The work of Ariel Glaser Pediatric AIDS Healthcare Initiative (AGPAHI) was initiated under Track 1.0 funding to support comprehensive care and treatment services in Tanzania, with a focus on sustainability and transition of responsibility to local government. Over the life of the project, AGPAHI will progressively transfer capacity to the RHMT as well as CHMTs to move toward a fully-capacitated local health management system where CHMTs conduct program management and oversight of service provision at facilities, and the RHMT performs the supportive supervision, mentoring, and management of respective CHMTs. Activities will take place at 41 sites in the Shinyanga region.

The goals and objectives of AGPAHI are in line with GHI strategy IR 1 (Increased access to quality services) as well as IR 2 (Improved health systems) while also supporting PF Goals 1 (services) and 5 (human resources).

Regular data collection, monitoring and evaluation will take place on a regular basis, with quarterly data analysis reviews. Efforts are ongoing to improve data quality, including building the capacity of service providers through onsite mentorship and supportive supervision.

AGPAHI will support HBHC by strengthening the provision of integrated high-quality HIV care and support aimed at extending and optimizing quality of life for PLWHIV from the time of diagnosis throughout the continuum of HIV care by strengthening leadership, management, and accountability of the CHMTs; improved human resources at CHMTs; as well as evidence-based and strategic decision-making by improved data and data utilization. AGPAHI will work with the respective districts and oversee the provision of services at 41 sites in the Shinyanga region.

AGPAHIs support to lower level health facilities and hospitals is in line with the MOHSW and PEPFAR country strategy. Active acceleration of growth will occur during this COP period in order to achieve greater reach (depth) of patients enrolled and retained on care. Cost effectiveness strategies will involve an increase in the number of patients on treatment. Policy changes, such as the 2010 WHO guidelines, will help facilitate this by increasing patients at the same sites. AGPAHI will ensure care and treatment services are brought close to the patient through outreach services and further integration into existing facilities that can provide care and support.

AGPAHI will ensure referral and tracking systems are strengthened to minimize the loss to follow-up of pre-ART clients through improving linkages between HIV care, support, treatment and prevention sites , other health facilities and the community. Activities have enhanced focus on diagnosis and management of opportunistic infections, pain and symptom management, integration with other key services (PMTCT, RCH, FP, TB etc). Activities will support and extend nutritional assessments and counseling in all supported sites. AGPAHI will integrate and finally expand Positive Prevention services in all supported facilities while providing continued support, strengthened coordination and collaboration mechanisms between partners in the operational regions and building the capacity of local government and civil society for sustainable service provision for PLWHIV.

AGPAHI will continue to support ongoing efforts to improve data quality, including building the capacity of service providers through onsite mentorship and supportive supervision. Adult care data collection, utilization, and reporting will continually be addressed and data quality audits performed.

AGPAHI will support HVTB by strengthening the provision of integrated high-quality TB/HIV activities, which are aligned with Tanzania national policies and strategic plans for TB and HIV, as laid out in National Multi-Sectoral HIV/AIDS Framework (2008-2012) and the Health Sector HIV/AIDS Strategic Plan III (2009-2015). AGPAHI will strengthen TB/HIV integration at National, Regional, District and site levels. AGPAHI will ensuring the availability of sufficient number of trained personnel, providing regular on site mentorship and supportive supervision.

Intensified case finding of tuberculosis among PLHIV at CTC, RCH, OPD and Adult/Pediatric wards shall be strengthened using the TB screening questionnaire and work-up of TB suspects in accordance with the national diagnostic algorithm. AGPAHI will work in strengthening the TB IC measures at all units within supported health facilities. AGPAHI will support the role out of the National IPT pilot program. TB/HIV data triangulation will be conducted regularly to improve data recording and reporting at CTCs and TB clinics.

AGPAHI will continue to support and strengthen TB/HIV coordinating committees at all levels, including supportive supervision; on-the-job training and mentorship; quarterly review meetings; and interdepartmental meetings, including TB unit, CTC, lab, inpatient unit, and OPD units. The main activity during this COP year is to maintain services related to implementation of the Three I's.

AGPAHI, in collaboration with RHMT and CHMT, will continue to support ongoing efforts to improve data quality, including building the capacity of service providers through onsite mentorship and supportive supervision. TB/HIV data collection, utilization, and reporting are some of the challenges that are being addressed. Focus is on registers, CTC2 cards, and databases to be updated as well as ensuring that the existing HIV care and treatment M&E tools capture TB/HIV indicators.

A continuous effort shall be made to incorporate TB/HIV activities into the comprehensive council health plan, a strategy for sustaining the program through promoting ownership by the local entities. In addition, AGPAHI will work closely with other partners working on TB/HIV in leveraging resources.

With these funds AGPAHI will support PDCS through a focus on strengthening the provision of integrated high-quality pediatric HIV care and support aimed at extending and optimizing quality of life to the target population of HIV-exposed and infected infants, children, and adolescents at the selected 41 sites in Shinyanga region.

Active acceleration of growth will occur during this COP period, achieving greater reach of children enrolled and retained in care. Cost effectiveness strategies toward scaling up will not only increase the number of sites, but will involve an increase in the number of patients. Expanded efforts to early infant diagnosis (EID) and integration with other service sites, such as RCH clinics, will help facilitate this. Activities promoting integration with routine pediatric care, nutrition services, and maternal health services include emphasizing identification of infected infants through PITC at all contact points and routine assessment of exposure status at RCH. This will be combined with the strengthening of EID services. AGPAHI will scale up cotrimoxazole (CTX) prophylaxis for HIV-exposed and infected children and adolescents, as well as diagnosis and management of tuberculosis and other opportunistic infections (OI's), palliative care, and psychosocial support. Additionally, lab diagnostics will be strengthened in collaboration with HLAB and EID funded activities.

Quality improvement activities will be implemented at the supported sites that provide pediatric care. Activities will incorporate strategies that include quality through supportive supervision, on-the-job training, and clinical mentorship. Quality improvement activities will measure performance of key indicators in order to identify strengths and develop strategies to address pediatric care challenges at the site level. Community mobilization and linkage activities to community-based care will also be undertaken. Additional activities include providing nutrition assessment, counseling and support, and kids corners in CTC clinics.

AGPAHI will support ongoing efforts to improve data quality, including building the capacity of service providers through on-site mentorship and supportive supervision. Pediatric treatment data collection, utilization, and reporting will continually be addressed and data quality audits will be performed

HLAB funds will support a series of mentorship and capacity building activities towards laboratory accreditation of district labs and municipal laboratories in Shinyanga. These activities will focus on accurate forecasting, planning, and budgeting for laboratory program activitiescommodities and reagents; expanded coverage of laboratory testing in the geographic area; development of training activities focused on laboratory management; and quality assurance of laboratory testing.

For COP 2012, AGPAHI will support HTXS through a focus on strengthening the provision of integrated high-quality HIV ART treatment aimed at extending and optimizing quality of life for PLWHIV through the implementation of activities focused on ensuring adherence and retention of patients on treatment. HTXS activities will take place at 41 sites in Shinyanga region .

AGPAHIs support to lower level health facilities and hospitals is aligned with the MOHSW and PEPFAR country strategy. Active acceleration of growth will occur during this COP period in order to achieve greater reach of patients enrolled and retained on care. Cost effectiveness strategies towards scale up not only will increase the number of sites, but will also involve an increase in the number of patients. Policy changes, such as the 2010 WHO guidelines, will help facilitate this by increasing patients at the same sites. In line with other COP strategies, AGPAHI will ensure care and treatment services are brought close to the patient through outreach services and further integration into existing facilities that can provide care and support.

AGPAHI will conduct supportive supervision, on-the-job training and clinical mentorship. Furthermore, AGPAHI will conduct quarterly review and interdepartmental meetings, between CTC, lab, and in the community. Capacity building and providing service delivery will be of focus to assist in the transition of ART sites from international partners in the supported regions. AGPAHI will evaluate clinical outcomes and other performance data through regular supportive supervision visits, quarterly data review, and annual data quality assessments.

AGPAHI aims to improve retention of patients initiated on ART by focusing on high quality HIV services at existing sites by identifying problems along with strategies that will lead to increased retention of patients on ART. Activities to mitigate above challenges will be met with supportive solutions, such as on-the-job training, on-site mentorship, advocacy, community mobilization, defaulter tracing, and updating of tools for tracking and retention, with a focus more on clinical mentorship, supportive supervision, and adherence to consolidation of in-service ART trainings in the zonal training centers. All activities will be interlinked, with referrals to and use of a comprehensive care and treatment package, including ART provision, cotrimoxazole prophylaxis, and TB screening.

EGPAF will continue to support ongoing efforts to improve data quality, including building the capacity of service providers through onsite mentorship and supportive supervision. Adult treatment data collection, utilization, and reporting are continually being addressed and data quality audits performed.

These funds are proposed for implementation of integrated pediatric HIV care and treatment services the following activities, for implementation in the Shinyanga region: enhanced early identification and diagnosis of HIV exposed for infants and children through scaling up of EID services, PITC in-patient and out-patient settings, such as immunization, OVC, and TB/HIV clinics; family testing at CTC; increased ART treatment enrollment of all HIV infected children <24 months to identify HIV infected children through implementation of updated WHO treatment guidelines, including treatment of all HIV infected children <24 months; and pre ART review of all children in care to determine eligibility for the new 2012 NACP guideline. These funds will also be used to improve monitoring response and adherence to treatment.; linkages to testing and counseling and other relevant services for relatives and household members of clients. These activities will be achieved through training, on-site mentorship, advocacy, community mobilization, and implementing pediatrics specific quality improvement initiatives. The target is to reach 1,135 new pediatric patients and 1,796 current pediatric patients on treatment.