Detailed Mechanism Funding and Narrative

Details for Mechanism ID: 4556
Country/Region: Tanzania
Year: 2007
Main Partner: Mbeya Referral Hospital
Main Partner Program: NA
Organizational Type: Host Country Government Agency
Funding Agency: USDOD
Total Funding: $3,305,000

Funding for Treatment: Adult Treatment (HTXS): $3,112,500

ARV Services-Mbeya Referral Hospital

The Mbeya Referral Hospital (MRH) is one of five zonal hospitals in Tanzania. Its function in the Southern Highlands is to provide training, to coordinate and oversee the quality of treatment and to establish health service referral systems among four regions (Mbeya, Iringa, Rukwa and Ruvuma) serving a catchment population of over six million people. Initiated in late 2004, under Emergency Plan funding and multiple donor support, an extensive infectious disease medicine clinic, in-patient services and training facility with a referral level laboratory at this hospital continue in evolution.

The FYO7 aliquot of funding will support the referral hospital in its role as a training center for HIV care, technical supervisor for the services in the Mbeya, Rukwa and Ruvuma Regions, and provider of direct patient treatment. By September 2008, the Mbeya Referral Hospital will have published its regional and national, certificate level training program at this facility based on the current national curriculum in close concert with the National AIDS Care Programmme's (NACP) Care and Treatment Unit. The present basic lab and treatment courses will be revised and updated with short courses and a much more developed outreach systems of courses at regional seats for medical personnel representing the Southern Highlands and other regions of Tanzania in comprehensive HIV care by September 2008.

By September 08, the USG will continue to complement clinical training with instruction for laboratory technicians in the zone on required safety labs and advanced monitoring techniques for HIV-positive individuals. This will be linked to the submission under Lab and include collaborative efforts among the Referral Hospital, American Society for Clinical Pathology (ASCP), African Medical and Research Foundation (AMREF), CDC and the U.S. Department of Defense (DoD) - its main US Agency partner. All of the training at the referral hospital will be directly linked and integral to service provision at this facility. In partnership with CDC and the central laboratory in Dar es Salaam, the lab at the referral hospital will execute a quality assurance program and supervision of regional health facilities.

MRH serves not only as a referral and training center but also as a primary care facility. With assistance from the MOH and direct Emergency Plan FY04-7 funding, the Referral Hospital has been able to initiate and sustain a large scale ART program. Though it was only able to begin full recruitment of patients in January 2005, it now boasts a patient-load of over 1700 on ART and 4,500 on care. Though it experienced a slow start, it will exceed its September 2008 ART targets of 5,000, enrolling over 200 new patients a month. Through September 2008, it will continue to expand direct ARV treatment to reach at least an additional 1,000 individuals, bringing the total under ART at this facility to 6,000 and under care to 8,500 by September 2008. Currently, the referral hospital provides technical supervision to six additional hospitals in the Mbeya Region supporting a total patient population of 3000 on ART and another 6,000 with care. The number of facilities under its supervision will expand to an additional six by September 07 and by at least another five by September 2008. Supervisory teams from the referral hospital consisting of a medical officer, clinical office and nurse attend clinic days at lower level facilities once or twice per month. FY 2007 will be used to further strengthen the Strategic Information systems of the zone, utilizing the Mbeya Referral Hospital as the central hub for data management in the Mbeya Region with plans to expand to support all of the Southern Highlands.

Although traditional PMTCT offered by several MOHWS facilities, pregnant women in their third trimester are being identified and evaluated for triple ARV if their CD4 is less than 350/microliter. This is in process at antenatal clinic of the Mbeya Referral Hospital, and will soon became the norm at four district hospitals and three regional hospitals, and will by Sep 2007 be ensconced in 4 facilities in Rukwa and 4 in Ruvuma.

Through these sites, the pediatric ward at the referral hospital, and linkages with over ten NGOs and FBOs providing support to OVCs in the Municipality, pediatric cases are identified and evaluated for treatment. Currently over 11% of the ART and care population is between the ages of zero to 14 years. It is expected that a total of 5,420 patients (16% pediatric) will be on ART by September 2008. Mbeya Referral Hospital will increase the enrollment of children especially younger ones by promoting and supporting routine counseling and testing of children and their mothers at all contact points in the health

facilities, including immunization clinics, outpatient clinics, and in-patient wards and through PMTCT programs.

Mbeya Referral Hospital will promote couple counseling and testing for all clients that receiving counseling, care and treatment. This strategy will become the backbone for the hospital's efforts to promote prevention for positive and will also assist in boosting the number of males on treatment. As part of ensuring the continuum of care, the Mbeya Referral Hospital works in close concert with several NGOs and FBOs in the Municipality. These organizations not only assist in patient identification and referral to the HIV Care and Treatment Center (CTC) at the hospital but provide at home follow up of patients under treatment. In order to link services, training will emphasize that care for People Living with HIV/AIDS should be provided in a continuum with links from care & treatment to other programs within the health facilities and extend from the health facilities into the community.

These referrals are supported through a social worker placed at the CTC. Mentoring of these organizations with medical officers from the CTC provides additional capacity for these groups in this role. This aliquot of FY 06 funding will support continued development of the hospital in its role as a zonal center for training of clinical personnel, reagents for continued monitoring of patients, drugs for opportunistic suppression (like cotrimoxazole, fluconazole, acyclovir and even vincristine) and treatment, ART, supportive supervision to the zone, strengthening of zonal referral mechanisms and patient tracking, and expansion of the community referral system and technical support to participating NGOs and FBOs.

Mbeya Referral Hospital is requesting $500,000 in plus up funding to provide laboratory capacity building and laboratory reagents in the regions of Mbeya, Ruvuma and Rukwa in which more than 23 NACP accredited CTC sites are scattered in 17 districts. The number of patients as of March 2007 is about 25,000 since the start of ART services in October, 2004. The number of patients is expected to rise to 30,000 by the end of 2009. Pressing demand to increase testing and intervention for more pregnant mothers and infant product coupled with drive to get all ARV drug services closer to local point of care requires more resources. Funds are also requested to support the renovation of 9 lab rooms in the zone, procure ELISA, haematology, chemistry, equipments, and reagents for 9 labs and train 18 lab technicians. Mbeya Referral is requesting $100,000 to expand Strategic Information (SI) training in the regions of Mbeya, Ruvuma and Rukwa in which more than 23 NACP accredited CTC sites are scattered in 17 districts.

Funding for Laboratory Infrastructure (HLAB): $142,500

This activity links to activities HLAB MOHSW 7758, 7779 NIMR, CDCBase 7834, CLSI 7696, APHL7682, AIHA7676, ASCP 7681, AMREF 7672, RPSO 7792, BMC 7685, ZACP 8224; Track 1 ART CU7697/7698, EGPAF 7705/7706, HARVARD7719/7722, AIDSRelief 7692/7694, Blood Safety; CT NACP 7776, TB/HIV 7781, PMI, SCMS 8233, FHI 7712; SI NACP 7773, MOHSW 7761

The Ministry of health and social welfare (MOHSW) has decentralized HIV/AIDS laboratory infrastructure and capacity building to the zonal referral laboratories to expand HIV/AIDS laboratory capacity and to embrace the network model for a continuum of HIV/AIDS prevention care and treatment services. The Mbeya Referral Hospital (MRH) has one of the five zonal hospital referral laboratories which functions in the Southern Highlands to coordinate and oversee the quality of laboratory services, to provide training, and establish health laboratory service network systems among three regions, Mbeya, Rukwa and Ruvuma, which serve a catchment population of over six million people.

Emergency Plan support through the DoD is assisting this facility in realizing it role as a zonal center of excellence in clinical prevention, care and treatment. In late 2004, under Emergency Plan funding and multiple donor support, an extensive infectious disease medicine clinic, in-patient services and training facility with a referral level laboratory was initiated and is close to completion. MRH received funding in FY 2006 which was utilized for minor renovations of the current hospital laboratory and purchase of basic equipment for the laboratory. Once completed the clinical laboratory will be housed within the larger and more spacious facility.

In FY 2007 MRH will apply the quality system approach to build its own capacity as a center of excellence and support a network of regional, district faith based and private laboratories supporting HIV/AIDS prevention, care and treatment in the Southern Highlands Zone. MRH will train staff at its laboratory to perform testing for HIV diagnosis, disease staging and treatment monitoring in order to optimize prevention, care and treatment services, train laboratory and non-laboratory staff from other facilities providing similar services and support and help monitor performance through supportive supervision.

Currently, the MRH laboratory provides technical supervision to six additional hospital laboratories in the Mbeya Region supporting a total patient population of 3,000 on ART and another 6,000 with care. The number of facilities under its supervision will expand to an additional six by September 2007 and another five by September 2008. Through a USG coordinated effort high volume chemistry, hematology and CD4 equipment were supplied to MRH. This equipment will not only allow MRH to increase its direct service support capacity to the region but also develop its role as a zonal laboratory training and monitoring facility for quality assurance.

Using FY 2007 funds DoD, with its executing partner MRH, proposes to continue assisting laboratory infrastructure development and capacity building activities in the Southern Highlands. Funding in FY 2007 will enable MRH to provide ongoing technical assistance through supportive supervision to the laboratories in support of ART diagnosis care and treatment in the four regions of Iringa, Mbeya, Rukwa, and Ruvuma. MRH will organize four training workshops of 70 participants from its regions for rapid HIV and ELISA testing, CD4, and basic hematology and chemistry testing and provide training on records and specimen management. Supportive supervision team from MRH will work with district and regional laboratory staff on a quarterly basis on quality assurance documents and records to ensure that Good Laboratory Practices are implemented.

Under this submission, DoD/MRH in collaboration with CDC, will implement a zonal external laboratory quality assurance scheme (ZELQAS). Both these activities will develop the MRH capacity in maintaining and implementing standard operating procedures and Quality Assurance/Quality Control programs and assure that all regional laboratories successfully participate in the NELQAS.

Funding for Laboratory Infrastructure (HLAB): $0

This activity links to activities HLAB MOHSW 7758, 7779 NIMR, CDCBase 7834, CLSI 7696, APHL7682, AIHA7676, ASCP 7681, AMREF 7672, RPSO 7792, BMC 7685, ZACP 8224; Track 1 ART CU7697/7698, EGPAF 7705/7706, HARVARD7719/7722, AIDSRelief 7692/7694, Blood Safety; CT NACP 7776, TB/HIV 7781, PMI, SCMS 8233, FHI 7712; SI NACP 7773, MOHSW 7761

This activity links to activities under lab: Ministry of Health and Social Welfare (MOHSW), the African Medical Research Foundation (AMREF), the American Society of Clinical Pathology (ASCP), the Clinical Laboratories Standards Institute (CLSI), the American Public Health Laboratories (APHL), and the Regional Procurement Support Office (RPSO). This activity also links to activities under treatment: Mbeya Referral Hospital, Mbeya, Rukwa and Ruvuma Regional Medical Offices, and Family Health International (FHI). This activity also links to counseling and testing (Mbeya Referral Hospital, Mbeya, Rukwa and Ruvuma Regional Medical Offices).

The laboratory officers will provide technical assistance to Referral, Regional, District hospitals in the Southern Highlands of Tanzania. This support is centrally housed at the MRH. The laboratory team provides technical assistance to all three regions (Mbeya, Rukwa and Ruvuma) in maintaining and implementing standard operating procedures and Quality Assurance/Quality Control programs. This assures that all district and regional laboratories contribute to our treatment goals in the Southern Highlands of Tanzania.

MRH provides technical supervision to six additional hospitals in the Mbeya Region supporting a total patient population of 3,000 on antiretroviral therapy (ART) and another 6,000 with care. The number of facilities under its supervision will expand to an additional six by September 2007 and by at least another five by September 2008.

Currently three laboratory personnel provide lab services to support to the Department of Defense's DOD's treatment efforts in achieving COP targets. FY 2007 funding will continue to support lab technicians at MRH and also support and monitor performance of HIV/AIDS related laboratory testing services through the development of supportive supervision teams from the MRH.

Any technical assistance to Mbeya Referral Hospital will be provided through the National Technical Assistance through the Department of Human Health Services Centers for Disease Control (HHS/CDC) as part of USG collaboration for technical assistance.

Table 3.3.12:

Funding for Health Systems Strengthening (OHSS): $50,000

These funds will support a pilot anti-stigma project in the three densely populated wards of Sinde, Manga, and Ruanda in Mbeya region. The pilot will ensure that youth and parents have access to the facts about HIV, including: basic prevention; the physical and emotional aspects of living with the chronic disease, including the affects of stigma; confronting prejudice; and reducing discrimination, denial, and social fear related to HIV/AIDS. The PACT Stigma Toolkit will be used as a starting point for stigma-related activities.

After-school programs will be conducted at a local non-medical, non-religious center where music, sports, and other team activities are normally conducted. The HIV/AIDS curriculum from the Ministry of Education and Vocational Training will be taught and reinforced through team building and relationship building processes. Special use of medical professionals as mentors will be an additional entry point for stigma reduction. The mentors will be carefully selected from the pool of care and treatment staff working in Mbeya. It is anticipated that their involvement in the anti-stigma campaign will have the added benefit of reinforcing their own sense of awareness around the need for education and stigma reduction. Knowledgeable parents and older youth will also be encouraged to become mentors.

The in- and out-of school youth, including those undergoing vocational training, will be encouraged to develop their own unique programs once or twice per year to help affirm their commitment to spreading truthful information about HIV/AIDS, and to promote just treatment of individuals and families infected and affected. Likewise, home based care workers and orphans and vulnerable children will also be encouraged to participate.

FY 2007 funds will support this small pilot in three wards, but with the recent establishment of the Mbeya HIV Network of ten NGOs and FBOs in July 2006 there may soon be fertile ground for expansion of this program.