HIV-RH INTEGRATION IN TANZANIA By: Dr Mukome Nyamhagatta, SIO-MOH View PPT in presentation mode and click through to the end to view available multimedia.

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 PMTCT coverage By 2014, 91%(n= 5361) of RCH Clinics were providing PMTCT services. About 92% (n=4,943) of these were providing– Life Long Antiretroviral therapy for Pregnant and Lactation women (LLAPLa) and 76% (n= 4058) were providing HIV Early Diagnosis (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

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

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