FXB is one of several US Universities selected to provide training and technical assistance to HIV/AIDS programs domestically and internationally. Using this mechanism, PEPFAR countries are afforded a direct mechanism to support the transfer of HIV/AIDS expertise across continents and countries. Objectives Through technical assistance (TA) to the MOHSW, the FXB Center aims to support the national scale-up and strengthening of PMTCT programs and services. Strategies will be informed by a needs assessment that builds on existing knowledge and experience of the MOHSW and the PMTCT implementing partners. Four objectives have been identified for FY 2010-11: 1. Conduct a national needs assessment to further define barriers and gaps in the delivery of comprehensive PMTCT services, and identify strategies to address them. (Mainland) 2. Support the MOHSW to develop and conduct annual meeting with implementing partners for the purpose of enhancing communication, disseminating materials and tools, sharing experiences and best practices, refining strategies for scale-up of programs using the most efficacious ARV regimens for PMTCT, and effectively linking mothers, infants and families to care and treatment. (Mainland) 3. Using information gained from the needs assessment, along with scientific updates and updated WHO guidance, provide support to the PMTCT TWG to review, update, pilot test and support dissemination of the national: PMTCT guidelines, PMTCT training package, PMTCT support tools, stand-alone training toolkit for PMTCT. (Mainland) 4. Conduct refresher trainings on PMTCT for HCWs and orientation on updated PMTCT training package and guidelines. (Zanzibar)

Contribution to Health System Strengthening The FXB Center aims to continue to strengthen the capacity of the national PMTCT program to achieve its goals by expanding PMTCT services through system linkages with the national pediatric HIV program and integration of these services in routine reproductive and child health services nationally. Specific activities include: 1. Establish sustainable linkages between the pediatric unit of the NACP and the MOHSW RCH Division 2. Facilitate coordinated work planning and operational activities with the PMTCT and pediatric units of the NACP 3. Strengthen linkages with and between implementing partners The PMTCT guidelines and clinical support tools will be developed first. The guidelines will inform the content of training materials, and training on the use of clinical support tools will be included in the training package to ensure healthcare workers know how to use the tools to best effect.

Cross cutting issues Key issues such as gender, family planning and child survival will be addressed with MOHSW and partners as FXB works with them to update and improve guidelines and training materials.

Cost efficiencies The FXB Center's approach to technical assistance is to strengthen existing capacity and foster new skills development. As FXB develops the skills of local, in country staff, the need for on-site technical assistance from US-based staff will be dramatically reduced. With that in mind, the FXB Center has developed a "strategic withdrawal" as opposed to an exit strategy to ensure project continuation. Geographical coverage

By providing TA directly to the MOHSW, FXB's work will have an impact at the national level. The national needs assessment will inform strategies for improving PMTCT service delivery throughout the country. With a focus on PMTCT and EID, FXB will be targeting women and infants.

Link to Partnership frame work

Goal 1 of the PF addresses service maintenance and scale-up, with quality improvement considered an integral part of the goal. FXB, by updating and revising PMTCT guidelines as well as training materials for HCW involved in PMTCT service delivery, will contribute to this goal of quality service provision. Goal 2 focuses specifically on prevention, which is the primary goal of PMTCT programs. The Framework emphasizes increasing the efficacy of programming for prevention and enhancing the enabling environment for the provision of prevention services. FXB will be enhancing the environment in which PMTCT services are delivered. Improvements in national guidelines, including a focus on standardizing the implementation of these guidelines will enable HCW to more effectively provide PMTCT services. FXB's second objective of developing an annual partners meeting will allow for and encourage the exchange of experiences, tools and materials, which speaks to increasing prevention programming efficacy. Goal number 6 emphasizes the use of evidence in planning and decision making. The national needs assessment will provide MOHSW with evidence that will inform their decision-making processes regarding PMTCT and EID programs at the national level.

Monitoring and Evaluation Monitoring and evaluation is facilitated by a detailed workplan that identifies project outputs and corresponding performance measures for each objective. The findings of the needs assessment will help define work plan targets and outcomes. The FXB Center Country Manager will hold regular meetings with CDC-Tanzania and CDC-Atlanta to report on the status on work plan activities and seek guidance as needed. The FXB Center will hold frequent consultations with the MOHSW to seek continued guidance, feedback and input on the TA provided. Adjustments to the work plan will be made accordingly.

Support to the MOHSW mainland to review, update, pilot test and support dissemination of the national: PMTCT guidelines, PMTCT training package, PMTCT support tools and stand alone training tool kit for PMTCT update training and onjob mentorship Conduct a national needs assessment (at representative sites)for mainland to identify capacity and barriers for delivery of comprehensive PMTCT services.this will be based on outcomes of FY 2009 desk review and feedback from implementing partners and MOHSW.Support MOHSW mainland to Update PIT guidelines for mainland to enrich paediatric component Support the MOHSW mainland to develop and conduct annual meeting with implementing partners for the purpose of enhancing communication, disseminating materials and tools, sharing experiences and best practices, and refining strategies for scale-up of programs using the most efficacious ARV regimens for PMTCT and effectively link mothers, infants and families to care and treatment. Conduct refresher trainings for PMTCT TOTs and orientation on updated PMTCT training package and guidelines for ZanzibarConduct a national needs assessment (at representative sites)for mainland to identify capacity and barriers for delivery of comprehensive PMTCT services.this will be based on outcomes of FY 2009 desk review and feedback from implementing partners and MOHSW.Support MOHSW mainland to Update PIT guidelines for mainland to enrich paediatric component Support the MOHSW mainland to develop and conduct annual meeting with implementing partners for the purpose of enhancing communication, disseminating materials and tools, sharing experiences and best practices, and refining strategies for scale-up of programs using the most efficacious ARV regimens for PMTCT and effectively link mothers, infants and families to care and treatment. Conduct refresher trainings for PMTCT TOTs and orientation on updated PMTCT training package and guidelines for Zanzibar