Ariel Glaser Pediatric AIDS Healthcare Initiative (AGPAHI)

Transcription

1 Ariel Glaser Pediatric AIDS Healthcare Initiative (AGPAHI) Annual Report An Affiliate of the Elizabeth Glaser Pediatric AIDS Foundation P.O Box: Dar es Salaam Tel: P.O Box: 1368 Shinyanga Tel:

2 Much Progress has been made, momentum is with us, and success is within our reach. With your help, we can eliminate pediatric HIV in our country. - Excerpt from Elizabeth Glaser Speech

3 Contents Board Members Chairperson s Introduction Executive Director s Report About AGPAHI Quality Assurance Process Staffing Pay for Deliverable Review of the 2014 Activities Future Programatic Plans Financial Reviews

4 AGPAHI AIDS ANC ART CDC CHMT C&T CTC DBS DED DRCHCO EGPAF HEI HIV LGA LTFU MoHSW MSD PLHIV PMO PMTCT RALG RHMT TB UNFPA USAID List of Acronyms Ariel Glaser Pediatric AIDS Healthcare Initiative Acquired Immune Deficiency Syndrome Ante-natal Clinic Antiretroviral therapy Centers for Disease Control and Prevention Council Health Management Team Care and Treatment Care and Treatment Centre Dried Blood Spot District Executive Director District Reproductive and Child Health Coordinator Elizabeth Glacier Pediatric AIDS Foundation HIV Exposed Infant Human Immune Virus Local Government Authority Lost To Follow Up Ministry of Health and Social Welfare Medical Store Department People Living with HIV Prime Minister s Office Prevention of Mother to Child Transmission Regional Administration and Local Government Regional Health Management Team Tuberculosis United Nations Population Fund United States Agency for International Development

5 Board Members Dr. Aggrey K. Mlimuka Chairperson Prof. Eleuther M. Mwageni Vice Chairman Mr. Laurean R. Bwanakunu Secretary to the Board/Executive Director Mr. Ally H. Laay Treasurer Dr. Oswald J. Mashindano Board Member Dr. Anja Giphart Board Member Dr. Edith M. Ngirwamungu Board Member Ms. Asha D. Mtwangi Board Member Dr. Marina A. Njelekela Board Member Ms. Rosemary W. Mwakitwange Board Member Ms. Tatu Y. Msangi Board Member

6 6 AGPAHI 2014 ANNUAL REPORT Chairperson s Introduction I am delighted to introduce the 2014 annual report, the period which we have witnessed Ariel Glaser Pediatric AIDS Healthcare Initiative (AGPAHI) intensify HIV and AIDS interventions in Shinyanga, Simiyu and Geita regions. Tanzania represents 4.2% of the global HIV burden as of 2014 (UNAIDS report, 2014), with an estimated 1.5 million people living with HIV (PLHIV), including 66,000 children. In the last decade, Tanzania has made significant progress in its response to HIV, including scaling up treatment to 39% of PLHIV and decreasing national prevalence from 5.7% in 2008 to 5.1% in 2011(THIMS, 2012). AGPAHI has continued to aim at improving the health of children and families with special focus on prevention and elimination of pediatric HIV and AIDS. With the support from United States Centers for Disease Control and Prevention (CDC), United States Agency for International Development (USAID), United Nations Population Fund (UNFPA) and Elizabeth Glaser Pediatric AIDS Foundation (EGPAF), AGPAHI has been able to support and contribute to the improvement of the health sector in Shinyanga, Simiyu and Geita Regions. The collaboration received from the Ministry of Health and Social Welfare (MoHSW), Prime Ministers Office Regional Administration and Local Government (PMO-RALG) has enabled AGPAHI to implement HIV and AIDS prevention, care, treatment and support related programs in the above mentioned regions. I have received positive feedback from the field about AGPAHI s support and contribution it has registered in increasing access and availability of quality care and treatment services to the needy. As you read the report, I hope you will grasp some success stories from the field. AGPAHI has not only strengthened the capacity of Council Health Management Teams (CHMTs) to deliver but also increased access of quality health services which is making a huge impact in the community. Wherever I go, I am humbled by the commitment of the AGPAHI family the staff, partners and supporters. Through our hard work, we are able to contribute to the efforts of curbing the HIV/ AIDS and help to transform lives of millions. As Elizabeth Glaser once said words won t save lives if they re not backed up with necessary commitments, I thank each one for their commitment, passion, dedication and their generosity. Dr. Aggrey K. Mlimuka Chairperson, AGPAHI Board of Directors

7 AGPAHI 2014 ANNUAL REPORT 7 Executive Director s Report I am excited to present AGPAHI s 2014 Annual Report. This report will cover AGPAHI activities implemented in Shinyanga, Simiyu and Geita regions. Since we embarked in responding to the call to eliminate pediatric AIDS in 2011, the journey has been enlightening and learning. The support from CDC, USAID, EGPAF and UNFPA is highly appreciated. In the last year we have seen an increase in funding for our Care and Treatment (C&T) programs, Prevention of Mother to Child Transmission (PMTCT), and family planning integration programs. During this reporting period (January December 2014) our four year strategic plan was completed and disseminated, reviewed and later used to amend our 2011 Constitution. We have also taken an in-depth look at our organizational structure and made modifications to ensure effectiveness and efficiency in delivering our programs. In 2014, we invested in the capacity of our staff and partners to become better service providers in pediatric HIV and AIDS prevention, family care and treatment. By building the capacity of our staff and partners, we strengthened the implementation of Pay for Deliverable scheme, expanded outreach services to include more children, and commenced the implementation of Tuberculosis HIV co-infection services¹. Our expanded scope went hand-in-hand with our focus on improving quality across all projects, subjecting them to intensive quality control of delivery through data audits and mentorship of service providers. Our greatest achievement was in expanding our services to support 9 more C&T sites thus reaching 77 sites (located in Shinyanga, Simiyu and Geita regions) with C&T related services. Through our programs, we managed to reach 43,188 clients on care², 2,850 children under the age of 5 years and 186,165 (79.8%) of pregnant women who visited Antenatal Clinic (ANC) and tested for HIV. Furthermore, out of the total clients on care, we managed to test 162,271 clients for TB. Of those tested for TB, 1.15% were positive and initiated treatment. The year however was not without challenges; notably, the delayed supplies especially from Medical Stores Department (MSD) for items such as Dried Blood Spot test kits (DBS) and HIV test kits affected among others the uptake of HIV testing among pregnant mothers in the second half of the year. Throughout the pages of this report, I invite you to reflect on the huge range of AGPAHI s activities and achievement that has been implemented by great staff and partners who provided support endlessly. Their contribution, in addition to the support from the Board of Directors, is highly appreciated as we continue to work towards eliminating pediatric HIV and AIDS. We will continue to do more, do better and reach further with limited resources at our disposal. Enjoy reading! Laurean Rugambwa Bwanakunu Executive Director ¹ Client has TB and HIV infection at the same time. ² Client on care means client has HIV infection but not yet eligible to start treatment as per WHO guidelines.

8 8 AGPAHI 2014 ANNUAL REPORT About AGPAHI Founded in 2011, AGPAHI is a Tanzania based NGO named in honor of Ariel Glaser, the daughter of pediatric AIDS advocate, Elizabeth Glaser. Elizabeth contracted HIV through a blood transfusion while giving birth to Ariel, and unknowingly passed on the virus to Ariel through breast milk. The establishment of AGPAHI has its roots in the efforts made by EGPAF to build local momentum and sustainable progress for increased access to high-quality HIV services that contributes to the elimination of pediatric AIDS by strengthening local organizations. AGPAHI is an independent affiliate of EGPAF. AGPAHI works to eliminate pediatric AIDS and provide care and treatment to people living with HIV (PLHIV) in Tanzania. In collaboration with the government of Tanzania and partners, AGPAHI supports the provision of high-quality HIV services and ensures that efforts to eliminate pediatric AIDS are sustainably integrated into existing health systems. All of AGPAHI s work is framed by our commitment to five broad based objectives: i. To promote the health of children and families including prevention and elimination of pediatric HIV and AIDS by working in partnership to create and implement sustainable healthcare programs (increased access and equity); ii. iii. iv. v. To strengthen the capacity of institutions involved in healthcare service delivery to offer sustainable solutions for prevention and elimination of pediatric HIV and AIDS (capacity building); To improve participation and awareness about rights of children, adolescents/ youth and women in HIV and AIDS program, and promote male involvement (inclusive participation); To foster partnership and promote networking among stakeholders in the health sector, which include communities, government and Civil Society Organizations (CSOs), for ensuring sustainable health services (partnership and networking); and To undertake empirical research, evaluations, studies and appraisals that relate to important reproductive and child health issues in order to promote and support evidence based analysis and advocacy for sound health policies (evidence based programming). Within this framework we focus on the following programmatic areas in which we aim to achieve positive change: HIV Care and treatment: to increase access to the comprehensive package of sustainable, high quality, cost effective services for HIV infected families;

9 AGPAHI 2014 ANNUAL REPORT 9 Family planning: to increase the number of PLHIVs and communities in Shinyanga Region with integrated family planning services when accessing HIV services; PMTCT: to increase the quality (testing, enrollment and retention), efficiency and cost effectiveness of comprehensive HIV and AIDS services in Shinyanga, Simiyu and Geita regions and to ensure sustainable and locally owned response. Innovations in Reproductive Health and Family Planning program: to improve access to and effective utilization of integrated family planning services. Furthermore, the project supported transfer of skills from skill laboratory skills lab to clinical practice at Kolandoto Nursing School to ensure graduates are competent in conducting safe delivery. Where We Work Our activities cut across 13 district councils of Geita, Simiyu and Shinyanga Regions Geita Shinyanga Simiyu Mission Statement AGPAHI aims to improve health of children and families in Tanzania, including prevention and elimination of pediatric HIV/AIDS by working in partnership with the Ministry responsible for health and other partners to create and implement sustainable healthcare programs. Vision Statement AGPAHI envisions a nation wide Non-Governmental Organization that would facilitate children and families to have access to quality health services and HIV/AIDS treatment.

10 10 AGPAHI 2014 ANNUAL REPORT AGPAHI is guided by the following core values: Teamwork: Working together with local governments or partnering with array of other organizations is the only way to provide sustainable solutions for health empowerment to individuals and families. Innovation: The Organization believes in creativity, readiness to learn, continuous learning and adapting as well as sharing knowledge in order to achieve its mission. Accountability: Striving for highest integrity, honesty, transparency and ethical standards in all aspects of work in order to fulfil expectations of those it serves and who support it. Integrity: Striving to uphold strong moral principles, while acting according to the values, beliefs and principles upheld. Ethical Conduct: Striving to act in ways consistent with what society and individuals typically think are good values. Passion: Committed to making positive difference in the country and in people s health, particularly for underserved population. Excellency: The highest attainable quality is our drive. Honesty: Committed to straightforward work conduct and manners guided by being sincere, truthful, trustworthy, honorable, fair, genuine and loyal with integrity. Transparency: Culture of openness and striving to keep clear lines of communication.

11 AGPAHI 2014 ANNUAL REPORT 11 Quality Assurance Process AGPAHI complements the MoHSW efforts to ensure healthy lives for Tanzanians especially children, by implementing programs that aim to eliminate pediatric HIV and AIDS through strategic partnership with district councils. The organization supports 77 health facilities in the provision of HIV prevention and C&T services. AGPAHI ensures quality service is delivered and data is routinely collected at each site. This is recognized as essential for the implementation of high quality and comprehensive HIV programs and ultimately better outcome for the client. To provide comprehensive quality HIV services to all PLHIVs and maintain quality HIV programs, AGPAHI developed a quality assurance and improvement program that detailed out standard operating procedures and indicators to measure performance. AGPAHI worked with regional, districts and site based staff to collaboratively assess facility performance, identify gaps and introduce measures at site level to improve performance. The team also ensured that site staffs were supported to appropriately follow all the national guidelines and polices for services provided. AGPAHI installed electronic database to 25 out of 77 facilities providing care and treatment service to ensure that the data collected from the facilities is of excellent quality. In addition, AGPAHI in collaboration with CHMTs and RHMTs conducted data quality assurance activities for the facilities on semi-annual basis. Staffing AGPAHI has 60 employees who implement different programs with commitment, dedication and passion. The employees have skills and experiences which has enabled the organization to continue achieving its goals and objectives. Building employee s capacity is an essential part of program implementation at AGPAHI. Therefore, AGPAHI is committed to building the capacity for its employees locally and internationally in order to improve their productivity which leads to higher performance and efficiency. AGPAHI staff - May 2014

12 12 AGPAHI 2014 ANNUAL REPORT Pay for Deliverable The momentum behind Pay for Deliverable was built towards the end of 2013 following an internal assessment by the AGPAHI team. This initiative was adopted to overcome the limitations of the extra duty reimbursement arrangements by aligning payment with outcomes. The initiative targeted the senior districts and regional officials responsible for management and implementation of the project. Implemented in the districts of Shinyanga and Simiyu regions, Pay for Deliverable targeted District Executive Directors, District and Regional AIDS Control Coordinators, District CTC in-charges, Regional and District Medical Officers, Medical Officers in-charges, District Treasures and Project Accountants. By virtue of their positions, these officials are custodians of the program (by signing contracts), have the capacity to track performance, manage program funding and oversee activity implementation. US $150 per month (remitted quarterly) was the highest set amount payable per staff. To receive the payment, evidence was needed to show achievement for predefined indicators. The indicators included: 1. New adult and pediatric on care, 2. New adult and pediatric on ART, 3. New pediatrics on ART, 4. Current clients on ART and months cohort³. How was the implementation managed? Respective districts collected data on quarterly basis from project sites. AGPAHI in collaboration with CHMT conducted data collection and verification exercises through physical monitoring visits to all care and treatment sites. Data analysis meeting was conducted at the regional level with the representation from CHMT and RHMT to share experiences and reach mutual agreement on the data. Upon the completion of data analysis, payments were made to those who had achieved the set targets as per the indicators. The mechanism that AGPAHI has employed in implementing P4P has been a motivating factor especially for district council management to ensure increased accountability in the hierarchy for reaching the target set within time and expected quality. I can equate this mechanism with the way Chief Auditor General issues audit certificate to the council which demonstrates great sense of accountability. [Dr. Leonard Masale, DED Itilima] ³ Clients who have been on care and treatment for consecutive 12 months.

13 AGPAHI 2014 ANNUAL REPORT 13 As a result of this initiative, 2014 recorded increased enrollment of clients in the C&T sites. This among other things is attributed to intensified supportive supervision by the district officials. For instance, in the July September 2013 quarter, only 218 new children on care were registered compared with 272 registered a year later. Furthermore, 28,046 clients were on ART in the July September 2013 quarter compared with 37,390 clients in the July September 2014 quarter. Moreover, accountability at the sites, district and regional levels increased and quality of service rendered was enhanced. With regard to quality of service, a participant observed in one of the analysis workshop that comprehensive care, follow up and provider-client relationship had improved which resulted into improved client retention, thanks to the support provided by AGPAHI (workshop participant in Shinyanga Region). In a nutshell, we have learnt that participatory mechanism that we have put in place for implementing Pay for Deliverable in Shinyanga and Simiyu regions provides a fertile ground for the successful implementation of related interventions like Performance Based Financing (PBF).

14 14 AGPAHI 2014 ANNUAL REPORT Review of the 2014 Projects This section presents the organization s goals and objectives set for the year It will also explore the targeted activities that were conducted to attain the intended goals and objectives. Activities were implemented in partnership with 13 district councils of Shinyanga, Simiyu and Geita regions. 1. HIV Care and Treatment This is a 5-year project funded by CDC with the aim of increasing access and use of a comprehensive package of sustainable, high quality, cost-effective HIV/AIDS care, treatment, and support services in AGPAHI supported sites. Objective The objective of the project is to improve the quality and maintain enrollment of clients in care and treatment services, as well as increase linkages and strengthen referral networks to community and other related services Achievements As of December 2014, there were 77 HIV care and treatment supported sites in Shinyanga, Simiyu and Geita regions. This scale up of 9 sites (from 68 to 77) was contributed by Ushetu and Msalala districts which formed new sites in response to increased demand due to high HIV prevalence rates and difficulties in accessing care and treatment facilities. Figure 1: 2014 care and treatment performance Total New on Care New on Care (Pediatrics} Total New on ART New on ART (Pediatrics) Total Current on Care Screened for TB (Adults & Children Total Current on ART T - Target P - Performance 0 T P T P T P T P T P T P T P

15 AGPAHI 2014 ANNUAL REPORT 15 The project enrolled 17,702 new clients on care of which 6.9% were children. By the end of 2014, 43,188 clients (6.57% children) were on care and 37,390 (6.55% children) were on ART. TB screening was conducted for 162,271 clients (10,580 children). Of the screened clients, 1,947 were found to have TB, among them 144 were children. 56 service providers attended ART training at Bugando Medical Center. Technical support provided to health facilities for integrated and comprehensive services in PMTCT, TB/HIV, PITC and Home Based Care (HBC). HBC technical assistance was done jointly with support and supervision from RHMT, Tanzania Red Cross Society and Pathfinder International. Trained 14 service providers on TB/HIV and Chest X-ray interpretation to improve diagnosis of TB/HIV co-infected patients. The training improved staff capacity and increased the comprehensiveness of HIV services offered to clients. Through technical support on forecasting, ordering and inventory management provided to the districts, less than 21 facilities (27%) of the 77 supported CTC facilities ran out of stock on one or more of the tracer items (TLE Tabs⁴, Ped ABC/3TC Tab⁵, Nevirapine Syrup, and Determine and Unigold test kits). 2 Regional Pediatric Technical Working Groups (TWG) have been formed in Shinyanga and Simiyu to monitor and ensure quality of services related to HIV and AIDS care and treatment. The group is comprised of the Regional Medical Officer, Regional AIDS Control Coordinator, Regional Pharmacist, Regional Lab Technician and Regional Reproductive and Child Health Coordinator while at the District Council level, District Medical Officer, District AIDS Control Coordinator and District Reproduction and Child Health TB-HIV SUCCESS Equipping service providers with appropriate knowledge and skills is at the heart of AGPAHI strategy. We trained 28 service providers from Shinyanga Regional Hospital and Bariadi, Kahama, Maswa District Hospitals on the implementation of TB-HIV collaborative activities. The service started towards the end of quarter four (Oct Dec 2014) with 11,970 HIV positive clients enrolled in care. Out of the clients in care, 8% of the screened clients were found to be negative for TB hence initiated on Isoniazid INH preventive treatment. Majority of clients initiated treatment were from Kahama and Bariadi [Alio Hussein, AGPAHI Program Officer TB/HIV]. ⁴ TLE Tabs = Tenofovir 300mg, Lamivudine 300mg and Efavirenz 600mg Tablets ⁵ ABC/3TC = Abacavir 60mg and Lamivudine 30mg

16 16 AGPAHI 2014 ANNUAL REPORT Coordinator. In addition of the regional and council officials, partners like Baylor, Tanzania Red Cross Society, Intra-health and Pathfinder do participate in the TWG meetings. To strengthen DBS transport to remote facilities, 5 motorcycles were procured and distributed to Dutwa Health Centre, Ushetu Health Center, Bulungwa Health Center, Bulekela Dispensary and Chambo Dispensary. 40 community volunteers have been trained to trace exposed infants, children and adults who are lost to follow up (LTFU). As a result, community volunteers have been able to trace 2096 lost clients in collaboration with service providers so as to improve retention. Under Pay for Deliverable, 4 quarterly data analysis meetings with CHMT and health care workers from 77 care and treatment sites were held. The meetings reviewed and cleaned respective district data that was then used to reward service providers based on their performance. Mentorship was provided to 80 service providers in documentation, data management, reporting protocol and data use. Towards the end of 2014, 100% of the reports were received on time with over 80% data accuracy. Community mobilizations and sensitizations activities were conducted across the regions to emphasize on health seeking behaviours. For example, testing campaigns in Kishapu and Shinyanga DC were conducted where 2,214 people were tested including 162 children. 77 radio programs were aired on community radios based in the regions. About 35 psychosocial children groups were formulated enrolling a total of 1,541 children. Throughout the year, Information, Education and Communication (IEC) materials were dissemination. Conducted 1 Ariel Camp to 43 children (24 female and 19 males) aged between 7 and 17 years. All districts where AGPAHI works had a representative at the camp. The camps are crucial since they impact knowledge to children on the importance of disclosure, adherence to drugs, dealing with stigma and discrimination. Children are also encouraged to be good ambassadors to help identify or trace other children who need HIV care and treatment support.

17 AGPAHI 2014 ANNUAL REPORT 17 Children singing during the 2014 Ariel Camp in Moshi Kilimanjaro. LESSON FROM MBOGWE Data quality has been a challenge in most of the CTC sites. Realizing this gap, AGPAHI worked closely with the CHMT and jointly decided to use a continuum of care meetings to support facilities (started with 5 CTC sites of Mbogwe District Council) in improving report generation, verification and data collection. Thus, the first few reports generated were NACP cross-sectional, cohort analysis, mother to child follow up, labor and delivery and ANC. Out of these few reports, AGPAHI noted improved data generation and correctness in reporting. Hence, between April and December 2014, AGPAHI witnessed 100% increase of timely submitted reports, zero incomplete report, 80% accurate data and 70% time reduction for number of days used for data verification [Nahayo Ben Simon, AGPAHI Program Officer Clinical Services].

18 18 AGPAHI 2014 ANNUAL REPORT Testimony from clients attending Care and Treatment Centre (CTC) HEART TO HEART: STORY FROM PAUL AND MARIA My husband started getting sick perpetually. At the beginning, I would take him to the nearby dispensary each time he got ill. We never suspected anything. In 2006, the illness became more serious and intense, stated Maria (39 years), a wife to Paul (45 years). In November 2006, we visited Malampaka Health Centre (HC) an AGPAHI s supported facility where Paul received HIV counselling and consented to be tested for HIV. She continued. His results came out immediately. While receiving post testing counselling, Paul was advised to go to Maswa District Hospital for CD4 count check. Back in the days, CD4 samples were taken at the district hospitals and thereafter sent to Bugando Medical Centre laboratory for testing. It would take a month for clients to receive results. However, as days moved on, AGPAHI has facilitated the devolution of points of care (PIMA machines) to lower level health facilities. Because of this devotion, it took Paul 20 minutes to know his CD4 count at Malampaka HC. Observed Maria Upon receipt of the result, I informed my wife, brother and parents, who received the information with mixed reactions, said Paul. Fortunately my wife provided un-wavering support that made me strong continued Paul. In the early days my husband went through a number of reactions associated with HIV positive results- from frustration, disbelief, anger, denial, stigma to acceptance, said Maria who was tested negative for HIV. The community never regarded HIV+ people as useful, but rather saw them as burden to the society. They also regarded them as immoral and people not fit to interact with. All this was due to stigma associated with HIV and AIDS pandemic Paul and Maria

19 AGPAHI 2014 ANNUAL REPORT 19 said. HIV positive people were regarded as outcasts in the society. They were isolated, called different names and even finger pointed. Maria also confesses that Paul s condition changed the perceptions and stereotypes she had towards people living with HIV and AIDS. She also wanted to protect the family name since she loved her husband. Paulo and Maria were the first people in Malampaka village to be known as discordant couple, a situation where one spouse is HIV- while the other is HIV+. Following the education obtained from the service providers, Paul and Maria have continued living together and have 4 children, all HIV negative with the youngest being 5 years old. The youngest child was born after Paul knew his HIV status. Paul is now working as a volunteer at the Care and Treatment Centre (CTC) in Malampaka HC and has been actively engaged in giving testimonies about his status, advising other HIV positive clients on positive living and has been assisting with tracing clients who are lost to attend treatment with special emphasis to children. From their experience Paul and Maria have learned: That HIV and AIDS is everywhere and thus the need to accept the fact that it exists and maximum attention and caution should be given, The need to strongly believe that its God s plan for us to live as a discordant couple and that we should tell the story to the world for people to believe, AIDS is a normal disease, if one adheres to the measures taught on how to handle it, he/she shall live a normal life, get ill just like any other person in the society, We have benefited from the support provided by AGPAHI and this includes information on HIV/AIDS, attended workshops on HIV/AIDS, nutrition and living as discordant couple. Through Paul and Maria, AGPAHI has reached many people in community informing them that it is possible in a marriage to have one partner as HIV+ and if he/she adheres to the measures for positive living the infected partner can protect the spouse. Social support amongst couples and relatives is very crucial in such situations.

20 20 AGPAHI 2014 ANNUAL REPORT 2. Prevention of Mother to Child Transmission (PMTCT) The previous story of Paul and Maria, is among the many stories of clients receiving support at AGPAHI supported sites. AGPAHI being a pediatric focused organization pays a special focus on pregnant women to ensure that they receive services to prevent mother to child transmission of HIV through provision of quality comprehensive⁶ services. This will eventually lead to reduced number of HIV exposed infants⁷ contracting HIV infection. The project is funded by USAID through EGPAF and is implemented in 310 sites with the aim of providing quality, efficient and cost-effectiveness of comprehensive HIV & AIDS services to ensure a sustainable and locally-owned response. Objective The following are project objectives: To increase access to integrated, quality and comprehensive PMTCT, RCH and Community-based HIV and AIDS services. To strengthen linkages and referral networks across service delivery points, facility and community-based services to improve services and ensure a continuum of care. To ensure sustainability through a strengthened health system, transfer of capacity, management and oversight of activities to the local government and other local institutions Achievements Through the support provided to CHMTs, there has been an increase of PMTCT sites offering Early Infant Diagnosis (EID) services from 279 to 310 (a growth of 10% i.e. from 57% to 67% of all RCH sites in the supported districts). This is associated with increased proportion of HIV Exposed Infants (HEIs) taken Dried Blood Spot (DBS) for HIV testing. 298 out of 310 sites are providing ART Option B+⁸ services to all pregnant women upon diagnosis irrespective of WHO stage or CD4 count (test and treat). ⁶ TComprehensive services include receiving health talk, counselling, HIV testing and results. Clients tested HIV positive are enrolled to Anti-Retro Viral therapy (ART) and retained. ⁷ Infants born by HIV positive mothers. ⁸ According to WHO Guidelines for PMTCT & Breastfeeding, Option B+ provides all HIV-positive pregnant or breastfeeding women with a course of antiretroviral drugs to prevent mother-to-child transmission. A triple-drug antiretroviral regimen should be taken throughout pregnancy, delivery and breastfeeding - continuing for life, regardless of CD4 count or clinical stage,

21 AGPAHI 2014 ANNUAL REPORT 21 The following shows the overall activity performance. Table1: Indicates flow of Pregnant Women from testing point to CTC Quarter Name PW Eligible for testing Tested HIV Tested Positive Women CTC-ART Jan-Mar ,713 31,658 1,138 1,083 Apr-Jun 2014 Jul-Sept 2014 Oct-Dec 2014 Overall ,862 45,594 48, ,726 44,298 37,085 41, ,458 1,439 1,011 11,00 4,688 1, ,334 4,691 The table above shows that 200,726 pregnant women attended ANC for the year Out of these, 154,458 received HIV testing (76%). Furthermore, from the women who were tested, 4,688 tested HIV+ and 4,691 were enrolled into CTC and initiated ART. The increased rate of testing was contributed to the increased number of sites offering Option B+. HIV testing uptake has been maintained above 75% for all eligible pregnant women. However the trend in quarter 3 and 4 dropped due to inadequate supply of HIV testing kits country wide (refer to figure 2 below - see the red bar). The figure continues to show that throughout the year, there has been a steady increase of infants taken DBS in each quarter (see the green bar). Figure 2: Shows cascade of HIV Exposed Infants (HEI) uptake , , ,449 1,447 1,097 1, Jan -Mar 2014 April - June 2014 July - Sept 2014 Oct - Dec 2014 HIV+ Preg Women Infants Registered HEI taken DBS

22 22 AGPAHI 2014 ANNUAL REPORT Figure 3: Shows HIV Exposed Infants (HEI) tested and registered at CTC Jan -Mar April - June July - Sept Oct - Dec HEI Taken DBS HEI Tested HIV+ HIV+ Infants registered at CTC This figure shows the number of HEI taken DBS, tested HIV positive and eventually registered at CTC. DBS is taken at the age of 4 to 8 weeks of the infant s life. However, not all exposed children are brought for testing on the specified time. Some mothers attend postnatal clinic 2 months and beyond after delivery which results in delay in taking DBS at the recommended time. From the chart, in all 4 quarters, the number is not steady because not all HEI tested are registered in the same quarter. Source: DHIS, 2014

23 AGPAHI 2014 ANNUAL REPORT 23 Reaching Exposed Infants with Care and Treatment Services: The Story from Meatu District By Jane Kashumba [AGPAHI Program Officer Clinical Services] Meatu District is one of the five districts of Simiyu Region. It is bordered to the north by the Bariadi District, to the west by the Maswa and Kishapu Districts, to the east by the Arusha Region, to the southeast by the Manyara Region and to the south by the Singida Region. By the end of 2014, there were 46 facilities in Meatu that provide RCH services in which 40 facilities provide option B+ services and 9 facilities provide care and treatment services and HIV early infant diagnosis (HEID) services. Just like in many other districts, reaching infants who are exposed to HIV has remained a challenge. Recognizing this, Meatu CHMT worked closely with AGPAHI team and ascertained that the main barriers for reaching exposed infants were: 1) the capacity of providers in collecting DBS; Taking DBS sample from an infant. 2) availability of DBS kits; 3) distance from services and; 4) stigma. To overcome these challenges, a special campaign for increased DBS uptake among infants was established. To ensure that this is done, task force comprising of 2 district mentors, 1 medical attendant and a DRCHCo was formed. Dried Blood Spot (DBS) Samples The team agreed and organized DBS collection campaign at identified collection sites that included facility and community based sites. The task force ensured that community mobilization was conducted through community leaders (ward and village executive officers and hamlet leaders) religious leaders, at schools

24 24 AGPAHI 2014 ANNUAL REPORT and community radios. In addition, AGPAHI ensured that DBS kits were available for the campaign. The campaign was successful despite a slow start in the first quarter of the year (28 out of 76 registered infants were reached). The campaign was at the peak in quarter three of 2014 where 122 out of 252 exposed infants were reached which included the identified but not tested infants for the previous two quarters. The higher The DBS campaign helped us reach the national target and we were awarded the National Green Card Score which is Presidential perfomance recognition. This is the only district in Simiyu Region which received this recognition. registered number, that is 122, is due to the high backlog of infants from quarter one and two. Towards the end of 2014, 52 (100%) of the registered exposed infants were reached and DBS sample collected. See the figure below. Figure 4: DBS Uptake for Infants in Meatu District Oct-Dec Jan-March April-June July-Sept Oct-Dec 2014 Source: District Health Information System (DHIS), 2014 Registered infants DBS Taken The support provided by AGPAHI during this campaign has beyond reasonable doubt increased the uptake of DBS for exposed infants. Operationalization of the campaigns and its mainstreaming into the district plans for sustainability is at the heart of AGPAHI strategy. By so doing, districts will consistently reach the national target of 90% in the identification of infants, initiation of ART and retention of infants respectively.

25 AGPAHI 2014 ANNUAL REPORT Reproductive Health and Family Planning Goal To integrate reproductive health and family planning services in HIV and AIDS services so as to increase access of family planning among PLHIV. Objective To build capacity of service providers through in-service trainings, supportive supervision, mentorship and demand creation for FP service utilization at facility and community level. This project is funded by UNFPA Achievements By the end of 2014, HIV/family planning integrated services was scaled up from 26 to 52 CTC sites and from 30 to 53 VCT sites in supported districts of Shinyanga and Simiyu Regions. Technical Assistance was provided on the implementation of quality integrated family planning services to 7 councils namely; Bariadi DC, Bariadi TC and Itilima DC (in Simiyu region) and Kahama TC, Shinyanga MC, Msalala DC and Ushetu HC (in Shinyanga Region). Capacity of 72 service providers was built and managed to sharpen their skills and knowledge on how to integrate family planning so as to meet the needs of PLHIV towards sexual and reproductive health. Improved and maintained a constant supply of FP commodities to all supported facilities of Shinyanga and Simiyu Regions. Supported the sites through mentorship, supervision and training which increased family planning services for PLHIV at CTC and VCT from 59% in July, 2014 to 71% by September, 2014.

26 26 AGPAHI 2014 ANNUAL REPORT 4. The Innovations in Reproductive Health and Family Planning project (IRHFP) From July 2012 to July 2014, AGPAHI implemented IRHFP project through the support from USAID. The project aimed at improving access to and effective utilization of integrated family planning (FP) services. Furthermore, the project supported transfer of skills from skill laboratory skills lab to clinical practice at Kolandoto Nursing School to ensure graduates are competent in conducting safe delivery. Integration of family planning services This involves integration of family planning services into existing health services such as Reproductive and Child Health Clinics (RCH), Care and Treatment Clinics (CTCs) and Community Based Distributors (CBDs). The project was implemented in four districts councils of Bukombe, Kishapu, Meatu, and Shinyanga. This integration benefited communities in meeting their sexual and reproductive health needs. After integration, all districts showed an increased number of new clients accessing family planning through various outlets. Figure 5: Clients who accessed integrated family planning services x 23% CBD Outrreach FP/Immunization x 18% x 16% x 43% CTC/FP RCH/PMTCT TOTAL New Revisit Total x - % The figure above shows the total clients who accessed services (new and revisit) as 54,805. However, only 31,239 clients accessed FP services through various outlets such as CBDs, outreach services, CTC and RCH. Further, if FP services were only offered at RCH Units (as it used to be in the previous years) 23,566 clients would have accessed the services.

27 AGPAHI 2014 ANNUAL REPORT 27 Figure 6: Family planning enrollment trends Oct-Dec 2012 Jan-March 2013 Apr-June 2013 July-Sept 2013 Oct-Dec 2013 Jan-March 2014 April-June 2014 The figure above shows trend of new FP clients enrolment per quarter. More clients were reached each quarter due to continuous sensitization and service expansion. Kolandoto student nurse transfer of skills from skills lab to clinical practice Following the establishment of skills lab at Kolandoto College of Health Sciences by JHPIEGO, AGPAHI supported the lab to facilitate transfer of skills to clinical practice to ensure graduates are competent in conducting safe deliveries. This was achieved through transfer of class room instruction into clinical practice first by exposing students to skills lab models before working on real patients. The following are achievements reached throughout the life of the project; Basic Emergency Obstetric and Newborn Care (BEmONC) Through skills lab, 15 providers (10 preceptors and 5 Midwifery tutors) were trained for two weeks on BEmONC in collaboration with MoHSW. AGPAHI in collaboration with Kolandoto College utilized preceptors working at Labor wards based in Misungwi, Maswa, Nzega, Kahama and Shinyanga Regional Hospital during clinical rotation for both normal and abnormal deliveries to facilitate transfer of skills to students during midwifery rotations. During the implementation process both preceptors and midwifery tutors were supported to provide onsite supervision and mentorship to students for 2 weeks so as to improve competency of students while transferring skills from skills lab to real patients. Furthermore, examination results show that, out of 116 students who sat for final oral and practical midwifery examinations NTA⁹ level 5 & 6, 15 students scored grade A, 14 students scored grades B+, 58 students scored grades B while 29 students ⁹ National Technical Awards

28 28 AGPAHI 2014 ANNUAL REPORT scored grade C (Tanzania Nursing and Midwifery Council (TNMC) examination results March/April NTA Level 5 & August/September 2014 NTA level 6 results). Generally 87 students (75%) scored B and above which is above AGPAHI set target of 50%. This is outstanding performance can be compared to the base line results for 2010 where only 6 students (16%) scored B and above as indicated in figure below: Figure 7: Midwifery students performance before and afterproject % % baseline Midwefry practical final results 2014 end of Midwefry practical final results 0 Total Midwifery students Total Midwifery students score B and above % score >B

29 AGPAHI 2014 ANNUAL REPORT 29 Student midwives NTA level 6 (with green gown and pink) demonstrating resuscitation of new born baby at skills lab. Onlooking are 2 preceptors and a nurse tutor. Student at skills lab practicing on how to conduct vaginal examination to a pregnant woman to assess dilatation of the cervix.

30 30 AGPAHI 2014 ANNUAL REPORT Future Programatic Plans AGPAHI has continued to work towards improving the health of children and families with special focus in prevention and elimination of pediatric HIV/ AIDS. With the support from U.S. Center for Disease Control and Prevention (CDC), UNFPA, Ministry of Health and Social Welfare, PMO-RALG and 13 district councils, AGPAHI is planning to continue strengthening its programs as follows: Enhancing operational support to care and treatment sites to ensure quality comprehensive HIV care, support, and treatment services in Shinyanga, Simiyu and Geita; Increasing uptake and maintain access to quality, comprehensive adult HIV care, support and treatment services; Strengthening focus of pediatric HIV services to improve enrolment and retention to HIV services; Building capacity of the CHMTs and health facilities systems and structures to sustain provision of comprehensive, quality HIV care, support and treatment services; Scaling up the integration of reproductive health and family planning services into HIV services for increased access by PLHIV; Creating demand and improve retention into HIV care, support and treatment; Documenting and share success and lessons in various forums within and outside Tanzania; Increasing frequency of outreach services, including testing campaigns, for reaching more children in the peripheries; Expanding psycho-social support through children clubs, camps and PLHIV support groups; and 10. Strengthening CHMTs and RHMTs capacity in managing grants from different donors.

31 Financial Reviews AGPAHI 2014 ANNUAL REPORT 31

32 32 AGPAHI 2014 ANNUAL REPORT

33 Much Progress has been made, momentum is with us, and success is within our reach. With your help, we can eliminate pediatric HIV in our country. - Excerpt from Elizabeth Glaser Speech

34 An Affiliate of the Elizabeth Glaser Pediatric AIDS Foundation P.O Box: Dar es Salaam Tel: P.O Box: 1368 Shinyanga Tel: