Decentralized and Integrated HIV and AIDS Care, Treatment and Support Services

Facility Based Care and Support for PLHIV

Many CTCs have started using a block appointment system to manage client congestion and take into consideration the patient’s convenience. The expert patients, lay counsellors and community volunteers provide invaluable support in CTC clinics in offering health education including individual testimonies. Also, in collaboration with Community based volunteers they offer home-based care patient tracking in case of missed appointments and LTFU. In addition, they support to make sure that people diagnosed with HIV are linked to CTC (patient escort), retained in treatment (adherence counselling and follow up) and their viral loads suppressed (VL monitoring)

Priority

• Strengthen mechanisms for linkage from HIV testing services to care for all HIV positive individuals
• Strengthen HIV care entry points for HIV exposed infants, pregnant women, children, adolescents and men
• Strengthen community level follow-up and treatment support mechanisms for PLHIV on ART (Health facilities provide back up and support to CBHCW).
• Provide a guideline of uniform package of care to implementing partners to scale-up
• implementation of prevention and treatment of AIDS-related opportunistic infections
• Strengthen integration of nutrition assessment, counselling and support in HIV care and treatment services
• Initiate/expand ARV refill sites in health facilities that do not provide ART services

ART services for adults

In harmonizing UNAIDS targets of 90-90-90, Tanzania has committed to continue with the “Treat all “approach which started (as “Test and Treat”) in October 2016 as a new approach towards achieving universal coverage of ART for all PLHIV. This approach is expected to increase ART coverage

Priority

• Strengthen implementation of SDMs to support identification and retention of adults on care
• Enhance early initiation into ART and adherence support services for all PLHIV with special focus on adolescents and elderly
• Establish quality assurance and quality improvement activities at all HIV care and treatment sites
• Strengthen adherence counselling, health education and linking clients to community groups to reduce stigma and discrimination

Pediatric ART Services

The country has been implementing Tanzania Initiative for Accelerating Children on Treatment (TI-CoT). This initiative showed great success in enrolling children into ART services. The country intends to build on the successes and lesson learnt from paediatric HIV/ AIDS interventions including TI-CoT initiative to increase the paediatric ART coverage to 95% by 2020.

Priority

Pediatric Care

• Strengthen case identification strategies to all Pediatric entry points in order to enhance early ART initiation for HIV positive children
• Strengthen adherence and retention on treatment including provision of psychosocial support to ensure viral suppression
• Strengthen linkages between RCH and CTCs, or integration of pediatric ART within RCH clinics that are implementing PMTCT Option B+
• Scale up implementation of focused PITC in all health facilities attending children (RCH clinics, OPD, hospital paediatric wards)
• Strengthen linkage mechanisms for MVC/OVC services to enhance identification, enrolment and retention of OVCs into care and treatment services
• Strengthen paediatric nutrition assessment, counselling and support (NACS) and treatment of severe acute malnutrition (SAM) including use of ready to use therapeutic food (RUTF, F75 & F100) for severely malnourished children
• Strengthen mechanisms such as facility and community-based adherence support package to increase retention into care and treatment services
• Strengthen coordination and accountability structures for effective scale-up of EID and paediatrics ART coverage from national to district level

Adolescents care

• Increase capacity of health facilities providing quality prevention, care and treatment services for adolescents and youth living with HIV
• Expand access to and utilization of integrated quality HIV and AIDS services by adolescents and youth
• Strengthen linkage mechanisms for facility and community-based services to increase retention in care and treatment services for adolescents and youth
• Establish programmes to enhance retention and adherence among adolescents and youth such as special clinic days, teen clubs and camps

ART for Pregnant and Lactating Women

In order to ensure improved retention into PMTCT Care and outcomes of both HIV infected Pregnant and Lactating Women together with their respective HIV-Exposed Infants, the Ministry of Health in Collaboration with PMTCT Partners, developed, piloted, evaluated and disseminated the Mother-Child   Cohort Monitoring System.

Priority

• Expand provision of appropriate treatment; care and support to women living with HIV, and their infants and family
• Strengthen follow up of HIV infected mothers and infants at facility and community
• Implement the community interventions service package for eMTCT, MNCH, Paediatric HIV care and treatment by using CHWs.
• Improve community knowledge, awareness, attitudes, perceptions, behaviours and practice in eMTCT and Paediatric HIV care and treatment through communication interventions
• Increase male involvement in eMTCT services through improved awareness, reduction in stigma, and community engagement
• Develop mHealth services for increased follow up and retention
• Strengthen community involvement and enhanced participation of community structures in comprehensive eMTCT and Paediatric care and support

HIV co-infections & co-morbidities

HIV infection lowers the immunity of those infected with the virus leading to opportunistic infections such as TB, Cryptococcosis and Toxoplasmosis and co-infections such as Hepatitis and Human papilloma virus which have the same mode of transmission.

Priority

• Strengthen and improve integration of TB, HIV and other sectors such as Reproductive and Child Health at all levels to reduce the burden of HIV among TB patients and TB among PLHIV
• Improve TB case notification among PLHIV by improving the quality of TB screening and facilitating increased use of GeneXpert MTB/RIF
• Scale up provision of IPT and CTX to all eligible PLHIV as per national guidelines
• Consolidate TB infection control measures in congregate settings
• Increase the scope of CTC and other specialized clinics to manage HIV and HIV co-infections & co-morbidities including NCDs

Community Based HIV/AIDS Care

Community based interventions for HIV and AIDS have continued to improve. Over the past couple of years more Councils are including Community Based HIV and AIDS Services (CBHS) in their plans and attracted more support from implementing partners for HIV-related community based interventions. The coordination of CBHS in regions and districts has improved significantly through the work of regional and district HBC coordinators.

Priority

• Strengthen existing CBHS programs and ensure they are in the council comprehensive health plans with clear funding mechanism, monitored and evaluated.
• Strengthen community level follow-up and treatment support mechanisms for PLHIV on ART (Health facilities provide back up and support to CHW).
• Strengthen effective linkages and referrals between community and clinic-based services
• Strengthen community systems and structures (including CMAC, WMAC, VMAC and PLHIV Clusters) to support CBHS programs and linkage with health facilities to ensure a continuum of comprehensive and integrated services for PLHIV.
• Improve the tracking system for PLHIV missed appointment and Lost to Follow up to enhance retention.
• Ensure continuous monitoring and mitigation of stigma and discrimination of PLHIV (facilities based, community-based and self-stigma) to enhance adherence on ART.
• Strengthen provision of psychosocial support to PLHIV and linkage to social welfare and legal services.

Achieving Viral Suppression

HIV Viral Load (HVL) monitoring is a gold standard for detection of HIV/AIDS treatment failure. The viral load monitoring is also way of follow up of disease progression and any development of resistance due to treatment failure. With this importance; MOHCDGEC through NACP has embarked into building the country’s HVL testing capacity

Priority

• Ensure quality assurance, validation and post market surveillance of all ARVs.
• Identify and mitigate all factors that contribute to treatment failure and promptly switching to appropriate regimen
• Expand and improve accessibility of HVL testing (Hubs and sample transportation) at all CTC to improve monitoring of viral load suppression.
• Expand use of simplified single-tablet ARV regimen to enhance adherence and hence viral suppression • Improve mechanism for routine monitoring of viral load for all patients on ART after 6 months of treatment (cohort analysis).