PEPFAR’s $6.6 billion invested to save lives in Tanzania in 20 years

Mbeya. Tanzania has so far received $6.6 billion (or roughly Sh15 trillion) from the US government as part of the support for HIV programmes in the past 20 years.

The assistance has helped significantly in accelerating the fight against HIV. In 2003, the US government announced a relief fund whose aim was to control the HIV epidemic by preventing new infections and reducing the mortality rate in more than 50 countries.

Called the US President's Emergency Plan for AIDS Relief (PEPFAR), the fund is the largest commitment by any nation to address a single disease in history.

This initiative which is turning 20 this year, has enabled free availability of ARV drugs for free, equipment, and other facilities in the beneficiary countries.

The US government is said to be the largest supporter of HIV relief in Tanzania, according to Dr Alick Kayange, senior prevention advisor at Walter Reed Army Institute of Research – Department of Defence (WRAIR-DOD) – one of the US agencies which supports the HIV response in Tanzania.

“We have been working together with the government to ensure that the relief services are sustainable in Tanzania and today we see the impact,” he said.

“We always make sure that the ARVs are available in all health facilities including the dispensaries and there are no shortages at all,” he added.

AIDS-related deaths in Tanzania have declined by 76 percent from 120,000 in 2003 to 29,000 in 2021, he said, adding that new infections have also declined by 58 percent from 130,000 to 54,000 during the same period.

According to him, PEPFAR supports more than 1.5 million people on life-saving ARV treatment. Tanzania is estimated to have 1.7 million people who are infected with the HIV, according to the Ministry of Health. When the programme started in 2003, less than 1,000 people were using the ARVs which were scarce in Tanzania.

As one of the beneficiaries of PEPFAR, Mbeya region has seen several interventions which are accelerating the efforts towards ending the HIV.

Mbeya is one of the regions which have higher infection rate, at 9.3 percent, compared to a national average of about four percent.

The region has benefited from the support which has improved laboratory services, training of staff and other programmes which saves vulnerable groups and women. According to the Mbeya Regional Commissioner, Mr Juma Homera, Mbeya has so far achieved 76/99/98 in the UNAIDS targets of making sure that 95 percent of people living with HIV know their status; 95 percent of those diagnosed are on treatment; and 95 percent of those on treatment are virally suppressed (commonly known as 95/95/95).

“We have seen a lot of changes and with the current progress, we see light at the end of the tunnel towards achieving the 2030 targets,” said the Mbeya Regional Commissioner, Mr Juma Homera.

The US support has managed to reach about 109,000 people out of 142,000 who are estimated to live with HIV in Mbeya region, said Mr Homera. Currently, it's estimated that 80 percent of the HIV patients who use ARVs in Mbeya are considered "stable clients" meaning that their virus can neither be detected nor transmitted.

Mbeya Zonal Referral Hospital has received support in different aspects but most notably in improving the laboratory services.

“One of the improvements is buying of modern equipment which has come with a lot of changes,” said Dr Imani Mwakabanje, director of laboratory services at Mbeya Zonal Referral Hospital.

“Previously, in order to provide drugs to people living with HIV, we would test their body immunity (CD4), but today, we have a modern device that can check viral load and even drug resistance,” he said, adding that such changes can help to provide proper medication for the patients.

According to him, the capacity to test samples has also increased from just 10 samples to 5,000 a day.

In Tunduma, there is a mobile laboratory which helps to test HIV, cancer and tuberculosis among other diseases in areas where there are no such laboratory services. Another mobile lab also provides circumcision services which reduce the risk of acquiring HIV.

Tanzania is one of the African countries which conduct HIV-related research called Africos which is supported by PEPFAR.

Former President Jakaya Kikwete thanked his Ex-US counterpart George W Bush for conceiving PEPFAR at a moment HIV was one of the most threatening killer diseases.

 He said a positive HIV diagnosis was like a death sentence at that time, noting that the only questions on the patient’s mind was not if but when they were going to die.

“However, when PEPFAR commenced supporting us, it was no longer the issue of when one was going to die, particularly when antiretroviral (ARV) drugs were made available,” President Kikwete said during the ceremony to mark 20 years of the initiative.

Mr Kikwete who assumed office in 2005 said intensifying the war against HIV/AIDS was among his campaign promises. He began with creating ABC disease awareness (Abstaining from sex; Being faithful to one partner; and use Condoms).

“This wasn’t enough. It dawned in my mind that more should be done. I said let’s launch a nationwide testing campaign because if everybody is tested and knows their status, those who are HIV positive will know how to behave and those found to be negative but they have been living sexually irresponsible lives will change their ways,” he said.

“But even in this the challenge remained how to get testing kits. I called the US Ambassador at the State House where I shared my plan with him. He reassured me of the US commitment to help in provision of testing kits, hence that is how the initiative began,” he added.

The ex-leader said in order to lead by example he and his wife had to test publicly at the official launch of the public HIV testing campaign that saw 11,000 other citizens tested.

“The step was effective in reducing anxiety surrounding testing, eliminating stigma, and encouraging people to confidently and publicly declare their status after testing,” he said. But that was not the end of challenges for Mr Kikwete. People started asking what was next after testing, and especially if they tested positive.

“I assured them that ARVs will be there for them,” added Mr Kikwete. According to him, the testing campaign helped in reducing prevalence from seven to 5.1 percent by the time he was leaving office in 2015, adding that the reduction in prevalence has continued to date.

Furthermore, he said through ARVs many lives have been served and that viral load testing has prevented more infections.

Thanking the US Congress and the American people, Mr Kikwete said the US was the first country in the world to massively invest on one disease.

He said PEPFAR has helped Tanzania formulate policies, institutions, response programmes, training professionals and aided the international accreditation of 44 labs.

“With the labs, professionals, systems and programmes, why shouldn’t things work when you have commitment?” he questioned participants of the event organized by the George W. Bush Institute. “Now we have a new lady president [Tanzania President Samia Suluhu Hassan] who is doing so well. She sends her regards to you and she is grateful for the wonderful idea of establishing PEPFAR,” added Mr Kikwete.

Mr Kikwete added that continued collaborations and cooperation will defeat the disease in accordance with the 2030 targets.

According to him, PEPFAR, Millennium Challenge and the President’s Malaria Initiative (PMI) were US gateway initiatives to the rest of the world.

Former President Bush said during the event that PEPFAR has enabled African countries to deal with other diseases including the Covid-19 pandemic.

“The initiative has contributed to leaving behind a healthcare structure that never existed prior to 2003,” he said.