Community based Index- and Mobile Testing complements and effective in pediatric HIV case finding in Tanzania

• Authors: Caterina Casalini1, Albert Komba1, Gaspar Mbita1 Edina Hauli1, Deusdedit Mjungu1, Flavian Ngeni1 Upendo Kategile2, Jema Bisimba2, Meena Srivastava3, Sharon Lwezaula4

• Affiliations: Jhpiego Tanzania1, USAID Tanzania2, USAID DC3, National AIDS Control Program Tanzania4

HIV Background: Tanzania

2018 UNAIDS 1; Q2 FY19 PEPFAR Tanzania 2 ; 2016-17 THIS 3

• Adult population (15 to 49 years):

– 1.5M PLHIV with 4.7% HIV

prevalence 1

– 69% ART Coverage 2

• Pediatric population (0 to14 years):

– 105,704 CLHIV 1

– 0.4% HIV prevalence 3

• 0.4% under five years

• 0.5% aged 5-9 years

• 0.3% aged 10-14 years

• Highest prevalence in Njombe

(2.3%) and Iringa (1.4%)

– 54% ART Coverage 2

– 80% Viral Load Coverage 2

– 65% Viral Load Suppression 2

Services are provided Day and Night, from Monday to Saturday

Biomedical

services

Saving and

Loaning

Services

Behavior

change

education

• Individual peer to peer

• IEC material

• Social Media

(WhatsApp)

• Testimonials (FP)Hot Spot Mapping

by Community Based HIV Service

Providers (peer educators)

Biomed venues

• Tent

• Rented rooms in brothel, bar

• Workplaces

• Private residences

Saving/Loaning, SBCC

venues

• Schools

• Gv offices

• Private residences

Background Sauti Project in Tanzania

Goal: Contribute to improved health for all Tanzanians

through sustained reduction in new HIV infections.

• Sauti Project, led by Jhpiego, is funded by PEPFAR through

USAID

• Sauti offers community-based health care, behavioral, and

structural interventions for key and vulnerable populations

(KVP)

• Partners: Government of Tanzania; 18 civil society

organizations

How Sauti reaches children

Index testing for biological children of all HIV+ clients

OVC program through risk assessment

SBCC groups to FSW and

SBCC/Saving Loan groups to AGYW

Hot spots during HTS to adult

clients

Children of KVP & non-KVP

Intervention FSW MSM AGYW PFSW OHSP Peds

1. Biomedical

• Risk assessment and counseling X X X X X X

• HTS / Index testing X X X X X X

• HIV Self Testing X X X

• FP counseling and services X X X

• STI screening X X X X X X

• STI periodic presumptive treatment X X

• Condoms Promotion Provision X X X X X X

• TB screening X X X X X X

• GBV screening X X X X X X

• Alcohol and drug screening X X X X X X

• Escorted referral Care & Treatment Clinic,

GBV services, RCHS, OVC Services

X X X X X X

• ART Outreach to stable PLHIV X X X X X X

• Pre Exposure Prophylaxis X X

2. SBCC

• Demand creation X X X X X X

• SBCC group education X X

• SBCC individual education X X

3. Economic Empowerment

• Saving and Loaning and Parenting X

• Cash transfer program X

5. PLHIV support groups X X X X X

6. SASA! X X X X X X

Sauti Core Package of Services

FSW: Female Sex Workers; PFSW: Partners FSW; AGYW: Adolescent Girls Young Women ages 15-24 out of school; OHSP:

Other Hotspot Populations male and female (OHSPM; OHSPF); Peds: Pediatric population

Context

• In fiscal year 19 (FY19: 1 October 2018 to 17 March 2019)

compared to fiscal year 18 (FY18: 1 October 2017 to 31

September 2018), the project scaled up the following

interventions:

– Index testing next to mobile testing

– Training of health care providers on fidelity of

testing procedures and beneficiaries’ categorization

– Enhancing peer educators’ capacity on

demand creation for testing to those at highest

risk of HIV

Materials & Methods

• Routine data were recorded in FY18 (14 regions and

51 districts) and FY19 (13 regions and 33 districts)

• The pediatric population was defined from 18

months – 14 years of age as:

– Children of KVP

– Children of non-KVP

• Biological children of an HIV positive mother

categorized as index testing. Any other test was

categorized as mobile testing.

• This analysis describes the testing yield and trend by

type of population and modality

Results

Mobile HIV Testing Positivity Children of non-KVP vs Children of KVP by FY

124,199

7,940 2,356 2,035 759 137 20 107

0.6%

1.7%

0.8%

5.3%

0.0%

1.0%

2.0%

3.0%

4.0%

5.0%

6.0%

-

20,000

40,000

60,000

80,000

100,000

120,000

140,000

FY18 FY19 FY18 FY19

Children non-KVP Children KVP

Mobile HTS HIV+ Pos rate

1.1% increase

95% CI:0.8-1.4; p<0.0001

4.5% increase

95% CI:3.50-5.59; p<0.0001

Index Testing Positivity Children of non-KVP vs Children of KVP by FY

131,338

4,809 7,234 6,197 1,189 175 73 197

0.9%

3.6%

1.0%

3.2%

0.0%

0.5%

1.0%

1.5%

2.0%

2.5%

3.0%

3.5%

4.0%

-

20,000

40,000

60,000

80,000

100,000

120,000

140,000

FY18 FY19 FY18 FY19

Children non-KVP Children KVP

Index HTS HIV+ Pos rate

2.7% increase

95% CI:2.2.-3.3; p<0.0001

2.2% increase

95% CI:1.71-2.71;

p<0.0001

HIV Testing Positivity by ModalityChildren of non-KVP vs Children of KP by FY

FY18 FY19

Children non-

KVP

Children

KVP

Children

non-KVP

Children

KVP

Mobile

Testing

Positivity

0.6% 0.8% 1.7%* 5.3%*

*increase of 3.6% (95% CI:

2.65-4.69; p<0.0001)

Children non-

KVP

Children

KVP

Children

non-KVP

Children

KVP

Index

Testing

Positivity

0.9% 1.0% 3.6% 3.2%

Conclusions • The significant increase of testing yield over a two

year period reflects increased project capacity to

support effective demand creation, provision of

services with fidelity, and scale-up of targeted testing

modalities that are effective in identifying at risk

children with HIV.

• This was particularly true for those children of KVP

reached through community-based mobile testing,

which in FY19 was a successful complementary

strategy to index testing

• Scaling index testing with fidelity can improve

pediatric case finding

Gracias!

Acknowledgements

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

Tanzania Commission forAIDS

PEPFAR/USAID

Civil Society Organizations, Stakeholders, Beneficiaries, Sauti Team