HIV-RH INTEGRATION IN TANZANIA

By: Dr Mukome Nyamhagatta, SIO-MOH

 Background

• Tanzania is located in Eastern part of Africa

• Area: 945,855 Square km
• Population: Projected at 48,775, 567
• Total Fertility rate: 5.2 per woman (NBS, 2015)
• Teenager Pregnancy: 27% (7%-45%) (NBS, 2015)
• Contraceptive Prevalence Rate: 38% (Modern- 32%, Traditional-6%)
• Unmet need for FP: 22%
• HIV Prevalence: 5.1% (NBS, 2012), Youth: 2% (at age23-24; 6.6%-Females, 2.8%-
males) (THMIS, 2011-2012)
• HIV services are integrated into RH Services and vice versa
 Background…..

• Policy documents available insist on integration

 PMTCT Guideline and eMTCT Strategic Plan
 Health Sector HIV/AIDS Strategic Plan
 National Multi-sectoral HIV/AIDS Strategic Framework
 Road Map to Accelerate Reduction of Maternal and Child Mortality (One Plan)
 Health Sector Strategic Plan
• Levels of integration: Community, Primary, Secondary & Tertiary Health Facilities
• Areas of integration
 Community-Information on FP, HIV Prevention, HTC , ART adherence, VMMC, STIs/RTIs,
CeCaP, SGBV, TB and Psychosocial support
 Facility- Provide services including FP, FANC, PMTCT, cPAC, PNC, HEID, PITC, SGBV Screening,
STI Screening, Reproductive Organ Ca and Psychosocial support
KEY FINDINGS
Increased Health Facility Coverage of PMTCT/HEID Services

• By 2014, 91%(n= 5361) of PMTCT coverage

RCH Clinics were
providing PMTCT services. PMTCT service Coverage
6000
About 92% (n=4,943) of 4914
5361

these were providing– 5000 4603

4832
4943

Life Long Antiretroviral

Number of PMTCT Sites

4000 3626 3808 4058

therapy for Pregnant and 3000 2732

Lactation women
(LLAPLa) and 76% (n= 2000
1357 1165

4058) were providing HIV 1000

Early Diagnosis (HEID) 0

3

services Baseline (2009) 2011 2012

Year
2013 2014

Number of ANC sites offering PMTCT Number of PMTCT sites offering B+

ANC Sites providing HEID services
Increased HIV Testing uptake among Pregnant and Lactating women

Number of pregnant women attending ANC, tested for HIV, received post-test counselling, and
percent tested for HIV, 2010-2015, Tanzania, PMTCT programme data
Increased ARV Uptake among Pregnant and Lactating women

Number of HIV-infected pregnant women already on ART, number

newly tested positive, number initiated on ART, percent received
ARV/ART and percent newly initiated on ART, 2012-2015, Tanzania
Decreased HIV Positivity among tested Children
Lessons learned

• Integration encourage clients of one service to take up the other

service within the facility, community-based setting or through a
facilitated referral
• RH-HIV Integration resulted into increased PMTCT Service coverage
and utilization
MAJOR CHALLENGES
Low retention of clients on LLAPLa into care

Retention in PMTCT care, 3,6, and 12 months; Overall, B-plus, and

Already on ART
Reten on in PMTCT care
100%
80% 80%
70% 73%
80% 74% 63%
60% 72%
67%
60%
40%
20%
0%
At 3 Months At 6 Months At 12 Months

Overall Reten on Bplus ini ates Already on ART

Other major challenges…..

• Low coverage of Community Based PMTCT Services

• Interrupted supply of Rapid HIV Test kits in some regions and other
supplies
Result into missed opportunities of HTC
• Low identification and inadequate follow up of HEI
• Low coverage of Pediatric ART
Plans for country scale-up

• Roll out of Mother-Baby Cohort Monitoring System

• Train more CHWs using integrated RMNCAH Community Service
Package
• Create community awareness using mass media and other IEC
materials
• Integrate Pediatric ART into RCH clinics
• Scale up Viral Load Testing
THANK YOU