TITLE: Strengthening and scaling up PMTCT services in Zanzibar

NEED and COMPARATIVE ADVANTAGE: The goal of the National Health Sector HIV/AIDS strategic plan

is to increase access and utilization of PMTCT and PMTCT plus services by 50% by 2009. Currently only

28 % of pregnant women in Zanzibar access PMTCT services through antenatal clinics (ANC) and at

Maternity hospitals during labour and delivery. To achieve the national goal, in FY 2008 ZACP is planning to

strenghthen existing services as well as scale up PMTCT service availability and accessibility in the islands

by establishing additional and strengthening existing PMTCT sites.

ACCOMPLISHMENTS: Established six PMTCT sites with increased uptake in RCH clinics by 99% and

improved enrollment in maternity wards (From 5% in 05/06 to 14% in 06/07). The unit has developed the

Zanzibar PMTCT training manuals and guidelines. Trained 90 and sensitized 519 HCW, established infant

diagnosis. Sensitized community gate keepers namely: 180 district officials, Shehas, religious leaders and

traditional birth attendants have been sensitized.

ACTIVITIES: In order to achieve the goal of PMTCT sevices in Zanzibar, the proposed activities in FY 2008

are: 1) Strengthen the quality of existing PMTCT services and increase service uptake particularly in labour

and delivery wards 1a) Train additional health care workers on PMTCT and other related trainings e.g.

infant feeding in the context of HIV in existing sites and refresher training for existing PMTCT service

providers.1b) Employ four additional nurses for maternity wards in major hospitals such as Mnazi Mmoja

and Mwembeladu. 1c) conduct supportive supervision on existing sites in collaboration with the zonal and

district RCH coodinators. 1d) Conduct supportive meeting with PMTCT service providers quarterly. 1e)

Strengthen referral system for care and treatment and other related services for the HIV positive mothers,

their partners and children. 1f) Procure HIV testing kits, reagents and related supplies, basic protective

gears and delivery kits.

2) Establish ten new PMTCT sites 2a) Identify and conduct site readiness assessment. 2b) Renovate

infrastructure and update the counseling and testing rooms. 2c) Train service providers and deploy them to

appropriate sites. 2d) Procure equipment for new sites.

3) Create demand for service utilization 3a) Sensitize health workers, community leaders and religious

leaders and other members of the community on PMTCT services through meetings and drama

performances. Traditional birth attendants within the ten districts will also be sensitized to refer pregnant

women to deliver in health facilities and advocate for PMTCT services. 3b) Develop information, education

and communication materials and mass mobilisation activities including radio spot to mitigate stigma and

discrimination associated with HIV/AIDS, low hospital delivery and low male involvement in PMTCT

services.

4) Support national PMTCT coordination unit 4a) Support office expenses. 4b) Support vehicle running cost

for the coordination unit.

LINKAGES: ZACP will work in collaboration with Columbia University and Tanzania mainland to ensure

smooth running of PMTCT activities, share experience, best practices and challenges, avoid duplication of

efforts. Currently PMTCT services has been intergraded and being provided within RCH services and

therefore allows women and mothers to easy access services e.g. family planning, immunization services

for children etc. Pregnant women who found to be HIV positive are referred to care and treatment services

for further evaluation and management. The HIV positive women are also linked with home based care

services for continuum of care and follow up of mother and children. Regular meetings between PMTCT

health care providers, community and facility home base care providers will be conducted for information

exchange and ensure effective referral and feedback. HIV positive pregnant women and mothers are also

referred and linked to organizations of people living with HIV/AIDS and other HIV services and non HIV

related support like psychosocial support, nutrition, legal assistance etc.

CHECK BOXES: The areas of emphasis were chosen because activities will include renovation of new sites

as determined by site assessments in order to get rooms which will ensure privacy and maintain

confidentiality. The emphasis is also on training for service providers to build their capacity. Pregnant

women are the entry point for prevention of mother to child transmission of HIV. Appropriate and early

testing can impact interventions to lower and prevent viral transmission to children and strengthen

continuum of care for women and their families.

M&E: PMTCT services will be monitored through paper based monitoring tools adapted from Tanzania

Mainland and all PMTCT health care providers at the new sites will be trainned on the monitoring tools.

ZACP in collaboration with the RCH program and the Health Management Information System (HMIS) is

currently working on the development of an integrated PMTCT and reproductive health monitoring system

to ensure easy collection of data and reporting. Supportive supervision will also be trengthen to ensure

quality of data and services

Data from health facilities will be collected monthly and analysed. The quarterly and progress reports will

prepared and the analysed data will be used with in the facility to improve services. At the regional and

national level the data will be used for improving program management.

SUSTAINABILITY: This will be ensured through capacity building of staff, community participation and

involvement, absorption of activities within the health sector work plans.

TITLE: Abstinence and faithfulness programming in HIV/AIDS interventions in Zanzibar

The first HIV/AIDS index case in Zanzibar was diagnosed in 1986. Since then, routine surveillance

conducted using pregnant women (ANC) has documented HIV prevalence of <1% on the islands. Similarly,

an HIV magnitude validation survey and a recently finalized ANC surveillance study have documented HIV

rates at 0.6% and 0.87% respectively. Higher HIV infection rates have been documented in females

compared to males (1:5 respectively) with heterosexual transmission accounting as the significant route of

HIV transmission. Concurrently, voluntary counselling and testing (VCT) data have shown an annual

increase in the number of clients diagnosed as HIV-positive from 180 (ZACP, 1996) to 690 (ZACP, 2006).

Based on these data, it is necessary to raise public awareness of behaviors that put individuals at the risk of

contracting or transmission of HIV and other sexually transmitted diseases. The likelihood of transmitting

HIV is greatly increased for those who have multiple sex partners and engage in unprotected sex. All

sectors at different levels are involved in enhancing public awareness, particularly at the community level, to

empower the community to develop culturally appropriate approaches in prevention of HIV transmission.

These include; being faithful to the same partner; practicing abstinence; and delaying engagement in sexual

practices according to well-informed individual decisions. A functional faith-based initiative that positively

promotes abstinence and faithfulness in a holistic manner is an important strategy for the prevention of HIV

among Zanzibaris.

ACCOMPLISHMENTS:

N/A

The HIV/AIDS Faith Based Initiative that currently works in close collaboration with ZACP will establish an

abstinence and faithfulness program for youth and the general population focusing on the following:

spiritual, social, psychological and health gains associated with abstinence and faithfulness; personal risk

assessment; adherence to faith-based teachings on abstinence and faithfulness contained in the Qur'an,

the Bible and the Hindu holy books; awareness on the role of abstinence and faithfulness in the prevention

of unplanned pregnancies, sexually transmitted diseases, and HIV/AIDS; and promotion of spiritual and pre-

marriage counseling for couples.

The HIV/AIDS Faith Based Initiative will adopt mass media communication strategies that address

promotion of AB activities for youths aged 10-24 and adults. One theme will be the slogan, "Life without

substance abuse and HIV/AIDS is a pearl to Zanzibaris." Other issues to be addressed in the AB promotion

campaign include raising awareness, increasing understanding of the negative aspects of early sex,

developing resistance to peer pressure, and promoting parent and child communication. There will be

collaboration with the Tanzanian media to use television and radio spots to support a compassionate

response from faith communities on AB messages that will use quotes directly from the Holy texts.

LINKAGES:

CHECK BOXES:

Religious leaders

Adults (male and female, 25 and over)

Adolescents (male and female, 15-24)

Adolescents (male and female, 10-14)

M&E:

Monitoring and evaluation will be conducted quarterly and indicators on the performance of the program will

include: number of youth attending VCT services in 10 districts; number of youth reporting to have learned a

positive lesson from the media strategies on ABY; number of outreach faith-based organization (FBO)

programs in schools; and number of trained religious leaders and peer educators on AB.

SUSTAINAIBLITY:

This activity will be implemented by faith-based leaders currently working with ZACP. These leaders are

interwoven with and supported by community members. As a result, their activities are propagated and

sustained.

TITLE: Community Center for Comprehensive HIV Prevention, Care and Treatment and Substance Abuse

Services in Zanzibar.

NEED and COMPARATIVE ADVANTAGE: Zanzibar has observed an incremental growth of two

challenging and intertwining public health crises: HIV/AIDS and illegal substance use. Both have markedly

affected and increased the burden to families, communities, and Zanzibar as a whole. Although the HIV

prevalence in the general Zanzibari population is estimated at less than 1%, in some populations,

particularly IDUs, the prevalence is much higher. A recent substance abuse study documented HIV

infection among general substance users at 13% (30% for female substance users and 12% for males) and

25% for IDUs. The impact of other infectious diseases among this population is also notable. Twenty-six

percent of substance users had a sexually transmitted infection (STI) (11% had syphilis), and 16% were

infected with hepatitis C.

Preventing the spread of HIV and alleviating the impact of AIDS are top health priorities for USG's efforts in

Zanzibar in collaboration with the Zanzibar AIDS Control Program (ZACP). ZACP is implementing a broad

HIV prevention strategy on the island. PEPFAR funds currently are being used to support efforts to

understand the scope of injection drug use in Zanzibar. Interventions also are planned in 2007 to target

most at risk populations, including IDUs, and CSW and MSM who exchange sex for drugs. In view of the

importance of drug use as a mode of transmission of HIV in Zanzibar, a missing component of this strategy

to date has been provision of services to treat drug abuse, including alcohol. An existing rehabilitation

program in Kenya will be examined as a model and used to guide implementation on the island.

ACTIVITIES:

The goal of the of these planned activities by the Zanzibar AIDS Control Program is to reduce new HIV and

sexually transmitted infections by 50% by 2011 and to provide treatment, care, and support to substance

users with a special focus on injecting drug users and their affected families. To achieve this goal, the

following activities are planned:

•Renovation of neutral community center for IDUs and overlapping populations (e.g., CSW and MSM) to

receive comprehensive HIV prevention, care and treatment, and substance abuse services.

1)Training of workers to deliver comprehensive care and behavioral modification/substance abuse

counseling in the renovated space.

2)Service delivery, including: 2a)Assessment of individual substance abuse factors using a multi-disciplinary

approach, including case management. 2b)HIV counseling and testing. 2c)STI screening and treatment. 2d)

Care and treatment services for those found to be HIV-positive.

2e)Condom promotion and distribution. 2f)Injection use related risk reduction strategies. 2g)Treatment for

drug related emergencies and acute problems. 2h)Preparation for long-term recovery and behavior change

through peer support, relapse prevention, pre-employment counseling, employment coaching, recovery

coaching (including stage-appropriate recovery education, assistance in recovery management and

telephone monitoring), and family support services.

In time, it is anticipated that the government would allow a small-scale pilot to assess the feasibility of

medical treatment with either methadone or buprenorphine. The goal is that substance abusers who

complete detoxification and treatment would stop or reduce their drug use and related risk behaviors,

including risky injection practices and unsafe sex.

LINKAGES: The Zanzibar AIDS Control Program believes these services will be an important avenue for

providing current information on HIV/AIDS and related infectious diseases, HIV counseling and testing

services, and referrals for medical and social services. As a result, linkages will be made with USG

partners providing services in Zanzibar including Columbia.

CHECK BOXES: Construction/renovation

Human capacity development: in-service training

Local organization capacity building

Wrap around programs: family planning, TB, economic strengthening, education

Most at risk populations (injecting drug users, men who have sex with men, non-injecting drug users,

persons in prostitution, persons who exchange sex for money and/or other goods, street youth)

M&E: The Zanzibar AIDS Control Program will develop an M&E system to track client encounters, services

delivered, and referrals (e.g., to counseling and testing, and care and treatment centers). Other variables

will be explored depending on the exact activities. Whenever possible, national tools will be used and

existing systems will be supported.

SUSTAINABILITY: The national government and donor partners working in Zanzibar are very committed to

addressing the substance abuse issues on the island. A recently published HIV and substance use

prevention framework outlines the multi-sectoral response, which will be critical for the sustainability of

these efforts.

TITLE: Strengthening and Scale-up of Home-based Care (HBC)

NEED and COMPARATIVE ADVANTAGE: Home-based care (HBC) services for HIV/AIDS began in

Zanzibar in 1988. Since then, HBC services have been established in eight out of ten districts. There is a

need for HBC to expand into all ten districts as well as offer a platform of services to people living with

HIV/AIDS (PLWHA) to ensure a continuum of care. Additionally, there is a need to strengthen the

management of HBC systems, expand access and integrated service networks including prevention, and

increase community awareness and support. The Zanzibar AIDS Control Programme (ZACP) is the lead

government agency leading care and treatment in Zanzibar.

ACCOMPLISHMENTS: Nearly 1000 people are accessing HBC services in Zanzibar. Approximately 170

health care workers (HCW) and 100 community HBC providers have been trained in HBC. Seventeen

facility-based and 27 community-based HBC kits have been distributed. Supportive supervision has been

conducted on both Unguja and Pemba islands. The Zanzibar AIDS Control Programme (ZACP) has

adapted and printed HBC guidelines; developed and distributed information, education, and communication

(IEC) materials to promote HBC services; and developed mass media and faith-based campaigns.

ACTIVITIES: With FY 2008 funding, ZACP will expand their HBC services, as well as coordinate services

on the archipelago more effectively. ZACP will strengthen their role as the central body for setting

standards, developing curricula, and monitoring quality of services. In addition, they will identify ways to

enhance the quality, comprehensiveness, and coverage in Zanzibar. Key activities for FY 2008 will be to:

1. Scale up HBC services in the remaining two districts. ZACP will update and print palliative care training

manuals, expanding HBC to a broader, holistic palliative care model. They will train approximately 60

facility-based palliative care providers, primarily for HBC, as well as 60 additional community-based lay

HBC providers. ZACP will conduct coordination meetings with HBC implementers and district health

management teams (DHMT).

2. Strengthen HBC management information systems, participating also in the development of the

mainland's monitoring system development. ZACP will print the revised monitoring tools. They will work to

build organizational capacity through a five-day supervision training for DHMT and conduct supportive

supervision on HBC implementing districts. Facility HBC coordinators and DHMT will supervise activities by

community HBC volunteers using a HBC supervision check list. The supportive supervision will include

technical advice to address any emerging issues. Coordinators will also conduct monthly meetings with

providers to respond to gaps. They will train community HBC providers on basic HBC reporting and

conduct quarterly zonal HBC stakeholders meeting.

3. Expand access and integrated service networks of PLWHA to the continuum of care and comprehensive

HIV/AIDS services as well as preventive care. ZACP will train NGOs and FBOs on HBC services. These

organizations will then train community-based lay health workers as described above. ZACP will support

NGOs, FBOs, and community volunteers to conduct home visiting. Clients will be provided with a basic

preventive package including insecticide treated nets, water treatment, IEC materials, condoms, family

planning and cotrimoxazole.

4. Increase community awareness on HBC services. This will be accomplished through a sensitization

meeting for the Sheha AIDS Coordinating Committee on HBC services and also meetings with family care

givers on nutrition and basic hygiene.

5. Advocacy for HBC services. ZACP will update different types of IEC materials on HBC services and

stigma reduction. They will also conduct radio and TV programs on HBC services and stigma reduction.

6. Strengthen unit to coordinate HBC services. Procure one laptop and LCD machine. Conduct study tour

in Uganda for HBC coordinators to share experiences and learn from others about providing a basic care

package to PLWHA through HBC.

LINKAGES: ZACP has linkages with various services including voluntary counseling and testing and

provider-initiated testing and counseling, care and treatment clinics, prevention of mother-to-child

transmission services, Zanzibar Association of People Living with HIV/AIDS (ZAPHA+) as well as other

HBC implementers. ZACP works with CDC and other implementing partners including Clinton HIV/AIDS

Initiative, Global Fund, WHO and World Bank, Family Health International, and Africare (which represents

Tunajali in Zanzibar). Also, the President's Malaria Initiative (PMI) is very active in Zanzibar, and this

program would like with the PMI to ensure that PLWHA receive insecticide treated mosquito nets.

CHECK BOXES: Increased human and organizational capacity building will ensure high-quality services

and sustainability. Wraparound program will ensure comprehensive care for PLWHA.

M&E: The HBC unit, in collaboration with the strategic information unit of ZACP, have revised and updated

different monitoring tools for facility and community-based providers to capture information concerning HBC

services. The new tools provide ZACP with the information it needs to monitor, plan, and share results on

the progress of HBC in Zanzibar. Progress reports will be submitted regularly following the same procedure

as other USG supported interventions. Supervision is conducted in all HBC implementing health facilities in

collaboration with DHMTs.

SUSTAINAIBLITY: Through high-quality training, ZACP will continue to build the technical capacity of

HCWs and NGOs to provide HBC services. To ensure sustainability of HBC services, ZACP will support

the DHMT in the roll-out of HBC services by training of DHMTs in supervision and management of HBC

services and also leading regular coordinating meetings.

TITLE: Strengthening HIV Counseling and Testing Services in Zanzibar

NEED and COMPARATIVE ADVANTAGE: The Ministry of Health and Social Welfare, through the Zanzibar

AIDS Control Program (ZACP), has the responsibility of coordinating the Zanzibar health sector response to

HIV/AIDS. ZACP through its Counseling Unit (CU) coordinates the Zanzibar Counseling and Testing (CT)

program through development of policies and guidelines, training protocols and manuals; standard

operating procedures and job aides. ZACP also provides supervision and technical guidance to

implementing partners; strengthens training of counselors to secure the required quantity and quality of

services; and monitors the progress of implementation of CT activities through reports from district councils,

NGOs, and other stakeholders.

ACCOMPLISHMENTS: With USG PEPFAR support, ZACP has been able to achieve many goals including

testing 22,461 clients in 2006.

ZACP also has:

1. Developed the Zanzibar Counseling guidelines and training manuals;

2. Established provider initiated testing and counseling (PITC) services at Mnazi Mmoja and Chake Chake

Hospitals;

3. Conducted training of 24 health care workers in PITC;

4. Established CT coordination forum;

5. Procured and distributed the HIV Kits for CT sites; and

6. Produced and distribute IEC materials on VCT service.

ACTIVITIES:

With FY 2008 funds, ZACP will accomplish the following:

1. Establish PITC services in three hospitals and strengthen PITC services at Mnazi Mmoja Referral

Hospital and Chake Chake Hospital.

2. Establish VCT services at 13 new sites within five districts and maintain the existing activities at 27 sites.

3. Offer HIV VCT services at the VCT Gold Standard site at Mnazi Mmoja referral hospital.

4. Develop policy guidelines, training manuals for counseling and testing of children and special groups like

the hearing and speech impaired.

5. Train 30 health care workers from 13 sites and retrain 58 counselors from 27 health facilities.

6. Conduct specialized training in HIV CT for children and special groups like the hearing and speech

impaired.

7. Procure HIV test kits and related commodities.

8. Provide mentoring and facilitative supervision to 28 hospitals and health centers providing CT services.

9. Mobilize and sensitize communities for the uptake of CT services.

10. Support NGOs on CT outreach services.

11. Continue working in collaboration with the IEC unit at ZACP and other partners to design, develop and

pretest IEC messages for the health facilities.

12. Monitor the progress of CT activities by conducting supportive supervision and strengthening of

monitoring and reporting.

13. Standardize the CT monitoring system, to capture all the information for clients attending both VCT and

PITC.

14. Strengthen the capacity of Counseling and Testing Unit at ZACP to coordinate CT services in Zanzibar.

LINKAGES: For individuals testing HIV-positive, linkages will be made with various programs including

palliative care/home based care and HIV treatment. HIV-negative persons will be linked with resources

(e.g., post-test clubs) to help them maintain their negative status. Work will be completed in collaboration

with various implementing partners including, Columbia University, CHAI, and ART and TB partners.

CHECKBOXES: Coordination of CT services, training of health care workers, service provision for VCT and

PITC and supporting the District Health Management Teams (DHMTs) in the roll out of CT services.

Disseminate the CT guidelines and training materials to all partners implementing CT services.

M&E: ZACP will continue to support integration of HIV CT in HMIS and training for M&E tools. ZACP will

also provide support in the use of the tools in day to day operations. All supported sites will use MOHSW

daily registers and monthly summary forms, which will harmonize recording and reporting of CT services.

SUSTAINABILITY: To ensure sustainability of CT services, ZACP will support the training of DHMTs on

mentoring and supportive supervision of CT services (VCT and PITC) and in directly supports the overall

HIV Care and Treatment Plan. This activity will also strengthen the DHMTs to manage and supervise the

implementation of quality CT services at the council level through monthly/quarterly coordinating meetings.

It will also strengthen the referrals and linkages to care, as well as treatment and prevention activities in all

sites and the integration of CT services into other services.

TITLE: Expanding Comprehensive Care and Treatment Services in Zanzibar

NEED and COMPARATIVE ADVANTAGE: By 2008, there will be an estimated 900 HIV positive people in

need of comprehensive ARV treatment services in Zanzibar. Currently 668 have been enrolled and 519

have been initiated on ARVs. For the time being there are five care and treatment clinics in four regions. All

care and treatment services are provided in public hospitals. This year the target is to scale-up services to

two private hospitals and strengthen existing services through staff training, on-the-job training, supportive

supervision, improved coordination, and access and quality of care and treatment services.

ACCOMPLISHMENTS: In collaboration with ART partners working in Zanzibar, two more care and

treatment sites have been established making a total of five CTC sites currently providing services. Almost

100% achievements of year two targets for enrollment on ART have been met. A functional CTC database

has been established at the Mnazi Mmoja hospital; 56 health care workers (HCWs) have been trained on

the provision of ARV services; 24 HCWs have been trained on adherence counseling from four care and

treatment clinics; and 27 HCWs have been trained on pediatric HIV/AIDS management. Also, post exposure

prophylaxis guidelines (PEP) and training manuals have been developed.

ACTIVITIES: 1) In FY 2008, the ZACP will continue working with partners to maintain care and treatment

services in the existing sites and coordinate scale-up of services to new sites 1a) Coordinate partners

implementing ART services within Zanzibar by conducting quarterly stakeholders meetings to discuss

various issues including policy and guidance, quality of services, sharing best practices, sharing data,

tracking progress against national goals, and improving program implementation coordination of care and

treatment services 1b) Review, update, and disseminate care and treatment training materials and

guidelines 1c) Conduct supportive supervision to ensure quality of services 1e) Work with M&E unit to

coordinate the roll-out of the revised M&E tools for care and treatment 1d) Coordinate training and refresher

training, and provide support for those attending workshops and conferences within and outside the country

1f) Procure drugs for opportunistic infections, and HIV reagents including test kits and protective gear 1g)

Sensitize health care workers and the community on newly established CTC sites

2) Coordinate and work with partners in the implementation of Post-Exposure Prophylaxis (PEP).

2a) Sensitize health sector officials and train health care workers on the importance of prevention of blood

borne pathogens and PEP.

3) Advocate for care and treatment services. 3a) Conduct community sensitization sessions to influential

leaders on comprehensive care and treatment services 3b) Develop, print and distribute demand generated

IEC materials 3c) Conduct a mass media campaign for demand creation (inclusive of TV and radio spot

announcement and panel discussions).

4) Collaborate and coordinate with partners to strengthen linkages and referral between care and treatment

services and other HIV and non HIV related services like PMTCT, TB HBC, psychosocial support, legal

support, food support that will allow a smooth flow of patients

4a) Support a monthly information exchange meeting between care and treatment staff, PMTCT, TB, VCT,

HBC and other services 4b) Update, print and distribute referral forms.

5) Provide supportive supervision to ensure quality of service.

5a) Train two teams on supportive supervision in Unguja and Pemba. 5b) Conduct supportive supervision at

the regional level once a year.

6) Support minor renovation of infrastructure of two hospitals which are not renovated by partners for

provision of care and treatment services. This activity will ensure confidentiality, safe storage of ARVs, and

enough space for consultation, counseling and laboratory services.

LINKAGES: The care and treatment unit works in collaboration with other implementing units such as

PMTCT, TB, HBC, VCT, and IEC and SI units. It also collaborates with other partners including Columbia

University, Clinton HIV/AIDS Initiative (CHAI), and World Health Organization (WHO). The partners provide

technical and material support to strengthen quality provision of services and realize the set objectives.

Care and treatment services are conducted within the framework of the health system. Linkages between

care and treatment services and other implementing units and partners is an ongoing intervention in FY

2008 .

CHECK BOXES: The area of emphasis are chosen because:

1.Renovation of new sites will improve access to care and treatment services in an acceptable environment.

2.Human and local organization capacity building will ensure quality of services and sustainability.

M&E: ZACP in collaboration with partners has established monitoring tools to capture information on clients

accessing care and treatment services. These tools include CT2 forms available in all clinics and the CTC

database which has been established in the Mnazi Mmoja hospital. Supervision is conducted in all care and

treatment clinics to improve the collection and processing of gathered information.

SUSTAINAIBLITY: ZACP will continue to build the technical capacity of the local staff and at the health

facilities in both public and private facilities. Capacity will be built through coordinating and supporting the

training of health workers, the general community, and local government authority. Interventions identified

herein have been acknowledged and incorporated within the health sector budget and are among the key

interventions in the national poverty reduction strategy.

TITLE: ZACP SI capacity, Surveillance, M&E of HIV/AIDS activities

NEED and COMPARATIVE ADVANTAGE: The SI unit of the ZACP is the custodian of health sector HIV

data in Zanzibar. The unit is mandated to coordinate, collect, store, retrieve, and analyze various types of

data for planning and policy formulation. Simultaneously, the unit has good capacity for data handling,

hence, it will complement efforts of the HMIS unit within the MoHSW in the production of health data

required by stakeholders. The SI Unit has started to set up data collection tools to include information on

Care & Treatment, HIV surveillance, PMTCT, HIV Testing, Home Based Care, Laboratory and STI

services.

ACCOMPLISHMENTS: 1) Increased capacity to monitor and evaluate HIV/AIDS interventions, 2)

Conducted behavioral and biological surveys for Most At Risks Populations (MARPS) specifically men who

have sex with men (MSM), commercial sex workers (CSWs), and intravenous drug users (IDUs), 3) Piloted

respondent-driven sampling (RDS) methodology during MARPs surveys, 4) Assessed prevalence of blood-

borne infections among populations of interest during MARPs surveys, 5) SI unit has trained HMIS staff on

HIV monitoring.

ACTIVITIES: The activities for this year include: Antenatal Clinic (ANC) surveillance, behavioral surveillance

(BSS) of MARPs, and strengthening M&E and program monitoring capacity.

1.Surveillance

a.) Antenatal Clinic (ANC) HIV surveillance will be repeated in 2008 with the 20 sites using the PMTCT

approach complemented by dried blood spot (DBS) methodology for specimen collection. Additionally, trend

analyses will be performed on three data points (2002, 2005, 2007 & 2008) specifically using data for those

sites which did participate in all four rounds. ANC surveillance data will be compared to PMTCT counseling

& testing data in order to assess the feasibility of replacing ANC surveillance with PMTCT (if PMTCT

services coverage is satisfactory) as the main method of tracking the epidemic in the general population in

Zanzibar.

b.) ZACP staff will also participate in the behavioral surveillance survey with biological marker(s) (BSS+)

among prisoners and uniformed services. This will include training of trainers (TOTs); laboratory support,

data management and analyses, and preparing and disseminating reports. With FY 2008 funds, the staff

will also participate in the repeat of the BSS+ among IDUs.

2. Human Capacity Development

a) Human capacity needs are substantial across all teams within ZACP. The ZACP SI section is in charge

of HIV and STI surveillance, monitoring and evaluation of programs, and information systems activities.

As a result, personnel to be recruited will include: a Strategic Information Coordinator (Epidemiologist), a

Surveillance Coordinator, a Monitoring and Evaluation (M&E) Officer, a Data Manager and four Data Entry

Clerks.

b) Train HCW staff on basic epidemiology, basic computer skills, database management using Epi Info (for

Windows), data entry, analysis using other complemntary statistical packages, data presentation and report

writing.

c) Attend regional and international trainings and conferences.

3. Develop Health sector HIV M&E framework to include a comprehensive set of national and international

indicators to track progress against set targets; guidelines for activity planning, monitoring and reporting;

capacity-building for data use; a more standardized/formalized way of reporting health information up to

ZACP; and development/strengthening of existing linkages between the different program activities.

4. Harmonize HIV data at ZACP programs. Each unit of ZACP is collecting data related to counseling and

testing e.g. PMTCT, PITC. These data need to be harmonized in SI unit for management and analysis.

LINKAGES: The Strategic Information Unit is working in collaboration with other units within ZACP. Linking

health sector HIV information to the national HIV data set. Data are collected from Public and private health

facilities that include, FBO and NGO facilities. ZACP will also continue to collaborate with Tulane University

on the MARPs surveys. ZACP works closely with Tulane University, which has technical expertise on

respondent driven sampling to collect BSS data on MARPs.

CHECK BOXES: The areas of emphasis were chosen because activities will include training of health care

workers, approved targeted evaluations and surveillance. The general population will be targeted in our

testing activities.

M&E:

The SI Unit of ZACP supports the all national HIV monitoring systems, both paper-based and electronic

systems HIV monitoring systems, across the program areas, including PMTCT, CT, Treatment, Home-

based Care. The unit is also responsible for training staff on the data collection tools and rolling out of the

monitoring systems to facilities throughout Unguja and Pemba islands. Supportive supervision is provided to

all sites, specifically on data collection, management and reporting of aggregate data to the district/regional

and central levels. Data quality assurance protocols will be developed and the Surveillance Officer will

conduct periodic supportive supervision at the facility-level.

SUSTAINAIBLITY: Evidence-based planning forms part of the health sector management process.

Designed interventions fall in line with the national priority of monitoring health and particularly in monitoring

HIV patterns and disease management. The poverty reduction strategy paper which is pivotal in health

sector planning acknowledges the need to monitor MDGs inclusive of HIV and AIDS. Inclusion of HIV

information in the national data set is critical for evidence-based planning. Training programs are included in

the plan for continuing education for HCW and forms part of the human resource retention and development

plans.