Detailed Mechanism Funding and Narrative

Years of mechanism: 2008 2009

Details for Mechanism ID: 1512
Country/Region: Tanzania
Year: 2009
Main Partner: Columbia University
Main Partner Program: NA
Organizational Type: University
Funding Agency: HHS/CDC
Total Funding: $4,400,000

Funding for Treatment: Adult Treatment (HTXS): $4,400,000

ACTIVITY HAS BEEN REVISED SIGNIFICANTLY FROM FY2008COP.

Title: Expanding HIV Care and Treatment Services in Kagera, Kigoma, Pwani, Zanzibar

Need and comparative advantage: Columbia University (CU) has supported high quality comprehensive

HIV Care and Treatment services for adults and children in Tanzania since 2004. It is well positioned to

further expand these services in FY 2009. CU supports ART services in areas (HIV prevalence of 0.9%-

7.2%) where there is currently an estimated 51,503 patients in need of ART. In response to the Ministry of

Health and Social Welfare's (MOHSW) need to decentralize services, CU is supporting the establishment of

ART services at lower-level facilities. This involves infrastructure rehabilitation, training of health care

workers (HCWs) and establishing systems that are necessary to support ART programs.

Results: During FY 2008, CU supported ARV service in 44 health facilities (HFs) (31 hospitals, 13 health

centers (HCs)) increasing from 27 in September 2007. By June 2008, CU enrolled 10,281 new clients in

HIV care, and initiated 4,601 on ART (64% females and 36% males). Among the new enrollments, 88%

were screened for active TB, 8% were identified as TB suspects, 37% were diagnosed with tuberculosis

and initiated on treatment. 489 (68%) of the TB/HIV patients started co-trimoxazole preventive therapy

(CPT). Since the onset of the program, 115 pregnant women started ART and over 300 children under the

age of 15 received ART. Through early infant diagnosis (EID) activities, 1,101 HIV-exposed infants were

identified. Of those, 975 received an HIV test, 123 tested HIV-positive, and 50 received HIV care and

treatment (CT). The International Center for AIDS Care and Treatment Programs (ICAP), working with

district and regional health management structures, initiated sub grant programs in all 18 of their mainland

and Zanzibar districts.

Activities

Ensure high quality ART service coverage. Decentralize ART service to peripheral HFs, focusing on

primary care facilities; improve infrastructure at peripheral HFs for ART provision; continue expanding

continuing medical education (CME) program for HCWs, focused on improving treatment outcomes,

monitoring side effects and treatment failure; implement the Family Testing Model for all clients receiving

ART; ensure linkages between different services (care and treatment, PMTCT, TB etc) are established, and

strengthen both the facility and the community; implement partner-initiated counseling and testing (PITC)

linked to ART at district and regional hospitals, focusing on in-patient wards; strengthen the capacity of

sites, districts and regions in the collection, analysis and interpretation of data, and empower them in data

ownership; conduct regular data feedback sessions with implementers, regional authorities and MOHSW;

hire additional staff at high volume ART sites.

Ensure sustainability of ART service

Capacity building. Empower Regional and Council Health Management Teams (RHMTs and CHMTs) in

planning, implementation and supportive supervision. Ensure that ART-related activities are included in the

Comprehensive Council Health Plans. Train and clinical mentor HCWs on ART provision. Facilitate the

ART service provision task-shifting process. PLWHA groups will conduct ART adherence support activities.

Develop a training program for pharmacists on forecasting and ordering of ARVs.

Partnerships. Expand ART service to private organizations and faith-based HFs. Engage local authorities

and private partners (PPs) on collaborative provision of ART service. Identify urban and Para-urban sites

with a shortage of priority health care packages (PHCPs) where private groups can initiate ART services.

Train PPs on ART management. Collaborate with private for-profit businesses to provide ART for

employees at the work place.

System strengthening. Ensure uninterrupted ARV/opportunistic infection (OI) drug management through

regular Record & Reporting at pharmacy level and strengthening the capacity of RHMTs and CHMTs in

forecasting and gap filling.

Strengthen laboratory network. Upgrade laboratories for ART provision at lower level health centers.

Ensure access to CD4 testing at baseline and every 6 months for all clients on-site or through linkages.

Train staff on laboratory management and practices and OI diagnosis. Provide a minimum package of

laboratory equipments and reagents to the regional, district, and HC laboratories. Strengthen the sample

transportation system. Support laboratories' supplies chain management. Establish a laboratory data

management system. CU will support MOHSW quality assurance/quality control activities by supporting

regional and facility Quality Assurance Officers in supportive supervision of all regional and district CTCs in

their four regions. Support equipment services and maintenance by training 100 lab staff and two Zonal

Engineers on planned preventive maintenance.

Linkages: CU will strengthen partnerships with; PLWHA organizations/NGOs on improving the quality of

ART services; Population Services International (PSI) and Mennonite Economic Development Associates

(MEDA) on strengthening commodity provision; STRADCOM on information education and communication

(IEC)/behavior change communications (BCC) and ART radio programs; Interchick, Kagera Sugar, Uvinza

Salt, KabangaNickel Mines, Nyanza Cooperative Cotton growers on ART program for workers and

surrounding communities; WFP and faith-based organizations on enhancing nutritional support.

M&E: CU will collaborate with the National AIDS Control Program (NACP)/MOHSW to implement the

national M&E system in four regions. Data will be collected and reported using paper-based and electronic

National CTC tools to generate national and OGAC reports. CU will promote site feedback and data use by:

continuing the monthly feedback of achievements in enrolment of patients with HIV, training staff to

generate quarterly, semi-annual/annual reports; and planning future interventions. A data quality assurance

protocol for paper-based and electronic data will be implemented at all sites with one quality assurance

supervision visit per quarter. The NACP Access database will be scaled up. CU will train HCW in M&E

systems and provide technical assistance to all CTCs across 21 districts, three regional offices and

Zanzibar. CU will undertake critical reviews of the data, and support sites/districts/regions to share their

data at stakeholder meetings, workshops and conferences.

Sustainability: This year's focus will be local governments, private sector engagement and work with

PLWHA organizations/NGOs for ART service sustainability and treatment adherence.

New/Continuing Activity: Continuing Activity

Continuing Activity: 13456

Continued Associated Activity Information

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

System ID System ID

13456 3474.08 HHS/Centers for Columbia 6508 1512.08 Track 1.0 $4,400,000

Disease Control & University

Prevention

7697 3474.07 HHS/Centers for Columbia 4529 1512.07 Central Budget $4,400,000

Disease Control & University

Prevention

3474 3474.06 HHS/Centers for Columbia 2876 1512.06 $4,400,000

Disease Control & University

Prevention

Emphasis Areas

Human Capacity Development

Estimated amount of funding that is planned for Human Capacity Development $796,000

Public Health Evaluation

Food and Nutrition: Policy, Tools, and Service Delivery

Food and Nutrition: Commodities

Economic Strengthening

Education

Water

Table 3.3.09:

Cross Cutting Budget Categories and Known Amounts Total: $796,000
Human Resources for Health $796,000