1. United Republic of Tanzania Ministry of Health & Social Welfare MINISTRY OF HEALTH AND SOCIAL WELFARE NATIONAL AIDS CONTROL PROGRAM HIV CARE AND TREATMENT SERVICES IN TANZANIA DR. MATHIAS NKINGWA, MD, PdGH, MPH 29 TH NOVEMBER, 2014

2. outline 1. Prevalence of HIV in Tanzania 2. Health Sector HIV and AIDS Strategic Plan III (2013-17) 3. ART program- Achievements and impact 4. ARV requirement projection 5. Challenges 6. Initiatives for Sustainability of ART Program 7. Conclusion

3. 1. Prevalence of HIV Infections by Regions

4. 2. Health Sector HIV Strategic Plan III (2013-17 ) HSHSP III (2013-17) developed by the MOHSW is guided by the NMSF III 2013-17/18.  The goal is to achieve universal access to comprehensive HIV prevention, treatment, care and support services in Order to significantly minimize the transmission of New HIV infections and reduce HIV related mortality, Stigma and discrimination  To strengthen the capacity of the health system to Support quality HIV and AIDS interventions and foster integration within the health sector  The HIV interventions in the health sector will contribute towards the achievement of the impact results of the NMSF III Strategic Results Framework

5. 2. Health Sector HIV Strategic Plan III (2013-17 ) National HSHSP III targets to reach 90% of infected children HIV Care. Target: to provide ART services to 90% of all PLHIV in need of ART Target: To retain 90% of PLHIV on treatment 12 months after initiation of ART

6.  The GOT in collaboration with Partners started ART services started in 2004,  By June 2014:  1,209 H/facilities providing ART services compared 96 HF in 2005  1,446,916 PLHIV were cumulatively enrolled into HIV care and treatment services  567,892 are current on ART among them 39,317 were children. 3. ART Program Achievements

8. United Republic of Tanzania Ministry of Health & Social Welfare 3. ART Program Achievements (Cont. ) ART coverage by June 2014  All Eligible ART Coverage 60%  Adult ART coverage 70.3%  Pediatric ART Coverage 30 %

9. 3. Impact: HIV Incidence projections, Tanzania 2009 -2017 (SPECTRUM)

10. 3. Benefit/impact: Annual AIDS Deaths in Tanzania (2005 -2013)

11. 4. ARV requirement projection  Projections are based on the current guidelines;  Eligibility criteria of Adults with CD4 <350,  all Peds <2 yrs, peds 2-5 years with CD4 <750, peds 5 to 15 years CD4 <350,  all HIV +Ve Pregnant women  All TB/HIV co-infected patients.

12. 4. ARV requirement projection cont…… AdultsPediatrics PMTCT B+Total July 2014492,60351,77756,506600,886 July 2015569,90765,573122,864758,344 July 2016633,22675,698171,757880,681 By end of June 2017745,54682,068168,770996,384

13. 4. ARV requirement projection cont.…. Commodity Item Implementation period Jul 14 - Jun 15Jul 15 - Dec 15Jan 16 - Jun16Jul 16 - Jun 17 Total Costs ($) ARV197,798,81273,788,67884,202,412178,246,769 Lab39,457,06828,133,25528,444,76356,931,384 Total Requirements 237,255,880101,921,934112,647,176235,178,153 Allocated funds184,996,981101,921,93478,831,2490.00 Funding gap52,258,8990.0033,815,926235,178,153

14. United Republic of Tanzania Ministry of Health & Social Welfare Sustainability of the ART programs???? Shortage of human resource to deliver HIV and health services: - skills and number Inadequate infrastructure of the health system in general to cope with increasing number of clients needing health and Social welfare services Inadequate coverage of services compared to population needs: Partial coverage of HIV services in both public and private Health centres and dispensaries. Inadequate integration of HIV Prevention, care and treatment with other services. 14 5. Challenges

15. United Republic of Tanzania Ministry of Health & Social Welfare Inadequate access to paediatric HIV treatment, which is 30% by June 2014, contributed in part by inadequate skilled personnel for treatment and limited diagnostic capacity to identify children with HIV infection Stigma and discrimination for People living with HIV and AIDS as well as key populations. 15 5. Challenges cont.

16. United Republic of Tanzania Ministry of Health & Social Welfare 6. Initiatives for Sustainability of ART Program Sustainability is viewed in the context of providing quality, accessible and affordable health care services. Ensure equity is key to all strategies/ interventions at all levels. Allocation of resources to the high impact HIV Interventions

17. 6. Initiatives for Sustainability of ART Program cont. 1. Domestic Health financing Establishment of AIDS Trust Fund Goal: Ensures availability of financial resources for HIV and AIDS response and Provide financial support to various stakeholders who implement HIV interventions. Demonstrate the government’s commitment to address the epidemic. Sources of Fund: Contribution from the GOT, Support contribution, grants, special events

18. 6. Initiatives for Sustainability of ART Program cont MOHSW is in the process of developing National Health Financing Strategy Objective: To achieve Universal Health Coverage through increased mobilization of the domestic resources Means to cover the poor who can not afford to pay for the health care services Increased involvement of the private sector in the prepayment schemes- (NHIF, CHF) Comprehensive Council Health Plans (CCHP)

19. 6. Initiatives for Sustainability of ART Program cont 2. Service Delivery Efficiency in the utilization of available resources  Integration of services- PMTCT Option B+, TB/HIV, ART in the Medically Assisted Therapy (MAT) Focus in the 10 regions with Higher burden of HIV (HIV Prevalence of HIV Inf.) Focus in the H/facilities with high yield (High volume sites) Ensure no duplication of efforts by Implementing Partners in regions

20. 6. Initiatives for Sustainability of ART Program cont. Allocation of resources to the greatest unmet need for services eg. Paediatric ART services Establishment of Community Health workers- will address Retention/Adherence, TB/HIV/PMTCT and other conditions. Focus on Key Pop (CSW, PWID, MSM, Prisoners). Also Miners for TB/HIV care and treatment. MOHSW has approved Guidelines for Key Population services and Training Package.

21. HIV prevalence amongst KPs-

22. 6. Initiatives for Sustainability of ART Program cont. 3. Local Civil society Organizations Capacity Building in service delivery, resource mobilization (including in country), infrastructure development, In-service and pre-service training of HCWs Examples BMF, THPS, MDH, EGPAHI Community System Strengthening

23. 6. Initiatives for Sustainability of ART Program cont. 4. Improve Human Resources for Health Increase availability of adequate human resources for Health services at all levels of service delivery from 56,600 (2012/13) to 64,449 (2013/14) Increased production of pre-service students into the health and social welfare training institutions from 5,365 (2010) to 8,582 (2013/14) MOHSW is implementing Human Resource for Health and Social Welfare Strategic Plan 2014 – 2019.

24. 7. Conclusion Multiple initiatives are required for Sustainability of ART Program. Requires Collaboration GOT (MDAs), DPG Community, CSO, Private Sector, Academic and Research Institutions Efficiency in the use of available resources

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