Decline in the prevalence HIV among pregnant women attending antenatal clinics in Tanzania, 2001-2011

Background: The Tanzania National AIDS Control Programme has established HIV sentinel surveillance among antenatal clinic (ANC) attendees as one of the methods for collecting data on HIV prevalence. This article provides trends on HIV prevalence for 92 sentinel sites that have constantly been part of the surveillance system since 2001 and have participated in at least three consecutive rounds.Method: The surveillance population included all pregnant women aged 15–49 years who were attending a selected sentinel ANC site for the first time for any pregnancy between 2001 and 2011. Serial testing for HIV infection was done anonymously by detecting for the presence of IgG antibodies to HIV on dried blood spot (DBS) specimens. HIV trends were calculated taking into account random effects from sites on the following variables:  region, sites and socio-demographic characteristics defined as age, marital status, parity, education level and duration of stay at present residence.Results: Overall, there was a significant decline in HIV prevalence from 9.6% in 2001 to 5.6% in 2011 (p<0.01). Specifically, the HIV prevalence among 15-24 years’ pregnant women significantly declined from 7.8% in 2001/2002 to 4% in 2011 (p<0.01). The decline in HIV prevalence occurred irrespective of residence, marital status, education level or previous pregnancies.Conclusion: There has been a significant decline in HIV infections among young pregnant women attending ANC clinics in Tanzania since 2001. This study also indicates that ANC surveillance among pregnant women over time can provide useful estimates of HIV situation between the population surveys

Monitoring prevention or emergence of HIV drug resistance: results of a population-based foundational survey of early warning indicators in mainland Tanzania

BACKGROUND: In Tanzania, routine individual-level testing for HIV drug resistance (HIVDR) using laboratory genotyping and phenotyping is not feasible due to resource constraints. To monitor the prevention or emergence of HIVDR at a population level, WHO developed generic strategies to be adapted by countries, which include a set of early warning indicators (EWIs). METHODS: To establish a baseline of EWIs, we conducted a retrospective longitudinal survey of 35 purposively sampled care and treatment clinics in 17 regions of mainland Tanzania. We extracted data relevant for four EWIs (ART prescribing practices, patients lost to follow-up 12 months after ART initiation, retention on first-line ART at 12 months, and ART clinic appointment keeping in the first 12 months) from the patient monitoring system on patients who initiated ART at each respective facility in 2010. We uploaded patient information into WHO HIVResNet excel-based tool to compute national and facility averages of the EWIs and tested for associations between various programmatic factors and EWI performance using Fisher’s Exact Test. RESULTS: All sampled facilities met the WHO EWI target (100%) for ART prescribing practices. However, the national averages for patients lost to follow-up 12 months after ART initiation, retention on first-line ART at 12 months, and ART clinic appointment keeping in the first 12 months fell short, at 26%, 54% and 38%, respectively, compared to the WHO targets ≤ 20%, ≥ 70%, and ≥ 80%. Clinics with fewer patients lost to follow-up 12 months after ART initiation and more patients retained on first-line-ART at 12 months were more likely to have their patients spend the longest time in the facility (including wait-time and time with providers), (p = 0.011 and 0.007, respectively). CONCLUSION: Tanzania performed very well in EWI 1a, ART prescribing practices. However, its performance in other three EWIs was far below the WHO targets. This study provides a baseline for future monitoring of EWIs in Tanzania and highlights areas for improvement in the management of ART patients in order not only to prevent emergence of HIVDR due to programmatic factors, but also to improve the quality of life for ART patients