MDH will maintain and strengthen provision of integrated high-quality HIV care and support aimed at extending and optimizing quality of life for PLHIV from the time of diagnosis throughout the continuum of illness. This will be achieved through enhanced diagnosis and management of opportunistic infections, pain and symptom management, intergration with other key services (PMTCT, RCH, FP, TB etc). Ensure referral and tracking systems are strengthened to minimize the loss to follow-up of pre-ART and ART clients through improving evidenced linkages between health facilities and the community. Support and extend nutritional assessment and counseling in all supported sites. MDH will intergrate and expand Positive Prevention services in all supported facilities while building the capacity of local government and civil society for sustainable service provision for PLHIV. Provide continued support, strengthen coordination and collaboration mechanisms between partners in operational regions. The services will be provided in 3 districs in Dar-Es-Salaam.

Focus on high quality HIV services at existing sites by reducing retention gap through identification of problems and strategies that will lead to increased retention of patients on ART. Continue capacity building and provide service delivery in an effort to take over ART sites from the international partner in the allocated regions. Focus more on clinical mentorship, supportive supervision and adhere to consolidation of in-service ART trainings in the zonal training centers. Partner works in 3 districts in Dar es Salaam and currently covers 33943 patients.

These funds are proposed for the following activities: Scale up cotrimoxazole (CTX) prophylaxis for HIV-exposed and infected children; provide nutrition assessment, counseling and support; provide prevention, diagnosis and management of tuberculosis and other opportunistic infections (OI's); provide palliative care and psychosocial support. The funds will be used to improve linkages to Community Based Care including: under 5 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. These activities will take place in Dar es Salaam.

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 be achieved through training, on-site mentorship, advocacy and community mobilization, and development of tools for tracking and retention. These activities will take place in Dar es Salaam with the aim of enrolling 3900 new children on ART.

Harvard University School of Public Health will continue implementing PMTCT activities in Dar es Salaam, which has 3 districts and a high HIV prevalence of 7%. Dar es Salaam has high volume sites and a site coverage of 53%. The Implementing Partner (IP) will support scale-up of PMTCT services to cover 80% of pregnant women with counseling and testing. For those found HIV negative, retesting will be considered in late pregnancy, labour and delivery or during postpartum period (and document sero-conversion). Women found HIV positive will be provided with ARV prophylaxis (75% and 85% of HIV positive pregnant women in 2011 and 2012 respectively) in three regions. The IP will support scale-up of EID to 65% of HIV exposed infants through RCH clinics.

Maintain services related to implementation of the Three I's. It is estimated that around 20 % of new patients enrolling into ART would present with signs and symptoms of advanced HIV deases and diagnosing TB among this group is difficult as the routine diagnostic tests (AFB smear microscopy and/or chest X ray) are neither very sensitive nor very specific and un diagnosed 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 MDH will ensure that CTRL get adequate reagents for MIGT and Line Probe Assay from SCMS. SCMC will purchase reagents for MIGT and Line Probe Assay at a cost of $ 392,280. Clinical SRU agreed that funds for procurement of these reagents come from SCMS. CTRL services for these tests will be provided in Dar region and surrounding regions. (Pwani, Morogoro, Mtwara, Lindi, Tanga etc.) This will be achieved in close collaboration with Global Fund, PASADA, and PATH. Participate in the pilot and subsequent scale up of Three I's as well as the Early Mortality Study. This mechanism relates to mechanism system ID 84 MDH