Mbeya Regional Medical Office (RMO) supports the implementation of prevention, care, and treatment programs throughout its region. Mbeya region has eight districts with 379 health facilities, among which 46 are CTCs. The estimated regional total population is 2,742,762, with an annual population growth rate of 2.4%. The main objectives of the Mbeya RMO are to improve the quality of HIV/AIDS interventions, ensure appropriate access to care and treatment services for PLHIV, address the needs of vulnerable populations, strategically scale-up quality care and treatment services, and build local capacity of other indigenous organizations to foster local ownership and sustainability.

Mbeya RMO supports TB/HIV collaborative activities, PMTCT through RCH platform, adult and pediatric HIV care and treatment, including EID, nutrition counseling and support, MC, and gender-based violence and womens empowerment. In addition, the program is linked to other programs such as malaria, TB, FP, child and maternal survival programs, and community mobilization and sensitization to improve health care seeking behavior.

Mbeya RMO will strive to improve quality of services and efficiencies through combined supportive supervision, on-the-job mentorship, and continuous quality improvement activities, strategically scaled-down support of in-service training, and decentralization of services to districts. Districts will be visited quarterly for supportive supervision. Routine monitoring and data collection and reporting will be undertaken using standardized national tools.

Mbeya is a vast region with difficult terrain and a poorly developed road network. A 4WD vehicle is needed to allow uninterrupted supportive supervision and on-the-job mentorship.

Mbeya is one of the regions with the highest HIV prevalence in the country of 9.2%. Mbeya Regional Medical Office (RMO) supports the implementation of facility- based adult care programs at the regional hospital and all CTCs at district and other hospitals in Mbeya regions. The services aim to extend and optimize quality of life for HIV-infected clients and their families throughout the continuum of illness by providing clinical, psychological, spiritual, social, and prevention services.

For COP 2012, Mbeya RMO will provide facility based HBC services to PLHAs and their families through the following activities which make up a standard DOD package of care activities:

Provision of prevention and treatment of OIs and other HIV-related complications such as malaria and diarrheaNutritional assessment, counseling and support (NACS) to PLHA at all CTCsProvision of quality pain and symptom relief to PLHA, including improving technical support to community-based partnersProvision of couples counseling and testing services that are integrated to other services such as, family planning, ANC, PNC, ART, VMMC and PMTCTProvision of risk reduction counseling and adherence counseling and support to PLHAIndividual and group psychological and spiritual support, including bereavement services to PLHA and their families, in collaboration with outreach partners and religious organizationsProvision of STI diagnosis and treatment services that are integrated into other services such as family planning, ANC, PNC, ART, VMMC, PMTCTLinkage of condom services to other services such as family planning, ANC, PNC, ART, VMMC and PMTCTStrengthened PHDP counseling among all staff providing treatment at CTCs to improve retention into care and treatment adherenceLinkage of PLHAs with available support mechanisms including home/community -based HBC servicesImproved M&E framework by harmonizing data collection tools, data recording and reporting. Quarterly performance appraisals meeting will be conducted to discus program data and share results with home/community based HBC partners in Mbeya regionProvision of supportive supervision and on-the-job mentorship to facility based adult care and support HCW to district hospital and support CHTMs/DHMTS to provide timely support supervision to adult care and support services in lower level facilities/

Mbeya Regional Medical Office (RMO) supports the implementation of prevention, care, and treatment programs throughout its region, supporting 293 RCH sites and providing supervision to the regional hospital and district level facilities. Mbeya is one of the regions with the highest HIV prevalence in the country of 7.9%. It is estimated that there are 200,000 PLHIV in need of services in this region.

Mbeya RMO began full recruitment of patients in 2005 and by the end of FY 2010, the region had a cumulative number of over 19,000 patients on ART with 4,200 new patients enrolled. Despite this achievement, loss to follow up has been a major challenge to the program, with a retention rate of 81.8% (APR 2010). Efforts to improve retention include linking with CBOs to track patients in the community, use of support groups, CHWs (HBC workers and community-owned resource persons) for adherence counseling, and tracking of patients in their homes.

For COP 2012, Mbeya RMOs TB/HIV portfolio will include the following activities:

1) Continue TB screening for PLHIV attending care and treatment clinic. Those found with active TB will be referred to TB clinics for treatment;2) Strengthen and scale-up implementation of the three Is in the region;3) Support establishment of TB/HIV coordinating bodies at all levels within the region to oversee the implementation of TB/HIC collaborative services;4) Ensure availability and use of standard National TB/HIV tools, such as screening tools and clinical assessment forms;5) Strengthen the implementation of TB infection control practices in care and treatment settings to prevent transmission of TB among PLHIV as well as health care providers;6) Strategic in-service training of HIV clinic staff on TB infection control practices and implementation of the three Is;7) Continue strengthening of laboratory services including sputum smear microscopy and quality assurance to ensure quality TB care services;8) Provide supportive supervision and mentorship to satellite CTCs within the region; and9) Provide technical support to the districts for integration of ARV services in high-volume TB clinics.

HIV prevalence in Mbeya region is 7.9%, with at least 15,000 children under 15 years of age in need of care and support. All health facilities provide these services. FY 2012 funding will be used to scale-up cotrimoxazole prophylaxis, infant feeding counseling, nutritional assessments and support, management of OIs, palliative care, psycho-social support, home-based care services, , age-specific counseling and improve referrals and linkages. These activities will be achieved through community mobilization, training, and on-the-job mentorship and implemented in collaboration with Baylor International Pediatric AIDS Initiative (BIPAI).

Local manpower and systems will be strengthened to improve care for children. For COP 2012, male and female children will be reached. Targets will be monitored and discussed during zonal technical meetings and national partner meetings. Home-based care and OVC service providers will employ strategies to increase child enrollment into care. Infrastructural improvements will specifically address pediatric needs.

Mbeya RMO will strengthen the existing efforts in pediatric care and support to improve involvement of adolescents and children in PHDP services and formation of support groups. Technical support will be provided to these groups for peer counseling and education to improve retention into treatment and adherence to medications.

Mbeya RMO provides comprehensive MCH services including screening, diagnostic services, and provision of ARVs to HIV-positive mothers and children under one roof. The integration of these services leverages on the national referral system to ensure quality, sustainable care, and support. The USG/T-supported activities will continue to be incorporated into the regional health plans through national funding such as central funding through MOHSW budget, basket funding, and cost sharing mechanisms.

Mbeya Regional Medical Office (RMO) supports the implementation of prevention, care, and treatment programs in Mbeya region, supporting 293 RCH sites and providing supervision to the regional hospital and district level facilities. At 7.9% HIV prevalence, Mbeya is among the regions with highest HIV prevalence in the country. Quality PMTCT services are critical given the high ANC HIV prevalence of 12.6%.

Mbeya RMO will work with DHMTs and CHMTs to plan and implement decentralized integrated PMTCT services to improve MCH services in the region. As per DOD guidance, a package of standard interventions will be implemented as listed below:

1) Complement Emergency Obstetric Care (EmOC) package by linking with district authorities and health programs that support EmOC and establish needs; supporting training in EmOC through a national TOT model to roll out EmOC services in respective districts;2) Integrate ART and TB/HIV services into PMTCT sites. This will include supporting PMTCT sites to provide ART and More Efficacious Combination Regimens (MECR) by training MCH health care providers in ART and pediatric HIV management, providing guidelines and job aids, and providing CD4, biochemistry, hematology machines. Additionally, linkage and integration of PMTCT and EID services into MCH will ensure that exposed and infected infants are identified early and linked to Care, Treatment and Support;

3) Complement FP and Focused Antenatal Care (FANC) package by linking/liaising with districts authorities and health programs that support FP and FANC and establish needs and conducting training in FP and FANC through a national TOT model to roll out FP and FANC service in respective districts;4) Procure drugs, reagents, and other essential supplies if not available through central procurement mechanisms;5) Strengthen and support monitoring and evaluation and BPE, document lessons learned including PMTCT costing studies, and support use of data to assess site specific services and develop a plan of action to address problems;6) Improve facility infrastructure through renovations of MCH and labor wards and ensure that they are functional and offer friendly services to mothers and children;7) Promote infant feeding counseling options (AFASS criteria), linking mothers to safe water programs in the region. For those choosing to breastfeed, the program will counsel them to exclusively breastfeed with early weaning. Infant feeding and nutritional interventions during lactation period will be promoted;8) Support national efforts to standardize EID logistics (transportation samples and DBS results);9) Provide PHDP counseling package based on the USG-developed approach in Tanzania; and10) Improve community sensitization and demand creation to improve participation in PMTCT/RCH services, including encouraging HIV positive women to bring in family members for testing.11) Continue training and mentoring of HCWs to provide quality PMTCT services according to the new national PMTCT guidelines, including training HCWs at each new site using a full site model;12) Support Mbeya Referral Hospital (MRH) to train ANC and laboratory staff for the entire Southern Highlands in collection of DBS for infant diagnosis and send DBS to MRH and USG/T lab partners;13) Build capacity of regional and district health teams to plan, execute, and monitor PMTCT activities, and support DHMT to include PMTCT activities in council health plans and budget.

Mbeya Regional Medical Office (RMO) supports the implementation of prevention, care, and treatment programs throughout its region, providing supervision to the regional hospital and district level facilities. Mbeya is one of the regions with the highest HIV prevalence in the country of 7.9%. It is estimated that there are 200,000 PLHIV in need of services in this region.

Full recruitment of patients in the region started in 2005, and by the end of FY 2011 the region had a cumulative number of over 41,000 patients on ART with 93730 new patients enrolled. Loss to follow up, however, has been a major challenge to the program. Based on the APR 2010 data, the proxy retention rate is approximately 73 % (APR 11). Measure to address this problem include linking with CBOs to track patients in the community, consistent and improved adherence counseling at all CTC sites and use of CHWs (HBC workers and community-owned resource persons) for adherence counseling, use of support groups, and tracking of patients in their homes.

For COP 2012, planned activities are:

1) Support provision of integrated care and treatment services: renovate selected facilities in the region; provide strategic in-service training, support supervision and mentorship to HCWs, linkages and integration of care and treatment services into other programs (e.g. MCH, TB, EPI, and PITC);2) Improve M&E system by supporting CQI in CTCs and electronic data capture: solar power will strategically be installed in high volume sites to improve electronic data collection, analysis and reporting. Gaps identified during quarterly performance appraisals will also be incorporated into regional work plans; RHMT and CHMTs in the region will be strengthened for better service coordination; Participate in zonal ART meetings organized by Mbeya Referral Hospital.3) Improve budgeting and financial performance by strengthening administrative and financial capacity. A contractor will be retained to build RMOs capacity in budgeting and financial reporting.4) Work with the DHMT and facility directors in developing and implementing facility-based work plans and facility pharmacists to improve forecasting, stock management and ordering;5) Improve patient identification and monitoring by procuring lab equipment and reagents including new CD4 machines and ensure regular maintenance. Also procure drugs and other commodities when not available through a central mechanism;6) Improve M&E framework by harmonizing data collection tools, data recording and reporting, ensuring gaps identified during quarterly performance appraisals are incorporated into regional work plans. To achieve this, solar power will be installed in selected facilities to improve electronic data management.7) Strengthen PHDP counseling among all staff providing treatment at CTCs, and link PLHAs with available support mechanisms;8) Improve infection prevention and control at high volume sites. This will be achieved through improved waste separation and disposal that will include building efficient and environmentally friendly incinerators;As part of Tanzanias decentralized health care approach, Mbeya RMO is the highest ranked local MOHSW representative in the region. Through its Regional AIDS Control Program and strong working relationship with District Medical Officers (DMOs), Mbeya RMO leads planning and execution of health services for the region.

HIV prevalence in Mbeya region is 7.9%, with at least 15,000 children under 15 years of age in need of care and support. FY 2012 funding will be used to scale-up the quality of pediatric care and treatment services. Mbeya RMO is tasked with coordinating and overseeing the quality of pediatric treatment services in the region, in collaboration with Baylor International Pediatric AIDS Initiative (BIPAI), based at MRH. Currently, BIPAI provides pediatric outreach care and treatment services as well as pediatric ART services, training, and mentorship for health workers in the region.

Mbeya RMO will support provision of comprehensive, integrated and quality pediatric care and treatment services in the region through strategic in-service training, supportive supervision and on-job mentorship to HCWs. supply of pediatric drugs and commodities, adherence counseling, and linkage of care and treatment services with community support groups to ensure a continuum of care. Peer counseling and education to improve retention into treatment will be promoted through technical support to adolescent support groups.Care and treatment services will be integrated into other services (HBC, OVC, PITC, EPI, PMTCT, TB/HIV, and RCH) to increase child enrolment. Improvement of facility infrastructure will address pediatric needs.

Mbeya RMO will strengthen the QA/QC system in data collection, analysis and reporting. Targets and results will be discussed among stakeholders (Local government, donors, NGOs, CSOs) and used to inform the program.

The integration of these services leverages the national referral system to ensure quality and sustainability. Mbeya RMO will continue to incorporate the regional health plans into existing funding mechanisms such as central funding through MOHSW budget, basket funding, and cost sharing mechanisms.