Tailored Approaches to Improve Early Infant Diagnosis Coverage and Outcomes in Tanzania

ART coverage, particularly in infants and young children, is low due to inadequate coverage and utilization of early infant diagnosis (EID) services. Challenges in follow-up of HIV-exposed infants during the postpartum period persist, highlighting the need for timely uptake of virological testing. Tanzania's goal for the elimination of mother-to-child transmission of HIV aims to reduce new HIV infections among HIV-exposed infants from 7.6% in 2016 to below 2.0% in 2021. However, HIV-exposed infant enrollment into care after birth declined from 70.4% in 2015 to 62.2% in 2019. HIV testing in the form of dried blood spot (DBS) testing among exposed infants significantly dropped from 79.0% in 2015 to 58.1% in 2019. The USAID Boresha Afya North/Central Zone project in Tanzania implemented tailored strategies to support mother and infant pairs, focusing on retention and addressing identified gaps in the HEI cascade. An adapted package of PMTCT services was developed, emphasizing increased coverage and uptake of ARVs and viral load testing among HIV-positive pregnant women and breastfeeding mothers and their infants attending post-natal care. Implementation of the multi-faceted response led to several valuable lessons, including the importance of utilizing mother-baby cohort registers for longitudinal cohort monitoring, introducing new tools such as the cohort monitoring register, and ensuring provision of health education for pregnant women on how to live with HIV and prevent their infants from acquiring HIV. Leveraging experience sharing platforms and investing in improved data capture also enhanced awareness of real-time trends and strengthened implementation of EID services and referrals. The array of approaches employed in the USAID Boresha Afya North/Central Zone project resulted in improved EID coverage and outcomes from 2017 to 2021. Overall EID coverage improved from 81% in 2017 to 90% in 2021, with EID coverage specifically within 2 months of birth improving from 64% to 77%. The percentage of HIV-exposed infants with a documented final outcome increased from 61% to 88%, and the positivity among infants with a documented outcome by 18 months dropped from 6.1% to 2.8%.