Ruvuma 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. Ruvuma RMO coordinates HIV activities among DOD-supported partners in the region. The program will be rolled equally throughout all five districts. The target populations consist of PLHIV, their partners, and children as well as caretakers of orphans born to HIV-positive mothers. The program areas implemented include PMTCT, care and treatment services for adults and children, and TB/HIV.

Ruvuma RMO region has a population of over 1.3 million people with an HIV prevalence of 5.9%. It is estimated that there are 80,000 HIV positive people in need of care and treatment services in this region.

Ruvuma RMO will continue to strengthen its integrated platform, which closely ties with the USG/T GHI Strategy, where multiple essential health services are provided under one roof. The quality of ART services is also a key priority for both Ruvuma RMO and the Partnership Framework. This requires strong oversight and supervisory visits from facilities to the communities. As such, Ruvuma RMO will procure one vehicle, which is critical for conducting outreach efforts and proper supervision. The vehicle will be allocated to Songea Municipality, but can be accessed by other districts including the RMO office when a need arises.

The HIV prevalence in Ruvuma region is 5.4%. Within the facility-based setting, Ruvuma RMO provides care and support services to adult patients infected with HIV and their families in order to extend and optimize the continuum of care.

For COP 2012, the activities include:

Strengthen regional capability to provide adult care and support services through strategic in-service training, mentorship and supportive supervision to improve HCWs and CHWs skills in adult care and support services;Support scale-up of management of OIs including provision of cotrimoxazole prophylaxis;Provide palliative care including pain and symptom relief to PLHA;Strengthen the provision of comprehensive care and support services including psycho-social, spiritual and bereavement services to PLHA and their families;Provide nutritional assessments and support (NACS) to all patient seeking care at CTCs in the region;Support linkages and integration of adult care and support services into other services such as ART, OVC, home/community adult care and support, TB/HIV, MCH, EPI, PMTCT and HTC as well as strengthening the referral systems to ensure that patients get appropriate care timely;Improve regional M&E system by using harmonized data collection, analysis and reporting tools and discuss and share program performance with outreach adult care and support partners to ensure program coordination among stakeholders.

Ruvuma 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. Ruvuma RMO will strategically scale-up TB/HIV services in the region.

For COP 2012, the TB/HIV portfolio for Ruvuma RMO will include the following activities:

1) Improve quality and scale-up of TB/HIV services in the region through provision of technical support to districts and high-volume clinics, in-service training and mentorship to HCWs on TB control practices and implementation of the three Is;2) Strengthen laboratory services including sputum smear microscopy and quality assurance for quality TB care services;3) Strengthen case detection among PLWHAs attending care and treatment clinics through screening;4) Improve patient referrals and integration of TB/HIV services into other programs e.g. ART, HTC, and PMTCT;5) Improve district M&E framework by ensuring availability and use of standard National TB/HIV tools, such as screening tools and clinical assessment forms;6) Support establishment of regional and district TB/HIV coordinating bodies to oversee the implementation of TB/HIV services.

HIV prevalence in Ruvuma region is 5.4%, with at least 3,400 children under 15 years of age in need of care and support within a network of 25 CTCs. All health facilities provide these services. Through DOD support, Ruvuma RMO will assist in the roll-out of pediatric HIV treatment services to strategically selected additional health facilities. For COP 2012, the activities include:1) Scale-up the provision of cotrimoxazole prophylaxis, infant feeding counseling, nutritional assessments and support, management of OIs, palliative care, psycho-social support, and improve referrals;2) Strengthen regional capability to provide pediatric care and support services through strategic in-service training, mentorship and support supervision to improve HCWs and CHWs skills in management of pediatric HIV/AIDS;3) Support linkages and integration of pediatric care and support services into other services such as ART, OVC, HBC, TB/HIV, MCH, EPI, PMTCT and HTC;4) Improve the regional M&E system through data collection, analysis and reporting, and ensure harmonization of M&E tools as well as program coordination among stakeholders;5) Improve pediatric care and support infrastructure to provide pediatric friendly services;6) Strengthen community mobilization, including involvement of adolescents and children in PHDP services and formation of support groups to gain participation and create local ownership.

Ruvuma Regional Medical Office (RMO) supports the implementation of PMTCT services in the region, supporting 220 RCH sites and providing supervision to the regional hospital and district level facilities. Ruvuma RMO will scale-up and integrate PMTCT with prevention, care, treatment and support services in the region. With an ANC HIV prevalence of 11.3%, quality PMTCT services are critical.

With COP 2012 funding, Ruvuma RMO will implement the following PMTCT activities under the guidance of DOD standard package:

1) Complement Emergency Obstetric Care (EmOC) package by linking with DHMTs and CHMTs to establish EmoC needs and supporting its implementation through a national TOT model 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;3) Complement FP and Focused Antenatal Care (FANC) package by linking/liaising with DHMTs and CHMTs to support FP and FANC. Training in FP and FANC will be done in respective districts based on the national TOT model;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) Ensure linkage and integration of PMTCT and EID into MCH services to improve identification and linkage of all HIV exposed and infected infants (HEI) into Care, Treatment and Support. This will also ensure that all HEI are initiated on cotrimoxazole prophylaxis as appropriate;8) 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;9) Support national efforts to standardize EID logistics (transportation samples and DBS results);10) Provide PHDP counseling package based on the USG-developed approach in Tanzania; and11) 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.12) 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;13) Train ANC and laboratory staff in DBS sample collection for early infant diagnosis;14) 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.

Ruvuma Regional Medical Office (RMO) supports the implementation of prevention, care, and treatment programs throughout the region, providing supervision to the regional hospital and district level facilities. Ruvuma RMO will strategically scale-up HIV/AIDS care and treatment services in the region to an estimated 80,000 PLHIV.

Ruvuma RMO began full recruitment of patients in 2005 and by the end of FY 2011; the region had a cumulative number of over 14,777 patients on ART with 2,589 new patients enrolled. Despite this achievement, loss to follow up has been a major challenge to the program with a proxy retention rate of 69.8% (APR 2011). 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, the following activities will be performed:

1) Strategically scale up quality care and treatment services in the region, including improvement of physical infrastructure through renovation of CTC facilities, strategic on-job training, support supervision and mentorship;2) Complement procurement of drugs, commodities, CD4 machines, other lab equipment and supplies to ensure timely initiation into treatment, improve lab efficiency as well as quality of care, treatment and support;3) Improve patient record and data collection while working with DOD, DHMT, and facility staff to analyze data to improve service quality. To achieve this, high volume sites will be identified and solar power installed to ensure regular power supply for electronic data recording, storage and reporting. This will also improve laboratory efficiency. Gaps identified during quarterly performance appraisals will be incorporated into regional work plans.4) Work with the DHMT and facility directors in developing and implementing facility-based work plans;5) Strengthen PHDP counseling among all staff providing treatment at CTCs and linkage of PLHA to available support mechanisms;6) Continue supporting linkages and service integration focused on special groups (girls, women, and children) and improved referrals, programs and services such as MCH, TB, EPI, and PITC;7) Strengthen administrative and financial management capacity to improve execution. Specifically, work with facility pharmacists to improve capacity in forecasting and stock management. In addition a contractor will be retained to build RMOs capacity in budgeting and financial reporting.8) Continue to provide evaluation for malnutrition and nutritional counseling to all PLHIV clients;9) For better infection prevention and control, improve waste management at high-volume facilities including provision of efficient and environmentally friendly incinerators;

Ruvuma RMO will also participate in zonal ART meetings with Mbeya Referral Hospital to discuss treatment roll-out, identify areas of need, determine solutions, and coordinate resolutions.

HIV prevalence in Ruvuma region is 5.4%, with at least 3,400 children under 15 years of age in need of care and support within a network of 24 CTCs. COP 2012 funding will be used to scale-up the quality of pediatric care and treatment services. Ruvuma 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. These activities will be achieved through support supervision, community mobilization, training and on-the-job mentorship. Ruvuma RMO has a catchment area that includes five districts with a population of over 1.3 million people.COP 2012 funding intends to reach 499 children, with a plan to roll out care and treatment services to 32 additional health facilities, bringing the total number of facilities to 60.

Planned activities for COP 2012:1) Provide quality pediatric care and treatment services through strategic on-the-job training, mentorship and support supervision to HCWs, improved pediatric PITC, procurement and logistics fo+B39r diagnostics and pharmaceutical supplies, and infrastructural improvement to specifically address pediatric needs2) Integrate pediatric HIV care and treatment services into other services (HBC, OVC, PITC, EPI, TB/HIV, RCH and PMTCT);3) Provide comprehensive adherence counseling by HCWs, CHWs and support groups;4) Strengthen linkages and referrals between pediatric care and treatment programs to improve child enrollment;5) Improve M&E system through use harmonized data collection and reporting tools, analysis and use of data to inform the program and tracking of children lost to follow-up. Targets will be monitored and discussed during zonal technical meetings and national partner meetings.

Pediatric care and treatment services at Ruvuma RMO are integrated into existing health systems and services. The integration of these services leverages 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.