The goal of this program is to increase the number of local partners with the capacity to expand activities to maximize coverage through quality comprehensive HIV care and treatment services. The initial geographic focus regions are Pwani, Kigoma, Kagera, Zanzibar and Mtwara. Activities to be supported by one or more local indigenous partner in the FY2013 COP focus on six key objectives to accomplish; 1) Increase percentage of adults and children alive and on treatment at 12 months, from 67% to 85%; 2) Increase percentage of HIV positive pregnant mothers initiated on ART through PMTCT from 14% to 98% as a result of implementation of Option B+; 3) Increase percentage of TB/HIV co-infected individuals tested and treated with ARVs from 40% to 90% due to full adoption of WHO 2010 treatment guideline ; 4) Increase retention of HIV positive patients in care and treatment from 67% to 85% through improved adherence counseling and proper linkages, referrals and patient tracking; 5) Increase percentage of individuals confirmed with HIV positive test result from HTC sites and successfully linked to care and treatment services, from 60% to 80%, including testing services for male circumcision clients; and 6)Improve the ability of C/RHMTs to plan, implement, and manage an HIV program, as demonstrated by the ability to lead 100% of quarterly partner coordination meetings; and to increase their annual URT budgets to absorb 25% and PEPFAR supported-staff. The program supports Goals 1 (Services) and 5 (HRH) of the Partnership Framework. In order to establish local ownership and move towards sustainable programs, the partner will work closely with regional authorities and other local and international partners, and also support comprehensive care and treatment provision.

Care and support programming will focus on two areas. The first priority area is early identification of HIV individuals, with a well-documented and closed loop linkage system and retention in care: the partner will also improve the linkage system to ensure that a newly diagnosed individual is enrolled into care and treatment, and be expected to demonstrate an improved adherence rate and a reduction in loss to follow up. The partner will coordinate with community, HTC, TB, and PMTCT partners in their region to harmonize and improve the tracking system of patients enrolled in care. The partner(s) will maximize efficiencies to ensure continuum of care. The second priority area is provision of a complete and high quality clinical care package, which includes: physical assessment, WHO staging, CD4 and other lab monitoring, nutritional assessment, counseling and support, detection and management of opportunistic infections, cotrimoxazole prophylaxis, ART management, screening for cervical cancer, Positive Health Dignity and Prevention (PHDP), pain management and end of life care.

The partner will provide supportive supervision and mentorship to ensure delivery of a high quality and complete clinical care package. Funds will be allocated for activities and initiatives that will utilize continuous quality improvement science and methods to demonstrate a measurable improvement in the complete clinical care package as well as systems of linkages and retention.

With these funds, the partner(s) will strengthen TB screening and case detection by implementing Intensified Case Finding (ICF) at care and treatment clinics (CTC), among pregnant women, OVC, pediatrics, uniformed forces and in congregate settings. Identify TB suspects, act rapidly to conduct diagnostic evaluation of suspects and 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 TBHIV 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.

FY2013 COP funds for pediatric care will focus on scaling up cotrimoxazole (CTX) prophylaxis for HIV-exposed and infected children, and providing nutrition assessments, which include anthropometric measurements for growth monitoring, nutritional counseling, support and referral for severe malnourished children. Funds will also be used to provide incentives to community support groups to improve retention through tracking of loss to follow up in children and families. The facility care and treatment partner will collaborate with a HBC partner to maximize efficiency and ensure continuum of care for families. The program will target low coverage regions for ART for the partners to collaborate with Medical Professional bodies to cascade pediatric outreach services, training, mentorship, advocacy and community mobilization that will increase enrollment to treatment for children to reach WAD targets.

The proposed funds will support the rollout of Option B+ whereby all HIV positive pregnant women will be initiated on ART, regardless of CD4 count or WHO clinical stage. While preparing for B+, the PMTCT program will continue scaling up services to 100% of all facilities offering RCH services, providing prophylaxis/treatment to 95% of all HIV positive pregnant women identified. The partner will also increase coverage for EID sites to cover 80% of PMTCT sites with EID services, and scale up testing for HIV exposed infants to at least 60%.

Furthermore, additional efforts will be made to scale up community-based initiatives, including mother peer support groups, and follow-up of mother-infant pairs in the community to ensure timely delivery of DBS results to the mother and provide outreach services. Couples counseling will be advocated as well as gender based violence andPHDP issues. Quality improvement will also focus on PMTCT and MCH services, and strengthen service integration and linkage of PMTCT and CTC services. The partner will also continue to support the national efforts to scale up BEmONC and FANC, and to initiate support for the roll out of post-natal care and the community health worker approach, which have just been approved by the MOHSW.

FY2013 COP funds will focus on scaling up and maintaining ART services in the Kigoma, Kagera, Pwani, Zanzibar, and Mtwara regions. The partner will focus on intensive strategies and activities leading to increased identification of HIV positive people, timely ART initiation with maintenance of these patients on ART through quality clinical services, and retention of patients on care and treatment. The partner will ensure coordination and collaboration among the ART, HIV Testing and Counseling, and Home/Community Based Care partners to increase identification, strengthen linkages of identified HIV+ patients, refer them to care and treatment facilities, and retain them in care and treatment. In addition, to accommodate the full adoption of the new National ART guidelines, by which all patients with a CD4 count under 350 should be initiated on ART, the partner will promote increasing clinic days at facilities, conduct comprehensive reviews of pre-ART patient charts to determine eligibility, and enhance efforts to conduct outreach services. These initiatives will support the MOHSW and NACP to reach ambitious National ART targets.

The program will implement training, on-site mentorship, advocacy, community mobilization, and pediatric-specific quality improvement initiatives in Kigoma, Kagera, Pwani, Zanzibar, and Mtwara regions. Specific activities proposed include:

- Enhance the identification and diagnosis of HIV for infants and children through scaled up EID services, PITC in in-patient and out-patient settings, immunization, OVC services, and TB/HIV clinics;

- Encourage family testing at CTCs;

- Increase treatment enrollment to identify HIV infected children through implementation of updated WHO treatment guidelines, including treatment of all HIV infected children <24 months;

- Conduct pre ART review of all children in care to determine eligibility for the new 2012 NACP guideline.

FY2013 COP funds will also be used to improve monitoring response and adherence to treatment.