TITLE: IRC PMTCT Services in Nduta and Kanembwa Refugee Camps

NEED and COMPARATIVE ADVANTAGE: Tanzania hosts thousands of refugees who fled ethnic violence

and other conflicts in the Great Lakes Region of Central Africa. The International Rescue Committee (IRC)

has been serving this population in western Tanzania since December 1993 as a lead agency identified by

the UNHCR for provision of health and nutrition assistance in Kibondo district.

Refugees in Tanzania are not allowed to travel beyond four km from the camps and therefore rely entirely

upon services provided by the implementing partners of UNHCR for their livelihoods.

With the support from PEPFAR, IRC has been running PMTCT and VCT programs serving 55,300 refuges

and host populations in the camps located in Kibondo district since 2003. There are only three PMTCT

facilities in the Kibondo district, one at the district hospital and two in the camps run by IRC. The two IRC

facilities are characterized by high service utilization, partner enrollment and developed referral system with

other components of its program, IRC contributes significantly to the reduction of HIV morbidity and

mortality as well as mitigates stigma and other consequences of HIV epidemic in the district.

Since the official transition of UNHCR country policy concerning Burundian refugees from facilitation to

promoting repatriation IRC provides support to the above process by providing medical screening and

ensuring continuity of medical care to refugees repatriating to Burundi.

Along with the refugees, IRC provides health care to the host communities neighboring Kibondo refugee

camps. Currently nearly 19.6% of our beneficiaries, visiting IRC PMTCT centers are coming from the host

communities. IRC in cooperation with its partners, local authorities and NGOs, will work towards

strengthening health systems in the Kibondo area and improving access and quality of health care provided

to the host populations.

ACCOMPLISHMENTS: Building on its solid HIV/AIDS programming expertise and leveraging from its

multisectoral program and partners, IRC with the support from PEPFAR-CDC established a successful

PMTCT project, as a part of its wider HIV/AIDS program, that is consistent with the national HIV and the

country five-year PEPFAR strategies.

Strong community health program, health education, effective referral links between IRC programs and

comprehensive support enables enrolment of more than 95% of pregnant women in beneficiary

communities in our antenatal clinic (ANC) services. All pregnant women in our program receive

comprehensive medical follow up as well as supplementary foods for six months during pregnancy and

three months postpartum. HIV positive mothers receive supplementary foods and formula if opted for

artificial feeding. Infant formula that complies with the "Codex standards for infant formula" is purchased

locally from the supplies certified by the Government of Tanzania. One hundred percent of the program's

needs are met owing to the funding from UNHCR and BPRM. Solid procurement and supply storage

systems and organization of the infant formula provision and monitoring of its use by mothers in the IRC

program in Tanzania ensures safety of this feeding option for children in its beneficiary communities. All

HIV+ pregnant women are advised to delay their repatriation until completion of six months of formula

feeding.

During the period from October 2006 to end of June 2007 2,345 women made their first antenatal visit on

the occasion of current pregnancy and all of them accepted to be tested for HIV as did 1,699 of their

spouses (72.5%). Of the mothers who were tested positive (31), 100% agreed to receive PMTCT services.

The HIV-positive rate among women in our PMTCT program is 1.32 % which is lower than the estimated

HIV prevalence in Kigoma region. During the reporting period 21 HIV+ women delivered and received NVP.

ACTIVITIES: The activities that will be implemented under PMTCT with FY 2008 funds include: 1.

Strengthen counseling and testing provided in two IRC PMTCT sites -Through this more women will learn

their serostatus which will enable them to benefit from timely use of PMTCT as well as care and treatment

services available at the IRC clinics. Counseling and disclosure will help guide women's and their partner's

health and lifestyle choices. 1a) Ensure that at any time there are at least 10 staff trained on provision of

counseling and testing at PMTCT sites. (20 people will be trained to compensate for rapid turnover of staff)

1b) Purchase necessary quantities of HIV whole blood rapid tests and other supplies for smooth functioning

of two PMTCT CT sites from the local suppliers certified by the Tanzania Food and Drug Authority 1c) Refer

patients who are tested positive to other services within and outside the IRC program.

2. Promote PMTCT services through community sensitization campaigns and referrals from IRC other

projects. This will increase community awareness about availability and rationale of PMTCT services and

increase demand for PMTCT. 2a) Carry out small group meeting sessions for informing communities about

PMTCT and discuss its benefits for maternal and child health. 2b) Carry out community mobilization

campaigns and promote mass awareness about IRC PMTCT services through radio programs. 2c) Develop

and disseminate health education materials informing beneficiaries about PMTCT. 2d) Maintain and

strengthen referral links between PMTCT and other services within and outside IRC program in Kibondo.

2e) Continue to develop linkages with HIV/AIDS organizations working outside the camps and government

run health facilities to increase coverage and service utilization of PMTCT services.

3. Provide mothers and their children with timely and appropriate dose of antiretrovirals in accordance with

the standards of the Ministry of Health of Tanzania. This will supply HIV positive mothers and their children

with the appropriate dose of quality ARV-s to prevent HIV vertical transmission. 3a) Purchase ARVs to

provide prophylaxis to at least 30 HIV positive mothers and their newborns from the local suppliers certified

by the Tanzania Food and Drug Authority 3b) Purchase medical and non medical supplies to ensure

smooth running of PMTCT services. 3c) Conduct refresher training to 20 health staffs according to the

National PMTCT curriculum.

LINKAGES: The success of IRC PMTCT program in Kibondo is widely conditioned by its linkages it has with

the beneficiary communities, local authorities and partners.

IRC will continue maintain and strengthen collaboration with the communities, involving beneficiaries in the

program evaluation as well as with Kibondo District hospital and local NGOs as Tanganyika Christian

Refugee Service (TCRS), Relief to Development Society (REDESO) and Southern African Extension Unit

(SAEU) in increasing coverage and utilization of PMTCT services in the district.

IRC PMTCT program will capitalize on collaboration with the National Aids control program for the

facilitation of PMTCT trainings and Jesuit refugee service (JRS) - Radio Kwizera, that was established to

inform refugee communities in Kigoma, Shinyanga, Mwanza and Kagera regions, for the mass awareness

Activity Narrative: campaigns.

IRC team in Tanzania has developed its own IEC materials such as posters, leaflets, cloth teaching

flipcharts, t-shirts and booklets, that are based on the analysis of Kibondo camp dwellers' beliefs and

traditions to effectively address issues facilitating spread of HIV in the IRC Tanzania beneficiary

communities. New education materials are being developed and old ones modified absorbing the

knowledge of lessons learnt and best practices from other HIV programs around the world.

CHECK BOXES: The areas of emphasis will be gender, human capacity development, strategic information

and "wraparound" programs.

The target population will be adolescents 15 - 24 years girls and boys and adults over 25 years.

M&E: IRC data collection and reporting procedures fully correspond to Tanzania's Ministry of Health

standards and procedures for PMTCT services.

In addition IRC developed a database that conforms to PEPFAR planning and reporting cycles and allows

reporting on both refugee and Tanzanian nationals receiving services though IRC PMTCT sites.

The IRC monitoring and evaluation officers will be responsible for following up the accuracy of the data. At

the field office, the HIS Officer will take lead in analyzing electronically and summarize the data.

SUSTAINAIBLITY: IRC will continue to work with the local health authorities and strengthen coordination

with local NGOs working in the host communities on HIV/AIDS programs to better mitigate the effect of

refugees repatriation on these communities.

TITLE: IRC HIV Counseling and Testing Services in Nduta and Kanembwa Refugee Camps, Kigoma

NEED and COMPARATIVE ADVANTAGE: Tanzania hosts thousands of refugees who fled ethnic violence

and other conflicts in the Great Lakes Region of Central Africa. The International Rescue Committee (IRC)

has been serving this population in western Tanzania since December 1993 as a lead agency identified by

the UNHCR for provision of health and nutrition assistance in the Kibondo district. With PEPFAR funds, IRC

provides HIV counseling and testing services in the camps as part of health services. Refugees in Tanzania

are not allowed to travel beyond four km from the camps and therefore rely entirely upon services provided

by the implementing partners of UNHCR for their livelihoods. Since the official transition of UNHCR country

policy concerning Burundian refugees from facilitation to promoting repatriation IRC provides support to the

above process by providing medical screening and ensuring continuity of medical care to refugees

repatriating to Burundi. The repatriation process is currently scaling-up, however exact numbers of

beneficiaries that will leave the country in the coming year is difficult to predict. Analyzing current trends, we

can estimate that somewhere between 2,000 to 4,000 Burundian refugees will repatriate to Burundi monthly

and thus by June 2008 we can estimate having between 7,000 and 31,000 Burundian refugees in the area.

Along with the refugees, IRC in Tanzania provides health care to the local communities residing in the areas

neighboring refugee camps. Currently nearly 20.3% of our beneficiaries visiting IRC CT centers come from

the local communities. IRC in cooperation with its partners, local authorities, and NGOs, will work towards

strengthening health systems in the Kibondo area and improving access and quality of health care provided

to local populations.

ACCOMPLISHMENTS: As part of health services and with PEPFAR funds IRC provides counseling and

testing services to a population of 55,300 refugees and an additional number of local Tanzanians through

four counseling and testing facilities.

In total 3,998 people were tested and received results of their HIV tests during the period from October

2006 to end of June 2007 at IRC CT sites in hospitals and youth centers. Eighty-seven clients were found to

be HIV positive (2.17%).

Until April 2007, eight counseling and testing sites were maintained by IRC in four camps (two in each

camp) when consolidation of Mkugwa and Mtendeli to Nduta and Kanembwa came to its end.

Subsequently IRC provided services through four sites located in two camps.

The HIV/AIDS services that IRC provides in Kibondo are characterized by their comprehensiveness and

strong linkages with services within and outside of the wider IRC program. This enables people accessing

CT to gain access to a variety of quality health and social support services such as post test clubs, home-

based care, maternal and child health services, nutrition, life skills training and referral to HIV care, and

treatment.

ACTIVITIES: The activities that will be implemented under CT with COP 2008 funds include:

1. Maintain and strengthen service provision and uptake of both client and provider initiated CT in Nduta

and Kanembwa refugee camps. More people will get to know their serostatus which will guide their life and

health choices and will allow timely access to existing support and treatment services. 1a) Ensure that at

any time there are at least 10 staff trained on provision of quality in depth counseling and testing at CT

sites. (20 people will be trained to compensate for rapid turnover of staff) 1b) Purchase necessary quantities

of quality HIV whole blood screening and confirmatory rapid tests and other supplies for smooth functioning

of CT sites. 1c) Carry out small group meeting sessions for informing community about CT. 1d) Carry out

community based mobilization campaigns and promote mass awareness through radio programs, informing

about CT services and their availability. 1e) Develop and disseminate in the beneficiary communities health

education materials, informing about CT as well as benefits of early testing and disclosure. 1f) Maintain and

strengthen referral links between CT and other programs within and outside IRC program. 1g) Continue to

develop linkages with HIV/AIDS organizations working outside the camps and government run health

facilities.

2. Support activities of post test clubs in Nduta and Kanembwa refugee camps. This will help overcome

negative impacts of the HIV epidemic such as stigma and marginalization and will foster active involvement

of community members in planning and implementation of the IRC HIV activities. 2a) Support post test

clubs in organizing meetings and events aimed at advocating on behalf of people infected and affected by

HIV. 2b) Involve post tests club members in planning and implementation of information, education,

communication (IEC) and behavior change communication (BCC) activities, including promotion of CT

services 2c) Support post tests club members by providing them with personal hygiene items and clothing.

3. Strengthen institutional capacity to implement routine CT quality assurance systems in Nduta and

Kanembwa refugee camps. This will ensure provision of the highest possible quality of counseling and

testing at IRC CT sites, which will uphold effectiveness of its HIV/AIDS intervention at high levels. 3a)

Provide refresher trainings to 20 staff members on counseling and testing in accordance with national

protocols and standards 3b) Train 20 staff on HIV testing quality assurance 3c) Identify reference laboratory

for quality assurance of HIV testing carried through in the IRC CT service outlets.

LINKAGES: IRC will continue to collaborate with the National Aids Control Program (NACP) to facilitate

HIV CT trainings. In addition, it will strengthen collaboration with the Kibondo district hospital and the

PEPFAR partner Columbia to organize provision of ART to refugees (and Tanzanian) who are found to be

HIV positive and eligible for treatment. IRC will continue work with HIV/AIDS organizations serving the local

populations since on average 20.3% of person accessing health in the camps are Tanzanian nationals. In

addition to Columbia University, IRC will collaborate with local organizations and other PEPFAR funded

organizations working in prevention, home based care and counseling and testing.

CHECK BOXES: The areas of emphasis will be gender, human capacity development, strategic information

and "wraparound" programs. The target population will be adolescents 15 - 24 years (girls and boys) and

adults over 25 years.

M&E: IRC data collection and reporting procedures fully correspond to Tanzania's Ministry of Health

standards and procedures for CT services.

In addition, IRC developed a database that conforms to PEPFAR planning and reporting cycles and allows

reporting on both refugee and Tanzanian nationals receiving services though IRC counseling and testing

sites. The IRC monitoring and evaluation officers will be responsible for following up the accuracy of the

data. At the field office, the HIS officer will take the lead in analyzing electronically and summarize the data.

SUSTAINABILITY: IRC will continue to work with the local health authorities and strengthen coordination

Activity Narrative: with local NGOs working in the host communities on HIV/AIDS programs to better mitigate the effect of

refugees repatriation on these local communities.