Background: In October 2015, the World Health Organization (WHO) issued a treat-all approach guidance recommending antiretroviral therapy (ART), for everyone living with HIV regardless of clinical stage and CD4 cell count, widely known as Test and Start. Tanzania Ministry of Health Community Development, Gender elderly and Children (MOCDGEC) and MOH in Zanzibar adapted Test and Start Strategy in October 2016. As an implementing partner in Kigoma, Pwani regions and Zanzibar, Tanzania Health Promotion Support (THPS) worked with the regional and district health management teams (R/CHMTs) and Zanzibar Integrated HIV, TB and Leprosy program (ZIHTLP) to roll out Test and Start . The achievement of the 90-90-90 strategy is determined by the intensive identification of HIV +ve (1st 90) and effective linkage and timely ART initiation to all clients testing HIV +Ve (2nd 90).
i. Managers Orientation of Test and Start towards epidemic control i.e. 90-90-90
ii. Intensified targeted identification of HIV infected clients at health facilities through PITC at OPD, IPD, TB and Immunization clinics as well as VCT, index client testing. At all high volume HFs PITC became a standing Agenda items during morning clinical meetings i.e. for all admissions one had to report how many were tested/HIV+ve/ enrolled at CTC.
iii. Ensuring that all clients testing HIV positive are linked in care and started on ART immediately, same day diagnosis and initiation on ART. To ensure linkage of all clients and same day initiation were effected, same day enrolment was done and HIV positive clients were physically escorted by expert PLHIV (Peer educators) and community outreach workers for KPs up to reach CTC.
iv. Ongoing intensive site support, on the job training/coaching to health care workers. THPS clinical mentors and counsellors worked at CTCs with clinicians, nurse counselors and peer educators to demonstrate that this was feasible. Ongoing adherence was also emphasized.
v. Data usage: Weekly monitoring of new PLHIV identified and linked to ART at health facility and SNU to follow up newly diagnosed PLHIV not started on ART
vi. Provision of health talks by Peer educators sensitizing Test and Start at clinic waiting areas
vii. Expansion of ART services through ART refill sites which were again capacitated to initiate ART using mother site CTC numbers while mobile data clerks (famous roving data clerks) from mother sites capturing all records.
viii. Various innovations put in place include Okoa Maisha program, (phone numbers of Peer Educators were placed in all HTC points for easy access to facilitate physical escort in case clients) and Jaza ujazwe (where a HCP is incentivized for ensuring newly diagnosed client is linked to care with same day ART initiation goal)
Results: Within a year using the above strategies same day ART initiation improved from 61% in October –December 2016 to 84% in July – September 2017, and from 78% to 92% within two weeks as recommended by the MOHCDGEC Tanzania as seen in the chart below.