Final Results from Tanzania HIV Impact Survey Shed Light on Priorities for Strengthening the Country’s Efforts to Control HIV

Tanzania HIV Impact Survey Launch on April 13, 2019 in Dodoma, Tanzania

Tanzania, which has been one of the countries at the epicenter of the HIV epidemic in sub-Saharan Africa, now has a critical set of data about its progress in addressing HIV among its people – and equally critical insight into the work that still lies ahead.

On April 13, 2019, officials gathered in the Tanzanian capital, Dodoma, to announce the final results of the Tanzania HIV Impact Survey (THIS) 2016-17. The survey, which is part of the multi-country Population-based HIV Impact Assessment (PHIA), was conducted by ICAP at Columbia University in partnership with the Government of Tanzania through the Tanzania Commission for AIDS (TACAIDS) and Zanzibar AIDS Commission (ZAC), funding from the US President’s Emergency Plan for AIDS Relief (PEPFAR) and technical assistance from the U.S. Centers for Disease Control (CDC). THIS provides an important new reference point in Tanzania’s march toward epidemic control within its borders and the global response to HIV at large.

In Tanzania, THIS was conducted between October 2016 – August 2017. It surveyed over 14,000 households and interviewed more than 33,000 adults (15 and older) and 10,000 children (14 and younger). The results provide extensive data on the number of people living with HIV in Tanzania (prevalence), number of new HIV infections occurring each year (incidence) and use of health services by people living with HIV.

At the event, the Minister of State in the Prime Minister’s Office responsible for Parliament, Policy Coordination, Labour, Employment, Youth and the Disabled, Jenista Mhagama, stressed the importance of using the THIS report to inform future HIV program implementation. “The main objectives from the results of THIS 2016-2016, apart from other interventions, is to prevent new HIV infections – for those who are HIV-negative to remain negative – and those found to be HIV positive to be enrolled into care and start ART immediately,” Minister Mhagama said.

Key findings from the report reveal that 5.0% of adults (15-64 years) in Tanzania are currently living with HIV. A large percentage of these adults – nearly 40% – are unaware of their positive status, well-below the UNAIDS target of 90% of all people living with HIV knowing their status by 2020. Conversely, there has been progress in adults living with HIV who are aware of their status, with 93.6% receiving anti-retroviral therapy (ART) and 87.0% of those on ART having viral load suppression.

Minister Mhagama also urged those working on HIV programming to encourage people to volunteer for HIV testing, provide counselling for those found to be living with HIV, and address HIV-related stigma and discrimination.

At the event, the Tanzania Commission for AIDS’ (TACAIDS) Executive Director, Dr. Leonard Maboko, encouraged policy makers, planners and stakeholders to use the report findings to make informed HIV policy decisions.

The findings furnish the government, key health stakeholders and the general public with official statistics for use in planning, policy making, monitoring and evaluating programs on HIV,” stated Dr. Maboko.

After the report’s release, the National Council of People living with HIV and AIDS (NACOPHA) announced that the results will be used to design awareness campaigns on prevention, medication and stigma for people living with HIV in Tanzania.

For additional information and access to the final report, visit:

THIS was led by the Government of Tanzania through the Tanzania Commission for AIDS (TACAIDS) and Zanzibar AIDS Commission (ZAC), and the Ministry of Health, Community Development, Gender, Elderly and Children (MoHCDGEC), the Ministry of Health Zanzibar (MoH), National Bureau of Statistics (NBS) and the Office of Chief Government Statistician (OCGS). THIS was conducted with funding from the U.S. President’s Emergency Plan for AIDS Relief (PEPFAR) and technical assistance through the U.S. Centers for Disease Control and Prevention (CDC) and ICAP at Columbia University.

From Arm to Freezer: PHIA Project Laboratory Network Supports Ambitious HIV Testing Targets

How can a large public health survey in sub-Saharan Africa collect blood samples efficiently? Is it possible to perform sophisticated lab tests in people’s homes? What is the best way to transport samples collected from remote locations? The Population-based HIV Impact Assessment (PHIA) Project, which relies on laboratory testing of blood samples as a core component, is providing answers to these questions. Led by ICAP at Columbia University, the PHIA surveys will assess the HIV epidemic in 13 select countries located primarily in sub-Saharan Africa. Fieldwork is nearly complete in three countries, with ten more national surveys to follow over the next two to three years. The surveys depend on well-trained staff and sufficient laboratory infrastructure to collect, test, and transport blood from individuals in approximately 15,000 households in each country.

Conducted in partnership with ministries of health and the Centers for Disease Control and Prevention (CDC), with support from the U.S. President’s Emergency Plan for AIDS Relief (PEPFAR), the PHIA Project draws on the expertise of ICAP and its partners for all aspects of its laboratory activities, from facility selection to staff training, laboratory setup, and quality assurance. Critical support in these areas has come from the CDC’s International Laboratory Branch, which builds sustainable laboratory capacity in PEPFAR-supported countries.

Currently, throughout Zimbabwe, Malawi, and Zambia, PHIA survey teams are visiting thousands of households to collect blood samples and perform rapid HIV tests, point-of-care CD4 tests, and in some countries, hepatitis B and syphilis rapid tests. While many other population-based surveys have collected a few drops of blood through a finger prick, the PHIA surveys collect two test tubes of blood from a vein in order to have both whole blood and plasma for testing. Participants receive test results within minutes, in the privacy of their homes. But that is not the final stop for each blood sample.

Quality assurance testing is performed in nearby satellite laboratories to ensure that the initial field test results are accurate. “All HIV-positive samples are retested using the Geenius HIV-1/HIV-2 test in the satellite lab to confirm the results,” says Dr. Herbert Longwe, one of ICAP’s regional lab advisors for the PHIA Project. “We also retest the first 50 of each field worker’s samples and 5 percent of all HIV-negative samples with the same rapid test kits to ensure accurate and trustworthy results.” Dried blood spots are prepared and then plasma and blood cells are separated, steps necessary for further testing. With a targeted “arm-to-freezer” time of less than 24 hours, the samples are then placed in a freezer and sent to a central lab for HIV incidence and HIV viral load testing, as well as for long-term storage.

The last steps in the testing process consist of specialized tests such as viral load testing to measure the quantity of HIV RNA in plasma, HIV incidence assays, DNA-PCR for HIV diagnosis in HIV-exposed infants, assays to detect antiretroviral agents, and HIV drug resistance testing. The two latter tests will be performed after survey completion at labs in several locations, including South Africa and Zimbabwe. The detailed data these additional tests provide can help improve HIV programming at local and national levels by indicating what percentage of people on treatment have achieved viral load suppression, a measure of whether they are on treatment and if treatment is working well.

To handle samples collected in remote locations in Zambia and Tanzania, PHIA teams are using mobile labs to ensure specimen quality. The mobile labs are fully equipped with a centrifuge, refrigerator, a -20⁰ C freezer, and basic supplies. “Mobile labs are an innovative way to handle samples when other labs are not close enough,” says Dr. Yen Pottinger, ICAP’s PHIA senior technical advisor for laboratory.

As part of the focus on high-quality testing and processing of PHIA samples, the PHIA team conducts instrument verification and assay validation to ensure tests are accurate and reliable. Working together, CDC’s International Lab Branch and ICAP monitor the accuracy of the HIV testing in the field and provide ongoing reviews to ensure each and every staff member’s proficiency with the techniques they learned in lab training.

“It was a challenge to create, but the PHIA Project now has a simple, workable quality assurance system in place, and this is one of the most exciting things I’ve seen in my career,” Longwe observes.

HIV viral load results are returned to a health facility of the participant’s choice, where they can consult with a health care provider to interpret the results and gain a greater understanding of their health status. Providing these results to participants is another innovative aspect of the PHIA survey. “Viral load testing is not yet routinely available in many of the survey countries. By returning the results within about eight weeks, the PHIA Project is making it possible for HIV-positive individuals and their doctors to have access to important clinical data to help manage their treatment,” says Pottinger.

PHIA’s complex network of satellite labs is helping the survey teams perform a high volume of HIV tests at the community level—more than 30,000 in Zimbabwe since October, more than 23,000 in Malawi since November, and more than 27,000 in Zambia since March—with accuracy. The systems established by CDC and ICAP also demonstrate the benefits of strong partnerships for a large, complex project, and allow the PHIA Project to pave the way for future surveys to handle blood samples.