The TBD partner will be the lead PEPFAR external partner for TA to improve clinical capacity of local, regional and federal entities in Ethiopia who are responsible for the delivery of comprehensive HIV/AIDS clinical services. HIV incidence has decreased and the capacity of public institutions has greatly improved in Ethiopia over the last nine years through PEPFAR. Having one international PEPFAR partner to meet gaps in external technical assistance is the most efficient way to facilitate the transition to sustainable local ownership. The TBD partner will support a range of activities, including HMIS implementation, laboratory systems, comprehensive HIV/AIDS clinical services in hospitals and health centers, and training of physicians and emergency surgical officers in universities. Capacity building of local partners through TA provided by the TBD partner will decrease over time as local partners assume greater responsibility for implementation. To facilitate the transition to country ownership, this TBD partner will coordinate with USG and government agencies/universities. The grantee will systematically transition activities that support comprehensive HIV clinical care and treatment to the appropriate government entity. The international TA partner will also liaise with other USG supported implementing partners to maximize complementary activities. The grantee will address remaining gaps by the end of the program period. By the end of the program period, the grantee will successfully transition local capacity, sustainability and ownership of HIV programs to government and non-governmental entities in Ethiopia.

Activities that focus on care and support include:

Collaborate with case managers and adherence supporters and interact CBOs as well as with HEWs in order to enhance the tracing of LTFU PLHIVs who are in chronic care

Support to strengthen the intra-facility and two way referrals and linkages between health facilities and communities care and support services.

Support health facilities to develop community-based resource mapping matrix to refer PLHIVs to community HIV and wrap-around services

Support integration of mental health services into chronic care unit and/or strengthen referral and link PLHIV who need mental health service to psychiatric clinics in order to enhance PLHIVs medication compliance

Strengthen the facility-based prevention with positive interventions and scale-up integration of FP services into ART units

Strengthen pain assessment and management with pharmacologic and non-pharmacologic interventions to ease distressing pain and symptoms of PLHIVs in all ICAP supported facilities

Strengthen pain assessment and management in all supported facilities and work closely with PFSA to ensure the supply of pain medicines including oral morphine to supported health facilities.

Strengthen site level mentorship and supportive supervision and consider CPT as quality indicator and review CPT performance on a regular basis.

Strengthen nutrition assessment, counseling and support services at ART and PMTCT units.

Ensure the availability, distribution, utilization, and monitoring of the adult preventive care package.

Support involvement of community-based organizations in multidisciplinary teams and catchment area meetings.

These HBHC activities will be implemented in all ART sites including the additional health center sites that the international TA partner is now supporting following the PEPFAR-Ethiopia interagency program realignment.

The TBD partner will:

Strengthen regional and facility-level TB/HIV program coordination.

Support sites to perform routine TB screening for HIV positive patients and promote integration into ANC, PMTCT, pediatric clinics and potentially high yield areas.

Collaborate with EHNRI and regional laboratories to introduce improved TB diagnostic services (e.g., bleach concentration, fluorescent microscopy, culture and drug sensitivity testing methods, molecular methods).

Collaborate with EHNRI to assess feasibility of task shifting of FNA specimen collection and preparation of sample referral for histopathologic exam.

Design evidence-based interventions to enhance IPT uptake.

Strengthen PICT for TB patients and links between TB/HIV patients to HIV care and treatment services and thereby increase the proportion of TB/HIV patients placed on ART.

Ensure TB treatment for HIV-infected patients with active TB

Strengthen the family-based approach and contact investigation, particularly to improve pediatric TB diagnosis for HIV exposed and infected children. Support limited renovation to TB clinics, waiting areas and isolation wards to minimize nosocomial transmission.

Implement basic administrative and environmental TB infection control measures at supported facilities, and provide supplies.

Strengthen TB/HIV monitoring and evaluation through training, supportive supervision, and mentorship.

Strengthen and expand PPM-TB DOTS ( Public Private Mix- TB DOTS ) in the private hospitals.. This is a year-I activity where by the TBD partner continue to provide TA on TB and TB/HIV to the existing private hospitals (about 12 sites) supported by partners.

Improve access to PWP services at the TB clinics and strengthen TB/HIV ACSM ( Advocacy, Communication and Social Mobilization )

Support local universities to develop in-service training units to equip health workers with TB/HIV clinical skills and transition training.

Screen at least 90% of HIV positive currently on care for TB during their last follow up visit and Ensure TB treatment for 1200 HIV-infected patients with active TB; test >95% of TB patients on DOTS treatment and link all HIV co-infected TB patients to HIV care and treatment services.

Activities include:

Technical support to national/regional health bureaus and assist with revision of national pediatric HIV guidelines according to the new WHO guidelines. Support local universities to integrate pediatric management into their in-service training units.

Conducting site-level mentoring and assist with provision of IEC materials/job aids and supplies for pediatric management.

Ensuring rollout, implementation and monitoring of pediatric preventive care package.

Ensuring availability of pediatric drug formulations, utilization of co-trimoxazole prophylaxis, TB screening, malaria prevention and treatment (including ITNs), prevention and treatment of diarrhea, linkages to immunization programs, Isoniazid Prophylaxis (IPT) for HIV positive children, and promotion of healthy hygiene and safe water interventions.

Promotion of interventions for psychosocial care and support for children and adolescents addressing psychological and spiritual needs, as well as end of life care.

Ensuring that sites increase utilization of early infant HIV diagnosis using appropriate techniques (e.g., dried blood spot) and all eligible HIV positive children are promptly referred for ART care.

Ensuring nutritional counseling/assessments are completed at all entry points targeting pediatric patients and HIV exposed/infected infants through training and site-level mentoring; liaise with partners to ensure availability of supplemental feeding products.

Strengthening internal/external referral linkages to identify and link HIV positive children and orphans and vulnerable children with family, social and adherence support.

Establishing HIV positive adolescent support groups to promote adherence and positive living.

Focus on quality improvement of Pediatric PC/Nutrition services including tool development, training & mentoring.

In the first year of the program period, the following activities will be carried out in the four regions of SNNPR, Addis Ababa, Gambela and Benishangul Gumuz:

Train laboratory personnel on quality management system, laboratory management, safety, ART monitoring, TB microscopy, malaria microscopy, HIV rapid test, SLIPTA/SLMTA, basic microbiology, and preventive maintenance. A total of 150 laboratory personnel will be trained in different laboratory diagnostic disciplines

Support 15 regional and hospital laboratories towards accreditation through mentorship and implementation of SLMTA/SLIPTA (Strengthening laboratory management towards accreditation) and Implement basic laboratory quality management system in all health centers.

Strengthen integrated sample referral network in the regions and improve laboratory inventory systems, preventive maintenance, and troubleshooting of equipment failures.

Strengthen regional external quality assurance program (REQAS) for TB and malaria microscopy, and HIV rapid testing.

Establish equipment maintenance centers at regional laboratories

Improve the laboratory physical infrastructure through minor renovations, procurement of laboratory equipment and safety materials to support the WHO-AFRO accreditation effort.

Support establishment of clinical bacteriology diagnostic capacity at selected hospitals.

Technical assistance will continue for early infant diagnosis, viral load testing, and TB culture.

Support the implementation of LIS at selected sites in collaboration with other stakeholders.

Provide technical assistance to facilitate transition of laboratory activities to regional laboratories by strengthening the technical and programmatic management capacity of the regional laboratories and collaborative implementation of laboratory program.

The TBD partner will:

Support RHB mentors and sites to complete documentation of pre-ART, ART, TB/HIV, PMTCT, VCT, and PICT information on HMIS forms.

Establish data quality assessment and feedback mechanisms

Build capacity of site staff on data analysis and data use.

Facilitate annual, regional and catchment area review and planning meetings.

Strengthen sites by providing data clerks and M&E tools to fill gaps.

Facilitate the integration of HIV/AIDS related data with the HMIS and support HMIS implementation in new health facilities.

Facilitate the training of RHB mentors to take on the role of mentoring facility staff on HMIS.

Collaborate with partners in HMIS implementation and integration of HIV information into the national systems.

Assess and address gaps in space, furniture, equipment and training to implement HMIS and EMR systems.

Support sites to collect, archive, retrieve, compile and report data for all HIV-related services.

Support catchment area and health facility multi-disciplinary teams meetings.

In the first year of the program period, the following activities will be carried out in the four regions of SNNPR, Addis Ababa, Gambella and Benishangul Gumuz to fill the gaps left by the departure of another partner whose cooperative agreement is ending :

Provide support for site level program data capturing, analysis, interpretation and utilization at health facilities that implement HIV/AIDS, STI and TB/HIV programs.

Provide support to RHBs to continuously capture all required PEPFAR indicators related to health facilities and ensure timely reporting of the PEPFAR Semi-Annual Progress Report (SAPR) and Annual Progress Report (APR).

The grantee will provide technical assistance and support to roll out the health management information system at site level in order to eventually transition the reporting of, and the accountability for PEPFARs required performance indicators from US-based clinical partners to the RHBs. The program areas covered for both adults and children will include prevention, laboratory, HCT, PMTCT, clinical care and ART, HIV-related clinical care including HIV/TB and in-service training

Needs Assessment

The TBD Partner will:1) Coordinate with USG-Ethiopia, FMOH, EHNRI, RHBs, local and international partners, to develop a prioritized HIV-related capacity needs assessment to ensure that health system gaps are identified and addressed 2) Develop an operational plan to implement transition of managerial and technical functions of program activities under this agreement to local partners and/or government units (FMOH, EHNRI, and RHBs) within the terms of this cooperative agreement 3) By the end of year one, a prioritized capacity needs assessment will have been developed for the delivery of comprehensive HIV services nationwide and for medical education and IESO's 4) An annual operational plan demonstrating transition of managerial and technical functions and services of program and education activities to local partners and/or government units will be submitted. The TBD partner will support seven local universities to improve in-service training programs and pre-service medical education in the country. In year 1, the grantee will support 5 local universities and two teaching hospitals in medical education and IESO training, and 7 local universities in year 2 to 5 to establish and strengthen in-service training units and support them to design a plan to sustain in-service training units. The grantee will also provide technical assistance to RHBs for the development of annual HIV/AIDS in-service training plans and build capacity to deliver such training through local universities. By the end of year one, 180 medical doctors will graduate from local universities, and 70 emergency surgical officers enrolled.

Infrastructure

The following activities will be carried out in the four regions of SNNPR, Addis Ababa, Gambela and Benishangul Gumuz. A site assessment will be conducted and the grantee will support basic restoration and renovation of health facilities as needed. 1) By the end of year one, the partner will develop a prioritized list of infrastructure projects and renovation of 10 priority sites in the four regions will be completed 2) Work with FMOH, EHNRI, and the RHBs in the respective regions to assess health system capacity development needs, and prioritize areas for capacity-building support 3) Work with local partners to ensure adequate systems developed within the Ethiopian national, regional, and local health authorities to plan, and manage infrastructures built by PEPFAR Ethiopia. Assist FMOH and RHBs to develop a strategic plan for infrastructure development including maintenance 4) Collaborate with existing partners, currently charged with developing Continuous Quality Improvement (CQI) programs, to ensure that CQI have been established at the respective levels of the health system.

Operational Support

Provide support to RHBs and other local partners in administrative and financial management of their CoAgs and establish resource management systems. This may include: 1) Transfer technology and/or training to improve data management systems 2) Develop long-term financial plans for self-sufficiency including providing grants proposal writing to local NGOs and government entities to allow them to directly compete for and be awarded funds to conduct comprehensive HIV program activities 3) Strengthen organizational performance management and internal monitoring and evaluation systems.

Technical and Programmatic system strengthening activities addressed will be addressed in this program area.

In prior years, voluntary medical male circumcision (VMMC) activities were carried out in eight sites in Gambella region and more than 35 health care providers have been trained in male circumcision surgical procedures. In FY 2012 to date, 7,775 clients were circumcised. The other activity is to link these VMMC services to existing HIV/AIDS services, such as HTC, STI management and reproductive health services. Service providers will receive basic and refresher training. VMMC kits, consumable supplies and infection prevention equipment will be procured and distributed to the existing sites in collaboration with FMOH.

In the first year of the program period, the following activities will be carried out in Gambella Region:

Expand male circumcision capacity to conduct adult and neonatal Voluntary Medical Male Circumcision (VMMC) in Gambella region.

Ensure quality of VMMC services in Gambella region.

The following targets are expected to be met:

By the end of year one, circumcise about 10,000 15,000 adult men in Gambella and meet 80% the planned target.

By the end of year one, integrate VMMC services into all existing ART sites in Gambella. Integrate VMMC services into at least one health center per woreda by the end of the program period.

By the end of year one, conduct in-service training on VMMC and make standard operating procedures (SOPs) and quality manuals on VMMC available.

The mission of the FMOH is the provision of safe and adequate blood and blood products to all patients who require blood transfusion as part of their treatment. The target of the FMOH is to collect 120,000 units per annum from voluntary blood donors, test all the blood in a quality assured manner in the regional blood banks and preposition stocks of blood for use at the health facilities. The TBD partner in year one will provide technical support to blood banks and health facilities in three regions (SNNP, Gambella and Benshangul Gumuz) in the implementation of their blood safety programs

The TBD partner will:

1.Strengthen the clinical interface through training of clinicians and nurses on appropriate clinical use of blood as well its safe administration to patients as well as support the establishment of hospital transfusion committees in the regions of SNNP, Gambella and Benshangul Gumuz.

2.Support the creation of linkages between blood banks and the hospitals in the including transportation of blood and blood products, supplies as well maintenance of blood inventory at the hospitals

3.Support the strengthening of data collection both from the blood banks and the regional blood banks and develop a comprehensive monitoring and evaluation plan as well as support reporting of blood bank activities to the RHB and the FMOH.

4.With the support and collaboration of WHO, conduct mentorship 6 blood banks in the regions to ensure quality of services in the regions. This will be achieved through the mentors trained through WHO support

5.Improve the collection of blood through mobile collection teams. The selected partner will support the activities of the mobile collection teams of the regional blood banks through target setting and development of collection plans

6.Support blood donor education and mobilization through effective engagement with local radio stations, print media, and training of communication experts, blood donor mobilizers and blood bank staff.

Support national and regional IP working groups to update training manuals and guidelines. Support the integration of injection safety and waste management into HTC, ART, PMTC, and TB/HIV training curricula. Train HCWs and support staff on IP/injection safety.

Revise IP tool for capturing quality improvement assurance of IP/injection safety and integrate it into existing training modules.

Set standard national indicators for IP/injection safety to improve monitoring and evaluation of IP programs.

Secure some IP commodities for health facilities of Addis Ababa, SNNPR, Gambella and Benishangul Gumuz in collaboration with RHBs and the FMOH

Strengthen capacity to secure universal access to PEP in health facilities.

Ensure that performance monitoring and data quality sampling techniques and data documentation tools and systems are in place.

Continue to identify and support the production of locally produced, low-cost, personal protective equipment, antiseptic hand rubs and aprons, and customized basic IP supplies. Refer to indicators and targets for details on the magnitude and impact of the international TA partners program.

The primary goal of support in the area of prevention is to strengthen STI / HIV prevention activities. Assistance that focuses on "abstinence and / be faithful" includes:

Education of STI patients about the importance of secondary abstinence to reduce the risk of HIV/STI transmission. Promote fidelity among STI patients to reduce the risk of HIV/STI transmission.

Education of STI patients on reducing multiple and concurrent partners to prevent sexual transmission of HIV/STIs.

STI/ HIV prevention information, education and behavior change and communication materials will be adapted and used to educate STI patients at facility level.

Mini media and AIDS Resource Centers at the health facilities will be supported to deliver continuous messages about STI/HIV/RH. In addition, gender issues should be incorporated, with a particular emphasis on reducing violence and coercion.

Printing and distribution of STI job aid materials such as guidelines, wall charts and flipcharts for all the health facilities in the region.

Production and distribution of IEC/BCC materials on reducing multiple and concurrent partnership, fidelity and STIs.

The following will be indicators for the above mentioned activities.

All STI patients seen the public health facilities supported by the partner will get education on secondary abstinence, and fidelity.

All the health facilities supported by the partner will have STI job aid materials, IEC/BCC materials on reducing multiple and concurrent partnership, fidelity and STI.

HVCT Specific activities will include:

Conducting basic HTC training for health care workers and community counselors and build capacity of university in-service training units to conduct such training.

Targeting provider initiated testing and counseling (PITC) trainings to at least 8-25 trainees per site.

In collaboration with Family Guidance Association of Ethiopia via the confidential STI clinics, support targeting of HTC services to MARPs and hard-to-reach populations.

Increasing efforts to identify more HIV positives and discordant couples by using patient expert and peer educators to promote partner testing in ART clinics and ANC outlets.

Through strengthening linkages HIV positives will be linked to care and treatment service and ensure referred clients reached and received the services through feedback mechanism.

Promoting HTC services using different media and events such as national HTC day and World AIDS Day as well as provide support to development of multimedia materials in support of HTC and World AIDS Days.

Collaborating with Ethiopia HIV/AIDS Counselors Association (EHACA) to conduct case review meetings to improve quality of HTC services in the HCT outlets.

Improving data analysis and use to better guide implementation and management of activities.

Working with Handicap International, regional HIV/AIDS Program Coordination Office, Ethiopian National Disability Action Network (ENDAN) and other stakeholders to reach the disabled people. Refer to indicators and targets for details on the magnitude and impact of the international TA partners program.

In the first year of the program period, RHBs in the four regions of SNNPR, Addis Ababa, Gambela and Benishangul Gumuz, will be supported to provide quality HIV Testing and Counseling (HTC), including couples/partner and family testing and counseling services. This support includes training at both basic and refresher levels, providing mentorship to improve quality of HCT services, support in facilitating availability of test kits at the facility level, and ensuring linkage services for those who test HIV positive to care, support, and treatment services.

The following targets are expected to be met:

By the end of year one, 197 HIV Testing and Counseling (HTC) service sites will be supported though mentorship.

By the end of year one, a total of 1.1 million people will have tested for HIV and received result.

By the end of year one, 170 Health Care Workers (HCWs) will be trained to provide HCT services.

By the end of year one 80% of STI patients will receive PITC at public health facilities.

In COP 13, the following prevention activities will be carried out in the four regions of SNNPR, Addis Ababa, Gambela and Benishangul Gumuz:

Training of Health Care Workers (HCWs) on syndromic management of Sexually Transmitted Infections (STI) screening and treatment.

Provision of syndromic screening and treatment.

Promotion and distribution of pre-packaged STI treatment kits and condoms in the health facilities in the regions .Support Provider Initiated Testing and Counseling (PITC) for all STI clients coming in for services in all the health facilities.

Provision of onsite mentoring for STI screening via questionnaire of all clients coming into clinic sites.

Improving monitoring and evaluation, data recording and reporting of STI treatment and prevention activities and site- level STI data to improve service delivery.

Actively participating in the national STI technical working group and providing technical assistance in the revision of national STI guidelines.

Conducting training using innovative onsite or group-based approaches to ensure large numbers of workers are trained at the site level with a focus on ensuring HIV and STI linkages at facility level.

Mentoring healthcare providers to establish a good rapport with patients and give youth, adolescent, women and MARPS-friendly service.

Ensuring that adequate patient education and counseling is given to all patients diagnosed with STIs.

Verifying that all clients diagnosed with STIs are offered HIV testing and all clients found positive are enrolled in HIV care.

Confirming that partner management is addressed for all STI cases according to guidelines.

Collaborating with appropriate partners to ensure that all appropriate STI drugs and supplies are available at each site.

Establishing an adequate condom supply in all STI treatment sites and ensure condom promotion and distribution is done for clients in all STI treatment sites.

Transitioning the confidential sex workers clinic in Addis Ababa and Hawassa to the FGAE. In addition, throughout all prevention activities, gender issues have been incorporated, with a particular emphasis on reducing violence and coercion. IN COP 13,10,000 pre-packaged STI treatment kits and condoms will be distributed in public health hospitals

The following will be indicators for the above mentioned activities.

1,000 HCWs from public health facilities will be trained on syndromic management of STIs.

10, 000 patients will receive STI screening and treatment at public health facilities.

PMTCT activities will include:

Work with the RHBs and Local Universities to effectively transfer PMTCT activities to the respective RHBs and Local Universities with emphasis on referral linkages.

Support for PMTCT services and expanding outreach PMTCT services focusing on high prevalence and hotspot areas with emphasis on referral linkages.

Support the FMOH in roll out of the new national PMTCT guidelines, training packages and implementation manuals based on Option B+.

Implementing quality improvement to improve retention of HIV positive mothers and HEIs in care; expanding role of case managers and mother support groups (MSGs) and strengthen referral linkages.

Supporting FMOH and regional health bureaus with the implementation of the monitoring system for PMTCT.

Supporting training of safe pregnancy/family planning counseling and promote integration of family planning and HIV services and build capacity of university in-service units to conduct such training.

Scaling up couple counseling / partner testing, facilitate male friendly services, and establishing a monitoring system.

Expanding counseling, prevention with positives (PWP) and treatment services for discordant couples.

Expanding MSGs to at least 10 new sites, assess new sites for MSGs needs, and establish linkages with economic strengthening activities.

Expanding integrated MNCH/ART/PMTCT services.

Enhancing postnatal follow-up of HIV-infected mothers and HIV-exposed infants.

Strengthening and expanding Essential Newborn Care (ENC) services.

Supporting minor renovation, refurbishment, and repair of ANC, labor and delivery rooms, and maternity wards.

Supporting provision of 80% of supported facilities with e-mobile phones and airtime cards to facilitate inter-facility communication including consultation requests for transport, referrals, lab test results and client tracing.

Setting the research/ evaluation agenda with the GOE and support PMTCT program evaluation.

Specific areas of support to build the capacity of RHBs and local universities for Treatment include:

Training health care providers on ART and building capacity of RHBs and local in-service units at universities to conduct such training.

Distance learning, teleconferencing and case discussion activities with ART providers.

Mentorship at each ART site.

Dissemination of appropriate educational information to ART patients, their care givers and the community to overcome the false beliefs and practices around HIV and ART, and reduce stigma and discrimination of HIV patients.

Supporting case management in collaboration with PLHIV associations to promote ART adherence and retention of patients in care and support programs.

Improve health network systems by supporting catchment area meetings, inter-facility and facility-community linkages and the referral system as well as support the establishment and functioning of facility ART multi-disciplinary teams.

Implement quality improvement approaches.

Support ART monitoring and evaluation activities including support to the national HMIS.

Furnish, maintain, renovate and restore basic functions of ART facilities in collaboration with the RHB.

Family Centered Care and Treatment for Children, Adults, and Pregnant Women

In the first year of the program period, the following activities will be carried out in the four regions of SNNPR, Addis Ababa, Gambela and Benishangul Gumuz:

Support local universities to establish in-service training units to be able to provide in-service basic and Training for Trainer (TOT) trainings on the full spectrum of HIV/AIDS related clinical services including care and support (covering nutrition, pain management and mental health for HCWs, adult care and treatment, pediatric care and treatment, and PMTCT.

Support and expand integrated PMTCT/ART/ Maternal New Born Child Health (MNCH) services at public health facilities and expand outreach PMTCT services focusing specifically on high yield sites

Strengthen and scale-up the availability of post exposure prophylaxis (PEP) services for occupational and non-occupational exposure.

Ensure sites implement early infant HIV diagnosis and all eligible HIV-positive children are promptly referred for ART care.

Ensure Nutrition Assessment and Counseling Support (NACS) are completed at all entry points.

Train HCWs in comprehensive TB, TB/HIV and Multi-Drug Resistant (MDR)-TB.

Support implementation of TB/HIV collaborative activities at health facilities.

Support the implementation of basic TB infection control interventions.

Provide technical assistance and support to RHBs and local universities to establish a clinical mentoring program for HIV/AIDS services in hospitals, health centers and confidential STI clinics.

Pediatric Treatment Program area activities will include:

Build regional capacity to plan implement and monitor site level programs

Provide TA to national l working groups to update guidelines, protocols, training materials, IEC materials.

Expand-ART uptake by maximizing entry points for children testing via PIHCT at under-five clinics, pediatric inpatient services, TB clinics, and EPI clinics.

Strengthen family-focused HTC, care and treatment, and linkages to other services.

Expand comprehensive pediatric HIV care and treatment in private sector.

Strengthen management of HIV-exposed and infected infants and early treatment for HIV infants per national guidelines.

Mentoring to improve service quality and provide onsite updates for providers.

Training on Pediatric ART, advanced learning through telemedicine and case review sessions using local university trainers.

Community involvement to support uptake and adherence of HIE and pediatric patients and link to OVC programs.

Implement services for adolescent groups and camps designed to provide psychosocial support; incorporate family-focused elements to increase family involvement in pediatric HIV care and adherence.

Integrate adherence supporters into stand alone pediatric ART units to ensure, retention, tracking and referral for support services to available community based organizations

Continue monitoring and evaluation support to facilities as per national mandated standards

Ensure utilization of quality improvement tools to identify and respond to gaps.

Support the use of IEC/BCC materials in local languages to enhance public awareness of pediatric HIV care and treatment services

Establish strategies to integrate pediatric HIV services with other MNCH and child survival interventions.