THIS IS A NEW ACTIVITY

NEED and COMPARATIVE ADVANTAGE: Tanzania ranks ninth globally in the total number of deaths for

children under five years old; amounting to approximately 188,000 in 2006 (UNICEF). HIV/AIDS ranks

among the five leading causes of pediatric mortality throughout Tanzania; in high prevalence regions such

as Mbeya, HIV/AIDS may represent the second leading cause of pediatric mortality (UNICEF, TACAIDS

2008). Considerable effort has been initiated by several USG agencies and partners, including the US

Department of Defense (DOD), Columbia University, and AIDSRelief, to ensure coverage of pediatric

HIV/AIDS services. Baylor will collaborate with these partners to strengthen the national effort to address

pediatric HIV and AIDS. In addition, Baylor will work with treatment partners to support the scale-up of

family-centered pediatric HIV/AIDS care and treatment throughout Tanzania, especially the Lake and

Southern Highlands Zones.

The Baylor College of Medicine International Pediatric AIDS Initiative (BIPAI) was established in 1996 to

foster international HIV/AIDS prevention, care, and treatment, health professional education, and clinical

research. As the largest university-based program worldwide dedicated to improving the health and lives of

HIV-infected children, operating in several countries, BIPAI brings a wealth of experience to Tanzania. The

mission of BIPAI and its affiliated non-government organizations (NGOs) is to conduct a program of high-

quality, high-impact, highly ethical pediatric and family-centered HIV/AIDS care and treatment, health

professional training, and operational research relevant to the local context.

BIPAI is also one of 23 Fogarty International Center-funded AIDS International Training and Research

Programs, which supports the advanced training of African and other international fellows at Baylor College

of Medicine in Houston, Texas. As the principal technical assistance partner to UNICEF in pediatric and

family HIV/AIDS care and treatment, BIPAI literally accesses the cumulative experiences and best practices

of more than 120 countries, on every continent. The skill set developed by BIPAI over the course of more

than a decade of work in providing care and treatment services to HIV-infected children and families in

resource-poor settings provides a nearly ideal basis for the program.

BIPAI brings a Public-Private Partnership to this program, engaging resources from the Abbott Foundation

and the Bristol-Myers Squibb Foundation, as well as private contributions, to make an equal match for

support.

ACTIVITIES: The goal of the program is to focus attention on pediatric HIV/AIDS services, augmenting

treatment partners' efforts and reducing HIV/AIDS-related morbidity and mortality among infants, children,

and adolescents in Tanzania. This will be achieved through the scale-up of comprehensive pediatric and

adolescent HIV/AIDS care and support services in the zonal regions of Mbeya and Mwanza. The program

will bring focus to the needs of HIV-positive children, and will complement ongoing care and treatment

services. It will develop a pediatric-centered approach intended to build the number of providers who are

competent to care for HIV-positive children at both referral hospitals and lower-level facilities. Scale-up of

pediatric HIV/AIDS prevention, care, and treatment services will initiate in Mbeya and Mwanza, and will

proceed in two phases. Phase One involves the provision of pediatric specialists and establishment of a

transitional clinic for the provision of family-centered pediatric HIV/AIDS prevention, care and treatment at

the zonal referral hospital, and the construction of two Pediatric AIDS Centers of Excellence to serve as the

zonal hub of upcoming activities. Phase Two will primarily occur in subsequent fiscal years, but during FY

2009, BIPAI will perform an assessment and develop the plan for program will roll-out, first to the region and

then to the larger zones. It will initiate outreach services to district hospitals and health centres. Based on

needs and gaps determined during Phase One, additional Baylor Pediatric AIDS Corps (PAC) physicians

and local health professionals will be recruited to support programs initiated in Phase One. BIPAI will

continue to support and strengthen referral hospital activities.

Specifically, in FY 2009 the program will:

1. Provide comprehensive primary and HIV/AIDS specialty care and support to all known HIV-infected

children following a ten-point Pediatric HIV Management Plan and a Basic Care Package developed by

BIPAI, based on experience in other countries. The Management Plan will be adapted to the Tanzanian

setting and serve as the cornerstone element of the initiative. The Plan and Basic Care Package includes

infant feeding counseling, other nutritional support, Cotrimoxazole prophylaxis, access to early infant

diagnosis, malaria interventions, safe water interventions, immunization, treatment for opportunistic

infections (OIs) or other acute needs, adolescent care and support, and linkages to routine maternal-child

health services. Shortfalls in pediatric staffing will be addressed through the placement of PAC physicians

to work side-by-side with Tanzanian health workers for effective mentoring. The program will build on

existing maternal-child health services, wrapping around child survival, malaria, and Prevention of Mother-to

-Child Transmission programs.

2. Expand case finding for children who are HIV-positive through strengthened pediatric HIV/AIDS

counseling and testing using a family-centered testing model, especially by supporting and expanding

existing hospital-based testing and counseling. The identification of an HIV-infected mother will provide the

opportunity to test other family members, including other children and male partners. For children less than

18 months of age, DNA PCR (polymerase chain reaction) equipment is already available in Mwanza and

Mbeya. HIV-exposed infants who test negative, but are still breastfeeding, can be identified for continued

care, monitoring, and Cotrimoxazole prophylaxis until after weaning, when a definitive HIV diagnosis can be

made. HIV-positive children will be screened for OIs and identified OIs will be managed according to

national guidelines. The program will work closely with the TB/HIV group to modify and update guidelines

and adopt appropriate tools to screen and identify HIV-positive children likely to be exposed to or have TB.

The program will provide Isoniazid preventative therapy, as indicated, as well as TB treatment.

The program will extend services to OVC through the Most Vulnerable Children's Committees and

community support groups, so that HIV-exposed children can be identified, tested, and provided with

appropriate follow up.

Activity Narrative: 3. In collaboration with the Ministry of Health and Social Welfare (MOHSW), district hospitals, and local

stakeholders, BIPAI pediatric faculty will initiate ongoing training of health professionals in Mbeya and

Mwanza regions using a three-pronged approach, including didactic trainings, practical clinical attachments,

and on-site support supervision and mentorship. In addition, BIPAI health professionals will provide

supportive supervision and mentorship by working side-by-side with local health professionals to deliver

family-centered HIV/AIDS care and treatment in their own health facilities.

4. Work with Columbia University, Elizabeth Glaser Pediatric AIDS Foundation (EGPAF) and other key

partners to inform pediatric HIV policy and strengthen the local human resource and health system capacity

to provide comprehensive, family-centred paediatric HIV/AIDS care and support services. BIPAI will also

work with other partners, as requested, to strengthen approaches to increase identification and care and

support services to HIV-positive children.

5. Work with major training institutions, e.g., Bugando University of Health Sciences, to enhance the

training curriculum and methods for pediatric care, and strengthen practicum opportunities for health worker

trainees.

6. Sensitize and mobilize local government authorities, people living with HIV/AIDS (PLWHA) and the

general population to support the provision of pediatric and family-centered pediatric HIV/AIDS prevention,

care, and treatment services. The program will conduct of surveys of community-based organizations

located in the Mwanza and Mbeya zones/regions, and launch a program of community mobilization in the

first quarter of 2009. The goals of these community outreach initiatives include improving the knowledge of

the benefits and availability of pediatric and family-centered HIV/AIDS care and treatment; mobilizing adults

to have at-risk infants children tested for HIV and subsequently enrolled into care as necessary; supporting

patient appointment and treatment adherence; enhancing patient retention in care, i.e. reduce the number

of patients lost to-follow-up; and identifying orphans and vulnerable children (OVC) who may have been

exposed to HIV at birth.

Program and general family-centered HIV/AIDS service information will be provided through entertainment,

media opportunities for public awareness,, and printed materials, such as leaflets or pamphlets.

Mobilization will concentrate on the services most needed and having the greatest impact.

LINKAGES: All programs are intended to build on and not duplicate existing services. BIPAI will be

committed to collaborative partnerships with existing USG-supported partners, especially AIDSRelief and

the Touch Foundation in Mwanza, Columbia University, and EGPAF in other areas of the Lake Zone, the

US DOD in Mbeya, Deloitte/Family Health International in Iringa, and EGPAF at Kilimanjaro Christian

Medical Centre. BIPAI staff on the ground in Tanzania will collaborate with the MOHSW Pediatric AIDS

Working Group through the National AIDS Control Programme (NACP) community leaders, Most

Vulnerable Children's Committees who oversee OVC care in the community, and other stakeholders to

ensure that OVC benefit from these services and that there is effective integration of program activities and

services into the existing landscape. BIPAI staff will liaise with community leaders to develop and "brand"

the program.

M&E: A formal and comprehensive M&E plan will be developed prior to program implementation. The M&E

plan will also delineate responsibilities for data collection, reporting, analysis, and dissemination. The

program will standardize processes for quality assurance (e.g., record keeping, data management,

adherence to procedures and policies) and for quality control of service delivery. In the interim, BIPAI will

work with the USG, MOHSW/NACP to agree upon an M&E system. It will ensure a computerized patient

database and electronic medical record. Summary reports of activity at individual sites and across the

whole network will be prepared and circulated on a monthly basis. More complex evaluations of program

impact also will be considered (e.g., impact on patient quality of life, community socioeconomic status,

health facility status).

SUSTAINABILITY: The success of BIPAI models includes the establishment of multi-tiered public-private

alliances for 1) the construction of the Centers of Excellence and satellite centers; 2) sustainable

operational support through public-private partnerships; 3) provision of decentralized comprehensive, family

-centered pediatric HIV/AIDS prevention, care and treatment services; 4) technical assistance and capacity

building initiatives for health professional training and health systems strengthening; and 5) community

mobilization initiatives to support family-centered pediatric HIV prevention, care and treatment services.

Once the Centers of Excellence are completed and operational, BIPAI will commit to securing resources for

the improvement of existing MOHSW periphery facilities in both zonal regions which will act as satellite

Centers for decentralized care and health professional training platforms.

New/Continuing Activity: New Activity

Continuing Activity:

Emphasis Areas

Health-related Wraparound Programs

* Child Survival Activities

* Malaria (PMI)

Human Capacity Development

Estimated amount of funding that is planned for Human Capacity Development $100,000

Public Health Evaluation

Food and Nutrition: Policy, Tools, and Service Delivery

Food and Nutrition: Commodities

Economic Strengthening

Education

Water

Table 3.3.10:

THIS IS A NEW ACTIVITY.

Need and comparative advantage: Tanzania ranks 9th globally in the total number of deaths in children

under five years old, some 188,000 in 2006 (UNICEF). HIV/AIDS ranks among the five leading causes of

pediatric mortality throughout Tanzania; in high prevalence regions such as Mbeya, HIV/AIDS may

represent the 2nd leading cause of pediatric mortality (UNICEF, TACAIDS 2008). In summary, an urgent

need exists for scale-up of family-centered pediatric HIV/AIDS care and treatment throughout Tanzania,

especially the Lake and Southern Highlands Zones.

The Baylor College of Medicine International Pediatric AIDS Initiative (BIPAI) was established in 1996 to

foster international HIV/AIDS prevention, care, and treatment, health professional education, and clinical

research. It has rapidly become the largest university-based program worldwide dedicated to improving the

health and lives of HIV-infected children, operating in several countries. The mission of BIPAI and its

affiliated non-government organizations (NGO) is to conduct a program of high quality, high impact, highly

ethical pediatric and family HIV/AIDS care and treatment, health professional training, and operational

research relevant to the local context. BIPAI is also one of 23 Fogarty International Center-funded AIDS

International Training and Research Programs, which supports the advanced training of African and other

international fellows at Baylor College of Medicine, Houston, Texas. As principal technical assistance

partner to UNICEF in pediatric and family HIV/AIDS care and treatment, BIPAI literally accesses the

cumulative experiences and best practices of more than 120 countries on every continent. The skill set

developed by BIPAI over the course of more than a decade of work in providing care and treatment services

to HIV-infected children and families in resource-poor settings, provides a nearly ideal basis for the

proposed program.

BIPAI brings a Public-Private Partnership to this program, engaging resources from the Abbott Foundation

and the Bristol-Myers Squibb Foundation, as well as private contributions, to make a 1:1 match for support.

Activities: The goal of the program is to reduce HIV/AIDS-related morbidity and mortality among infants,

children, and adolescents in Tanzania through the scale-up of comprehensive pediatric and adolescent

HIV/AIDS prevention, care and treatment services in the zonal regions of Mbeya and Mwanza. The program

will bring focus to the needs of HIV-positive children, and will complement ongoing care and treatment

services. It will develop a pediatric-centered approach intended to build the number of providers who are

competent to care for HIV-positive children at both referral hospitals and lower level facilities. Specifically:

1. The program will provide comprehensive primary and HIV/AIDS specialty care and treatment to all

known HIV-infected children following the 10-point Pediatric HIV Management Plan and a Basic Care

Package developed by BIPAI, based on experience in other countries. It will be adapted to the Tanzanian

setting and serve as the cornerstone element of the initiative. The Basic Care Package was designed and

selected based on evidence-based research and data collected from Ugandan health care evaluation is a

patient-managed, home-based care system that empowers HIV-positive people to prevent opportunistic

infections, delay the progression of HIV to AIDS and prevent transmission of HIV to others. Scale-up of

pediatric HIV/AIDS prevention, care, and treatment services in Mbeya and Mwanza will proceed in two

phases. Phase I involves the establishment of a transitional clinic for the provision of family-centered

pediatric HIV/AIDS prevention, care and treatment at the zonal referral hospital. Assessment of current

models of treatment will determine whether BIPAI medical staff will be integrated into current pediatric

HIV/AIDS-related activities or whether these activities would have to be developed de novo. To immediately

supplement local health professional capacity, BIPAI will recruit four Pediatric AIDS Corps (PAC) doctors.

Two physicians will be assigned to each of the two referral hospitals. Outpatient pediatric HIV/AIDS services

will take place in a transitional facility at each zonal referral hospital until the COE construction is completed.

In Phase II, the program will roll out outreach services to district hospitals and health centers. Based on

needs and gaps determined during Phase I, additional PAC physicians and local health professionals will be

recruited to support care and treatment programs initiated in Phase I. Referral hospital activities will

continue to be supported and strengthened.

2. The program will expand case finding for children who are HIV-positive through strengthened pediatric

HIV/AIDS counseling and testing using a family-centered testing model, especially by supporting and

expanding existing hospital-based testing and counseling. The identification of an HIV-infected mother will

provide the opportunity to test other family members, including other children as well as male partners. For

children less than 18 months of age, DNA PCR is already available in Mwanza and is being initiated in

Mbeya. HIV-exposed infants who test negative but are still breastfeeding can be identified for continued

care and monitoring and cotrimoxazole prophylaxis until after weaning, when a definitive HIV diagnosis can

be made.

3. The program will strengthen the local human resource and health system capacity to provide

comprehensive, family-centred paediatric HIV/AIDS prevention, care, and treatment services.

In collaboration with the Ministry of Health and Social Welfare (MOHSW), district hospitals, and local

stakeholders, BIPAI will provide ongoing training of health professionals in Mbeya and Mwanza regions

using a three-pronged approach, including didactic trainings, practical clinical attachments, and on-site

support supervision and mentorship. In addition, BIPAI health professionals will provide support supervision

and mentorship by working side-by-side with local health professionals to deliver family-centered HIV/AIDS

care and treatment in their own health facilities. BIPAI will also work with major training institutions, e.g.,

Bugando University of Health Sciences, to enhance the training curriculum and methods for pediatric care.

BIPAI will also work with other partners, as requested, to strengthen approaches to increase identification

and services to HIV-positive children.

4. Lastly, BIPAI will sensitize and mobilize people living with HIV/AIDS (PLWHAs) and the general

population to support the provision of pediatric and family-centered pediatric HIV/AIDS prevention, care,

and treatment services. In conjunction with conduct of surveys of Community-Based Organizations (CBOs)

located in the Mwanza and Mbeya zones/regions, a program of community mobilization will be launched in

the first quarter of 2009. Program and general family-centred HIV/AIDS service information will be provided

Activity Narrative: through entertainment, speeches, and printed materials like leaflets or pamphlets. Mobilization will

concentrate on the services most needed and having the greatest impact.

Linkages: BIPAI will partner other stakeholders and the Government of Tanzania in the establishment of

regionally integrated programs that will satisfy PEPFAR pediatric treatment objectives. All programs are

also intended to build on and not duplicate existing services. BIPAI will be committed to collaborative

partnerships with existing USG-supported partners, especially AIDS Relief and the Touch Foundation in

Mwanza, Columbia, and EGPAF in other areas of the Lake Zone, US Department of Defense in Mbeya,

Deloitte/Family Health International in Iringa, and EGPAF at Kilimanjaro Christian Medical Centre.

BIPAI staff on the ground in Tanzania will collaborate with the MOHSW Pediatric AIDS Working Group

through the National AIDS Control Program (NACP) community leaders, Most Vulnerable Children's

Committees (MVCC) who manage OVC in the community, and other stakeholders to ensure that OVC

benefit from these services and that there is effective integration of program activities and services into the

existing landscape. BIPAI staff will liaise with community leaders to develop and "brand" the program.

Target Population: Children with HIV and their families are the main target population, including orphans

and vulnerable children, in the Mbeya and Mwanza Zones for prevention, diagnosis, care, treatment and

support.

M&E: A formal and comprehensive monitoring and evaluation (M&E) plan will be developed prior to

program implementation. The M&E plan will also delineate responsibilities for data collection, reporting,

analysis, and dissemination. Standardized processes for quality assurance (e.g., record keeping, data

management, adherence to procedures and policies) and for quality control of service delivery. In the

interim, BIPAI will work with the USG, MOHSW/NACP to agree upon an M&E system. It will ensure a

computerized patient database and electronic medical record. Summary reports of activity at individual

sites and across the whole network will be prepared and circulated on a monthly basis. More complex

evaluations of program impact also will be considered (e.g., impact on patient quality of life, community

socioeconomic status, health facility status). Finally, BIPAI has prepared a toolkit to guide organizations

through the process of developing, monitoring and evaluating HIV pediatric treatment programs in resource-

limited settings. BIPAI will adapt this toolkit for specific use in the proposed program in Mbeya and

Mwanza.

Sustainability:

The success of BIPAI models includes the establishment of multi-tiered public-private alliances for 1) the

construction of the COEs and satellite centers; 2) sustainable operational support through public-private

partnerships; 3) provision of decentralized comprehensive, family-centered pediatric HIV/AIDS prevention,

care and treatment services; 4) technical assistance and capacity building initiatives for health professional

training and health systems strengthening; and 5) community mobilization initiatives to support family-

centered pediatric HIV prevention, care and treatment services. Once the COEs are completed and

operational, BIPAI will commit to securing resources for the improvement of existing MOHSW periphery

facilities in both zonal regions which will act as satellite centers of excellence (SCOE) for decentralized care

and health professional training platforms.

New/Continuing Activity: New Activity

Continuing Activity:

Emphasis Areas

Human Capacity Development

Estimated amount of funding that is planned for Human Capacity Development $200,000

Public Health Evaluation

Food and Nutrition: Policy, Tools, and Service Delivery

Food and Nutrition: Commodities

Economic Strengthening

Education

Water

Program Budget Code: 12 - HVTB Care: TB/HIV

Total Planned Funding for Program Budget Code: $8,017,799

Total Planned Funding for Program Budget Code: $0

Program Area Narrative:

Program Area Context

HVTB - Palliative Care: TB/HIV

COP 2009

Program Area: Palliative Care: TB/HIV

Budget Code: HVTB

Total Requested Budget: $ 7,977,150

Program Area Context:

The Tanzania Health Sector Strategy on HIV/AIDS identifies Tuberculosis (TB) as the leading cause of death among people living

with HIV/AIDS (PLWHA). According to the Ministry of Health and Social Welfare (MOHSW), the incidence of TB cases has

increased, due in part to the expanding HIV epidemic, with 61,603 and 65,665 TB cases reported in 2001 and 2005, respectively.

In 2006, 52% of all TB patients in Tanzania were HIV-positive (National TB and Leprosy Programme [NTLP] annual report).

USG TB/HIV programs focus on supporting national efforts to strengthen collaborative TB/HIV activities. These efforts include:

strengthening mechanisms for collaboration between TB and HIV programs; reducing the burden of HIV among TB patients by

testing all TB patients for HIV; reducing the burden of TB among PLWHA by screening for TB in HIV care and treatment settings

using TB screening tool; and implementing TB infection-control and provision of Isoniazid preventive therapy (IPT) in selected

sites.

In TB clinics, all TB patients are offered HIV counseling and testing, and those found to be HIV-positive are referred to the care

and treatment clinic (CTC) for care, treatment, and support. According to NTLP report, from October 2007 to December 2007,

2,635 (72%) out of 3,682 registered TB patients (spanning across eight regions supported by Global Fund and other non-USG

partners), were counseled, tested, and received their HIV test results. According to PEPFAR semi-annual progress reports

(SAPR) of 2008, 13,990 (82%) of 17,035 registered TB patients (spanning across 14 regions supported by the USG), were

counseled, tested for HIV, and received their test results. Over 500 health care workers were trained in the management of

TB/HIV co-infection including provider-initiated counseling and testing (PITC) for TB patients.

Under USG support, and working with ART partners in CTC, HIV-positive patients are being screened for TB, and those

confirmed to have active TB are referred to TB clinics for treatment. According to the USG 2007 Annual Report, a total of 8,108 of

166,892 (4.86%) enrolled HIV-positive patients received treatment for TB under direct USG-supported sites.

During FY 2008, with support from the USG and other bilateral donors, a National Policy for Collaborative TB/HIV activities and on

standard TB screening tool for PLWHA was developed and disseminated to all ART partners in the country. Health care workers

will continue being trained on the use of the tool. The national TB/HIV co-management training guidelines and manual are ready

for printing and distribution.

With technical assistance from the USG, and in collaboration with the National AIDS Control Program (NACP), NTLP and other

partners, the guidelines for TB infection-control have been developed and will be finalized, printed, and distributed to all partners

by the end of October 2008. In addition, NTLP, NACP, and other implementing partners will conduct an evaluation and give

recommendations on the experience of provision of ART in TB clinics using the so-called supermarket approach. This approach

is an attempt to address the low uptake of ART, delay ART initiation for TB/HIV co-infected patients, and reduce risk of TB

infection to immunocompromised patients at CTC. Data collection is planned for March 2009, and the report will be ready for

dissemination by May 2009.

During supportive supervision conducted during FY08 at some of the TB/HIV implementing sites, challenges identified included

low TB screening of PLWHA attending CTCs and lack of implementation of TB infection control (due to lack of knowledge and

guidelines). Feedback between TB clinics, CTCs, and laboratories, referrals and follow ups of patients are still weak. Recording

and reporting of TB screening needs to be improved. Provision of IPT is not implemented in care and treatment clinics. This is

due to lack of experience across Tanzania in the provision of IPT and the delay in finalization of IPT provision guidelines. About

46% of the nation's population is younger than 15 years of age. However, pediatric TB contributes only 9.4% of all known TB

cases in Tanzania. It is believed that TB is one of the major causes of death among children living with HIV, and a greater

number of children die from TB annually than is officially recorded.

To address the identified challenges, the MOHSW, through NTLP, NACP, and partners, will review and update guidelines for

TB/HIV. In addition, the MOHSW will utilize intensified TB case-finding (ICF) and TB M&E tools to reflect pediatric TB. These

guidelines will direct health care providers in their approach to ICF in pediatrics. The USG will support NACP to take the lead in

identifying best practices for intensified TB case finding among PLWHA and bolstering TB infection-control in care and treatment

settings to prevent TB among health care providers and PLWHA receiving care. The USG will also support NACP to: pilot IPT in

a limited number of care and treatment clinics to inform a large scale up; conduct supportive supervision; and support training for

health care providers working at CTCs on TB/HIV co-management, recording and reporting, patient follow up, and referrals

between CTCs, laboratories, and TB clinics.

A major focus in FY 2009 will be to support NACP and ART partners in strengthening HIV/TB activities in care and treatment

settings. Funds will be used to: maintain, support and scale up of HIV counseling and testing in TB clinical settings, intensified TB

case finding (ICF) and implementation of infection control in health care and congregate settings; develop/finalize, print and

distribute TB/HIV guidelines; coordinate HIV/TB collaborative activities; strengthen the capacity of health care providers in both

the public and private health sector to manage HIV/TB co-infected patients; conduct regular supportive supervision; pilot the

provision of IPT; and improve/update data collection tools to capture needed TB/HIV information. The TB recording and reporting

system will be evaluated to improve patient care, data quality, and program improvement. In addition, NACP and NTLP, in

collaboration with UGS and non-USG TB/HIV implementing partners, will evaluate and improve the ICF system before piloting IPT

at selected HIV care and treatment sites.

FY 2009 funds will continue to support 12 ART partners working in direct service delivery in care and treatment settings and

PMTCT clinics. These funds will also support two USG partners working directly in TB clinics within 87 districts. All TB/HIV

implementing partners (ART and TB) will coordinate and collaborate with guidance and technical support from MOHSW, through

NACP and NTLP, to ensure quality of services. USG ART partners will train health care providers on HIV/TB co-management

including the implementation of the

"Three Is".

Support from child survival funds, which will be received through USAID and TBCAP for laboratory strenthening, will increase TB

case-finding and improve TB diagnostisis with the use of new diagnostic technologies like Microbacterium Indicator Growth Tube

(MIGT) and LED microscopes. The Fund will also support laboratory quality assurance and TB surveillance systems including

screening for MDR-TB. The Fund will aid the involvement of the private sector who screen PLWHA attending HIV clinics for TB

using sputum smear microscopy, implement TB infection control in health care setting, and offer HIV counseling and testing for TB

patients. Communities will be supported in the identification and management of TB cases. Support from Global Fund and

Supply Chain Management Systems (SCMS) will also complement USG and Government of Tanzania (GoT) efforts in

forecasting, procurement, and distribution of HIV test kits, as well as requisite laboratory reagents. This will synergistically

augment work to promote implementation of TB/HIV-integrated services across the country.

PEPFAR HIV/TB funding in Tanzania complements similar efforts of other donors such as the Clinton Foundation, Germany

Leprosy Relief Agency, Global Fund Round three, and six donors that work with the MOHSW in the implementation of HIV/TB

collaborative activities. These activities include development and dissemination of TB/HIV policy and training guidelines and

manuals and conducting trainings and joint supportive supervisions. All USG and non-USG partners will work in collaboration with

NACP and NTLP to: improve TB screening of PLWHA attending care and treatment services; implement TB infection control at

care and treatment settings; track referrals; improve recording and reporting system; and monitor program evaluation and

ensuring quality of collaborative HIV/TB services in Tanzania.

By the end of 2009, TB/HIV collaborative services within TB clinics will be provided in all 132 districts of Tanzania with 49,680

(80%) TB patients expected to be counseled, tested, and informed of their HIV status. Of those districts, the Global Fund to Fight

AIDS, TB and Malaria (GFATM), and other partners, will support 45 (34%) districts and provide counseling and testing to 12,010

(22%). USG partners will cover 87 (66%) districts and provide counseling and testing to 38,670 (78%). USG ART partners, by

the end of FY 2009, are expected to provide services to 35,599 PLWHA attending CTC while concurrently receiving treatment for

TB. In collaboration with MOHSW, USG partners will train 2,713 health care providers on HIV/TB co- management including the

implementation of "Three Is". All patients who test positive for HIV will receive Cotrimoxazole through the TB clinic, and will be

referred for HIV care. All TB patients will be provided with information and messages on HIV prevention, as well as condoms and

condom demonstrations. The program will also encourage TB and TB/HIV co-infected patients to refer their sexual partners for

HIV testing and counseling.

Table 3.3.12: