The LIFE program is a five-year intervention awarded December 2011. It aims to provide comprehensive and sustainable PMTCT and community-based HIV/AIDS services in four regions: Tabora, Mwanza, Pwani, and Zanzibar. The program contributes to Partnership Framework Goal 1, which ensures service maintenance and scale-up by mitigating the effects of HIV/AIDS disease. The program focuses on strengthening linkages between facility and community-based services for PLHIV as well as expands PMTCT services facilities and communities to reach HIV-free survival in Tanzania as outlined in the national PMTCT strategy. For community-based services, the program provides PLHIV with a care and support package, as per the URT guidance. For COP 2012, the program will increase focus on quality of life for PLHIV by rolling out new Positive Health, Dignity and Prevention (PHDP) interventions and expanding nutritional assessment and counseling (NACS) amongst program beneficiaries.

In line with the GHI Strategy, the program ensures PLHIV access care across the continuum, particularly maternal, newborn and child health, as well as family planning and reproductive health services. Finally, at the community level, the program promotes health-seeking behaviors, particularly targeting women and girls through innovative and appropriate strategies.

The program builds capacity of local governments to improve planning, management and coordination of care and treatment activities to achieve sustainability and country ownership by the end of the project. In addition, the program includes technical assistance to improve existing government M&E systems at various levels to ensure data quality and data use for decision-making.

The LIFE program provides comprehensive clinical and community care to adults and children living with HIV/AIDS in the four regions of Tabora, Mwanza, Pwani, and Zanzibar. Building on a previous intervention, the program continues to support partners by providing HBC services through the networks of community home-based care providers who have been trained using a newly revised training curriculum finalized with support from USG/T in FY11.

Services are tailored to the stage and general outlook of the disease. Services include community based palliative care, provision of the PHDP package, linkages to and provisions of safe drinking water options, sanitation services, and household food security, and economic strengthening. These community based activities are linked to facility based care and support services.

The program supports strengthened linkages between facilities and communities through improved service provision by Community home-based care providers (CHBCPs). Through the program, the role of CHBCPs is expanded to assist in linking facility services to the community by acting as community agents for care and treatment, PMTCT, TB/HIV, pediatric HIV, and family planning. The program trains CHBCPs and provides them with effective tools to track clients lost to follow up and drop-outs from CT and PMTCT clinics, referring traced clients back to the facilities. CHBCPs are also trained to support PLHIV clients receiving TB treatment.

As ART clients in Tanzania become healthier and require less palliative care, the program supports CHBCPs to increase health promotion activities, such as nutritional assessment and counseling, lay counseling for home counseling and testing, and plans for them to conduct home testing for HIV (once approved by MOHSW). To achieve this range of services and gain program efficiencies, the program capitalizes on community and facility referrals and linkages, civil society organizations (CSOs), faith based organizations (FBO), and services provided by non-government organizations (NGOs). To ensure sustainability and transition to local organizations and local government, the project is implemented using government guidelines and existing structures. Technical assistance to service providers is provided to ensure that involved partners practice and implement improved administrative, financial, and technical efficiencies over the lifetime of the project. Sub grantees and local government receive TA in the areas of M&E, measuring quality improvement, and project management.

At the service delivery point, the program provides support to CHBCPs to enable them to carry out their roles effectively. This support ranges from centrally procuring HBC kits and production of IEC material to training and capacity development. Throughout the program, innovative approaches will be used to enhance program integration, secure other financing schemes, and seek opportunities that already exist locally in order to leverage resources that support the long-term sustainability of community activities.

The LIFE program expands PMTCT services, particularly to women of reproductive age and their families in the four target regions. Cost efficiencies will be achieved by progressively decreasing sub grants to district councils and local partners and advocating for increased funding of program activities from URTs own resources. The program focuses on sustainability with the ultimate goal of transitioning all program activities, utilizing URT as the primary transition partner and recipient of capacity-building efforts. The base funding will mainly be used to increase quality of services related to mother and child health. This program will maintain the targets that have already been met.

In Tanzania, the decision to regionalize partners working in PMTCT took place in 2007. Since then, a fairly standardized package of services is implemented throughout the country by multiple partners in their respective regions. By the end of the program, the project will scale-up PMTCT services to cover 98% of the facilities providing RCH services in Tabora, Mwanza, Pwani, and Zanzibar. In support of the USAID Policy Framework, the target local governments will be provided with grants to support services that include, but are not limited to, HIV testing (in ANC and labor and delivery as well as at the FP clinic), partner testing, counseling on infant feeding options, strengthening of counseling on FP methods to HIV+ mothers during postpartum visits, referrals to care and treatment, clinical staging of the HIV+ pregnant women at the RCH clinic by the PMTCT service providers with linkages to CTC, roll-out of more efficacious regimen to facilities with the capacities, provision of ART prophylaxis to HIV+ pregnant women who are not eligible for ART, provision of Cotrimoxazole to all eligible pregnant women and exposed infants, PMTCT outreach services in hard to reach areas, and quarterly supportive supervision by the RHMT to ensure quality of services.

In collaboration with MOHSW, bi-annual supportive supervision will also be done in all regions. Psychosocial support groups will be formed in collaboration with the local government structures and community home-based providers in order to increase adherence and retention to care. The program ensures the availability of HIV test kits will be procured to fill gaps and an adequate supply of drugs will be provided for a more efficacious regimen based on needs. Printing and distribution of IEC materials and job aids is also supported.

The program provides technical assistance to districts and service providers to strengthen M&E in PMTCT and ensure guidelines and M&E tools are available. Service providers are trained to fill out the PMTCT monitoring tools and engage in Data Quality Assurance activities to improve the data collection systems. The program also strengthens and facilitates CHMT annual review meetings, support the formation and integration of regional PMTCT task forces into reproductive and child health, facilitate regional quarterly partners meetings, and strengthen linkages and referrals.