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: 2007 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 not changed
*END ACTIVITY MODIFICATION*
TITLE: Strengthening and scaling up PMTCT services in Zanzibar
NEED and COMPARATIVE ADVANTAGE: The goal of the National Health Sector HIV/AIDS strategic plan
is to increase access and utilization of PMTCT and PMTCT plus services by 50% by 2009. Currently only
28 % of pregnant women in Zanzibar access PMTCT services through antenatal clinics (ANC) and at
Maternity hospitals during labour and delivery. To achieve the national goal, in FY 2008 ZACP is planning to
strenghthen existing services as well as scale up PMTCT service availability and accessibility in the islands
by establishing additional and strengthening existing PMTCT sites.
ACCOMPLISHMENTS: Established six PMTCT sites with increased uptake in RCH clinics by 99% and
improved enrollment in maternity wards (From 5% in 05/06 to 14% in 06/07). The unit has developed the
Zanzibar PMTCT training manuals and guidelines. Trained 90 and sensitized 519 HCW, established infant
diagnosis. Sensitized community gate keepers namely: 180 district officials, Shehas, religious leaders and
traditional birth attendants have been sensitized.
ACTIVITIES: In order to achieve the goal of PMTCT sevices in Zanzibar, the proposed activities in FY 2008
are: 1) Strengthen the quality of existing PMTCT services and increase service uptake particularly in labour
and delivery wards 1a) Train additional health care workers on PMTCT and other related trainings e.g.
infant feeding in the context of HIV in existing sites and refresher training for existing PMTCT service
providers.1b) Employ four additional nurses for maternity wards in major hospitals such as Mnazi Mmoja
and Mwembeladu. 1c) conduct supportive supervision on existing sites in collaboration with the zonal and
district RCH coodinators. 1d) Conduct supportive meeting with PMTCT service providers quarterly. 1e)
Strengthen referral system for care and treatment and other related services for the HIV positive mothers,
their partners and children. 1f) Procure HIV testing kits, reagents and related supplies, basic protective
gears and delivery kits.
2) Establish ten new PMTCT sites 2a) Identify and conduct site readiness assessment. 2b) Renovate
infrastructure and update the counseling and testing rooms. 2c) Train service providers and deploy them to
appropriate sites. 2d) Procure equipment for new sites.
3) Create demand for service utilization 3a) Sensitize health workers, community leaders and religious
leaders and other members of the community on PMTCT services through meetings and drama
performances. Traditional birth attendants within the ten districts will also be sensitized to refer pregnant
women to deliver in health facilities and advocate for PMTCT services. 3b) Develop information, education
and communication materials and mass mobilisation activities including radio spot to mitigate stigma and
discrimination associated with HIV/AIDS, low hospital delivery and low male involvement in PMTCT
services.
4) Support national PMTCT coordination unit 4a) Support office expenses. 4b) Support vehicle running cost
for the coordination unit.
LINKAGES: ZACP will work in collaboration with Columbia University and Tanzania mainland to ensure
smooth running of PMTCT activities, share experience, best practices and challenges, avoid duplication of
efforts. Currently PMTCT services has been intergraded and being provided within RCH services and
therefore allows women and mothers to easy access services e.g. family planning, immunization services
for children etc. Pregnant women who found to be HIV positive are referred to care and treatment services
for further evaluation and management. The HIV positive women are also linked with home based care
services for continuum of care and follow up of mother and children. Regular meetings between PMTCT
health care providers, community and facility home base care providers will be conducted for information
exchange and ensure effective referral and feedback. HIV positive pregnant women and mothers are also
referred and linked to organizations of people living with HIV/AIDS and other HIV services and non HIV
related support like psychosocial support, nutrition, legal assistance etc.
CHECK BOXES: The areas of emphasis were chosen because activities will include renovation of new sites
as determined by site assessments in order to get rooms which will ensure privacy and maintain
confidentiality. The emphasis is also on training for service providers to build their capacity. Pregnant
women are the entry point for prevention of mother to child transmission of HIV. Appropriate and early
testing can impact interventions to lower and prevent viral transmission to children and strengthen
continuum of care for women and their families.
M&E: PMTCT services will be monitored through paper based monitoring tools adapted from Tanzania
Mainland and all PMTCT health care providers at the new sites will be trainned on the monitoring tools.
ZACP in collaboration with the RCH program and the Health Management Information System (HMIS) is
currently working on the development of an integrated PMTCT and reproductive health monitoring system
to ensure easy collection of data and reporting. Supportive supervision will also be strengthen to ensure
quality of data and services
Data from health facilities will be collected monthly and analyzed. The quarterly and progress reports will
prepared and the analyzed data will be used with in the facility to improve services. At the regional and
national level the data will be used for improving program management.
Activity Narrative: SUSTAINABILITY: This will be ensured through capacity building of staff, community participation and
Involvement, absorption of activities within the health sector work plans.
New/Continuing Activity: Continuing Activity
Continuing Activity: 13528
Continued Associated Activity Information
Activity Activity ID USG Agency Prime Partner Mechanism Mechanism ID Mechanism Planned Funds
System ID System ID
13528 3503.08 HHS/Centers for Ministry of Health 6542 4781.08 ZACP $357,000
Disease Control & and Social
Prevention Welfare, Tanzania
- Zanzibar AIDS
Control Program
7756 3503.07 HHS/Centers for Ministry of Health 4781 4781.07 ZACP $969,000
3503 3503.06 HHS/Centers for Ministry of Health - 2893 1131.06 $512,000
Disease Control & Zanzibar,
Prevention Tanzania
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 $20,000
Public Health Evaluation
Food and Nutrition: Policy, Tools, and Service Delivery
Food and Nutrition: Commodities
Economic Strengthening
Education
Water
Table 3.3.01:
UNCHANGED FROM FY 2008; IN FY 2009, USG WILL CONTINUE TO WORK WITH ZACP TO ENSURE
THAT ITS ACTIVITIES REINFORCE THE USG PREVENTION STRATEGY.
TITLE: Abstinence and faithfulness programming in HIV/AIDS interventions in Zanzibar
The first HIV/AIDS index case in Zanzibar was diagnosed in 1986. Since then, routine surveillance
conducted using pregnant women (ANC) has documented HIV prevalence of <1% on the islands. Similarly,
an HIV magnitude validation survey and a recently finalized ANC surveillance study have documented HIV
rates at 0.6% and 0.87% respectively. Higher HIV infection rates have been documented in females
compared to males (1:5 respectively) with heterosexual transmission accounting as the significant route of
HIV transmission. Concurrently, voluntary counselling and testing (VCT) data have shown an annual
increase in the number of clients diagnosed as HIV-positive from 180 (ZACP, 1996) to 690 (ZACP, 2006).
Based on these data, it is necessary to raise public awareness of behaviors that put individuals at the risk of
contracting or transmission of HIV and other sexually transmitted diseases. The likelihood of transmitting
HIV is greatly increased for those who have multiple sex partners and engage in unprotected sex. All
sectors at different levels are involved in enhancing public awareness, particularly at the community level, to
empower the community to develop culturally appropriate approaches in prevention of HIV transmission.
These include; being faithful to the same partner; practicing abstinence; and delaying engagement in sexual
practices according to well-informed individual decisions. A functional faith-based initiative that positively
promotes abstinence and faithfulness in a holistic manner is an important strategy for the prevention of HIV
among Zanzibaris.
ACCOMPLISHMENTS:
N/A
The HIV/AIDS Faith Based Initiative that currently works in close collaboration with ZACP will establish an
abstinence and faithfulness program for youth and the general population focusing on the following:
spiritual, social, psychological and health gains associated with abstinence and faithfulness; personal risk
assessment; adherence to faith-based teachings on abstinence and faithfulness contained in the Qur'an,
the Bible and the Hindu holy books; awareness on the role of abstinence and faithfulness in the prevention
of unplanned pregnancies, sexually transmitted diseases, and HIV/AIDS; and promotion of spiritual and
premarriage
counseling for couples.
The HIV/AIDS Faith Based Initiative will adopt mass media communication strategies that address
promotion of AB activities for youths aged 10-24 and adults. One theme will be the slogan, "Life without
substance abuse and HIV/AIDS is a pearl to Zanzibaris." Other issues to be addressed in the AB promotion
campaign include raising awareness, increasing understanding of the negative aspects of early sex,
developing resistance to peer pressure, and promoting parent and child communication. There will be
collaboration with the Tanzanian media to use television and radio spots to support a compassionate
response from faith communities on AB messages that will use quotes directly from the Holy texts.
LINKAGES:
CHECK BOXES:
Religious leaders
Adults (male and female, 25 and over)
Adolescents (male and female, 15-24)
Adolescents (male and female, 10-14)
M&E:
Monitoring and evaluation will be conducted quarterly and indicators on the performance of the program will
include: number of youth attending VCT services in 10 districts; number of youth reporting to have learned a
positive lesson from the media strategies on ABY; number of outreach faith-based organization (FBO)
programs in schools; and number of trained religious leaders and peer educators on AB.
SUSTAINAIBLITY:
This activity will be implemented by faith-based leaders currently working with ZACP. These leaders are
interwoven with and supported by community members. As a result, their activities are propagated and
sustained.
Continuing Activity: 16392
16392 16392.08 HHS/Centers for Ministry of Health 6542 4781.08 ZACP $150,000
Table 3.3.02:
ACTIVITY HAS BEEN MODIFIED IN THE FOLLOWING WAYS:
TITLE: Comprehensive HIV Prevention, Care and Treatment and Substance Abuse Services in Zanzibar.
NEED and COMPARATIVE ADVANTAGE: Zanzibar has observed an incremental growth of two
challenging and intertwining public health crises: HIV/AIDS and illegal substance use. Both have markedly
affected and increased the burden to families, communities, and Zanzibar as a whole. Although the HIV
prevalence in the general Zanzibari population is estimated at less than 1%, in some populations,
particularly IDUs, the prevalence is much higher. A recent substance abuse study documented HIV infection
among general substance users at 13% (30% for female substance users and 12% for males) and 25% for
IDUs. The impact of other infectious diseases among this population is also notable. Twenty-six percent of
substance users had a sexually transmitted infection (STI) (11% had syphilis), and 16% were infected with
hepatitis C.
Overlapping populations, including CSW and MSM, are also at risk of acquiring HIV and often are unable to
consistently access health services. According to a baseline assessment conducted by Medicos del
Mundo, only 37% of CSW reported reusing a condom either sometimes or always and the majority (81%)
never had an HIV test. Half (50%) of CSWs use alcohol or other drugs on a daily basis. Data collected by
ZACP found that HIV prevalence a cohort of CSW was 11% and among MSM HIV prevalence was 12%.
Preventing the spread of HIV and alleviating the impact of AIDS are top health priorities for USG's efforts in
Zanzibar in collaboration with the Zanzibar AIDS Control Program (ZACP). ZACP is implementing a broad
HIV prevention strategy on the island. PEPFAR funds currently are being used to support efforts to
understand the scope of injection drug use in Zanzibar. In addition, efforts supporting prevention and
outreach activities among CSW and MSM, particularly those that are also substance users, are critical to
decreasing the number of newly infected and to engaging them in positive health seeking behaviors.
Interventions were planned in 2007 to target most at risk populations, including IDUs, and CSW and MSM
who exchange sex for drugs.
ACTIVITIES:
In FY08, funds were allocated to renovate a neutral community center for IDUs to receive comprehensive
HIV prevention, care and treatment, and substance abuse services. FY09 funds will be used to support the
following activities:
1) Continue to facilitate training and capacity development of workers to deliver comprehensive care and
behavioral modification/substance abuse counseling in the community center.
2) Provide services for IDUs, including: 2a) Assessment of individual substance abuse factors using a multi-
disciplinary approach, including case management. 2b) HIV counseling and testing. 2c) STI screening and
treatment. 2d)
Care and treatment services for those found to be HIV-positive. 2e) Condom promotion and distribution. 2f)
Injection use related risk reduction strategies. 2g) Treatment for drug related emergencies and acute
problems. 2h) Preparation for long-term recovery and behavior change through peer support, relapse
prevention, pre-employment counseling, employment coaching, recovery coaching (including stage-
appropriate recovery education, assistance in recovery management and telephone monitoring), and family
support services.
3) Support HIV prevention services for CSW and MSM. Supported activities targeting CSWs will focus on
behavior change messages which raise awareness on means of HIV transmission, the importance of and
proper use of condoms and harm reduction techniques related to alcohol and drug use. Trained peer
educators will conduct outreach sessions in locales frequented by CSWs, including sex worker
establishments, as is possible. Referral systems, including tracing of those lost-to-follow-up, will be
facilitated for counseling and testing services, care for sexually transmitted infections (STIs), and care and
treatment services for those who are HIV-positive. Activities tailored to MSMs will also be spearheaded by
peer educators, many of whom have previously conducted prevention outreach activities. Particular focus
will be directed towards social networking among the target population to increase dissemination of
prevention messages. Also, aspects related to prevention among IDUs will be included, as intravenous
drug use is prevalent among MSMs. Prevention messages will therefore convey information on harm
reduction techniques, as well as condom-use promotion and engaging with health services for STI
diagnosis and treatment.
TITLE: Community Center for Comprehensive HIV Prevention, Care and Treatment and Substance Abuse
Services in Zanzibar.
particularly IDUs, the prevalence is much higher. A recent substance abuse study documented HIV
infection among general substance users at 13% (30% for female substance users and 12% for males) and
25% for IDUs. The impact of other infectious diseases among this population is also notable. Twenty-six
percent of substance users had a sexually transmitted infection (STI) (11% had syphilis), and 16% were
infected with hepatitis C.
understand the scope of injection drug use in Zanzibar. Interventions also are planned in 2007 to target
most at risk populations, including IDUs, and CSW and MSM who exchange sex for drugs. In view of the
importance of drug use as a mode of transmission of HIV in Zanzibar, a missing component of this strategy
to date has been provision of services to treat drug abuse, including alcohol. An existing rehabilitation
Activity Narrative: program in Kenya will be examined as a model and used to guide implementation on the island.
The goal of the of these planned activities by the Zanzibar AIDS Control Program is to reduce new HIV and
sexually transmitted infections by 50% by 2011 and to provide treatment, care, and support to substance
users with a special focus on injecting drug users and their affected families. To achieve this goal, the
following activities are planned:
• Renovation of neutral community center for IDUs and overlapping populations (e.g., CSW and MSM) to
receive comprehensive HIV prevention, care and treatment, and substance abuse services.
1)Training of workers to deliver comprehensive care and behavioral modification/substance abuse
counseling in the renovated space.
2) Service delivery, including: 2a)Assessment of individual substance abuse factors using a multi-
disciplinary
approach, including case management. 2b)HIV counseling and testing. 2c)STI screening and treatment. 2d)
Care and treatment services for those found to be HIV-positive.
2e)Condom promotion and distribution. 2f)Injection use related risk reduction strategies. 2g)Treatment for
drug related emergencies and acute problems. 2h)Preparation for long-term recovery and behavior change
through peer support, relapse prevention, pre-employment counseling, employment coaching, recovery
coaching (including stage-appropriate recovery education, assistance in recovery management and
telephone monitoring), and family support services.
In time, it is anticipated that the government would allow a small-scale pilot to assess the feasibility of
medical treatment with either methadone or buprenorphine. The goal is that substance abusers who
complete detoxification and treatment would stop or reduce their drug use and related risk behaviors,
including risky injection practices and unsafe sex.
LINKAGES: The Zanzibar AIDS Control Program believes these services will be an important avenue for
providing current information on HIV/AIDS and related infectious diseases, HIV counseling and testing
services, and referrals for medical and social services. As a result, linkages will be made with USG
partners providing services in Zanzibar including Columbia.
CHECK BOXES: Construction/renovation
Human capacity development: in-service training
Local organization capacity building
Wrap around programs: family planning, TB, economic strengthening, education
Most at risk populations (injecting drug users, men who have sex with men, non-injecting drug users,
persons in prostitution, persons who exchange sex for money and/or other goods, street youth)
M&E: The Zanzibar AIDS Control Program will develop an M&E system to track client encounters, services
delivered, and referrals (e.g., to counseling and testing, and care and treatment centers). Other variables
will be explored depending on the exact activities. Whenever possible, national tools will be used and
existing systems will be supported.
SUSTAINABILITY: The national government and donor partners working in Zanzibar are very committed to
addressing the substance abuse issues on the island. A recently published HIV and substance use
prevention framework outlines the multi-sectoral response, which will be critical for the sustainability of
these efforts.
Continuing Activity: 16369
16369 16369.08 HHS/Centers for Ministry of Health 6542 4781.08 ZACP $450,000
Table 3.3.06:
ACTIVITY UNCHANGED FROM FY 2008.
TITLE: Strengthening and Scale-up of Home-based Care (HBC)
NEED and COMPARATIVE ADVANTAGE: Home-based care (HBC) services for HIV/AIDS began in
Zanzibar in 1988. Since then, HBC services have been established in eight out of ten districts. There is a
need for HBC to expand into all ten districts as well as offer a platform of services to people living with
HIV/AIDS (PLWHA) to ensure a continuum of care. Additionally, there is a need to strengthen the
management of HBC systems, expand access and integrated service networks including prevention, and
increase community awareness and support. The Zanzibar AIDS Control Programme (ZACP) is the lead
government agency leading care and treatment in Zanzibar.
ACCOMPLISHMENTS: Nearly 1000 people are accessing HBC services in Zanzibar. Approximately 170
health care workers (HCW) and 100 community HBC providers have been trained in HBC. Seventeen
facility-based and 27 community-based HBC kits have been distributed. Supportive supervision has been
conducted on both Unguja and Pemba islands. The Zanzibar AIDS Control Programme (ZACP) has
adapted and printed HBC guidelines; developed and distributed information, education, and communication
(IEC) materials to promote HBC services; and developed mass media and faith-based campaigns.
ACTIVITIES: With FY 2008 funding, ZACP will expand their HBC services, as well as coordinate services
on the archipelago more effectively. ZACP will strengthen their role as the central body for setting
standards, developing curricula, and monitoring quality of services. In addition, they will identify ways to
enhance the quality, comprehensiveness, and coverage in Zanzibar. Key activities for FY 2008 will be to:
1. Scale up HBC services in the remaining two districts. ZACP will update and print palliative care training
manuals, expanding HBC to a broader, holistic palliative care model. They will train approximately 60
facility-based palliative care providers, primarily for HBC, as well as 60 additional community-based lay
HBC providers. ZACP will conduct coordination meetings with HBC implementers and district health
management teams (DHMT).
2. Strengthen HBC management information systems, participating also in the development of the
mainland's monitoring system development. ZACP will print the revised monitoring tools. They will work to
build organizational capacity through a five-day supervision training for DHMT and conduct supportive
supervision on HBC implementing districts. Facility HBC coordinators and DHMT will supervise activities by
community HBC volunteers using a HBC supervision check list. The supportive supervision will include
technical advice to address any emerging issues. Coordinators will also conduct monthly meetings with
providers to respond to gaps. They will train community HBC providers on basic HBC reporting and
conduct quarterly zonal HBC stakeholders meeting.
3. Expand access and integrated service networks of PLWHA to the continuum of care and comprehensive
HIV/AIDS services as well as preventive care. ZACP will train NGOs and FBOs on HBC services. These
organizations will then train community-based lay health workers as described above. ZACP will support
NGOs, FBOs, and community volunteers to conduct home visiting. Clients will be provided with a basic
preventive package including insecticide treated nets, water treatment, IEC materials, condoms, family
planning and cotrimoxazole.
4. Increase community awareness on HBC services. This will be accomplished through a sensitization
meeting for the Sheha AIDS Coordinating Committee on HBC services and also meetings with family care
givers on nutrition and basic hygiene.
5. Advocacy for HBC services. ZACP will update different types of IEC materials on HBC services and
stigma reduction. They will also conduct radio and TV programs on HBC services and stigma reduction.
6. Strengthen unit to coordinate HBC services. Procure one laptop and LCD machine. Conduct study tour
in Uganda for HBC coordinators to share experiences and learn from others about providing a basic care
package to PLWHA through HBC.
LINKAGES: ZACP has linkages with various services including voluntary counseling and testing and
provider-initiated testing and counseling, care and treatment clinics, prevention of mother-to-child
transmission services, Zanzibar Association of People Living with HIV/AIDS (ZAPHA+) as well as other
HBC implementers. ZACP works with CDC and other implementing partners including Clinton HIV/AIDS
Initiative, Global Fund, WHO and World Bank, Family Health International, and Africare (which represents
Tunajali in Zanzibar). Also, the President's Malaria Initiative (PMI) is very active in Zanzibar, and this
program would like with the PMI to ensure that PLWHA receive insecticide treated mosquito nets.
CHECK BOXES: Increased human and organizational capacity building will ensure high-quality services
and sustainability. Wraparound program will ensure comprehensive care for PLWHA.
M&E: The HBC unit, in collaboration with the strategic information unit of ZACP, have revised and updated
different monitoring tools for facility and community-based providers to capture information concerning HBC
services. The new tools provide ZACP with the information it needs to monitor, plan, and share results on
the progress of HBC in Zanzibar. Progress reports will be submitted regularly following the same procedure
as other USG supported interventions. Supervision is conducted in all HBC implementing health facilities in
collaboration with DHMTs.
SUSTAINAIBLITY: Through high-quality training, ZACP will continue to build the technical capacity of
HCWs and NGOs to provide HBC services. To ensure sustainability of HBC services, ZACP will support
the DHMT in the roll-out of HBC services by training of DHMTs in supervision and management of HBC
services and also leading regular coordinating meetings.
Activity Narrative: MAJOR ACTIVITIES:
1. Scale up HBC services to remaining two districts.
2. Support HBC management information system.
HIV/AIDS services as well as preventive care.
4. Increase HBC awareness to the community.
5. Advocate for HBC services using IEC tools.
6. Maintain and support the HBC unit to coordinate HBC services on Zanzibar.
Continuing Activity: 13530
13530 8695.08 HHS/Centers for Ministry of Health 6542 4781.08 ZACP $115,000
8695 8695.07 HHS/Centers for Ministry of Health 4781 4781.07 ZACP $100,000
Table 3.3.08:
TITLE: Expanding Comprehensive Care and Treatment Services in Zanzibar
NEED and COMPARATIVE ADVANTAGE: By 2008, there will be an estimated 900 HIV positive people in
need of comprehensive ARV treatment services in Zanzibar. Currently 668 have been enrolled and 519
have been initiated on ARVs. For the time being there are five care and treatment clinics in four regions. All
care and treatment services are provided in public hospitals. This year the target is to scale-up services to
two private hospitals and strengthen existing services through staff training, on-the-job training, supportive
supervision, improved coordination, and access and quality of care and treatment services.
ACCOMPLISHMENTS: In collaboration with ART partners working in Zanzibar, two more care and
treatment sites have been established making a total of five CTC sites currently providing services. Almost
100% achievements of year two targets for enrollment on ART have been met. A functional CTC database
has been established at the Mnazi Mmoja hospital; 56 health care workers (HCWs) have been trained on
the provision of ARV services; 24 HCWs have been trained on adherence counseling from four care and
treatment clinics; and 27 HCWs have been trained on pediatric HIV/AIDS management. Also, post exposure
prophylaxis guidelines (PEP) and training manuals have been developed.
ACTIVITIES: 1) In FY 2008, the ZACP will continue working with partners to maintain care and treatment
services in the existing sites and coordinate scale-up of services to new sites 1a) Coordinate partners
implementing ART services within Zanzibar by conducting quarterly stakeholders meetings to discuss
various issues including policy and guidance, quality of services, sharing best practices, sharing data,
tracking progress against national goals, and improving program implementation coordination of care and
treatment services 1b) Review, update, and disseminate care and treatment training materials and
guidelines 1c) Conduct supportive supervision to ensure quality of services 1e) Work with M&E unit to
coordinate the roll-out of the revised M&E tools for care and treatment 1d) Coordinate training and refresher
training, and provide support for those attending workshops and conferences within and outside the country
1f) Procure drugs for opportunistic infections, and HIV reagents including test kits and protective gear 1g)
Sensitize health care workers and the community on newly established CTC sites
2) Coordinate and work with partners in the implementation of Post-Exposure Prophylaxis (PEP).
2a) Sensitize health sector officials and train health care workers on the importance of prevention of blood
borne pathogens and PEP.
3) Advocate for care and treatment services. 3a) Conduct community sensitization sessions to influential
leaders on comprehensive care and treatment services 3b) Develop, print and distribute demand generated
IEC materials 3c) Conduct a mass media campaign for demand creation (inclusive of TV and radio spot
announcement and panel discussions).
4) Collaborate and coordinate with partners to strengthen linkages and referral between care and treatment
services and other HIV and non HIV related services like PMTCT, TB HBC, psychosocial support, legal
support, food support that will allow a smooth flow of patients
4a) Support a monthly information exchange meeting between care and treatment staff, PMTCT, TB, VCT,
HBC and other services 4b) Update, print and distribute referral forms.
5) Provide supportive supervision to ensure quality of service.
5a) Train two teams on supportive supervision in Unguja and Pemba. 5b) Conduct supportive supervision at
the regional level once a year.
6) Support minor renovation of infrastructure of two hospitals which are not renovated by partners for
provision of care and treatment services. This activity will ensure confidentiality, safe storage of ARVs, and
enough space for consultation, counseling and laboratory services.
LINKAGES: The care and treatment unit works in collaboration with other implementing units such as
PMTCT, TB, HBC, VCT, and IEC and SI units. It also collaborates with other partners including Columbia
University, Clinton HIV/AIDS Initiative (CHAI), and World Health Organization (WHO). The partners provide
technical and material support to strengthen quality provision of services and realize the set objectives.
Care and treatment services are conducted within the framework of the health system. Linkages between
care and treatment services and other implementing units and partners is an ongoing intervention in FY
2008 .
CHECK BOXES: The area of emphasis are chosen because:
1.Renovation of new sites will improve access to care and treatment services in an acceptable environment.
2.Human and local organization capacity building will ensure quality of services and sustainability.
M&E: ZACP in collaboration with partners has established monitoring tools to capture information on clients
accessing care and treatment services. These tools include CT2 forms available in all clinics and the CTC
database which has been established in the Mnazi Mmoja hospital. Supervision is conducted in all care and
treatment clinics to improve the collection and processing of gathered information.
SUSTAINAIBLITY: ZACP will continue to build the technical capacity of the local staff and at the health
facilities in both public and private facilities. Capacity will be built through coordinating and supporting the
training of health workers, the general community, and local government authority. Interventions identified
herein have been acknowledged and incorporated within the health sector budget and are among the key
interventions in the national poverty reduction strategy.
Continuing Activity: 13532
13532 5319.08 HHS/Centers for Ministry of Health 6542 4781.08 ZACP $245,000
7757 5319.07 HHS/Centers for Ministry of Health 4781 4781.07 ZACP $250,000
5319 5319.06 HHS/Centers for Ministry of Health - 2893 1131.06 $402,440
Construction/Renovation
Table 3.3.09:
TITLE: Strengthening HIV Counseling and Testing Services in Zanzibar
NEED and COMPARATIVE ADVANTAGE: The Ministry of Health and Social Welfare, through the Zanzibar
AIDS Control Program (ZACP), has the responsibility of coordinating the Zanzibar health sector response to
HIV/AIDS. ZACP through its Counseling Unit (CU) coordinates the Zanzibar Counseling and Testing (CT)
program through development of policies and guidelines, training protocols and manuals; standard
operating procedures and job aides. ZACP also provides supervision and technical guidance to
implementing partners; strengthens training of counselors to secure the required quantity and quality of
services; and monitors the progress of implementation of CT activities through reports from district councils,
NGOs, and other stakeholders.
ACCOMPLISHMENTS: With USG PEPFAR support, ZACP has been able to achieve the following:
1. Developed the Zanzibar Counseling guidelines and training manuals;
2. Established provider initiated testing and counseling (PITC) services at Mnazi Mmoja and Chake Chake
Hospitals and Kivunge health centre;
3. Conducted training of 24 health care workers in PITC;
4. Established CT coordination forum;
5. Procured and distributed the HIV Kits for CT sites;
6. Produced and distributed IEC materials on VCT services; and
7. Officially opened VCT Gold Standard site on World AIDS Day 2007.
With FY 2009 funds, ZACP will accomplish the following:
1. Strengthen the PITC services at Mnazi Mmoja Referral Hospital , Chake Chake Hospital and establish
PITC services at three additional hospitals (Wete, Mkoani and Micheweni ) and PHCU which provide STI
2. Strenghen the VCT services at 41 sites and establish 11 new sites including Centre of Excellence.
3. Offer HIV VCT services at the VCT Gold Standard site at Mnazi Mmoja referral hospital.
4. Adapt policy guidelines, training manuals for counseling and testing of children and special groups like
the hearing and speech impaired.
5. Train 30 health care workers from 11 sites and retrain 58 counselors from 28 health facilities to
strengthen human capacity development and sustain delivery of CT services.
6. Conduct specialized training in HIV CT for children and special groups like the hearing and speech
impaired.
7. Procure HIV test kits and related commodities.
8. Provide mentoring and facilitative supervision to 41 hospitals, health centers and PHCU providing CT
services to maintain quality of services provided.
9. Mobilize and sensitize communities for the uptake of CT services.
10. Support NGOs on CT outreach services.
11. Continue working in collaboration with the IEC unit at ZACP and other partners to design, develop and
pretest IEC messages for the health facilities.
12. Monitor the progress of CT activities by conducting supportive supervision and strengthening of
monitoring and reporting.
13. Standardize the CT monitoring system, to capture all the information for clients attending both VCT and
PITC.
14. Strengthen the capacity of Counseling and Testing Unit at ZACP to coordinate CT services in Zanzibar.
15. Disseminate information to appropriate partners and leaders.
ACCOMPLISHMENTS: With USG PEPFAR support, ZACP has been able to achieve many goals including
testing 22,461 clients in 2006.
ZACP also has:
Hospitals and ;
5. Procured and distributed the HIV Kits for CT sites; and
6. Produced and distribute IEC materials on VCT service.
With FY 2008 funds, ZACP will accomplish the following:
1. Establish PITC services in three hospitals and strengthen PITC services at Mnazi Mmoja Referral
Hospital and Chake Chake Hospital.
2. Establish VCT services at 13 new sites within five districts and maintain the existing activities at 27 sites.
Activity Narrative: 3. Offer HIV VCT services at the VCT Gold Standard site at Mnazi Mmoja referral hospital.
4. Develop policy guidelines, training manuals for counseling and testing of children and special groups like
5. Train 30 health care workers from 13 sites and retrain 58 counselors from 27 health facilities to .
8. Provide mentoring and facilitative supervision to 28 hospitals and health centers providing CT services.
LINKAGES: For individuals testing HIV-positive, linkages will be made with various programs including
palliative care/home based care and HIV treatment. HIV-negative persons will be linked with resources
(e.g., post-test clubs) to help them maintain their negative status. Work will be completed in collaboration
with various implementing partners including, Columbia University, CHAI, and Global Fund other ART and
TB partners.
M&E: ZACP will continue to support integration of HIV CT in HMIS and training for M&E tools. ZACP will
also provide support in the use of the tools in day to day operations. All supported sites will use MOHSW
daily registers and monthly summary forms, which will harmonize recording and reporting of CT services.
SUSTAINABILITY: To ensure sustainability of CT services, ZACP will support the training of DHMTs on
mentoring and supportive supervision of CT services (VCT and PITC) and in directly supports the overall
HIV Care and Treatment Plan. This activity will also strengthen the DHMTs to manage and supervise the
implementation of quality CT services at the council level through monthly/quarterly coordinating meetings.
It will also strengthen the referrals and linkages to care, as well as treatment and prevention activities in all
sites and the integration of CT services into other services.
Continuing Activity: 13531
13531 8690.08 HHS/Centers for Ministry of Health 6542 4781.08 ZACP $500,000
8690 8690.07 HHS/Centers for Ministry of Health 4781 4781.07 ZACP $240,000
Table 3.3.14:
THIS NARRATIVE HAS BEEN MODIFIED IN THE FOLLOWING WAYS:
Surveillance: Analyzed and disseminated data from behavioral and biological surveys of Most at Risk
Populations (MARPS), specifically men who have sex with men (MSM), commercial sex workers (CSWs),
and intravenous drug users (IDUs); conducted capacity building workshops in data analysis and manuscript
writing for ZACP staff. ANC sentinel surveillance was completed in 2008 and included testing for hepatitis B
and C.
2007 BSS of most at risk populations (MARPS) groups took place on Unguja Island, Zanzibar and little is
yet known about most at risk populations on the sister island of Pemba. In 2009, ZACP staff will conduct
behavioral surveillance surveys with biological markers among MARPS groups on Pemba Island,
specifically CSW and MSM. This will include training, laboratory support, data management and analyses,
and preparing and dissemination of reports.
In 2009, funds will also be used to conduct qualitative follow-up to explore results and refine data collection
tools from 2007 BSS+ among CSW, MSM and IDU on Unguja Island. BSS+ using respondent-driven
sampling (RDS) will be repeated in 2009 among those same populations. Other activities will include
holding a series of meetings/workshops to ensure use of the results from this and previous surveys and
initiate intervention components.
In FY 2009 follow up work on the ANC sentinel surveillance round will include technical assistance for
hepatitis B vaccinations and care and hepatitis C care for ANC survey participants and incidence estimation
using the BED assay on ANC sentinel surveillance and BSS specimens. Also, to further characterize the
epidemic and target prevention efforts, subtyping for HIV and hepatitis will be conducted. In addition, ANC
sentinel surveillance data and PMTCT data will be compared for the possibility of using PMTCT program
data for surveillance purposes.
Human Capacity Development: During FY 2009, funds will be used to maintain support for positions
describe below, all of which will be hired during FY2008. During FY2009, the focus for human capacity
development will be on TA and training to build in country capacity for all areas of SI among the full cadre of
staff. The development of the Health Sector M&E framework will be completed during 2008, and
implemented with partners and stakeholders during FY 2009. Data harmonization will also continue. In the
area of M&E, there will be an increased focus data utilization and data quality.
TITLE: ZACP SI capacity, Surveillance, M&E of HIV/AIDS activities
NEED and COMPARATIVE ADVANTAGE: The SI unit of the ZACP is the custodian of health sector HIV
data in Zanzibar. The unit is mandated to coordinate, collect, store, retrieve, and analyze various types of
data for planning and policy formulation. Simultaneously, the unit has good capacity for data handling,
hence, it will complement efforts of the HMIS unit within the MoHSW in the production of health data
required by stakeholders. The SI Unit has started to set up data collection tools to include information on
Care & Treatment, HIV surveillance, PMTCT, HIV Testing, Home Based Care, Laboratory and STI
ACCOMPLISHMENTS: 1) Increased capacity to monitor and evaluate HIV/AIDS interventions, 2)
Conducted behavioral and biological surveys for Most At Risks Populations (MARPS) specifically men who
have sex with men (MSM), commercial sex workers (CSWs), and intravenous drug users (IDUs), 3) Piloted
respondent-driven sampling (RDS) methodology during MARPs surveys, 4) Assessed prevalence of
bloodborne
infections among populations of interest during MARPs surveys, 5) SI unit has trained HMIS staff on
HIV monitoring.
ACTIVITIES: The activities for this year include: Antenatal Clinic (ANC) surveillance, behavioral surveillance
(BSS) of MARPs, and strengthening M&E and program monitoring capacity.
1.Surveillance
a.) Antenatal Clinic (ANC) HIV surveillance will be repeated in 2008 with the 20 sites using the PMTCT
approach complemented by dried blood spot (DBS) methodology for specimen collection. Additionally, trend
analyses will be performed on three data points (2002, 2005, 2007 & 2008) specifically using data for those
sites which did participate in all four rounds. ANC surveillance data will be compared to PMTCT counseling
& testing data in order to assess the feasibility of replacing ANC surveillance with PMTCT (if PMTCT
services coverage is satisfactory) as the main method of tracking the epidemic in the general population in
Zanzibar.
b.) ZACP staff will also participate in the behavioral surveillance survey with biological marker(s) (BSS+)
among prisoners and uniformed services. This will include training of trainers (TOTs); laboratory support,
data management and analyses, and preparing and disseminating reports. With FY 2008 funds, the staff
will also participate in the repeat of the BSS+ among IDUs.
2. Human Capacity Development
a) Human capacity needs are substantial across all teams within ZACP. The ZACP SI section is in charge
of HIV and STI surveillance, monitoring and evaluation of programs, and information systems activities.
As a result, personnel to be recruited will include: a Strategic Information Coordinator (Epidemiologist), a
Surveillance Coordinator, a Monitoring and Evaluation (M&E) Officer, a Data Manager and four Data Entry
Clerks.
b) Train HCW staff on basic epidemiology, basic computer skills, database management using Epi Info (for
Windows), data entry, analysis using other complemntary statistical packages, data presentation and report
writing.
c) Attend regional and international trainings and conferences.
3. Develop Health sector HIV M&E framework to include a comprehensive set of national and international
indicators to track progress against set targets; guidelines for activity planning, monitoring and reporting;
Activity Narrative: capacity-building for data use; a more standardized/formalized way of reporting health information up to
ZACP; and development/strengthening of existing linkages between the different program activities.
4. Harmonize HIV data at ZACP programs. Each unit of ZACP is collecting data related to counseling and
testing e.g. PMTCT, PITC. These data need to be harmonized in SI unit for management and analysis.
LINKAGES: The Strategic Information Unit is working in collaboration with other units within ZACP. Linking
health sector HIV information to the national HIV data set. Data are collected from Public and private health
facilities that include, FBO and NGO facilities. ZACP will also continue to collaborate with Tulane University
on the MARPs surveys. ZACP works closely with Tulane University, which has technical expertise on
respondent driven sampling to collect BSS data on MARPs.
CHECK BOXES: The areas of emphasis were chosen because activities will include training of health care
workers, approved targeted evaluations and surveillance. The general population will be targeted in our
testing activities.
The SI Unit of ZACP supports the all national HIV monitoring systems, both paper-based and electronic
systems HIV monitoring systems, across the program areas, including PMTCT, CT, Treatment, Homebased
Care. The unit is also responsible for training staff on the data collection tools and rolling out of the
monitoring systems to facilities throughout Unguja and Pemba islands. Supportive supervision is provided to
all sites, specifically on data collection, management and reporting of aggregate data to the district/regional
and central levels. Data quality assurance protocols will be developed and the Surveillance Officer will
conduct periodic supportive supervision at the facility-level.
SUSTAINAIBLITY: Evidence-based planning forms part of the health sector management process.
Designed interventions fall in line with the national priority of monitoring health and particularly in monitoring
HIV patterns and disease management. The poverty reduction strategy paper which is pivotal in health
sector planning acknowledges the need to monitor MDGs inclusive of HIV and AIDS. Inclusion of HIV
information in the national data set is critical for evidence-based planning. Training programs are included in
the plan for continuing education for HCW and forms part of the human resource retention and development
plans.
Continuing Activity: 13534
13534 3502.08 HHS/Centers for Ministry of Health 6542 4781.08 ZACP $300,000
7755 3502.07 HHS/Centers for Ministry of Health 4781 4781.07 ZACP $120,000
3502 3502.06 HHS/Centers for Ministry of Health - 2893 1131.06 $100,000
Estimated amount of funding that is planned for Human Capacity Development $100,000
Table 3.3.17:
