WEAB027 - Amref Health Africa International Conference

Report
Innovative community based HIV
counseling and testing models for
identifying new HIV positive adults and
children: a case of a countrywide
program in Tanzania
Presented by: Beati Mboya
Amref Health Africa International Conference
26 November 2014
Contents
 Background
 Aim and Objectives
 The Intervention
 Results
 Lessons learned
 Challenges
Background
• Tanzania has a population of about 44.9 million (Census 2012)
• Tanzania HIV and Malaria Indicator Survey of 2007/08 and 2011/2012
 HIV prevalence decreased from 9.4% in 2000 to 5.7% in 2007/8 to 5.1% in
2011/12
 Percent of individuals ever tested has increased from about 30% in 2007/8 to
50% in 2011/12
• The U.S. President's Emergency Plan for AIDS Relief through USAID Tanzania
funded AMREF to implement a country wide HIV Testing and Counseling
program, Angaza Zaidi
• Angaza Zaidi program addresses the need for increased HIV counseling and
testing in Tanzania and identification & linkage of HIV positive individuals to
continuum of care
Aim and Objectives
Aim: Mobilize innovative strategies to rapidly scale-up
counselling and testing (HTC) approaches in the Tanzania
mainland
Objectives:
1. Increase the number of Tanzanians who know their serostatus, receive counselling, and are linked to treatment,
care, and prevention services
2. Compare the efficiency and effectiveness of different HTC
approaches in identifying new HIV positive individuals
The Intervention
(strategies, the model)
Decentralization &
Community Engagement
Brandi
ng
Branding
Empowering
Programming
Targeting
BENEFICIRIES
&
COMMUNITIES
Enabling
Environment
Advocacy & System
Strengthening
Mechanism
Partnership &
Sub granting
The Intervention cont…
• 42 HTC Outlets established to provide onsite and outreach
HTC services
• 31 PLHIV groups established and engaged in HIV prevention
• 957 health providers trained on HTC, grant-management,
referral and M&E
• Conduct quarterly supportive supervision to all sites
• Engaged in development and dissemination of guidelines,
SOPs and data collection tools
Angaza Zaidi HTC Modalities
Angaza Zaidi offered HTC services through three key clientinitiated modalities
• Standalone HTC (sHTC): independent static
HTC outlet, not directly linked to a health
facility, that is strategically located in high risk
areas to attract a high volume of clients
• Integrated HTC (iHTC): a static HTC outlet,
located near or within a facility and has
directly linkage to a health facility- is regarded
as part/section of a health facility
• Outreach Community Based HTC (cHTC): a
mobile HTC outlet changes location from time
to time and targets high population areas,
hard to reach areas and high risk populations
Methods
• Intervention – data collected before and after
intervention
• Routine quantitative data collected using national
tools
• Routine data quality control measures implemented
at each level
• Data analyzed using Microsoft excel
• Effectiveness of different HTC modalities compared
• Expenditure per HIV positive client identified
estimated for each modality
RESULTS
Age Sex Distribution of Clients reached
Sex
Male
Female
Total
<14 years >=14Yrs
Total
25,217
1,194,925
1,220,142
(2.1%)
(97.9%)
(100%)
26,782
1,094,375
1,121,157
(2.4%)
(97.6%)
(100%)
51,999
2,289,300
2,341,299
(2.2%)
(97.8%)
(100%)
Percent individuals
Tested HIV
Percent of Individuals Testing HIV Positive by age group
(n=2,341,299 )
10%
8%
6%
6.2%
5.2%
5.2%
>14 years
All agegroups
4%
2%
0%
<14 years
Percent of Individuals Tested Positive
Percent of individuals testing positive was higher <14yrs than >14yrs
Percent individuals Tested HIV
Positive
Comparison of proportion of individuals tested positive by sex
8.0%
6.6%
6.6%
6.0%
Males
Females
4.0%
5.8%
2.0%
3.9%
0.0%
<14 years
>14 years
• Across the age categories, females had higher proportion of individuals testing HIV positive
• Difference between male & female among <14yrs is less than those >14 yrs
Percent individuals Tested
HIV Positive
Comparison of trends of proportion of individuals tested
positive over years by age category
10.0%
8.0%
6.0%
4.0%
2.0%
0.0%
Oct. 2008 Sept. 2009
Oct. 2009 Sept. 2010
<14 Years
Oct. 2010 Sept. 2011
Oct. 2011 Sept. 2012
Oct. 2012 Sept. 2013
>14 Years
Over the five years percent of individuals testing positive has
decreased more among >14 years than <14years
Number of Individuals reached through various HTC modalities
HTC Modality
Number
Tested
HIV+Ve
% +ve
Integrated HTC
566,883
51,191
9.0%
Standalone HTC
451,443
32,407
7.2%
Community Based HTC
1,429,903
41,857
2.9%
• cHTC reached many more individuals than the other two modalities
• iHTC was more efficient in identifying HIV+ve individuals than the other
two modalities
Individuals
Individuals tested by HTC approach by age category
1,600,000
1,400,000
1,200,000
1,000,000
800,000
600,000
400,000
200,000
0
Integrated
Standalone
Outreach
HTC Modality
<14 years
>14Yrs
Majority were reached through outreach HTC approach
(Over 55 percent of clients tested)
Distribution of percent Positive by HTC approach by Age Category
16.0%
14.0%
12.0%
10.0%
8.0%
6.0%
4.0%
2.0%
0.0%
Integrated
Standalone
<14 years
Outreach
>14Yrs
Integrated & Stand alone HTC modalities were more effective in
reaching more positive individuals compared to outreach
Comparison of proportion positives among Repeat testers
Sex
<14 years
>14 years
Males
3.3%
1.3%
Females
3.1%
2.5%
•
About 1 percent (4,236) of all repeat testers (385,256) were <14 years
•
Among repeat testers, percent positive was higher among <14 years
Expenditure per individual reached by HTC Modality
Expenditure/HIV+ve Identified
$160
$143
$140
$120
$100
$80
$60
$88
$74
$41
$40
$20
$0
Integrated HTC
Stand alone HTC
Community Based
HTC
All Modalities
Expenditure/HIV+ve Identified
Stand alone sites seems more efficient than other modalities
Lessons Learned
 Outreach is effective in reaching many individuals within short time, both adults and
children
 Integrated & standalone approach are more effective in identifying HIV +ve individuals
than outreach
 Although standalone approach is the cheapest model, long term sustainability is a
challenge
 Percent positive among <14years is higher than adults, need further research to
explain and understand the situation more
 Improve cost-effectiveness of outreach HTC approach by targeting key and high-risk
populations
 More rigorous cost effective study to compare HTC modalities
Major Challenges of the HTC
programs
• Inadequate HIV test kits most of the time
• Staff turnover – issues in technical & financial
reporting
• Effective referrals & linkages still a challenge

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