This activity also relates to activities in treatment (MoH/NACP), TB/HIV (#7781), CT (#7776, MRH, MRMO, Rukwa and 8661) and palliative care (KIHUMBE, HJFMRI, Pathfinder and Care Tumaini).

IntraHealth International, in collaboration with NACP, will conduct a project designed to increase the capacity of the public and private health facilities to provide counseling and testing (CT) approaches, including routine CT in specialized clinics (TB, STIs, IPD, OPD). IntraHealth will work with NACP to achieve this goal by: (1) strengthening the capacity of the MOHSW/NACP to promote provider-initiated testing and counseling (PITC) by improving policy and infrastructure; (2) creating an enabling enviroment to support PITC services through enhanced clinical and managerial skills, and strengthened performance support systems; (3) strengthening referral networks; and (4) building the capacity of GOT organizations to participate in HIV prevention, AIDS care and support, and IEC/BCC activities. IntraHealth will use a performance improvement approach, wherein stakeholders collaboratively identify gaps between actual and desired services, analyze the root causes of gaps, and adapt training curriculum and other interventions to close gaps.

To implement this comprehensive strategy, IntraHealth will engage in the following activities in FY 2007:

Activity 1: Assist in the finalization of PITC guidelines in collaboration with NACP. NACP is currently adapting WHO guidelines on PITC to the Tanzanian context. IntraHealth will provide technical assistance to help the process and use them to guide the development of the whole site facility trainings in the selected districts. The output of this activity will be a protocol for PITC services with same day results.

Activity 2: Identify sites for phased implementation of PITC. Site identification will be accomplished by analyzing HIV prevalence, sizes of facility catchment areas, facility infrastructure, human resources availability and other factors. This will allow IntraHealth to determine which facilities to target for PITC roll out in order to maximize impact.

Activity 3: Build capacity of health workers in the selected facilities using a RCT training developed by USG/CDC. IntraHealth will work with Muhimbili Health Information center (MHIC) and Zonal Training Centers (ZTCs), building on the expertise and experiences of these institutions in training health workers. IntraHealth also will work with USG treatment partners in the selected regions to facilitate information exchange and experience sharing. The trained TOTs will conduct whole facility training, a training approach that employs on the job training methodologies. Whole facility training will allow clinical, laboratory and management staff to receive comprehensive training in PITC, integration of PITC into OPD, IPD, MCH, TB, STI clinics and other special clinical services. In the selected regions, 200 health care workers (each district hospital will have 10-15 participants) will be trained on the PITC approach with an emphasis on providing appropriate prevention messages for HIV positive clients. The training will involve existing staff responsible for TB, STI, Maternal, Children and primary health care for earlier recognition of HIV related illnesses and provide better services including counseling and testing at all levels. PITC services will be provided to an estimated 50,000 clients attending OPD and IPD, and receiving STI and TB services in the health facilities.

Activity 4: Provide supportive supervision and follow up of program activities. IntraHealth will work in collaboration with the Regional District Health Management Teams (R/DHMTs) to build their capacity to conduct effective supervision of these activities at the district level.The R/DHMTs will work closely with the supervisory units of each facility to provide sustainable quality assurance and oversight that meet national standards and that build internal supervisory capacities.

Activity 5: Enhance the capacity of sites to procure equipment, materials and supplies. Funding will go specifically to train health care workers on logistics systems and the procurement of test kits and supplies for their facilities using the new algorithm. The partner will provide assistance in forecasting need for HIV test kits, and facility laboratory technicians, pharmacists and service delivery point heads will receive specialized training in logistics management. As a result, each facility will be able to adequately plan, manage, and restock all supplies and commodities - including rapid test kits and elements of the basic care package.

Activity 6: Develop necessary infrastructure for planned activities. IntraHealth will facilitate assessment of facility physical infrastructure needs, including space appropriate for confidentiality and client flow patterns. IntraHealth will the facilitate minor renovations that require few resources. This assessment will assist MOHSW/NACP in developing an infrastructure plan to roll out PITC nationally in both public and private health facilities.

Activity 7: Develop Information Education and Communication/Behavior Change Communication (IEC/BCC) strategies. IntraHealth will work with MOHSW/NACP and other partners to develop, design, and pretest nationally standardized RCT materials and assist with stakeholder buy in. These materials will target community leaders, policy makers, and educators and be used to promote demand for PITC services thus increasing the uptake of services.

Activity 8: Strengthen intra- and inter-facility referral protocols, standards, and processes into the National Care and Treatment Plan. Prior to initiating whole facility training, the partner will work with MOHSW/NACP, USG/CDC and R/DHMTs to evaluate the current facility referral networks, referrals to care and treatment clinics (CTCs), and client follow up. If necessary the referral forms and registers will be revised and tested for compliance and flow. IntraHealth will develop a model to establish and strengthen the referrals and linkages/networking at the district levels to provide continuum of care to existing care and treatment services at the district level.

Activity 9: Conduct routine monitoring and evaluation of activities. IntraHealth will work with MOHSW/NACP to adopt the existing monitoring tools that are currently being revised by the M&E unit to include all forms of CT services. In addition, the stakeholders will agree upon a monitoring unit responsible for supervision and oversight and draft a monitoring agreement.

Throughout the proposed acitivities, routine process monitoring will occur. This will facilitate information exchange and lessons learned sharing with other partners implementing PITC. The policies, guidelines, training curriculum and IEC/BCC materials developed for this project will be available to other organizations, including ZACP.

Reprogrammed funds will be used to allow IntraHealth to support the publication and distribution of national guidelines for provider initiated testing and counseling (PITC). The National AIDS Control Program received limited financial support from WHO to develop draft guidelines; however, plans for dissemination activities were not included. IntraHealth will fill this void and professionally publish the guidelines and ensure that the documents are widely distributed to governmental and private partners at all levels. IntraHealth also plans to produce training materials and job aides, which providers can use to increase awareness of the government's new position on PITC. Following these supplemented activities, IntraHealth will continue to work with the NACP to design, implement, manage and evaluate effective, appropriate and locally sustainable ways of scaling up CT services as previously planned.