Reaching men in Tanzania right time right place

Reaching men in Tanzania ✔�right time ✔�right place ✔�right service model Dr. Gissenge J. Lija, National AIDS Control Program Ministry of Health, Community Development, Gender, Elderly and Children, Tanzania

HIV in Tanzania • HIV prevalence (national, ages 15– 64): 5. 0% • Prevalence ranged from 11. 4 percent in Njombe to less than one percent (<1%) in Lindi and Zanzibar • Male 15– 64 years: 3. 5% • Female 15– 64 years: 6. 5% • HIV incidence (national, ages 15– 64): 0. 29% • 81, 000 new cases of HIV annually • Male 0. 17% • Female 0. 40% Source: Tanzania HIS 2016– 2017

Sex disparities across the cascade Tanzanian males are less likely than females to know their HIV status, be on ART, and/or be virally suppressed Source: Tanzania HIS 2016 -2017

Right Place and Time GIS Mapping of Men Hot Spots Demand Creation by Men Community Based HIV Service Providers When ? • Bar, night clubs • Brothels, Guest houses • Fishing villages • Mining communities • Plantations • Truck / taxi drivers parking • Private residences Where? Interventions 1. Mobile Biomedical Services Risk assessment and counseling HTS/Partner Notification/Incentivized Peer Network and HIVST* FP Services STI screening STI periodic presumptive treatment* Condom Promotion and Provision TB screening GBV screening Alcohol and drug screening Escorted referral CTC, GBV services, RCHS Pr. EP* Community ART 2. SBCC Curriculum-based education* 3. SASA! community dialogues to address gender norms and violence *Key Populations only From Mondays to Saturdays, Day and Night (Moonlights)

Right Place: Men Reached in Community Based Testing Figure 1. Distribution by population group, among HTS to Men, Oct 2107 to Jun 2018 1% • 735, 922 key and vulnerable adults who received HTS 336, 336 (46%) were men • 37% (10, 782) of HIV positive were men • HIV yield increased by age; sharp increase from ages 40+ particularly among PFSW and MSM (Figure 2) • About 87% are new HIV+ PFSW 70% • Among all men who received community HTS, majority were: • ages 25– 29 (32%) followed by ages 30– 34 (18%) • PFSW (70%), defined as reporting paying for sex within past 12 month; followed by other hot-spot populations (28%) and MSM (1%) (Figure 1) MSM 28% OHSPM Figure 2. HIV Yield, by men sub-population and by age, 1 Oct 2017 to 30 Jun 2018 14. 0% 12. 0% 10. 3% 9. 5% 10. 0% 8. 0% 7. 4% 6. 0% 4. 4% 4. 0% 2. 0% 0. 0% 2. 5% 1. 2% 15 -19 4. 7% 2. 3% 5. 1% 3. 0% 4. 8% 3. 9% 5. 2% 4. 7% 0. 9% 20 -24 OHSPM Yield 25 -29 30 -34 MSM Yield 35 -39 40 -49 PFSW Yield 50+

Right Service Models Community HTS

Right Service Model: Social Networks One third of all the HIV+ KP (MSM) were reached through Incentivized Peer Network, with a yield 3 times higher than the routine mobile service

Partner Notification for HIV Testing Services in Tanzania, Study Conducted June to September 2015 • Male index clients were 2. 3 times more likely to successfully refer their female partners compared to female index clients and 5 times more likely to list multiple partners • Male index clients more likely to successfully refer, this may be an important way to increase male involvement in HTS • Female partners may need additional support to list and refer male partners

Right Service Model: Enhanced Index Testing Focus on scaling up index testing across Tanzania

Shifting to Targeted Testing in Voluntary Medical Male Circumcision 2. 9 million men reached with VMMC including HTS since 2009 Screening tool piloted with 1000 VMMC clients to assess sensitivity VMMC Client HIV Status in 3 Regions by Age, September 2009 and June 2016

Recommendations • Continue to use mapping technology and community outreaches to meet men where they are • Female index partners may need additional support to successfully refer male partners • Given the 3 x higher yield and overall high acceptability rate, social network testing is an important strategy to reach undiagnosed men • Reaching partners of female sexual workers is an important strategy to find undiagnosed men given high prevalence in this population • HIV self testing to reach this men

Conclusion • Tanzania utilizes technology, current data and research to identify the right place and right time to offer services • Tanzania offers various approaches to ensure the right service model for maximum male engagement in HTS including: • • partner tracing mobile and community outreach social network testing targeted testing among VMMC adolescent clients

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