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Tanzania Country Operational Plan (COP)

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Tanzania Country Operational Plan (COP) FY 2015 Tanzania Country Operational Plan (COP) The following elements included in this document, in addition to “Budget and Target Reports” posted separately on www.PEPFAR.gov, reflect the approved FY 2015 COP for Tanzania. 1) FY 2015 COP Strategic Development Summary (SDS) narrative communicates the epidemiologic and country/regional context; methods used for programmatic design; findings of integrated data analysis; and strategic direction for the investments and programs. Note that PEPFAR summary targets discussed within the SDS were accurate as of COP approval and may have been adjusted as site- specific targets were finalized. See the “COP 15 Targets by Subnational Unit” sheets that follow for final approved targets. 2) COP 15 Targets by Subnational Unit includes approved COP 15 targets (targets to be achieved by September 30, 2016). As noted, these may differ from targets embedded within the SDS narrative document and reflect final approved targets. 3) Sustainability Index and Dashboard Approved FY 2015 COP budgets by mechanism and program area, and summary targets are posted as a separate document on www.PEPFAR.gov in the “FY 2015 Country Operational Plan Budget and Target Report.” TANZANIA Country Operational Plan (COP) 2015 Strategic Direction Summary August 12, 2015 Table of Contents Goal Statement Epidemic, Response, and Program Context Summary statistics, disease burden and epidemic profile Investment profile Sustainability Profile Alignment of PEPFAR investments geographically to burden of disease Stakeholder engagement Core, near-core and non-core activities for operating cycle Geographic and population prioritization 4.0 Program Activities for Epidemic Control in Priority Locations and Populations 4.1 Targets for priority locations and populations 4.2 Priority population prevention 4.3 Voluntary medical male circumcision (VMMC) 4.4 Preventing mother-to-child transmission (PMTCT) 4.5 HIV testing and counseling (HTC) 4.6 Facility and community-based care and support 4.7 TB/HIV 4.8 Adult treatment 4.9 Pediatric Treatment 4.10 OVC 5.0 Program Activities to Maintain Support in Other Locations and Populations 5.1 Maintenance package of services and expected volume in other locations and populations 5.2 Transition plans for redirecting PEPFAR support to priority locations and populations 6.0 Program Support Necessary to Achieve Sustained Epidemic Control 6.1 Laboratory strengthening 6.2 Strategic information (SI) 6.3 Health system strengthening (HSS) – clear linkages to program 7.0 USG Management, Operations and Staffing Plan to Achieve Stated Goals Appendix A- Core, Near-core, Non-core Matrix Appendix B- Budget Profile and Resource Projections 2 | P a g e Version 6.0 Goal Statement Working collaboratively across U.S. Government agencies and the Government of Tanzania (GOT), implementing partners (IPs), multilateral representatives, and civil society representatives, the U.S. President’s Emergency Plan for AIDS Relief in Tanzania (PEPFAR/T) has developed a Country Operational Plan (COP) to achieve sustained epidemic control in Tanzania by scaling up coverage in the 42 highest burden districts. These 42 “Scale-Up” Districts represent approximately 55% of persons living with HIV (PLHIV) in Tanzania and are subdivided into 27 “Scale-Up to Saturation” Districts, 13 “Aggressive Scale-Up” Districts, and two key population hotspot districts. The goal in the Scale-Up to Saturation Districts is to reach 80% coverage of all PLHIV on ART by 2017, while the goal of the Aggressive Scale-Up Districts will be to reach 80% coverage by 2019. Two key population hotspot districts are also prioritized for saturation. The remaining 129 “Sustained” Districts will continue with a passive enrollment plan. Within the Scale-Up Districts, IPs will focus implementation and site level targets in epidemiologic hotspots. PEPFAR/T has strategically narrowed its prevention focus and scope to key and carefully selected priority populations in Scale-Up Districts with comprehensive packages that optimize uptake of antiretroviral therapy (ART). This package will include scaling up evidence-based behavioral and clinical prevention activities for key and priority populations. PEPFAR/T has established a minimum package of prevention, care, treatment, and support for all beneficiaries currently in care and treatment, pregnant women provided ART at PMTCT sites, and core services for orphans and vulnerable children (OVC) in COP 2015. The interagency team designed programs and allocated funding to achieve 80% coverage of all PLHIV on ART in the Scale-Up to Saturation Districts by the end of FY 2017, reaching nearly half of the scale-up coverage in FY 2016. The recently approved, but not yet implemented, Ministry of Health and Social Welfare (MOHSW) treatment guidelines to initiate ART at CD4 of 500 will support the 80% coverage target. PEPFAR/T will work with the GOT to develop a roll out strategy for the new national guidelines that emphasizes Scale-Up Districts. GOT has indicated that they intend to initiate the new criteria by January 2016 and have already extended access to all PLHIV under 15 years old regardless of CD4 cell count. Through the testing yield analyses initiated in 2014, PEPFAR/T identified 2,438 no and low yield facility and community testing sites that, subsequently, are no longer receiving PEPFAR support for HIV testing and counseling. PEPFAR/T also reviewed FY 2014 Annual Program Report (APR) and FY 2015 Semi- Annual Program Report (SAPR) data to identify low volume ART facilities in Sustained Districts. In Sustained Districts, there were 849 sites that were seeing no patients. Additionally, there were 2,352 sites in Sustained Districts supporting fewer than 100 clients, and seeing a total of 21,494 PLHIV. PEPFAR/T will review this support with the GOT and geographically map sites and discuss the potential to transfer clients to higher yield sites by FY 2017. PEPFAR/T will also reduce IP site visits to these locations, while working with the GOT to continue site supervision and support. The Tanzanian Parliament recently approved the AIDS Trust Fund (ATF) to facilitate increased domestic contribution to address the epidemic, from both public and private sector sources. PEPFAR/T is collaborating with the Global Fund to Fight AIDS, Tuberculosis, and Malaria (GFATM) and other donors to advocate that the GOT utilize ATF and other domestic resources to support key strategic priorities, including commodities. PEPFAR/T will continue to implement a health diplomacy strategy to address key gaps in the sustainability of the national HIV plan, including: mobilization of domestic investments to provide direct support for ART, selected medication and lab commodities, human resources and quality 3 | P a g e Version 6.0 service delivery. PEPFAR/T will work with the GOT to plan for a phased and increasing proportion of government to government activities and salary support across all mechanisms to transition to GOT support. PEPFAR/T will continue to plan closely with the ATF and the GFATM to avoid duplication and maximize efforts to achieve epidemic control. 1.0 Epidemic, Response, and Program Context 1.1 Summary statistics, disease burden and country or regional profile According to the 2014 UNAIDS Gap Report and most recent national census, adult HIV prevalence in Tanzania is estimated at 5.0%, with 1.4 million Tanzanians living with HIV and a total population of 47,451,847. An estimated 72,000 new infections and 78,000 AIDS-related deaths occur in Tanzania annually, with regional HIV prevalence ranging from 14.8% (Njombe) to 0.1% (Kaskazini Unguja, Zanzibar). Since 2004, PEPFAR/T has worked closely with the GOT, the GFATM, and other donors to respond to the HIV epidemic. Tanzania has made significant strides in reducing prevalence and incidence, but to attain epidemic control more geographic and population-focused interventions will be required. This includes shifting resources toward higher volume and yield sites and higher burden districts, and aligning partners for better program efficiency. The country grapples with weak health infrastructure, poor quality data, shortages of health and social workers, high levels of stigma, and cumbersome government procurement systems. PEPFAR/T supports the GOT to implement the Third National Multi-Sectoral Framework on HIV and AIDS (NMSF III) and other relevant national strategic documents, which closely correspond to the PEPFAR Blueprint: Creating an AIDS-free Generation, and the UNAIDS Fast Track Strategy by strategically prioritizing prevention of mother-to-child transmission (PMTCT) option B+, targeted scale-up of both adult and pediatric ART coverage, increasing access to and uptake of voluntary medical male circumcision (VMMC), targeted and focused HIV counseling and testing (HTC), and increased condom use. In December 2014, the National Bureau of Statistics announced a revision of its national accounts in which they rebased economic indicators to 2007 prices. This revision produced an estimated 31.9% increase of the 2013 Gross Domestic Product and an updated per capita GDI of $977. The new estimate brings the country closer to the World Bank threshold of $1,046 to qualify for lower middle income status. Qualification as lower middle income status would have significant implications for GOT counterpart financing requirements for the GFATM (raising it from 5% to 15%) as well as other health- related and development financing platforms. Although the Parliament recently approved the creation of the ATF,
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