Goals and objectives EGPAF will work within the existing framework to scale-up and improve the quality of PMTCT and related MCH services, thereby improving the overall health and well-being of mothers and their children and increasing the number of babies born free of HIV.

Objective (1): Scale up PMTCT services to 80% coverage in assigned regions The base funding will especially be used to increase quality of services related to mother and child health in a program which has already reached 87% geographical PMTCT coverage and in which 90% of all women who come to ANC are tested and receive results. For this reason, the additional funding will have a modest effect on the targets for the number of sites and the number of pregnant women tested and received results. The program will scale-up PMTCT services to cover 90% of the facilities providing RCH services in Arusha, Kilimanjaro, Shinyanga, Tabora and Mtwara regions.

Objective (2): Improve quality of PMTCT and MCH services and strengthen service integration EGPAF will provide respective districts with grants and to support services that include but are not limited to: HIV testing (in ANC, L&D), partner testing, counseling on infant feeding options (IF), strengthening counseling on FP methods to HIV+ mothers during postpartum visits, offering HIV testing at the FP clinic, offering 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,

Objective (3): Improve PMTCT effectiveness for mothers and infants Roll 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.

Systems Strengthening: The programs will renovate and equip facilities to provide space for offering integrated PMTCT services. EGPAF will ensure the availability of HIV test kits by procurement to fill gaps, ensure adequate supply of drugs for more efficacious regimen based on needs and 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 and WHO staging. The program will carry out mentoring of HCW and support use of retired nurses to provide integrated PMTCT services in the region The program will strengthen and facilitate RHMT annual review meetings, the formation and integration of regional PMTCT task forces into Reproductive and child health, support regional quarterly partners meetings and strengthen linkages and referrals.

Cross cutting programs and key issues EGPAF will work with the respective districts and reproductive health partners. EGPAF will carry out facility infrastructure improvement after carrying out facility audits; subsequently they will renovate and equip facilities to provide space for offering integrated PMTCT services at RCHC and L&D, FP, FANC and BEMOC. EGPAF 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. EGPAF 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, ensuring availability of PMTCT guidelines and job aids, supporting transportation of CD4 samples of HIV+ pregnant women,

Geographical and target population EGPAF will implement PMTCT activities in 5 regions ( Kilimanjaro, Arusha, Shinyanga, Tabora, Mtwara). EGPAF supports PMTCT activities in 5 regions (Kilimanjaro, Arusha, Shinyanga, Tabora, Mtwara). The program works in a total of 34 districts. The ANC prevalence in the regions is as follows: Kilimanjaro: 3.5%, Arusha: 3.5%, Shinyanga: 4.6%, Tabora: 5.5%, Mtwara: 4.4%, with an average of 4% (based on EGPAF program data). Current site coverage is at 87%.

Monitoring and Evaluation EGPAF will strengthen M&E in PMTCT and will ensure guidelines and M&E tools are available, improve data collection systems, and train service providers on filling of the PMTCT monitoring tools. EGPAF will ensure availability of PMTCT M&E tools and integrate HIV counseling and testing in all the RCH services, including pediatric wards.

How IM will link to PF goals

The Tanzania Partnership Framework focuses on six goals: service maintenance and scale-up; prevention; leadership, management, accountability and governance; sustainable and secure drug and commodity supply; human resources; and evidence-based and strategic decision making. PMTCT activities are reflected within Goal One: Maintenance and Scale-up of Quality Services.

IM Strategy to become cost efficient EGPAF will provide grants to the district and gradually integrate focus on the community and its demand through activities that include: sensitization of the community through different media on the improved MCHC/RCHC services with emphasis on PMTCT, EID services and FP, engaging men through different avenues to participate in RCH services (use of invitation letters, priority treatment, through involvement of village authorities etc) and collaboration with the Mother to Mother program to establish psychosocial support groups in the 5 regions. EGPAF will also integrate FP programs and link with partners supporting emergency obstetrics, new born and pediatric health and cervical cancer screening services. EGPAF will ensure program ownership and sustainability by working with districts to ensure that PMTCT/pediatric AIDS activities are planned and prioritized and funding allocated through the Council Health Plans.

EGPAF will implement PMTCT activities in 5 regions ( Kilimanjaro, Arusha, Shinyanga, Tabora, Mtwara). EGPAF supports PMTCT activities in 5 regions (Kilimanjaro, Arusha, Shinyanga, Tabora, Mtwara). The program works in a total of 34 districts. The ANC prevalence in the regions is as follows: Kilimanjaro: 3.5%, Arusha: 3.5%, Shinyanga: 4.6%, Tabora: 5.5%, Mtwara: 4.4%, with an average of 4% (based on EGPAF program data). Current site coverage is at 87%.

The base funding will especially be used to increase quality of services related to mother and child health in a program which has already reached 87% geographical PMTCT coverage and in which 90% of all women who come to ANC are tested and receive results. For this reason, the additional funding will only have a modest effect on the targets for the number of sites and the number of pregnant women tested and received results. The effect of the additional funding on mother and child health will have to be measured by other indicators including the number of hospital deliveries, the number and percentage of exposed children receiving PMTCT prophylaxis, maternal and infant mortality etc.

The program will scale-up PMTCT services to cover 90% of the facilities providing RCH services in Arusha, Kilimanjaro, Shinyanga, Tabora and Mtwara regions. EGPAF will provide respective districts with grants and to support services that include but are not limited to: HIV testing (in ANC, L&D), partner testing, counseling on infant feeding options (IF), strengthening counseling on FP methods to HIV+ mothers during postpartum visits, offering HIV testing at the FP clinic, offering 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. EGPAF will collaborate with community support groups including the Mother to Mother 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 renovate and equip facilities to provide space for offering integrated PMTCT services. EGPAF will ensure the availability of HIV test kits by procurement to fill gaps, ensure adequate supply of drugs for more efficacious regimen based on needs and 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 and WHO staging. The program will carry out mentoring of HCW and support use of retired nurses to provide integrated PMTCT services in the region EGPAF will strengthen M&E in PMTCT and will ensure guidelines and M&E tools are available, improve data collection systems, and train service providers on filling of the PMTCT monitoring tools. The program will strengthen and facilitate RHMT annual review meetings, the formation and integration of regional PMTCT task forces into Reproductive and child health, support regional quarterly partners meetings and strengthen linkages and referrals.

EGPAF will work with the respective districts and reproductive health partners. EGPAF will carry out facility infrastructure improvement after carrying out facility audits; subsequently they will renovate and equip facilities to provide space for offering integrated PMTCT services at RCHC and L&D, FP, FANC and BEMOC. EGPAF 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. EGPAF 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, ensuring availability of PMTCT guidelines and job aids, supporting transportation of CD4 samples of HIV+ pregnant women, ensuring availability of PMTCT M&E tools and integrate HIV counseling and testing in all the RCH services, including pediatric wards. EGPAF will focus on the community and its demand through activities that include: sensitization of the community through different media on the improved MCHC/RCHC services with emphasis on PMTCT, EID services and FP, engaging men through different avenues to participate in RCH services (use of invitation letters, priority treatment, through involvement of village authorities etc) and collaboration with the Mother to Mother program to establish psychosocial support groups in the 5 regions. EGPAF will also integrate FP programs and link with partners supporting emergency obstetrics, new born and pediatric health and cervical cancer screening services. EGPAF will ensure program ownership and sustainability by working with districts to ensure that PMTCT/pediatric AIDS activities are planned and prioritized and funding allocated through the Council Health Plans.