Both interim and renewal funding for a total $79 million have been approved to assist in Tanzania's efforts to combat an HIV epidemic that has infected an estimated 1.6 million of the country's nearly 48 million people.
Interim funding of $51 million for grant TNZ-809-G13-H will cover about 70% of the antiretroviral shortfall and allow Tanzania to achieve its HIV treatment targets of some 650,000 people by July 2015. The Global Fund Secretariat estimates that some 460,000 Tanzanians are on ART.
The balance of $28.3 million was awarded in incremental renewal funding for grant TNZ-405-G06-H, implemented by Population Services International (PSI).
In Phase 2, comprehensive services for the prevention of mother-to-child transmission of HIV (PMTCT) are expected to cover 4,914 of the 5,972 health facilities that provide reproductive health care services in Tanzania, which is a more than four-fold increase from 1,100 sites that provided ARVs in December 2012.
The PSI grant will fund HIV prevention by increasing correct and consistent condom use; and by increasing the adoption of safer sexual behaviour and reducing risk-taking behaviour among target key populations: female sex workers and men who have sex with men (MSM). The targets are to reach 15,132 female sex workers and 9,079 MSM with prevention services.
Tanzania is experiencing a mix of a generalised epidemic and concentrated epidemics among specific key affected populations. Although a significant proportion of new infections are occurring in key populations, accurate estimates of the size of these populations have not been established. The GAC said that programming for key populations in Tanzania is relatively new.
When it reviewed the two funding requests, the Technical Review Panel (TRP) found them to be technically sound in light of Tanzania’s adoption of a more effective first-line ARV regimen (using tenofovir) and Option B+ for preventing mother-to-child transmission of HIV. The TRP also expressed concerns about the limited access to early infant diagnosis and about the high TB mortality rate. The TRP recommended improving access to optimum care and treatment for babies exposed to HIV; developing tracking mechanisms to actively identify and follow up HIV-positive pregnant women and their newborns; and strengthening existing mechanisms to screen TB patients for HIV infection and to make appropriate referrals. These recommendations will be addressed during grant-making.
The TRP urged PSI to develop a clear implementation strategy that considered changes in HIV epidemiology and to demonstrate how proposed prevention activities will address identified gaps and issues, including the reported decline in condom use among men who pay for sex. Given that young women are more likely to be HIV-positive than young men, and given that married women are especially vulnerable, the TRP questioned how PSI arrived at what it considered to be an underestimation of the needed number of female condoms for its Phase 2 request.
The TRP also required more clarification in PSI plans to scale-up condom distribution beyond the capital, Dar-es-Salaam, and especially to the eight regions with increasing HIV seroprevalence that were identified during the 2011-2012 HIV/AIDS and Malaria Indicator Survey. These issues will also be addressed during grant-making.
The TRP noted that the two funding requests were focused on addressing only the current ARV funding gap and specific interventions related to prevention. To prepare for the full rollout of the new funding model, the TRP said, Tanzania needs to urgently understand and address the underlying issues highlighted by the survey.
For its part, the GAC underscored the need to strengthen TB/HIV collaborative activities. The GAC said the programme should push harder to refocus on geographical hot spots, ensuring equitable access and coverage of ARVs, and on prioritising and targeting high transmission regions. The GAC expressed concern that the requests for funding did not address the needs of people who inject drugs (PWID) despite the rapidly escalating epidemic within this population. The GAC said Tanzania was fostering a conducive environment for relatively modest investments that could achieve maximum impact among PWID.
Also evoking concern by the GAC was the lack of a single responsible agency for condom coordination, which is currently perceived as an NGO activity. All of these issues will be addressed during grant-making.
Information for this article was taken from Board Decisions GF-B30-EDP3 and GF-B30-EDP4 and from GF-B30-ER2, the Report of Secretariat Funding Recommendations. These documents are not available on the Global Fund website.