The Shinyanga Patient: A Patient’s Journey through HIV Treatment Cascade in Rural Tanzania

Abstract

The 2016–2017 Tanzania HIV Impact Survey (THIS) reported the accomplishments towards the 90-90-90 global HIV targets at 61-94-87, affirming the need to focus on the first 90 (i.e., getting 90% of people living with HIV (PLHIV) tested). We conducted a patient-pathway analysis to understand the gap observed, by assessing the alignment between where PLHIV seek healthcare and where HIV services are available in the Shinyanga region, Tanzania. We used existing and publicly available data from the National AIDS Control program, national surveys, registries, and relevant national reports. Region-wide, the majority (n = 458/722, 64%) of THIS respondents accessed their last HIV test at public sector facilities. There were 65.9%, 45.1%, and 74.1% who could also access antiretroviral therapy (ART), CD4 testing, and HIV viral load testing at the location of their last HIV test, respectively. In 2019, the viral suppression rate estimated among PLHIV on ART in the Shinyanga region was 91.5%. PLHIV access HIV testing mostly in public health facilities; our research shows that synergies can be achieved to improve access to services further down the cascade in this sector. Furthermore, effective engagement with the private sector (not-for-profit and for-profit) will help to achieve the last mile toward ending the HIV epidemic.

The effects of traditional healing on HIV and AIDS management: An ethnographic study

“…They always adhere to the rule of confidentiality and their clients trust them with everything, rather than trusting health workers, who they fear might divulge their information as they are working in groups. Okere et al 6 and Rohwer et al 20 concur with the statement that resistance to attend health facilities for HIV treatment is due to the lack of confidentiality in the health facilities and the fear of unintentional disclosure of HIV status due to frequent clinic visits. Also sharing the same narrative are findings in the study 3 conducted in rural Uganda that clients easily confide in their traditional healers rather than in health institutions, as they are afraid of their HIV status being known.…”

“…Both the Ministry of Health and traditional healers should work together to achieve proper management of HIV and AIDS by both health institutions and traditional healers, with neither misleading the other due to a lack of knowledge on the part of the traditional healers and their clients. The study 6 conducted in rural Tanzania found that denial amongst those infected with HIV is an issue and that there is a lack of knowledge when it comes to the management of HIV by traditional healers, as they believe that they can heal HIV.…”