What I’m doing in Tanzania
I’m in Tanzania for another two weeks gathering information to write a research proposal to study the equivalence of providing home-based vs. clinic-based care and treatment for people living with AIDS who qualify for treatment. The proposed research will largely replicate findings from a study in Uganda that was published last year in The Lancet. Our innovation is how we sample study participants. In the Uganda study, participants were selected from clinic rosters. In our study, we propose to use clinic rosters, but also identify participants via mobile HIV testing in communities selected for the trial.
It all sounded like a great idea when I proposed it with SIC to 3ie a year ago… so good they gave us the seed money for the information gathering to write the proposal. Unfortunately, it turns out the study as we imagined it is not within the Tanzanian Ministry of Health/National AIDS Control Programme (NACP) guidelines for AIDS treatment and care. First, the Uganda study used lay workers (not doctors or nurses). Second, they provided services in the patient’s home. Neither of these aspects of care are allowed in Tanzania. In fact, no AIDS patient services except social and material support has been allowed in the home. There are two organizations that have been allowed to provide home-based HIV testing, but no others, despite the overwhelming positive response to home-based testing (over 95% of people accepted testing in their home–similar to study findings in Malawi, especially among the poor).
A colleague from Africare, a partner organization to SIC, suggested altering the study proposal to rigorously test the impact of the home-based care that is allowed in Tanzania (the provision of social and material support to AIDS patients by community health workers). There isn’t evidence of any impact, and donors are questioning whether they should continue to support it, especially in this current era of tightened budgets. I’m keeping that as an option, but will have to do a proper literature review to see if it’s been done elsewhere (even if the colleague believes it has yet to be done in Tanzania).
Next week I’ll be in Babati, where I’ll meet with and listen to the frontline healthworkers and support groups caring for AIDS patients in remote areas.