ACTIVITY HAS BEEN MODIFIED IN THE FOLLOWING WAYS:

TITLE: Scaling up of HIV/TB Collaborative Activities in Tanzania"

Requested funds for FY 2009 will continue to support the implementation of collaborative TB/HIV services

in 57 existing districts, ensuring the continuation of services. In collaboration with NACP, USG and non-

USG partners, NTLP will review and develop guidelines for pediatric TB/HIV, including guideline for

pediatric screening and diagnosis. Implementing partners will be coordinated; they will be provided with

technical support for the implementation of Intensified TB case finding (ICF), TB Infection control (IC) in

care and treatment settings, and piloting the provision of Isoniazid preventive therapy. At health facilities,

NTLP will support meetings to exchange information between health care providers working in TB clinics,

and those working at HIV clinics. Implementation of provider initiated HIV testing and counseling (PITC) in

TB clinical settings will be strengthened through ensured availability of HIV test kits, improved referrals,

linkages and patient follow-up. This will help ensure that all TB-HIV co-infected patients are referred to HIV

care, and can access the services. Districts will be supported to develop and implement TB infection

control plans. Supportive supervision and mentoring will be strengthened to improve quality of services. At

TB clinics, all TB patients will be offered HIV counseling and testing. TB patients who are co-infected with

HIV will be referred to the CTC for care and treatment services. All TB-HIV co-infected patients will be

counseled on HIV prevention, including condom education, promotion and provision. Prevention messages

will be provided to all HIV-infected patients. They will be encouraged to disclosure their HIV status to their

sexual partners. HIV co-infected TB patients will be encouraged to advise their partners to get tested for

HIV. Patients will be linked to other services including STI, PMTCT and family planning, according to their

needs. NTLP will continue to strengthen human capacity by training health care providers on TB/HIV co

management. This will include HIV rapid testing, recording and reporting, implementation of IPT, IC and

smear microscopy to improve TB diagnosis. NTLP will support TB/HIV coordinators and officers at the

national and district level. NTLP will offer administrative cost support at the district, regional and national

levels. NTLP will ensure that Contrimoxazole is available at all TB clinics for TB/HIV co-infected patients.

Council health management teams (CHMT) will incorporate collaborative TB/HIV activities into their

Comprehensive Council Health Plans (CCHP). NTLP will strengthen CHMTs capacity to provide supportive

supervision to health care facilities in the field. In collaboration with I-TECH, best practices will be

documented, shared and disseminated. Advocacy communication and social mobilization (ACSM)

strategies will be reviewed and updated to include pediatric TB and TB/HIV. Information Education and

Communication (IEC) materials will be printed and distributed to all health facilities. Communities will be

sensitized to TB/HIV collaborative activities. In FY 2009, surveillance systems, including an M&E system,

will be improved to allow districts, regions and national government health entities to generate TB/HIV

reports, and facilitate monitoring of patients. TB Monitoring and evaluation tools will be reviewed and

revised to reflect the pediatric TB-positive and TB/HIV-positive demographic. NTLP will conduct an

evaluation to determine whether the TB surveillance system is being used and is beneficial.

NEED and COMPARATIVE ADVANTAGE: Scale-up of TB/HIV activity will contribute to the PEPFAR and

National targets of providing care and treatment services to PLHA. By the end of 2008, with support from

Global Fund to Fight AIDS, TB and Malaria (GFATM), Program for Appropriate Technology in Health

(PATH) and Clinton HIV/AIDS Initiative (CHAI), TB/HIV services will be provided in about 100 districts in the

country; 57 districts will be supported by PEPFAR (42 existing and 15 new districts). Expansion in 15

districts will result in 6000 TB patients receiving diagnostic counseling and testing (DCT) and 1500 (40%)

receiving Anti-Retroviral drugs (ARV). By the end of 2009 it is expected that the services will be scaled up to

226 service outlets resulting to 24011 (80%) TB patients receiving DCT and 6002 (40%) on ARV. Scale-up

of TB/HIV services will be challenged with increased workload and quality of the results. These challenges

call for task shifting, human capacity building, strengthening system quality and increasing capacity for

acidfast

bacilli (AFB) microscopy, which should be supported by higher volume equipment, Mycobacterium

Growth Indicator Tubes (MGIT) and quality assurance. In order to improve quality of TB/HIV monitoring

data and increase efficiency in report generation, the Electronic TB Register (ETR) needs to be expanded

and decentralized at the district level.

ACCOMPLISHMENTS: A total of 381 health care workers (HCW) trained on TB/HIV activities. Protocol for

Extensively Resistant TB (XDR) and Multi-Drug Resistant TB (MDR) resistance surveillance finalized.

From July 2005 and March 2007, a total of 6,387 (75%) TB patients were tested and received their HIV

results, 733 on ARV and 1,474 cotrimoxazole prevention therapy (CPT) (from CDC supported sites).

Currently, TB/HIV services are implemented in 61 service outlets in 14 districts. TB/HIV policy was

developed and is now in the process of final review. Modified TB data collection tools including forms and

registers which are currently in use. Developed TB screening tool for PLHA. Supportive supervision

conducted in 61 outlets and sensitization conducted to 237 health management team members.

ACTIVITIES: 1) Establish TB/HIV services within 15 new districts to increase access to services; 1a)

Conduct needs assessment in 15 new districts; 1b) Hiring 15 supervisor staff at district level and 30

clinicians to support provision of ART in TB clinic; 1c) Procure and maintain 15 motorcycles to enhance

mobility of supervisors staff; 1d) Facilitate planning for TB/HIV activities to ensure TB/HIV activities are

incorporated into Comprehensive Council Health Plans (CCHP).

2) Strengthen capacity for the districts, managers and health workers in both the public and private sector to

provide quality TB/HIV services; 2a) Train 350 HCW and supervisors on TB/HIV activities. 2b) Conduct

supervision to ensure quality services.

3) Strengthen mechanism for collaboration and improve linkage and referral system to ensure patients'

follow up, effective coordination and harmonization of services; 3a) Facilitate monthly facility technical

meetings to strengthen referrals and linkages between TB and HIV sites; 3b) Facilitate quarterly

coordinating and information exchange meetings at regional and districts levels; 3c) Document and share

best practices and disseminate information twice per year.

Activity Narrative: 4) Enhance community participation in TB/HIV through awareness activities to create demand and

utilization of services; 4a) Sensitize 309 Health Management Teams; (HMTs) 4b) Print and distribute IEC

materials, broadcasting, and social marketing; 4c) Conduct advocacy meeting to districts leaders and

influential community leaders on TB/HIV interventions and use of IEC; 4d) Community sensitization to

educate public on TB/HIV services.

5) Support the implementation of services in 42 existing districts to ensure continuation and sustainability of

established TB/HIV services; 5a) Pay salary to 50 staff at the national and district levels; 5b) Provide

administrative cost at the district, regional and national levels; 5c) conduct quarterly coordinating meetings

at all levels; 5d) Conduct supervision at all levels including M&E, TB/HIV information, and the use of the

Electronic TB Register (ETR.Net); 5e) Disseminate TB/HIV information at the national and international

levels; 5f) Document and share best practices twice per year; 5h) Facilitate district planning; 5g) Conduct

Advocacy Communication and Social Mobilization 5h) Conduct refresher training to 250 HCW on TB/HIV

services.

6) Strengthen laboratory TB/HIV activities; 6a) Train 140 laboratory staff on TB, AFB Microscopy,

Mycobacterium culture and first line drug susceptibility testing; 6b) Strengthen national QA network for AFB

microscopy; 6c) Procure one MGIT machine through RPSO to improve diagnosis of TB to HIV patients and

strengthen surveillance of MDR; 6d) Procure 57 Light Emitted Diod (LED) microscopy (one per district) 6e)

Liaise with TB/HIV Regional laboratory training center to be established in Southern African regions for

training and certifying personnel in standardized techniques and promoting external quality assessment

(EQA) activities.

7) Coordinate and collaborate with Columbia University in providing Technical Assistance in the

implementation of TB Infection control in care and treatment clinics.

8) Strengthen M&E systems to improve data management. This will allow districts, regions and central

levels to generate TB/HIV reports and facilitate monitoring of patients. 8a) Orient all HCW in TB clinic on the

use of modified TB forms and registers in 14 districts; 8b) update and maintain the ETR.Net software to

generate TB/HIV standardized reports; 8c) train 38 TB/HIV assistants, District TB and Leprosy Coordinators

(DTLC) and 17 administrators on the use of ETR.net; 8d) procure 33 computers and accessories for 29

districts and for M&E at central a level unit; 8e) update print and distribute

TB/HIV data collection tools; 8f) conduct mid term evaluation to determine whether TB surveillance system

is being used.

LINKAGES: NTLP works in collaboration with NACP and other development partners such as WHO, KNCV,

and GLRA who provide technical/financial support to help the program to meet its goals. It also works with

other implementing partners: PATH, CHAI, Harvard university, Columbia university, EGPAF, FHI, FBOs and

private care sectors to ensure coordination and harmonization of services. TB/HIV activities are conducted

within the framework of the health system.

CHECK BOXES: The areas of emphasis are chosen because NTLP will focus on in-services training of

providers in TB clinics and HIV sites to ensure quality of services. Building regional capacity to roll out

TB/HIV training and ensure sustainability. Renovation of infrastructure in TB clinics for provision of ARVs

services. These activities will ensure patients to access both TB and care and treatment services under one

roof, accelerate the number of TB/HIV co infected patients enrolled for ART and reduce transmission of TB

to immuno-compromised patients attending CTC.

M&E: 5% of the total budget is allocated for M&E. NTLP has developed standardize data tools that are

used in the country. At facility and district levels paper-based tools are used as a source for an electronic

database at the national level. Installation of ETR.Net will capture data electronically from the district to the

national level. On quarterly basis, data is collected, compiled and analyzed at all levels. Feedback of the

analyzed data from the national level is sent back to the respective regions. NTLP conduct regional,

quarterly, and bi-annual national coordinators' meetings to monitor program progress. Technical assistance

for both paper-based and electronic tools is provided through supervisions. The NTLP through NACP will

establish strong linkages with ART treatment partners to ensure M&E capacity building. This will include

tracking cross referrals, data quality decentralization of ETR, and data use for patient management at

facility level and program improvement.

SUSTAINAIBLITY: To ensure sustainability TB/HIV activities will be incorporated into comprehensive

council health management plans. So that in future, these activities will be directly funded by the counsels

and the government. The recruited staff in this project will be gradually absorbed into the government

establishment and paid by the government. Training of trainers will be done to ensure that local capacity is

build at the district levels. TB/HIV services are integrated into the existing health care system to avoid

formation of parallel program activities.

New/Continuing Activity: Continuing Activity

Continuing Activity: 13549

Continued Associated Activity Information

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

System ID System ID

13549 3464.08 HHS/Centers for National 6545 1253.08 $2,200,000

Disease Control & Tuberculosis and

Prevention Leprosy Control

Program

7781 3464.07 HHS/Centers for National 4568 1253.07 $1,100,000

Disease Control & Tuberculosis and

Prevention Leprosy Control

Program

3464 3464.06 HHS/Centers for National 2868 1253.06 $600,000

Disease Control & Tuberculosis and

Prevention Leprosy Control

Program

Emphasis Areas

Health-related Wraparound Programs

* TB

Human Capacity Development

Public Health Evaluation

Food and Nutrition: Policy, Tools, and Service Delivery

Food and Nutrition: Commodities

Economic Strengthening

Education

Water

Table 3.3.12: