“We have been looking for something like this before – and now it is here,” says Dr. Solomon Ole Logilunore, a municipal medical officer of health in the Arusha region of Tanzania.

More available routine HIV counseling and testing – badly needed in a country in which 7% of the population is already infected with the disease—has arrived through the IntraHealth International-led Provider-Initiated Testing and Counseling (PITC) project. The project is funded through the US Centers for Disease Control and Prevention (CDC).

The number of people who are being tested for HIV in two districts in the Arusha region has increased dramatically now that the project has ensured health care staff members can counsel clients and administer the HIV test on-site. PITC aims to have HIV counseling and testing (CT) offered in departments throughout clinics and hospitals so that patients coming in for other reasons have the opportunity to get tested while they are at the facility. The project is currently working in three regions: Arusha, Kigoma and Mwanza.

IntraHealth is collaborating with the National AIDS Control Program and regional and council health management teams to conduct regional trainings for PITC trainers so that they, in turn, can train health workers in their own regions. IntraHealth provides support and supervision for the health workers and assesses clinical compliance and supply availability.

The PITC project has trained 12 providers in the Kaloleni Health Center in the Arusha region to counsel and test patients. The center has a total of 55 full-time employees and has started implementing and integrating HIV CT services into routine medical care through the outpatient department; the dental, child welfare, family planning and eye clinics; and outreach services. In the first month following implementation, the trained providers counseled and tested 819 people. Out of those, 50 tested positive for HIV, and 49 of them have been referred to one of three hospitals that can provide treatment services.

The center’s principal nursing officer—Margareth Mjema—was herself counseling and testing an average of five clients per day at the facility’s testing center before PITC was implemented. Now, her client numbers have nearly doubled.

The Challenges

Making sure HIV-positive clients get the treatment they need, however, can be difficult, says Nurse Mjema. She refers clients to a care and treatment center (CTC) in the regional hospital, and with the clients who do come back and see her, she develops a relationship and often provides them with resource referrals to social service agencies and to organizations for spiritual and legal support. But often clients do not follow up with her, she notes, and the referral form sent with the client is not returned by the CTC to notify her that the client has indeed started treatment.

Another challenge that Tanzania will increasingly face is how treatment facilities will equip themselves to care for the growing number of people who are finding out that they are HIV-positive. But finding out one’s HIV status is a necessary and important first step in handling the HIV epidemic. More counseling and testing needs to be available, says Dr. Aziz Msuya, a district medical officer of Meru district. Now that the project has started to reach more people, he does not want the momentum to stop.

“When you eat the goat, you have to eat up to the tail,” he remarks, referring to the need to complete counseling and testing for everyone. Dr. Msuya hopes that a new project will provide home-based HIV CT and have trained counselors going from house to house offering the service.

Dr. Msuya is impressed with the progress IntraHealth has made in such little time. He says the hospital in Meru was testing 725 clients a month. After PITC started, the facility counseled and tested 1,193 clients, 41 of whom tested positive for HIV.

“We really appreciate . . . what (IntraHealth) is doing” adds Dr. Msuya. “This is a very good thing for the people of the district. . . . If this program continues, we are sure we will lower the percentage of HIV-positive people.”

As of December 2007, PITC had implemented CT services in 65 health facilities throughout the three regions. Seventeen local trainers—oriented on PITC service delivery—have trained 479 service providers in CT. Through the project, an average of 10,627 people per month are presently receiving testing for HIV in the three regions.