EGPAF will support MOHSW in strengthening the provision of integrated high-quality HIV care, treatment, and support aimed at extending and optimizing quality of life for PLWHIV throughout the continuum of HIV care. Capacity building for CHMTs will be aimed at improving oversight of service provision at facilities, including supportive supervision, mentoring, and management. Previous work that was initiated under Track 1.0 funding will continue with the ultimate goal of transitioning responsibility to local government. EGPAF will work at 124 sites in the regions of Kilimanjaro, Arusha, Tabora, and Lindi.

The program objectives are to build a foundation for sustainability by strengthening overall technical, management, and leadership capacity of the RHMTs to support the CHMTs in health planning, budgeting, and quality improvement; empower the local government authorities to create and coordinate linkages and referral networks, eliminate duplication, and ensure sustainability of testing, care and treatment, and TB services in the HIV continuum of care in order to provide high quality patient service delivery among implementing partners in the regional health care system; and ensure a continuation of quality care and treatment services, with a focus on improving pediatric enrollment.

Program data collection, monitoring, and evaluation will take place on a regular basis with quarterly data analysis reviews. Efforts are on-going to improve data quality, including building the capacity of service providers through on-site mentorship and supportive supervision.

EGPAF will support HBHC through a focus on strengthening the provision of integrated high-quality HIV care and support aimed at extending and optimizing quality of life for PLWHIV from the time of diagnosis throughout the continuum of HIV care. To do this, leadership, management, and accountability of the CHMTs must be strengthened, CHMTs human resources need to be improved, and evidence-based and strategic decision-making must be made by utilizing improved data. EGPAF will work with the respective districts and oversee the provision of services at 124 sites in the regions of Kilimanjaro, Arusha,, Tabora and, Lindi* with the aim of having 60,414 adults on HIV care. The target group for HBHC activities are HIV-infected men and women not eligible for treatment (CD4 counts higher than 350).

EGPAFs support to lower level health facilities and hospitals is aligned with the MOHSW and PEPFAR country strategy. Active acceleration of growth will occur during this COP period in order to achieve greater reach of patients enrolled and retained on care. Cost effectiveness strategies towards scale up not only will increase the number of sites, but will also involve an increase in the number of patients. Policy changes, such as the 2010 WHO guidelines, will help facilitate this by increasing patients at the same sites. In line with other COP strategies, EGPAF will ensure care and treatment services are brought close to the patient through outreach services and further integration into existing facilities that can provide care and support.

EGPAF will ensure referral and tracking systems are strengthened to minimize the loss to follow-up of pre-ART clients through improving linkages between HIV care, support, treatment and prevention sites, other health facilities, and the community. Activities have been enhanced to focus on diagnosis and management of opportunistic infections, pain and symptom management, and integration with other key services (PMTCT, RCH, FP, TB etc). Activities will support and extend nutritional assessments and counseling in all supported sites. EGPAF will integrate and expand positive prevention services in all supported facilities while providing continued support, strengthened coordination, and collaboration mechanisms between partners in the operational regions. Capacity will be built of local government and civil society for sustainable service provision for PLWHIV.

EGPAF will continue to support on-going efforts to improve data quality, including building the capacity of service providers through on-site mentorship and supportive supervision. Adult care data collection, utilization, and reporting will continually be addressed and data quality audits performed.

*Shinyanga will be covered and reported by EGPAF (41 sites) through September 2012, at which time, local affiliate AGPAHI will take on full responsibility for the region.

EGPAF will support HVTB through a focus on strengthening the provision of integrated high-quality TB/HIV activities, which are aligned with URTs policies and strategic plans for TB and HIV, the National Multi-sectoral HIV/AIDS Framework (2008-2012), and the Health Sector HIV/AIDS Strategic Plan III (2009-2015). It is estimated that around 15% of new patients enrolling into ART would be present with signs and symptoms of advanced HIV, however, diagnosing TB among this group remains difficult. In response, EGPAF piloted a provision of IPT to PLWHIV which is consistent with the national guidelines.

EGPAF will continue to support and strengthen TB/HIV coordinating committees at all levels, including supportive supervision, on-the-job trainings and mentorships, and quarterly review meetings and interdepartmental meetings. The main activity during this COP year is to maintain services related to the implementation of the Three I's.

Support of on-going efforts to improve data quality, including building the capacity of service providers through on-site mentorship and supportive supervision, will continue to be prioritized. TB/HIV data collection, utilization, and reporting are some of the challenges that are being addressed. The focus will be on registers, CTC2 cards, and updating databases as well as ensuring that existing HIV care and treatment M&E tools capture TB/HIV indicators.

EGPAF will support PDCS through a focus on strengthening the provision of integrated high-quality pediatric HIV care and support aimed at extending and optimizing quality of life to the target population of HIV-exposed and infected infants, children, and adolescents. PDCS activities will take place at 124 sites in the regions of Kilimanjaro, Arusha, Tabora, and Lindi* with the aim of having 6,712 children on care and support.

Active acceleration of growth will occur during this COP period, achieving greater reach of patients enrolled and retained on care. Cost effectiveness strategies toward scaling up will not only increase the number of sites, but will involve an increase in the number of patients. Expanded efforts to early infant diagnosis (EID) and integration with other service sites, such as RCH clinics, will help facilitate this. Activities promoting integration with routine pediatric care, nutrition services, and maternal health services include emphasizing identification of infected infants through PITC at all contact points and routine assessment of exposure status at RCH. This will be combined with the strengthening of EID services. EGPAF will scale up cotrimoxazole (CTX) prophylaxis for HIV-exposed and infected children and adolescents, as well as diagnosis and management of tuberculosis and other opportunistic infections (OI's), palliative care, and psychosocial support. Additionally, lab diagnostics will be strengthened in collaboration with HLAB and EID funded activities.

Quality improvement activities will be implemented at the site levels (district hospitals and lower-level health facilities (LLHF)) that provide pediatric care. Activities will incorporate strategies that include quality management teams and indicator mapping that is done through supportive supervision, on-the-job training, and clinical mentorship. Quality improvement activities will measure performance of key indicators in order to identify strengths and develop strategies to address pediatric care challenges at the site level. A strong health systems strengthening focus is part of EGPAFs overall program strategy and aims to reach care sites.

Community mobilization and linkage activities include creation of childrens and teens clubs; community-based care, including under five 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. Additional activities include providing nutrition assessment, counseling and support, and kids corners in CTC clinics.

EGPAF will continue to support ongoing efforts to improve data quality, including building the capacity of service providers through on-site mentorship and supportive supervision. Pediatric treatment data collection, utilization, and reporting will continually be addressed and data quality audits will be performed.

*Shinyanga will be covered by and reported from EGPAF (41 sites) by the end of FY2012, at which time AGPAHI will take on full responsibility for the region.

EGPAF will support HLAB through a series of mentorship and capacity building activities towards laboratory accreditation of five district labs and Kilimanjaro Christian Medical Center (KCMC). These activities will focus on accurate forecasting, planning and budgeting for laboratory support for program activities; expanded coverage of laboratory testing in the geographic area; development of training activities focused on laboratory management; and quality assurance of laboratory testing.

EGPAF will support HTXS through a focus on strengthening the provision of integrated high-quality HIV ART treatment aimed at extending and optimizing quality of life for PLWHIV through the implementation of activities focused on ensuring adherence and retention of patients on treatment. HTXS activities will take place at 124 sites in the regions of Kilimanjaro, Arusha, Tabora, and Lindi with the aim of enrolling 10,929 new adults on ART. Shinyanga region will be covered by and reported from EGPAF (41 sites) through September 2012, at which time AGPAHI will take on full responsibility for the region. This transition will focus on building the capacity of local partners in financial accountability, technical support, program oversight, including planning and implementation, and monitoring and evaluation.

EGPAFs support to lower level health facilities and hospitals is aligned with the MOHSW and PEPFAR country strategy. Active acceleration of growth will occur during this COP period in order to achieve greater reach of patients enrolled and retained on care. Cost effectiveness strategies towards scale up not only will increase the number of sites, but will also involve an increase in the number of patients. Policy changes, such as the 2010 WHO guidelines, will help facilitate this by increasing patients at the same sites. In line with other COP strategies, EGPAF will ensure care and treatment services are brought close to the patient through outreach services and further integration into existing facilities that can provide care and support.

EGPAF will conduct supportive supervision, on-the-job training and clinical mentorship. Furthermore, EGPAF will conduct quarterly review and interdepartmental meetings, between CTC, lab, and in the community. Capacity building and providing service delivery will be of focus to assist in the transition of ART sites from international partners in the supported regions. EGPAF will evaluate clinical outcomes and other performance data through regular supportive supervision visits, quarterly data review, and annual data quality assessments.

EGPAF aims to improve retention of patients initiated on ART by focusing on high quality HIV services at existing sites by identifying problems along with strategies that will lead to increased retention of patients on ART. Activities to mitigate above challenges will be met with supportive solutions, such as on-the-job training, on-site mentorship, advocacy, community mobilization, defaulter tracing, and updating of tools for tracking and retention, with a focus more on clinical mentorship, supportive supervision, and adherence to consolidation of in-service ART trainings in the zonal training centers. All activities will be interlinked, with referrals to and use of a comprehensive care and treatment package, including ART provision, cotrimoxazole prophylaxis, and TB screening.

EGPAF will continue to support ongoing efforts to improve data quality, including building the capacity of service providers through onsite mentorship and supportive supervision. Adult treatment data collection, utilization, and reporting are continually being addressed and data quality audits performed.

EGPAF will focus on strengthening the provision of integrated high-quality pediatric HIV care and treatment aimed at extending and optimizing quality of life for pediatrics through the implementation of activities focused on earlier identification and improved access to treatment, based on the new WHO guidelines. PDPX activities will take place at 124 sites in the regions of Kilimanjaro, Arusha, Tabora, and Lindi* with the aim of enrolling 1,817 new children on ART. The target population is HIV-exposed and infected infants, children, and adolescents.

Active acceleration of growth will occur during this COP period, achieving greater reach of patients enrolled and retained on care. Cost effectiveness strategies toward scaling up will not only increase the number of sites, but will involve an increase in the number of patients. Policy changes, such as the 2010 WHO guidelines, will help facilitate this by giving more patients at the same sites and further integration into existing sites, i.e. RCH clinics.

EGPAF will implement revised 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; increase 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 improve tracking and retaining children in care and treatment.

EGPAF will conduct supportive supervision, on-the-job training and clinical mentorship. Furthermore, EGPAF will conduct quarterly review and interdepartmental meetings, between CTC, lab, and in the community. This will strengthen the pediatric HIV skills of health care providers. They will provide job aids and guidelines, and ensure availability of essential commodities such as pediatric ARV formulations.

EGPAF will implement activities to support adherence in pediatric populations, improve retention on treatment, and establish functional linkages between programs and within the communities to reduce losses to follow-up and improve long-term outcomes. Activities will include strengthening referrals and linkages both within facilities and between facilities and community services, increased advocacy, community mobilization, defaulter tracing, and updating of tools for tracking and retention.

Activities will focus on integration of pediatric HIV treatment services into MCH and RCH platforms of service delivery and linkages with nutrition support programs and community-based activities, programs, and services. Additional activities include expanding EID services to high volume sites, introducing the use of SMS printers to distribute DBS-PCR results back to EID testing sites, and orienting service providers on the use of SMS printer technology.

EGPAF will continue to support ongoing efforts to improve data quality and capacity to collect data, including building the capacity of service providers through on-site mentorship and supportive supervision. Pediatric treatment data collection, utilization, and reporting will continually be addressed in collaboration with the USG and national program. In addition, data quality audits will be performed.

*Shinyanga will be covered by and reported from EGPAF (41 sites) through FY2012, at which time AGPAHI will take on full responsibility for the region.