This activity is specifically linked with activity #7734, #7849 in AB, with #8723 and #7847 in Other Prevention, with #7723 and #7735 in Palliative Care, with #7724 and #7783 in OVC, with #8658 and #8660 in CT and with #7747 and #7749 in ARV services.

Through the Henry M. Jackson Foundation, the Department of Defense (DoD) established HJF Medical Research International (HJFMRI) in Tanzania in 2004 to manage and provide technical assistance to HIV care initiatives in the Southern Highlands. In FY 2005, HJFMRI worked with several local non-government (NGOs) and faith-based organizations (FBOs) in the Mbeya Region to form an HIV Network (Network) in support of HIV programming in three of the four regions in the Southern Highlands Zone (Mbeya, Ruvuma, and Rukwa Regions). Most of these 10 organizations that presently form the Network are well established within this Zone, functioning anywhere between two to 20 years.

Currently, the Network works in a coordinated manner to sensitize and mobilize communities on issues related to counseling and testing, HIV care, and anti-retroviral treatment (ART). Each Network member has unique expertise. Some examples of members and their strengths include: KIHUMBE (which receives its own funding as a prime partner under 7734 and does not receive funds under the Network) excels in home-based care and is the Zone's premier source of training in both technical areas working along side the Mbeya Regional AIDS Control Programme (MRACP); the Iringa Residential Training Foundation (ITRF) has extensive experience with income generation project training and small business start up; Save Tanzania (SETA) trains other network members to build an organization's capacity in program and budget management; the Anglican Diocese of the Southern Highlands has extensive experience in training orphan counselors and orphan caregivers.

In support of sustainable programming, in FY 2007, the oversight of the Network, activities currently under taken by HJFMRI, will be transferred to a local institution. This will occur through an open and competitive process where a local organization with a demonstrable track record in service provision, coordination and excellent management and accountability, will be selected to serve as the umbrella organization for the Network. The selected organization or entity will be the prime partner for this activity under this submission, determining awards, ensuring regional coverage, and assuring proper fiscal management and oversight with sub-grantees implementing activities at the community level. The funding under this submission will support management on the Network and all AB prevention activities conducted by the TBD as part of its overall prevention portfolio and ensuring a comprehensive program to address effective AB messaging in the region. In FY 2007, the TBD and its sub-partners (members) will expand on previous AB prevention education programs in 2005 and 2006 through three main activities: community presentations and two large-scale, annual campaigns. In total, the Network members should reach approximately 340,000 individuals with AB messages in FY 2007.

Small-scale interventions are accomplished through the production and presentation of dramas, songs and other communication methods (such as traditional poems and folk stories) to community groups and schools and at community events. These presentations provide accurate AB HIV/AIDS prevention messages and contribute to the Network developed coordinated prevention campaign known as "Know the Facts". Each Network member will deliver a certain number of presentations per year with an average audience of 500. As a group, the Network will collaborate to produce up to 80 programs/presentations covering the three regions in the Zone and reaching a total of 40,000 people. These presentations are used as openings or follow-up sessions to other events. While KIHUMBE is a member of the network, it focuses only on Mbeya Municipality where it is located and is funded as a prime partner in a separate submission. (7734). The geographic coverage for the Network includes the Rukwa and Ruvuma Regions and other districts within the Mbeya Region. Funding for this activity will support the costs associated with sub-grantees/members under this award in producing and presenting these dramas, including transport of the drama groups and education personnel.

In addition to prevention messages, the presentations will address the importance of knowing one's sero-status and the benefits and availability of HIV care and ART. This includes providing information about local counseling and testing services, home based care organizations and hospitals providing ART. Their prevention program therefore not only provides information on behavior modification but also serves as a link across the

continuum of care encouraging service seeking behavior at both private/not-for-profit and public health facilities in Mbeya, Rukwa, and Ruvuma..

Over 100 personnel from various Network members will be trained by KIHUMBE in how to effectively implement AB programs based on guidance from the National AIDS Control Programme's (NACP) web site and pamphlets and training from KIHUMBE. All messages and their content are coordinated with input from local medical providers and the MRACP to ensure consistency of messages across services in the region. Funding will support the cost of the personnel in attending these trainings.

The Network will also take advantage of the 2007 Dala Dala World AIDS Day campaign and assist KIHUMBE in distributing audiocassettes providing AB messages in four different languages to be played in public commuter buses (Dala Dalas). This campaign was initiated by the Network in Mbeya in 2005 to complement other World AIDS Day activities in the region. One hundred cassettes were played in dala dalas through out the day and an additional 100 cassettes were distributed to their customers upon request. These tapes were well received and were used by the drivers for an additional period of three months, continuing to reinforce AB messaging and the promotion of the "Know the Facts" campaign. Funding in FY 20007 will cover the Network member's individual participation in this campaign in distributing the audiocassettes and include community mobilization. Production of the cassettes will be undertaken by and funded through KIHUMBE (7734).

Another annual activity for the Network is participation in the Southern Highland's Nanenane. Nanenane is a farmers' show and exposition covering all four regions in the Southern Highlands which include Mbeya, Iringa, Ruvuma and Rukwa. Nanenane draws an audience of 1,000,000 to 4,000,000 people over the course of seven days. In 2005, the Network as a group sponsored and staffed a booth and stage to present dramas focusing on AB messaging, distribute prevention materials and provide voluntary counseling and testing services. The Network counted a total audience of over 300,000 for their dramas and of those individuals who visited their booth, 700 were counseled and tested for HIV. In 2006, they again had an audience of around 300,000 for dramas and presentations, recorded 50,000 visitors to their booth, counseling and testing 755 of those individuals. It is estimated that this campaign in 2007 will reach a similar number (300,000) of people with prevention messages. Funding in this submission will support member participation in this campaign for 2007 which will include transport, materials, booth construction, space rental and equipment.

Table 3.3.02:

This activity also relates to activities in AB prevention (#8688), counseling and testing (#8658), treatment (#7749, #7794, #7797), and other activities under palliative care (#7735, #7851, water and supply procurement).

Through the Henry M. Jackson Foundation, the Department of Defense (DOD) established HJF Medical Research International (HJFMRI) in Tanzania in 2004 to manage and provide technical assistance to HIV care initiatives in the Southern Highlands. In FY 2005, HJFMRI worked with several local non-government (NGOs) and faith-based organizations (FBOs) in the Mbeya Region to form an HIV Network (Network) in support of HIV programming in three of the four regions in the Southern Highlands Zone (Mbeya, Ruvuma, and Rukwa Regions) and work in a coordinated manner to implement HIV services.

Each Network member has unique expertise which is shared with other members to strengthen the overall capacity and program for all. Some examples of members and their strengths include: KIHUMBE (which receives its own funding as a prime partner and does not receive funds under the Network) excels in home-based care and prevention education and is the Zone's premier source of training in both technical areas working along side the Mbeya Regional AIDS Control Programme (MRACP); the Iringa Residential Training Foundation (located in Mbeya Municipality) has extensive experience with training in income generation and small business start up; Save Tanzania trains other network members to build an organization's capacity in program and budget management; the Anglican Diocese of the Southern Highlands has extensive experience in training orphan counselors and orphan caregivers; and The Evangelical Lutheran Church of Tanzania, provides training in gender, legal and human rights through their Local Community Competence Building scheme. Since the Network was formed, significant results have been achieved in all areas of member programming and it is allowing them to achieve coordinated and sustainable solutions and members draw upon their expertise to ensure a comprehensive package of services.

In support of sustainable programming, in FY 2007, the oversight of the Network, activities currently under taken by HJFMRI, will be transferred to a local institution. This will occur through an open and competitive process where a local organization with a demonstrable track record in service provision, coordination and excellent management and accountability, will be selected to serve as the umbrella organization for the Network. The Network itself has been incorporated as a legal entity, has developed a steering committee and is working on strengthening an administrative core to manage and oversee member activities. The selected organization or entity will be the prime partner for this activity under this submission, determining awards, ensuring regional coverage, and assuring proper fiscal management and oversight with sub-grantees implementing activities at the community level. The funding under this submission will support management on the Network and palliative care services as part of its portfolio ensuring a comprehensive program to address HIV services in the region.

In FY 2006, Network members provided HBC services for over 900 clients. Under FY 2007 funding the number of clients receiving services will be increased significantly as the capacity of current members organizations are further developed and new organizations covering sites in the Rukwa and Ruvuma Regions are added. HBC partner expansion through the Network mirrors the National AIDS Control Programme's ART facility roll out to ensure comprehensive services for clients from the facility to the home supporting the continuum of care model in the Southern Highlands. New community HBC providers will be trained by KIHUMBE in basic HBC skills. Both new and current providers from Network members will be trained in the additional skills necessary for ART counseling and ART and TB adherence in a six-day refresher course to cover topics in adherence and basic patient monitoring using the national ART adherence curriculum

Training by KIHUMBE will also include a module on record keeping and Network members will be provided tools and questionnaires to assist the CHBC volunteer in identifying signs of complications due to treatment and when patients need to be referred to a health care facility. In addition to the care management forms, providers will be given tools to monitor and evaluate the outcome of using CHBC providers as a means to enhance follow-up of patients on treatment. This data will be collected by the RMOs to monitor the quality and inform improvement of services in their regions.

The basic care package provided by these organizations for PLWHA include provision of non-prescription medication, psycho-social-spiritual counseling, education on healthy living choices for positives, provision of situation-appropriate basic commodities, legal literacy, access to training in IGA, and nutritional support and counseling. HBC providers also offer informal training to caregivers of clients on skills necessary to assist in the support of the HIV-positive members in their homes. To monitor quality and expand the level of services member organizations can provide, each member is "assigned" medical expertise with ART-trained clinicians through an agreement with the nearest medical facility to which they are linked. The assigned medical officers assist the organizations in providing prescription medications to clients. This includes the use of cotrimoxazole prophylaxis as preventive therapy for PLWHA. Funding under this submission for delivery of services will support the provision of supplies for basic palliative care (non-prescription medications and disposables). Cotrimoxazole and other items such as insecticide treated bed nets and WaterGuard units and supplies will be provided through a joint USG procurement.

Combined, these organizations will care for 6,000 patients, train 175 HBC providers and 500 caregivers. New patient identification by Network members complements HBC through the offering of counseling and testing in client's homes and will be expanded though to the use of mobile teams. All patients will be linked to HIV Care and Treatment Centres (CTC) at district, regional, or referral hospitals for facility-based palliative care and ART. The number of member organizations providing these services will increase from 17 in FY 2006 to 28 in FY 2007 (including branches of larger organizations).

To complement HBC services funded under this submission, attempts will be made to link to organizations outside the Network. Peace Corps Volunteers working in the Mbeya and Ruvuma Regions will be approached to provide technical assistance in the training of Network member staff, clients and providers in permaculture and home/community gardening. Basic services will also be complement by providing longer term, clean water solutions for clients. Through a new partnership initiated on a pilot basis in FY 2006 with the U.S.-based NGO Enterprise Works, members will address safer drinking water needs for rural patients and their families. The work will focus on development of low cost shallow well systems, training people in building lost cost point of contact water filtration systems for individual use and as an income generating activity. The activity will continue in FY 2007 and is wholly financed by Enterprise Works.

Plus up funding will be used to expand home-based VCT services in the Rukwa, Ruvuma and some parts of Mbeya regions of in the Southern Highlands of Tanzania; train health care workers to provide VCT services door-to-door; expand home-based palliative care services to 1,250 person; and to help assure coordination of the 10 implementing groups, including the training of an additional 35 persons.

Table 3.3.06:

This activity also relates to activities in Palliative Care (#7723) in the Southern Highlands, as well as activities in Orphan and Vulnerable Children (OVC) programs being implemented by KIHUMBE (#7736), FHI (#7715), PACT (#7783), treatment (#7749, #7794, #7797) and the Southern Highlands OVC and Home-based Care network (#7724 and #7735) activities, both TBD.

Mbeya, Rukwa and Ruvuma regions reportedly have the highest OVC populations per capita (18% according to the Tanzanian HIV/AIDS Survey), yet ranks as the area with the least capacity for meeting the full needs of its OVC population.

Through the Henry M. Jackson Foundation, the Department of Defense (DOD) established HJF Medical Research International (HJFMRI) in Tanzania in 2004 to manage and provide technical assistance to HIV care initiatives in the Southern Highlands. In FY 2005, HJFMRI worked with several local non-government (NGOs) and faith-based organizations (FBOs) in the Mbeya Region to form an HIV Network (Network) in support of HIV programming in three of the four regions in the Southern Highlands Zone (Mbeya, Ruvuma, and Rukwa Regions) and work in a coordinated manner to implement HIV services.

As a locally based organization, HJFMRI has had two successful years in Mbeya City and is now reaching out to Rukwa and Ruvuma regions increasing the capacity of several other local organizations providing support to OVC and their caregivers. In FY06, it helped found a Mbeya HIV Network of NGOs and FBOs which have been active in providing services to community members in the region and the Southern Highlands from anywhere between two to eighteen years.

Each Network member has unique expertise which is shared with other members to strengthen the overall capacity and program for all. Some examples of members and their strengths include: KIHUMBE (which receives its own funding as a prime partner and does not receive funds under the Network) excels in home-based care and prevention education and is the Zone's premier source of training in both technical areas working along side the Mbeya Regional AIDS Control Programme (MRACP); the Iringa Regional Training Foundation (located in Mbeya Municipality) has extensive experience with training in income generation and small business start up; Save Tanzania trains other network members to build an organization's capacity in program and budget management; the Anglican Diocese of the Southern Highlands has extensive experience in training orphan counselors and orphan caregivers; and the Evangelical Lutheran Church of Tanzania provides training in gender, legal and human rights through their Local Community Competence Building scheme. Since the Network was formed, significant results have been achieved in all areas of member programming and it is allowing them to achieve coordinated and sustainable solutions and members draw upon their expertise to ensure a comprehensive package of services.

As the number of OVC increases, it is essential to scale up support of OVC services more rapidly. In FY07, through an open and competitive process, local NGOs and FBOs with demonstrable track records in direct service provision at a community level and excellent management and accountability, will be selected to serve as the Network and carry out this activity on a broader scale. The selected organization or consortium will be the prime partner for this activity under this submission, determining awards, ensuring regional coverage, and assuring proper fiscal management and oversight with sub-grantees implementing activities at the community level.

The activities of theNetwork organizations are coordinated with programs implemented by other donors in the Mbeya, Ruvuma, and Rukwa Regions and will work to provide services in six districts in Mbeya, the Mbeya Municipality itself and the large urban center of the Rukwa Region, Sumbawanga and its four districts while Ruvuma has five districts with Songea as its population center.

Key activities to be funded by this COP07 submission will include providing over 6,000 OVCs with basic needs (clothing, bedding, school uniforms, nutritional support, and ensuring access to proper medical care), improvement of psycho-social-spiritual support through training of 160 caregivers as part of services by the Anglican Diocese of the Southern Highlands, education of OVC and caregivers on their legal rights, and assisting in the identification of HIV positive OVC and ensuring their access to treatment. Training will

be extended to home-based care providers to strengthen their ability to deal with vulnerable children in the households they serve. Support will also include assistance in financing appropriate fees for secondary school and access to vocational training for older OVCs. In addition, through informal training using OVC providers, over 6,000 caregivers/heads of households (many of whom are OVCs themselves) will learn skills in supporting of basic needs of OVCs through income generating activity training. By virtue of linkages with each other through the Network, these organizations will support and strengthen each other through the sharing of lessons learned and identification of additional resources.

Funding under this COP07 submission will cover the provision of all services and basic needs, including assistance with fees, transport for volunteers, supportive supervision, and peer support meetings and events for OVCs, including mentoring, parenting for OVC who are head of household, hygiene, vocational training, development of relationship skills through group programs like sports, entrepreneurship training along with basic budgeting and anti-stigma education.

Members of the Network will receive training in various income generating activities by the Iringa Residential Training Foundation which is a member of the Network. This particular training will enable the members of the Network to assess the potential of an individual, family, or village association of clients to begin and sustain income generating projects for the benefit of orphans and their caregivers. In addition, to complement the package of services for OVC, Peace Corps Volunteers working in the Mbeya Region will be approached to provide technical assistance in the training of Network staff, caregivers and clients in permaculture and home/community gardening. Mentoring and monitoring of these projects will ensure their success. Under the Tanzanian National OVC/MVC National Plan of Action, Most Vulnerable Children's Committees (MVCCs) are expected to undertake the basic long-term role of identifying OVC, linking them with community-based OVC services, and providing data for the national Data Management System (DMS) to track OVC and OVC services. The slow roll out of the National DMS is a consequence of not having MVCC in many districts of Tanzania. Plus up funding will be used to establish Most Vulnerable Children's Committees and MVC identification in two wards per district. A portion of this funding will cover the provision of services and basic needs to 40 OVCs in select wards. To help ensure service provision once the MVCs are identified, additional funding will be sought in COP 2008.

Table 3.3.08:

This activity also relates to activities in palliative care (7723, 7735), treatment (7747, 7749, 7794, 7797), AB prevention (8688), and other activities in counseling and testing (8657, 8660).

Through the Henry M. Jackson Foundation, the Department of Defense (DoD) established HJF Medical Research International (HJFMRI) in Tanzania in 2004 to manage and provide technical assistance to HIV care initiatives in the Southern Highlands. In FY 2005, HJFMRI worked with several local non-government (NGOs) and faith-based organizations (FBOs) in the Mbeya Region to form an HIV Network (Network) in support of HIV programming in three of the four regions in the Southern Highlands Zone (Mbeya, Ruvuma, and Rukwa Regions). Most of these 10 organizations that presently form the Network are well established within this Zone, functioning anywhere between two to 20 years.

The Southern Highlands, Mbeya Region in particular, is situated along the Trans-African Highway, at the junction between Malawi and Zambia. This location on the "trade" route has contributed to a large percentage of the overall HIV infected population in Tanzania. Prevalence in the population along this route averages around 19% according to data from NGOs and FBOs providing VCT services but can range as high as 68% among bar workers. (Riedner, et al: 'Baseline survey of sexually transmitted infections in a cohort of female bar workers in Mbeya Region, Tanzania' Sexually Transmitted Infections , 2003 Oct; 79(5);382-7)

Currently, the Network works in a coordinated manner to sensitize and mobilize communities on issues related to counseling and testing, HIV care, and anti-retroviral treatment (ART). Each Network member has unique expertise which is shared with other members to strengthen the overall capacity and program for all. Some examples of members and their strengths include: KIHUMBE (which receives its own funding as a prime partner and does not receive funds under the Network) excels in home-based care and prevention education and is the Zone's premier source of training in both technical areas working along side the Mbeya Regional AIDS Control Programme (MRACP); the Iringa Residential Training Foundation (ITRF) (located in Mbeya Municipality) has extensive experience with income generation project training and small business start up; Save Tanzania (SETA) trains other network members to build an organization's capacity in program and budget management; the Anglican Diocese in the Southern Highlands has extensive experience in training orphan counselors and orphan caregivers; and The Evangelical Lutheran Church of Tanzania (ELCT), provides training in gender, legal and human rights. Since the Network was formed, significant results have been achieved in all areas of member programming and it is allowing them to achieve coordinated and sustainable solutions. While KIHUMBE is a member of the network, it focuses only on Mbeya Municipality where it is located and is funded as a prime partner in a separate submission, the geographic coverage for the Network includes the Rukwa and Ruvuma Regions and other districts within the Mbeya Region.

In support of sustainable programming, in FY 2007, the oversight of the Network, activities currently under taken by HJFMRI, will be transferred to a local institution. This will occur through an open and competitive process where a local organization with a demonstrable track record in service provision, coordination and excellent management and accountability, will be selected to serve as the umbrella organization for the Network. The Network itself has been incorporated as a legal entity, has developed a steering committee and is working on strengthening an administrative core to manage and oversee member activities. The selected organization or entity will be the prime partner for this activity under this submission, determining awards, ensuring regional coverage, and assuring proper fiscal management and oversight with sub-grantees implementing activities at the community level. The funding under this submission will support management of the Network and all counseling and testing activities conducted by the TBD as part of its overall counseling and testing portfolio in the region.

FY2007 funding will support a mobile VCT effort as a means for overcoming existing health service infrastructural deficiencies, bringing desperately needed HIV/AIDS counseling and testing, education, care and treatment to people throughout the year. Isolated and rural communities served by members of the Network will be targeted. Regional and district hospitals will be an integral part of this program as they will provide the vehicles that will transport mobile VCT staff and their testing materials from one

location to another. In addition, the regional and district hospitals will determine the actual location of the mobile VCT based on local prevalence rates and community need. In accordance to national guideline, clients will be counseled and tested by a team of certified counselors provided by member NGOs as well as the regional and district hospitals. Clients who are found to be HIV positive will be referred to the nearest Care and Treatment Centre (CTC) attached to the hospital providing the mobile VCT vehicle for evaluation. Clients that test HIV positive will be referred to local community support groups for people with HIV/AIDS to access emotional and spiritual support and to home based care (HBC) organizations working in their area for additional palliative care, many of them members of the Network.

The Mobile VCT program will be linked to health centers to provide the client with information about local and district CTC, behavior change, healthy living choices, and information about local income generating projects and training through IRTF to help promote the lively hood of PLWHA. In order to maximize coverage and reduce the change of overlap, the Network will work with all members to assign areas of coverage based on current program services footprints in HBC or prevention. Working in concert with the Network, the Family Health International's Regional Outreach Addressing AIDS through Development Strategies (ROADS) Program (under the Transport Corridor Initiative), and local health center and dispensary VCTs, this mobile VCT activity will target a total of 10,000 individuals who will receive counseling and testing and their results and will train an estimated 120 peer educators living in target communities to assist in community mobilization. Existing VCT counselors from Network member organizations and participating hospitals will be used for service delivery so no additional staff will need to be trained.

Funding in FY 2007 will support costs related fuel for the Mobile VCT unit, transportation and remuneration of volunteer counselors, tents, and community mobilization necessary to carry out counseling and testing.

Plus up funding will be used to procure two vehicles to provide mobile services targeting underserved, hard-to-reach, and high-risk populations such as truckers and commercial sex workers. In accordance to national guideline, clients will be counseled and tested by a team of certified counselors provided by TBD member NGOs as well as the regional and district hospitals. Clients who are found to be HIV positive will be referred to the nearest Care and Treatment Center. This mobile VCT activity will target a total of 10,000 individuals who will receive counseling and testing and their results at 20 sites in the initial stages of the program. Existing VCT counselors from participating NGOs and hospitals will be used for service delivery so no additional staff will need to be trained.

Table 3.3.09: