This activity is linked to PharmAccess submissions in TB/HIV and ART.

The Tanzanian Peoples Defense Forces (TPDF) has a network of eight military hospitals through out the country, supporting a total of over 40,000 enlisted personnel and an estimated 90,000 dependents. The services at these hospitals are not limited to the military or their dependents with 80% of their patient load attributable to the civilian populations surrounding the facilities. Of these eight hospitals, seven offer district level services with the largest hospital, Lugalo, located in Dar es Salaam serving the role of a national referral center for military medical services. Strengthening of HIV/AIDS prevention and care and treatment programs with the TPDF and at military health facilities not only targets the high-risk, uniformed population but also their dependents and other civilians from the surrounding communities.

The TPDF and PharmAccess, a large not-for-profit organization based out of the Netherlands, have developed a strong working relationship over the past five years in the area of health service provision. PharmAccess is experienced in providing management services, products and technical assistance supporting HIV/AIDS care and treatment in resource poor settings in collaboration with governments, donor organizations, NGOs, and corporations through out Africa. In Tanzania, PharmAccess has been working directly with the MOHSW in implementing MTCT programs in several referral hospitals since 1998. In May 2004, PharmAccess became the official implementing partner of the Tanzanian National AIDS Control Programme (NACP), overseeing site evaluation and readiness for national ART roll out.

In FY 2004 the TPDF started offering PMTCT services at Lugalo Hospital. With Emergency Plan FY 2005 and FY 2006 funds, the TPDF and PharmAccess introduced these services in eight regional military hospitals (Mbalizi, Mwanza, Mzinga, Monduli, Ruvuma, Mirambo, Bububu) and one satellite clinic of Lugalo Hospital (Mwenge). All sites were chosen to assure that TPDF was contributing to national expansion of PMTCT and Care and Treatment services. These activities are only now beginning due to the late arrival of FY 2006 funds.

Under this submission, PharmAccess will work with the TPDF to strengthen and expand PMTCT services at the military treatment facilities mentioned above, plus three satellite sites (in Mbeya, Mwanza and Tabora). Services will include routine, opt-out pre-test counseling (group and individual) in both ANC and as an integral part of labor and delivery. Those testing negative will be given primary prevention counseling. HIV positive mothers will receive posttest "prevention for positives" counseling and information on care and treatment services. These women will be encouraged to bring in family members (especially partners) for counseling and testing (CT) at either the ANC or the hospital's VCT center.

All TPDF hospitals and satellite sites mentioned will be included in FY 2007 plans for CT, PMTCT, TB and ART services thereby ensuring a comprehensive approach to clinical HIV prevention, care and treatment. All HIV-infected women will be referred for further evaluation and qualification for TB treatment and ART within each facility. Those not qualifying for ART will be provided NVP for mother and infant and encouraged to return to the hospital for delivery. Implementation of services will mirror changes in guidance and policy by the MOH both for ART eligibility and regimen. Mother and infant will then be referred for care, including pediatric follow up care with cotrimoxazole and serologic diagnosis. HIV positive mothers will be provided with infant feeding counseling options and for those choosing breastfeeding, will be counseled to exclusively breast feed with early weaning.

The introduction of opt-out CT in January 2005 has proven very effective at Mwenge Maternal Child Health Centre, the ANC serving as a satellite site of Lugalo Hospital. This strategy has led to a very high (95%) uptake of PMTCT services at this site. This strategy is currently being introduced at the other seven military hospitals and in FY 2007 will be introduced at the military satellite sites in Mbeya, Mwanza and Tabora, providing HIV services. In FY 2007, it is anticipated that a total of 6,000 pregnant women will be counseled and tested at the eleven sites combined, 420 (7%) of which are expected to test positive and receive full prenatal and delivery PMTCT services (including their children) over a twelve-month period by September 2008.

This funding will fully develop PMTCT services in the network of eight military hospitals and four satellite military health centers. Funding will support the introduction and improvement of PMTCT services which will include initial (or refresher) training of three health care workers per site, renovation or refurbishing of counseling and delivery rooms at three new satellite sites, procurement of test materials and protective safety gear, and community education efforts promoting increased access to services and partner testing. NVP will be procured through the Boehringer donation program.

Expansion of PMTCT activities in FY 2007 will ensure a close linkage of military implementation to national strategies and programs supporting MOH goals of providing this service to 80% of the projected HIV positive mothers by September 2008. Funding for the TPDF through PharmAccess will provide much needed technical support, management assistance and M&E for all TPDF activities in this COP. Lugalo, the military referral hospital in Dar es Salaam, will serve as the coordinating body for services and over see quality assurance following national standards. Additional support for military facilities in Mbeya and Ruvuma will be provided by the US Department of Defense field office overseeing civilian based activities in these regions.

This activity is specifically linked with activity #7667 and #(Uniformed Services) in OP, #7789 in CT, #7790 in TB/HIV, #7788 in PMTCT, and #7786 in ARV Services.

The 2003-2004 Tanzania HIV/AIDS Indicator Survey estimates the national HIV prevalence at approximately 7%. As with many militaries in Africa, HIV prevalence among uniformed personnel in Tanzania is estimated to be higher than that of the general population - somewhere between 15% and 30%. Continued aggressive measures are needed to address this high-risk population as it can serve as a bridge for HIV transmission to the population at large. This activity will support ongoing efforts started in FY 2005 and continued in FY 2006, in collaboration with the Tanzanian Peoples' Defense Forces (TPDF), to provide prevention, education and condom distribution services to military personnel and to communities surrounding military posts, including military health facilities.

An HIV/AIDS education program, based on adapted life-skills modules and developed for the TPDF in FY 2005 and FY 2006, will be utilized in all TPDF basic training centers for recruits. A unique aspect of the military is that all recruits must be HIV-negative in order to join the Armed Forces and all service members who serve outside of Tanzania (such as in UN-supported peace keeping operations) must also be HIV-negative. Those who have sero-converted while in the army stay in the army, at least for the contract period. Further steps in opt-out and mandatory testing are considered but have not been translated into policy yet.

15 TOTs and a total of 250 peer educators have already been trained and retrained in FY05 and FY06. USG funding in FY2007 will support refresher training of the 15 TOTs, refresher training of 100 peer educators and 100 newly trained, (1:200 servicemen; at least 2 peer educators per camp). The peer educators will continue to receive refresher and advanced training in support of their prevention/outreach efforts throughout their period of military service. Activities will be directed at eight military hospitals, six satellite sites, 14 training camps of the National Services and 16 TPDF camps. The training camps of the National Services focus on individuals ranging from 18 to 22 years of age who enlist for a two-year, pre-service training. These young adults are removed from family and other support mechanisms, and are often exposed to high-risk populations such as commercial sex workers, putting them at greater risk of infection. Efforts within the TPDF will continue to focus on 16 TPDF basic training, special detachment and border camps where service members are stationed outside their residential areas for periods usually ranging from six to 24 months (or longer).

USG funding will support the training of 36 counselors at the eight military hospitals (three per site) and six satellite sites (two per site) in promoting "prevention for positives" messages and counseling for those patients attending the HIV Care and Treatment Clinics (CTCs) at the hospitals. Abstinence and being faithful will be the key message in IEC materials and in the training curriculums of clinicians and counselors. One serious obstacle in relation to the ‘B' message is that new recruits are not allowed to marry until they have served at least 6 years or are over 30 years of age. This rule is currently under discussion at HQ. Stigma reduction and alcohol abuse are central elements in the training of peer educators and in the training curriculum of nurse-counselors.

Condom distribution and education services will be incorporated through prevention efforts and as part of VCT services at post/camp treatment clinics, basic training centers and special detachment and border camps. Condoms will be obtained through AED/T-MARC and national procurement efforts, which will also assist in distribution. Their cost is not included in this budget.

Ante and post natal services, including clinical monitoring of HIV+ children, is usually highly effective for women and children who live in the barracks nearby the health facilities. Special attention is to be paid to the civilians who live further away from the health facilities.

It is expected that this OP activity will reach a target of approximately 4,000 recruits at basic training centers; 3,000-4,000 men and women under the National Services; and a total of approximately 20,000 service members, their dependents and surrounding community members by September 2008. Prevention outreach will be linked to

counseling and testing and PMTCT activities in support of the continuum of care.

The TPDF and PharmAccess have developed a strong working relationship since 2002 in the area of health service provision. Funding for the TPDF through PharmAccess will provide much needed technical support, management assistance and M&E for all TPDF activities in this COP.

Plus-up funds are requested to support assessments of the policy environment and development of IEC materials on GBV at 36 military sites covering about 20,000 military personnel and civilians, and 40 peer educators will be trained.

This activity narrative links to activity # 7749 ART services and activity narrative # 7733 ARV drugs.

The Tanzanian Peoples Defense Forces (TPDF) has a network of eight military hospitals and a multitude of dispensaries, supporting 40,000 personnel and 90,000 dependents. Services at these hospitals are not limited to military personnel or their dependents, however, as 80% of patient load is attributable to the civilian population.

PharmAccess International (PAI), a large, nonprofit organization based in the Netherlands, is experienced in providing management services, products, and technical assistance supporting care and treatment in sub-Saharan countries. PAI focuses on private and public sector HIV/AIDS workplace programs.

Over the past four years, PAI and TPDF have developed a strong working relationship in the area of health service provision. PAI, with direct technical assistance from the U.S. Department of Defense (DOD), is the primary partner supporting Emergency Plan (EP) activities with the TPDF.

This DOD/PAI Emergency Program supports a comprehensive HIV/AIDS program in eight military hospitals. The program started with FY 2005 funds and includes prevention, voluntary counseling and testing (VCT), prevention of mother-to-child transmission, and care and treatment (CT) services in Lugalo, the national military referral hospital, and the regional military hospitals within eight regions Due to the delay of release of funds some activities are only now beginning to ramp up.

Current HIV/TB Activities in the Military Hospitals includes an ongoing Directly Observed Therapy (DOT)-tuberculosis (TB) program monitored by the Regional Medical Officer (RMO), in line with the guidelines of the National Tuberculosis and Leprosy Program (NTLP) and the Ministry of Health and Social Welfare (MOHSW). TPDF contributes space and staff.

Lugalo Hospital, with two-year EP support, is far ahead of the seven regional hospitals in terms of numbers of patients, referrals, and quality of TB and HIV/AIDS services. Lugalo currently has 2,000 HIV-positive patients enrolled, and 1,200 are on antiretrovirals (ARVs). At present, 120 patients are receiving DOT at the TB Unit (250 patients per year).

PAI have initiated an active referral policy between the TB-, VCT- and CT-units. Also, PAI counsel all TB-positive patients to be tested for HIV. Approximately 50% of the TB patients are HIV-positive.

PAI are also performing screening of all newly diagnosed HIV-positive persons at the Care and Treatment Clinics (CTCs) for TB. HIV patients are evaluated for TB symptoms and 30% of these (300) individuals are found to be positive for TB, and are referred to TB Unit for management.

Recent assessments have shown that capacity and infrastructure for HIV/AIDS care and treatment services are substandard in the seven regional hospitals. Capacity for TB and ARV services in these hospitals is limited to 1-3 clinicians/medical officers who serve the entire facility, and who see both the TB and HIV/AIDS patients. In these cases there is no referral between the TB Unit and the CTC.

HIV testing of TB-positive patients will be done on the to all patient in TB Clinics. The total number of patients under HIV care and treatment services in the seven hospitals is less than 500, and the number of patients on ARVs is currently 160. The number of HIV-positive patients varies from 20-150. The number of patients on ARVs varies from 0 to 80. At any given time, each hospital has 20-40 patients on TB treatment, and each may treat 40- 60 patients per year.

In conclusion: a total of 300-350 patients are currently on TB treatment (600-700 per year) in all eight military hospitals. We predict that 50% of those individuals are HIV-positive. A total of 2,500 HIV-positive patients are known at the CTCs, and 1,360 patients are on ARV treatment.

Only Lugalo Hospital has a well-functioning referral system between the TB Unit and the CTC. Training of staff in the TB Units and the CTCs, and refurbishment of counseling rooms and laboratories, are priorities under the FY 2005 and FY 2006 programs. Expansion of treatment under this funding includes the development of all services related to identification of, and care for, HIV-positive and TB-positive individuals

In FY07, PAI will strengthen referrals between the TB Units and the CTCs at all sites. Funding will support intensive training for clinicians, nurses, laboratory technicians on comprehensive management for TB/HIV co- infection including opt-out HIV counseling and testing, TB diagnostics and HIV care and treatment

Through US Supply Chain Management, PAI will procure cotrimoxazole and provide to diagnose HIV patients with TB. In collaboration with the University Computing Center of Dar es Salaam and NACP/ MOHSW, and in agreement with TB/HIV reporting obligations, we will organize electronic data handling for all CTCs; we will train two persons per site on data-handling.

By September 2008, PAI anticipate that 600 TB-positive individuals attending the TB units at TPDF hospitals will undergo opt-out counseling and testing for HIV and 50% (300) will be co-infected and will be evaluated for ART eligibility.

In FY 2007, 3000 new HIV-positive patients attending the CTCs and 70% will be screened for TB. It is estimated that all HIV patients that will be diagnosed to have TB will be referred to TB clinic for TB treatment Targets for prophylaxis and treatment of OIs will be determined by the number of eligible patients and by the availability of medication, depending on MOHSW and the Supply Chain Management System's capacity to deliver.

Activities under this submission will support achievement of EP goals towards care and treatment for the general public, as 80% of the population accessing services at military facilities is civilian. Under the FY 2007 submission, PAI will provide technical support and management assistance to ensure that TB/HIV activities become a routine part of the service package. Lugalo, the national military referral hospital, will serve as the coordinating body for services and oversee quality assurance following national standards. Additional support for military facilities in Mbeya and Ruvuma will be provided by the USG/DOD field office overseeing civilian-based activities in these regions.

With plus up funding, PIA proposes to scale up year 2007 TB HIV activities by strengthen diagnostic counseling and testing of TB clients, screening TB to HIV infected clients and those on ART and providing preventative prophylaxis based on the national guidelines. PAI will also improve infection control practices and strengthen referral mechanisms to enhance patient client care. Under this submission PharmAccess will work in 10 facilities: 5 police and 5 prison health facilities in Dar es Salaam, Mbeya, Mwanza, Moshi, and Zanzibar. Funding will support training of 60 clinicians and counselors (3 per TB unit and 3 per CTC), infrastructure improvement and equipping the laboratories for basic TB monitoring. Target population is 1600 HIV +, of which 400 will receive TB prophylaxis or -treatment. Police and prison hospitals are open for general public. 80% of the population accessing these services is civilian.

This activity is linked to PharmAccess submissions in Other Prevention (7787), TB/HIV (7790) and ART (7786).

The Tanzanian Peoples Defense Forces (TPDF) has a network of eight military hospitals and numerous health centers throughout the country, supporting a total of over 40,000 enlisted personnel and an estimated 90,000 dependents. The services at the military hospitals and health centers are not limited to the military or their dependents. 80% of the patient load is attributable to the civilian population surrounding the facilities. The military hospitals are Lugalo (DSM), Mbalizi (Mbeya), Mwanza, Mzinga (Morogoro), Monduli (Arusha), Mirambo (Tabora), Songea (Ruvuma) and Bububu (Zanzibar). Lugalo has currently three satellite sites in the Dar region, serving as VCT and ARV refill stations. All military hospitals were under the COP FY05 and FYO6. FHI will end its support to Lugalo and the three satellite sites in September 2006. All military sites will then be under support of DOD/PharmAccess /TPDF only.

Under FY 2007, VCT services will be extended with three health centers: one satellite site in Mbeya, one in Mwanza and one in Tabora region. Three healthcare workers per site will be trained, and renovations to the counseling and testing center will be completed, prior to the initiation of care at these sites. Movement towards the standard use of provider initiated/diagnostic CT at the out patient clinics and inpatient wards will be expanded in line with changes in the MOH policy and USG efforts. The TPDF is already undertaking similar opt out CT approaches in both their TB clinics and antenatal clinics and translating those lessons to other hospitals services. Referrals from other clinics to the CTC to ensure improved access to care after testing will continue to be strengthened in FY 2007. Under FY 2005 and FY 2006 plans, VCT was not only introduced at military hospitals and satellite sites, but also to reach high-risk groups at 14 training, detachment and border camps. The prevalence rate in detachment and border camps is estimated at no less than 10-12%. Three cars, serving as mobile counseling and testing stations, play a significant role in providing VCT services at the camps. Each mobile station is staffed with 2 counselors and 1 laboratory technician. The stations are equipped to set up temporary space for counseling, and to provide rapid HIV and confirmatory testing. A fourth mobile station will be procured under FY 2007 funds.

HIV-infected patients from the camps and from the surrounding civilian communities accessing these services are and will be referred to the nearest military, district or regional hospital as necessary for follow-up. HIV/AIDS prevention and awareness campaigns and the options of testing are also available for civilians in the communities surrounding campsites through these efforts. It is expected that approximately 20,000 individuals will be tested by September 2008 through both VCT and hospital based CT under this submission.

Expansion of VCT activities in FY 2007 will ensure a close linkage of military implementation to national strategies and programs. Funding for the TPDF through PharmAccess will provide much needed technical support, management assistance and M&E for all TPDF activities in this COP. Lugalo, the military referral hospital in Dar es Salaam, will serve as the coordinating body for services and over see quality assurance following national standards. Additional support for military facilities in Mbeya and Ruvuma will be provided by the US Department of Defense field office overseeing civilian based activities in these regions.

Funding for FY 2007 will support (re-) training of a total of 80 nurse-counselors, lab technicians and pharmacists or pharmacy assistants; three from each hospital (24), three per satellite site (18), two per health center at each camps (26) and three per mobile center (12). Additionally, funding will allow for renovation of counseling rooms and storage facilities at the three new satellite sites and the dispensaries in the military camps, procurement of one mobile center and maintenance of four mobile centers. Provision of condoms at TPDF CT centers through linkages with other USG funded partners under prevention will complement these CT services.

The higher cost of services in FY 2007 compared to FY 2006 is due to the inclusion of Lugalo Hospital plus three satellite sites under this program; the need to establish three new satellite sites; procurement of one additional mobile center and maintenance of four mobile testing vehicles; and an increase in the number of (re-) trained health care

workers. It is anticipated that the overall cost per client will decrease dramatically in out years.

In FY2006, VCT services where introduced at all eight military hospitals. However, like any other military in Africa, the TPDF has been grappling with the circumstances under which testing should be conducted. A concept HIV/AIDS Policy document written this year by a taskforce of commanders and lawyers and it stipulates that HIV testing will become part of the annual physical exam for every serviceman. As a result, CT services will need to be expanded at more than 32 health centers and satellite sites beyond the 8 main military hospitals that currently provide non-HIV health services. The prevalence rate in detachment and border camps is estimated at no less than 10-12%. This funding will support: three health care workers (medical officer, counselor, pharmacy assistant) per site who will be trained in VCT and PITC following the national curriculum of the Ministry of Health and Social Welfare. Once the HIV/AIDS Policy is approved the number of servicemen and women to be tested will increase to 35,000, plus dependents and civilians living with the vicinity of the health facility. In order to cope with the increased demand for counseling and testing at the 32 sites: 1. three health care workers per site will need to be trained following the national 4 weeks curriculum from the Ministry of Health and Social Welfare; 2. each site will need at least 2 rooms to be refurbished and furnished; 3. referral of HIV+ persons to nearby military, regional. or district hospitals will need to be organized for follow-up of (routine and CD4) testing and care and treatment services. This activity will target a total of 35,000 individuals who will receive counseling and testing and their results, and will train 96 individuals at 32 sites.

This activity is linked to PharmAccess submissions in Other Prevention (7787), CT (7789) and TB/HIV (7790).

The Tanzanian Peoples Defense Forces (TPDF) initiated one of the first ART programs in Tanzania in March 2003, at Lugalo Hospital in Dar es Salaam. As part of FY04's Emergency Plan funding from USAID through Family Health International (FHI), Lugalo Hospital has been able to expand care and treatment services at this facility to reach a total of 2,000 HIV-infected military personnel and their dependents. In FY06, the TPDF initiated counseling and testing and Prevention of Mother-to-Child Transmission (MTCT) services in the seven remaining military hospitals throughout the country (Mbalizi, Mwanza Mzinga, Monduli, Mirambo, Ruvuma and Bububu). With FY06 funding ART services began at all facilities. These activities are just now being initiated due to late arrival of FY06 funds. As part of the regionalization plan for treatment services lead by the MOH and National AIDS Control Programme (NACP), FHI will end its support for ART services at Lugalo and 3 satellite in the Coast Region in September 2006. Thereafter these sites will come under the support of US Department of Defense (DOD)/PharmAccess/TPDF.

Under this submission, PharmAccess will work with the military to continue to expand ART services in all eight supported military hospitals as well as six satellite sites. These include Bububu Hospital in Zanzibar, in response to a request from the Zanzibar AIDS Control Program to initiate ART at this facility. This military hospital has recently been re-built completely. The new Bububu Hospital will serve as a referral hospital for the northern part of Zanzibar with an estimated catchment population of 80,000, military and civilians.

Funding will support initial and refresher training of 56 medical personnel from all military hospitals and satellite health centers; infrastructure improvement of the six satellite sites; equipment and consumables for basic laboratory requirements for monitoring of patients (to include haematology and chemistry testing); capacity for CD4 monitoring is currently present at Lugalo hospital and will be developed at the military hospitals of Mwanza, Mbalizi and Mzinga; community education and mobilization of other support groups for patients on ART. The medical treatment facilities of all military hospitals and satellite sites will be supported through nearby regional and zonal facilities under the National Care and Treatment Plan. Referral mechanisms, e.g. for CD4 testing, have been put in place and will be strengthened. Treatment of OI's and ARVs will be supplied by EP funds through USAID/SCMC and the MOH/MSD).

ART-experienced clinicians, nurse-counselors, laboratory and pharmacy specialists from Lugalo, Mbalizi and Mwanza military hospitals will serve as preceptors for the other hospitals and satellite sites following participation in NACP training, building upon experienced personnel in the TPDF. All hospitals will be included in the FY07 plans for continued CT, PMTCT and TB services ensuring development of comprehensive HIV services at military facilities as well as the establishment of strong referrals between services. Counselors at the VCT centers will be trained additionally on counseling of HIV+ patients. Referral between TB-units and CTCs and between the CTCs and HBC providers has been introduced under the FY06 program and will be strengthened under FY07. All HIV-infected men and women will be referred for further evaluation and qualification for TB treatment and ART within the same facility. Expansion of ART at military facilities will assist in national coverage and the availability of these services to the surrounding civilian communities.

HIV-positive children are identified through PMTCT programs supported at the eight military hospitals mentioned above and the satellite sites in Dar es Salaam, Mbeya, Mwanza and Tabora regions. Pediatric cases will be identified at the ante and postnatal (ANC) services and pediatric wards of the hospitals and will be referred to the HIV Care and Treatment Centers at the hospitals for staging and ART eligibility. Currently over 13% of the ART and care population at Lugalo Hospital is between the ages of zero to 14 years. The relatively high uptake is due to the fact that families of military employees live in the barracks near the hospitals and that all military hospitals provide ANC services. Overtime, with a larger share of civilians in the ART program, the percentage may go down somewhat. Civilians who live further away from the hospitals tend to visit ANC services in their village. A family care model will be used to inform women attending the ANC at the military sites to raise the pediatric caseload.

It is expected that a total of 4,000 patients (13% pediatric) will be on ART and an additional 4,000 on non-ART care by September 2008. ARV services in the military hospitals started 3-4 years ago, exclusively for military personnel and their dependents. The majority of patients on treatment therefore are male. Since FY06 ARV services are open for civilians in the communities surrounding the military hospitals. As 80% of the population accessing services at military facilities is civilian we expect that the gender imbalance will be corrected over time.

Under FY05 funding FHI has initiated referral to community support groups, HBC services and d patient self-help groups at Lugalo Hospital and its 3 satellite sites. Continuation of these functions after FHI's pull-out is guaranteed under the regionalization plus-up funds. Functions will be introduced at all other military health centers under FY07 TPDF/DOD/PharmAccess program under FY07. For most military hospitals this is a new activity.

All military hospitals will be equipped and staff will be trained to enter patient data electronically. The national database, developed by the University Computing Center (UCC) for NACP, will be used for that purpose.

To ensure sustainability there will be no appointments of new staff for the TPDF hospitals and health centers. Current staff will be trained to strengthen their capacity to provide adequate care and treament services.

Expansion of ART services in FY07 will ensure a close linkage of military implementation to national strategies and programs. Funding for the TPDF through PharmAccess will provide much needed technical support, management assistance and M&E for all TPDF activities in this COP. Lugalo Hospital will serve as the coordinating body and oversee quality assurance following national standards.

Pharmaccess International is requesting $400,000 to scale up ART treatment services in the TPDF. A new policy stipulates that HIV screening will become part of the annual physical check-up for all servicemen and women whose total population is 35,000. As a result of this new policy, the 8 military hospitals will need to be equipped for CD4 testing and 18 health centers need to be prepared for care and treatment services. Funding under this submission will accomplish the following. Three health care workers per site will be trained to provide treatment services, following the national curriculum of the MOHSW. Each site will be refurbished and furnished to provide treatment services, and OI drugs. Samples and patients with clinical complications will be referred to nearby military hospitals for follow-up and CD4 testing. The prevalence rate in detachment and border camps is estimated at no less than 10-12%. The funds will be used to train 54 health care professionals: three health care workers (medical officer, counselor, pharmacy assistant) per site who will be trained to provide and manage ARV following the national curriculum of the Ministry of Health and Social Welfare.