The goal of the project is to support MOHSW and NACP to expand, strengthen, and sustain high quality HCT and MC services for HIV prevention. Specific objectives are to increase access to quality HCT services by strengthening HCT and MC services; support MOHSW and NACP to expand comprehensive MC services for HIV prevention; build district council capacity with grants and TA; and support MOHSW to develop and operationalize guidelines and tools for QA of HCT services. HCT will be implemented in Arusha, Kigoma, Musoma, Mwanza, and Shinyanga while targeting MARPs, persons attending health care facilities, and hard to reach populations. MC will be implemented in Shinyanga targeting men ages 10-49 years.

Implemented strategies will be aligned with national policies and guidelines. The primary framework for capacity building and sustainability will entail direct grants to four districts. HCT will focus on institutionalizing quality of care, building local capacity, orientation of the new guidelines, providing mobile HCT to MARPs and remote areas, and the roll out of HCT QA tools. Comprehensive MC services will be expanded through static and outreach campaigns, implementation of family-centered approach targeting older men, and incorporation of couples counseling and shared sexual decision-making.

Cost efficiency will be ensured through cost effective initiatives and training that minimizes disruption of services. Documentation and dissemination of best practices will be coordinated with partners at all levels.

Transition plans will focus on reinforcing efforts in two districts of Kigoma and rely on joint district planning in all districts. M&E will be done in collaboration with MOHSW at all levels with participation in service evaluation.

The comprehensive package of Voluntary medical Male Circumcision (VMMC) services includes MC counseling for HIV prevention, risk assessments and reduction, HCT, physical examination, sexually transmitted infection screening, syndromic diagnosis and treatment, MC surgical procedure, provision of condoms and referrals to other care and treatment services. In support of efforts to scale-up VMMC in PEPFAR programs, readily available data have been applied to estimate the potential cost and impact of scaling-up VMMC in Tanzania to reach 80% of adult (ages 15-49) and newborn males by 2015. The target for FY 2012 is 50,000 and FY 2013 is 70,000 men. Those testing positive with their partners will be referred to care and treatment clinics (CTC) for enrolment.

With this funding, Intrahealth will scale up VMMC services to 5 health facilities in Shinyanga region and conduct a phased MC Service provider training for 90 health care workers (HCWs).

The funding will also allow collaboration with the MC Technical Working Group to facilitate the development and dissemination of national VMMC related policies, guidelines, monitoring tools as well as standards operating procedures.

The funds provided will support district planning and whole site orientation meetings to HCWs on MC for HIV prevention in order to create awareness, ownership and increase participation. Capacity building of council health management teams (CHMTs) will take place on planning and facilitate and advocating for inclusion of VMMC activities and budgets in the districts Comprehensive Council Health Plans for sustainability.

Funds will be used to strengthen MC services in four static clinics during normal working hours as well as Outreach services in hard to reach areas, mining settlements, ginneries, cotton plantations, during special events when need arise and through mass campaigns. Setting up these services requires space identification, site strengthening, minor renovation, procurement of MC supplies, community mobilization, orientation to key stakeholders and training of service providers.

For capacity building purposes, the funds will be used to support regional and district VMMC supportive supervision, mentoring, training and site strengthening. This will enhance mentoring, client follow up, data management and general quality of services.

Data management will be strengthened through on the job mentoring, Data Quality Assessment and capacity building for CHMTs on using data for decision making. Printing and distribution of MC registers, client appointment/identification cards, client files, theater registers, MC counseling and testing and follow up registers, monthly site report forms, carbon copy referral forms, adverse event record forms, posters/brochures and client booklets will also be done.

MC surgical procedures generate a lot of waste that need proper disposal. For waste management purposes, the funds will be used to purchase waste containers and support minor renovations of incinerators to improve waste management.

The support will be used for demand creation which is essential for continuity of service and will be strengthened in all sites. Awareness raising will be enhanced through printing of information and Education materials and other communication channels. In collaboration with MOHSW/NACP, JHU and EngenderHealth-Champion, messages targeting older men and women will be developed, pre-tested and distributed.

COP 2012 funding will assist in strengthening existing HTC services at 286 facilities with emphasis on HTC Quality Assurance (QA), expansion and maintenance of PITC services and prevention of Gender Based Violence. Funding will also focus on identifying HIV-infected patients in need of care and treatment. HTC services will target 250,000 clients in health facilities, MARPs, VMMC clients, couples, hard to reach and nomadic populations.

This funding will allow closer collaboration between Intrahealth, NACP and regions in delivering quality HTC services and providing technical support to the Counseling and Social Support Unit at NACP in developing a training roll out plan for HTC QI.

Funds received will be used to conduct refresher trainings for health care providers, to update them on new comprehensive HTC guidelines, revised HTC M&E tools, HTC QI and new HIV prevention initiatives, to increase knowledge and the quality of services. The content of refresher courses will also be based on gaps identified during supervision visits and emphasis on referral mechanisms. 35 health workers will be trained to screen for GBV and alcohol misuse within the context of HTC and MC services, safety planning, psychosocial support, referral and follow up to establish referral network among available GBV support services.

PITC services will be scaled up into 30 new facilities with basic training for 96 Health staff, site activation and trainee follow-up. Efforts will be made to integrate activities into the Council Comprehensive Health Plans for sustainability. Mobile community HTC and mobile PITC services will be organized in collaboration with regional and district teams in hard to reach areas.

With this funding, Intrahealth will support districts to conduct supportive supervision and trainee follow up for HTC service sites to ensure that there is improved program management, performance and quality of services at all levels. For coordination purposes, the funds obtained will be used to conduct regional partnership meetings in two regions aimed at strengthening coordination, collaboration and sustainability with other HTC and Treatment partners.

The funds will be used to set innovative ways to document best practices in M&E at all levels of implementation, support roll-out of new HTC monitoring tools, and data management for HTC. The anticipation of these initiatives is to create a culture in data use for implementers and decision makers, but it requires staff orientation

From the activities emanating from implementation of HTC, a number of reports will be produced; funds will be used to disseminate the reports locally and internationally for knowledge and experience sharing.

Funding will also be used to support rolling out the implementation of the new comprehensive HTC guidelines, developing and pre-testing IEC messages to expand awareness and increase demand and up-take of HTC. Support received will as well be used in printing HTC national recording and reporting tools, new HTC guidelines, HCT QA tools and any other intervention when needs arise.

Lastly, COP 2012 funds will be used to maintain existing 22 staffs and an additional four positions to be filled. Support received will enable staff to strengthen their managerial skills through study tours, program management and other short courses available at Chapel Hill, supplemented by TA visits from Chapel Hill.