Detailed Mechanism Funding and Narrative

Years of mechanism: 2007 2008 2009

Details for Mechanism ID: 4950
Country/Region: Tanzania
Year: 2008
Main Partner: U.S. Centers for Disease Control and Prevention
Main Partner Program: NA
Organizational Type: Own Agency
Funding Agency: HHS/CDC
Total Funding: $6,769,171

Funding for Biomedical Prevention: Prevention of Mother to Child Transmission (MTCT): $276,365

TITLE:PMTCT Activities, Management and Staffing (GHAI)

ACTIVITIES: Management and staffing funds are split between Base and GHAI to ensure continuity of

activities and no interruption in staff funding.

FY 2008 funds will support a total of two full-time staff. One senior PMTCT advisor to oversee the PMTCT

program and provide guidance on implementation of regionalization and one program specialist to manage

cooperative agreements.

HHS/CDC will continue close collaboration with the Government of Tanzania, Ministry of Health and Social

Welfare (MOHSW), and other key partners to further strengthen technical and program capacity to ensure

appropriate Emergency Plan implementation. This will include the establishment and expansion of quality-

assured national systems in prevention of mother to child transmission (PMTCT).

In FY 2008, this funding will support the PMTCT in-country program staff to provide technical assistance

and support to PMTCT implementing partners as they operationalize the new district approach model and

regionalization of PMTCT services. The in-country staff will work with implementing partners to expand

PMTCT services to lower-level facilities and empower districts in order to serve the targeted population. In-

country staff will provide technical assistance to MOHSW and implementing partners to strengthen linkages

between ART, PMTCT, TB, malaria, family planning, and nutrition services at the national, district and site

level. An integrated approach to care and treatment will be emphasized.

Early infant diagnosis and enrollment into pediatric care and treatment is a main focus in FY 2008. In-

country staff will provide technical assistance for all early infant diagnosis activities and will ensure that all

PMTCT services are in line with the USG technical strategy and national guidelines. Field visits and

attendance at regional authority meetings will be necessary for continued program monitoring.

PMTCT staff will provide technical assistance for the Ministry of Health and Social Welfare (MOHSW) to

finalize and operationalize the recently revised national guidelines and move into a predominant role of

national coordination and program planning. Increased technical assistance will be provided in the area of

monitoring and evaluation to ensure quality of data and that data is used for decision-making.

In addition, the HHS/CDC in-country team will work with implementing partners to develop annual work

plans, conduct training and ensure overall program monitoring. Staff will also ensure that all HHS/CDC

programs adhere to the national and USG PMTCT strategies and protocols.

Funding for Sexual Prevention: Abstinence/Be Faithful (HVAB): $21,000

TITLE: Management and Staffing

ACTIVITIES: This activity is split-funded between GAP and GHAI. Please refer to activity #9423.08 for the

activity narrative.

Funding for Biomedical Prevention: Blood Safety (HMBL): $61,012

TITLE: Blood Safety-Management and Staffing

NEED and COMPARATIVE ADVANTAGE: In FY 2004, the National Blood Transfusion Service (NBTS) in

the Ministry of Health and Social Welfare (MOHSW) established a cooperative agreement with the CDC for

rapid strengthening of blood safety services in Tanzania. The USG strategically focused on establishing a

nationally sustainable and coordinated body, developing infrastructure, and acquiring necessary capacity

building for collection, processing, storage, and distribution of safe blood. Health and Human Services,

through CDC provides technical assistance and financial support to the mainland NBTS and Zanzibar

Blood Transfusion Services (ZBTS) through a central funding mechanism to NBTS and the Association of

American Blood Banks provides (AABB) consulting services. This technical assistance (TA) involves visits

from the project officer in Atlanta as well as in-country site visits to central, zonal, and regional centers

operated by NBTS, the Tanzania Red Cross society, and military hospitals under Tanzania People ‘s

Defense Forces.

ACCOMPLISHMENTS: Due to the expansion and development of the NBTS scope of services, FY 2006-

2007 funds supported the recruitment of an in-country CDC blood safety program officer who provided TA

to NBTS toward renovating, equipping , and operationalizing zonal centers. Collaboration between NBTS,

AABB, and CDC resulted in the development of policy, guidelines, quality systems and processes, a

monitoring and evaluation (M&E) framework, as well as M&E tools. With FY 2007 funds, HHS/CDC is

providing TA to NBTS to formulate, promote, and strengthen existing blood donor clubs. This has

strengthened the capacity of the NBTS to effectively and efficiently manage its programs through training,

mentoring, advocacy for the implementation of the NBTS as an executive agency, and ensuring

sustainability through a cost recovery process.

ACTIVITIES: With FY 2008 funds, CDC will collaborate with the AABB to provide TA in M&E, quality

management, and the efficient use of the database system to monitor, record, and account for different

blood related variables. In addition CDC will collaborate with NBTS to provide capacity building for staff, and

effective management of donor clubs in order to ensure repeat donations. This will result in an increase in

the supply of sustainable, safe, and adequate blood supply. CDC will also provide TA to the Abbott

Foundation, which is renovating regional hospitals and will incorporate blood banks in their blueprints to

ensure adequate supply and proper storage procedures. CDC willalso provide TA and assist with

equipment procurement for the regional blood banks. In order to achieve this CDC will obtain expertise

through contractual mechanisms and collaboration with AABB.

The CDC and the AABB will combine their resources to provide essential TA to NBTS to facilitate formation

of regional blood committees, training of individuals within those committees, and feedback from physicians

on rational blood uses at different levels. Working collectively, CDC, supply chain management systems

(SCMS), NBTS, and other partners will ensure a sufficient backup supply for test kits and reagents.

Additionally, CDC will assist NBTS to integrate PMI and prevention activities in their work plan and will

subsequently assist in reviewing their completed work plan, budget, and reports in addition to linking with

private public partnership toward implementing Phones for Health and the use of Personal Digital Assistants

(PDAs) to enhance data transmission and communication . Collaboration between the CDC and the

Counselling and Testing and the Presidential malaria initiative (PMI) programs incorporate malaria

prevention messages and sexual abstinence and be faithful messages in blood safety activities. CDC will

work with the counseling and testing programs to include messages that promote donor recruitment

targeted to the general public.

LINKAGES: The Blood Safety Program will work with PMI, malaria, injection safety and counseling and

testing programs to develop preventive messages, and promote donor recruitment across these PEPFAR

programs.

SUSTAINAIBLITY: TA provided by HHS/CDC and USG partners is geared toward developing sustainable

blood systems.

Funding for Sexual Prevention: Other Sexual Prevention (HVOP): $16,200

TITLE: Management and Staffing (GHAI)

ACTIVITIES: As identified in the USG five-year strategy, targeted behavior change and condom distribution

to reduce transmission in MARPs, including prevention messages for PLWHA and special work place

interventions must be emphasized in 2008.

Emphasis will be placed on building the capacity of the relevant organizations to develop appropriate

behavior change communication strategies and IEC materials for OP. Staff will collaborate with key USG

OP partners including the NACP/ TAYOA, ZACP, and the TBD MARPs partner and other USG funded OP

partners. Staff expertise with behavior change and behavioral theory will enhance the effectiveness of the

HIV/AIDS programs that promote OP interventions for the general public.

The USG staff will work directly with implementing partners, both governmental and non-governmental, to

improve the quality and reach of the OP activities. Technical assistance will be provided through site visits,

capacity assessments, mentoring, and skills building, as well as monitoring the progress of the programs.

The staff will work directly with USG partners to develop effective interventions and disseminate lessons

learnt to the others. The staff will also collaborate with GOT on defining national priorities and strategies to

achieve sustainability of the programs.

Funding for Care: Adult Care and Support (HBHC): $17,700

TITLE: Palliative Care: Basic Health Care Management and Staffing

NEED and COMPARATIVE ADVANTAGE: USG agencies provide direct technical support for all of its

HIV/AIDS programs through US and Tanzania based organizations, which manage and implement in-

country activities. These activities are funded through cooperative agreements and contracts that are

performed at the field level in direct partnership and collaboration with Tanzanian governmental and non-

governmental organizations. The non-governmental implementing partners have considerable experience in

the field of HIV/AIDS and have established offices in Tanzania to carry out these activities.

ACCOMPLISHMENTS: FY 2006 funds supported the in-country Palliative Home-based Care program staff

to assist the Ministry of Health and Social Welfare (MOHSW) Home-based Care Unit to initiate the Basic

Care preventive package program and Home-based Care counseling and testing. Technical support was

provided in the zonal Home-based Care meeting and at the sub committee meetings. The staff worked with

MOHSW through the Counseling and Social Services Unit (CSSU) in conducting supportive supervision and

preparing scale up and expansion plans for Palliative Home-based Care activities in Tanzania.

ACTIVITIES:

In FY 2007 the USG will continue to collaborate closely with the Government of Tanzania, Ministry of Health

(MOHSW), and other key partners to further strengthen technical and program capacity for implementing

the Presidents Emergency Plan for AIDS Relief (PEPFAR). This will include the establishment and

expansion of quality-assured national systems in the areas of surveillance, prevention of mother-to-child

transmission (PMTCT), laboratory services, blood safety and blood transfusion, antiretroviral treatment,

care and TB/HIV programs. In FY 2007, this funding will support the in-country Palliative Care: Basic

Health Care/Support program staff at the US Centers for Disease Control (CDC). The staff will: 1) support

the National AIDS Control Programme (NACP) - Counseling and Social Services Unit in their coordination

role; 2) assist with the provision of integrated, high quality care and support for people living with HIV/AIDS;

3) provide guidance for the strengthening of referrals between community and facility based care; 4) assist

in the preparation for implementation of the preventive care package; 5) provide guidance on improving the

monitoring and information system; 6) assist with enhancement of national guilelines for palliative care; 7)

conduct field visits and supportive supervision to USG sites that are implementing Home-Based Care(HBC);

8) review and compile quarterly and annual reports and oversee the HBC program mid- term review.

SUSTAINAIBLITY: The technical assistance (TA) and support provided by the USG through cooperative

agreements and contracts will ensure a long-term sustainable system for providing HIV/AIDS services to

Tanzanians.

Funding for Care: TB/HIV (HVTB): $33,000

TITLE:HIV/TB Collaborative Activities, Management and Staffing (GHAI)

NEED and COMPARATIVE ADVANTAGE: Tanzania established TB/HIV program in 2001. In 2005, the

Ministry of Health through NTLP signed a Cooperative Agreements with CDC for implementation of the

TB/HIV collaborative activities in Tanzania. HHS/CDC provides direct technical support for all HIV/HIDS

programs through US and Tanzania based organizations, which manage and implement in-country

activities. Cooperative Agreements fund these activities which are performed at the field level in direct

partnership and collaboration with Tanzanian governmental and non-governmental organizations. The

responsibilities of the TB/HIV staff include working with the Ministry of Health (MOH) through the National

Tuberculosis and Leprosy Program (NTLP) and other partners, to oversee the overall activities within the

program, guide the partners on the PEPFAR goals and ensure quality services.

ACCOMPLISHMENTS: FY 2006 funds supported the in-country TB/HIV program staff and technical

assistance (TA) from Headquarters who aided the MOH with the development of TB/HIV policy, training

curriculums and manuals for TB/HIV collaborative services. The staff provided technical support for the

development of needs assessment tools, TB screening tools for PLHA and modification of TB data

collection to incorporate HIV information. The staff worked with MOH through NTLP to conduct needs

assessment, training, supportive supervision and preparing scale-up and expansion plans for TB/HIV

activities in Tanzania.

ACTIVITIES: The core activities for the TB/HIV program staff in FY 2008 will include: providing technical

assistance to MOH though NTLP, The National AIDS Control Program (NACP) and other partners

implementing TB/HIV collaborative activities in the scaling-up of TB/HIV activities in Tanzania; guiding the

partners on the PEPAR goals and required indicators; working with NTLP and other partners in conducting

needs assessment and supportive supervision activities; participating in, and providing technical support for

the training of health care providers and sensitization of regional, district and community leaders on TB/HIV

collaborative services; following up, in collaboration with NTLP, on the renovation of TB clinics (to done by

the Regional Procurement Support Office [RPSO]) ensuring that they are able to provide TB/HIV

collaborative services including provision of Anti-Retroviral Treatment (ART); providing assistance to

partners in reviewing their work plan and budgets, report writing and timely submission; providing

assistance to the Senior Program Manager for Care in overall program planning, establishment of new

strategies, resource allocation, and expansion of the Government of Tanzania (GOT) supported TB/HIV

Program to achieve the overall goals of program; assisting the Senior Program Manager with collaborations

involving MOT through NTLP and insuring that the CDC TB/HIV program embodies its needs and

objectives; closely monitoring and supervising TB/HIV collaborative activities allocated by the Senior

Program Manager for Care and serving as a consultant to TB/HIV national and district coordinators in

addressing and resolving TB/HIV implementation issues; evaluating TB/HIV collaborative implementation

activities and making modifications based on protocols and available data; performing other duties as

assigned by immediate supervisor or other Senior CDC/Tanzania management.

SUSTAINAIBLITY: The technical assistance and support provided by HHS/CDC through Cooperative

Agreement will ensure a long term sustainable system for providing TB/HIV collaborative services in

Tanzania.

Funding for Prevention: HIV Testing and Counseling (HVCT): $29,400

TITLE: HIV CT Activities, Management and Staffing (GHAI)

ACTIVITIES:

This activity is split-funded between GAP and GHAI. Please refer to activity #9608 for the activity narrative

for this position.

Funding for Treatment: Adult Treatment (HTXS): $526,828

TITLE:ARV Services, Management and Staffing, GHAI funding

NEED and COMPARATIVE ADVANTAGE:

Management and staffing funds are split between Base and GHAI to ensure continuity of activities and no

interruption in staff funding. This activity relates to # 9399.

FY 2008 funds will support a total of four full time staff. Three technical staff will assist in coordinating

activities within this program area as well as serve as technical leads for aspects of the work. The specific

composition of the staffing is two full-time specialists given the scope and magnitude of the treatment roll-

out in Tanzania, and the evolving responsibility of the USG in the coordination of the various ARV treatment

partners.

In addition, one aministrative specialist will assist the team with all logistical and communication work. With

the enormous growth of the program during the last fiscal year, this position has become a critical addition

to the team.

Finally, a public health advisor will be integral part of the team by providing data analysis for program

planning and evaluation.

In FY 2008, USG/Tanzania ART implementing partners will assist the GOT in scaling up ARV services to

additional sites throughout the country, especiallly to lower level health care facilities. USG partners will

continue providing some level of support, and will be integrated within the regional and district annual health

budget and plans.

In support of this, the technical full-time staff members will work directly with implementing partners, both

governmental and non-governmental partners, specifically providing technical assistance to the National

AIDS Control Program (NACP) and USG ART partners. Field visits and attendance at regional authority

meetings will be a necessary. One staff member, in addition to the focus on ARV Services, will help oversee

the ongoing integration of non-ARV services such as PMTCT, TB/HIV and Care. One specialist will mainly

focus on the multi-dimensional strategic approach to pediatric HIV/AIDS.

Funding for Treatment: Adult Treatment (HTXS): $200,000

TITLE: Evaluation of the Tanzania National Treatment Monitoring and Reporting System and of ART

treatment outcomes

NEED and COMPARATIVE ADVANTAGE:

Fostering evidence-based decision-making is one of the most important uses of HIV/AIDS data. As

countries continue to scale-up treatment services and build infrastructure to support these services, there is

need to regularly carryout national analyses of routine monitoring data to determine treatment outcomes in

order to inform the program implementers and policy makers on the effectiveness and impact of ART.

Regular evaluation of the quality of these services will also provide program managers with the information

they need to make evidence-based decisions and plan programs.

The Care and Treatment program in Tanzania was initiated in 2004 with 32 health facilities. Additional 64

and 104 facilities were established in 2005 and 2006 respectively. By the beginning of FY 2007, there were

204 operational Care and Treatment Clinics (CTCs), all located in referral, regional, district, private and

mission hospitals.

In FY 2007, the Ministry of Health and Social Welfare (MoHSW)/National AIDS Control Program (NACP)

regionalized care and treatment services in Tanzania, whereby each region of the country was assigned to

only one supporting treatment partner. This resulted in EP partners providing support to 19 out of 21 (90%)

regions in mainland Tanzania as well as to Unguja and Pemba Islands of Zanzibar

ACCOMPLISHMENTS:

Tanzania has developed national standardized care and treatment monitoring & reporting tools that are

used at almost all facilities. The system consists of; i) a patient appointment card (CTC1), ii) a patient

management record (CTC2), iii) HIV chronic care registers (Pre-ART and ART registers) adapted from the

WHO. These are longitudinal patient records transcribed from CTC2 forms and iv) cross sectional and

cohort reports.

In FY 2006, the NACP M&E unit contracted the University Computing Centre (UCC) through the Global

Fund to develop an electronic database based on the CTC2 form. The CTC2 database, which is capable of

generating national and PEPFAR reports for treatment services, is currently in use at 35 of the 204 existing

CTCs. In order to facilitate in-depth national analyses of treatment data, UCC has also developed, within the

CTC2 database, a data-export capability that can place de-identified patient level data into an external

DBMS such as excel, which can then be analyzed using statistical programs such as SAS, Stata or SPSS.

Furthermore, other partner-supported databases such as the Harvard system in Dar es Salaam (four CTCs)

and the DoD system in Mbeya, Rukwa and Ruvuma regions (15 CTCs), have links to the national system

for reporting purposes, and can also post similarly de-identified patient-level data to the national analyses

database. Facilities using electronic databases will increase from 79 by Sept 2008 to 240 by Sept 2009.

(CTC2 system - 60 to 160; Harvard system - 4 to 31; DoD System - 15 to 49).

ACTIVITIES:

This is a continuation of activities started in FY 07 where the USG and implementing partners will

collaborate with NACP and other treatment partners to conduct a national evaluation of the impact of ART in

Tanzania. Data will be abstracted from patient records in a representative sample of 40- 50 facilities

randomly selected from the 204 existing care and treatment facilities. This will be a regular (yearly)

assessment to track progress of the implementation the care and treatment program including assessment

of ;-

a) implementation of the program monitoring and reporting system

b) implementation and scale-up of the national longitudinal electronic patient monitoring system

c)treatment outcomes. A common theme is these yearly national assessments will be the promotion of data

for decision-making culture through capacity building for personnel to routinely carryout these assessments

at all levels.

Specific activities will be;-

1) Assessment of the implementation of the national care and treatment monitoring and Reporting system at

all facilities including data and report flow.

2) Treatment Outcomes: this is a continuation of activities described in FY 2007 where patient records will

be abstracted to assess a variety of impact indicators including retention in therapy, survival and changes in

weight and CD4 count. Other activities include analyses of abstracted data, report writing and

dissemination.

3) Assessment of scale-up and use electronic systems for care and treatment.

4) Capacity building activities for analyses and use of care and treatment information.

a) In order to better identify, analyze, use, and disseminate data for treatment program decision-making, the

USG Tanzania in collaboration with NACP plans to exploit existing data from the CTC2 and similar

databases which, by Sept 2008, will be in use by 80 facilities; (60 facilities using CTC2, four (4) facilities

using the Harvard system, and 15 the DoD system). Most of these facilities are referral, regional, and high

volume district hospitals that were part of the 96 facilities that were fully functional by June 2005, and

therefore have follow-up data for patients on ART for 24 months more. Although not from a representative

sample of all facilities in Tanzania, cohort analyses of these data will provide the NACP with the much

needed information on treatment outcomes e.g. CD4 and weight differential after 6, 12 & 24 months on ART

compared to baseline. Survival analyses will be carried out to determine mortality and retention in therapy

overtime. Loss to follow-up, mortality, and transfer rates over time will be determined. We will also describe

TB treatment rates in both those who are on, and those who are not on ART. We shall also describe

cumulative, new, and current number of patients on ART by age group and sex as a validation to the

aggregate reports received from partners every quarter and for S/APR. Each partner will bring their facility

level data in the CTC2 database format. All patient-level data will be stripped of all names, address and

other obvious identifiers, and only the patient ID numbers will uniquely distinguish the patient. Once the data

is cleaned and merged, National level cohort analyses will be performed to determine the outcomes

mentioned above. The findings will be presented Nationally and locally by the respective impementing

partner.

4b) The second objective of this exercise will be to build the capacity of treatment partner SI personnel to

Activity Narrative: enable them to perform regular cohort analyses at sub-national level for their supported sites. A national

stakeholder group made up of all organizations involved in the treatment program in Tanzania will provide

oversight for this activity; A National task force will develop all assessment protocols and work plans while a

core group within the taskforce will implement the activities.

LINKAGES:

This activity will be carried out collectively by SI and program personnel in order to bridge the gap that often

exists between the SI personnel who are charged with collecting and managing the data and the program

managers who need the information to make evidence-based decisions and plan programs. This will ensure

that the data analysts (SI) work closely with the program managers who can identify key program questions

that data can be used to address, and can provide feedback as to whether data are presented in a format

that answers the key questions.

A national stakeholder group representing all groups involved in the treatment program will oversee all the

activities described above. A national task force which will be formed from within the stakeholder group will

develop all assessment protocols and report back to the stakeholder group. A core group within the

taskforce, made up of both program and SI personnel will implement the assessments, analyze the data,

and assemble the reports. Stakeholder and task force meetings to review the findings and presentation

format will ensure that the content and packaging information is in a format and language suitable for the

intended audience, and make the information available through appropriate channels and as rapidly as

possible.

CHECK BOXES:

Training will be conducted on the job which will lead to increase in capacity of participants and service

providers. Increased capacity in data analysis will lead to strengthened program monitoring.

M&E: SI targets: Number of organizations given SI TA: 65 (15 partners and 50 CTCs). Number of HCWs

trained in SI activities: 50

SUSTAINAIBLITY:

The approaches used in this activity ensure ownership and promotes sustainability. These include a country

-assessment that brings together SI personnel with program managers and policy makers to;

a) jointly understand the functions and needs of data users

b) determine the information that each group needs to perform functions appropriately

c) understand what data have already been collected, the quality of that data, and what additional data need

to be collected to meet users needs

d) develop content and packaging information in a format and language suitable for the intended audience

e) make the information available through appropriate channels, and as rapidly as possible

f) build individual and institutional capacity to interpret, disseminate and use information.

Funding for Treatment: Adult Treatment (HTXS): $0

Title of Study: Drivers and Barriers to Treatment-Seeking Behaviours in HIV-Positive Men

Expected Timeframe of Study:

Year 2: field work has not started. Plan to complete in 2008

Funds: No new funds needed in FY2008

Local Co-investigator: Zanzibar AIDS Control Program (ZACP), co-investigator

Project Description:

We proposed to conduct a public health evaluation to determine the barriers and drivers to treatment-

seeking behaviours among men in Zanzibar. The evaluation has four components to identify factors and it

uses triangulation of data to identify drivers and barriers. It will include interviewing men attending voluntary

counseling and testing sites, conducting focus groups of men at risk of infection, interviewing men who are

currently attending care and treatment centers, and interviewing health care professionals, pharmacists,

and workers in local pharmacies. During the ongoing field work, prevention messages and linkages to care

and treatment will be provided.

Status of Study:

The planning and implementation of this study was delayed due to the continuing resolution in FY 2007 and

ongoing surveillance activities with ZACP (e.g., Antenatal Clinic Surveillance and Respondent Driven

Sampling), this study has not yet started. Discussions will start in October 2007 to begin protocol

development and human subjects review in Tanzania and the US.

Lessons Learned: None to date.

Information Dissemination Plan:

Study findings will be presented in a workshop and in a written report with key stakeholders, including non-

governmental organizations implementing activities in Zanzibar. Data from the study may also be

presented at scientific meetings and published in peer-reviewed journals.

Planned FY 2008 Activities:

Finalize protocol development and submit for human subjects review, conduct field work in early 2008 and

complete study by June 2008.

Budget Justification for FY 2008 Monies: (in US$)

No additional budgetary requirements.

Funding for Treatment: Adult Treatment (HTXS): $100,000

Title of Study: Public health evaluation on the cost and cost-effectiveness of HIV treatment to support

resource planning

Expected Timeframe of Study and Funds: Year Two.

Project initiated in calendar year 2007, with planning-and-assessment activities conducted in October 2007,

year one field data collection anticipated for November 2007, and year one data analysis completed by mid-

calendar year 2008; the field data collection for year two is anticipated to occur in the latter part of calendar

year 2008 with subsequent data analysis completed by early calendar year 2009. The FY 2007 budget was

$279,000. FY 2008 budget is $100,000 for a total two-year budget of $379,000.

Local Co-investigator:

Local co-investigator to be identified during planning-and-assessment visit in October 2007. It is expected

to be Ministry of Health, Department of Policy and Planning.

Project Description:

The specific objectives of the analysis are 1) to estimate the annual per-person costs of providing quality

comprehensive ART for adult and pediatric clients; 2) to evaluate the range of ART costs across settings; 3)

to inform resource allocations decisions to meet the targets of the Emergency Plan; 4) to guide planning for

long-term sustainability of ART in country; 5) to assess the relative cost-effectiveness of the differing

program types and program delivery systems; 6) to provide an estimate of patient time and travel costs and

their effect on treatment outcomes; and, 7) to assess the differing resource needs that arise from extension

of treatment to primary health care (PHC) settings. The final objective has been added since the original

conception of the project, to address information needs arising from efforts to extend HIV treatment services

to PHCs. Specifically, the PHE will add additional sites to the sample, all PHCs, in order to assess how the

expected costs of providing comprehensive HIV treatment change with the change in the treatment delivery

settings.

Status of Study: The evaluation study comprises three complementary components: calculation of costs,

assessment of program outcomes (from a complementary project) and estimation of program cost-

effectiveness. The costing component of the proposed evaluation builds on the methods and tools

developed for the centrally funded five-country costing targeted evaluation. This approach takes advantage

of well-honed data collection and analysis tools and assures comparability of costing data across country

settings. The cost of comprehensive treatment will be estimated at the facility-level data and will be

collected to capture the full cost (financial and economic) of operating the program, including both USG and

other-than-USG sources of support. The cost data will by fully disaggregated by input type and

programmatic activity to which the input is directed, and will track the source of support for each cost

component. Costs for pediatric and adult care will be split. In addition, patient non-medical direct costs for

time and travel to access treatment will be estimated through patient surveys.

The cost-effectiveness of HIV treatment will be assessed in the sample facilities, utilizing the cost and

health outcomes data collected at each site. An initial proposal of outcomes would utilize retrospective chart

review to identify a successful patient as one who 1) was retained in the program 12 months after initiation

of ART, and 2) had demonstrated treatment success based on the best available indicator. With

appropriate selection of representative treatment sites that are to be included in the evaluation, the cost-

effectiveness analyses will provide measures of how cost-effectiveness is influenced by settings, facility

types, and program model. Additionally, with the collection of information on patient time and travel costs,

the effect of these costs as potential barriers-to-care will be assessed using health outcomes data.

The protocol has been developed with only minor modifications expected following the planning-and-

assessment visit in October of this year. The human subjects review in Tanzania and the US has not yet

been completed, but the protocol on which this PHE is based was previously determined to be IRB-exempt

so significant delays in implementation because of human subjects issues are not anticipated. The planning

and field data collection for this project was initially delayed because of late enactment of the FY 2007

budget and injury to the principal investigator earlier in the calendar year.

Lessons Learned: None to date.

Information Dissemination Plan:

Evaluation findings will be shared orally and in a written report with key stakeholders. Data from the study

may also be presented at scientific meetings and published in scientific journals. Prior to initiating data

collection, issues of scientific dissemination and co-authorship will be agreed upon by the USG country

team, the costing study team and other stakeholders as appropriate.

Planned FY 2008 Activities:

Planning and assessment visit by investigators (October 2007); field data collection in initial sample sites is

anticipated to begin in November 2007; data analysis for the initial study sites to occur in mid-2008; field

data collection in the PHC sites is planned for late 2008.

Budget Justification for FY08 Monies: (in US$)

Salaries/fringe benefits: 60,000

Equipment: nil

Supplies: nil

Travel: 35,000

Participant Incentives: nil

Laboratory testing: nil

Other: 5,000

Total: 100,000

Funding for Laboratory Infrastructure (HLAB): $638,764

TITLE: Laboratory Infrastructure and Capacity Building Management and Staffing

NEED and COMPARATIVE ADVANTAGE: HHS/CDC laboratory infrastructure program has the necessary

expertise to support care and treatment partners and the MOHSW in the provision of well-equipped

laboratories staffed by qualified personnel applying goodl laboratory practices which are essential in the

fight against HIV/AIDS. The Ministry of Health and Social Welfare (MOHSW) with support from USG in FY

2004 developed a plan to strengthen HIV/AIDS laboratory capacity. Emergency Plan funds were allocated

to support the network of zonal, regional, and district laboratories and provide capacity to diagnose HIV

infection, disease staging of HIV/AIDS, and treatment monitoring.The HHS/CDC laboratory infrastructure

program draws resources and support from the Global AIDS Program International Laboratory branch which

has a wealth of expertise and human resources, and International Laboratory partners. HHS/ CDC is a

renouned institution for its laboratory expertise and is therefore best placed to support the laboratory

Infrastructure Program

ACHIEVEMENTS: HHS/CDC provided technical assistance to the MOHSW and coordinated technical

assistance by international and in country laboratory partners in order to meet the needs for HIV diagnosis,

and monitoring of care and treatment. HHS/CDC has provided technical assistance at all levels of the

National Laboratory Network to ensure a comprehensive infrastructure and capacity building.

HHS/CDC provided technical assistance in the revision of the national rapid testing algorithm and the

subsequent training and roll out. Technical assistance and coordination was provided in the training for

CD4, Chemistry and Hematology undertaken by Association of Clinical Pathologists (ASCP) and the African

Medical Research Foundation (AMREF), technical assistance in the development of standard operational

procedures and quality systems implementation by the Clinical and Laboratory Standards Instituted and in

the revision of data collection and reporting tools and further implementation of Laboratory Information

Systems by The Association of Public Health Laboratories (APHL). HHS/CDC also coordinates the

laboratory support provided by the USG care and treatment partners in order to ensure a cohesive

implementation without duplication of efforts but also to meet the increasing demand for laboratory support

to care and treatment sites.

HHS/CDC works to build laboratory capacity in the country. This has been achieved through its

participation in national laboratory activities and attending coordination meetings. The training of trainers

with teach back methodology has been adapted from CDC and is now the modus operandi for all in-service

training. This has ensured that training capacity is left in the country.

HHS CDC undertook renovation and equipping of the National Quality Assurance Laboratory and Training

Center (NHLQATC) which is now complete. This center will be responsible for the quality assurance

activities of the country through the implementation of the National Quality Framework as well as training to

achieve the quality.

HHS/ CDC has provided leadership and guidance to the implementation of the Early HIV Infant Diagnosis

Program and has been involved in the preparation of policies and guidelines.

HHS/CDC has procured high through put equipment for three zonal hospitals and one military referral

hospital. This effort was complementary to the global fund which procured medium and low through put

Equipment for the regional and district laboratories while the AXIOS procured equipment for the fourth

Zonal Hospital.

ACTIVITIES: The HHS/CDC Laboratory Infrastructure Program works in collaboration with MOHSW and

partners to impliment National Laboratory Plan in support of HIV/AIDS Care and Treatment Plan. The

program supports the laboratory network at all levels in infrastructure and capacity building.

FY 2008 funds wil be used to maintain the existing staff consisting of a senior laboratory advisor and a

senior laboratory technologist and hire additional two members of staff approved in FY07. These will be the

Infant Diagnosis Program officer and an additional senior laboratory technologist whose positions are

currently vacant.

HHS CDC will financially support the procurement of reagents, equipment and supplies in the first year of

operations of the NHLQALTC as the MOHSW plans to take over not only the building but also works on

making the NHQALTC into an executive agency which will make it autonomous. This process is anticipated

to take a year. In FY 2008 HHS/ CDC will assist MOHSW to coordinate Technical Assistance to the

National HIV Quality Assurance Laboratory and Training Centre from USG partners. The NHLQALTC will

provide leadership and serve as a focal point for HIV/AIDS-related laboratory training, quality systems

implementation and will support and promote operational research into various aspects of HIV including its,

treatment, control and prevention and related opportunistic infections. The NHLQALTC will serve as a

referral laboratory for specimens that present unusual or unique testing problems and facilitate referral for

specialized testing not available in the country, such as genetic sub-typing, HIV drug resistance testing, HIV

-1 incidence, and other specialized microbiological assays. In the long term the NHLQALTC will undertake

greater Public Health Laboratory Functions such as the surveillance of new and emerging infections such

as Avian Influenza.

HHS/CDC will continue to coordinate and provide technical Assistance to the Track 1.0 ART awardees

(Columbia University, Harvard University, Elizerbeth Glazer paediatric foundation (EGPAF), Family Health

International, AIDSRelief) , who provide support to the laboratory network at the regional level, provide

support and Technical assistance to the MOHSW and coordinate the implementation of the Early HIV Infant

diagnosis program in the country by the care and treatment partners. The target is to build early infant

diagnosis capability at KCMC Moshi, Muhimbili National Hospital, Mbeya referral hospital and develop

capacity to manage speciment transportation and results back to the patients .This activity will be

undertaken in collaboration with the PMTCT, RCHP, HBC, OVC and other community based intervention

programs. The activities will include the finalisation of the national infant diagnosis guidelines, customisation

of training modules for Tanzania from existing national and international documents, training on Dried blood

Spot (DBS) collection transportation system; provide technical assistance for the renovation of three

referral laboratiry facilities to implement DNA PCR; support the training of three technologist per site on

DNA PCR

HHS/ CDC will support MOHSW efforts to establish a national HIV laboratory quality assurance system to

meet international standards of Good Laboratory Practices (GLP) and will provide and coordinate technical

assistance to MOHSW and US based partners CLSI, APHL, ASCP and in country based partners NIMR,

AMREF Bugando Medical center Track 1 and non-USG organizations that support the national laboratory

plan such as WHO, AXIOS, JICA and the Clinton HIV/AIDS foundation.. The areas of technical assistance

include laboratory infrastructure renovation, equipment specification and procurement, laboratory

information systems, training, quality assurance framework development and implimentation, assessment

for provision of services for infant diagnosis, policy formulations and guidelines in various areas of

Activity Narrative: laboratory based and affiliated services

LINKAGES: The HHS/CDC staff work with all USG partners in collabotion with MOHSW and its non -USG

partners such as GTZ, Clinton Foundation (CHAI), WHO in the planning and implementation of the

HIV/AIDS laboratory activities. The activities are in line with the National HIV/AIDS multisectorial

Framework, the National Laboratory Operational Plan in support of HIV/AIDS care and treatment for

Tanzania and PEPFAR goals. The activities are undertaken in consultation with the National AIDS Control

Program and the PMTCT,VCT, PITC programs

CHECK BOXES: N/A

M&E: N/A

SUSTAINAIBLITY: HHS/CDC works to build capacity nationally for the sustainability of quality laboratory

services. This is in the areas or training trainers, standardization of information and data collection in line

with country requirements, implementation of quality systems with a long term goal towards accreditation

and establishment of implementation, oversight and management structures within the network in line with

the MOHSW operational framework.

Funding for Strategic Information (HVSI): $1,600,100

TITLE: Management & Staffing - SI CDC (GHAI)

ACTIVITIES: CDC Management and Staffing in strategic information (SI) will be used to support CDC

agency-specific staffing needs in Tanzania as they relate to ensuring that the goals and objectives of

PEPFAR are met.

The FY 2008 funds will support seven full-time equivalent staff that will coordinate activities in strategic

information. The composition of the staffing includes the following: 1) Senior Surveillance Advisor, a

contractor, who will oversee all CDC specific activities related to surveillance/surveys and provide

biostatistical support for public health evaluations; 2) Health Management Information System (HMIS)

Advisor, a contractor, who will provide support and technical expertise in developing, implementing, and

maintaining information systems for the Government of Tanzania, and within CDC and USG ; 3) Monitoring

and Evaluation Team Lead, a local hire, who will coordinate all CDC specific activities related to internal and

external M&E and oversee target-setting for OGAC indicators for CDC partners. This advisor will work

closely with the Ministry of Health and Social Welfare (MOHSW), Zanzibar AIDS Control Program (ZACP),

and other CDC partners to standardize and strengthen M&E capacity to ensure sustainability; 4)

Surveillance Advisor, a contractor, to replace the exiting Surveillance ASPH (Association of Schools of

Public Health) fellow, who will provide technical assistance for the development and implementation of HIV

surveillance activities related to PEPFAR, including antenatal clinic surveillance, drug resistance surveys

and monitoring, and behavioral and biological surveys among most at-risk populations. S/he will also

conduct trainings and participate in technical working groups to build capacity within the ministries of health;

5) M&E Advisor, a contractor, to replace the exiting M&E ASPH fellow. The M&E Advisor will support the

M&E senior advisor in implementing M&E activities for CDC and its partners. S/he will work closely with

CDC program officers to build their capacity in program monitoring; 6) M&E Officer, a local hire or ASPH

fellow, to implement M&E related activities for CDC and its partners; and 7) a Database Administrator, a

local hire, who will oversee the planning, maintenance and development of databases, including

implementation of a program monitoring system for PEPFAR Tanzania, and who will also coordinate on the

US Government side, the implementation and use of data from the Phone for Health Initiative.

All CDC SI personnel will be members of the USG Strategic Information Inter-Agency Technical Team (ITT)

and serve as the SI focal person on at least one of the programmatic ITTs.

All of the CDC SI staff described will work directly with the MOHSW on the Mainland and the ZACP on

Zanzibar to provide ongoing technical assistance and building capacity in SI among the respective

Epidemiology Units. They will work with CDC's implementing partners to establish and maintain health

information systems, and monitor and evaluate the activities of CDC's partners. This includes the

development and implementation of national and USG databases for HIV/AIDS, specifically ART

monitoring, counseling and testing, home-based care, PMTCT, and TB/HIV linkages where feasible and

appropriate. It also includes building capacity in monitoring and evaluation and managing and analyzing

surveillance data. In FY 2008, additional emphasis will be placed on building capacity among local research

institutions, including the National Institute of Medical Research and the Muhimbili School of Public Health,

for public health evaluations and surveys. With the implementation of the Phones for Health Initiative in

Tanzania, building interfaces among existing information systems and ensuring the use of data at local

levels will be a major focus. Trainings for Epi Info, data use and activity planning and monitoring will be

conducted for both CDC program officers and CDC's partners.

The FY 2008 funds will support travel, both international (trainings, meetings, and conferences), and

domestic (USG strategic planning meetings, partner meetings, workshops, and partner site visits).

This activity will contribute to developing the human and institutional capacity building within CDC-Tanzania

and its partners, USG agencies, and the Ministries of Health in the United Republic of Tanzania.

LINKAGES: CDC Tanzania's SI Team links with other USG agencies SI professional staff to provide overall

support to the PEPFAR Tanzania team. All SI staff serve on inter-agency technical teams (ITTs). There is

also a linkage with the Measure Resident Advisor in SI through the SI ITT.

CHECK BOXES: Activities will include training and capacity building of local organizations and Government

of Tanzania public health professionals in strategic information, with a primary focus on CDC's partners.

CDC SI staff will provide technical support to public health evaluations through PEPFAR Tanzania. Training

and capacity building in M&E, HMIS, and surveys/surveillance are the objectives of the SI team in CDC

Tanzania.

SUSTAINAIBLITY: CDC Tanzania's approach for sustainability in SI is to ensure that capacity is built in

M&E, HMIS, and surveillance/surveys among local organizations and GoT (Ministry of Health and other line

ministries). Capacity building includes both pre-service and in-service approaches. In addition to the above

-mentioned areas, a particular focus will be placed on work plan development and monitoring of activities.

There will be an increased focused on building capacity of local research institutions in public health

evaluations in FY 2008.

Funding for Health Systems Strengthening (OHSS): $625,000

TITLE: Establishment of Tanzania Field Epidemiology and Laboratory Training Program (FELTP)

NEED and COMPARATIVE ADVANTAGE: The Tanzanian Ministry of Health and Social Welfare (MOHSW)

has identified a need at the national, regional, and district levels to develop a cadre of competent field

epidemiologists and public health laboratory managers who will help strengthen surveillance and the public

health response to priority communicable and non-communicable diseases particularly HIV/AIDS. To build

this capacity the MOHSW will establish a FELTP in Tanzania.

Tanzania Field Epidemiology and Laboratory Training Program (FELTP) is an applied epidemiology

program that helps countries develop and implement dynamic public health strategies to improve and

strengthen their public health system and their infrastructure. Currently South Africa and Kenya have

established programs. The Kenyan FELTP program, which will graduate four Tanzanians next year, is

unable to continue to accept Tanzanians into its program as the demand for space is so high.

The vision is to build a sustainable and independent program that will provide graduate training. The

program will be funded by PEPFAR, President's Malaria Initiative, and other bilateral partners. Graduates

of the program will be public health leaders in disease control and prevention and public health laboratory

management. They will be able to investigate disease outbreaks, strengthen surveillance and routine

program monitoring and laboratory systems, and serve as mentors to others. FELTP differs from traditional

trainings as students spend 75 percent of the second year undertaking practical fieldwork. The Tanzania

FELTP will be a degree granting program in collaborating with Muhimbili University of Health and Allied

Sciences (MUHAS).

ACCOMPLISHMENTS: This is a new activity for the MOHSW. However, in past years PEPFAR, through

the National Institute for Medical Research (NIMR), supported training for four Tanzanians at the Kenyan

FELTP program. Current students include: one who will return to strengthen the Zanzibar AIDS Control

Program in Zanzibar and one who will work in the Laboratory Diagnostic Unit of the MOHSW on Mainland.

These students, who will graduate in 2008, will pay a key role in the establishment of a Tanzania FELTP.

ACTIVITIES: FELTP is a two year, full-time training and service program, which involves classroom

instruction and field assignments. During the first year of the program short courses will be offered and a

cadre of ten students will be admitted. The first short course will be on routine program monitoring,

surveillance and outbreak investigation, laboratory quality assurance, as well as management. Participants

will include field epidemiologists, public health laboratory managers, and veterinary workers from various

regions working in HIV/AIDS and malaria.

Course participants will be required to conduct an applied learning project in Tanzania after which they will

present their work and receive degrees. The initial cohort of students will take classes in epidemiology,

communications, economics, management and will learn about quantitative and behavior-based strategies.

Field work will include: epidemiologic investigations and field surveys; evaluating surveillance systems; and

performing disease control and prevention measures.

FY 2008 funds will be use to support: a) ten students; b) provision of short courses; c) initial steering

committee and stakeholder meetings; d) travel cost related to FELTP seminars, outbreak, research and

surveillance evaluations, select conferences; and e) operations costs including stipends for fellows,

development and maintenance of field sites, accommodations for residents, tuition and honoraria.

An in country resident advisor for a number of years will be provided and funded through AFENET (African

Field Epidemiology Network) to help guide training and technical assistance. AFENET is a non-profit

network of organizations that share resources and best practices among FELTPs in Africa.

CDC Atlanta will provide technical assistance in the first year of the program in the form of physicians,

epidemiologists, public health advisors, instructional designers, and health communications specialists to

provide additional training and technical assistance.

LINKAGES: Developing partnerships is an important element of establishing, supporting, and sustaining the

program. Costs for establishing the Tanzanian FELTP program will be shared by African Field Epidemiology

Network (AFENET), the President's Malaria Initiative, MUHAS, NIMR, CDC Atlanta, and USAID

Washington.

SUSTAINAIBLITY: FELTP Tanzania will allow for key public health specialists to undertake training in-

country rather than traveling abroad. FELTP graduates will be field trained epidemiologists and laboratory

managers who will be competent in practical applications of epidemiologic methods. This will lead to

sustainable improvements interventions, implementation, surveillance and epidemic investigation and

response and overall supervision of the HIV/AID epidemic.

M&E: In order to ensure that FELTP is effective in developing personal to meet the human resource

shortage in Tanzania and is a sustainable program, a system for periodic monitoring and evaluation of

outputs and outcomes is critical. The an evaluation workgroup, with input from Atlanta and field-based staff,

has developed programmatic indicators for this activity. This M&E plan will allow the MOHSW to document

program activities, monitor and evaluate the program, implement program improvements, adjust the

program to changing priorities, and ensure the program is meeting the long-term priorities. In addition, a

database has been developed to support program management and the tracking of programmatic

indicators. All PEPFAR indicators necessary will be also incorporated into the monitoring system.

Funding for Health Systems Strengthening (OHSS): $125,000

TITLE: Management and Staffing CDC OPSS (GHAI) funding

NEED and COMPARATIVE ADVANTAGE: As the CDC portfolio has grown over the last five years there

has been a need for adequate personnel to manage the PEPFAR activities.

ACTIVITIES: This is a split activity with Activity ID #9575

FY 2008 funds will support one full time equivalent, locally employed staff (LES) who will assist in

coordinating activities for the OPSS program area at CDC Tanzania. The employee will also serve as the

technical lead for aspects of the work, including provision of direct technical assistance in systems

strengthening to the Ministry of Health and Social Welfare, National AIDS Control Programme, and other

CDC partners. Primary implementing counterparts include the National Institute for Medical Research

(NIMR), the International Training and Education Center for HIV/AIDS (I-TECH), and the American

International Health Alliance Twinning Center (AIHA). The LES will oversee AIHA and I-TECH activities

across program areas, as well as manage other human capacity development activities within CDC across

program areas. She/he will also serve as the Inter-Agency Technical Team Lead for OPSS.

Funds will also be used to support a program health analyst for the program strengthening strategic unit and

to support technical assistance for a three-month period by a fellow. Funds also include local and

international travel for these two positions.

In addition, funds will also be used to access technical assistance from Atlanta for the establishment of a

Field Epidemiology and Laboratory Training Program in Tanzania. Assistance will be provided from Atlanta

and the Kenya program based on the specific needs identified by CDC.

The persons funded with these monies will provide technical assistance to implementing partners, including

the MOHSW to ensure capacity is built.

SUSTAINAIBLITY:Through working with local organizations, capacity in human resources for health will be

built.

Funding for Management and Operations (HVMS): $2,498,802

TITLE: Management and Staffing (GHAI)

ACTIVITIES: Please see narrative for Activity code 3521.08 GAP.

Subpartners Total: $0
University of California at San Francisco: NA
National Institute for Medical Research - Tanzania: NA
Cross Cutting Budget Categories and Known Amounts Total: $0
Food and Nutrition: Commodities $0
Food and Nutrition: Commodities $0