HIV and TB Overview: Tanzania

Background

The partnership between the U.S. Centers for Disease Control and Prevention (CDC) and the Government of Tanzania (GOT) began in 2001. CDC is a key implementer of the U.S. President’s Emergency Plan for AIDS Relief (PEPFAR). CDC works with GOT to build a sustainable, high impact national HIV response program. CDC also collaborates with the Ministry of Health in mainland Tanzania and Zanzibar. This collaboration supports HIV testing, prevention, and treatment services and strengthens health systems.

Current programmatic priorities include:

• Scaling up targeted testing strategies.
  • Strategies include index testing and social network testing.
• Limiting treatment interruption of antiretroviral therapy (ART).
• Switching to optimal treatment regimens for adult and pediatric clients.
• Achieving viral suppression.
• Tuberculosis preventative treatment for all people living with HIV.
• Eliminating mother-to-child transmission of HIV.

HIV and TB data

HIV/AIDS

Tuberculosis (TB)

Key activities and accomplishments

Scaling up targeted testing strategies

Tanzania began index testing in 2018. Index testing yield has increased from less than 10 percent to around 20 percent. The number of individuals with HIV infection identified through index testing increased from about 10 percent to more than 50 percent. Tanzania monitors the modality by tracking performance across the cascade of service provision. This is key to ensuring the safe and ethical implementation of index testing services.

Implementing newer strategies, such as social network testing and self-testing, will also help reach additional populations whose HIV status remains unknown.

Keeping adolescents and young adults on treatment

Data from Tanzania shows that adolescents and young adults living with HIV are more likely to experience interrupted treatment. CDC-Tanzania leverages a combination of data driven interventions supporting adolescents and young adults living with HIV to continue treatment. Interventions include:

• Using map cues and details to locate clients.
• Peer-driven psychosocial support.
• Appointment reminders.
• Same-day tracking of missed appointments.
• Multi-month drug dispensing and community ART provision.

Laboratory accreditation and certification

In 2010, Tanzania introduced Strengthening Medical Laboratory Quality Management Toward Accreditation (SLMTA) approach for medical laboratories. To date, 96 laboratories have been enrolled in SLMTA cohorts. Sixty-one laboratories have been accredited to international standards, and over 600 personnel were trained in laboratory quality management systems. Improvements in lab capacity mean improvements for the HIV program. In 2017, the national viral load coverage was 38 percent, and coverage now exceeds 95 percent as of December 2022.

Project Extension for Community Healthcare Outcomes (ECHO)

Project ECHO is a distance learning and mentorship model for building healthcare worker capacity. It extensively trains and mentors HIV testing providers in all 31 regions of Tanzania and Zanzibar. Nine hubs and more than 421 high-volume health facilities use Project ECHO for knowledge sharing. Project ECHO has expanded to include other public health issues. Project ECHO also provided site level management to increase support when in-person engagement was limited during COVID-19.

Workforce development

In 2008, CDC established the Field Epidemiology & Laboratory Training Program (FELTP) in Tanzania. In 2016, Tanzania’s FELTP expanded to include three training programs for frontline, intermediate, and advanced residents. To date, FELTP Tanzania has produced more than 924 FELTP graduates across the three programs (as of July 2023). The three different programs ensure critical epidemiologic skills in all levels of the health care system.

Data driving decision-making and programmatic action

CDC actively uses monthly near-real-time, granular site-level data to monitor and drive program performance. Significant improvements can be seen in reductions in client treatment interruption and the rapid scale-up of key interventions. Interventions include multi-month dispensing and the introduction of optimized ARV regimens.

A regional approach to reaching epidemic control

Since 2019, CDC-Tanzania has leveraged a regional approach to implement and monitor programs to align with the country’s evolving epidemic. In August 2021, CDC implemented an intensive regional support structure. In this structure, selected staff were identified to oversee all program activities in a specific CDC-supported region. This structure provided an effective and flexible model leading to key improvements in routine HIV/Tuberculosis (TB) service delivery. Throughout 2021-2022, CDC-Tanzania effectively leveraged its regional support structure to drive COVID-19 vaccination uptake among PLHIV and healthcare workers.

TB/HIV prevention services

CDC supports end TB efforts contributing to PEPFAR through three main objectives: intensified TB case finding, optimized TB and HIV care and treatment, and TB prevention. CDC supports successful models for integrating TB and HIV services, including prevention services. CDC supports the National TB & Leprosy Programme to review and update national TB infection prevention control guidelines and implementation of TB infection prevention control measures in health facilities

Resources

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