Detailed Mechanism Funding and Narrative

Years of mechanism: 2010 2011 2012

Details for Mechanism ID: 7398
Country/Region: eSwatini
Year: 2012
Main Partner: University Research Corporation, LLC
Main Partner Program: NA
Organizational Type: Private Contractor
Funding Agency: USAID
Total Funding: $1,100,000

In FY12, HCI will continue to: 1) Scale up and strengthen provision of integrated TB/HIV includingMDR-TB care and treatment services to PHC clinics and communities; 2) Institutionalize QualityImprovement/Quality Assurance for TB/HIV services; 3) Strengthen the capacity of MOH TuberculosisControl and AIDS programs to lead and manage roll out of TB/HIV care and treatment services; 4)Contribute to health systems strengthening; 5) Conduct operational research to inform current practices;6) Strengthen community participation in the provision of TB/HIV and MDR-TB care and treatment; and 7)Knowledge management, monitoring and evaluation and project administration. The project will work in allfour regions to support 30 more TB diagnostic units and 60 primary health clinics initiating TB treatmentintegrated with HIV care. The project will work with the following target populations: general population atrisk for TB and HIV; people living with HIV; pediatric TB and HIV patients; members of the military andarmed services; inmates and prison service members in 4 main prisons (one per region); and employeesof large scale corporate organizations at risk for TB/HIV co-infections. In a bid to increase efficiency, theproject will reallocate workloads and technical support from focusing on specific technical areas to providesupport in all technical areas to reduce redundancy to ensure maximum output and accountability. HCIwill continue to work collaboratively with PEPFAR and other donors to maximize technical support,increase efficiency and reduce cost from duplication. HCI supports the MOH to develop and useevidence-based policy guidelines and capacity building strategies that promote ownership.

Funding for Care: Adult Care and Support (HBHC): $0

HCI will cover the whole country. HCI will work with NTCP/SNAP to target TB clinical settings, HIVclinical settings and will target adolescents, men and women. A special group targeted by HCI will beprisoners. HCI supports the provision of adult care and support for PLWHA in the TB treatment and carefacilities and will build on existing technical support for adult care and support, retention, referrals andlinkages within TB/HIV clinical settings. HCI will support SNAP to achieve its objectives of earlyidentification and retention in care through: supporting provision of HIV partner counseling and testing inTB clinics; supporting TB management among PLWHA attending HIV clinics; and supporting provision ofthe comprehensive package of care for PLWHA. Appropriate referrals for palliative and communitysupport care will be supported. In collaboration with SNAP/NTCP and CBOs, HCI will provide communityeducation for TB. URC will coordinate these efforts with CHAI/ICAP. HCI will provide support for humanresources development and health systems strengthening through: integrating adult care and support inthe integrated TB/HIV management training, clinical mentoring, and support supervision; working withclinic supervisors and RHMTs in planning, supervision and implementation; working with CMS andpartners to support the quantification and the drug supply chain management for cotrimoxazole andisoniazid; and supporting decentralization and implementation of the comprehensive care guidelines,

essential health care package, TB/HIV decentralization package and the intensified case finding,isoniazid preventive therapy and infection control guidelines. HCI will collaborate with SWAGAA tomainstream gender and develop strategies for addressing male norms and behaviors related to TB/HIVservices. HCI will monitor and evaluate the quality of care and support services through ensuring thecapture of care and support indicators into the normative TB and HIV registers, integration in thereporting tools and in the quality improvement objectives of the facility QI teams.

Strategic Area Budget Code Planned Amount

Funding for Care: TB/HIV (HVTB): $1,100,000

HCI's primary target populations include adults, children, PLHIV and high risk groups for MDR-TB. HCIalso covers health care workers, the general public and policy makers. HCI will build on its successes inorder to address gaps/bottlenecks for achievement of national and PEPFAR targets, and implement newactivities that address new national and international priorities. In FY12 HCI aims to: scale up andstrengthen provision of integrated TB/HIV including MDR-TB care and treatment services to PHC clinicsand communities; institutionalize Quality Improvement/Quality Assurance for TB/HIV services at nationaland health facility levels; strengthen the capacity of MOH Tuberculosis Control and AIDS programs tolead and manage roll out of TB/HIV care and treatment services; contribute to health systemsstrengthening; conduct operational research to inform current practices; strengthen the programmaticand clinical MDR-TB management; and improve TB/HIV knowledge management, monitoring andevaluation. HCI will continue to: strengthen TB screening and diagnosis in all HIV clinics as well as themilitary and correctional services; engage CBOs to advocate and/or provide TB/HIV care like patientsupport, provision of community DOTs both for drug sensitive and drug resistant TB; collaborate withCMS, MSH and CHAI in forecasting and quantification of both 1st and 2nd line anti-TB drugs; scale upthe provision of TB diagnostic and treatment services in primary health clinics in the regions supported;and collaborate with business societies and the public service commission to continue providingresources for information dissemination and education among their employees.

Strategic Area Budget Code Planned Amount

Funding for Care: Pediatric Care and Support (PDCS): $0

HCI will continue to support the pediatric HIV care and support program in TB clinical settings toachieve early identification of HIV exposure and infection status in infants attending the TB clinics by:referring infants to sites that perform the DBS and/or offering HIV testing to the parents; and supportingthe provision of CTX prophylaxis for HIV exposed and HIV infected infants through clinical mentoring andsupport supervision. HCI in collaboration with other development partners will continue to support the

prevention, diagnosis and management of pediatric TB through: working with EPI to improve access toBCG for children; intensified case finding using pediatrics TB screening tool and contact tracing;advocating for TB infection prevention and control both at home through patient education andcommunity sensitization and in facilities through implementation and adherence to Infection controlguidelines; provision of Isoniazid preventive therapy for exposed children under 5 years as well aseligible HIV infected children; improving the capacity of providers to diagnose and manage TB in childrenthrough training and clinical mentoring of HCWs; and working with SINAN and the nutrition council tointegrate TB screening in the OTP feeding centres to identify and treat TB among malnourished children.

Strategic Area Budget Code Planned Amount

Funding for Treatment: Adult Treatment (HTXS): $0

HCI provides technical assistance to the NTCP in the implementation of early initiation of ART in TB/HIVco-infected patients in TB clinical settings. HCI will continue to develop capacity for ART initiation in TBpatients to ensure sustainability and efficiency in the programs of HIV/AIDS and TB through: support thetraining of human resources in the Nurse Led ART initiation program in TB clinics; ‘twinning' with nationalprogram staff to support facilities and regions; provide technical and clinical mentoring support to theNational AIDS program and TB control program through the secondment of an HIV/TB clinical advisor;institutionalize ART delivery for TB patients in TB clinical care settings and encourage inclusion of uptakeof ART in co-infected patients as one of the quality indicators for facility QI teams; and conduct humanresource development through training and retraining of facility and regional staff using IMAI and theintegrated HIV/TB curriculum. HCI will ensure compliance with guidelines, quality of adult treatmentservices in TB/HIV co-infected patients and provide oversight through: clinical mentoring of HCWs atfacilities supporting the integration of ART as a critical element of the TB/HIV services in conjunction withthe regional TB and HIV coordinators; support supervision provided in collaboration with clinicsupervisors to build local capacity; working with RHMTs to ensure coordinated and sustainable adulttreatment services for TB/HIV co-infected patients; conduct on-site supervision and training in areas ofadult treatment in order to address gaps in knowledge and skills including tracking of clinical indicatorsfor TB/HIV co-infected patients; and support the regional quarterly data review meetings to trackperformance at regional and national levels to design evidence based interventions.

Strategic Area Budget Code Planned Amount

Funding for Treatment: Pediatric Treatment (PDTX): $0

To assist the national effort to increase quality pediatric HIV treatment HCI will continue to scale up andprovide ART for the TB/HIV infected pediatric population, by providing: resources and technical

assistance to implement the updated treatment recommendations for co-infected infants and children;support the early initiation of ART as well as support the scale up of pediatric HIV care and treatmentservices through decentralization of pediatric TB services; support policy development and adaptation;provide training and ongoing mentoring for nurses to initiate and maintain children on ART through theNARTIS program; provide cross training of health care providers in TB/HIV management, in conjunctionwith development partners; and support the national effort of task shifting and the integration of thepediatric TB/HIV treatment and care modules into in-service and pre-service training. HCI will work withother partners to increase the number of children testing HIV positive who initiate HIV treatment and willwork with SNAP to set pediatric targets for pediatric treatment. To support the monitoring & evaluation ofthe programs, HCI will continue to provide technical assistance to the MOH (SNAP, NTCP and SID) fordata management, quality assurance as well support data analysis and feedback to national, regionaland site levels. TB registers and reporting tools will be modified to cater for the collection of agedisaggregated data for 0 - 4 and 5 - 15 years age groups receiving pediatric treatment within the TBclinical settings.

Key Issues Identified in Mechanism
Addressing male norms and behaviors
Increasing gender equity in HIV/AIDS activities and services
Child Survival Activities
Military Populations
Workplace Programs