Background

The Programme for Prevention of Mother to Child Transmission of HIV infection (PMTCT) in Tanzania started in year 2000 as a pilot project. The project was established in four referral Hospitals and one regional Hospital namely Muhimbili referral Hospital, KCMC, Bugando, Mbeya and Kagera. In year 2004-2010 the Government of Tanzania scaled up PMTCT services countrywide, and by December 2019 a total of 6,829 health facilities were recorded to provide PMTCT services. These services are implemented under the Reproductive and Child Health (RCH) platform as part of RCH services in routine Reproductive Maternal, Adolescent and Child Health clinics.

In order to reduce new HIV infection in children and to improve maternal survival, WHO (2011) recommended test and treat approach to all HIV pregnant women and breastfeeding mothers regardless of immunological or clinical stage (Option B+), with the assumption that, this approach increases access to ARVs among women, and significantly reduces the risk of mother to child transmission of HIV infections. However, all women diagnosed with HIV infections their blood is collected viral load, CD4 cell count checked and they are clinically evaluated to monitor their progress as they start ART.

In 2012, Tanzania being among the 21 high HIV burden countries, adapted the global elimination agenda for PMTCT and developed the National Plan to Eliminate Mother to Child Transmission of HIV (eMTCT 2012 – 2015). In 2013, the country started the rollout of Life Long ART for Pregnant and Lactating women Living with HIV (LLAPLA) whereby all pregnant and lactating mothers were initiated in a combination therapy of Tenofovir, Lamivudine and Efavirenz (TLE) for them to use for the rest of their life.

Year 2016, marked a new era whereby,the first elimination plan phased out and the second eMTCT strategic Plan II 2018-2021 was developed. eMTCT II endorses the global framework which advocates for three frees; start free, stay free and AIDS free. The framework has the goal to fast track elimination of Mother to Child Transmission of HIV by 2021. On the other hand, HIV response in Tanzania is guided by the Health HIV Sector Strategic Plan IV (HSHSP IV 2017-2022) which adopted the Joint United Nations Programme on HIV/AIDS (UNAIDS) global targets of 90/90/90 plan whose aim is to diagnose 90% of all HIV-positive persons, provide antiretroviral therapy (ART) for 90% of those diagnosed, and achieve viral suppression for 90% of those treated by 2020. The overall goal is to end HIV epidemic by 2030.

Although Tanzania has made significant progress towards achieving the elimination goal, MTCT rates is 9.4% as of December 2019 (UNAIDS spectrum estimates, 2019). The target however, is to reach below 2% by 2025. HIV prevalence among ANC attendees in ANC sentinel surveillance survey was reported to be 6% in 2016. Service coverage for children and retention of mother-baby pairs are major challenges that need to be addressed effectively during this period to reach elimination goal.

As the last mile towards ending AIDS for every child approaches, complacency is dangerous. Sustained commitment to refining the response to ensure that all children and adolescents, especially the most vulnerable, are reached by prevention, testing and treatment well into the future is more essential than ever.

Vision

The programme contributes to the national Vision 2025 that identifies health as one of the priority sectors contributing to a higher-quality livelihood for all Tanzanians. This is being attained through strategies, which ensure realisation of the following health service goals:

• Access to quality primary health care for all;
• Access to quality reproductive health services for all individuals of appropriate ages;
• Elimination of new HIV infections and related deaths among children, women and their families.

Mission

Provision of equitable, gender sensitive, quality PMTCT services for HIV free generation.

National eMTCT Goal 2018 - 2021

To achieve a nation with children born free of HIV infection, helping them navigate adolescence and youth stage free of HIV, and attain healthier life trajectories.

Strategic Objectives

1. To foster evidence based planning, results based management and coordination of the PMTCT program in Tanzania
2. To improve quality of PMTCT care through mentoring, accreditation/star rating of health facilities providing PMTCT and RMNCH services.
3. To increase community dialogue, participation and accountability for quality and equitable PMTCT care
4. To develop accountability and resilience mechanisms, through monitoring, evaluation, and learning
5. To improve responsiveness of health logistic systems towards PMTCT care demands

Impact Results

1. Eliminate new HIV infection at end of exposure, among HIV exposed infants from 7.6 % in 2016 to below 2% in 2021
2. Reduce proportion of adolescents and young women among PLHIVs from 14% in 2016 to 4% by 2021
3. Increase access to ART among HIV infected children from 60% in 2016 to 95% by 2021

Four elements of a comprehensive approach to PMTCT

A comprehensive approach to PMTCT consists of four elements that guide interventions

1. Primary prevention of HIV among women of childbearing age and their partners
2. Prevention of unintended pregnancies amongst women living with HIV
3. Prevention of vertical transmission of HIV from mothers to their infants
4. Provision of treatment, care and support to women living with HIV and their partners,infants, and families.