Abstract
A performance evaluation was conducted of two USAID-funded human immunodeficiency virus (HIV) testing and counseling (HTC) projects in Tanzania. The first, a project titled "Rapid Scale up of Innovative HIV Counseling and Testing Approaches on Tanzania Mainland," is known locally as Angaza Zaidi, and was implemented by African Medical and Research Foundation (AMREF) and partners starting in 2008 with a budget of $16.3 million over five years. The main goal of Angaza Zaidi was to increase the number of Tanzanians who know their HIV status and link those who test positive to care and treatment services. A non-profit affiliate of the Johns Hopkins University, Jhpiego, and partners received $16.5 million USD, also in 2008, to lead the other project, Universal HIV/AIDS Intervention for Counseling and Testing (UHAI-CT) over five years. UHAI-CT's main goal was to increase testing and counseling particularly among high-risk populations. Angaza Zaidi implemented HTC through stand-alone voluntary counseling and testing (VCT), integrated VCT and community outreach, while UHAI-CT implemented HTC through provider-initiated testing and counseling (PITC) and community outreach. The aim of this performance evaluation was to provide USAID/Tanzania, the Government of Tanzania, and other in-country stakeholders with an objective, independent assessment of the efficiency and quality of the performance of these two projects at the national, regional, facility and community-based service levels. To do this, the evaluation team used a cross-sectional design to evaluate the two projects and collected data using a mix of qualitative and quantitative methods in six regions: Iringa, Tabora, Njombe, Tanga, Kilimanjaro, and Dar es Salaam. The evaluation: (1) identifies achievements, implementation gaps and challenges; (2) documents lessons learned and best practices; and (3) provides key recommendations for future programming. The evaluation team concludes that both projects met many, but not all, of their objectives and targets. Although the evaluation documents several weaknesses, both projects had more strengths than weaknesses. While all of the HTC modalities played a significant role in increasing HTC and reaching different populations, they were not used strategically to reach populations at high risk. Among a number of key lessons learned by both projects is the necessity for a decentralized approach to project management in Tanzania to facilitate project monitoring, communication, and stakeholder engagement. Neither project created a robust, traceable linkage system to ensure HIV-positive clients are linked to care and treatment. However, both projects made measurable progress towards building the capacity of local institutions and institutionalizing practices for HTC. (Excerpt, modified)