Abstract
Reducing HIV-related morbidity and mortality, and effectively eliminating HIV transmission risk, depends on use of antiretroviral therapy (ART) to achieve and maintain viral load suppression (VLS)* (1,2). By 2020, sub-Saharan African countries are working to achieve VLS among 90% of persons using ART and 73% of all persons living with HIV infection (1). In Tanzania, a country with 1.4 million persons with HIV infection, 49.6% of HIV-positive persons aged 15-49 years had achieved VLS in 2017, including only 21.5% of men and 44.6% of women aged 25-29 years (3). To identify interventions that might increase VLS in Tanzania, and reduce VLS-associated sex and age-group disparities, the Bukoba Combination Prevention Evaluation (BCPE) scaled up new HIV testing, linkage to care, and retention on ART interventions throughout Bukoba Municipal Council (Bukoba), Tanzania, during October 2014-March 2017 (4,5). Located on the western shore of Lake Victoria, Bukoba is a mixed urban and rural municipality of 150,000 persons and capital of Kagera Region. Of the 31 regions of Tanzania, Kagera has the fourth highest prevalence of HIV infection (6.8%) among residents aged 15-49 years (3). CDC analyzed data from BCPE preintervention and postintervention surveys and found that VLS prevalence among HIV-positive Bukoba residents aged 18-49 years increased approximately twofold overall (from 28.6% to 64.8%) and among women (33.3% to 67.8%) and approximately threefold among men (20.5% to 59.1%) and young adults aged 18-29 years (15.6% to 56.7%). During 2017, BCPE facility-based testing and linkage interventions were approved as new service delivery models by the Tanzania Ministry of Health, Community Development, Gender, Elderly and Children (4,5). After a successful rollout to 208 facilities in 11 regions in 2018, BCPE interventions are being scaled up in all regions of Tanzania in 2019 with support from the United States President's Emergency Plan for AIDS Relief (PEPFAR).†.
Highlights
In 2017, BCPE facility-based human immunodeficiency virus (HIV) testing and linkage case management interventions were approved as new service delivery models by the Ministry of Health, and were implemented in 2018 by four nongovernmental organizations in 208 health care facilities and as part of community-based services in 11 regions of Tanzania (4,5)
In Bukoba, Tanzania, scale-up of new testing, linkage to care, and retention on antiretroviral therapy interventions over 2.5 years helped increase viral load suppression (VLS) among HIV-positive persons approximately twofold overall and threefold among men (20.5% to 59.1%) and adults aged [18–29] years (15.6% to 56.7%)
PEPFAR is supporting the nationwide scale-up of BCPE interventions in Tanzania in 2019 and recommends optimized provider-initiated HIV testing services and peer-delivered, linkage case management as potential strategies for countries to help achieve ≥73% prevalence of VLS among all persons with HIV infection by the end of 2020 (10)
Summary
Threefold Increases in Population HIV Viral Load Suppression Among Men and Young Adults — Bukoba Municipal Council, Tanzania, 2014–2017. CDC analyzed data from BCPE preintervention and postintervention surveys and found that VLS prevalence among HIV-positive Bukoba residents aged [18–49] years increased approximately twofold overall (from 28.6% to 64.8%) and among women (33.3% to 67.8%) and approximately threefold among men (20.5% to 59.1%) and young adults aged [18–29] years (15.6% to 56.7%). HIV testing¶ was routinely offered at 11 participating health care facilities, in homes, and at community venues (Supplementary Figure, https://stacks.cdc.gov/view/ cdc/80050) (4). Among 4,206 HIVpositive clients of all ages referred to participating facilities and who received BCPE linkage case management services, 3,918 (93%) enrolled in HIV care (3,186 before Test and Start), 2,521 (64%) of whom initiated ART within 3 months of diagnosis. Participation in preintervention and postintervention household surveys to assess effectiveness of new HIV testing, linkage to care, and retention on antiretroviral therapy interventions — Bukoba Combination Prevention Evaluation, Bukoba Municipal Council, Tanzania, 2014–2017.
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