Detailed Mechanism Funding and Narrative

Details for Mechanism ID: 4530
Country/Region: Tanzania
Year: 2007
Main Partner: Columbia University
Main Partner Program: NA
Organizational Type: University
Funding Agency: HHS/CDC
Total Funding: $4,810,720

Funding for Biomedical Prevention: Prevention of Mother to Child Transmission (MTCT): $800,720

With the addition of requested Supplemental funds to our current allocation of COP07 funding, total funding will support: partnerships with 18 district health authorities to strengthen their capacity for pMTCT initiation and supervision among 80 facilities; 50,000 pregnant women to receive counseling and test results; 1800 pregnant women to receive a completed course of ARV prophylaxis; and 200 health workers trained in pMTCT services.

Goals and Objectives Goal: To support the pMTCT program of the Tanzania MOHSW to reduce mother-to-child transmission of HIV among HIV-positive pregnant and post-partum women and their infants. Objective 1: To provide an additional 31,600 pregnant women with comprehensive pMTCT services and 1025 HIV-positive pregnant women with complete ARV prophylaxis Objective 2: To increase capacity of district health management teams to design, implement and monitor pMTCT services in an additional 56 health facilities Objective 3: To create support systems for the retention of HIV-positive mothers and children in HIV care services Objective 4: To support the national-level implementation of the revised pMTCT guidelines Key Approaches • Use of ‘District Network Model'to dramatically increase pMTCT access: ICAP Tanzania will partner with council health management teams (CHMTs) to implement and strengthen pMTCT services. ICAP Tanzania and CHMTs will develop district pMTCT plans which will include identification of key staff in facilities, training of health care workers on the national pMTCT curriculum, procurement of pMTCT supplies, and supportive supervision of services by CHMT members. • pMTCT Rapid Start-up Teams for accelerated service expansion: ICAP-Tanzania staff will provide technical assistance to CHMTs on design and implementation of pMTCT rapid start-up teams that will initiate pMTCT services at new health centres and dispensaries within districts. Activities will focus on counseling and testing, uptake of antiretroviral prophylaxis regimens, providing HIV-exposed infants (HEIs) with cotrimoxazole prophylaxis, and engaging HIV-infected mothers, their HIV-infected infants, and other family members in care and treatment. Follow-up supportive supervision visits will be conducted jointly by ICAP-Tanzania and CHMTs. As facilities and CHMTs become more proficient in pMTCT service delivery, ICAP-Tanzania will phase out its level of technical assistance in order for health authorities and facilities to complete ownership of programs and to allow for initiation of services in new districts and facilities. • Enhanced pMTCT prophylaxis and infant feeding counseling to markedly reduce HIV transmission: As per the revised national pMTCT guidelines, program emphasis will also focus on uptake of the more efficacious WHO recommended regimens. Activities will focus on provision of pMTCT refresher trainings, design of site-level continuing education sessions, and creation of job aids and patient education materials to increase awareness among health workers and clients. Since post-partum transmission accounts for nearly 40% of MTCT of HIV, enhanced technical assistance on infant feeding counseling is critical. Activities will include provision of infant feeding training, continuing medical education sessions on infant feeding counseling techniques, as well as interventions designed for use via client support groups and expert patient programs. • Expedited initiation of ART among eligible pregnant women to curtail HIV-transmission and promote the health of mothers: HIV-positive mothers will receive immediate CD4 screening to determine ART eligibility, as well as clinical staging for HIV disease. Program systems will be designed so that mothers who are ART-eligible will receive expedited initiation onto ARV therapy. Services will include transport of blood samples to district labs for CD4 testing as well as patient referral and tracking for enrollment into care and treatment clinics. • Family support groups to keep families in care and adherent to ARVs: Family support groups for HIV positive mothers and their families will be established. This will provide a forum for follow up and retention of the family in pMTCT services, improving uptake of antiretroviral prophyaxis, ensuring adherence and discussing issues like infant feeding options. The group will also assist in tracing of mothers and infants who are lost-to-follow-up. • Partner invitation letters to increase male involvement in PMTCT services: All pregnant mothers will be provided letters inviting partners to attend an ANC appointment to learn how to better support the well-being of the expectant baby. Upon arrival at the ANC, the male partner and the pregnant mother will participate in couples counseling on the needed

care for newborns, including HIV counseling and testing.

Funding for Sexual Prevention: Other Sexual Prevention (HVOP): $200,000

Funds are requested to support assessments to guide medical male circumcision policy development and planning for future service delivery in Tanzania. The Government of Tanzania, through staff from the Ministry of Health and Social Welfare's National AIDS Control Program, participated in WHO MC consultations and there is continued interest in this area. The ministry believes that additional information about the feasibility and acceptability of MC in Tanzania is needed to assist with further decision-making. Assessments will be conducted to determine: the prevalence and acceptability of MC; the current capacity of the Tanzanian medical infrastructure to delivery MC services; and the current policy environment. The assessments will be designed and carried out by Columbia University with assistance from the PEPFAR MC task force. Whenever possible, WHO/UNAIDS tools will be adapted and used for assessment activities.

Funding for Care: TB/HIV (HVTB): $300,000

The Columbia program in Tanzania will use FY07 Plus Up funds to fully implement the integration of TB and HIV in their 28 care and treatment sites in four regions in Tanzania: Pwani/Coast, Kagera, Kigoma and Zanzibar. As part of their robust care and treatment program, they will expand services to include screening of at least 80% of HIV care and treatment clients for TB at all care and treatment clinics (CTC). This will involve instituting a "TB screening checklist" as part of routine clinical assessment at each visit; training of providers in co-management of TB and HIV and on effective TB screening (symptom checklist and diagnostic algorithm) and carrying out supportive supervision at CTC sites. They will also provide family members of TB-positive CTC clients with TB screening through use of the genealogy TB testing tree tool and provide training and supportive supervision on quality TB screening, such as TB microscopy to laboratory staff. All TB clients will be actively provided routine counseling and testing, either directly in the TB clinic or as part of an active referral system within the facility. CU will seek innovative methods to link with local community based organizations or private groups providing TB services.

Within district and district-designated hospitals, CU will assist in building linkages between the TB and HIV clinics through a multi- disciplinary team approach. Management and focal persons in the CTC and the TB clinics will be supported to plan and implement an integrated program. To improve access to care at lower level centers as part of a district network approach, CU will increase the referral of TB/HIV positive adult and pediatric clients from these sites to CTC's and TB service outlets. This will involve linking these clients from lower level health centers to the appropriate CTC service outlet and tracking them through a two-way referral system.

CU will implement practical measures to prevent TB transmission in health care settings such as minor repairs, innovative work schedules, improved ventilation and protective gear. Clinical care will also focus on decreasing incidence of opportunistic infections among TB/HIV co-infected adults, children and infants through training providers on the use of cotrimoxazole prophylaxis among TB/HIV co-infected clients. Finally, CU will emphasize adherence to both TB and HIV treatment. They will ensure delivery of adherence counseling to minimize loss to follow up, as well as implement a defaulter tracing system. They will institute a system of coordinated appointments for families with multiple HIV-positive family members, train providers and pharmacists in adherence counseling at each visit and train providers in family-oriented adherence.

Funding for Treatment: Adult Treatment (HTXS): $3,260,000

Expanding HIV Care and Treatment Services in Kagera, Pwani, Mtwara, Kigoma and Zanzibar (TZ funds)

Columbia University, International Center for AIDS Care and Treatment Programs (ICAP) in Tanzania, has collaborated with the MOH in the expansion of HIV/AIDS services in the regions of Kagera, Pwani, and Zanzibar. In FY06, ICAP supported 13 hospitals in six regions and 5750 people on ART, including 170 children. Under regionalization, ICAP will expand to 28 health facilities allowing for 100% coverage of NACP-designated ART sites with possible expansion to additional sites in Kigoma. ICAP's target is to enroll over 12,000 HIV-positive adults and 1400 children on ART by September 2008.

In FY07, ICAP activities consist of three components: general care and treatment, PMTCT-Plus, and pediatric care and treatment. Several activities will support the development of these program components.

1) Increasing access: (a) Community sensitization will be essential to increasing uptake. Past experience has demonstrated that voluntary counseling and testing (VCT) utilization increased by nearly 50% after ICAP implemented sensitization activities. Activities will sensitize influential leaders on HIV transmission, the harmful impact of stigma, the importance of knowing one's HIV status, and the availability of services. Many of these interventions will be implemented by local organizations. In Zanzibar, ICAP will promote treatment availability among most at risk populations (MARPS).

(b) Strengthening Entry Points: Provider-initiated counseling and testing (PICT) will be supported in the maternal and child health (MCH) clinic, outpatient wards, and in adult and pediatric medical wards. Health workers will be trained in counseling and testing (C&T) then allocated to hospital wards and outpatient departments. Hospital administration will be encouraged to hold bi-weekly meetings to identify testing goals, to review progress, and to develop strategies for improvement. ICAP will also support mobile VCT through local NGOs. TADEPA has been providing C&T services and home-based care in Bukoba districts of Kagera. ICAP will partner with them to expand services to another three districts to support mobile VCT. In Zanzibar, ICAP will explore partnerships with local organizations with experience in mobile VCT among MARPS. Prevention with Positives (PWP), specifically HIV disclosure, will be incorporated into C&T programming. As discordant couples who do not disclose are common, techniques and training on HIV disclosure will be supported. Strengthening of district networking of pMTCT will increase identification of HIV-infected pregnant women and HIV-exposed infants and will ensure their prompt referral to care and treatment.

(c) Linkages: M&E activities will focus on patient tracking, utilizing existing MOH reporting mechanisms to assist with identification and referral to care. Referring counselors will compare lists of patients referred to CTCs with the list of patients actually enrolled, and patients who are lost to follow-up will be traced by local community-based organizations or, where none exist, district health authorities.

2) Quality Services (a) CU will train 90 health workers in care, ART, and adherence counseling through Zonal Training Centers and in collaboration with regional health authorities, will provide on-site clinical mentoring on HIV care and management of ART toxicities and treatment failure and co-management of TB and HIV. HIV clinic providers will be trained to conduct TB screening in the CTC using a standard questionnaire. Those with suspicion of TB will be referred for sputum smears and x-ray examination. Clients diagnosed with TB will be provided a two-way referral letter and a CTC counselor will either escort the client to the TB clinic or for ensuring client follow-up through patient tracking. All CTC patients diagnosed with TB will be provided cotrimoxazole prophylaxis and ART, when appropriate. Specific interventions for pregnant women include CD4 screening of all HIV-infected pregnant women with expedited initiation onto ART for those eligible. Links with malaria prevention programs will be supported as well. HIV disclosure and family testing and PWP will be reinforced during clinician sessions. Micronutrient supplementation will also be provided, in addition to referral to food supplementation programs.

b) Pediatrics: Technical assistance (TA) will focus on increased case-finding of

HIV-exposed infants and infected infants and children. HIV counseling and testing - either through opt-out services in the MCH, use of testing algorithms for DCT in pediatric wards, or PCR DNA testing for early infant diagnosis - will be the key mechanisms for entry of HIV-positive children into care and treatment. In the MCH, protocols will establish specific staff (i.e. nurse counselors or receptionist) responsible for identifying and referring mothers with unknown status for testing and for transferring HIV status of the mother from the ANC card to the well-baby card. As MCH clinics include well and sick baby services, opt-out testing of the mother in immunization clinics and clinical staging algorithms of children in under-5 clinics will be a focal point of technical assistance. Two-way referral systems with back-up defaulter tracing will help ensure HIV-exposed infants and infected children are followed. ICAP's assistance will prioritize use of cotrimoxazole. Providers will be trained on the use of cotrimoxazole and on the national pediatric ART guidelines. Pediatric TB screening will be supported in CTC's, as well as referral for food supplementation and malaria preventive measures.

c) Adherence support and retention in care: With District AIDS Coordinators, ICAP will develop an inventory of HIV related services offered by CBOs, PLWHA groups and NGOs in the district. CTC clients will be linked with these organizations, depending on the client's needs. A two-way referral system will be used and a point person in the CTC will be responsible for ensuring sound linkage between client and community support. When possible, CBOs will participate in CTC multidisciplinary team meetings for case conferencing of clients and to identify areas for client support. In communities where such services are not available from NGOs, village health workers in district health systems will provide adherence support for CTC clients and will be trained to assist in patient tracking. All ICAP supported CTC's will be linked to HIV support groups. Support groups will be encouraged to discuss HIV disclosure, family testing, coping strategies, reduction of risky behaviour, particularly as they may affect adherence to treatment.

3) Strategic information: M&E activities will focus on strengthening and optimally utilizing existing MOH reporting mechanisms between facility levels to assist with identification and referrals. Effective paper reporting systems will be established, with computerization of 7 high volume sites. M&E Officers and data managers will be assigned specific regions where they will be responsible for the reporting systems and data flow, with central coordination in the Dar es Salaam office. In Kagera where CU is supporting PMTCT, CTC and Infant Diagnosis activities, there will be a fully dedicated M&E Officer and data manager. The M&E staff will be instrumental in establishing and strengthening two-way linkages between service delivery points and implementing data quality assurance protocols for both paper-based and electronic systems for collection of national indicators. Site supportive supervision visits will be conducted quarterly with training workshops semi-annually. In this way, CU plans to build the capacity of site staff to independently collect and summarize data and to conduct simple analyses for input into program activities.

Funding for Laboratory Infrastructure (HLAB): $250,000

Tanzania mainland has a generalized HIV epidemic with a prevalence of 7% in the general population and 8.7% in the antenatal clinics (ANC) surveys. Approximately 1.4 million women give birth annually, 122,000 of them infected with HIV. In the absence of any intervention 40% (48,800) of these children are at risk of getting infected.More than half of these children are likely to die if not identified and provided with care and treatment by the age of 12 months. The rapid disease progression and the high fatality rate demand a focused effort to identify and diagnose HIV exposed infants as early as possible. However, the high morbidity and mortality rates in untreated children justify the efforts needed to develop an early infant diagnosis program (HEID) which the Tanzania Ministry of Health and Social Welfare (MOHSW) has taken positive steps to implement.

Although widespread accessibility to HIV testing is being scaled up through innovative approaches such as provider-initiated testing, a definitive diagnosis of HIV infection in infants through serological testing is complicated by maternal antibodies circulating in the infant for as long as 18 months. Serological tests on the mother or infant only define exposure whereas a definitive diagnosis hinges on detection of virus nucleic acid by polymerase chain reaction (PCR). This molecular-based technology is costly and requires dedicated laboratory space and appropriately trained staff. A negative serological test in a non-breastfeeding infant is considered as an indication of no infection. A public health approach is therefore required to enable widespread availability in a resource constrained country such as Tanzania. Tanzania's strategy is to establish centralized diagnostic DNA PCR capacity at the four zonal hospitals on the mainland and sample transportation mechanisms utilizing Dried Blood Spot (DBS) filter papers thereby facilitating widespread access to early infant diagnosis, and therefore, care and treatment. Currently only the Bugando Medical Center in Mwanza funded by Columbia University (CU), a USG partner, has established DNA PCR.

In order to rapidly scale up HEID, the MOHSW formed an Infant Diagnosis Steering Committee. A task force was also established by the committee comprising stakeholders from both clinical and laboratory programs. The task force has conducted a situational analysis for HEID implementation in the four zones, drafted a National HEID strategic action plan and laboratory standard operating procedures (SOP) for HEID in Tanzania. The situational analysis revealed several gaps in infrastructure, equipment, personnel and laboratory organization. The draft National HEID addresses these gaps with partners and stakeholders playing crucial roles such as The Clinton Foundation, AMREF, CU and CDC. In addition, other USG funded treatment partners, Family Health International, Harvard, Elizabeth Glaser Pediatrics AIDS Foundation (EGPAF), Department of Defense (DOD) have zonal infant diagnosis responsibilities in the Eastern, Dar es Salaam, Northern and Southern Highland zones respectively. Columbia, in addition to their national efforts, also has responsibility for the Lake Zone.

USG in collaboration with the MOHSW and other stakeholders, would like to fund Columbia (CU) to take the technical lead in assisting the MOHSW to roll out HEID in Tanzania. These activities will build on CU experience in Mwanza, and will complement the logistic support from AMREF. The activities to be funded will establish and strengthen national systems for service implementation, and increase service availability in the four geographical EID zones. CU will participate in the design of national guidelines and tools by June 2007, the modification of pilot program tools in order to develop national laboratory specimen logs and sample tracking tools, patient registers and patient tracking forms. This funding is requested to enable CU in the development of /enhancing technical capacity within national health authorities by July 2007: CU will train with MOHSW and CDC, 15 MOHSW officials to serve as master trainers in early infant HIV diagnostics and 10 zonal trainers in each of the four early infant diagnosis (EID) geographical zones. Each zone will have an EID Start-up Team, consisting of zonal trainers and CU Tanzania staff. CU will phase-out direct involvement in the start-up teams after the ninth month. CU will be directly responsible for facilitating initiation of EID services in 4 EID zones by end of August 2007. CU will provide technical assistance on service initiation in the zonal hospital and two peripheral facilities in each of the four zones, totaling 12 facilities. They will conduct site pre-assessment two weeks prior to training as part of the EID Start-up Team. At each site they will: sensitize facility health workers; determine site-level patient flow patterns; identify multiple entry points such as pediatric wards; reproductive and child health clinics; implement a HEI register; establish a HEI follow-up clinic; sensitize staff on routine monitoring of HEI (i.e. growth and developmental milestones monitoring and

cotrimoxazole prophylaxis administration); establish linkages between home based care groups and HEI follow-up clinic for lost-to-follow-up tracing; and identify two focal persons for the program and identify training participants. In addition, CU will establish systems for seven program elements: These are identification system for HIV-exposed infants, collection, storage, transport, and tracking of dried blood spot (DBS) samples, follow-up care including co-trimoxazole prophylaxis, infant feeding practices, lost-to-follow-up tracing, care and treatment for infected infants and quality assurance of laboratory procedures. CU will partner with AMREF to establish transport and tracking of DBS samples and train AMREF in the design and implementation of these services. CU will train 240 health workers from the 12 facilities on DBS sample management and program implementation; the EID Start-up Teams will conduct two-day didactic trainings. CU in collaboration with AMREF will support the training costs. Training will consist of : Introduction to Infant Diagnosis, Diagnosis of HIV infection in children, Collection, Storage and Transportation of DBS samples, Cotrimoxazole prophylaxis, Growth Monitoring, Infant feeding, Infant Diagnosis monitoring and evaluation and case studies. Didactic sessions will be followed by a five-day session of onsite mentoring on the seven program elements (listed above), as well as assistance with completion of program tools and with testing algorithm interpretation. CU will lead the implementation of the supportive supervision schedule by the EID start-up team; conduct joint supportive supervision visits one morning per week for months 1-3 and one morning per month for months 4-9 and facilitate zonal meeting between implementing sites to share experiences and lessons learned. With a view to increasing service availability in the four EID zones, CU will establish technical capacity among USG ART implementing partners by training five staff from each of the five USG ART implementing partner organizations on DBS sample management and program implementation. These participants will be trained by the zonal trainers and the implementing partners will scale-up services in their respective regions in accordance with national planning.

Targets

Target Target Value Not Applicable Number of tests performed at USG-supported laboratories during  the reporting period: 1) HIV testing, 2) TB diagnostics, 3) syphilis testing, and 4) HIV disease monitoring Number of laboratories with capacity to perform 1) HIV tests and 2) 3  CD4 tests and/or lymphocyte tests Number of individuals trained in the provision of laboratory-related 246  activities

Table 3.3.13: Program Planning Overview Program Area: Strategic Information Budget Code: HVSI Program Area Code: 13 Total Planned Funding for Program Area: $ 5,937,026.00

Program Area Context:

USG's emphasis for Strategic Information (SI) in Tanzania is two-fold: 1) ensuring that quality data are collected and used for planning and implementing HIV interventions; and 2) building local SI infrastructure and capacity to ensure sustainability of HIV programs.

The USG Five-Year strategy and a recently-updated three-year strategy for SI (in supporting documents) guide FY 2007 COP activities. A data platform in support of integrated health management information systems (HMIS) is the primary new activity in SI.

Successes in FY06 include: a) strengthening of the USG SI Team, b) conducting HIV surveillance and surveys that provide information about the HIV epidemic in Tanzania for resource planning, and c) strengthening HMIS in selected activity areas.

Challenges specific to SI within PEPFAR are a) insufficient human resources in Tanzania to manage and analyze data at sub-national levels, b) SI activities conducted in other program areas are not consistently reported by partners, and c) the SI indicators do not adequately capture the scope of SI work.

Planning and Reporting:

The USG SI team includes an SI Liaison and staff in M&E, surveillance and HMIS. MEASURE/Evaluation provides a Resident Advisor and technical assistance (TA) and USG agency headquarters also provide TA. SI staff coordinates reporting on indicators for the semi-annual and annual reports. For the COP, SI staff prepares the SI section; participates in USG program area thematic groups to ensure linkages on target-setting and HMIS; and oversees COP data entry. SI staff monitors partner SI activities across PEPFAR program areas and works with the Government of Tanzania (GOT) on SI related activities. In FY 07, the USG will implement an information system based on a relational database design for tracking progress toward meeting targets.

Technical Work/Services:

In FY07, USG will support GOT through direct funding and TA to carry out surveys, surveillance, HMIS, and M&E activities described below. The USG SI focus is on decentralized data management: strengthen paper-based tools to ensure that reliable data across HIV service areas are collected at provider level, and facilitate data transfer from sub-national to national level with use of data for program monitoring and planning. Feedback to program staff is important to improve the quality of data and to support data use for decision making. Provision of information on a set of standardized indicators for the GOT, PEPFAR partners, and for other donors (e.g., Global Fund and bi-laterals) will also be strengthened.

Surveys: USG will support the Ministry of Health and Social Welfare (MOHSW) and the National Bureau of Statistics (NBS) to disseminate results from the 2004 Demographic Health Survey (TDHS) and the 2003-2004 Tanzania HIV Indicator Survey (THIS) and to implement a repeat THIS in 2007. USG will support NBS to disseminate results from two facility-based surveys conducted in 2006, the Service Provision Assessment (SPA), conducted in 600 facilities, and Services Availability Mapping (SAM).

Surveillance: USG will support the National AIDS Control Programme (NACP) to conduct surveillance among antenatal clinic (ANC) attendees in 128 sites in 21 regions. With TA from USG and UNAIDS, the NACP conducted trend analysis using three years of ANC data. NACP will conduct a repeat HIV Drug Resistance Threshold survey, with greater geographical coverage, nested in ANC surveillance. In addition, SI and PMI have discussed the possibility of adding a malaria prevalence component to the ANC survey. Tanzania will use the BED-CEIA (capture enzyme immunoassay) to estimate HIV-1 incidence in 2006 ANC attendees and possibly the 2007 THIS (both sentinel and population-based serosurveys). To provide

information to inform prevention activities for most at-risk populations (MARPs), and potential bridging populations, behavioral surveillance surveys with biological markers will be conducted in mainland and Zanzibar. This is particularly important to Zanzibar which has a concentrated epidemic.

HMIS for service delivery: The SI team will work closely with the GOT in mainland and Zanzibar to improve data collection for monitoring of ART, PMTCT, TB/HIV, CT, HBC, OVC, and Laboratory programs while ensuring confidentiality of patient-level data. The GOT's policies and strategies are followed to harmonize paper and electronic data collection tools, which differ by program area. For ART, USG and its partners are supporting GOT's use of Care and Treatment Clinic (CTC) 2 and 3 forms, with flexibility for partners to use their own HMIS. DOD has an electronic medical record system which will be scaled up to other sites in DOD's three regions (7747 in HTXS). A national assessment of the impact of ART services in Tanzania will be conducted with the GOT and treatment partners (in HTXS). To support the development and strengthening of information systems and use of data within the NACP, USG has put funding directly in programmatic areas.

A WHO Resident Advisor (supported by FY06 funds) will support the NACP in program monitoring. Use of personal data assistants (PDAs) will be piloted during supportive supervision to improve quality of data collection and data use. Several treatment partners will fund M&E Officers at sub-national levels to build capacity and increase demand for data.

Data platform for integration of separate activity-area HMIS: The USG will identify a partner (TBD) to work with MOHSW to develop a data warehouse platform, an electronic system upon which all of the databases can sit. The District Health Management Team will be able to enter data for multiple program areas using a single portal (e.g., NACP, Diagnostic Services). This partner will work with the University of Dar es Salaam Computing Center on system development to ensure local ownership and build sustainability. A wide area network (WAN), built in 8 regions using FY 05 and FY 06 funds, will be strengthened to support the platform and data transfer needs in FY07.

Public Health Evaluations: A previously approved evaluation of MARPs in Dar es Salaam and Zanzibar (7818) will address service needs of injection drug users (IDUs) and inform the design of interventions. An evaluation funded in FY 05-06 of a stigma reduction campaign will be completed in FY 07. Two additional evaluations (in HTXS), will address costing of ART service delivery through regionalization (8840) and drivers and barriers to treatment-seeking behaviors in HIV-positive men (8841).

Policy, Three Ones, and Linkages: In FY07, the USG will help build GOT M&E capacity by hiring staff for and collaborating closely with both the NACP and the ZACP. TACAIDS (mainland), the GOT entity responsible for the multi-sector approach to HIV and AIDS activities, has recently received support from World Bank to develop a National M&E Roadmap, an integrated costed work plan, to which USG contributed. USG SI staff serves on the TACAIDS M&E technical working group. The USG communicates regularly with WHO, UNAIDS, the World Bank, and participates in the Development Partners M&E Group. The SI Team is exploring collaborations with GOT and donors, including the GFATM, to address mechanisms for expanding the skills of staff responsible for data management and M&E at the sub-national level.

Sustainability: USG supports staff in the Epidemiology Unit of NACP and ZACP and provides training and TA for data systems to ensure overall coordination and program monitoring and evaluation. The data warehouse and capacity-building activities will provide critical inputs to ensure that quality data are collected and data are used for decision making.

The SI section contains 19 narratives: 4 in USG M&S and HQ TA, 8 for GOT (ZACP, ZAC, MOH, and 5 for NACP), WHO in support of NACP, 2 for MEASURE, SCMS for procurement, a TBD TE for IDUs, FHI for a FY 05-06 TE, and a TBD for the data platform.

Program Area Target: Number of local organizations provided with technical assistance for strategic 752 information activities Number of individuals trained in strategic information (includes M&E, 2,042 surveillance, and/or HMIS)

Table 3.3.13:

Subpartners Total: $2,827,964
Tanzania Development and AIDS Prevention Trust: NA
Deloitte Consulting Limited: $997,084
Ocean Road Cancer Institute: $180,025
Medecins du Monde: $699,956
Bagamoyo District Hospital: $152,357
Tumbi Regional Referral Hospital: $138,535
Kisarawe District Council: $76,060
Mkuranga District Council: $77,342
Zanzibar AIDS Control Program: $81,933
Zanzibar NGO Cluster for HIV/AIDS Prevention and Control: $60,000
Zanzibar Association of People Living with HIV And AIDS: $50,000
Service, Health and Development for People Living Positively with HIV And AIDS: $30,000
Mafia District Council: $77,392
Rufiji District Council: $71,660
Mchukwi Mission Hospital: $75,620
Regional Medical Office Kagera: $20,000
Regional Medical Office Kigoma: $20,000
Regional Medical Office Pwani: $20,000