innovative community based hiv counseling and testing models for identifying new hiv positive adults...
TRANSCRIPT
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
• 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
Background
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
Aim and Objectives
ProgrammingBENEFICIRIES
& COMMUNITIES
Decentralization & Community Engagement
Advocacy & System Strengthening
Empowering
Enabling Environment
Mechanism
Branding
Targeting
Branding
Partnership & Sub granting
The Intervention (strategies, the model)
• 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
The Intervention cont…
Angaza Zaidi HTC 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
Angaza Zaidi offered HTC services through three key client-initiated modalities
• 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
Methods
RESULTS
Age Sex Distribution of Clients reached
Sex <14 years >=14Yrs Total
Male
25,217
(2.1%)
1,194,925
(97.9%)
1,220,142
(100%)
Female
26,782
(2.4%)
1,094,375
(97.6%)
1,121,157
(100%)
Total
51,999
(2.2%)
2,289,300
(97.8%)
2,341,299
(100%)
<14 years >14 years All agegroups0%
2%
4%
6%
8%
10%
6.2%5.2% 5.2%
Percent of Individuals Tested Positive
Per
cent
indi
vidu
als
Tes
ted
HIV
Pos
itiv
ePercent of Individuals Testing HIV Positive by age group (n=2,341,299 )
Percent of individuals testing positive was higher <14yrs than >14yrs
<14 years >14 years0.0%
2.0%
4.0%
6.0%
8.0%
5.8%3.9%
6.6% 6.6%
MalesFemales
Perc
ent i
ndiv
idua
ls T
este
d H
IV
Posi
tive
Comparison of proportion of individuals tested positive by sex
• 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
Oct. 2008 - Sept. 2009
Oct. 2009 - Sept. 2010
Oct. 2010 - Sept. 2011
Oct. 2011 - Sept. 2012
Oct. 2012 - Sept. 2013
0.0%
2.0%
4.0%
6.0%
8.0%
10.0%
<14 Years >14 Years
Perc
ent i
ndiv
idua
ls
Test
ed H
IV P
ositi
ve
Over the five years percent of individuals testing positive has decreased more among >14 years than <14years
HTC ModalityNumber 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%
Number of Individuals reached through various HTC modalities
• cHTC reached many more individuals than the other two modalities
• iHTC was more efficient in identifying HIV+ve individuals than the other two modalities
Integrated Standalone Outreach0
200,000400,000600,000800,000
1,000,0001,200,0001,400,0001,600,000
<14 years >14Yrs
HTC Modality
Indi
vidu
als
Tes
ted
Individuals tested by HTC approach by age category
Majority were reached through outreach HTC approach (Over 55 percent of clients tested)
Distribution of percent Positive by HTC approach by Age Category
Integrated Standalone Outreach0.0%
2.0%
4.0%
6.0%
8.0%
10.0%
12.0%
14.0%
16.0%
<14 years >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
Stand alone sites seems more efficient than other modalities
Integrated HTC Stand alone HTC Community Based HTC
All Modalities$0
$20
$40
$60
$80
$100
$120
$140
$160
$74
$41
$143
$88
Expenditure/HIV+ve Identified
Expenditure/HIV+ve Identified
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
Lessons Learned
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
