community based index- and mobile testing complements...
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Community based Index- and Mobile Testing complements and effective in pediatric HIV case finding in Tanzania
• Authors: Caterina Casalini1, Albert Komba1, Gaspar Mbita1 Edina Hauli1, Deusdedit Mjungu1, Flavian Ngeni1 Upendo Kategile2, Jema Bisimba2, Meena Srivastava3, Sharon Lwezaula4
• Affiliations: Jhpiego Tanzania1, USAID Tanzania2, USAID DC3, National AIDS Control Program Tanzania4
HIV Background: Tanzania
2018 UNAIDS 1; Q2 FY19 PEPFAR Tanzania 2 ; 2016-17 THIS 3
• Adult population (15 to 49 years):
– 1.5M PLHIV with 4.7% HIV
prevalence 1
– 69% ART Coverage 2
• Pediatric population (0 to14 years):
– 105,704 CLHIV 1
– 0.4% HIV prevalence 3
• 0.4% under five years
• 0.5% aged 5-9 years
• 0.3% aged 10-14 years
• Highest prevalence in Njombe
(2.3%) and Iringa (1.4%)
– 54% ART Coverage 2
– 80% Viral Load Coverage 2
– 65% Viral Load Suppression 2
Services are provided Day and Night, from Monday to Saturday
Biomedical
services
Saving and
Loaning
Services
Behavior
change
education
• Individual peer to peer
• IEC material
• Social Media
(WhatsApp)
• Testimonials (FP)Hot Spot Mapping
by Community Based HIV Service
Providers (peer educators)
Biomed venues
• Tent
• Rented rooms in brothel, bar
• Workplaces
• Private residences
Saving/Loaning, SBCC
venues
• Schools
• Gv offices
• Private residences
Background Sauti Project in Tanzania
Goal: Contribute to improved health for all Tanzanians
through sustained reduction in new HIV infections.
• Sauti Project, led by Jhpiego, is funded by PEPFAR through
USAID
• Sauti offers community-based health care, behavioral, and
structural interventions for key and vulnerable populations
(KVP)
• Partners: Government of Tanzania; 18 civil society
organizations
How Sauti reaches children
Index testing for biological children of all HIV+ clients
OVC program through risk assessment
SBCC groups to FSW and
SBCC/Saving Loan groups to AGYW
Hot spots during HTS to adult
clients
Children of KVP & non-KVP
Intervention FSW MSM AGYW PFSW OHSP Peds
1. Biomedical
• Risk assessment and counseling X X X X X X
• HTS / Index testing X X X X X X
• HIV Self Testing X X X
• FP counseling and services X X X
• STI screening X X X X X X
• STI periodic presumptive treatment X X
• Condoms Promotion Provision X X X X X X
• TB screening X X X X X X
• GBV screening X X X X X X
• Alcohol and drug screening X X X X X X
• Escorted referral Care & Treatment Clinic,
GBV services, RCHS, OVC Services
X X X X X X
• ART Outreach to stable PLHIV X X X X X X
• Pre Exposure Prophylaxis X X
2. SBCC
• Demand creation X X X X X X
• SBCC group education X X
• SBCC individual education X X
3. Economic Empowerment
• Saving and Loaning and Parenting X
• Cash transfer program X
5. PLHIV support groups X X X X X
6. SASA! X X X X X X
Sauti Core Package of Services
FSW: Female Sex Workers; PFSW: Partners FSW; AGYW: Adolescent Girls Young Women ages 15-24 out of school; OHSP:
Other Hotspot Populations male and female (OHSPM; OHSPF); Peds: Pediatric population
Context
• In fiscal year 19 (FY19: 1 October 2018 to 17 March 2019)
compared to fiscal year 18 (FY18: 1 October 2017 to 31
September 2018), the project scaled up the following
interventions:
– Index testing next to mobile testing
– Training of health care providers on fidelity of
testing procedures and beneficiaries’ categorization
– Enhancing peer educators’ capacity on
demand creation for testing to those at highest
risk of HIV
Materials & Methods
• Routine data were recorded in FY18 (14 regions and
51 districts) and FY19 (13 regions and 33 districts)
• The pediatric population was defined from 18
months – 14 years of age as:
– Children of KVP
– Children of non-KVP
• Biological children of an HIV positive mother
categorized as index testing. Any other test was
categorized as mobile testing.
• This analysis describes the testing yield and trend by
type of population and modality
Results
Mobile HIV Testing Positivity Children of non-KVP vs Children of KVP by FY
124,199
7,940 2,356 2,035 759 137 20 107
0.6%
1.7%
0.8%
5.3%
0.0%
1.0%
2.0%
3.0%
4.0%
5.0%
6.0%
-
20,000
40,000
60,000
80,000
100,000
120,000
140,000
FY18 FY19 FY18 FY19
Children non-KVP Children KVP
Mobile HTS HIV+ Pos rate
1.1% increase
95% CI:0.8-1.4; p<0.0001
4.5% increase
95% CI:3.50-5.59; p<0.0001
Index Testing Positivity Children of non-KVP vs Children of KVP by FY
131,338
4,809 7,234 6,197 1,189 175 73 197
0.9%
3.6%
1.0%
3.2%
0.0%
0.5%
1.0%
1.5%
2.0%
2.5%
3.0%
3.5%
4.0%
-
20,000
40,000
60,000
80,000
100,000
120,000
140,000
FY18 FY19 FY18 FY19
Children non-KVP Children KVP
Index HTS HIV+ Pos rate
2.7% increase
95% CI:2.2.-3.3; p<0.0001
2.2% increase
95% CI:1.71-2.71;
p<0.0001
HIV Testing Positivity by ModalityChildren of non-KVP vs Children of KP by FY
FY18 FY19
Children non-
KVP
Children
KVP
Children
non-KVP
Children
KVP
Mobile
Testing
Positivity
0.6% 0.8% 1.7%* 5.3%*
*increase of 3.6% (95% CI:
2.65-4.69; p<0.0001)
Children non-
KVP
Children
KVP
Children
non-KVP
Children
KVP
Index
Testing
Positivity
0.9% 1.0% 3.6% 3.2%
Conclusions • The significant increase of testing yield over a two
year period reflects increased project capacity to
support effective demand creation, provision of
services with fidelity, and scale-up of targeted testing
modalities that are effective in identifying at risk
children with HIV.
• This was particularly true for those children of KVP
reached through community-based mobile testing,
which in FY19 was a successful complementary
strategy to index testing
• Scaling index testing with fidelity can improve
pediatric case finding
Gracias!
Acknowledgements
Ministry of Health, Community Development, Gender, Elderly and Children
Tanzania Commission forAIDS
PEPFAR/USAID
Civil Society Organizations, Stakeholders, Beneficiaries, Sauti Team