Overview  Launched in 2011, PRRR is a partnership of public and private organizations with a shared goal of reducing deaths from cervical and breast cancers in low- and middle-income countries.  It builds on existing health care programs to integrate cervical cancer prevention—including access to HPV vaccinations, screenings, and treatment, as well as breast and cervical cancer education in sub-Saharan Africa.  The partnership is in 5 countries: Botswana, Ethiopia, Namibia, Tanzania, and Zambia.

 Organizing Members › The George W. Bush Institute › The U.S. President’s Emergency Plan for AIDS Relief (PEPFAR) › The Joint United Nations Program on HIV/AIDS › Susan G. Komen  Corporate and Foundation Members › Beckton Dickinson and Company › Bill and Melinda Gates Foundation › Bristol-Myers Squibb Foundation › Caris Foundation › Glaxo Smith Kline › IBM › Merck › Qiagen  Collaborating Partners › National Breast Cancer Foundation

 PRRR was launched by President Kikwete and former President George W. Bush during the First Ladies’ Summit in  Tanzania was the 3 rd country to join the PRRR partnership. Why Expand into Tanzania? › 11 million women 15 years and older at risk of developing cervical cancer › 33% of population has an HPV infection › Second highest incidence rate of cervical cancer in sub-Saharan Africa › Cervical cancer is the leading cause of cancer-related morbidity and mortality.

 The cervical cancer response in Tanzania is led by the MoHSW.  The Tanzania Cervical Cancer Technical Working Group provides guidance to the national program.  Ocean Road Cancer Institute is the main government institution that acts as a referral center for cancer treatment in Tanzania.  PRRR works under the purview of the National Cervical Cancer Prevention and Control Strategy and the MoHSW vision.

Commitments  PEPFAR: $3 million over 5 years (16 cryotherapy machines donated; plans to expand cervical cancer screening and treatment and to building on the PEPFAR program)  UNAIDS: $100,000 over 3 years to Tanzania, Botswana, and Zambia (To support the engagement of women living with HIV and to support community- based engagement by working with local partners)  Bristol-Myers Squibb Foundation: $1.2 million over 3 years (To support community outreach and mobilization along with community systems strengthening)

The U.S. government will use $3 million dollars over 5 years to:  Build on existing PEPFAR-supported platforms  Support the MoHSW to strengthen national cervical cancer activities  Help the Reproductive Health Cancer Unit develop a national quality assurance approach for cervical cancer screening and treatment  Develop capacity at 3 referral hospitals to serve as zonal hubs from which regional and district hospitals can receive support to › Provide quality screening and treatment for cervical cancer › Establish referral networks for treatment of larger lesions › Provide care to women affected by cervical cancer

Funded Activities  Establish screening services, treatment, and referral for women at 3 zonal hubs and peripheral facilities (focusing on HIV-positive women).  Ensure availability of supplies and equipment for cryotherapy.  Establish systems for routine maintenance of machines.  Build capacity by training and mentoring staff and maintaining a high standard of clinical services at peripheral sites.  Disseminate national monitoring and evaluation tools for data collection and analysis to inform future programming.  Develop a national quality assurance process to inform the national roll out of guidelines and tools.

 $1.2. million over 3 years to assist with community outreach, mobilization, and community systems strengthening.  Support local organizations who can provide community outreach for cervical cancer prevention services.  Promote linkages to referral level care.  Work with community organizations to establish meaningful referral systems from lower-level facilities for women who need specialized services. Each hub zone will develop its own community approach based on the platform with which it is currently working.

Organizations Selected  Medical Women’s Association of Tanzania (MEWATA) MEWATA’s mission is to promote professional development of women medical and dental doctors for better delivery of quality health services for the women of Tanzania.  Wanawake na Maendeleo (WAMA) Foundation WAMA focuses on advocacy to the ministry of health, local government authorities, other partners in the region, and identified health facilities and communities.  Tanzania Youth Alliance (TAYOA) This NGO is committed to serving youth in urban and rural areas through Information Communication Technology (ICT).  T-MARC This Tanzanian non-profit organization is working to improve public health and promote social development.  Mbeya HIV/AIDS Network This is an umbrella NGO of 26 organizations that implement effective cervical cancer awareness campaigns and community mobilization activities.

TAYOA MBEYA HIV/AIDS Network T-MARC MEWATA - WAMA

 The U.S. government proposal serves as a platform for the PRRR program in Tanzania.  Launch of the community piece is strongly supported by the First Lady, Mama Kikwete (WAMA Foundation).  PRRR launched advocacy and mass screening campaigns for cervical cancer in Mwanza, Iringa, and Mbeya.

 PEPFAR › 16 cryo machines distributed to 12 satellite sites serving as feeders into the hubs  MEWATA › 2-day cervical and breast cancer awareness and screening campaign launched in the Mwanza Region resulted in health care training (VIA/cryotherapy) and thousands of screenings  TAYOA › 38 networks of volunteers created to link women to health centres and women’s groups  T-MARC › Produced and distributed cervical cancer IEC and promotional material to all implementing partners.  MBEYA HIV/AIDS NETWORK › 1447 women sensitized and referred for screening

All Levels  Shortage of staff, trainers, and equipment  Limited budget  Low community awareness and coverage of services  Equipment and supplies not included in MSD catalogue Site Level  Lack of the pathology services  Referrals system  Long-term sustainability of the program  Pre-service training on VIA/cryo and LEEP

 UNAIDS positions (e.g., PRRR Coordinator and M&E Officer sitting at RCHS)  Implementation of the U.S. government proposal  Monitoring and evaluation plan for PRRR