Detailed Mechanism Funding and Narrative

Details for Mechanism ID: 4604
Country/Region: Tanzania
Year: 2007
Main Partner: U.S. Department of Defense
Main Partner Program: NA
Organizational Type: Other USG Agency
Funding Agency: USDOD
Total Funding: $1,758,832

Funding for Sexual Prevention: Abstinence/Be Faithful (HVAB): $10,000

This activity is linked to narratives #9460 and #9461in AB.

The USG/Tanzania Prevention Working Group has identified its critical technical assistance needs for FY07 funding in AB. These specific requests will assure effective support of the USG Team and identified implementing partners in this section of the COP. This technical assistance is envisioned to provide up to date technical information and programming guidance for effective AB messaging which includes AB for Youth and B Messaging for adult males. The identified technical assistance needs for DOD includes:

Technical assistance to work with DOD implementing partners in Mbeya Region for up-to-date information for effective AB messaging and male involvement. No specific consultant has been identified.

Funding for Testing: HIV Testing and Counseling (HVCT): $6,100

This activity relates to technical assistance being provided by the CDC and USAID. FY 2007 funds will support counseling and testing (CT) technical assistance (TA) visits by USG headquarters staff including Centers for Disease Control and Prevention (CDC), Department of Defense (DOD), and the United States Agency for International Development (USAID). This activity supports the travel, per diem and miscellaneous costs of DOD participation. The TA builds upon a March 2006 interagency technical assistance visit made by the CT technical working group (TWG). This TA team made a number of recommendations to strengthen national CT services including: increased CT promotion, introduction of an updated HIV test kit algorithm, use of lay counselors in CT settings, development of a provider-initiated counseling and testing (PICT) training curriculum, and stronger prevention counseling including increased condom education and distribution. In the coming year, USG staff will provide technical assistance in order to improve upon these issues, as well as to address the complexities of HIV counseling and testing for couples and children.

In FY 2006, USG/Tanzania made progress with CT issues. Following the March 2006 CT TWG visit, a supplemental TA visit was conducted in September/October 2006. During this visit, assistance was provided to the Ministry of Health (MOH) through the National AIDS Control Program (NACP) to finalize national PICT guidelines, and to adapt a draft CDC PICT training curriculum to the local context to be used in future PICT trainings.

Future TA visits will be supported in FY 2007 to enhance the capacity of a new CT partner, IntraHealth International, to assist NACP in the national roll-out of PICT in clinical settings. In the second quarter of FY 2007, TA assistance will focus on PICT training for health workers as well as training on couples counseling and testing for counselors already trained in VCT.

In the third quarter of FY 2007, members of the interagency CT TWG, including representatives from DOD and USAID, will return to observe settings where national PICT roll-out has occurred, as well as to monitor the progress made on their March 2006 recommendations, and make further recommendations as necessary. The CT TWG will pay particular attention to child counseling and testing issues.

A subsequent TA visit in the fourth quarter of FY 2007 will focus on the national progress of PICT, CT promotion, condom education and distribution, and other issues as requested by NACP and other partners. During this visit, assistance will also be given in the preparation of the FY 2008 COP.

During FY 2007, four interagency TA visits will be made to Tanzania to assist in national PICT roll-out as well as conduct site visits and assist in implementation of activities to address the CT TWG's March 2006 recommendations.

Targets

Target Target Value Not Applicable Number of service outlets providing counseling and testing  according to national and international standards Number of individuals who received counseling and testing for HIV  and received their test results (including TB) Number of individuals trained in counseling and testing according to  national and international standards

Table 3.3.09:

Funding for Treatment: Adult Treatment (HTXS): $487,500

DoD M&S for ARV services This activity relates to activities in treatment (7747l, 7749, 7794, 7797, 7786).

The US Department of Defense (DoD) will provide technical and managerial support to two primary programs: the Walter Reed HIV/AIDS Care Program in the Southern Highlands and activities with PhamAceess International and the Tanzanian Peoples Defense Forces (TPDF). The DoD, has been working directly with the Mbeya Referral Hospital since June 2004 in rolling out treatment throughout the Southern Highlands.

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 Sep 08, 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 Sep 07 and by at least another five by Sep 08. 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. In support of this effort, staff and technical assistance (TA) specifically dedicated to the treatment program area are included in this submission.

The Clinical Care Medical Director directly supporting the US Department of Defense's Walter Reed HIV/AIDS Care Program in the Southern Highlands, is a US physician, retired Army, with over 20 years of experience in providing ART to HIV positive individuals. This individual works as a member of the Mbeya Referral Hospital, fully accredited to practice medicine in Tanzania. He has worked with the Department of Internal Medicine at this facility to help establish its HIV Care and Treatment Center (CTC) as well as help maintain its day-to-day operations. Along with MOH employees at the facility, he also works directly with the three regional medical offices listed above to adapt CTC standard operating procedures to their particular needs. With the assistance of three FSN equivalent technical advisors, hired by the DoD (one physician, clinical officer and nurse), and Mbeya Referral Hospital personnel, the Walter Reed Program undertakes supportive supervision throughout the Southern Highlands for all CTCs.

In addition to in country personnel, the DoD offers excellent US based TA in this area. Clinicians and laboratory personnel for support of treatment efforts make routine visits to Tanzania primarily in support of military-to-military efforts with the TPDF. This technical assistance includes, but is not limited to, development of quality assurance/quality control measures for care and monitoring, standard operating. procedures in both clinic and supporting lab services, and patient record management. This TA will require on average quarterly visits by two personnel for approximately one week each trip. The cost estimate of each TA visit will include airfare, per diem and lodging.

Funding under this submission will support salary and benefits for the Clinical Care Medical Director, three Tanzania medical personnel including one physician, clinical officer and nurse.

Targets

Target Target Value Not Applicable Number of service outlets providing antiretroviral therapy  Number of individuals who ever received antiretroviral therapy by  the end of the reporting period Number of individuals receiving antiretroviral therapy by the end of  the reporting period Number of individuals newly initiating antiretroviral therapy during  the reporting period Total number of health workers trained to deliver ART services,  according to national and/or international standards

Target Populations: Doctors Nurses Pharmacists Policy makers Host country government workers Other MOH staff (excluding NACP staff and health care workers described below) Public health care workers Laboratory workers District level staff

Coverage Areas Mbeya

Rukwa

Ruvuma

Table 3.3.11:

Funding for Treatment: Adult Treatment (HTXS): $15,000

DoD TA for ARV Services

Each year, it is important to call together all of the treatment implementing partners, the government of Tanzania and key members of the PEPFAR Treatment Technical Working Group (TWG) to share perspectives on effective service delivery, discuss challenges and possible solutions, and to map out a way forward to scale up services strategically and cost effectively. The Treatment TWG brings a fresh eye to service delivery in this resource challenged environment, bringing experiences and lessons learned from other countries in the region.

In FY2007, given the anticipated scale-up of services under regionalization this annual meeting wll be a critical component of our planning.

These funds will support the Headquarters staff who will attend the meeting and provide the in-country team and our host country counterparts technical assistance during the week of the meeting.

Table 3.3.11:

Funding for Laboratory Infrastructure (HLAB): $47,994

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 Department of Defense's (DOD's) management and staffing costs for laboratory will support three laboratory technicians. These laboratory officers will provide technical assistance to Referral, Regional, District hospitals in the Southern Highlands of Tanzania. This support is centrally housed at the Mbeya Referral Hospital (MRH) and covers the Mbeya, Rukwa and Ruvuma regions.

MRH provides technical supervision to six additional hospitals 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, FY 2005 funding under Centers for Disease Control (CDC) and RPSO was used to purchase high volume chemistry, hematology and CD4 equipment.

Currently three laboratory personnel provide lab services to support to DOD's treatment efforts in achieving Country Operational Plan (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.

To date DoD has been able to establish a well functioning laboratory team that provides technical assistance to all three regions (Mbeya, Rukwa and Ruvuma) in maintaining and implementing standard operating procedures and Quality Assurance/Quality Control programs and assuring that all district and regional laboratories contribute to the DoD treatment goals in the Southern Highlands of Tanzania.

Funding for Strategic Information (HVSI): $61,720

DoD SI Management and Staffing

This activity also relates to activities in treatment (Mbeya Referral Hospital and Mbeya, Rukwa and Ruvuma Regional Medical Office)

FY07 funds will be used to support four SI personnel in DoD. The DoD management and staffing costs for Strategic Information will support three Data Management officers and one Monitoring and Evaluation officer. These SI officers will provide technical assistance to Referral, Regional, District hospitals in the Southern Highlands of Tanzania. This support is centrally housed at the Mbeya Referral Hospital and covers Mbeya, Rukwa and Ruvuma regions.

The Mbeya Referral Hospital (MRH) is one of five zonal hospitals in Tanzania and 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.

The FY 2007 funding will continue to support ongoing technical assistance to DoD's partners in establishing and maintaining health information systems, performing and monitoring program activities. Currently, three data management personnel provide data management support assistance to treatment, palliative care, OVC support and laboratory services. In FY 2006, a Monitoring and Evaluation officer will be hired to further strengthen our capacity to monitor and evaluate the progress of our programs in meeting our COP targets.

SI staff will continue to strengthen the necessary infrastructure of the zone, with the emphasis being put in Mbeya, Ruvuma, and Rukwa, then down to districts facilities. Each site will receive the necessary hardware which will be programmed in MS Access. Hospital personnel from the three regions will be trained in use of the database including data entry, analysis and production of reports.

To date we have been able to establish a well functioning SI team that provides technical assistance to all three regions (Mbeya, Rukwa and Ruvuma) in the areas of training, supportive supervision, electronic data upload, and generating NACP reports. This activity will contribute to developing the human and institutional capacity building within the Southern Highlands of Tanzania.

Funding for Management and Operations (HVMS): $878,518

This activity links to: Activity ID 8918 - DOD Cost of Doing Business.

The US Department of Defense (DoD) will provide technical and managerial support to two primary programs: the Tanzanian Peoples Defense Forces (TPDF) and the Walter Reed HIV/AIDS Care Program in the Southern Highlands. Collectively between the two programs, more than six million Tanzanians will have access to HIV prevention, care, and treatment services. Covering active military and their dependents and fostering direct US-Tanzania military interactions, the TPDF is based in Dar es Salaam and covers eight military hospitals and over 30 camp sites nationwide including the National Service. PharmAccess, an NGO based out of the Netherlands, will provide direct management of the program with the DoD assisting with US and local technical support to this program primarily in the areas of treatment and laboratory development.

The Walter Reed HIV/AIDS Care Program is centered in the Mbeya Municipality at the Mbeya Referral Hospital, the primary location for surveillance and vaccine studies conducted by the United States Military HIV Research Program. The US DoD assisted with introduction of comprehensive HIV care and treatment services to this area in October 2004 under the Emergency Plan and through MOHSW support, thereby fulfilling a moral obligation to Tanzanians living in a previously underserved geographic region for treatment. It works closely with the Referral Hospital and Regional Medical Offices of Mbeya, Rukwa and Ruvuma in supporting regional development of treatment capacity as directed by the guidance of the National AIDS Care Programme of the MOHSW.

Having rapidly grown to provide care and treatment in four districts within the Mbeya Region including five treatment facilities and over 10 community based groups in the Southern Highlands (supporting extension of clinical services), the Walter Reed HIV/AIDS Care Program is extending this program in FY 2007 to six additional hospitals by September 2007 and by at least another five by September 2008, within the Southern Highland zone to support a catchment area of greater than four million Tanzanians. By the end of FY 2007, the Walter Reed Program will support 17 hospitals in three regions of Mbeya, Rukwa and Ruvuma.

Currently, six (two Tanzanian/LES, three USPSC/Contractors and one USG Direct Hire) staff provide technical assistance to treatment, palliative care, and OVC support services. Seven Tanzanian staff provide administrative support including accounting, and other program support services. Three Tanzania staff provide laboratory services and supportive supervision to the other three regions.

The US Contract laboratory manager for the DoD under technical advisors/non-M&S is leveraged from research/operating expenses and is not included under Emergency Plan funds. One of the US Contractors and the three Tanzanian technical advisors specifically support clinical care and treatment and are supported under a line item submission in the treatment program area. The USG direct hire, located in Dar es Salaam, is responsible for administering the program and represents the DoD field effort and TPDF programs with the USG Team, other bilateral donors and GOT. All but four of the staff supporting the combined DoD efforts in Tanzania are in country nationals who work closely with our implementing partners. As much as possible, local staff is hired to fill needed administrative and technical positions. This not only provides partners with added resources but the expansion of the technical skills and expertise among the DoD local staff as part of program implementation adds to the development of the human capacity in addressing HIV/AIDS issues in Tanzania.

Administrative costs will support both the TPDF and Walter Reed HIV/AIDS Care Programs and include the provision of technical assistance required to implement and manage the Emergency Plan activities. DoD personnel, ICASS, local travel, management, and logistics support in country will be included in these costs.

Funding for Management and Operations (HVMS): $252,000

This activity links to: Activity ID 7842 - DOD Management & Staffing

The US Department of Defense (DoD) will provide technical and managerial support to two primary programs: the Tanzanian Peoples Defense Forces (TPDF) and the Walter Reed HIV/AIDS Care Program in the Southern Highlands. Collectively between the two programs, more than six million Tanzanians will have access to HIV prevention, care, and treatment services. Covering active military and their dependents and fostering direct US-Tanzania military interactions, the TPDF is based in Dar es Salaam and covers eight military hospitals and over 30 camp sites nationwide including the National Service. PharmAccess, an NGO based out of the Netherlands, will provide direct management of the program with the DoD assisting with US and local technical support to this program primarily in the areas of treatment and laboratory development.

The cost of doing business will include support for one direct hire to oversee both the TPDF and Walter Reed HIV/AIDS Care Programs and the provision of technical assistance required to implement and manage the Emergency Plan activities. This submission will support ICASS costs associated with this position.

Table 3.3.15: