This activity narrative link to activity # 7781 HVTB and 7771, 7694, 7722, 7705 ARV Services.

The Program for Appropriate Technology (PATH) proposes to continue scaling up a coordinated response to TB/HIV through the public and private sectors in close collaboration with the Ministry of Health and Social Welfare (MoHSW), National TB and Leprosy Program (NTLP), the National AIDS Control Program (NACP), and the Association of Private Health Facilities of Tanzania (APHFTA). The objective of the project include strengthening human resource capacity, introducing and scaling up integrated TB/HIV services, stimulating community awareness of TB and TB/HIV, and mobilizing communities to reduce stigma and promote HIV testing and care-seeking. The project capitalizes on existing human resources in both public and private sectors, supplementing the existing core with a minimal number of critical staff at central, zonal, and district levels.

During FY 2006, PATH's key task was to carry out start-up activities such as establishing an office, engaging MOHSW and the association of Private Health Facilities in Tanzania (APHFTA) through signing a Memorandum of Understanding (MoU) and recruiting key project staff. PATH initiated TB/HIV activities in 10 districts in four regions: Ilemela and Nyamagana municipalities, Geita, Misungwi, (Mwanza); Arusha municipality (Arusha); Ilala and Kinondoni municipalities (Dar es Salaam); and Bagamoyo, Kibaha, Kisarawe (Coast region) by placing local TB/HIV coordinators also referred to as DTHCs.

PATH, in collaboration with MoHSW and other stakeholders supported MoHSW to draft TB/HIV policy and develop a modular DTHCs training course for TB/HIV collaborative services. Using this module, one training course that had 13 participants took place and the course has been endorsed by MoHSW to be the course for the rest of the TB/HIV coordinators through Zonal training teams. The 13 trainees have been earmarked as TB/HIV facilitators for facility-based staff training.

In addition, assessment of facilities' capacity to provide TB/HIV collaborative services was carried out in all 10 districts where TB/HIV services have been initiated; four of the district hospital provides Diagnostic Counseling and Testing (DCT), Cotrimoxazole Preventive Therapy (CPT), and condoms under one roof. By the end of FY 2006, 30 service outlets will be providing TB/HIV collaborative services.

Work has started to develop a TB/HIV manual and information, education, and communication (IEC) strategy. A total of 52 media persons participated in seminars on TB and TB/HIV education and advocacy aimed at building their capacity and establishing good working relationships with media houses.

During FY 2007, PATH will continue to support and expand services in current Project districts and introduce services in eight new districts (Kwimba, Magu, Sengerema, Ukerewe (Mwanza); Arumeru, Monduli (Arusha); Mafia Island; and Mkuranga in Coast region) where the President's Emergency Plan for AIDS Relief (PEPFAR) is expanding access to Antiretroviral Therapy (ART). The current DTHCs will be tasked to coordinate expansion of TB/HIV services to neighboring districts, except for Mafia, Dar Es Salaam and Arusha. For Mafia Island a new DTHC will be recruited to respond to the logistical challenge the island presents and ZTHC will be recruited to coordinate activities and improve efficiency in the Coast, Dar es Salaam, and Arusha regions.. In both the current and new districts TB/HIV collaboration plans will be incorporated into Comprehensive Council Health Plans (CCHP). In total, TB/HIV collaborative services will be introduced to 40 outlets in the new districts and 15 additional outlets in the 10 initial Project districts. PATH will also support establishment of Regional and District TB/HIV Coordinating Committees according to National TB/HIV Policy guidelines. By September 2007, about 7,000 new TB/HIV co-infected patients will be identified through the offering of DCT to new TB patients and referred for HIV care and support at nearby CTCs. TB/HIV patients will continue receiving CPT and condoms at TB clinics until after completion of their TB therapy when they will be referred to CTCs for further care and support. By scaling up TB/HIV integrated activities, it is envisioned that by end of the project period (2009) the following practices will be routine in both TB clinics and CTCs at both public and private facilities in targeted districts: (1) DCT of all TB patients, (2) TB screening of all confirmed HIV positives, and (3) HIV/AIDS Care and Treatment. PATH will support NTLP to introduce TB services in both the public and private health care

sectors as a strategy for introducing TB/HIV collaborative services. Support will be provided on work already underway to finalize the TB/HIV manual and other training materials for consistent and quality training at the district level. PATH will also support exchange of experiences between districts and between health facilities by facilitating staff participation in quarterly DTHCs and service outlets meetings, strengthening of the referral system, and provision of tools for patient referral, case management, and monitoring of systems and data quality through supportive supervision and on-the-job training. A public health evaluation on improving the diagnostic capability of the TB/HIV service will be carried out including Mycobacteria Growth Indicator Tube (MGIT) as a diagnostic tool and options for simple digital X-ray that omit the need for x-ray films will be considered and supported. To reach patients through the private sector, PATH will continue to engage private-sector providers, diagnostic and service-delivery facilities in close collaboration with APHFTA. The private sector will play a crucial role in the referral network, supporting a seamless flow of patients between the public and private sectors. DTHCs will support day-to-day implementation, including on-the-job training and supervision of service outlets, CTC and laboratory staff. A total of 209 individuals will be provided with training on TB/HIV by September 2007. To stimulate community awareness of TB and TB/HIV and mobilize communities to reduce stigma, PATH will support completion of the TB/HIV Collaborative IEC and Social Mobilization strategy, establish community-based IEC committees, train Community's Own Resource Persons (CORPS), and explore opportunities within schools and through public and private networks. PATH will also continue to operate through media and health journalists to increase awareness and community knowledge and promote uptake of HIV testing and ART. PATH will continue to develop and disseminate TB/HIV patient education materials.

With availability of this supplementary funding, PATH plans to recruit 7 additional DTHCs who will work to coordinate TB/HIV collaborative services in the new Project districts of Monduli, Arumeru (Arusha), Kwimba, Magu, Sengerema, Ukerewe (Mwanza) and Mkuranga in Coast region. Availability of these additional personnel will greatly enhance and accelerate the scaling up of TB/HIV services in these districts. It will also ensure DTHCs who used to cover their own districts and the new districts can concentrate better in their own localities. In addition PATH plans to procure 7 motorbikes for the new coordinators to support them in their work and provide refresher course for all existing DTHCs and 2 Zonal TB/HIV Coordinators (ZTHCs). Part of the training will be to introduce the changes on the HIV testing protocol/algorithm that promotes the use of non cold chain dependent test kits. Similarly, gaps in DOT nurses skills (nurses that provide DOT) for Diagnostic counseling and Testing that that were observed during supervisory visits, will be addressed through training so that DOT nurses are better empowered to provide DCT to TB positive clients.