PEPFAR Funded Community Based HIV and TB-HIV Services

MDH has an extensive profile in implementation of community-based initiatives for prevention, diagnosis and management of HIV and TB diseases. MDH in collaboration with R/CHMTs has supported marked expansion, standardization, and M&E of community-based HIV services (CBHS) encompassing tracking and follow-up services, peer psychosocial support services, and economic empowerment programs for PLHIV and linkage to other community-based services. By the end of September 2017, MDH had facilitated scale-up of CBHS to 217 (94%) wards in Dar es Salaam and Kagera regions. This was achieved through capacity building of over 1000 CBHS providers – through training, mentorship and supportive supervision- on a range of CBHS services including patient tracking and follow-up, stigma reduction, Gender Based Violence (GBV) and violence against children (VAC), HTS services, and reaching out to key and vulnerable populations.

To support effective patient follow-up, tracking, retention and continuum of care, MDH’s CBHS program devised an innovative approach called, “CBHS-Community-CBHS-facility loop” which entails engagement of 241 Community Based Health Care (CBHC) providers stationed at health facilities to work in collaboration with 1,218 CBHS providers stationed at the street/village level (1-2 per street/village) to provide comprehensive HIV care, support and follow-up services and maintain continuum of care. These providers routinely engage with PLHIV in care across levels (facility and community) to provide continuous health education and support on HIV prevention, care and treatment, reproductive, maternal, newborn and child health, nutrition, psychosocial health, socio-economic strengthening and other support services as per need. By September 2017, MDH’s CBHS program had enrolled and served 105,223 PLHIV. MDH’s CBHS program also actively engages and collaborate with other community implementing partners (IPs) to facilitate linkage of new PLHIV identified at the community to HIV CTCs, through physical escort, for enrollment and ART initiation. This approach was found to be highly effective in facilitating linkage of 780 out of 829 new PLHIV (linkage rate 94%) identified through community HTS in Dar es Salaam from Apr – Sep 2017.

Other key innovations and achievements of MDH’s CBHS program include sensitization, capacity building and engagement of 12,660 PLHIV in Village Community Banking (VICOBA) initiatives aimed at addressing socio-economic barriers to successful ART adherence, retention and outcomes. Up to functional 422 VICOBA groups (with an average of 30 members each) have been formed in Dar es Salaam and Kagera regions.

The Global Fund HIV-TB 2015-17 and TB 2018-20 Projects

MDH is a sub-recipient of Save the Children and Amref Tanzania in a Global Fund (GF) funded project; aimed at supporting the GOT to reduce the HIV and TB epidemic and burden. 22015-2017, MDH led implementation of community-based TB/HIV case finding and prevention in 6-regions through Save the Children global fund financial support. From 2018 to 2020 MDH leads implementation of community-based TB case finding initiatives in 8 regions of Tanzania, including pediatric and Multi Drug Resistant (MDR) TB and employed various community-based initiatives including sensitization and engagement of community health workers (CHWs), community leaders, traditional healers and lay sputum fixers, active tracing of contacts of sputum-smear positive TB cases in the community; as well as TB screening and testing in congregate and community settings (mining, markets boarding schools). By the end of 2018, through this project, MDH diagnosed 4,783 new TB cases (101% of annual targets), including 540 children and 53 MDR TB cases.

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