This activity is specifically linked with activity #8688 and #7849 in AB, with #8723 and #7847 in Other Prevention, with #7723 and #7735 in Palliative Care, with #7724 and #7783 in OVC, with #8658 and #8660 in CT, and with #7747 and #7749 in ARV services.

Kikundi Huduma Majumbani (KIHUMBE) has worked closely with the Mbeya Regional AIDS Control Program (MRACP) since 1991, augmenting MOH prevention efforts throughout the Mbeya Region. KIHUMBE continues to be a leader in prevention education efforts in the region and have won national awards annually from the Tanzanian Art Council and Kilimanjaro Music Awards for their dramas since 2000. Messaging is developed and up dated using the National AIDS Control Programme's (NACP) web site and pamphlets. Coordination with local medical providers and the MRACP ensures consistency of messages across services in the region. With FY 2006 funding, they began supporting other organizations through training and supervision in providing accurate AB HIV/AIDS prevention messages and contributed to development a local coordinated prevention campaign known as "Know the Facts". The geographical focus for KIHUMBE's activities is Mbeya City. In addition in FY 2006 KIHUMBE expanded its programming to Mbalizi and Tukuyu towns, both within Mbeya Region.

In FY 2007, KIHUMBE proposes to continue to expand on previous AB prevention education programs by training 120 KIHUMBE program volunteers to present dramas, songs and the use of other communication methods (such as traditional poems and folk stories) to inform individuals about HIV. Eighty education programs that range from drama and music presentations to audience dialogues and personal testimonies will be presented. These productions will focus on AB prevention messages and reach approximately 100,000 individuals within their communities. This includes the OCV cared for by KIHUMBE which receive prevention education as part of their care package. In addition to prevention messages, the presentations will address the importance of knowing one's sero-status and the benefits and availability of HIV care and ART. This includes providing information about local counseling and testing services, home based care organizations and hospitals providing ART. Their prevention program therefore not only provides information on behavior modification but also serves as a link across the continuum of care encouraging service seeking behavior at both private/not-for-profit and public health facilities in Mbeya.

To reinforce messages provided as a part of community programming, KIHUMBE will also undertake at least 40 targeted educational presentations at primary and secondary schools and at the Center for HIV Prevention for Youth which is headquartered in Mbeya City. KIHUMBE anticipates this approach will provide a complement to their community focused programs and allow the program to reach the same youth in several venues for reinforcement of AB messages. This will provide an additional tool for school counselors and teachers to use to supplement HIV education and prevention efforts in their classrooms.

Currently, Students Partnership Worldwide, SPW, has had its college bound volunteers working in many of the primary and secondary schools in Mbeya providing fact-based education about HIV/AIDS and AB. As these students head for colleges and universities, these primary and secondary schools will have no specific HIV/AIDS educational programs between September and January. KIHUMBE will build upon the excellent work of the SPW student volunteers to bridge this gap at these schools as new volunteers are brought on.

Funding for the above prevention activities will support the transportation of drama group members and education personnel to communities and schools for events, the cost of conducting the events, the distribution of educational materials, and costs associated with advertising and development of new materials on improved AB messaging.

KIHUMBE will also take advantage of the Dala Dala World AIDS Day 2007 Campaign. This campaign was initiated by a Network of 10 NGOs and FBOs, of which KIHUMBE is a member, in Mbeya in 2005 to complement other World AIDS Day activities in the region. Working with the Network, KIHUMBE assisted in the preparation of audio-cassettes in four local languages providing AB behavior messages and information on HIV services and distribution of those cassettes to approximately 100 public commuter buses (Dala Dalas). These cassettes were played in the dala dalas through out the day and an additional 100 cassettes were distributed to their customers upon request. These tapes were well received and were used by the drivers for an additional period of three months, continuing

to reinforce AB messaging and the promotion of the "Know the Facts" campaign. Funding in FY 20007 will cover KIHUMBE's participation in support of this activity to include the actual production of the audiotapes and the cost of their involvement in distribution and community mobilization.

Another annual activity for KIHUMBE and other members of the Network is participation in the Southern Highland's Nanenane. Nanenane is a farmers' show and exposition covering the four regions in the Southern Highlands which include Mbeya, Iringa, Ruvuma and Rukwa. This Nanenane takes place between August 1-8 every year in Mbeya and is the equivalent to US State Fairs, drawing an audience of 1,000,000 to 4,000,000 people over the course of the seven days. In 2005, the Network as a group sponsored and staffed a booth and stage to present dramas focusing on AB messaging, distribute prevention materials and provide voluntary counseling and testing services. The Network counted a total audience of over 300,000 for their dramas and of those individuals who visited their booth, 700 were counseled and tested for HIV. In 2006, they again had an audience of around 300,000 for dramas and presentations, recorded 50,000 visitors to their booth, counseling and testing 755 of those individuals. It is estimated that this campaign in 2007 will reach a similar number of people with prevention messages. These targets are included in the AB submission for TBD (#8688) which covers funding for the Network and their activities. Funding in this submission will support KIHUMBE's involvement in this campaign for 2007 and will include their transport, materials, and their portion of the booth construction, space rental and equipment.

KIHUMBE will continue provide support to members of the Network, including new members in Rukwa and Ruvuma, for their various educational events and instruct them on how to tailor each program to suit a given audience. KIHUMBE will conduct two trainings for the members of the various groups to reinforce their skills and creativity in presenting AB messages to youth and young adults. Fifty-five members of NGOs and FBOs in Rukwa and Ruvuma Regions will be trained by KIHUMBE in effective implementation of AB programs. Funding will cover transportation of personnel, trainers' stipends and training materials. Combined, these trainees will undertake 60 presentations by September 2008 with an average audience of 500 or a total target of 30,000.

This activity specifically links with activity #7667, #7717 in OP, with #7734 and #8688 in AB, with #7723 and #7735 in Care, with #8658 and #8660 in CT and with #7747 and #7749 in ARV services..

Kikundi Huduma Majumbani (KIHUMBE) has worked closely with the Mbeya Regional AIDS Control Program (MRACP) since 1991, augmenting MOH prevention efforts throughout the Mbeya Region. KIHUMBE continues to be a leader in prevention education efforts in the region and have won national awards annually from the Tanzanian Art Council and Kilimanjaro Music Awards for their dramas since 2000. Messaging is developed and up dated using the National AIDS Control Program's (NACP) web site and pamphlets. Coordination with local medical providers and the MRACP ensures consistency of messages across services in the region. With FY 2006 funding, they began supporting other organizations through training and supervision in providing accurate and predominantly AB HIV/AIDS prevention messages and contributed to development a local coordinated prevention campaign known as "Know the Facts." The geographical focus for KIHUMBE's activities is Mbeya City. In addition in FY 2006 KIHUMBE expanded its programming to Mbalizi and Tukuyu towns, both within Mbeya Region. The funding under this submission will support all Other Prevention messaging activities conducted as part of KIHUMBE's overall prevention portfolio and ensuring a comprehensive program to address KIHUMBE's clients' needs.

In FY 2007, KIHUMBE proposes to continue to expand on previous other prevention education programs by training 120 people to present dramas, songs and the use of other communication methods (such as traditional poems and folk stories) to inform individuals about HIV. Fifty presentations that range from dramas to audience dialogues and personal testimonies will be presented. These activities are separate from their AB presentations which target large community gatherings and schools. These "other prevention" productions focusing on safer sex practices and partner reduction messages and are targeted to smaller audiences such as work place programs, community leaders and community HIV committees with an average audience of 180 and will reach approximately 10,000 individuals overall with FY 2007 funding. In addition to prevention messages, the presentations will address the importance of knowing one's sero-status and the benefits and availability of HIV care and ART. This includes providing information about local counseling and testing services, home based care organizations and hospitals providing ART. Their prevention program therefore not only provides information on behavior modification but also serves as a link across the continuum of care encouraging service seeking behavior at both private/not-for-profit and public health facilities in Mbeya. Funding will support the transportation of drama group members and education personnel to communities and schools for events, the cost of conducting the events, and the distribution of educational materials.

Targets

Target Target Value Not Applicable Number of targeted condom service outlets 3  Number of individuals reached through community outreach that 9,000  promotes HIV/AIDS prevention through other behavior change beyond abstinence and/or being faithful Number of individuals trained to promote HIV/AIDS prevention
through other behavior change beyond abstinence and/or being faithful

Target Populations: Adults Community leaders Doctors Street youth HIV/AIDS-affected families Non-governmental organizations/private voluntary organizations People living with HIV/AIDS Pregnant women Teachers Volunteers Secondary school students University students Out-of-school youth Other Health Care Worker

Key Legislative Issues Stigma and discrimination

Coverage Areas Mbeya

Rukwa

Nkasi

Table 3.3.05:

This activity relates to activities in treatment (7747, 7749, 7797, 7794, 9240), counseling and testing (8660), prevention (7734) and other activities in palliative care (7723, 7851, 9640).

Kikundi Huduma Majumbani (KIHUMBE) is a large, local non-government organization (NGO) which has been serving the needs of PLWHA in the Mbeya Municipality's 36 wards and surrounding rural wards since 1991. It has one of the more comprehensive care and support programs in the region, linking its clients to the continuum of care through direct association with treatment facilities and by coordinating with an Mbeya "Network" of NGOs and FBOs to maximize coverage. KIHUMBE does this through two primary activities: the building the capacity of local providers in the region through training and supervision; and the direct provision of quality home-based palliative care services.

With FY 2006 funding, KIHUMBE expanded its Community Home Base Care (CHBC) volunteer staff to 85 trained individuals as well as trained 40 individuals from other organizations participating in a "network". This Network, of which KIHUMBE is a member, was formed in 2005 by 10 local NGOs and faith-based organizations (FBOs) in the Mbeya Region to coordinate community based prevention, counseling and testing, HIV home-based palliative care, and support for orphans and vulnerable children (OVC) in three of the four regions in the Southern Highlands Zone (Mbeya, Ruvuma, and Rukwa Regions).

Since its inception, KIHUMBE has worked with the Mbeya Regional Medical Office (MRMO), the local Ministry of Health and Social Welfare (MOHSW) office, responsible for supporting overall regional training in HBC. As a continuation of this collaboration, KIHUMBE has been designated by the Network to train volunteer CHBC providers from the other organizations. Individual volunteers to be trained will meet basic education requirements of having at least completed primary school and are able to read and write Kiswahili. Training in basic palliative care services for new volunteers in the Network, Ruvuma, and Rukwa regions will be conducted by the accredited training staff of KIHUMBE.

There is now a national curriculum for the training of CHBC providers in anti-retroviral (ART) adherence. KIHUMBE's medical staff is working closely with the regional TB and ART experts at the three Regional Medical Offices and the Mbeya Referral Hospital to devise a six-day refresher course to cover topics in adherence and basic patient monitoring using the curriculum. A module on record keeping will include provision of tools and questionnaires to assist the CHBC volunteer in identifying signs of complications due to treatment and when patients need to be referred to a health care facility. In addition to the training and care management forms, KIHUMBE and the RMOs are designing tools to monitor and evaluate the outcome of using CHBC providers as a means to enhance follow-up of patients on treatment and a data collection tool to control duplication of services to individuals or homes. Funding for the training will support staff salaries, rental of venues, transport of staff and materials, including production of management tools for distribution.

In the area of direct service delivery, KIHUMBE has been partnering with the Mbeya Referral Hospital with explanation of ART services since national support for ART roll out initiated in 2004. KIHUMBE serves as an excellent referral mechanism for patients to the ART Care and Treatment Centres (CTC) at the Referral Hospital and supports referrals from the hospital to aid in patient support when they return home. These referrals are facilitated by a social worker placed at the CTC specifically for this purpose. New patient identification by KIHUMBE is through the offering of counseling and testing at their municipal facility, in client's homes and through expansion to the use of mobile teams.

As the treatment population has expanded, so has the role KIHUMBE in HBC. In FY 2006 KIHUMBE opened branches in the towns of Mbalizi and Tukuyu. The branch in Mbalizi, just 30 minutes west of the Municipality, supports the military hospital and the new Mbeya Rural Designated District Hospital which have just initiated ART. The second in Tukuyu, 85 minutes south of the Municipality along the road to Malawi, is working with the Rungwe District Hospital to follow up their patients at home. Both new branches have seen rapidly expansion in the numbers of HBC clients this year. FY 2007 will see continued expansion of all three KIHUMBE sites, in order to assist these facilities and members of the community they serve.

KIHUMBE's basic care package for PLWHA includes provision of non-prescription medication, psycho-social-spiritual counseling, education about healthy living choices for positives, provision of situation appropriate basic commodities and nutritional support and counseling. Medical officers volunteering for KIHUMBE expand its capacity to provide prescription medications following a medical examination at home. This includes the use of cotrimoxizole prophylaxis as preventive therapy for PLWHA. In addition, HBC providers informally train caregivers of their clients in basic skill in hygiene, nutrition and caring for infected individuals. In FY 2007, produce from their agricultural plot initiated with FY 2004 funding (and now self sufficient) will continue to be used to supplement dietary needs of their clients as part of their nutritional counseling. KIHUMBE will provide produce grown on its plot to new ART clients on a "prescription" basis for a three to six month period as treatment is initiated.

Funding under this submission for services will support the provision of supplies for basic palliative services (non-prescription medications and disposables) for 550 individuals in 500 households with over 350 of these clients on ART, training of 200 CHBC providers in ART and TB adherence and patient follow up and 200 caregivers through at-home sessions in basic palliative support for the members of their household. Funds will also support the improvement of the organization's capacity, programmatic and administrative staff to assist the RMOs in monitoring the use of CHBC providers in treatment adherence and follow up. Cotrimoxazole and other items such as insecticide treated bed nets and WaterGuard units and supplies will be provided through a joint USG procurement.

In addition to provision of direct services, KIHUMBE works with other organizations through out the region to complement its package of services. Community providers and HBC clients will receive training in various income generating activities from the Network member the Iringa Residential Training Foundation. This will assist in the improvement of the livelihood of HIV+ and those who provide the services. In addition, attempts will be made to link to Peace Corps Volunteers working in the Mbeya Region with KIHUMBE to provide technical assistance in the training of staff, clients and providers in permaculture and home/community gardening.

KIHUMBE also looks to complement its services by accessing longer term, clean water solutions for its clients. Safe water is one of the greatest challenges for rural patients and their families in the Mbeya Region. Many clients have poor access to clean water, leading to frequent occurrence of diarrhea among HIV+ individuals in a household and thereby increasing the occurrence among other family members. A new partnership in FY 2006 between KIHUMBE and the US based NGO, Enterprise Works will continue into FY 2007. Enterprise Works helps develop systems of shallow wells at a very low cost and train people to make low cost point of contact water filtration systems for individual use and as an income generating activity. These activities are wholly financed by Enterprise Works.

This activity also relates to activities in Prevention-Abstinence and Be Faithful (#7734), treatment (#7747, #7749), palliative care (#7735, #7715, #7783), and others in OVC (#7724, #7850).

KIHUMBE is a local NGO that has been serving the needs of people living with HIV/AIDS (PLWHA) and orphans and vulnerable children (OVC) in the City of Mbeya and surrounding rural wards since 1991. In FY 2006, it opened additional branches in the Mbeya Region in Mbalizi and Tukuyu towns. It has one of the more comprehensive care and support programs in the region, linking its clients to the continuum of care through direct association with treatment facilities and by coordinating with an Mbeya "Network" of NGOs and FBOs to maximize coverage. This Network, of which KIHUMBE is a member, was formed in 2005 by 10 local NGOs and faith-based organizations (FBOs) in the Mbeya Region to synchronize community based prevention, counseling and testing, HIV home-based palliative care, and support for orphans and vulnerable children (OVC) in three of the four regions in the Southern Highlands Zone (Mbeya, Ruvuma, and Rukwa Regions).

Funding in FY 20007 under this submission will assist KIHUMBE in the implementation of the OVC National Plan of Action through provision of the direct support to OVC identified through the national Most Vulnerable Child (MVC) identification process in the Mbeya Region. This will include working in collaboration with the Most Vulnerable Children's Committees (MVCC) in communities it is working to support the OVC covered by KIHUMBE's services.

FY 2007 funds will support 1,200 OVC through the provision of basic needs and assistance of fees in primary, secondary schools, and vocational training as well as continued development of OVC caregiver's and MVCC capacity to assist in long-term support. OVC will be provided with psycho-social-spiritual counseling and be linked to KIHUMBE's home based care program to support medical needs are required. KIHUMBE community workers have received training in various income generating activities by the Iringa Residential Training Foundation, member of the Network. This particular training will enable KIHUMBE to assess the potential of an individual, family, or village association of clients to begin and sustain income generating projects for the benefit of orphans and their caregivers. In addition, to complement the package of services for OVC, Peace Corps Volunteers working in the Mbeya Region will be approached to provide technical assistance in the training of KIHUMBE staff, caregivers and clients in permaculture and home/community gardening. Mentoring and monitoring of these projects will ensure their success.

In addition, FY 2007 funds will also be used to train an additional 52 individuals, including the members of the local MVCC in counseling of OVC and their caregivers. This training will be funded under this submission and be conducted by the Anglican Diocese of the Southern Highlands, also a Network member. KIHUMBE will continue to assist the Referral and Regional Hospital in identifying OVC who are HIV positive and assist in patient care and adherence monitoring for OVCs qualifying for ART and/or TB therapy.

National focus has highlighted the need for strengthening the communities and MVCCs in on-going education in the issues of human, legal and gender rights of OVC and their caregivers. Nine members of KIHUMBE previously trained in this area will each train 10 individuals who can locally provide information and possible assistance in understanding these laws and issues. These same community workers have been well trained to provide developmental age- appropriate HIV prevention education and reproductive health information through KIHUMBE's long standing prevention program and close relationship with local medical providers. These workers also help individuals and communities to be sensitive to the stigma experienced by OVC and infected families.

As an OVC partner, KIHUMBE will link with the Government of Tanzania National Implementing Partner Group Network for OVC, which is supported by the USG-funded PACT Jali Watoto activity. As with all USG-funded implementing partners, KIHUMBE will support the implementation of the national Data Management System (DMS), and will use that system for their own Monitoring and Evaluation (M&E) system. These systems ensure that information about those MVC/OVC identified at the local level feeds into the national system, but also that it is available to MVCCs at the local level for planning, decision-making, and monitoring. Assistance in implementation of these systems will be

provided by Family Health International as a part of their national technical assistance role.

This activity also relates to activities in treatment (7747, 7749), Palliative care (7723, 7735), AB and Other prevention (7734, 8723) and others in counseling and testing (8657, 8658)

Kikundi Huduma Majumbani (KIHUMBE) is a large, local non-government organization (NGO) which has been serving the needs of PLWHA in the Mbeya Municipality's 36 wards and surrounding rural wards since 1991. It has one of the more comprehensive care and support programs in the region, linking its clients to the continuum of care through direct association with treatment facilities and by coordinating with an Mbeya "Network" of NGOs and faith-based organizations (FBOs) to maximize coverage. This Network, of which KIHUMBE is a member, was formed in 2005 by 10 local NGOs and faith-based organizations (FBOs) in the Mbeya Region to coordinate community based prevention, counseling and testing, HIV home-based palliative care, and support for orphans and vulnerable children (OVC) in three of the four regions in the Southern Highlands Zone (Mbeya, Ruvuma, and Rukwa Regions). Unlike the other members of the Network whose geographic coverage encompass Ruvuma and Rukwa Regions and parts of the Mbeya Region, KIHUMBE's activities fall within the Mbeya Municipality, its rural wards and the towns of Mbalizi and Tukuyu and their surrounding rural communities.

The Mbeya Region is situated along the Trans-African Highway, at the junction between Malawi and Zambia. This location on the "trade" route has contributed to a large percentage of the overall HIV infected population in Tanzania. Prevalence in the population along this route averages around 19% according to data from NGOs and FBOs providing voluntary counseling and testing (VCT) services but can range as high as 68% among bar workers (Riedner, et al: 'Baseline survey of sexually transmitted infections in a cohort of female bar workers in Mbeya Region , Tanzania' Sexually Transmitted Infections , 2003 Oct; 79(5);382-7).

For FY 2007, KIHUMBE proposes to implement a mobile VCT program to reach currently underserved populations in the areas they serve. The Mobile Health VCT program seeks to bring HIV/AIDS counseling and testing to people in the Mbeya Region who may otherwise not have access to these services. FY 2007 funding will support a mobile VCT unit as means for overcoming existing health service infrastructural deficiencies, bringing desperately needed HIV/AIDS counseling and testing, education, care and treatment to people throughout the year. Regional and district hospitals will be an integral part of this program as they will provide the vehicles that will transport mobile VCT staff and rapid tests and disposables for testing. The regional and district hospitals will determine the actual location for deployment of the mobile VCT based on local prevalence rates and community need. In accordance to national guideline, clients will be counseled and tested by a combined team of certified counselors provided by KIHUMBE and the regional or district hospitals. Clients who are found to be HIV positive will be referred to the nearest Care and Treatment Centre (CTC) attached to the hospital providing the mobile VCT vehicle and staff for evaluation. Clients that test HIV positive will be referred to local community support groups for people with HIV/AIDS to access emotional and spiritual support and to home based care (HBC) organizations working in their area for additional palliative care.

The Mobile VCT program will be linked to health centers to provide the client with information about local and district CTC, behavior change, healthy living choices, and information about local income generating projects to help promote the lively hood of PLWHA. Though KIHUMBE has distinct geographic coverage related to other members of the Network, as member, KIHUMBE will work with the Network to ensure there is no overlap in services or target populations with similar activities conducted by the Network. Working in concert with the Network, the Family Health International's Regional Outreach Addressing AIDS through Development Strategies (ROADS) Program (under the Transport Corridor Initiative), and local health center and dispensary VCTs, this mobile VCT activity will target a total of 6,000 individuals who will receive counseling and testing and their results and train an estimated 95 peer educators working with KIHUMBE and living in target communities to assist in community mobilization. Existing VCT counselors for KIHUMBE and the hospitals will be used for service delivery so no additional staff will need to be trained.

Funding in FY 2007 will support KIHUMBE's costs related fuel for the Mobile VCT,

transportation and remuneration of volunteer counselors, tents, and community mobilization necessary to carry out counseling and testing.

Plus up funding will be used to procure a vehicle to provide mobile services targeting underserved, hard-to-reach, and high-risk populations such as truckers and commercial sex workers. This activity will target a total of 6,000 individuals who will receive counseling and testing and their results at 6 sites in the initial stages of the program. Existing VCT counselors from participating NGOs and hospitals will be used for service delivery so no additional staff will need to be trained.