TITLE: Expansion of PASADA's PMTCT program in Dar es salaam Archdiocese.

NEED and COMPARATIVE ADVANTAGE: PASADA's PMTCT program has been operating since 2002 and

currently operates in 12 facilities. The current HIV prevalence in Dar Es Salaam is 13% and current PMTCT

coverage is still low. In addition, PMTCT clients encounter numerous challenges: women not wanting to test

due to fear of violence and abandonment; not enough involvement of male partners; mobility of mothers

after delivery and lack of community awareness about PMTCT. Based on PASADA's experience and the

fact it works at community level, it will use its outreach program to sensitize the community, particularly in

the semi-urban areas where access to information is generally limited. The program is now specifically

targeting the male partners of pregnant women, as without their collaboration and acceptance, women will

not enroll in the program. PMTCT is closely linked to PASADA's other care and treatment, counseling and

HBC Palliative Care services, guaranteeing continuum of care. PASADA will strengthen the facilities it

supports to enhance quality of care and scale up coverage.

ACCOMPLISHMENTS: Sensitization activities have increased the number of men attending antenatal

clinics with their partners for HIV testing, leading to women being able to access PMTCT more freely.

Women's attitudes about HIV+ status being a "death sentence" have changed. They are therefore more

willing to test. Involvement of people living with HIV/AIDS (PLWHA) has proved extremely useful in the

sensitization of activities at the community level and has educated communities that are now taking

preventive measures in cultural practices. 4,729 pregnant women tested and received their results from July

2006 to June 2007. Over the past 12 months, 101 health workers, 80 community volunteers and 60

Traditional Birth attendants (TBAs) were trained in PMTCT issues.

ACTIVITIES: 1) Increasing coverage of PMTCT in the catchments area by: 1a) adding one new antenatal

site to the program; 1b) employing four new nurse/counselors in four antenatal sites; 1c) recruitment and

training of 100 new PMTCT community volunteers who will be actively involved in PMTCT sensitization at

community level; 1d) employment of one extra PMTCT community nurse in PASADA.

2) Increasing the demand for PMTCT services by: 2a) increasing the number of PMTCT sensitization

interventions at community level utilizing the

trained PMTCT community volunteers; 2b) through targeted drama performances transmitting appropriate

messages; 2c) through the involvement of community leaders at all levels.

3) Improving the quality of the PMTCT services provided by: 3a) provision of refresher training for all

PASADA staff and antenatal sites staff on PMTCT issues; 3b) training of all new staff on the best way to

provide PMTCT services; 3c) supervision, monitoring and evaluation of activities; 3d) employment of two

extra PMTCT nurses and maintenance of salaries for PMTCT staff.; 3e) providing opt out testing based on

the new national algorithm, women will be tested in ANC, LW and post natal, with rapid test and results

given on same day. Based on capacity, both single dose nevirapine (SDN) and more complex regimen will

be provided with a view of accessing more women to more efficacious regimen as capacity of the facility

allows. Cotrimoxazole will be provided to eligible mothers and their exposed children.

4) Promoting adherence to the PMTCT program through 4a) Targeted PMTCT sensitization and counseling

with couples; 4b) Targeted sensitization meetings with male groups at community level; 4c) Targeted

PMTCT training for pregnant women attending the antenatal clinics; 4d) Provide social support to poor HIV+

women accessing delivery services

5) Promoting maintenance of contact between the program and women enrolled in PMTCT after delivery, to

facilitate testing of all newborn at 18 months 5a) provision of social support to HIV+ mothers; 5b) Breast

feeding for six months will be promoted based on guidelines and mechanism for provision of food

supplements to mothers who have delivered within the program will be explored; 5c) provision of milk

support to children.

LINKAGES: PASADA's PMTCT program is closely linked with the national program and with other

organizations providing PMTCT services e.g. Muhimbili National Hospital, Temeke Hospital Hindu Mandal

Hospital. The Ministry of Health has provided PMTCT training for staff. The program works closely with the

current 12 antenatal sites, ten of which have maternity units. Referral systems exist for women needing

social support over and above what PASADA can offer, for example with the local offices of the Ministry of

Health and Social Welfare religious organizations of all faiths. The program also links up with community

social support groups. Linkage with VCT, C&T, TB/HIV and OVC programs supported by PASADA will be

strengthened. Linkages between facilities will also be strengthened and PASADA will continue to

collaborate with facilities funded by the Global Fund and others. Linkages with RCH activities especially

Malaria and Syphilis in Pregnancy programs, Family planning and nutritional and child survival programs in

the military facilities will be improved.

CHECK BOXES: 1) Gender: the program educates both men and women on gender issues, particularly

those around sexual behavior and relations and equality for women in accessing care and treatment. It also

focuses on violence due to blame for HIV+ status. Men in particular are targeted for behavioral change. 2)

Human capacity development: the program focuses on training of staff (PASADA, antenatal clinics,

maternity units) and of community PMTCT volunteers, so that some tasks can be shifted from nurses to

volunteers. 3) Local organization capacity building: this is achieved in the dispensaries and small

community groups. 4) Health related wrap around: infant-feeding, safe motherhood, and TB. 5) Non-health

related wrap around: economic strengthening through PASADA's Community-based Microfinance Savings

and Credit scheme for HIV+ women (in collaboration with Caritas DSM), education within the program and

some limited food security.

M&E: PASADA will work with the MOHSW and USG partners such as HARVARD in rolling out the revised

PMTCT Monitoring and Evaluation and the commodity logistic (LMIS) tools to all of the sites it supports. It

will support the facilities teams in collection and reporting of PMTCT data based on the national protocol

and will provide feedback on tool performance. PASADA will work with these institutions to strengthen and

implement PMTCT quality framework and providing regular supervision

PASADA's PMTCT program collects and compiles all data from the antenatal clinics and feeds into the

national data collection system. PMTCT volunteers report to the PMTCT coordinator. Monitoring of activities

takes place on a regular basis, as does referrals to and from other related PASADA services, particularly

Activity Narrative: VCT, ART, TB and HBC and Palliative Care programs. Temeke Municipality and Temeke Hospital are

involved in monitoring of the program.

SUSTAINAIBLITY: 1) Antenatal clinic staff have been trained in PMTCT and infant feeding, thereby leading

to sustainability in their sites. 2) Women themselves are more empowered in seeking further information

and taking decisions about their own sexuality and pregnancies. 3) Couple counseling in PMTCT engages

the commitment also of the male partner leading to adherence to PMTCT and continued connection of the

mother to the program for testing of the newborn. 4) PMTCT contributes to the number of people testing for

HIV and therefore, accessing ART and the continuum of care. 5) PASADA will work with the Dar Es Salaam

Regional and District Councils to include PMTCT activities in their Comprehensive Council Health Plans

and increase funding from additional sources such as basket funding, GF and overtime districts own

recourses. The districts contribution to sustainability is by fully integrating PMTCT in the RCH, services,

providing the health infrastructure and staffing. 6) The project will build local ownership by working through

government and building human capacity through training, mentoring and supportive supervision.

TITLE: Consolidation and Scale Up of Home-based Palliative Care Services in all Districts of Dar es Salaam

and Four Districts of Coast Region

NEED and COMPARATIVE ADVANTAGE: Home-based and palliative care can relieve the burden of care

currently allocated to the health system and families. Demand is rising as more people become aware of

their status. Also through HBC, stigma about HIV/AIDS is reduced and the need to access the continuum of

care increases. PASADA's home-based care (HBC) and facility-based palliative care program started in

1994 and has evolved to include the PASADA main site and 12 satellite sites at the community level. The

service operates through nurse supervisors, outreach nurses, and trained community volunteers.

PASADA's strong and sustained experience in home-based and facility-based palliative care, as well as

their extensive geographical accessibility, make them an ideal partner in addressing this need.

ACCOMPLISHMENTS: PASADA offers holistic care to both adults and children by providing spiritual and

general counseling to patients and caregivers regarding treatment, nutritional support, pain control, linkage

to community volunteers and support groups, and referral to and from antiretroviral therapy (ART) and TB

services, as well as services for orphans and vulnerable children. The participation of trained community

HBC volunteers has enabled the service to reach more people in need. In FY 2007, approximately 3,500

clients received assistance in their homes. Training of caregivers in basic nursing skills has improved the

quality of HBC and continuous contact and training with communities has reduced stigma and

discrimination. Many of PASADA's palliative care team have been trained at Hospice Uganda, which

serves as a model of palliative care for Africa. In addition, PASADA has secured permission from the

Ministry of Health and Social Welfare (MOHSW) to use oral morphine for pain control. Of note, PASADA

"graduated" from sub-partner status to direct support this past year.

ACTIVITIES: In FY 2008, PASADA will work to increase access to both HBC and facility-based palliative

care by expanding of the service to three new sites (Makoka, Kibangu, and Luhanga). They will identify and

train 30 nurses to work in government and private facilities on palliative care both home-and facility-based).

PASADA will hire additional trained nurses in overburdened outreach sites.

PASADA will also focus on improving the quality of HBC and palliative care services by training six nurses

in palliative care using a distance-learning course from Kampala, Uganda. PASADA will provide additional

training for community HBC volunteers in order to increase their knowledge and skills. Refresher courses

for all nursing staff involved in the service, including upgrading of counseling skills will be organized.

PASADA, operating under the auspices of the Archdiocese of Dar es Salaam, will ensure regular payment

of salaries to all staff in the service, in order to retain competent, qualified, and motivated personnel.

Through the provision of support (nutritional, transport costs, and motivational meetings) to trained

community HBC volunteers PASADA will maintain motivation and activities. Staff will be trained in data

collection and management in order to improve reporting skills. PASADA will maintain regular supervision

throughout the tier system and ensure the regular and constant supply of appropriate and sufficient

pharmaceutical and medical consumables.

PASADA will ensure adherence to treatment and improvement in the physical condition of patients by

providing nutritional support to qualified individuals using specific criteria for eligibility, duration, and

quantity. PASADA will provide basic essentials including bedding, insecticide treated mosquito nets, and

cooking utensils to the most needy. In addition, they will promote adherence and prevention messages with

HIV positive patients.

Since the project's area of service is large and patients are often located in areas with difficult access, it is

vital to ensure continuity and efficiency of HBC and palliative care service by ensuring, maintaining, and

fuelling the two service vehicles; providing travel reimbursement to nurses operating in outreach sites;

ensuring communication through the provision of telephone facilities; and maintaining and improving referral

links to ART, TB, counseling, and OVC services.

LINKAGES: PASADA is a member of the Tanzania Palliative Care Association. The program has a two-

way referral system with PASADA's other services (e.g. ART, general medical, counseling and OVC) and a

referral system with Muhimbili National Hospital, Ocean Road Cancer Hospital, Temeke District Hospital,

and other facilities. The program is linked with all the satellite sites in which PMTCT is operating. The

service is linked with Selian and Muheza Hospitals for exchange visits and collaborates closely with other

organizations involved in palliative care, particularly those involved in facilitation in training. At the

community level, the program offers training to local organizations. In addition, PASADA links with

community programs that provide wraparound services, such as income generating activities, small loans,

and nutritional support. PASADA also links with the National AIDS Control Programme (NACP).

CHECK BOXES: The program covers both sexes of all ages and through its links with other PASADA

services, also the specific groups mentioned. Capacity building of local organizations and human capacity

building are achieved through training activities. The HBC palliative care program is closely linked with TB

program as it identifies and refers patients for TB diagnosis and treatment. It also operates as a two-way

referral system for ART.

M&E: Community HBC volunteers submit regular reports to outreach nurses who then compile their own

reports, which are submitted to the HBC palliative care supervisors. Overall reports are sent to district

authorities to feed information into the national system. The program holds regular monitoring meetings to

review progress, challenges, and solutions. Internal annual evaluations are carried out and the results are

used for decision-making in future strategies and plans. All activities are in line with the national guidelines

on palliative care. Once the new national palliative care monitoring system is available, PASADA will use

this system for its own monitoring, as well as to inform the national program.

FY 09 targets for community based care is 1913 and facility based care is 10291 with a de duplicated target

of 10965.

SUSTAINAIBLITY: One of the priorities of the palliative care program is to support family caregivers by

increasing their knowledge and skills (which also improves the quality of care in the home). Community

HBC volunteers are also supported with motivational activities and psychosocial support. Both are

important for sustainability, as the program could not reach such high numbers of patients without their

collaboration. Regular meetings are held so that they can share experiences and challenges. The program

Activity Narrative: is fully integrated into a continuum of care with general medical, ART, PMTCT, TB, and OVC services,

which also enhances sustainability. Community awareness and acceptance of HBC contributes to stigma

reduction and further sustainability.

TITLE: Scaling up of PASADA's integrated TB/HIV service in PASADA and in outreach sites

NEED and COMPARATIVE ADVANTAGE:

This service was started in PASADA in response to the evident association between HIV/AIDS and TB. It

was also seen that while all HIV+ clients presenting typical symptoms of TB in PASADA were tested, TB

patients at the district level were not being encouraged and advised to test for HIV. The need to integrate

HIV/AIDS Home-Based Care services with TB services was also recognized. PASADA's TB service started

gradually in late 2003 and has enrolled approximately 1,400 TB patients to date. It is a diagnosis and

treatment site within the National TB Control program, and is part of the Integrated TB/HIV/AIDS Program in

collaboration with Temeke District. It is part of the continuum of care in PASADA e.g. general medical, ART,

HBC and Palliative Care, counseling and OVC services and has nine outreach sites in local dispensaries.

ACCOMPLISHMENTS:

The program has been innovative particularly with regard to the integration of Community-based TB and

HIV/AIDS Home-Based Palliative Care and its relative referral system. The program has also trained 100

PLWHA who are, or were, infected with TB, on community education skills and stigma reduction. Currently,

70 of these volunteers are active in community sensitization and community directly observed therapy

(DOT). The program also trains clinical staff in government and non-government dispensaries to encourage

TB patients to test for HIV status. To date, the program has registered approximately 2,100 patients on TB

treatment.

ACTIVITIES:

1) Increasing the number of outreach services from nine to 13 by

1a) upgrading one DOT centre to diagnostic centre;

1b) establishing four new diagnostic centers;

1c) training 300 training of HCP in the Care and Treatment Clinic on TB/HIV collaborative activities.

2) Ensuring effective referrals and links with other comprehensive PASADA services e.g. general medicine,

ART, HBC and Palliative Care, Counseling and OVC and with all outreach sites and TB clinics through

2a) regular supervision of TB outreach sites and review meetings with site administrators

2b) regular meetings with district TB clinics

2c) interdepartmental meetings in PASADA

2d) maintaining regular report submission to the National TB Control Program.

3) Strengthening community responses and referrals to TB/HIV services by

3a) carrying out community awareness activities with targeted drama performances

3b) sensitize community leaders and community volunteers on identification of TB patients, treatment

adherence, HIV and AIDS education, ART, Home-Based and Palliative Care. This community-level

education aims at raising awareness about the continuum of care available.

4) Improving the quality of TB/HIV services by

4a) regular provision of Cotrimoxazole as prophylaxis HIV/TB therapy to all TB/HIV patients

4b) continuous availability of funds to pay for X-ray examinations for all suspected TB patients with sputum

negative (PASADA does not have an X-ray machine)

4c) training TB service staff in order to increase their knowledge, skills and performance

4d) guaranteed payment of TB service staff salaries; 4e) increasing the number of supervisory visits to

outreach sites and improving the quality of supervisory tools

4f) providing transport for supervision and community activities

4g) using NTLP monitoring tools.

5) Improve TB infection control practices in the CTC and in patient wards to prevent transmission of TB

among HIV+ as well as health providers

5a) CTC staff will be trained on TB infection control practices

5b) assess and modify CTC to ensure ventilation

2c) provide protective safety gear and support in proper use to clinic and laboratory staff.

LINKAGES:

To date PASADA's HIV/TB service has been funded by the German Leprosy and TB Relief Association

(GLRA) and Norwegian Heart and Lung Association (the latter donor funds the collaboration with Temeke

District). However, these funds are limited and do not allow expansion. The service operates within the

National TB Control Programme. It is currently linked to nine dispensaries (outreach sites) and to local

community groups for sensitization. It has a two-way referral system with all other PASADA services.

Training of counselors and Community Health Educators on TB/HIV has been carried out through the

Global Fund. Strong links exist with Temeke District, as partners in integrated TB/HIV and home-based

care and in collaboration with district TB clinics with PASADA.

CHECK BOXES:

The HIV/TB service targets the general population, male and female and all age groups. Training is carried

out at different levels: health care workers in outreach sites, PASADA staff in other services, PLWHA and

community members. Sensitization targets the general population, but in some semi-urban geographical

areas of the catchment area specifically targets army personnel and the Masai mobile population. The

service is part of the National TB Control Program.

M&E:

The activities of the HIV/TB service are reported on from outreach sites and reports are compiled for

submission to the National TB Control Program and to donors. The National Program regularly monitors the

service. Internal narrative and statistical reports on progress are also compiled and submitted to PASADA

management for decision-making. There is a need to develop appropriate monitoring tools, as specified

above in the activities section. A percentage of the budget will be dedicated to Monitoring and Evaluation

(5%). By mid 2008, PASADA will have a centralized data collection system which will guarantee access to

accurate data for decision making. For the specific collaboration with Temeke District, all relative data is

submitted to the person in charge.

SUSTAINAIBLITY

Activity Narrative: At community level, sustainability is enhanced through sensitization and training of different groups of

community members. The contribution made by PLWHA groups is particularly important. Capacity building

with regard to the management of HIV/TB services at the outreach dispensary sites also contributes to the

general sustainability of the National TB Control program. Sustainability of the referral system is guaranteed

in PASADA - through regular training and review meetings, and with the district, through similar events.

TITLE: Expansion of PASADA's Support Services to Orphans and Vulnerable Children (OVC) in Dar es

Salaam Archdiocese

NEED and COMPARATIVE ADVANTAGE: The number of orphans and vulnerable children (OVC) is

steadily rising and their growing needs must be addressed. Children orphaned by HIV/AIDS are particularly

disadvantaged due to the trauma of losing their parents and the stigma surrounding HIV/AIDS. Although

not orphans, many children are deemed vulnerable because of the pandemic and these individuals are

often even more difficult to identify and assist. PASADA is a faith-based program operating under the

auspices of the Catholic Diocese of Dar es Salaam. It currently serves over 20,000 People Living with AIDS

(PLWHA) and nearly 4,000 OVC with many different services. Assistance to OVC started in PASADA in

1994. Services aim at building the capacity of OVC in education, psychological stability, empowerment, and

other areas of need. Services are closely linked to the care and treatment components of the PASADA

program and to communities. One of the main priorities is assisting communities to identify and strengthen

their response to the problems of OVC.

ACCOMPLISHMENTS: PASADA has developed an expanded system of support to OVC with regulated

service entry and exit points, aimed at avoiding "dependency syndrome." Extensive psychosocial support is

provided, including memory work and residential grieving groups. Educational support at all school levels,

including a vocational training program with training on small business management and a small grant on

successful completion of vocational training courses (graduates' small businesses are then monitored

regularly). PASADA also offers support services to the elderly (mainly grandmothers) caring for OVC,

including training on parenting skills. PASADA, as a comprehensive service HIV/AIDS program, is poised

to identify both OVC in the community and serve their needs.

ACTIVITIES: Key activities to address the needs of OVC with FY 2008 funding include:

1) Expansion of support to OVC for education from nursery to secondary school level through to vocational

training level with promotion of remunerated activities for teenage OVC. These include: provision of

uniforms, books, stationary, shoes, bags, and bus fares; payment of school fees; monitoring of child's

progress with teachers; increased number enrolled in VT programs; increased number trained in small

business management; increased number receiving small grants to start small enterprises; and increased

involvement of the private business section in apprenticeships for vocational training graduates.

2) Capacity building and empowerment of OVC through: "Stepping Stones Life Skills" training; training on

alcohol and drug abuse; training on the legal rights of children; memory work (together with parent/s who

are still alive and/or with guardians; residential grieving groups aimed at helping OVC overcome the

traumas they have endured; various peer group activities including sports and the arts; and consolidation

and expansion of the TAYOPAD initiative that aims at training and developing community linkages of

vulnerable youth groups, teenage OVC on the borderline of risky behavior, and the local police force. The

reformed youth groups are trained as trainers of "Stepping Stones Life Skills" and train and counsel OVC

who are about to be involved in, or are already engaged in behavior that could lead to HIV infection. Local

police are also trained on how to work with youth groups and OVC.

3) Support to caregivers, particularly elderly guardians, through: care and parenting training to elderly

guardians; care and parenting training to small community groups; provision of basic household essentials

to families who need them most; provision of health care for elderly guardians; provision of social support;

and provision of opportunities for income-generating activities for elderly caregivers.

4) Strengthening of the OVC department and ensuring quality of services through: regular payment of

salaries to staff; capacity building of staff through targeted training courses; monitoring and evaluation of

strategies and activities; and ensuring regular operation of the department.

5) Assisting communities to identify their own responses to the problems of OVC in their midst and

provision of technical assistance in the consolidation of those responses. This will occur specifically

through collaboration with specific community groups, local political and religious leaders, small Christian

communities and others.

LINKAGES: PASADA's OVC department works closely with other departments (e.g., home-based care,

medical, and Antiretroviral Treatment, counseling, and community education) in order to ensure integrated

action and support. The department also works closely with the Ministry of Health and Social Welfare

(MOHSW) on policy issues; the Institute of Social Welfare for field work of their students in PASADA; NGOs

working to support OVC; with small local grassroots associations; and with key participants and

stakeholders within the legal system with vested interest in issues of children's rights and child abuse. The

department has established a good network with vocational training centers throughout Dar es Salaam, with

head teachers and teachers in primary and secondary schools, and with teachers in special schools for the

physically and psychologically disadvantaged.

CHECK BOXES: The target populations chosen reflect the effective target population of all PASADA OVC

services: children from 0 years to 18 years of age (male and female); vulnerable youth groups; children on

the streets; and children on the borderline of various types of risky behavior. The services also target key

stakeholders in the community who are involved in the problems and activities surrounding OVC and can

serve as role models (e.g., executives for vocational training activities, teachers, and religious leaders) as

persons in positions of authority and power with regard to community behavior and outcomes. Areas of

emphasis also reflect the services offered.

M&E: All OVC enrolled in the OVC service have personal files and monitoring and updating of these is

computerized. Regular reports are sent to the appropriate government agencies at district level, thereby

feeding into the national system. PASADA reports the implementation of the national Data Management

System and will use that system for its own M&E. Regular progress reports evaluating key indicators are

compiled monthly and submitted to donors. Community groups report to the PASADA OVC department on

their activities and refer identified OVC in need of services to the applicable agencies.

SUSTAINAIBLITY: The difficult area of sustainability is addressed at various levels: empowering OVC

themselves, psychologically and in terms of capacity to build their own future lives in terms of education,

vocational training, and initiation of small businesses ; involving the community through identifying and

Activity Narrative: consolidating their responses to OVC; empowering the guardians of OVC to carry out their parenting role

and to support the OVC in their care; awareness raising and training at community level; improving the

capacity of affected individuals to manage OVC problems. Sustainability is also considered in terms of

quality services and this can be achieved through retaining competent, qualified, and motivated staff and by

improving knowledge and skills.

TITLE: Expansion and Quality Improvement of PASADA's Counseling and Testing Outreach Sites in Dar

es Salaam Archdiocese

NEED and COMPARATIVE ADVANTAGE: Increased access to and integration of CT services (both PITC

and VCT) is essential for curbing transmission and facilitating access to care and treatment. PASADA's

VCT services operate from the PASADA HIV/AIDS Centre and from 17 satellite sites around the catchment

area. Thirteen of these sites also have PASADA HBC and palliative care services and are located in

dispensaries. The other four are stand-alone VCT sites.

Currently, PASADA carries out over 1,200 HIV tests per month and has over 20,000 registered clients.

There is a two-way referral system between the VCT service and all other PASADA services. All sites are

regularly supervised by the PASADA supervisory team for continuous quality improvement. All sites provide

ongoing supportive counseling for HIV+ clients. Many of the trained counselors are non-medical personnel

and many are PLWHAs.

ACCOMPLISHMENTS: All clients testing HIV+ are registered and access a full continuum of care,

treatment, and psychosocial support free of charge including palliative care, ART, TB, HBC, OVC and

supportive counseling. PASADA also continuously trains batches of 50 to 100 PLWHA in basic counseling

skills and prevention strategies, so that they are actively involved at the community level in mobilization,

prevention, promotion of VCT, and dissemination of information about available services and living

positively with HIV. PASADA also trains VCT counselors from other government and non-government

institutions. PASADA operates according to national guidelines and the new testing algorithm. Some of the

sites are already providing same-day results and the others are now preparing to do so.

ACTIVITIES: In FY 2008, PASADA will improve access to VCT by setting up three new VCT outreach sites

where clinical and HBC services already exist; conducting VCT training of new staff and participants from

other institutions; training of all clinical and other health workers in the dispensaries on the importance and

implementation of PITC; continuous training of PLWHA to enable them to be actively engaged in

prevention, promotion of HIV testing, and provision of services. It will also improve referral services

between CT services and other PASADA integrated services and share lessons learned through regular

meetings between PASADA service sites and other nearby service providers. PASADA will also increase

supervisory visits to all sites; continue in-service training of all counselors to ensure skills and knowledge

remain current and support appropriate services to facilitate disclosure, counsel discordant couples, and

enable prevention among both HIV positive and negative clients.

PASADA will implement anti burn-out strategies within the counseling department through twice-yearly

review counselor retreats; individual counselor mentoring counselor (professional and personal) and regular

peer counseling meetings to share experiences, difficulties, and jointly identify solutions.

All PASADA sites test children and one of PASADA's priorities in FY 2008 is to emphasize active pediatric

ART case finding through increased child testing. PASADA also promotes "Living Positively with HIV and

AIDS" through monthly "Now that you know" meetings. These are meetings held at the end of each month

and all clients who test HIV+ in that month are invited. Important service provision information is provided,

referral to services not provided by PASADA, and sharing with other veteran clients who are living positively

with the virus. These meetings also provide a venue for sharing of information, discussing problems and

solutions, forming self-support groups and receiving external speakers on specific issues identified by the

clients themselves. In FY 2008 PASADA will also expand PLWHA-run help desks at all VCT sites. These

help desks are staffed by PLWHAs who are trained in counseling and are available to answer questions and

provide support and referrals to all VCT clients.

LINKAGES: PASADA's VCT department operates according to NACP guidelines for VCT and will also

adopt NACP guidelines for PITC in outreach sites located in dispensaries. The department collaborates with

many government and non-government institutions, particularly in facilitation of training events. It also

collaborates with private companies and some embassies with general counseling and information sharing

for employees. The outreach counselors are also linked to local schools, community leaders, and groups.

M&E: All outreach sites send monthly reports to their respective districts while PASADA Upendano

compiles quarterly reports and sends them to the districts. All outreach VCT sites collaborate closely with

the dispensaries in which they are located and with the PASADA HBC and palliative care staff working in

the same location. Individual performance of counselors is monitored through regular supervisory visits to

sites and through individual mentoring. Site performance is also monitored through regular supervision

(monitoring tools are already in place) and through analysis of collected data. By mid 2008, PASADA will

have a centralized data collection system which will greatly assist management in monitoring the quality of

service provision and in decision-making for improvement. Internal evaluations are carried out at the end of

each year. Additionally, the program will ensure effective monitoring and evaluation of services by a)

training counselors on the importance of data collection and management and how to do it; b) training of

decision-makers within PASADA on effective and useful analysis of data for the improvement of services; c)

establishing an efficient monitoring system and developing monitoring tools; d) carrying out an external

evaluation of the services.

CHECK BOXES: The VCT services target the general population, male and female of all age groups.

Particular emphasis is placed on women and young girls and children as the most vulnerable groups, with

specific regard to HIV associated gender violence and to access to services. The service collaborates in

workplace programs and is heavily involved in ART and TB counseling.

TITLE: Continued expansion of PASADA's comprehensive ART services in Dar es salaam Archdiocese.

NEED and COMPARATIVE ADVANTAGE:

PASADA is a Faith-Based Organization providing comprehensive HIV services to a catchments population

of 800,000. The need for ART services in the region is still high, evidenced by the increasing number of

HIV+ clients registered (currently over 20,000). PASADA plans to expand its services and to enroll at least

5,100 people on ART, including pediatric cases. PASADA is already decentralizing ART services to 4

satellite sites in its catchments area bringing services closer to those who need them. PASADA plans to

decentralize further to 6 other sites which are in need of having these services, capacity building in terms of

training in ART management, renovation and pharmaceutical supplies. PASADA is well placed to expand

the provision of quality ART services, offering a continuum of care from prevention and VCT to Home-

Based and Palliative Care, TB diagnosis and treatment, PMTCT and support to OVC.

By September 2008, over 5,100 clients will be on ART and 1,400 trained PLWHA actively promoting

prevention, gender awareness and reduction of stigma at community level. By September 2009, 11 sites will

be providing ART services and 600 providers trained. Strong linkages exist between the sites, community

volunteers, groups and members. Training of staff in satellite sites on ART management has been

continuous.

ACCOMPLISHMENTS:

PASADA "graduated" from sub-grantee status to being supported directly by the USG in FY2007. Working

in 5 ART sites, 2,142 people were started on ART, including 231 children and 52 pregnant women. The

program has succeeded in providing comprehensive and integrated services that provide a continuum of

care to 17,500 patients who have received Cotrimoxazole prophylaxis. A total of 254 health care providers

were trained in ART management. PASADA works through its community-based sites and deploys over 300

trained community volunteers.

ACTIVITIES:

1) PASADA plans to carry out expansion of the ART program to five lower level satellite dispensaries. This

is a critical element in PASADA's ART program as expansion to lower levels of care improves access and

adherence not only to ART, but to the whole continuum of care It will base the ART services on the national

ART guidelines and cater for adults, children and pregnant women. It will involve 1a) training of clinical and

laboratory staff in ART management. 1b) providing technical and financial/management support to initiating

ART in lower level sites so as to carry out minor renovation work, furnishing and supply of appropriate

clinical and diagnostic equipment commodities and supplies; 1c) supervision, monitoring and evaluation of

ART progress; 1d) promoting linkages and referrals between ART, PMTCT, counseling and HBC services;

1e) Support for the employment of 2 clinical staff in each of the five dispensaries

2) Increasing the number of children on ART through active pediatric case finding in MCH settings,

involving provision of Cotrimoxazole and other appropriate OI prophylaxis, ITNs and nutrition; 2a)

Sensitization at community level on importance of HIV testing for children to access care, treatment and

support throughout the catchments area; 2b) training of ART program staff (clinical staff, adherence

counselors, HBC nurses) in PASADA and the dispensaries on management of pediatric ART.

3) Increasing the number of PLWHA actively involved in promotion of prevention, stigma reduction, gender

awareness and ART adherence at community level, through 3a) training in basic counseling skills; 3b)

training on ART and adherence counseling; 3c) continuation of Help Desks manned by trained PLWHA

(also referred to as ‘expert clients'. Community awareness increases access to care and treatment,

particularly for women and children and, in turn, creates other resource people at community level.

4) Improving quality of treatment services through 4a) innovative on-site continuing education program of

all ART program staff; 4b) strengthening linkage with other associated services i.e. HBC and Palliative

Care, Counseling; PMTCT, OVC and Community Education for prevention; Prevention for positives 4c)

improving data collection and management; 4d) employment and retaining of competent, qualified and

motivated staff (including salaries of ART program staff); 4e) ensure continuous availability of

pharmaceuticals, medical consumables, laboratory reagents, test kits, equipment and supplies in PASADA.

5) Organizational strengthening, including improvement of general management skills and financial

management and accountability through 5a) ensuring regular transport for activities; 5b) ensuring regular

maintenance and insurance of project vehicles, buildings etc.; 5c) maintaining security services of the

organization; 5d) ensuring communication and general organizational support.

LINKAGES:

PASADA will ensure that it continues to provide services that support a continuum of care model by

providing several reproductive health (RH) and HIV related services within its sites and also though linkages

with public, private faith based organizations and continued strong linkages with communities. Specifically,

linkages with TB/HIV, family planning, malaria and child survival services. Close collaborative links with

government agencies already exist e.g. TACAIDS, NACP, National TB Control Program, Global Fund and

government health facilities e.g. Muhimibili National Hospital, Ocean Road Cancer Hospital and Temeke

District Hospital; with some specific NGOs involved in HIV and AIDS e.g. Pact, Pathfinder International,

Catholic Relief Services, Action Aid, Help Age International.

At community level, PASADA works closely with Parish Health Committees, Small Christian Communities,

local community groups and different faith groups, including the Muslim community. Promotion of interfaith

collaboration in the fight against HIV and AIDS is one of PASADA's priorities, particularly through the

Community Education and prevention program.

CHECK BOXES:

1) Construction and renovation: minor renovation work to dispensaries.

2) Gender issues: gender is crosscutting in all activities and all ART and non-ART clients are counseled and

assisted in gender issues.

3) Human capacity development: program activities include extensive training of PASADA and dispensary

staff, community volunteers and community members.

4) Local organizational capacity building: the program assists capacity building of dispensaries.

5) PASADA does carry out training in the management of HIV/AIDS in the workplace for private companies

and other institutions. 6) Wraparound programs: PASADA is a site within the national TB control program

and has an integrated community-based TB/HIV HBC program and is involved with activities in all other 3

Activity Narrative: wraparound programs.

M&E:

PASADA will use the ART monitoring system developed and updated by the MOHSW/NACP.

PASADA CTC and its 5 satellite facilities use the national paper-based tools to collect patient data which

are then entered into the National CTC2 database. Data entry, management and analyses is centrally

located at PASADA where the electronic system generates national (NACP) and USG reports as well as

feedback reports to the CTC teams and PASADA management for utilization in informing patient

management and program improvement. All departments involved in the ART program hold regular M&E

meetings to review progress, discuss issues of concern and chart the way forward. The CTC2 database at

PASADA is currently managing data from the PASADA CTC as well as 4 satellite sites. The database

currently has 20,045 registered clients, over 6,000 of which are actively patients in care at any given time

and of which, 2,142 are on ART. The database will have data from 1 CTC & 5 satellites and 1 CTC & 11

satellites by Sept 2008 and 2009 respectively.

SI Targets: To do above activities, PASADA will support training of 150 HCW in SI and provide technical

assistance to 11 satellite CTCs.

SUSTAINAIBLITY:

Focus for sustainability will be on: improving the technical and management capacity of PASADA in

general; improving the technical and management capacity of lower level sites; improving the capacity of

PLWHA to be actively involved in prevention, stigma reduction, ART adherence and counseling at

community level; assisting communities to identify and strengthen their own responses to the problems of

HIV and AIDS; improving links with government and other agencies.