Voices from the Field: An Assertive Approach Boosts HIV Services in Tanzania

“The introduction of provider-initiated HIV testing and counseling [PITC] services has made a remarkable change in increasing the number of people knowing their HIV status and those accessing care, treatment, and support services.”

A champion of universal access to HIV testing and counseling services

In Tanzania’s Arusha region, Lilian Msoffe is a pioneer in integrating HIV testing and counseling into routine health care services. A nurse by profession, Msoffe has served as regional reproductive and child health coordinator for over 20 years and trains health workers in PITC service provision. The approach works like this: when patients—or relatives escorting a patient—come into a health facility department—whether it be the out-patient, in-patient, family planning clinic, dental clinic, eye clinic, or child welfare clinic—the provider offers them an HIV test along with the services they came in for.

Empowering people to improve their health

In Tanzania, 5.7% of the population is HIV-infected. If people can find out their status, they can take the necessary steps to remain negative or access care and treatment services if positive. To further this goal, the Government of Tanzania made a policy decision to expand HIV testing and counseling availability by introducing PITC. Integrating PITC into comprehensive services allows providers to offer testing and counseling as a standard component of medical care and can reduce the stigma attached to receiving an HIV test since every patient is asked if they want to be tested. Proactively offering testing and counseling also can increase acceptance of HIV testing among populations who are most likely to be infected and need care, and facilitate linkages to care and treatment.

Since 2006, the Centers for Disease Control and Prevention (CDC) has funded the IntraHealth International-led Provider-Initiated HIV Testing and Counseling (PITC) project to train health workers in the approach. The project works in partnership with the National AIDS Control Program and regional and council health management teams.

Thinking wide but starting small

”We had a strategy,” Msoffe says of the work that began four years ago. “Think wide and start small.” That method paid off: all seven districts of the Arusha region now offer PITC services. To date, the region’s eight trainers have trained a total of 790 health workers to provide PITC services, which are now integrated into different departments in 73 health facilities.

Most importantly, as of June 30, 2010, PITC-trained health workers had provided counseling and testing to 118,643 individuals in the Arusha region; of those, 6,925 were HIV-positive and were referred to care and treatment services. In all the regions in which IntraHealth works, the project has counseled and tested 380,440 people and referred the 28,913 people who tested positive to a care and treatment clinic.

Expanding to a fifth region

Already working in four regions of Tanzania—Mwanza, Shinyanga and Kigoma, as well as Arusha—the PITC project is now expanding its work in the Mara region.

“The PITC [program] broke new ground in Tanzania in terms of working in facilities to provide testing and counseling services,” sums up Jim McMahan, senior program manager at IntraHealth. “Once the training of health care providers was begun, the numbers of people tested and therefore knowing their HIV status began to rise dramatically. Now other programs have seen it can be done successfully and have adopted similar models.”