obstetric care activities, cholera, Zika virus research, and meningitis surveillance.
- Unité de Gestion de Projet (UGP): UGP is the MOH project management unit created in 2005 to direct CDC support to the Government of Haiti’s (GOH) national HIV/AIDS response. UGP coordinates closely across government sectors to decrease the annual number of new HIV infections in Haiti and to prevent HIV related deaths by improving the quality of service provision, promoting social and gender equity, focusing on vulnerable populations, and promoting strong governance. The UGP network includes 29 health facilities situated across eight geographic departments reaching over 250,000 patients a year with HIV testing and clinical services. As of FY18, UGP has over 23,000 patients enrolled on antiretroviral treatment (ART) in its network. To improve patient retention in care, UGP employs multi-month scripting of ART and community distribution of drugs. In addition to supporting Haiti’s national HIV/AIDS program, CDC works directly with UGP on a number of critical health programs including disease surveillance; TB; laboratory capacity; water, sanitation and hygiene (WASH); and the Field Epidemiology Training Program.