PEPFAR's annual planning process is done either at the country (COP) or regional level (ROP).
PEPFAR's programs are implemented through implementing partners who apply for funding based on PEPFAR's published Requests for Applications.
Since 2010, PEPFAR COPs have grouped implementing partners according to an organizational type. We have retroactively applied these classifications to earlier years in the database as well.
Also called "Strategic Areas", these are general areas of HIV programming. Each program area has several corresponding budget codes.
Specific areas of HIV programming. Budget Codes are the lowest level of spending data available.
Expenditure Program Areas track general areas of PEPFAR expenditure.
Expenditure Sub-Program Areas track more specific PEPFAR expenditures.
Object classes provide highly specific ways that implementing partners are spending PEPFAR funds on programming.
Cross-cutting attributions are areas of PEPFAR programming that contribute across several program areas. They contain limited indicative information related to aspects such as human resources, health infrastructure, or key populations programming. However, they represent only a small proportion of the total funds that PEPFAR allocates through the COP process. Additionally, they have changed significantly over the years. As such, analysis and interpretation of these data should be approached carefully. Learn more
Beneficiary Expenditure data identify how PEPFAR programming is targeted at reaching different populations.
Sub-Beneficiary Expenditure data highlight more specific populations targeted for HIV prevention and treatment interventions.
PEPFAR sets targets using the Monitoring, Evaluation, and Reporting (MER) System - documentation for which can be found on PEPFAR's website at https://www.pepfar.gov/reports/guidance/. As with most data on this website, the targets here have been extracted from the COP documents. Targets are for the fiscal year following each COP year, such that selecting 2016 will access targets for FY2017. This feature is currently experimental and should be used for exploratory purposes only at present.
Years of mechanism: 2009 2010 2011 2014
THIS IS AN ONGOING ACTIVITY FROM FY 2008. ACTIVITIES LISTED HAVE BEEN INITIATED AND
WILL PROCEED DURING FY 2009 AS IN THE PREVIOUS YEAR. ACCOMPLISHMENTS WILL BE
REPORTED IN THE FY 2008 APR. PLEASE NOTE THAT THE ACTIVITY NARRATIVE REMAINS
UNCHANGED FROM FY 2008.
The funding for this activity has not changed
*END ACTIVITY MODIFICATION*
TITLE: Expanding PMTCT Services in Mara, Manyara, Mwanza, and Tanga
NEED and COMPARATIVE ADVANTAGE: AIDS Relief (AR), a 5-member consortium consisting of Catholic
Relief Services (CRS) (lead agency), Interchurch Medical Assistance World Health, Institute of Human
Virology, University of Maryland School of Medicine, Constella Futures, and Catholic Medical Mission
Board, has proven experience in ART and linkages to other HIV-related services. Existing complementary
programming supported by individual consortium members (e.g. OVC, HBC, agriculture, and fluconazole
partnership), represents a key comparative advantage of AR for scale-up and ensuring wrap-around
support to clients. In FY 2007, AR will partner with 29 facilities in four regions (Mwanza, Tanga, Manyara,
and Mara) where HIV prevalence ranges from two percent to over seven percent. By September 30, 2009,
AR will work in a further 19 health facilities providing training, supplies and equipment, opportunistic
infection (OI) and ARV prophylaxis and treatment, safe delivery kits, protective gear, and improved facilities
for counseling and delivery. AR will help sites reach national targets by providing counseling & testing to
90% of antenatal clinic (ANC) attendees and access to ARV prophylaxis for PMTCT to 85% of HIV-positive
mother-infant pairs either on-site or through care and treatment clinic (CTC) referrals.
ACCOMPLISHMENTS: To date, no accomplishments have been made. When FY 2007 supplemental
funding is awarded and disbursed, AR will support 13,300 PMTCT clients at 29 health facilities in 4 regions.
From October 2007 to February 2008, AIDSRelief will provide capacity building programs for PMTCT staff &
improve linkages to other HIV-related programs and the community. Partners will receive material inputs
including opportunistic infection drugs, ARV prophylaxis and treatment, test kits, safe delivery kits, CD4 test
reagents, and protective gear. Anticipated results include increased referrals to PMTCT, more births in
health facilities, more mother-infant dyads receiving a full course of ARV prophylaxis, and improved patient
tracking.
ACTIVITIES: 1) AIDSRelief will expand the availability of quality PMTCT services by training 192 health
care workers (HCW) to provide quality PMTCT services to mother & child. 1a) Train four HCW per site using
the revised national PMTCT training curricula 1b) Implement the WHO-tiered approach for ARV prophylaxis
to ensure HIV positive women and HIV-exposed children receive the most efficacious treatment, including a
multidrug regimen where possible. Provide single dose Nevirapine at time of HIV diagnosis to ensure all
HIV positive women receive at least the minimum ARV regimen; 1c) Provide on-site technical assistance to
initiate, implement, and improve provider-initiated (opt-out) testing with same day results for all pregnant
women attending antenatal clinics (ANC), labor and delivery (L&D) and postnatal wards; 1d) Work with
regional and district medical teams to conduct PMTCT supportive supervision at all levels of service
delivery.
2) Improve environment of PMTCT centers to motivate staff and ensure confidential services. 2a) Work with
site managers to refit waiting areas, counseling rooms, delivery rooms, and waste disposal facilities (e.g.
biological wastes or rubbish bins); 2b) Procure clinical and office equipment; 2c) Promote task shifting to
address human resources shortfall.
3) Strengthen linkages among health facility programs including PMTCT, community outreach, ANC,
maternal and child health (MCH), tuberculosis (TB), malaria, and adult and pediatric HIV care and
treatment. Providing follow-up of patients at different service points will increase utilization of the full-range
of PMTCT and continuum of care services. 3a) Ensure all PMTCT programs have two community workers
to conduct education activities and track PMTCT clients. 3b) Train community workers and PLWHA groups
to conduct patient monitoring and community education on prevention for positives, the importance of
prophylaxis for mother & child, benefits of delivering at health facility, HIV testing and care and treatment
services, as well as, the benefits of PMTCT and continuum of care services. Train community workers,
including PLWHA, on referral systems and making referrals; 3c) Provide supportive supervision of
community outreach activities; 3d) Promote HIV testing for partners of PMTCT clients, emphasize male
involvement in PMTCT, and emphasize prevention for positives in counselling sessions; 3e) Use national
registers to track HIV-exposed infants for follow-up care and treatment. 3f) Work with maternal and child
health (MCH) clinics to identify HIV-exposed infants during routine immunization visits, and refer infants to
CTC services. Mother's PMTCT information will be transferred to the child immunization card to assist with
identification of HIV-exposed infants.
4) Improve the laboratory and pharmacy capacity of PMTCT sites to prevent stock-outs and ensure quality
care is provided to mother and child. 4a) Work with Ministry of Health, Medical Stores Department (MSD),
and partners to improve forecasting of key reagents, PMTCT commodities, ARV prophylaxis, and OI drugs.
4b) Supply partners with adequate quantities of delivery kits, delivery beds, and protective gear. 4c) Train
PMTCT providers for referral of samples for infant diagnosis to Bugando Medical Center's early infant
diagnosis (EID) program. Collaborate with Columbia to ensure processing of samples and return of results;
4d) In line with national guidelines, offer cotrimoxazole prophylaxis to HIV-positive pregnant women as
indicated and all HIV-exposed infants from 4 weeks after birth until proven HIV-negative.
5) Strengthen program capacity to support the regionalization of PMTCT services. 5a) AIDSRelief
consortium will hire an additional four technical staff to train and supervise PMTCT sites; 5b) At site level,
AIDSRelief will fund one nurse as a PMTCT coordinator; 5c) Train 12 accountants and 52 coordinators in
finance, compliance regulations, and monitoring and evaluation (M&E) respectively.
LINKAGES: Within the health facilities, AIDSRelief will use its relationships with other HIV-related programs
Activity Narrative: to build linkages for a continuum of care. TB/HIV programs in the same health facilities will identify their
pregnant clients for referral to the PMTCT program. Linkages with community outreach activities and
PLWHA groups will be strengthened in order to ensure proper referrals are made and HIV-positive women
and HIV-exposed children are identified and receive care and treatment. AIDSRelief will also train service
outlets to refer patients from PMTCT to its care & treatment programs, many of which are located in the
same facility or a nearby district hospital. PMTCT staff will use national referral forms to refer HIV+ women
to the CTC, where registers will be used to track referrals. Pediatric clients will be referred to CRS
sponsored OVC programs within the same regions, whereby children may be eligible for nutritional support.
Linkages with reproductive child health, malaria, nutrition, child survival, and syphilis in pregnancy programs
will be developed. AR will continue to collaborate with Global Fund by assisting districts with sustainable
resource mobilization.
CHECK BOXES: The areas of emphasis were chosen because activities will include training of PMTCT
health workers, refitting infrastructure, and strategic information support. CRS will also provide wraparound
support through its PEPFAR-funded home-based care (HBC) and OVC programs which extend palliative
care, education and nutritional support. The general population will be targeted in the community outreach
activities to increase uptake of PMTCT services. Children under five and pregnant women will be targeted in
testing, treatment, and referral activities.
M&E: (7% of the budget) AR will collaborate with the National AIDS Control Program (NACP) and support
PMTCT sites in the improvement of data quality & reporting. PMTCT patient data will be compiled using
NACP electronic registers and paper-based longitudinal medical records. AR will assist sites with
implementation of the revised community logistic tools and national PMTCT monthly reporting forms for
ANC and L&D and promote data use culture in patient care and management. Feedback on tool
performance will be provided to NACP and partners. Continuous quality improvement committees will be
established at sites to manage and analyze data to measure quality and success of the program. This will
support PEPFAR and MOH objectives of monitoring and evaluating the availability, coverage and uptake of
PMTCT services.
SUSTAINAIBLITY: AIDSRelief will encourage Council Health Management Teams (CHMTs) to integrate
PMTCT activities in Council Health Plans and budgets at the district level. To improve administrative
capacity, AIDSRelief will work with regional and district authorities for better program coordination. To build
local authority's technical capacity, AIDSRelief will participate in Regional Health Management
Teams' (RHMTs) and CHMTs' supportive supervision activities including those for M&E. Clinicians from
RHMTs and CHMTs will be included in central trainings alongside the health facility staff to improve
technical skills and build collaboration across different levels of service providers. One hundred and thirty
health workers at district, regional, and health center level will receive ongoing training to support scale-up
of PMTCT services and promote sustainability.
New/Continuing Activity: Continuing Activity
Continuing Activity: 13450
Continued Associated Activity Information
Activity Activity ID USG Agency Prime Partner Mechanism Mechanism ID Mechanism Planned Funds
System ID System ID
13450 12379.08 HHS/Health Catholic Relief 6504 2368.08 $2,000,000
Resources Services
Services
Administration
12379 12379.07 HHS/Health Catholic Relief 4525 2368.07 AIDRelief $800,000
Resources Services Consortium TZ
Services Budget
Emphasis Areas
Health-related Wraparound Programs
* Child Survival Activities
* Family Planning
* Malaria (PMI)
* Safe Motherhood
* TB
Human Capacity Development
Estimated amount of funding that is planned for Human Capacity Development $420,000
Public Health Evaluation
Food and Nutrition: Policy, Tools, and Service Delivery
Food and Nutrition: Commodities
Economic Strengthening
Education
Water
Table 3.3.01:
ACTIVITY HAS BEEN REVISED SIGNIFICANTLY FROM FY 2008 COP.
TITLE: Care and Support for People Living with HIV/AIDS
NEED and COMPARATIVE ADVANTAGE: AIDSRelief (AR) provides HIV care and treatment in the regions
of Mwanza, Mara, Manyara and Tanga, where HIV prevalence ranges from 2%-7%. To scale up effectively
and provide quality services in these regions, care and treatment clinics (CTCs) require improved
infrastructure and staff capacity, quality improvement interventions, strengthened supply chains, and
enhanced management systems. With four regionally-based teams working closely with Regional and
Council Health Management Teams (RHMT and CHMT), faith- and community-based groups, Catholic
Relief Services' AIDSRelief clinical consortium has the capacity to provide technical support and material
inputs necessary to increase care and support services and support ongoing quality improvement. The
program supports the delivery of a comprehensive continuum of care for people living with HIV/AIDS
(PLWHA) through facility- and community-based care and support.
ACCOMPLISHMENTS: By the end of FY 2008, AR was supporting over 50 sites in four regions;
approximately 60,000 patients have been enrolled into care and support programs, and approximately
22,000 cumulative patients have been enrolled into treatment. Through AIDSRelilef support, significant
achievements include improved clinical skills of health workers; strengthened supply chain and laboratory
support systems; improved strategic information skills and implementation; increased computerization of
medical records and data; and improved program management.
ACTIVITIES: AIDSRelief will continue to enroll patients into care and support programs. Strategies to
increase the number of patients accessing care include: 1) increasing HIV testing to bring more patients into
the health system; 2) improving quality of HIV care and support; 3) decongesting and decentralizing
services to lower-level health facilities; and 4) producing reliable data to inform clinical providers and
increase quality of care.
IN FY 2009, AIDSRelief will collaborate with RHMTs and CHMTs to provide mentoring and preceptorship
visits to assist clinical providers in the provision of quality HIV care and support; strengthen linkages and
referrals between clinical units within the health institution; promote provider-initiated testing and counseling
(PITC); and promote TB care and treatment through intensified case finding, izoniazid preventive therapy,
and Infection control. The program will sponsor a family-centered approach to care and support in order to
identify more HIV-exposed and infected infants and children. AIDSRelief will ensure that CTC staff have
basic training in care, support, and treatment of People Living with HIV/AIDS (PLWHA), as per National
AIDS Control Programme (NACP) guidelines, and that clinical staff are skilled in the identification and
management of opportunistic infections (OIs). AIDSRelief will participate in the NACP treatment technical
working group and advocate for increased opportunities for HIV testing and treatment in line with
international guidelines and best practices. Finally, the program will develop organizational capacity of
CTCs by improving appointment systems, triage, patient flow, and addressing other systematic challenges.
There will be increased focus on prevention with positives. PLWHA will be provided with information about
ways they can protect their own health, prevent common illnesses, and improve access to safe water and
hygiene practices. AIDSRelief will ensure that interventions address the comprehensive needs in an
environment free from stigma and discrimination. Depending on the appropriateness of the setting, sexually
active PLWHA will be provided with condoms. PLWHA will be linked with sexually transmitted infection
treatment services and counseling to reduce high-risk behaviors. Counselors will discuss with PLWHA
specific strategies for disclosing one's HIV status to sexual partners, and offer confidential HIV testing to the
partners of and children born to all PLWHA in their coverage areas. AIDSRelief partners will link PLWHA
with programs that distribute insecticide-treated bed nets (ITNs) and promote their correct usage.
To ensure all patients are receiving quality care and support, AIDSRelief will train and mentor health care
workers on principles and practices of palliative care, including objective pain assessments and appropriate
pain management. Health facility staff will be provided with support mechanisms to prevent staff burn-out,
and the program will establish a clinical team of three or four people to focus primarily on palliative care for
PLWHA.
In order to maximize human resources and support appropriate task shifting, AIDSRelief will provide training
for CTC Nurse Coordinators and head CTC staff to clarify roles, responsibilities and management within the
CTCs. The program will train and mentor nurses on triaging, HIV care, support, treatment and community-
based nursing. AIDSRelief will also provide resources for nurses to become more proficient in World Health
Organization staging, side effects of treatment, as well as the basics of OI diagnosis and management. To
ensure comprehensive care, AR will improve linkages with other services in the health facility, especially the
TB and antenatal units for prevention of mother-to-child transmission services. Finally, the program will
collaborate with the Nurses Council of Tanzania to develop guidelines and curriculum for nurses to increase
their role in provision of HIV care and support.
Key activities for the Community-Based Treatment Support Services (CBTSS) will focus both on facility and
community outreach and will provide training for community-based organizations (CBOs), home-based care
volunteers and community health workers on referrals and patient tracking mechanisms between
community organizations and CTCs. The program will also train community-based service providers on
treatment preparation and adherence counseling, and will work with CBOs do develop work plans for
community health support programs. To ensure consistency of services, facility nurses will be integrated
into the CBTSS teams. Community-based service providers will receive training on the TB Screening Tool
and recognition of signs of TB and other major OIs. Under this initiative, AIDSRelief will conduct enrollment
campaigns to increase participation in HIV treatment, CD4 monitoring, pediatric testing days, and HIV
testing for families with an emphasis on pregnant women. AIDSRelief will also participate in the NACP
community health technical working group to advocate for community-based testing of HIV for all family
members and promote adherence to treatment regimens.
Activity Narrative: A cornerstone of the AIDSRelief model of care has been continuous quality improvement (CQI). The
program has been encouraging management to use available data to influence programmatic decisions. In
FY 2009, the CQI team will focus on identifying monthly and quarterly reports for health facilities to use to
monitor their own achievements to inform service delivery improvements. The program will monitor select
indicators, and introduce small changes following discussions with CTC and hospital management. The
CQI team will document best practices and disseminate these results among partner health facilities, with
the aim of replicating model practices at other partner health facilities.
In order to provide increased laboratory support, AIDSRelief will use FY 2009 funding to provide
mentorships and preceptorships to establish standard operating procedures and strengthen laboratory
capacity to be able to implement baseline and follow-up tests for quality care; strengthen capacity to
forecast and procure lab reagents; introduce documentation on CD4 testing and other laboratory tests
performed for patients under care and support; and train laboratory staff on specimen collection and
transportation. The program will also provide the means necessary to transport these specimens, and hire
and train a laboratory engineer to support maintenance of lab equipments. Finally, quality HIV testing is
essential to successful service delivery, and the program will advocate for continuous quality assurance and
control.
AIDSRelief will provide program and financial support through sub-agreements with all partners
accompanied by approved work plans and budgets, supportive supervision, and quarterly meetings with all
partners, including RHMTs and DHMTs; and capacity building of program staff through finance and
compliance training.
In FY 2009, AIDSRelief will intensify efforts in nutritional support for PLWHA. Specifically, AIDSRelief will
support CTCs to conduct anthropometric measurements and determine nutritional status using Body Mass
Index calculations for and other appropriate measurements, such has mid-upper arm circumference
(MUAC) and weight for age. AIDSRelief will procure the necessary equipment required to carry out
effective nutritional assessment such as weighing scales, MUAC tapes, and stadiometers. Training in the
use of these tools will be conducted, as well as in providing dietary assessments of patients and nutrition
counseling and education. In addition, AIDSRelief will link with other organizations addressing household
food security and economic strengthening to ensure PLWHA have access to these services.
LINKAGES: AIDSRelief will reinforce established relationships with regional and district authorities,
including RHMTs and DHMTs, faith-based networks and community-based groups. Many of AIDSRelief ‘s
71 current partners link to other programs in Tanzania's portfolio, including support for orphans and
vulnerable children, nutritional support, home-based care, water resource development, and
microenterprise.
During FY 2009, AIDSRelief will strengthen formal linkages between CTCs and groups providing home-
based palliative care in supported areas, such as Tunajali. Outreach and adherence staff, using patient
attendance data, will utilize these networks to follow up on missed appointments or patients lost to follow-
up. PLWHA groups will assist with scale-up by performing roles as lay counselors and adherence support
partners.
The program will intensify efforts to strengthen linkages between the CTCs, TB units, reproductive and child
health units, outpatient and inpatient services within health facilities by engaging the facility management.
In addition, AIDSRelief will strengthen referrals between local-level facilities and hospitals in order to
maximize the provision within the continuum of care.
M&E: AIDSRelief will continue providing M&E technical assistance to 65 existing health facilities, with the
addition of three community-based groups. The technical assistance will be accompanied by regional and
district level personnel from the Ministry of Health and Social Welfare (MOHSW). This approach will build
the capacity of facility-based staff to use existing MOHSW tools for patient monitoring and tracking as well
as to enhance the ability of MOHSW staff to provide quality supportive supervision. Initial and refresher
trainings in the use of revised MOHSW data collection tools will be provided to approximately 500 health
care workers, including members of RHMTs and CHMTs. Physical improvements include computerization
of paper-based information systems at 35 hospital facilities, further enhancing their ability to generate and
use data for quality improvement, patient management, and reporting to MOHSW. Approximately 7% of
project support is designated for M&E.
SUSTAINABILITY: To ensure sustainability of program activities, AIDSRelief will: 1) support RHMTs and
CHMTs in planning, implementation and supportive supervision, and ensure that care and support activities
are included in the comprehensive council health plans; 2) conduct joint supportive supervision with RHMT
and CHMT members; 3) support local partners (faith-based organizations); 4) support groups of PLWHA to
conduct adherence support activities; and 5) address policy issues around the use of lay counselors and
task shifting among health care workers at the national level.
AIDSRelief will work with stakeholders to develop a transition plan that transfers components of the care
and support program over to local partners. The plan will be designed to ensure the continuous delivery of
quality HIV care and support, and the program will continue to implement all activities in close collaboration
with the Government of Tanzania to ensure coordination, information sharing and long-term sustainability.
For the transition to be successful, sustainable institutional capacity must be present within the indigenous
organizations and local partner treatment facilities they support; therefore, AR will strengthen the selected
indigenous organizations according to their needs, while continuing to strengthen the health systems of the
local health facilities. This capacity strengthening will include human resource support and management,
financial management, infrastructure improvement, and strengthening of health management information
systems.
Continuing Activity: 16354
16354 16354.08 HHS/Health Catholic Relief 6504 2368.08 $200,000
Estimated amount of funding that is planned for Human Capacity Development $631,000
Estimated amount of funding that is planned for Food and Nutrition: Policy, Tools $25,000
and Service Delivery
Table 3.3.08:
ACTIVITY HAS BEEN REVISED SIGNIFICANTLY FROM FY2008COP
Need and comparative advantage:
AIDSRelief (AR) provides HIV care and treatment in four regions: Mwanza, Mara, Manyara, and Tanga,
where prevalence ranges from 2-7%. To effectively scale up and provide quality services in these regions,
care and treatment centers continue to require improved infrastructure, staff capacity building, strengthened
supply chains and enhanced management systems. With four regionally-based teams working closely with
Regional and Council Health Management Teams (RHMT and CHMT), faith and community-based groups,
CRS' AIDSRelief clinical consortium has the capacity to provide the technical support and material inputs
necessary to increase ART enrollment and support ongoing quality improvement.
Accomplishments:
AIDSRelief supports the delivery of a comprehensive continuum of care for HIV-infected adults and children
extending from health facilities to the community. By June 30, 2008, AIDSRelief was supporting 51 sites in
four regions; 58,742 patients (77% of September 30, 2008 target) had been enrolled into care (male 20,635
and female 38,107) and 21,171 cumulative patients had been enrolled into ART (9,747 males and 17,424
female). 69%, or 18,685 patients (6507 male and 12,178 female), were actively enrolled as of June 30th
2008. That number represents 74% of the September 30th 2008 target. In the past year, notable
achievements in addressing improved quality of care have included: increased health workers' clinical skills,
strengthened systems in supply chain and laboratory support, improved strategic information skills and
implementation at sites (with increased understanding, through computerization of medical records) and
improved program management. Campaigns such as the "CD4 campaign" yielded a 100% increase in the
number of CD4 measurements in a targeted number of sites. The median CD4 level in a 6 month cohort
increased from a baseline of 128/mm3 to 234/mm3; in a 12 month cohort, the baseline was 164/mm3 and
after 12 months was 311/mm3.
Activities:
By February 2009, AR will continue to initiate ART treatment to adult patients. AR's strategies will comprise
of : 1) increased HIV testing to bring more patients into the health system; 2) improved quality of HIV care
and treatment; 3) decongestion and decentralization to lower level health facilities; and 4) reliable data that
informs clinical providers and increases the quality of care, as well as feeding into donor and national
government reporting.
Clinical Management
Through clinical leadership, AIDSRelief, in conjunction with RHMTs and CHMTs, will focus on the following
key activities: mentoring/preceptorship visits to assist clinical providers in the provision of quality HIV care
and treatment; strengthening linkages and referrals between different clinical units within the health
institution; promoting partner-initiated counseling and testing (PICT); promoting the three "I's" for TB:
intensified case finding, INH prophylaxis and infection control; promotion of a family-centered approach to
care in order to identify more HIV-exposed and infected infants and children; ensuring that CTC staff have
basic ARV training as per The National AIDS Control Program (NACP) guidelines; training and mentoring
clinical staff in the identification of first line regimen failure and rational switch to second line regimens;
participation in NACP ART technical working groups (TWG) and advocating for increased opportunities for
HIV testing and treatment in line with international guidelines and best practices; providing input into clinic
organization, including appointment systems, triage and patient flows (critical levels of trained health
professionals require attention be paid to maximizing these resources and appropriate task shifting). The
nursing team will also focus on: training of CTC nurse coordinators and CTC-in-charge on roles,
responsibilities, and management of CTC; training and mentoring nurses at health facilities on triaging, ART
care, and community nursing; improving linkages with other services in the health facility, especially TB
units and antenatal clinics (ANC) for PMTCT; training and mentoring nurses in CTC, RCH, and health
centers to become proficient in WHO staging, ARV side effects and basics of OI diagnosis and
management; collaborating with Nurses Council of Tanzania to develop guidelines and curricula for nurses
to increase their role in ART provision.
Support for adherence is crucial for durable viral suppression. A critical component of the AR model of care
has been adherence preparation and strong links from health facility to community through a variety of
mechanisms, which include support groups and working through CBOs. Key activities for the Community-
Based Treatment Support Services (CBTSS) will focus on both facility and community outreach, and will
comprise of: training all providers at health facilities to perform adherence assessments, adherence
preparation and provide counseling using an adherence tool developed by the CBTSS team; integrating
facility community nurses into the CBTSS team, including traveling with the CBTSS team; training HBC and
community health workers (CHW) on the TB screening tool and on recognition of symptoms and signs of TB
and other major opportunistic infections; training HBC and CHWs on common ARV side effects, and how to
provide basic nursing services to patients during community visits; rolling out enrollment campaigns (ARV,
CD4, pediatric testing days and HIV testing for families including pregnant women); participating in the
NACP TWG on community health and treatment support to: (1) advocate for community-based testing of
HIV for all family members (2) promote the AR adherence and treatment support model
A cornerstone of the AR model of care has been continuous quality improvement (CQI) by instilling a culture
of data usage to influence clinical and management decisions (utilizing a process of small steps of change).
In addition, AR plans to carry out on an annual basis chart abstraction and viral load and adherence
questionnaires on a selected number of sites. The CQI team will also focus on: identifying reports health
facilities generate on a monthly and quarterly basis for use at their own sites to ensure on-going
improvement of service delivery, including increasing number of patients on ART per month; training health
facility staff to implement Life Table analysis as part of routine data use, how to use local report generation
to monitor their own activities and achievements. The CQI team will review findings from chart reviews with
CTCs, introduce small tests of change upon discussion with CTC and hospital management as a follow-up
to chart reviews at five health facilities. The CQI team will perform chart abstractions at five hospitals,
administer adherence surveys at five hospitals, collect viral load samples and send them for analysis,
perform statistical analysis of the data generated, disseminate results to health facilities, MOHSW, and
Activity Narrative: donors, collaborate with national partners of NACP to work on quality issues, document best practices at
health facilities, disseminate best practices amongst partner health facilities, and replicate model practices
at other partners' health facilities.
Pharmaceutical and supply chain management
There has been an established and documented gap in ARV management, particularly in forecasting,
dosage monitoring, products selection (switching and initiation) and medicine information given to
caregivers. To address this gap, AIDSRelief pharmaceutical management and supply chain team
(ARPMSCT) will provide continuous monitoring of ARVs in the national pipeline by liaising with Medical
Stores Department (MSD) and NACP to get regular updates. They will relay that information to LPTFs.
Likewise, feedback from LPTFs on inventory status will be communicated to relevant actors. ARPMSCT
will improve the ability of LPTF staff to use available ARV logistics management information systems (MIS)
tools to forecast, order and dispense ARVs by providing centralized training and on-site mentorship.
ARPMSCT will improve the rational use of ARVs by: documenting ARV rational drug use issues (such as
dispensers' knowledge through review of prescriptions) and dispensing records and feedback from patients.
ARPMSCT will advise on dosing, and dosing schedules, by providing easy to use information packages,
national dosing charts and treatment updates. ARPMSCT will establish therapeutic drug committees at the
health facility level. AIDSRelief will develop a user friendly drug information leaflet (in Swahili) to be handed
over during dispensing. The content will be basic ARV information on the specific drug, dosing and
dosages, usage, drug interaction and side effects.
Laboratory
AR will expand MOHSW zonal quality assurance (QA) and quality control (QC) activities by working with
regional and facility-level QA officers to support the zonal QA officersin conducting supportive supervision
of all regional district and CTCs in the zone. AR will support implementation of the zonal external laboratory
quality assurance activities by supporting the quarterly meetings, and ensuring enrollment and participation
of four regional labs in national and international external quality assurance (EQA) programs. AR will
support equipment services and maintenance by training 41 lab staff and four zonal equipment engineers
on planned preventive maintenance. AR will support zonal equipment engineers to perform quarterly
supervisions, and produce quarterly updates on equipment status, then report to the zonal director, ART
partner and equipment engineer at MOHSW diagnostic.
AR will work with Supply Chain Management Systems (SCMS) and the USG lab team to build the capacity
of 41 CTC laboratory staff in logistics and planning and doing laboratory supplies and reagent forecasting to
ensure uninterrupted quality laboratory services. AR will procure reagents for hematology, chemistry, CD4
count and DNA polymerase chain reaction (PCR) for early infant diagnosis.
AR will procure for two hard-to-reach care and treatment center laboratories: equipment for CD4, six
chemistry and six hematology analyzers.
Program and Finance Support
This will be accomplished through:
sub agreements with all partners accompanied by agreed-upon workplans and budgets; provision of
resources; supportive supervision and no fewer than quarterly meetings with all partners (including liaising
with RHMTs and CHMTs); capacity building through finance and compliance training.
Linkages
AIDSRelief will reinforce established relationships with regional and district authorities, including RHMTs
and CHMTs, faith-based networks and community based groups. Many of our 71 (65 LPTFs plus Christian
Social Science Commision (CSSC), Archdiocese of Mwanza, African Inland Church, Evangelical Lutheran
Church of Tanzania (ELCT), Anglican Health Secretariat and Mennonite Church) current partners link to
programs in Tanzania's portfolio including OVC and nutritional support, HBC, water resource development,
micro enterprise and other international and private donors.
During year six, formal linkages will be strengthened between CTCs and groups providing home based
palliative care in these areas, such as Tunajali. Outreach and adherence staff, using patient attendance
data, will utilize these networks to follow up on missed appointments or patients lost to follow up. PLWHA
groups will assist with scale up by performing as lay counselors and adherence support partners.
Specific efforts will be made, by engaging the facility management, to strengthen linkages between the CTC
and TB units, RCH, out-patient and in-patient services within health facilities. In addition, referral linkages of
local-level facilities to hospitals will be strengthened in order to maximize the provision within the continuum
of care (prevention, PMTCT, care and treatment).
Areas of Emphasis and Populations
Capacity building of health care workers to offer quality care to PLWHA on ART; Supply chain
management; Human resource development ; Laboratory services strengthening;; Proper use and
documentation of pediatrics information.
Monitoring and Evaluation
AIDSRelief will continue providing M&E technical assistance to 65 existing health facilities plus three
community based groups. The technical assistance will be accompanied by regional and district-level
MOHSW personnel. This approach will build the capacity of facility-based staff to use existing MOHSW
tools for patient monitoring and tracking. This approach will also enhance the ability of MOHSW staff to
provide quality supportive supervision. Initial and refresher trainings in the use of revised MOHSW data
collection tools will be provided to 498 HCW's, including members of RHMT and CHMT. AR will provide
physical improvements, including computerization of paper-based information systems at 35 hospital
facilities, further enhancing their ability to generate and use data for quality improvement, patient
management and reporting to MOHSW. Approximately 7% of project support is designated for M&E.
Sustainability
Activity Narrative: AIDSRelief will a) support RHMTs and CHMTs in planning, implementation, and supportive supervision, and
to ensure ART support activities are included in the Council Comprehensive Health Plans (CCHPs), b)
conduct joint supportive supervision with CHMT and RHMT members, c) support local partners (FBOs e.g.
Christian Social Science Commision (CSSC), Archdiocese of Mwanza, African Inland Church, Evangelical
Lutheran Church of Tanzania (ELCT), Anglican Health Secretariat and Mennonite Church; CBOs), (c)
support PLWHA groups to conduct adherence support activities; d) address policy issues around the use of
lay counselors and task shifting amongst HCWs at the national level.
Specifically, AIDSRelief will work with stakeholders to develop a transition plan that transfers components of
the care and treatment program over to local partners. The plan will be designed to ensure the continuous
delivery of quality HIV care and treatment All activities will continue to be implemented in close
collaboration with the Government of Tanzania to ensure coordination, information sharing and long term
sustainability. For the transition to be successful, sustainable institutional capacity must be present within
the indigenous organizations and LPTFs they support. Therefore, AR will strengthen the selected
indigenous organizations according to their assessed needs, while continuing to strengthen the health
systems of the LPTFs. This capacity strengthening will include human resource support and management,
Continuing Activity: 13452
13452 5505.08 HHS/Health Catholic Relief 6504 2368.08 $12,800,000
7694 5505.07 HHS/Health Catholic Relief 4525 2368.07 AIDRelief $8,070,000
5505 5505.06 HHS/Health Catholic Relief 2888 2376.06 AIDSRelief $3,620,000
Resources Services Consortium
Estimated amount of funding that is planned for Human Capacity Development $1,106,315
Table 3.3.09:
THIS IS A NEW ACTIVITY.
TITLE: Pediatric Care and Support
NEED and COMPARATIVE ADVANTAGE: Despite increased numbers of children accessing antiretroviral
therapy (ART), only 7% of eligible children are receiving treatment. There is a need to increase access to
services, especially for younger children. With four regionally based teams working closely with Regional
and Council Health Management Teams (RHMTs), faith- and community-based organizations (FBOs and
CBOs), AIDSRelief provides necessary technical and material support to increase enrollment of children
under 15 in 65 care and treatment clinics (CTCs). To scale up pediatric care and support services
effectively in Tanga, Manyara, Mwanza, and Mara regions, AIDSRelief intends to build on its family-
centered approach by increasing staff skills and knowledge, improving infrastructure, strengthening early
infant diagnosis (EID) and enhancing supply chain and management systems. Hospital outpatient
departments, reproductive and child health clinics (RCH), and pediatric wards will serve as entry points to
bring more children into care and treatment. In addition, AIDSRelief is working closely with the Ministry of
Health and Social Welfare (MOHSW), Bugando Medical Centre (BMC), and Baylor International Pediatric
AIDS Initiative (BIPAI) to strengthen pediatric AIDS care and support.
ACCOMPLISHMENTS: Since initiating care and treatment programs in July 2004, AIDSRelief has promoted
a comprehensive package of support to HIV care and treatment partners, enabling them to respond to the
needs of patients along a continuum of care, and promoting the conditions necessary to achieve durable
viral suppression. As of the end of FY 2008, over 51 AIDSRelief-supported HIV care and support centers
located in four regions are providing care to approximately 60,000 patients. Of these, over 5,000 are
children in care (8%). Approximately 90% of these children are receiving Cotrimoxazole.
ACTIVITIES: AIDSRelief will provide care and support for all children registered to local partner facility sites.
AIDSRelief strives to approach the target that children be at least 12% of all HIV patients on care. In order
to increase testing of infants and children at multiple entry points, AIDSRelief shall:
- Initiate community mobilization campaigns for pediatric testing days
- Advocate for increased community-based HIV testing with the National AIDS Control Programme (NACP)
- Follow children born to HIV-positive mothers from PMTCT programs to as to ensure infants are monitored
and tested and infant feeding practices minimize transmission of HIV.
- Facilitate training of staff at health facilities for EID by collaborating with NACP and Columbia University
To reach additional children requiring care and support, AIDSRelief shall also:
- Promote EID and initiate testing at supported sites
- Promote family-centered care and Cotrimoxazole prophylaxis
- Collaborate with BIPAI to develop a zonal Pediatric Center of Excellence at BMC
- Increase staff knowledge and skills through centralized and onsite trainings
- Promote integration of services and provider-initiated testing and counseling between care and treatment,
RCH, outpatient, and inpatient wards
To improve the quality and comprehensiveness of services, AIDSRelief shall
- Provide onsite clinical mentoring of all HIV care and support facilities, regular supportive supervision to all
65 partner facilities, and ongoing quality improvement
- -Provide ongoing training and retraining for a total of 498 care and treatment staff
- Perform nutritional assessments using appropriate anthropometric measurements on all children receiving
care and support, and ensuring those who are malnourished either receive food by prescription or are
referred for nutritional support.
- Ensure access to prophylaxis, diagnosis and treatment of opportunistic infections
- Link with malaria control programs to ensure access to insecticide treated bed nets for children
- Ensure that children are referred to other child survival programs, strengthening existing Integrated
Management of Childhood Illnesses practices in the Maternal Child Health (MCH) Clinics.
To strengthen local capacity and systems, AIDSRelief shall:
- Expand regional laboratory capacity and improve pharmaceutical management
- Strengthen financial and administrative systems
Laboratory activities include: training laboratory staff on specimen collection, providing means for specimen
transportation, and hiring and training a lab engineer to support maintenance of lab equipments.
AIDSRelief has also supported the purchase of six hematology machines, six chemistry machines and five
Facs Count Machines for local partner facility sites, as well as two ELISA machines. Local partner facilities
have also received general laboratory consumables. Training was focused on onsite mentorship during site
visits.
Program and finance support will be accomplished through provision of resources, capacity-building through
finance and compliance training, and supportive supervision.
In addition, to strengthen pharmaceutical and supply chain management, AIDSRelief shall continue to
monitor pediatric HIV/AIDS commodities in the national pipeline by liaising with Medical Stores Department
and NACP for regular updates and to relay information to and from local partner facility sites. AIDSRelief
will also improve the ability of partner facilities to select, forecast, store, order and dispense pediatric
HIV/AIDS commodities by providing centralized training and onsite mentorship. Also, rational use of
pediatric HIV/AIDS commodities will be achieved by incorporating a pediatric treatment component into the
rational use of medicines trainings, providing easy-to-use information packages and national dosing charts
and treatment updates, and technical support on use of the national Integrated Logistics System tools to
accurately capture pediatric requirements.
AIDSRelief will develop (or adapt if one exists) a drug information leaflet for caregivers (in Swahili) to be
Activity Narrative: handed over during dispensing. The content will be basic ART information on the specific drug, dosing and
M&E: AIDSRelief will monitor and report on the uptake and enrollment of HIV-infected children per site,
focusing on identifying HIV-exposed infants. AIDSRelief will also strengthen the capacity of sites, districts,
and regions to properly document, analyze and interpret data, and empower staff on data ownership and
use; AR will hire additional data clerks for new sites. In collaboration with sites, AIDSRelief will introduce
the International Quality (IQ) Care data package to sites that have larger data size (Muheza, Seko Toure,
Bombo, and Bugando) and can accommodate large numbers of patients. The IQ tool will be introduced to
all new sites and strengthened at older sites to support validation of data and provide quality reports.
SUSTAINABILITY: To ensure sustainability, AIDSRelief will empower Regional Health Management Teams
(RHMT) and Council Health Management Teams (CHMTs) in planning, implementation and supportive
supervision, and ensure ART-related activities are included in the Comprehensive Council Health Plans
(CCHP). AIDSRelief will also conduct joint supportive supervision with CHMT and RHMT members. Lastly,
AIDSRelief will continue working with FBOs and people living with HIV/AIDS (PLWHA) to support children
on care and treatment.
LINKAGES: AIDSRelief's established relationships with regional and district government and local
organizations, including RHMTs, CHMTs, FBOs and CBOs reinforce linkages for improved patient support.
Many of the 65 local partner facilities, plus the Christian Social Services Commission (CSSC), Archdiocese
of Mwanza, African Inland Church of Tanzania (AICT), Evangelical Lutheran Church of Tanzania (ELCT),
Anglican Health Secretariat and Mennonite Church (KMT), link to other complementary programs in
Tanzania's portfolio, including services for orphans and vulnerable children, nutritional support, home-based
care (HBC), water resource development, microenterprise, and other support from international and private
donors.
During program year six, formal linkages will be strengthened between CTCs and groups providing HBC in
these areas. Through onsite mentorship and centralized training, AIDSRelief will strengthen information
sharing and utilization between CTCs and MCH clinics. Outreach and adherence staff, using patient
attendance data, will utilize these networks to follow-up on missed appointments or patients lost to follow-
up. Groups of PLWHA will assist with scale-up by performing roles as lay counselors and adherence
support partners.
M&E: AR will continue to provide monitoring and evaluation (M&E) technical assistance to 65 local partner
facility sites. Support will be provided to all facilities on a quarterly basis by AR staff accompanied by RHMT
and CHMT members. This approach will build the capacity of facility-based staff to use existing MOHSW
tools for patient monitoring and tracking as well as enhance the ability of local partner facility staff to provide
quality supportive supervision. Initial and refresher trainings in the use of revised NACP data collection
tools will be provided to 498 healthcare workers, including members of RHMT and CHMT. Physical
improvements include computerization of paper-based information systems at the 35 hospital facilities,
further enhancing their ability to generate and use data for quality improvement, patient management and
reporting to MOHSW and other stakeholders. Approximately 7% of project support is designated for M&E.
SUSTAINABILITY: AR will support RHMTs and CHMTs in planning, implementation, and supportive
supervision, and pediatric care and support activities are included in the CCHP and facilitate supportive
supervision to be done by CHMT and RHMT. AR will also support local FBOs (e.g., AICT, ELCT, CSSC,
Anglican Church of Tanzania, KMT and Archdiocese of Mwanza); CBOs (e.g., Tanga AIDS Working
Group); and non-governmental organizations in each region. In addition, AR will support groups of PLWHA
to conduct adherence support activities. Also to enhance sustainability, AR will address policy issues
around the use of lay counselors and task shifting amongst healthcare workers at national level.
Estimated amount of funding that is planned for Food and Nutrition: Policy, Tools $10,000
Estimated amount of funding that is planned for Food and Nutrition: Commodities $15,000
Table 3.3.10:
NEED AND COMPARATIVE ADVANTAGE:
There are approximately 140,000 children living with HIV in Tanzania. By the end of 2007 only 11,176 had
ever received ART. There is a need to increase access, especially to younger children. With 4 regionally-
based teams working closely with Regional & Council Health Management Teams (RHMT & CHMT), faith &
community-based groups, AIDSRelief (AR) provides technical support & material inputs necessary to
increase ART enrollment among children under 15 in 65 local partner treatment facilities (LPTF). To
effectively scale-up pediatric ART services in Tanga, Manyara, Mwanza and Mara regions, AR intends to
build on its family-centered approach by increasing staff skills & knowledge, improving infrastructure,
strengthening EID and enhancing supply chain and management systems. Linkages between out-patient
departments (OPD), RCH clinics & pediatric wards will serve as entry points to bring more children into care
& treatment. In addition, AR is working closely with MOHSW, Bugando Medical Centre (BMC) & Baylor
Pediatric AIDS Institute to develop a zonal pediatric center of excellence at BMC in Mwanza.
ACCOMPLISHMENTS FROM FY 2007 AND FY 2008 FUNDING:
AIDSRelief's family-centered comprehensive package of support to HIV care and treatment partners
enabled them to respond to the needs of patients and promoted the conditions necessary to achieve
durable viral suppression.
By the end of June 2008, AIDSRelief has enrolled 58,738 clients in care, of which 4,399 (7.49%) are
children under the age of 15 years of age, in 51 CTC in the four AR-supported regions; AR has been able to
initiate 27,171 people on ART, of these, 1987 are children on ART (6.98%). By September 2008, 2360
children will be enrolled on ART, of which 11.2% will be less than 2 years of age.
ACTIVITIES:
Coverage and Quality Pediatric ART provision
Of the total number of patients receiving treatment at 65 sites in the 4 regions, 10% shall be children. Strong
focus will be on increasing testing of infants and children at multiple entry points by: (1) community
mobilization campaigns for pediatric testing days, (2) advocating for increased community-based HIV
testing with the National AIDS Control Program (NACP), (3) facilitating training of staff at health facilities for
early infant diagnosis (EID) in collaboration with NACP and Columbia University, and (4) partner-initiated
counseling and testing (PITC) at pediatric wards.
Other activities will include: (1) promoting improved capturing and tracking of all HIV-exposed infants and
infected children through mentorship and didactic training (2) promoting family-centered care and treatment
clinics, (3) continuing collaboration with Baylor Pediatric AIDS Institute to develop a zonal pediatric center of
excellence at BMC in Mwanza, (4) conducting centralized and on-site trainings on pediatric ART and
pediatric counseling by AR clinical staff and visiting international experts for staff from partner health
facilities and RHMT/CHMT and (5) establishing child friendly centers at Bombo, Muheza and Musoma
hospitals.
See Pediatric Care narrative for complete package of services for pediatric patients on ART.
In Year five, AR strengthened its capacity to provide technical assistance (TA) to improve LPTF
pharmaceutical and supply chain management. In Year six, the program will (1) continue to monitor
pediatric HIV/AIDS commodities in the national pipeline by communicate with Medical Stores Department
(MSD) and NACP for regular updates, relay information to LPTFs, and provide feedback from LPTFs and
(2) improve the ability of LPTFs to select, forecast, store, order and dispense Pediatric HIV/AIDS
commodities by providing centralized training and on-site mentorship. In addition, Rational Use of Pediatric
HIV/AIDS Commodities will be achieved through; 1) Incorporating pediatric treatment component into the
rational use of medicines trainings, 2) providing easy-to-use information packages, national dosing charts
and treatment updates and 3) providing technical support on using the national integrated logistics system
(ILS) tools to accurately capture pediatric requirements.
AIDSRelief will develop a drug information leaflet for care givers (in Swahili) to be handed over during
dispensing. The content will be basic ARV information on the specific drug, dosing and dosages, usage,
drug interaction & side effects. This information will also focus on pediatric ARVs. To date, the drug
information job aids used in Tanzania have been developed for health workers; this will be the first drug
information leaflet geared toward mothers and care givers.
Laboratory support will include (1) training Laboratory staff on specimen collection and transportation (2)
providing means for specimen transportation and (3) hiring and training of lab engineers to support
maintenance of lab equipment. Lab tests will include CD4 and basic chemistry and blood tests. See lab
and Adult ARV narratives for more information.
This will be accomplished through (1) provision of resources
(2) Capacity building through finance and compliance training and (3) supportive supervision.
LINKAGES:
AIDSRelief's established relationships with regional and district government, including RHMTs, faith-based
networks and community-based groups to reinforce linkages for improved patient support. Many of our 71
(65 LPTFs plus Christian Social Service Commission (CSSC), Archdiocese of Mwanza, African Inland
Church, Evangelical Lutheran Church of Tanzania (ELCT), Anglican Health Secretariat and Mennonite
Church) current partners link to programs in Tanzania's portfolio including OVC and nutritional support,
HBC, water resource development, micro enterprise and other international and private donors.
Activity Narrative: During year six, formal linkages will be strengthened between CTCs and groups providing home based
palliative care in these areas. Through on-site mentorship and centralized training, AIDSRelief will
strengthen information sharing and utilization between CTC and RCH clinics. Outreach and adherence staff,
using patient attendance data, will utilize these networks to follow up on missed appointments or patients
lost to follow up. PLWHA groups will assist with scale up by performing roles as lay counselors and
adherence support partners.
AREAS OF EMPHASIS AND POPULATIONS:
(1) Capacity building of health care workers to offer quality care to infants & children; (2) Supply Chain
Management (3) Human resource development (4) Laboratory services strengthening (5) EID (6) Proper
use and documentation of pediatrics information.
MONITORING AND EVALUATION:
AIDSRelief will continue providing M&E technical assistance to 65 existing partners. The technical
assistance will be accompanied by Regional and District level MOHSW personnel. This approach will build
as enhance the ability of MOHSW staff to provide quality supportive supervision. Initial and refresher
trainings in the use of revised MOHSW data collection tools will be provided to 498 HCW's, including
members of RHMTs and CHMTs. Physical improvements include computerization of paper-based
information systems at 35 hospital facilities, further enhancing their ability to generate and use data for
quality improvement, patient management and reporting to MOHSW. Approximately 7% of project support is
designated for M&E.
HEALTH MANAGEMENT INFORMATION SYSTEMS (HMIS):
AIDSRelief will (1) provide updates on the uptake and enrollment of HIV infected children per site, focusing
on identifying HIV exposed infants and providing PITC at pediatric out-patient clinic and in-patient wards; (2)
strengthen the capacity of sites, districts and regions in the proper documentation, analysis and
interpretation of data and empower them on data ownership and data use. (3)In collaboration with sites
AIDSRelief will support hiring of additional data clerks for new sites. (4) AR will provide ongoing training and
retraining a total of 498 CTC staff. (5) AIDSRelief will introduce the IQCare data package to sites which
have larger data size (Muheza, Seko Toure, Bombo and Bugando) which can accommodate large numbers
of patients. (6) International Quality (IQ) Tool will be introduced to all new sites and strengthen older sites in
order to support validation and provision of quality reports.
SUSTAINABILITY:
AIDSRelief will a) support RHMTs and CHMTs in planning, implementation, and supportive supervision, and
ensure pediatric care and support activities are included in the Council Comprehensive Health Plan
(CCHP), b) conduct joint supportive supervision with CHMT and RHMT members, c) support local partners
(FBOs e.g. Christian Social Service Commission (CSSC), Archdiocese of Mwanza, African Inland Church,
Evangelical Lutheran Church of Tanzania (ELCT), Anglican Health Secretariat and Mennonite Church);
CBOs e.g. Tanga AIDS Working Group; NGOs in each region to support children on treatment (c) support
PLWHA groups in conducting adherence support activities; d) address policy issues around the use of lay
counselors and task shifting amongst HCWs at national level
Estimated amount of funding that is planned for Human Capacity Development $106,910
Table 3.3.11:
ACTIVITY HAS BEEN MODIFIED IN THE FOLLOWING WAY
TITLE: Scale up of TB/HIV collaborative services in Mara, Manyara, Mwanza, and Tanga
FY09 activities will focus on the strengthening collaborative TB/HIV activities which will include
implementation of the "Three Is " to make sure that HIV infected patients attending care and treatment are
all screened for TB at all visits, TB infection control is implemented and provision of Isoniazid Preventive
Therapy (IPT) is piloted. The activities described are to be conducted in collaboration with the Ministry of
Health and Social Welfare (MOHSW) through the National AIDS Control Program (NACP), National
Tuberculosis and Leprosy Program (NTLP), Regional Health Management Team (RHMT) and Council
Health Management Team (CHMT). Specific activities will include: strengthen Intensified TB Case Finding
(ICF), strengthen TB screening to family members of TB/HIV co-infected patients, strengthen TB screening
at Reproductive and Child Health - Prevention of mother to child transmission of HIV clinics for pregnant
women who are HIV positive and children, implement TB infection control (IC) measures to all HIV clinics,
conducting regular sites visits and on job-training, print and distribute TBHIV guidelines including screening
tools, SOPs and job aids, conduct training sessions on ICF, IC and TB diagnostics and quality assurance to
Health Care Workers (HCW) and laboratory staff to improve TB diagnosis and quality assurance. Catholic
Relief Services will ensure availability of HIV test kits at TB clinic, procurement and maintenance of
microscopes, supplement laboratory reagents for direct sputum smear microscopy, print and distribute
TB/HIV guidelines, job aids, strengthen the referral system between CTC, laboratory, TB clinics and other
services, improving regular and comprehensive TB/HIV patients' education. AIDS Relief will participate in
the national TB/HIV planning, share information and data evaluation at district, regional and health facility
level through USG partners and NTLP/NACP meetings. Work with Ministry of Health in the finalization and
development of TB/HIV guidelines, Support the RHMT and DHMT/ CHMT in planning the integration of
TB/HIV activities and training on TB/HIV collaborative services.
NEED and COMPARATIVE ADVANTAGE: There have been government efforts toward universal access to
quality TB care and treatment services, particularly for those co-infected with HIV, yet targets are still unmet
due to minimal entry points to TB services from other HIV-related programs. To maximize entry points for
HIV diagnosis, treatment and screening for TB, AIDSRelief plans to strengthen links between Anti Retroviral
Treatment (ART) and TB services through its network of partners providing quality HIV care and treatment.
AIDSRelief uses this network to link and strengthen referral systems, thereby creating a bi-directional entry
into HIV prevention, care and treatment services. Using its 37 ART partners in Manyara, Tanga, Mara and
Mwanza regions, a total of 27,162 patients from care and treatment centers (CTC) will be screened for TB.
Those found to be TB/HIV co-infected (approximately 10%) will be referred to a TB clinic for care. The
TB/HIV co infected patients referred from TB clinics will be received at a CTC, and provided with quality
care and treatment services. AIDSRelief will scale-up TB screening services to a total of 37 sites by end of
February 2009, up from 31 sites in 2008.
ACCOMPLISHMENTS: With FY 2006 and FY 2007 funding, 30,719 clients (including TB patients) who
were referred to volunteer counseling and testing units (VCT) received counseling and testing at VCT. Of
those, 6,183 (20%) tested positive. Among HIV infected clients, 59% were screened for TB. In order to
strengthen TB/HIV services, AIDSRelief provided training on HIV counseling and on management of TB/HIV
co-infection to 16 health care providers. AIDSRelief also improved referral methods and linkages among
TB, ART, VCT, and Prevention of Mother to Child Transmission (PMTCT) services to reduce missed
opportunities for diagnosis and care and treatment. Improved referral methods and linkages resulted in a
higher acceptance rate (96%) for testing after counseling, and increased referrals among VCT, ART and TB
services.
ACTIVITIES: 1) Decrease the burden of TB among people living with HIV and AIDS attending AIDS Relief
supported sites 1a) Strengthen intensified TB case-finding at existing AIDSRelief supported sites 1b)
Establish intensified case-finding at newly established AIDSRelief supported sites. Needs assessment will
be conducted at 31 current TB/HIV sites and 6 new sites to identify areas for scale-up.
1c) Train Health Care Workers (HCW) at the new sites on TB/HIV collaborative services using the national
TB/HIV training curriculum. Print and distribute TB screening tool and job aids. Conduct refresher training
for HCW from 31 existing sites. 1d) Provide ongoing supportive supervision to ensure proper linkages
between HIV-related services and improved quality. 1e) Screen all family members of PLHAs who have
been diagnosed with active TB 1f) Strengthen referral methods and linkages between HIV and TB clinics at
AIDSRelief supported sites through regular information exchange meetings of HCW from HIV and TB sites.
1g) Conduct refresher training for laboratory technicians/personnel in TB diagnostics and quality assurance.
1h) Implement infection control measures to all CTC sites. 1i) Receive all TB/HIV co-infected patients from
TB clinic.
2) Establish mechanisms for TB/HIV collaboration. 2a)Collaborate with the National Tuberculosis and
Leprosy Program (NTLP), National AIDS Control Program (NACP), Program for Appropriate Technology in
Health (PATH) and other NGOs, regional, district and facility based TB/HIV bodies in the implementation of
TB/HIV activities. 2b) Participate in the National TB/HIV planning and share information at the district,
regional and site level through annual stakeholder meetings and regular support to the districts and sites.
2c) Participate in national TB/HIV monitoring and evaluation activities to further refine TB management
tools. 2d) Support the Regional and District Health Management Teams (RHMT & DHMT respectively) in
planning the integration of TB/HIV activities, supervision by training RHMT and DHMT members on TB/HIV
collaborative services. 2e) Work with other TB/HIV implementing partners such as PATH and NTLP to
improve linkages through regular communications and meetings.
to build effective linkages for TB/HIV co-infected patients' continuum of care. All PLHA from CTC, VCT, and
PMTCT who will be screened for TB and found to have active TB will be referred to a TB clinic for
management, according to the national guidelines. Working in collaboration with NTLP and PATH, all
HIVinfected
Activity Narrative: TB patients referred from TB clinics will be received at CTC and provided with quality care and
treatment services; feedback will be provided to the referring clinic staff. Those facilities without TB
diagnostic services will refer all PLHA suspected to have TB to TB clinics for management, which includes
sputum smear microscopy and X-ray. Patients will be linked to other HIV and non-HIV related services in
the district/region e.g HBC, legal assistance, spiritual support, food support services etc. AIDSRelief
supports 47 ART centers in the 4 regions, and will collaborate with other partners implementing TB/HIV in
the same region such as PATH in Mwanza and NTLP in Tanga, Mara and Manyara to ensure smooth
referral, linkages and follow up of patients.
CHECK BOXES: The areas of emphasis were chosen because activities will include training for TB and HIV
health workers along with on-site strategic information and technical assistance. The general population will
be targeted in HIV counseling and testing activities to increase uptake of VCT services. Persons living with
HIV will be targeted in TB screening and referral activities.
M&E: a) AIDS Relief will collaborate with the NACP and NTLP to implement national M&E systems for
TB/HIV collaborative services in the 4 regions of Tanga, Manyara, Mwanza and Mara b) The TB Screening
tool will be implemented at all 47 existing, and 6 new sites and c) TB/HIV referrals will be documented using
the 2-way referral form between CTC and TB clinics d) AIDSRelief will provide technical assistance at all
sites for implementation of TB/HIV M&E systems and share quarterly and semi-annual/annual reports at the
site, district, regional and national level e) Data quality will be ensured through regular supervision visits f)
70 HCW will be trained in the TB/HIV M&E system in the 4 regions supported by AIDSRelief.
SUSTAINAIBLITY: TB/HIV program will be sustained by integrating the services into the existing health
system, by involving regional and district health management teams, incorporating the activities in the
district health plans, building capacity of local authorities, coordinators, and health care providers on TB/HIV
collaborative activities through training. Training of local authorities will improve capacity to manage
integrated TB/HIV programs from both an administrative and a technical stance.
Continuing Activity: 13451
13451 5114.08 HHS/Health Catholic Relief 6504 2368.08 $350,000
7693 5114.07 HHS/Health Catholic Relief 4525 2368.07 AIDRelief $350,000
5114 5114.06 HHS/Health Catholic Relief 2886 2368.06 AIDSRelief $350,000
Table 3.3.12:
Need and comparative advantage: Bugando Medical Centre (BMC) laboratory is a referral center for six
regions Mwanza, Shinyanga, Mara, Kagera, Tabora and Kigoma providing laboratory services for HIV
diagnosis, Antriretroviral Therapy (ART) monitoring, Tuberculosis, and is the first laboratory offering infant
diagnosis services. The BMC laboratory began is implementing quality system with a goal to attain
international accreditation in FY 2007 As part of this process, with USG support the Clinical and
Laboratory Standards Institute (CLSI) conducted an assessment of BMC laboratory using ISO 15189 and
Tanzanian Health laboratory Standards documents. A gap analysis reported was presented to the BMC
laboratory, the BMC management and the Ministry of Health and Social Welfare (MOHSW). In 2007 and
2008 CLS I placed experienced laboratory mentors in the laboratory for short periods of time to provide
guidance on accreditation. AR will use FY 2009 funding to address the identified gaps.
AIDSRelief (AR) provides HIV care and treatment in 4 regions: Mwanza, Mara, Manyara, and Tanga
regions and works closely with RHMTs, CHMTs, faith and community-based groups and MOHSW and has
exhibited the capacity to provide technical support and material inputs necessary to assist BMC laboratory
to implement quality system. AR has implemented laboratory strengthening in Mwanza, Mara, Manyara
and Tanga regions. By June 30th 2008, AIDS Relief was supporting 36 laboratories in these regions with
provision of technical assistance in laboratory management, organization, specimen management, supply
chain system, quality assurance, laboratory documentation and reporting, equipment maintenance and the
use and maintenance of Standard Operational Procedures. AR has provided reagents for CD4,
haematology, chemistry and laboratory consumables, procured equipment and recruited technical staff in
10 laboratories in these four regions AR established a CD4 testing network within its regions that has
improved support for CD4 supplies. AR conducted a campaign to increase CD4 testing which resulted in a
a 100% increase in the targeted sites.
Accomplishments: New partner
.Activities: The purpose of this funding is to implement Labortory Quality Management Systems at BMC
referral laboratory and attain international accreditation. With USG support, Bugando Medical Center will be
strengthened to support the regions within the Lake Zone . With FY 09 funds AIDS Relief will support
BMC laboratory become an effective tertiary laboratory for Lake Zone covering the six regions of Mwanza,
Mara, Kigoma, Tabora, Shinyanga and Kagera. AR will train 20 laboratory personnel at BMC on quality
management systems, laboratory management, equipment usage and maintenance, supply chain
management and specific testing procedures . Laboratory personnel will be trained onsite with individual
interaction with AIDS Relief laboratory specialist. Trainings will include the provision of general standard
operating procedures, bench aids, documentation logs, and reference materials. Laboratory technicians and
technologists will be trained on planned preventive maintenance and equipment maintenance logs to
ensure that all equipment at the center are functional at all times to reduce down time. AR will utilize
standardized MOHSW training materials and documents such as laboratory registers, request forms,
temperature charts, equipment monitoring logs, analytical charts, and Standard Operational Procedures. AR
will conduct a hospital wide training for laboratory and non laboratory staff who handle laboratory
specimen on specimen management . This will include specimen collection, transportation, safety and post
exposure prophylaxis.
AR Laboratory specialists will provide quarterly supportive supervisory visits to monitor progress and meet
capacity building needs. All quality laboratory assessments will be performed using MOHSW standard
laboratory assessment and evaluation tools A site action list will be developed at the end of each visit listing
the tasks to be accomplished before the next quarterly visit and will be provided to the laboratory manager,
BMC management and MOHSW
BMC will continuously improve and monitor improvement of the laboratory services and customer
satisfaction by meeting with laboratory and clinical staff on a regular basis.
Linkages: AR will link with MOHSW, African Medical Research Foundation, and the other USG laboratory
Implementing partners Clinical and Laboratory Standards Instituted, American Society for Clinical
Pathologists, Association of Public Health Laboratories, American Institute for Health Alliance , American
Society for Microbiology The BMC laboratory component is closely linked with the ART services in BMC and
the lake zone , the National TB Reference Laboratory, MOHSW diagnostic services, the National Health
Laboratory Quality Assurance and Training Center and Columbia University.
M&E: Monitoring forms for HIV/AIDS services at BMC currently do not have a representative laboratory
component. AR will collaborate with MOHSW CDC and CLSI to develop quality indicators to guide and
monitor implementation of the quality system utilizing the checklist developed by MOHSW.
Sustainability: The BMC management was involved at the inception of the accreditation process and are
supportive of the activity. All of the activities are implemented by BMC personnel with financial and
technical assistance from AR, CDC Tanzania and USG laboratory partners.. The staff meetings between
the hospital management, clinicians and laboratory personnel as part of customer satisfaction and
continuous improvement will promote laboratory integration in the day to day hospital management
activities and thereby sustain the quality initiatives,. Management support is crucial to the success of quality
systems implementation. . .
New/Continuing Activity: New Activity
Continuing Activity:
Table 3.3.16:
