1. 5 th National Quality Improvement Forum Hyatt Regency Hotel, Dar es Salaam 26 -27 August 2015 Presented by: Pendo Bukori Increasing HIV Testing and Counselling uptake through integration with Cervical and Breast cancer screening: A case study in Tanzania

2. Background Although HIV prevalence is high among adults in Tanzania (5.1%), uptake of routine HIV Counselling and Testing (HCT) is about 50% despite several innovations (VCT &PITC) which are used. With high burdens of cervical and breast cancer in Tanzania, THPS facilitated integrated screening for the three conditions.

3. Objective To increase uptake of HIV testing and counselling during cervical and breast cancers screening To determine effectiveness of integration of cervical and breast cancers screening in improving HTC

4. Methods Between 2011- 2014 THPS facilitated four major and 14 small community mass screening campaigns integrating HTC, cervical and breasts cancers. Community sensitization was conducted prior to campaigns. Health Providers were not from the vicinity of the campaign area. One event was conducted outside health facility. Assumption data collected in one campaign is comparable to quarterly data routinely collected within the same locality.

5. Mass screening campaign event in Pwani region

6. Results In integrated mass screening (19 days) a total of 5,620 clients were tested for HIV equivalent to 296 clients per day. Out of whom 285 clients, equivalent to 16 clients per day were HIV positive. During the same period (spread in eight quarters or 528 days), 23,232 clients, equivalent to 44 clients per day were screened; out of whom 850 clients were HIV positive, equivalent to 1.6 clients per day.

7. HTC in routine vs. integrated health services, 2011-2014 Event/Period HIV testing RoutineIntegrated ScreenedHIV positive ScreenedHIV+ Total Per dayTotal per dayTotalPer dayTotalPer day World AIDS Day Mtwara November 2013551869153617816 5 Kerege campaign, September 2013 0 0 00 57019020 7 Mkoani, Chalinze, Bagamoyo and Ikwiriri campaigns 20143,42351 326 5272490887 29 Kerege campaign November 20140 0 0 02297614 5 Other small campaigns (2012 - 2014)19,258 42 455 11561223158 23 Total23,23244 8501.65,620295.729515.5

9. Discussion: Access to integrated health services offered in a campaign model reached many people within a short period of time. Routine services are essential; however periodical sensitization and campaigns addressing HIV and other reproductive health challenges can stimulate people to seek health services. Flexibility during campaigns (service provided up to 6:00 pm and weekends) and swapping of routinely known providers may be associated with increased uptake.

10. Conclusion and recommendation: Integration increased uptake of HTC services in Pwani and Mtwara regions. Although mass screening involve additional financial/human resources, it is still cost effective in reaching more people within a short period in HIV populations with high prevalence. Further studies are recommended to determine cost effectiveness for early diagnosis of HIV especially at hot spots.

11. Acknowledgements All Clients served in Mtwara and Pwani regions Regional and Council Health Management Teams for Mtwara and Pwani. TACAIDS & MEWATA Ministry of Health and Social Welfare CDC and PEPFAR

12. Thank you