WEAB027 - Amref Health Africa International Conference

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Transcript WEAB027 - Amref Health Africa International Conference

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 sero status, 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

Brandi ng The Intervention (strategies, the model ) Decentralization & Community Engagement

Empowering

Branding Targeting

Programming

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 client initiated 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 25,217 (2.1%) 26,782 (2.4%) 51,999 (2.2%) 1,194,925 (97.6%) 2,289,300 (97.8%) Total 1,220,142 (97.9%) 1,094,375 (100%) 1,121,157 (100%) 2,341,299 (100%)

Percent of Individuals Testing HIV Positive by age group (n= 2,341,299 ) 10% 8% 6% 4% 2% 0% 6,2% 5,2% 5,2% <14 years >14 years All agegroups Percent of Individuals Tested Positive Percent of individuals testing positive was higher <14yrs than >14yrs

Comparison of proportion of individuals tested positive by sex 8,0%

6,6% 6,6%

6,0% 4,0% Males Females

5,8% 3,9%

2,0% 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

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 >14 Years Oct. 2012 Sept. 2013 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

Integrated HTC

Number Tested

566,883

HIV+Ve

51,191

% +ve

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 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 HTC Modality <14 years >14Yrs Outreach 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 >14Yrs Outreach Integrated & Stand alone HTC modalities were more effective in reaching more positive individuals compared to outreach

Comparison of proportion positives among Repeat testers Sex Males Females <14 years 3.3% 3.1% >14 years 1.3% 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 $140 $120 $100 $80 $60 $40 $20 $0 $74 $41 $143 $88 Integrated HTC Stand alone HTC Community Based HTC Expenditure/HIV+ve Identified All Modalities 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