Goals and Objectives: The ultimate goal of the program, Support for Health Systems Strengthening and HIV/AIDS Service Delivery in Malawi's South-East Zone, is to contribute to achieving the highest standard of health and well-being in Malawi. The program is designed to accomplish this by pursuing three objectives, which leverage Dignitas's core competencies and are closely aligned with the Malawi National Action Framework and the Partnership Framework, including: a. Reducing new HIV infections; b. Improving treatment, care and support for people living with HIV/AIDS; and, c. Strengthening health systems.

The program will implement activities across eight Technical Areas, including PMTCT, Adult Care and Treatment, TB/HIV, Counseling and Testing, Pediatric Care and Treatment, Laboratory Infrastructure, Strategic Information, and Health Systems Strengthening.

Link to Partnership Framework: As captured above, the three objectives of: reducing new HIV infections; improving treatment, care and support for people living with HIV/AIDS; and, strengthening health systems are closely linked to the Partnership Framework.

Geographic Coverage and Target Populations: The program will be implemented in the South-East Health Zone - the districts of Balaka, Machinga, Mangochi, Mulanje, Phalombe and Zomba - with a combined population of greater than 3.1 million people. The beneficiaries of the program fall into three categories: a. Front-line healthcare workers: Approximately 2,000 individuals including Medical Doctors, Clinical Officers, Medical Assistants, Nurses, ART and PMTCT Providers, ART and HTC Counsellors, ART Clerks, Health Surveillance Assistants, and Patient Care Attendants who work in health facilities across the South-East Health Zone; b. Health systems supervisors and managers: More than 100 individuals, including Zonal Health Office (ZHO) staff, District and Deputy District Health and Nursing Officers, HTC, TB, ART and PMTCT Supervisors and members of District Health Management Teams; and, c. The population of the South-East Health Zone: More than 3 million people are considered as beneficiaries. As of December 2008, nearly 225,000 individuals had ever registered to receive ART in Malawi, including 41,000 people in the South-East Health Zone; during the implementation of the program, Dignitas will assist the MoH to enroll approximately 45,000 people on ART in the South-East Health Zone.

Key Contributions to Health Systems Strengthening: The program's key contributions to health systems strengthening include:

a. Strengthening Systems for Referral, Patient Tracking and Follow-Up b. Systems and Processes (e.g., development of Standard Operating Procedures for decentralization, implementation of stakeholder meetings to ensure that the PEP and TB/ HIV programs are operating effectively) c. Pharmacy Management (e.g., management of supplies, establishment of effective protocols) d. Strengthening Coordination (e.g., mentoring and supporting ZHO and DHOs in the development of the HIV-related program components of the yearly District Implementation Plans)

Cross-Cutting Programs and Key Issues: The cross cutting programs include: HRH; and, Gender: Reducing Violence and Coercion. The key issues are: Health-Related Wraparounds; Gender, EOP Evaluation; and, Workplace Programs.

Cost Efficiency: The program is designed to build sustainable, locally owned capacity and increased local autonomy, during a finite time-span, thus becoming more cost efficient over time. In order to avoid dependency, Dignitas will plan with the ZHO and DHOs, establishing project goals together. Services are delivered through the existing system, strengthening it over time, rather than building a parallel system.

Link to the Government of Malawi: The program has been planned through consultation with MoH officials at all levels, including the Zonal Health Office. This has made it possible for partners to incorporate innovative programming that will have an impact on policy and practice, while remaining consistent with the goals and implementation plans developed under the Malawi National Action Framework.

M&E Plans: Dignitas will conduct routine, systematic and integrated M&E across all program areas and activity streams, to assess program impact on health outcomes and cost-effectiveness. Dignitas will also work to bolster the capacity of the ZHO, DHOs and health facilities to conduct appropriate data gathering and reporting, to reflect on this data, and to adjust their practices accordingly. In addition, Dignitas will perform targeted evaluations at key points in the intervention cycle: baseline assessment upon new program initiation including: a) geographic expansion and scale-up (to identify health-service gaps in each new district); b) training needs assessment of District Health Supervisors; mid-term audit of District Health Supervisor support program (including supervisory tools, curriculum, and training); annual audits of clinical programs (PMTCT, HTC, ART); and, an end-of-term evaluation compiling lessons learned and intervention outcomes (measured against targets).

PFIP Year 1 Funds - USD 642,182 PFIP Year 2 Funds - USD 2,151,773

II. BUDGET CODE: 08-HBHC:

PFIP Year 1 - $8,867 PFIP Year 2 - $29,713

Activity One: Adult Care and Treatment at Tisungane Clinic & HRH: Dignitas will continue to manage Tisungane ART Clinic at ZCH, a high-burden site with over 36,000 clinician visits per year. The focus from 2010-2011 will be on building and supplementing the capacity of the MoH to provide high-quality, integrated care for HIV+ patients in the context of rapid decentralization of ART across Zomba District and the zone. Activities include the management of a Healthcare Worker Clinic, and the training and management of Expert Patients. These activities are facility-based. Outreach for new clients is done by training hospital and health centre staff to conduct access-related information, education and communication sensitizations.

Client retention is supported by defaulter tracing and referrals between sites are managed through supporting the development of a district wide referral system (see Budget Code 18-OHSS), which also

supports linkages with other HIV and non-HIV services. Program M&E includes quality improvement initiatives identified through operational audits in addition to collection and analysis of routine programmatic data. As well, these activities support research studies that will help to answer important clinical and programmatic knowledge gaps, such as optimal timing of ART in TB-HIV co-infection, the incidence of ART toxicity and side effects and the prevalence of occult opportunistic infections in patients on ART.

Products/ Deliverables • Provision of clinical care for HIV+ patients not yet qualifying for ART (target: 7,200 by end of FY 2011). • Provision of clinical care and support for ART patients in the Tisungane cohort and at decentralized or independent ART sites (target: 27,000 by end of FY 2011). • Provision of specialist HIV consultation services for inpatients at ZCH and for tertiary care referrals from other health facilities in the zone. • Management and staffing of a specialist Healthcare Worker Clinic (target: about 200 consultations/ month). • Training and Management of a team of Expert Patients (in-service training and mentorship) (target: 10 by end of FY 2011).

Activity Two: Building Healthcare Worker Capacity Through Innovative Clinical Tools and Training: Scaling-Up of STAT-PALM+ to the Zone - In Zomba District, with support from the Canadian International Development Agency (CIDA), Dignitas is presently undertaking a 2-year knowledge translation project that will facilitate the integration of HIV/AIDS and TB care with primary care through activities that build sustainable capacity in the district health system. The project is focused on a set of integrated symptom- and sign-based primary care guidelines, and an innovative in-service training curriculum for healthcare workers.

In South Africa, this combination has been shown to promote higher-quality evidence-based practice, expanded access to care, reduced misdiagnoses and inappropriate treatments, and, just as important, enhanced staff satisfaction and confidence. This intervention package, STAT-PALM+ (Simplified Tools and Training - Practical Approach to Lung health plus HIV/AIDS in Malawi), is a Malawian adaptation of PALSA+ (Practical Approach to Lung Health and HIV/AIDS in South Africa), and takes the form of a guideline and clinical toolkit that consists of the following: • HIV/AIDS (pre-diagnosis, testing, treatment and management, including ART); • TB diagnosis in the context of a high HIV burden; • PMTCT of HIV; • Communicating and promoting adherence to HIV and TB therapy; • Sexual assault referral and post-exposure HIV prophylaxis (PEP);

• Sexually transmitted infections (STIs); • Female reproductive health; • Chronic respiratory disease; • Malaria management; • Skin rashes and lesions (including shingles, scabies, etc.); and, • Malnutrition.

Activities include coordination meetings.

Products/ Deliverables & Targets: The scale-up of STAT-PALM+ is not anticipated to commence until the final quarter of FY 2011. Therefore, the principal product/ deliverable during the period FY 2010 and FY 2011 is coordination meetings with DHOs and DHMTs (target: 3 by end of FY 2011).

III. BUDGET CODE: 09-HXTS:

PFIP Year 1 - $127,426 PFIP Year 2 - $426,970

Activity One: Adult Care and Treatment at Tisungane Clinic: Refer to Budget Code 08-HBHC: Adult Care and Support for an overview of the activity. Activities include PEP, registration, counseling and initiation of patients and the procurement of non-medical supplies. Clinical outcomes are tracked and evaluated monthly through an electronic database. Adherence to ART is monitored through self report at each clinic visit, and adherence counseling is a component of each clinical interaction.

Products/ Deliverables • Provision of post-exposure prophylaxis (PEP) in cases of occupational exposure and sexual assault (target: 150 by end of FY 2011). • Registration, counseling and initiation of patients beginning ART (target: 7,200 by end of FY 2011). • Procurement of non-medical supplies (e.g., stationery, ink, pens, furniture, flipcharts, teaching aids), provision of routine maintenance of equipment at Tisungane, and purchase of buffer stocks of medicines and laboratory supplies to ensure continued operation in the face of supply interruptions.

Activity Two: Support for ART Decentralization: To expand equitable access to care, it is vital to enable

local health centres to provide basic ART-related services that are, at present, mostly available only through district hospitals and private facilities. Through training, community sensitization and supportive supervision, Dignitas will support the DHOs to provide these services. In accordance with the model developed with the Zomba DHO, and with the cooperation of the ZHO and relevant DHOs, decentralization will proceed through three phases (i.e., Phase 1 - new ART sites are permitted only to manage follow-up care of stable ART patients; Phase 2 - new ART sites are permitted to initiate patients on ART and manage the follow-up care of stable patients from the district hospital; Phase 3 - the ART site is independent).

Products/ Deliverables • Initial training of ART providers (target: 70 by end of FY 2011), refresher trainings for ART providers (target: 180 by end of FY 2011), patient registration clerks (target: 70 by end of FY 2011), and ART initiation counselors (target: 60 by end of FY 2011). All ART provider trainings have an in-service component with follow-up through mentorship. • Community sensitizations are intended to ensure awareness of HIV transmission, prevention and treatment, and to increase awareness of where, when, and how to access HIV-related services and will be conducted as ART services are rolled-out to new sites (target: 20 by end of FY 2011). • Supportive Supervision: o Mentoring will be provided to DHMT and health centre management to ensure that health centres receive appropriate support to progress through the phased introduction of ART - mentorship conducted on a weekly basis for "late Phase 1" facilities and on a quarterly basis at all Phase 2 sites. o Quarterly meetings of ART providers in Zomba District will provide a forum for information exchange. o Implementation of integrated supervision at Health Centres means that all Health Centres will receive supportive supervision for all HIV-related services during the same supervisory visit, including ART/OI clinical management, PMTCT, HTC, data management (including use of the pre-ART register), management of drug stocks and supplies, and TB/HIV integration.

Activity Three: Increased Access to Early Maternal HAART - Women testing HIV+ can radically reduce the chances of passing on HIV to their babies before, during, and after childbirth by taking full-scale HAART, or the AZT combination regimen from 28 weeks gestation onward. Activities will ensure access to CD4 testing, the coordination of decentralized CD4 services and supportive supervision.

Products/ Deliverables • Ensuring access to twice-yearly CD4 testing for all pre-ART patients, with priority given to pregnant women in Zomba; in the rest of the Zone, access to CD4 testing will be decentralized along with ART services (target: 20 sites by end of FY 2011). • Assisting DHOs in coordinating decentralized CD4 services.

• Supportive Supervision: o Mentoring district laboratory staff to manage time and resources more efficiently and at the health centre level to improve ordering of CD4 testing and timely follow-up of results o Working with designated lab supervisors from the DHO to ensure the quality of CD4 testing through semi-annual supervision visits to test sites.

Activity Four: Building Healthcare Worker Capacity Through Innovative Clinical Tools and Training: Scaling-Up of STAT-PALM+ to the Zone: Refer to Budget Code 01-MTCT Prevention: PMTCT for an overview of the activity and products/ deliverables.

V. BUDGET CODE: 12-HVCT

PFIP Year 1 - $119,018 PFIP Year 2 - $398,795

Activity One: Counseling and Testing - Basic HTC services are well developed in Zomba District. In the five other districts in the Zone, Dignitas will assist DHOs in completing the scale-up of basic HTC services (includes national quality assurance program). Additional activities include training, assessment, provision of non-medical supplies, sensitization to reach target population and the establishment of protocols. HTC services use the national algorithms and include client-initiated and provider-initiated testing, as well as couples testing, pediatric testing, and involvement in local and national "Know Your Status" campaigns. Regular M&E is conducted to national standards, and annual operational audits are planned. Linkages to care, treatment and prevention services will be supported through development of a referral system (see Budget Code 10-OHSS).

Products/ Deliverables • Scaling-up of HTC services to the zone (target: 20 sites by end of FY 2011). • Initial training of HTC counselors (target: 50 by end of FY 2011) and refresher training of counselors (target: 70 by end of FY 2011), the latter of whom will receive training in paediatric HTC and/ or couples counseling; additionally, HTC counselors (target: 140 by end of FY 2011) will be trained and mentored in paediatric HTC procedures. • Assessment to determine the need for additional mentorship and/or supportive supervision in

coordination and clinical practice. • Provision of non-medical supplies. • Sensitizing care providers to the need for PITC, and providing them with the knowledge necessary to implement it and to make appropriate referrals. • Establishment of protocols to identify and track infants in need of HIV testing.

VII. BUDGET CODE: 14-PDCS Care:

PFIP Year 1 - $13,390 PFIP Year 2 - $44,857

Activity One: Early Diagnosis and Treatment of Pediatric HIV Infection: Pediatric ART and Supporting HIV+ Adolescents - Relative to adolescent or adult HIV infection, paediatric HIV infection is characterized by rapid progression. It is therefore imperative to follow-up on HIV exposed infants, promptly diagnose HIV infection, and quickly initiate appropriate treatment. A core component of Dignitas's program is to support the MoHs Early Infant Diagnosis (EID) and Pediatric ART programs through supportive supervision and mentorship activities. The EID program's main focus is to strengthen laboratory support/diagnostics for pediatric clients. Additional activities include the establishment of a Teen Club for HIV+ adolescents, empowering them to build positive relationships, improve their self-esteem and acquire life skills through peer mentorship, adult role-modeling and structured activities.

Products/ Deliverables • Support for the national scale-up of EID through the development of logistics plans to transport DBS samples for DNA PCR testing, assessment of HC and hospital needs, and the development and implementation support of a proposal for the zonal scale-up of PCR testing. • Establishment of a Teen Club for HIV+ adolescents (target: 170 by end of FY 2011). • Supportive Supervision/ Quality Assurance: o Provision of ongoing mentorship in paediatric ART at decentralized ART sites in the zone (target: 20 by end of FY 2011).

Activity Two: Child Care and Treatment at Tisungane Clinic & HRH - Refer to Budget Code 08-HBHC: Adult Care and Support and Budget Code 09-HTXS Treatment: Adult Treatment for an overview of the

activity and products/ deliverables. Products/ deliverables that are specific to children are mentioned below. Procurement of pediatric drugs and nutritional support are provided through national mechanisms.

Products/ Deliverables • Provision of clinical care for HIV+ child patients not yet qualifying for ART (target: 720 by end of FY 2011). • Provision of clinical care and support for paediatric ART patients in the Tisungane cohort and at decentralized or independent ART sites (target: 2,700 by end of FY 2011). • Registration, counseling and initiation of patients beginning ART (target: 720 by end of FY 2011).

Activity Three: Support for ART Decentralization - Refer to Budget Code 09-HTXS Treatment: Adult Treatment for an overview of the activity and products/ deliverables, which focus on training, supervision, improving quality of care and strengthening health services. Decentralization of ART services promotes integration with routine pediatric care and maternal health services.

VI. BUDGET CODE: 13-PDTX

PFIP Year 1 - $18,717 PFIP Year 2 - $62,717

Activity One: Child Care and Treatment at Tisungane Clinic - Refer to Budget Code 08-HBHC: Adult Care and Support and Budget Code 09-HTXS Treatment: Adult Treatment for an overview of the activity and products/ deliverables, which focus on the provision of PEP, and the procurement of non-medical supplies. Procurement of pediatric drugs and nutritional support are provided through national mechanisms.

Activity Two: Support for ART Decentralization - Refer to Budget Code 09-HTXS Treatment: Adult Treatment for an overview of the activity and products/ deliverables, which focus on training, supervision, improving quality of care and strengthening health services. Decentralization of ART services promotes integration with routine pediatric care and maternal health services.

IX. BUDGET CODE: 17-HVSI

PFIP Year 1 - $219,292 PFIP Year 2 - $734,788

Activity One: Strengthening Supervision and M&E Capacity - Health systems M&E in the South-East Zone is rudimentary and hampered by gaps and overlaps in reporting. This is an urgent action area, given the rapid decentralization of ART care to rural health centres, and the need to monitor clinical outcomes to facilitate continuous quality improvement. Key activities include development of district and zonal supervisory structures, assessments, training of HSA supervisors and supportive supervision. This will support national capacity building to collect, manage, analyze and use data, and support broader M&E initiatives.

Products/ Deliverables • Collaborative development of functional district and zonal supervisory structures and processes with regard to supervision of service delivery, the referral system, and M&E. • Assessments to determine the needs of: a. supervisors, and a subsequent assessment and revision of supervisory tools, curriculum and training; and, b. HSA supervisor training. • Training of HSA supervisors through outreach training mechanisms and the development of appropriate structures and tools. • Supportive Supervision/ Quality Assurance: o On-the-job training for Supervisors. o Monthly and quarterly reviews of ART, TB/HIV, HTC, and PMTCT data collected at health centres. o Quarterly mentorship of District ART, TB, HTC, PMTCT, and HBC Supervisors to promote appropriate supervision of service delivery, and collection of M&E data. o Routine supervisors' meetings to exchange lessons learned, best practices, and challenges, and to share and collaboratively interpret data and suggest ways forward. o Collaborative knowledge translation mentorship project that will conduct program quality control audits, discuss results at dissemination meetings and incorporate lessons learned into district and zonal implementation planning process.

Activity Two: Health Management Information Systems (HMIS) - Specific activities include the adoption of unique patient identifiers, the incorporation of patient-level TB, HTC and PMTCT data in the Tisungane

database, and to implement an electronic medical records system, facilitating integration of non-ART and ART data (i.e. Activity One above).

Products/ Deliverables • Adoption of unique patient identifiers and the incorporation of patient-level TB, HTC and PMTCT data in the Tisungane database. • Implementation of the Baobab electronic medical records system at Tisungane Clinic and one additional site in Zomba, and roll-out to district hospitals across the zone (target: 2 sites by end of FY 2011).

X. BUDGET CODE: 18-OHSS

PFIP Year 1 - $63,403 PFIP Year 2 - $212,447

Activity One: Strengthening Systems for Referral, Patient tracking, and Follow-up - In 2008, Dignitas initiated the development, with a task force of stakeholders, of a referral system for Zomba District. The task force is developing a series of tools and processes to strengthen links between communities and health facilities, to empower healthcare providers to make appropriate referrals and to close incomplete referral feedback loops, and to rapidly identify and trace ART defaulters and pre-ART patients and HIV- exposed infants lost to follow-up, with the assistance of HSAs. Key activities include meetings, the roll- out of the referral system in Zomba district, an analysis of patient tracking in Zomba, the development of a system to track patients in Zomba, engagement with Community Health Centre Committees, and quality assurance.

Products/ Deliverables • Facilitation of quarterly task force meetings to complete development work of referral system and to lead annual referral guideline reviews and revisions. • Roll-out of referral system across Zomba District (the introduction of the referral system at the zonal level will occur in FY 2012), including unique patient identification system, generic referral forms and feedback systems and orientation of health providers to use tools and processes. • Conducting an analysis of patient tracking in urban Zomba, to better understand the particular challenges associated with retaining this cohort in care. • Development and implementation of a system to track patients in Zomba District.

• Engagement with Community Health Centre Committees including conducting audits to assess community needs in relation to Health Centres and to measure the responsiveness of Health Centres to those needs. • Quality Assurance: Completion of an audit to quantify and qualify the performance of the system.

Activity Two: Systems and Processes - A number of systems and consultative processes will be developed and implemented at ZCH which will be refined, and then disseminated to other district hospitals in the zone through decentralization support initiatives. Key activities include the development of Standard Operating Procedures and the holding of stakeholder meetings.

Products/ Deliverables • Development of Standard Operating Procedures for decentralization, drug stock management, patient flow procedures for pre-ART patients, defaulter tracing, quarterly supervision, data cleaning, and clinical tools (e.g., clinical protocols and checklists). • Implementation of stakeholder meetings to ensure that the PEP and TB/HIV programs are operating in an effective and responsive manner.

Activity Three: Improved Pharmacy Management - Dignitas will employ a Pharmacy Technician to provide mentorship to district and health centre pharmacies. The key activity is supportive supervision.

Products/ Deliverables • Supportive Supervision: o Management of supplies of ARVs, drugs for the treatment of opportunistic infections, and HIV test kits. o Establishment of effective protocols and tools to facilitate timely communication between district and health centre pharmacies. o Assisting new ART sites to project stock needs accurately, order supplies (including ARVs and other essential drugs) in a timely manner, and to follow MoH protocols to safeguard drugs and manage stock (e.g., stock rotation).

Activity Four: Strengthening Coordination - In all districts, Dignitas will seek to improve coordination among stakeholders in the short-term, and build the capacity of health systems managers to accomplish this goal in the future. The key activity is supportive supervision.

Products/ Deliverables • Supportive Supervision: o Provision of mentorship and support to ZHO and DHOs in the development of the HIV-related program components for the yearly District Implementation Plans (DIPs)

o Semi-annual meetings with ZHO and DHOs review implementation progress and support planning for the coming months o Review of progress and challenges with ZHO and DHMT staff on a quarterly basis.

I. BUDGET CODE: 01-MTCT ($425,000.00)

Activity One: Improved Early Uptake of ANC and HTC Services - In order to provide the most effective PMTCT care, women need to be tested for HIV prior to 28 weeks gestation. This requires availability and awareness of, and access to, services.

Products/ Deliverables • Scaling-Up HTC services in the Zone (target: 20 sites by end of FY 2011). • Mobilization of HTC, PMTCT and ART providers to promote HTC/ Early ANC to their clients and to test them directly (target: 580 by end of FY 2011). • Conduct community sensitization sessions (target: 25 by end of FY 2011). • Production and dissemination of service maps and directories (target: 6 by end of FY 2011). • Quality Assurance: Processes established and promoted to track whether ANC attendees have been tested for HIV, and to follow-up with those not tested.

Activity Two: Improved Access to PMTCT-Specific Drug Regimens & Perinatal HTC - Dignitas will assist by training and supporting PMTCT providers to prescribe and manage the new AZT combination regimen, and to perform the hemoglobin test that is necessary to monitor women receiving combination therapy.

Products/ Deliverables • Training for PMTCT providers (target: 240 by end of FY 2011) in initial trainings (target: 90 by end of FY 2011) and refresher trainings (target: 150 by end of FY 2011) at sites (target: 20 by end of FY 2011). • CD4 and Hemoglobin Testing available at PMTCT sites in the zone or through transport (target: 20 by end of FY 2011). • Mobilization of PMTCT providers to practice PITC in the perinatal period (target: 240 by end of FY 2011). • Supportive Supervision/ Quality Assurance: o Provision of targeted support, and integrated supervision and mentorship visits to PMTCT providers

(target: 240 by end of FY 2011) as they roll-out the new drug regimen. o Implementation of semi-annual meetings of PMTCT providers (target: 3 by end of FY 2011). o Provision of ongoing quarterly mentorship and support.

Activity Three: Training, mentoring, and quality improvement for comprehensive PMTCT in the the Mulange District

Although Dignitas received $200,000 of FY2010 base funds for PMTCT, this support is inadequate to support scale-up of comprehensive PMTCT in the South Eastern Zone where approximately 1/3 of all MTCT occurs in Malawi. While BASICS and CHAI are operating in several of the districts in this zone, additional PMTCT initiative funding will be utized for on-site mentoring and quality improvement activities in Mulange District, which is a high prevalence, high burden district that currently lacks facility-based support from other partners for PMTCT. This will enable high quality PMTCT services to be scaled up more rapidly to sites throughout Mulange.

Activity Four: Capacity building to improve data utilization and reporting While there is support SI capacity building with the Dignitas FY10 base, this applies broadly to ART, HIV care, and PMTCT activities. Given the need to focus on PMTCT data quality and use in the coming year, Dignitas will receive a small amount of additional PMTCT funding to enable its staff to work side by side with South Eastern zonal staff and district health staff to build their capacity to interpret and use data to improve PMNTCT programs and enable them to be able to better report to the MOH on the national level what they have accomplished. PMTCT Data will be reviewed on at least a quarterly basis with health officers; action plans will be developed and implemented to address data quality issues identified; and feedback will be provided to PMTCT sites to enable them to improve their program in specific ways and monitor such improvements.

VIII. BUDGET CODE: 16-HLAB

PFIP Year 1 - $712.00 PFIP Year 2 - $2,386

Activity One: Lab Capacity - At ZCH, Dignitas will employ a Lab Technician who will continue to provide

lab services as well as mentorship for quality assurance, and training in CD4 testing. A senior Dignitas Lab Technician will serve as Lab Services Coordinator, and will provide mentorship and training to lab staff in other facilities across the zone. Other laboratory management activities include workflows, stock management and the establishment of protocols.

Products/ Deliverables • Establishing efficient and effective workflows governing daily and weekly laboratory procedures, managing incoming orders, managing incoming and outgoing data. • Managing stock, including record-keeping, and forecasting and procurement of supplies, timely communication with colleagues regarding stock-outs. • Establishing and following protocols for on-site and decentralized testing, especially CD4, DNA PCR, and hemoglobin.

Activity Two: Access To and Uptake of Lab Services - In addition to PMTCT clients, increased availability and uptake of CD4 testing will facilitate monitoring of the pre-ART cohort to ensure timely initiation of ART, and may enable earlier diagnosis of treatment failure among the ART cohort. In order to ensure sustainable, accredited laboratory services, the program prioritizes technical assistance to optimize the quality and throughput of service in existing MoH facilities. In addition to the products/ deliverables mentioned in Budget Code 01-MTCT Prevention: PMTCT, another activity includes the management of stock. Products/ Deliverables • Provision of a limited stock of medical and non-medical supplies, as needed.

IV. BUDGET CODE: 10-HVTB

PFIP Year 1 - $11,669 PFIP Year 2 - $39,100

Activity One: Integration of TB/HIV -Dignitas will facilitate the integration of TB/HIV screening and care at each district hospital, and will continue to staff and manage an integrated TB/HIV clinic at Zomba Central Hospital. TB/HIV integration will also be incorporated into other trainings and meetings. These activities support the MoH and partner organizations in achieving the goals of the national TB strategy, and the integration focus supports sustainability of the program over time. TB/HIV clinical outcomes will be

integrated in the electronic database to facilitate high quality data for review, reporting and tracking progress. The electronic database allows flexibility of reporting to adjust to new indictors.

Products/ Deliverables • Management of an integrated TB/HIV Clinic. • Incorporation of TB/HIV integration into all trainings and routine meetings. • Integration of TB/HIV at each district hospital in the zone, including a contribution to site refurbishment (target: 2 by end of FY 2011).