With PEPFAR's support, Pact and partners transform Tanzania's battle against HIV

In the early 2000s, before the launch of the President's Emergency Plan for AIDS Relief, or PEPFAR, Tanzania was grappling with a formidable foe: the HIV/AIDS epidemic. With no access to life-saving antiretroviral drugs (ARVs), there was little that could be done for those diagnosed with HIV.

Dr. Leonard Maboko, the former executive director of the Tanzania Commission for AIDS, vividly recalls those challenging times.

“Without the hope of treatment, health care for our research participants and other people diagnosed with HIV focused on counselling to prepare them for the end of life,” Maboko remembers.

The first wave of HIV hit Tanzania in 1983, and the Kagera region, nestled in the country's northwestern corner, bore the brunt of the devastation. Although the Tanzanian government and other organizations made efforts to respond, limited resources hindered progress. Stigma, discrimination and deeply ingrained societal beliefs, including ancestral practices and witchcraft, undermined response measures.

Amid these challenging circumstances, local organizations like HUMULIZA emerged in 1997. HUMULIZA's mission was to mobilize communities and provide vital psychosocial support to those affected and infected by HIV/AIDS in the Kagera region. These grassroots initiatives planted the seeds of transformation that would later flourish with the support of PEPFAR.

For more than a decade, Pact has worked with the government of Tanzania, organizations like HUMULIZA and local communities to transform the local HIV response. Since 2010, Pact has led three major USAID/PEPFAR-funded HIV programs in Tanzania, including Pamoja Tuwale, Kizazi Kipya and now ACHIEVE. Together, the projects have contributed to markedly improved HIV testing, treatment and prevention for the most vulnerable, reaching more than 5 million orphans and vulnerable children (OVC) and their caregivers with age-appropriate HIV related services, spanning care, health, nutrition, education, protection, livelihoods and psychosocial well-being.

"With PEPFAR support, we have witnessed the strengthening of community-based health systems,” says Lightness Mpunga, the program manager at HUMULIZA, an ACHIEVE partner.

“There are more facilities with advanced care and treatment options. We have community structures that offer integrated case management services where coordination of referrals and services across a wide range of government sectors – protection, justice, social welfare, HIV and AIDS, health and education – is done to achieve the best outcomes for children. This provides our clients comprehensive services not only at the facility but also in communities.”

Apart from providing comprehensive health and HIV/AIDS services, Pact works to build the capacity of the national and community-level health and social services workforce, as well as systems and structures to ensure the delivery of high-quality services for OVC, children and adolescents living with HIV and HIV-exposed infants, at-risk adolescent girls and young women, and other people living with HIV.

The inadequacy of health and social welfare services significantly amplifies these vulnerable groups' risks. For instance, limited access to health care makes them more susceptible to the adverse effects of their conditions. Inadequate support systems also limit access to education and economic opportunities, perpetuating poverty.

The mobility of individuals, combined with the swift transmission of infectious diseases, underscores that global health security is a shared concern, irrespective of geographic boundaries.

“With PEPFAR, we have spent the past decade-plus building up responses to every need and root cause related to HIV,” says Dr. Levina Kikoyo, the country director for Pact in Tanzania and the Tanzania ACHIEVE project director. “This has changed the course of the epidemic here dramatically.”

Fast forward to the present, and Tanzania's fight against HIV has witnessed a remarkable evolution. In 2009, only 22% of people living with HIV had access to lifesaving ARVs. By 2022, that percentage had soared to over 98%, according to UNAIDS. Concurrently, the number of new HIV infections has plummeted from 98,000 annually in 2010 to 32,000 in 2022, a 68% reduction.

“Working with government of Tanzania and other institutions over 20 years, PEPFAR completely transformed the lives of people living with and at risk of HIV. Prevention and treatment for HIV and AIDS are now accessible in the areas hardest hit by the epidemic, fostering hope, dignity and security for generations to come,” Maboko says. “I am proud to have partnered with the U.S. government in these lifesavings HIV programs for 20 years. When we began, there were fewer than 1,000 people on ARV treatment. Today, there are more than 1.5 million.”

The key to this extraordinary success lies in integrated approaches and partnerships. True transformation in the lives of marginalized people necessitates the cooperation of diverse disciplines and sectors through collaborative partnerships. This creates inclusive programs that amplify impact and ensure long-term sustainability. Community engagement has been at the core of Pact's work, and PEPFAR's support has been instrumental in fostering these efforts.

Dr. Kikoyo underscores this approach.

"Our multifaceted interventions encompass health, livelihoods, early childhood development, environment, capacity development and innovation – all aimed at bringing about systemic improvement in people's lives."

Building local capacity has been especially key.

“By empowering local organizations and communities to take ownership of their development, we are not only addressing immediate needs but also laying the foundation for sustainable development,” Kikoyo says.

“This would not have been possible without PEPFAR.”