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: 13580
Continued Associated Activity Information
Activity Activity ID USG Agency Prime Partner Mechanism Mechanism ID Mechanism Planned Funds
System ID System ID
13580 3398.08 Department of Rukwa Regional 6554 1138.08 $350,000
Defense Medical Office
7796 3398.07 Department of Rukwa Regional 4575 1138.07 $300,000
3398 3398.06 Department of Rukwa Regional 2839 1138.06 $50,000
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
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
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:
THIS IS A NEW ACTIVITY.
TITLE: Expansion of Adult Care and Support Services in Rukwa Region
NEED and COMPARATIVE ADVANTAGE: The Rukwa Regional Medical Office (RMO) supports the
implementation of prevention, care, and treatment programs throughout the region, providing funding and
supervision to the regional hospital and district-level facilities. As is being done in other regions, Rukwa will
be scaling up treatment in the districts through the health centers.
To scale up services effectively in Rukwa, care and treatment centers require significant infrastructure
improvements, staff capacity building, strengthened supply chains, and enhanced management systems at
the district hospitals and health centers. Located in the far west of the country along the border with the
Democratic Republic of Congo, regular interaction with zonal support through the MRH and the National
AIDS Control Programme (NACP) in Dar es Salaam is difficult. The poor conditions of the roads isolate
them even further, particularly during the rainy season when they are impassible. This makes provision of
services throughout the region very challenging.
The DOD has stationed personnel in Rukwa to work closely with the RMO, the District Medical Officers, and
Regional and District Health Management Teams (RHMT and DHMT) to provide direct technical support
and material inputs necessary to improve site capacity.
ACCOMPLISHMENTS: Currently, over 3,900 patients from the region are on ART, 94% of which are adults.
Over 75 staff members have been trained in ART provision and care and support services. Two district
laboratories at the Nkasi and Mpanda District Hospitals have been renovated, equipped, trained, and are
currently performing their own hematology and chemistry assays. Provider-initiated testing and counseling
(PITC) for HIV/AIDS has been implemented in all the hospitals in the region and supportive supervisory
teams have now been extended to facilities below the district level to expand ART services to all health
centers in the region.
ACTIVITIES: In FY 2009, the Rukwa RMO and DOD will provide significant inputs to roll out HIV care and
treatment to 20 additional health centers, bringing the total number of facilities to 43 by September 2010.
All NACP identified facilities in this region for ART services will receive support to ensure that care and
support services are available in all four districts in the region.
Specifically, the Ruwka RMO will:
1. Expand care and support services to a total of three hospitals and 20 primary healthcare facilities in the
region, covering all four districts. Work with the DHMT and facility directors to develop and implement
facility-based work plans and to ensure basic services are provided. These include Cotrimoxazole
prophylaxis, treatment of opportunistic infections and other HIV/AIDS-related complications, pain and
symptom relief, and psychosocial support, and referral for community services. Assist in the acquisition of
reagents, medications, and clinical supplies through local distributors when these are not available through
central mechanisms. Work with facility pharmacists to improve capacity in forecasting, stock management
and ordering.
2. Continue to improve the quality of care. Strengthen and reinforce implementation of standard operating
procedures for care and support services, laboratory monitoring, and maintenance of patient records.
Expand mentoring and supportive supervision beyond the district-level facilities through regional medical
teams. Improve patient record/data collection, working with DOD, DHMTs and facility staff to analyze data
to inform improvement of services.
3. Reinforce and expand PITC to all facilities. Train 75 staff in inpatient wards and outpatient clinics in HIV
care and treatment, 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. Increase enrollment of adults in care and support services. Ensure all TB/HIV co-infected patients are
initiated on Cotrimoxazole prophylaxis as appropriate.
5. Intensify efforts in nutritional support for people living with HIV/AIDS (PLWHA). Specifically, the program
will support CTCs to conduct anthropometric measurements and determine nutritional status using Body
Mass Index calculations and other appropriate measurements such has mid-upper arm circumference
(MUAC) and weight for age. The RMO 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. Finally, the program will link with other organizations addressing household food
security and economic strengthening to ensure PLWHA have access to these services.
6. Reinforce comprehensive nature of clinical services. Provide prevention with positives messages to
people living with HIV/AIDS, including provision of condoms, importance of safe water and good hygiene,
counseling about adherence and disclosure, and referral for family planning or sexually transmitted
diseases, as needed. Strengthen and formalize referrals to and from community-based organizations
(CBOs), non-governmental organizations (NGOs) and faith-based organizations (FBOs) 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 ART services (pediatric and adult), as well as those of the other regions
in this zone (Mbeya 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.
The Rukwa RMO will continue to promote outreach services from the facilities to the communities. Each
Activity Narrative: facility has/will have lists of NGOs, CBOs, FBOs, and home-based care providers involved in HIV/AIDS
support, indicating geographical coverage and types of services offered. These lists are displayed in
CTCs and other clinics/wards so health staff can refer clients to those organizations as necessary. Rukwa
will strengthen these referrals, as well as referrals from community organizations to the facility, through
facility staff serving as points of contact for the community organizations.
M&E: Quality assurance and control for clinical services is conducted through the zonal and regional
supportive supervisory teams discussed above.
M&E data activities for all CTCs under the Rukwa RMO 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 the MRH for synthesis, generation of NACP and USG reports, and provision of feedback
to CTC teams for use in patient management.
SUSTAINABILITY: Rukwa RMO is ensuring sustainability through capacity building of health care facilities
and staff, sensitization of community members, and advocacy through influential leaders. This is also
accomplished by strengthening "systems," such as DHMTs, the regional supportive supervisory team, and
the zonal weekly ART meetings as part of existing zonal support and routine Rukwa RMO functions.
New/Continuing Activity: New Activity
Continuing Activity:
Estimated amount of funding that is planned for Human Capacity Development $71,300
Estimated amount of funding that is planned for Food and Nutrition: Policy, Tools $10,000
Table 3.3.08:
ACTIVITY HAS BEEN REVISED SIGNIFICANTLY FROM FY 2008 COP.
TITLE: Expansion of Adult ART Services in Rukwa Region
NEED and COMPARATIVE ADVANTAGE:
The Rukwa Regional Medical Office (Rukwa RMO) supports the implementation of prevention, care, and
treatment programs throughout its region, providing funding and supervision to the regional hospital and
district level facilities. As in other regions, Rukwa will be scaling up treatment in the districts through the
health centers. As a DOD partner and a region under the support of the Mbeya Referral Hospital, roll out of
Pediatric ART in this region mirrors that in Mbeya and Ruvuma.
ACCOMPLISHMENTS:
Currently, over 3,900 patients from the region are on ART; 94% of them are adults. Over 75 staff members
have been trained in ART provision. Two district laboratories at the Nkasi and Mpanda District Hospitals
have been renovated, equipped, trained, and are up and running performing their own hematology and
chemistry assays. Provider initiated testing and counseling (PITC) of HIV/AIDS has been implemented in all
the hospitals in the region and supportive supervisory teams have now been extended to facilities below the
district level to expand ART services at all health centers in the region.
ACTIVITIES:
To effectively scale-up services in Rukwa, care and treatment centers require significant infrastructure
improvements, staff capacity building, strengthened supply chains and enhanced management systems at
DRC, regular interaction with zonal support through the Mbeya Referral Hospital and the NACP in Dar is
difficult. The poor conditions of the roads isolate them even further, particularly during the rainy season
when they are impassible. This makes provision of services through out the region challenging. The DOD
has stationed personnel in Rukwa to work more closely with the RMO, the District
Medical Officers (DMOs), and Regional and District Health Management Teams (RHMT and DHMT) to
provide direct technical support and material inputs necessary to improve site capacity.
Under FY 2009 funding, the Rukwa RMO and DOD will provide significant inputs to roll out HIV care and
treatment to additional health centers by September 2010.
All NACP identified facilities in this region for ART services will receive support to ensuring available of
services in all four districts in the region. Within the region activities will include: Expanding services and
support to a total of three hospitals and twenty primary health care facilities by : working with DHMT in
initiating ART services in the twelve new health centers; Renovate space at most of the facilities to support
CTC and train an additional health providers/clinical staff in ART. Quality of treatment services will improve
by expanding mentoring and supportive supervision down beyond the district level facilities through 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 and improving
patient record/data collection, working with DoD, DHMT and facility staff to analyze data to
inform improvement of services. Efforts to increase the number of adult patients on ART through
reinforcement of the comprehensive nature of clinical services; strengthen pre-ART follow-up within the
CTC for evaluation for treatment ; strengthening TB/HIV co-management in the TB clinics and CTC
strengthen referral systems for services within a facility among wards and clinics and using site
coordinators 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. Patients records will be checked by M&E officers and
strengthen ing of referrals to and from CBO, NGO and FBO serving patients in their communities through
facility social workers will continue..
Train 15 lab technicians on PMTCT lab activity such as Syphilis testing , rapid HIV test trainings and Rapid
HIV quality assurance activities; Train 20 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 15 lab technicians on rapid HIV testing, TB
diagnosis acid-fast method; Continue to procure reagents for hematology, chemistry and CD4 and viral load
for all CTC hospital lab's in Rukwa Hospitals.; Continue to roll out HIV Early infant diagnosis, to 20 health
centers by training health workers on sample management, transportation. Also the labs will continue
implement the external laboratory quality assurance scheme in collaboration with MRH and DOD; while
MRH will continue to service bi- annually hematology, chemistry and facscount equipments in the Rukwa
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 (Mbeya 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.
facility has/will have lists of NGOs, CBOs and home-based care (HBC) providers involved in HIV/AIDS
support, indicating geographical coverage and types of services offered. These lists are displayed in the
CTCs and other clinics/wards so health staff can refer clients to those organizations as necessary. These
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 and CT; significant
infrastructure improvement for existing and new sites; provision of equipment, supplies and medications;
strengthening linkages with TB/HIV, PMTCT and community groups.
Activity Narrative: 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 Rukwa RMO 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 Rukwa RMO will be 10 and 11 by September 2008 and September 2009 respectively.
SUSTAINABILITY
Rukwa RMO 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 District Health Management Teams (DHMT), the
regional supportive supervisory team, and the zonal weekly ART meetings as part of already existing zonal
support and routine Rukwa RMO functions.
April 2009 Reprogramming:
$75,000 reprogrammed to (activity id 3395.23432.09) support procurement of lab reagents through SCMS
Continuing Activity: 13581
13581 3395.08 Department of Rukwa Regional 6554 1138.08 $1,835,000
7794 3395.07 Department of Rukwa Regional 4575 1138.07 $850,000
3395 3395.06 Department of Rukwa Regional 2839 1138.06 $450,000
Estimated amount of funding that is planned for Human Capacity Development $154,250
Table 3.3.09:
ACTIVITY HAS BEEN REVISED SIGNIFICANTLY FROM FY 2008 COP
TITLE: Expansion of Pediatric HIV Care and Support Services in Rukwa Region
NEED and COMPARATIVE ADVANTAGE: The Rukwa region in Tanzania has an HIV prevalence rate of
4.5%, with an estimated 20,000 children 14 years of age or less in need of care and treatment. The Rukwa
Regional Medical Office (RMO) supports the implementation of pediatric prevention, care, and treatment
programs through out the region. As in other regions, Rukwa will be scaling-up pediatric services from the
district hospitals to the health centers and dispensaries. As a US Department of Defense (DOD) partner,
and as a region under the supervision of the Mbeya Referral Hospital (MRH), rollout of pediatric care,
support, and antiretroviral therapy (ART) in this region will mirror that in Mbeya and Ruvuma.
ACCOMPLISHMENTS: Currently, over 500 children from the region are on ART, with nearly 1,000 receiving
care and support. Over 75 health workers have been trained in ART management including treatment of
children with HIV and AIDS. Two district laboratories at the Nkasi and Mpanda District Hospitals have been
renovated, equipped, their staff trained, and systems are up and running, performing both hematology and
chemistry assays. Provider-initiated testing and counseling (PITC) has been implemented in all the
hospitals in the region, and supportive supervision teams have now been extended to facilities below the
district level to expand pediatric care and support services at all health centers in the region.
ACTIVITIES: To scale up pediatric HIV/AIDS services in Rukwa effectively, care and treatment centers
(CTCs) require significant infrastructure improvements, staff capacity-building, strengthened supply chains
and enhanced management systems at the district hospitals and health centers. Provision of pediatric
services is challenging due to the poor conditions of the roads, particularly during the rainy season when
they are impassible. DOD is has stationed personnel in Rukwa to work more closely with the Regional
Medical Officer, the District Medical Officers, and Regional and Council Health Management Teams (RHMT
and CHMT) to provide direct technical and material support necessary to improve site capacity. Technical
assistance and input from other USG treatment partners will continue to play a major role in scaling-up
pediatric treatment services in this region. In partnership with the Baylor International Pediatric AIDS
Initiative, a specialized pediatric HIV/AIDS outpatient center is being developed at the MRH. Pediatricians
working within this facility will conduct outreach services to mentor pediatric ART and HIV care providers
and provide specialized services where required. This partnership will contribute significantly to the
activities to be executed through the Rukwa RMO in support of pediatric HIV services throughout the region.
Under FY 2009 funding, the Rukwa RMO and DOD will provide significant inputs to roll out pediatric
HIV/AIDS care and treatment to 20 additional health centers, bringing the total number of facilities to 23 by
September 2010. That will provide pediatric HIV care and treatment coverage at all facilities identified by
the National AIDS Control Program (NACP), and ensure that services are available in all four of the districts
in the region.
In FY 2009, the Rukwa RMO will expand pediatric care and support services to 20 primary health care
facilities in the region, covering all four districts (Rukwa Urban, Rukwa Rural, Mpanda, and Nkasi), using the
revised national ART guidelines. In support of this goal, the program will work with the CHMT and facility
supervisors to develop facility-based pediatrics HIV care work plans and oversee implementation. To
ensure availability of treatment, the Rukwa RMO will assist in the acquisition of reagents, medications, and
clinical supplies through local distributors when not available through central mechanisms, and work with
facility pharmacists in improving forecasting, stock management, and ordering of pediatric drugs and
supplies. The program will also scale up early Infant diagnosis (EID) services to reach all primary health
care facilities.
The Rukwa RMO will continue to improve the quality of pediatric care and implement the national quality
improvement initiative. Psychosocial support and counseling, including promoting HIV status disclosure,
will be provided to all clients, and a link with the US Presidential Malaria Initiative and the national voucher
scheme will provide insecticide-treated nets to infants and HIV-positive children. The program will
strengthen and reinforce implementation of standard operating procedures for laboratory monitoring and
maintenance of pediatric records, and expand mentoring and supportive supervision beyond the district-
level facilities through regional medical teams. The program will also improve pediatric record/data
collection, working with DOD, CHMTs and facility staff to analyze data that informs improvement of
services. To serve hard-to-reach poor communities, the Rukwa RMO will conduct mobile pediatric ART
care and support services, particularly with the collaboration of the Baylor program that is being initiated in
Mbeya.
The Rukwa RMO will increase pediatric case finding through reinforced and expanded PITC to all facilities.
This includes training 60 staff in pediatric inpatient wards and outpatient clinics in HIV care and treatment;
providing PITC to all patient contact points, including immunization clinics and antenatal clinics; and
continuing to sensitize maternal and child health (MCH) clinical staff and clients on voluntary counseling and
testing as a regular part of all pediatric care services. The program will train health care workers on infant
feeding counseling and practices, using the national curriculum, and follow children born to HIV-positive
women identified through prevention of mother-to-child transmission (PMTCT) programs. The Rukwa RMO
will continue to improve and strengthen referrals between ANC, TB, and CTC services for evaluation of HIV-
positive children. Finally, the program will train ANC and CTC staff in the collection of dried blood spots
(DBS) for EID, who will send samples to the MRH for HIV testing; and ensure all HIV-exposed and infected
children are initiated on Cotrimoxazole prophylaxis as appropriate.
The Rukwa RMO will reinforce the comprehensive nature of clinical services by strengthening referral
systems for services available within a facility. Site coordinators will conduct daily checks of registers in
pediatric outpatient clinics, inpatient wards, MCH and TB clinics to track pediatric patients referred to the
CTC. The program will strengthen and formalize referrals to and from community-based organizations
(CBOs), non-governmental organizations (NGOs), and faith-based organizations serving children,
especially those who are orphaned and most vulnerable.
Activity Narrative: In FY 2009, the Rukwa RMO will intensify efforts in nutritional support for HIV-positive children. Specifically,
the program 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. The Rukwa RMO 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, the Rukwa RMO will ensure
the identification of clients eligible for the pilot therapeutic supplemental feeding program. Finally, the RMO
will link with other organizations addressing household food security and economic strengthening to ensure
PLWHA have access to these services, and include counseling services for caregivers to prevent and
manage food- and waterborne diseases, and improve infant and young children feeding practices.
LINKAGES: This activity is linked to activities under this partner in PMTCT and palliative care, as well as
those of the other regions in this zone (Mbeya 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 case
management and infection control. In particular, this activity will be linked with the new Baylor International
Pediatric AIDS Initiative that will establish a pediatric AIDS Centre of Excellence at MRH with outreach
services and strengthening of health worker skills in pediatrics to regions in the Southern Highlands Zone.
The Rukwa RMO will continue to promote pediatric outreach services from the facilities to the communities.
Each facility has/will have lists of NGOs, CBOs, and home-based care providers involved in providing
services to OVC and HIV-positive children. These lists will indicate geographical coverage and the types of
services offered. These lists are displayed in the CTCs and other clinics/wards so that health staff can refer
clients to those organizations. The program will strengthen these referrals, as well as referrals from
community organizations to the facility, through staff serving as the point of care at the facility for the
community organizations.
supportive supervisory teams discussed above. M&E data activities for all the CTCs under the Rukwa RMO
are supported by technical assistance from the DOD Strategic Information 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 the MRH. There, it is
analyzed, NACP and USG reports are generated, and feedback is provided to CTC teams for use in patient
management.
SUSTAINABILITY: Rukwa RMO attempts to ensure sustainability through capacity building of health care
providers, sensitization of community members, and advocacy through influential leaders. Sustainability is
also accomplished by strengthening systems, such as the improved capacity of CHMTs, the regional
supportive supervisory team, the zonal weekly ART meetings (as part of already existing zonal support),
and routine Rukwa RMO 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)
Please list the regions: Rukwa
Estimated amount of funding that is planned for Human Capacity Development $1,000
Estimated amount of funding that is planned for Food and Nutrition: Policy, Tools $1,000
Table 3.3.10:
TITLE: Expansion of pediatric ART Services in Rukwa Region
Rukwa Region has a HIV prevalence rate of 4.5% with an estimated number of 20,000 children less than 14
years of age in need of care and treatment. The Rukwa Regional Medical Office (Rukwa RMO) supports the
implementation of a comprehensive pediatric HIV intervention that has prevention, care, and treatment
components throughout its region. As in other regions, Rukwa will be scaling up pediatric treatment from the
district hospitals to the health centers. As a DOD partner, and a region under the support of the Mbeya
Referral Hospital (MRH), roll out of Pediatric ART in this region mirrors that in Mbeya and Ruvuma.
Currently, over 500 children from the region are on ART. Over 75 staff members have been trained in ART
management including treatment of children with HIV/AIDS. Two district laboratories at the Nkasi and
Mpanda District Hospitals have been renovated, equipped, trained, and are up and running, performing their
own hematology and chemistry assays. Provider initiated testing and counseling (PITC) of HIV/AIDS has
been implemented in all the hospitals in the region and supportive supervisory teams have now been
extended to facilities below the district level to expand pediatric ART services at all health centers in the
region.
To effectively scale-up pediatric HIV/AIDS services in Rukwa, care and treatment centers require significant
infrastructure
Improvements, staff capacity building, strengthened supply chains and enhanced management systems at
the district hospitals and health centers. Provision of pediatric services is challenging due to poor conditions
of the roads particularly during the rainy season when they are impassible. DOD is has stationed personnel
in Rukwa to work more closely with the RMO, the District Medical Officers (DMOs), and Regional and
Council Health Management Teams (RHMT and CHMT) to provide direct technical support and material
inputs necessary to improve site capacity. Technical assistance and input from other USG treatment
partners will continue to play a factor in scaling up pediatric treatment services in this region. As the
specialized pediatric HIV/AIDS out-patient 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. It will be executed through the
MRMO in support of pediatric HIV services through out the region.
HIV/AIDS care and
Treatment to additional health centers by September 2010. That will provide ART coverage for 100% of the
National AIDS Control Program (NACP)-identified facilities in this region. It will ensure services are
available in all four districts in the region. Expand pediatric ART services and support primary health care
facilities in the region, covering all four districts (Rukwa urban, Rukwa rural, Mpanda and Nkasi ); work with
CHMTs to initiate pediatric ART services in the new health centers; Supervise and coordinate the scale-up
of pediatric ART in the region; Continue to provide evaluation of malnutrition and nutritional counseling to all
pediatric HIV-positive clients as part of treatment; Work with facilities' pharmacists to improve their capacity
to forecast, manage and order their stock; Train the existing counselors in the CTC/PMTCT to provide
psychosocial support and counseling (including adherence and disclosure) for HIV-infected children and
their care givers; Continue to improve upon the number of individuals trained to identify pediatric cases
early through provision of PITC at antenatal clinics, during postnatal follow up, as part of immunizations
clinics, at out-patient clinics and through in-patient wards; Continue to improve the quality of pediatric
treatment service; Continued provision of pediatric ART to the established CTCs and refill health facilities,
and provision of counseling on ART adherence. The care elements, including 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 (SOP) for pediatric ART
services and maintenance of patient records;. Provide ongoing pediatric ART mentoring and supportive
supervision through regional medical teams; Participate in weekly zonal ART meetings with the MRH to
discuss treatment roll out; Improve pediatric record/data collection. Work with DOD, CHMTs and facilities'
staff to analyze data for improvement of services; Continue to strengthen TB/HIV co-management for
children identified in the postnatal clinics (PNC) and CTC; Conduct mobile pediatric ART services to the
rural and hard-to-reach poor communities; Increase the number of children on ART from 5.4% to 12% of the
total patients population; Continue to improve and strengthen referrals between ANC, PMTCT services and
CTC for evaluation for treatment initiation; Train PNC and CTC staff in the collection of dried blood spot
(DBS) for infant diagnosis; Continue to roll out HIV early infant diagnosis (EID), to health centers in
Ruvuma by training health workers on sample management and transportation; Train health workers on
DBS collection and transportation; Strengthen the referral system between pediatric HIV service points at
the MRH; Use an M&E officer to conduct daily checks on registers in out-patient pediatric clinics, in-patient
pediatric wards, MCH and the TB clinic to keep track of patients referred to the CTC; Strengthen and
formalize referrals to and from community-based organizations (CBOs), NGOs and faith-based
organizations (FBOs) serving pediatric patients
This activity is linked to activities under this partner in PMTCT and palliative care, as well as those
of the other regions in this zone (Mbeya and Ruvuma). It is also linked to the DOD submission under adult
care and treatment, SI and other USG treatment partner submissions providing expertise in areas of
pediatric care and TB infection-control.
Activity Narrative: Each
Facility has/will have lists of NGOs, CBOs and home-based care (HBC) providers involved in child
HIV/AIDS
Support. This list indicates geographical coverage and the type of services offered. These lists will be
displayed in the
Referrals, as well as referrals from community organizations to the facility, will be further strengthened
Through facility's staff serving as the point of care for the community organizations.
The areas of emphasis will include: initial and refresher training of staff in pediatric ART and CT; significant
Infrastructure improvement for existing and new sites; provision of equipment, supplies and medications;
Strengthening linkages with TB/HIV, PMTCT and community groups.
M&E:
Quality assurance/quality control 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 Rukwa RMO 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 (EMRS) and transported to
the DOD data center located at Mbeya Referral Hospital. There, it is 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 Rukwa RMO will be 10 and 21 by September 2008 and September 2009 respectively.
Rukwa RMO in ensuring sustainability through capacity building of health care facilities 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 Council Health Management Teams (CHMT), the
Regional supportive supervisory team, the zonal weekly ART meetings (as part of already existing zonal
Support) and routine Rukwa RMO functions.
Estimated amount of funding that is planned for Human Capacity Development $15,200
Table 3.3.11:
ACTIVITY HAS BEEN MODIFIED IN THE FOLLOWING WAYS:
TITLE: Expanding and Integrating TB/HIV activities in Rukwa Region
Rukwa Regional Medical Office (RRMO) will continue to provide support for implementation of collaborative
TB/HIV activities in the region. The services will be provided in hospitals as well as in lower level heath
facilities where HIV care and treatment services are provided. FY09 focus will be on the improving
Intensified TB case finding in care and treatment settings. 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. RRMO 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 the TB/HIV activities including intensified TB case finding, use of TB screening tool and modified clinical
forms, 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.
RRMO will strengthen existing laboratory services needed to implement TB/HIV program activities including
supplement of HIV test kits and X-ray films. Outreach ART services to remote TB clinic in the regions will be
strengthen with improved referral system. RRMO will advocate for integration of collaborative TB /HIV
services in HIV clinics including PMTCT and STI. Supportive supervision will be conducted regularly to
improve quality of services.
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 Rukwa
Regional Medical Office (RMO) has been providing ART and TB services to patients in three district
hospitals and one health center and plans to provide TB/HIV services to up to additional 7 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.
Rukwa RMO supports the implementation of prevention and care and treatment programs throughout its
region, overseeing funding and supervision to the regional hospital and district level facilities. As a DOD
partner and a region under the support of the Mbeya Referral Hospital, roll out of TB/HIV in this region
mirrors that in Mbeya and Rukwa.
Currently, over 1,300 patients from the three district hospitals and one of the health centers in the region are
on ART. The Rukwa RMO 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 further in FY 2008.
Using a "cluster" approach, the region has been divided based on the three primary districts (Sumbawanga
Urban included as part of Sumbawanga Rural), using the hospitals supporting high density areas in these
districts as the primary points of support and moving out from those facilities to health centers. The Rukwa
RMO will expand TB/HIV services and support to a total of three hospitals and eight primary health care
facilities in the region covering all districts.
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 referral to the TB clinic to initiate an uninterrupted treatment using direct observation therapy
(DOT).
1a) Support the making of clinical forms with TB screening tool.
1b) Clinicians 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.
LINKAGES: This activity is linked to activities under this partner in PMTCT, treatment, and palliative care as
well as those of the other regions in this zone (Mbeya 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.
Activity Narrative: The Rukwa RMO will continue to promote outreach services from the facilities to the communities. Each
facility has/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 are 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 (POC) for the community organizations.
The areas of emphasis will include: initial and refresher training of staff in TB/HIV co-management, 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 Council
Comprehensive Health Plans (CCHPs)..
M&E data activities for all the CTCs under the Rukwa RMO are supported by technical assistance (TA)
from the DOD SI team based at the Mbeya Referral Hospital. 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. Data at each CTC is collected using standardized forms based on the National AIDS
Control Program (NACP) and facility data needs. It is 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
SUSTAINABILITY:
districts as the primary points of support and moving out from those facilities to health centers.
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 supervisory team
and the zonal weekly ART meetings as part of already existing zonal support and routine MRMO functions
Continuing Activity: 17425
17425 17425.08 Department of Rukwa Regional 6554 1138.08 $100,000
Table 3.3.12:
