TITLE: Scaling-up PMTCT through Strengthened Linkages Between Prevention and Treatment

NEED: According to the 2003/04 the HIV indicator survey (THIS), 6.8% of pregnant women are living with

HIV, yet only 10% of those have access to PMTCT services. The mission to decentralize PMTCT, scale-up,

and develop strong linkages between PMTCT and care and treatment (C&T) holds considerable promise,

particularly where PMTCT activities are integrated into other reproductive health (RH) activities.

In recent past, through funding from EGPAF, EngenderHealth implemented comprehensive and integrated

PMTCT services including maternal and child health (MCH) affiliated voluntary counseling and testing

(VCT), antiretroviral (ARV) prophylaxis, strengthening referral linkages to care and treatment, integration of

VCT in family planning (FP) services and encouraging male involvement. The proposed project will build on

lessons learned and replicate best practices. EngenderHealth employs competent staff to backstop the

project. Our global HIV team will also provide technical assistance as needed.

In FY 2007, EngenderHealth received PEPFAR funding from USAID to initiate comprehensive and

integrated PMTCT services in 12 districts in Manyara and Iringa. In collaboration with council health

management teams (CHMTs), 48 sites were identified (five per district). EngenderHealth collaborates with

AIDS Relief in Manyara and Family Health International (FHI) in Iringa regions where the two agencies are

supporting C&T activities in hospitals. The project start-up activities, including participatory planning with

CHMTs, will start in August 2007.

ACTIVITIES: EngenderHealth plans to expand a comprehensive and integrated package of PMTCT

interventions to help strengthen maternal and child health (MCH) services and other care, treatment, and

support services in 60 new public sites, in addition to strengthening the program in 48 old sites in 12

districts in Manyara and Iringa regions (five districts in Manyara and seven in Iringa, respectively).

EngenderHealth's strength in facilities and operations management, with a strong systems approach, will

focus on the provision of technical assistance and establishment of PMTCT services in the two regions.

The proposed project aims to reduce the vertical transmission of HIV and enhance access to quality care,

treatment, and support services for women and their partners in the 12 districts of Manyara and Iringa

regions of Tanzania. This will be achieved through five key objectives:

1) integrating a core package of PMTCT interventions into reproductive and child health (RCH) clinics in 60

new sites, and strengthen the program in 48 sites;.

2) integration of family practice (FP) and HIV services for women attending FP, Child Welfare clinics, and

care and treatment services in 108 health facilities in 12 districts.

3) building capacity of health care providers in health facilities to provide quality PMTCT, VCT, and care and

support services.

4) strengthening referral mechanisms between higher and lower-level health facilities and between PMTCT,

VCT, and care and treatment services through an integrated network model approach.

5) building local partners' capacity for community-based care and support to address treatment adherence,

HIV/STI prevention, and care and support needs of HIV-positive women, their partners, and their children.

The project will build on previous lessons learned from implementation in Arusha and initiate PMTCT

activities where they do not currently exist using the following competencies: quality assurance and quality

improvement (QI) of services and service delivery through client-oriented, provider-efficient services

(COPE) methodology on PMTCT and C&T; establishment of PMTCT and VCT for women attending FP and

other RCH services as multiple entry points for greater utilization and saturation of C&T services; sensitivity

to clients' rights, equity and respect for a woman's informed choice throughout all program activities;

infection-prevention (including universal precautions) and reduction of HIV/AIDS-related stigma and

discrimination among health care workers; male involvement implemented through the men as partners

(MAP) approach seeking to use men's critical position as decision-makers to enhance uptake of

interventions; linkage to EngenderHealth's ACQUIRE project to strengthen family planning services and

FP/RH needs of HIV positive women and their partners; collaborate with district hospitals to conduct mobile

PMTCT services targeting hard to reach communities (e.g., nomadic populations in specific districts).

LINKAGES: The project will build strong referral networks of health facilities and existing community

structures to provide support and follow-up of HIV-positive mothers and their infants and link them to C&T

services. The project will also work with the facilities to develop strong service linkages between PMTCT

and family planning, and a follow-up program at the under five growth-monitoring clinic for exposed infants.

Other linkage interventions will include follow-up of HIV-positive mothers and their exposed infants at both

the facility and community levels. EngenderHealth will collaborate with FHI in Iringa region and AIDS Relief

in Manyara to create synergy and functional referrals between PMTCT and C&T. Additionally,

EngenderHealth will collaborate with partners in the area who have expertise to provide community and

home-based care, social and religious support groups, nutritional support, financial assistance/income

generation opportunities, and legal assistance.

The follow-up of exposed children will be linked to growth-monitoring programs and immunization clinics. All

exposed infants will receive cotrimoxazole syrup as early as 4 weeks. The project will give special attention

to young, married girls and adolescents with early pregnancies, and provide them with services tailored to

their needs The program will also apply the basic principles of human rights and gender equity to promote

sustainable and continuous prevention, care, support, treatment adherence, and referral for related services

for HIV-positive women, their partners, and children.

M&E: The project will adhere to PEPFAR reporting requirements. Sites will use national PMTCT

instruments to collect data based on PEPFAR indicators which include: number of service outlets providing

the minimum package of PMTCT services according to national and international standards; number of

pregnant women who received HIV counseling and testing for PMTCT and received their test results;

number of pregnant women provided with a complete course of antiretroviral prophylaxis for PMTCT;

number of health workers trained in the provision of PMTCT services according to national and international

Activity Narrative: standards; and number of HIV-positive pregnant women referred to care and treatment centers. Regional

and district RCH coordinators will receive training in writing reports, and subsequently submit monthly and

quarterly reports to EngenderHealth and MOHSW.

SUSTAINAIBLITY: The project will build on, and adapt best practices and lessons learned from

EngenderHealth's previous PMTCT projects in Arusha region. This will include participatory planning with

regional health management teams (RHMT) and CHMTs and integration of interventions into

comprehensive council health plans for sustainability. Since October 2003, EngenderHealth has received

field support from USAID to assist the MOHSW in expanding access to, and the utilization of, reproductive

health services in Tanzania. Presently, EngenderHealth through the ACQUIRE Project, works in all 21

regions and Zanzibar. This project will build onto sites proposed for the ACQUIRE family

planning/reproductive health project where EngenderHealth provides technical assistance to districts to

include these activities in their comprehensive council health plans to ensure sustainability.