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 2008 PMTCT targets have been modified
TITLE: PMTCT Services in Ruvuma Region
NEED and COMPARATIVE ADVANTAGE: Similar to the Rukwa Region, Ruvuma has a recorded general
HIV prevalence of a little over 6% with prevalence at antenatal clinics recorded at 9.9%. Expansion of
PMTCT under direct MOHSW funding was slow and not well implemented. To effectively scale-up services
in Ruvuma, ANC will require significant infrastructure improvements, staff capacity building, strengthened
supply chains, and enhanced management systems at the district hospitals and health centers.
ACCOMPLISHMENTS: Funding from FY 2006 was used to train six counselors at the ANC at three USG
funded sites executing ART. Integration of PMTCT services as part of regular antenatal care and ART
services improved uptake of pregnant women for counseling and testing at these sites with 2,200 accepting
counseling and testing and approximately 150 women receiving ART prophylaxis in a twelve month period.
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 24 by September 30, 2009 covering 100% of National AIDS Control
Program (NACP) identified hospitals and health centers in the region and several dispensaries. The
number of service outlets supported in 2007 was three, but with 2007 plus-up funding the number of service
outlets supported increased to 13 as DOD transitioned into sites formerly supported by MOHSW.
1a) Train health care workers at each new site using a "full site" approach similar to Engender Health
whenever possible, ensuring at least 4 ANC staff per site are trained.
Adopt an opt-out counseling and testing policy in both 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 CTCs to support the delivery of comprehensive
HIV services.
2b) Evaluate HIV+ women for eligibility for full 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
HIVexposed
children receive the most efficacious treatment (AZT and NVP or NVP only).
2c) Provided "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, counseled 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 Dried Blood Spot (DBS) for infant diagnosis.
2h) Send 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 to regional and district authorities with the assistance of other USG partners
(such as Engender Health) to work with the Ruvuma RMO 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 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 HIV+ are evaluated
for ART as described above. Both populations are linked to reproductive health (RH) services. In addition,
the Ruvuma RMO will continue to promote outreach services from the facilities to the communities for HIV+.
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 through facility staff
serving as POC for the community organizations.
CHECK BOXES: This funding will fully develop PMTCT services covering all the districts including health
centers and down to dispensaries as possible. Funding will support the introduction and/or improvement of
Activity Narrative: PMTCT services in the region. Emphasis will be put into training of health care workers in district hospital
and 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 (QA/QC) of services will be provided by Ruvuma RMO 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 FY2008.
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 NACP
and the USG.
SUSTAINABILITY: Ruvuma 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 Regional AIDS Control
Program, the DHMT, and through regional supportive supervisory teams as part of already existing zonal
support and routine RMO functions. Most of this funding will be spend at the district level and health facility
level thereby building capacity and sustainability at the level where the services are provided.
New/Continuing Activity: Continuing Activity
Continuing Activity: 13582
Continued Associated Activity Information
Activity Activity ID USG Agency Prime Partner Mechanism Mechanism ID Mechanism Planned Funds
System ID System ID
13582 3402.08 Department of Ruvuma Regional 6555 1139.08 $350,000
Defense Medical Office
7799 3402.07 Department of Ruvuma Regional 4576 1139.07 $300,000
3402 3402.06 Department of Ruvuma Regional 2840 1139.06 $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 the Ruvuma Region
NEED and COMPARATIVE ADVANTAGE: The Ruvuma Regional Medical Office (RMO) supports the
implementation of prevention, care, and treatment programs throughout its region, overseeing funding and
supervision to the region at hospital and district-level facilities. As a US Department of Defense (DOD)
partner and a region under support of the Mbeya Referral Hospital (MRH), rollout of ART in this region
mirrors that in Mbeya and Rukwa.
To scale up services in Ruvuma effectively, health facilities require significant improvement in infrastructure,
development of staff capacity, strengthening of supply chains, and enhanced management systems at the
district hospital and health center level. This region is geographically isolated with poor road access. This
fact, in addition to an almost year-long lag in receiving government of Tanzania (GOT) antiretrovirals to
initiate programs, has caused the slower progression of the roll-out of ART services in this region. To
improve and increase the rate of implementation and roll out, DOD will likely need to station personnel in
Ruvuma to work closely with the RMO, District Medical Office, Regional and District Health Management
Teams (RHMT and DHMT), faith-based organizations (FBOs) and community-based organizations (CBOs)
to provide direct technical support and material inputs necessary to expand and increase patient enrollment
for HIV/AIDS care and treatment services in Ruvuma.
ACCOMPLISHMENTS: Nearly 7,000 patients are on antiretroviral therapy (ART) at all three district
hospitals in the region, with over 11,500 on facility-based care and support. Over 100 staff trained in
service provision. The laboratories at the Mbinga and Tunduru District Hospitals have been renovated and
equipped, and technicians have been trained and are running hematology and chemistry assays. Provider-
initiated testing and counseling (PITC) is being implemented in all the hospitals in the region and
supervisory teams have now been extended to facilities below the district hospital level to introduce of ART
and related care and support to health centers.
ACTIVITIES: Technical assistance from and collaboration with other USG treatment partners will continue
to play a factor in scaling-up treatment services in this region
In FY 2009, the Ruvuma 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 44 by September 2009, with 100% of
National AIDS Control Programme (NACP) identified facilities supporting ART in the region.
Specifically, the Ruvuma RMO will:
1. Expand services and support to a total of 20 primary health care facilities in the region. This will be at a
two to four health centers per district. Work with DHMT to achieve the expansion, using NACP health
center assessments and strengthening reports as a reference. 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.
2. Continue to improve the quality of care and treatment services. Strengthen and reinforce implementation
of standard operating procedures for clinical services, laboratory monitoring, and maintenance of patient
records. 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 100 staff in inpatient wards and outpatient clinics in HIV
care and treatment and promote PITC for all patient points of contact. Continue to sensitize hospital staff
and clients in care and treatment as a regular part of all out patient services, including the TB clinic.
Reinforce sensitization through rotation of staff from the CTCs to assist regular hospital staff in patient
identification and service provision.
4. Increase the number of adult patients enrolled at the CTCs. Promote and support routine counseling and
testing including mobile voluntary counseling and testing (VCTs) at all contact points in the health facilities
and communities. Ensure all TB/HIV co-infected patients are initiated on cotrimoxazole prophylaxis as
appropriate.
5. Intensify its efforts in nutritional support for people living with HIV/AIDS (PLWHA). Specifically, the RMO
will support care and treatment clinics (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 the 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 CBOs, NGOs and 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
Activity Narrative: transmission (PMTCT), TB/HIV, adult and pediatric treatment, as well as those of the other regions in this
zone (Mbeya and Rukwa). 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 Ruvuma RMO will continue to promote outreach services from the facilities to the communities. Each
facility 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 will be displayed in CTCs and
other clinics/wards so health staff can refer clients to those organizations as necessary. The program 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 the CTCs under the Ruvuma RMO are supported by TA 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 the MRH for synthesis, generation of NACP and USG reports, as well as to provide
feedback to CTC teams for use in patient management.
SUSTAINABILITY: As with other DOD partners in the Southern Highlands of Tanzania, the Ruvuma RMO
ensures 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 the improved capacity of DHMT, the regional supportive supervisory team, and the zonal weekly
ART meetings as part of existing zonal support and routine Ruvuma RMO functions.
New/Continuing Activity: New Activity
Continuing Activity:
Estimated amount of funding that is planned for Human Capacity Development $75,000
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 Ruvuma Region
NEED and COMPARATIVE ADVANTAGE:
Over 7,000 (481 (6%) children) patients are on ART at all three district hospitals in the region with 100 staff
trained in service
provision. The laboratories at the Mbinga and Tunduru District Hospitals have been renovated, equipped,
and technicians are trained and are running hematology and chemistry assays. Provider initiated testing
and counseling (PITC) is being implemented in all the hospitals in the region and supervisory teams have
now been extended to facilities below the district hospital level to introduce of ART to health centers. ART
services will be expanded to a total of 12 facilities by September 2008, ensuring 50% coverage of facilities
in the region.
ACTIVITIES:
To effectively scale-up services in Ruvuma, health facilities require significant improvement in infrastructure,
development of staff capacity, strengthening of supply chains and enhanced management systems at the
district hospital and health center level. Similar to the Rukwa region, this region is geographically isolated
with poor road access. This, in addition to an almost one year lag in receiving government of Tanzania
(GOT) ARVs to initiate programs, has influenced the slower progression of roll out of ART services in this
region. To improve and increase the rate of implementation and roll out, DOD is exploring mechanisms for
stationing personnel in Ruvuma to work closely with the RMO, District Medical Office (DMO), and Regional
and District Health Management Teams (RHMT and DHMT), faith-based organizations (FBOs) and
Community-based Organizations (CBO) to provide direct technical support and material inputs necessary to
expand and increase ART enrollment in Ruvuma. Technical assistance from and collaboration with other
USG treatment partners will continue to play a factor in scaling up treatment services in this region.
Under FY 2009 funding, the Ruvuma RMO and DOD will provide significant inputs to roll out HIV treatment
to additional health centers by September 2009 reaching 100% of NACP identified facilities supporting ART
in the region. 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 hospitals and primary health care facilities by : working with DHMT in initiating ART
services in the 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 strengthening of referrals to and from CBO, NGO and
FBO serving patients in their communities through facility social workers will continue
Strategies to improve laboratory services will include : Training of 18 lab technicians on PMTCT lab activity
such as Syphilis testing , rapid HIV test trainings and Rapid HIV quality assurance activities; Training 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 and strengthening
TB/HIV lab activities by training 18 lab technicians on rapid HIV testing, TB diagnosis acid-fast method.
DOD will continue to procure reagents for hematology, chemistry and CD4 and viral load for all CTC
hospital lab's in Ruvuma Hospitals; Continue to roll out HIV Early infant diagnosis, to 20 health centers by
training health workers on sample management, transportation. Also, the region will continue to 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 Ruvuma 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 Rukwa). 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 will have lists of NGOs, CBOs and HBC providers involved in HIV/AIDS support, indicating
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;
and strengthening linkages with TB/HIV, PMTCT, and community groups.
M&E:
Quality assurance/quality control (QA/QC) for clinical services is conducted through the zonal and regional
Activity Narrative: supportive supervisory teams discussed above.
based at the Mbeya Referral Hospital. Data at each CTC is collected using standardized forms based on
NACP and facility data needs, entered into the electronic medical record system (EMRS) and transported to
the DOD data center located at Mbeya referral hospital for synthesis, generation of NACP and USG reports,
as well as to provide feedback to CTC teams for use in patient management. The number of CTCs
supported by Mbeya RMO will be 24 and 44 by Sept ember 2008 and September 2010 respectively.
SUSTAINABILITY:
As with other DOD partners in the Southern Highlands of Tanzania, the Ruvuam RMO ensures
sustainability through capacity building of health care facilities and its staff, through sensitization of
community members and advocacy through influential leaders. This is also accomplished by strengthening
"systems", such as the improved capacity of DHMT, the regional supportive supervisory team, and the zonal
weekly ART meetings as part of already existing zonal support and routine Ruvuma RMO functions.
April 2009 Reprogramming:
$75,000 reprogrammed to (actvity id 9237.23465.09) support procurement of lab reagents through SCMS
Continuing Activity: 13583
13583 3399.08 Department of Ruvuma Regional 6555 1139.08 $1,830,000
7797 3399.07 Department of Ruvuma Regional 4576 1139.07 $850,000
3399 3399.06 Department of Ruvuma Regional 2840 1139.06 $450,000
Estimated amount of funding that is planned for Human Capacity Development $161,000
Table 3.3.09:
ACTIVITY HAS BEEN REVISED SIGNIFICANTLY FROM FY 2008 COP
TITLE: Expansion of Pediatric HIV care and support Services Ruvuma Region
NEED and COMPARATIVE ADVANTAGE: Over 7,000 patients are on antiretroviral therapy (ART) at all five
district hospitals in the Ruvuma region. Of those, only 481 (6%) of patients are children under the age of
15. However, within the regional hospitals, 100 staff have received formal trained in pediatric HIV and AIDS
service provision.
ACCOMPLISHMENTS: In FY 2008, the Ruvuma Regional Medical Office (Ruvuma RMO) supported
pediatric care and support services in four established care and treatment centers (CTCs) and several
prescription refill sites. The laboratories at the Mbinga and Tunduru District Hospitals were renovated and
equipped, laboratory technicians were trained, and the laboratories now have the capability to conduct
hematology and chemistry assays. To support the rollout of early infant diagnosis (EID), the Ruvuma RMO
has provided training for 40 health care workers, who have begun to collect and transport dried blood spot
(DBS) samples to the Mbeya Referral Hospital (MRH) for analysis. Provider-initiated testing and counseling
(PITC) is being implemented in all the hospitals to increase testing and enrollment into treatment for HIV-
positive children. Pediatric and adult care and support, as well as ART services, will be expanded to a total
of 12 facilities by September 2008, ensuring 50% coverage of facilities in the region.
ACTIVITIES: To scale up pediatric care and support services in Ruvuma effectively, health facilities require
significant improvement in infrastructure, capacity building of staff, strengthened supply chains, and
enhanced management systems at the district hospital and health center level. To meet these objectives,
the Ruvuma RMO will renovate facilities, provide staff trainings, and streamline the procurement and supply
chain. The US Department of Defense (DOD) has stationed skilled personnel in Ruvuma to work closely
with the Regional Medical Office, District Medical Office, Regional and Council Health Management Teams
(RHMT and CHMT), faith-based organizations (FBOs) and community-based organizations (CBOs) to
improve the rate of program implementation and roll out. The DOD provides direct technical and material
support to expand care and support services of HIV-positive children in Ruvuma.
The MRH, in partnership with Baylor International Pediatric AIDS Initiative, is developing a specialized
pediatric HIV/AIDS outpatient center, to be completed during FY 2009 and FY 2010. The pediatricians
working within this facility will conduct outreach services to mentor pediatric ART providers and provide
specialized care services where required. This partnership will significantly enhance activities in support of
pediatric HIV services scale-up throughout the region.
Under FY 2009 funding, the Ruvuma RMO and DOD will roll out pediatric care and support, based on the
revised national guidelines, to 20 additional health centers covering five districts, bringing the total number
of facilities to 44 by September 2009. All of the facilities are National AIDS Control Programme (NACP)
identified facilities supporting pediatric ART in the region. The program will support the training of health
care workers in EID and infant feeding counseling and practices. The Ruvuma RMO will work with the
CHMT and facility supervisors to develop facility-based pediatric care plans and oversee implementation of
these plans, and scale up EID services to all health care facilities. To ensure availability of treatment, the
Ruvuma 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 to improve
capacity in forecasting, stock management and ordering of pediatric drugs and supplies.
The Ruvuma RMO will continue to improve the quality of pediatric care and implement the national quality
improvement initiative. Psychosocial support and counseling, including disclosure, will be provided to all
clients, and a link with the Presidential Malaria Initiative and the national voucher scheme will provide
distribution of insecticide-treated nets to infants and HIV-positive children. The program will ensure that all
HIV-exposed and infected children are initiated on Cotrimoxazole prophylaxis based on national guidelines,
and conduct mobile pediatric care and support services for the rural areas, including hard-to-reach poor
communities. Mentoring and supportive supervision beyond the district-level facilities will be supported by
the Ruvuma RMO and provided through regional medical teams. The program will also strengthen and
reinforce implementation of standard operating procedures for laboratory monitoring, and improve pediatrics
record/data collection, working with DOD, CHMT and facility staff to analyze data that informs improvement
of services
The Ruvuma RMO will increase pediatric case finding through reinforced and expanded PITC to all
facilities. This includes training 60 staff in inpatient wards and outpatient clinics in pediatric HIV care and
treatment to promote PITC for all children (contact points will include immunization clinics and antenatal
clinics); continuing to sensitize maternal and child health (MCH) clinical staff and clients in voluntary
counseling and testing as a regular part of pediatric outpatient services; and promoting and supporting
routine counseling and testing of mothers and their children at all contact points in the health facilities,
including antenatal clinics (ANC), labor and delivery wards, immunization clinics and female and pediatric
inpatient wards. In an effort to increase the number of children on ART, the program will continue to roll out
EID to 20 health centers in Ruvuma by training health workers on DBS sample management and
transportation to the MRH for analysis. The Ruvuma RMO will support evaluation of HIV-positive children
for care and treatment by strengthening referrals between ANC, prevention of mother-to-child transmission
(PMTCT), TB, and CTC services.
The Ruvuma 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 CBOs, NGOs and FBOs serving
children, including orphans and vulnerable children (OVC).
In FY 2009, the Ruvuma RMO will intensify its efforts in nutritional support for people living with HIV/AIDS
(PLWHA). Specifically, the program will support CTCs to do nutritional assessments on children, using
Activity Narrative: anthropometric measurements and Body Mass Index calculations, as well as other appropriate
measurements such as mid-upper arm circumference (MUAC) and weight for age. The Ruvuma 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 Ruvuma RMO will ensure the identification of clients eligible for the pilot therapeutic supplemental
feeding program. Finally, the program 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 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 Rukwa). It is also linked to the DOD submission under
SI and other USG treatment partner submissions providing expertise in the areas of pediatric care and TB
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 Ruvuma RMO will continue to promote pediatric outreach services from the facilities to the
communities. Each facility will display lists of NGOs, CBOs, and home-based care providers involved in
providing services to OVC and HIV-positive children, 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. The program will strengthen these referrals, as well as referrals from
community organizations to the facility, through staff serving as point of contact for the community
organizations.
supportive supervisory teams discussed above. M&E data for all CTCs under the Ruvuma 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 Mbeya referral hospital. There, it is
analyzed, NACP and USG reports are generated, and feedback is provided to CTC teams for use in patient
management.
ensures sustainability through strengthening of the facility and capacity building of health care workers.
This includes the sensitization of community members and advocacy through influential leaders.
Sustainability is also accomplished by strengthening systems, such as the improved capacity of CHMT, the
regional supportive supervisory team, and the zonal weekly ART meetings (part of already existing zonal
support and routine Ruvuma 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.
Estimated amount of funding that is planned for Food and Nutrition: Policy, Tools $1,000
Estimated amount of funding that is planned for Food and Nutrition: Commodities $1,000
Table 3.3.10:
TITLE: Expansion of Pediatric ART Services Ruvuma Region
Over 7,000 patients are on ART in the five districts in Ruvuma region with 100 staff trained in ART service
provision. Among all patients under care, 481 (6%) only are children under the age of 14 years.
ACCOMPLISHMENTS: In FY 2008 Ruvuma Regional Medical Officer (RRMO) supported pediatric HIV
treatment services in four established CTCs and several refill sites. The laboratories at the Mbinga and
Tunduru District Hospitals were renovated and equipped; trained technicians are now running hematology
and chemistry assays. 40 health care workers were trained in early infant diagnosis (EID). Collection and
transportation of dried blood specimens (DBS) to MRH was initiated. Provider initiated testing and
counseling (PITC) is being implemented in all the hospitals to increase testing and enrollment into
treatment. Pediatric and adult ART services will be expanded to a total of 12 facilities by September 2008,
ensuring coverage of 50% of facilities in the region.
To effectively scale-up Pediatric ART services in Ruvuma, health facilities require significant improvement in
infrastructure, development of staff capacity, strengthening of supply chains and enhancement of
management systems at the district hospital and health center level. These will include renovation of
facilities, trainings and the streamlining of the procurement and supply chain. DOD has stationed skilled
personnel in Ruvuma to work closely with the Regional Medical Office (RMO), District Medical Office
(DMO), Regional and Council Health Management Teams (RHMT and CHMT), faith-based organizations
(FBOs) and community-based organizations (CBOs) to improve and increase the rate of implementation
and roll out. They will provide direct technical support and material inputs necessary to expand and
increase pediatric ART enrollment in Ruvuma. As the specialized pediatric HIV/AIDS outpatient centre is
developed through FY 2009/2010 at the MRH in partnership with Baylor International Pediatric AIDS
Initiative (BIPAI), the pediatricians working within this facility will conduct outreach services to mentor
pediatric ART providers and provide specialized services where required. This latter partnership will
significantly add to those activities to be executed through the MRMO in support of pediatric HIV services
throughout the region.
Under FY 2009 funding, the Ruvuma RMO and DOD will provide significant inputs to roll out pediatric HIV
treatment to additional health centers by September 2009 in order to reach 100% of NACP identified
facilities supporting pediatric ART in the region. Activities will include: Expand Pediatric ART services to
primary health care facilities in the
region covering all five districts (Songea rural and urban, Namtumbo, Tunduru, Mbinga);Work with CHMT in
initiating
ART services in the new health centers; Supervise and coordinate scale-up of pediatric ART in the region;
Renovate strategic department/clinic facilities to support pediatric ART at the MCH and Lab; Train an
additional health providers/clinical staff in ART and TB/HIV co-management; Work with facility pharmacists
to improve capacity in pediatric ARV forecasting, stock management and ordering; 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 MCH/immunization clinics, at out-patient pediatric
clinics and through in patient pediatric wards; Continue to improve the quality of pediatric treatment service;
Strengthen and reinforce implementation of revised pediatric guidelines and the relevant standard operating
procedures 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 Mbeya referral hospital (MRH) to discuss treatment roll out; Conduct mobile pediatric
ART services to the rural areas including hard-to-reach poor communities
Funds will also be used to increase the number of children on ART from 6% to 12% of the total patient's
population by continue to improve and strengthen referrals between MCH, postnatal clinic (PNC) services
and CTC for evaluation of
HIV-positive children for treatment; Train MCH, PNC and CTC staff in the collection of DBS for infant
diagnosis; Continue to roll out HIV EID to health centers in Ruvuma by training health workers on DBS
collection and transportation and Continue to strengthen TB/HIV co-management for children identified in
the MCH, PNC and CTC
Lastly funds will be used to strengthen referral system between pediatric HIV services delivery points in
Ruvuma through: Use an M&E officer to conduct daily checks on registers in pediatric out-patient clinics, in-
patient pediatric wards, MCH and the TB clinic to keep track of patients referred to the CTC and formalize
referrals to and from CBOs, NGOs and FBOs serving pediatric patients
This activity is linked to activities under this partner in PMTCT, palliative care, and OVC, as well as those
of the other regions in this zone (Mbeya and Rukwa). It is also linked to the DOD submission under SI and
other
facility will have lists of NGOs, CBOs, OVC and HBC providers involved in HIV/AIDS support, and indicate
their
geographical coverage and the types of services offered. These lists will be displayed in the CTCs and
serving as points of contact for the community organizations.
Activity Narrative: CHECK BOXES:
The areas of emphasis will include: initial and refresher training of staff in ART and care and treatment;
significant
M&E data activities for all the CTCs under the Ruvuma RMO are supported by technical assistance 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. It is then 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
and feedback to CTC teams for use in patient management. The number of CTCs supported by Mbeya
RMO will be 24 and 44 by September 2009 and September 2010 respectively.
As with other DOD partners in the Southern Highlands of Tanzania, the Ruvuma RMO ensures
sustainability through capacity building of health care facilities' staff, sensitization of community members
and advocacy through influential leaders. Sustainability is also accomplished by strengthening systems,
such as the improved capacity of CHMT, the regional supportive supervisory team, and the zonal weekly
ART meetings (part of already existing zonal support and routine Ruvuma RMO functions).
Estimated amount of funding that is planned for Human Capacity Development $16,000
Table 3.3.11:
ACTIVITY HAS BEEN MODIFIED IN THE FOLLOWING WAYS:
TITLE: Expanding and Integrating TB/HIV activities in Ruvuma Region
Ruvuma Regional Medical Office (RRMO) will expand TB/HIV services in the facilities providing HIV
services. FY09 focus will be to improve Intensified TB case finding in care and treatment settings, TB
infection control and improve patient's referral and follow up. 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.
NEED and COMPARATIVE ADVANTAGE: According to the National Tuberculosis and leprosy Program
(NTLP), TB /HIV dual infection contributes to 17.5 % of the total disease burden in Tanzania (Ministry of
Health and Social Welfare (MOHSW), Manual of National Tuberculosis and Leprosy Program in Tanzania,
Fifth Edition, 2006). Currently, the Ruvuma Regional Medical Office (RMO) supports ART and TB services
in three district hospitals and two health centers and plans to provide TB/HIV services to an additional 10
health centers where we currently have a functional Care and Treatment Centers (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.
Ruvuma 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
ACCOMPLISHMENTS: Over 1,400 patients are on ART at each of the three district hospitals and two
health centers in the region. The Ruvuma 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 TB
diagnosis, as well as treatment and follow, up will be strengthened further in FY 2008.
ACTIVITIES: The Ruvuma RMO will expand TB/HIV services and support to a total of four hospitals and 12
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 will be immediately
referred to the TB clinic to initiate an uninterrupted treatment using Directly Observed Therapy (DOT) 1a)
Support the making of the 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
HIVinfected
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.
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
serving as points of contact (POC) for the community organizations.
CHECK BOXES: The areas of emphasis will include: initial and refresher training of staff in TB/HIV
comanagement,
Activity Narrative: infection control, provision supplies and medications, and capacity building. Council Health
Management Teams (CHMTs) will be supported in planning and incorporating TB/HIV activities in
Comprehensive Council Health Plans (CCHPs).
M&E: M&E data activities for all the CTCs under the Ruvuma 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 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, and providing feedback to CTC teams for use in patient management.
SUSTAINABILITY: As with other DOD partners in the Southern Highlands of Tanzania, the Ruvuam RMO is
ensuring sustainability through capacity building of health care facilities and its staff, sensitization of
"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 Ruvuma RMO functions.
Continuing Activity: 16449
16449 16449.08 Department of Ruvuma Regional 6555 1139.08 $100,000
Table 3.3.12:
