International World Aids Day!
“ A central achievement is the reduction of Mother-To-Child-Transmission (MTCT) of HIV within the One Stop Clinic – a nested project integrating services for HIV-affected families. With consequent HIV-testing during pregnancy and enrollment into care, it was possible to reduce the number of infected infants to 2%, far below the country’s average of 9% – proving that elimination of MTCT is possible“
Dr. Maja Weisser, Head of IHI’s Chronic Diseases Clinic
HIV remains one of the most important diseases in Africa. The World’s AIDS day – on first of december – should remind us of what has been achieved and what needs to be done to reduce number of transmissions and to improve the health for people living with HIV.
In Tanzania, the prevalence of HIV has stabilized and even decreased after tremendous efforts to curb the epidemics to 4.7% in 2015. Nevertheless the number of people living with HIV remains high with 1.4 million. Of these, only 53% are receiving an antiretroviral treatment. Only this year, Tanzania – as the second African country – has released universal treatment guidelines for all HIV-positive persons, an urgently needed, but also courageous decision, as a lot of action is required to make this happen.
The Ifakara Health Institute (IHI) is engaged in HIV care from the very beginning – by direct service delivery and by research. The Chronic Diseaeses Clinic Ifakara (CDCI) was established 2005 as the first rural Care and Treatment Center and since then has enrolled more than 9000 patient into one of the largest and oldest patient cohorts in Africa. Innovative approaches to combine service delivery and research led to a constant improvement of patient care.
A central achievement is the reduction of Mother-To-Child-Transmission (MTCT) of HIV within the One Stop Clinic – a nested project integrating services for HIV-affected families. With consequent HIV-testing during pregnancy and enrolment into care, it was possible to reduce the number of infected infants to 2%, far below the country’s average of 9% – proving that elimination of MTCT is possible.
A lot of work needs to be done to improve early diagnosis of HIV, reduce stigma and enrol patients into care. With hospital-wide testing, CDCI diagnoses 50 – 80 HIV infections in patients not known to be HIV-positive so far. Of these, 60% present late with CD4 <350cells/mm3 and considerable co-morbidities such as Tuberculosis or Crypotococcal Meningitis. To diagnose these devastating co-morbities early, innovative implementation of diagnostics are studied within research projects. The rollout of a easy to perform antigen test for diagnosis of Cryptococcal meningitis and the integration of sonography into diagnosis of Tuberculosis aim at improving early diagnosis and initiation of adequate treatment.
In addition, IHI in collaboration with other instituitions including Ministry of Health, Community development, Gender, Elderly and Children is conducting an ‘Evaluation of the impact of a community health agent intervention on antiretroviral therapy retention and adherence in Tanzania’. Among HIV infected patients who seek health service, there is a problem with retention in, and linkage to, HIV care and treatment and the need for a systematic Community-based HIV/AIDS services (CBHS) intervention in Tanzania is essential. This evalution is in implementation in four regions namely; Mbeya, Songwe, Kagera and Pwani. The results of this evalution will improve understanding of how CBHS providers can contribute to the HIV continuum of care and provide an evidence base to inform the development of GOT policies and programmatic guidelines surrounding use of CBHS providers at community level.