Scalingup Provider Initiated HIV Testing and Counseling Services in Tanzania

1

• Scaling-up Provider Initiated HIV Testing and
  Counseling Services in Tanzania
  
• Moshi Ntabaye, Director
• Provider Initiated Testing and Counseling
  Project
  

2
Overview

• Presentation objectives
• Describe provider initiated HIV testing and
  counseling approach in scaling-up CT
  
• Discuss strategies and activities used to
  scale-up PITC services in Tanzania
  
• Discuss challenges and ways to overcome them in
  scaling-up PITC services

3
Overview

• Map of Tanzania

4
Overview

• HIV epidemic in Tanzania (THIS 2003/4)
• 7 of adults are HIV infected (Women7.7,
  Men6.3)
  
• 8.2 of ANC attendees are HIV infected
• 15 of adult men and women know their HIV status
• Care and Treatment
• Target for 2008 440,000 on ART
• Dec 2007 247,359 people enrolled
• Dec 2007 127,895 on ART

5
Overview

• What is PITC?
• PITC refers to HIV testing and counselling which
  is recommended by health care providers to
  persons attending health care facilities as a
  standard component of medical care
• (Source MoH Guidelines for PITC, 2007)

6
Overview

• The Provider Initiated Testing and Counseling
  Project (PITC) is a five-year project funded by
  CDC.
  
• The Project was awarded to IntraHealth in
  September 2006.

7
Overview

• Project Goal
• To support Tanzanias MOHSW in strengthening
  and expanding provider-initiated HIV testing and
  counseling and strengthening referral processes
  in Tanzania 

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Strategies and activities for PITC scale-up

• Engaging regional and District Health Management
  Teams
  
• Whole site Training of health workers in PITC
  service delivery
  
• Implementation of PITC services
• Monitoring of PITC services

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Strategies and activities for PITC scale-up

• 1. Engaging Regional and District Health
  Management Teams (R/CHMT)
  
• Participatory planning meeting
• Development of a district implementation plan
• Selection of trainees
• Forecasting of HIV testing kits and other supplies

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Strategies and activities for PITC scale-up

• 2. Whole site training of health workers
• Participate in the development of MOH Trainers
  guide for PITC
  
• Orientation of district Trainers in PITC
• Training of health workers in PITC service
  delivery using draft MOH curricula
  
• Trainee follow-up

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Strategies and activities for PITC scale-up

• 3. Implementation of PITC services (sites)
• OPD
• STI clinic
• In patients
• FP clinic
• ANC, if there is no PMTCT program
• Other RCH clinics Growth monitoring,
  immunization,
  
• TB, if the MOH program on TB/HIV integration has
  not started
  
• Outreach/mobile services

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Strategies and activities for PITC scale-up

• 4. Monitoring of PITC services
• Daily register for Counseling and Testing (MoH)
• Monthly Site summary form
• Monthly District and Regional summary form
• Supervision by DHMT, Trainers and Project staff

13
Barriers and challenges to PITC scale-up

• Shortage of skilled human resources
• Availability of HIV testing kits
• Referral to care and treatment centers

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Barriers and challenges to PITC scale-up

• Actions to overcome challenges
• Train lower cadre staff e.g. Nurse assistants
• Strengthening of forecasting, quantification,
  ordering and reporting to NACP/MSD
  
• Trained health workers on intra- and inter-
  facility referral systems to care and treatment
  centres (CTC)
  
• Strengthening of feedback mechanisms from CTC to
  testing sites
  
• Trainee follow up

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