Standardizing and Scaling up Quality Adolescent Friendly Health Services in Tanzania.

Adolescents in Tanzania require health services that respond to their sexual and reproductive health - and other - needs and are delivered in a friendly and nonjudgemental manner. Systematizing and expanding the reach of quality adolescent friendly health service provision is part of the Tanzanian Ministry of Health and Social Welfare's (MOHSW) multi-component strategy to promote and safeguard the health of adolescents. We set out to identify the progress made by the MOHSW in achieving the objective it had set in its National Adolescent Health and Development Strategy: 2002-2006, to systematize and extend the reach of Adolescent Friendly Health Services (AFHS) in the country. We reviewed plans and reports from the MOHSW and journal articles on AFHS. This was supplemented with several of the authors' experiences of working to make health services in Tanzania adolescent friendly. The MOHSW identified four key problems with what was being done to make health services adolescent friendly in the country - firstly, it was not fully aware of the various efforts under way; secondly, there was no standardized definition of AFHS; thirdly, it had received reports that the quality of the AFHS being provided by some organizations was poor; and fourthly, only small numbers of adolescents were being reached by the efforts that were under way. The MOHSW responded to these problems by mapping existing services, developing a standardized definition of AFHS, charting out what needed to be done to improve their quality and expand their coverage, and integrating AFHS within wider policy and strategy documents and programmatic measurement instruments. It has also taken important preparatory steps to stimulate and support implementation. The MOHSW is aware that the focus of the effort must now shift from the national to the regional, council and local levels. The onus is on regional and council health management teams as well as health facility managers to take the steps needed to ensure that all adolescents in the country obtain the sexual and reproductive health (SRH) services they need, delivered in a friendly and non-judgemental manner. But they cannot do this without substantial and ongoing support

Antiretroviral treatment coverage in a rural district in Tanzania--a modeling study using empirical data.

BACKGROUND: The Tanzanian Government started scaling up its antiretroviral treatment (ART) program from referral, regional and district hospitals to primary health care facilities in October 2004. In 2010, most ART clinics were decentralized to primary health facilities. ART coverage, i.e. people living with HIV (PLHIV) on combination treatment as a proportion of those in need of treatment, provides the basis for evaluating the efficiency of ART programs at national and district level. We aimed to evaluate adult ART and pre-ART care coverage by age and sex at CD4 < 200, < 350 and all PLHIV in the Rufiji district of Tanzania from 2006 to 2010. METHODS: The numbers of people on ART and pre-ART care were obtained from routinely aggregated, patient-level, cohort data from care and treatment centers in the district. We used ALPHA model to predict the number in need of pre-ART care and ART by age and sex at CD4 < 200 and < 350. RESULTS: Adult ART coverage among PLHIV increased from 2.9% in 2006 to 17.6% in 2010. In 2010, coverage was 20% for women and 14.8% for men. ART coverage was 30.2% and 38.7% in 2010 with reference to CD4 criteria of 350 and 200 respectively. In 2010, ART coverage was 0 and 3.4% among young people aged 15-19 and 20-24 respectively. ART coverage among females aged 35-39 and 40-44 was 30.6 and 35% respectively in 2010. Adult pre-ART care coverage for PLHIV of CD4 < 350 increased from 5% in 2006 to 37.7% in 2010. The age-sex coverage patterns for pre-ART care were similar to ART coverage for both CD4 of 200 and 350 over the study period. CONCLUSIONS: ART coverage in the Rufiji district is unevenly distributed and far from the universal coverage target of 80%, in particular among young men. The findings in 2010 are close to the most recent estimates of ART coverage in 2013. To strive for universal coverage, both the recruitment of new eligible individuals to pre-ART and ART and the successful retention of those already on ART in the program need to be prioritized