From record viral suppression to community-led research, the Chronic Diseases Clinic of Ifakara proves rural Africa can lead the fight against HIV.

In one of eastern Africa’s longest-running HIV programmes, the Chronic Diseases Clinic of Ifakara (CDCI) at St. Francis Regional Referral Hospital quietly posted an impressive list of clinical, scientific and community achievements in 2025. 

Drawing on two decades of data from the Kilombero and Ulanga Antiretroviral Cohort (KIULARCO), the clinic showed that high-quality HIV care, outreach and research can thrive even in a remote setting.

Here are the key 2025 milestones highlighted in the clinic’s just-released annual report. Authors of the report are: Dr. Ezekiel Luoga, Dr. Frazisca Mmbando; Dr. Getrud Mollel, Prof. Maja Weisser.

Record-breaking viral suppression in rural Africa

CDCI achieved some of the highest viral suppression rates reported anywhere in sub-Saharan Africa. Among the 2,359 patients on active follow-up, 95 % reached suppression below 1,000 copies/ml and 93 % below 50 copies/ml — well above Tanzania’s national average of 79 % and close to the UNAIDS 95-95-95 target.

The clinic’s laboratory processed 15,166 viral-load tests for Ifakara Town Council alone, contributing to a district-wide total of 24,081 tests. These figures confirm that sustained, high-quality care in a rural referral hospital can match or exceed urban benchmarks.

Reaching the hardest-to-reach: fisher camps and schools

CDCI took services directly to high-risk populations often missed by standard programmes. Outreach teams visited remote fishing camps in Itoo, Katululukila and Luona villages, offering integrated HIV, tuberculosis and non-communicable disease screening.

Of 143 people tested for HIV, one new positive case was identified and immediately linked to care. Among 38 individuals screened for TB, eight showed symptoms and one was confirmed with pulmonary tuberculosis and started treatment.

School-based outreaches at Birgit English Medium School and in Mlabani brought free testing, counselling and health education to adolescents, parents and teachers. The clinic also partnered with teams from University Hospital Basel and Charité Berlin for cervical-cancer, breast-cancer and STI screening, expanding services beyond HIV alone.

Launch of Patient and Public Involvement (PPI) Initiative

In a first for the region, CDCI formally launched a Patient and Public Involvement (PPI) programme through KIULARCO. A steering committee — including patient representative George Mfanando, head counsellor Leila Samson, clinic leaders and Swiss research coordinator Prof. Maja Weisser — formed an eight-member community Advisory Group.

The group’s first meeting provided direct input into a planned mental-health study, setting the foundation for greater community voice in future research and clinical decisions.

Declining new HIV cases, but persistent challenges

New diagnoses continued to fall. The hospital tested 10,755 people in 2025; 168 (1.56 %) were positive. KIULARCO enrolled 155 new patients (149 adults, 6 children).

The clinic now cares for 4,145 people on antiretroviral therapy (4,021 adults and 124 children). While new enrolments have declined — largely because more peripheral clinics now exist closer to patients’ homes — gaps remain, especially among children aged 0–14 and young women, who still face higher risks nationally.

TB-HIV co-epidemic under control

The clinic treated 220 TB patients, of whom 107 (48 %) were microbiologically confirmed. 44 cases (20 %) occurred in people living with HIV. The majority (143) were pulmonary; 75 were extrapulmonary.

Advanced diagnostics, including 1,322 Xpert MTB/RIF tests, helped maintain tight control of the dual epidemic.

Staff training and local expertise boom

CDCI continued its strong investment in human capital. Three staff completed or started PhDs (including Dr. Robert Ndege, who defended his thesis in epidemiology at Swiss TPH). Five others finished master’s degrees in public health or epidemiology.

The clinic ran its first MCT-accredited two-day course on “Diagnosing and Approaching Bacterial Infections in Times of Antimicrobial Resistance” and conducted refresher training on good clinical practice and consenting. Several clinicians undertook specialised attachments and workshops, building a pipeline of locally trained researchers and leaders.

Research powerhouse: KIULARCO’s 2025 output

The 20-year-old cohort produced a steady stream of high-impact publications. Eight papers from KIULARCO appeared in 2025, covering topics such as retention in care, severe HIV disease in children, physical activity among adolescents, stigma and depression, and experiences of “undetectable = untransmittable” (U=U).

Approximately 20 studies are currently running, with patients themselves now helping shape research priorities through the new PPI initiative. The cohort’s large biobank and prospective data continue to generate evidence that informs both local care and global HIV policy.

20-Year cohort milestone

KIULARCO marked two full decades as one of eastern Africa’s longest-standing HIV cohorts. Since 2005 it has enrolled 13,740 people living with HIV, with roughly 3,600 still in active care. The prospective database and stored samples have already yielded hundreds of scientific papers and remain a vital platform for understanding long-term treatment outcomes in a rural African setting.

Lab as national referral backbone

The on-site laboratory has become a critical referral hub for the entire Kilombero Valley. In 2025 it performed 24,081 HIV viral-load tests across four districts and served as a backup facility for the rest of Tanzania. It also carried out hundreds of CD4 counts, chemistry panels, Xpert TB tests and early-infant HIV diagnoses, ensuring timely results even for the most remote patients.

Looking ahead, clinic leaders say these milestones — achieved through strong local-international collaboration — position CDCI as a model for integrated chronic care in resource-limited settings. With continued community engagement, training and research, the next chapter for rural HIV services in Tanzania looks brighter than ever.

>> Read the full report, here.