Five Ways Tanzania is Fighting HIV

A community caseworker from the Pwani Region in Tanzania with one of the beneficiaries she supports in her village. / Erick Gibson for JSI Research & Training Institute, Inc.

1.4 million: that’s the number of Tanzanians who live with HIV. 2.3 million: that’s the number of children who have been orphaned due to AIDS. And the biggest challenge of all: Tanzania has only 44% of the health and related staff needed to control the HIV epidemic.

This is where JSI’s Community Health and Social Welfare Systems Strengthening Program (CHSSP), in partnership with World Education and funded by the United States Agency for International Development, is helping. From training more than 18,800 community caseworkers to link vulnerable children and their families to HIV testing and treatment to empowering community advocacy groups to link people to HIV testing and treatment, CHSSP is building Tanzania’s capacity to achieve the UNAIDS 90–90–90 goals and realize an HIV-free generation. In observation of this year’s World AIDS Day, we highlight five ways that Tanzania is fighting HIV.

1. Helping communities lead their own HIV response

In 2003, the Tanzania Commission for AIDS (TACAIDS) established multi-sectoral AIDS committees (MACs) to involve community members in the HIV response.

Ten years later, TACAIDS worked with JSI and other implementing partners to update guidelines for MACs — which define committee processes and members’ roles and responsibilities — in line with global and national HIV policies. The updated guidelines improve coordination, services, and community involvement in the HIV response.

CHSSP has helped the government revitalize MACs in 106 councils and ensure that they know how to manage the HIV and AIDS response in their communities.

2. Implementing an HIV-sensitive case management system and training a workforce to identify people at risk for HIV and link them to testing and treatment

CHSSP helped Tanzania develop its first National Integrated Case Management System (NICMS), which coordinates efforts of service providers who work with children and their families across the health, protection, and social welfare sectors. The NICMS is used by more than 19,000 CHSSP-trained community case workers and other groups working on the HIV response in Tanzania’s communities.

CHSSP has trained over 18,000 community caseworkers across the country who are able to identify, manage and track HIV cases. / Erick Gibson for JSI Research & Training Institute, Inc.

The NICMS empowers community case workers and others to triage cases, provide appropriate services, and refer PLHIV to clinical service providers and facilities as needed for HIV testing and treatment. Once started on treatment, community case workers help people stay on treatment to achieve viral suppression. In this way, community case workers are a critical part of helping Tanzania achieve the UNAIDS 90–90–90 goals.

Community caseworkers make routine household visits to be able to track the progress of the beneficiaries they support in their respective villages. / Erick Gibson for JSI Research & Training Institute, Inc.

CHSSP also worked with the Ministry of Health, Community Development, Gender, Elderly, and Children (MOHCDGEC) and the President’s Office-Regional Administration and Local Government to develop a national NICMS training manual for Tanzania’s community case workers.

3. Ensuring women and children who have experienced abuse/violence get tested for HIV and, if positive, linked to treatment right away

In Tanzania, nearly 1 in 3 girls experience some form of sexual violence before turning 18; almost 4 in 10 women have experienced physical violence; and 1 in 5 women reports experiencing sexual violence in her lifetime (Tanzania Demographic and Health Survey 2010), which increases her chance of contracting HIV.

In 2016, the Government of Tanzania developed a five-year National Plan of Action to End Violence against Women and Children (NPA-VAWC) to improve coordination, deliver high-quality services, implement prevention and response measures, and end all forms of violence against women and children.

In 2018, the government, CHSSP, and other partners reviewed and identified several gaps in the NPA-VAWC, including lack of information about how to identify children infected and affected by HIV and lack of an approach for identifying and reaching most vulnerable children (MVC).

CHSSP worked with the government to integrate the NICMS into the NPA-VAWC training package to ensure that most vulnerable children and adolescents at risk of contracting HIV are correctly identified and linked to health, social welfare, and protection services. CHSSP has established and/or revitalized violence against women and children committees in 52 councils, who are now able to refer women and children affected by violence to health and social welfare services, including HIV testing.

Hilda Muarabu is a social welfare officer but also a member of her local violence against women and children committee. During the quarterly committee meetings, she provides updates on current cases, including violence cases, and how they are being supported by the committee. / Erick Gibson for JSI Research & Training Institute, Inc.

4. Empowering PLHIV to link peers to HIV testing and help those who are positive get and stay on treatment

PLHIV groups and clusters are an important part of Tanzania’s HIV response. Established by and for community members, these entities are well equipped to find people who are most vulnerable to HIV transmission and often hidden due to stigma and other barriers. Members also encourage adherence and retention to treatment and promote referrals and linkages to both clinical services and programs that empower PLHIV socially and economically.

Jane Mwaliego (far right) leads her local PLHIV group to support community members to get tested for HIV and to start and stay on treatment if they are found to be positive. / Erick Gibson for JSI Research & Training Institute, Inc.

To strengthen and expand this important work, CHSSP provides hands-on institutional support to PLHIV clusters and their coordinating body, the National Council of People Living with HIV and AIDS. To date, CHSSP has provided more than 100 PLHIV clusters with critical support to help them better connect community members to testing and treatment and to help their members stay on treatment, once started. In this way, PLHIV groups and clusters are an important part of helping Tanzania reach the UNAIDS 90–90–90 goals.

5. Strengthening HIV-focused civil society organizations

CHSSP strengthens the financial and management capacity of 46 HIV-focused civil society organizations (CSOs) in Tanzania to help them better contribute to the HIV response in their communities.

This support is critical because CSOs advocate for the rights of people living with and affected by HIV and link people to HIV testing, care, and treatment. HIV services that CSOs provide result in better health, higher community resilience, and improved cost-efficiency.

According to the Tanzania HIV Impact Survey, in 2018 60.6% of adults were aware of their status; 93.6% of adults who are aware of their HIV-positive status are on antiretroviral therapy, and 87.0% of adults on treatment have suppressed viral loads (Tanzania HIV Impact Survey, December 2018). The Community Health and Social Welfare Systems Strengthening Program has created an interconnected community support system that will ensure that Tanzania can reach the UNAIDS 90–90–90 goals and achieve an AIDS-free generation.