1. Partnering to Reach an AIDS Free Generation in Tanzania DPG-Health Meeting September 2015

2. Ending AIDS Scenario: New HIV Infections
Total number of people living with HIV/AIDS (PLWHA)
79M PLWHA
52M PLWHA
35M PLWHA
$31B in additional Tx cost/year
$8B in additional
Tx cost/year
SOCO: There is not enough funding within the USG or globally to continue putting people on treatment without enhanced focus on epidemic control.
Preventing new infections is our common PEPFAR goal.
We need to change the trajectory of new HIV infections and get on the Green Line trajectory. This can happen with accelerated and expanded coverage of Combination Prevention interventions in priority locations and among those most in need.
44M PLWHA
48M PLWHA 2
Source: UNAIDS 2014 GAP Report

3. PEPFAR/Tanzania Goal Statement
To reach 80% of PLHIV with lifesaving treatment by 2020, starting in districts of highest need

4. Tanzania Funding Levels
2005 $100
2006 $129.9
2007 $205.4
2008 $313
2009 $ $50
= $ $30 $20
= $ $30 $20
= $ $30 $20
2013  
Base PF     PMTCT

5. Tanzania Strategic Pivot for Epidemic Control
RIGHT PLACES
Districts
Sites
Populations
RIGHT THINGS
PEPFAR-support for core interventions
Budget for Impact

6. Geographic Pivots for Epidemic Control
42 Scale-Up Districts to reach 90/90/90 by 2020
Represents 55% of PLHIV in Tanzania
27 Scale-Up to Saturation Districts: 80% PLHIV on ART by 2017
15 Aggressive Scale-Up Districts: 13 districts with increased rate of ‘new on ART’ to achieve saturation by 2018/ Key Population Hot Spot districts
129 Sustained Districts

7. District Prioritization
PLHIV by District
PEPFAR Scale-Up District Focus

8. Site-Level Pivots

9. Site-Level Pivot: Scale-Up Districts
Low and high volume site overlap in Scale-Up Districts

10. Site Prioritization: Scale-Up Districts
Plan for detailed analysis to determine appropriate client referrals

11. Site-Level Pivot in Sustained Districts
In 129 low burden, Sustained Districts:
Discontinue support for 849 sites with no beneficiaries
Sustain semi-annual quality monitoring in 2,352 sites with <100 clients
Focus services in 509 high volume ART facilities

12. 90% of PLHIV know their status
Core
Non-Core
Demand creation for HTC targeting Key and Priority Populations (Adolescent Girls & Young Women)
Scale-Up Districts: PITC, PMTCT opt out testing, VMMC
All Districts: Early Infant Diagnosis and Pediatric HIV case finding
Focus on testing OVC (HIV exposed and malnourished)
Community-Based HTC index case finding
Non-targeted HTC

13. 90% are of PLHIV on ART Core Near Core Non-Core
Active identification, enrollment and treatment clients in pre-ART
Active identification, enrollment, and treatment of HIV+ KP/PP (AGYW), peds, pregnant women, TB, discordant couples
Strengthen PLHIV networks and support groups to track loss to follow up and link back to care
FP integration
CTX gap filling
Procurement of ARVs and commodities to cover needs above Global Fund support
Basic care kit
Hematology and chemistry
Infrastructure for training institutions

14. Viral Suppression Core Routine viral load monitoring
Focus on retention and adherence
Laboratory EQA and Information Management Systems
Quality improvement methods

15. Package of Services in Scale-Up vs. Sustained Districts
Facility packages are the same across all districts
Treatment targets in Sustained Districts assume passive enrollment
Service package in Scale-Up Districts will include:
Demand creation for HTC at community level
Viral load testing
Continuous service and data quality improvement
Completed referrals
Focus on key populations
Policy directive: No duplication of funding from clinical partners that are now under the national Results-Based Financing program (eg: allowances, renovation)

16. Continuation of Non Scale-Up Support
Central Support Sites:
Overarching PEPFAR national support and QA/QI will continue to ensure quality services
Non-Core site specific activities will transition no later than March 2016
Lab- Chemistry and Hematology
Sustaining Commodities:
PEPFAR will coordinate with GFATM and GOT to continue to commodity support to sites even without PEPFAR site level support.

17. Population Pivots

18. Key/Priority Populations – Key Pivots
Increased focus on detecting and successfully treating Key Populations
Targets and budget have increased
Only one focus “Priority Population” instead of 7: Adolescent Girls & Young Women (AGYW)
Utilize Sex Worker and AGYW platform for condom promotion and HTC linkage for high-risk men
Additional $4.2 million directed to condom programming to fill the gap in Global Fund support
Study to learn more about the military population; Military sites are aligned with Scale-Up Districts in Tanzania

19. Priority Populations: Children/Adolescents
Accelerating Children’s Treatment (ACT)
Focused from districts
Aligned with Adult Prioritization and OVC programs
Implementation of Test & Treat for children <15yrs regardless of CD4
Children on ART by SAPR 2015
Children on ART by APR 2016
37,716
76,136

20. Determined, Resilient, AIDS-free, Mentored, and Safe (DREAMS)
Zanzibar
Iringa
Kigoma
Tabora
Rukwa
Mbeya
Singida
Shinyanga
Kagera
Mwanza
Mara
Pwani
Morogoro
Ruvuma
Mtwara
Lindi
Dodoma
Manyara
Arusha
Tanga
Dar es Salaam
Kilimanjaro
221,203 AGYW reached with combination prevention program including testing
In full alignment with VMMC, ART, and ACT interventions

21. OVC Pivot to Contribution to Epidemic Control
Reduction in districts and full alignment with PLHIV: 136 to 27 Scale-Up to Saturation Districts
Scale up of OVC Case Management Model
Identify and refer OVC for testing, adherence and retention
ACT & DREAMS
Find HIV+ OVC:
Nutrition Assessments
Out of School children who are not in family care
Engagement of caregivers to support ART adherence & retention for children

22. Budget Realignment for Program Sustainability

23. Above Site Decision Tree
Scale-Up District? No
Crucial to Epidemic Control?
Reduce or Cut?
Yes
Synergies between programs/HSS/lab?
Appropriate funding level?
Above Site Decision Tree

24. Budget Realignment of ‘Above Site’ to Reinvest in Increased Coverage
Starting Point
$94.7M
Reinvest savings in treatment coverage, procurement, VMMC, KP/PP programming
Category
Pre-COP Review
Post-COP Review
Percent Reduction
Health Systems
$37.5M
$18.8M
50%
Above Site Level
$28.3M
$19.1M
32%
G2G
$19.5M
$11.9M
39%
Strategic Information
$5.3M
$3.7M
30%
Lab
$4.0M
$2.4M
42%
TOTAL
$94.7M
$55.9M
41%

25. Quarterly Monitoring
Quarterly calls with PEPFAR HQ will be aligned with Executive Committee and CSO Engagement
Updates on implementation of initiation of CD4 500
Review SIMS visits and data
Review MER Indicators
Review Updates on Human Rights

26. PEPFAR Tanzania’s Health Diplomacy Priorities
Implementation of CD4 500 eligibility: Jan 2016
Tanzania assume funding for a phased and increasing proportion of activities that PEPFAR is currently funding
Continued attention to human rights of PLHIV and Key Populations

27. ASANTENI