CDC/PEPFAR continues to engage local governmental institutions to build their capacity and transition the technical support for the implementation of the HIV treatment program. As a result, the Tigray Regional Health Bureau (TRHB) will be awarded funds in COP 2013 through a cooperative agreement with CDC, and will be a direct recipient of PEPFAR funds. The TRHB will work on strengthening its technical and administrative capacity in the planning of the ART program, supporting ART program implementation, coordination of the various region wide activities, and M&E of ART program implementation. The TRHB will take over the existing program activities from the international technical assistance partner, and thereby increase local ownership and ensure sustainability of the program. The TRHB will work to improve the health network model and the health systems in the region for effective delivery of services for PLHIV. The TRHB will work to strengthen the human resource and infra-structure of the care and treatment facilities in the region for the provision of integrated, comprehensive HIV services to PLHIV and other individuals affected by HIV. The TRHB will support implementation of ART services in all the HIV care and treatment providing hospitals and health centers in Tigray. The Tigray region has a total population of nearly 4.9 million inhabitants. The adult prevalence of HIV in Tigray region for 2013 is estimated at 1.8% with a total of about 61,000 PLHIV. The TRHB will coordinate the different activities and initiatives being implemented by multiple partners in order to maximize efficiency.

The Tigray Regional Health Bureau will recruit or assign a care and support focal person who will oversee the implementation of care and support related activities and take over the adult care and support activities being implemented by international TA partner. In COP 2013, the TRHB will undertake the following activities:

Strengthen the intra-facility and two way referrals and linkages between health facilities and the community.

Coordinate and harmonize work with community-based organizations (CBOs) working on HIV/AIDS care and support services, and facilitate their involvement in health facilities multi-disciplinary team and catchment area meetings; use CBOs and urban health extension workers to trace and link lost to follow-up PLHIV.

Intensify prescription of co-trimoxazole prophylactic therapy (CPT) for eligible PLHIV; consider CPT as one of the quality monitoring indicators and review its performance regularly

Provide nutritional assessment and counseling services and provide nutritional support to malnourished PLHIV in collaboration with partners working on nutritional support.

Integrate mental health services into the chronic care unit or link PLHIV who need mental health service to psychiatric clinics.

Strengthen PwP prevention messages and services

Strengthen pain assessment and management services for PLHIV, and improve access to pain medication for PLHIV, including morphine.

Ensure training, distribution and utilization of basic preventive care package components

The TRHB will oversee implementation of cervical cancer prevention service at Bahirdar, Debre-Markos and Dessie hospitals.

In COP 2013, the TRHB will strengthen its capacity to support and monitor TB/HIV program and service integration in a sustainable manner through training and integrated mentorship activities, and ensuring quality of TB/HIV care.

In COP 2013, the TRHB will:

Develop a costed strategic plan for TB/HIV program support as part of the comprehensive HIV/AIDS program plan.

Strengthen TB and HIV control program coordination and integration at regional and sub-regional health care structure levels.

Undertake assessment of the TB and TB/HIV program to identify key program gaps and focus areas for the regional TB control program.

Strengthen TB program management and human resource capacity at regional and sub-regional levels through training of TB and TB/HIV control program staff.

Undertake regular supportive supervision and review meetings to monitor the TB/HIV programs.

Organize a pool of a core team of trainers for comprehensive TB-Leprosy, TB/HIV and MDR-TB training at the regional level.

Organize regional TOTs and in-service trainings on comprehensive TB, TB/HIV TOTs in collaboration with local universities and partners.

Organize mentorship teams composed of RHBs, health facilities and local university staff; in collaboration with partners, undertake mentorship of the comprehensive TB and TB/HIV control programs in health facilities in the regions.

Undertake TB and TB/HIV related program evaluations.

Strengthen TB diagnostic services and EQA in collaboration with EHNRI, regional laboratories, and partners.

Strengthen patient referral networks across TB/HIV delivery sites; print and distribute TB/HIV guidance documents and job aids.

Support TB and TB/HIV Advocacy Communication and Social Mobilization (ACSM) activities

In COP 13, the core activities to be undertaken by the RHB will be to build its managerial and technical capacity to manage the pediatric care and treatment program in preparation for a full transition of the support by 2015. In COP 2013, TRHB will collaborate with the international TA partner to takeover certain site level pediatric care and support activities.

In COP 2013, the TRHB will:

Support the implementation of standardized care and support services for HEIs & infected children to improve their quality of life.

Participate in the revision of national pediatric guidelines, training curricula, and standard operating procedures for pediatric HIV care as appropriate.

Emphasize successful implementation and scale up of EID for early identification of HEIs.

Work on prevention and treatment of OIs and other HIV/AIDS related complications including malaria, diarrhea, pain, and symptom relief.

Support nutritional assessment and counseling as well as the integration of food provision in coordination with other partners.

Support training in coordination with local universities to ensure provision of appropriate counseling about HIV treatment and care adherence support group formation for children, adolescents, caregivers and families to enhance adherence to interventions.

Provide technical support for the provision of preventive services; including infant feeding counseling, multi-micronutrient supplement, CPT, enhanced TB case-finding and provision of IPT, malaria screening and distribution of ITNs for children under5 in endemic areas,

Promote POU water sanitation, hand washing and personal and household hygiene

Provide onsite clinical mentorship, basic care and support provision, care and support training and supportive supervision

Strengthen and improve the quality of implemented activities.

Enhance the documentation of all infants HIV exposure status & follow-up.

Integrate child survival interventions into the following activities immunization, safe water and hygiene, micronutrient supplement, growth monitoring, improved infant and young child feeding, and treatment of life-threatening childhood illnesses.

In COP 2013, The Tigray Regional Laboratory (ARL) will work closely with the international TA partner to facilitate the transition of laboratory program activities in the region. The ARL will:

Conduct baseline assessment of laboratories to be enrolled in SLIPTA, participate in SLIPTA training, and mentor participating laboratories.

Procure ancillary laboratory equipment and safety materials to support laboratory accreditation through SLIPTA.

The TRHB will collaborate with Mekele University and ITECH-Ethiopia to conduct training on laboratory quality management system, laboratory management, HIV rapid testing, safety and ART monitoring.

Establish central equipment maintenance capacity through employment of equipment maintenance engineers, training of the maintenance engineers and procurement of preventive maintenance tool kits and calibration equipment. The workshop will have the capacity to maintain ancillary equipments, conduct calibration, and provide preventive maintenance for larger equipment.

Strengthen the Regional EQAS program and increase coverage of facilities in the region. The Regional Laboratory will implement process improvement informed by REQAS performance. The Regional laboratory will procure equipments and supplies required for regional EQAS.

The Regional Laboratory will organize regional laboratory program review meetings.

The Regional Laboratory will collaborate with EHNRI to establish data management capacity (Data base) for major laboratory program areas such as training, sample referral networks, EQA, SLIPTA and equipment maintenance.

Closely work with EHNRI, the postal service, and I-TECH Ethiopia to strengthen sample referral networks. The ARL will train laboratory personnel on sample referral networks, and monitor network performance. The Regional Laboratory will procure sample transportation and storage materials to strengthen the sample referral network.

Strengthen the microbiology laboratory service at the regional laboratory to support referral testing, disease surveillance, and outbreak investigation in the region.

The TRHB is a local government institution and will be directly funded by PEPFAR in COP 2013 to implement HIV program activities. Starting in COP 2013, in the SI program area, the TRHB will support and strengthen monitoring and evaluation of the HIV program activities in order to be able to report on PEPFAR indicators for the region, and to utilize data at site level and regional level to inform evidence-based planning and quality improvement. The partner will manage the smooth transition of key technical and managerial activities from I-TECH Ethiopia to the Regional Health Bureau. Technical and management support includes, but is not limited to, on-site mentoring and supportive supervision, coordination of in-service training through collaboration with local universities, and implementation of a monitoring system that will result in capacity to report on PEPFAR performance indicators. In COP 2013, the TRHB will:

:

Effectively transition key technical and managerial activities to the Regional Health Bureau.

Assign M&E/HMIS staff and HIT/Data clerks that will be trained in HMIS and HIV/AIDS data management and take over full responsibilities from the existing international TA partner working on this.

Use site level performance data for informed decision making.

Work together with the international partner to take over the reporting on PEPFAR performance indicators.

Document its activities, share best practice, undertake monitoring and evaluation of the program, and provide site supportive supervision.

Conduct regular regional review meetings.

Collaborate with the international partner and local universities to strengthen the M&E unit of the RHB through SI specific in-service trainings.

This is a new activity to be implemented by Regional Health Bureaus.

Health system strengthening remains a priority for the Government of Ethiopia (GOE) and all stakeholders in the health sector as weaknesses in the health system are critical barriers to achieving country capacity to sustain the response to HIV/AIDS over time. The goal of this program is to build the technical and managerial capacity of the regional health bureaus to successfully transition technical and management support for the implementation of comprehensive HIV prevention, care, and treatment services. In particular, this program will be geared toward supporting the implementation of strategic objective 5 (improve quality of health care), strategic objective 6 (enhance harmonization and alignment), and strategic objective 13 (improve human capital and leadership) of the GOEs Health Sector Development Program IV (HSDP IV).

In COP 2013, the TRHB will work closely with local universities to coordinate the implementation of pre- and in-service training, support the deployment and implementation of human resources information system (HRIS) at the RHB, support and coordinate the implementation of hospital reform and quality improvement programs, conduct regional joint supportive supervision with implementing partners, support regular health sector review meetings, implementation guidelines, best practices, and evaluation findings. The RHB will work closely with the USG and other partners to avoid programmatic duplication and to synergize activities for optimal use of resources.

The Tigray Regional Health Bureau blood safety program will implement the following activities in COP 2013:

The TRHB will manage and coordinate collection and testing of blood from voluntary non remunerated donors through a stationary collection site and a mobile outreach team. One mobile team will be established under the regional blood bank. The Regional Health Bureau will assist the blood banks in setting up mechanisms for pre and post donation counseling, donors test result notification for transfusions, transmissible infections (TTIs), and referral to health facilities for those who require clinical care. To meet the need for safe blood in the rapidly expanding health care facilities in the region, the TRHB has set a target of collecting, testing and distributing 24,000 units of blood in COP 2013.

The TRHB will coordinate and facilitate training of hospital clinical staff on appropriate clinical use of blood to ensure the safety of the recipients and reduce poor transfusion practices. At least one clinician from each transfusion hospital will receive a TOT training on the clinical use of blood components from WHO to cascade the training to clinical staff working in each transfusion hospital in the region. To build the capacity of the TRHB on blood safety, they will train 35 professionals and 2 blood banks on blood safety, blood bank management, donor recruitment, blood testing, and processing by WHO and the FMOH/NBTS.

Recruitment of blood donors is an important component of transfusion services. Therefore, the TRHB will assist the blood bank in the region to create public awareness around blood donation and community mobilization, development, dissemination, and utilization of communication materials. This will also include the use of different communication channels such as print and electronic media for blood donor education, mobilization, recruitment, and retention. It will also assist with the establishment of community blood donors clubs with the support of the existing regional blood bank.

In collaboration with WHO, the TRHB will roll out quality management systems to blood banks in the region and assist the blood bank and hospitals in setting up a mechanism and systems for M&E of the regional blood safety program.

The TRHB will also assist the blood bank and hospitals to set up and maintain a cold chain system for proper storage and transportation of blood and blood products. The RHB will therefore assist with the effort to furnish the blood bank and hospitals with appropriate cold chain equipment to ensure correct temperatures for the storage and transportation of blood.

The TRHB will support the establishment of blood bank hospital linkages by mapping all facilities within a 100 kilometer radius that are eligible to provide blood transfusion services and also assist the blood bank and hospitals in the region to establish haemovigilance and a review system, in addition to supporting the establishment of transfusion committees in all transfusion hospitals in the region.

Medical Injection/Infection Prevention (IP) procedures are important components for providing quality health care services and to prevent the transmission of HIV and other diseases. The international TA partner has been implementing various activities in health facilities under the management of the TRHB/TRHB, which includes technical support through training, provision of basic IP/personal safety equipment, ISS, and clinical mentoring.

In COP 2013, some of the IP and patient safety activities will be transitioned to the TRHB, to support health facilities under the RHB focusing on building IP management capacity through providing trainings, printing and distribution of IPPS guidelines, integrating injection safety and waste management practices into all OPD/IPDs in the facilities, and procuring and distributing selected standard IP commodities.

The RHB will work closely with the health facilities under its management, other implementing agencies, and the IP committee in all health facilities, to build capacity through mentoring of clinical staff and waste handlers, ISS, and providing IP support materials. This support will include assistance with planning for cost effective, appropriate, and environmentally friendly waste management techniques at the facility level. The HRHB will also assist the health facilities to continue work on ventilation of TB wards and complete the MDR/XDR TB prevention activities. It will also assist with implementation of a continuous quality improvement assessment on the injection safety activities and closely monitor Infection Prevention and waste management activities at the facility level to identify and close gaps in collaboration with the IP committees at health facilities.

In the past, I-TECH has supported HIV testing and counseling (HTC) services in health facilities in the Tigray region. In COP 2013, some activities of the HCT program will be transitioned to the TBD international TA partner. Under COP 2013, the TRHB HCT program will:

Support the implementation of VCT services including couples/partner and family testing and counseling, and routine HIV testing at point-of-care (POC) in all health care facilities where the service is provided.

Strengthen pediatric PITC in all entry points at all health facilities including in pediatric inpatient facilities, under five outpatient departments, therapeutic feeding units, and immunization outlets.

Work with partners to implement index case testing in hospitals and health centers.

Build human resource capacity through onsite training of health care workers on couples and individual HTC and PITC.

Strengthen systems through regular mentorship and supportive supervision to ensure quality HTC service delivery.

Support HIV rapid testing and quality assurance through regular supervision of labs.

Develop SOPs for HTC activities.

Establish stronger HTC related partnerships at national and regional levels and provide technical and logistic support to sites implementing HTC services.

Work in close collaboration with I-TECH Ethiopia

The TRHB will be provided with technical support by ITECH Ethiopia to carry out these activities.

Since 2005, the international TA partner has been supporting the RHBs to strengthen STI services and program activities.

In COP 2013, the following activities will be transitioned to the RHB to ensure sustainability and local ownership of the STI/HIV program by the GOE

Strengthening the capacity of HCWs in Tigray to diagnose and treat STIs/HIV. Health care providers from public health hospitals and health centers in Tigray will be trained on syndromic management of STIs.

Improving the linkage of STI/HIV / AIDS services through provision of PICT for STI clients at public hospitals and health centers in Tigray. At least 80 percent of STI patients will be tested for HIV and linked to care and treatment services.

Strengthen STI screening for PLWHAs at ART clinics, and also HCT, family planning, and ANC clients in public hospitals and health centers in the Tigray.

Strengthen condom demonstrations and access at the public health facilities in the Tigray, particularly for STI patients and PLWHAs at the ART clinics.

Strengthen risk reduction counseling and health education for STI patients at the public health facilities in the Tigray.

Support the capacity of public health facilities in the Tigray to print and distribute STI job aid materials, (national STI guidelines, wall charts, and flipcharts) and IEC/BCC materials on STI/HIV prevention.

Improve access to prepackaged STI treatment kits in the public health hospitals and health centers in the region in collaboration with other partners (PFSA &PSI).

In COP 2013, The Tigray RHB will work with the respective CDC/PEPFAR international implementing partner to build its capacity, and will gradually transition PMTCT activities to strengthen ownership and ensure sustainability of the program. They will enhance the capacity of Zonal/Woreda Health Offices to support the effective transition of PMTCT services.

In COP 2013, the TRHB will:

Support the transition of the TA for PMTCT services away from the US-based partner to public hospitals and health centers in the regions.

Support rolling out of Option B+ through training and mentoring of health care providers at facilities providing PMTCT services.

Conduct site supportive supervision, use site level performance data, and implement quality improvement approaches to improve retention of HIV positive mother and HEIs in care services

Strengthen the capacity of Case Mangers and MSGs to improve retention of HIV+ women and family members in care and treatment services.

Support implementation of the updated PMTCT monitoring system in line with the Option B+ strategy.

Support training on safe pregnancy and FP counseling and also promote integration of FP and HIV services.

Support Integration of TB Screening with PMTCT program

Scale-up couples counseling and partner testing, facilitate male friendly services, and establish a monitoring system related to these services.

Support minor renovations, refurbishment, and repairs of ANC, labor and delivery rooms, and maternity wards.

Improve the referral system to ensure continuum of PMTCT care.

Support the catchment area meetings and conduct regular regional review meetings.

The Tigray RHB is a local governmental institution that is governing and responsible for all health care and related activities in the respective region. Through these funds, the TRHB will work on strengthening their technical and administrative capacity in program planning at the regional level, support the implementation of the ART program activities at the sites, coordinate the various program activities, and monitor and evaluate the implementation of ART program activities. The TRHB will strengthen the health network model and the referral systems in the region to ensure the efficient delivery of the continuum of HIV care and treatment services to the beneficiaries. They will support and strengthen catchment area meetings and the effective functioning of the ART Multi-Disciplinary Teams in each ART site.

The TRHB will work to support, conduct, and strengthen the clinical and system mentoring activities in the region in order to support site level implementation of care and treatment services. The TRHB will implement Quality Improvement (QI) activities in ART sites. The TRHB will collaborate with NEP+ to implement and support case management activities in the region to improve adherence, reduce ART patient attrition, and improve linkages between the different services. The TRHB will undertake regular integrated site supportive supervision, conduct regional review meetings, and periodic evaluation of program activities. The TRHB will undertake minor renovations, furnishing, maintenance, and restoration of basic functions for the delivery of quality HIV care and treatment services.

In COP 2013, the core activities to be undertaken by the TRHB will be to build its managerial and technical capacity to manage the pediatric care and treatment program in preparation for a full transition of the support by 2015. In COP 2013, the RHB will collaborate with the international TA partner to takeover certain site level activities in implementation of the pediatric care and support services:

In COP2013, the TRHB will:

Provide technical support in the areas of family-centered HIV care and treatment, and work with the national ART Program to strengthen the growing Ethiopian pediatric HIV program.

Emphasize increased pediatric ART service uptake at all sites through improving detection of HIV infected children at service entry points.

Emphasize strengthening the internal and external linkages including internal referrals to HIV care clinics from various points of care, and externally through referrals to and from community-based services,

Support the development and implementation of strategies to integrate the pediatric HIV program with child survival and MNCH programs.

Support the scale-up of ART service through technical assistance (TA)

Support pediatric ART training, according to national guidelines and curriculum in collaboration with local universities.

Expand case management service to pre-ART and pediatric wards to decrease dropout rates.

Assess and improve quality of service for pediatric care and treatment through standardized approach in all operating sites.

Build the capacity of care providers on quality ART monitoring through inservice training, on-the-job mentoring, case-based discussion and distance learning.

Expand adherence support to inpatient wards and extend adherence support through home visits using outreach workers.

Build the capacity of HIV committees and providers on quality assurance and monitoring for clinical and non-clinical ART outcomes as well as performing targeted program evaluations.

Conduct integrated regular mentoring, supportive supervision, and review meetings with stakeholders.

Support the use of Information, Education and Communication and Behavior Change Communication (IEC/BCC) materials in local languages to enhance public awareness of pediatric HIV care and treatment services.