THIS IS A NEW PROJECT INITIATIVE FOR FY09: UHAI-CT program

NEED AND COMAPRATIVE ADVANTAGE:

Despite great progress in developing counseling and testing (CT) policies, guidelines, and training

materials, as well as a diversity of service models, Tanzania still faces considerable challenges in reaching

the goals of the national CT program and the targets for number of patients on antiretroviral therapy (ART).

To date, CT programs that target groups at high risk due to sexual behavior, livelihood, or geographic

location have been limited in number and in impact. Other constraints to expanded CT services include:

- Overstretched medical personnel;

- Negative perceptions about CT;

- Lack of quality assurance (QA) processes, resulting in limited supervision/monitoring of services and lack

of standardized service delivery;

- Weak links with care and treatment services, as well as poor integration with other health services;

- Weak coordination among Government of Tanzania (GoT) stakeholders and between GoT and civil

society organizations (CSOs) at the district level;

- Inconsistent availability of rapid diagnostic test (RDT) kits; and

- Lack of robust school- and workplace-based interventions.

Moving toward universal access to CT in Tanzania requires a continuation of the enormous political will and

leadership generated by the GoT, as well as significant social mobilization at all levels of Tanzanian society.

GoT leadership has shown strong support for addressing HIV/AIDS, from the former President Benjamin

Mkapa declaring AIDS a national disaster in 1999, to the launch of the national CT campaign in July 2007

by current President Kikwete. Under the UHAI-CT program, Jhpiego and partners will work closely with the

GoT to build on this platform of national support and successes to quickly and effectively strengthen the

ability of the public and CSO sectors to provide expanded, improved, and coordinated CT services linked to

care, treatment and support.

UHAI-CT will use a two-pronged approach to scale up CT. At the facility level, provider initiated testing and

counseling (PITC) will be implemented at health facilities as the standard of care, in accordance with

national guidelines and in line with national PITC scale up plans. PITC is the primary emphasis of this

program. At the community level, a creative mix of community-based voluntary counseling and testing

(VCT) outreach strategies will be implemented with a focus on high prevalence areas as well as very high-

risk and hard-to-reach populations such as CSW, IDU etc.

Jhpiego will also collaborate closely with GOT, USG and other CT stakeholders to maximize effective

geographic coverage and programmatic synergies. Specifically, Jhpiego work closely with AMREF to

implement community outreach strategies that fill gaps and complement AMREF activities and will focus on

highest risk sub-populations not traditionally served by AMREF. Jhpiego will also coordinate closely with

Intrahealth and Pathfinder to ensure coordinated and complimentary PITC scale up plans that are guided by

the GOT PITC roll out strategy.

ACCOMPLISHMENTS:

UHAI-CT is a recently-awarded program (August 2008).

ACTIVITIES:

Planned activities include:

- Coordinating with the GOT and PITC stakeholders to affect coordinated roll out of PITC nationally;

- PITC activities which include: development of performance-based standards for quality services;

orientation of regional and district CT supervisors to the PITC program and PITC standards; adaptation of

existing PITC training package to onsite methodology; development of necessary provider job aids;

production of materials (onsite training packages, job aids); training of onsite training teams to prepare for

hospital trainings; onsite training - 59 hospitals, 8 wards each; development of promotional/IEC materials;

work with District AIDS Coordinating Committees (DACCs) to roll out and systematize existing PITC

registers in all sections of all relevant health facilities; and sampled observational assessments of PITC/ CT

service quality;

- Community outreach and mobilization activities which include: advocacy for policy allowing for lay CT

practitioners; identification of retired or unemployed health professionals who have the clinical qualifications

to provide CT services as service corps volunteers (SCVs); training of SCVs in the continuum of care

approach; pre-solicitation of CSOs; review and approval of CSOs to participate in pre-proposal conference;

pre-proposal conference; CSO proposal review; pre-award assessments; and short-list review, involving

other implementing partners;

- Integration of CT promotion messages into the Vaa Kondom campaign with a particular focus on

addressing male norms that discourage men from getting tested;

- Meetings with National AIDS Control Programme (NACP) to develop plans for rollout of national database

on CT;

- Training of DACCs and other relevant groups on reporting, analysis, planning and data for decision-

making with CT data;

- Semi-annual meeting with care and treatment partners to share CT program progress and discuss

strategies to strengthen linkages;

- Capacity building of care and treatment partners staff in CT for incorporation into their own programming;

- Annual "state of CT" stakeholders summit to review year's CT results; and

- Quarterly meetings with national level stakeholders to review program progress.

LINKAGES:

For PITC activities, UHAI-CT will coordinate with the Ministry of Health and Social Welfare (MoHSW) to

scale up services for hospitals and health centers currently lacking other technical assistance (TA) partners,

hence avoiding duplication of efforts. For community outreach, UHAI-CT will serve as a liaison between the

government and local CSOs, facilitating government support of outreach efforts by supplying space for

mobile CT units, distributing RDT kits, offering options for waste disposal, etc.

Activity Narrative: From inception and throughout delivery, UHAI-CT will involve TACAIDS, NACP and its Counseling and

Social Support Unit (CSSU), the Regional AIDS Control Coordinators, the DACCs, the District Council

Health Management Teams (CHMT), and Most Vulnerable Children Committees (MVCCs) at the district

level. Other government partners will include the Zanzibar AIDS Commission and Medical Stores

Department (MSD) health facilities staff. UHAI-CT Program Managers will spearhead the relationship

building at the district and regional level, working closely with CT coordinators from CHMTs to identify new

community-based CT sites, build capacity at current sites, link national level policies and communities, liaise

with local organizations, and jointly analyze data and results for program monitoring.

UHAI-CT will closely partner with other PEPFAR-funded HIV/AIDS partners (AMREF, FHI, AIDSRelief,

Deloitte, Columbia University, Elizabeth Glaser Pediatric AIDS Foundation, etc.) to ensure that all efforts are

complementary and non-duplicative. UHAI-CT will meet with these partners as part of initial program

planning and discuss areas of mutual interest and collaboration, including advocacy for policy change,

development of trainers and training materials, design of communications initiatives and key messages and

quality improvement efforts. UHAI-CT will also meet with PEPFAR-funded VCT partners at national level on

a quarterly basis to review each program's progress and planned next steps, status of initiatives of mutual

concern (such as policy change and capacity development) and challenges being faced by both programs

that need to be addressed in partnership. At a district level, UHAI-CT will work with its partner CSOs,

particularly AMREF, to establish linkages with VCT static sites in the geographic area for purposes of

referral and support. In addition, UHAI-CT will closely collaborate with the World Bank-sponsored Regional

Facilitating Agencies that are facilitating and supporting districts in development, implementation, and

monitoring of community HIV/AIDS initiatives.

Target Population: General population; Most at risk populations; Business community; Discordant couples;

Pregnant women

M&E:

Targets and achievements are based on actual service provision and do not include numbers from CTC

partners trained by Jhpiego to integrate PITC into their facilities. UHAI-CT is committed to reaching key

national, PEPFAR, and USAID goals. All impact indicator reporting will be done by secondary or primary

analysis of national, population-based surveys. Quantitative indicators will be collected systematically

through service delivery sites, supervisors of HBC providers, or monitoring systems from partner and

grantee organizations. Qualitative indicators will be collected through special surveys, including exit

interviews, focus group discussions, and participatory research methods.

UHAI-CT recognizes the vital importance of data monitoring and reporting for scale up of CT in Tanzania. At

the national level, UHAI-CT will work with NACP, TACAIDS, and other partners to: 1) increase submission

to existing data systems for CT, referral, and care and support services; 2) support NACP's CounTest and

CTC databases; 3) disseminate national achievements through an annual "State of CT and Support

Services" summit; and 4) publish or present results in national and international forums. At regional and

district levels, UHAI-CT will work with key stakeholders, including USAID, to strengthen information systems

for CT and referral services (data collection, reporting, feedback), and build capacity of district stakeholders

to use data for decision making.

SUSTAINABILITY:

UHAI-CT plans to build the CT expertise of the GoT to ensure long-term sustainability of program efforts, as

the government is responsible for overall leadership and guidance of the national program. In partnership

with other organizations supporting CT efforts, UHAI-CT will collaborate with the NACP's CSSU to further

develop their capacity to provide leadership, oversight, and support to the national CT program. CSSU staff

will be involved in advocacy, strategic design, planning, implementation, and monitoring of all program

activities, with programmatic and technical expertise transferred to the greatest extent possible. While

supporting capacity development at the national level, UHAI-CT will work in partnership with local

government authorities, including CT coordinators working within district CHMTs, to build their skills in

program implementation and coordination and to strengthen working relationships with CSOs in their

districts. UHAI-CT regional program managers will assist local authorities to develop and foster these

connections, so that CSO efforts are well-coordinated and linked with CHMT strategies and annual

workplans.

In collaboration with other CT partners, and particularly AMREF, UHAI-CT will also work with trainers at

zonal, regional, and district levels to further develop their ability to implement training, develop relevant

training materials, and conduct supportive supervision visits, with an aim toward creating a pool of technical

resources that can be subsequently tapped by national counterparts for assistance in supporting and further

developing the national CT program.

New/Continuing Activity: Continuing Activity

Continuing Activity: 13416

Continued Associated Activity Information

Activity Activity ID USG Agency Prime Partner Mechanism Mechanism ID Mechanism Planned Funds

System ID System ID

13416 8656.08 U.S. Agency for JHPIEGO 6528 1171.08 $1,500,000

International

Development

8656 8656.07 U.S. Agency for To Be Determined 4976 4976.07 TBD CT follow

International on

Development

Emphasis Areas

Human Capacity Development

Estimated amount of funding that is planned for Human Capacity Development $350,000

Public Health Evaluation

Food and Nutrition: Policy, Tools, and Service Delivery

Food and Nutrition: Commodities

Economic Strengthening

Education

Water

Table 3.3.14: