Title

Diagnose one, link one1 (D1L1): Strategy increases new HIV diagnoses and improves testing yield among key and vulnerable populations in Tanzania

Presenter

Caterina Casalini

Authors

C. Casalini¹, G. Mbita², N. Rutabanzibwa¹, D. Mjungu¹, M. Ndolichimpa¹, M. Katabalila¹, E. Mlanga³, G. J.Lija⁴, A. Komba¹, K. Curran⁵

Institutions

¹Jhpiego, Program, Dar es Salaam, Tanzania, United Republic of, ²Jhpiego, Research, Dar es Salaam, Tanzania, United Republic of, ³USAID, Dar es Salaam, Tanzania, United Republic of, ⁴NACP, Dar es Salaam, Tanzania, United Republic of, ⁵Jhpiego, Baltimore, United States

Background: The 2016-17 Population HIV Impact Assessment suggests that Tanzania is not on track to reach the first 90 of UNAIDS'' 90-90-90 goals. Sauti is a PEPFAR/USAID funded project which provides combination HIV prevention services including HIV testing and linkage to care to key and vulnerable populations (KVP) in 14 regions of Tanzania. HIV testing services (HTS) are provided on an outreach basis in hotspots such as bars, brothels, mines and truck stops, or in homes in the case of HIV-exposed partners and children of index cases. In fiscal year (FY) 2017 (Oct 2016-Sept 2017) Sauti aimed to test 541,682 and diagnose 37,450 individuals, but halfway through the year had reached 43% of the testing target and 23% of the new diagnosis target, respectively.
Methods: Due to mid-year achievement concerns, in May 2017 project leadership communicated a new strategy, “Diagnose One, Link One” (D1L1), to Sauti''s 290 frontline HTS providers. The strategy consisted of: 1) Daily providers'' target allocation; 2) Daily providers'' performance monitoring and guidance using WhatsApp groups; 3) Effective use of GIS and data dashboards to guide HTS delivery; 4) Efficient leveraging of services and resources across partners and project-platforms. We conducted a two-population proportions z-test to compare the increase of HIV yield between Q4 and Q1.
Results: By year-end FY 2017, Sauti project had tested 505,274 and diagnosed 35,920 HIV infected KVP, 93% and 95% of the annual target. In Q1 and Q2, the project identified 1,524 and 7,614 new HIV positive KVP, respectively, compared to 10,862 in Q3 and 15,920 in Q4. These findings represent an increase in HIV yield as well as total clients diagnosed, from 4-5% in Q1 and Q2, to 8% in Q3 and 11% in Q4, a trend observed among all sub-populations (See Fig 1). The 7% increase in yield between Q1 and Q4 was statistically significant (p< 0.001, z=8.5562).
Conclusions: A rapid increase in both new HIV diagnoses and HIV testing yield among KVP was observed following the introduction of the Diagnose One, Link One performance monitoring strategy. Similar approaches could help community based HTS programs achieve the first 90 of the UNAIDS'' 90-90-90 goals.

[Figure 1.Quarterly progress in number and percentage tested positive, by population category, FY17 ]

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