Community-based HIV services during Differentiated Service Delivery Models: a cross-sectional survey from nine regions in Tanzania

Abstract

Introduction: To combat the HIV epidemic and reach the 90-90-90 goals, community-based HIV/AIDS services (CHBS) plays a great role. However, how well CHBS works in the era of adopting differentiated service delivery models for care and treatment has not been adequately evaluated. We hence assessed CBHS programs implemented by various partners with a focus on the coverage; program needs; linkage and referral process; consistent use of guidelines and training curricula and challenges faced by providers and clients.

Methods: It was a cross-sectional study conducted in July 2020 in 9 regions using both quantitative and qualitative methods. Quantitative data were analyzed using STATA version 12 and qualitative data were managed using Thematic Content Analysis.

Results: 26 implementing partners were offering CBHS in biomedical, behavioral, and structural areas. Their focus was on PLHIV, orphans, and key and vulnerable populations. The majority of PLHIV had a positive perception of different CBHS. Key factors in the perceived effectiveness of community HIV services were the consistent use and availability of guidelines and training curricula, standard operating procedures, and readiness of essential commodities and supplies. Out of 1391 PLHIV who were involved, 67.4% and 25.0% were tested at the health facility and communities respectively. About 69.8% were referred after confirming their seropositivity and forms were not given to about 57.5% when referred from health facilities to communities for CBHS. There was a deficit of 45% in health workers across different cadres, a deficit in all categories of supplies and equipment example the HIV test kit by 53.8%. Challenges for CBHS included financial hindrances, HIV-related stigma, and discrimination, distance to health facilities, and poor incentives for community health workers.

Conclusion: it is important to address HIV-related stigma hence accelerating efforts to limit the spread of the HIV epidemic in the respective communities.