Abstract
In 2008, USAID procured two HIV Testing and Counseling (HTC) projects, Angaza Zaidi and Universal HIV and AIDS Intervention for Counseling and Testing (UHAI-CT), both with indicators and targets aimed at contributing to increased use of HIV/AIDS prevention to care services and products. The primary goal of the Angaza Zaidi project is to improve the health of Tanzanians by ensuring that they know their HIV status, take steps to protect themselves, and have better quality of life if infected. The Angaza Zaidi technical approach uses three modalities: (1) integrated voluntary HTC; (2) stand-alone HTC; and (3) community-based HTC. Implementation is guided by strategies of: (1) targeting; (2) decentralization and community engagement; (3) branding; (4) partnerships and sub-granting; (5) advocacy; and (6) counseling and testing systems strengthening. The primary goal of the UHAI-CT project is to increase access to testing and counselling services to Tanzanian families, couples, and individuals, particularly those at high risk, and to link those found to be HIV-positive to relevant HIV care, treatment, and prevention services. The UHAI-CT technical approach is guided by the principles of: (1) innovation; (2) rapid expansion; (3) diversity of strategies; (4) quality; (5) sustainability; (6) strong links to HIV care; and (7) treatment and cost effectiveness. UHAI-CT activities are implemented using Providor Initiated Testing and Counseling (PITC) and community outreach. Main questions for this program evaluation were the following: (1) has each project achieved its stated goals and objectives; (2) what are each project's strengths, weaknesses, and gaps in planning, management, routine data use, and service delivery; (3) how did each project strategically use different HTC modalities to achieve its goals and objects [and] were these modalities effective in reaching the target populations [and] what are the lessons learned from successful interventions that merit continuation or replication, better practices, significant products and tools for possible dissemination and replication; (4) was each project able to successfully refer newly-identified HIV-positive clients to HIV care and treatment facilities [and] what systems were used during these referrals; (5) how has each project built capacity and/or institutionalized its practices to heighten opportunities for sustainability [and] were these efforts successful. 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)