1. 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 2007- March 2010(3 years). Duration: April 2007- March 2010(3 years). Date: February 23 rd 2006. Date: February 23 rd 2006.

2. 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 2010. 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 2010. Patient record register, Treatment register, lab.register, DPHO records. Department of Health services takes TB/HIV as a priority program.

3. 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 2007. 2-1.The number of patients attending health center in district Dang with TB/HIV has increased by 30% by the year 2008. 3- 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. 2-1. 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.

4. 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. 2-1. 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.

5. Activities: 2-2. Conduct group discussions involving mothers group, FHW, local leaders etc. 3. Design HWs training prog. 3-1. produce training materials, IEC materials. 3-2. Capability building training to HWs, IEC materials given.

6. Activities: 4. Build up intensive case finding for earlier detection of TB and INH prevention therapy. 4-1. Introducing increased access to VCT. 4-2. Introducing HIV prevention and Cotrimoxazole therapy. 4-3. Antiretroviral therapy. SUPPORT ACTIV. 5. Joint operational research.

7. Thank you