Tulane's activities will fall into two program areas: prevention of mother-to-child transmission (PMTCT) and strategic information. In regards to PMTCT, Tulane will provide PMTCT services in Kinshasa, Democratic Republic of Congo (DRC) to women and male partners attending clinics sponsored by private companies like Bralima (brewing company) or ONATRA (transport company). Currently, approximately 40% of pregnant women in Kinshasa are covered by PMTCT services, with many women not attending ANC services at all or in informal clinics run by a variety of healthcare professionals or individuals without any biomedical training. A joint assessment by the National AIDS Control Program (PNLS) and the University of North Carolina (UNC), an existing partner with experience in providing PMTCT services in Kinshasa, indicated that women attending clinics sponsored by private-sector companies are a group of women that can be readily accessed in order to increase the percentage of PMTCT coverage in Kinshasa. UNC currently provides PMTCT services to public and faith-based maternities and ANC clinics and will be scaling up their services in these same settings in FY 2010; Tulane will complement these activities by focusing on clinics sponsored by private companies, work synergistically with UNC to strengthen the referral network and linkages to care and treatment programs, as well as benefit from their significant experience in providing comprehensive PMTCT services in Kinshasa.

In regards to SI, Tulane will assist local partners in the execution and reporting of 2010 antenatal care clinic (ANC) surveillance and execute a special study for an as-yet-to-be determined population. For the 2010 ANC surveillance, Tulane will provide technical assistance and help build the capacity of two local institutions for planning, implementation, analysis and dissemination of ANC surveillance and data: the Kinshasa School of Public Health (KSPH) and the PNLS. Twenty years ago, Tulane played a pivotal role in the start-up of KSPH, today one of the CDC's oldest scientific and academic partners in DRC. Tulane will subcontract the execution of ANC surveillance to KSPH and provide the PNLS with technical assistance and supervision, although PNLS will be receiving a separate award to carry out data collection in the field for ANC. Tulane will be responsible for the special study on a vulnerable but as yet-to-be- determined population. The selection of the population will be made according to input and recommendations from the GDRC Surveillance Taskforce, made up of the HIV/AIDS Strategic Information Center (CISSIDA), the PNLS, the National Multi-Sectoral AIDS Control Program (PNMLS), the World Health Organization (WHO), the CDC, KSPH, and UNAIDS. As data on vulnerable or hard-to-reach populations is non-existent in DRC, PEPFAR DRC pledged in the Partnership Framework Implementation Plan to support special studies as one of several ways to promote strategic information as the foundation for planning and coordinating the national HIV/AIDS response.

Tulane's cross-cutting budgetary attributions focus on human resources for health, as in-service training and performance assessment and quality improvement constitute important pieces of both programs. Tulane will perform evaluations on a periodic basis throughout the life all activities as well as a final

evaluation based on the quality assurance measures used by UNC in PMTCT activities and on the description of monitoring and evaluation protocols approved for the ANC surveillance and the planned special studies.

Tulane's PMTCT activities will utilize the model used by University of North Carolina (UNC). UNC

currently provides a comprehensive package of services that at minimum includes appropriate

management of pregnancy-related complications, TB screening and case management, sulfadoxine-

pyrimethamine for presumptive malaria treatment, promotion of insecticide treated bed net use, tetanus

vaccinations, routine iron and folate supplementation, and family planning counseling. Due to the

challenges of starting up new programs in several clinics (6 in year 1), Tulane will initially focus on

identifying HIV+ mothers and giving prophylactic antiretroviral treatment (ART) to HIV+ mothers and their

infants, providing other services when possible. Keeping with national guidelines, Tulane will administer a

complex ART regimen; however, availability of ARVs is dependent on the Global Fund, and if adequate

supplies of the complex regimen are not available sdNVP will be used as a stop-gap measure. Women

eligible for cotrimoxazole prophylaxis and therapeutic ART will be referred to a care and treatment center

for follow-up. HIV+ women will be encouraged to join a psychosocial support group, potentially one

currently supported by UNC if in close proximity. Tulane will work to strengthen male partner involvement

with technical assistance from UNC, and if feasible provide access to CD4 testing at clinics and cover

costs of delivery. Tulane will assess if candidate clinics follow guidelines issued by the National

Reproductive Health Program as reproductive health services are the platform for PMTCT services.

Selected clinics will receive eight days of integrated training for all clinic staff involved in reproductive

health service provision, eight-day practical training for two staff members, and specialized didactic and

practical training for lab technicians. Program staff will supervise new clinics on a daily basis for two to

four weeks after training and on a monthly basis thereafter to ensure quality service delivery. Tulane will

use $30,000 to provide in-service PMTCT training for existing healthcare workers, performance

assessment and quality improvement, and for task-shifting of PMTCT responsibilities from physicians to

nurses.