Selian Lutheran Hospital AIDS Control Program (ACP) is comprehensive, integrated program of services providing a full continuum of care to those affected by HIV/AIDS. Selian hospital has been running a Prevention of Mother to Child Transmission (PMTCT) program since 2001.

The PMTCT effort began as a Selian funded effort and was later funded by PEPFAR through a sub-grant from EGPAF/Engender Health. This relationship allowed Selian to move from offering only single antiretroviral prevention using Nevirapine (NVP) to using Highly Active Antiretroviral Therapy (HAART) for selected women attending the main hospital. PMTCT is currently provided through four sites: the Selian Hospital, the Arusha Town Clinic, the Kirurumo Clinic in the rural community of Mto wa Mbu, and the Bangata Clinic. These sites are collectively providing services to over 1,000 women, counseling and testing over 90% women and treat 50 - 80 newborns annually. The services are integrated into the Maternal and Child Health Clinics where all pregnant women reporting for antenatal care are educated, counseled and offered HIV testing. Over 90% of women are agreeing to be tested. HIV+ women are referred to the CTC for evaluation.

At the rural sites, the standard National AIDS Control Program intervention with NVP for mother and child at time of delivery is practiced. Women enrolled in the Care and Treatment Center (CTC) are assessed for their need to initiate HAART and followed jointly by the CTC team. PMTCT services will continue at the existing sites and expand into two additional rural dispensaries during FY 2007. In keeping with the approach of all USG partners, Selian Lutheran Hospital will implement a standardized approach at its sites using opt-out testing, rapid tests with same day results. Testing and NVP will be provided in both labour and delivery wards; the national PMTCT monitoring system, supportive supervision tools, infant feeding counseling job aids, and the national PMTCT training curriculum will be adopted. Commodities for PMTCT, including NVP, test kits, AZT, and will be supplied and delivered to sites through SCMS. Follow-up of positive infant and mothers will be carried out in addition to provision of Cotrimoxazole. This will result in an estimated increase in the number of women served to over 1,000. An even higher rate of utilization of the services is expected as the program continues to sensitize and mobilize the communities served. To accomplish this additional staff will be recruited and trained to serve the new and existing sites.

This activity also relates to activities in Prevention of Mother-to-Child Transmission (#8220), Counseling and Testing (#8662), Orphans and Vulnerable Children (#7804), and HIV/AIDS Treatment (#7805). In addition, the program will be linked with the African Palliative Care Association (#8704) and the National AIDS Control Programme (#8692).

This activity's main component provides home-based care and palliative care to patients suffering with AIDS and the complications of the disease. Selian Lutheran Hospital AIDS Control Programme is a faith-based initiative with a wide spectrum of HIV/AIDS-related services, which work together to achieve a continuum of care. The overall program includes prevention and relief of suffering by means of early identification and effective assessment and treating of pain and other problems, physical, psychological and spiritual. The program includes prevention and relief of suffering by means of early identification and effective assessment and treating of pain and other problems, physical, psychological and spiritual.

Selian has been developing its Hospice and Palliative Care Programme since 1999. The initial focus was on end-of-life care, and that expanded with USG-funding through the Care/Tumaini activity. With FY06 Plus-up Funds, Selian "graduated" from sub-grantee status with several USG implementing partners to being supported directly by the USG for an array of programs, including palliative care and OVC, treatment, PMTCT, and counseling and testing. This will be an important year for Selian to develop their own capacity, especially in the area of their own programmatic and fiscal accountability.

Present services include pain control, physical and environmental hygiene, psychological and spiritual support, medication administration, and teaching and education for caregivers. Care is facilitated by the Selian Team, with the local assistance of 150 fully trained home-based care volunteers. By the end of FY06, the Home-based and Palliative Care program provided care to over 1,500 patients in four districts of Arusha. In addition, a Day Care Program was introduced at four sites in FY06. Currently, between 20 to 30 patients attend the Day Care Program each day.

With FY07 funds, the program will expand within the four district service areas, increasing the number of wards covered within each district. The Home-based and Palliative Care Programme plans to increase the number of patients receiving service to over 2500. The program will be enhanced to increase the comprehensiveness of services so that they meet the basic package identified in the Government of Tanzania Guidelines for Home-based Care.

In addition, staff at Selian Hospital are also the founders and officers of the newly formed Palliative Care Association of Tanzania. This is a progressive program that can help to strengthen other home-based and palliative care programs in Tanzania. In FY07, Selian also seeks to expand its training capabilities to serve as a training site for other programs initiating Home-based Care and Palliative Care.

With these additional Plus Up funds, Selian will be able to expand their home-based care services to other additional wards throughout the catchment area. 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 relates to activities in Palliative Care: Basic Health Care and Support (#7803), PMTCT (#8220), and Treatment (#7805). As an Orphan and Vulnerable Children (OVC) partner, this activity will also link with the PACT Coordinating Implementing Partner Group (IPG) Network for OVC (#7783) and the FHI OVC Data Management System (#7715).

Selian Lutheran Hospital AIDS Control Program (ACP) is a comprehensive, integrated program of services providing a full continuum of care to those affected by HIV/AIDS.

Care and services to OVC have been integrated into a wider community outreach project which has developed a system of community-based care sites located in congregations of the local churches. The 106 community-based sites have served as the contact point for outreach to the orphans and vulnerable children. Through the OVC and Community Outreach Program, the ACP has registered over 3,700 people. Over 100 congregations have formed special committees to coordinate OVC and Community Support activities.

This is the first year that the Selian Program will have direct USG support for their programs, having "graduated" from being a sub-grantee under several implementing partners. Previously, Selian received support and technical assistance for service delivery to OVC from the Care/Tumaini activity. As a direct grantee in FY07, Selian will link with the national IPG network, and will work with those partners to standardize the availability of services to OVC. This will be a transitional year for Selian, as the package of services they provide will be refined, and the approach may change to align with the Government of Tanzania National Plan of Action for Most Vulnerable Children. Selian will also help to establish Most Vulnerable Children's Committees to help the community and households identify and address the needs of OVC. As with all USG-funded implementing partners, as a member of the IPG, PASADA will implement stigma and discrimination activities from the Stigma Tool Kit.

With FY07 funding, the OVC Program expects to expand the number of active community sites to over 200, with a goal to serve 1,500 OVC with comprehensive services and train 5 caregivers. OVC with HIV-positive parents will be linked with the Selian home-based care community volunteers, and HIV-positive OVC will be referred to Selian treatment services. Finally, this activity will wraparound with other USG-funded programs, such as PMI.

As with all USG-funded implementing partners, PACT will 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 identified at the local level feeds not only into the national system, but is also available to MVCCs at the local level for planning, decision making, and monitoring.

Selian Lutheran Hospital AIDS Control Program (ACP) is a comprehensive, integrated program of services providing a full continuum of care to those affected by HIV/AIDS. Selian hospital has been running Voluntary Counseling and Testing (VCT) Services since 1995. Selian has been a leader in introducing VCT to the Arusha area and for availability of VCT services in the rural communities of Arusha. Selian provides VCT services at five fixed sites and multiple mobile units. These are geographically distributed throughout Arusha and the surrounding districts. The fixed sites are the Selian Hospital, the Arusha Town Clinic, the UZIMA Centre, the Tumaini site in Njiro area of Arusha, and at the Kirurumo Health Centre in Mto wa Mbu. These sites currently serve over 9,400 clients per year.

In FY 2007, Selian is currently providing a limited amount of provider initiated testing and counseling having locally adapted existing VCT guidelines. This service will be expanded to clinical services such as TB, STI and MCH clinics and inpatient settings following the finalization of national curriculums and protocols. Clients who are found to be HIV+ are referred to the nearest Care and Treatment Centre, Selian Town Clinic, for evaluation and TB screening. In addition, the centers will provide education and information together with same day counseling and testing for HIV/AIDS.

The program will work with the MOHSW in phasing out the old and adopting the new HIV testing algorithm and will engage/rely on the new SCMS mechanism to procure and distribute buffer stocks of test kits and other commodities.

In keeping with the MOHSW guidance, Selian will support the use of "lay counselors" and work within the facilities and communities they support in implementing this new initiative. Referral will also be made to the VCT Centers' community support groups for people with HIV/AIDS to access emotional, legal, and nutritional support for these organizations. The plan is for the current VCT services to continue and to expand in the funding year ahead. The sites seek to increase those served by 20% in the funding year and will thus serve over 11,000 clients annually. This will be accomplished by closer cooperation with the Home Based Care Team, through further targeting of special groups such as married couples, and increasing the number of mobile VCT activities provided. Selian will draw experience and expertise from AMREF and expand its capacity to carry out mobile VCT service using mobile vans.

Selian AIDS Control Program Care and Treatment Services

This activity also relates to activities in Counseling and Testing (#8662), Prevention of Mother-to-Child Transmission (#8220), Orphans and Vulnerable Children (#7804), and Palliative Care (#7803).

This activity provides care and treatment to patients suffering from HIV and AIDS and the complications of the disease. Selian Lutheran Hospital AIDS Control Programme is a faith-based initiative with a wide spectrum of HIV/AIDS related services, which work together to achieve a continuum of care. The overall program includes prevention and relief of suffering by means of early identification and effective assessment and treating of pain and other problems, physical, psychological and spiritual. To enhance the continuum of care, a new feature was added to the program in FY06: voluntary Adherence Counselors (VAC), who are patients on ART who volunteer to visit other patients in their homes and to serve as motivator for better adherence to ART regimens. The full array of services, including Counseling and Testing, Prevention of Mother-to-Child Transmission, facility- and home-based palliative care, and services for orphans and vulnerable children (OVC) are provided through the network of Selian facilities. These include Selian Hospital, the Arusha Town Clinic, the Health Centre at Mto wa Mbu, and through a number of dispensaries and mobile clinics. The immediate catchment area of the project is Arusha and neighboring communities, with the beginnings of movement into the furthest reaches of the Arusha and Manyara Regions. Mto wa Mbu is one of the first rural health centres in Tanzania to be a Care and Treatment Clinic (CTC) for anti-retroviral therapy (ART).

Toward the end of FY 2006, the Selian CTC provided care to over 1,800 patients in four districts of Arusha, with approximately 900 on ART. Mto wa Mbu has nearly 100 additional persons on treatment.

Until late FY 2006, Selian was a sub-grantee of Catholic Relief Services for care and treatment, and the Mto wa Mbu Health Centre in rural Manyara was funded through Deloitte. With FY 2006 Plus-up Funds, Selian "graduated" from sub-grantee status to being supported directly by the USG, and Mto wa Mbu will operate as a satellite clinic

With estimates that less that ten percent of Arusha's HIV patients requiring ART be on treatment, there is great need for rapid expansion of patients enrolled in the CTCs. With COP07 funds, the program will focus on expansion of service provision and strengthened linkages among programs across a broader geographic service area. The program will continue to increase testing to scale up those identified as HIV positive, including children. This will be promoted through increased community mobilization, increasing the number of VACs and home-based care outreach, and strengthening links into the referral points. The target is to have 1,800 on treatment by the end of FY07, and 3,900 on treatment by the end of FY08. With COP07 funds, Selian expects to enrolled 5,600 patients, putting approximately 2,800 on treatment. Practically, this calls for far better referral mechanisms. Community outreach will include awareness raising, stigma reduction, and training for religious and political leaders in the community. In addition, Selian will establish additional training and linkages to other health care providers in the community for referral into the Selian CTCs. In particular, focus will be placed on making provider-initiated testing a reality, especially in under-5 clinics, antenatal clinics, TB clinics, and pediatric in-patient wards. This will be complemented by training to sensitize all clinical staff of the facility and those who provide OVC services to ensure they are aware of suggestive symptoms and signs suggestive of HIV/AIDS, or to identify those with histories of possible exposure. Selian will also participate in the network being developed at Kilimanjaro Christian Medical Centre to strengthen training and back-up support for providers of pediatric AIDS services. In addition, to promote treatment services and adherence, an additional 30 VACs will be recruited and trained. Selian also plans to establish one new support group for patients on ART at each CTC.

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.

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.