Goal To provide quality HIV care, support and treatment services. Objectives are 1. To provide Anti retroviral therapy in accredited health facilities 2. To expand VCT/PITC services in all health facilities in the Region 3.To expand and establish PMTCT services in the Region 4.To build Capacity to health workers by training and mentorship 5. To enhance community awareness on STI/HIV/AIDS and ARV treatment.6. To Construct and renovate health facilities.7. To provide safe Male circumcision for HIV prevention 7.To Conduct Monitoring and Evaluation for program management. The Rukwa Regional Medical Office (Rukwa RMO) supports the implementation of prevention, care, and treatment programs through out its region, providing technical support and supervision to the regional hospital and district level facilities. As in other regions, Rukwa will be improving quality of treatment in the districts through the health centers. Currently, over 6,500 patients from the region are on ART; over 90% of them are adults. Provider initiated testing and counseling (PITC) of HIV/AIDS has been implemented in 17 health facilities in the region and supportive supervisory teams have now been extended to facilities below the district level to expand ART services at all health centers in the region. In FY 10 Rukwa RMO will start to provide safe Male circumcision program as part of comprehensive HIV prevention at the regional hospital level. To effectively improve HIV/AIDS care and treatment services in Rukwa, the RMO will significant improve infrastructure, staff capacity building, strengthened supply chains and enhanced management systems at the district hospitals and health centers.

Health system strengthening Rukwa RMO will continue to contribute to the health system strengthening by providing capacity building to the districts and their health facilities. This will include intensive management and technical capacity building including M&E capacity. Regular coordination meetings with stakeholders (NGOs, CBOs, FBOs etc) will continue at different levels of health care. Training on data management will be done to build health care's capacity to collect, store, analyze, use and report quality data. Coverage Rukwa has a population is about 1.5 million people. Majority are scattered in small 312 villages. There are no substantial industries or institutions. The regional GDP is estimated at Tsh278 million and the Per Capital Income at Tsh. 143 million. 50% of the population is below the Poverty Datum Line. Literacy level is among lowest in the republic. Health care system and provision is accordingly among the least in the republic with only 4 hospitals, 31 health centres and the rest 191 are dispensaries. Like people those health centres and dispensaries are scattered unevenly in 21 divisions, 86 wards and 415 villages. Those health centres and dispensaries serve over 90% of the population. Linkage to Partnership Framework Efforts to improve ART quality of service are a key element for achieving the Partnership Framework between the GOT and the USG. One of the objectives in the PF document is to expand prioritized care, treatment, and support services, dependent on available resources and the USG is committed to fund/support introduction of innovations/new care, treatment, and support services, as well as agreed upon priority requests. Rukwa RMO is committed to improve ART quality of services. This program also contributes to the Partnership Framework goal on Prevention through implementation of safe male circumcision program to sexually active men aged 14-49. Mc has shown to reduce 50-60% of HIV infections among circumcised men. Rukwa has HIV Prev 4.9%, MC rate 23.9%, No of uncircumcised men aged 15-49: 274,217. In FY 10 Rukwa RMO will provide to 2,160 sexually active men comprehensive MC service package including the HIV testing and counseling, treatment for Sexually Transmitted Infections, adequate infection control measures, promotion of safer sex practices, provision of male and female condoms and correct and consistent condom use, linkages to other prevention and social support services

M&E The Rukwa RMO will continue to support support supervision visits and promote outreach services from the facilities to the communities. Each facility has/will have lists of NGOs, CBOs and home-based care (HBC) providers involved in HIV/AIDS support, indicating geographical coverage and types of services offered. These lists are 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. M&E data activities for all the CTCs under the Rukwa RMO are supported by TA 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, 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.

Rukwa regional medical office (RMO) will coordinate and provide facility based care services in all facilities in the region where care and treatment program is set up. This will include the intergration of Positive prevention services, supporting nutritional assessment and counseling. Rukwa RMO will support improving linkages of facilities with other services including home based care in Rukwa region.

Maintain Quality HIV services at existing sites and scaling up to cover private hospitals and previously underserved areas. This will be accomplished through regular supportive supervision, clinical and nutrition mentoring, patient monitoring, and ensuring uninterrupted supply of drugs and reagents through cental procurement mechanism,Capacity building to local partners in financial accountability, technical support, program oversight and M&E. Partner works in four district and currently covers 4399 patients on treatment. As much efforts are done in TB/HIV and prevention program including PITC and PMTCT we expect an increase in number of new HIV positive patients refered to existing Care and Treatment Clinic. Additional funds will be used to support passive growth of approximately 400 new patients coming to existing Care and treament clinic managed by Rukwa.

Maintain and improve quality of existing pediatric HIV Care services. This will be achieved through provisison of CTX, Screening and Treatment for OIs, Nutritional Assessment and support and Linkages with other programs such as OVC and HBC, PMTC, TB/HIV. The services will be provided in Rukwa Region

Maintain and improve quality of existing pediatric HIV services. This will be achieved through support supervision visits, inservice training including on site mentorship, infrastructure devolopment and supplies of essential commodities including drugs. The work will occur in Rukwa.

Mc has shown to reduce 50-60% of HIV infections among circumcised men. Rukwa has HIV Prev 4.9%, MC rate 23.9%, No of uncircumcised men aged 15-49: 274,217. In FY 10 Rukwa RMO will intiate MC services in the region. Rukwa RMO will do site selection, site preparation, site strengthening, whole site orientation, community sensitization / mobilization, MC skills training for HCWs, initiation of MC services and routine monitoring & evaluation

Rukwa RMO will provide to 2,160 sexually active men comprehensive MC service package including the HIV testing and counselling, treatment for Sexually Transmitted Infections, adequate infection control measures, promotion of safer sex practices, provision of male and female condoms and correct and consistent condom use, linkages to other prevention and social support services

Base funds

Rukwa has ANC HIV prevalance of 6.7%. The Rukwa RMO will continue to implement PMTCT services in all 5 districts of Rukwa Region.

Activities to be supported using base funding

The program will scale-up PMTCT services to cover 80% of the facilities providing RCH services in the region . Rukwa RMO will technical and financial Support to respective districts and these services will include but not be limited to: HIV testing (in ANC, L&D), including partner testing, Counseling on infant feeding options (IF), Strengthen counseling on FP methods to HIV+ mothers during postpartum visits, offer HIV testing at the FP clinic and offer referrals to CTC and vice versa, Clinical staging of the HIV+ pregnant women at the RCH clinic by the PMTCT service providers with linkages to CTC, Rolling out of more efficacious regimen to facilities with the capacities, Provision of ART prophylaxis to HIV+ pregnant women who are not eligible for HAART, Provision of Cotrimoxazole to all eligible pregnant women and exposed infants, Conduct PMTCT outreach services in hard to reach areas, Quarterly supportive supervision by the RHMT to ensure quality of services. In collaboration with MOH, bi-annual supportive supervision will also be done in both regions.

Rukwa RMO will collaborate with community support groups including M2M program to form psychosocial support groups, which will provide psychosocial support and increase adherence and retention to care. Expert patients will carry out non-medic chores in the facilities.

In addition, mother to mother program and other partners within the regions will follow up mother-infant pairs in the community.

The programs will Renovations, procurement and materials as follows:

Renovate and equip facilities to provide space for offering integrated PMTCT services. Rukwa RMO will ensure availability of HIV test kits by procuring to fill gaps, ensure adequate supply of drugs for more efficacious regimen, based on needs, support printing and distribution of IEC materials and job aids.

The program will also train nurses, nurse midwives and other cadres in PMTCT, IF, drug monitoring and stock outs, including WHO staging.

The program will carry out Mentoring of HCW and support use of retired nurses to provide integrated PMTCT services in the region

It will ensure guidelines and M & E tools are available, improve data collection systems, and train service providers on filling of the PMTCT monitoring tool.

The program will strengthen and facilitate RHMT annual review meetings, formation and integration of regional PMTCT task forces into Reproductive and child health. Support regional quarterly partners meeting and strengthening linkages and referrals.

PF Funds:

Activities to be supported using PF Funding

Rukwa RMO will work with Reproductive health partners and with the respective districts, will carry out facility infrastructure improvement after carrying out facility audit; subsequently they will renovate and equip facilities to provide space for offering integrated PMTCT services at RCHC and L&D, FP, FANC and BEmoc

The RMO will Improve conditions in the maternity wards so as to attract more women to deliver at the facilities by procuring appropriate equipments such as delivery beds/kits, suction machines, weighing scales, protective gears etc.

The RMO will strengthen PMTCT-ART Integration by supporting Hospitals, Health Centers and Dispensaries to develop capacity to provide more efficacious PMTCT regimen, training PMTCT HCP at RCH on ART so that they can refill ARV drugs at the RCH; Ensure availability of PMTCT guidelines and job aids; Support transportation of CD4 samples of HIV+ pregnant women; Ensure availability of PMTCT M&E tools and Integrate HIV counseling and testing in all the RCH services, including Pediatric wards

The RMO will focus on community and demand creation activities that include: sensitize the community through different media on the improved MCHC/RCHC services with emphasis on PMTCT, EID services and FP), Engage men through different avenues to participate in RCH services (use of invitation letters, priority treatment, through involvement of village authorities etc), Collaborate with Mother to Mother program to establish psychosocial support groups in the 4 regions. Also, will integrate its FP program and link with partners supporting Emergency obstetrics, new born and pediatric health and cervical cancer screening services.

Rukwa RMO will ensure program ownership and sustainability by working with districts to ensure that PMTCT/pediatric AIDS activities are planned and prioritized.

Implement PMTCT and improve MCH and PMTCT services (see PF package)

Continue implementing activities to reduce burden of TB among PLHIV, strengthen collaboration, linkages as well as referral systems, training of health care providers, mentoring and supportive supervision. Additional funds ($50,000) will be used to improve coveragein hard to reach areas . Services will be provided in 3 districts of Rukwa region