National Accelerated Action Plan on HIV Testing Services 2019–2020

Objectives

Tanzania’s 2018 National Accelerated Action Plan for HIV Testing Services provides a two-year, targeted and prioritised framework to accelerate HIV testing as the gateway to prevention, treatment, care and support. It aims to increase the proportion of people living with HIV who know their status to 90% by 2020 and 95% by 2023, contributing to the goal of ending HIV as a public-health threat by 2030.[1][2][3]The plan responds to an estimated 61% status-awareness level at the end of 2017 and seeks to identify approximately 440,000 to 500,000 people living with HIV who were not aware of their status.[4][5]

• Increase equitable access to comprehensive, high-quality and efficient HIV testing services across facilities, communities and priority settings, while improving testing yield, linkage to antiretroviral therapy and retention in care.[1][3]
• Prioritise men, adolescents and young people, adolescent girls and young women, children, orphans and vulnerable children, key and vulnerable populations, and people in geographical hotspots and high-burden regions.[6][7][8]
• Focus geographical targeting on regions and councils with high numbers or proportions of people living with HIV who do not know their status, while applying focused testing in lower-burden or lower-yield settings.[6][9]
• Strengthen differentiated HIV testing models, provider-initiated testing and counselling, community-initiated testing and counselling, voluntary counselling and testing, index testing, prevention of mother-to-child transmission, voluntary medical male circumcision and community outreach.[10][11]
• Integrate HIV testing into tuberculosis, sexually transmitted infection, outpatient, inpatient, antenatal, postnatal, family-planning, reproductive and child health, blood-transfusion and other relevant service entry points.[12][13][14]
• Maintain testing quality, reliable recording systems, differentiated service delivery and an uninterrupted supply of HIV testing kits and related commodities.[10][3]
• Support wider prevention and treatment goals, including reduced new infections among adolescent girls and young women, elimination of mother-to-child transmission, male engagement, condom use, and improved antiretroviral therapy enrolment, adherence and viral suppression.[15][7][16]

Implementation

Implementation combines facility-based and community-based HIV testing, using data on epidemic burden, testing gaps, positivity yield and population need to allocate services and resources from national and sub-national levels to communities.[17][9]The National AIDS Control Programme is identified as the principal implementing institution for many activities, with the Ministry of Health, Community Development, Gender, Elderly and Children providing policy leadership and, for selected activities, collaboration with the Tanzania Commission for AIDS, Medical Stores Department, implementing partners, community stakeholders and international agencies.[9][18][19]

• Deliver targeted facility testing through provider-initiated testing and counselling, including screening and risk-symptom targeting where yield is low, and offer testing at priority clinical entry points.[4][14]
• Expand community outreach, mobile and hotspot testing in settings such as fishing communities, mining areas, long-distance lorry stops, prisons, workplaces and other locations with elevated unmet need.[12][6][20]
• Use index-client testing, voluntary assisted partner notification and confidential partner referral approaches to identify sexual and needle-sharing partners and children of index clients.[12][16]
• Provide tailored, integrated packages for key and vulnerable populations, including HIV testing, condoms, family planning, sexually transmitted infection services, gender-based violence services, post-exposure prophylaxis, peer outreach and supported referral.[20]
• Strengthen services for men through couple and partner testing, workplace campaigns, male-friendly clinics and outreach near high-prevalence locations.[12][13]
• Expand adolescent-friendly and paediatric services, including targeted outreach, community health-worker support, integration with sexual and reproductive health services, and age- and sex-disaggregated data collection.[7][18]
• Link consenting clients with HIV-positive results promptly to antiretroviral therapy, using escorted referral, community health workers, lay workers and follow-up of community-tested clients to confirm linkage and support retention.[20][19]
• Build provider capacity through orientation, certification, task-sharing, supportive supervision, tester mentoring and implementation of rapid-testing quality-improvement measures.[12][21][22]
• Strengthen commodity management through forecasting, quantification, procurement, distribution, stock monitoring and coordination between government and implementing partners, including Medical Stores Department capacity and health-facility therapeutic committee oversight.[16][23]

Monitoring is intended to use an accelerated-plan indicator matrix, routine reports, District Health Information Software 2 and electronic links between HIV testing facilities and the national data system.[24][17][9]Priority measures include testing volume, HIV-positive diagnoses and yield, knowledge of status, testing quality, linkage and retention, modality contributions, commodity availability, and performance disaggregated by region, age and sex.[2][25][23]The plan envisages regular data review, analysis, re-planning and quarterly partner coordination to identify bottlenecks and improve efficiency.[17][23]

National testing targets total 10,162,150 tests in 2019 and 10,670,277 in 2020.[26]The 2019 objective was to identify 233,243 people living with HIV, while the testing-positive target of 264,216 accounted for repeat tests and incomplete linkage in the absence of unique identifiers.[9]The supplied material does not provide a quantified overall budget, unit costs, funding gap, detailed financing allocation or economic assumptions; activity cost fields are frequently recorded as “TBD”.[8][18][19]

Monitoring & Evaluation

Monitoring and evaluation centre on accelerating HIV testing services, improving testing yield and quality, strengthening linkage to antiretroviral therapy, and tracking progress towards the first 90-90-90 target. The plan aims for 90% of people living with HIV to know their status by 2020 and 95% by 2023, against an estimated 61% knowing their status at the end of 2017.[2][27][5]

• Track testing volumes, HIV-positive diagnoses, testing yield, knowledge of HIV status, linkage to treatment, retention, viral suppression, prevention of mother-to-child transmission, voluntary medical male circumcision, mortality and HIV incidence.[15][27]
• Set national testing targets of 10,162,150 tests for 2019 and 10,670,277 for 2020, with regional, council and population-specific targets intended to support prioritisation and accountability.[26]
• Monitor testing results over time, including 7,362,222 people tested and 227,879 HIV-positive results in 2017, a reported yield of 3.01%; the plan anticipated that greater testing scale would reduce yield further.[2]
• Use regional burden, testing performance, data quality and geographical gaps to guide resource allocation, target revision, data review and re-planning, particularly in high-burden regions and locations with substantial numbers of people whose HIV status is unknown.[17][6][9]
• Disaggregate data by age and sex, including for adolescents, young people, children, men and key and vulnerable populations, to address gaps in access and service uptake.[9][7][8]
• Link HIV testing facilities and testing points electronically to national data systems, including District Health Information Software 2, and use routine reporting, modality-specific data and implementing-partner information where routine data are unavailable.[17][25][9]
• Strengthen recording and reporting for integrated services, use agreed national tools, and convene data-review meetings to improve data quality across population groups.[16]
• Monitor facility- and community-based index testing, including sexual partners and children of index clients; index testing’s contribution to HIV-positive results reportedly rose from 1% in financial year 2017 quarter 1 to 17% in quarter 4.[14]
• Follow up community-tested clients after one month to confirm linkage to treatment and trace those not linked through community-based health workers.[20]
• Assess testing quality through internal quality control, external quality assessment, proficiency testing, compliance with national rapid-testing procedures and algorithms, repeat testing, result validation, tester mentoring and supportive supervision.[10][11][28][22]
• Monitor commodity availability, test-kit consumption and accountability, the relationship between kits procured and used, distribution to testing points, and stock-out prevention.[12][23][29]
• Use indicators for priority-service delivery, including hotspot mapping and support, testing coverage, referrals, linkage to antiretroviral therapy, retention, adolescent service integration, male-focused interventions and workplace self-testing initiatives.[30][31][32][33]

Specified operational targets include 90% linkage of identified hotspot clients to antiretroviral therapy, 95% linkage of HIV-positive adolescents and young people to antiretroviral therapy, 95% retention on antiretroviral therapy, 100% HIV testing-kit availability, and more than 80% proficiency-testing performance in specified settings.[30][31][19][23][22]Formal evaluation designs, surveillance methodology, reporting timetables and independent accountability arrangements are not comprehensively specified in the supplied extracts.[24][7][13]

Costing & Financing

Financing is framed principally through targeted, coordinated and cost-effective allocation of resources according to HIV burden, service gaps, testing targets and local epidemiology. The extracts identify inadequate funding, weak supply-chain capacity and insufficient technology as implementation constraints, but do not provide an overall programme budget, unit costs, financing gap or quantified resource requirement.[17][4]

• Prioritise resource allocation for high-burden regions, hotspots, key and vulnerable populations, men, adolescents and groups with low access to testing or high numbers of undiagnosed people.[12][6][9]
• Mobilise sufficient and timely funding for HIV and related commodities, alongside strengthened forecasting, quantification, procurement, distribution and commodity accountability.[16][23][29]
• Manage HIV test-kit consumption cost-effectively by linking supplies and consumption to quantified testing targets and monitoring kit use from the Medical Stores Department to testing users.[25][23]
• Coordinate partners and quarterly reviews to support commodity planning and delivery; the Ministry of Health, Community Development, Gender, Elderly and Children acknowledged technical and financial contributions from partners, including financial support for plan development from the World Health Organization and the Joint United Nations Programme on HIV/AIDS.[1][34][29]

Several activity tables record cost or resource fields as “TBD”, including listed HIV testing activities for 2019–2020.[8][18][21][28]The supplied material does not specify funding allocations, named programme financing sources beyond development support, a resource-mobilisation target, economic assumptions or a costing methodology.[4][14][35]