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: 2008 2009
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 increased from 350,000 to 550,000.
FY 2009 PMTCT targets have been modified
*END ACTIVITY MODIFICATION*
TITLE: PMTCT Services in Mbeya.
NEED and COMPARATIVE ADVANTAGE: Mbeya is one of the regions with the highest HIV prevalence
(13.5%) with prevalence at antenatal clinics recorded at 12.7% It is estimated that there are 300,000 HIV
positive
people in need of services in this region, 20% of whom should qualify for treatment.
As part of Tanzania's decentralized health care approach, the Mbeya Regional Medical Office (MRMO) is
the highest ranked local MOHSW representative in this region. Through its Regional AIDS Control
Programme, and strong working relationship with DMOs, the MRMO leads planning and execution of health
services for its region. It has been executing PMTCT in 19 facilities, receiving technical assistance from
GoT, but is in need of funding and additional support in expanding the number of services site to reach
more of the population.
ACCOMPLISHMENTS: In FY 2006 the MRMO began to integrate PMTCT as part of HIV treatment services
where ART was available. It also began to rapidly scale-up basic PMTCT services by introducing them to
additional health centers serving neglected rural communities. In FY 2007, facilities under the MRMO tested
16,862women and provided prophylaxis to 2,145 HIV+ women, 12.7% of those identified as positive.
ACTIVITIES: With PMTCT regionalization by the USG, PEPFAR funds will be awarded to DOD partners to
directly support PMTCT sites (both current as well as planned) originally served by funding through the
MOHSW. As a result, the existing referral system will be further developed so that HIV+ women identified
will be linked to nearby treatment centers.
1. Expand PMTCT sites to a total of 33 by September 30, 2009.
1a) Train health care workers at each new site using a "full site" approach similar to Engender Health, and
whenever possible, ensuring at least four ANC staff per site are trained.
Adopt an opt-out counseling and testing policy in both an ANC setting and labor ward and delivery.
1b) Renovate ANCs where needed to improve confidentiality.
1c) Procure commodities, such as rapid test kits, when not available through central procurement
mechanisms.
2) Strengthen PMTCT interventions and integration of PMTCT to ART services.
2a) Where ART is available, either at the same facility or a nearby service center, efforts will be made to
establish formal referrals from PMTCT services/sites with counseling and testing centers (CTCs) to support
the delivery of comprehensive HIV services.
2b) Evaluate HIV+ women for eligibility for Highly active anti retroviral therapy (HAART), and provide ARV
regimens based on the new revised guidelines following the WHO-tiered approach for ARV prophylaxis to
ensure HIV positive women and HIV-exposed children receive the most efficacious treatment Zidovudine
(AZT) and Nevirapine (NVP or single dose Nevirapine (SDNVP).
2c) Provide "prevention for positives" counseling package based on the USG-developed approach in
Tanzania.
2d) Encourage HIV+ women to bring in family members for counseling and testing at either the ANC or the
hospital's VCT center
2e) Promote infant feeding counseling options (AFASS), linking mothers to safe water programs in the
region, and for those choosing to breastfeed, counsel them to exclusively breastfeed with early weaning.
2f) Infant feeding and nutritional interventions during lactation period will be promoted.
2g) Train ANC staff in collection of DBS for infant diagnosis.
2h) Send dried blood spot (DBS) to MRH which will be receiving equipment from the Clinton Foundation
and technical assistance from USG lab partners to conduct infant diagnosis for the entire Southern
Highlands.
2i) Ensure all HIV exposed and infected children are initiated on cotrimoxazole prophylaxis as appropriate.
3. Build capacity of regional and district health teams to plan, execute and monitor PMTCT activities.
3a) Acquire technical support for regional and district authorities with the assistance of other USG partners
(such as Engender Health) to work with the MRMO in conducting site assessments and supportive
supervision
3b) Use data collected to work with District Health Management Teams to assess site specific services and
develop a plan of action to address problems.
3b) Support DHMT to include PMTCT activities in council health plans.
LINKAGES: This activity is linked to activities under this partner in ART, TB/HIV, and palliative care. It is
also linked to other USG partner entries in the program area which can provide additional technical
assistance such as Engender Health or EGPAF.
Linkages for services will include pre and post-test counseling (group or individual). Those testing negative
are given education on protective measures and practices for avoiding infection while those testing HIV+
are evaluated for ART as described above. Both populations are linked to RH services. In addition, the
MRMO will continue to promote outreach services from the facilities to the communities for HIV positive
clients. Each facility will have lists of NGO's, CBOs and HBC providers involved in HIV/AIDS support,
indicating geographical coverage and types of services offered. These lists will be displayed in the CTCs
and other clinics/wards so health staff can refer clients to those organizations as necessary. These
referrals, as well as referrals from community organizations to the facility, will be further strengthened
Activity Narrative: through facility staff serving as points of contact (POC) for the community organizations.
CHECK BOXES: This funding will fully develop PMTCT services covering all the districts including health
centers and dispensaries. Funding will support the introduction and/or improvement of PMTCT services in
the region. Emphasis will be put into training of health care workers in the district hospital, health centers
and dispensaries, renovation counseling and delivery rooms, and commodities for services when not
available through central procurement mechanisms.
M&E: Quality Assurance/Quality Control of services will be provided by MRMO staff conducting quarterly
site assessments (more frequently for new sites). Technical assistance will also be sought by other USG
PEPFAR partners such as Engender Health which is executing a successful "full site" approach to PMTCT
and is initiating PMTCT support in the nearby region of Iringa in FY 2008.
Data will be collected using both paper-based tools developed by MOHSW, and adaptation of the electronic
medical record system (EMRS) (see DOD SI entry) to incorporate PMTCT data. On site electronic data
entry will take place. All sites will have laptops with a data base and output functions as developed by UCC
for the National C&T program. Data clerks will be retrained, and the data collected will be reported to NACP
and the USG.
SUSTAINABILITY: The MRMO is ensuring sustainability through capacity building of health care facilities
and its staff, sensitization of community members, and advocacy through influential leaders. This is also
accomplished by strengthening "systems," such as the improved capacity of the Regional AIDS Control
Programme, the District Health Management Team (DHMT), through regional supportive supervisory teams
as part of already existing zonal support, and routine MRMO functions. Most of this funding will be spent at
the district and health facility level, thereby building capacity and sustainability at the level where the
services are provided.
New/Continuing Activity: Continuing Activity
Continuing Activity: 16410
Continued Associated Activity Information
Activity Activity ID USG Agency Prime Partner Mechanism Mechanism ID Mechanism Planned Funds
System ID System ID
16410 16410.08 Department of Mbeya Regional 6536 1135.08 $350,000
Defense Medical Office
Emphasis Areas
Gender
* Addressing male norms and behaviors
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 $80,000
Public Health Evaluation
Food and Nutrition: Policy, Tools, and Service Delivery
Food and Nutrition: Commodities
Estimated amount of funding that is planned for Food and Nutrition: Commodities $20,000
Economic Strengthening
Education
Water
Table 3.3.01:
ACTIVITY HAS BEEN REVISED SIGNIFICANTLY FROM FY2008 COP.
TITLE: Expanding care and support in Mbeya Region
NEED and COMPARATIVE ADVANTAGE: Mbeya is one of the regions with the high prevalence (7.9%). It
is estimated that there are 300,000 HIV-positive people in need of services in this region, 20% of whom
should qualify for treatment. Over 10,000 have been initiated on ART to date through out the region and at
the Mbeya Referral Hospital (MRH) (separate entry). Even with these achievements, there are still an
estimated 46,000 in need of care and treatment.
As part of Tanzania's decentralized healthcare approach, the Mbeya Regional Medical Office (MRMO) is
the highest ranked local Ministry of Health and Social Welfare representative in this region. Through its
Regional AIDS Control Programme and strong working relationship with District Medical Officers, the
MRMO leads planning and execution of health services for its region.
ACCOMPLISHMENTS: In FY 2008, the MRMO is supporting treatment services in 18 established care and
treatment centers (CTCs). Under this same funding, MRMO will train an additional 100 healthcare workers
on ART provision, bringing the total trained in the region to 300. By September 30, 2008, the MRMO has
enrolled over 18,000 in facility-based care and support.
ACTIVITIES: All hospitals in the Mbeya region now support ART and pre-ART care and support, though the
majority of patients are still identified through the MRH. Here they undergo their initial evaluation after
which they are referred down to the regional and district hospital for management. It is believed this is due
to the higher quality of services and better infrastructure at MRH, including its large inpatient wards.
As part of FY 2008 and FY 2009 activities, the Department of Defense (DOD) will continue working with the
MRMO in developing strategies beyond provider-initiated testing and counseling (PITC) to decentralize
identification and enrollment of patients to increase up take of services. This will be a key component of the
overall improvement of services at the district level, including expansion to health centers.
In FY 2009, ART will be expanded to 20 more health centres focusing on high density areas along trade
routes but also identifying isolated rural communities in which the health centre provides the only source of
regular medical services. This expansion will bring the total number of ART sites supported in the region to
54 by September 2010; ensuring services are available in over 77% of all facilities and to more than 95% of
the population. Specificically, MRMO will:
1. Expand services and support to a total of 20 primary health care facilities in the region covering all eight
districts. Work with the District Health Management Teams (DHMT) and facility directors in developing
facility-based work plans and implementation of these plans. Assist in the acquisition of reagents,
medications and clinical supplies through local distributors when not available through central mechanisms.
2. Continue to improve the quality of care. Strengthen and reinforce implementation of standard operating
procedures for laboratory monitoring and maintenance of patient records. Expand mentoring and
supportive supervision beyond the district level facilities through regional medical teams. Improve patient
record and data collection, working with DOD, DHMT and facility staff to analyze data to inform
improvement of services.
3. Reinforce and expand PITC to all facilities. Train 60 staff in inpatient wards and outpatient clinics in
CTCs, actively promoting PITC for all patient contact points. Continue to sensitize hospital staff and clients
in care and treatment as a regular part of all out patient services, including the TB clinic.
4. Expand services and support to a total of three hospitals and 20 primary health care facilities in the
region, covering all four districts. This will be at a rate of three to four health centres per district. Work with
the DHMT and facility directors in developing facility-based work plans and implementation of these plans.
Assist in the acquisition of reagents, medications, and clinical supplies through local distributors when not
available through central mechanisms. Work with facility pharmacists in improving capacity in forecasting,
stock management, and ordering.
5. Increase enrollment of HIV-positive adults in care and support services. Promote routine counseling and
testing at all contact points. Continue to strengthen pre-ART within the CTC for evaluation and follow-up for
treatment. Ensure all TB/HIV co-infected patients are initiated on cotrimoxazole prophylaxis, as
appropriate.
6. Increase emphasis in provision of positive prevention to PLWHA. PLWHA will be provided with
counseling, and linked to support groups or peer-led interventions through the Home-based Care (HBC)
system. There will be increased involvement of PLWHA in providing information about ways they can
protect their own health, prevent common illnesses, and access safe water and improved hygiene practices.
MRMO will ensure that interventions address the comprehensive needs in an environment free from stigma
and discrimination. All sexually active PLWHA will be provided with condoms, which is an essential
component of prevention of further HIV transmission. PLWHA will be referred for family planning, if
relevant. Coupled with condom provision, PLWHA will be linked with sexually transmitted infection
treatment services and high-risk behavioral counseling. MRMO will discuss specific strategies with PLWHA
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 coverage areas. Several specific activities will be implemented by sites to
provide positive prevention services. These include: procurement and/or distribution of Insecticide Treated
Nets to PLWHA and promotion on correct usage; cotrimoxazole prophylaxis for prevention of opportunistic
infections; and water treatment tablets and water vessels in order to provide safe drinking water.
7. Intensify efforts in nutritional support for PLWHA. Specifically, MRMO will support CTCs to conduct
anthropometric measurements and determine nutritional status using Body Mass Index (BMI) calculations
Activity Narrative: for and other appropriate measurements such has mid-upper arm circumference (MUAC) and weight for
age. Tunajali 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 dietary assessments of patients and the provision of nutrition counseling and
education. In addition, MRMO will link with other organizations addressing household food security and
economic strengthening to ensure PLWHA have access to these services.
8. Reinforce comprehensive nature of clinical services. Strengthen and formalize referrals to and from
community-based organizations (CBOs), non-governmental organizations (NGOs) and faith-based
organizations serving patients in their communities through facility social workers.
LINKAGES: This activity is linked to activities under this partner in prevention of mother-to-child
transmission (PMTCT), TB/HIV, and palliative care as well as those of the other regions in this zone (Rukwa
and Ruvuma). It is also linked to the DOD submission under SI other USG treatment partner submissions
providing expertise in areas of pediatric care and TB infection control.
The MRMO will continue to promote outreach services from the facilities to the communities. Each facility
will have lists of NGOs, CBOs and home-based care providers involved in HIV/AIDS support, indicating
geographical coverage and types of services offered. These lists will be displayed in the CTCs and other
clinics/wards so health staff can refer clients to those organizations as necessary. These referrals, as well
as referrals from community organizations to the facility, will be further strengthened through facility staff
serving as points of contact for the community organizations.
M&E: Quality assurance and control of clinical services are conducted through the zonal and regional
supportive supervisory teams discussed above.
M&E data activities for all the CTCs under the MRMO are supported by technical assistance from the DOD
SI team based at the MRH. Data at each CTC is collected using standardized forms based on NACP and
facility data needs, entered into the electronic medical record system and transported to the DOD data
center located at Mbeya Referral Hospital for synthesis, generation of National AIDS Control Programme
and USG reports as well as to provide feedback to CTC teams for use in patient management.
SUSTAINABILITY: The MRMO is ensuring sustainability through capacity building of healthcare facilities
and staff, sensitization of community members and advocacy through influential leaders. This is also
accomplished by strengthening "systems," such as the improved capacity of DHMT, the regional supportive
supervisory team, and the zonal weekly ART meetings as part of already existing zonal support and routine
MRMO functions.
Continuing Activity: 16530
16530 16530.08 Department of Mbeya Regional 6536 1135.08 $200,000
Estimated amount of funding that is planned for Human Capacity Development $175,000
Estimated amount of funding that is planned for Food and Nutrition: Commodities $15,500
Table 3.3.08:
ACTIVITY HAS BEEN REVISED SIGNIFICANTLY FROM FY 2008 COP.
1. Adult Treatment Information (09-HTXS)
TITLE: Expanding Adult ART in Mbeya Region
NEED and COMPARATIVE ADVANTAGE: Mbeya is one of the regions with the high prevalence
(7.9%). It is estimated that there are 300,000 HIV positive people in need of services in this region, 20% of
whom should qualify for treatment. Over 10,000 have been initiated on ART to date through out the region
and at the Mbeya Referral Hospital (MRH) (separate entry). Even with these achievements, there are still an
estimated 46,000 in need of ART.
Programme and strong working relationship with District Medical Officers (DMOs), the MRMO leads
planning and execution of health services for its region.
ACCOMPLISHMENTS: In FY8, the MRMO is supporting treatment services in18 established CTCs. Under
this same funding, MRMO will train an additional 100 health care workers on ART provision, bringing the
total trained in the region
to 300. As of June 31, 2008, the MRMO supported 10,300 people on treatment, 6% of which were children,
and has enrolled over 18,000 in care.
ACTIVITIES: All hospitals in the Mbeya region now support ART, though majority of
patients are still identified through the MRH. Here they undergo their initial evaluation after which they are
referred
down to the regional and district hospital for management. It is believed this is due to the higher quality of
services and better infrastructure at MRH, including its large inpatient wards.
As part of FY 2008 and FY2009 activities, the DOD will continue working with the MRMO in developing
strategies beyond Provider Initiated Testing and Counseling (PITC )to decentralize identification/enrollment
of patients to increase uptake of services. This will be a key component of the overall improvement of
services at the district level, including expansion to health centers.
In FY 2009, ART will be expanded to more health centers focusing on high density areas along trade
routes but also identifying isolated rural communities in which the health center provides the only source of
regular medical services. This expansion will increase the total number of ART sites supported in the region
by September 2010, ensuring services are available in over 77% of all facilities and to more than 95% of
the population. Activities will include: Expand services and support to primary health care facilities in the
region
covering all six districts; Work with District Health Management Teams (DHMT) in finalizing the identification
of new health centers for introduction of ART services; Work with the DHMT and facility directors in
developing facility based-work plans and implementation of these plans; Renovate space at 20 health
centers to support CTC; Train health providers/clinical staff in ART and TB/HIV co-management; Work with
facility pharmacists in improving capacity in forecasting, stock management and ordering; Continue to
improve the quality of care and treatment services; Provide ongoing mentoring and supportive supervision
through combined zonal and regional medical teams; Participate in weekly zonal ART meetings with the
Mbeya Referral Hospital to discuss treatment roll out, identify areas of need, determine solutions and
coordinate resolution;Improve patient record/data collection, working with DOD, DHMT and facility staff to
analyze data for improvement of services; Reinforce comprehensive nature of clinical services; Strengthen
prevention for positives counseling among all staff providing treatment at CTC; Strengthen of referral
system between services points at the MRH; Strengthen referral systems for services within a facility among
wards and clinics; Use site coordinator to conduct daily checks on registers in outpatient clinics, in-patient
wards, MCH and the TB clinic to keep track of patients referred to the CTC; Strengthen and formalize
referrals to and from CBO, NGO and FBO serving patients in their communities through facility social
workers.
Laboratory Services:
Train 30 lab technicians on PMTCT lab activity such as Syphilis testing, rapid HIV test trainings and Rapid
HIV quality assurance activities; Train 28 counselors which are mainly focused on counseling and testing
lab Activities such as PITC, VCT. The training will be focused on Rapid HIV testing and Quality Assurance
of Rapid HIV testing;Strengthen TB/HIV lab activities by training 14 lab technicians on rapid HIV testing, TB
diagnosis acid-fast method; DOD will continue to procure reagents for hematology, chemistry and CD4 and
viral load for all CTC hospital lab's in Mbeya Hospitals.
6e Continue to roll out HIV Early infant diagnosis, to 20 health centers in Mbeya,by training health workers
on sample management, transportation; MRMO will continue implement the external laboratory quality
assurance scheme in collaboration with MRH and DOD; MRMO will continue implement the external
laboratory quality assurance scheme in collaboration with MRH and DOD; MRMO will continue to service bi-
annually hematology, chemistry and facscount equipments in the zone by using the technical skills of DOD
hired Tanzanian medical engineer
LINKAGES: This activity is linked to activities under this partner in PMTCT, TB/HIV, and palliative care as
well as those of the other regions in this zone (Rukwa and Ruvuma). It is also linked to the DOD submission
under SI other USG treatment partner submissions providing expertise in areas of pediatric care and TB
infection control.
will have lists of NGO's, CBOs and HBC providers involved in HIV/AIDS support, indicating geographical
coverage and types of services offered. These lists will be displayed in the CTCs and other clinics/wards so
Activity Narrative: health staff can refer clients to those organizations as necessary. These referrals, as well as referrals from
community organizations to the facility, will be further strengthened through facility staff serving as POC for
the community organizations.
CHECK BOXES: The areas of emphasis will include: initial and refresher training of staff in ART, TB/HIV co-
management,
and CT; infrastructure improvement for new sites; provision of equipment, supplies and
medications; strengthening linkages with TB/HIV, PMTCT and community groups.
M&E: QA/QC for clinical services is conducted through the zonal and regional supportive supervisory teams
discussed above.
M&E data activities for all the CTCs under the MRMO are supported by TA from the DoD SI team based at
the Mbeya Referral Hospital. Data at each CTC is collected using standardized forms based on NACP and
facility data needs, entered into the electronic medical record system (EMRS) and transported to the DoD
data center located at Mbeya Referral Hospital for synthesis, generation of NACP and USG reports as well
as to provide feedback to CTC teams for use in patient management. The number of CTCs supported by
Mbeya RMO will be 34 and 54 by Sept 2009 and Sept 2010 respectively.
SUSTAINABILITY: The MRMO in ensuring sustainability through capacity building of health care facilities
and its staff, sensitization of community members and advocacy through influential leaders. This is also
accomplished by strengthening "systems", such as the improved capacity of DHMT, the regional supportive
supervisory team and the zonal weekly ART meetings as part of already existing zonal support and routine
April 2009 Reprogramming:
$75,000 Reprogrammed to (activity id 9237.23465.09) support procurement of lab reagents through SCMS.
Continuing Activity: 13519
13519 3386.08 Department of Mbeya Regional 6536 1135.08 $3,238,000
7749 3386.07 Department of Mbeya Regional 4557 1135.07 $850,000
3386 3386.06 Department of Mbeya Regional 2837 1135.06 $600,000
Construction/Renovation
Estimated amount of funding that is planned for Human Capacity Development $309,000
Table 3.3.09:
ACTIVITY HAS BEEN REVISED SIGNIFICANTLY FROM FY 2008 COP
TITLE: Expanding Pediatric HIV Care and Support in the Mbeya Region
NEED and COMPARATIVE ADVANTAGE: Mbeya is one of the regions with a high HIV prevalence (7.9%).
It is estimated that there are 300,000 HIV-positive people in need of services in this region, 20% of whom
should qualify for antiretroviral therapy (ART). It is estimated that of these 300,000 individuals, 70,000 are
children less than 15 years of age.
ACCOMPLISHMENTS: In FY 2008, the Mbeya Regional Medical Office (MRMO) supported pediatric
treatment services in 18 established care and treatment center (CTC) sites. The program trained 100
health care workers on provision of antiretroviral services, including pediatric ART, bringing the total trained
in the region to 300. As of the end of FY 2008, MRMO has over 18,000 people enrolled in care and
support, approximately 6% of whom are children.
ACTIVITIES: All hospitals under the MRMO in the region support the provision of pediatric ART services,
though a majority of children are still identified through the Mbeya Regional Hospital (MRH). As part of FY
2008 and FY 2009 activities, the US Department of Defense (DOD) will continue working with the MRMO
and MRH to strategize the decentralization of identification and enrollment of patients to lower-level facilities
in order to increase uptake of services. More health facilities will be renovated and health workers trained
on pediatric ART management, including early infant diagnosis (EID) and psychosocial counseling to
improve adherence and disclosure in children. Collection and transportation of dried blood specimens
(DBS) to the zone reference laboratory will be improved. These will be key components of the overall
improvement of pediatric ART services at the district level, including expansion to health centers. Existing
CTC staff will receive refresher training on pediatric ART management and scale-up. The specialized
pediatric HIV/AIDS outpatient center is developed through FY 2009 - FY 2010 at the MRH in partnership
with Baylor International Pediatric AIDS Initiative (BIPAI). The pediatricians working within this facility will
conduct outreach services to mentor pediatric ART providers and provide specialized services where
required. This latter partnership will be executed through the MRMO, and will significantly augment
activities in support of the pediatric HIV services scale-up throughout the region.
In FY 2009, ART services, including pediatric care and support, will be expanded to 20 more health centers.
Focus will be on high density areas along trade routes while also identifying isolated rural communities in
which the health center provides the only source of regular medical services. This expansion will bring the
total number of CTC sites supported in the region to 54 by September 2010. Pediatric services will be
available in over 77% of all facilities, and to more than 95% of the population.
Specifically, MRMO will:
1. Expand pediatric HIV care and support services, using the revised national ART guidelines, to a total of
20 primary healthcare facilities in the region covering all eight districts (Mbeya Urban, Mbeya Rural, Mbozi,
Kyela, Rungwe, Ileje, Mbarali and Chunya). Work with the Council Health Management Team (CHMT) and
facility directors to develop and implement facility-based work plans and program linkages. Scale up EID
services to all primary health care facilities, and ensure that all HIV-exposed children are initiated on
Cotrimoxazole prophylaxis as appropriate.
2. Continue to improve the quality of pediatric care, link with and implement the national quality
improvement initiative. Provide nutritional education and counseling with nutrition support to HIV/AIDS
malnourished children after Body Mass Index assessments, and counseling services to caregivers to
prevent and manage food- and waterborne diseases, and improve infant and young children feeding
practices. Provide psychosocial support and counseling to include disclosure. The program will link with
the Presidential Malaria Initiative for the distribution of insecticide-treated nets to infants and HIV-positive
children. Ensure all HIV-exposed children are initiated on Cotrimoxazole prophylaxis based on national
guidelines. Strengthen and reinforce implementation of standard operating procedures for laboratory
monitoring. Expand mentoring and supportive supervision beyond the district-level facilities through
regional medical teams. Improve pediatrics record/data collection, working with DOD, CHMT, and facility
staff to analyze data that informs improvement of services.
3. Increase the number children on ART. Promote and support routine counseling and testing of mothers
and their children at all contact points in the health facilities, including antenatal clinics (ANC), labor and
delivery wards, immunization clinics and pediatric inpatient wards. Conduct mobile pediatric care and
support services to the rural areas including hard-to-reach poor communities. Continue to roll-out EID to 20
health centers in Mbeya by training health workers on sample management and transportation. Train ANC,
CTC, and postnatal clinic staff on EID with an emphasis on collection and transportation of DBS, which will
be sent to the MRH.
3. Reinforce and expand provider-initiated testing and counseling (PITC) to all facilities. Train 60 staff in
pediatric inpatient wards and outpatient clinics in HIV counseling and testing, actively promoting PITC for all
patient contact points, including immunization clinics, and antenatal clinics. Continue to sensitize hospital
staff and clients in counseling and testing as a regular part of all outpatient services, including the TB clinic.
Train health care workers on infant feeding counseling and improved practices using the national
curriculum.
4. Reinforce the comprehensive nature of clinical services by strengthening referral systems for services
within a facility among wards and clinics. Use site coordinators to conduct daily checks on registers in
pediatric outpatient clinics, inpatient wards, maternal and child health (MCH) and TB clinics to keep track of
patients referred to the CTC. Also, ensure appropriate referrals to other services, particularly the MCH
clinics so that children benefit from important child survival interventions. Strengthen and formalize referrals
of pediatric patients to and from community-based organizations (CBOs), non-governmental organizations
(NGOs) and faith-based organizations (FBOs) serving orphans and vulnerable children (OVC) in their
Activity Narrative: communities through facility-based social workers.
5. Ensure that appropriate commodities, equipment, and related skills are in place. Assist in the acquisition
of reagents, medications, and clinical supplies through local distributors when they are not available through
central mechanisms. Work with facility pharmacists in improving capacity in pediatric ART forecasting,
stock management and ordering. Procure the necessary equipment required to carry out effective
nutritional assessment such as weighing scales, MUAC tapes, and stadiometers. The program will conduct
training in the use of these tools, as well as in dietary assessments of patients and the provision of nutrition
counseling and education.
transmission (PMTCT) and adult care and support care, as well as those of the other regions in this zone
(Rukwa and Ruvuma). It is also linked to the DOD submission under SI and other USG treatment partner
submissions providing expertise in areas of pediatric care and TB infection control. It also is linked to the
BIPAI activity to scale up pediatric AIDS services and skills building in the zone.
The MRMO will continue to promote pediatric outreach services from the facilities to the communities
targeting rural and poor communities. Each facility will have lists of NGOs, CBOs, FBOs, and home-based
care providers involved in providing services to OVC and HIV-positive children, indicating geographical
health staff can refer clients to those organizations as necessary. These referrals, as well as referrals from
community organizations to the facility, will be further strengthened through facility staff serving as point of
care for the community organizations. Finally, MRMO will link with other organizations addressing
household food security and economic strengthening to ensure PLWHA have access to these services.
M&E: Quality assurance and control for clinical services is conducted through the zonal and regional
supportive supervisory teams discussed above. M&E activities for all the CTCs under the MRMO are
supported by technical assistance from the DOD SI team based at the MRH. Data at each CTC is collected
using standardized forms based on National AIDS Control Programme (NACP) and facility data needs. It is
entered into the electronic medical record system and transported to the DOD data center located at the
MRH. There it is analyzed, NACP and USG reports are generated and feedback is provided to CTC teams
for use in patient management. The number of CTCs supported by MRMO will be 22 and 34 by September
2008 and September 2009 respectively.
SUSTAINABILITY: The MRMO is ensuring sustainability through strengthening of the facility and capacity
building of healthcare providers, sensitization of community members and advocacy through influential
leaders. This is also accomplished by strengthening systems, such as the improved capacity of CHMT, the
regional supportive supervisory team and the zonal weekly ART meetings (as part of existing zonal support
and routine MRMO functions). All pediatric HIV care interventions will be integrated in the districts'
comprehensive council health plans so that future support for the program is seen as part of the overall
district plans.
Geographic Coverage Areas: (Regions) Mbeya
Estimated amount of funding that is planned for Food and Nutrition: Policy, Tools $5,000
and Service Delivery
Estimated amount of funding that is planned for Food and Nutrition: Commodities $10,000
Table 3.3.10:
THIS IS A NEW ACTIVITY.
TITLE: Expanding Pediatric ART in Mbeya Region
NEED and COMPARATIVE ADVANTAGE: Mbeya is one of the regions with a high prevalence (7.9%). It is
estimated that there are 300,000 HIV-positive people in need of services in this region, 20% of whom
should qualify for treatment. It is estimated that out of these 300,000 individuals, over 70,000 are children
less than 14 years of age.
ACCOMPLISHMENTS: In FY08, the Mbeya Regional Medical Office (MRMO) supported pediatric treatment
services in 18 established CTC sites. The program trained 100 health care workers on ART provision,
including pediatric ART, bringing the total number trained in the region to 300. As of June 31, 2008, the
MRMO supported 10,300 people on treatment, 6% of whom were children, and has enrolled over 18,000 in
care.
ACTIVITIES: Hospitals under the MRMO in the Mbeya region support a majority of the pediatric ART
patients in the region, though majority of those children are still identified through the Mbeya Regional
Hospital (MRH) As part of FY 2008 and FY2009 activities, the DOD will continue working with the MRMO
and MRH to develop strategies to decentralize identification/enrollment of patients to lower level facilities,
increasing uptake of services. More health facilities will be renovated and health workers trained on
pediatric ART management, including early infant diagnosis (EID) and psychosocial counseling to improve
adherence and disclosure in children. Collection and transportation of dried blood specimens (DBS) to the
zone reference laboratory will be improved. These will be key components of the overall improvement of
pediatric ART services at the district level, including expansion to health centers. Existing CTC staff will
receive refresher training on Pediatric ART management and scale-up. As the specialized pediatric
HIV/AIDS outpatient centre is developed through FY 2009/2010 at the MRH in partnership with Baylor
International Pediatric AIDS Initiative (BIPAI), the pediatricians working within this facility will conduct
outreach services to mentor pediatric ART providers and provide specialized services where required. This
latter partnership will significantly add to those activities' being executed through the MRMO in support of
pediatric HIV services throughout the region.
In FY 2009, ART services, including pediatric ART, will be expanded to more health centers. Focus will be
on high density areas along trade routes in addition to identifying isolated rural communities in which the
health center provides the only source of regular medical services. Pediatric care and treatment activities
will also expand to these sites. This will ensure pediatric services are available in over 77% of all facilities,
and to more than 95% of the population.
Funds will be used for expansion of Pediatric ART services to primary health care facilities in the region
covering all eight districts. (Mbeya urban, Mbeya Rural, Mbozi, Kyela, Rungwe, Ileje, Mbarali and Chunya) ;
Work with Council Health
Management Teams (CHMT) to finalize the 20 new health centers' introduction of ART, including pediatric
ART service; Supervise and coordinate scale-up of pediatric ART throughout the zone; Continue to provide
evaluation of malnutrition and nutritional counseling to all pediatric HIV-positive clients as part of treatment;
Renovate space At identified health centers to support CTC including pediatric ART; Train an additional
health providers/clinical staff in pediatric ART management; Work with facility pharmacists in improving
capacity in pediatric ARV forecasting, stock management and ordering and continue to improve upon the
number of individuals trained to identify pediatric cases early through provision of provider initiated testing
and counseling (PITC) at antenatal clinics, during post-natal follow up, as part of immunization clinics, at out
-patient clinics and through in-patient wards
FY 2009 funds will also be used to continue to improve the quality of care and treatment service through:
Provision of pediatric ART and counseling on ART adherence in main MRH CTC, Meta and at
satellite/health centers. Care elements, including the basic prevention package, for these patients under
treatment are detailed in the Pediatric Care and Support entry for this partner; Strengthen and reinforce
implementation of standard operating procedures for pediatric clinical services and maintenance of patient
records; Provide ongoing pediatric ART mentoring and supportive supervision through combined zonal and
regional medical teams; Participate in weekly zonal ART meetings with the Mbeya Referral Hospital to
discuss treatment roll out and conduct mobile pediatric ART services to the rural areas including hard-to-
reach poor communities
Funds will be used to increase the number children on ART from 6% to 12% of the total patient population
through strengthening referrals between antenatal clinics, PMTCT, TB services and CTC for evaluation of
HIV-positive children for treatment initiation; Train prenatal clinic (PNC) and CTC staff in the collection of
DBS for infant diagnosis; Continue to roll out HIV EID, to health centers in Mbeya by training an additional
health workers on DBS collection and transportation; Continue to strengthen TB/HIV co-management for
children identified in the PNC and CTC
Lastly funds will be used to strengthen referral system between pediatric HIV services points at the MRMO
by use an M&E officer to conduct daily checks on registers in outpatient pediatric clinics, in-patient pediatric
wards, MCH and the TB clinic to keep track of patients referred to the CTC and strengthen and formalize
referrals to and from community-based organizations (CBOs), NGOs and faith-based organizations (FBOs)
serving pediatric patients
LINKAGES: This activity is linked to activities under this partner in PMTCT, TB/HIV and palliative care, as
under SI and other USG treatment partner submissions providing expertise in areas of pediatric care and
TB
Activity Narrative: will have lists of NGOs, CBOs and HBC providers involved in pediatric HIV/AIDS support. It will indicate
clinics/wards so
community organizations to the facility, will be further strengthened through facility staff serving as points of
contact for
M&E activities for all the CTCs under the MRMO are supported by technical assistance from the DOD SI
team, based at
facility data needs. It is then entered into the electronic medical record system (EMRS), transported to the
DOD
data center located at Mbeya Referral Hospital, synthesized, NACP and USG reports are generated, and
feedback is provided to CTC teams for use in patient management. The number of CTCs supported by
Mbeya RMO will be 22 and 34 by September 2008 and September 2009 respectively.
and their staff, sensitization of community members and advocacy through influential leaders. This is also
accomplished by strengthening systems, such as the improved capacity of CHMT, the regional supportive
supervisory team and the zonal weekly ART meetings (part of already existing zonal support and routine
MRMO functions).
Estimated amount of funding that is planned for Human Capacity Development $32,000
Table 3.3.11:
ACTIVITY HAS BEEN MODIFIED IN THE FOLLOWING WAY
TITLE: Expanding and Integrating TB/HIV activities in Mbeya Region
Mbeya Regional Medical Office (MRMO) will continue providing support for implementation of HIV care and
treatment services together with collaborative TB/HIV activities. In FY 2009, ART will be expanded to
health center level focusing on high density areas along trade routes, but also identifying isolated rural
communities in which the health center provides regular medical services. For TB/HIV activities in FY09
focus will be to improve Intensified TB case finding in care and treatment settings and TB infection control in
all care and treatment clinics (CTC). All HIV infected patients receiving HIV care and treatment will be
screened for TB disease routinely and those found to have active TB will be referred to TB clinic to initiate
an uninterrupted treatment using Directly Observed Therapy (DOT). Diagnosis of TB will follow national TB
and Leprosy guidelines. Referral, linkages and patients follow up from care and treatment clinic to
laboratory, TB clinic and to other HIV related services e.g. home based care will be improved. MRMO will
print and distribute all TB/HIV guidelines including guidelines for implementation of TB infection control. TB
infection control will be implemented to all care and treatment sites to prevent transmission of TB among
People Living with HIV/AIDS (PLWHA) as well as health care providers. Training on TB/HIV activities
including intensified TB case finding, use of TB screening tool, reporting and recording will be conducted to
health care providers working at HIV clinics. Health care providers will also be trained on TB infection
control practices, ensuring good ventilation at the clinics. Laboratory services will be improved making sure
sputum smear microscopy performed are of high quality. MRMO will strengthen existing laboratory services
needed to implement TB/HIV program activities including supplement HIV test kits and X-ray films.
Outreach ART services to remote TB clinic in the regions will be strengthen with improved referral system.
MRMO will advocate for integration of collaborative TB /HIV services in HIV clinics including PMTCT and
STI
NEED and COMPARATIVE ADVANTAGE: According to the National Tuberculosis and leprosy Program
(NTLP), TB /HIV dual infection contributes to 17.5 % of the total disease burden in Tanzania (Ministry of
Health and Social Welfare (MOHSW), Manual of National Tuberculosis and Leprosy Program in Tanzania,
Fifth Edition, 2006). Currently, the Mbeya Regional Medical Office (RMO) supports ART and TB services in
10 hospitals and four health centers and plans to provide TB/HIV services to an additional eight health
centers where we currently have a functional Care and Treatment Center (CTC). This integrated approach
will further strengthen collaboration between TB care and HIV/AIDS care, reducing the burden of TB among
PLWHA and reducing the burden of HIV among TB patients, resulting in more effective control of TB among
HIV-infected people.
ACCOMPLISHMENTS: Currently, the MRMO supports treatment services in all six districts in the region
and will continue to strengthen the monitoring of HIV patients who are on TB care. Monitoring TB patients
through the use of clinical forms with TB screening questions has been key to ensuring the screening and
referral of all HIV and TB patients. Patients referred both ways have been well documented in the care and
treatment clinics. Integration of HIV care and treatment and the TB diagnosis, as well as treatment and
follow up will be strengthened in FY 2008.
ACTIVITIES: In FY 2008, ART will be expanded to 12 more health centers focusing on high density areas
along trade routes, but also identifying isolated rural communities in which the health center provides the
only source of regular medical services.
1) All HIV infected patients receiving HIV care and treatment will be screened for TB disease routinely, and
those suspected will access TB diagnostic services. Those found positive for TB disease will be
immediately referred to the TB clinic to initiate an uninterrupted treatment using the Direct Observation
Therapy (DOT). 1a) Support making of the clinical forms with TB screening tool. 1b) Clinicians and nurses
at each site will be trained on TB/HIV collaborative activities including use of modified clinical forms to
routinely identify underlying TB signs and symptoms for all clients attending at CTC. 1c) Develop a referral
system for access of HIV-infected TB suspects to laboratory diagnosis and treatment for TB.
2) TB infection control practices will be implemented in the care and treatment clinics to prevent
transmission of TB among PLWHA as well as health providers. 2a) CTC staff at each site will be trained on
TB infection control practices. Ensure ventilation in Care and Treatment clinics.
3) Strengthen existing laboratory services needed to implement TB/HIV program activities. 3a) Supplement
supply of X-ray films.
4) Support outreach ART services to remote TB clinic in the regions.
TB infection control.
contact (POC) for the community organizations.
CHECK BOXES: The areas of emphasis will include: initial and refresher training of staff in TB/HIV
comanagement,
infection control, provision of supplies and medications, and capacity building. Community
Health Management Teams (CHMTs) will be supported in planning and incorporating TB/HIV activities in
Activity Narrative: Council Comprehensive Plan (CCHPs).
M&E: Quality Assurance and Quality Control (QA/QC) for clinical services is conducted through the zonal
and regional supportive supervisory teams discussed above.
All efforts will be made to capture all the HIV care and treatment related data from both the CTCs and TB
clinics using NTLP data collection, recording and reporting tools. M&E data activities for all the CTCs under
the MRMO are supported by technical assistance (TA) from the DoD SI team based at the Mbeya Referral
Hospital.
SUSTAINABILITY: In order to sustain our efforts in integrating and expanding the TB/HIV services, MRMO
will continue working very closely with the National TB/Leprosy Control Program. The MRMO will ensure
sustainability through capacity building of health care facilities and its staff, sensitization of community
members, and advocacy through influential leaders. This is also accomplished by strengthening "systems",
such as the improved capacity of District Health Management Teams (DHMT), the regional supportive
Continuing Activity: 16442
16442 16442.08 Department of Mbeya Regional 6536 1135.08 $100,000
Table 3.3.12:
