Tanzania is among countries with very high HIV burden, with an estimated 1.7 million people living with HIV (PLHIV) or 5.1% out of the total population of 61,741,120 people. The country’s HIV epidemic is complicated by the general health system challenges as a result of low resources. Yet, significant progress toward HIV/AIDS control have been made over the years. Reports indicate that 83% of PLHIV in Tanzania now know their HIV status, that 90% of these are currently receiving anti-retroviral treatment (ART) and among those on treatment, 92% are attaining viral suppression. Progress was also made on the elimination of mother to child transmission (MTCT) of HIV disease, reducing the rate from 26% in 2011 to 7.8% in 2015 following government, donors, and other stakeholders’ efforts. Despite these successes, gaps still remain, as the shifting demography of the disease presents new and additional challenge. A significant number of individuals who are HIV-positive have not been identified and linked to treatment yet. This is attributed to Sub-optimal testing among key and vulnerable populations (KVP) especially those who do not have regular contact with the formal health system. Inefficiencies in linking those who are tested for HIV to ART services is also another challenge.
Amref Tanzania in consortium with partners the University of Maryland in Baltimore (UMB), Afya Plus, and The Tanzania Center for Development and Communications (TCDC) collectively known as “Afya Thabiti” proposes a comprehensive patient-centered data driven program that will improve access and uptake of quality HIV & TB services, expanding the cohort of PLHIV on ART and accelerating progress towards the attainment of the UNAIDS 95-95-95 targets for epidemic control in Tanzania. Afya Thabiti will implement various initiatives, using multi-disciplinary HF teams to provide site level technical support that include training, mentorship, and coaching. Community-centered and population-specific approach including the use of expert clients and peer volunteers be used by Afya Thabiti to reach Key and vulnerable populations (KVPs). Key stakeholder engagement at all stages of the project will include the MoH, Regional and Council Health Management Teams (R/CHMTs), KVP-led CSOs, other implementing partners. These initiative and approaches will facilitate the delivery of the set of activities the consortium have designed to respond to the MOH priorities as set in the NSP 2020-2025 as well as the outcomes presented by CDC in the present NOFO.
The proposed project consists of six strategic objectives (SO) and a robust evaluation and performance management plan. SO one will focus on implementing efficient HIV case-finding activities to achieve the 1st 95 target, SO two will focus on the immediate linkage to treatment for those newly diagnosed with HIV and prevention services for the HIV-negatives. SO three and five focuses on ensuring that individuals are receiving high-quality ART and TB services including the prevention of mother to child transmission of HIV (PMTCT). In SO four, Afya Thabiti will deliver strategic voluntary medical male circumcision (VMMC) support to R/CHMTs and health facilities (HFs) helping to reduce HIV transmission. Lastly, SO six presents the projects activities that will ensure collection, transmission, and utilization of high-quality data from the HFs. Activities will be driven by continuous quality improvement principles supported by integrated supportive supervision to ensure ownership and sustainability of program by the R/CHMTs and site staff.
To implement project activities, there needs to be reflections, accountability and reviews built-in to track progress. Afya Thabiti will implement robust performance monitoring and management using routine and advanced analytic techniques to glean information from program, providing timely feedback to site level staff, R/CHMTs as well as program managers, with a view to improving program performance.