Since November 2004, the Harvard/MDH program has served the Dar es Salaam region by enrolling over 116,000 PLHV into comprehensive HIV care and support, whereby over 76,000 have been initiated on ART. The program has served as a role model in providing quality HIV care and treatment in 50 health facilities as well as PMTCT services to 180 RCH clinics. The program is now transitioning its obligations in program management and clinical services to MDH, a local NGO.

For COP 2012, the MDH goal is to build district capacity to provide quality ART services through increased access to ART while maintaining comprehensive care for patients on ART. To do this, critical gaps in service coverage and strengthened capacity must be prioritized. The following activities are aimed at addressing these critical gaps:

(1) Maintaining quality of care and treatment services within the existing 50 public and private sites;(2) Supporting districts to identify innovative, cost efficient models of care while identifying priority areas for program support; and(3) Strengthening health systems to improve efficiency and effectiveness.

Harvard will support MDH in building up the existing M&E system where all HIV indicators will be reported, using data from available MOH tools, to train health care providers on data management and utilization for quality improvement. HSPH will assist MDH with data analysis through the development of process and outcome indicators using the clinical data and national CTC2 database as feedback for site staffs, districts, and MOHSW.

Harvard will provide TA through distance learning and targeted mentorship to MDH and clinic staff, focusing on data management, QI finance and grants, and effectiveness of training.

Harvard School of Public Health (HSPH) will continue to support the local partner, MDH, to maintain and strengthen provision of integrated high-quality HIV care and support aimed at extending and optimizing quality of life for HIV-infected clients and their families. These services will include TB screening, diagnosis prophylaxis and treatment, STI screening including cervical cancer primary screening, psychosocial counseling, gender based violence services, and food by prescription will be initiated at all sites.

As a TA provider, HSHP wll be implementing similar support activities across a spectrum of technical areas. HSPH will provide TA in the area of data collection and management through weekly calls between MDH and the Boston M&E Team, periodic site visits, and assistance with statistical programming. HSPH M&E, QA and clinical mentors will assist to develop and improve site-based data analysis, quality improvement initiatives, and targeted TA programs for facility-based care and support services.

A training specialist will assist the MDH training unit to perform assessments of site capacity and provide appropriate needs-based training; assist the HR unit to develop a system for tracking staff training records and needs; and lead development of the advanced ART Training Programs for the Mnazi Moja Center of Excellence. HSPH will support international clinical preceptors to travel to Tanzania to provide advanced ART and resistance case management and didactic trainings. HSPH M&E team will also develop training programs on data collection, management and analysis for site-based clinical personnel.

The functions of the Temeke Reference Lab will also receive support

HSPH will address any other TA needs identified by HRSA ClASS and CDC assessments to ensure a smooth transition of program management activities from Harvard to MDH.

The Harvard/MDH PMTCT Program currently supports 90% (180/200) PMTCT sites out of 214 RCH facilities, of which 14 are supported by PASADA. HIV Early Infant Diagnosis (EID) of HIV is performed at 44% (80/180) of the facilities. Using the district approach, MDH will support scale up of quality PMTCT services by providing technical assistance through district PMTCT teams to conduct on-the-job training and mentorship in comprehensive PMTCT services. This will include couples counseling, counseling on family planning, and infant feeding, targeting 100% (200) RCH site coverage.

As a TA provider, HSHP wll be implementing similar support activities across a spectrum of technical areas. HSPH will provide TA in the area of electronic data collection and management for PMTCT. HSPH M&E, QA and clinical mentors will assist to develop and improve site and district PMTCT data analysis, quality improvement initiatives, and targeted TA programs.

A training specialist will assist the MDH training unit to perform assessments of site capacity and provide appropriate needs-based training to supported PMTCT sites; enhance patient tracking and referral systems to reduce loss to follow up; assist the HR unit to develop a system for tracking staff training records and needs; and lead development of advanced PMTCT training programs for Mnazi Moja Center of Excellence. The program will support the functions of the Temeke Reference Lab. HSPH will support international clinical preceptors to travel to Tanzania to provide advanced ART and resistance case management and didactic trainings. HSPH M&E team will also develop training programs on data collection, management and analysis for site-based clinical personnel.

HSPH PEPFAR admin team will support MDH and other sub-grantee finance and admin units to develop IT and financial management systems for budgeting, accounting, time and effort reporting, and payroll. This team will also address any other issues raised in the annual A-133 and financial audits as well as assist the Grants Management team in the development of systems for sub-recipient selection, contracting and monitoring. Health Systems Strengthening will receive support with assistance in HR, supply chain management, governance and developing leadership skills. HSPH will address any other TA needs identified by HRSA ClASS and CDC assessments to ensure a smooth transition of program management activities from Harvard to MDH.

Harvard School of Public Health (HSPH) will continue to support our local partner MDH to provide quality ART services to reach more people who are in need of ARV drugs, improve ART M&E systems, ensuring availability of ARV drugs and drugs for OI prophylaxis and treatment, establish efficient systems for the procurement and supply chain management of ARVs and other drugs, and ensure strong laboratory services and infrastructure.

As a TA provider, HSHP wll be implementing similar support activities across a spectrum of technical areas. HSPH will provide TA in the area of data collection and management through weekly calls between MDH and the Boston M&E Team, periodic site visits, and assistance with statistical programming. HSPH M&E, QA and clinical mentors will assist to develop and improve site-based data analysis, quality improvement initiatives, and targeted TA programs.

A training specialist will assist the MDH training unit to perform assessments of site capacity and provide appropriate needs-based training; assist the HR unit to develop a system for tracking staff training records and needs; and lead development of the advanced ART Training Programs for the Mnazi Moja Center of Excellence. HSPH will support international clinical preceptors to travel to Tanzania to provide advanced ART and resistance case management and didactic trainings. HSPH M&E team will also develop training programs on data collection, management and analysis for site-based clinical personnel.

HSPH PEPFAR admin team will support MDH and other sub-grantee finance and admin units to develop IT and financial management systems for budgeting, accounting, time and effort reporting, and payroll. This team will also address any other issues raised in the annual A-133 and financial audits as well as assist the Grants Management team in the development of systems for sub-recipient selection, contracting and monitoring. Health Systems Strengthening will receive support with assistance in HR, supply chain management, governance and developing leadership skills. HSPH will support professional development of the MDH executive leadership and senior management team, including an induction program and training for the Board of Members and Board of Directors. HSPH will address any other TA needs identified by HRSA ClASS and CDC assessments to ensure a smooth transition of program management activities from Harvard to MDH.

Currently, 7% of patients enrolled in ART in Dar es Salaam are children under the age of 15 years. Up to 80 (40%) of RCH sites in the region implement EID and approximately 60% of children are born to mothers living with HIV, which has lead to their being tested for HIV using DNA PCR.

At Infectious Disease Clinics, special pediatric HIV care and treatment services operate daily, however, all other care and treatment supported sites have a special day dedicated for pediatric services. The program has a member in the TWG for pediatrics care and treatment and has taken an active role in the review of the national guidelines on the management of pediatric HIV/AIDS. In addition, pediatric friendly clinics have been initiated.

As a TA provider, HSHP wll be implementing similar support activities across a spectrum of technical areas. HSPH will provide TA in the area of collection and management of pediatric treatment data, through weekly calls between MDH and the Boston M&E Team, periodic site visits, and assistance with statistical programming. HSPH M&E, QA and clinical mentors will assist to develop and improve site-based data analysis, quality improvement initiatives, and targeted TA programs.

A training specialist will assist the MDH training unit to perform assessments of site capacity and provide appropriate needs-based training; assist the HR unit to develop a system for tracking staff training records and needs; and lead development of Pediatric Treatment Programs for Mnazi Moja Center of Excellence. The program will support the functions of the Temeke Reference Lab. HSPH will support international clinical preceptors to travel to Tanzania to provide advanced ART and resistance case management and didactic trainings. HSPH M&E team will also develop training programs on data collection, management and analysis for site-based clinical personnel.

HSPH PEPFAR admin team will support MDH and other sub-grantee finance and admin units to develop IT and financial management systems for budgeting, accounting, time and effort reporting, and payroll. This team will also address any other issues raised in the annual A-133 and financial audits as well as assist the Grants Management team in the development of systems for sub-recipient selection, contracting and monitoring. Health Systems Strengthening will receive support with assistance in HR, supply chain management, governance and developing leadership skills. HSPH will support professional development of the MDH executive leadership and senior management team, including an induction program and training for the Board of Members and Board of Directors. HSPH will address any other TA needs identified by HRSA ClASS and CDC assessments to ensure a smooth transition of program management activities from Harvard to MDH.