TITLE: SCALING UP INTEGRATED PREVENTION OF MOTHER TO CHILD TRANSMISSION OF HIV IN

TANZANIA

NEED and COMPARATIVE ADVANTAGE:In Tanzania, HIV prevalence is 8.7% among pregnant women.

PMTCT coverage only reaches 15% of this population with services concentrated primarily in urban areas.

Elizabeth Glaser Pediatric AIDS Foundation (EGPAF) has contributed to more than 30% of the national

coverage. HIV prevalence rate in EGPAF-supported PMTCT sites is around 5%, and still few mothers and

children have access to Care and Treatment (C&T).

EGPAF, as a leading organization in PMTCT and C&T, intends to work with the government of Tanzania

(GoT) and the USG toward increasing coverage and access to PMTCT services throughout the country by

improving and expanding the PMTCT program.

Expansion using the district approach facilitates quick expansion, builds capacity of the districts in

managing PMTCT programs, and ensures sustainability. All EGPAF PMTCT-supported sites will implement

an integrated program and provide ART services which coincides with the GoT C&T and PMTCT

regionilization plan.

ACCOMPLISHMENTS: The number of sub grantees supported by EGPAF in Tanzania increased from

three in 2003 to 16 in March 2007. By March 2007, EGPAF supported 290 health facilities providing

PMTCT services. From October 2006 to March 2007, the program provided counseling and testing to a

total of 76,800 mothers (95% of whom were new Antenatal clinic (ANCs). Over 2,700 individuals were

given antiretroviral (ARV) prophylaxis and 365 providers were trained in basic PMTCT concepts. Linkages

between PMTCT and ARV services are currently occurring and will continue to be a central focus of

EGPAF's mission. From February 2006-December 2006, Masasi district tested over 8,800 mothers, 464

(5.2%) were positive, and among those individuals, 254 (55%) were enrolled in C&T, 59 of whom (23%) are

also on antiretroviral therapy (ART).

ACTIVITIES: EGPAF will expand PMTCT services within existing districts and also into new districts. By

supporting 12 new sub grantees, this will bring the grand total of funded partners to 34. Through

collaboration with other partners, EGPAF will assist in improving quality of care to 580 sites with PMTCT

services by the end of September 2009 in Arusha, Kilimanjaro, Mtwara, Lindi, Tabora and Shinyanga

regions. In order to better provide support to rural regions, EGPAF will open an office in Mtwara to

effectively monitor and support Mtwara and Lindi. Upon completing a needs assessment, EGPAF will assist

all districts in integrating PMTCT programs in existing outreach or mobile services.

In order to effectively scale-up PMTCT services, EGPAF will execute capacity building by training and

retraining 80 PMTCT trainers employed by 10 sub grantees. In addition, EGPAF will orient 145 supervisors

from district and regional levels to improve management and supervision of PMTCT services. Strengthening

and supporting sub grantee staff is also a key priority to ensure adequate project oversight, guidance, and

financial management according to USG rules and regulations. EGPAF will train 50% of PMTCT service

providers to effectively stage and provide care to HIV-positive mothers. Additionally, measures to assist the

Ministry of Health and Social Welfare (MOHSW) to coordinate integrated PMTCT services will occur

through EGPAF's support of one staff member to work at the MOHSW.

Scale-up of PMTCT services will include testing in antenatal clinics (ANC), labor wards (LW), and postnatal

wards with rapid test and results given on the same day. Testing will be ‘opt-out' based on the new national

algorithm. 330,000 women will be tested annually in six regions, and of those, almost 14,000 women will

receive ARV prophylaxis. Based on capacity, both single-dose (SD) Nevirapine (NVP) and more efficacious

regimens will be provided with an emphasis on providing the most effective regimens to more pregnant

women. EGPAF will strengthen infant feeding (IF) counseling through collaboration with University research

corp (URC) and other partners.

EGPAF will begin treatment of cotrimoxazole for 75% of HIV exposed children, all of whom will be tracked

and tested after 15-18 months. This will lead to the integration of HIV testing in other reproductive and

child health (RCH) services, thereby increasing the number of men tested through the PMTCT program.

Documentation of lessons learned and best practices will be completed and shared during regular meetings

at all levels with MOHSW and other organizations. EGPAF will continue to play a role in identifying issues

that warrant advocacy for policy improvement/change that can increase access and usage of PMTCT and

Care and Treatment services, including pediatric C&T services. EGPAF will engage and collaborate with

key stakeholders and media organizations, utilizing (IEC) materials to address PMTCT issues.

Selected health facilities will be renovated to ensure confidentiality for PMTCT service provision. In addition,

EGPAF will support improvement of the quality of service-delivery to increase facility-based deliveries in

selected districts.

EGPAF will provide support for basic equipment, supplies, test kits, and commodities (only to supplement in

case of shortages) to ensure continuity of services provided at the required standards.

LINKAGES: HIV positive mothers will be staged, and receive care at the maternal and child health (MCH)

clinic at selected sites, or be referred to C&T on the day of diagnosis. HIV-exposed infants will receive

growth and monitoring cards immediately after delivery, will be marked according to the national guidelines

for identification, and linked to follow-up services. Client follow-up will be reinforced, and linkages will be

strengthened to community based services (e.g., home based care, TBAs and local community-based

organizations-CBOs). Linkages will also be strengthened between PMTCT and: voluntary counseling and

testing (VCT), the TB/HIV program, OVC programs, malaria and syphilis in pregnancy programs, family

planning, prevention for positives, nutritional programs, and child survival programs. EGPAF will continue

to collaborate with other USG and GoT partners in all working regions. EGPAF will support the GoT

coordination function by assisting in the organization of quarterly meetings and annual national meetings.

CHECK BOXES: The main area is prevention of mother to child transmission. Primary target or population

for the program is pregnant women who attend ANC and those in labor and delivery (L&D), but include

adolescents of 15-24 years and adults aged 24 and above. Male partners of women under the mentioned

population are also included. Additionally, children under 5-years are included because there will be HIV-

exposed and HIV-infected among them who are attending the RCH clinic for other services. In-service

Activity Narrative: training will be conducted to train workers who will provide PMTCT service.

M&E: The national PMTCT monitoring and evaluation (M&E) system will be used at all sites. EGPAF will

work with the MOHSW in rolling out the revised PMTCT M&E and commodity logistic (LMIS) tools to all of

the supported sites. This will include provision of support for the regional and district teams to collect and

report PMTCT data based on the national protocol, and provide feedback on tool performance. EGPAF will

work with partners to strengthen and implement PMTCT quality framework, and will provide regular

supervision. Monitoring of sub-grantees for compliance and financial accountability will be carried out,

documented, and shared. EGPAF will carry out supportive supervision visits to all sub-grantees twice a

year at a minimum.

SUSTAINAIBLITY: EGPAF will work with the district councils to include PMTCT activities in their

comprehensive council health plans (CCHP) and increase funding from additional sources such as basket

funding, global fund (GF), and districts' own recourses. The program will be integrated in the existing district

structure that ensures proper coordination of activities and management of resources. At the district level,

PMTCT will be monitored by council health management teams (CHMTs). Sustainability will occur through

fully integrating PMTCT in RCH services, thereby providing the necessary health infrastructure and staffing.

EGPAF will encourage districts to work with community groups whereby their role will include conducting

health talks to the community and client follow up. This also helps to sustain PMTCT messages.