The following is a guest post from Mkama Mwirjarubi, a program officer at IntraHealth International in Dar es Salaam, Tanzania.
by Mkama Mwijarubi
As the fight against HIV rolls into its fourth decade, those of us who are involved in combating the epidemic have mixed feelings. While HIV continues to affect the lives of many here in Tanzania, there is also joy in the landmarks we’ve reached in research, clinical and public health interventions.
In Tanzania, one of our clearest successes is the decreasing rate of new infections. In addition, the Tanzania HIV and Malaria Indicator Survey shows that HIV prevalence has declined from 5.7percent to 5.1 percent among adults aged 15-49 between 2007 and 2012.
This year, the US Centers for Disease Control and Prevention is embarking on a new strategic direction for interventions in Tanzania funded by the U.S. President’s Emergency Plan for AIDS Relief, making program impact its highest priority — or, as the CDC states, putting a greater focus on the right thing, at the right time, in the right place, and with the right people.
In response to this new CDC direction, international nongovernment organizations in Tanzania are changing the way they work.
IntraHealth International, for instance, through its Tanzania HIV Prevention Project, is revitalizing its HIV testing and counseling intervention strategies to identify more HIV-positive clients and strengthen linkages to care and treatment services.
A CDC assessment of IntraHealth-supported HIV testing and counseling sites during October–December 2014 found that 55 had identified fewer than five HIV-positive clients in 2014. The result is that testing and counseling services for these “low-yield” sites will now be handled directly by the Tanzanian government, without PEPFAR support. The project will shift its focus to 340 other sites, including 302 “high-yield” and 38 “new high HIV prevalence” sites in areas that have high rates of HIV.
In essence, these changes aim to make extra resources available to address HIV in places where the scope of the problem is likely to overstretch government resources, all by shifting it from areas where the HIV burden has been reduced to levels that Tanzania’s health system can now handle on its own.
As a result of this strategic shift, the project’s most important objectives are now:
- Identifying more HIV-positive clients through increased testing: We’re doing this by integrating testing and counseling services into vaccination outreach, partnering with other HIV care providers (who focus on home-based care, tuberculosis care, and more) to provide outreach and mobile testing and counseling, and pinpointing hot spots where at-risk populations and young people need access to services.
- Promoting pediatric HIV testing: Children are an important demographic in HIV interventions but are often excluded from testing due to the belief that they are not at high risk of contracting HIV. Tanzania’s national target is to test 90% of all pediatric clients, enroll 90% of all children who are identified to be HIV-positive, and retain 90% of all enrolled HIV-positive children in treatment. These will be achieved through the Know Your Child’s HIV Status Campaign, which includes the following strategies:
- Services at static facilities: Health workers will conduct pediatric HIV testing in all in-patient departments, on both male and female medical wards.
- Mobile HIV testing and counseling: These services will piggyback on routine immunization outreach services. Health workers will encourage parents to know their children’s HIV statuses and, in high-prevalence areas, conduct house-to-house HIV testing, focusing on children. HIV-positive clients will be encouraged to bring their children for testing.
- Consolidation of services at high-yield facilities: In high-yield areas, officials will focus on ensuring the availability of HIV test kits, HIV testing campaigns in health facilities focused on families, and setting testing targets for health workers and health facilities.
- Strengthening high-quality supportive supervision, mentorship, and coaching: At the core of our work is the health worker. Communities need capable health workers to provide voluntary medical male circumcision, HIV testing and counseling, and services for victims of gender-based violence. Through supportive supervision, mentorship, and coaching, we prepare frontline health workers to serve their communities.
In the new strategic environment we must:
- Create, in collaboration with district partners, a standardized approach to conducting supportive supervision, mentorship, and coaching.
- Initiate and monitor quality assurance activities, focusing on the HIV-positive clients identified and enrolled at care and treatment clinics.
- Jointly plan and conduct supportive supervision with regional health management teams, council health management teams, and other implementing partners.
- Establish and identify supervisory and mentoring teams for HIV testing and counseling at both the regional and district levels, focusing on systems and mentorship strengthening to improve individual capacity for better service delivery.
We hope this harmonious partnership between the government of Tanzania and the CDC will result in widespread successes and new landmarks on the way to Tanzania’s AIDS-free generation.
IntraHealth International continues to support the Tanzania Ministry of Health and Social Welfare in expanding and strengthening HIV testing and counseling services in seven regions. Since it started in 2011, the Tanzania HIV Prevention Project has supported a total of 359 sites and tested a total of 430,329 men and women, 17.5 percent (75,537) of whom were identified as HIV-positive and were referred to care.