Mid-Term Review of Clinton Foundation HIV/AIDS Initiative's Program for Scaling-Up of Prevention of Mother-To-Child Transmission of HIV (PMTCT) Services in Tanzania

The Project

The main goal of the program is “to provide universal access to high quality Prevention of Mother-To-Child Transmission(PMTCT) services to pregnant women in the Lindi region and expand access to HIV/AIDS care and treatment services to eligible HIV+ children and adults in Lindi and Mtwara regions by December 2010”. Major program activities include facility renovation, human resource capacity building through recruitment and training, task-shifting, provision of HIV drugs and commodities, support for supply chain management, early infant diagnosis (EID), laboratory strengthening including sample transportation systems, and community based activities to improve coordination between health facilities and community home based care.

Interesting Findings

• The major achievement of the program has been the rapid and tremendous scale up in making PMTCT and care and treatment services accessible to people living in the two regions. This has led to a huge increase of people enrolled in PMTCT programs and registered in Care and Treatment Centres (CTC).
• However, in terms of results and impact the situation is more mixed. In the best case only six out of ten pregnant HIV positive pregnant women identified in Ante-Natal Cate (ANC) have come back for prophylaxis. How many of those who have received a complete course of HIV prophylaxis during pregnancy, labour and delivery is not known.
• Concerning CTC some of the major achievements have been to train staff in the provision of treatment and care, improve the transport of CD4 counts, secure the provision of ARV medicine in cases where there has been a risk of stock outs, and to offer Paediatric Fixed Dose Combinations for children in need of Anti-Retroviral Treatment (ART).
• There are some anecdotal evidence and indications that quality of the services is not optimal in terms of handling side effects of Ante-Retroviral (ARV) medicine, treating opportunistic infections and identifying patients in need of second line treatment.
• There is a lack of reliable data about compliance and number of people dying while under treatment due to weak monitoring.
• It is very much appreciated by the partners that CHAI is intending to use and strengthen the government system rather than setting up a vertical program and that CHAI is collaborating with and understanding the needs of local partners.
• Other important achievements are the contributions to infrastructure improvements through the installation of solar power and rehabilitation of clinics.
• There is a critical lack of monitoring and reliable data needed to assess the impact of the program and to address problematic issues related in particular to the quality of the services offered. No data is presented concerning the percentage or number of HIV infected women identified in Ante-Natal Cate (ANC) who have received complete course of ARV prophylaxis in ANC and maternity. Likewise, data is not available about the proportion of patients who have started on ART who are lost to follow up or proportion of patients alive and with a high drug adherence. The figures that do exist indicate only a modest success in PMTCT indicating a strong need to refocus on improving the quality of the services and the performance of the staff rather than continuing the rapid expansion.