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 250,000 to 355,000.
FY 2009 PMTCT targets have been modified
TITLE: Providing PMTCT services to Tanzania Peoples Defense Force
NEED and COMPARATIVE ADVANTAGE: The Tanzanian Peoples Defense Forces (TPDF) has a network
of military hospitals, health centers and dispensaries through out the country, supporting a total of over
30,000 enlisted personnel and estimated 60-90,000 dependants. Eighty percent of patients at these
hospitals are civilians living in the vicinity of the health facilities. The eight hospitals offer district-level
services with the largest hospital, Lugalo, located in Dar es Salaam, serving the role of a national referral
center for military medical services. The MOHSW goal is providing PMTCT service to 80% of the projected
HIV-positive mothers by September 2009. The national PMTCT coverage is still low, at 15%. Military
hospitals and health centers will play an important role in realizing MOHSW goals.
ACCOMPLISHMENTS: In FY 2004 the TPDF started offering PMTCT services at Lugalo Hospital. With
PEPFAR FY 2005, FY 2006 and FY 2007 funds, the TPDF and PharmAccess International (PAI) introduced
these services in the remaining seven military hospitals (Mbalizi, Mwanza, Mzinga, Monduli, Songea,
Mirambo, Bububu) and four health centers of Mwenge, Mbalizi, Mwanza and Tabora Hospital. In FY 2007, a
total of 1,260 pregnant women were tested in the last 12-month reporting period, of which 324 women
received ARV prophylaxis.
ACTIVITIES: 1) Expand PMTCT services to an additional 10 health for a total of eight hospitals and 14
health centers.
1a) Using the four-week national curriculum, carry out training of three health care workers per hospital (24)
and two per satellite health center (28).
1b) Renovation of counseling and delivery rooms at 10 new satellite sites/health centers.
1c) Train PMTCT service providers in staging of HIV+ mothers and provision of ART where capacity exist. If
capacity is not available on-site, then patients will be referred to nearest military, District or Regional
Hospital
2) Provide PMTCT services at 22 military health facilities:
2a) Support the role-out of the new national PMTCT guidelines (50% of the HIV+ women are expected to
receive NVP, 30% AZT+NVP, and 20% ART).
2b) provide services using the opt-out approach, based on the new national testing algorithm using rapid
test with results given on same day.
2c) Provide PMTCT to women in ANC and labor, delivery, and post natal wards.
2d) Promote infant-feeding counseling options (AFASS), linking mothers to safe water programs in the
region, and for those choosing to breastfeed, counseled to exclusively breastfeed with early weaning.
2e) Infant feeding and nutritional interventions during lactation period will be promoted.
2f) Train ANC staff in collection of dried blood spot (DBS) for infant diagnosis.
2g) Establish a formal referral system for HIV+ women and their HIV-exposed infants from the health
centers to TPDF hospitals or District and Regional hospitals for additional ANC services, infant diagnosis,
ART, and TB/HIV at CTC.
2h) Procure test materials and protective safety gear through the District Medical Offices (DMO) and
Medical stores department (MSD) under the national PMTCT program.
3) Promote and manage quality services.
3a) Lugalo Hospital will serve as the coordinating body for services, and oversee quality assurance
following national standards for follow-up at district or regional hospitals.
3b) Conduct ‘Open House' days and other awareness campaigns at each center distributing information
about the available services of the facilities, including PMTCT.
3c) Train volunteers/social support providers to conduct community education, home-visits, and assist in the
development of the organization of post-test.
LINKAGES: Expansion of PMTCT activities in FY 2008 will ensure a close linkage of military
implementation to national strategies and programs supporting MOHSW goals. Activities will be linked with
organizations of women living in the barracks for promotion and patient follow up at home. Linkages will be
established as well as referral for HIV+ individuals from the satellite sites to TPDF hospitals or public
regional and district hospitals for CD4, TB testing, and complicated cases. Linkage will be strengthened with
Prevention activities under the TPDF Program, including promotion and counseling of preventive measures
for HIV+ individuals, provider initiated testing and counseling (PITC,) C&T, TB/HIV and OVC programs.
Linkages will also be improved with reproductive child health (RCH) activities especially Malaria and
Syphilis in Pregnancy program, family planning, and nutritional and child survival program as these are all
provided in the military facilities. Furthermore, linkages with nearest by District and Regional Hospitals will
be established for referral of complex clinical cases and laboratory testing. PAI will continue to collaborate
with facilities supported, other USG treatment partners, and Global Fund.
CHECK BOXES: This funding will fully develop PMTCT services in the network of military hospitals and
satellite military health centers. Funding will support the introduction and/or improvement of PMTCT
services. More emphasis will be put into training of health care workers per hospital and from satellite health
centers, renovation or refurbishing of counseling and delivery rooms, community education, and providing
test materials and protective safety gear.
M&E: PAI will support the military facilities teams to collect and report PMTCT data based on the national
protocol, and provide feedback on tool performance to the NACP. PAI will work with these institutions to
strengthen and implement the PMTCT quality framework and provide regular supervision. PAI will continue
Activity Narrative: to support the district and regional teams with supportive supervision visits to monitor the collection of data,
reporting of the data, and the continued on-site training of facility staff. Data will be collected both
electronically and by paper-based tools. PAI will work with the MOHSW in rolling-out the revised PMTCT
M&E: patient-based registers, the Monthly Summary Forms for both ANC and L&D, and the commodity
logistic (LMIS) tools to all of the sites it supports. PAI, in collaboration with UCC, will train 52 health care
workers and provide technical assistance to 22 facilities. PAI will continue to promote the synthesis and use
of data by facility staff, and strengthen its use for decision-making for facilities and the district and regional
management teams.
SUSTAINAIBLITY: In the military setting, turnover of medical staff is low. Once trained, this capacity will
stay within the forces. Health facilities of the Military Forces are under the administration of the Ministry of
Defense, not under the Ministry of Health. PAI will encourage the Office of the Director Medical Services to
integrate care and treatment activities in military health plans and budgets at the facility and national level.
To improve administrative capacity, the PAI will work with military authorities to build local authority's
technical and managerial capacity to manage the program, as well as incorporate data collection and
analysis as part of regular health service planning and management.
New/Continuing Activity: Continuing Activity
Continuing Activity: 13568
Continued Associated Activity Information
Activity Activity ID USG Agency Prime Partner Mechanism Mechanism ID Mechanism Planned Funds
System ID System ID
13568 3393.08 Department of PharmAccess 6551 1136.08 $250,000
Defense
7788 3393.07 Department of PharmAccess 4572 1136.07 $150,000
3393 3393.06 Department of PharmAccess 2838 1136.06 $150,000
Emphasis Areas
Gender
* Addressing male norms and behaviors
* Increasing gender equity in HIV/AIDS programs
Health-related Wraparound Programs
* Child Survival Activities
* Family Planning
* Malaria (PMI)
* Safe Motherhood
* TB
Military Populations
Workplace Programs
Human Capacity Development
Estimated amount of funding that is planned for Human Capacity Development $60,000
Public Health Evaluation
Food and Nutrition: Policy, Tools, and Service Delivery
Estimated amount of funding that is planned for Food and Nutrition: Policy, Tools $20,000
and Service Delivery
Food and Nutrition: Commodities
Economic Strengthening
Education
Water
Table 3.3.01:
ACTIVITY UNCHANGED FROM FY 2008.
TITLE: Providing HIV/AIDS Prevention programs to TPDF, with focus on Gender Based Violence (GBV)
NEED and COMPARATIVE ADVANTAGE:
The HIV prevention and awareness-raising activities under this program aim to reach a target of
approximately 4,000 recruits at basic TPDF training centers; 3,000-4,000 men and women under the
National Services; 25,000 other servicemen and -women and their dependents; tens of thousands civilians
from the communities around the military hospitals, health centers, and military camps by September 2009.
Prevention efforts within the TPDF will continue to focus on military hospitals, health centers/satellite sites,
TPDF training centers, detachment camps, border camps, and the training camps of the National Services.
Service members are highly at risk for HIV/AIDS since they are often stationed outside their residential
areas for long periods, which usually range from 6 to 24 months. Included in these critical prevention efforts
are addressing gender issues, especially gender-based violence (GBV), and this target population.
GBV can be defined as any unlawful act perpetrated by a person against another person because of their
sex that causes suffering on the part of the victim and results in physical, psychological, and emotional
harm or economic deprivation among other criteria. Attention has been increasingly directed at the possible
role military personnel could play in preventing HIV/AIDS within their ranks and in the civilian communities
they come in contact with. The Tanzania People's Defense Forces (TPDF), like any other African military, is
grappling with how to best stem the spread of HIV/AIDS among its officers. The TPDF serves 33,000
service members in addition to thousands of civilians living near eight military hospitals. A workplace
prevention model has been adopted by the TPDF as the most effective tool for combating HIV/AIDS in the
military as it provides a standardized approach to prevention, HIV/AIDS awareness, peer education, and
critical issues of gender and care and treatment while enhancing force readiness.
The military arena provides a unique setting for reaching people with information on these themes. This is
because military personnel are a relatively captive audience while in the military and are used to receiving
new information and in-service training and upgrading of skills education. We integrate HIV/AIDS prevention
messages in peer education training (focused on higher rank officers), ‘life-skills' training (focused on
recruits) and we train all TPDF and Youth Service trainers (including trainers in sports, exercises,
administration, etc) to integrate HIV/AIDS preventive messages in their regular training programs.
ACCOMPLISHMENTS:
A dedicated TPDF task force has been formed to develop IEC and life skills materials. A video, a card
game, and several other printed life skills materials have been produced and distributed to all camps and
health facilities, many of which were supplied through UN programs for militaries. Twenty-four TOTs and
480 peer educators have been trained. Twenty-four trainers from the National Service have been trained as
TOTs on life-skills for recruits. Condoms have been procured by Tanzania Marketing and Communications
company (TMARC) and MSD and distributed to 86 outlets. Prevention for positives counseling through
health facilities for HIV-positive persons on the risk of HIV transmission has been initiated under FY 2007
and FY008 funds. This AB component of PAI's program will be implemented as an integrated part of the
peer-education and the life-skills training programs. With FY 2009 funds, PAI will continue to support
assessments of the policy environment and development of IEC materials specifically related to issues of
GBV, (GBV, male norms, alcohol use, etc) at 36 military sites. These activities will cover all military
personnel and civilians living near TPDF health facilities and camps.
ACTIVITIES:
Additional information about the extent of GBV in TPDF and enabling policy environment is needed to assist
with further decision-making.
1) Developing and distributing new IEC and life skills materials, as well as newly designed materials and
prevention components on GBV by a dedicated TPDF taskforce, in collaboration with the GBV Program of
Engender Health.
2) Special efforts will be focused on counseling of HIV-positive persons to raise awareness about the risks
of HIV transmission, with an additional emphasis on partner reduction and being faithful. USG funding will
support the training of 102 clinicians and HIV counselors of eight military hospitals (three per site), nine
health centers, 16 training camps, and 14 training sites of the National Service (two per site).
3) (Re-)training of 24 TOTs and training of an additional 240 peer educators, at least two per military, navy,
and air force camp, with particular emphasis on gender issues, such as GBV, as well as alcohol abuse and
their relationship to HIV transmission. The peer educators will be supported in continued
prevention/outreach efforts throughout their period of military service. Activities will be directed to all military
hospitals, detachment, training and border camps,
4) (Re-) training of 24 TOTs on life-skills for recruits of the National Service
5) Organize one-day HIV/AIDS awareness sessions for the higher cadres at TPDF Head Quarters, the five
Brigades and the Head Offices of the Navy and the Air Force.
6) Establishing post-test group sessions of HIV-positive persons with referrals to critical care and treatment
services.
The AB component of PAI's program is an integrated part of all training programs and the awareness
sessions mentioned above.
LINKAGES:
PAI and the TPDF will continue to link activities in this program area with clinical service and VCT activities
undertaken by the military. It will also link with organizations of women living in the barracks who will be
trained in social support and home-based care for HIV-positive persons in and outside the barracks. Links
will also be made with Engenderhealth and with local NGOs operating in communities surrounding barracks
to coordinate and collaborate on broader prevention programs. Condoms will be obtained through MSD and
District Medical Officers in the respective districts. Prevention outreach will be linked to counseling and
testing, PMTCT, and care and treatment activities in support of the continuum of care. Expansion of
prevention services in FY 2009 will ensure a close linkage of the HIV/AIDS programs of the TPDF to
national strategies and programs implemented under the Ministry of Health and Social Welfare (MOHSW).
Activity Narrative: M&E:
Quantification of the effect of prevention activities is not yet standardized. PAI wishes to collaborate with the
Tanzania Data Quality Assurance Team (DAT) to develop standard monitoring and evaluation tools and
procedures for data collection, storage, reporting, and data quality. KAP surveys will be introduced in all
training programs. Plans for data use for decision-making within the organization and with stakeholders will
be outlined.
SUSTAINAIBLITY:
In a military setting, staff turnover is low. Once trained, this capacity will stay within the forces. PAI will
encourage the Office of the Director Medical Services to integrate services in military budgets at the
barracks and at the national level. To improve administrative capacity, the PAI will work with military
authorities to build local technical and managerial capacity to manage the program as well as incorporate
data collection and analysis as part of regular health service planning and management.
Continuing Activity: 16394
16394 16394.08 Department of PharmAccess 6551 1136.08 $250,000
Table 3.3.02:
THIS ACTIVITY HAS BEEN MODIFIED IN THE FOLLOWING WAYS
TITLE: Providing other HIV/AIDS Prevention programs to TPDF, with focus on peer education and ‘life-
skills' for recruits.
NEED and COMPARATIVE ADVANTAGE: The HIV prevention and awareness-raising activities under this
program aim to reach a target of approximately 4,000 recruits at basic TPDF training centers; 3,000 to
4,000 men and women under the National Services; 25,000 other servicemen and -women, their
dependents; tens of thousands of civilians from the communities around the military hospitals, health
centers, and military camps by September 2009. Prevention efforts within the TPDF will continue to focus
on military hospitals; health centers/satellite sites, basic training, special detachment, border camps, and
training camps of the National Services. Service members are highly at risk for HIV/AIDS as they are often
stationed outside their residential areas for periods, which usually range from six to 24 months.
ACCOMPLISHMENTS: A dedicated TPDF task force has been formed to develop IEC and life skills
materials. A video, a card game, and several other printed life skills materials have been produced and
distributed to all camps and health facilities, many of which were supplied through UN programs for
militaries. 24 TOTs and 480 peer educators have been trained. 24 trainers from the National Service have
been trained as TOTs on life-skills for recruits. Condoms have been procured by Tanzania Marketing and
Communications Company (TMARC) and MSD and distributed to 86 outlets. Prevention for positives
counseling through health facilities for HIV-positive persons on the risk of HIV transmission has been
initiated under FY07 and FY08 funds. With FY 2009 funds, PAI will continue to support assessments of the
policy environment and development of IEC materials specifically related to issues of HIV prevention and
GBV at 36 military sites. These activities will cover all military personnel, their dependents and civilians
living near military camps and health facilities.
1) Adapt and distribute new IEC and life skills materials obtained from the UN and other African military
program by a dedicated TPDF taskforce. Extra attention will be focused on recruits from TPDF and the
National Service
4) (Re-) training of 24 TOTs on life-skills for all recruits of the National Service. Trainers are any trainers in
the National Service, whether in sports and other physical exercises, education, administration, use of fire-
arms, etc. The purpose of this is to make HIV awareness and life-skills a continuous and integrated part of
all training programs in TPDF and the Youth Service
7) Distribute condoms and include prevention education as part of counseling and testing services at
post/camp treatment clinics, basic training centers, special detachment, and border camps. Condoms will
be obtained through District Medical Officers in the respective districts. In incidental cases, when the public
system does not deliver and when stock-outs may occur, condoms will be procured and distributed through
T- MARC.
8) The Phones for Health partnership will leverage its existing infrastructure in Tanzania to enable DoD to
send outgoing SMS messages to active military stationed in remote or cross-border areas. This activity is
linked to the CDC/Phones for Health SI activity, which supports a pilot to disseminate HIV/AIDS prevention
messages via SMS to the host nation's military, especially service members stationed in remote areas.
Under this activity, DOD will work with PAI and the TPDF to design and administer pre- and post-pilot
surveys targeting HIV knowledge and attitudes among military stationed in remote areas. The pre-pilot
survey will provide a pre-intervention baseline, while the post-intervention survey will measure any changes
in knowledge, attitudes, intentions and behaviors. The comparison of the pre- and post-pilot findings will
inform the future expansion or adaptation of miltary-to-military SMS messaging in Tanzania to include
improvements to the approach, strengthening of messages and possible incorporation of messages
regarding other HIV services available.
undertaken by the military, as well as the Phones for Health activity in Strategic Information. It will also link
with organizations of women living in the barracks who will be trained in social support and home-based
care for HIV-positive persons in and outside the barracks. Links will also be made with Engenderhealth and
with local NGOs operating in communities surrounding barracks to coordinate and collaborate on broader
prevention programs. Condoms will be obtained through MSD and District Medical Officers in the respective
districts. Prevention outreach will be linked to counseling and testing, PMTCT, and care and treatment
activities in support of the continuum of care. Expansion of prevention services in FY 2009 will ensure a
close linkage of the HIV/AIDS programs of the TPDF to national strategies and programs implemented
under the Ministry of Health and Social Welfare (MOHSW).
M&E:
Activity Narrative: training programs. Plans for data use for decision-making within the organization and with stakeholders will
Continuing Activity: 13569
13569 3392.08 Department of PharmAccess 6551 1136.08 $236,200
7787 3392.07 Department of PharmAccess 4572 1136.07 $535,000
3392 3392.06 Department of PharmAccess 2838 1136.06 $300,000
Table 3.3.03:
THIS IS A NEW ACTIVITY.
TITLE: Providing HIV/AIDS prevention to TPDF through a male circumcision program.
At the request of the GOT, the USG will implement a pilot male circumcision (MC) program through 5
partners including: JHPIEGO, Columbia University, AED/TMARC, Pharm Access and the Mbeya Regional
Hospital (MRH). JHPIEGO will provide technical oversight, training and support with systems development
(i.e., supervision, quality improvement, etc.) to the other implementing partners as well as implement the
MC demonstration program at Iringa Regional Hospital. JHPIEGO will also conduct formative research on
traditional circumcisers in Mara. Columbia University will implement the MC demonstration program in
Kagera, the MRH will implement in Mbeya, and Pharm Access in Dar es Salaam (with the TPDF).
AED/TMARC will work closely with JHPIEGO in the development of appropriate communications initiatives
targeting health care providers as well as surrounding demonstration site communities.
program aim to reach military staff living near one of the eight military hospitals in the PEPFAR/PAI/TPDF
HIV/AIDS workplace Program. Service members are at high risk for HIV/AIDS as they are often stationed
outside their residential areas for periods, ranging from six to 24 months. Comparative advantages of this
Program are that MC services can be provided at the eight hospitals and that good follow-up of the
servicemen is guaranteed.
ACCOMPLISHMENTS: The MC program is a new activity that fits well in the ongoing comprehensive
PEPFAR/DOD/PAI/TPDF HIV/AIDS workplace program, which include:
1. HIV screening as part of the yearly medical check-up of all military personnel in the TPDF. The yearly
medical check-up will provide accurate data on the current percentage of MC in the military. These data, in
combination with HIV-test results will show whether there is a difference in HIV prevalence amongst
circumcised and non-circumcised men.
2. A dedicated TPDF task force has been formed to develop IEC and life skills materials in relation to HIV
prevention and Gender Based Violence. The taskforce will be involved in the development of materials to
inform military personnel about the risks and benefits of MC.
3. Eight military hospitals have been renovated, laboratories have been equipped, and clinicians, nurse
counselors, laboratory technicians and pharmacists have been trained in basic HIV service provision,
making these an excellent platform for MC.
4.The hospitals have been equipped with computers and data-entry staff have been trained for program
monitoring purposes. After additional training these hospitals are ready for quality MC services and for
follow-up monitoring of the men participating in this program.
ACTIVITIES: 1. Adapt and distribute Life skills, GBV and MC advocacy materials to male military personnel
living near the military hospitals of Dar es Salaam.
2. Train clinicians and nurse counselors and data management staff of these hospitals on MC, male norms
and behaviors in relation to HIV infection.
3. Collect information on MC at the yearly medical check-up of male military personnel.
4) Counseling of HIV-negative military men on the risks and benefits of MC.
5. Circumcision of the HIV-negative men who agree to participate.
6. Follow-up of circumcised and non-circumcised military men on their HIV-status over time, at the yearly
medical check-up / HIV test.
LINKAGES: PAI and the TPDF will link activities in this program area with HIV prevention activities, clinical
service and VCT undertaken by the military. Condoms will be obtained through MSD and District Medical
Officers in the respective districts. Prevention outreach will be linked to counseling and testing, PMTCT, and
care and treatment activities in support of the continuum of care. Expansion of prevention services in FY
2009 will ensure a close linkage of the HIV/AIDS programs of the TPDF to national strategies and programs
implemented under the MOHSW.
M&E: PAI will begin implementation of an M&E plan upon receipt of FY 2009 funds. The plan will outline
procedures for data collection, storage, reporting, and data quality, and will outline plans for data use for
decision-making within the organization and with stakeholders and will work to harmonize with other
PEPFAR AB and OP partners as appropriate.
SUSTAINAIBLITY: In a military setting, staff turnover is low. Once trained, this capacity will stay within the
forces. PAI will encourage the Office of the Director Medical Services to integrate services in military
budgets at the barracks and at the national level. To improve administrative capacity, the PAI will work with
military authorities to build local technical and managerial capacity to manage the program as well as
incorporate data collection and analysis as part of regular health service planning and management
Geographic Coverage Areas: Dar es Salaam (Lugalo National Military Hospital)
New/Continuing Activity: New Activity
Continuing Activity:
* Reducing violence and coercion
Refugees/Internally Displaced Persons
Table 3.3.07:
ACTIVITY HAS BEEN MODIFIED IN THE FOLLOWING WAYS:
In addition to activities described in the FY 2008 narrative, PharmAccess International (PAI) will expand
services to put additional emphasis on nutritional support and prevention for positives.
The importance of nutrition in determining clinical outcomes for people on ART is becoming increasingly
more apparent. In FY 2009, USG/Tanzania will put more emphasis on addressing food and nutrition needs
of clients receiving care and support. In home visits, PAI will conduct nutritional counseling and refer
patients to the CTC facility for nutritional assessments, which will help to inform the clinical management of
PLWHA.
In FY 2009, there will be an increased emphasis on provision of prevention with positives (PWP) services
for People Living with HIV/AIDS (PLWHA). All sexually active PLWHA will be provided with condoms and
linked with sexually transmitted infection treatment services and counseling to reduce high-risk behaviors.
Referrals will be made for family planning, if appropriate. Implementing partners will discuss with PLWHA
specific strategies for disclosing one's HIV status to sexual partners, and offer confidential HIV testing to the
partners of and children born to all PLWHA in their coverage areas.
In addition, PAI will strengthen its basic prevention package. PLWHA will be provided with counseling, and
linked to support groups or peer-led interventions through the HBC system. There will be increased
involvement of PLWHA in the communities in service provision as HBC providers. PLWHA will be provided
with information about ways they can protect their own health, prevent common illnesses, and improve
access to safe water and hygiene practices. PAI will ensure that interventions address the comprehensive
needs in an environment free from stigma and discrimination. PAI will support procurement and/or
distribution of insecticide-treated bed nets to PLWHA, and promotion on their correct usage. PAI will ensure
that all PLWHA are receiving Cotrimoxazole for prevention of opportunistic infections. PLWHA will also be
provided with water treating tablets and water vessels in provision of safe drinking water. PAI will train HBC
providers on screening for TB and linking the clients to services. HBC volunteers will also be addressing
and monitoring adherence to TB treatment.
*END ACTIVITY MODIFICATION*
TITLE: Providing comprehensive adult care and support services at TPDF health facilities
of military hospitals, health centers and dispensaries throughout the country, supporting a total of over
hospitals are civilians living in its direct vicinity. The eight TPDF hospitals offer district level services with the
largest hospital Lugalo, located in Dar es Salaam, serving as a national referral center for military medical
services. PharmAccess International (PAI) has been working with the TPDF on health issues since 2003.
ACCOMPLISHMENTS: TPDF initiated Care and Treatment services including ART at Lugalo Hospital, Dar
es Salaam. Under FY04-FY07 ART services have been expanded to eight military hospitals and nine
satellite sites. The target for FY08 is that 15 new health centers / satellite sites and four mobile centers
provide VCT and Care and Treatment Services, to a total of 36 sites. For FY09 the number will increase to
38 sites. Focus of the FY09 program will be on quality improvement of the Care and Treatment services.
As of July 2008, cumulative of 5,140 adult HIV+ persons have been initiated on Care and Treatment.
A draft HIV/AIDS Policy that will make HIV testing mandatory has been written by a TPDF Task Force. The
Policy is to be approved by the Parliament before it becomes effective. In FY08 provider-initiated HIV
testing and counseling will be offered as part of the annual medical check-up. It is anticipated that this will
lead to the identification of a large numbers of army personnel requiring care and treatment in addition to
those regularly identified through VCT and through other medical services. The military hospitals, health
centers and mobile centers need to be prepared for a stark increase in patient load.
1) Increase the number of health facilities under the TPDF to a total of eight hospitals and 26 health centers
and four mobile centers.
1a) Renovate counseling rooms at 2 new satellite sites/health centers
1b) Conduct initial and refresher Care and Support training of 48 medical staff from the military hospitals, 84
from the satellite sites and mobile centers
1c) Train 200 volunteers, mostly women living in the barracks in home-base care and home-visits
1d) Involve NGOs and community support groups, especially women groups from the barracks near the
health facilities and camps, to provide care and support, including nutritional support
1d) Conduct community education and mobilization through "Open House" days at each facility to increase
access to services and partner testing
1e) Strengthen the referral system between the TPDF health facilities and District and Regional hospitals for
ANC services and adult and infant diagnosis, ART and TB/HIV at CTC
2) Provide Care and Treatment Services to a total of 9,700 adults through TPDF facilities. (Plus 800
children = 10,500)
2a) Reinforce provider initiated counseling and testing (PITC) as part of all out-patient services
2b) Procure OI drugs when not available through central mechanism
2c)Evaluate patients for malnutrition and offer nutritional counseling and support; involve women groups
from the barracks in identification, selection and supporting patients
2d) Continue to improve patient record/data collection, working with TPDF HQ and facility staff to collect,
record and analyze data
2e) Monitor quality of services at the hospitals through linkages with regional supportive supervisory teams
and Lugalo Hospital as well as through quarterly TPDF meetings (attended by all chief ART staff)
3) Ensure that proper lab capacity to monitor infants on ART is developed at eight hospitals and ensure
Activity Narrative: that this capacity is available at the referral hospitals for children attending the TPDF health centers,
3a)Provide CD4 equipment to two TPDF hospitals
3b) Train and re-train laboratory technicians of the eight TPDF hospitals in TB and HIV diagnosis (adults
and infants), hematology and biochemistry analysis
LINKAGES: All HIV-infected patients will be referred for further evaluation and qualification for TB treatment
within each facility. Linkages will be strengthened with Prevention activities under the TPDF Program.
Referrals from the health centers to TPDF hospitals or public regional and district hospitals for CD4, TB
testing and treatment of complicated cases will be established. PAI will ensure linkages with organizations
of women living in the barracks for home-based support and adherence counseling. Linkages will be
developed with existing local NGOs operating in those communities to ensure a continuum of care, not only
for military personnel but also for civilians living near the military hospitals. PAI will continue to collaborate
with Regional and District Health Management teams and with USG treatment partners for supportive
supervision purposes, and technical assistance.
M&E: Data will be collected electronically and by paper-based tools. All sites will have laptops with a
database and output functions as developed by University Computing Center (UCC) for the NACP. 76 data-
entry clerks will be trained for that purpose. PAI will continue to promote the synthesis and use of data by
facility staff, TPDF HQ team, NACP and the district and regional management teams.
stay within the Forces. Health facilities of the Military Forces are under the administration of the Ministry of
integrate treatment activities in military Health Plans and budgets at the facility and national level. To
improve administrative capacity, PAI will work with military authorities to build local authority's technical and
managerial capacity to manage the program as well as incorporate data collection and analysis as part of
regular health service planning and management.
Continuing Activity: 16426
16426 16426.08 Department of PharmAccess 6551 1136.08 $200,000
Estimated amount of funding that is planned for Human Capacity Development $126,750
Estimated amount of funding that is planned for Food and Nutrition: Policy, Tools $25,000
Table 3.3.08:
ACTIVITY HAS BEEN REVISED SIGNIFICANTLY FROM FY 2008 COP.
TITLE: Providing comprehensive adult treatment services at TPDF health facilities
The Tanzanian Peoples Defense Forces (TPDF) has a network of military hospitals, health centers and
dispensaries throughout the country, supporting a total of over 30,000 enlisted personnel and estimated 60-
90,000 dependants. Eighty percent of patients at these hospitals are civilians living in its direct vicinity. The
eight TPDF hospitals offer district level services with the largest hospital Lugalo, located in Dar es Salaam,
serving as a National Referral center for military medical services. PharmAccess International (PAI) has
been working with the TPDF on health issues since 2003.
TPDF initiated VCT and Care and Treatment services at Lugalo Hospital, Dar es Salaam in 2003. Under
FY04 - FY07 services have been expanded to eight military hospitals and nine satellite sites. The target for
FY08 is that 15 new health centers / satellite sites and four mobile centers provide VCT and ART, to a total
of 36 sites. For FY09 the number will increase to 38 sites. As of July 2008, cumulative of 3,883 persons
have received CT. Focus of the FY09 program will be on quality improvement of the services and a
substantial increase in the numbers for testing.
lead to the identification of a large numbers of army personnel requiring care and treatment. The military
hospitals, health centers and mobile centers need to be prepared for a stark increase in capacity to test and
in an increase in patient load.
PharmAccess will continue to work with TPDF to increase the number of health facilities under the TPDF to
hospitals, health centers, and mobile centers. New satellite sites/health centers counseling and treatment
rooms will be renovated . PAI will conduct initial and refresher ART training of medical staff from the military
hospitals, from the satellite sites and mobile centers and train volunteers from the barracks in basic home-
base care. Community education and mobilization be conducted through "Open House" days at each facility
to increase access to services and partner testing. Strengthening of the referral system between the TPDF
health facilities and District and Regional hospitals for ANC services and adult and infant diagnosis, ART
and TB/HIV at CTC will continue.
ART services will expand to cover individuals with diagnosed HIV through TPDF facilities. This will be
achieved through: reinforcement of provider initiated counseling and testing (PITC) as part of all in and out-
patient services; procurement of OI drugs when not available through central mechanism and monitoring
quality of services at the hospitals through linkages with regional supportive supervisory teams and Lugalo
(National Military Referral Hospital). Evaluation of patients for malnutrition and offer nutritional counseling
and support will continue in all health facilities. Monitoring and evaluation activities for ART services will be
strengthened by improving patients record/data collection and working with TPDF HQ and facility staff to
collect, record and analyze data. Also, conducting quarterly meetings with site representatives and experts
in specific fields (ART developments, pediatrics, AIDS and TB etc) to discuss and review quality of ART
The lab capacity will be developed at all eight hospitals for patient monitoring and OI diagnostics. Standard
operating procedures (SOP) will be developed and also training in QA/QC at Regional and District hospitals.
TPDF will purchase and install CD4 equipment to two TPDF hospitals. Laboratory Technicians will be re-
trained on TB- and HIV diagnosis, routine laboratory testing and equipment maintenance. Procurement of
reagents and consumables will be done when they are not available through national supply chain
Linkages will be strengthened with Prevention activities under the TPDF Program. All HIV-infected patients
will be referred for further evaluation and qualification for TB treatment within each facility. Referrals from
the health centers to TPDF hospitals or public regional and district hospitals for CD4, TB testing and
treatment of complicated cases will be established. PAI will ensure linkages with organizations of women
living in the barracks for home-based support and adherence counseling. Linkages will be developed with
existing local NGOs operating in those communities to ensure a continuum of care, not only for military
personnel but also for civilians living near the military hospitals. PAI will continue to collaborate with
Regional and District Health Management teams and with USG treatment partners, specifically with
DOD/MRH in the Southern Highlands, for supportive supervision purposes, and technical assistance.
M&E
Data will be collected electronically and by paper-based tools. All sites have or will have laptops with a
In the military setting, turnover of medical staff is low. Once trained, this capacity will stay within the Forces.
Health facilities of the Military Forces are under the administration of the Ministry of Defense, not under the
Ministry of Health. PAI will encourage the Office of the Director Medical Services to integrate treatment
Activity Narrative: activities in military Health Plans and budgets at the facility and national level. To improve administrative
capacity, PAI continues to work with military authorities to build local authority's technical and managerial
capacity to manage the program as well as incorporate data collection and analysis as part of regular health
service planning and management.
Continuing Activity: 13572
13572 3390.08 Department of PharmAccess 6551 1136.08 $2,270,000
7786 3390.07 Department of PharmAccess 4572 1136.07 $2,165,600
3390 3390.06 Department of PharmAccess 2838 1136.06 $1,550,000
Estimated amount of funding that is planned for Human Capacity Development $182,250
Table 3.3.09:
ACTIVITY HAS BEEN REVISED SIGNIFICANTLY FROM FY 2008 COP
TITLE: Providing Comprehensive Pediatric Care and Support Services at Tanzania People's Defense Force
Health Facilities
NEED and COMPARATIVE ADVANTAGE: The Tanzanian People's Defense Forces (TPDF) has a network
of military hospitals, health centres, and dispensaries throughout the country, supporting a total of over
30,000 enlisted personnel and an estimated 60-90,000 dependants. Eighty percent of patients at these
hospitals are civilians living in nearby communities. The eight TPDF hospitals offer district-level pediatric
care and support services with the largest hospital, Lugalo, located in Dar es Salaam, serving as a national
referral center for military medical services. PharmAccess International (PAI) has been working with the
TPDF on health issues since 2003, and is poised to increase access to pediatric HIV care and support in
the military facilities across Tanzania.
ACCOMPLISHMENTS: TPDF, in partnership with PAI, has expanded HIV/AIDS care and treatment for
adults and children to eight military hospitals and nine satellite sites. By the end of FY 2008, services will
be available at 15 new health centres/satellite sites and four mobile centers. This will bring the total to 36
sites, providing voluntary counseling and testing and care and treatment services, along with early infant
diagnosis (EID). Since mid-2008, dried blood spots (DBS) from HIV-exposed children attending the eight
military hospitals have been transported to one of Tanzania's four zonal hospitals for diagnosis through
DNA polymerase chain reaction (PCR). One satellite site (in Mwenge, Dar es Salaam) has a dedicated
pediatric care and treatment clinic (CTC) and ward that is supervised by pediatric staff from Lugalo Hospital.
By the end of FY 2008, over 300 HIV-positive children 15 or less had received care and support services.
Organizations of women living in the barracks around the TPDF hospitals were trained in FY 2008 to
advocate for HIV testing, promote treatment adherence, and provide psychosocial and nutritional support to
HIV-positive patients. The women play a key role in identifying and supporting HIV-positive children
ACTIVITES: In FY 2009, PAI will offer provider-initiated testing and counseling (PITC) as part of the annual
medical check-up of all military employees. It is anticipated that this exercise will increase the number of
children tested and the number enrolled into care and treatment. It is anticipated that PAI will provide care
and support to a total of 800 children through TPDF facilities, putting additional emphasis in FY 2009 on
nutritional assessment and support and linkages for exposed children with community OVC support
programs.
Specifically, PAI will:
- Train 48 personnel from eight military hospitals and 84 personnel from the 28 satellite health centers on
pediatric HIV and TB diagnosis, care and support, with an emphasis on EID.
- Train 200 volunteers from the barracks in pediatric HBC, to assist in patient follow-up and to provide
management for care and support activities.
- Conduct community education and mobilization through "Open House" days at each facility to increase
access to services and HIV testing.
- Strengthen the referral system between health centres and hospitals, between district and regional
hospitals to increase EID at CTCs, and between health facilities and community programs that provide care
and support services to vulnerable children.
- Reinforce PITC as a regular part of all clinical services at the pediatric outpatient department, TB unit, and
various wards.
- Transport DBS samples from HIV-exposed children to the four referral hospitals in Tanzania with capacity
for pediatric DNA PCR testing (Muhimbili in Dar es Salaam, Kilimanjaro Christian Medical Center in Moshi,
Bugando in Mwanza and the Mbeya Referral Hospital).
- Provide drugs for opportunistic infections to HIV-positive children (not yet on ART) at the TPDF health
facilities or at the nearest district or regional hospitals.
- Monitor the quality of pediatric services at the TPDF hospitals and health facilities through linkages with
regional supportive supervisory teams at Lugalo hospital and Mwenge health centre, as well as through
quarterly TPDF meetings (attended by all chief clinical staff)
In FY 2009, PAI will intensify its efforts in nutritional support for people living with HIV/AIDS (PLWHA).
Specifically, PAI will evaluate children and women in the breastfeeding period for malnutrition and offer
nutritional counseling and support. PAI will support CTCs to conduct anthropometric measurements and
determine nutritional status of children using Body Mass Index calculations and other appropriate
measurements such as mid-upper arm circumference (MUAC) and weight for age. PAI will 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. In addition, PAI will
ensure the identification of clients eligible for the pilot therapeutic supplemental feeding program. Finally,
PAI will link with other organizations addressing household food security and economic strengthening to
ensure PLWHA have access to these services.
LINKAGES: PAI will strengthen linkages with prevention activities under the TPDF program by promoting
measures such as PITC, counseling and testing, prevention of mother-to-child transmission, TB/HIV
treatment, family planning, and OVC support. The program will refer all HIV-infected patients for further
evaluation of qualification for TB treatment within each facility; and establish formal referrals from the health
centers to TPDF or local hospitals for CD4 and TB testing. PAI will ensure linkages with organizations of
women living in the barracks for HBC, nutritional support and adherence counseling. For children in the
surrounding communities, the program will develop linkages with existing local non-governmental
organizations (NGOs) operating in those communities to ensure a continuum of care. PAI will continue to
collaborate with Regional and Council Health Management Teams (RHMT/CHMT) and with USG treatment
partners for supportive supervision purposes and technical assistance. PAI will also link with Pediatric AIDS
programs underway through Baylor International Pediatric AIDS Initiative, Columbia University, and
Activity Narrative: Elizabeth Glaser Pediatric AIDS Foundation to take advantage of tools, materials, and lessons learned.
M&E: Data will be collected electronically and by paper-based tools. All sites will have computers with a
database and output functions as developed by University Computing Center for the National AIDS Control
Program (NACP). PAI will train 76 data-entry clerks for that purpose. PAI will continue to promote the
synthesis and use of data by facility staff, TPDF headquarters' team, NACP, RHMTs and CHMTs.
stay within the forces. Health facilities of the military forces are under the administration of the Ministry of
Defense, rather than the Ministry of Health and Social Welfare. PAI will encourage the Office of the Director
of Medical Services to integrate care and treatment activities into military health plans and budgets at the
facility and national level. To improve administrative capacity, PAI will work with military authorities to build
local authorities' technical and managerial capacity to manage the program as well as incorporate data
collection and analysis as part of regular health service planning and management.
Estimated amount of funding that is planned for Human Capacity Development $2,000
Estimated amount of funding that is planned for Food and Nutrition: Policy, Tools $2,500
Estimated amount of funding that is planned for Food and Nutrition: Commodities $5,000
Table 3.3.10:
TITLE: Providing comprehensive pediatric treatment services at TPDF health facilities
dispensaries throughout the country, supporting a total of over 30,000 enlisted personnel and an estimated
60-90,000 dependants. 80% of patients at these hospitals are civilians living in their direct vicinity. The eight
TPDF hospitals offer district-level pediatric services with the largest hospital, Lugalo, located in Dar es
Salaam, serving as the national referral center for military medical services. PharmAccess International
(PAI) has been working with the TPDF on health issues since 2003, and is poised to continue and increase
access to pediatric HIV care and support in the military facilities across Tanzania.
TPDF, in partnership with PharmAccess, expanded HIV/AIDS care and treatment for adults and children to
eight military hospitals and nine satellite sites in 2006 and 2007. The target for FY 2008 is expansion to 15
new health centers/satellite sites and four mobile centers, for a total of 36 sites, providing VCT and care and
treatment services, along with infant diagnosis. Dried blood spots (DBS) from HIV-exposed children
attending the eight military hospitals have been shipped to one of the four zonal hospitals of Tanzania for
infant diagnosis/ polymerase chain reaction (PCR) since mid 2008. One satellite site (in Mwenge, Dar es
Salaam) has a dedicated pediatric CTC and a ward that is closely supervised by pediatric staff from nearby
Lugalo Hospital. As of July 2008, cumulative of 302 HIV-positive children under 15 years of age have
received care and support services.
advocate HIV testing, look after treatment adherence, and provide psychosocial and nutritional support to
HIV-positive patients. The women play a key role in identifying and supporting HIV-positive children. 200
women from the barracks around the hospitals and the health centers will be re-trained in home-visits and
home-based care services, in and outside the barracks.
In FY 2008, provider-initiated HIV testing and counseling (PITC) will be offered as part of the annual
medical check-up of all military employees. It is anticipated that this exercise will increase the numbers of
children tested and those enrolled into care and treatment.
All hospitals under the TPDF support the provision of pediatric ART services. As part of FY 2009 activities,
PAI will continue working with the TPDF to develop strategies to increase up take 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 DBS to the laboratory will be improved. These will be key components of the overall
improvement of pediatric ART services within the military community.
FY 2009 funds will be used to increase the total number of health facilities providing ART services under the
TPDF hospitals, health centers, and mobile centers. Specific activities will include; Renovation of counseling
and testing and treatment rooms at new satellite sites/health centers; Train and re-train clinicians, nurse-
counselors, laboratory technicians and pharmacy assistants in HIV and TB diagnosis of infants: medical
staffs from the military hospitals, satellite sites, and mobile centers. Special attention will be given to
management of prophylaxis for children; Train nurses and volunteers from the military barracks on home-
based care and home visits to advocate HIV testing, support treatment compliance and provide
psychosocial support for adults and children; Conduct community education and mobilization through "Open
House" days at each facility that increase access to services and partner testing, and strengthen the referral
system between the TPDF health facilities and district and regional hospitals for antenatal clinic (ANC)
services and adult and infant diagnosis, ART and TB/HIV for adults and children at the CTC.
Funds will also be used to initiate ART to children and activities will include reinforcing PITC as part of all in-
and out-patient pediatric services. Blood samples from HIV-exposed children will be taken at all police and
prison VCT and PMTCT sites, and will be sent to the four referral hospitals in Tanzania capable of doing
pediatric PCR testing: Muhimbili in Dar es Salaam, Kilimanjaro Christian Medical Center (KCMC) in Moshi,
Bugando in Mwanza and the Mbeya Referral Hospital; Provision of drugs for opportunistic infections (OI) to
HIV-positive children will also be done.
FY 2009 funds will support evaluation of HIV-positive mothers and children for malnutrition, and offer
nutritional counseling and support. In order to improve the quality of ART services a three monthly meetings
with representatives of the sites and experts in specific fields (ART developments, pediatrics, AIDS/TB etc.)
will be conducted. Monitoring of quality of pediatric services at the hospitals will be done through linkages
with regional supportive supervisory teams and Lugalo as the National Military Referral Hospital
Lastly funds will be use to ensure proper lab capacity is developed at all military hospitals for patient
monitoring and OI diagnostics.
Linkages will be strengthened with prevention activities under the TPDF Program, including promotion of
and counseling for preventive measures for HIV-positive PITC, counseling and testing, PMTCT, TB/HIV,
family planning and OVC. All HIV-infected patients will be referred for further evaluation of qualification for
TB treatment within each facility. Formal referrals will be established from the health centers to TPDF
hospitals, or public regional and district hospitals, for CD4, TB testing and complications. PAI will ensure
linkages with organizations of women living in the barracks for home-based care, nutritional support and
adherence counseling. For clients in the surrounding communities, linkages will developed with existing
local NGOs operating in those communities to ensure a continuum of care. PAI will continue to collaborate
Activity Narrative: with Regional and Council Health Management Teams, and with USG treatment partners for supportive
Data will be collected electronically and by paper-based tools. All sites will have laptops with a database
and output functions as developed by University Computing Center (UCC) for the National AIDS Control
Program (NACP). 76 data-entry clerks will be trained for that purpose. PAI will continue to promote the
synthesis and use of data by facility staff, TPDF headquarters' team, NACP and the council and regional
In the military setting, turnover of medical staff is low. Once trained, this capacity will stay within the forces.
Health facilities of the military forces are under the administration of the Ministry of Defense, not under the
Ministry of Health. PAI will encourage the Office of the Director of Medical Services to integrate treatment
activities in military health plans and budgets at the facility and national level. To improve administrative
capacity, PAI will work with military authorities to build local authorities' technical and managerial capacity to
manage the program, as well as incorporate data collection and analysis as part of regular health service
planning and management.
Estimated amount of funding that is planned for Human Capacity Development $21,600
Table 3.3.11:
TITLE: Providing comprehensive TB/HIV diagnoses and treatment to Tanzania People's Defense Forces
(TPDF)
PharmAccess with the support from Department of Defense will continue to provide support for
implementation of collaborative TB/HIV activities in military the hospitals. The activities provided will include
those for reducing burden of TB among people living with HIV/AIDS as well as reducing burden of HIV
among TB patients. The activities described below are to be conducted in collaboration with the Ministry of
Health (MOH) through the National Tuberculosis and Leprosy Program, National AIDS Control Program and
the Regional and Council Health Management Teams. PharmAccess will provide technical assistance to
implement Intensified TB case finding (ICF) TB infection control (IC). ICF will be strengthen to all health
facilities providing HIV care and treatment services including hospitals, health centers and four mobile
centers, ensuring regular and proper use of the TB screening questionnaire; establish systems to prevent
TB infection. Work with MOH in the development and finalization guidelines for ICF, IC and provision of
Isoniazid preventive therapy. Guidelines will be printed and distributed to all military health facilities. 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. At TB clinic all
TB patients offered HIV counseling and testing. TB patients who will be co-infected with HIV will e referred
to CTC for care and treatment services. All TB-HIV co infected patients will be counseled on HIV prevention
including condoms promotion and provision. Prevention messages will be provided to all HIV infected
patients with encouragement to disclosure HIV sero status to their sexual partners. HIV co-infected TB
patients will be encouraged encourage to advise their partners to undergo HIV test. Patients will be liked to
STI, PMTCT and family planning services according to the need of the patient. Referral, linkages and
patients follow up from care and treatment clinic to laboratory, TB clinic, PMTCT, STI clinic and to other HIV
related services e.g. home based care will be improved. PharmAccess will provide support in the Health
System Strengthening by refurbishing heath facilities to have counseling rooms which will provide privacy
and confidentiality during HIV counseling and testing. Human capacity will be supported through training of
heath care providers on TB/HIV integration and co-management. Health care providers including laboratory
technologists from Tanzania Police Defense Force (TPDF) hospitals, health centers and mobile centers will
train using national TB/HIV training curriculum. The focus will be on Intensified TB Case Finding among
PLWHA attending care and treatment services, TB infection control in HIV clinics and congregate settings,
referral system, linkage and patients follow up. Referral system from care and treatment clinic (CTC),
Laboratory, TB clinics, STI and PMTCT clinics will be improved. Laboratory capacity for TB diagnosis will be
strengthen by providing microscopes for TB diagnosis and laboratory supplies. PharmAccess will support
health facilities with Cotrimoxazole supply for TB/HIV patients to ensure continuum of care for PLWHA.
Strengthen Community awareness through "Open House" days to increase access to VCT service and TB
screening for TPDF personnel and the community at large. Conduct nutritional and dietary assessments of
TB+ persons and provide nutrition counseling and support. Supportive supervision will be conducted
regularly to improve quality of services
30,000 enlisted personnel and an estimated 60-90,000 dependant. TPDF hospitals do not only service
military personnel and their dependents, but also civilians living in the vicinity of the health facilities. In fact
80% of the patients are civilian. The eight hospitals offer district level services. The largest hospital, Lugalo,
located in Dar es Salaam serves the role of a national referral center for military medical services. With an
average HIV prevalence of six to seven percent, Tanzania is amongst the hardest hit countries in Africa.
The rates are thought to be higher in the military setting. PAI is poised to continue to address the needs to
improve coverage and access, and to strengthen and expand care and treatment activities in the military
hospitals and health centers/satellite sites across Tanzania for military personnel and civilians, and ensure a
close service linkage of military HIV program being implemented in-line with the national Health Sector HIV
strategy.
A concept HIV/AIDS Policy to make HIV testing an integrated part of the yearly medical check-up for all
TPDF personnel has been written by a dedicated TPDF Task Force. Authorization of the Policy by HQ is
expected in the last quarter of 2007. The consequence of the new Policy will be that large numbers of army
personnel will be tested and that an extensive increase of HIV+ and TB+ persons who need care and
treatment can be expected. PharmAccess will work with TPDF to provide comprehensive quality care and
treatment services in eight military hospitals and 25 health centers / satellite sites.
Approximately 40-50% of TB patients are HIV-infected and, conversely, it is estimated that roughly one-third
of HIV-infected patients develop clinically-overt TB. Expanded case identification and treatment of TB is
needed in order to reduce morbidity and mortality associated with HIV infection. In addition, aggressive HIV
counseling and testing of TB patients represents an important public health strategy which will be a key to
further identification and treatment of other HIV-infected individuals. Military hospitals are small with limited
medical staff. The same clinicians see TB and HIV/AIDS patients.
ACCOMPLISHMENTS: A training for three clinicians and nurse counselors from the eight military hospitals
in June 2007 was the start of harmonization of the HIV/AIDS-TB under the DOD/PAI/TPDF Program. A
dedicated TB-laboratory and a container with rooms for TB counseling have been refurbished in June and
July. Referrals to and from the TB-Unit and the CTC started then.
Data-handling to keep track of referrals from the TB-Unit to the CTC and vice versa need to be put in place
now at all military hospitals.A total of 226 patients were tested for HIV in the period January - June 2007.
115 were HIV+, 82 were referred to the TB-Unit; 26 have been reported TB+.
ACTIVITIES: It is expected that a total of 550 of the 5,000 HIV-infected patients from the CTC's of the eight
military hospitals and their satellite sites will require treatment for clinically-overt TB illness in FY 2008. It is
also expected that a total of 700 of the 6,300 HIV-infected patients from CTC's of the 8 military hospitals
Activity Narrative: and their satellite sites will require treatment for clinically-overt TB illness in FY 2009. Approx 2000 will then
receive prophylaxis for opportunistic infections (OI). It is also anticipated that 95% of the TB positive
individuals attending the wards or Out Patient Department (OPD) of the TPDF health facilities will undergo
counseling and testing for HIV in that period.
1) Strengthening HIV/TB services among TPDF facilities, expanding services to an additional 10 health
centers: 1a) Renovate and furnish patient counseling rooms at 10 new satellite sites/health centers; 1b)
train staff from eight hospitals and 25 satellite sites/health centers in TB diagnostic methods to increase
detection and referral of TB cases among their HIV positive patients; 1c) train additional health care
providers of the TB-Units at Lugalo and Mbalizi in provider-initiated HIV testing and counseling of all
confirmed TB positive patients; 1d) procure microscopes for TB diagnosis at each site and procure
labmaterials
when not available through the central mechanism; 1e) provide cotrimoxazole prophylaxis to HIV+
persons testing positive for TB, in accordance with existing NTLP guidelines.
2) Improve TB infection control practices in the CTC and in patient wards to prevent transmission of TB
among HIV+ persons as well as health providers: 2a) CTC staff will be trained on TB infection control
practices; 2b) assess and modify CTC to ensure ventilation; 2c) provide protective safety gear to clinic and
laboratory staff, and support in proper use.
3) Strengthen the continuum of care for TB/HIV services: 3a) Establish a referral system for HIV+ persons
from the 25 health centers to the eight military hospitals and/or to nearby Regional and District hospitals for
CD4 testing and for care and treatment of complicated cases; 3b) conduct community education on TB/HIV
co-infection and co-management during "Open Houses" at each of the eight hospitals; 3c) train women
(many who are spouses of soldiers) from organizations serving the barracks in directly observed therapy
(DOT) for follow up and provision of home-based services for both TB and ART treatment.
LINKAGES: Administration of the hospitals and health centers of the TPDF is not under the MOHSW but
under the Ministry of Defense. TB/HIV services under this program will ensure a close linkage with national
HIV/AIDS and TB strategies and programs of the TB Unit of the NACP and the National TB and Leprosy
Programme (NTLP). Coverage will increase through the eight military hospitals and 25 health centers. All
HIV-infected men and women will be referred for further evaluation and qualification for TB treatment and
ART within the facility. Linkage will be strengthened with prevention activities under the TPDF Program,
including promotion of and counseling on preventive measures for HIV+ persons, provider-initiated
counseling and testing (PITC), C&T, PMTCT, TB/HIV and OVC.
Linkages will be established as well as referral for HIV+ persons from the satellite sites to TPDF hospitals or
district hospitals for CD4, TB testing and complicated cases. PharmAccess will ensure linkages with
organizations of women living in the barracks. We anticipate that these women will also operate as care
providers within the barracks. No NGO or other private social support organization or social support
organization is allowed to work/operate within the military barracks. However for clients in the surrounding
communities, we anticipate to form linkages with existing local NGOs operating in those communities so as
to ensure continuum of care.
Linkages have been and will be established with the Regional and District Health Management teams for
supportive supervision purposes, and technical assistance.
CHECK BOXES: The areas of emphasis were selected because the activities will include support for
training of medical staff, purchase of TB-specific laboratory diagnostic equipment and reagents,
consumables for HIV confirmatory diagnosis and isoniazid (INH) and cotrimoxazole for treatment and
prophylaxis purposes. It is expected that a total of 2,000 people, representing approximately 50% of the
4,000 HIV-infected patients who will be on care or treatment by September 2009, will be found to be
coinfected
with TB and will require TB services.
M&E: Data will be collected both electronically and by paper-based tools. All sites use the paper forms
developed by National TB and Leprosy Program (NTLP) and NACP. TB screening and HIV-screening
registrars need to be adapted to keep track of TB+ patients referred for HIV-screening and HIV+ patients
referred for TB-screening. Registrars need to be checked by a member of the referring clinic to ensure that
referred patients are reached.
On-site data entry will take place. All sites will have been provided with PCs, a database and output
functions as developed for the National C&T program. 66 Data clerks from the eight hospitals and the 25
health centers will be all trained by, or in collaboration with the Ministry of Health's Unit of Control and
Coordination (UCC). PAI and UCC will provide supportive supervision and the hospitals will support the
satellite sites. Data will be provided to NTLP, NACP and OGAC for reporting purposes.
SUSTAINAIBLITY: PAI will encourage the Office of the Director Medical Services to integrate HIV/AIDS TB
harmonization activities in military Health Plans and budgets at the facility and national level. To improve
administrative capacity, PAI will work with military authorities to build local authority's technical and
managerial capacity to manage the program.
The facilities provide staff and health infrastructure. Most of these program costs are for training and for
infrastructure improvement. Investments are done at the start-up phase of the program. It is therefore
expected that the costs per patient will decrease dramatically over time. In the military setting, turnover of
medical staff is low. Once trained, this capacity will stay within the forces.
Continuing Activity: 13570
13570 5093.08 Department of PharmAccess 6551 1136.08 $200,000
7790 5093.07 Department of PharmAccess 4572 1136.07 $200,000
5093 5093.06 Department of PharmAccess 2838 1136.06 $150,000
Table 3.3.12:
ACTIVITY REMAINS UNCHANGED FROM FY 2008 COP
TITLE: Providing Care and Support for Orphans and Vulnerable Children (OVC) of Military Personnel in
barracks surrounding TPDF hospitals
NEED and COMPARATIVE ADVANTAGE: Family of military service members are required to leave the
barracks when the service member passes away. Spouses often have no relatives nearby to support them,
since service members are transferred to and from various camps throughout their enlistment. When both
parents pass away, their children often do not have relatives to take care of them. Many community groups
are reluctant to provide services to these children, as they are not seen as coming from the community.
The management of Mbalizi Military Hospital in the Mbeya region has reported that approximately 200 OVC
of military personnel have been identified. Unfortunately, about half of these children are living on the
streets, and the remainders are residing with older stepparents in extremely poor households. This facility
has advocated for the need to address military involvement in supporting OVC from their "ranks" and will
serve as a pilot to determine feasibility of this type of program under FY08.
ACCOMPLISHMENTS and EXISTING GAPS: Care for OVC is a new activity for PharmAccess International
(PAI) and the Tanzanian People's Defense Force (TPDF). This activity started with a pilot project for OVC
military in Mbalizi, Mbeya in FY08.
1) Provide services to 200 military and civilian OVC in Mbalizi, Mbeya:
1a) Using the Department of Social Welfare (DSW) identification tool, work with the local most vulnerable
children committees (MVCCs) and KIHUMBE (an organization providing support for OVC in nearby wards),
to identify OVC of military personnel and civilians in Mbalizi;
1b) Refurbish and furnish a support center for approximately 200 children near the barracks of Mbalizi
military hospital;
1c) Contract and train ten support staff to look after the children in the afternoon thereby providing a respite
for caregivers;
1d) Train 20 foster families in proper care of OVC;
1e) Provide all OVC with psychosocial support through individual and group counseling;
1f) Depending on outcomes of the needs assessment conducted as part of the identification process,
prioritize services needed by individual OVC for educational support (fees, uniforms, and supplies), shelter,
and nutritional assessment and assistance;
1g) Train staff and caregivers in the identification of HIV related illness for proper referral of children who
may be HIV infected
2) Conduct assessment of military associated OVC care at seven other barracks:
2a) Using the DSW identification tool, work with the local MVCC and non-government organizations (NGOs)
to identify OVC of military personnel at seven other military facilities;
2b) With the MVCC and the local DSW representative, map other OVC services in the communities to
ensure comprehensive services of military OVC.
3) Determine feasibility of reintegrating OVC within their original communities and extended family
members:
3a) In collaboration with local social workers and the DSW, assess human resource (HR) requirements of
the TPDF to execute linkages through local DSW offices;
3b) Review TPDF statistics on service personnel and accuracy in assisting to identify home-of-record and
kin for linkages; 3c) With the DSW, evaluate the safety of this approach for OVC (it has been reported that
some widowed women leave their children in the communities of their spouse's last post to increase their
chances of remarrying once they have returned to their childhood communities).
4) Develop a strategy for TPDF involvement in OVC support:
4a) Convene a task force to evaluate data from site and HR needs assessments;
4b) Initiate discussions on gaps to be addressed within the TPDF and feasible support for OVC through
either direct services or improving linkages with community based groups and/or reintegration with original
community/extended family members.
This project will include delivery of services to OVC and a feasibility study to link OVC back to their original
communities. The program will also assess the need for such support at seven other military hospitals in
Dar es Salaam, Mzinga, Monduli, Mwanza, Mirambo, Songea, and Bububu (Zanzibar).
LINKAGES: The program implementation will contribute to the MVC National Plan of Action (NPA). It will be
organized in close collaboration with Mbalizi Military Hospital (counseling and testing, and medicalservices,
including pediatric AIDS treatment), schools in Mbalizi town, a woman-run NGO living in thebarracks of
Mbalizi military hospital, the local MVCC, local government, and KIHUMBE. Collaboration will occur on all
levels to support the reintegration of the children to their original families and fostering of thechildren whose
original lineage cannot be traced.
M&E: This activity will use the national Data Management System tool to collect data for the targeted
beneficiaries and caregivers trained and feed to the national OVC data. M&E activities will be coordinated
with the MVCCs and KIHUMBE, which provides OVC support to some of the wards surrounding Mbalizi.
Close collaboration will ensure that duplication of services will not occur in providing assistance and support
to OVC.
SUSTAINAIBLITY: Staff turnover is low within a military setting. Once trained, individuals providing support
in this capacity will stay within the forces. Based on the outcomes and findings of this pilot, the PAI will
encourage the Office of the Director of Medical Services to integrate services in military budgets at the
Activity Narrative: barracks and national level. To improve administrative capacity, the PAI will work with military authorities to
build local technical and managerial capacity to manage the program as well as incorporate data collection
and analysis as part of regular health service planning and management. While the initial start-up costs are
relatively high per child, this initial expenditure will pay off in the long term once sustainable services are
developed.
Continuing Activity: 16422
16422 16422.08 Department of PharmAccess 6551 1136.08 $150,000
Estimated amount of funding that is planned for Human Capacity Development $2,625
Estimated amount of funding that is planned for Food and Nutrition: Policy, Tools $5,000
Estimated amount of funding that is planned for Food and Nutrition: Commodities $10,000
Estimated amount of funding that is planned for Education $50,000
Table 3.3.13:
ACTIVITY UNCHANGED FROM FY 2008
TITLE: Expanding CT and Provider Initiated Counseling and Testing Services within the TPDF
Though unconfirmed, the prevalence is thought to be higher in the military than that of the general
population (7%, Tanzania HIV/AIDS Indicator Survey 2003-2004) due to their mobility, long periods of
separation from their families, and special standing in the community placing them at greater risk.
Continued aggressive measures are needed to reach this mostly young and sexually active portion of the
population that can serve as a bridge for HIV transmission to the population at-large.
This activity will support ongoing efforts in providing CT and identification of HIV+ individuals among the
military for both target prevention and linkages to services. Started under FY 2005 funding by the Tanzanian
Peoples Defense Forces (TPDF) with assistance from PharmAccess International (PAI), this activity will
focus on increasing provision of CT services to military personnel and to communities surrounding military
posts and health facilities.
FY04-FY07 services have been expanded to eight military hospitals and nine satellite sites. The target for
of 36 sites. For FY09 the number will increase to 38 sites. As of July 2008, 30,000 persons have received
CT in the preceding 12 months. Focus of the FY09 program will be on quality improvement of the services
and a substantial increase in the numbers for testing.
testing and counseling have been introduced as part of the annual medical check-up. It is anticipated that
this will lead to the identification of a large numbers of army personnel requiring care and treatment. The
military hospitals, health centers and mobile centers need to be prepared for a stark increase in capacity to
test and in an increase in patient load.
1a) Renovate counseling and testing rooms at 2 new satellite sites/health centers
1b) Conduct initial and refresher CT and PITC training of 164 medical staff from the military hospitals, from
the satellite sites and the mobile centers
1c) Strengthen the referral system between the TPDF health facilities and District and Regional hospitals
for ANC services and adult and infant diagnosis, ART and TB/HIV at CTC
2) Provide CT to 30,000 individuals through TPDF facilities
2a) Reinforce provider initiated counseling and testing (PITC) as part of all in- and out-patient services
2b) Provide mobile CT services to border camps and surrounding communities and Procure two mobile
centers, train staff and conduct bi-monthly visits to 12 border camps
2c) Include counseling of HIV+ persons on risk behavior and HIV prevention' as a critical part of all HIV
services
2d) Conduct nutritional and dietary assessments of HIV+ persons and provide nutrition counseling and
support
2f) Continue to improve patient record/data collection, working with TPDF HQ and facility staff to collect
2g) Discuss and improve quality of CT services through 3-monthly meetings with representatives of the
sites and experts in specific fields (ART developments, pediatrics, AIDS and TB etc)
2h) Monitor quality of services at the hospitals through linkages with regional supportive supervisory teams
and Lugalo, the National Military Referral Hospital
3) Develop community linkages to improve service up-take and strengthen prevention component of CT:
3a) Conducting training for nurse-counselors from each CT site for home visits to discuss and offer CT to
relatives of HIV+ index patients;
3b) Train 200 volunteers from the barracks in home visits and home-base care;
3c) Organize post-test clubs (for HIV-negatives and HIV- positives);
3d) Provide prevention messages targeted to the clients HIV status upon testing, encouraging negatives to
remain negative and prevention with positives counseling as an initiation into care and treatment;
3e) HIV/AIDS sensitization campaigns, advocating CT, through home-visits and "community events" in the
barracks;
4) Ensure proper lab capacity is developed at all eight hospitals for HIV- and STI screening purposes
4a) Provide CD4 equipment to two TPDF hospitals
4b) Provide standard operating procedures and training in QA/QC at Regional and District hospitals;
4c) (Re-) train technicians in TB-, STI and HIV diagnosis, routine laboratory testing and equipment
maintenance
4d) Procure reagents, consumables and safety gear (gloves, materials for safe disposal of sharps and other
wastes) when not available through national supply chain.
living in the barracks to advocate for HIV-testing, home-based support and adherence counseling. Linkages
Activity Narrative: will be developed with existing local NGOs operating in those communities to ensure a continuum of care,
not only for military personnel but also for civilians living near the military hospitals. PAI will continue to
collaborate with Regional and District Health Management teams and with USG treatment partners for
activities in military Health Plans and budgets at the facility and national level. To improve administrative
Continuing Activity: 13571
13571 3394.08 Department of PharmAccess 6551 1136.08 $749,500
7789 3394.07 Department of PharmAccess 4572 1136.07 $920,000
3394 3394.06 Department of PharmAccess 2838 1136.06 $490,000
Table 3.3.14:
