With COP 2012, Selian will be providing comprehensive and sustainable clinical and community based HIV/AIDS services. This program will support local institutions and entities to scale up, expand and integrate HIV/AIDS care services in the two regions of Arusha and Manyara. Special emphasis will be placed on ensuring that adults and children living with HIV/AIDS benefit from a comprehensive package of HIV and health related interventions.

In line with PF Goal on service maintenance and scale up, activities at both facility and community levels will be involved. Facility based care and support services will include counseling and testing services, palliative care, TB/HIV screening and treatment services; management of opportunistic infections including Cotrimoxazole prophylaxis, cervical cancer screening, family planning and reproductive health services, provision of insecticide treated nets, malaria prophylaxis, Positive Health, Dignity and Prevention (PHDP) services and nutritional assessment counseling and services (NACS). Community-based services will include the provision of the PHDP package, community-based palliative care, linkages to and provision of safe drinking water options and sanitation services, and linkages to and provision of household food safety and economic strengthening.

To achieve this array of services and gain program efficiencies, Selian will rely on the existing local organization and government system to establish and strengthen referral networks and linkages to civil society organizations (CSO), faith-based networks, and services provided by non- Government Organizations (NGO).

In Tanzania, HBHC partners implement a standard package of care activities. This program will provide comprehensive clinical care and support in Arusha and Manyara regions. It will combine two components of care packages; first being clinical care and second community home-based care.

With COP 2012 funds, Selian will continue to support HBC services through the network of community home-based care providers who are already trained using the revised curriculum. In line with the reviewed home-based care guidelines, initial assessments will be done to ascertain the number of existing CHBCP and the coverage of the services. Those trained using new curriculum will be taken aboard while those trained using old curriculum will be provided with refresher training.

Services to patients will be tailored as to the stage and general outlook of the disease. Tailored services include community based palliative care, provision of PHDP package, linkage to and provision of safe drinking water options and sanitation services, linkage to and provision of household food security, and economic strengthening activities. These community based activities and CHBCP activities will be linked to facility based care and support services. CHBCPs will play a bigger role in linking the facility services to the community by acting as community agents for care and treatments, PMTCT, TB/HIV, Pediatric HIV and Family planning. In the community CHBCPs will link with the facility to track loss to follow up and drop outs from CT clinics and PMTCT and refer them back to the facilities. They will also monitor patients on DOTS treatment for TB. CHBCPs will increasingly carry out health promotion activities like nutritional assessment and counseling, lay counseling for home counseling and testing and when the MOH issues permission, conduct home testing for HIV. To achieve this range of services and gain program efficiencies, the program will capitalize on the community and facility referral and linkages, civil society organizations (CSOs), faith based organizations (FBO), and services provided by non-governmental organizations (NGOs). To ensure sustainability and transition to local organization and local government the Selian supported program will be implemented using the government guidelines and existing structures.

Selian will sought TA from partners such as EGPAF, PATHFINDER who areinvolved in implementing this similar activities to support to improve quality of service and efficiencies over the time of the project. TA will also be sought in the areas of M&E, quality improvement measure, project management etc. At the service delivery point support will be provided to CHBCPs to enable communities carry out their roles effectively. Selian will access centrally procured HBC kits, IEC materials and trainings. Innovative approaches will be used through program integration, use of other financing schemes and other opportunities existing locally to leverage resources to support the community activities for a long term sustainability.

The program will focus on building the capacity of local community structures, especially local CBOs, to respond directly to the needs of children and their families. This program will implement its activities through district and lower local government authorities, while OVC and youth services will be provided by CBOs who utilize community volunteers. Its efforts will also highlight a core principle of the GHI strategy by leveraging other efforts as demonstrated by the local governments contributing significant financial resources to some of the MVC services. At the same time, this program will encourage other implenmeting partners to share staff skills and costs of training volunteers (e.g. peer educators and para social workers). After the initial training and capacity building of partners and volunteers, the cost of delivering services will significantly decrease over time.

The program will continue to train a network of community volunteers (para social workers, mama mkubwas or big mothers, peer educators, and community justice facilitators) to sustainably provide care to OVC households. Local government leaders are involved in all stages and processes through meetings and trainings, by mobilizing communities to participate in the project activities, offering support supervision, and monitoring the work of local partners and their activities within the respective communities.

As a right to all identified children and within the government policy framework to care and protect children's social welfare and future, the program will ensure that every identified and registered child has a birth certificate issued by the regional governments and a community health insurance fund card so that children can access free health care at any of the government health facilities. All children under five will be taken to health centers for vaccinations in the event this had not been done previously.

This program will provide a comprehensive package of direct services to OVC households. Caregivers grouped in 10-15 households will benefit from economic strengthening and income generating support, as well as food security and nutrition education. Children with emotional problems will be given psychosocial support and protection against any risk of sexual and/or physical abuse. Health care and treatment services will be mapped to ensure all children in need of health services are properly referred to and linked with service providers. In addition, children who have dropped out of schools will be supported to return to school, while adolescents will be organized in groups to receive HIV prevention and life skills training.

Selian's implementation of TB activities is consistent and fits into the country wide strategy for responding to TB. This includes the following activities supporting with COP 2013 funding:

- Strengthen TB screening and case detection by implementing Intensified Case Finding (ICF) at CTCs, among pregnant women, OVC, pediatrics, uniformed forces and in congregate settings.

- Identify TB suspects, including rapid action to conduct diagnostic evaluation of suspects and to treat the disease.

- Provide Isoniazid Preventive Therapy (IPT) for individuals who screen negative for TB symptoms.

- Implement infection control measures to prevent TB transmission in both TB and CTC settings.

- Integrate Positive Health, Dignity and Prevention (PHDP) into TB clinical settings.

- Provide HIV comprehensive care and treatment services (including ART initiation) for TB/HIV co-infected patients.

- Scale up provision of HIV services in TB clinics through increasing the number of TB clinics with one stop TBHIV services and/or renovation of TB clinics to allow provision of comprehensive care and treatment services. Support scale up of pediatric TBHIV services.

With COP 2012 funds, this follow-on program will play a key role in improving the health and well-being of children in Arusha and Manyara, as the program implements a standard package of care interventions. The care program will enhance and strengthen linkages between facility and community-based services by integrating nutrition assessments counseling and support (NACS), offering counseling and support across care programs, and promoting integration of OVC, maternal newborn and child health (MNCH), PMTCT, and pediatric AIDS interventions to children infected by HIV.

Specifically, the program will enhance the roles of community care providers in promoting a more integrated community response. The program will build on the successful results of the community care/MCH Community Health Workers training.

Through enhanced community services, the program will strengthen the continuum of care for HIV-affected children from birth through adolescence. Focus will be in the provision of cotrimoxazole prophylaxis to eligible children, linking and integrating cotrimoxazole provision with MNCH services, and improved documentation on child health cards. In a collaborative effort with the OVC program, child protections issues will be addressed as the program seeks to pilot and scale up the community-based child protection model. Working with the OVC program, the follow-on program will strategically intensify interventions to improve the well-being of girls.

To contribute to program sustainability, the program will build the capacity and strengthen the skills of community and facility-based care providers through human resource for health (HRH) activities in the focus regions, while also addressing food security and nutrition issues for children living with HIV/AIDS and OVC.

The program will strengthen M&E in care and treatment by ensuring national guidelines and M&E tools are available, improving data collection systems, and training service providers on filling out care and treatment monitoring tools. CHMT annual review meetings will be facilitated and strengthened, while support of activities in the focus districts and regions will be aimed at strengthening coordination of care and treatment services.

This program will adopt the strategy of using mobile VCT services to increase the number of people testing for the HIV virus. This strategy in previous years brought the number of people tested monthly from about 1,500 to over 6,000. In an attempt to identify more HIV+ children in need of services, door-to-door counseling and testing will also be initiated. Close collaboration with other program services will continue, as will regular supervision of all VCT sites, in order to guarantee quality of service and the availability of supportive counseling for all clients in need. PLHIV will be trained and involved in all these activities. Private community based health facilities will be sensitized on the need for Provider Initiated Testing and Counseling. A special training for teenagers will also be done to promote HIV testing among young people.

Care for counselors will continue through various anti-burnout strategies including review retreats, in-service training, upgrading courses and supervision. VCT volunteers will be provided with onsite training as a way of building their capacity and maintaining motivation. This program will also pay particular attention to monitoring and evaluation and quality data collection and management.

In Tanzania, the USG team had decided to regionalize partners working in PMTCT. Consequently, a fairly standardized package of services is implemented throughout the country by multiple partners in their respective regions. This program will continue support for PMTCT services in Arusha and Manyara. The target populations include women of reproductive age and their families. Cost efficiencies will be achieved by decreasing cost inactivities such as centralized, introducing mentoring and and advocating for increased funding of program activities from the GoT's own resources. The prgram will focuses on sustainability and the ultimate goal is support program with local government. The GoT will be the primary transition partner and recipient of capacity-building efforts.

The base funding will especially be used to increase quality of services related to mother and child health in a program reached by a ongoing PMTCT project . In addition, it will maintain the targets that have been met, and will try to even go beyond.

The program will scale-up PMTCT services to cover 98% of the facilities providing RCH services in focused facilities in Arusha and Mnanyara. Selian will support services that include but are not limited to: HIV testing (in ANC, L&D), partner testing, counseling on infant feeding options (IF), strengthening counseling on FP methods to HIV+ mothers during postpartum visits, offering HIV testing at the FP clinic, offering 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, rolling 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, conduct PMTCT outreach services in hard to reach areas and normadic populations, quarterly supportive supervision together with the RHMT to ensure quality of services. Selian will ensure the availability of HIV test kits by linking with MSD and SCMS, ensure adequate supply of drugs for more efficacious regimen based on needs and support printing and distribution of IEC materials and job aids.

TA will be sought from EGPAF and AIDS RElief to strengthen M&E in PMTCT and will ensure guidelines and M&E tools are available, improve data collection systems, and train service providers on filling of the PMTCT monitoring tools, including Data Quality Assurance activities. The program will strengthen and participate in CHMT annual review meetings, the formation and integration of regional PMTCT task forces into Reproductive and child health, support regional quarterly partners meetings and strengthen linkages and referrals.

In Tanzania, treatment partners implement a standard package of services throughout the country in their respective regions. The Selian program will continue to support adult ART services in Arusha and Manyara. The target population includes men, women, and their families.

The program will support the ART serices in several CTC clinics it currently support, and ensure it implements and monitor a comprehensive ART program. Activities for the program will include supporting initiating, refill and outreach sites, increasing the number of pregnant women and HIV+ TB patients who are initiated on treatment, improving linkages and referrals between HIV program areas, strengthening support groups in facilities and communities, improving health seeking behaviors, integrating family planning methods in HIV/AIDS care and treatment services, and introducing point of care CD4 testing (PIMA).

Selian will supports and implement the URTs initiative of adopting the latest WHO recommendations and roll out implementation of the guidelines in a phased approach. The program supports initiation of ART for all HIV positive pregnant women with CD4 counts below 350. In addition, irrespective of CD4 counts, all TB patients co-infected with HIV, all HIV positive children below the age of 24 months, and all patients with clinical stage 3 and 4 will be initiated on ART through the program. Patients identified in need of treatment from feeder systems (such as PMTCT, TB/HIV clinics, PITC, and EID) will be accommodated, while treatment support for HIV-infected pregnant women to reduce maternal mortality and prevent HIV-transmission to the baby will be prioritized. Point of care CD4 tests at ANC will be deployed, once endorsed (PIMA currently being in the final evaluation phase) , and ARV services will be integrated into TB and ANC clinics. Through their regions and districts, providers will be supported to build their capacity through refresher training and mentoring.

The program will sought TA from EGPAF and AIDSRelief and strengthens M&E in care and treatment by ensuring national guidelines and M&E tools are available, used, and improving data collection systems, and training service providers on filling out care and treatment monitoring tools. Selian will participate in CHMT annual review meetings are facilitated and strengthened, while support of activities in the focus districts and regions will be aimed at strengthening coordination of care and treatment services.

In Tanzania, treatment partners implement a standard package of services throughout the country in their respective regions. The Selian program will continue to support adult ART services in Arusha and Manyara.

Activities will focus on improving the quality of services being provided to children infected with HIV, with a specific focus on scaling up early diagnosis and treatment through Early Infant Diagnosis (EID). Focus on provider initiated testing and counseling (PITC) for older children in all pediatrics entry points, including MCH, pediatrics wards, malnutrition rehabilitation wards, care and treatment clinics, and OPD.

The program will strengthen follow-up and linkages to treatment. The revised PITC and PMTCT guidelines will be utilized, while early identification of HIV exposure will be prioritized. Adoption of WHO guidelines, including earlier treatment for infected children below two years, will be incorporated into the program. Onsite mentoring, training, and resources to health care providers will be supported to improve their capacity and competency in the implementation of pediatric care and treatment interventions. Links to PMTCT and pediatric HIV care and treatment will initiate efforts to scale up comprehensive PMTCT and pediatrics HIV care, treatment, and support services. The program will promote the provision of pediatrics care and treatment services at RCH sites, which includes early identification of HIV status and infection, and follow up of HIV exposed infants.

The program wil sought TA from EGPAF and AIDS Relief to strengthen M&E in pediatric care and treatment by ensuring national guidelines and M&E tools are available, improving data collection systems, and training service providers on filling out care and treatment monitoring tools. Selian will participate CHMT annual review meetings will be facilitated and strengthened, while support of activities in the focus districts and regions will be aimed at strengthening coordination of care and treatment services.