Project Title. Project Title: to improve the care of people who are infected with both TB and HIV, through training and collaborative care initiatives. : District Dang 11 VDC, Province Rapti, Mid-western region of Nepal. Target area: District Dang 11 VDC, Province Rapti, Mid-western region of Nepal. Target group: People living on the borders of Nepal, migrant workers going to India frequently and sex worker Target group: People living on the borders of Nepal, migrant workers going to India frequently and sex worker Duration: April March 2010(3 years). Duration: April March 2010(3 years). Date: February 23 rd Date: February 23 rd 2006.

PROJECT DESIGN MATRIX Narrative Summary Objectively verifiable Indicators Means of verification Important Assumption Overall goal: To improve the survival rate of patients living with TB/HIV coinfection The mortality rate of people living with TB/HIV co-infection in the 11 VDC of district Dang has decreased by 20% by the year DPHO reports and quarterly performance reports. The ministry of Health does not bring any changes regarding TB and HIV collaboration. Project purpose: To decrease the decease burden of TB among HIV cases & HIV among TB cases. The number of cases with TB/HIV co- infection in the 11 VDC of Dang has declined by 10% by March Patient record register, Treatment register, lab.register, DPHO records. Department of Health services takes TB/HIV as a priority program.

Out puts: 1.Guidelines for implementing collaborative TB & HIV prog. activities, followed. 2.Adequate health education given to the HWs and to the community. 3. Health workers skills are improved in TB/HIV management. 4. TB and HIV programmes conduct joint collaborative activities. 1.By the year 2010 more than 50% of the health workers in 11 VDC of Dang follow guidelines. 2.60% of health workers have completed a TB/HIV education programme by the end of The number of patients attending health center in district Dang with TB/HIV has increased by 30% by the year About 50% of HWs in district Dang go through the training by the year 2008 & qualify the skills requirement for managing TB/HIV. 4-New collaborating management systems are introduced and case detection increased by 20% of the people living with TB/HIV. 1- Project survey reports on health workers compliance with guidelines and policies. 1.Project survey records of health education prog Patients records, lab.register & treatment register. 3- Project records of health workers training programme. 4- Project survey records of joint activities, patients records, lab. register, treatment register, DPHO records, quarterly performance reports and HMIS. 1- Donors support the project efficiently. 2- Trained health workers continue working for their facilities. 3- ARV drugs supply from donors and government continues.

Activities: 1.Specify the rules and practices in the guidelines that the health workers follow. 1.A co- ordination committee or body formulated. for TB/HIV activities. 2.Conduct workshop for HWs. Formulate the WS. for commitment and motivation among them Conduct advocacy meetings with donors, stakeholders and the media. Inputs: Personnel- Long Term Expert: Project leader Project co-ordinator Advisor, short term experts as required. Equipmqnts: Vehicles, maintenance equipment. Diagnostic Kits for HIV testing. Funding support for in- country trainings and workshops. DOHS: ARV drugs, office equipments. Facilities like PHCC office, Preconditions : The MOH, DOHS and JICA support the programme.

Activities: 2-2. Conduct group discussions involving mothers group, FHW, local leaders etc. 3. Design HWs training prog produce training materials, IEC materials Capability building training to HWs, IEC materials given.

Activities: 4. Build up intensive case finding for earlier detection of TB and INH prevention therapy Introducing increased access to VCT Introducing HIV prevention and Cotrimoxazole therapy Antiretroviral therapy. SUPPORT ACTIV. 5. Joint operational research.

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