Pastoral Activities and Services for People with AIDS-Dar es Salaam (PASADA), has been operating since 1992, in urban Dar es Salaam, under the auspices of the Roman Catholic Archdiocese of Dar es Salaam. PASADA offers a community-based holistic approach to care and provides a wide range of HIV/AIDS Services, including voluntary counseling and testing (VCT), home-based and palliative care, health education and prevention, prevention of Mother-to Child Transmission (PMTCT), and social support to those infected with or affected by HIV/AIDS.

Until 2006, PASADA was a sub-recipient under Catholic Relief Services, but for the FY07 COP, it was listed as a prime partner for the US Government. For the first year, funds available were awarded to PASADA for scaling up, and their focus was on facility based palliative care. PEPFAR presently funds PASADA under treatment, PMTCT, VCT, and OVC. With this additional Plus Up funding, PASADA will be abel to expand their home based care services to other church clinics thoughout the diocese, and through that expansion will identify additional people requiring home-based palliative care services. Additional targets to be met include 600 new individuals provided with home-based palliative care, with an additional 35 people trained to provide and supervise these services.

This activity also relates to the PASADA ARV services (#7784) activity. As an OVC partner, this activity will link with the PACT Coordinating Implementing Partner Group (IPG) network for OVC (#7783) and the FHI OVC Data Management System (#7715).

The PASADA Orphans and Vulnerable Children program provides services and support to orphans and their supporting extended families. Services are provided completely free of charge to all in need and cover a catchment area of 800,000 people. At present, PASADA serves more than 16,000 people living with HIV/AIDS (PLWHA) and nearly 4,000 orphans and vulnerable children (OVC). PASADA aims to build the capacity of OVC in education and other areas of need. The program will be closely linked to the care and treatment components of the PASADA program, both at the main PASADA site and in the satellite health facilities of the Archdiocese of Dar es Salaam.

With FY07 funding, PASADA will focus on the following areas: strengthening referrals; expanding support and supervision; providing educational support; community education; capacity-building of extended families; and life skills training.

Referrals will be strengthened for OVC in need of treatment, home-based care, or other services by making appropriate referrals within the diocese of Dar es Salaam. FY07 funds will be used to expand the provision of support and supervision to nearly 4,650 children who have lost one or both parents due to HIV infection. This will be accompanied with the provision of education, vocational training, and life skills development training to help OVC address the tremendous loss, pain, and stigma attached to HIV infection.

PASADA will build the capacity of OVC by providing school fees (nursery, primary, secondary and vocational schools) and school supplies, such as uniforms, stationary, etc. OVC face numerous financial problems due to the illness or death of parents. This situation affects their opportunities to continue their education. PASADA will focus its efforts on ensuring that OVC can stay in school so as to make the most of their future.

The community education component will be focused on raising awareness of issues affecting OVC within communities, and creating a supportive environment for children affected by HIV/AIDS. This will be done by organizing awareness raising workshops addressing religious leaders, teachers, and other important stakeholders in the community in order to reduce stigma and reluctance to discuss HIV/AIDS-related issues in the community.

PASADA will strengthen the capacity of extended families to cope with the challenge of raising OVC through improving their parenting skills by providing training, direct support of basic needs, services and small grants. The majority of orphans in PASADA's program are cared for in extended families and others live in child-headed households. Those extended families are challenged because they are headed by elderly grandparents who are very poor, economically unproductive, and physically weak. They also may have other members of the extended family living with them. Worse yet, child-headed households have significant housing, nutritional, and emotional needs. PASADA will provide and link with organizations to provide comprehensive support for these caretakers.

Finally, PASADA will provide life skills training to OVC in order to enable them to make positive decisions, and impart parenting skills for OVC who have children of their own.

As with all USG-funded implementing partners, as a member of the IPG, PASADA will embrace key elements of UGS-funded activities. This means they will implement stigma and discrimination activities from the Stigma Tool Kit. PASADA will also support the implementation of the national Data Management System, and will use that system for their own Monitoring and Evaluation system. They will ensure that information about MVC/OVC identified at the local level not only feeds into the national system, but that it is also available to MVCCs at the local level for planning, decision making, and monitoring.

The requested Plus Up funding will extend services to an additional 1,250 OVC and training to an additional 1,000 caregivers. Moreover, PASADA will strengthen the capacity of extended families to cope with the challenge of raising OVC by improving their parenting skills through training, direct support of basic needs, services, and small grants. PASADA will provide and link with organizations to provide comprehensive support, such

as Income Generating Activities, for these caretakers.

Expansion of HIV/AIDS treatment/ART service programme at PASADA

This activity also relates to activities in Orphans and Vulnerable Children (#8708).

This activity provides care and treatment to patients suffering from HIV and AIDS and the complications of the disease. Since its founding in 1992, PASADA's services and client base have expanded tremendously. Today, it serves more than 800,000 people every year through its main Upendano Clinic and 15 diocesan health facilities located throughout Dar es Salaam. Operating under the Roman Catholic Archdiocese of Dar es Salaam, PASADA targets the poorest of the poor, offering comprehensive care and support to all people living with AIDS, regardless of religious affiliation. These services include voluntary counseling and testing; home-based care; educational, psychological, social, and economic support to orphans and vulnerable children; diagnosis and treatment of opportunistic infections; and prevention of mother-to-child transmission (PMTCT) in eight of its 15 sites. The program also offers support groups, nutritional assistance, and access to income generating activities. Part of the uniqueness of the PASADA program is the strong linkages between and among the various services the program offers, and the referral mechanisms with the Archdiocesan facilities. By the end of FY 2006, PASADA has approximately 17,000 HIV patients registered for various services, with 1,200 on anti-retroviral treatment (ART).

Until late FY 2006, PASADA was a sub-grantee of Catholic Relief Services for care and treatment, and the strengthening of services via the referral clinics received funding and technical assistance from Deloitte. With funds from FY 2006, PASADA "graduated" from sub-grantee status to being supported directly by the USG.

With FY 2007 funds, the PASADA Treatment Programme will focus on the expansion of ART services at PASADA and in the satellite health facilities of the Archdiocese of Dar es Salaam. In addition to supporting the treatment program at PASADA, treatment services will be piloted at four dispensaries in the Archdiocese of Dar es Salaam. This "downward" expansion fits with the National AIDS Control Programme's planned devolution of services to lower-level facilities, and should also help to enhance pediatric AIDS case finding.

A critical component of the planned expansion of services is the training that will be provided to PASADA and dispensary staff on the management of ART patients, adherence, and their responsibilities in the prevention of new infections. With FY 2007 funds, PASADA expects to enroll 5100 people on ART.

In addition to expansion, priorities for FY 2007 funding to support the treatment and related programs are: 1) improved quality of treatment services, especially the implementation of quality improvement programs; 2) strengthened linkages between and among PASADA clinical and community services; 3) training of providers and outreach workers in stigma to reduce it as a barrier for people seeking counseling/testing, as well as treatment; 4) strengthening of the organization and management of PASADA, including both fiscal and programmatic accountability; and 5) regular planning, monitoring, and evaluation of the program (particularly with regard to decentralization process) to ensure that planned objectives are reached.

With FY 2007 funds, linkages between and among the various components of PASADA's continuum of care, such as PMTCT services, will be strengthened to ensure additional referrals. Attention will be paid to consolidate and scale up Voluntary Counseling and Testing (VCT) services, especially of pregnant women, in order to increase the number that can access ART. PASADA will also train People Living with HIV/AIDS (PLWHA) on basic counseling skills so that they can be involved in raising community awareness about the importance of HIV testing and treatment, and to reduce stigma and discrimination. This community awareness is intended to increase access to care and treatment for women, children, and families affected with HIV and AIDS identified in the dispensaries, and to empower them with information so that they, too, can become community resource people. This community awareness will also help to link HIV-positive individuals to care and treatment services.

Through the PASADA OVC program, training will be conducted to sensitize all staff to ensure they are aware of suggestive symptoms and signs suggestive of HIV/AIDS, or to

identify those with histories of possible exposure so that the children are referred in for testing and possibly for treatment. This will be part of a stepped-up approach to identification and treatment of HIV-positive children in the catchment area. PASADA expects that the expansion into dispensaries and sensitization of health providers at those facilities will allow for improved pediatric AIDS case-finding and referral, as necessary.

To improve the effectiveness of treatment, PASADA will continue to provide targeted nutritional support to clients who are severely malnourished and income-generating opportunities to families. Because PASADA deals with the poorest of the poor, whose economic base has been paralyzed by the HIV epidemic and whose families are already over stretched, food and income generation are particular challenges.

Lastly, PASADA will organize awareness raising workshops addressing religious leaders, teachers, and other important stakeholders in the community in order to reduce stigma and reluctance to discuss HIV/AIDS-related issues in the community.

Procurement for cotrimoxazole will be handled through the Supply Chain Management System (SCMS), which will provide experience with SCMS and if successful, the program will expand to other procurements in FY 2008.

In addition to the programmatic growth and enhancement, additional attention will be given with FY 2007 funds to strengthen the data collection and statistical analysis of patients care, as well as to strengthening fiscal accountability.