usaid assist project tanzania country report fy17 · tanzania country report fy17 ... e-mtct...

44
Tanzania Country Report FY17 AUGUST 2017 This annual country report was prepared by University Research Co., LLC for review by the United States Agency for International Development (USAID). The USAID Applying Science to Strengthen and Improve Systems (ASSIST) Project is made possible by the generous support of the American people through USAID. Cooperative Agreement Number: AID-OAA-A-12-00101 Performance Period: October 1, 2016 – August 17, 2017 USAID ASSIST Project

Upload: phamtram

Post on 13-Jul-2019

236 views

Category:

Documents


0 download

TRANSCRIPT

Page 1: USAID ASSIST Project Tanzania Country Report FY17 · Tanzania Country Report FY17 ... e-MTCT Elimination of mother-to-child transmission of HIV FP Family planning . USAID ASSIST Tanzania

Tanzania Country Report FY17

AUGUST 2017

This annual country report was prepared by University Research Co., LLC for review by the United States Agency for International Development (USAID). The USAID Applying Science to Strengthen and Improve Systems (ASSIST) Project is made possible by the generous support of the American people through USAID.

Cooperative Agreement Number:

AID-OAA-A-12-00101

Performance Period:

October 1, 2016 – August 17, 2017

USAID ASSIST Project

Page 2: USAID ASSIST Project Tanzania Country Report FY17 · Tanzania Country Report FY17 ... e-MTCT Elimination of mother-to-child transmission of HIV FP Family planning . USAID ASSIST Tanzania
Page 3: USAID ASSIST Project Tanzania Country Report FY17 · Tanzania Country Report FY17 ... e-MTCT Elimination of mother-to-child transmission of HIV FP Family planning . USAID ASSIST Tanzania

USAID ASSIST Project

Applying Science to Strengthen and Improve Systems

Tanzania Country Report FY17 Cooperative Agreement Number AID-OAA-A-12-00101

Performance Period: October 1, 2016 – August 17, 2017

AUGUST 17, 2017

DISCLAIMER

This country report was authored by University Research Co., LLC. The views expressed do not necessarily reflect the views of the United States Agency for International Development or the United States Government.

Page 4: USAID ASSIST Project Tanzania Country Report FY17 · Tanzania Country Report FY17 ... e-MTCT Elimination of mother-to-child transmission of HIV FP Family planning . USAID ASSIST Tanzania

Acknowledgements

This country report was prepared by University Research Co., LLC (URC) for review by the United States Agency for International Development (USAID) under the USAID Applying Science to Strengthen and Improve Systems (ASSIST) Project, which is funded by the American people through USAID’s Bureau for Global Health, Office of Health Systems. The project is managed by URC under the terms of Cooperative Agreement Number AID-OAA-A-12-00101. URC's global partners for USAID ASSIST include: EnCompass LLC; FHI 360; Harvard T.H. Chan School of Public Health; HEALTHQUAL International; Initiatives Inc.; Institute for Healthcare Improvement; Johns Hopkins Center for Communication Programs; and WI-HER, LLC.

For more information on the work of the USAID ASSIST Project, please visit www.usaidassist.org or write [email protected].

Recommended citation

USAID Applying Science to Strengthen and Improve Systems (ASSIST) Project. 2017. Tanzania Country Report FY17. Published by the USAID ASSIST Project. Chevy Chase, MD: University Research Co., LLC (URC).

Page 5: USAID ASSIST Project Tanzania Country Report FY17 · Tanzania Country Report FY17 ... e-MTCT Elimination of mother-to-child transmission of HIV FP Family planning . USAID ASSIST Tanzania

USAID ASSIST Tanzania Country Report FY17 i

Table of Contents List of Figures and Tables ............................................................................................................................................... i Abbreviations ................................................................................................................................................................. ii

1 INTRODUCTION ....................................................................................................................................... 1

2 PROGRAM OVERVIEW ............................................................................................................................ 2

3 KEY ACTIVITIES, ACCOMPLISHMENTS, AND RESULTS .................................................................... 4

Activity 1. Strengthen the capacity of the MOHCDGEC leadership and middle-level managers to continuously improve the quality of PMTCT care and lead scaling up and spread of PHFS to all implementing partners and scale-up councils ..................................................................................................................................................................... 4 Activity 2. Support the MOHCDGEC leadership and middle-level managers to scale up improvement activities for ART services to achieve sustainable coverage, retention, and improved viral suppression ........................................ 12 Activity 3. Support the MOHCDGEC, IPs, MVC stakeholders, and local structures to strengthen quality of care, support, and protection to Most Vulnerable Children and adolescents through improvement approaches .................. 16 Activity 4. Support the MOHCDGEC, LGAs, and community-based IPs to strengthen community-based mechanisms for improving HIV testing, ARV pick-up, adherence, retention as well as facility-community referrals and linkages for PLHIV ........................................................................................................................................................................... 19 Activity 5. Work with MOHCDGEC and IPs to improve safety, increase efficiency, and the level of integration of VMMC/EIMC services into primary health services ...................................................................................................... 21 Activity 6. Work with MOHCDGEC and IPs to improve the quality of HIV rapid testing services ................................. 24

4 IMPROVEMENT IN KEY INDICATORS .................................................................................................. 26

5 SUSTAINABILITY AND INSTITUTIONALIZATION ............................................................................... 32

6 KNOWLEDGE MANAGEMENT PRODUCTS AND ACTIVITIES ........................................................... 32

7 GENDER INTEGRATION ........................................................................................................................ 34

List of Figures and Tables

Figure 1. Improving HEI tested with DNA-PCR at 4-6 weeks in Morogoro (8 sites), Pwani (8 sites) and Kilimanjaro (7 sites) regions (Jan 2014-May 2017) ...................................................................................... 6

Figure 2. Percent of children <15 years tested for HIV at IPD, OPD, TB and CTC clinics each month, 7 facilities, Shinyanga Region (Sep 2015-Jan 2017) ....................................................................................... 7

Figure 3. Improving HIV testing among exposed children, 5 sites, Njombe Region (May 2014 – May 2017) ...................................................................................................................................................................... 8

Figure 4. Percentage of HIV+ mother-HEI pairs seen at the facility each month, 10 facilities, Arusha District (Jan 2014-May 2017) ........................................................................................................................ 9

Figure 5. Percentage of HIV-exposed children receiving confirmatory HIV test 6 weeks after cessation of breast milk (15 months after birth), 12 sites, Arusha District (Jan 2015-May 2017) ..................................... 9

Figure 6. Improving male partner HIV testing, as a proxy for male partner involvement, in PMTCT and ART services, 8 facilities, Rorya District Council, Mara Region (Jul 2015-May 2017) ............................... 10

Figure 7. Percentage of mother-baby pairs attending HIV services and percentage of HIV-positive pregnant and lactating women on ART each month, 10 sites, Mufindi DC (Jun 2013-Oct 2016) .............. 11

Figure 8. HIV positivity rate among HEI, 10 PHFS sites, Mufindi DC (2013-2015) .................................... 12

Figure 9. Percentage of eligible clients who did not miss picking up their ARVs on appointed dates (retention), 5 EAR sites, Mbeya District Council (Dec 2015 – April 2017) .................................................. 13

Figure 10. Percentage of clients who have self-management plans, 5 EAR sites, Mbeya DC (Dec 2015-April 2017) ................................................................................................................................................... 14

Figure 11. Percentage of HIV-infected children <15 years of age currently on ART, Dar es Salaam and Pwani sites (Jul-Sept 2015 to Apr-Jul 2017) ............................................................................................... 15

Page 6: USAID ASSIST Project Tanzania Country Report FY17 · Tanzania Country Report FY17 ... e-MTCT Elimination of mother-to-child transmission of HIV FP Family planning . USAID ASSIST Tanzania

ii USAID ASSIST Tanzania Country Report FY17

Figure 12. Percentage of HIV+ clients scheduled for 60 days ARV pick-up who missed their scheduled appointment, 3 sites in Muheza District (Oct 2013 – Feb 2017) ................................................................. 16

Figure 13. Increased access HIV testing and counseling for vulnerable children through community mobilization in six neighborhoods, Kambarage Ward, Shinyanga Region (Oct 2015-Apr 2017) ............... 18

Figure 14. Increased access to community health fund cards for vulnerable children through community mobilization, 6 neighborhoods, Kambarage Ward, Shinyanga Region (Oct 2015-Apr 2017) .................... 18

Figure 15. Percentage of new HIV+ clients enrolled in care and linked to community-based health providers for follow-up, Muheza Designated District Hospital (May 2015 - May 2017) .............................. 21

Figure 16. Compliance to VMMC standards, 12 sites, Njombe Region (Aug 2015 – Nov 2016) ............... 22

Figure 17. Baseline assessment dashboard for 12 EIMC sites, Iringa Region (April 2017) ....................... 23

Figure 18. Improved adherence to national Internal Quality Control Standards, Rungwe DC (Oct 2016-May 2017) ................................................................................................................................................... 26

Table 1. Tanzania: PHFS outcome results on HEI enrolled into care, confirmed HIV status, and confirmed HIV-positive, Mufindi District Council and Mbeya City Council (2013-2015) .............................................. 12

Table 2. Increased compliance to rapid testing safety standards, 21 HIV rapid testing points, 6 health facilities, Rungwe DC, Mbeya Region (Aug 2016 and June 2017) ............................................................. 25

Table 3. Baseline versus final values for sex-disaggregated and gender-sensitive indicators tracked by ASSIST in Tanzania .................................................................................................................................... 34

Abbreviations

AIDS Acquired immunodeficiency syndrome

ANC Antenatal care

ART Antiretroviral therapy

ARV Antiretrovirals

ASSIST USAID Applying Science to Strengthen and Improve Systems Project

CBHS Community-based HIV services

CC City council

CDC U.S. Centers for Disease Control and Prevention

CHF Community health fund

CHMT Council health management team

CHW Community health worker

CQI Continuous quality improvement

CTC Care and Treatment Center

DBS Dried blood spot

DC District council

DDH Designated District Hospital

DH District Hospital

DNA-PCR Deoxyribonucleic acid polymerase chain reaction

DOD Department of Defense

DSW Department of Social Welfare

EAR Engagement, adherence, and retention

EGPAF Elizabeth Glaser Pediatric AIDS Foundation

EID Early infant diagnosis

EIMC Early infant male circumcision

e-MTCT Elimination of mother-to-child transmission of HIV

FP Family planning

Page 7: USAID ASSIST Project Tanzania Country Report FY17 · Tanzania Country Report FY17 ... e-MTCT Elimination of mother-to-child transmission of HIV FP Family planning . USAID ASSIST Tanzania

USAID ASSIST Tanzania Country Report FY17 iii

FY Fiscal year

HBC Home-based care

HC Health center

HEI HIV-exposed infant

HIV Human immunodeficiency virus

HJFMRI/WRP Henry Jackson Foundation Medical Research International/Walter Reed Program

HTC HIV testing and counselling

HTS HIV testing services

IP Implementing partner

IPC Infection prevention and control

IPD Inpatient department

IPT Isoniazid preventive therapy

KCMC Kilimanjaro Christian Medical Center

LGA Local government authority

LTFU Lost-to-follow-up

M&E Monitoring and evaluation

MC Municipal council

MMC Medical male circumcision

MOHCDGEC Ministry of Health, Community Development, Gender, Elderly, and Children

MVC Most vulnerable children

MVCC Most vulnerable children’s committee

NACP National AIDS Control Program

OPD Outpatient department

OVC Orphans and vulnerable children

PASADA Pastoral Activities and Services for people with AIDS Dar es Salaam Archdiocese

PCR Polymerase chain reaction

PEPFAR U.S. President’s Emergency Plan for AIDS Relief

PHFS Partnership for HIV-Free Survival

PITC Provider-initiated HIV testing and counseling

PLHIV People living with HIV

PMTCT Prevention of mother-to-child transmission of HIV

QA Quality assurance

QI Quality improvement

QIT Quality improvement team

QM Quality management

RCH Reproductive and Child Health

RHMT Regional health management team

RTQII Rapid HIV Testing Quality Improvement Initiative

SIMS Site Improvement through Monitoring System

SOP Standard operating procedures

TA Technical assistance

TB Tuberculosis

THPS Tanzania Health Promotion Support

UNAIDS United Nations Programme on HIV/AIDS

URC University Research Co., LLC

USAID United States Agency for International Development

VCT Voluntary counseling and testing

VMMC Voluntary medical male circumcision

Page 8: USAID ASSIST Project Tanzania Country Report FY17 · Tanzania Country Report FY17 ... e-MTCT Elimination of mother-to-child transmission of HIV FP Family planning . USAID ASSIST Tanzania
Page 9: USAID ASSIST Project Tanzania Country Report FY17 · Tanzania Country Report FY17 ... e-MTCT Elimination of mother-to-child transmission of HIV FP Family planning . USAID ASSIST Tanzania

USAID ASSIST Tanzania Country Report FY17 1

1 Introduction In response to the UNAIDS 90-90-90 targets of HIV epidemic control in Tanzania by 2020, the USAID Applying Science to Strengthen and Improve Systems (ASSIST) Project was invited during COP 16 to continue supporting the Ministry of Health, Community Development, Gender, Elderly and Children (MOHCDGEC) and PEPFAR implementing partners (IPs) to scale up quality improvement (QI) interventions for HIV/AIDS care to all regions.

The project aimed to continue work started during the USAID Health Care Improvement Project (HCI) in 2008-2012. The main interventions were to adapt and sustain evidence-based practices to improve access to HIV testing, antiretroviral therapy (ART) enrolment, retention in care for HIV-infected patients, and ensuring wellbeing of people living with HIV (PLHIV). This was achieved through capacity building of Regional Health Management Teams (RHMTs) and Council Health Management Teams (CHMTs) and continuous quality improvement (CQI) teams in analyzing and redesigning processes of care, devising new care delivery models, developing QI tools, and sharing platforms for MOHCDGEC structures. In all intervention sites, improvement efforts focused on implementation of a package of core interventions that included scaling up ART, prevention of mother-to-child transmission of HIV (PMTCT), orphans and vulnerable children (OVC), and voluntary medical male circumcision (VMMC) services, as well as community home-based care (CHBC) volunteers in line with PEPFAR 3.0 guidance. The project also supported the development of interventions and strategies to improve the quality of HIV rapid testing as well as community-based interventions to improve linkages, ART adherence, and retention.

In fiscal year 2017 (FY17), ASSIST Tanzania continued to support the MOHCDGEC to build on the gains of the previous years as the country adopted the Test and Treat ART delivery model as a strategy to achieve the 90-90-90 targets. In this fiscal year, ASSIST supported improvement interventions in 40 scale-up saturation, 44 scale-up aggressive, and 98 sustained councils in collaboration with the respective regional IPs. In the same districts, the project supported the spread of the Partnership for HIV-Free Survival (PHFS) model across districts to optimize access to ART as well as support IPs to test various differentiated service delivery models to optimize ART delivery at the community level. In the same context, the project continued supporting stepwise improvement of the quality of HIV rapid testing at points of care as well as laboratories to reduce errors, inconsistencies, and improve safety and accuracy in all priority districts. Furthermore, the project supported QI teams to roll out working innovations to improve ART adherence (e.g., patient self-management, testing changes to improve access to viral load testing as well as viral load suppression rate follow-up in scale-up councils). For VMMC, the project supported improved compliance to national VMMC standards, while for vulnerable children, the project supported increased access to quality HIV testing services (HTS) and linking most vulnerable children (MVC) to comprehensive HIV and AIDS services and other social services. All the support sought to link facility and community-based initiatives so that services could reach all who needed them.

Page 10: USAID ASSIST Project Tanzania Country Report FY17 · Tanzania Country Report FY17 ... e-MTCT Elimination of mother-to-child transmission of HIV FP Family planning . USAID ASSIST Tanzania

2 USAID ASSIST Tanzania Country Report FY17

Scale of USAID ASSIST’s Work in Tanzania

MOHCDGEC, 18 IPs

84 PEPFAR scale-up and 98 sustained councils

618 facilities

260 communities

781 QI teams

23,289,864 out of 50 million

2 Program Overview What are we trying to accomplish? At what scale?

1. Strengthen the capacity of the MOHCDGEC leadership and middle-level managers (CHMTs) to continuously improve the quality of PMTCT care and lead scaling up and spread of PHFS to all implementing partners (IPs) and scale-up councils

• Strengthen MOHCDGEC leadership to facilitate institutionalization of QI as a tool towards achievement of elimination of mother-to-child transmission of HIV (e-MTCT)

• Support MOHCDGEC, Regional and Council Health Management Teams (R/CHMTs) and IPs to increase access to HIV prevention, testing, care, treatment, and support to pregnant, postnatal women, HIV-exposed and infected children

• Support R/CHMT, facility improvement teams, and IPs to improve retention to HIV care for infected women and their exposed infants

• Support R/CHMT, facility improvement teams, and IPs to improve wellbeing of the infected pregnant and breastfeeding women and their families

27 out of 30 regions 84 PEPFAR focused councils (44 scale-up aggressive councils and 40 scale-up saturated councils) 98 sustained councils 618 of 4,010 sites

2. Support the MOHCDGEC leadership and middle-level managers to scale up improvement activities for ART services to achieve sustainable coverage, retention, and improved viral suppression

• Support MOHCDGEC, R/CHMTs and IPs to scale up HIV/AIDS care improvement efforts to the PEPFAR focused scale-up councils

• Provide technical assistance (TA) to MOHCDGEC, R/CHMT in integrating essential services with ART program

• Strengthen follow-up of ART patients for retention and clinical outcomes at the community level

• Strengthen patient-centered care and treatment at facility and community level

27 out of 30 regions 84 PEPFAR councils (44 scale-up aggressive councils and 40 scale-up saturation councils) 618 of 4,010 sites

• Strengthen patient-centered care and treatment 2 councils in Morogoro: 14 facilities

Scale-up Aggressive & Saturation Councils

Sustained Councils

Page 11: USAID ASSIST Project Tanzania Country Report FY17 · Tanzania Country Report FY17 ... e-MTCT Elimination of mother-to-child transmission of HIV FP Family planning . USAID ASSIST Tanzania

USAID ASSIST Tanzania Country Report FY17 3

What are we trying to accomplish? At what scale?

3. Support the MOHCDGEC, IPs, MVC stakeholders and local structures to strengthen quality of care, support, and protection to Most Vulnerable Children (MVC) and adolescents through improvement approaches

• Support the Department of Social Welfare (DSW) of the MOHCDGEC and MVC IPs to improve and strengthen access to HIV services among most vulnerable children through application of QI guidelines and service package

National

• Strengthen MVC households to improve care, support, and child protection among vulnerable children and adolescents

2/6 councils in Pwani Region

• Strengthen community structures and systems to provide quality referral and linkage to HIV service among most vulnerable children

4/30 regions: Njombe, Iringa, Tanga, Shinyanga, support 6/30 councils In Arusha: support 1/8 councils

4. Support the MOHCDGEC, local government authorities (LGAs), and community-based IPs to strengthen community-based mechanisms for improving HIV testing, ARV pick-up, adherence, retention as well as facility-community referrals and linkages for PLHIV

• Support MOHCDGEC and IPs to design and implement effective community-based interventions for HIV testing and counselling (HTC) nationwide

Nationwide

• Support R/CHMT and IPs to design and pilot community-based models for monthly ARV pick-up for stable patients on ART

2/30 regions: Tanga and Njombe 6/14 councils: Tanga City, Korogwe, Muheza, Njombe Town Council, Njombe District Council, and Makambako

• Support R/CHMT and IPs to build the capacity of CHW, CBHC volunteers and community support groups to support PLHIV adherence to ART and TB medication

3/8 councils in Tanga Region

• Support R/CHMT and IPs to strengthen community-based mother support groups to enhance retention in care and adherence for mother-baby pairs

6/14 councils in 4 regions

• Support R/CHMT to build the capacity of CHWs in promoting bidirectional referrals and linkages

6/14 councils in 4 regions

5. Work with MOHCDGEC and IPs to improve safety, increase efficiency and the level of integration of VMMC services into primary health services

• Support MOHCDGEC and IPs (AIDSFree, Henry Jackson Foundation, and IntraHealth) to implement CQI to complement VMMC and early infant male circumcision (EIMC) services at fixed sites and selected outreaches in the priority districts

• Work with the MOHCDGEC and IPs to conduct sustainability readiness needs assessment and gaps identification in selected priority districts

• Support the MOHCDGEC to sustain CQI as an integral component of the national EIMC/VMMC sustainability framework

• Review, revise, and finalize VMMC and EIMC CQI tools and integrate into national quality improvement framework

26 councils in Iringa, Njombe, Mbeya, Songwe, Shinyanga, and Tabora regions

Page 12: USAID ASSIST Project Tanzania Country Report FY17 · Tanzania Country Report FY17 ... e-MTCT Elimination of mother-to-child transmission of HIV FP Family planning . USAID ASSIST Tanzania

4 USAID ASSIST Tanzania Country Report FY17

What are we trying to accomplish? At what scale?

6. Work with MOHCDGEC and IPs to improve the quality of HIV rapid testing services

• Support MOHCDGEC, RHMT/CHMTs, and IPs to facilitate institutionalization, spread, and sustainability of the rapid HIV testing quality improvement initiative in 27 PEPFAR scale-up saturation councils

• Support testing points to improve compliance to HIV rapid testing standards, increase uptake and coverage, and demonstrate impact

• Support MOHCDGEC to increase uptake and coverage of proficiency testing programs and demonstrate impact

• Support frontline workers to improve HIV testing, safety, referral, and logistics and supplies

• Support MOHCDGEC to establish a framework for sustainable stepwise improvement of HIV rapid testing and certification

27/40 scale-up saturation councils

3 Key Activities, Accomplishments, and Results

Activity 1. Strengthen the capacity of the MOHCDGEC leadership and middle-level managers to continuously improve the quality of PMTCT care and lead scaling up and spread of PHFS to all implementing partners and scale-up councils

BACKGROUND

In FY17, ASSIST provided technical support to MOHCDGEC structures, regional IPs, faith-based organizations, and community groups to apply QI methods towards attaining PEPFAR 3.0 and UNAIDS 90-90-90 goals on achieving HIV epidemic control. Learning sessions, quarterly coaching and mentoring visits, and on-the-job trainings were provided to improve the full range of HIV services in the 84 PEPFAR scale-up and 98 sustained councils, reaching a total of 618 sites.

KEY ACCOMPLISHMENTS AND RESULTS

Lindi Region

• ASSIST staff conducted coaching and mentoring in 7 sites implementing PMTCT. A total of 22 health care providers and 2 RHMT and 2 CHMT members were reached (7th -18th, Nov 2016).

• Results:

o The percentage of pregnant women making 4 antenatal care (ANC) visits increased from 19% in October 2014 to 88% in October 2016 in 7 sites.

o Second dose of malaria intermittent preventive treatment (IPT2) uptake increased from 0% at baseline in Dec 2014 to 77% in October 2016 in tandem with increased 4th ANC visit attendance.

Kigoma Region

• ASSIST staff provided TA to RHMT, CHMT and the IP--Tanzania Health Promotion Support (THPS)--to strengthen their capacity in organizing and conducting a QI learning session (18th to 22nd April, 2017). A total of 47 health care workers from 13 health facilities from Kibondo, Uvinza and Kigoma Ujiji councils attended the session. Participants were trained on how to conduct process analysis, develop and test changes, and monitor improvement using run charts. Teams were also supported to develop improvement work plans for delivering HTC services, linkages, retention, IPT services, dried blood spot (DBS), and viral load turn-around time.

• Results:

o Percentage of children below 15 years tested for HIV in pediatric wards in 13 sites increased from 0% in Jan 2016 to 80% in March 2017.

o HIV testing among adults admitted to the ward increased from 5% in Jan 2016 to 45% in March 2017 for the same sites.

o Enrolment in care for the clients identified as HIV+ increased from 23% in Jan 2016 to 95% in March 2017 for 15 sites.

Page 13: USAID ASSIST Project Tanzania Country Report FY17 · Tanzania Country Report FY17 ... e-MTCT Elimination of mother-to-child transmission of HIV FP Family planning . USAID ASSIST Tanzania

USAID ASSIST Tanzania Country Report FY17 5

o Percentage of HIV+ pregnant and breastfeeding women lost to follow-up decreased from 24% in May 2016 to 0% by March 2017 in 15 sites.

Dodoma Region

•••• ASSIST conducted meetings with Dodoma Region RHMT and Dodoma Municipal Council (MC) CHMT to align QI TA in support of new proposed management structures at regional and council level (governance and technical committees) (Feb 14th -15th, 2017). A total of 61 participants (31 RHMTs and 30 CHMTs) attended the meetings and shared the challenges raised during different assessments, including SIMS and Big Results Now (BRN). The teams developed action plans and indicators to monitor progress of QI interventions.

• ASSIST in collaboration with members from technical committees conducted follow-up coaching and mentoring to 35 QI team members in six health facilities and eight spread sites (March 2017).

• ASSIST in collaboration with MOHCDGEC conducted a second learning session which was followed by a one-day QI stakeholders meeting to introduce the QI leadership framework (19th - 21st April 2017). Participants included 5 RHMTs, 6 CHMTs, 3 IPs (PACT, EGPAF) and 27 QI team members from 10 facilities supported by IPs (EGPAF and JSI). Performance indicators were reviewed and new indicators developed to address the 90-90-90 PEPFAR–UNAIDS strategy.

Morogoro Region

• In FY17 ASSIST in collaboration with Boresha Afya, the regional IP conducted three coaching and mentoring sessions (Nov 21st -Dec 8th, 2016; Feb. 20th–March 9th, 2017 and 12th – 23rd June 2017) to 11 sites in three councils of Morogoro Region (Morogoro Municipal, Mvomero DC, and Morogoro DC). A total of 139 health care providers were supported during these visits.

• Sex-disaggregated data for HIV-infected adults and children below 15 years was collected from 9 of the 11 QI sites (Nov 21st- Dec 8th, 2016).

• Provided technical support to Baylor (pediatric ART IP) to conduct a 3-day CQI learning session for 71 pediatric HTC service providers from 20 collaborative sites in six regions (Feb 21-23, 2017).

• In FY17, ASSIST oriented 48 council technical committee members (15 Regional Hospital Technical Committee members, 15 Morogoro Municipal Council, and 18 from Mvomero DC) on QI to build their capacity to support facility QI teams in their respective councils (Feb 27th and March 4th, 2017).

• ASSIST supported technical committee members to lead two coaching and mentoring sessions to QI teams (Feb 24th – Mar 8th and June 11th – 23rd, 2017).

• Results:

o Early Infant Diagnosis for HIV-exposed infants (HEI) generally improved with first DNA PCR test at 4-6 weeks increasing from 5% in September 2015 to 77% in May 2017 (Figure 1); while 2nd HIV test after cessation of breastfeeding increased from 25% in September 2014 to 67% in March 2017 from 8 reporting sites.

o HIV+ mother-HEI pairs attended HIV services at the facility each month increased from 58% in October 2014 to 77% May 2017 in sites.

o HIV testing for children under 15 years admitted to paediatric wards improved from 1% in May 2014 to 63% in May 2017 in five reporting sites.

o Service integration focusing on use of family planning methods by both male and female clients on ARV uptake increased from 20% in Jan 2014 to 69% in May 2017 in three reporting sites implementing gender integration.

o Boresha Afya (Regional IP), RMHT, and CHMT members had spread QI efforts to four new sites of Mvomero DC (Mvomero, Melela, Mlali health centers and Chazi hospital).

Dar es Salaam and Pwani Regions

• ASSIST supported three Pastoral Services for AIDS in Dar es Salaam Archdiocese (PASADA) QI focal persons to conduct coaching and mentoring to 93 QI team members from10 demonstration and three spread sites owned by the PASADA located in Dar es Salaam and

Page 14: USAID ASSIST Project Tanzania Country Report FY17 · Tanzania Country Report FY17 ... e-MTCT Elimination of mother-to-child transmission of HIV FP Family planning . USAID ASSIST Tanzania

6 USAID ASSIST Tanzania Country Report FY17

Pwani regions (10th -28th April 2017). The facilities included two hospitals, three health centers and eight dispensaries.

• Results: o HIV testing through DNA-PCR increased from 55% April 2015 to 80% March 2017 in 9 sites. o Second HIV testing after cessation of breastfeeding increased from 24% April 2015 to 80% in

March 2017 in 8 reporting sites in Pwani (Figure 1). o Mother-baby pairs attended together for HIV care increased from 48% in April 2015 to 71%

March 2017, 4 sites. o HEI retained to care for 12 months increased from 41% in October 2015 to 98% in March 2017, 6

sites.

Kilimanjaro Region

• A coaching visit was conducted to five sites of Moshi DC and three sites of Moshi MC (11th -24th June 2017). A total of 43 participants (1 RRHMT and 2 CHMT) were coached.

• Results: o HEI tested with DNA-PCR at 4-6 weeks increased from 59% January 2014 to 100% December

2016 and then decreased 67% in May 2017 in 7 reporting sites (Figure 1). o All visited facilities had active QI teams that meet monthly and had data compiled up to May

2017. o All facilities have started collecting and testing for viral load. o The turnaround time for viral load results is still long (about a month) except for Kilimanjaro

Christian Medical Center (KCMC). o Most of testing points use registers and log books.

Figure 1. Improving HEI tested with DNA-PCR at 4-6 weeks in Morogoro (8 sites), Pwani (8 sites) and Kilimanjaro (7 sites) regions (Jan 2014-May 2017)

0%

20%

40%

60%

80%

100%

Jan

-14

Ma

r-1

4

Ma

y-1

4

Jul-

14

Se

p-1

4

No

v-1

4

Jan

-15

Ma

r-1

5

Ma

y-1

5

Jul-

15

Se

p-1

5

No

v-1

5

Jan

-16

Ma

r-1

6

Ma

y-1

6

Jul-

16

Se

p-1

6

No

v-1

6

Jan

-17

Ma

r-1

7

Ma

y-1

7

% HEI received DNA/PCR at 4-6 in Morogoro Region % HEI received DNA/PCR at 4-6 in Pwani Region

% HEI received DNA/PCR at 4-6 in Kilimanjaro Region

0

100

Jan

-14

Ma

r-1

4

Ma

y-1

4

Jul-

14

Se

p-1

4

No

v-1

4

Jan

-15

Ma

r-1

5

Ma

y-1

5

Jul-

15

Se

p-1

5

No

v-1

5

Jan

-16

Ma

r-1

6

Ma

y-1

6

Jul-

16

Se

p-1

6

No

v-1

6

Jan

-17

Ma

r-1

7

Ma

y-1

7

Total # HEI Enrolled to care in the month in Morogoro Region Total # HEI Enrolled to care in the month in Pwani Region

Total # HEI Enrolled to care in the monthin Kilimanjaro Region

Denominator: Total number of HEI enrolled

Page 15: USAID ASSIST Project Tanzania Country Report FY17 · Tanzania Country Report FY17 ... e-MTCT Elimination of mother-to-child transmission of HIV FP Family planning . USAID ASSIST Tanzania

USAID ASSIST Tanzania Country Report FY17 7

Mbeya Region: Kyela District Council

• Conducted coaching and mentoring to 15 health care providers from 5 sites implementing QI activities. Two RHMT and 2 CHMT members were also involved (Oct 24th - 29th, 2016).

• Results:

o During the visit, it was observed that the percentage of clients who were lost-to-follow-up and tracked back increased from 9% (443 out of 4,697) in July 2016 to 11% (490 out of 4,646) in Sept 2016.

Shinyanga Region

• ASSIST conducted coaching and mentoring sessions in Shinyanga Region; 45 health care providers from 7 sites and 16 RHMT and CHMT members were involved (March 6-18, 2017).

• Results:

o Percent of adults and children who were alive and on treatment 12 months after initiation of ART improved from 72% (Sept 2015) to 93% (Feb 2017) in seven sites.

o Percent of infants born to HIV+ women who received a HIV viral test within 12 months of birth improved from 92% (Sept 2015) to 98% (Feb 2017).

o Percent of children <15 years tested for HIV at in-patient department (IPD), out-patient department (OPD), TB, and care and treatment clinics (CTC) each month increased from 18% (Sept 2015) to 91% (Jan 2017) (Figure 2).

Figure 2. Percent of children <15 years tested for HIV at IPD, OPD, TB and CTC clinics each month, 7 facilities, Shinyanga Region (Sep 2015-Jan 2017)

Njombe Region

• In FY17 ASSIST conducted four coaching and mentoring sessions to 11 sites (Oct 24th – 28th, 2016, and 21st -25th, Nov 2016, Feb 20th to 3rd March 2017 and June 11th to 24th 2017). During the visit, 22 QI team members and 6 CHMT QI focal persons were supported on QI. CHMTs were also supported to establish council level QI teams and to develop council level QI plans. TUNAJALI (now Boresha Afya) worked with R/CHMTs to spread QI to nine new sites in the region.

• In the reporting year, ASSIST supported Njombe RHMT and five CHMTs (Njombe, Ludewa, Makambako, Wangingo’mbe and Makete DCs) to form CQI teams and develop action plans based on above-site SIMS results (Nov 21st to 25th 2016 and June 11th to 24th 2017). A total of 49 R/CHMT QIT members participated, including the Regional Medical Officer and District Medical Officers.

18%

91%

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

Sep-15 Nov-15 Jan-16 Mar-16 May-16 Jul-16 Sep-16 Nov-16 Jan-17

Pe

rce

nta

ge

Tested Changes

- Special desks for PITC placed at general OPD

- Every clinician on duty to prioritize HIV testing to <15years children and report numbers at the end of duty

- Every QI team assigned one member responsible for PITC follow up and reporting

0

20000

Sep-15 Nov-15 Jan-16 Mar-16 May-16 Jul-16 Sep-16 Nov-16 Jan-17

Total Number of children < 15 years attended at IPD,OPD,TB,CTC Clinics in the month

Page 16: USAID ASSIST Project Tanzania Country Report FY17 · Tanzania Country Report FY17 ... e-MTCT Elimination of mother-to-child transmission of HIV FP Family planning . USAID ASSIST Tanzania

8 USAID ASSIST Tanzania Country Report FY17

• During this reporting period, council QI teams participated in follow-up coaching and mentoring visit to 11 sites, and improvement was sustained in the area of access to HIV testing among exposed children.

• Results:

o Improvement has been observed in first DNA-PCR testing at 4-6 weeks from 45% May 2014 to 84% in May 2017 in 5 facilities (Figure 3).

o Second HIV test six weeks after cessation of breastfeeding increased from 33% in May 2014 to 75% in May 2017 (Figure 3).

Figure 3. Improving HIV testing among exposed children, 5 sites, Njombe Region (May 2014 – May 2017)

Arusha Region

• ASSIST staff in collaboration with RHMT, CHMTs, and the regional IP--Elizabeth Glaser Pediatric AIDS Foundation (EGPAF)--conducted two coaching and mentoring visits February 27-March 10, 2017 and 18th -30th June 2017 to 10 health facilities, including 7 high-volume sites of Arusha City Council and 3 high-volume sites of Arusha District Council. Significant improvement was noted in most of the indicators, including retention of mother-baby pairs, HEI confirmatory test, 1st DNA PCR test, male partner testing for HIV at RCH, ART initiation among HIV-positive pregnant women and children under 15 years as well as family planning uptake among HIV-positive women of reproductive age. o During the coaching, review of HIV viral load testing was done whereby number of samples that

have ever been taken were noted, the number of clients with rejected samples, and the number of clients with readings below and above 1000 pc/ml was noted for follow-up of baseline of this activity.

• Results: o Increased percentage of HIV+ mother-HEI pairs attending HIV services at the facility each month,

from 8% in January 2014 to 82% in May 2017 in 10 sites, Arusha District (Figure 4).

0

10

20

30

40

50

60

70

80

90

100

Ma

y-1

4

Jul-

14

Se

p-1

4

No

v-1

4

Jan

-15

Ma

r-1

5

Ma

y-1

5

Jul-

15

Se

p-1

5

No

v-1

5

Jan

-16

Ma

r-1

6

Ma

y-1

6

Jul-

16

Se

p-1

6

No

v-1

6

Jan

-17

Ma

r-1

7

Ma

y-1

7

% of HIV exposed infants received DNA/PCR within 4-6 wks each month

% of HIV exposed children receiving second HIV test 6 wks after cessation of

breast milk

Tested Changes

- On site training

regarding infant

BF and how to fill

MCFR to HCW

- Review of HEID

card during

provision of

Mother-baby pair

services and

identify eligible

children for HIV

confirmation, 6

weeks after

complete

0

100

1 3 5 7 9 11 13 15 17 19 21 23 25 27 29 31 33

Denominator

Total number of HIV Exposed infant registered

Total number of exposed children eligible for HIV 2nd test after cessation of BF ( 15months after birth)

Page 17: USAID ASSIST Project Tanzania Country Report FY17 · Tanzania Country Report FY17 ... e-MTCT Elimination of mother-to-child transmission of HIV FP Family planning . USAID ASSIST Tanzania

USAID ASSIST Tanzania Country Report FY17 9

o Increased percentage of HIV-exposed children receiving confirmatory HIV test 6 weeks after cessation of breast milk (15 months after birth) from 31% in January 2014 to 82% in May 2017, 12 sites, Arusha District (Figure 5).

Figure 4. Percentage of HIV+ mother-HEI pairs seen at the facility each month, 10 facilities, Arusha District (Jan 2014-May 2017)

Figure 5. Percentage of HIV-exposed children receiving confirmatory HIV test 6 weeks after cessation of breast milk (15 months after birth), 12 sites, Arusha District (Jan 2015-May 2017)

Page 18: USAID ASSIST Project Tanzania Country Report FY17 · Tanzania Country Report FY17 ... e-MTCT Elimination of mother-to-child transmission of HIV FP Family planning . USAID ASSIST Tanzania

10 USAID ASSIST Tanzania Country Report FY17

Mara Region

• Between May 29th and 2nd June 2017, ASSIST conducted coaching and mentorship sessions to high-volume ART/PMTCT service delivery sites in Musoma Municipal Council. In these sessions, 40 health service providers, 1 RHMT member, and 4 CHMT members participated. A similar exercise was conducted in Rorya District Council from 5th to 9th June 2017 in which 31 health care providers, 1 RHMT member, and 3 CHMT members were involved.

• Results:

o The number of male partners tested for HIV at Reproductive Child Health (RCH) increased from 50 (14.3%) out of 350 in July 2015 to 290 (72%) out of 320 mothers booked at ANC in May 2017 (Figure 6).

Figure 6. Improving male partner HIV testing, as a proxy for male partner involvement, in PMTCT and ART services, 8 facilities, Rorya District Council, Mara Region (Jul 2015-May 2017)

Partnership for HIV-Free Survival

Nzega and Mufindi DCs

• ASSIST staff conducted coaching and mentoring and collected outcome data from the initial PHFS sites in Nzega and Mufindi councils. In Mufindi, 23 health care workers and one CHMT member were coached while in Nzega District Council, 30 health care workers and two CHMT members were involved in the coaching (Nov 22nd – Dec 15th, 2016).

• The same exercise was carried out in Mbeya City Council to 10 PHFS initial sites implementing the program (Feb 14- March 4, 2017). A total of 21 health care workers, one RHMT member, and one CHMT member participated in this activity.

• With a focus on increasing efficiency, QI efforts led to: o Reduced workload for health care providers.

o Reduced cost to clients as they attend the same day instead of different days.

o Reduced frequency of visits.

• Results from 10 sites in Nzega and 10 sites in Mufindi: o HIV testing among pregnant women increased from 50% in Aug 2013 to 93% in Dec 2016.

o Percentage of HIV-positive infants linked to care increased from 40% in Oct 2013 to 100% in Sept 2015.

o Malnutrition rates among HIV-positive pregnant and lactating women decreased from 4% in June 2013 to 1% in Dec 2016.

0

50

100

150

200

250

300

350

400

450

Jul-

15

Au

g-1

5

Se

p-1

5

Oct

-15

No

v-1

5

De

c-1

5

Jan

-16

Fe

b-1

6

Ma

r-1

6

Ap

r-1

6

Ma

y-1

6

Jun

-16

Jul-

16

Au

g-1

6

Se

p-1

6

Oct

-16

No

v-1

6

De

c-1

6

Jan

-17

Fe

b-1

7

Ma

r-1

7

Ap

r-1

7

Ma

y-1

7

Nu

mb

er

of

clie

nts

Number of male partners tested and counseled for HIV at RCH clinic

Total number of pregnant women booking for ANC that month

Page 19: USAID ASSIST Project Tanzania Country Report FY17 · Tanzania Country Report FY17 ... e-MTCT Elimination of mother-to-child transmission of HIV FP Family planning . USAID ASSIST Tanzania

USAID ASSIST Tanzania Country Report FY17 11

o Survival rate for HEI at 12 months of age improved from 48% in Apr 2013 to 82% in Dec 2016 in 10 sites.

o The retention rates of mothers to care was at 100% at the first 12 months and dropped to 70% at 36 months of care. This reduction is expected as mothers learn their infants are HIV-negative.

o At 10 sites in Mufindi DC, mother baby pair attendance at HIV services increased from 0% in June 2013 to 90% in Oct 2016 (Figure 7).

o All HIV+ pregnant women were initiated on ART with good retention to ensure maximum adherence to ART and thus the percentage of women who were active on ART increased from 55% in June 2013 to 97% in Oct 2016 (Figure 7).

o The outcome of PHFS was to reduce HIV transmission rate from mother-to-child to less than 5%. Mufindi District Council successfully reduced the HIV transmission rate from 7% in 2013 to 3% in 2015 (Figure 8).

o Table 1 presents the outcome data from both Mufindi District Council and Mbeya City Council. In Mbeya City Council, HIV transmission rates were reduced from 11% in 2013 to 4% in 2015. The data is only until 2015 because infants born since then are still not old enough for confirmatory testing per national guidelines.

Figure 7. Percentage of mother-baby pairs attending HIV services and percentage of HIV-positive pregnant and lactating women on ART each month, 10 sites, Mufindi DC (Jun 2013-Oct 2016)

Page 20: USAID ASSIST Project Tanzania Country Report FY17 · Tanzania Country Report FY17 ... e-MTCT Elimination of mother-to-child transmission of HIV FP Family planning . USAID ASSIST Tanzania

12 USAID ASSIST Tanzania Country Report FY17

Figure 8. HIV positivity rate among HEI, 10 PHFS sites, Mufindi DC (2013-2015)

Table 1. Tanzania: PHFS outcome results on HEI enrolled into care, confirmed HIV status, and confirmed HIV-positive, Mufindi District Council and Mbeya City Council (2013-2015)

YEAR HEI ENROLLED

INTO CARE CONFIRMED HIV

STATUS CONFIRMED HIV-

POSITIVE

2013 Mufindi DC 206 125 (60.7 %) 9 7.2%

Mbeya CC 152 130 (85.5%) 14 11%

2014 Mufindi DC 838 700 (83.5%) 34 4.8%

Mbeya CC 748 728 (97.3%) 44 6%

2015 Mufindi DC 796 552 (69.3%) 19 3.5%

Mbeya CC 995 847 (81.1%) 34 4%

SPREAD OF IMPROVEMENT

In FY17, ASSIST continued to support MOCDGEC, R/CHMTs and regional PMTCT IPs to spread the PHFS change package to all scale-up and saturated councils. The focus was on: Early Infant Diagnosis for both DNA-PCR and rapid test after cessation of breastfeeding; pairing HEI and mother for same-day access to PMTCT follow-up services, and delivery of ART to pregnant and lactating HIV-positive mothers.

Activity 2. Support the MOHCDGEC leadership and middle-level managers to scale up improvement activities for ART services to achieve sustainable coverage, retention, and improved viral suppression

BACKGROUND

In FY17, ASSIST supported the MOHCDGEC, IPs, and R/CHMTs to scale up ART improvement efforts in priority districts of Tanga, Mara, Mbeya, Dodoma, Njombe, Dar es Salaam, and Pwani regions. In these regions, ASSIST worked with R/CHMTs to establish QI activities in high-volume facilities focusing on ART retention, update of viral load, addressing SIMS gaps, and ensuring quality of HIV testing. ASSIST also continued to provide technical support to R/CHMTs and partners in initial regions to improve identification and enrolment to HIV care, retention, and clinical monitoring of PLHIV. As part of strengthening

Page 21: USAID ASSIST Project Tanzania Country Report FY17 · Tanzania Country Report FY17 ... e-MTCT Elimination of mother-to-child transmission of HIV FP Family planning . USAID ASSIST Tanzania

USAID ASSIST Tanzania Country Report FY17 13

leadership skills in QI among RHMT and CHMT members, ASSIST developed a draft leadership framework for quality and supported training of regional and districts level technical committees on QI approaches.

KEY ACCOMPLISHMENTS AND RESULTS

Mbeya DC

• Conducted coaching and mentoring to four high-volume sites implementing the Engagement Adherence, and Retention (EAR) program (Oct 30 -Nov 11, 2016, May 3-12, 2017). During the Oct-Nov coaching visits, one RHMT member, one CHMT member, and 12 health care providers were reached. During the May coaching visits, 16 providers from facility QI teams and 5 expert patients were reached.

• Results:

o Increased percentage of clients keeping appointments from 79% in Oct 2016 to 83% in Jan 2017 and the percentage of clients taking ARVs from 80% in Oct 2016 to 88% in April 2017 in five sites (Figure 9).

o Decreased the percentage of clients categorized as having moderate acute malnutrition (MAM) or severe acute malnutrition (SAM) from 5% in Nov 2016 to 1% in April 2017 in the five EAR sites.

o Decreased the percentage of clients with CD4 counts less than 200 from 42% in Oct 2016 to 11% in April 2017 in the five EAR sites.

o Increased the percentage of clients who have self-management plans in the five EAR facilities in Mbeya DC, from 8% in Dec 2015 to 89% in April 2017 (Figure 10).

Figure 9. Percentage of eligible clients who did not miss picking up their ARVs on appointed dates (retention), 5 EAR sites, Mbeya District Council (Dec 2015 – April 2017)

Page 22: USAID ASSIST Project Tanzania Country Report FY17 · Tanzania Country Report FY17 ... e-MTCT Elimination of mother-to-child transmission of HIV FP Family planning . USAID ASSIST Tanzania

14 USAID ASSIST Tanzania Country Report FY17

Figure 10. Percentage of clients who have self-management plans, 5 EAR sites, Mbeya DC (Dec 2015-April 2017)

Njombe Region

• ASSIST conducted coaching and mentoring to 10 sites to explore opportunities for ART differentiated care and to help QI teams strengthen implementation of the possible models based on the relevant national guidelines (Feb 20– March 4, 2017). HIV-positive adults on ART 48 months after starting ART services in two sites (Lugarawa and Ikonda Mission Hospitals) increased from 60% in December 2013 to 90% in January 2017.

Dodoma Region

• ASSIST staff conducted coaching and mentoring involving technical committees (March 15–18, 2017). During the visit, an increase was observed in number of lost to follow-up (LTFU) clients traced back to care from 26% in January 2016 to 79% in January 2017 at four sites.

Morogoro Region

• ASSIST staff in collaboration with the regional IP (TUNAJALI) and R/CHMTs, oriented 15 Regional Referral Hospital technical committee members, 15 council technical committee members of Morogoro Municipal Council, and 18 technical committee members from Mvomero DC on their roles (Feb 27 and March 4, 2017).

• Supported technical committee members to lead coaching and mentoring sessions to QI teams (Feb 24–March 8, 2017).

• Provided technical support to Baylor (pediatric ART IP) to conduct a 3-day CQI learning session for 71 pediatric HTC service providers from 20 collaborative sites (Feb 21-23, 2017).

• ASSIST supported coaching and mentoring to 10 sites (Nov 21-Dec 8, 2016). The age- and sex- disaggregated data for clients on ART were collected and have been updated up to May 17 for further analysis to inform further improvement in provision of quality HIV services.

• Results:

o HIV testing for children under 15 years admitted to pediatric wards increased from 1% in May 2014 to 72% in Jan 2017 in three reporting sites.

o ART clients keeping appointments improved from 1% in May 2014 to 75% in Sept 2016 in three reporting sites.

o Regarding age- and sex-disaggregated data analysis, the following was observed out of 24,016 (females 16,807; males 7209) clients who ever received care from the 10 facilities:

Page 23: USAID ASSIST Project Tanzania Country Report FY17 · Tanzania Country Report FY17 ... e-MTCT Elimination of mother-to-child transmission of HIV FP Family planning . USAID ASSIST Tanzania

USAID ASSIST Tanzania Country Report FY17 15

- Among adults 15 years and above currently on ART, females account for 73.75% and males represent 26.25%. Females account for about 60% of PLHIV, so more females than males are receiving care, which is in line with known low health-seeking behavior of males.

- Among children under 15 years currently on ART, 48.3% and 51.8% were female and male, respectively.

- Retention to care among children < 15 years was 47.2% for girls and 52.8% for boys. - Retention to care for adults 15 years and above was 72.3% among females and 27.6%

among males.

Tabora Region

ASSIST provided technical assistance from May 23-June 2, 2017 to Nzega Council facility QI teams supported by EGPAF and supported teams to develop action plans to address SIMS performance gaps and update viral load testing among eligible PLHIV involving a total of 10 QI teams.

•••• ASSIST facilitated a QI learning session for the regional and council health management teams and health facility staff in the Tabora Region (June 19th to 24th, 2017). About 40 managers were equipped with QI knowledge and skills to provide comprehensive HIV services in line with the UNAIDS 90-90-90 Strategy.

•••• ASSIST conducted a learning session with laboratory technicians and HIV testers from Tabora Municipal, Igunga, Kaliua, and Uyui scale-up councils (June 27th -29th, 2017). Thirty participants, including laboratory technicians and HIV rapid testers, were trained on CQI. The learning session was aimed at ensuring quality HIV testing services and reliability of HIV test results in line with the test and treat strategy.

Dar es Salaam and Pwani regions

• Coaching and mentoring was provided by ASSIST in Dar es Salaam and Pwani regions to 7 sites supported by PASADA. Improvement was noted in the area of HIV-infected children currently on ART (Figure 11).

Figure 11. Percentage of HIV-infected children <15 years of age currently on ART, Dar es Salaam and Pwani sites (Jul-Sept 2015 to Apr-Jul 2017)

Tanga Region

•••• ASSIST supported a QI learning session with 87 health care providers from 3 facility QI teams

and 8 community QI teams (April 19-29, 2017). In addition, two RHMT and six CHMT members

were trained on QI approaches to increase engagement of PLHIV into ART care. Data updated from

facility QI teams in Muheza District showed that at the beginning in October 2013, among 100 PLHIV

0

500

1000

July -Sept

15

Oct-Dec 15 J-M 16 A-J 16 J-S 16 O-D 16 J-M 17 A-J 17

Denominator

Ever enrolled children expected to continue with ART

76%

93%

0%

20%

40%

60%

80%

100%

July -Sept

15

Oct-Dec 15 J-M 16 A-J 16 J-S 16 O-D 16 J-M 17 A-J 17

Changes tested

QI teams reviewed data to

identify HIV-infected children

on ART and initiate ART

services

IPs established separate

clinics days for HIV-infected

children.

Page 24: USAID ASSIST Project Tanzania Country Report FY17 · Tanzania Country Report FY17 ... e-MTCT Elimination of mother-to-child transmission of HIV FP Family planning . USAID ASSIST Tanzania

16 USAID ASSIST Tanzania Country Report FY17

who were scheduled for ARV pick-up, 24 missed their appointment. After improvement work, by

February 2017 among 100 PLHIV who were scheduled for ARV pick up only two missed their

appointment (Figure 12).

Figure 12. Percentage of HIV+ clients scheduled for 60 days ARV pick-up who missed their scheduled appointment, 3 sites in Muheza District (Oct 2013 – Feb 2017)

SPREAD OF IMPROVEMENT

In FY17, ASSIST scaled up ART QI initiatives to scale-up councils of Tabora, Mbeya, Tanga, Dar es Salaam, Dodoma, and Pwani. The scale-up focused on retention and care of PLHIV (Mbeya DC), uptake of viral load test among eligible PLHIV (Tabora, Njombe, and Dodoma), addressing retention among HIV-infected children on ART (Dar es Salaam and Pwani), and addressing SIMS assessment gaps in Njombe and Tabora. In these initiatives, ASSIST supported capacity-building activities to regional and district level technical committees as part of strengthening their leadership skills for QI activities.

During the scale-up and spread of improvement interventions, CHMTs and RHMTs developed improvement plans to facilitate facility QI teams to test and evaluate changes to address the prevailing gaps on SIMS, viral load uptake, and retention in care. In Nzega DC, 10 facility QI teams in collaboration with the council’s QI teams and IPs, formed a WhatsApp group to facilitate communication and monitoring of viral load uptake, to help ensure that eligible clients get a HIV viral load test to support achievement of the PEPFAR third 90.

Activity 3. Support the MOHCDGEC, IPs, MVC stakeholders, and local structures to strengthen quality of care, support, and protection to Most Vulnerable Children and adolescents through improvement approaches

BACKGROUND

MOHCDGEC and partners are committed to improving the life of vulnerable children and their families by strengthening community systems and structures to allocate and mobilize local available resources to ensure their care, support, and protection. In FY16, ASSIST started to work with the Department of Social Welfare (DSW) and IPs to review and update the national MVC QI guideline and develop the essential service package and training guide for MVC and adolescents affected by and living with HIV. In FY17,

Page 25: USAID ASSIST Project Tanzania Country Report FY17 · Tanzania Country Report FY17 ... e-MTCT Elimination of mother-to-child transmission of HIV FP Family planning . USAID ASSIST Tanzania

USAID ASSIST Tanzania Country Report FY17 17

ASSIST continued to work with IPs, DSW, and CHMTs to build their capacity by coaching and mentoring MVC Committees (MVCC)/QI teams and local structures to identify performance gaps and plan for changes to improve performance in service delivery for most vulnerable children and households. The essential service package for vulnerable children and adolescents was finalized and will support community service providers in effective case identification, linkage to care and support, as well as linking MVC and adolescents with HIV services (testing, enrolment, and retention to HIV care).

KEY ACCOMPLISHMENTS AND RESULTS

Shinyanga Region

• ASSIST staff conducted coaching and mentoring visits to 126 (48 male and 78 female) community QI team members from six neighbourhoods in Kambarage Ward in Shinyanga Municipal Council. The coaching aimed at strengthening teams’ capacity in identifying, supporting, and linking vulnerable children to HIV and social services (Oct 27-Nov 4, 2016).

• ASSIST conducted coaching and mentoring to 94 QI team members (66 male and 28 female) at Tinde Ward in Shinyanga District Council (Feb 13-23, 2017).

• ASSIST conducted coaching and mentoring to 96 members (63 male, 33 female) of community QI teams in Tinde Ward, Shinyanga DC to support and build capacity of the teams to work with the community to improve HIV testing and provision of quality services to vulnerable children (May 2, 2017). By May 2017, 71 (35 male and 36 female) out of 648 vulnerable children had been tested for HIV while 19 who tested HIV-positive were enrolled into care.

• ASSIST conducted coaching and mentoring to strengthen the capacity of CQI team members in Shinyanga MC in identifying, supporting, and linking MVC to HIV and social services (May 11th, 2017). A total number of 156 CQI team members (69 male and 87 female) were supported on improving access to HIV and social services to most vulnerable children and adolescents. By May 2017, 454 out of 458 (99%) MVC had been tested for HIV, as shown in Figure 13.

• Results: o Community QI teams in Kambarage Ward, in collaboration with village authorities, obtained birth

certificates for 350 out of 462 vulnerable children (76%): 168 males out of 216 (78%) and 182 females out of 246 (74%). By May 2017 a total of 329 out of 345 were supported with the community health fund (CHF) through community resource mobilization (Figure 14).

Njombe Region

• Coaching and mentoring was conducted with nine community QI teams in two wards of Njombe Town Council reaching 61 (33 male and 28 female) community QI team members (Oct 17-28, 2016). Coaching and mentoring was conducted again from May 2-14, 2017 reaching 85 (54 male and 31 female) community QI team members.

• Results:

o Through community mobilization and sensitization on voluntary HIV testing for vulnerable children, 206 (49%) vulnerable children (109 male, 97 female) out of 417 (220 male and 197 female) were tested for HIV; 29 (16%) of those tested were confirmed HIV-positive (14 males and 20 females), and all were enrolled into care.

o Community QI teams mobilized resources in collaboration with village authorities and managed to obtain community health fund (CHF) cards for 48 (13%) (20 female out of 194, and 28 males out of 197) out of 375 vulnerable children above 5 years of age. Also 73 (18%) vulnerable children (411 males and 32 females) out of 417 received birth certificates because of these efforts.

Page 26: USAID ASSIST Project Tanzania Country Report FY17 · Tanzania Country Report FY17 ... e-MTCT Elimination of mother-to-child transmission of HIV FP Family planning . USAID ASSIST Tanzania

18 USAID ASSIST Tanzania Country Report FY17

Figure 13. Increased access HIV testing and counseling for vulnerable children through community mobilization in six neighborhoods, Kambarage Ward, Shinyanga Region (Oct 2015-Apr 2017)

Figure 14. Increased access to community health fund cards for vulnerable children through community mobilization, 6 neighborhoods, Kambarage Ward, Shinyanga Region (Oct 2015-Apr 2017)

Morogoro Region - Mvomero District

• ASSIST conducted coaching and mentoring with eight community QI teams in Dakawa and Melela wards in Morogoro Region (June 12-23, 2017). A total of 89 (45 male and 44 female) members from community QI teams were reached.

19

3642

5966

7279

91 91 91 94 94 94 96 96 97 98 99 99 99

0102030405060708090

100

Oct-

15

Nov-

15

Dec-

15

Jan-

16

Feb-

16

Mar-

16

Apr-

16

May-

16

Jun-

16

Jul-

16

Aug-

16

Sep-

16

Oct-

16

Nov-

16

Dec-

16

Jan-

17

Feb-

17

Mar-

17

Apr-

17

May-

17

% Male 14 28 36 49 59 73 78 89 89 89 92 92 92 96 96 97 97 99 100 100

% Female 25 45 49 71 73 73 80 93 93 93 95 95 95 96 96 96 99 88 88 88

% All OVC 19 36 42 59 66 72 79 91 91 91 94 94 94 96 96 97 98 99 99 99

Tested Changes

• Teams worked to identify all MVC

• Teams conducted awareness creation to community members on HIV issues.

• Team members worked with HBC volunteer to link MVC for HIV services.

0

10

20

30

40

50

60

70

80

90

100

% of MVC Male above 5 year with CHF cards

% of MVC Female above 5 year with CHF cards

% of Total MVC above 5 year with CHF cards

Tested Changes

- Worked with local authority on resource mobilization

- Community QI team members divided by neighborhoods to more efficiently provide awareness-raising on CHF cards

Page 27: USAID ASSIST Project Tanzania Country Report FY17 · Tanzania Country Report FY17 ... e-MTCT Elimination of mother-to-child transmission of HIV FP Family planning . USAID ASSIST Tanzania

USAID ASSIST Tanzania Country Report FY17 19

• Results:

o Teams linked and referred MVC to facility and outreach campaigns for HIV testing. A total of 88 (18%) (39 male and 49 female) out of 495 (242 female and 253 male) vulnerable children were tested for HIV, and among those 12 (10 male and 2 female) were found positive and enrolled into care.

o In collaboration with village authorities, teams conducted resource mobilization for CHF cards. To date, a total of 144 (24%) (78 male and 66 female) MVC out of 589 have received CHF cards.

Iringa Region

• ASSIST conducted coaching and mentoring to 5 community QI teams in Kinyanambo Ward in Mafinga Town Council (Oct 17-21, 2016). A total of 34 (22 male and 12 female) members from community QI teams were reached. During the coaching, teams were strengthened in their capacity to provide quality HIV and other social services through identification of gaps and planning and testing changes. Two teams linked 12 vulnerable children (4 male and 8 female) to HIV testing whereby 10 (4 males and 6 female) vulnerable children tested HIV-positive and were enrolled to care.

• In collaboration with the CHMT, Social Welfare Officer, and IP TUNAJALI, ASSIST conducted coaching and mentoring to 18 community QI teams from four wards in Mufindi District Council (Oct 22–28, 2016). A total of 117 community QI team members (81 male and 36 female) were reached. During the exercise, it was learned that teams linked 227 out of 1,213 vulnerable children to HIV testing and counselling services by October 2016 as compared to 37 out of 571 vulnerable children in May 2016.

• In collaboration with IPs MWANZO BORA and Afya-women, the RHMT, and the CHMT, ASSIST conducted coaching and mentoring to 30 (13 male and 17 female) community QI team members from five neighborhoods including Kinanambo, Gangilonga, Tanganyika, Mizani and Ifingo in Kinyanyambo Ward in Mafinga TC (May 2-5, 2017).

• In collaboration with IPs MWANZO BORA and Afya-women, the RHMT, and the CHMT, ASSIST conducted coaching and mentoring to 156 (male 85 and 71 female) members of 18 community QI teams from four wards (Mbalamaziwa, Malangali, Idunda and Ihowanza in Mufindi DC) (May 8-12, 2017). Teams have been able to link 432 out of 1387 (31%) most vulnerable children to HIV testing and counselling.

Arusha Region

• ASSIST staff in collaboration with regional and district social welfare officers and the IP ELCT-Kizazi Kipya conducted coaching to 12 community QI teams from 3 wards of Nduruma, Kisongo and Bwawani in Arusha District Council (June 12th – 23rd, 2017). A total of 85 (54 males, 31 females) community volunteer team members were coached. Coaching focused on strengthening their capacity in identification of MVC needs and supporting vulnerable children through referrals and linkages to different services. During the visit, community teams were able to collect baseline data whereby 147 MVC out of 1302 (11%) were linked to HIV testing and counselling; and 10 out of 1302 (1%) had accessed birth certificates.

SPREAD OF IMPROVEMENT

This activity was spread from six district councils to nine. The new districts include Mvomero, Shinyanga, and Arusha District Councils.

Activity 4. Support the MOHCDGEC, LGAs, and community-based IPs to strengthen community-based mechanisms for improving HIV testing, ARV pick-up, adherence, retention as well as facility-community referrals and linkages for PLHIV

BACKGROUND

Despite progress made on increasing ART coverage countrywide, the coverage and scope of community-based HIV services (CBHS) remains limited and not aligned with facility-based ART services. Community-based HIV services have not contributed sufficiently in detection of PLHIV, ART provision, and retention in care as well as promoting linkages to care. To address these challenges in FY17, ASSIST supported work across all levels to support the MOHCDGEC and IPs to build the capacity of community-based mechanisms to contribute significantly to the achievement of the UNAIDS 90-90-90 targets of HIV

Page 28: USAID ASSIST Project Tanzania Country Report FY17 · Tanzania Country Report FY17 ... e-MTCT Elimination of mother-to-child transmission of HIV FP Family planning . USAID ASSIST Tanzania

20 USAID ASSIST Tanzania Country Report FY17

epidemic control related to HIV testing; introduction of community-based ARV dispensing sites for stable patients; proactive adherence and retention mechanisms; and strengthening of bi-directional referrals and linkages between health facilities and community-based actors.

Specific activities included:

•••• Designed and implemented targeted door-to-door home-based testing (to families of index HIV-

positive clients).

•••• Integrated HIV-testing interventions in community-based multi-disease prevention campaigns such as

distribution of Insecticide-treated Bednets (ITNs), TB-DOTS, TB screening, hypertension screening,

growth monitoring, malnutrition screening, immunization updates for children under five, etc. in all

intervention sites.

•••• Strengthened and scaled up community-based ART adherence interventions using CBHS providers,

PLHIV, groups, and peer mentors, including use of mobile phone text messages.

•••• Developed and piloted community-based model for monthly ARV pick-up for stable patients on ART.

•••• Strengthened bidirectional community-facility referral systems, including community outreach and

models to support HIV testing and clinic visits for stable patients.

•••• Strengthened community-based mother support groups and built capacity for enhancing retention in

care and adherence for children and mother-baby pairs.

KEY ACCOMPLISHMENTS AND RESULTS

Muheza, Korogwe, and Tanga City councils (Tanga Region)

• ASSIST staff supported RHMT and CHMTs in Muheza DC to organize a coaching and mentoring session to 8 community teams and 3 high-volume health facilities to strengthen teams’ capacity in improving facility-community linkages; follow-up of ART patients; early ANC booking; and improving clinical outcomes at the community level. A total of 100 community team members, 20 community home-based care (HBC) providers, 2 RHMT members,

and 6 CHMT members participated (10th to 17th June 2017).

• ASSIST supported Korogwe, Muheza, and Tanga City CHMTs to conduct a learning session for health care providers working in Care and Treatment Clinics (CTC), Reproductive and Child Health (RCH) clinics, and labor and delivery wards to share facility indicator performance in run charts and share experiences and review collected data to determine ways of improving various processes such as viral load testing, rapid HIV testing, adherence and retention of PLHIV on ART, and bidirectional community-facility referral systems. About 87 health service providers and 2 RHMT and 12 CHMT members were reached (April 19th – 29th 2017).

• Results: o Increase in percentage of new HIV+ clients enrolled in care and linked to community-based

health providers for closer follow-up from 0% in May 2015 to 86% in May 2017 at Muheza Designated District Hospital (DDH). The change idea included assigning a focal person to document new clients attached to community-based health providers and sensitization for PLHIV to be attached to nearby community-based health providers (Figure 15).

Page 29: USAID ASSIST Project Tanzania Country Report FY17 · Tanzania Country Report FY17 ... e-MTCT Elimination of mother-to-child transmission of HIV FP Family planning . USAID ASSIST Tanzania

USAID ASSIST Tanzania Country Report FY17 21

Figure 15. Percentage of new HIV+ clients enrolled in care and linked to community-based health providers for follow-up, Muheza Designated District Hospital (May 2015 - May 2017)

SPREAD OF IMPROVEMENT

In FY17 ASSIST supported CHMT members in Tanga City to spread changes tested at Muheza DDH. Focal persons at 8 health facilities identified and assigned roles and responsibilities to document all new HIV+ clients attached to community-based providers in 14 wards of Tanga City.

Activity 5. Work with MOHCDGEC and IPs to improve safety, increase efficiency, and the level of integration of VMMC/EIMC services into primary health services

BACKGROUND

In 2015, ASSIST in collaboration with MOHCDGEC and IPs, initiated the process of building capacity for CQI as an integral component of VMMC and early infant male circumcision (EIMC) services. During this period, national VMMC policies, guidelines, and VMMC quality compliance assessment tools were developed and used for baseline assessment at 55 sites. Since that time, compliance assessments were conducted quarterly at all the 55 sites in six regions (Mbeya, Songwe, Iringa, Njombe, Tabora and Shinyanga). The main performance gaps identified included: inadequate counselling, lack of privacy, inadequate recording of adverse events, irregular supply of commodities, inadequate space, and lack of effective management.

In 2016, ASSIST provided technical support to providers on assessing changes to optimize compliance to the global male circumcision standards. CHMTs were supported to set up site-level QI teams that would routinely conduct reviews of work processes to assess and document the extent to which circumcision clients receive a package of services that comply with global standards. During the same period, ASSIST supported the development and piloting of EIMC quality standards at four sites in the Iringa Region and develop an implementation guide to support scaling up of QI services.

In 2017, working with the AIDSFree Project, ASSIST conducted a baseline assessment of EIMC QI using the newly developed assessment tool at 12 sites in the Iringa Region. The major gaps identified were inadequate leadership and sustainability, management systems, supplies, equipment and environment, communication and infant assessment, and monitoring and evaluation. While originally, the plan was to add sites in the Iringa Region and introduce QI activities at 8 sites in Njombe Region, due to the closure

Page 30: USAID ASSIST Project Tanzania Country Report FY17 · Tanzania Country Report FY17 ... e-MTCT Elimination of mother-to-child transmission of HIV FP Family planning . USAID ASSIST Tanzania

22 USAID ASSIST Tanzania Country Report FY17

of ASSIST in Tanzania in August, introduction of EIMC QI work in Njombe Region will be carried out by the AIDSFree Project, with support from ASSIST consultants.

KEY ACCOMPLISHMENTS AND RESULTS

• ASSIST provided TA to MOHCDGEC to finalize comprehensive national guidelines for VMMC and EIMC services (Nov 14-18, 2016).

• ASSIST conducted national VMMC/EIMC technical working group meeting to finalize the national EIMC CQI tool (Nov 28 – Dec 2, 2016).

Mbeya Region

• ASSIST supported the RHMT and CHMTs to conduct coaching and mentoring of 16 QI teams at VMMC sites (Oct 10-20, 2016). Compliance of VMMC sites to standards showed improvement in male circumcision procedures, supplies, and infection prevention and control (IPC).

Shinyanga Region

• ASSIST conducted QI assessments, coaching, and mentoring to 8 VMMC sites (Nov 20 – Dec 2, 2016). Most of the sites maintained their performance.

Tabora Region

• ASSIST participated in interagency external quality assurance assessments organized by MOHCDGEC in Tabora Region using the National VMMC CQI tool developed with support of ASSIST (March 13-24, 2017). Lack of ownership of VMMC by top leadership at regional, council, and facility levels was found to be a major gap.

Njombe Region

• Assessments, coaching and mentoring VMMC QI were conducted at 12 sites of Njombe Region (Nov 7-18, 2016).

• Results:

o Compliance to VMMC standards showed steady increases as shown in Figure 16. Three assessments were conducted. The first, which was a baseline assessment, was conducted in August 2015. The second was conducted in June 2016, and the third in Nov 2016. The first five sites (shaded) were within the priority councils and have progressed more than those in the non-priority councils due to more frequent supportive supervision provided to the priority sites compared to non-priority sites, as per PEPFAR guidance.

Figure 16. Compliance to VMMC standards, 12 sites, Njombe Region (Aug 2015 – Nov 2016)

BASELINE ASSESSMENT August 2015

>8

0%

-

Go

od

50

-

<8

0%

-

<50%

Not assessed

2ND RE-ASSESSEMENT JUNE 2016 3RD RE -ASSESSEMENT NOVEMBER 2016

Health

facility

by C

ouncil

Man

agem

ent sy

stems

Supplie

s, equipment &

enviro

nmen

t

Reg

istration Group ed

uca

tion an

d IE

C

Individ

ual co

unselin

g & HIV testin

g

Male circu

mcis

ion su

rgical p

roced

ure

Monito

ring & eva

luatio

n

Infec

tion prev

entio

n

Overall

Man

agem

ent

Supplies

Group Educa

tion

Individual C

ouns

MC Proce

dure

M& E

IPC

Overall

Man

agem

ent sys

t

Supplies

Reg

istratio

n

Indi. C

ounsellin

g

MC proced

ure

Monito

ring

Kibena Hiosp 50 67 100

42 80 79 58 57

90 100 83 94 90 97 92 92 90 100 100 94 80 100

Anglican HC 80 66 50 58 77 0 42 55 80 83 83 89 95 85 85 81 90 83 100 83 82 92

Wanging'ombe HC

60 83 83 50 70 86 58 68 70 83 50 84 70 85 69 73 90 100 100 89 90 85

Ilembula Hospital 50 83 100

50 45 57 62 48 100

67 100 83 80 92 92 86 80 100 100 83 81 92

Makambako 50 83 100

67 77 100

85 82 70 83 100 83 87 10

0 77 85 90 100 100

100

80 100

Lupembe HC 0 83 100

78 45 10 64 48 80 83 75 67 80 44 69 71 78 83 54

Makete H 40 20 20 50 50 83 42 48 80 83 83 83 90 85 90 85 80 83 92

Matamba 40 33 100

67 40 93 58 67 80 100 80 83 80 44 77 77 80 83 83 67 55 61

Ipelele HC 30 100

83 50 65 64 17 54 80 83 69 69 74 90 50 38

Mlangali 40 33 83 83 77 29 67 64 30 67 84 100

74 80 83 85

Ludewa DH 40 50 75 44 73 92 77 64 80 67 50 56 90 92 77 87 89 67 77

Page 31: USAID ASSIST Project Tanzania Country Report FY17 · Tanzania Country Report FY17 ... e-MTCT Elimination of mother-to-child transmission of HIV FP Family planning . USAID ASSIST Tanzania

USAID ASSIST Tanzania Country Report FY17 23

Iringa Region

• Supported MOHCDGEC to pilot test the draft National Early Infant Male Circumcision (EIMC) CQI tool at three sites (Oct 24-26, 2016). EIMC trainers conducted the field test while National AIDS Control Program (NACP), ASSIST, and AIDSFree staff were observers. The National VMMC/EIMC technical working group incorporated findings from the pilot test into the final tool.

• ASSIST in collaboration with IPs – AIDSFree/Jhpiego, IntraHealth, and Henry Jackson Foundation of Medical Research Institute (HJFMRI) – supported baseline assessments for CQI of EIMC service in 12 sites of Iringa Region (April 9-14 and 17-21, 2017). The National EIMC CQI tool developed by ASSIST was used. The majority of the EIMC sites had excellent performance in EIMC procedures and communication/infant assessment. During the baseline assessment, CQI teams for EIMC were established and facilitated to develop improvement plans based on gaps identified in the service standards for monitoring and evaluation, management systems, IPC, supplies, and instruments and environment for EIMC. Figure 17 shows scores of the assessment using the EIMC tool, which covers 8 areas of services quality. Ipogolo health center performed better than any facility. Overall, the major problem areas for EIMC sites were related to Leadership and Sustainability, Monitoring and Evaluation, and Management Systems.

Figure 17. Baseline assessment dashboard for 12 EIMC sites, Iringa Region (April 2017)

KEY

BASELINE ASSESSMENT APRIL 2017

>80% -Good

50 - <80%-

<50% Not assessed

Hea

lth

fac

ility

by

Co

un

cil

Lea

der

ship

,

Pla

nn

ing

&

Su

stai

nab

ility

Man

agem

ent

syst

ems

Su

pp

lies,

inst

rum

ents

&

equ

ipm

ent

for

EIM

C

Co

mm

un

icat

ion

, ed

uca

tio

n &

infa

nt

care

EIM

C p

roce

du

re

Co

nti

nu

ity

of

care

//Po

st-

op

erat

ive

care

Mo

nit

ori

ng

&

eval

uat

ion

Infe

ctio

n

pre

ven

tio

n &

con

tro

l

Ove

rall

1.IRINGA TC

Ipogolo HC 86 70 100 75 67 100 83 93 84

2 Frelimo Hosp 85 30 40 100 67 50 67 79 61

3 IRINGA DC

Tosamaganga Hosp

14 50 60 33 71 53

4 Nzihi 14 50 60 75 75 42 86 65

5 MUFINDI DIST

Mafinga DH 43 50 40 100 100 100 9 62 66

6 Lugoda Hosp 50 70 80 16 86 57

7 Usokami Hosp

67 40 60 33 86 55

8 Ngome HC 67 50 80 100 100 25 86 86

9 Iringa RH 67 63 60 100 100 25 92 72

10 Igumbilo DH 50 70 60 75 75 100 79 77

11 Ilula Hosp 50 70 80 75 100 86 86 85

12 Kimande HC 57 40 60 75 75 17 71 56

SPREAD OF IMPROVEMENT

This activity was spread from three initial demonstration regions to six regions. This was done through regular learning sessions, coaching, and mentoring which were conducted on a quarterly basis. In each region, a pool of coaches and supervisors for quality improvement of VMMC services were capacitated to conduct VMMC CQI assessments and support sites in addressing the identified gaps. QI for EIMC services was introduced in Iringa Region at four sites and later spread to 12 sites.

Page 32: USAID ASSIST Project Tanzania Country Report FY17 · Tanzania Country Report FY17 ... e-MTCT Elimination of mother-to-child transmission of HIV FP Family planning . USAID ASSIST Tanzania

24 USAID ASSIST Tanzania Country Report FY17

Activity 6. Work with MOHCDGEC and IPs to improve the quality of HIV rapid testing services

BACKGROUND

Tanzania is committed to achieve the UNAIDS/PEPFAR 90-90-90 targets by 2020, while scaling up the Test and Treat Strategy for those found to be HIV-positive. HTC approaches target identification and support of individuals with greatest need and risk of HIV infection by ensuring quality HIV rapid testing and addressing common service delivery issues regarding HIV rapid testing in points of care. In FY16, USAID/Tanzania invited ASSIST to support the MOHCDGEC and IPs through capacity building on improving the quality of rapid HIV testing services by addressing the gaps identified during the Rapid HIV Testing Quality Improvement Initiative (RTQII) baseline assessment. Improvement activities for rapid HIV testing were conducted in four councils (Mbeya DC, Rungwe DC, Nyamagana MC, and Geita DC). In FY17 USAID ASSIST continued to support improvement activities for rapid HIV testing in four councils: Mbeya DC, Rungwe DC, Nyamagana MC, and Geita DC.

KEY ACCOMPLISHMENTS AND RESULTS

•••• ASSIST disseminated findings of the RTQII baseline results to the USG Laboratory Technical

Working Group comprised of USAID, DOD, and CDC (Nov 2016). Key gaps identified in the report

included personnel training and certification, external quality assurance, testing, safety, and post-

testing follow-up.

•••• Developed a rapid testing QI strategy to guide implementation of quality HIV rapid testing in

204 sites where the baseline audit was conducted (Nov 2016).

Mbeya and Rungwe district councils (Mbeya Region)

•••• ASSIST staff conducted a learning session on HIV rapid testing improvement for 11 sites in

Mbeya DC (Nov 8-12, 2016) and 10 sites in Rungwe DC (Nov 15-19, 2016). Follow-up activities

were conducted in March 2017 and in June 2017.

Arusha Region

•••• ASSIST conducted a training of trainers in rapid testing QI for 20 laboratory managers in

Arusha Region followed by follow-up audit at 3 sites in the region (Jan 20-27, 2017).

Nyamagana Municipal Council (Mwanza Region)

•••• ASSIST conducted a rapid testing QI training of trainers for 20 Laboratory Quality Officers in

Mwanza Region who will facilitate scale-up of rapid testing QI processes in regions and districts

(Feb 17-25, 2017).

•••• ASSIST staff conducted a rapid testing quality follow-up audit in 17 testing points in 5

facilities in Nyamagana MC in Mwanza Region (Table 2). This was followed by coaching and

mentoring to 59 QI team members and testers and 1 RHMT and 1 CHMT member. HIV rapid testing

standardized registers and logbooks documentation were reviewed to establish the existing gaps in

the processes of HIV rapid testing services and develop changes for addressing identified gaps (Feb

27-March 3, 2017).

•••• With regard to rapid testing safety standards, all testing points improved safety practices from

the baseline in August 2016, compared to re-assessment in June 2017. The changes which led

to improvement included: Assigning one responsible person to oversee quality issues related to HIV

testing points; listing and distributing standard operating procedures to all testing points; requesting

and ensure availability of disinfectants; on-site coaching and mentorship on waste segregation,

including sharps; and reorienting HTS providers on rationale for waste segregation, including the use

of labelled buckets for waste segregation.

Page 33: USAID ASSIST Project Tanzania Country Report FY17 · Tanzania Country Report FY17 ... e-MTCT Elimination of mother-to-child transmission of HIV FP Family planning . USAID ASSIST Tanzania

USAID ASSIST Tanzania Country Report FY17 25

Table 2. Increased compliance to rapid testing safety standards, 21 HIV rapid testing points, 6 health facilities, Rungwe DC, Mbeya Region (Aug 2016 and June 2017)

Health Facility HIV Testing Point Baseline

(Aug 2016)

Reassessment (June 2017)

Tukuyu District Hospital

PITC-OPD 23% 82%

PITC-IPD 23% 91%

PMTCT 41% 82%

Laboratory 55% 100%

Ndaga Dispensary PMTCT 50% 86%

PITC 45% 100%

Masukulu HC

PMTCT 41% 73%

PMTCT-Labor Ward 5% 68%

PITC 23% 77%

Laboratory 36% 91%

Lufingo Dispensary PMTCT 50% 68%

PITC 23% 91%

Kisa HC

PITC 45% 64%

Laboratory 27% 95%

PITC 32% 55%

Ikuti HC PMTCT 41% 68%

Laboratory 41% 68%

Igogwe Mission Hospital

VCT 45% 86%

PITC 59% 100%

PMTCT 32% 59%

Laboratory 64% 100%

• Performance of internal quality controls are prescribed in the national HTS guidelines. As a result of the QI initiative, sites increased the performance of expected internal quality controls from 40% in October 2016 to over 140% in June 2017 as shown in Figure 18. The overachievement was because after a learning session and series of coaching visits, health care providers started performing internal quality controls beyond the minimum requirements. The Tanzania guideline requires that at minimum, that internal quality controls should be performed whenever a new HIV kit lot is opened. Additionally, internal quality controls can be done whenever there is a new tester, exposure of kits to extreme temperatures, or other events which might compromise testing validity.

Page 34: USAID ASSIST Project Tanzania Country Report FY17 · Tanzania Country Report FY17 ... e-MTCT Elimination of mother-to-child transmission of HIV FP Family planning . USAID ASSIST Tanzania

26 USAID ASSIST Tanzania Country Report FY17

Figure 18. Improved adherence to national Internal Quality Control Standards, Rungwe DC (Oct 2016-May 2017)

SPREAD OF IMPROVEMENT

ASSIST continued to support MOHCDGEC, IPs, and RHMT/CHMT to improve the quality of HIV rapid testing in four scale-up saturation councils (Mbeya DC, Rungwe DC, Nyamagana MC, and Geita DC). Lessons learned from these sites were used to provide guidance for further scale-up of the process in other councils.

4 Improvement in Key Indicators Indicators Facility Baseline Oct –

Dec ‘15 Jan – Feb ‘16

Mar – May ‘16

June-Aug ‘16

Sept- Nov ‘16

Dec- Feb ‘17

Most recent

% of pregnant women who bring their male partners and the male partners are tested and counselled for HIV at RCH

Dar es Salaam and Pwani)

3% (Apr 2015, 10

sites)

26% (Nov

2015, 11 sites)

28% (Feb

2016, 5 sites)

21% (Apr

2016) (6 sites)

36% (June

2016, 8 sites)

42% (Sept

2016, 3 sites)

51% (Oct

2016, 8 sites)

48% (Mar

2017, 3 sites)

Morogoro 14% (Sep,

2014) 2 sites

39.1% (Dec,

2015) 7 sites

35.3 % (Feb,

2016) 6 sites

45.7 % (May,

2016) 5 sites

82 % (Aug,

2016) 5 sites

81% (Nov

2016, 6 sites)

42% (Feb

2017, 7 sites)

58% (Apr

2017, 8 sites)

Njombe 17% (May

2014, 6 sites)

19% (Oct

2015, 6 sites)

61% (Feb

2016, 3 sites)

53% Mar 2016, 3 sites)

45% (Jun

2016, 4 site)

50% (Nov

2016, 3 sites)

73% (Jan

2017, 9 sites)

79% (May

2017, 5 sites)

Mara 10% (Jan 2015, 11

sites)

38% (Dec

2015, 11 sites)

20% (Feb

2016, 11 sites)

- - 66% (Oct

2016, 11 sites)

66% (Oct

2016, 11 sites)

72% (May

2017 8 Sites)

Dodoma - - - - - - 68% (Jan

2017, 8 sites)

66% (Mar

2017, (8 sites)

0%

20%

40%

60%

80%

100%

120%

140%

Oct-16 Nov-16 Dec-16 Jan-17 Feb-17 Mar-17 Apr-17 May-17

Internal Quality Control: Adherence to National Standards for IQC

Changes:

- Assigned responsible person to oversee HIV testing points quality issues.

- Weekly preparation and supply of positive and negative sample for internal quality controls for each testing

point in the facility.

Page 35: USAID ASSIST Project Tanzania Country Report FY17 · Tanzania Country Report FY17 ... e-MTCT Elimination of mother-to-child transmission of HIV FP Family planning . USAID ASSIST Tanzania

USAID ASSIST Tanzania Country Report FY17 27

Indicators Facility Baseline Oct – Dec ‘15

Jan – Feb ‘16

Mar – May ‘16

June-Aug ‘16

Sept- Nov ‘16

Dec- Feb ‘17

Most recent

% of HIV-exposed children testing for 1st PCR within 4-6 weeks

Dar es Salaam and Pwani

53% (Apr 2015, 11

sites)

75% (Dec

2015, 7 sites)

53% (Feb

2016, 5 sites)

78% (Apr

2016, 11 sites)

82% (Jun

2016, 8 sites)

94% (Sept

2016, 5 sites)

95% (Oct

2016, 8 sites)

80%( Mar

2017, 3 sites)

Morogoro 30%(Jan 2015 9 sites)

53% (Dec

2015, 9 sites)

63% (Feb

2016 9 sites)

77% (Apr

2016 10 sites)

87% (Aug

2016, 8 sites)

83% (Oct

2016, 8 sites)

64% (Feb

2017, 8 sites)

77% (May

2017, 8 sites)

Dodoma - - - - - - 10% (Jan

2017, (6 sites)

61% (Jan

2017, 7 sites)

Njombe 45 % (May

2014, 8 sites)

63% (Oct

2015, 11 sites)

58% (Jan

2016, 12 sites)

67% (Apr

2016, 12 sites)

74% Aug

2016, 11 sites

91% (Nov

2016, 12 sites)

86% (Jan

2017, 9 sites)

84% (May

2017, 10 sites)

Mara 40% (Jan 2015, 8 sites)

68% (Dec

2015, 8 sites)

52% (Jan

2016, 12 sites)

- - 65% (Oct

2016, 15 sites)

65% (Oct

2016, 15 sites)

67% (May

2017, 12 sites)

% of HIV-positive mother-baby pairs attending HIV service each month

Nzega DC

0% (Apr 2013,

10 sites)

100% (Dec.

2015, 10 sites)

92% (Feb.

2016, 10 sites)

97% (Mar

2016, 10 sites)

97% (Jun,

2016, 10 sites)

95% (Sept

2016, 9 sites)

93% (Oct.

2016, 10 sites)

98% (May

2017, 10 sites)

Mufindi 0% (June 2013, 10

sites)

91% (Sept

2015, 10 sites)

92% (Feb

2016, 10 sites

95% (Mar

2016 10 sites

- 90% (Oct

2016, 9 sites)

90% Oct.

2016, 10 sites

90% (Oct.

2016, 10 sites)

Mbeya CC

18% (Jun 2013, 10

sites)

91% (Dec

2015, 10 sites)

91% (Feb

2016) 10 sites

92% (Mar

2016) 10 site

84% June – August

2016, 10 sites

91% (Nov

2016), 10 sites

91% (Dec. 2016),

10 sites

94% (April,

2017, 10 sites)

Dar es Salaam and Pwani

15% (Dec,

2015) 3 sites

- 16% (Feb,

2016) 5 sites

78% (Apr,

2016) 5 sites

- 100% (Sep

2016, 4 sites)

93% Jan.

2017, 2 sites

71% (Mar

2017, 3 sites)

Morogoro 46% (Sept

2014, 8 sites)

80% (Mar

2015, 8 sites)

82% (Feb

2016 8 sites)

86% (Mar

2016, 9 sites)

98% (Aug

2016, 6 sites)

92% (Nov

2016, 6 sites)

90% (Jan.

2017, 11 sites)

80% (May

2017, 7 sites)

% of HIV-exposed children receiving second HIV test 6 weeks after cessation of breast-feeding

Dar es Salaam and Pwani

25% (Apr 2015, 7 sites)

51% (Oct.

2015, 9 sites)

79% (Feb

2016, 6 sites)

79% (Apr

2016, 5 sites)

88% (Jun,

2016) 4 sites

83% (Sept

2016, 5 sites)

64 % (Jan

2017, 11 sites)

100% (Mar

2017, 2 sites)

Morogoro 14% (May,

2015, 3 sites)

63% (Dec

2015, 2 sites)

35% (35, Jan

2016) 7 sites

31% June,

2016, 6 sites)

67% (Aug,

2016) 6 sites

66% (Nov

2016, 8 sites)

77% (Feb.

2017, 6 sites)

53% (May

2017, 7 sites)

Ruvuma

13% (Jan 2015, 11

sites)

84% (Dec

2015, 6 sites)

71% (Feb

2016, 6 sites)

- 100% (June

2016, 13 sites)

- 100% (June 2016

(13sites

92% Jan

2017 (13 sites)

Dodoma - - - - - - 24% Jan

2017 (3 sites)

56% Mar

2017 (4 sites)

Page 36: USAID ASSIST Project Tanzania Country Report FY17 · Tanzania Country Report FY17 ... e-MTCT Elimination of mother-to-child transmission of HIV FP Family planning . USAID ASSIST Tanzania

28 USAID ASSIST Tanzania Country Report FY17

Indicators Facility Baseline Oct – Dec ‘15

Jan – Feb ‘16

Mar – May ‘16

June-Aug ‘16

Sept- Nov ‘16

Dec- Feb ‘17

Most recent

Njombe 35% (May

2014, 11 sites)

56% (Dec

2015, 10 sites)

61% (Feb

2016, 10 sites)

70% (May

2016, 9 sites)

89% (Aug

2016, 9 sites)

86% (Nov

2016, 8 sites)

87% (Jan

2017, 6 sites)

87% (Jan

2017, 6 sites)

% of pregnant women tested and counselled for HIV during the ANC period

Korogwe, Muheza and Tanga City

65% (Aug

2015, 11 sites)

68% (Oct

2015, 11 sites)

85% (Jan

2016, 11 sites)

100% (May

2016, 11 sites)

- 100% (Sept,

2016 13 sites)

100% (Dec

2016, 11 sites)

100% May

2017 11 sites

Mara 83% (Jan 2015, 15

sites)

94% (Oct

2015, 15 sites)

92% (Feb

2016, 15 sites)

100% (June

2016, 13 sites)

- 100% (Oct

2016, 15 sites)

100% (Oct

2016, 15 sites)

100% May

2017 15 facilities

Dodoma - - - - - - 99% (Jan

2017, (10

sites)

99% (May 2017, (10

sites)

% of new HIV+ pregnant & breastfeeding women screened for TB

Ruvuma 82% (Jan 2015, 11

Sites

100 % (Dec

2015, 6 Sites)

100% (Feb

2016, 5 Sites)

100% (May

2016, 6 Sites)

100% (June

2016, 10 sites)

100% (Oct

2016, 15 sites

100% (Oct

2016, 15 sites)

100% (Oct

2016, 15 sites)

% of HIV+ mothers at RCH practicing exclusive breastfeeding

Nzega 33% (Apr 2013, 10

sites)

85% (Dec

2015, 10 sites)

98% (Feb

2016, 10 sites)

99% (Apr

2016 10 sites)

97% (June

2016 10 sites)

93% (Sept

2016, 9 sites)

100% (Oct.

2016, 10 sites)

100% (May.

2017, 10 sites)

Mufindi

51% (Apr 2013, 10

sites)

95% (Dec

2015, 10 sites)

100% (Feb

2016, 10 sites)

97% (March

2016, 10 sites)

100% (Aug.

2016 10 sites

100% (Oct

2016 10 sites)

100% (Dec.

2016, 10 sites)

100% (Dec.

2016, 10 sites)

Mbeya CC

67% (Jun 2013, 10

sites)

93% Nov,

2015, 10 sites)

95% (Jan

2016, 10 sites

97% (Mar

2016 10 sites)

94% (August 2016),

10 sites

94% (October 2016),

10 sites

100% (Dec. 2016

10 sites)

99% (April 2017),

10 sites

Magu 43% (Oct 2013, 11

sites)

52% (Sept

2014, 25 sites)

- 95% (Apr

2016, 23 sites)

- - 95% (Apr

2016, 23 sites)

95% (May

2017, 23 sites)

% of postnatal mothers who attend four standard visits (2, 7, 28 and 42) days

Nzega 0% Apr 2013 (10

Sites)

99% (Dec

2015, 10 sites)

91% (Jan

2016, 10 Sites)

91% (Mar

2016, 10 sites)

100% (June 2016

97% (Sept

2016, 9 sites)

100% (Oct.

2016, 10 sites)

91% (May.

2017, 10 sites)

Mufindi 0% (June 2013, 10

Sites)

52 (Dec 2015, 10

Sites)

100% (Feb

2016, 10 Sites)

- - 93% (Oct

2016, 10 sites)

93% (Oct.

(2016, 10 sites)

93% (Oct.

(2016, 10 sites)

Mbeya CC

14% (June

2013, 10 sites)

93% (Sept

2015, 10 sites)

- 61% (Mar

2016 10 sites)

- - 42% (Dec.

2016, 8 sites)

42% (Dec.

2016, 8 sites)

% of HIV+ patients who are keeping appointment

Morogoro 68% (Oct 2015, 3 sites)

74% (Dec

2015, 3 sites)

62% (Feb

2016, 5 sites)

72% (May

2016, 5 sites)

79% (Jul,

2016) 5 sites

- 69% (Feb.

2017, 2 sites)

80% (May

2017, (8 sites)

Mbeya DC

59% (Dec 2015,5 sites)

59% (Dec 2015,5 sites)

70% (Feb 2016, 5 sites)

71% (May 2016 ,5 sites)

74% (August 2016,5 sites)

78% (Nov 2016,4 sites)

91% (Jan 2017,3 sites)

96% (April 2017), 5 sites

Page 37: USAID ASSIST Project Tanzania Country Report FY17 · Tanzania Country Report FY17 ... e-MTCT Elimination of mother-to-child transmission of HIV FP Family planning . USAID ASSIST Tanzania

USAID ASSIST Tanzania Country Report FY17 29

Indicators Facility Baseline Oct – Dec ‘15

Jan – Feb ‘16

Mar – May ‘16

June-Aug ‘16

Sept- Nov ‘16

Dec- Feb ‘17

Most recent

% of pregnant women who book for first ANC by 12 weeks

Mara 12% (Jan 2015, 12

sites)

11% (Dec

2015, 12 sites)

13% (Feb

2016, 12 sites)

- - 6% (Oct 2016, 14

sites)

6% (Oct 2016, 14

sites)

8% (May,

2017 (16 sites)

Morogoro 8% (Jan 2016, (6

sites

- 12% (Jan

2016, 8 sites)

14% (Mar

2016, (8 sites

14% (Jun

2016, 8 sites)

20% (Sept

2016, (8 sites

15% (Dec

2016, (8 sites)

22% (May

2017, (7 sites)

% HIV+ pregnant & breast feeding women currently (actively) on ART

Nzega 13% (May 2013

10 sites)

88% (Dec

2015, 10 sites)

91% (Jan

2016, 10 sites)

87% (Mar

2016, 10 sites)

92% (June

2016 10 sites)

99% (Sep

2016, 9 sites)

93% (Oct.

2016, 6 sites)

96% (May.

2017, 10 sites)

Mufindi 0% (June 2013, 10

sites

96% (Dec

2015, 10 sites)

100% Feb.

2016, 10 sites)

- - 97% (Oct.

2016, 10 sites)

97% (Oct.

2016,10 sites)

97% (Oct.

2016,10 sites)

Mbeya 5% (June 2013, 10

sites)

88% (Dec

2015, 10 sites)

- 89% (Mar

2016, 10 sites)

- - 96% (Dec

2016, 8 sites)

96% (Dec

2016, 8 sites)

% of HIV+ pregnant & lactating women receiving nutritional counselling

Nzega 0% (Oct 2013, 10

sites)

93% (Dec

2015, 10 sites)

91% (Feb

2016, 10 sites)

98% (May

2016, 10 sites)

98% (Aug

2016, 10 sites)

88% (Sept

2016, 9 sites)

100% (Oct. 2016)

91% (May.

2017, 10 sites)

Mufindi 0% (Oct 2013, 10

sites)

99% (Dec

2015, 10 sites)

100% (Feb

2016, 10 sites)

- - 95% (Oct

2016, 5 sites)

95% (Oct.

2016, 5 sites)

95% (Oct.

2016, 5 sites)

Mbeya CC

5% (June 2013, 10

sites)

100% (Dec

2015, 10 sites)

- 93% (Mar

2016, 10 sites)

- - 98% (Dec

2016, 8 sites)

98% (Dec

2016, 8 sites)

% of HIV-positive pregnant and postnatal women who are malnourished

Nzega 0% (June 2013, 10

sites)

3% (Dec 2015, 10

sites)

1% (Jan 2016, 10

sites)

1% (Mar 2016, 10

sites)

1% (June

2016 10 sites)

1% (Sept

2016, 9 sites)

1% Oct. 2016, 6 sites)

1% (May.

2017, 10 sites)

Mbeya CC

0% (June 2013, 10

sites)

1% (Dec 2015, 10

sites)

- 2% (Mar 2016, 10

sites)

- - 1% (Dec 2016, 8 sites)

1% (Dec 2016, 8 sites)

% of infants below 12 months who are malnourished

Nzega 14% (Aug

2013, 5 sites)

2% (Dec

2015, 5 sites)

2% (Jan

2016, 5 sites)

1% (Mar

2016, 5 sites)

1% (June

2016 10 sites

2% (Sept

2016, 9 sites)

2% (Oct

2016, 10 sites)

2% (May 2017, 10 sites)

Mufindi 33% (June

2013, 5 sites)

2% (Dec 2015, 5 sites)

1% (Feb 2016, 5 sites)

- 1- 2% (Oct 2016, sites)

1% Oct. 2016 (10

sites)

1% Oct. 2016 (10

sites)

Mbeya 33% (Jan 2014, 5 sites)

1% (Dec 2015, 5 sites)

- 1% (Mar 2016, 5 sites)

- - 0% (Dec 2016, 10

sites)

0% (Dec 2016, 10

sites)

% of clients assessed & categorized for nutritional status each clinic day

Mbeya DC

29% (Dec

2015, 5 sites)

29% (Dec

2015, 5 sites)

48% (Feb

2016, 5 sites)

48% (May

2016, 5 sites)

51% (Jul 2016, 5 sites)

- 41% (Jan.

2017, 4 sites)

41% (Jan.

2017, 4 sites)

Page 38: USAID ASSIST Project Tanzania Country Report FY17 · Tanzania Country Report FY17 ... e-MTCT Elimination of mother-to-child transmission of HIV FP Family planning . USAID ASSIST Tanzania

30 USAID ASSIST Tanzania Country Report FY17

Indicators Facility Baseline Oct – Dec ‘15

Jan – Feb ‘16

Mar – May ‘16

June-Aug ‘16

Sept- Nov ‘16

Dec- Feb ‘17

Most recent

% of mal-nourished clients who are treated for MAM or SAM

Mbeya DC

34%(Dec 2015, 5 sites)

34%(Dec 2015, 5 sites)

90% (Feb

2016, 5 sites)

86%(May 2016, 5 sites)

65% (Jul 2016, 5 sites)

- 94% (Jan.

2017, 4 sites)

94% (Jan.

2017, 4 sites)

Indicators Facility Baseline Oct – Dec ‘15

Jan – Feb ‘16

Mar – May ‘16

June-Aug ‘16

Sept- Nov ‘16

Dec- Feb ‘16

Most recent

% of MVC with access to Community Health Fund

Bagamoyo 0% (May 2011, 25

sites)

23%(Dec 2015, 25 sites)

23% (Feb

2016, 25 sites)

- 23%(Sept 2016, 25 sites)

45% (Nov

2016, 25 sites)

23% (Dec

2016, 25 sites)

23% (Dec

2016, 25 sites)

% of MVC with birth certificates

Bagamoyo District

6% (May 2011,

25 sites)

74% (Dec

2015, 25 sites)

74% (Feb

2016, 25 sites)

- 74% (Sep

2016, 6 sites)

53% (Nov

2016, 25 sites)

74% (Dec

2016, 25 sites)

74% (Dec

2016, 25 sites)

% of MVCs who have been tested for HIV

Shinyanga 23 % (Oct

2015, 7 sites)

45% (Oct-Dec 2015, 7 sites)

66% (Feb

2016, 7 sites)

91% (May

2016, 7 sites)

94% (Sep

2016, 6 sites

98% (Dec

2016, 6 sites)

99% (Feb

2017,7 sites)

99% (May 2017, 6 sites)

Njombe 3% May 2014, 6

sites

28% (Dec

2015, 6 sites

17% Feb 2016, 6

sites

- - 47% (Sept

2016, 6 sites)

47% (Sep

2016, 6 sites)

49% (May

2017, 6 sites)

Indicators Facility Baseline Oct – Dec ‘15

Jan – Feb ‘16

Mar – May ‘16

June-Aug ‘16

Sept- Nov ‘16

Dec- Feb ‘16

Most recent

% of VMMC clients who come for 48-hour follow-up visit

Iringa 94% (Jul 2015,

11 sites)

99% (Oct. 2015, 7 sites)

- 100% (Apr 2016,11 sites)

- - 100% (Apr 2016, 11 sites)

100% (Apr 2016, 11 sites)

Njombe - - - 100% (Apr 2016, 10 sites)

- 99% (Nov 2016, 12 sites)

100% (Nov. 2016, 10 sites)

100% (Nov. 2016, 10 sites)

Tabora 82% (Jul 2015, 4 sites)

89% (Oct 2015, 4 sites)

93% (Feb, 2016, 4 sites)

85% (Apr, 2016,4 sites)

- - 80% (March 2017, 4 sites)

80% (March 2017, 4 sites)

Shinyanga 100% (Jul 2015,

13 sites)

100% (Oct 2015) 13 sites

- 100% (Apr 2016) 8 sites

- 100% (Dec 2016, 8 sites)

100% (Dec 2016, 8 sites)

100% (Dec 2016, 8 sites)

Page 39: USAID ASSIST Project Tanzania Country Report FY17 · Tanzania Country Report FY17 ... e-MTCT Elimination of mother-to-child transmission of HIV FP Family planning . USAID ASSIST Tanzania

USAID ASSIST Tanzania Country Report FY17 31

% of VMMC clients who come for 7-day follow-up visit

Shinyanga 63% (Jul 2015, 13 sites)

71% (Oct 2015, 13 sites)

- 69% (Apr 2016, 8 sites)

- 77% (Dec, 2016, 12 sites)

77% (Dec, 2016, 12 sites)

77% (Dec, 2016, 12 sites)

Njombe - - - 59% (Apr 2016, 10 sites)

- - 80% (Nov. 2016, 10 sites)

80% (Nov. 2016, 10 sites)

Tabora 47% (Jul 2015, 4 sites)

62% (Oct 2015, 4 sites)

72% (Feb 2016, 4 sites)

85% (Apr 2016, 4 sites)

- - 60% (March 2017, 4 sites)

60% (March 2017, 4 sites)

Indicators Facility Baseline Oct – Dec ‘15

Jan – Feb ‘16

Mar – May ‘16

June-Aug ‘16

Sept- Nov ‘16

Dec- Feb ‘16

Most recent

% of children <15 years tested for HIV at pediatric inpatient wards

Njombe 7% May 2014,

1 sites)

27% (Oct 2015, 6 sites)

39% (Feb 2016, 8 sites)

55% (May 2016, 6 sites)

59% (Aug 2016, 4 sites

50% (Nov, 2016, 3 sites)

58% (Jan 2017, 17 sites)

58% (Jan 2017, 17 sites)

Ruvuma 14% (Oct 2014, 8 sites)

27% (Oct. 2015, 6 sites)

43% (Feb 2016, 3 sites)

71% (May 2016, 2 Sites)

48% (Jul 2016, 11 sites)

52% (Nov 2016, 3 sites)

93% (Jan 2017, 4 sites)

93% (Jan 2017, 4 sites)

Kigoma 0% (Jan 2016, 13 sites)

0% (Jan 2016, 13 sites)

32% (May 2016, 12 sites)

31% (Aug 2016, 9 sites)

37% (Nov 2016, 6 sites)

77% (Feb 2017, 4 sites)

80% (March 2017, 4 sites)

Rukwa 33% (Jan 2015, 10 sites)

34% (Dec 2015, 10 sites)

54% (Feb 2016, 8 sites)

- 64% (June 2016, 10 sites)

- 64% (June 2016, 10 sites)

64% (June 2016, 10 sites)

Morogoro 36% (Feb, 2015, 7 sites)

28% (Dec 2015, 7sites)

42% (Feb 2016, 8 sites)

53% (May 2016, 5 sites)

81% (Aug, 2016, 2 sites)

74% (Dec 2016, 3 sites)

72% (Jan 2017 ,3 sites)

63% (May 2017, (5 sites)

% of HIV-infected infants & children <15 yrs enrolled into care & started on ART treatment

Morogoro 0% (Jan. 2015, 10 sites)

100% (Dec. 2015, 10 sites)

100% Feb 2016, 10 sites)

100% (May 2016, 10 sites)

100% (Aug, 2016) 5 sites

- 61.5% (Feb 2017, 4 sites)

67% (Mar 2017, (4 sites)

% of HIV-infected infants & children <15 yrs currently on ART at the end of the reporting period

Njombe 67% (May 2014, 12 sites)

70% (Dec 2015, 12 sites)

Mar 68% (Jan 2016, 11 sites)

72% (June 2016, 12 sites)

- 72% (Sept 2016, 9 sites)

73% (Jan. 2017, 12 sites)

73% (Jan. 2017, 12 sites)

Morogoro 65% (May 2014, 6 sites)

93% (Dec 2015, 1 sites)

95% (Feb 2016, 2 sites)

- 73% (June 2016, 5 sites)

- 73% (June 2016, 5 sites)

99% (Mar 2017, (4 sites

Dar es Salaam/ Pwani

0 % Sept, 2015 (2 sites)

89% (Dec 2015, 2 sites)

79% (Jan 2016, 5 sites)

93% (Jun 2015, 5 sites)

96% (Jul 2016, 5 sites)

- 96% (Jul 2016, 5 sites)

96% (Mar 2017, 5 sites)

Page 40: USAID ASSIST Project Tanzania Country Report FY17 · Tanzania Country Report FY17 ... e-MTCT Elimination of mother-to-child transmission of HIV FP Family planning . USAID ASSIST Tanzania

32 USAID ASSIST Tanzania Country Report FY17

Indicators Facility Baseline Oct – Dec ‘15

Jan – Feb ‘16

Mar – May ‘16

June-Aug ‘16

Sept- Nov ‘16

Dec- Feb ‘16

Most recent

% of new women attending FP services tested for HIV

Ruvuma 16% (Jan 2015, 8 sites)

38% (Oct 2015, 7 sites)

54% (Feb 2016, 5 sites)

94% (May 2016, 3 sites)

79% (Jul 2016, 11 sites)

- 54% (Jan. 2017, 4 sites)

54% (Jan. 2017, 4 sites)

% of HIV-positive women of reproductive age receiving FP methods

Ruvuma 5% (Jan 2015,

2 sites)

44% (Dec 2015, 2 sites)

55% (Feb 2016, 2 sites)

64% (May 2016, 2 sites)

72% (Jul 2016, 10 sites)

- 38% (Jan. 2017, 4 sites)

38% (Jan. 2017, 4 sites)

Morogoro 26% (Jan 2014,

2 sites)

39% (Dec 2015, 3 sites)

43% (Mar 2016, 2 sites)

- 82% (Aug 2016, 5 sites)

79% (Oct 2016, (5 sites)

39% (Feb. 2017, 3 sites)

39% (Feb. 2017, 3 sites)

5 Sustainability and Institutionalization Throughout the ASSIST Project’s work in Tanzania, efforts were made to ensure that improvement interventions were implemented within the MOHCDGEC structures to create a better way of doing work and instill a new work culture in the workforce. Policies and guidelines were developed to guide practice, while MOHCDGEC staff were trained in quality improvement to allow them use the skills in their day-to-day work. To sustain the momentum, a long-term plan – the National QI Strategic Plan (2013 – 2018) –was developed to make clear the national improvement agenda for all stakeholders. This also helped to harmonize practice, since all stakeholders were required to support implementation.

ASSIST also supported the development of national quality assessment tools and QI data management and display formats which are now in use nationally. Further, the project organized on an annual basis a National QI Forum to share improvement experiences among all stakeholders.

At the national level, ASSIST created a critical mass of improvers, a pool of trained coaches, and various sets of training tools which will support institutionalization of improvement approaches. Currently, some councils have started setting aside some of their own funds for quality improvement while more executives are using improvement metrics to make decisions.

6 Knowledge Management Products and Activities • Second National Pediatric ART Quality Improvement Learning Platform: In November 2016,

ASSIST, in collaboration with the MOHCDGEC and IPs, organized a Second National Pediatric ART Quality Improvement Learning Platform that took place from November 8-10, 2016 in Dar es Salaam. The three-day platform brought together approximately 340 participants, including officials from MOHCDGEC, USAID/Tanzania, guests from Lesotho (USAID ASSIST), USG HIV/AIDS IPs, MVC IPs from all levels, community leaders, patients, and representatives of children and youth.

• Service package for MVC and adolescents affected by or living with HIV: ASSIST supported technical working meetings for the Department of Social Welfare to develop the first draft of the training manual of the service package for MVC and adolescents affected by or living with HIV. The meeting took place in Bagamoyo from Nov 28-Dec 3, 2016. Between Jan and Mar 2017 ASSIST in collaboration with MOHCDGEC and other MVC IPs (JSI, NACOPHA, PACT, WEI, etc.) conducted two technical working group meetings (TWG) to review and incorporate inputs for the National Training Manual of the service package. ASSIST is planning to pre-test the document and share with the Department of Social Welfare for approval.

• National QI Technical Working Group – Quality Management Retreat Meeting: ASSIST collaborated with MOHCDGEC to organize a three-day retreat meeting for members of the National Technical Working Group on Quality Management (TWG-QM) from February 1-3, 2017. The role of TWG-QM is to advise MOHCDGEC on issues of Quality Assurance/Quality Improvement (QA/QI) and to provide guidance on coordination and harmonization of all quality initiatives in the country by various stakeholders. The objective of the meeting was to discuss the implementation of the QA/QI

Page 41: USAID ASSIST Project Tanzania Country Report FY17 · Tanzania Country Report FY17 ... e-MTCT Elimination of mother-to-child transmission of HIV FP Family planning . USAID ASSIST Tanzania

USAID ASSIST Tanzania Country Report FY17 33

agenda in the Health Sector Strategic Plan (HSSP-IV 2015 – 2020) and come up with an action plan for the TWG-QM, discuss the evaluation report of the National Health and Social Welfare Quality Improvement Strategic Plan (NHSWQISP-1 2013-2018), make recommendations for the way forward, harmonize the implementation of QA/QI activities at all levels (tools and approaches, activity schedules at national, regional and LGA levels), explore experiences with establishment of an accreditation body, and come up with recommendations to the MOHCDGEC. The retreat’s outcome was the presentation of the draft operational plan developed in the meeting to the Health Services Inspectorate and Quality Assurance Directorate for finalization and submission to Sector Wide Approach (SWAp) meeting. It was agreed that MoHCDGEC should harmonize formats for QI assessments and work plans, assign IPs by levels of health facility, develop a harmonized QI reporting system and reporting format, and develop a document with guiding principles on harmonization.

• USAID ASSIST staff retreat: ASSIST staff in Tanzania held a three-day retreat meeting from February 7-10, 2017 in Bagamoyo District, Pwani Region. The objective of the retreat was to strengthen and refocus the team, review QI approaches, and how to strengthen collaboration within USAID ASSIST teams and implementing partners. The key areas discussed teamwork strengthening, presentation skills, how to deal with difficult working environment, and knowledge on how to conduct analysis on efficiencies and effectiveness (“value for money”).

• USAID visited ASSIST QI activities in Arusha City and Arusha DC: The week of March 6-10, 2017, two USAID Mission staff in Tanzania visited ASSIST QI activities in Arusha Region for supportive supervision, aiming to determine the scope of ASSIST work and how it collaborates with implementing partners working at facility and community levels in Arusha Region, to have a clear and comprehensive understanding of how ASSIST QI initiatives support EGPAF and community IPs (JSI, NACOPHA, etc.) programs' achievements. They were accompanied by ASSIST staff, RHMT, CHMT, and IP (EGPAF) when they visited 4 QI sites. The USAID Mission staff were impressed with the existing partnership between ASSIST and other implementing partners and said this should be strengthened more. They recommended that ASSIST should present its work in different fora to advocate their good work and in collaboration with IPs to conduct follow-up QI training to review and update program indicators to conform with current 90-90-90 PEPFAR goals.

• Tanzania Partnership for HIV-Free Survival (PHFS) Implementation Experience and Change Package was produced in June 2017 and is available here: https://www.usaidassist.org/resources/tanzania-partnership-hiv-free-survival-phfs-implementation-experience-and-change-package

• Exploring Peer Mentor Retention in Tanzania: Research and Evaluation Report was produced and is in review.

• ASSIST worked with MOHCDGEC to develop an outline for a Generic QI Training Package (Participants Manual) relevant for QI training among managers and frontline healthcare workers in Bagamoyo district (May 8th – 11th, 2017). About eight ASSIST staff and seven MOHCDGEC staff participated.

• ASSIST and MOHCDGEC met at a workshop in Morogoro Region to conduct document review to obtain relevant references and content for development of the training package as per the agreed outline of the Generic QI Training Manual. The exercise brought together ASSIST staff and MOHCDGEC staff from May 21st to June 3rd, 2017.

• ASSIST in collaboration with DSW and Mvomero District staff pretested the Essential Service Package, Training Manual, and QI guide for IPs and community service providers in two wards of Dakawa and Melela to understand their applicability before finalization (April 10th – 13th, 2017). The tools are intended to support implementation of the National Costed Plan of Action II and the MVC program.

Page 42: USAID ASSIST Project Tanzania Country Report FY17 · Tanzania Country Report FY17 ... e-MTCT Elimination of mother-to-child transmission of HIV FP Family planning . USAID ASSIST Tanzania

34 USAID ASSIST Tanzania Country Report FY17

7 Gender Integration • ASSIST in collaboration with CHMTs had increased the number of sites working to improve male

partner involvement among females receiving RCH/PMTCT care through tracking male partners who test for HIV at RCH from three sites (Sept 2014) to seven sites (May 2017) in Morogoro Region. During this reporting period three coaching and mentoring sessions were conducted (Nov 28–Dec 8, 2016, Feb 24- 8 Mar 2017, and 12–23 June 2017). HIV testing among male partners in seven sites of Morogoro Region increased from 8% (Jan. 2015) to 22% (May 2017) in seven sites. Family planning use among males and female ART clients increased from 4% and 26% to 68% and 69%, respectively, by June 2017. During this reporting period, Ngerengere Health Center identified two HIV-positive male partners but both of them preferred to be enrolled to other clinics.

• Starting in October 2016, ASSIST collected EAR data by sex from 4 facilities (Mbalizi Designated Council Hospital, Ilembo Health Center, Igoma Health Center, and Isuto Dispensary) to analyze the following two EAR indicators by sex: 1) percentage of PLHIV who keep their appointment and pick-up of ARVs; and 2) percentage of PLHIV with moderate and severe malnutrition. While malnutrition was found in 0% of clients, keeping appointments was at 95% among male patients and 88% among female patients. For ARV pick-up, there was no sex difference: 92% among males and 92% among females.

• Table 3 shows sex-disaggregated and gender-sensitive indicators tracked by ASSIST in Tanzania.

Table 3. Baseline versus final values for sex-disaggregated and gender-sensitive indicators tracked by ASSIST in Tanzania

Region Indicator Sex Baseline Latest

Morogoro 2 Districts (Morogoro Municipal and Morogoro DC)

% of PLHIV of reproductive age receiving FP method

F 12% (Jan 14) 40% (May 2017)

M 10% (Jan 14) 31% (May 2017)

% of male partners testing HIV at RCH enrolled to CTC

M 0% (Jan 14) 100% (April 2017)

Iringa (Mufindi District) %of MVC with Birth certificates F 0% (May 15) 41% (Apr 2017)

M 0% (May 15) 37% (Apr 2017)

% of MVC with Community Health Funds cards (CHF)

F 3% (May 15) 19% (Apr 2017)

M 2% (May 15) 18% (Apr 2017)

% of MVC who have been linked and tested for HIV

F 1% (May 15) 30% (Apr 2017)

M 1% (May 15) 32% (Apr 2017)

Njombe (Town Council) %of MVC with Birth certificates F 0% (0ctober 15) 17% (Apr 2015)

M 0% (0ctober 15) 19% (Apr 2015)

% of MVC with Community Health Funds cards (CHF)

F 0% (0ctober 15) 11% (Apr 2015)

M 0% (0ctober 15) 14% (Apr 2015)

% of MVC who have been linked and tested for HIV

F 0% (0ctober 15) 49% (Apr 2015)

M 0% (0ctober 15) 50% (Apr 2015)

Shinyanga MC %of MVC with Birth certificates F 21% (Oct 15) 83% (May 2017)

M 11% (Oct 15) 95% (May 2017)

% of MVC with Community Health Funds cards (CHF)

F 25% (Oct 15) 97% (May 2017)

M 17% (Oct 15) 94% (May 2017)

% of MVC who have been linked and tested for HIV

F 25% (Oct 15) 98% (May 2017)

M 14% (Oct 15) 100% (May 2017)

Mara Region % of male partners of female clients tested for HIV at RCH

M 14.3% (July 2015)

72% (May 2017)

Page 43: USAID ASSIST Project Tanzania Country Report FY17 · Tanzania Country Report FY17 ... e-MTCT Elimination of mother-to-child transmission of HIV FP Family planning . USAID ASSIST Tanzania
Page 44: USAID ASSIST Project Tanzania Country Report FY17 · Tanzania Country Report FY17 ... e-MTCT Elimination of mother-to-child transmission of HIV FP Family planning . USAID ASSIST Tanzania

USAID APPLYING SCIENCE TO STRENGTHEN AND IMPROVE SYSTEMS PROJECT

University Research Co., LLC

5404 Wisconsin Avenue, Suite 800

Chevy Chase, MD 20815

Tel: (301) 654-8338

Fax: (301) 941-8427

www.usaidassist.org