Antiretroviral treatment (ART) coverage for people living with HIV (PLHIV) in Lusaka Urban District (the capital and largest city in Zambia) was estimated to be near 70 percent in January 2019, with lower coverage for children, men, and young adults. In March 2018, recognizing that growth in the HIV treatment program had plateaued, CoH leadership, in coordination with CRS, created a new model to identify PLHIV and immediately link to same-day ART initiation. Critical elements of the model include: its acceptability by the service utilizer, the location of the community posts, the stakeholder engagement of the local community, and the selection of local CHWs who know the geographic and social terrain of the surrounding community. After implementing the community post model, CoH saw immediate and sustained increase in HIV case identification. Ninety-two percent of HTS_POS from March 2018 – March 2019 reported by CoH were identified at the community posts; only 8 percent were from the central facility.
As coverage of male circumcision increases, it becomes more difficult to identify eligible men for this HIV prevention activity. Using triangulated data to generate maps has helped to identify areas of eligible men and thus increased program performance by 200 percent. Through innovative solutions like this one, Tanzania is on-track to reach its target of 90 percent male circumcision coverage among 10-29 year-olds by 2020.
Voluntary medical male circumcision (VMMC) is an evidence-based prevention approach that can reduce HIV transmission. However, sustaining demand and lowering costs of this core intervention can be challenging. In Tanzania, engagement and use of a volunteer community-based cadre of lay workers to promote and create demand for VMMC led to an almost five-fold increase in VMMCs performed in health facilities. This increase was sustained over time, with a cumulative 45,182 VMMCs performed eighteen months after the introduction of this model. Moreover, this model also reduced costs by 13%.
Through the support of the United States Government’s President’s Emergency Plan for AIDS Relief (PEPFAR), Elizabeth Glaser Pediatric AIDS Foundation (EGPAF) introduced comprehensive men’s clinics at selected high-volume health facilities in order to scale-up the Test and Start approach among HIV-infected men. The men’s clinics provide a male-friendly environment that encourages men to get tested for HIV, and therefore be identified as HIV positive and linked to HIV care and treatment services.