How Tanzania can close gaps in fight against HIV
The chief executive officer of the Benjamin Mkapa Foundation, Dr Ellen Senkoro, speaks at a past event. PHOTO| FILE
What you need to know:
Today is World Aids Day, a global event themed ‘Know your status’. Countries across the world have expressed their determination to end the spread of HIV through this campaign. UNAids seeks to achieve 90 per cent of all HIV positive individuals knowing their status, 90 per cent of those diagnosed with the virus being put on ARVs and 90 per cent of them having viral suppression. It’s dubbed: 90-90-90 targets, to be achieved by 2020.
With only a year to the deadline, Tanzania has so far achieved by 52.2 per cent on the first 90, which rhymes with this year’s World Aids Day theme.
How can the country bridge the remaining gap? To answer this question, The Citizen’s Health reporter Syriacus Buguzi spoke to the chief executive officer of the Benjamin Mkapa Foundation (BMF), Dr Ellen Senkoro. Excerpts:
Question: Dr Senkoro, your organisation, BMF, has been involved in HIV/Aids interventions at community level for a long time. What should be done to ensure that under-served areas are reached by HIV interventions from stakeholders and the government?
Answer: Through our experience, we see that the communities residing in rural and underserved areas need interventions that follow them in their localities. In this regard, HIV community interventions that will give these people an opportunity of receiving HIV services in a combined and integrated manner.
An example is having HIV services integrated in all health and social services provided at the community level with the aim of ensuring that no one is left behind…there should be focused investment at the facility level to ensure that facilities are sustainably responsive to provide quality HIV/Aids services particularly to absorb the increased demand contributed by the community investment.
In our targets to ensure that 90 per cent of all HIV positive individuals know their status (as per UNAIDs 90-90-90 targets), Tanzania has so far attained 52.2 per cent. Now that we are left with about a year to reach 2020, the deadline for attaining the targets, what should be done to cover the gap?
We should be able to think beyond the normal approaches by quickly learning the epidemic distribution as well as the epidemic drivers in and across regions and at the community level and act accordingly. There is no one perfect approach, so we should be able to quickly recognise what works well, where and go with a specific and responsive focus. We should employ targeted approaches that will help us to reach the right population. In this case I will say innovative approaches will help us to reach high risk groups within the general population with targeted HIV testing as well as identification of areas with high prevalence that can help us reach the first 90. In addition, there should be efforts to help HIV negative individuals remain negative.
Are the ongoing campaigns for HIV screening in Tanzania paying off?
Yes, the ongoing HIV testing campaigns currently known as ‘Furaha Yangu’ are paying off. This year BMF as part of other stake holders taking part in these campaigns have been supporting its scale up in 8 councils located in Arusha (Ngorongoro DC and Monduli DC), Manyara (Simanjiro DC and Mbulu DC), Tanga (Pangani DC and Kilindi DC) and Mtwara (Mtwara MC and Masasi DC).
These campaigns have been conducted in 40 wards where 82,980 people as part of the general population (43,871 males and 39,109 females) have been tested and received their HIV results and out of these, 674 (252 males and 422 females) were found to be HIV positive. We see this as a success and a big contribution towards the National efforts of reaching the first 90. Also, we ensure that all the identified new HIV cases are followed up and linked to care. We are seeing a very positive community urge to know their status and through this we do ensure constant provision of behavioural interventions which aims at reducing risky behaviours among the communities.
What is BMF doing to bridge the gap?
BMF, through funding support and partnership with the government, non-governmental organisations and development partners have been working in multiple approaches to address the gap.
Firstly, Community service delivery -- Through this, we are taking services to those who are not intending or not able to visit the health facilities for care. We are ensuring that we use all possible community testing approaches that will help us reach the right population like identification of hotspots, index testing and moonlight testing. We are ensuring full regional, district, facility and community involvement so as to enable continuation of care and ownership of the implemented interventions.
Secondly, other health systems approaches include contributing on placing of health care workers in the facilities with critical shortage were BMF is supporting placement of 302 skilled health care workers; further BMF is continuing to place about 929 formal community health care workers in communities with high health needs particularly those associated with HIV/Aids.
Moreover, BMF is strengthening community structures to create responsive community systems and structures to accelerate quality planning, accountability and provision of quality health services as well as promoting community involvement in ensuring access of quality services for the underserved population.
What are the potential sources of new HIV infections that should now be addressed at the community level?
I would point out the HIV positive individuals who are not aware of their status and thus keep on transmitting the virus to others. In this group, more males are not aware of their HIV status. Also, as highlighted in the Heath Sector HIV and Aids Strategic Plan 2-17-2022 the prevalence is still high among key population groups, people who inject drugs form 36 per cent, and female sex workers form 26 per cent while Males who have sex with males form 25 per cent. These groups could be the potential source new HIV infection in the community.
They need a differentiated care approach as part of the general population so as to ensure HIV prevention and timely care and treatment. Also, harmful traditional behaviours and taboos like polygamy, early marriages as well as gender issues related to male dominance also contribute to new infections. Stigma; is still high causing people not to uptake HIV testing or disclose their HIV status hence perpetuating the rate of new infection.
Is the current financing in HIV prevention and treatment sufficing the needs? It seems that having many people getting to know their HIV status may come with a challenge of mobilizing more resources to put them on ARVs. What are the possible sources of funding that can help bridge this gap?
According to Unaids over 90 per cent of the HIV and Aids resources are externally funded but the government has initiated internal efforts through Aids Trust Fund which aims at supporting HIV/Aids programmes and mitigate donor dependency. This is a measure that will help to combat challenges upcoming with the increased ARV demand.
To accelerate the target of ATF there is a need to employ more innovative and sustainable resource mobilisation strategies and mechanisms by engaging mult- stakeholders within and outside the government. In addition to this, the communities should be strengthened to access health insurance in so as to enable them to access health services with minimal or without depending on out of pocket payment as need arise.
