Tanzania HIV Prevention Project

First in His Village, 100,000^th in the Shinyanga Region

Anonymous — Wed, 14 Sep 2016 13:13:29 +0000

First in His Village, 100,000<sup>th</sup> in the Shinyanga Region Anonymous (not verified) September 14, 2016

July 05, 2013

The other village officials in the room thought Damasi Ngereja was joking when he volunteered to be first in line for circumcision in the Tanzanian village of Lunguya. But Damasi wasn’t laughing. If anything could help convince his friends and neighbors that medical male circumcision was worth thinking about, it was seeing the village executive officer—an elected official—go through it first.

Historically, Lunguya men haven’t practiced male circumcision, be it medical or ritual. Less than a third of men in the Shinyanga region—where Lunguya is situated—are circumcised, a much lower percentage than the national average of 72%. Shinyanga also has a higher HIV prevalence rate than the rest of the country—7.4% of 15-49 year olds are HIV-positive, compared to the national rate of 5.1%.

That’s no coincidence. Low rates of male circumcision often go hand-in-hand with high rates of HIV infection. Circumcision removes the foreskin tissue that is most vulnerable to HIV transmission. Men who are uncircumcised are not only more likely to contract the virus, but are more likely to pass it on to their partners.

That’s why a team made up of Shinyanga health workers and staff from the Tanzania Youth Alliance (TAYOA) and nonprofit IntraHealth International had arrived in Lunguya to talk about the procedure’s virtues. Knowing that plenty of locals would be skeptical about circumcision, Damasi and his colleagues were meeting with the team to talk about ways to inform the community and encourage men to take advantage of the services, which could lower their HIV risks. That’s when Damasi raised his hand.

“I will be first to be circumcised in Lunguya village,” he said.

Since 2010, IntraHealth has been working with health management teams in the Shinyanga Region to offer medical circumcision services to men, both in clinics and through outreach campaigns. Clients that live far away from health facilities can sign up to receive text messages about outreach services coming their way.

Damasi signed up for the texts. And it wasn’t long before he received a message about a campaign on its way to Lunguya. So Damasi talked to his neighbors about it, encouraged them to bring their friends, and even helped organize a social cinema night (complete with a bit of male circumcision education) out of TAYOA’s van. The day the campaign started at the local Lunguya Health Centre, Damasi was among the first to show up.

He sat with other clients for group education before an individual counseling session and a physical exam. Then it was time.

After the procedure, clinic staff gave Damasi a bottle of water, some painkillers, and tips on postoperative care. And before he left to recover at home, they made a follow-up appointment for him to come back in 48 hours, to make sure all was well with the healing process.

In just a few days, Damasi was walking to work again. And a few weeks later, he took his three sons to be circumcised as well. Thanks to Damasi, some 2,200 men and boys were circumcised over the course of three weeks at the Lunguya Health Centre.

“Many older men have come to ask me about the procedure and experience,” Damasi says. “I have escorted a church leader, a counselor, and teachers in getting [circumcision] services. The community needs this service and thank you very much for the [male circumcision] program and providers. Please come again after the rainy season, as there are still more people in need of the services and they are busy with farming activities now.”

Not only was Damasi one of the first men in Lunguya village to be circumcised—he was also the landmark 100,000th client in the Shinyanga Region. Today, over 125,000 men in the region have opted for the procedure, thanks to the efforts of the Shinyanga regional health management team and IntraHealth. Project staff hope to raise that number to 135,000 by September 2013.

This work was conducted by IntraHealth’s Tanzania HIV Prevention Project, which is funded by the President’s Emergency Plan for AIDS Relief through the Centers for Disease Control and Prevention.

Tanzania Tanzania HIV Prevention Project Family Planning & Reproductive Health Family Planning

5 Ways to End AIDS by 2030

Anonymous — Wed, 14 Sep 2016 13:13:29 +0000

5 Ways to End AIDS by 2030 Anonymous (not verified) September 14, 2016

December 01, 2014

This article originally appeared in Devex.

When it started in the early 1980s, everyone was scared. No one knew how to help the people who were filling U.S. hospitals and then swiftly dying, or what to do for others suffering the same fate around the world. It was 1984 when one U.S. health official expressed hope for a vaccine within two years.

Now, over three decades and 39 million deaths later, we finally know how to treat, prevent and control HIV, although a vaccine remains elusive. But knowing is different from doing. The real challenge is scaling up what we’ve learned to stop new infections for good.

Last month, UNAIDS announced its new fast-track strategy to end the AIDS epidemic by 2030. “If the world does not rapidly scale up in the next five years, the epidemic is likely to spring back with a higher rate of new HIV infections than today,” officials from the U.N. agency said. That’s partly because half of the 35 million people who live with HIV today don’t know they’re HIV-positive, so they don’t know they’re in danger of passing the virus on to others.

By 2020, if the fast-track approach goes to plan, 90 percent of people who live with HIV will know their status, 90 percent of people who know they are HIV-positive will be on treatment, and 90 percent of people on treatment will have suppressed viral loads, making them less likely to transmit the virus. And by 2030, AIDS will no longer be a threat to our public health.

The goal is ambitious. There are still a lot of global problems and prejudices to overcome. But today experts can see what once seemed impossible — ending the epidemic — is finally within reach, and these five focus areas are going to help make it happen.

1. More health workers, ready for anything.

Lab technicians, doctors, nurses, even the truck drivers who deliver antiretroviral therapies and other meds to clinics around the world are all health workers, and they’re at the heart of health and well-being in any community.

HIV demands all different types of health workers and skill sets, including palliative care, counseling, research, pharmacology and obstetrics, to name just a few. Pediatrics is another big one, as one of our greatest challenges ahead will be making sure all HIV-positive infants and children are on treatment.

According to the World Health Organization, we need some 7.2 million additional doctors, nurses and midwives worldwide. And unless we invest in the global health workforce, that number will grow to 12.9 million by 2035.

To end the AIDS epidemic, the world needs more health workers who are trained and ready to do the job, stationed in the right places, connected to the right technology, and safe from infection and violence. Countries also need to make better use of the health workers they have. Without health workers, we can’t test or treat even a single person — much less end an epidemic.

But it’s not just health workers’ skills the world needs. It’s also a commitment to equitable, unbiased health care for all.

2. Focus on key populations.

Members of key populations — something of a euphemism for sex workers, men who have sex with men, transgender people and injectable drug users — are marginalized and stigmatized. Their isolation and high-risk behaviors mean these groups have much higher HIV prevalence rates than others and they suffer the bulk of new infections.

Not so long ago, U.S. policy tried to prevent global health organizations from working with certain key populations. And when we did, we were often required to first document our moral indignation by proclaiming our opposition to, for example, prostitution.

Today this policy has changed. But that doesn’t mean that these key populations are getting the HIV services they need. Take Uganda’s infamous anti-homosexuality law — enacted and then repealed this year — which made it difficult for many to seek or even provide care without risking life in prison. Similar laws are still on the books in some countries.

Many members of key populations have been turned away by health workers. And many more have been socially outcast for so long that health care doesn’t even seem like an option anymore. So they fall through the cracks of health care systems around the world.

One example is in South Sudan. The HIV rate among the general population is relatively low, only 2.2 percent among adults. But among female sex workers — and there are many, particularly wherever there’s a strong military presence — the rates are much higher. The ongoing war and all its effects on the health system have turned the country into a tinderbox for potential HIV infections.

That’s why IntraHealth International, in partnership with the South Sudanese government, reaches out to sex workers at brothels and lodges, trains peer educators (that is, other active female sex workers), promotes and distributes condoms, provides testing and counseling for HIV and syphilis, and links women to other critical health services. Of the 546 sex workers we tested between July and September of this year, almost 32 percent were HIV-positive. Fortunately, most are now enrolled in treatment and getting the care they need.

3. Rock-solid health systems.

Over the past 35 years, we’ve seen what a strong health system can do to help countries respond to HIV. And in the past year, we’ve seen another virus, Ebola, spread out of control in West Africa. It’s clearer than ever that vulnerable health systems around the world have a long way to go.

Strong health systems are the bedrock of any healthy population. They lay a foundation built on governance, financing, technology, research, service delivery, and the health workforce (also known as human resources for health). To successfully address an epidemic such as HIV requires focus on each of these things, not just a few.

One way to make these systems stronger — and to lower rates of HIV — is to ensure systematic HIV testing and counseling. Integrating different types of services (HIV and tuberculosis, for example, or HIV and family planning) is a way to reach those at greatest risk.

Starting this year, a new USAID-funded global project called Linkages will play a big role in strengthening health systems around HIV. The project will build capacity within governments and civil society to offer high-quality HIV services that are sustainable, evidence-based, and comprehensive, specifically to key populations.

4. Strange bedfellows, unexpected results.

What do you get when you gather motorcycle taxi drivers, local traffic police, and a regional health management team in rural Tanzania? Hundreds of men and boys eager to lower their chances of contracting HIV and want to learn road safety tips all in one place.

It happened this year as part of a drive to offer voluntary medical male circumcision to men and boys in hard-to-reach areas. IntraHealth worked with the union of Kahama’s motorcycle taxi drivers to gather hundreds of community members together to offer the service, which lowers a man’s risk of contracting HIV through heterosexual intercourse by 60 percent.

Everyone had a great time, especially when a popular Tanzanian comedian showed up and talked about his own circumcision. And hundreds of men and boys opted for the procedure during the event.

Global health needs more strange bedfellows — that is, innovative partnerships — like these if we’re going to end the HIV epidemic.

5. ARVs to treat and prevent.

It was 2011 when U.S. scientist Myron Cohen and his team at the University of North Carolina at Chapel Hill discovered that treating HIV-positive patients with antiretroviral therapy while their immune systems are still strong significantly lowers their risk of transmitting the virus. His study proved the concept of treatment as prevention.

Today, some 13.6 million people (of the total 35 million who live with HIV) have access to antiretroviral therapy. We’ve come a long way. But the final push will mean making sure as many people who live with HIV as possible are taking these medications to reduce their viral loads — and their chances of transmitting the virus.

It will also mean honing our overall approach. Think community-based testing campaigns, provider-initiated testing and counseling, and even self-testing. But countries need health workers and strong health systems to support these approaches.

The endgame

“PEPFAR, the Global Fund and UNAIDS are all changing their programming priorities,” says Karen Blyth, director of East Africa programs at IntraHealth.

The new focus: key interventions that save lives.

“That’s because we know now that a generalized approach often doesn’t work,” Blyth explained. “In Uganda, for instance, new HIV infections are now rising, after dropping for 15 years. So from this point on, it’ll be about targeting the hotspots of the epidemic — reaching exactly the right people in the right places with the right treatment and services.”

The next 15 years are going to make global health history. They may mark the end of the most damaging epidemic in our lifetimes, during which countries around the world rallied together to face a unifying threat. Of course, these five approaches alone won’t be enough to bring this chapter to a close. But each one is vital to reaching our goal.

We’ve got just 15 years to make it happen. Let’s get to work.

IntraHealth’s work in Tanzania is funded by the US Centers for Disease Control and Prevention (CDC) and in South Sudan by the CDC and the US Agency for International Development. Meet your own unexpected bedfellows at SwitchPoint, an annual event that brings together the brightest thinkers from across industries to solve today’s most critical global issues.

By Margarite Nathe, senior editor/writer, IntraHealth International

South Sudan Tanzania Tanzania HIV Prevention Project HIV & AIDS

100,000 Men in Shinyanga Region, Tanzania, Opt for Medical Circumcision

Anonymous — Tue, 13 Sep 2016 12:26:14 +0000

100,000 Men in Shinyanga Region, Tanzania, Opt for Medical Circumcision Anonymous (not verified) September 13, 2016 June 04, 2013

More than 100,000 men in the Shinyanga Region of Tanzania are now less likely to contract the HIV virus thanks to the benefits of voluntary medical male circumcision and IntraHealth International’s Tanzania HIV Prevention Project.

IntraHealth has been working with the government of Tanzania to offer male circumcision services in Shinyanga Region since November 2010. The project is funded through PEPFAR by the US Centers for Disease Control and Prevention. As of April 28, 2013, some 110,760 men in the region had opted for the procedure.

Three randomized controlled trials conducted in 2005 and 2006 demonstrated that medical male circumcision may reduce heterosexual transmission of the HIV virus by as much as 60%ⁱ. Other studies since then have suggested the protective factor may be even higher.

Increasing the availability and use of male circumcision services could drastically diminish the spread of HIV in Tanzania. The national HIV prevalence rate in Tanzania stands at 5.1% and the national rate of male circumcision is 72%. Shinyanga Region—where male circumcision is less common (32.1%) and HIV prevalence is high (7.4%)—is one of eight regions or districts that the government of Tanzania prioritized for male circumcision services.

Voluntary medical male circumcision services include: male circumcision counseling; HIV testing and counseling; screening and treatment for sexually transmitted infections; the male circumcision surgical procedure; post-operation follow-up; promotion of safer sex practices; and linkages with other HIV prevention, treatment, care, and support services.

Making high-quality services accessible requires facilities, trained health workers, and equipment and supplies, but also cultural changes in attitudes and beliefs around male circumcision.

IntraHealth is using a variety of approaches to bring male circumcision services to men who could benefit from them. The services are available free of charge at health centers and at mobile clinics, and we are training more health workers in the procedure. We are engaging regional, district, and community leaders, conducting outreach services, and implementing mass social marketing campaigns to spread information about medical circumcision and to build demand for services. And it’s working.

“We are happy that the community has accepted [these male circumcision] services, the demand for services is high, and more people can be reached… Our focus now is to reach rural areas and to focus on adults,” said Shinyanga Region AIDS Control Coordinator, Dr. Amri Salehe Mawazo.

Much of the project’s success is built on collaborations. “We really appreciate the strong collaboration with the regional, district, and village authorities,” said IntraHealth’s Dr. Lucy Mphuru, project director for the Tanzania HIV Prevention Project. “Everyone has been at the forefront to make this program so successful. Kudos to all the Shinyanga leaders at different levels, as well as to the [male circumcision] providers who are working tirelessly to make sure every client in need of [these] services receives services on time despite the critical shortages of health care workers.”

The project will continue its existing work, train additional providers, and focus on bringing male circumcision services to health facilities in hard-to-reach areas. The project’s goal is to reach 135,000 clients by September 2013.

[i] Auvert B et al. 2006. Randomized, controlled intervention trial of male circumcision for reduction of HIV infection risk: The ANRS 1265 Trial. PLoS Medicine. 2005 Nov;2(11):e298. Erratum in: PLoS Med. 2006 May;3(5):e298.

Bailey RC et al. 2007. Male circumcision for HIV prevention in young men in Kisumu, Kenya: A randomised controlled trial. Lancet. 369(9562):643-56.

Gray RH et al. 2007. Male circumcision for HIV prevention in men in Rakai, Uganda: A randomised trial. Lancet 369:657-666.

Tanzania Tanzania HIV Prevention Project

Mandy Moore and Jennifer James See Tanzania's Health Workers in Action

Anonymous — Tue, 13 Sep 2016 12:26:12 +0000

Mandy Moore and Jennifer James See Tanzania's Health Workers in Action Anonymous (not verified) September 13, 2016 October 23, 2014

Health workers at an outreach facility in rural Shinyanga, Tanzania, hosted two special guests on October 8: Mandy Moore—American singer/songwriter, actress, and PSI global ambassador—and Jennifer James—founder of Mom Bloggers for Social Good and writer for the Bill & Melinda Gates Foundation and Huffington Post.

As part of a partnership between IntraHealth International and PSI, Mandy Moore and Jennifer James visited health facilities in Tanzania to learn more about health workers, health systems, and the global health workforce shortage.

At an IntraHealth-run site in Shinyanga, Mandy and Jennifer saw firsthand the inner workings of a rural, mobile HIV facility, where HIV testing, counseling, and voluntary medical male circumcision take place.

During IntraHealth’s three-week campaigns when the site is up and running, health workers from clinics and hospitals across the region take time away from their regular duties to staff the outreach facility. Men and boys flock to them, standing in long lines or in groups in the shade as they wait for services.

First clients sit in groups of 25 or so to learn about voluntary medical male circumcision and its benefits—namely that the simple 15-minute procedure reduces men’s risk of contracting HIV through heterosexual intercourse by up to 60%. Counselors also explain that circumcision won’t fully protect them from HIV, and that they still must take other appropriate protective measures, such as using condoms.

Then, one by one, clients enter a small tent for individual HIV testing and counseling. Inside, a health worker takes down the client’s health history, conducts rapid testing that can reveal the client’s HIV status within minutes, and answers any questions he may have about the results.

Nearby, in a larger, air-conditioned tent, health workers perform voluntary medical male circumcision on four clients at a time, working quickly and efficiently. They carry out about 40-60 circumcisions per day.

But demand is so great in Shinyanga that every day ends with a waiting list of clients who must come back the following day. The HIV prevalence rate there is 7.4%—higher than the national rate of 5% among adults—and communities are eager for services that can help.

Mandy and Jennifer talked with clients and health workers, watched nurses and counselors at work, and even followed one client through the entire process of HIV testing, counseling, and voluntary medical male circumcision.

“I was passing nearby and heard there was a tent and asked what was being done,” said 24-year-old Amos Emmanuel Kakere. “I was anxious to get the service.” (Read more about Amos in Jennifer’s Huffington Post article.)

IntraHealth has provided voluntary medical male circumcisions to 315,904 men and boys in three regions of Tanzania. We’ve also helped provide HIV testing and counseling to more than 1.1 million Tanzanians and trained 3,000 health workers to provide HIV services.

During the same week, Mandy and Jennifer also visited PSI facilities in Dar es Salaam, Tanzania. There, they met frontline health workers, including family planning providers, and visited two dispensaries that are part of the PSI Tanzania-supported Familia health franchise network.

IntraHealth’s Tanzania HIV Prevention Project is funded by the US Centers for Disease Control and Prevention. See photos here.

Study Shows More Clients Opt for HIV Testing When It's Offered Before Clinical Consultation

Anonymous — Tue, 13 Sep 2016 12:26:11 +0000

Study Shows More Clients Opt for HIV Testing When It's Offered Before Clinical Consultation Anonymous (not verified) September 13, 2016 January 12, 2016

A study of almost 80,000 health care clients in South Africa, Tanzania, and Uganda has found that clients are most likely to agree to HIV testing and counseling when a nurse or lay counselor offers the service before clinical consultation, rather than during or after.

Study authors examined three models of HIV testing and counseling to see if one might help health workers more effectively link newly diagnosed clients to antiretroviral medicines and other ongoing care. The models included the following scenarios:

A) Health workers referred eligible clients (aged 18-49 who had not been tested in the past year and were not known to be HIV-positive) to on-site voluntary counseling and testing with counselors after clinical consultation.

B) Health workers offered and provided testing and counseling to eligible clients during clinical consultation.

C) Nurses or lay counselors offered and provided testing and counseling to eligible clients before clinical consultation.

Both diagnosis and linkage to continuing care are critical steps in addressing the HIV epidemic and in achieving an AIDS-free generation, as UNAIDS and the global community have pledged to do by 2030.

Of the 16,099 age-eligible clients who were tested during the three-month study, 10% tested HIV-positive. Model C resulted in the highest proportion of clients tested (54.1%), followed by Model A (41.7%) and Model B (33.9%).

But in terms of linking clients to continuing care, there was no significant difference across models. While 94% of clients who tested HIV-positive were referred to care, only 58% entered care. This is a problem health sectors have long struggled to remedy.

“While the percentage of people ever tested for HIV in sub-Saharan Africa has increased over the past several years, linkage to care for patients with newly diagnosed HIV has remained low,” study authors write, “compromising the success of care, treatment, and prevention efforts.”

Understanding the characteristics of clients who have just been diagnosed with HIV and immediately enter care can help health workers develop solutions to link even more newly diagnosed clients with the care they need. That would mean fewer clients fall out of the HIV care continuum.

“In Tanzania, we have a health worker shortage that makes it difficult to offer universal HIV testing, which is a crucial part of making sure the one million Tanzanian adults living with HIV can get the care they need,” says Lucy Mphuru, one of the study authors and project director at IntraHealth International in Tanzania. “These study results give us some powerful evidence that will help us make sure more people know their HIV statuses. But we’re also finding that we have a lot of work to do in guiding clients to care after their initial diagnoses.”

“Implementation and Operational Research: Strengthening HIV Test Access and Treatment Uptake Study (Project STATUS): A Randomized Trial of HIV Testing and Counseling Interventions” was published in the August 15 issue of the Journal of Acquired Immune Deficiency Syndromes.

IntraHealth’s work in Tanzania is funded by the US Centers for Disease Control and Prevention.