The Cooperative Agreement with the National AIDS Control Program (NACP) covers six components, namely: strategic information, HIV testing and counseling (HTC), home-based care (HBC), HIV care and treatment, HIV/TB, prevention of mother to child transmission of HIV, information, education, and communication (IEC), and male circumcision (MC). The goal of NACP's agreement is to provide strategic leadership and management over the entire Tanzanian national AIDS program. To achieve this, NACP collaborates with multisectoral organizations in a variety of settings, including: developing and implementing comprehensive, quality HIV care and treatment strategies in public, private and community based settings, and providing quality HTC and HBC services to PLHIV and their families. NACP also aims to improve coordination and quality of IEC in support of increased demand, uptake and adherence to effective biomedical interventions and services, including MC. NACP strengthens the collaboration betweeen TB and HIV programs at national levels, to improve the quality of care and treatment for PLHIV with both diseases. In line with the Partnership Framework and the Global Health Initiative, NACP works to expand PMTCT coverage by increasing the percentage of HIV positive pregnant women who receive ARVs while improving child survival among HIV exposed and infected children. NACP, which covers all regions in Tanzania, will also strengthen its own capacity to coordinate the health sector in the implementation of strategic information objectives.

MOHSW, through NACP, is mandated to develop policy guidelines and to coordinate, monitor, and evaluate the implementation of home-based care (HBC) services in the country. Over the past 15 years, MOHSW has witnessed major successes in provision of HBC services through its implementing partners, including scaling up of HBC services from eight pilot districts in 1996 to 133 in 2010 with improved coordination capacity at NACP. NACP intends to use these funds to ensure provision of comprehensive and quality care at all levels and harmonization of HBC implementation in the country. NACP will continue to coordinate partners through bi-annual national level coordination meetings for HBC stakeholders and monthly meetings with national level HBC stakeholders. NACP will also provide guidance in the implementation of HBC services through the development of different strategies, including writing an HBC strategic plan, identifying and disseminating best practices, revision of guidelines, SOPs and training materials for HBC, and conducting comprehensive supportive supervision of regions, districts, and non-governmental implementing partners. With the scale up and need for sustainability of HBC services, local government involvement needs to be prioritized. Therefore, NACP intends to promote ownership of HBC services by working with the local governments and mentoring them through annual planning meetings with regional HBC/AIDS coordinators, annual feedback meetings, conducting and providing comprehensive supportive supervision, and monitoring and evaluating HBC services in the country. To ensure comprehensive quality service provision, tools for supportive supervision and mentoring service providers in HBC/PHDP will be developed and rolled out in all regions. Through supportive supervision, MOHSW will monitor the implementation of HBC services, identify opportunities and constraints in provision of HBC services, and monitor HBC data management at all levels. Planned activities include building capacity of regions to conduct supportive supervision and mentorship; conducting eight supportive supervision visits per year; and working in collaboration with the Global Fund, supply chain management system, and local government authorities to ensure availability of HBC kits and commodities for the districts. These activities aim to promote access and utilization of affordable and essential interventions and commodities, while improving the quality of HBC services for the general public, PLHIV, providers, and other vulnerable populations. These goals are aligned with PEPFAR and the Partnership Framework. Implementation of these activities requires the availability of adequate human resource personnel. In view of this, NACP will also use the funds to support one program officer.

MOHSW has adopted the WHO TB/HIV collaborative policy guidelines, which addresses TB and HIV jointly. The policy guidelines clearly demonstrate the need to fight the dual epidemics and provide the basis for action in collaborative TB/HIV activities by the National TB and Leprosy Program (NTLP), the National AIDS Control Program (NACP), and other stakeholders to work synergistically to reduce the burden of TB/HIV co-infection. This project is in line with MOHSWs revised health policy (2007), the Health Sector Strategic Plan III (July 2009-June 2015), the Five-Year Partnership Framework in support of the Tanzania national response to HIV/AIDS (2009 - 2013), National TB and Leprosy Program Strategic Plan 2009 to 2015, and National TB/HIV Policy Guidelines 2007. NACP will use the allocated funds to ensure coordination of all TB/HIV activities and implementing partners. Specifically, they will organize and conduct a bi-annual national TB/HIV coordinating committee, quarterly national TB/HIV technical working group meetings, and conduct joint supportive supervision on TB/HIV activities in collaboration with the NTLP and implementing partners. The funds will also be used to build capacity of RHMTs and CHMTs in implementation and monitoring of collaborative TB/HIV activities. NACP will ensure RHMT and CHMT include TB/HIV activities in their Comprehensive Council Health Plan (CCHP) for sustainability and ownership. The program has already adopted the revised Partnership Framework and PEPFAR II indicators. In addition, an M&E plan and tools have been updated to incorporate revised indicators. The indicators will be reported quarterly at district, regional, and national levels. One of the objectives of collaborative TB/HIV treatment is to reduce the incidence of TB disease among people living with HIV/AIDS (PLHIV). The WHO recommends the national programs and partners implement the 3Is to reduce TB disease among PLHIV. NACP, in collaboration with other partners, will continue scaling up of the 3Is beyond pilot sites and will print and distribute TB screening tools among care and treatment sites. NACP will also continue collaborating with the NTLP in the phased implementation of IPT as part of HIV care and treatment packages and subsequent countrywide scale up. NACP will ensure the incorporation of pediatric TB into all the TB/HIV activities while observing gender mainstreaming. The funds will also be used to enhance the capacity of frontline health care providers, including radiology and laboratory technicians, in the implementation and incorporation of the 3 Is into comprehensive HIV supportive supervision and mentorship checklists.

This fund will also be used to support two staff members to include a TB/HIV program officer and a planning officer. The following guidelines and tools for implementation of collaborative TB/HIV activities were produced: National Policy Guidelines for Collaborative TB/HIV Activities, collaborative TB/HIV activities training manual, 3Is training manual, 3Is M&E tools, TB infection control guidelines, pediatric TB/HIV guidelines, a revised TB diagnostic algorithm, revised M&E tools to include TB/HIV variables, TB/HIV job aids, and a strategic approach for 3I's phased implementation.

The funding will assist NACP in strengthening existing systems that produce data through routine reporting, surveys, evaluations, and surveillance. In routine reporting, various HIV health sector stakeholders will be capacitated through trainings and refresher trainings on revision of recording and reporting tools, good practices in data management, data use, and analytical skills. At the national level, programmers will be empowered in various scarce skills areas, such as monitoring and evaluation methods, costing studies, triangulation, research ethics and, thus, be capable to evaluate health sector HIV interventions. Special surveys are to be undertaken by NACP to better understand the HIV prevalence and trends in the general and key populations, including FSW, MSM, IDUs, and mobile populations, such as truck drivers and traders. Evaluation and comparison on utility of PMTCT data to data collected in ANC sentinel surveillance will be conducted using these funds to better understand what method technically suits the country's needs. Under surveillance, funds received will prepare logistics to conduct ANC sentinel surveillance as well as the HIV Drug Resistance Threshold Survey. These will entail procurement and distribution of supplies for field work and laboratory, training of data collectors, testing and retesting of samples collected, analysis, and report writing of data captured. The funds given will be used to set innovative ways that will document best practices in M&E at all levels of implementation, for example fora of meetings involving HIV health sector stakeholders. The anticipation of these fora is to create a culture in data use for implementers and decision makers. For coordination purposes, the funds obtained will be used to host technical working group meetings under the epidemiology unit, namely MARPs and HIVDR Technical Working Groups, M&E steering committee, research as well as M&E subcommittees. The allocated funds will also be used to hire new staff and maintain 10 staff that is under CDC support. From the activities emanating from the program, a number of reports will be produced using CDC funds, specifically implementation of HIV care and treatment services, surveillance reports, and any special survey report conducted. Same funds will be used to disseminate the reports locally and internationally whenever necessary for knowledge and experience sharing. For FY 2012, support received will be used to procure supplies and maintain personnel involved in HIVDR monitoring surveys at three sites and any key population survey selected by the MARPs Technical Working Group. A study tour will be conducted to understand how a data hub works in countries known to have good data use systems for planning and decision-making. Evidence To Action Data Hub will be done using these funds to assist the program towards formulating information management and sharing policy guidelines to systematically link M&E systems of vertical programs to the HMIS system within the MOHSW. This task will be done in collaboration with the MOHSW so as to ensure all program needs are met. Support received will as well be used in printing of recording and reporting tools for HIV care and treatment services, home-based care, and any other intervention when needs arise. Preventive maintenance of existing ICT infrastructure will also be addressed.

Through the National AIDS Control Program, MOHSW will continue to coordinate male circumcision (MC) services for HIV prevention. NACP will support and facilitate quarterly MC technical working group meetings to share updates and provide guidance for implementation of MC services in the country. In addition, NACP staff will conduct supervision visits, as well as annual external quality assurance (EQA) visits to MC service sites in the country. Possibilities to support additional staff to assist with oversight and technical guidance for this rapidly expanding service are also under discussion. Funds can be used to support a potential additional clinical position within the MOHSW central level and/or at the regional level.

Though COP 2012 funding for HTC, the NACP Counseling and Social Support Unit (CSSU) that coordinates and oversees HIV testing and counseling (HTC) services, will improve its ability to coordinate the expansion of HTC, including provider-initiated and home-based HTC; proactively reach out to the underserved key population; and focus on identifying larger numbers of HIV-infected patients in need of care and treatment-eligible patients. Strategies to achieve these goals include the expansion of provider-initiated testing and counseling (PITC), advocacy with higher level officials in regards to an expanded role for lay counselors, and home-based HTC in selected high prevalence areas. Major emphasis next year will include, in collaboration with the MOHSW PMTCT program, the roll-out and strengthening of couples HTC services. The funding will also allow closer collaboration between the MOHSW, NACP, and partners in delivering quality confidential HTC services, while increasing linkages with services such as PMTCT (e.g. for couples HTC), family planning, voluntary medical male circumcision(VMMC), and TB and sexually transmitted infection (STI). The funds will enable the unit to continue supporting and oversee the planning, monitoring, and implementation of confidential HTC services in Tanzania with the collaboration with the PEPFAR team, UN agencies, other donors and stakeholders, and regional health authorities, and in collaboration with other HTC partners , maintaining and expanding HTC services integrated with home -based care programs in selected high prevalence districts, as well as advocating with higher officials in regards to an expanded role for lay counselors. This funding will also enable the NACP to develop/adapt relevant curricula and tools for couples HTC roll-out in line with the comprehensive HTC guidelines , coordinate HTC services through conducting quarterly technical working group meetings on HTC, and strengthen and expand existing confidential HTC services, including establishing and strengthening of Couples HTC in as many HTC sites as possible. The funding will also be used to roll out the implementation of the new comprehensive HTC guidelines, disseminate paper-based monitoring tools, and develop and pre-test IEC messages to expand awareness and increase demand and uptake of HTC. NACP will also look into conducting supportive supervision and follow-up for HTC service sites. The funds will be used to establish HTC accreditation and quality improvement systems for HTC including the development and implementation of a plan for further roll-out of HTC Quality Assurance to all established HTC sites in collaboration with the MOHSW Diagnostic Unit and laboratory staff. For strengthening the capacity of CSSU HTC staff , COP 2012 will be used to maintain two staff and exploring the creation of an additional position. Support received will enable the unit staff to strengthen their managerial skills through study tours, program management and other short courses.

The Information Education and Communication (IEC) Unit at the Ministry of Health & Social Welfare (MOHSW) National AIDS Control Program (NACP) Coordinates and oversees all HIV communications efforts carried out under or by the health sector and its stakeholders on Tanzania mainland. The IEC unit supports other programs within NACP and the MOHSW with design, production, review and/or printing of materials that support demand creation, increased uptake and adherence. Examples include but are not limited to promotion of Male Circumcision (MC) and HIV Testing & Counseling (HTC) services, support for Positive Health Dignity and Prevention (PHDP), support for ART adherence and retention and others. The unit also receives, and provides technical inputs, guidance and approvals for IEC interventions and materials developed by a wide rage of stakeholders in the country. To this effect, capacity building for this unit supports improving monitoring and evaluation, and quality assurance and standards for IEC and Behavior Change Communication (BCC) interventions and materials. Under this Cooperative Agreement, quarterly IEC subcommittee meetings will be conducted. In addition to that, coordination meetings with implementing partners to share experiences on the implementation of IEC/BCC activities and relevant evaluations of IEC/BCC activities will be carried out twice a year. To ensure a variety and up-to-date HIV and AIDS information is available at the National AIDS Control Program, the library information system will be up-graded and maintained. In addition to the above, For COP 2012, NACP through the IEC Unit plans to coordinate different condom promotion and distribution activities that target and strengthen the demand for and access to free public health sector condoms beyond the health facilities where they are normally placed. To implement this, the National AIDS Control Program will coordinate meetings and activities carried out by the condom committee of the Ministry of Health and Social Welfare. The committee will be charged with the responsibility of advising on the various strategies to either increase and/or improve the availability, access and utilization of condoms for HIV prevention.

COP 2012 funds will be used to enhance program planning at the local level and promote ownership for planning at the regional and district levels by strengthening the capacity of authorities. This activity will begin with 10 districts that have no or only a few PMTCT activities incorporated into their CCHPs. The respective regional and district planners will be oriented on how to use the Essential PMTCT and Pediatric Planning Package. Refresher trainings to HCWs on PMTCT will be conducted as part of a strategy to roll out the new WHO guidelines. MOHSW will also coordinate these trainings, in collaboration with regionalized implementing partners, as well as TOT trainings. Service provider trainings on comprehensive PMTCT course will be oriented towards gap filling. Establishment of new HEID sites will continue with the aim of reaching all sites that provide PMTCT services. Two types of trainings will take place. The first will be a comprehensive training for participants who have not yet received PMTCT and EID trainings. The second will be the modular training on EID for those who have already undergone PMTCT training. To address critical challenges which include sample transportations, shortage of trained HCWs and longer turnaround time, increasing the number of health facilities providing EID services is a crucial step in realizing universal coverage. The program plans to support a series of meetings that will incorporate PMTCT into the HIV home-based care guidelines to addresses weaknesses in the community component, such as (1) An unsystematic community network to support health, leading to increased LTFU of HIV infected mothers and their exposed infant; (2) Cultural issues and taboos; (3) Limited male involvement; and (4) Limited community and family support for women, especially those living with HIV. The PMTCT program will also facilitate and hold annual sub-committee and secretariat meetings, while the eMTCT national task team and its sub teams will meet on a quarterly basis. The program will support bi-annual zonal meetings in each of eight RCH zones, with the aim of sharing experiences, achievements, challenges, and resolutions related to RCH service implementation, including PMTCT/HEID. Bi-annual supportive supervision and mentoring visits from the central level to regions and districts to follow up on the progress of PMTCT service provision will be conducted. These visits will complement those done regularly at district and facility levels by the respective local health authorities. The comprehensive supportive supervision and mentoring tool of HIV/AIDS health services will be used when conducting these visits. However, periodic data quality assessments will be conducted in poorly performing and reporting sites in order to ascertain availability of quality program data and proper utilization of the data at the lower levels. This will also include printing and distribution of PMTCT guidelines, training materials, and M&E tools. Lastly, support will include payment for office expenses, including stationery, electricity bills, fuel and car maintenance, telephone, fax, staff mobile phone, air time, and two wireless mobile internet modems. It will also cater to maintaining the existing 15 national PMTCT staff within the PMTCT offices. Furthermore, the funds will support national PMTCT program staff to attend short courses, meetings and international conferences.

Implementing partners supporting care and treatment services have contributed greatly in the success of the National AIDS Control Program (NACP). This program, as the coordinating organ of the MOHSW in HIV and health interventions, will continue to coordinate partners through bi-annual progress meetings on implementation of HIV care and treatment services; provide guidance in the implementation of services through development of different strategic documents, such as the Health Sector HIV/AIDS Strategic Plan II, guidelines for the management of HIV/AIDS, and conducting comprehensive HIV/AIDS supportive supervision to health facilities and the regions to oversee the implementation of the care and treatment services. With the scale up and need for sustainability of care and treatment services, local government involvement needs to be prioritized. NACP intends to capacitate local governments and promote ownership of HIV/AIDS care and treatment by working together on planning and budgeting of the care and treatment services; providing funding to Lindi and Shinyanga regions for the implementation of HIV care and treatment for supportive supervision, mentorship, and monitoring of HIV care and treatment services. The government of Tanzania has adapted the latest WHO treatment guidelines (2009). The revised national guideline will be printed and disseminated by the end of 2011. The implementation of the new guideline requires updating and reviewing the training package according to the new guideline and orienting health care workers on the new treatment guidelines. Integration of care and treatment services will increase accessibility, availability, and utilization of ART services, as well as improve retention of patients. Activities related to this component include building capacity of the health care workers on provision of care and treatment services among those working in PMTCT and TB clinics and providing mentorship and supportive supervision to the health care workers in those clinics. NACP will continue to work in collaboration with the Medical Stores Department, the supply chain management system, and local government authorities to ensure availability of these medicines and commodities to the CTCs. Furthermore, to capture adverse drug reactions of the most commonly used antiretroviral medicines, NACP and TFDA will collaborate to ensure pharmacy vigilance is implemented in most of the health facilities with HIV care and treatment services. Strengthening the capacity of the health care workers in managing ARVs and other HIV commodities through mentorship programs and ensuring a system for tracking of adverse drug reactions for HIV is being instituted in the care and treatment clinics through ADR form distribution. To ensure quality HIV service provision, tools for supportive supervision and mentoring health care workers on clinical and program management for HIV have been developed and rolled out in few regions. Upcoming activities include building capacity of regions to conduct supportive supervision and mentorship along with working with Tanzania Food and Nutrition Center to ensure incorporation of nutrition counseling and mentoring for PLHIVs on care and treatment programs. Implementation of these activities requires the availability of adequate human resource personnel. In view of this, NACP will also use the funds to support four additional staff: a training officer, office support staff, and two drivers.

NACP will use these funds to support two pediatric HIV/AIDS stakeholders meetings and supportive supervision and mentoring groups to selected regions. In addition, orientation for RHMT, CHMT, and facilities will be conducted on updated pediatric training materials, including emphasizing integration of services and printing and dissemination of IEC material and job aids. NACP, as the coordinating organ in HIV health interventions, will continue to coordinate partners through bi-annual progress meetings on implementation of pediatric HIV care and treatment services. Through these progress meetings, implementing partners get opportunities to share their experiences, while MOHSW takes this opportunity to disseminate guidance on implementation of services through the different developed strategic documents. Implementing partners support for care and treatment services has contributed greatly in the success of the program. MOHSW, through NACP and working in collaboration the with Pediatric Association of Tanzania (PAT), intends to capacitate local governments in the implementation of supportive supervision, mentorship, and monitoring of pediatric HIV/AIDS care and treatment services. Activities related to this component include building capacity in provision of care and treatment services among health care workers in RCH (FP and EPI), PMTCT, and TB clinics and providing mentorship and supportive supervision. The emphasis will also be on promoting integration of care and treatment services within other services, thus increasing accessibility, availability, early identification of infected infants, and utilization of ART services as well as improving retention of children on care. This is important in improving quality and access to services, thus reducing child morbidity and mortality associated with HIV infections. NACP will work in collaboration with Tanzania Food and Nutrition Center to ensure integration of nutrition aspects into the care and treatment program and mentoring on the management of HIV infected children. They will also work to build capacity of HCW in managing severe acute malnutrition of children as well as increase knowledge around availability, prescribing, counseling, and using ready to use therapeutic foods (RUTF). The national guidelines for management of HIV/AIDS has been revised in response to new WHO ART recommendations and other evidence based interventions. This necessitated a review and updated version of the national pediatric training package. MOHSW, through NACP, will use funds for the orientation and dissemination of the updated 2011 National Pediatric Training Packages and guidelines to RHMTs, CHMTs, and facility health care workers. With the scale up and need for sustainability of care and treatment services, local government involvement will be the key issue which needs to be given priority. There is a huge discrepancy between the estimated number of children living with HIV and those who access HIV care and treatment services. This could be due to lack of community awareness of pediatric HIV, stigma, or low competency among health care workers in managing infected children. The IEC materials and job aids will raise awareness and demand of services, thus improving access to the available services.