HIV Prevention, Care and Treatment

THPS strives to contribute towards epidemic control in the supported areas as per the global UNAIDS goals of 95-95-95 through Afya Kwanza project which support Regional and District health authorities and 126 PEPFAR high priority health facilities in providing high quality comprehensive HIV prevention, care, treatment and support services in Kigoma and Pwani. Prior to 2018, through PEPFAR funds, THPS was supporting over 500 health facilities in Pwani, Kigoma, Mtwara and Zanzibar.

1^st 95, 2^nd 95 and 3^rd 95: Includes identification of new individuals infected with HIV, linkage and adherence to antiretroviral (ART) services, and viral load monitoring as follows:

i. HIV testing and Counselling:

The following interventions are implemented in provision of HIV testing and counselling services:

Index testing (testing sexual partners and biological children of HIV infected clients).
Optimized Provider Initiated HIV testing and Counselling (o-PITC – HIV testing after screening for risk factors) conducted in the health facility settings and community.
Provider or client-initiated HIV testing and counselling in medical and pediatrics inpatient wards, TB clinics and OPD and facilitated referral

ii. Linkage, continuum of care, retention and adherence to antiretroviral (ART) services, stigma and discrimination

For a continuum of care, THPS implements the following strategies to ensure same day enrolment and linkage case management:

Early prevention of treatment defaulters including attachment of PLHIV to Peer Educators as treatment buddies (‘wateja marafiki’) for follow up and continuous counselling
Three boxes, filling map cues to facilitate tracing.
THPS facilitate conducive and friendly environment to retain PLHIV on treatment (staffing, availability of drugs and supplies, facility lead outreach, block appointments, drugs pick up etc.).
THPS supports Peer Educators (PEs) and Trackers for tracking retention purposes including peer education, facility and community-based health education, testimonials, facility and community based psychosocial support, pediatric and adolescent’s friendly clinics and clubs. Through well trained PEs and health care providers, stigma and discrimination are addressed and clients are capacitated to disclose.
THPS also supports Saturday and evening clinics.

iii. Viral load monitoring

THPS facilitates sample collection, processing and storage through provision of consumables, centrifuge and appropriate refrigerators; sample transportation from spokes to the hubs through well capacitated PEs and to the testing laboratories using PEs and program vehicles. THPS ensure results are timely brought back for client’s management manually or through electronic sample referral system (e-ESRS)

v. Cross cutting issues

THPS addresses knowledge gaps in all program areas through supportive supervision, mentorship, on job and didactic training to ensure services are provided based on the most updated guidelines and scientific updates. Supply chain management is done to ensure constant availability of drugs and medical supplies (accurate forecasting, timely order development submission and follow ups at Medical Stores Department and redistribution). Facilitates use of Electronic Logistics Systems (Pharmacy module, electronic Logistics Management Information System e-LMIS and CTC/Pharmacy Database). By December 2020, 131 health facilities in Kigoma and Pwani were using e-LMIS to report and request ARVs, Laboratory, TB and other program supplies.

vi. Use of technology to improve adherence to HIV care and ART

THPS facilitated placement of phones at health facilities to enable Peer Educators and Trackers to remind clients on their appointments with the intention of improving adherence to appointment. THPS facilitates SMS reminders to help clients’ adherence to appointments, encourage disclosure and clients are able to call back and ask questions. Up to December 2019, a total of 9,186 PLHV have been receiving SMS reminder from 47 supported site.

vii. Adolescent and Pediatric Friendly Services

THPS supports adolescents and pediatric friendly clinics. By June 2020, 2,551 adolescents were receiving HIV services in THPS supported sites, and their retention rate is 91%. Monthly adolescent clinics allow for additional age specific counselling, sexual and reproductive health (SRH) health education, nutritional counselling and assist guardians/parents with disclosure process. THPS supported clinics provide an integrated package of services that also includes STI and Family Planning (FP), sexual and reproductive health, and counselling on disclosure, adherence, loss and bereavement. Family centered approach is enhanced by supporting “Mtunze ang’ae” initiatives whereby capacity building is done to caregivers to provide care and support to adolescents living with HIV. To enhance services provided, psychosocial support and increased retention, THPS has supported high volume sites with playing materials, bonanzas and THPS champions’ camp to 258 adolescents from Kigoma and Pwani regions. Annual adolescent camps are avenues to build a peer support system, assisting adolescents with coping mechanisms and influence each other to adhere to, appointment dates, treatment and positive living. By Sept 2020 there are 60,337 People Living with HIV current in care at THPS supported sites, whereby 2,694 (4%) are children < 15 years, an achievement that is attributed to the child and adolescent friendly services and intense site support.