Deloitte will provide facility based care services which include the integration of the Positive Prevention services. Deloitte will support nutritional assessment and counseling in all supported facilities as well as improve linkages with other services, including home based care in the following regions: Morogoro, Dodoma, Iringa, and Singida.

Maintain high quality HIV services at existing sites by the reducing retention gap through identification of problems and strategies that will lead to increased retention of patients on ART. Continue capacity building and provision of service delivery and technical assistance to the identified local partner in an effort to transition ART services in the regions. Focus more on clinical mentorship, supportive supervision and adherence to consolidation of in-service ART trainings in the zonal training centers. Partner works in Morogoro, Singida, Iringa and Dodoma and currently covers 40,508 patients.

These funds are proposed for the following activities: (1) Scale up cotrimoxazole (CTX) prophylaxis for HIV-exposed and infected children; (2) provide nutrition asessment, counseling and support (3) provide prevention, diagnosis and management of tuberculosis and other opportunistic infections (OI's) (4) provide palliative care and psychosocial support. These funds will also be used to improve Linkages to Community Based Care including: under 5 community-based child survival interventions and community HIV supported services. These activities will be achieved through training and on-site mentorship, establishment of coordinating committees with community-based organizations, advocacy and community mobilization, and updating tools for tracking and retention of children on treatment and capacity building for sustainability. Also, continue capacity building and provision of technical assistance to the identified local partner as a way towards transitioning of Pediatric ART service delivery in the regions.These activities will take place in Iringa, Dodoma, Morogoro and Singida.

These funds are proposed for the following activities: Implement updated WHO treatment guidelines to improve access to pediatric ART, including treatment of all HIV infected children <24 months;enhance the identification and diagnosis of HIV for infants and children through EID, PITC in in-patient and out-patient settings, immunization, OVC, and TB/HIV clinics; improve follow-up services for HIV-exposed infants and children and track and retain children in care and treatment; monitor response and adherence to treatment. These activities will be achieved through training, on-site mentorship, advocacy, community mobilization, and updating of tools for tracking and retention. These activities will take place in Iringa, Dodoma,Singida and Morogoro with the aim of enrolling 3391 new children on ART. $100,000 in additional funds have been added in Iringa region for strengthening referrals and linkages due to a high ANC prevalence.

The program will implement PMTCT and improve MCH services (see PF package): The PF funds will support the scaling-up of quality PMTCT services by (1) Strengthening the linkages and referrals of HIV+ women and children to care and treatment services, point of care CD4 testing and staging will be introduced and linkages to other health and community programs strengthened, (2) Supporting PMTCT-ART Integration, ( 3) Deloite will complement FP and Focused Antenatal Care (FANC) services in particular training and provision of equipment. (4) Tunajali will also complement Emergency Obstetric Care (EmOC) and Newborn Health package to ensure that comprehensive quality services are provided.

Other areas of support will include (5) EID transportation of samples including DBS and sending back the results to the clients. (6) Improving infrastructure through renovation, (7) Improving the procurement of MCH-related equipment, drugs and supplies through a central procurement system, (8) Strengthening M&E systems to track and document the impact of the PMTCT program, (9) Providing training and improving retention rates of health care workers, and (10) Strengthening and expanding interventions to improve maternal and child survival, (11) Initiating support of new activities such as Cervical cancer screening. (12) Addressing community needs through community health workers and creating demand for PMTCT services. The program will also participate in tracking and monitoring effectiveness of the PMTCT interventions through evaluations and surveys.

Mentorship towards WHO accreditation of 5 district labs ($10,000 per lab)

Maintain services related to implementation of the Three I's. It is estimated that around 20% of new patients enrolling into ART would present signs and symptoms of advanced HIV disease and diagnosing TB among this group remains difficult as the routine diagnostic tests (AFB smear microscopy and/or chest X ray) are neither very sensitive nor very specific and undiagnosed TB remains a major cause of mortality in this group. To enhance TB diagnosis in this group, there is a high need of investing in sophisticated TB diagnostic tests e.g. Liquid culture and Line Probe Assays. To increase access to this service, the implementing partner (IP) will coordinate transportation of sputum and/or blood samples to CTRL /MRH for Liquid culture and LPAs. The IP should ensure TB screening and recording in the CTC2 is happening throughout the supported sites. The IP will participate in the pilot and subsequent scale up of the Three I's. Deloitte will continue to provide services in the 4 regions (Iringa, Dodoma, Singida, and Morogoro)