PRIME MINISTER'S OFFICE

TANZANIA COMMISSION FOR AIDS

National HIV Prevention Road Map

2023/24- 2026/27

MARCH 2024
 ‘LAST MILE EFFORTS TO
ENDING AIDS AS A PUBLIC
HEALTH THREAT BY 2030’

i|Page
FOREWORD
The Government of Tanzania, through support from multilateral and bilateral agencies, has, for
nearly three decades, in multi-sectoral response efforts to control the AIDS epidemic
nationwide. Significant progress has been registered to date, particularly in the reduction of
AIDS-related morbidity and mortality. With regard to progress towards achieving global goals
and targets, the recently released Tanzania HIV Impact Survey 2022-2023 (THIS 2022-2023)
indicated that 82.7% of individuals aged 15 years and older living with HIV were aware of their
HIV-positive status (84.8% of women and 78.4% of men); amongst those, 97.9% were on ART
(98.4% of women and 96.7% of men); and out of these, were on ART, 94.3% had achieved
viral load suppression (94.9% of women and 92.9% of men). However, despite this progress,
the rate of decline of new infections remains persistently slow. The survey found that there
were approximately 60,000 new cases of HIV among adults in Tanzania during the survey year
(less than a 50% decline from the 2010 baseline of 110,000). This is far from the global goal to
reduce new HIV infections by 75% by 2020 and makes Tanzania one of the 28 countries
contributing to most of the global total of new HIV infections.

In October 2017, 50 like-minded organizations (UNAIDS Cosponsors, civil society, public and
private sector funding partners, and UN Member States) formed the Global HIV Prevention
Coalition (GPC, or the Coalition), co-convened by UNAIDS and UNFPA. They endorsed the
2020
Road Map as the strategy to achieve the 2016 Political Declaration on HIV prevention targets,
initially focusing on 25 countries that were reporting most of the global total of new HIV
infections. In 2018, three more countries and the Southern African Development Community
(SADC) joined the coalition, totaling 34 members (including countries that have made
significant progress in reducing new HIV infections). Tanzania adopted the HIV Prevention
2020 Road Map, including the 10-point actions. The adopted 2017 - 2020 Road Map was
aligned with the NMSF IV and HSHSP IV and was built around five (5) prevention pillars –
combination HIV prevention for key and priority populations, Combination HIV prevention for
Adolescent Girls and Young Women (AGYW), Comprehensive Condom Program (CCP), Pre-
Exposure Prophylaxis (PrEP), and Voluntary Medical Male Circumcision (VMMC).

In July 2022, the coalition released a new Road Map that charts a way forward for country-level
actions to achieve an ambitious set of HIV prevention targets by 2025. Those targets emerged
from the 2021 Political Declaration on HIV and AIDS, which the United Nations General
Assembly adopted in June 2021 and are underpinned by the Global AIDS Strategy (2021–
2026). The 2025 Road Map builds on the previous HIV Prevention 2020 Road Map and
responds to the need for stronger action against the inequalities that hold back progress. It
takes account of an evolving context that is marked by persistent pandemics and economic
challenges.

In alignment with the GPC guidance, under the leadership of TACAIDS and NASHCoP, the
Government of Tanzania engaged in a multi-stakeholder consultative process to adopt and
domesticate the global Road Map. Therefore, this National HIV Prevention Road Map 2023/24-
2026/27 has been developed to reflect the local context and needs. The domesticated National
Prevention 2025 Road Map is aligned with the Southern Africa Development Community
(SADC) Road Map for Health and HIV and AIDS Sustained Responses, the East and Southern
Africa (ESA) commitments, the fifth National Multi-Sectoral Framework (NMSF V) 2021/22-
2025/26, the fifth Health Sector HIV and AIDS Strategic Plan (HSHSP V) 2021-2026, the fifth
Health Sector Strategic Plan (HSSP V) 2021-2026, the third National Five Year Development
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 Plan (FYDP III) 2021/22 – 2025/26, and the Tanzania Development Vision 2025. Underpinning
the Road Map is the Global AIDS Strategy goal to Ending Inequalities and Getting on Track to
End AIDS by 2030.

The National HIV Prevention Road Map 2023/24-2026/27 sets an ambitious goal to reduce
new HIV infections by 85% in 2025, using 2010 as the baseline. To achieve this, as
emphasized in the NMSF V and HSHSP V, the Road Map acknowledges the importance of
scaling up evidence-based prevention strategies across all population segments at risk,
ensuring equitable reach. Special attention is given to effectively engaging with and providing
comprehensive support to classical key and vulnerable populations (KVPs), including female
sex workers, men who have sex with men, and people who inject drugs alongside adolescents
and young adults. Additionally, the strategies recognize the need to extend these efforts to
other previously underrepresented KVPs (e.g., fisherfolks, miners, long-distance truck drivers,
plantation workers, and the sexual partners of KVPs) to ensure a more inclusive and effective
response. Based on the country’s epidemiological profile, prevention programs will be
intensified among adolescent girls and young women and on key and vulnerable populations,
not forgetting adolescent boys and young men. Recognizing that different people require
different prevention approaches, differentiated care models will be scaled up to tailor
interventions to each person’s needs, including enhanced use of proven community-based
services.

As we stand at the precipice of a pivotal moment in our collective journey towards eradicating
HIV/AIDS, it is both an honour and a duty to present the National HIV Prevention Road Map for
Tanzania, covering the period from 2023/24 to 2026/27. This document is not just a testament
to our resilience and dedication but also a beacon of hope for the future we are committed to
creating—a future where HIV/AIDS no longer shadows our communities but is a challenge we
have overcome together. Our journey has been long and fraught with challenges, yet it is the
unwavering spirit of our people and the steadfast support of our global partners that have
brought us to this juncture. The strides we have made in combating HIV/AIDS reflect a nation
united against a common enemy, armed with compassion, innovation, and an indomitable will
to protect the most vulnerable among us. This Road Map is a culmination of years of research,
dialogue, and collaboration across various sectors. It draws upon the lessons we have learned,
the successes we have celebrated, and the setbacks from which we have rebounded stronger
and more determined. It is a strategic blueprint designed to guide our actions in the next crucial
years as we strive to reduce new HIV infections, improve the quality of life for those living with
HIV, and ultimately, achieve our goal of ending AIDS as a public health threat by 2030. This
document delineates a comprehensive approach that addresses the multifaceted nature of the
HIV/AIDS epidemic. Our strategies are inclusive, evidence-based, and tailored to meet the
unique needs of our diverse population. From enhancing access to preventive services and
expanding treatment and care services to integrating HIV prevention into broader health and
social services, our approach is holistic and grounded in the principles of equity, dignity, and
respect for all.

As we journey forward with the National HIV Prevention Road Map 2023/24-2026/27, we are
called to strengthen our mutual commitment and work towards a future where Tanzania is free
from HIV/AIDS. Our collective resolve and unity are crucial for overcoming significant
challenges. This document is not just a strategy but a rallying cry for all to contribute towards
turning the tide against HIV/AIDS, aiming to end it as a public health threat by 2030 through
our combined efforts, compassion, and dedication.

Dr. Jim J. Yonazi

Permanent Secretary
Prime Minister`s Office – Policy, Parliamentary Affairs and Coordination

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ACKNOWLEDGEMENTS

The Tanzania Commission for AIDS (TACAIDS) wishes to acknowledge the tremendous
contributions of all the stakeholders who participated in developing the HIV Prevention Road
Map for Tanzania Mainland. This process was successful because of the great spirit of
teamwork, collaboration, and partnership demonstrated by all the stakeholders.

On a special note, TACAIDS would like to thank UNAIDS, UNFPA, and UNICEF for their
technical and financial support throughout this process. TACAIDS is also grateful for technical
inputs from PEPFAR and the Global Fund. Additionally, we would like to give a special note of
thanks to members from Ministries, Departments and Agencies, Research and Academic
Institutions, Development Partners (UNICEF, UNDP, WHO, CDC, USAID, DoD, and WHO),
Implementing Partners, Civil Society Organizations, Prevention Technical Working Group,
AYAS Sub-TWC, KVP Sub-TWC, and the Condom Sub-TWC who engaged in this exercise.

We would also like to recognize the UNAIDS technical team led by Dr. Bonaventura Mpondo
(Advisor – Service Implementation for All) and Dr. Grace Mallya (Advisor – Gender, Equality
and Human Rights) for their tremendous technical input. Special thanks to the TSM team for
their tremendous input towards developing this guidance.

Finally, we would like to thank the consultants, Dr. Albert Komba (Lead Consultant) and Dr.
Dereck Chitama (Costing Consultant), who supported and facilitated the process.

Dr. Jerome Kamwela

ACTING EXECUTIVE DIRECTOR
TANZANIA COMMISSION FOR AIDS

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ACRONYMS

ABYM Adolescent Boys and Young Men

ABC/M Activity-Based Costing and Management
AGYW Adolescent Girls and Young Women
AIDS Acquired Immune Deficiency Syndrome
ANC Antenatal Care
ART Anti-Retroviral Therapy
ASM Age Structured Model
ATE Association of Tanzania Employers
AYAS Adolescent and Young Adult Stakeholders
CABLA Long-Acting Cabotegravir
CC Constant Coverage
CCP Comprehensive Condom Programming
CDC Centers for Disease Control and Prevention
CSE Comprehensive Sexuality Education
CSO Civil Society Organizations
DCEA Drug Control Enforcement Agency
DHIS District Health Information System
DoD Department of Defense
DRMCH Directorate of Reproductive, Maternal and Child Health
DPP Directorate of Policy and Planning
DSDM Differentiated Service Delivery Model
EIMC Early Infant Male Circumcision
ESA Eastern and Southern Africa
FBO Faith-Based Organization
FCI Faith-Based Community Initiatives
FHR Female at High Risk
GBV Gender-Based Violence
GC Grant Cycle
GDP Gross Domestic Product
GF Global Fund
GPC Global Prevention Coalition
HAPCA HIV/AIDS Prevention and Control Act
HIV Human Immunodeficiency Virus
HLI Higher Learning Institution
HSHSP V Health Sector Strategic Plan V
HTS HIV Testing Services
IBBS Integrated Biological and Behavioral Surveillance
IEC Information, Education, and Communication
JTWG Joint Technical Working Group
KP Key Population
KVP Key Vulnerable Population
MPT Multipurpose Prevention Technology
MSD Medical Stores Department
MTCT Mother-To-Child Transmission
MoH Ministry of Health
MOJCA Ministry of Justice and Constitutional Affairs
MOEST Ministry of Education, Science and Technology
MOT Modes of Transmission
MHR Men at High Risk
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M-TEF Medium-Term Expenditure Framework
NAC National AIDS Council
NASHCoP National AIDS, STI, and Hepatitis Control Program
NHIF National Health Insurance Fund
NGO Non-Governmental Organization
NMSF V National Multisectoral Strategic Framework V
NSP National Strategic Plan
O-CCF Optimization- Constant Coverage Funding Scenario
OST Opioid Substitution Therapy
PEP Post-Exposure Prophylaxis
PEPFAR President's Emergency Plan for AIDS Relief
PLHIV People Living with HIV/AIDS
PMO Prime Minister's Office
PMTCT Prevention of Mother-To-Child Transmission
PO-RALG President's Office - Regional Administration and Local Government
POPSM GG President’s Office Public Service Management and Good Governance
P-SAT Prevention Self-Assessment Tool
PTWC Prevention Technical Working Committee
PWID People Who Inject Drugs
RCA Root Cause Analysis
RLA Research and Learning Agenda
RMNCAH Reproductive, Maternal, Neonatal, Child, and Adolescent Health
RNM Resource Needs Module
SBCC Social and Behavioral Change Communication
SoP Standard Operating Procedures
SRH Sexual and Reproductive Health
SRHR Sexual and Reproductive Health and Rights
SRHS Sexual and Reproductive Health Services
STIs Sexually Transmitted Infections
SWOT Strengths, Weaknesses, Opportunities, Threats
TAC Technical AIDS Committee
TasP Treatment as Prevention
TMA Total Market Approach
TWC Technical Working Committee
U=U Undetectable Equals Untransmittable
UHC Universal Health Coverage
USAID United States Agency for International Development
VAM Violence Against Men
VAWC Violence Against Women and Children
VEO Village Executive Officer
VMMC Voluntary Medical Male Circumcision
VMAC Village Multi-Sectoral AIDS Committee
WEO Ward Executive Officer
WHO World Health Organization
WLHIV Women Living with HIV
WMAC Ward Multi-Sectoral AIDS Committee
ZBTC Zonal Blood Transfusion Centre

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e
TABLE OF CONTENTS
FOREWORD ..........................................................................................................................iii
ACKNOWLEDGEMENTS .......................................................................................................iv
ACRONYMS ...........................................................................................................................v
1.0. INTRODUCTION ............................................................................................................11
01
1.1. Background ............................................................................................................11
03
1.2. Tanzania’s First National HIV Prevention Road Map 2017-2020 .........................13
01
2.0. CURRENT SITUATION OF PREVENTION IN MAINLAND TANZANIA ..........................14
04
2.1. Tanzania’s HIV Epidemiological Profile ...............................................................14
04
HIV prevalence .................................................................................................................14
04
HIV incidence ...................................................................................................................16
06
Vertical Transmission of HIV Infection...........................................................................16
06
Comprehensive Knowledge of HIV and High-Risk Sex Behavior .................................17
07
08
AIDS-Related Mortality ....................................................................................................21
2.2. Status of the Implementation of HIV Primary Prevention Interventions ............21
10
11
PILLAR 1: Combination Prevention for Key Populations .............................................23
PILLAR 2: Combination Prevention for Adolescent Girls and Young Women in High-
13
Prevalence Locations. ...........................................................................................24
PILLAR 3: Combination Prevention for Men and Adolescent Boys in Settings ..........25
14
with High HIV Incidence ..................................................................................................25
14
PILLAR 4: Promotion of Condoms .................................................................................25
14
PILLAR 5: Wider Access to Antiretroviral Based Prevention, including Pre-Exposure
Prophylaxis (PrEP) and Post-Exposure Prophylaxis (PEP) ................................26
15
2.3. Prevention Programming Focus Informed by Modeling the Impact and Cost of
16
the HIV Interventions ..........................................................................................................27
3.0. DEVELOPING TANZANIA’S NATIONAL HIV PREVENTION 2023/24 – 2026/27 ROAD
19
MAP ...............................................................................................................................31
3.1. Need to Adopt the Global HIV Prevention 2025 Road Map .................................31
19
3.2. Purpose of the National HIV Prevention 2023/24 -2026/27 Road Map ................32
20
3.3. Approach to Road Map 2023/24 – 2026/27 Domestication Process ...................33
21
3.4. Guiding Principles .................................................................................................34
22
4.0. HIV PREVENTION STRATEGIC PRIORITIES, INTERVENTIONS AND TARGETS ......35
23
4.1. Strategic Priorities for the 2023/24 – 2026/27 Road Map .....................................35
23
4.2. 24
HIV Prevention Interventions ................................................................................36
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 4.3. Key Elements of the 2023/24 - 2026/27 Road Map ...............................................38
26
5.0. THE 10-POINT ACTION PLAN TO ACCELERATE HIV PREVENTION IN MAINLAND
TANZANIA (2023/24 - 2026/27) .....................................................................................38
26
5.1. The Adopted 10-Point Action Plan for Tanzania Mainland..................................39
27
5.2. 28
Operationalizing the 10-Point Action Plan ...........................................................40
6.0. STAKEHOLDERS’ ROLES AND RESPONSIBILITIES IN NATIONAL HIV PREVENTION
EFFORTS ......................................................................................................................53
40
55
7.0. FINANCING THE HIV PREVENTION ROAD MAP 2023/24 - 2026/27 ...........................69
7.1. 55
Introduction ............................................................................................................69
7.2. 55
Methodology ..........................................................................................................69
7.2.1. The Costing Approaches ..........................................................................................69
55
7.2.2. Data Source, Collection, and Assumptions ..............................................................70
56
7.2.3. Adjusting for Inflation ...............................................................................................70
56
7.2.4. Adjusting for Foreign Exchange ...............................................................................70
56
56
7.2.5. Total Fund Needs for Implementing the Road Map ..................................................70
8.0. MONITORING AND RESULTS FRAMEWORK ..............................................................73
59
8.1. Monitoring and Evaluation Framework ................................................................73
59
8.2. Core Indicators.......................................................................................................73
59
8.3. 60
HIV Prevention Indicator Matrix ............................................................................74
9.0. REFERENCES ...............................................................................................................79
65
10.0. 66
ANNEXES................................................................................................................80
Annex 1: HIV Prevention Interventions .............................................................................80
66
77
Annexe 2: The 10-Point Action Plan SWOT Analysis .......................................................91
Annex 3: Unit Cost Assumptions ......................................................................................98
84

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1.0. INTRODUCTION
1.1. Background

The United Republic of Tanzania, a lower-middle-income country since July 2020, is the largest
East African country, covering an area of 947,300 square kilometres and constituting about 30%
of the population in the region. 1 The country borders Kenya and Uganda to the North, Rwanda,
Burundi, and the Democratic Republic of Congo to the West, Zambia, Malawi, Mozambique to
the South, and the Indian Ocean to the East. The 2022 National Population and Housing
Census shows that the population of Tanzania is estimated at 62 million, an increase of 37%
from 2012 (~60 million in Mainland and ~1.9 million in Zanzibar). 2 Nearly 44% of the population
is below 15 years of age, while about 54% are between 15 and 64. In accordance with the
country’s vision 2025, Tanzania aims to achieve the following by 2025: a) High-quality
livelihood; b) Peace, stability, and unity; c) Good governance; d) A well-educated and learning
society; and e) A competitive economy capable of producing sustainable growth and shared
benefits.

In this regard, investing in multi-faceted HIV response efforts to protect the health and well-
being of the country’s productive workforce is pivotal for the country’s sustainable economic
growth. HIV has a complex relationship with poverty.3 Poverty can make people more
vulnerable to HIV infection. Women and girls may find that, in the absence of other means to
raise resources, they are in situations where they sell sex in order to pay for food, housing , or
education. In their efforts to meet their most basic needs, vulnerable people are often unable to
negotiate condom use or avoid intimate partner violence and are at risk of exposure to HIV.
Households affected by HIV are more vulnerable to falling into and remaining in poverty. People
living with or affected by HIV may be unwell or spend extended periods seeking health services.
Consequently, they may be absent from their work, unable to produce food or feed themselves,
or unable to maintain their homes. Parents may be forced to take their children out of school to
work in the family home, business, or farm. These children are then denied a proper education
and the opportunity to secure a higher-paying job or a brighter economic future.

At global, regional, national, and community levels, progress in HIV prevention and treatment is
faltering around the world, putting millions of people in grave danger. Data shows that every day, 4000
people— including 1100 young people (aged 15 to 24 years)—become infected with HIV4 . If current
trends continue, 1.2 million people will be newly infected with HIV in 2025—three times more than the
2025 target of 370,000 new infections. The human impact of the stalling progress on HIV is chilling.
In 2021, 650,000 [500 000–860 000] people died of AIDS-related causes—one every minute.5
With the availability of cutting-edge antiretroviral medicines and effective tools to properly
prevent, detect, and treat opportunistic infections such as cryptococcal meningitis and
tuberculosis, these are preventable deaths. Without accelerated action to prevent people from

1
[Link] ([Link])
2
[Link] ([Link])
3
HIV/AIDS and poverty - the critical connection ([Link])
4
Full report — In Danger: UNAIDS Global AIDS Update 2022
5
[Link] ([Link])

01 | P a g e
reaching advanced HIV disease, AIDS-related causes will remain a leading cause of death in
many countries. In addition, continued rising new HIV infections in some regions could halt or
even reverse progress made against AIDS-related deaths.

Countries need to capitalize on efforts to strengthen political leadership, enhance community

engagement, employ rights-based and multisectoral approaches, and harness the consistent
use of scientific evidence to guide concerted action. This is very important considering the
global declining trends of developmental assistance for HIV (in 2021, international resources
available for HIV were 6% lower than in 2010) coupled with falling domestic financing of HIV
programming in low- and middle-income countries (in 2021, average domestic funding reduced
by 2%). Global economic conditions and the vulnerabilities of developing countries—which are
exacerbated by growing inequalities in access to health financing and commodities—threaten
both the continued resilience of HIV responses and their ability to close HIV-related inequalities.
High levels of indebtedness further undermine governments' capacity to increase HIV
investments. Debt servicing for the world’s poorest countries has reached 171% of all spending
on health care, education, and social protection combined. 6 Increasingly, paying off the national
debt is crowding out health and human capital investments that are essential to ending AIDS.
Middle-income countries—home to 71% of people living with HIV and 71% of people newly
infected with HIV—are in danger of being declared ineligible for HIV funding as donor countries
redirect their resources to other newly emerging priorities (e.g., supporting refugees in countries
experiencing wars and shifted focus to emerging pandemics).

Although new HIV infections globally continued to decline during the COVID-19 pandemic, the
reduction in new infections in 2021 was the smallest annual decline since 2017. Based on
current trends, 1.2 million people will be newly infected with HIV in 2025—almost three times
higher than the 2025 target. Based on the modelling conducted on behalf of UNAIDS and the
World Health Organization (WHO), results have shown that a six-month disruption to medical
supplies could have resulted in an additional 500,000 AIDS-related deaths in sub-Saharan
Africa alone by the end of 2021. Global pandemics can potentially reverse all the achievements
gained over the years.

The United Republic of Tanzania joins other countries globally in applying evidence-based
interventions to achieve set global and regional targets and goals. This is why, in 2021,
following the development of the new Political Declaration on HIV and AIDS (2021) and the
Global AIDS Strategy – End Inequalities. End AIDS (2021-2026), the Government of Tanzania
engaged multiple stakeholders to revise its two blueprint HIV/AIDS strategies (i.e., the Fifth
National Multi-Sectoral Framework [NMSF V] – 2021/22 -2025/26, and the Fifth Health Sector
HIV and AIDS Strategic Plan [HSHSP V] – 2021- 2026) in order to align with the new global
guidance. As part of this process, the national HIV prevention targets were adjusted to “New
HIV infections reduced by 85% in 2025 from the 2010 baseline”. Both the NMSF V and HSHSP
V strongly emphasize ‘amplifying’ evidence-based prevention strategies at scale by targeting all
population segments at risk ‘equitably’. This includes ‘effectively reaching’ and ‘saturating’ the
classical key and vulnerable populations (KVP) such as female sex workers, men who have sex

6
[Link]

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with men, people who inject drugs, adolescent girls/boys, and young women/men as well as
other unreached KVP, which include fisherfolks, miners, long-distance truck drivers, plantation
workers and sex partners of KVP, among others. Additionally, the strategies call for an
increased focus on reaching segments of the underserved general population (for whom there
have not been concerted efforts to target them in an impactful manner) with the ‘right mix and
dose’ of HIV prevention interventions. The HIV Prevention Road Map 2023/24 – 2026/27
developed is meant to guide all stakeholders seeking to reduce new HIV infections in Tanzania.

Triggered by the slow progress towards ending AIDS as a public health threat by 2030, in the
2016 Political Declaration on Ending AIDS of the United Nations General Assembly, Member
States committed to reducing the annual number of people newly infected with HIV globally to
fewer than 500 000 by 2020 (a 75% reduction from the 2010 baseline). In tandem with this
endeavour, the Global HIV Prevention Coalition (GPC) was launched in October 2017 to help
reboot HIV prevention. The initial GPC’s priorities were to map a clear path toward these 2020
prevention targets, marshal more substantial commitment, and generate greater investment for
prevention programs. At the coalition’s first meeting, the GPC endorsed an HIV 2020 Prevention
Road Map featuring a 10-point action plan for countries and supplementary actions for
development partners and civil society organizations.7

1.2. Tanzania’s First National HIV Prevention Road Map 2017-2020

Tanzania constitutes one of the 34 focus countries that adopted the Prevention 2020 Road Map
and has been monitoring the progress of implementing the 10-point actions and reporting them
to GPC as required. The adopted 2017 - 2020 Road Map was aligned with the NMSF IV and
HSHSP IV and was built around five (5) prevention pillars – combination HIV prevention for key
and priority populations, Combination HIV prevention for Adolescent Girls and Young Women
(AGYW), Comprehensive Condom Program (CCP), Pre-exposure Prophylaxis (PrEP), and
Voluntary Medical Male Circumcision (VMMC). While the most accurate metric for gauging the
impact of HIV primary prevention efforts is through measuring HIV incidence, the
implementation status of the 10 HIV Prevention Road Map Action Points serves as a credible
process indicator for measuring prevention efforts. This is why, in tandem with periodic HIV
impact surveys and statistical modelling, countries implementing the HIV Prevention Road Map
also conduct annual self-assessments of the action points and report the findings to the GPC
secretariat. Table 1 provides an illustrative summary of the annual progress in implementing the
10-point actions for Mainland Tanzania from 2017-2020.

Table 1: Progress in implementing the 10-point Road Map actions, 2017–2020

Action 10 Point Road Map 2020 Actions 2017 2018 2019 2020
Number Baseline
1 Needs Assessment

7 HIV Prevention 2020 Road Map ([Link] )

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 Action 10 Point Road Map 2020 Actions 2017 2018 2019 2020
Number Baseline

2 Prevention Targets
3 Prevention Strategy
4 Policy Reform
5a Key Population Size Estimates
5b Defined Key Population Package
5c Young Women Size Estimates
5d Young Women Package
6 Capacity and Technical Assistance Plan
7 Social Contracting
8 Financial Gap Analysis
9 Strengthen Monitoring
10 Performance Review
Key

Done In Progress Not Done Progress Not Submitted

Based on the assessment findings illustrated above, from adopting the Road Map in 2017-
2020, Tanzania has made remarkable steps in strengthening the leadership, oversight,
accountability, and coordination of HIV prevention response at the national level.

2.0. CURRENT SITUATION OF PREVENTION IN MAINLAND

TANZANIA

2.1. Tanzania’s HIV Epidemiological Profile

HIV prevalence
Tanzania is one of the highest HIV burden countries in Africa. Although the prevalence of HIV
among people aged 15-49 years has declined progressively from 7% in 2003/2004 to 5.7% in
2007/08 to 5.1% in 2011/2012, 4.7% in 2016/2017and 4.4% in 2022/23, about 1.7 million people
are living with HIV (PLHIV) which makes Tanzania one of five countries with the highest number
of PLHIV in Africa. 8 The prevalence of HIV varies geographically from 0.4% to 12.7%, with
regions in the southern highlands having the highest prevalence (i.e., Iringa, Njombe, and
Mbeya). The progressive decline in HIV prevalence is also seen among 15-34-year-old women
and 15-39-year-old men but not in the older age groups. The reasons for this pattern are

8
THIS2022-2023_Summary_Sheet.pdf ([Link])

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unclear, but it may indicate declining incidence rates in at least successive younger age cohorts.
Among women, HIV prevalence ranged from 0.8% in those aged 15-19 years to 13.0% in those
aged 45-49 years. HIV prevalence was also over 10% among women in the age groups from
40-59 years, markedly higher than HIV prevalence among those in the age groups from 15-34
years (mostly targeted by HIV prevention interventions). Among men, HIV prevalence varied
from 0.3% among those aged 15-19 years to 8.4% among those aged 50-54 years. It was close
to or over 6% in age groups from 40-64 years. HIV prevalence was markedly higher among
women than among men in the age groups between 30-49 years. This is an interesting
observation because, programming-wise, there are no specific interventions targeting this
segment of the female population. Figure 1 illustrates the observation described above.

Figure 1: HIV Prevalence by Gender and Age

Program data also shows that the HIV positivity rate declined among females from 4.9% in 2015
to 2.9% in 2018 and among men from 4.6% in 2015 to 2.3% in 2018. In terms of PLHIV’s
awareness about their status, THIS 2022/23 shows that 82.7% of adults (aged 15 years and
older) living with HIV are aware of their HIV-positive status (84.8% among women and 78.4%
among men). Individuals were classified as aware if they reported their HIV-positive status or
had a detectable antiretroviral (ARV) in their blood. However, disparities are observed in
knowledge of HIV status among adolescents and youth. Program data shows that as of the end
of December 2022, only 66% of the 10-19-year-olds and 73% of 20-24-year-olds were aware of
their HIV status. This is of significance because the infected individual poses a high risk of
onward transmission of HIV to their sexual partners.

Besides the variability in HIV prevalence by age and geography, the earlier conducted modes of
transmission (MOT) studies showed a disproportionately high burden among key and vulnerable
populations (KVP). These populations are defined groups that, due to specific high-risk
behaviours, are at an increased risk of acquiring HIV, irrespective of the epidemic type or
context. KVP often face legal and social issues related to their behaviour that increase their
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05
 vulnerability to HIV and limit their access to services. The WHO guidelines focus on five key
populations: 1) men who have sex with men, 2) people who inject drugs, 3) people in prison and
other closed settings, 4) sex workers, and 5) transgender people. On the other hand, vulnerable
populations include groups of people who are particularly vulnerable to HIV infection in certain
situations or contexts, such as adolescents (particularly adolescent girls and young women in
sub-Saharan Africa), orphans, street children, people with disabilities, and migrant and mobile
workers. In the Tanzanian context, mobile populations include long-distance truckers, fisher
folks, miners, specifically small-scale miners, construction workers, and displaced people, to
mention a few. Collectively, KVP are pivotal to the epidemic because of the risk of onward HIV
transmission. However, with increased efforts to reach this group using public health
approaches, downward trends in HIV prevalence have been observed. Program data shows
that the prevalence of HIV in Tanzania declined among Female at High Risk (FHR) from 31% in
2010 to 15.3% in 2017; among men at High Risk (MHR) from 22.3% in 2014 to 8.3% in 2017,
and among people who inject drugs (PWID) from 15.5% in 2014 to 8.7% in 2017. 9, 10, 11

HIV incidence
Even though the number of new HIV infections has been declining steadily over the years,
UNAIDS Spectrum estimates showed a decline from 110,000 new HIV infections in 2010 to
61,281, a 38% reduction against the target of 75% by 2020 despite the investments. Tanzania
HIV Impact Survey (THIS) 2016/17 showed an annual incidence rate of HIV infection among
adults of 0.34% in women, 0.17% in men, and 0.24% overall. The highest annual incidence rate
of 0.7% occurred among women aged 25-34 years, followed by men aged 35-49 years (0.37%),
women aged 35-49 years (0.24%), men aged 25-34 years (0.15%) and women aged 15-24
years (0.14%). On the other hand, THIS 2022/23 shows an annual incidence of HIV among
adults (aged 15 years and older) in Tanzania of 0.18%, which corresponds to approximately
60,000 new cases of HIV per year among adults. Similarly, variation by sex is observed,
whereby HIV incidence is 0.24% among women and 0.11% among men. Therefore, in terms of
trends of new HIV infections, compared to the progress registered as of 2022 (i.e., 38%
reduction), there is a remarkable decline of close to half (45%) in comparison with the 2010
baseline. Of significance to note is that spectrum data shows that over 34.3% of new HIV
infections occur among adolescent young people, and out of these, nearly three-quarters
(74.1%) are contributed by adolescent girls and young women.

Vertical Transmission of HIV Infection

Mother-to-child transmission (MTCT) rates of HIV in Tanzania remain a challenge, contributing
towards a mother-to-child transmission of HIV infection rate of 6.91% in 2022 against the global
and national target of <5%. The timely identification and provision of ARV medication to HIV-
infected pregnant and breastfeeding women is the most vital intervention to prevent MTCT of

9
HIV prevalence among men who have sex with men following the implementation of the HIV preventive guideline in Tanzania:
respondent-driven sampling survey | BMJ Open
Prevalence and risk factors associated with HIV-1 infection among people who inject drugs in Dar es Salaam, Tanzania: a sign of
successful intervention? - PMC ([Link])
11
HIV prevalence and associated risk factors among female sex workers in Dar es Salaam, Tanzania: tracking the epidemic - PubMed
([Link])

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HIV among exposed infants during pregnancy, labour and delivery, and breastfeeding. The
proportion of pregnant women enrolled in PMTCT services reached 92% in 2019. However,
there are poor retention rates (67% and 83%) among pregnant and lactating mothers. Generally,
in 2020, a total of 75,719 pregnant women were identified with HIV at Ante-natal Care (ANC);
about 69% of them were already known to be HIV-infected during their ANC booking, and about
31% were newly diagnosed HIV positive. The PMTCT program provided ART to 97.7% of
pregnant women living with HIV. Forty-eight per cent of pregnant and lactating women had a viral
load test in 2019, and the majority (93%) of those tested attained viral suppression. Despite the
geographical disproportionality, the coverage of HIV testing at the first ANC visit has been
consistently high (>95%) in the past 10 years. Most pregnant women receive their first HIV test
during this visit, but the HIV re-testing among pregnant women found to be negative during the
initial test has remained low. Maternal HIV retesting during the third trimester of pregnancy was
only 27.7% in 2020 and has never exceeded 30% in the past three years. Furthermore, a high
proportion of PMTCT clients drop out of care, the highest dropout being within the first twelve
months (26%, 30%, and 33% at 3, 6, and 12 months respectively), a period at which they are
transitioning from PMTCT to CTC. This drop may be attributable to stigma and discrimination.
The elimination of Mother-to-Child Transmission of HIV highly depends on timely ANC
attendance and quality care. The utilization of antenatal care services in Tanzania has been
almost universal for many years. However, early ANC attendance (before 12 weeks of
gestational age) has been low due to several factors, which include, but are not limited to,
cultural perceptions.

About one-third (30%) of newly identified women living with HIV (WLHIV) and one-quarter (24%)
of all women living with HIV receive ANC services in non-supported HFs. The lack of support for
these health facilities has affected the program's overall performance. For instance, the 2020
annual PMTCT report showed a disproportionate HIV prevalence among young women 25 years
old attending ANC clinics. About 81% of HIV-infected pregnant women at ANC clinics (known
and newly diagnosed as HIV positive) in 2020 were aged >25 years and above. The report
further shows that despite the decreased trend of HIV incidence among pregnant and
breastfeeding women from 2.09% (2015) to 1% (2020), among the newly diagnosed HIV-infected
pregnant women, young women (<25 years old) contributed the most (60% and 61% in 2019 and
2020, respectively). This further justifies the importance of tailoring eMTCT interventions
according to specific vulnerabilities of the population segments.

Comprehensive Knowledge of HIV and High-Risk Sex Behavior

Heterosexual transmission remains the main mode of transmission of HIV infections in
Tanzania. Comprehensive knowledge of HIV has declined among adolescents and young
people. Among women aged 15-19 and 20-24 years, comprehensive knowledge declined
progressively from 39% and 50% in 2003-2004 to 32% and 43%, respectively, in 2016-2017.
Similarly, among men aged 15-19 years and 20-24 years, there was a decline from 43% and
57% in 2003-2004 to 33% and 41%, respectively, in 2016-2017. Comprehensive knowledge for
other age groups was not reported in the THIS 2016/2017. Just as comprehensive knowledge
has declined, unsafe sex behaviour has increased in all age groups for both women and men.
Among people who had sex in the 12 months prior to the survey, 56% of men and 36% of
women had sex with a non-cohabiting, non-marital partner in 2016-2017, compared to 46% and
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23%, respectively, in 2003-2004. Among women and men, the percentage was highest among
teenagers and then declined with age. Over 96% of teenage men and 61% of teenage women
had sex with a non-cohabiting, non-marital partner. Furthermore, condom use declined in those
practising high-risk sex from 50% to 35% in men and from 38% to 28% in women. Women aged
30 years and above had the lowest rates of condom use for high-risk sex, while teenagers had
the lowest rates among men.

The level of comprehensive knowledge of HIV among KVP is similarly low, with rates of 46%
among FHR, 41% for MHR, and 36% for PWID. About 71% of FHR used a condom with their
last client. In the month before the survey, 79% of MHR had been paid by other men to have
anal sex, 63% of those who had anal sex with a non-paying male partner did so with two or
more people, only 32% used a condom with their paying male partner and less than 10% had
always used a condom with their non-paying partners. About 69% of PWID had received
payment for sex, while 36% had paid someone for sex. Only 25% used a condom with their last
non-paying partner; 46% used a condom the last time they paid for sex, and only 30% used a
condom the last time they were paid for sex. Based on this trend, it is unsurprising that
comprehensive condom use is also remarkably low and has been declining over the years. Data
show that about a third of individuals are practicing condom less sex, and also, about a third of
the population do not have comprehensive knowledge of HIV and AIDS. Figure 2 below
provides an illustrative summary.

Figure 2: HIV Knowledge and Condom Use

This observation may partially explain the reported high rates of STIs in Tanzania. This is
important because the literature suggests that untreated STIs can enhance both the risk of
acquisition and onward transmission of HIV and viral hepatitis up to 10-fold. Figure 3 provides
an illustrative summary of other parameters associated with HIV risk in Mainland Tanzania.
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Figure 3: Other HIV Risk Parameters

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Note: For details regarding the data source and year of the data in this figure, refer to NMSF V.

AIDS-Related Mortality
AIDS-related deaths declined significantly from 72,622 in 2010 to 32,639 in 2020, representing
a 55.06% reduction. In 2020, 22% of all estimated AIDS-related deaths were among children
aged below 15 years. AIDS-related deaths declined by 57.8% among adults and 53% among
children from 2010 to 2020 (UNAIDS Data 2020). Slightly over half (54%) of all the AIDS-related
deaths estimated to have occurred in 2020 were among adult men. The success in reducing
HIV mortality is attributed to increased ART coverage, early detection of opportunistic infections
among PLHIV with advanced HIV disease, and viral suppression.

Despite this tremendous progress, several barriers remain to ending AIDS as a public health
threat by 2030. Box 1 provides an illustrative summary of current gaps as informed by HIV
prevention scorecard findings, GPC’s prevention self-assessment (P-SAT) results, the mid-
term review of the HSHSP IV and NMSF IV, and other program review data available,

Box 1: Current Barriers / Challenges to Meeting HIV Prevention Goals by 2030

 Low coverage and saturation of key and vulnerable populations (classic and
non-classic), including vulnerable girls and young women
 Insufficient focus on mature and middle-aged women
 Low and declining comprehensive knowledge of HIV and AIDS
 Persistently low access and use of condoms by at-risk groups
 Low pace of scale-up of new prevention policies and tools
 Low awareness and scale-up of PrEP
 Dwindling investments in VMMC maintenance and sustainability (data
shows that large populations graduate into VMMC eligible population due to
a large younger population base)

2.2. Status of the Implementation of HIV Primary Prevention Interventions

Alongside other HIV interventions (i.e., HIV testing and antiretroviral treatment scale-up),
combination HIV prevention interventions that encompass biomedical, behavioural, and
structural interventions remain key for controlling the epidemic. The National HIV Prevention
Road Map 2023/24 – 2026/27 has adopted the five prevention pillars described in the Global HIV
Prevention 2025 Road Map. These pillars reflect the emphasis in the Global AIDS Strategy
(2021–2026) and the demands of an evolving epidemic. Pillars 1–3 describe people-centred
combination prevention packages for key populations everywhere and for adolescents and
young adults in geographical areas with high HIV incidence. Programs in these pillars include
population-specific behavioural and structural actions that ensure communities' access to the full
range of prevention choices. Pillar 4 on condoms and Pillar 5 on antiretroviral-based prevention
describe high-impact prevention tools that are relevant to all populations. Pillar 5 emphasizes the
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vital complementarity between HIV prevention and HIV treatment and care services. Pillar 1, on
key populations, applies globally, while Pillars 2 and 3 apply mostly in eastern and southern
Africa and some locations in western and central Africa (settings with high HIV incidence). Pillar
4 is also relevant globally, although outside sub-Saharan Africa, it mostly relates to prevention
programs for key populations (due to low HIV incidence among other populations and generally
widespread availability of condoms on the commercial market). Pillar 5 is also relevant globally,
with a focus on key populations and HIV-discordant couples, though it is relevant for other
populations as well as in settings in eastern and southern Africa where HIV incidence is high.

The pillars rest on a foundation of other enhancements. These include sustained investments,
integrated service delivery platforms, the use of a multisectoral approach, the creation of
enabling environments, and actions to reduce inequalities. There is a strong focus on addressing
policy and structural barriers that hinder access to prevention services, ending stigma and
discrimination, and advancing gender equality. Figure 4 provides an illustrative summary of the
implementation period from 2023/24 to 2026/27.

Figure 4: The Five Prevention Pillars for 2023/24 -2026/27 Road Map (Adopted from the
GPC’s 2025 Global Prevention Coalition Road
Map)

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PILLAR 1: Combination Prevention for Key Populations

Key populations (KP) are defined groups that, due to specific high-risk behaviours, are at an
increased risk of acquiring HIV irrespective of the epidemic type or context. Also, they often face
legal and social issues related to their behaviours that increase their vulnerability to HIV and limit
their access to services. The WHO guidelines focus on five key populations: 1) men who have
sex with men, 2) people who inject drugs, 3) people in prison and other closed settings, 4) sex
workers, and 5) transgender people. In the Tanzanian context, the definition has been
broadened to include other vulnerable populations (VP) such as migrant and mobile workers
(i.e., long-distance truckers, fisherfolks, miners, construction workers, prisoners, displaced
people, orphans, homeless children, and people with disabilities, just to mention a few. Sexual
partners and children of KVP also fall into this group. Collectively, key and vulnerable
populations (KVP) are pivotal to the epidemic because of the risk of onward HIV transmission. In
accordance with the UNAIDS 2021 report, data shows that, while KVP accounts for <5% of the
global population, they and their sexual partners contribute 70% of new HIV infections. In the
Eastern and Southern Africa region, key populations and their sexual partners comprise less
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than half of new HIV infections (46% in 2021). Through the current national guidelines,
programming KVP uses a public health approach and employs combination prevention
approaches. Interventions for creating an enabling environment are also part and parcel of
programming. Service delivery modes include facility-based and facility-led community-based
approaches. National guidelines clearly stipulate that services should be voluntary,
nonjudgmental, accessible, and competent in addressing KVP needs on the continuum of
prevention, testing, and treatment services. In alignment with universal health coverage (UHC)
2030 goals, the Road Map is that services are structured in ways that increase equitable access
and availability of the minimum package. The package encompasses services for preventing and
treating HIV, tuberculosis, viral hepatitis, and sexually transmitted infections (including the
provision of condoms and, where appropriate, Pre-Exposure Prophylaxis (PrEP) and post-
exposure prophylaxis (PEP). Given the prominence of unsafe injecting drug use due to the
limited availability of needle and syringe programs in the HIV epidemics in many countries,
comprehensive harm reduction services (including needle and syringe programs and opioid
substitution therapy) are part and parcel of the package.

PILLAR 2: Combination Prevention for Adolescent Girls and Young Women in High-
Prevalence Locations.

Women and girls continue to be disproportionately affected by HIV, accounting for 63% of the
region’s new HIV infections in 2021. New HIV infections are three times higher among
adolescent girls and young women (aged 15-24 years) than among males of the same age.
Since 2010, the decline in new HIV infection has been much sharper among adolescent boys
and young men (56%) than among adolescent girls and young women (42%) or older women
(aged 25-49 years) (29%). In Tanzania, in the year 2022, spectrum estimates indicate new HIV
infections accounted for 54,000 individuals of all ages in Mainland Tanzania. Notably, over
34.3% of these new infections occur among adolescent young people, and out of these, nearly
three-quarters (74.1%) are contributed by (AGYW. Program data shows that as of the end of
December 2022, only 66% of the 10-19-year-olds and 73% of 20-24-year-olds were aware of
their HIV status. Increased investment, including through the United States President’s
Emergency Plan for AIDS Relief (PEPFAR) and the Global Fund, has enabled more than 40% of
locations with high HIV incidence in 19 focus countries in sub-Saharan Africa to implement
dedicated combination prevention programs for young women. According to Tanzania's
Scorecard 2022 report, only 26% of locations have a dedicated comprehensive program on
AGYW. In order to ensure access in 95% of locations with high HIV incidence, those efforts must
become more widespread. The HIV Prevention 2023/24-2026/27 puts a strong focus on AGYW
by prioritizing the vulnerable ones. In accordance with the current guidelines, the recommended
service packages include comprehensive sexuality education (in and out of school), HIV and
sexual and reproductive health services (including male and female condoms and other
contraceptive tools), antiretroviral-based prevention and harm reduction for women who use
drugs. Gender inequalities and discrimination deny women and girls the ability to realize their
basic rights, including their right to education, good health, bodily autonomy, and economic well-
being––all of which can also reduce their risk of HIV infection. Combination prevention packages,
therefore, comprise interventions to change harmful gender norms, end gender-based
discrimination, inequalities, and violence, improve social protection, and support economic
empowerment.

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PILLAR 3: Combination Prevention for Men and Adolescent Boys in Settings
with High HIV Incidence

HIV prevention programs for boys and men remain essential for their health and for the health of
their female partners. This population segment has diverse needs, interests, beliefs, and unique
barriers to accessing health services. Furthermore, evidence suggests that the main fueling
factor that raises the HIV acquisition risk among AGYW is the presence of a high prevalence of
non-virally suppressed HIV-infected ABYM and adult males in a particular locality. Therefore,
preventing HIV infection among men and adolescent boys and linking them to HIV services to
reduce their own risk, as well as the likelihood of transmitting the virus to their female partners, is
critical. Therefore, Tanzania’s HIV Prevention Road Map 2023/24-2026/27 emphasizes offering
an expanded package of HIV prevention for men and boys while maintaining a strong focus on
the provision of condoms, as well as on voluntary medical male circumcision. Some of the at-risk
populations described in the earlier section (i.e., long-distance truckers, fisherfolks, miners,
construction workers, prisoners, and partners of KP) are part of this population. In recognition of
the diverse needs of this group, the Road Map focuses on providing male-friendly services within
and outside clinic settings. This entails community-based HIV testing, self-testing, linkages to
early antiretroviral treatment as required, condoms, pre-exposure and post-exposure
prophylaxis, comprehensive sexuality education, and other sexual and reproductive health
services, and harm reduction. Specifically, voluntary medical male circumcision (VMMC) services
need to reach greater numbers of adult uncircumcised men who are at high risk of acquiring HIV
infection. Early infant medical circumcision (EIMC) services must also be strengthened as it is an
approach to ensure the local sustainability of VMMC. The Road Map emphasizes building
sustainable systems to create service demand and improve access, especially for men with
lower incomes. In line with the UHC 2030 agenda for the country, these services need to be
offered as part of broader sexual and reproductive health services for men and boys. Services
include education on safe sex, condom use, provision, and healthy gender norms, as well as
information on HIV testing (and linkages to care and treatment, if required) and prevention and
management of sexually transmitted infections. It is important to support these services with
systematic efforts to promote gender-equitable norms and reduce gender-based violence.

PILLAR 4: Promotion of Condoms

Since the heterosexual route is the most predominant means of acquiring and transmitting HIV,
condom programming is among one of the important pillars of primary HIV prevention. Condoms
are safe and do not require a prescription. The correct and consistent use of male and female
condoms remains the only available highly effective multipurpose prevention technologies (MPT)
that provide triple protection in preventing HIV, STIs, and pregnancy. Condoms remain the most
widely used HIV prevention method, and they are a low-cost option for large numbers of people
who are at moderately high risk of acquiring HIV. Increased condom use is estimated to have
averted more than 100 million new HIV infections globally since 1990. Despite its capability to
offer dual protection, gaps and inequities in condom access and use persist, and they are
widening in several countries in the context of reduced investment. In Mainland Tanzania,
implementing the total market approach (TMA) has ultimately increased the market share of
public sector condoms from 21% to 50%. However, as of today, huge unmet needs for condoms
(including a persistent shortage of female condoms) exist. There is an insufficient number of public
condoms due to limited budgetary allocation. Condoms procured meet only 50% of the required
needs. But what is also alarming is the fact that, despite the procured condoms can meet 50% of
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the projected needs, data also shows that access and utilization of the available condoms is
unacceptably low. Close to 70% of at-risk men, adolescent boys, but also women, and
adolescent girls are not using condoms during sex. This situation justifies a heavy focus on the
National Prevention Road Map 2023/24-2026/27 to strengthen comprehensive condom
programming in Mainland Tanzania. Both availability and accessibility challenges need to be
addressed. Enhanced demand creation (especially for new generations of potential users),
procurement and supply of male and female condoms, social marketing, and private-sector sales
must be implemented to ensure full-scale access. Condom program stewardship at national,
regional, and district levels needs to be revived. Evidence-based design and TMA in which
public, private, and social marketing sectors work in synergy is strongly emphasized.

PILLAR 5: Wider Access to Antiretroviral Based Prevention, including Pre-

Exposure Prophylaxis (PrEP) and Post-Exposure Prophylaxis (PEP)

Available data since the inception of care and treatment programs globally provide conclusive
evidence of the contribution of viral suppression in preventing HIV transmission. Although
statistically, a non-zero risk estimate can never be completely ruled out in a mathematical sense,
despite the number of observations, the data tell us that the best estimate for the transmission
risk is zero and that future HIV transmissions are not expected when people with HIV remain
virally suppressed. If taken as prescribed, antiretroviral therapy (ART) reduces the amount of HIV
in the body (viral load) to a very low level, which keeps the immune system working and prevents
illness. This is called viral suppression—defined as having less than 1000 copies of HIV per
millilitre of blood. HIV medicine can even make the viral load so low that a test can’t detect it.
This is called an undetectable viral load. Getting and keeping an undetectable viral load by taking
ART is the best thing PLHIV can do to stay healthy and prevent transmission of HIV to others
through sex. This is sometimes referred to as Treatment as Prevention (TasP). Treatment as
prevention may also be referred to as Undetectable Equals Untransmittable (U=U). ART
programming also includes providing ART to prevent mother-to-child transmission (MTCT).

Also, evidence shows the role of post-exposure prophylaxis (PEP) in HIV prevention. PEP is the
use of antiretroviral drugs after a single high-risk event to stop HIV seroconversion in exposed
individuals (with maximum benefits if it is started as soon as possible and always within 72 hours
of possible exposure). Furthermore, evidence also shows that. This Road Map denotes that PEP
has been under-utilized in HIV prevention response, and there is a need to revitalize its use,
particularly by ensuring that it remains a critical component of the clinical management of rape
survivors and in reducing occupational risk and accidental occupational exposures.

Furthermore, evidence shows that pre-exposure prophylaxis (PrEP), where antiretroviral

medications are given to negative individuals with a substantial risk of HIV acquisition, is highly
effective in preventing HIV when taken as prescribed. Despite progress in providing PrEP, as
described earlier, the scale-up remains sub-optimal. THIS 2023 shows that the percentage of
individuals aware of PrEP is very low (i.e., 8.8% and 4.9% for urban and rural areas,
respectively). As a result of this, only 54.7% of people are willing to take PrEP (i.e., 59.7% and

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 49% for men and women, respectively).12 Scale-up plans require an increased investment and
actions that address barriers to consistent use. It also calls for linking the roll-out of PrEP with
related services (for example, HIV testing and sexual and reproductive health) and with
supportive social networks. This is why the national Road Map emphasizes ensuring that PrEP is
provided as part of combination prevention interventions. Given the constantly emerging
evidence on new prevention technologies, the Road Map includes strategies for rapidly analyzing
new evidence and coordinating the prompt introduction of new prevention technologies and
approaches as they become available depending on the country's needs. This includes the
Dapivirine vaginal ring and long-acting injectable Cabotegravir (CAB-LA). This is expected to
expand the choices for HIV prevention available to men, women, adolescent girls, and
adolescent boys who are at risk and eligible for PrEP according to the current guidelines.

Newly acquired maternal HIV infections also drive new infections in children during pregnancy
and the breastfeeding period. This requires increased focus on primary prevention for women
and their partners through platforms for the prevention of vertical transmission of HIV. HIV
prevention for women and their partners should be included in national guidelines for preventing
vertical transmission, and proven HIV prevention choices, including PrEP, should be promoted
for pregnant and lactating women and their partners in areas of high HIV incidence. In view of
the above, the National HIV Prevention Road Map 2023/24-2026/27 emphasizes ensuring that
primary prevention, HIV treatment, and programs for elimination of vertical transmission need to
work hand-in-hand.

2.3. Prevention Programming Focus Informed by Modeling the Impact and

Cost of the HIV Interventions

With technical assistance from Avenir Health and through close coordination with
UNAIDS/Tanzania SI team, in October 2022, a simulation modelling with the GOALS Age
Structured Model (GOALS ASM) was conducted to estimate the impact of achieving the 2025
targets and the expected cost. GOALS ASM, represents HIV transmission driven by age-related
factors such as behaviours and use of biomedical interventions. It exists as a module with the
Spectrum model, which has been used in Tanzania for many years to produce annual estimates
of key HIV indicators. The model uses Spectrum’s cohort component projection method to
simulate population dynamics and uses Spectrum’s AIDS Impact Module (AIM) to model HIV
disease progression and mortality by age, sex, and CD4 cell count, track ART status, and
simulate mother-to-child transmission. GOALS ASM is designed to model generalized HIV
epidemic contexts and represents heterosexual HIV transmission based on age-dependent
inputs: rates of partner change, preferential sexual mixing, and the risk of HIV transmission within
heterosexual serodiscordant partnerships. These transmission risks depend on condom use
within the partnership; the HIV infection stage, ART status, and viral suppression status of the
partner living with HIV; and male circumcision status, use of pre-exposure prophylaxis (PrEP)
methods, and STI status of the HIV susceptible partner. The model incorporates general
population behaviour change programs, including economic empowerment and school-based
prevention and sexuality education programs. The impacts of these programs are mediated by
their coverage levels and their effects on the frequency of condomless sex and other risk
behaviours.

The fitted model can be used to project into the future by making assumptions about the future
coverage of HIV interventions. For this analysis, two projections were used:

12
THIS2022-2023_Summary_Sheet.pdf ([Link])

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  Constant coverage: This projection assumes that the coverage of all interventions
remains constant at 2020 levels. This serves as the counter-factual scenario for the
calculation of infections and deaths averted.
 Targets achieved: This scenario assumes that the 2025 national targets (as per NMSF
V & HSHSP V) are achieved.

Figure 5 shows the impact of achieving these targets on the number of new infections through
2030. Trends clearly show that reducing new HIV infections by 85% by 2025 and, further by 90%
by 2030 (all from the 2010 baseline of 110,000 infections per year) translates into ensuring that
there are ≤16,135 and ≤12,693 newly infected HIV individuals in those two-year marks,
respectively

Figure 5: Impact of Achieving the Targets on New HIV infections

The contribution to this decline by intervention is shown in Figure 6. About half the impact is due
to the increased proportion of PLHIV who are virally suppressed on ART. The next largest
contributions are from condoms (23%), PMTCT (7%), PrEP (7%), VMMC (7%), key populations
(excluding PrEP) (2%), and AGYW programs (1%).

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Figure 6. Contribution to Decline in New Infections by Intervention Area

In terms of the cumulative impact on HIV incidence by the different interventions, figure 7 below
provides an illustrative summary of the absolute number of new infections averted contributed
by each of the interventions (independent or in combination).

Figure 7: Cumulative Infections Averted, 2022-2030 by Intervention Compared to

Constant Coverage of All Interventions

Based on the insights brought about by the modelling data, there are several key programmatic
considerations for the HIV Prevention Road Map 2023/24 – 2026/27. Box 2 below provides an
illustrative summary of issues to be taken into account in the Road Map document.
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Box 2: Implications & Considerations of Modeling Results for 2023/24 – 2026/27 HIV
Prevention Road Map

 The 95 -95 -95 achievement will only address 50% of incident HIV infections, and
therefore, being a low-hanging fruit, the Road Map prioritizes sustaining care and
treatment services.
 Condom is the second largest impactful intervention with an estimated 25%
attributable impact, but currently has a very low uptake; therefore, the Road Map
puts a strong focus on reinvigorating condom programming.
 Promotion and scaling up PrEP are high priorities for the Road Map, considering its
efficacy, cost-effectiveness, and low level of access and uptake of this service.
 Road Map continues advocating for increased investments in VMMC programming;
this is because the yearly gains are unsustainable due to the younger population
and high HIV incidence.
 Informed by the current epidemiological trend, a special focus is put on designing
and delivering interventions targeting mature women.

3.0. DEVELOPING TANZANIA’S NATIONAL HIV PREVENTION

2023/24 – 2026/27 ROAD MAP
3.1. Need to Adopt the Global HIV Prevention 2025 Road Map

Globally, HIV remains a significant health challenge affecting all regions, with the brunt of the
disease hitting Sub-Saharan Africa. Despite years of investment, besides a few countries whose
HIV burden has been reduced, new HIV infections have either plateaued or continue to rise in
some other countries. Whilst new HIV infections have reduced by 23% globally and by 38% in
the Eastern and Southern Africa region since 2010, UNAIDS reports that HIV infections
increased by 72% in Eastern Europe and Central Asia, 22% in the Middle East and North Africa
and 21% in Latin America. This unacceptably sluggish reduction in new HIV infections warrants
a need for a paradigm shift in programming. This is why, in June 2021, the United Nations
General Assembly issued an ambitious new Political Declaration that renewed the call on all
countries and all communities to make the necessary shifts to end AIDS as a public health
threat by 2030 and accelerate progress toward achieving the Sustainable Development Goals,
in particular Goal 3 on good health and well-being. In response to this, member states resolved
to take urgent action over the next five years through a coordinated HIV response based on
global solidarity and shared responsibility to meet the targets and fully implement the
commitments contained in the declaration. In particular, they agreed to prioritize HIV prevention
to reach a new global target of reducing new HIV infections to under 370,000 by 2025 (82.5%
reduction in new infections). These targets are underpinned by the Global AIDS Strategy (2021–

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2026. Accordingly, the GPC issued a revised HIV Prevention 2025 Road Map that charts a way
forward for country-level actions to achieve an ambitious set of HIV prevention targets by 2025.
The 2025 Road Map builds on the previous HIV Prevention 2020 Road Map (also adopted in
Mainland Tanzania to fit the country's context and needs) and responds to the need for stronger
action against the inequalities that hold back progress. It accounts for an evolving context
marked by persistent pandemics and economic challenges.

The Global HIV Prevention 2025 Road Map is aligned with the Southern Africa Development
Community (SADC) Roadmap for Health and HIV and AIDS Sustained Responses and the East
and Southern Africa (ESA) commitments. It also serves as a means to facilitate the acceleration
of the Abuja Declaration Targets wherein the Member States committed to allocate 15% of
national budgets to the health sector across the four pillars, which are Country-led multi-sectoral
response, Unwavering political commitment, Investing for impact and increased efficiencies;
Improve and accelerate “people-centred” integrated delivery that reaches those left behind (HIV
and UHC); and Sustainable multi-sectoral financing for long-term impact. The Road Map is also
aligned with the NMSF V and HSHSP V, whose development processes were guided by the
“2021 Political Declaration on HIV and AIDS: Ending Inequalities and Getting on Track to
End AIDS by 2030” and the Global AIDS Strategy 2021-2026: End Inequalities, End AIDS.”

Therefore, the Government of Tanzania (Mainland) adopted the National HIV Prevention 2025
Road Map in order to guide country-level efforts to achieve the global and national goals,
considering the slow progress towards achieving the prevention indicators (i.e., new infections
reduced by only 38% as of 2020 from the 2010 baseline). While the Global Road Map covers
the 2021-2025 implementation period, the domesticated Tanzania’s National HIV Prevention
Road Map covers the 2023/24-2026/27 timeframe. The Road Map seeks to portray a state of
urgency given that the HIV prevention targets for 2020 in Tanzania were not met.

3.2. Purpose of the National HIV Prevention 2023/24 -2026/27 Road Map
The purpose of the Tanzania National HIV Prevention Road Map 2023/24 – 2026/27 is to ensure
sufficient guidance on HIV prevention program implementation that adequately responds to
changing epidemic contexts and addresses existing social, cultural, and legal barriers. The Road
Map ensures community participation and service integration to attain clearly defined milestones
and targets aligned with global strategies. Specifically, the Road Map seeks to:
 Provide granular details to implementers on the combination of HIV prevention strategies,
interventions, and service delivery models defined in the NMSF V and HSHSP V.
 Ensure that the HIV prevention program goals, targets, and strategies are aligned with
current global HIV prevention program targets and strategies.
 Provide guidance for geographical and population prioritization of HIV prevention
interventions to optimize the reduction of new HIV infections.
 Provide detailed guidance and milestones to facilitate the scale-up of precision
combination HIV prevention through community leadership and an integrated
approach.
 Identify and adequately respond to the changing epidemic context.
 Facilitate rapid adoption of new technologies, digitalization, and innovations, such as the
use of virtual platforms to increase access to services for hard-to-reach populations.

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  Ensures multi-sectoral engagement in HIV prevention response efforts.
 Accurately defines HIV prevention resource needs and strengthens resource mobilization
and efficient utilization.
 Provide guidance for monitoring and tracking progress in HIV prevention.
 Reinforce HIV prevention leadership and accountability.

3.3. Approach to Road Map 2023/24 – 2026/27 Domestication Process

The process of developing the Road Map was participatory in nature, and it involved a wide
range of multiple stakeholders. This iterative process used diverse approaches, including
document review, data analysis, and stakeholder engagement. It started with a comprehensive
review of the Global HIV Prevention 2025 Road Map and the Global AIDS Strategy 2021-2026.
Despite the fact that recently released NMSF V and HSHSP V were informed by the Global AIDS
Strategy 2021-2026, the review process revisited these documents to ensure that all pertinent
HIV prevention issues and priorities were adequately prioritized in the current national strategies
for prevention. In conjunction with this step, consultative data reviews using multiple sources
were conducted. This included analyzing the HIV program data (programmatic and modelling),
HIV surveys and surveillances, GPC prevention self-assessment (P-SAT) findings, GPC HIV
prevention scorecards, as well as other international and national reports depicting HIV trends in
Tanzania. Through a series of multi-stakeholder workshops, experts and participants from the
health sector and beyond reviewed all the five HIV prevention pillars of focus. The main goal of
this systematic process was to ensure that high-impact HIV prevention interventions were
identified, standardized and prioritized based on the available evidence, as well as the country’s
needs and context. Stakeholders also thoroughly reviewed and adopted the 10-point actions
action plans to reach the 2025 targets and get on track to end AIDS by 2030. As a part of this
process, a Strength, Weakness, Opportunities, and Threat (SWOT) analysis and a Root Cause
Analysis (RCA) of the gaps and challenges of both the national response as well as the country’s
readiness and ability to implement the 10-point action plan was conducted. All the insights
gathered during this process and proposed solutions have been used to inform key strategies in
this document. Box 3 below lists the stakeholders represented in the process.

Box 3: List of Stakeholders Engaged in the Road Map Domestication Process

 Government Agencies: NASHCoP, DRMCH, TACAIDS, MoCDGWSG, PO-RALG, PMO-

LYED, and PMO-DCEA.
 Donor Agencies: PEPFAR (DoD, USAID, and CDC).
 Multi-Laterals: UNAIDS, UNFPA, UNICEF, WHO.
 Communities and KVP-Led Entities/ Representatives: Civil society organizations,
KVP-led/centred NGOs, Key and Vulnerable Population Forum (KVPF) Members, KVP
and PLHIV.
 Local and International Implementing Partners: Included PEPFAR implementing
partners (represented by FHI360, THPS, and HJF), GF SR (i.e., AMREF), and
NACOPHA.
 Prevention Technical Working Group: Selected members were represented from
inception to implementation.
 TNCM Members: Represented by the Secretary.

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 Private Sector: Tanzania Private Sector Foundation.

Under the leadership of both TACAIDS and NASHCoP, the engaged health and non-health
experts and stakeholders unanimously recommended the timeframe of the domesticated Road
Map to cover the period of 2023 – 2027. Furthermore, the overall consensus was that the 10
priority actions should ensure that by 2025, 95% of people at risk of HIV infection have access to
and use an appropriate, prioritized, person-centred, and effective combination; and by 2030, this
figure will increase to 100%.

3.4. Guiding Principles

The National HIV Prevention Roadmap 2023/24 – 2026/27 embraces the following guiding principles:

1. Ending Inequalities: Health outcomes will be addressed through Public Health approach by
improving the understanding the response to human rights and gender-related barriers to
accessing services.
2. Evidence-Based & Results-Driven Programming: Scaling up evidence-informed and
result-driven program design, planning, implementation, monitoring, and evaluation inspired
by flexibility, cost-effectiveness, and strategic investments.
3. Quality, Comprehensive & Integrated Services: Commitment to promoting access, quality,
integrated HIV services under principles of universal health coverage and promotion of
human rights as well as social justice, equality, and equity, and promoting gender equality.
4. People-centred service delivery: Placing people at the centre of the decision-making, with
the inclusion and participation of all stakeholders, including communities, people living with
HIV, and key and vulnerable populations.
5. Gender Responsiveness: A gender-responsive approach that caters to the different needs
of women, girls, men, and boys in accessing HIV information and Sexual Reproductive
Health (SRH) related services.
6. Inclusiveness: An inclusive and people-centred approach that recognizes different
prevention options that individuals may choose at different stages of their lives.
7. Country-Owned & Multi-Sectoral approach: Embracing partnership between the
government and communities, non-state actors, private sector, and development partners
and shared accountability for results.
8. Community-led program leadership, service delivery, and monitoring: Communities
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 such as key and vulnerable populations participate in delivering and monitoring HIV
prevention services to improve acceptance and retention in HIV prevention, care, and
treatment services.
9. Sustainability: Building on the principle of a sustainable program that includes reliance on
domestic resources, increasingly strategic partnerships with external funders, community
ownership, and leadership commitment.
10. Value for Money: Maximize and sustain equitable and quality health outputs, outcomes,
and impacts in a constrained economic and financial environment. The Roadmap applies the
principle of economy - HIV prevention programs strive to minimize costs of inputs for service
delivery whilst attaining acceptable levels of quality. Furthermore, the roadmap ensures
effectiveness, allocative, and technical efficiency in designing, implementing, monitoring, and
evaluating HIV prevention programs.

4.0. HIV PREVENTION STRATEGIC PRIORITIES,

INTERVENTIONS AND TARGETS

4.1. Strategic Priorities for the 2023/24 – 2026/27 Road Map

The recently launched Global AIDS Strategy (2021–2026) by UNAIDS seeks to end inequalities
that drive the AIDS epidemic and put people at the centre to get the world on-track to end AIDS
as a public health threat by 2030. The strategy aims to reduce the number of new infections to
fewer than 370,000 per year by 2025. According to UNAIDS reports, inequalities are a key
reason why the 2020 global targets were missed. The2021-2026 Global AIDS Strategy outlines a
comprehensive framework for transformative actions to confront these inequalities and, more
broadly, respect, protect, and fulfil human rights in the HIV response. By reducing the
inequalities driving the AIDS epidemic, the strategy aims to close the gaps in HIV prevention,
testing, treatment, and support by 2025 and put the world back on course to end AIDS by 2030.

The strategy encourages countries to set granular targets for population and geographic
localities. It also underlines the need to recognize that key populations are at high risk of HIV
infection and set a target to reach 95% of people at risk of HIV infection with combination HIV
prevention interventions. It aims to attain the new 95–95–95 testing, treatment, and viral
suppression targets across all demographics, populations, and geographic settings. It also aims
to eliminate new HIV infections in children. Additional targets include the 95–95–95 targets for
access to HIV services, the 10–10–10 targets for removing social and legal impediments to
accessing or using HIV services, and 30-60-80 targets for community-led services.

Note: The 30–60–80 targets are defined as follows in the Global AIDS Strategy: 30% of testing
and treatment services to be delivered by community-led organizations; 60% of the programs to
support the achievement of societal enablers to be delivered by community-led organizations;
80% of service delivery for HIV prevention programs for key populations and women to be
delivered by the community, key population and women-led organizations.

Informed by the Global AIDS Strategy 2021-2026 and the Global HIV Prevention 2025 Road
Map, the Domesticated National HIV Prevention Road Map 2023/24 – 2026/27 for Tanzania
Mainland focuses on scaling up primary prevention of HIV infections and introducing the policy,

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legal and societal enablers to prevent people from acquiring HIV infection. The Road Map
emphasizes the need for an intensified focus on reaching key and vulnerable populations
(including vulnerable adolescent girls and young women) and their sexual partners. It
emphasizes the need for addressing inequalities that fuel new HIV infections and strengthening
the roles of communities in HIV prevention.
The strategy builds on five interlinked strategic priorities:

 Strategic Priority 1: Maximize equitable and equal access to HIV services and
solutions
 Strategic Priority 2: Break down barriers to achieving HIV outcomes
 Strategic Priority 3: Fully resource and sustain efficient HIV responses and integrate
them into systems for health, social protection, humanitarian settings, and pandemic
responses.
 Strategic Priority 4: Precision Prevention
 Strategic Priority 5: Enhance Multi-Sectoral Engagement

4.2. HIV Prevention Interventions

In order to achieve an 85% reduction in new HIV infections by 2025, compared to the 2010
baseline, and to bring Tanzania closer to epidemic control by 2030 in line with NMSF V and
HSHSP V, the National HIV Prevention Road Map 2023-2027, prioritizes the 'scaling up' of
evidence-based prevention strategies. This involves targeting all at-risk population segments in
an 'equitable' manner. The focus is on 'effectively reaching' and 'saturating' key and vulnerable
population (KVP) groups such as PWID, FHR, men at-high risk, fisherfolks, miners, long-distance
truck drivers, plantation workers, and sex partners of key and vulnerable populations, among
others. It also extends to segments of the underserved general population, including adult men,
adolescent boys, and young men (ABYM), who have not been systematically targeted in an
impactful manner by the scopes of HIV prevention interventions.

The development of this Road Map ensures the preservation of the gains achieved during past
implementation periods. Deliberate efforts are made to strengthen proven interventions like
PMTCT, VMMC, blood safety, STI screening and management, and condom programming.
Simultaneously, the Road Map embraces new evidence-based interventions such as PrEP,
HIVST, and HIV recency testing. (Figure 8 refers)

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Figure 8: Conceptual Model for Reduction of New HIV Infections

Adequate Condom Targeted IEC/SBCC (using

Procurement traditional and digital
Comprehensive approaches)
Condom Use
Condom
Programming Community-based
Community-based
TMA distribution
distribution

HIV, Hep B and syphilis

screening and treatment
among PBFW Targeting by Risk Groups

HIV early infant Community- based

HIV early
and infant
PMTCT diagnosis
diagnosis
Pediatric distribution for Self-testing
ART and Pediatric
linkage
ART linkage
IQC, EQA, Post Market
Attain
Attain sustained
sustained viral
suppression
viral Surveillance
suppression for
for
PBFW
PBFW

PrEP Eligibility and Targeting by Risk

Risk transition
PrEP and STI monitoring GroupsCommunity-
Programming based Distribution
Reduction of New HIV

(Targeted PrEP) Community

Community based,
based,
Peer
PeerPrEP
PrEP
Delivery
Delivery
Infections

Index testing in lower

TasP, PMTCT, PrEP and
burden geographical
PEP settings Targeting by Risk Groups

Smart Testing and PLHIV

Targeted
Targeted Testing
Testing in
in hotspot
hotspot Community- based
places
places (Transport
(Transport corridors,
Identification and linkage to Mining,
corridors,
Recreational distribution for Self-testing
Mining, Recreational venues
ART and PEP venues,
,SocialSocial Networks
Networks etc.)
etc.)
IQC, EQA, Post Market
Surveillance
HTS Quality assurance

Rollout Recency testing Targeted response with

as part of HTS aggressive ART
Recent HIV infection
surveillance and targeted treatment support
response to halt Infection Establish Recency
Establish Recency infection
infection
spread response system (PrEP, for rapid viral suppression
Aggressive ART
Aggressive ART Initiation
Initiation
and support)
PrEP for HIV negative
Facility
Facility based
based VMMC
VMMC contacts
VMMC targeting and (Decentralize and support
EIMC and VMMC sustainability VMMC
VMMC capacity
capacity in
in lower
lower
HFs)
HFs)
Increase and sustain Recruit and maintain
quantity of donated blood non-remuneration donors
that meets country need
Access to safe blood Mass campaign in
Blood Safety (quantity and quality) targeted communities
Strengthen and sustain CQI
capacity for blood safety

Based on the above conceptual framework of ‘HIV prevention activities, and in alignment with the
5 HIV prevention pillars, the National HIV Prevention Road Map 2023/24 - 2026/27 has
organized HIV prevention interventions into four priority strategic areas. For consistency
purposes, these priority strategic areas and specific interventions are matched with the structure
used in HSHSP V as well as NMSF V.

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4.3. Key Elements of the 2023/24 - 2026/27 Road Map
The HIV prevention goal is aligned with the NMSF V, HSHSP V, and other national strategies.
Below are the key elements of the 2023/24 - 2026/27 Road Map for Tanzania Mainland.
 Geographic prioritization: This Road Map groups councils into three clusters (high,
medium, and low risk), based on Tanzania’s geographical disparities in HIV incidence,
and draws on this to identify priority populations. Key age groups and sex-
disaggregated data inform service delivery and prioritization.
 Combination prevention: Modelling is used to prescribe the optimal combination of
interventions and required coverage for each cluster and council in the country.
 Efficiency in delivery: This Road Map outlines implementation strategies and options
in community and facility settings. Tanzania Essential Package of Health cycles are
used to optimize provider contacts to deliver services.
 Leveraging: This Road Map identifies opportunities for leveraging other sectors and
emerging technologies and making HIV prevention ‘everyone’s business’ through
shared responsibility.
 Forecasting and tracking progress: This Road Map emphasizes monitoring
outcomes instead of processes. It anticipates emerging technologies, aims to increase
research uptake, and outlines national and cluster-specific research priorities.

5.0. THE 10-POINT ACTION PLAN TO ACCELERATE HIV

PREVENTION IN MAINLAND TANZANIA (2023/24 - 2026/27)
This new Road Map charts a way forward for country-level actions to achieve an ambitious set
of HIV prevention targets by 2025 and 2027, which will set Tanzania on the trajectory to meet
the 2030 targets. Those targets emerged from the 2021 Political Declaration on HIV and AIDS,
which the United Nations General Assembly adopted in June 2021, and they are underpinned
by the Global AIDS Strategy (2021–2026). Tanzania adopted these targets in the NMSF V and
HSHSP V. Through the National HIV Prevention Technical Working Committee (PTWC), which
falls under the broader HIV Joint Thematic Working Group (JTTWG) chaired by the Permanent
Secretary of the Prime Minister’s Office (coordinated by TACAIDS), already Tanzania is
employing multi-sectoral structures to provide oversight, leadership, and coordination in
monitoring country’s progress towards achieving the set global and national goals. PTWC’s
mandate is to serve as the coordination and oversight platform to support the operationalization
of global and regional commitments linked to HIV and SRH programming for adolescents and
young people aged 10-24 years. These include but are not limited to the Global AIDS Strategy
2021-26, Political Declaration on HIV and AIDS (2021), Global HIV Prevention 2025 Road Map,
Africa Union Commitment to End AIDS (2023), SADC Commitments to HIV and AIDS (Maseru
Declaration to combat HIV and AIDS, 2003 and Joint Meeting of Ministers of Health and
Ministers Responsible for HIV and AIDS, 2019), and the ESA Commitment on CSE and SRHS
(2013), amongst others. This scope also assists in planning, reviewing, validating, monitoring,
and evaluating the National HIV Prevention Road Map 2023/24 - 2026/27.
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5.1. The Adopted 10-Point Action Plan for Tanzania Mainland

Tanzania has domesticated GPC’s 10-point action plan to accelerate HIV prevention in
line with the Global HIV Prevention 2025 Roadmap. This 10-point plan for accelerated
action lays out the immediate concrete steps each country can take to accelerate
progress towards meeting the 2025 and 2030 commitments on HIV prevention (Figure
9). The actions have been adjusted to align with the country’s context, realities, and
planning processes and completed through an inclusive and participatory approach.
Proposed milestones and dates are included at the end of the document. The key
actions that Tanzania has prioritized include the following:

 Action Point # 1: Conduct an evidence-driven assessment of HIV prevention program

needs and barriers.
 Action Point # 2: Adopt a precision prevention approach to develop national HIV
prevention goals and aligned 2025 targets precision prevention approach.
 Action Point # 3: Determine country investment needs for adequately scaled HIV
prevention responses and ensure sustainable financing.
 Action Point # 4: Reinforce HIV prevention leadership entities for multisectoral
collaboration, oversight, and management of prevention responses.
 Action Point # 5: Strengthen and expand community-led HIV prevention services and
set up social contracting mechanisms.
 Action Point # 6: Remove social and legal barriers to HIV prevention services for key
and priority populations.
 Action Point # 7: Promote the integration of HIV prevention into essential related
services to improve HIV outcomes.
 Action Point # 8: Set up mechanisms for rapidly introducing new HIV prevention
technologies and program innovations.
 Action Point # 9: Establish real-time prevention program monitoring systems with
regular reporting.
 Action Point # 10: Strengthen accountability of all stakeholders for progress in HIV
prevention.

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Figure 9: HIV Prevention Road Map: Ten-point Action Plan

During the process of adopting the National HIV Prevention Road Map 2023/24 - 2026/27,
informed by insights from the P-SAT 2022 findings, HIV prevention 2022 scorecard, and the
2023 baseline assessment findings (conducted in each GP member state) of the HIV prevention
2025, a strength, weakness, opportunities, and threats (SWOT) analysis was conducted using
multi-stakeholder engagement process. Thereafter, priorities were developed to address the
identified weaknesses and threats while capitalizing on the strengths and opportunities. Annex 2
provides a summary of SWOT findings.

5.2. Operationalizing the 10-Point Action Plan

In order to achieve the specified HIV prevention targets for 2025 and 2030 in Tanzania Mainland,
the next phase of the HIV prevention response will centre on the effective implementation of
combination prevention interventions outlined in earlier sections, derived and refined from the
NMSF V and HSHSP V. This Road Map delineates the necessary actions to address various
challenges, acknowledging the dynamic nature of the HIV epidemic and its variations across the
country. Central to this Road Map is the pursuit of a 95% coverage target for individuals at risk of
HIV infection, with a focus on high-impact prevention programs for key and priority populations.
Community-led activities play a pivotal role in the scale-up of these programs, aiming to
significantly reduce new HIV infections. The Road Map advocates for discontinuing investments
in interventions of limited effectiveness and efficiency, emphasizing the reallocation of resources.
Furthermore, it underscores the imperative to end the inequalities that fuel the HIV epidemic,
hindering efforts to end it. It also highlights the importance of sound management and
accountability processes within a multisectoral response. Detailed below are the activities
corresponding to each of the 10-point actions, accompanied by their respective progress
markers for monitoring advancement.

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 Action Point # 1: Conduct an Evidence-Driven Assessment of HIV Prevention
Programme Needs and Barriers

The process of developing this Road Map is coming at a time when the final analysis of THIS
2.0 (2022-2023)13 is about to be concluded; the process of sharing preliminary findings is
continuing; therefore, this action point needs to build on the soon-to-be-availed granular national
and sub-national epidemiologic data. Listed below are the agreed activities proposed to be
undertaken from 2023/24 - 2026/27.
 Convene a national-level technical meeting to review THIS 2.0 report, TDHS 2022
findings, key global reports (GAM, Scorecards, and PSAT), and HIV/AIDS program data
(health and non-health), and conduct additional secondary analysis as needed to
examine HIV transmission trends and patterns (national, regional and council).
 Conduct an evidence-based and data-informed review of critical enablers and barriers to
prevention programming (i.e., stock-taking of policy, legal, and societal barriers hindering
service access and utilization).
 Conduct bi-annual multi-stakeholder workshops to review progress in implementing
prevention programs at scale, identify obstacles to service access and usage, and
determine critical technical and capacity needs to address any gaps (use the existing
Prevention TWC structure).
o Barriers/ obstacles are to be categorized into leadership, policy, legal, structural,
etc.
 Conduct regular (5-yearly) HIV stigma index studies.
 Conduct regular (5-yearly) legal and policy environmental assessment surveys.

MILESTONES TIMELINES
1) Report of epidemiology trends and patterns disseminated to national and July 2024*
sub-national stakeholders
2) Multistakeholder meetings to review transmission trends and patterns November 2024
convened as per the set schedule
3) Report on barriers and enabling factors for prevention programming (policy, December 2024
legal and societal)
4) HIV stigma index survey conducted as per the set schedule July 2025

Action Point # 2: Adopt a Precision Prevention Approach to Develop National HIV

Prevention Goals and Aligned 2025 Targets Precision Prevention Approach

In order to meet its 2025 and 2030 HIV prevention goals, the Government of Tanzania will build
on evidence-based and data-driven assessments and analysis to gather insights that will inform
targeting. The gathered data will identify and profile the populations and locations that require
urgent focus. Primary and secondary THIS 2.0 data will be utilized to calibrate programming (as

13
THIS2022-2023_Summary_Sheet.pdf ([Link])

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per NMSF V and HSHSP V), but more importantly, it will help the smart targeting of combination
prevention interventions in all population segments at risk. This is envisaged to also guide the
allocative efficiency of HIV prevention programming resources tailored to the needs.
 Conduct a data-driven multi-stakeholders review of the spectrum and THIS 2.0 (primary
and secondary) data to identify the age and sex-disaggregated populations and
locations at increased risk of HIV transmission and acquisition.
 Disseminate national and sub-national HIV prevention targets to national, regional, and council
stakeholders.
 Improve dissemination of spectrum estimates for HIV infections at national and sub-national
levels.
 Conduct regular (3-yearly) IBBS and KVP size estimates in order to guide HIV
programming (for classical and non-classical KVP).
 Adopt or adjust interventions and approaches shown to reduce new HIV infections with
an appropriate balance between biomedical, behavioural, and structural approaches.
 Adjust, adapt, and reprioritize HIV prevention interventions and investments to align
with the needs.
o Use THIS 2.014, spectrum, and AIM modelling data to recalibrate programming.
o Use the AGYW PSE and UNAIDS decision-making tools15 to guide and
recalibrate programming for AGYW.
 Conduct advocacy and sensitization meetings to build consensus and a common
understanding of precision HIV prevention approaches.
 Engagement of private sectors to deploy precise HIV prevention approaches, e.g., PrEP
provision through private drug dispensing units.

MILESTONES TIMELINES
1) Revised age, sex, and population disaggregated national, regional, and June 2024
council-level HIV prevention targets (for all combination prevention
interventions)
2) Updated IBBS report disseminated and used to guide programming August 2026
3) Circular on HIV prevention targets (national, regional, and council) released June 2024
and disseminated to all stakeholders (also hold virtual meetings on the same)
4) Mid-term review of the HIV prevention roadmap conducted December 2025
5) Annual HIV prevention program report developed and disseminated as per Annually
set schedule
6) Updated KVP size estimates disseminated and used to guide programming January 2027

Action Point # 3: Determine Country Investment Needs for Adequately Scaled HIV
Prevention Responses and Ensure Sustainable Financing

In accordance with the UNAIDS report, funding for HIV programs has continued to decline from
both international and domestic sources. In 2022, it fell back to the same level as in 2013 (i.e.,
approximately US$ 21 billion), far short of the US$ 29.3 billion needed by 2025. With this
observed trend, in the 2023/24 - 2026/27 implementation period, the Government of Tanzania
commits to strengthening its strategies to mobilize more resources, but more importantly,
14
THIS2022-2023_Summary_Sheet.pdf ([Link])
15
[Link] ([Link])

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improve allocative efficiency, reduce any potential wastages, and improve program efficiency.
The Government shall make concrete plans for adequate investments in HIV prevention as part
of a fully funded national response so that increased domestic resources and a quarter of HIV
spending on average goes towards prevention programs. In alignment with the GOALS ASM
results (see section 2.3) and the HIV Investment Case 2.0 recommendations, concerted efforts
will be made to direct funding towards the most cost-effective interventions in order to maximize
the impact of limited HIV prevention funds available. These include PMTCT, KVP (particularly
FHR and AGYW), PrEP, Comprehensive Condom Programming, and VMMC. Mass media
interventions will also be employed to generate demand for various services, address critical
enablers, and deliver SBCC messages. The allocation shifts towards the more cost-effective
interventions would occur gradually through a multi-stakeholder consultative engagement
process. Figure 10 shows the relative resource shifts for prevention funding as informed by the
HIV Investment Case 2.0 analysis.

Figure 10: Constant Coverage vs Optimization- Optimization- Constant Coverage Funding

Scenario (O-CCF) Resource Allocation 2019-2030 (Prevention Interventions)

Throughout the implementation, the Government will employ various evidence-based

approaches to assess the impact of all HIV prevention interventions; during this process,
interventions that will be found to be less cost-effective would have to be partially scaled back or
paused to free up additional funds. Below is the list of activities linked to this action.
 Revise and update HIV prevention financing needs, targets, and gaps in line with the
updated Global HIV Prevention Road Map (building on NMSF V and HSHSP V analytics,
as well as the HIV Investment Case 2.0 and the 2022 GOALS ASM Results).
 Convene a national dialogue between key domestic and international financing partners
to agree on how acute gaps can be filled and how to include the engagement of private-
sector to complement external and domestic funding allocated for prevention.
 Reallocate and prioritize HIV prevention investments by targeting the most at-risk
populations and locations (strengthen allocative efficiency).
 Incorporate HIV prevention into 5-year sustainability and transitioning plan to be
developed guiding shifting HIV financing framework from external support to domestic
sources.
o Formalize CHWs carder and link to the health system.
 Improve domestic resource mobilization and utilization for HIV prevention programming.
o Advocacy for domestic resource mobilization for the AIDS Trust Fund through
earmarked levies.
o Establish a social contracting mechanism (public funds to support communities to
lead program implementation, service delivery, and monitoring).

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 o Advocacy with members of parliament for increasing the Government budget for
health to reach the Abuja Declaration (15%).
o Advocacy for inclusion of HIV prevention budgets into MTEF and CCHPs.
o Strengthen primary health care to deliver comprehensive HIV prevention services.
o Integrate HIV prevention programming in existing health and social service platforms.
o Strengthen multi-sectoral coordination on HIV prevention at all levels (MDAs and
development partners) .
o Promote complementary financing for HIV response.
o Mobilize social protection system to support health promotion interventions for HIV
prevention i.e., NHIF and health insurance systems under Social security schemes.
o Mobilize the private sector for domestic resource mobilization earmarked for HIV
prevention.
 Institutionalize HIV expenditure tracking through the available proven approaches i.e.,
NASA, PER, and NHA (Every two years)

MILESTONES TIMELINES
1) Existence of the costed plan to achieve the 2023-2027 HIV Prevention Road April 2024
Map
2) Country-specific financing needs, targets, and benchmarks for HIV November 2024
prevention developed
3) Multi-stakeholders national dialogue between domestic and international August 2025
partners (including the private sector) conducted through advocacy and June 2026
sensitization meetings
4) Improved allocative efficiency for HIV prevention programming (aligned with Throughout
the HIV Investment Case 2.0 and the 2022 GOALS ASM Results or future
updates)
5) 5-year sustainability and transitioning plan for HIV prevention financing March 2026
6) US $ 1,095,953,767.18 for HIV prevention mobilized Throughout

Action Point # 4: Reinforce HIV Prevention Leadership Entities for Multisectoral

Collaboration, Oversight and Management of Prevention Responses

Tanzania has several lead entities responsible for oversight, leadership, and coordination of HIV
prevention efforts. Due to the multifaceted nature of HIV, TACAIDS – a multisectoral instrument
established by the Government of Tanzania takes the overall leadership in coordinating HIV
response efforts, including prevention. As the country is implementing last-mile efforts to control
the epidemic, the government is committed to working with public sector institutions,
development partners, the private sector, non-governmental and civil society organizations, and
service providers to fast-track efforts to make Tanzania AIDS-free. This goal is envisaged to be
attained by implementing the following steps:

 Enhance TACAIDS’ capacity to hold all sectors and implementers accountable in ensuring a
coordinated HIV response for impact.
o Review/ reinvigorate TACAIDS mandate and specific capacities to strengthen mechanisms
for cross-sectoral collaboration on HIV prevention, initiate policy reviews, and design
communications around prevention, including through the use of new media.
o Improve coordination and maximize synergies between different prevention program
components (NASHCoP, DCEA, PO-RALG, MOEST, MOH, MOJCA).
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 o Revitalize reporting needs by various sectors on progress towards national targets and
commitment.
o Clarify roles and responsibilities of other Ministries in facilitating the delivery of KVP
combination prevention services using public health approach (e.g., MOHA and MOJCA).
o Capacitate and coordinate the functionality of regional, council, ward, and village multi-
sectoral AIDS committees (R/C/W/VMACs).
o Capacitate TACAIDS to coordinate with NASHCoP and other stakeholders to translate
NMSF V and HSHSP V to regional and council levels.
 Revitalize the Prevention TWC, including its three sub-TWC (i.e., Adolescent and Young Adult
Stakeholders [AYAS], KVP, and Condom), and sustain the PrEP TWG under MoH.
o Review TOR, improve functionality, and their capacity to track prevention progress.
o The TOR will include guidance on adopting new initiatives and technologies for HIV
prevention programming.
o Ensure close coordination and synergy of the sub-TWC.
 Strengthen the Technical AIDS Committees (TAC') led by Permanent Secretaries for Public
Sector and Private Sector Coordination led by the Association of Tanzania Employers (ATE).
 Strengthen the engagement of multisectoral stakeholders on the regional framework for HIV
prevention (including all actors, especially CSO and community representatives).
 Strengthen financial and technical support to HIV prevention TWC, sub-TWC, and the
R/C/W/VMACs.

MILESTONES TIMELINES
1) Annual progress reports from all sectors (health, education, tourism, Annually
transport, fishing, agriculture, private sector, etc.) on how they are participating
in HIV prevention efforts submitted
2) Prevention TWG and the respective sub-Committees (i.e., AYAS, Condom, Quarterly
PrEP, and KVP) meeting as per schedule (quarterly)partners conducted
through Advocacy and sensitization meetings
3) TOR for HIV prevention leadership entities and TWGs reviewed/developed June 2024
4) National HIV Prevention Strategies (i.e., NSMF V, HSHSP V, and Road
Map) translated at regional and council levels to guide implementation, i.e., June 2024
HIV prevention targets developed and disseminated both at national, regional,
and sub-national levels
5) Improved participation of CSO and community-led organizations in planning, Throughout
implementation, and monitoring of HIV prevention interventions

Action Point # 5: Strengthen and Expand Community-Led HIV Prevention

Services and Set Up Social Contracting Mechanisms

As narrated in the earlier section, in order to achieve HIV prevention goals by 2025 and 2030,
the Government of Tanzania has committed to working in close partnership with local non-
governmental and community-based entities to design, plan, budget, implement, monitor and
evaluate HIV prevention programs at both national and sub-national levels. Building on lessons
learned from the ongoing community-led monitoring, for the 2023/24 - 2026/27 implementation
period, the following initiatives will be employed.
 Set national and regional targets and milestones for increasing the proportion of HIV
prevention services delivered by community-led organizations (adapt the 30-60-80
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 targets according to local context).
 Build technical and managerial capacity of community-led organizations and networks at
national, regional, and council levels.
o Train implementers on the use of KVP peer outreach SOP.
o Support the rollout of these KVP peer outreach SOP.
 Advocacy and sensitization of local government structures to meaningfully engage
community organizations.
 Engage the registrar of NGO to orient and facilitate community organizations to register
and implement interventions in accordance with the country’s laws, regulations, culture,
norms, and traditions.
 Forge strategic partnerships with international financing agencies to co-finance
community-led organizations to implement HIV interventions.
 Develop a social contracting framework for support and engagement of community-led
organizations/ entities (to include a legal framework for sub-contracting and an
implementation roadmap of gradually increasing the proportion of HIV prevention
services delivered by community-led organizations).
 Sub-contract eligible local entities to implement and monitor HIV prevention interventions
(using domestic resources).
o Prioritize and ringfence resources for community-led interventions.
 Monitor community-led response at national and sub-national level.

MILESTONES TIMELINES
1) National and regional-level targets and milestones for increasing the June 2024
proportion of HIV prevention services delivered by community-led
organizations developed
2) Community organizations capacitated and supported to implement HIV October 2024
prevention interventions
3) Social contracting framework developed June 2024
4) Number of community organizations financed to implement HIV prevention January 2025
interventions (domestic and external sources)

Action Point # 6: Create an Enabling Environment for HIV Prevention

Programming (Renamed from “remove social and legal barriers to HIV prevention
services for key and priority populations”)

Successful prevention programming is directly linked with the presence of a conducive policy
and legal landscape to facilitate the smooth implementation of HIV prevention interventions at
health facility and community levels. This includes the use of a public health approach to
providing services for key and vulnerable populations. In line with the country’s legal framework,
culture, norms, and traditions, Tanzania provides services to PLHIV, people living with
disabilities, and KVP using a public health approach. Healthcare providers, community health
workers, and volunteers are all expected to provide non-judgmental, non-discriminatory, gender-
responsive, age-appropriate, and KVP and youth-friendly services to any person seeking care
irrespective of their sexual behaviour and practices. Therefore, the Road Map will focus on
removing any social and legal barriers faced by individuals who are seeking HIV prevention

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34
services. Specific strategies are outlined below.
 Disseminate HAPCA, HIV Policy, and relevant HIV/AIDS Guidelines (e.g., KVP
Guidelines).
 Build the capacity of healthcare providers, religious leaders, academic institutions,
research institutions, media, civil society organizations, community, and KVP
beneficiaries about the link between HIV and KVP and the use of public health approach
to provide HIV and SRH services to KVP.
 Empower PLHIV and KVP beneficiaries by providing them with legal orientation
(knowing their rights and their responsibilities/ obligations in relation to the national and
local laws relevant to HIV prevention).
 Capacity building of CSO/ CBO implementing HIV combination prevention interventions
 Sensitize all the key gatekeepers (law enforcers, lawmakers, etc.) about HAPCA,
provisions of the current constitution, national KVP guidelines, and other key relevant
strategies, regulations, and policies that allow for and emphasize the use of public health
approaches to providing services to KVP. This assignment should go hand in hand with
revising the pre-service curriculum and developing learning resource packages for in-
service training.
 Expand community legal and paralegal services for PLHIV, people living with disabilities,
and KVP.
 Strengthen collaboration between the Government and relevant global partnerships for
creating a conductive HIV prevention environment.
 Adapt service delivery approaches (e.g., use of self-care, virtual/ mHealth services, and
outreaches) to cater to at-risk populations' unique needs.
 Establish a System for Monitoring and Enabling Environment for HIV Prevention
Programming.

MILESTONES TIMELINES
1) Key gatekeepers sensitized on national HIV prevention intervention August 2024
strategies and Road Map (using public health approach)
2) Key strategies, policies, and guidelines on HIV prevention disseminated December 2024
3) Functional system for monitoring enabling environment for HIV prevention
programming January 2025
4) Tanzania joining the Education Plus initiative October 2024
5) Populations at heightened risk of HIV transmission and acquisition Throughout
empowered

Action Point # 7: Promote the integration of HIV prevention into essential related
services to improve HIV outcomes

Integration of HIV services with other health services has been proposed as an important
strategy to boost the sustainability of the global HIV response. Evidence suggests that when
HIV services are integrated with other health services, improvement in both health and health
systems outcomes is observed. As the Government of Tanzania is making strides in
implementing UHC 2030 goals, integrating HIV prevention services into other essential related
services such as Viral Hepatitis, STIs, and other SRH services is pivotal. The release of the
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35
three WHO global health sector strategies on, respectively, HIV, viral hepatitis, and STIs 16
serves as a model of how this Road Map seeks to enhance readiness and operationalize
integration. In line with these strategies, in November 2023, Tanzania launched an Integrated
Health Sector HIV, Viral Hepatitis, and Sexually Transmitted Infections (STI) National Strategic
Plan. In tandem with this launch, the Ministry of Health has also restructured its National AIDS
Control Program (established in 1988) to form a newer program, namely, the National AIDS,
STIs and Hepatitis Control Programme (NASHCoP). Below is the list of strategies to be
employed for the 2023/24 - 2026/27 implementation period.
 Revise/ update and disseminate national strategies, policies, and guidelines for integration
of HIV prevention with other services.
o National Integrated Health Sector HIV, Viral Hepatitis and Sexually Transmitted
Infections (STI’s) Strategic Plan.
o National eMTCT Strategy.
o National Integrated HIV, Viral Hepatitis, and STI Management Guidelines.
o National Integration Guideline for RMNCAH and HIV Integration.
o Update HIV/SRH integration M&E indicators.
 Redesign current HIV services by integrating them with other services, including social
services (either collocating, linking, or providing one-stop services).
 Revise/ update HIV/AIDS service delivery training packages to include integration with
other essential services.
 Revise supportive supervision checklist/ tools to include integration of HIV and other
services.
 Allocate domestic funding for improving infrastructure to support the provision of integrated
services (e.g., HIV and RMNCAH).
 Capacitate healthcare providers on the provision of HIV-integrated services.
 Integrate HIV prevention services within the insurance schemes (align with UHC/
strategy).
 Advocate for private health facilities to integrate HIV prevention services.
 Strengthen existing integrated supply chain systems to enhance the provision of integrated
services.
 Advocate with the donor community to design grants/ interventions that consider the
integration of services.
 Revitalize HIV Integration TWG/TWC/ Committees and sub-TWG/TWC at the national
level.
 Monitor and report HIV integration M&E indicators.

MILESTONES TIMELINES
1) National Strategies. Policies and Guideline for Integration of HIV with Viral October 2024
Hepatitis, STI, and SRH/RMNCAH services updated and disseminated
2) National HIV, STI, and Viral Hepatitis Training Package updated and March 2025
disseminated
3) National FP/HIV integration training package/curriculum updated and June 2024
disseminated
4) Regional/District AIDS Control Coordinators (R/DACCs), Regional/District July 2024
Reproductive and Child Health Coordinators (R/DRCHCOs), Regional
Coordinators for TACAIDS (RCT), and Council HIV and AIDS Coordinators

16
Global health sector strategies on, respectively, HIV, viral hepatitis and sexually transmitted infections for the period 2022-2030
([Link] ([Link]))

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 (CHACs) capacitated on HIV, Viral Hepatitis, STI, and SRH Integration
5) FP/HIV sub-TWG revitalized July 2024
6) HIV/SRH indicators reported through existing M&E systems Throughout
Action Point # 8: Set Up Mechanisms for the Rapid Introduction of new HIV prevention
Technologies and Programme Innovations

Tanzania has been adopting innovations and technologies that enhance program effectiveness,
efficiency, and sustainability in the health sector. As far as HIV prevention is concerned, in the
last decade, new innovations/ technologies have emerged; these include oral PrEP, Dapivirine
ring, and injectable PrEP (CAB-LA). More innovative tools/ technologies are at different stages
of research and development. Therefore, this Road Map seeks to do the following.
 Develop a national guide/ framework for adopting/domesticating new technologies and
innovations (National HIV Technology & Innovations Adoption Guide/Framework defining
the process, approaches, and timeframe).
 Incorporate “the adoption of new HIV prevention technologies and innovations” as a
permanent agenda of the Prevention TWG and the broader HIV Joint Thematic Working
Group (revise TORs and track this action).
 Streamline the process of adopting new HIV prevention technologies/ innovations.
o Strategically engage key HIV technology entities (e.g., TMDA, TBS, Government
Chemist Laboratory Authority, Chief Pharmacist & MSD) to fast-track the registration of
new innovations and technologies.
o Initiate timely in-country discussions of the new innovations and technologies through
the existing TWG and forums.
o Domestication and adoption of new technologies and innovation through early revision
of existing policies and guidelines.
 Scale up the use of newly adopted HIV prevention technologies/ innovations.
o Strengthen community distribution of HIV prevention technologies.
 Advocate for domestic funding allocation for new HIV prevention technologies.
 Enhance and make adaptations of the current HIV prevention service delivery models to
increase their resilience for global pandemics/ unplanned life-threatening events.
o Enhance the provision of virtual HIV prevention services (including demand creation).
o Scale-up self-care services (HIVST scale-up).

MILESTONES TIMELINES
1) National Guide/ Framework for Adoption of HIV Prevention Innovations and June 2024
Technologies developed and disseminated
2) P-TWG and JTTWG have integrated New HIV Prevention Quarterly
Technology/Innovation in their quarterly meeting agenda
3) HIV prevention service delivery models adapted to increase resilience June 2024
during pandemics/ life-threatening events (including virtual demand creation,
counselling, and service provision)
4) Number of new HIV prevention technologies/options adopted (including August 2025
PrEP options)

Action Point # 9: Establish Real-Time Prevention Programme Monitoring Systems with

Regular Reporting

Successful prevention programming relies on the presence of quality, gender-sensitive, and

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37
population-specific routine monitoring systems that are able to promptly identify and address
implementation gaps and challenges and track program performance at all levels of
implementation, including both health and community components. Therefore, as it implements
the last mile actions to ending AIDS by 2030, the Government of Tanzania will continue to
closely coordinate with various stakeholders to prioritize real-time monitoring of the
implementation progress, including the ten-point Action Plan. Below are the specific strategic
actions:
 Conduct M&E systems need/ gap assessment to identify areas of strengthening.
 Allocate adequate resources to support competent institutions and expertise to develop
and maintain real-time data systems in the country.
 Review national data management guidelines to incorporate new developments and
indicators for HIV prevention interventions.
 Review national HIV prevention indicators to align with HIV prevention scorecards.
 Re-design/ upgrade the existing systems to allow real-time data reporting
o Map all relevant data elements for inclusion into the existing M&E. system for GAM
reporting.
 Fast track rollout and utilization of unified community system.
o Synchronize and harmonize recording and reporting systems for community HIV
interventions.
 Strengthen existing national multi-sectoral M&E system for routine data to capture all HIV
prevention programming/implementation barriers.
 Strengthen periodic program and data reviews for both national and sub-national levels on
a quarterly basis.
o Update HIV prevention scorecards at global, national, and subnational levels and
evaluate the cost-effectiveness and value for money of national institutions
coordinating and managing HIV prevention.
o Conduct bi-annual joint program and data review meetings both at national and sub-
national levels to inform HIV prevention programming.
 Conduct regular HIV M&E TWG meetings to support the coordination and monitoring of
HIV prevention interventions (with a constant agenda to review and track HIV prevention
indicators and scorecards).

 Strengthen capacity at regional and council levels to use M&E systems and data utilization
for programming and decision-making.
 Cascade down regular dialogues, joint reviews, and data reviews from the national to
regional and council levels.

MILESTONES TIMELINES
1) Routine M&E system gap assessment report (delineating the identified gaps Throughout
and areas of improvement)
2) M&E data management guidelines updated and disseminated Throughout
3) Upgraded routine M&E system June 2024
4) Unified community system rolled out nationwide (all implementing partners October 2025
using it)
5) Increasing the number of community-based HIV implementers reporting December 2025
through TOMSHA (GC 7 goal is to increase from 1,700 to 2,080)
6) National, regional, and council-level M&E personnel capacitated July 2024
7) M&E TWG meetings convened as per schedule Bi-annual

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Action Point # 10: Strengthen the Accountability of All Stakeholders for Progress in HIV
Prevention

Ending AIDS requires all key stakeholders (including financing partners, government,
implementers, private sector, and civil society) to work harmoniously while maintaining
accountability for the fidelity of program implementation, robust monitoring, and timely reporting
of results. This mutual accountability fosters cooperation and enables different sectors involved
in HIV prevention to work in coordination towards a common goal. Therefore, this Road Map
shall focus on the following:
 Develop an accountability framework for implementing, monitoring, and reporting HIV
prevention interventions (building on NMSF V’s Coordination, Governance, and
Leadership and HSHSP V’s Governance, Coordination, and Implementation guidance).
o Incorporate mechanisms within the existing P-TWG to ensure existing national-level
coordination structures (.e., technical working groups) deliver intended results.
o Strengthen data systems for monitoring accountability.
o Share the responsibility matrix with all sectors (government and non-government).
 Establish a robust system for all sectors (i.e., other ministries, departments, and agencies
with a stake in HIV prevention) to report sector-specific HIV prevention implementation
progress (for all sectors to report to TACAIDS).
 Conduct a high-level national stakeholders stewardship meeting (including stakeholders
from all sector Ministries and the private sector to review HIV prevention priorities,
implementation challenges, financing needs, gaps, and sectoral contributions).
 Increase efficiency on fund utilization within the government system to implement HIV
prevention interventions.
 Reinforce timely disbursement of funding commitments from development partners.
 Engage the private sector to increase their financial contribution to the overall health
sector budget.
 Review the HIV prevention Policy of 2008 and 2014 guidelines at the workplace (focus on
roles and responsibilities and accountability of employers, Association of Tanzania
Employers, and Workers Union).
 Track the National HIV Prevention Road Map implementation to identify weaknesses, take
corrective steps, and share lessons learned and good practices (monitor progress
indicators/ milestones for the 10-point actions).
o Bi-annual national performance monitoring.
o Quarterly regional and council-level performance monitoring.
 Utilize community-led monitoring reports on HIV prevention indicators and shadow reports
on Road Map implementation to improve accountability.
 Monitor and evaluate the impact of existing plans, strategies, and guidelines against
resources.

MILESTONES TIMELINES
1) Accountability framework developed and disseminated (including sharing of January 2025
stakeholder’s responsibility matrix
2) National-level multisectoral accountability meeting convened as per planned Annually
schedule (annually)
3) Joint accountability report incorporating government and community Annually
perspectives/insights (the latter to include community-led monitoring reports
and shadow reports)
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52
MILESTONES TIMELINES
4) Biannual and quarterly performance reports from all sector ministries timely Quarterly
obtained
5) Financial expenditure report on HIV prevention interventions implementation Annually

6.0. STAKEHOLDERS’ ROLES AND RESPONSIBILITIES IN

NATIONAL HIV PREVENTION EFFORTS
This chapter presents the coordination and management framework. In alignment with the
NMSF V, it lists various stakeholders' granular and specific roles and responsibilities in
implementing sector-specific HIV prevention efforts. Table 2 is a responsibility matrix that
provides the scope of all accountable stakeholders in ensuring multi-sectoral HIV prevention
interventions, and Table 3 further details a responsibility matrix outlining the key HIV prevention
interventions and specific details of stakeholders’ accountability expectations.

Table 3: Multi-Stakeholders’ Roles in Implementing HIV Prevention Road Map 2023/24 –

2026/27 In Mainland Tanzania

Sectors Focus Priority Responsibilities

Populations
Ministry of All  Integ
Health populations rate HIV programming into the Ministry’s plans and
at risk budgets.
 Ens
ure workplaces have peer educators trained on HIV
combination prevention interventions.
 Stre
ngthen coordination with the LGAs around respective
Ministry offices to facilitate constant delivery of HIV and
AIDS services.
 Lead the development of policy framework, strategies,
and guidelines for the delivery of high-quality
combination prevention services;
 Ensure the availability of quality HIV and AIDS
prevention, HIV testing, care, and treatment services
delivered under a differentiated service delivery mode.
 Adopt strategies to increase access to and utilization of
quality HIV prevention services in the country.
 Develop policy, guidelines, and operational plans.
 Coordinate a dialogue structure that guides the Sector
Wide Planning Approach (SWAp) for the health sector
and ensures it supports the HIV and AIDS response.
 Submi
t quarterly implementation reports to POPSM GG &
TACAIDS.
Prime Minister’s Lawmakers  Integ
Office (Policy, rate HIV programming into the Ministry’s plans and
Parliamentary budgets.
Affairs &  Ens
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Sectors Focus Priority Responsibilities
Populations
Coordination) ure workplaces have peer educators trained on HIV
combination prevention interventions.
 Stre
ngthen coordination with the LGAs around respective
Ministry offices to facilitate constant delivery of HIV and
AIDS services.
 Spearhead the development of policy framework,
strategies, and guidelines for the delivery of high-
quality combination prevention services.
 Sensitize parliamentarians (including parliamentary
committees) on HIV prevention issues.
 Sub
mit quarterly implementation reports to POPSM GG &
TACAIDS.
President’s Implementor  Prov
Office - Regional s (all ide overall leadership in interpreting and implementing
Administration sectors) policies and guidelines to guide the HIV and AIDS
and Local response, including drawing bylaws and ordinances to
Governments regulate activities that promote the prevention of HIV
and the uptake of HIV and AIDS services.
 Plan
ning, budgeting, coordinating, and monitoring all HIV
and AIDS activities in the local government.
 Ens
uring that resources are mobilized, allocated, utilized,
and accounted for in addressing local government HIV
and AIDS activities including facilitating the process of
annual budget for HIV and AIDS from RS and LGAs for
submission to the MoF.
 Sup
ervising and coordinating all implementing partners at
the local government level and appraising community
HIV and AIDS programs and projects for quality
assurance and accountability including to ensure that
the HIV coordination structures are functional and
supported, including CMACs, WMACS, and VMAC.
 Guid
ing HIV and AIDS mainstreaming in local government
programs, ensuring that all NMSF priorities are
integrated appropriately.
 In
partnership with Implementing partners and CSOs,
ensure quality HIV combination prevention services for
KVP, at-risk groups, and the general population.
 Ens
ure readily accessibility and utilization of HIV
prevention services such as condoms, VMMC, PrEP
throughout the Country.
 Wor
king with NSAs, facilitate and support community
mobilization activities to create demand for services
using enhanced SBCC, including mainstream and
social media.
 Facil
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Sectors Focus Priority Responsibilities
Populations
itate effective recruitment and deployment of skilled
workers in collaboration with POPSM GG and related
ministries and designing and developing planning
guidelines (MTEF) for the national AIDS response.
 Man
age, coordinate and sustain regional and council-level
responses to the HIV/AIDS epidemic through the
Council Multisectoral AIDS Committees (CMACS),
Ward level through the Ward Multisectoral AIDS
Committees (WMAC) and at the community or local
government level through Village in rural and Mitaa in
Urban Multisectoral AIDS Committees (VMAC).
Ministry of Construction  Integr
Works workers ate workplace HIV programming into the Ministry’s plans
and budgets.
 Provid
e prevention messages at all construction sites.
 Ensur
e all construction sites have condom dispensers and
information on other HIV prevention services.
 Streng
then coordination with projects surrounding the
community, health facilities, and local government
authorities (LGAs) in the delivery and coordination of HIV
and AIDS services.
 Ens
ure all construction sites have HIV self-testing kits and
a constant supply of condoms.
 Ens
ure construction sites have peer educators trained on
HIV combination prevention interventions.
 Ens
ure construction sites have HIV nurse counsellors
(mobile or stationed).
 Sub
mit quarterly implementation reports to TACAIDS.
Ministry of Mobile and  Inte
Transport migrant grate workplace HIV programming into the Ministry’s
(bridging plans and budgets.
populations)  Stre
ngthen coordination with the surrounding community
along the hotspot transport corridors, Health facilities,
and LGAs in the delivery and coordination of HIV and
AIDS services.
 Prov
ide prevention messages at all public transport stops
and stations for vehicles, trucks, and boda bodas.
 Ens
ure all stations/truck stops and hotspots have condom
dispensers, a regular supply of condoms, and
information on other HIV prevention services.
 Ens
ure all stations/truck stops and hotspots have HIV self-
testing kits.
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42
Sectors Focus Priority Responsibilities
Populations
 Ens
ure stations/truck stops and hotspots have peer
educators trained on basic HIV preventive
interventions.
 Ens
ure stations/truck stops and hotspots have HIV nurse
counsellors (mobile or stationed).
 Orga
nize outreach HIV testing and prevention services.
 Sub
mit quarterly implementation reports to POPSM GG &
TACAIDS.
Ministry of Mobile  Integ
Agriculture agricultural/ rate HIV programming into formal and informal
plantation agriculture sector plans and budgets.
workers and  Stre
surrounding ngthen coordination with LGAs and Health facilities
communities around the agricultural plantations to facilitate the
(tea, tobacco, delivery of HIV and AIDS services for agricultural
sugarcane) plantation workers and the surrounding communities.
 Prov
ide HIV prevention messages to agricultural/ plantation
workers to reduce high-risk sexual behaviours.
 Ens
ure all hotspots in the agricultural/ plantation have
access to condoms and information on other HIV
prevention services (including HIV self-testing kits).
 Ens
ure agricultural/ hotspot community hotspots have peer
educators trained on basic HIV prevention
interventions.
 Orga
nize outreach HIV testing and prevention services.
 Sub
mit quarterly implementation reports to POPSM GG &
TACAIDS.

Ministry of Fishing and  Integ

Livestock and pastoralist rate HIV programming into formal and informal
Fisheries communities livestock and fishery sectors.
 Stre
ngthen coordination with the LGAs and Health facilities
around the fishing and pastoral communities to
facilitate constant delivery of HIV and AIDS services.
 Prov
ide HIV prevention messages to at-risk pastoral and
fishing communities to reduce high-risk sexual
behaviours.
 Ens
ure hotspot communities have peer educators trained
on basic HIV prevention interventions.
 Prov
ide mobile services for HIV testing services and
linkages to other HIV prevention services.
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43
Sectors Focus Priority Responsibilities
Populations
 Sub
mit quarterly implementation reports to POPSM GG &
TACAIDS.
Ministry of Miners  Integ
Minerals rate workplace HIV programming into the Ministry’s
plans and budgets.
 Prov
ide prevention messages at all construction sites.
 Stre
ngthen coordination with the LGAs and Health facilities
around the mining communities to facilitate constant
delivery of HIV and AIDS services.
 Ens
ure all construction sites have condom dispensers and
information on other HIV prevention services.
 Ens
ure all hotspots in the mining areas (informal and
formal) have HIV self-testing kits.
 Ens
ure mining sites/ hotspots have peer educators trained
in HIV combination prevention.
 Ens
ure mining sites/ hotspots have HIV nurse counsellors
(mobile or stationed)
 Sub
mit quarterly implementation reports to POPSM GG &
TACAIDS.
Ministry of Home Uniformed  Integ
Affairs services, rate HIV programming into the Ministry’s mandate to
including those offer safety and security services to citizens.
in prison  Stre
settings, ngthen coordination with the LGAs and Health facilities
immigration, around the Uniformed forces and surrounding
fire brigade, communities to facilitate constant delivery of HIV and
and armed AIDS services.
forces.  Provide HIV prevention services to reduce high-risk
sexual behaviours while on duty and away from home.
Also, KVP  Ensure regular supplies of condoms with correct
(including messaging on their correct and consistent use.
prisoners)  Sensitize police officers on using the public health
approach for KVP service provision (create an enabling
environment).
o Orient police and prison officers to support HIV
prevention, especially among KVP groups.
o Sensitize police on harm reduction service
approach.
o Orient police and prison officers to facilitate
HIV prevention, especially among KVP groups.
o Others face social and legal barriers.
 Provide HIV prevention services for prisoners.
 Con
duct orientations to address HIV prevention issues
such as rape and other forms of sexual abuse, human
rights, domestic violence, and the relation between
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44 | P a g e
Sectors Focus Priority Responsibilities
Populations
alcohol and HIV infection; Ensure uniformed forces
offices have peer educators trained on HIV combination
prevention.
 Engage police in referrals of PWID.
 Submit quarterly implementation reports to POPSM GG
& TACAIDS.
Ministry of Defense and  Integ
Defense and security rate HIV programming into the Ministry’s mandate to
National Service services, led by protect and defend the country (including securing
the Tanzania borders).
People’s  Stre
Defense Force ngthen coordination with LGAs around defence and
(TPDF) security units to facilitate constant delivery of HIV and
AIDS services.
 Provide HIV prevention services to reduce high-risk
sexual behaviours while on duty and away from home.
 Ens
ure regular supplies of condoms with correct
messaging on their correct and consistent use. Ensure
defense and security units have peer educators trained
in HIV combination prevention.
 Submit quarterly implementation reports to POPSM GG
& TACAIDS.
Ministry of Justice Addressing  Integr
and Legal Affairs enabling ate workplace HIV programming into the Ministry’s plans
political and budgets.
environment for  Ens
HIV prevention ure workplaces have peer educators trained on HIV
and legal and combination prevention interventions.
structural  Stre
reforms ngthen coordination with the LGAs around respective
Ministry offices to facilitate constant delivery of HIV and
AIDS services.
 Integ
rate HIV programming into the Ministry’s mandate to
defend human rights and facilitate the administration of
justice (budgets and plans).
o Revi
ew and mainstream HIV and AIDS in all
national and sector policies, legislation,
agreements, and conventions.
o Ens
ure that appropriate legislations and policies
support the national response and facilitate
review of legislations and policies as well as
monitoring and evaluation;
o Addr
ess rights violation-related drivers of HIV
infection to the general public and specific
groups.
 Sensitize legal and paralegal officers on the use of
public health approaches for KVP service provision
(create an enabling environment)
 Facilitate gender-based violence campaign human
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45 | P a g e
Sectors Focus Priority Responsibilities
Populations
rights advocacy (free SMS and platforms).
 Ensure justice centres promote HIV prevention and
reform laws and policies.
 Integrate HIV prevention packages into judicial training.
 Submit quarterly implementation reports to POPSM GG
& TACAIDS.

Ministry of Tourism and  Integ

Natural hotels, rate HIV programming into the Ministry’s plans and
Resources and including budgets.
Tourism bars, lodges  Ens
and casinos ure workplaces have peer educators trained on HIV
combination prevention interventions.
 Stre
ngthen coordination with the LGAs around respective
Ministry offices to facilitate constant delivery of HIV and
AIDS services.
 Integrate HIV prevention messages and a regular
supply of free condoms into hotel facilities and other
touristic attractions (reception, bars, toilets, and
washrooms).
 Link with health facilities for prevention services and
outreach services for at-risk populations.
 Integrate HIV prevention packages into tourism
training.
 Submit quarterly implementation reports to POPSM GG
& TACAIDS.
Ministry of Adult males  Integ
Community and females, rate HIV programming into the Ministry’s plans and
Development, out-of- budgets.
Gender, Women, school  Ens
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46
Sectors Focus Priority Responsibilities
Populations
and Special youth, ure workplaces have peer educators trained on HIV
Groups orphans, combination prevention interventions.
and children  Stre
made ngthen coordination with the LGAs around respective
vulnerable Ministry offices to facilitate constant delivery of HIV and
by AIDS, AIDS services.
cultural  Facilitate and support the mainstreaming of gender in
institutions, HIV-related policies, programs, and budgets in public
and religious and private entities.
leaders.  Address sociocultural issues, including gender-based
violence, harmful cultural practices (such as female
genital mutilation, early marriages, and widow
inheritance), gender roles, inequality, and issues
surrounding masculinity.
 Use the platforms of cultural and religious leaders to
address men about issues that escalate HIV
transmission.
 Enhance the engagement of cultural and religious
institutions, special populations, and orphans and
vulnerable children.
 Facilitate programs that engage communities, with
specific reach to young people, including young women
and adolescent boys and girls, women and men that
address socio-cultural and economic barriers to
services;
 Programming for adolescents, orphans, and children
made vulnerable by AIDS to reduce vulnerability.
 Integ
rate programs into social sector development
programming and budgeting.
 Sub
mit quarterly implementation reports to TACAIDS.
Ministry of Adolescents  Integ
Education and young rate HIV programming into the Ministry’s plans and
Science and people in budgets.
Technology school  Ens
ure workplaces have peer educators trained on HIV
combination prevention interventions.
 Stre
ngthen coordination with the LGAs around respective
Ministry offices to facilitate constant delivery of HIV and
AIDS services.
 Ensure that the pre-service curriculum in training and
learning institutions integrates HIV and AIDS.
 Provide peer counselling and support, including AIDS
clubs and directives that address HIV and AIDS-related
stigma and discrimination.
 Collaborate with CSO to implement HIV prevention
interventions on campuses, including education about
condoms and HIVST.
 Address HIV and AIDS-related issues such as
coercion, rape and other forms of sexual abuse, human
rights, and predatory sex.
 Ensure there is a supportive environment for the
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60 | P a g e
Sectors Focus Priority Responsibilities
Populations
utilization of HIV and AIDS services among students
and staff and a specific focus on vulnerable groups,
including but not limited to young women and persons
with disabilities.
 Provide age-appropriate messages and comprehensive
sexuality education in accordance with the national
guidelines.
o Provide adolescent-friendly messages and
clubs.
 Ensure implementation of workplace interventions in all
institutions under the ministry.
 Integ
rate programs in education sector development
programming and budgeting.
 Sub
mit quarterly implementation reports to POPSM GG &
TACAIDS.
Ministry of Youth and  Integ
Information, adult men rate HIV programming into the Ministry’s plans and
Communications and women budgets.
, and Information  Ens
Technology ure workplaces have peer educators trained on HIV
combination prevention interventions.
 Liais
e with the LGAs around respective Ministry offices to
facilitate constant delivery of HIV and AIDS services.
 Develop guidelines to ensure media houses and outlets
support the national response by
disseminating and covering key HIV and AIDS
information.
 Work with media partners to cover campaigns that
reduce barriers to services among vulnerable
communities by addressing barriers to HIV services
uptake, including gender violence, stigma and
discrimination, persecution, and exploitation.
 Create a supportive environment for innovation and
creativity in the context of the utilization of ICT for
effective digital transmission of correct HIV and AIDS
information, including social media.
 Facilitate a supportive environment for stakeholders to
access and utilize key information, including affordable
internet services and coverage of strategic HIV and
AIDS services and forums, including but not limited to
the annual WAD commemoration symposiums and
events.
 Ens
ure appropriate storage and security of HIV data.
 Sub
mit quarterly implementation reports to TACAIDS.
Ministry of Adolescents  Integ
Culture, Arts and and young rate HIV programming into the Ministry’s plans and
Sports people in budgets.
school  Ens
ure workplaces have peer educators trained on HIV
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48
Sectors Focus Priority Responsibilities
Populations
combination prevention interventions.
 Stre
ngthen coordination with the LGAs around respective
Ministry offices to facilitate constant delivery of HIV and
AIDS services,
 Enhance the engagement of cultural and religious
institutions, special populations, and
 orphans and vulnerable children in implementing the
NMSF,
 Facilitate programs that engage communities, with
specific reach to young people, including,
 young women and adolescent boys and girls, women
and men that address socio-cultural and economic
barriers to services.
 Facilitate and support the mainstreaming of gender in
HIV-related policies, programs, and budgets in public
and private entities.
 Submit quarterly implementation reports to POSPM GG
& TACAIDS.
President’s Employers,  Integ
Office Public youth, and rate HIV programming into the Ministry’s plans and
Service adult men budgets.
Management and women  Ens
and Good ure workplaces have peer educators trained on HIV
Governance combination prevention interventions.
 Stre
ngthen coordination with the LGAs around respective
Ministry offices to facilitate constant delivery of HIV and
AIDS services.
 Facilitate mainstreaming of HIV and AIDS into General
Standing Orders, Guidelines, job descriptions,
employee appraisals, etc., as well as into the
Performance Management System.
 In cooperation with MOFP, use human resource
information to make human resource
planning projections for HIV and AIDS response
coordination across the government and ensure that
targets are met.
 Collaborate with TACAIDS on monitoring the
implementation of the Workplace Code of
 Conduct across sectors.
 Ensure appropriate workplace policies are in place and
enforced.
 Submit quarterly implementation reports to POPSM GG
& TACAIDS.
Ministry of Decision  Integ
Finance makers rate HIV programming into the Ministry’s plans and
budgets
 Ens
ure workplaces have peer educators trained on HIV
combination prevention interventions
 Stre
ngthen coordination with the LGAs around respective
Ministry offices to facilitate constant delivery of HIV and
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62
Sectors Focus Priority Responsibilities
Populations
AIDS services
 Facilitate and support the central and local
governments, ministries, departments, and agencies to
mobilize adequate financial resources for the
implementation of the NMSF
 Ensure that local government, ministries, departments,
and agencies provide for and disburse funds for NMSF
implementation
 Ring fence funds allocated for HIV and AIDS and
ensure they are thoroughly audited
 Oversee prudent financial management, procurement,
accountability, and periodic tracking of HIV-related
resources
 Ensure that all national development initiatives
integrate HIV as envisaged in the NMSF
 Submit quarterly implementation reports to POPSM GG
& TACAIDS
Other MDAs and All  Integ
Parastatals populations rate HIV programming into Ministries’ and Parastatals’
plans and budgets.
 Ens
ure workplaces have peer educators trained on HIV
combination prevention interventions.
 Stre
ngthen coordination with the LGAs around respective
Ministry offices to facilitate constant delivery of HIV and
AIDS services.
 Ens
ure that the National HIV and AIDS Response priority
activities are mainstreamed in all MDAs and
Parastatals.
 Ens
ure that appropriate HIV prevention interventions are
implemented in the respective sectors.
 Prov
ide leadership in integrating HIV and AIDS in livelihood
programs/
 Diss
eminate HIV and AIDS messages and services to staff
families and surrounding communities
 Sub
mit quarterly implementation reports to POPSM GG &
TACAIDS.
Private sector Include  Integ
banks, rate HIV programming into the private sector.
microfinance  Ens
institutions, ure workplaces have peer educators trained on HIV
private combination prevention interventions.
clinics,  Liais
industries e with the LGAs around respective Ministry offices to
and markets facilitate constant delivery of HIV and AIDS services.
 Provide HIV prevention messages in the workplace
(including HIV workplace policies).
 Institute preferential loan packages for vulnerable
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63 | P a g e
Sectors Focus Priority Responsibilities
Populations
groups (e.g., AGYW).
 Fund scholarship projects for keeping young girls in
school.
 Invest in HIV corporate social responsibility
 Budget for HIV prevention campaign.
 Contribute to funds/awards for good leadership on HIV
prevention, HIV testing services, and linkages and
referrals of staff for HIV prevention.
 Integrate programs into private-sector programming
and budgeting.
CSO/ CBO Implementer  Actively participate in the processes of establishing and
s, reviewing HIV and AIDS policies on prevention
communities program financing and ensure they address structural
challenges such as stigma, discrimination, and gender-
based inequalities) that constitute barriers to an
effective response to HIV and AIDS.
 Apply community-led solutions, including digital
technologies, to enhance data utilization from
community scorecards for quality improvement;
 Conduct evidence-informed advocacy at the local and
national levels aimed at holding duty bearers
accountable for HIV prevention services, AIDS
treatment, social support, and protection for the most
vulnerable communities (such as PWD, KP, women,
men, youths, and others).
 Collaborate with other stakeholders to conduct social
mobilization for improved service uptake by building
effective linkages with other actors in the public and
private sectors to reduce vulnerabilities and promote
equity.
 Spearhead efforts to build the capacity of lower-level
community-based organizations to fulfil their roles in
social mobilization, education, and resource
mobilization
 Bridge the resource gap (financial and human resource
mobilization) to complement government investment in
program interventions.
 Work with partners to engineer changes in social-
cultural beliefs, knowledge, behaviour, and attitudes at
the local level as factors that influence norms and
practices that fuel HIV transmission, GBV, and VAC.
Development Donors  Supporting the GoT to achieve its commitment to end
Partners the HIV/AIDS epidemic by 2030.
 Provide financial, programmatic, and technical support
to the Government of Tanzania.
 Support program design, planning, implementation,
monitoring, and evaluation.

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Table 3: Stakeholder Stewardship Matrix

Timelines
Stakeholders to be Involved
Areas of Focus Accountable Entities
(Illustrative)

2023

2024

2025

2026

2027
ESTABLISH HIV PREVENTION PROGRAMMING
NEEDS
NASHCoP, TACAIDS, DCEA,
PO-RALG, UNAIDS, UNICEF,
 Conduct analysis of epidemiologic trends and
WHO, PEPFAR, GF, HIV Prevention TWG & SI
patterns (THIS 2.0 primary and secondary data
X X X X X Prevention IPs, Community-led Teams from TACAIDS &
analysis, spectrum data review, and program
organizations, Academic NASHCoP
data review)
Institutions, Research
Institutions
NASHCoP, TACAIDS, DCEA, M&E TWG, Prevention
 Update KVP size estimates (all populations) X X X X X UNAIDS, WHO, Academic TWG, SI Teams from
Institutions TACAIDS & NASHCoP
 Generate HIV prevention targets at national and NASHCoP, TACAIDS, DCEA, M&E TWG, Prevention
sub-national levels (by different interventions X X X X X UNAIDS, WHO, Academic TWG, SI Teams from
and populations) Institutions TACAIDS & NASHCoP
 Determine HIV prevention technical, program,
administrative, and operational needs. MOH (NASHCoP, DPP,
o Commodity/ supply forecasting and DHRM), TACAIDS, DCEA,
quantification WHO, PO-RALG, UNAIDS, Prevention TWG,
o HRH (number and training needs UNICEF, PEPFAR, GF, HIV Prevention Units/ Teams
X X X X X
assessment) Prevention IPs, Community-led at TACAIDS &
o M&E systems/ tools review/ organizations, Academic NASHCoP, DCEA
development Institutions, Research
o Infrastructure/ equipment needs Institutions
assessment
NASHCoP, MOH-DPP,
TACAIDS, DCEA, PO-RALG,
 Develop/ revise the HIV prevention financial
UNAIDS, UNICEF, WHO,
budget to establish resource needs informed by Prevention TWG & SI
PEPFAR, GF, HIV Prevention
the targets, geographical coverage, and X X X X X Teams from TACAIDS &
IPs, Community-led
implementation plan (establish funding gap/ NASHCoP
organizations, Academic
needs)
Institutions, Research
Institutions
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65 | P a g e
Areas of Focus Timelines Stakeholders to be Involved Accountable Entities
(Illustrative)
MOBILIZE HIV PREVENTION PROGRAMMING
RESOURCES
NASHCoP, MOH-DPP,
TACAIDS (Advocacy & DNR),
PO-RALG, DCEA, UNAIDS, NASHCoP, MOH-DPP,
 Advocacy with external donors X X X X X UNICEF, UNDP, UNFPA, TACAIDS, PO-RALG,
UNWOMEN, UNDOC, WHO, DCEA, MoFP, PMO
CSO/ community-led
organizations
TACAIDS, NASHCoP, MOH-
DPP, PO-RALG, DCEA,
TACAIDS, MOH, and
 Allocate domestic resources X X X X X MoFP, and all sectoral
other MDA
ministries, departments, and
agencies (MDA)
TACAIDS, NASHCoP, MOH- TACAIDS, MOH, and
 Establish social contracting mechanisms
DPP, PO-RALG, DCEA, MoFP other MDA
CREATE AN ENABLING ENVIRONMENT FOR HIV
PREVENTION PROGRAMMING
NASHCoP, TACAIDS, DCEA,
PO-RALG, UN Agencies,
NASHCoP, TACAIDS,
 Multi-sectoral sensitization and buy-in X X X X X WHO, bilateral and multilateral
DCEA
partners, CSO/ community-led
organizations
 Community empowerment and monitoring --- as above--- --- as above---
 Policy and guidelines development/ reviews X X X X X --- as above--- --- as above---
 Training package development/ reviews X X X X X --- as above--- --- as above---
 Establish/ reinvigorate oversight and X X X X X --- as above--- --- as above---
coordinating structures (TWGs)
PREPAREDNESS FOR IMPLEMENTATION
NASHCoP, TACAIDS, DCEA,
 Capacitate national, regional, and council Prevention TWG,
PO-RALG, UN Agencies,
stakeholders to meaningfully participate in NASHCoP, TACAIDS,
X X X X X WHO, bilateral and multilateral
designing, planning, and implementing HIV DCEA, PO-RALG,
partners, CSO/ community-led
prevention interventions PEPFAR, GF,
organizations
MOH, TACAIDS, PO-RALG,
Prevention TWG,
MSD, TMDA, DCEA, PEPFAR,
NASHCoP, TACAIDS,
 Procurement of commodities and supplies X X X X X GF, UN Agencies, WHO, CSO/
DCEA, PO-RALG,
community-led organizations,
PEPFAR, GF,
private sector, MoFP
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66 | P a g e
 Areas of Focus Timelines Stakeholders to be Involved Accountable Entities
(Illustrative)
HRH training X X X X X --- as above--- --- as above---
CSO capacity building and support X X X X X --- as above--- --- as above---
Design/ refine M&E systems and tools X X X X X --- as above--- --- as above---
Assign HIV prevention scopes/ roles and Prevention TWG,
responsibilities to implement stakeholders X X X X X --- as above--- NASHCoP, TACAIDS,
(including sharing of targets and reporting tools) DCEA, PO-RALG
PROGRAM IMPLEMENTATION
Scale up combination prevention interventions
nationwide (using precision approaches) tailored
to HIV prevention needs, priorities, and HIV
incidence.
o AGYW NASHCoP, MOH (NBTS),
o KVP (KP and other VPs beyond MSD, TMDA, Chief
Prevention TWG,
AGYW) Pharmacist, TACAIDS, DCEA,
Prevention Units/ Teams
o Adolescent Boys & Men X X X X X PO-RALG, UNAIDS, UNICEF,
at TACAIDS &
o Condom Programming WHO, PEPFAR, GF, HIV
NASHCoP, DCEA
o PrEP (including new options) Prevention IPs, Community-led
o PEP organizations,
o VMMC/ EIMC
o STI
o SBCC & CSE
o Blood Safety
Support community-led organizations to
implement combination prevention interventions X X X X X --- as above--- --- as above---
(aiming to achieve the 30-40-80 global targets)
NASHCoP, TACAIDS,
DRMCH, PO-RALG, UNAIDS,
NASHCoP, DRMCH,
Expand eMTCT Services X X X X X UNICEF, WHO, PEPFAR, GF,
TACAIDS
HIV Prevention IPs,
Community-led organizations
NASHCoP, TACAIDS, PO-
RALG, UNAIDS, UNICEF,
NASHCoP, DRMCH,
Strengthen treatment as prevention/ ARV X X X X X WHO, PEPFAR, GF, HIV
TACAIDS
Prevention IPs, Community-led
organizations
Address social/ legal barriers and inequalities. Prevention TWG,
NASHCOP, TACAIDS, DCEA,
o Fight stigma and discrimination Prevention Units/ Teams
X X X X X PO-RALG, MoHA, MoCJA,
o Remove gender inequalities at TACAIDS &
CHRAGG
o SGBV Prevention and management NASHCoP, DCEA
MONITORING, EVALUATION & LEARNING

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Areas of Focus Timelines Stakeholders to be Involved Accountable Entities
(Illustrative)
NASHCoP, TACAIDS, DCEA,
M&E TWG, Prevention
PO-RALG, UN Agencies,
TWG, SI Teams from
 Monitoring fidelity to implementation X X X X X WHO, bilateral and multilateral
TACAIDS & NASHCoP,
partners, CSO/ community-led
DCEA
organizations
 Monitor the quality of services X X X X X --- as above--- --- as above---
 Monitor progress toward targets X X X X X --- as above--- --- as above---
 Monitor the flow of resources X X X X X --- as above--- --- as above---
 PSAT Assessments X X X X X --- as above--- --- as above---
 GAM report filling X X X X X --- as above--- --- as above---
 Scorecard filling/ reviews X X X X X --- as above--- --- as above---
 Mid-term review of the NMSF V X X X X X --- as above--- --- as above---
 Mid-term review of the HSHSP V X X X X X --- as above--- --- as above---
 Expenditure tracking X X X X X --- as above--- --- as above---
 Monitor implementation of the 10-point actions X X X X X --- as above--- --- as above---
 End-line review of the NMSF V X X X X X --- as above--- --- as above---
 End-line review of the HSHSP V X X X X X --- as above--- --- as above---
GOVERNANCE, OVERSIGHT & COORDINATION
NASHCoP, TACAIDS, DCEA,
PO-RALG, UNAIDS, UNICEF, Prevention TWG,
 Multi-stakeholder HIV prevention Road Map WHO, PEPFAR, GF, HIV Prevention Units/ Teams
X X X X X
reviews (quarterly) Prevention IPs, Community-led at TACAIDS &
organizations, all other key NASHCoP, DCEA
MDA
 R/C/W/VMAC meetings (quarterly) X X X X X --- as above--- --- as above---
 Community-led monitoring report review (bi- X X X X X --- as above--- --- as above---
annually)
 Prevention TWG meeting (quarterly) X X X X X --- as above--- --- as above---

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7.0. FINANCING THE HIV PREVENTION ROAD MAP 2023/24 - 2026/27
7.1. Introduction

This chapter presents an analysis of the estimated resource needs, projected future funding, and
resource gaps. It highlights key financing strategies for achieving HIV Prevention Road Map
2023/24-2026/27 strategies. The costing and financing analysis for the Road Map builds on a
similar analysis conducted for the Fifth National Multisectoral Framework (NMSF V 2021–2025),
Fifth Health Sector HIV Strategic Plan V (HSHSP V 2021-2025), and Condom Needs and
Resource Requirement Estimation Tool (The Condom Tool) 2019-2023, and the Fifth Health
Sector Strategic Plan V (HSSP V 2021/22-2025/26). The costing analysis was done and presented
in line with the National HIV Prevention Road Map 2023/24-2026/27, which prioritized evidence-
based prevention strategies and the domesticated GPC’s 10-point actions.

7.2. Methodology

7.2.1. The Costing Approaches

The costing of the Road Map employed a mixed-method approach in determining the resource
needs for its implementation: The top-down and bottom-up methods. The top-down method was
applied to cost the priority prevention interventions, and the general costing formulae were applied,
including  (Targeted Population size X % of Population in Need (PIN) X %Coverage target X
Unit cost).

Where:
(1). Relevant/target population size estimate for the priority populations # (data preloaded).
(2). PIN refers to the population estimates of the target population in need of service or
intervention.
(3). Coverage targets (%) reach of the intervention. Obtained from national and international
targets or experts' opinions.
(4). Unit cost computed or adapted from the literature.

For consistency, we adopted unit costs from existing studies and other recent cost estimations
done in various HIV/AIDS applications such as 7th GF cycle application (GC7), NMSF V 2021–
2025, HSHSP V 2021-2025, Condom Needs and Resource Requirement Estimation Tool (The
Condom Tool) 2019-2023, HSSP V 2021/22-2025/26), and the Activity-Based Costing and
Management (ABC/M) study17 conducted by Health Policy +.

The bottom-up or micro-costing method was used to cost the 10-point action plan. Microcosting
was applied by measuring and valuing each resource consumed in the process of implementing
the 10-point action plan. Steps in conducting the micro-costing/activity-based costing included (1)
defining the 10-point action plan activities and identifying inputs. (2) quantify inputs. Step 2
required systematically measuring the unit quantity of each type of resource consumed. (3). Value

17
Lee, B., H. Pan, G. Ruhago, M. Mizinduko, D. Peter, C. Mann, and S. Forsythe. 2021. Applying Activity-based Costing and
Management (ABC/M) to HIV Services in Tanzania. Washington, DC: Palladium, Health Policy Plus

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69 | P a g e
inputs and aggregate. In step 3, each type of input was assigned a unit cost, and for each input
type, the unit cost was multiplied by the unit quantity and aggregated to find the total cost.
7.2.2. Data Source, Collection, and Assumptions
Costing data and assumptions as inputs for the costing were collected from national documents,
literature, published and unpublished reports, and through a consultative process at workshops
and meetings including TACAIDS staff, development partners, HIV/AIDS implementing partners,
health managers, KVP, and other stakeholders working in HIV/AIDS response. Data sources to
inform costing included the NMSF V, HSHSP V 2021- 2026 costing files, costed sub-sector
strategic plans, the Medium-Term Expenditure Framework (MTEF), Condom Needs and Resource
Requirement Estimation Tool (The Condom Tool) 2019-2023 files, GFGC7 application, Investment
case 2.0, PEPFAR COP 21, and other published and unpublished costing studies. Expert opinions
were used in case of missing or incomplete data. Government circulars and group consensus were
used to standardize prices for common costing inputs such as conference packages, Per Diem
rates, transport costs, etc. Costs were collected in both TZS and U.S. dollars using an exchange
rate of TZS 2600 to 1 USD.18

7.2.3. Adjusting for Inflation

GDP implicit price deflators19 were used to adjust for inflation during the costing. To apply the GDP
implicit deflator, you multiply the cost by the ratio of the relevant metric from the year you want to
adjust the costs to and the year they are currently in. The adjustment for inflation applies the
following formulae:

7.2.4. Adjusting for Foreign Exchange

The assumption was made on the forex exchange rate at 1USD = TZS 2600

7.2.5. Total Fund Needs for Implementing the Road Map

Total Cost for Implementing the Road Map

The total cost for implementing the Road Map 2023/24-2026/27 will amount to US$ 1,101,859,718
(TZS 2,864,835,268,099.79), combining the priority intervention and the 10 Action Point Plan.

The HPRM 2024-2027 Priority Interventions

As reported in Table 4, the cost for the entire planning timeframe of the activities reported in the
HIV Prevention Road Map 2023/24-2026/27 Priority Interventions is equal to around US$
1,095,953,767.18 (TZS 2,849,479,794,668). This cost will continue to grow in the next 4-years
from US$ 224,671,543 in 2023 to US$ 311,698,859 by 2027.

18
BOT.2022. Monthly Economic Review April 2022
19
GDP implicit price deflators measure the changes in prices for all the goods and services produced in an economy

70 | P a g e
56
 Table 4: HIV Prevention Program Resource needs estimate

Interventions Priority Interventions Implementation Costs (USD)

Total (USD)
2024 2025 2026 2027
Reducing New
Infections

KVP Interventions
 MHR 5,326,779.78 6,841,939.27 8,546,492.22 9,266,196.83 29,981,408.10
 FHR 21,710,407.32 25,343,282.14 29,174,590.09 31,631,397.68 107,859,677.24
 PWID 1,776,600.00 2,073,884.40 2,387,406.92 2,588,451.72 8,826,343.04
 Prisoners 1,920,978.36 2,242,422.07 2,581,423.53 2,798,806.56 9,543,630.52
 AGYW
85,848,674.84 111,775,265.35 134,863,425.65 138,909,328.42 471,396,694.25
Interventions
Condom
202,036.61 226,963.08 252,367.47 273,619.47 954,986.64
Programming
PrEP 8,333,663.94 15,451,009.20 16,652,754.36 17,167,788.00 57,605,215.50
STI 12,496,891.39 14,593,701.05 16,304,277.64 17,677,269.44 61,072,139.52
Blood Transfusion 12,093,750.00 15,770,250.00 17,221,500.00 19,350,000.00 64,435,500.00
VMMC 32,069,303.64 33,160,190.58 33,031,382.75 36,334,521.02 134,595,397.99
SBCC (all at risk
2,512,778.80 10,388,379.19 10,352,648.66 10,663,228.12 33,917,034.78
groups)
Critical Enablers
Stigma &
3,944,992.04 3,470,098.54 2,593,622.42 890,477.03 10,899,190.03
Discrimination
GBV/VAC 16,728,303.42 1,728,581.05 1,723,015.25 1,774,705.71 21,954,605.43
PMTCT
Mothers 17,817,350.43 18,262,787.41 18,786,936.85 20,368,994.69 75,236,069.38
Infants 1,889,032.53 1,837,064.11 1,945,703.51 2,004,074.61 7,675,874.76
Total USD 224,671,543 263,165,817 296,417,547 311,698,859 1,095,953,767.18

57
The Cost of Implementing the 10-Point Actions of the Road Map
The total cost for implementing the 10 Action Point Plan for a period of four years (2024-2027) will amount to US$ 5,905,951.32,
ranging from US$ 1,536,222.91 in 2024 to US$ 948,806.24 in 2027. Table 5 shows the costs of implementing the 10 Action Point Plan.

Table 5: Road Map 10 Action Point Plan Implementation Cost

10-Point Actions TOTAL
2024 2025 2026 2027 (USD)
Action Point #1: CONDUCT AN EVIDENCE-DRIVEN
ASSESSMENT OF HIV PREVEPROGRAMME NEEDS 140,755.77 146,942.84 153,551.75 160,672.09 601,922.44
AND BARRIERS
Action Point #2: ADOPT PRECISION PREVENTION
APPROACH TO DEVELOP NATIONAL HIV 125,576.92 131,192.90 136,993.01 171,114.02 564,876.85
PREVENTION GOALS AND ALIGN 2025 TARGETS
Action Point #3: DETERMINE COUNTRY
INVESTMENT NEEDS FOR ADEQUATELY SCALED
54,346.15 70,122.86 69,990.30 70,184.33 264,643.64
HIV PREVENTION RESPONSES AND ENSURE
SUSTAINABLE FINANCING
Action Point # 4: REINFORCE HIV PREVENTION
LEADERSHIP ENTITIES FOR MULTISECTORAL
134,597.27 - - - 134,597.27
COLLABORATION, OVERSIGHT AND MANAGEMENT
OF PREVENTION RESPONSES
Action point# 5: STRENGTHEN AND EXPAND
COMMUNITY-LED HIV PREVENTION SERVICES AND 230,683.57 152,869.57 - 383,553.13
SET UP SOCIAL CONTRACTING MECHANISM
Action Point # 6: REMOVE SOCIAL AND LEGAL
BARRIERS TO HIV PREVENTION SERVICES FOR 151,711.54 1,053,538.46 - - 1,205,250.00
KEY AND PRIORITY POPULATIONS
Action Point # 7: PROMOTE THE INTEGRATION OF
HIV PREVENTION INTO ESSENTIAL RELATED 343,283.33 302,740.77 251,653.85 174,350.00 1,072,027.95
SERVICES TO IMPROVE HIV OUTCOMES
Action Point # 8: SET UP MECHANISM FOR THE
RAPID INTRODUCTION OF NEW HIV PREVENTION 120,403.85 52,238.46 67,500.00 70,630.04 310,772.35
TECHNOLOGIES AND PROGRAM INNOVATIONS
Action Point # 9: ESTABLISH REAL-TIME
PREVENTION PROGRAMME MONITORING SYSTEMS 424,240.38 266,567.31 334,336.54 266,567.31 1,291,711.54
WITH REGULAR REPORTING
Action Point # 10: STRENGTHEN ACCOUNTABILITY
OF ALL STAKEHOLDERS FOR PROGRESS IN HIV 41,307.69 - - 35,288.46 76,596.15
PREVENTION
Total (USD) 1,536,222.91 2,254,027.16 1,166,895.01 948,806.24 5,905,951.32

58
8.0. MONITORING AND RESULTS FRAMEWORK
8.1. Monitoring and Evaluation Framework

The Road Map builds upon existing or planned infrastructure for data management systems,
extending from the facility level through local government authorities to the national level. The
importance of effective monitoring, evaluation, and research systems in reporting on and guiding
the national response to HIV and AIDS cannot be overemphasized.

Throughout the implementation of this plan, the M&E system will be enhanced to measure progress
towards the timely achievement of the established objectives. The M&E system will monitor the
realization of planned program inputs, processes, outputs, outcomes, and impact. Ideally, a
comprehensive national M&E system will encompass various types of data collection and reporting
tools, as well as mechanisms to distribute attention to both data production and utilization equitably.

8.2. Core Indicators

Both impact and outcome indicators measure the extent to which the program has achieved its
objectives. Explicitly, impact indicators are linked to program objectives, while outcome indicators
are associated with the program goal. Table 6 highlights a few selected impact and outcome
indicators for the Road Map derived from NMSF V and HSHSP V.

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8.3. HIV Prevention Indicator Matrix

Table 6: HIV Prevention Results Framework

Baseline 2025 Targets 2027 Targets
Intervention Area Indicator Description
% Year Target % Year Target % Year
IMPACT INDICATORS

15-24 years –0.07% 15-24 years – 0.00% 15-24 years – 0.00%

1.1. HIV Incidence 15-49 years -0.24% 15-49 years –0.12% 15-49 years - <0.1%
15-64 years -0.25% 2020 15-64 years – 0.12% 2025 15-64 years - < 0.1% 2027
1. NEW 1.2. Proportion of infants born to
INFECTIONS HIV-infected mothers who are
HIVinfected after 18 months
7.9% 2018 <4% 2025 <2% 2027
from birth or three months after
cessation of breastfeeding.
OUTCOME INDICATORS

2.1. Proportional of exposed 90% 2020 98% 2025 100% 2027

infants surviving and HIV-free
at18 months of age.
2.2. Proportion of pregnant 98% (2017 data) 2020 100% 2025 100% 2027
women tested for HIV and who
2. ELIMINATION know their status
OFMOTHER-TO- 2.3. Proportion of pregnant and 96%(2016 data) 2020 95% 2025 100% 2027
CHILD lactating/ breastfeeding women
TRANSMISSION who know their status
(MTCT) 2.4. Percentage of HIV-infected
pregnant women receiving ARVs 98.6% 2020 100% 2025 100% 2027
to reduce the risk of MTCT of HIV
2.5. Proportion of Pregnant and 2020 95% at 12 months, 2025 95% at 12 months, 2027
lactating/ breastfeeding women 87%(2017 data) >90% at 24 months >95% at 24 months
with HIV virally suppressed

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 Baseline 2025 Targets 2027 Targets
Intervention Area Indicator Description
% Year Target % Year Target % Year
3. REDUCTION OF
SEXUALLY 68,000 2020 16,000 2025 <15,000 2027
3.1. Number of NEW HIV
TRANSMITTED
infections
AND BLOOD-
BORNE NEW HIV
INFECTIONS
FHR: 69%(2017 data)
Fishermen: 0.% (2018 data) 2020 95% 2025 >95% 2027
3.2. Percentage of members of Prison inmates: 0%(2018
Key and
KVP who are reached with a data)
vulnerable
minimum package of prevention Miners: 0%(2018 data)
populations (KVP)
interventions MHR: Data unavailable
PWID: Data unavailable
Vulnerable 3.3. Percentage of vulnerable
Adolescent Girls AGYW who have tested for HIV 27.8% 2020 95% 2025 >95% 2027
and Young Women in the last 12 months and know
(vAGYW) their results
3.4. Percent of females and
males aged 15–49 who were 31.7% 2020 95% 2025 >95% 2027
in non-marital, non-cohabiting
sexual relationships in the past
12 months who used a
condom during their last
sexualintercourse.
Comprehensive 3.5. Percentage of youth 15-24
Condom M: 42%(2016 data) 2020 80% 2025 >95% 2027
who used a condom at the last
Programming sexual intercourse
F: 37%(2016 data)
67% - Mining Men
3.6. Percentage of members of 50% -people in 2020 95% 2025 >95% 2027
KVPs who reported using a transport corridor
condom during their last high-risk 20% - fisherfolks
sexual encounter in the last 71% - FHR
3 months 20% - Men at-high
risk
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 Baseline 2025 Targets 2027 Targets
Intervention Area Indicator Description
% Year Target % Year Target % Year
48% - MHR (2012 data)
35.8% - PWID
3.7.a. Percentage of PrEP users
who continued oral PrEP for three 82% 2020 85% 2025 90% 2027
consecutive months after having
initiated PrEP in the last12
months.
3.7. b. PrEP Continuation (PrEP FHR 60%
CT) Men at high risk 50% 2020 70% 2025 85% 2027
Pre-Exposure
3.8. Proportion of targeted 67% - Miningmen
Prophylaxis (PrEP)
audience with 50% - People in
comprehensiveknowledge transport corridor
about PrEP 20% - fisherfolks
71% - FHR 2020 95% 2025 100% 2027
20% - Men at-high
risk
35.8% - PWID
Post-Exposure 3.9. Percent occupationally and
Prophylaxis (PEP) non-occupationally exposed HIV-
negative individuals timely Data unavailable 2020 90% 2025 95% 2027
received HIV Post- Exposure
Prophylaxis (PEP) services
3.10. Percentage of PEP users
2020 2025 0% 2027
who seroconvert 3 months No data 0%
after completing the course.
75% (2020
3.11. Proportion of
Program data)
circumcised males 2020 95% 2025
80% in THIS >95% 2027
(disaggregated byregions)
Voluntary male 2016
medical 3.12. Proportion of circumcised
0.00%
circumcision clients experiencing at least 0.18% 2020 0.00% 2025 2027
(VMMC) Services one moderate or severe adverse
event (AE) during or following
surgery within the reporting
period
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 Baseline 2025 Targets 2027 Targets
Intervention Area Indicator Description
% Year Target % Year Target % Year
Sexually
3.13. Prevalence of syphilis
Transmitted 1.5% 2020 NA 2025 N/A 2027
amongst pregnant women
Infections (STIs)
3.14. Proportion of donated blood
100% 2020 100% 2025 100% 2027
Blood safety units screened for HIV and
and Quality other TTIs in quality-assured
procedures per WHO standards
Social and 3.15. Percentage of young
9.1% Females
behaviour change women and men ages 15–24 2020 5% 2025 <5% 2027
communication whohave had sexual
14.3% Males
(SBCC) intercourse before the age of
15 years
4.1. Proportion of men and
40% 2020 0% 2025 0% 2027
4. CRITICAL women ages 15–49 who
ENABLERS experienced physical or sexual
[GENDER-BASED violence in the past 12 months
VIOLENCE (GBV) 4.2. Proportion of sexually
No data 2020 100% 2025 100% 2027
ANDVIOLENCE abused clients receiving HIV
AGAINST WOMEN post-exposure prophylaxis
AND CHILDREN 4.3. Proportion of sexually and
No data 2020 100% 2025 100% 2027
(VAWC), AND physically abused clients
STIGMA & tested for HIV
DISCRIMINATION) 4.4. Percentage of PLHIV who External stigma: 5.5%(2021 2020 <5% 2025 <5% 2027
experienced or perceived data)

5. SUPPLY 5.1. Percentage of tracer HIV 100% for ARVs 100% for ARVs
CHAIN prevention commodities that TBD 2020 2025 2027
MANAGEMENT were available in the HF at a 90% for other HIV 95% for other HIV
particular period out of items in commodities commodities
use (Commodityavailability)

63
77
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64
9.0. REFERENCES

1. Global Fund Strategy (2023-2028. Fighting Pandemics and Building a Healthier and More
Equitable World

2. UNAIDS Global AIDS Strategy (GAS) 2021 – 2026

3. HIV Prevention 2025 Roadmap
4. GF’s Technical Brief HIV Programming for Adolescent Girls and Young Women
Allocation Period 2023-2025 (published on 26th April 2023)
5. Modular Framework Handbook Allocation Period 2023-2025 (Date published: 29 July 2022 Date
updated: 12 December 2022)

6. GF HIV Information Note (Allocation Period 2023-2025 Date published: 29 July 2022;
Date updated: 5 December 2022)
7. Estimating the population size of young people at risk of acquiring HIV in
settings with high HIV incidence - A User’s Guide
8. GF AGYW Grant Cycle 7 (GC7) Briefing (shared in 2023)
9. 5th National Multi-Sectoral Framework (NMSF V)
10. 5th Health Sector HIV/AIDS Strategic Plan (HSHSP V)
11. National KVP Guidelines (2023)
12. National AGYW Vulnerability Index (2021)
13. Recommended Package of Core HIV & SRH Interventions for Vulnerable AGYW in
Mainland Tanzania (2021)
14. Tanzania HIV Investment Case 2.0 (2019)

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10.0. ANNEXES

Annex 1: HIV Prevention Interventions

1. REDUCTION OF NEW HIV INFECTIONS

1.1. Combination Prevention for Key and Vulnerable Populations
 Scale up the provision of high-quality, comprehensive, and client-centred HIV services to all identified key and vulnerable population
groups.
 Promote a supportive policy framework for expanding access and utilization of HIV services among KVP group members.
 Strengthen linkage with health and social services in delivering HIV services for all KVPs.
 Support strengthening of capacities of law enforcement officers, prison officers, and HCPs on respectful and inclusive HIV services
for PLHIVs, free from stigma and discrimination.
 Strengthen the availability of comprehensive harm reduction services in a community-based approach to reach PWID
 Improve the mainstreaming of rehabilitation and reintegration of PWID into society through mapping and working with CSO, FBO,
NGO, and CBO and trained KVPs.
 Strengthen the use of local epidemiological data to inform robust data-driven KVP programming (i.e., KVP profiling/characterization,
size estimates, geographical mapping, and granularized target setting). This will include expanding combination prevention services
to other unreached KVP (including sexual partners and children of KVP) as described in the earlier section.
 Improve resource allocation and accountability of KVP program implementation at all levels.
 Improve the current KVP M&E system, research and learning agenda (RLA) to be able to cater to program needs and shifts, inform
policymakers and program implementers, and track interventions for KVP.
 Strengthen community systems and PPP to foster sustainability of KVP interventions (This will include fostering the engagement of
KVP and capacity building of CSO to meaningfully engage in the design, implementation, and monitoring of KVP interventions).
 Scale-up community-led monitoring (CLM) to improve the quality KVP services.
 Increase investment in KP community-led organizations through existing partnerships.
1.2. Combination Prevention for Adolescent Girls, Young Women, and At-Risk Adult Women
 Support scale-up of differentiated HIV combination prevention interventions in schools, out-of-school settings, facility-based youth-
friendly services, and youth networks and clubs while involving parents and other community gatekeepers.
 Promote the scale-up of Interventions that address gender, economic, and social inequalities, GBV, and VAW. This will include
advocating for reform of laws and compliance to protect the rights of AGYW.
 Advocate for the expansion of social safety net programming through the promotion of livelihood initiatives and social transformation.
Emphasis will be on skills building, including vocational training, income generation, and employability readiness skills.
 Intensify efforts to increase a safe school environment and school retention for adolescent girls in collaboration with relevant
stakeholders.
 Promote public-private partnerships with appropriate stakeholders working with AGYW.
 Support strengthening and expansion of youth-friendly services and improved health-seeking behaviour
51 among AGYW

66
 Scale-up evidence-based and innovative AGYW combination prevention program interventions nationwide (prioritizing geographical
areas with high transmission dynamics).
 Strengthen the referral system and coordination between health and multi-sectoral social protection interventions.
 Strengthen the involvement of adolescent girls in HIV prevention programming for the elimination of new HIV/STI infections
(engaging them in the design, planning, implementation, operational research, monitoring, and evaluation of HIV combination
prevention interventions).
 Advance gender equality and girl empowerment.
 Strengthen parent/guardian engagement.
 Strengthen the integration of HIV and SRH services to meet AGYW needs.
 Create an enabling environment to facilitate access to HIV prevention programs and promote acceptable sexual and health-seeking
behaviours among AGYW.
 Strengthen M&E systems and operational research to inform policymakers and program implementers on AGYW HIV-related issues.
This initiative should include enhancing the capacity of frontline providers to analyze data for AGYW.
 Scale up comprehensive sexuality education (in and out of school).
1.3. Adolescent Boys, Young Men, and At-Risk Adult Men
 Revitalize the general population prevention programming agenda by advocating for donors, the private sector, community
structures, and implementers to increase HIV prevention focus.;
 Scale-up the provision of cost-effective, evidence-based, and risk-matched HIV prevention interventions to this population, including
re-launching, campaigns that showed evidence of better results, including mainstream social media and print SBC materials.
 Advocate for the inclusion of social safety net programming through the promotion of livelihood initiatives and social transformation.
Emphasis will be on skills building, including vocational training, income generation, and employability readiness skills.
 Expand adolescent and youth-friendly health services (AYFHS) to include adolescent boys.
 Mobilize resources and improve the allocation and accountability of R/CHMTs in planning, budgeting, coordinating, and overseeing
interventions targeting the general population.
 Leverage KVP programming investments and tools to enhance reach to the general population;
 Strengthen the current M&E system and the research and learning agenda (RLA) to cater to the needs of the general population.
 Employ data-driven approaches to segment and target the general population according to risk profiles;
 Promote meaningful engagement of age-appropriate ABYM peers to maximize uptake of prevention services among adolescent
boys and men.
 Integrate and intensify occupational and home-based approaches in reaching ABYM, at-risk women, and adult men with HIV
prevention services.
 Scale up hotspot mapping for ABYM, adult at-risk men and women targeting recreational venues and male-friendly corners.

1.4. Comprehensive Condom Programming

 Accelerate the Total Market Approach (TMA) to increase access and utilization of condoms with a targeted approach to high-risk
groups and hotspots.
 Support the improvement of the supply chain, including condom forecasting, procurement, and distribution at all levels.

67
 Support expanding distribution of public sector condoms using community outlets, workplaces, and hotspots.
 Strengthen a strong national M&E system for a condom to create evidence and inform condom programming and
 Strengthen condom promotion activities, including correct and consistent use of condoms through mass media and social media
strategies and through multiple channels.
 Empower adolescent girls and women to increase their condom negotiation skills.
 Diversify condom distribution and marketing approaches at different levels, including within communities:
a) Improve market stewardship through strong leadership and coordination in support of TMA.
b) Strengthen condom distribution from facility to community level (e.g., bars, guest houses, night clubs) using various
community channels and structures (CHACC, WEO, VEO, peers).
c) Scale up the community dispenser model by installing additional condom dispensers in unreached community
venues/hotspots, HLIs, and workplaces.
 Maximize market efficiency, equity, and sustainability by coordinating condoms available through the public, social marketing, and
commercial sector (including introducing a mechanism to regulate condom prices).
a) Strengthen the integration of condom programming with HIV, SRH, and other facility-and community-based interventions
(general population and at-risk groups).
b) Improve availability and consistent supply of male and female condoms.
c) Improve forecasting, quantification, and supply and planning of condoms, according to the NMCS and the newly issued
condom distribution guide (this process is supposed to be done in a participatory manner).
d) Strengthen the condom supply chain and distribution systems to ensure that adequate quantities are available in a timely
manner, accessible, and equitably distributed at the facility and community level, including workplaces. (This strategy goes
hand in hand with the development of a sustainable, cost-effective condom distribution model/ecosystem that uses local
structures).
e) Improve surveillance, evaluation, and operational research in condom programming.
f) Condom coordination at a low level is still an issue.
g) .Condom as an HIV prevention tool.
h) Quantification.
i) Condom use frequency of sexual acts is a challenge.
1.5. Pre-Exposure Prophylaxis (PrEP)
 Support improved coordination and linkages to scale up the provision of PrEP to selected groups of key and vulnerable populations.
 Support programs that develop and disseminate literacy materials that promote uptake and appropriate use of PrEP among the
prioritized groups.
 Enhance PrEP accessibility, acceptability, and effective use among PrEP users.
a) Support effective SBCC messages and ensure strong linkages between PrEP and existing and associated services, such as
sexual and reproductive health services.
 Capacity building of healthcare providers nationwide (improve HRH for PrEP).
 Scale-up facility-based and facility-led community-based quality PrEP services nationwide in alignment with the approved
implementation framework.
 Strengthen pharmacovigilance for PrEP.

68
 Establish a proactive mechanism for reviewing evidence, assessing acceptance, approval, registration, transitioning, and scale-up of
the PrEP options.
 Enhance the integration of PrEP into HIV combination prevention services (with special emphasis on comprehensive condom
programming).
 Build the capacity of CSO in PrEP service design, planning, delivery, and monitoring (Community-Led Monitoring).
 Engage multi-stakeholders at the national, regional, and council levels to foster ownership and sustainability (including R/CHMT,
CSO, etc.).
 Strengthen PrEP M&E systems (including the capability for registering transfer outs), enhance data used for programming, and
develop PrEP research and learning agenda to inform program improvement, quality assurance, and quality data for decision-
making to improve PrEP program implementation.
 Strengthen the quantification, forecasting, and procurement of PrEP commodities (laboratory reagents and medications).
1.6. Post-Exposure Prophylaxis (PEP)
 Improve community and healthcare worker awareness of HIV PEP, including specific community sensitization on post-violence care
for GBV/VAWC and sexually assaulted victims. This intervention will also include the dissemination of job aids for providers and
SBCC materials for the community.
 Strengthen efforts to prevent accidental exposure in healthcare, community settings, and other sectors.
 Build the capacity of HCPs in PEP service provision.
 Build the capacity of law enforcers and legal officers in PEP to enable them to facilitate timely access to PEP (particularly for cases
of sexual assault/rape)
 Strengthen the integration of HIV PEP in workplace programming.
 Strengthen oversight of PEP services at the central and local levels.
 Improve PEP reporting M&E system and tools.
1.7. Voluntary Male Medical Circumcision (VMMC)
 Support expansion of quality VMMC and EIMC services in line with the National VMMC sustainability manual. Specific efforts should
ensure sustainability, including mobilization of domestic resources and encouraging community and family involvement in bearing
the costs.
a) Strengthen VMMC/EIMC service integration.
b) Scale-up EIMC services to all hospitals and 50% of Health Centres in 17 priority regions.
c) Scale up VMMC services to high-risk groups and locations and increase focus on priority regions that have not yet attained
90% prevalence.
 Support demand creation efforts for VMMC services in priority regions through age-appropriate messages and developing SBCC
materials that address myths and misconceptions associated with VMMC and EIMC.
a) Strengthen the involvement of traditional circumcisers in demand generation to mobilize clients, especially adults, to uptake
services.
b) Strengthen community engagement, structures, and communication channels to promote VMMC among older males.
 Support strengthened and continuous improvement of the quality VMMC and EIMC services by ensuring the services are safe and
culturally acceptable and tracking adverse events resulting from the procedures.

69
 Develop and implement a cost-effective, shortened, modularized on-the-job training package for the utilization of the VMMC and
EIMC Sustainability Operational Manual.
 Mobilize domestic resources for VMMC/EIMC services.
1.8. Sexual and Reproductive Health (SRH) Services, STI screening, diagnosis and treatment
 Increase community awareness about STIs (including promotion of HPV vaccination for those eligible).
 Strengthen STI management services for PLHIV and KVP as part of the standard package of HIV prevention.
 Strengthen the integration of STI management into combination prevention services, namely PLHIV care, treatment services, and
other SRH services (including improving contact tracing).
 Revitalize regular antimicrobial resistance AMR surveillance of STIs to determine if current regimens are still effective and to guide
the selection of appropriate treatment regimens.
 Improve the quality of STI services (in all service delivery platforms) as part of the quality assurance and quality improvement
strategy.
 Rollout e-learning STI/RTI screening and management training.
 Improve the availability of STI commodities at the facility level (including medicines and laboratory reagents).
 Scale-up dual HIV/Syphilis testing for pregnant women attending ANC and appropriately manage those who are infected.
 Strengthen multi-sectoral approach to comprehensive HIV prevention modalities to meet community demand.
 Improve coordination, integrated management, and monitoring of HIV/SRHR services so as to ensure the quality of SRH.
 Strengthen the M&E system for the improvement of data collection and reporting from the source of STI management;
 STI surveillance and research.
 Improve quantification, procurement, and supply management for SRH commodities.
 Mobilize resources to support capacity building of HCWs on STI diagnosis and management, procurement of STI medicines and
laboratory commodities.
1.9. Social Behavioral Change Communication & Comprehensive Sexuality Education
 Scale-up evidence-based, locally-contextualized, age-appropriate, human-centred design (HCD) SBCC interventions using multiple
channels to facilitate risk reduction, increase uptake of HIV services, and address critical enablers and barriers of behavioural
change.
 Enhance the engagement of parents /guardians in promoting acceptable behavioural change, moving away from deviant behaviour
among adolescents and youth.
 Strengthen the engagement of religious and community leaders in behavioural change initiatives.
 Advocate for scale-up of faith-based community initiatives (FCI) to mainstream and integrate tailored SBCC activities for HIV
prevention.
 Revitalize community peer support groups, alcohol rehabilitation groups, sober houses, post-test clubs, and economic empowerment
groups to help increase access to information and education in the prevention of HIV.

70
 Integrate IEC into all HIV prevention interventions. IEC should be an integral element in promoting sustainable behavioural change
among KVP and the general population at risk of HIV acquisition, such as adolescent boys and men, at-risk women, etc. For IEC to
be effective, it should be administered nonjudgmentally based on known, factual, researched information to the targeted KVP and
the general population. Paying respect to social and cultural norms within the limits of the existing policy environment is of
paramount importance in the course of implementing IEC.
 Scale-up evidence-based messaging on the benefits of treatment as prevention (TasP), e.g., Undetectable = Untransmissible, and
support re-engagement in care.
 Ensure integration of occupational-based SBCC and peer education on HIV prevention services, e.g., targeted SBCC and peer
education for boda-boda, miners, fisher folks, garage, youth hangouts like spots and betting points, saloons, and massage parlours,
formal jobs, e.g., banking industry, etc.
 Reinforce stakeholder coordination across all levels of implementation, i.e., national, sub-national, and community levels.
 Advocate for policy and regulatory changes to strengthen the supportive environment for SBCC interventions and service provision,
e.g., alcohol and drug abuse prevention and management policies that promote behaviour change.
 Scale up comprehensive sexuality education.
 Strengthen SBCC M&E to include comprehensive HIV and AIDS behavioural and social science operational research.
 Ensure adequate financing and resources for implementing SBCC strategies at all levels. This strategy includes increasing the
engagement of the private sector to support SBCC interventions.
1.10. Strengthen Blood Safety and Quality
 Increase blood collection to meet the national requirement by strengthening the NBTS and its networks.
 Increase public awareness and community engagement in voluntary blood donation through innovative initiatives.
 Strengthen the sample transportation and supply chain system to reduce TAT on test result feedback.
 Strengthen the electronic information system of blood safety programs at all levels to enable referral, tracking, and linkage of blood
donors who tested HIV positive to care and treatment services.
 Establish and maintain engagement with private health facilities in the NBTS and blood safety program initiatives.
 Establish sustainable funding mechanisms to maintain access to and availability of safe blood and blood products.
 Support ZBTCs in implementing and maintaining quality management systems and participating in external quality assessment
(EQA) and accreditation programs to ensure blood safety.
 Strengthen the DHIS2 system to capture and track blood safety indicators.
2. ELIMINATION OF MOTHER-TO-CHILD TRANSMISSION OF HIV INFECTION
 Enhance initiatives that increase access and provision of quality PMTCT services that are delivered under a differentiated service
delivery model with a family approach.
a) Enhance the utilization of peer mothers to ensure more effective screening of infants and young children who are eligible for
testing by using immunization cards and following up mother-baby pairs (with a specific focus on mothers who are
adolescents and young women).
b) Expand and improve the quality of PMTCT services (HTS for pregnant women, retesting of previously negative women, EID
and HVL).

71
 c) Scale-up mother-to-mother and peer-led mentoring, counselling, and other community-based psychosocial support services
for pregnant and breastfeeding women.
d) Strengthen community involvement and enhance the participation of community structures in comprehensive eMTCT and
pediatric care and support. This will include the engagement of trained peer mothers and other key community health
volunteers using immunization cards and following up mother-baby pairs (with a specific focus on mothers who are
adolescents and young women).
e) Strengthen primary prevention of HIV among HIV-negative women identified during antenatal, postnatal, and breastfeeding
periods (including offering PrEP for pregnant and breastfeeding women who are at a greater risk of acquiring HIV).
 Facilitate the delivery of appropriate care for discordant couples, including PrEP and family planning.
 Promote strategic linkages between HIV, TB, RCH, NCDs, Family planning, Immunization, and Nutrition programs.
 Promote programs that improve community knowledge, awareness, attitudes, perceptions, behaviourals, and practices to support
eMTCT and Pediatric HIV care and treatment through communication interventions.
 Strengthen community-based OVC programs to support HIV testing among children and linkage to HIV care and treatment and
social services.
 Scale-up couples testing (including for HIV/Syphilis Duo and viral hepatitis) as well as HIV re-testing of negative PBFW at ANC,
Postnatal Care (PNC), and immunization clinics.
 Build the capacity of HCPs to improve their skills so that they can offer non-judgmental and supportive services to youth and KVP
seeking ANC and PNC services.
 Create community awareness to boost male partner involvement in PMTCT services (including testing of partners of pregnant
women).
 Deploy an electronic Case-Based Surveillance and Management (CBSM) response to all facilities offering PMTCT services.
3. ADDRESSING SOCIAL/ LEGAL BARRIERS AND INEQUALITIES
3.1. Fighting Stigma and Discrimination
 Advocate for the integration of stigma and discrimination programming into comprehensive HIV services and promote strategies that
reduce HIV-related stigma and discrimination.
 Support capacity building of health care providers, CHW, community religious leaders, law enforcers, and PLHIV networks to identify
root causes and address stigma and discrimination practices in facilities and communities.
 Enhance meaningful engagement of media and high-level Government leaders, Champions, Religious leaders, and PLHIV
testimonies to address stigma and discrimination, gender and age-related barriers to accessing HIV services.
 Promote meaningful engagement of PLHIVs, including young PLHIVs, in planning and delivering HIV services and build the capacity
of their association and networks to strengthen their voice and influence.
 Empower networks/support groups for PLHIV, KVP, and GBV survivors.
 Increase community awareness of issues related to stigma and discrimination.
 Build the capacity of HCPs, CHWs, and social welfare and media professionals, including raising awareness on human rights and
ethical issues related to medical records keeping to promote adherence to professional codes of ethics and conduct by HCWs.
 Create an enabling policy environment for HIV prevention, care, and treatment for all PLHIV, GBV survivors, and KVP that are free
of stigma and discrimination. This will include:
a) Scaling up SBCC interventions and campaigns to address harmful social norms at the community level.

72
 b) Strengthening and enforcing the implementation of workplace HIV policies and regulations for reducing and eliminating HIV-
related stigma and discrimination.
c) Capacity building on HIV-related Stigma and Discrimination among lawmakers and law enforcers.
d) Advocacy for the improvement of laws, legislations, regulations, and policies relating to HIV and AIDS and KVP HIV
Programming. This will also include carrying out a follow-up Legal Environment Assessment.
e) Enhance meaningful engagement of the media (involve high-level Government leaders, Champions, Religious leaders, and
PLHIV (testimonies) to address stigma and discrimination, gender, and age-related barriers to access HIV services).
f) Engage religious and community leaders in reducing stigma and discrimination based on HIV and gender-related barriers to
accessing HIV services.
 Enhance the implementation of Monitoring Evaluation and Reporting (MER) to track different forms of stigma.
3.2. Remove Gender Inequalities
 Promote mainstreaming of gender into comprehensive HIV strategies, programs, and services, including social protection for
vulnerable groups.
 Strengthen the capacity of HCP to identify and address socially constructed norms and practices that fuel gender-related barriers to
access and utilization of HIV services and address unequal gender inequalities in health outcomes.
 Support CSO Coalitions, FBO, private sectors, and government MDAs to design, innovate, and improve interventions addressing
societal norms, GBV, stigma, and other barriers to health services.
 Enhance health information systems to support the collection and utilization of gender-related data to support evidence-based
decision-making and interventions.
3.3. Prevention and Management of Gender-based Violence and Violence Against Women and Children
 Promote knowledge about GBV/VAWC/VAM among healthcare workers and strengthen its integration into comprehensive HIV and
social services.
 Support scale-up of gender-transformative interventions to address root causes of GBV.
 Mainstream HIV and specifically GBV/VAWC in inter and cross-sectoral national policies, guidelines, and programs.
 Advocate for increased investment in comprehensive combination prevention programs that integrate GBV for all populations.
 Promote engagement of other sectors CSO, coalitions, and FBO to design, innovate, and improve interventions addressing post-
GBV, stigma, and other barriers to services.
 Increase community awareness of GBV/VAWC (prevalence, link with HIV and other poor SRH outcomes, importance of reporting,
and available services and support); Increase awareness of GBV/VAWC at workplaces and academic institutions.
 Strengthen the integration of GBV/VAWC/VAM prevention and response in HIV combination prevention programs for all populations.
 Advocate for the amendment of legislation that increases the risk of HIV transmission among women, girls, and adolescent boys.
 Strengthen the bi-directional referrals and linkages for reporting, prevention, and management of GBV/VAWC.
 Strengthen M&E systems to collect, analyze, and produce gender-responsive data.
 Advocate for increased investment in comprehensive combination prevention programs that have integrated GBV for all populations.
4. RESILIENT AND SUSTAINABLE HEALTH AND COMMUNITY SYSTEMS FOR HIV PREVENTION
4.1. HIV Prevention Commodity Supply Chain Management

73
 Roll out the redesigned logistics system to all HFs, including reporting of monthly stock in hand and consumption data, as well as
improving logistics data quality at the last mile.
 Strengthen the use of electronic data systems (e-LMIS & PMD); integration of E10, e-LMIS, and PMD; analysis and use of data at all
levels of the system, including system improvement (dashboard) to enhance end-to-end visibility of key logistics and supply chain
data in the context of an integrated information system that links and triangulates facility-level logistic information and global PSM
data (order and shipment data) for better planning and monitoring.
 Develop an in-country procurement and shipment tracking system (dashboard) for health commodities procured by MSD and donors
(procurement tracking and upstream pipeline monitoring).
 Strengthen national-level capacity in forecasting and supply planning for HIV prevention commodities (MoH, MSD, and PO-RALG).
 Mobilize domestic resources through the AIDS Trust Fund using advocacy for increased government budget allocations and tap on
other sources, such as insurance funds and private sector funds, to fund the procurement and distribution of HIV commodities.
 Strengthen collaborative efforts in coordination and monitoring of supply chain management interventions between the MoH, PO-
RALG, and Implementing Partners.
 Improve MSD's storage and distribution capacity to facilitate the timely delivery of HIV prevention commodities.
 Improve HIV prevention commodity availability and reduce wastage through improved inventory and data management at all levels.
 Intensify health prevention commodity management, monitoring, and control to enforce accountability.
 Strengthen the use of the IMPACT Teams Approach to facilitate evidence-based decision-making.
 Employ and deploy pharmaceutical and laboratory personnel at all levels of the supply chain.
 Establish a dedicated Health Commodities Supply Chain Officer position (similar to LMS) at the regional and district level to support
capacity building and monitoring of the supply chain at HFs.
 Institutionalize national supply chain Key Performance Indicators (KPIs), especially the indicator on wastage that aims to improve
efficiency in health supply chains.
 Strengthen condom and lubricant quantification, procurement, and supply chain management.
4.2. Community-Led HIV Service Delivery and Monitoring
 Develop a Road Map and guidance on social contracting arrangements for CSO to provide funding, HIV commodities, and logistics
to community-led organizations to implement HIV prevention, community-based HIV testing, and socio-economic empowerment
services to PLHIV and KVPs.
 Build the capacity of community-led organizations and networks at national, regional, and council levels to enable them to participate
meaningfully in HIV response efforts.
 Support CSO to access needed resources, contribute to stronger health systems, and ensure a seamless continuum of care from
the health to the community system.
 Support implementation of community-led HIV program through involvement and engagement of affected communities, including
KVP in service delivery and monitoring.
 Foster collaboration and synergies among government representatives, civil society organizations, community-led organizations,
donors, and partners to strengthen country leadership and drive country-tailored solutions.
4.2. Preparedness & Mitigation of Impact of Pandemics and Emergencies on HIV Prevention Services
 Adapt prevention service delivery models to increase resiliency during times of pandemics/ emergencies.

74
 Build the capacity of healthcare providers (including community health workers).
 Reinforce infection prevention and control measures in HIV prevention platforms (including mask-wearing, hand hygiene, social
distancing, lifestyle adjustments, and vaccination).
 Promote and scale up self-care approaches to allow for maintained uptake of services in times of outbreaks/ emergencies.
 Empower community structures (including community leaders, KVP, and CSO).
 Strengthen the engagement of community gatekeepers in raising awareness and influencing their followers for the process of
pandemics and emergency mitigation.
4.2. Strengthen HIV Prevention Programing Monitoring, Evaluation, and Learning Agenda
 Collaborate with relevant sectors to increase access to pre and in-service training to increase M&E-related skills and reduce the
M&E Human resource gap.
 Support strengthening of program data generation and management systems across sectors and, where possible, ensure their
interoperability.
 Collaborate with sectors to strengthen data quality assurance mechanisms at each level of data generation and use.
 Enhance the availability of periodical and representative data on Key and Vulnerable Populations to track the epidemic in hidden
populations.
 Advocate for resources and strengthen local capacity for planning and implementation of national surveys.
 In collaboration with other sectors, identify and pilot innovative information technologies that will reduce the data capture burden and
enhance data security for community-based services.
 Establish forums for broad dissemination of Strategic Information based on programmatic routine data, disease surveillance,
Modelling, and operational research results.
 Collaborate with other sectors to strengthen HIV and AIDS Data and information use for decision-making by policymakers data use
for frontline workers at the subnational level.
4.2. Fully Resourced, well-coordinated, Efficient, and Sustainable HIV Response
 Review and update the resource mobilization strategy to strengthen ATF’s ability to effectively spearhead resource mobilization for a
well-funded response.
 Facilitate development and implementation of the sustainable HIV financing framework for the ATF to ensure sustainability in HIV
response.
 Review, update, and disseminate the ATF advocacy and information strategy in order to expand the involvement of stakeholders in
resource mobilization for the national HIV response.
 Advocate for inclusion of HIV prevention services into national health insurance schemes.
 Intensify advocacy to increase domestic funding from government, private, and other sectors. This will include the implementation of
the national resource mobilization strategy, including coordination of the construction sector’s contribution to the national HIV
response.
 Intensify advocacy to retain the current donors and maintain funding levels while aggressively expanding the donor base, including
bilateral, multilateral, and private foundations.
 Advocate for the integration of the District Multi-sectoral AIDS response into District Development Planning and Implementation
funding.

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  Facilitate community-led HIV Financing through the economic strengthening of community structures and individuals to finance
social protection schemes.

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Annex 2: The 10-Point Action Plan SWOT Analysis

10 Point Actions Strengths Weaknesses Opportunities Threats

Action #1:  Existence of a national multi-  PSE for some of the KVP  Availability of external  Sub-optimal budget
sectoral M&E system for groups missing (e.g., funding for HIV allocation for HIV M&E-
CONDUCT AN routine and periodic surveys fisher folks, miners, programs (e.g., Global related activities
EVIDENCE-DRIVEN DHIS2, UCS, CTC2 DB, prisoners, and long- Fund, USG, UN  Occurrence of global
ASSESSMENT OF TOMSHA, THIS, IBBS, ANC. distance Agencies, etc.) pandemics e.g. COVID-
HIV PREVENTION  Availability of trained human truckers)Inadequate  Availability of domestic 19
resources for HIV M&E capacity at sub-national resource mobilization
PROGRAMME  Shifting of global priorities
levels on using M&E funds for HIV (ATF)
NEEDS AND  Availability of a functional HIV on the HIV agenda may
systems and data use
BARRIERS M&E TWG  Availability of potential TA affect HIV-specific
for decision making
 Existence of updated spectrum support for HIV M&E funding, e.g.,
 Existence of multiple and prevention.
estimates for new HIV
parallel recording and
infections at national and sub-
reporting systems for
national level
community HIV
 KP PSE conducted in 2019 interventions
 Existence of a national HIV M&E  Lack of periodic legal and
plan that provides guidance on policy HIV assessments
relevant disaggregates and and surveys
data elements.
 Sub-optimal utilization of
 Existence of periodic HIV stigma the existing HIV
index study community M&E
 Existence of some national systems (e.g., condom
indicators for the global AIDS programming, AGYW
monitoring report and national module, KVP, PrEP)
targets for priority indicators
(inputs to GAM)

Action #2:  Existence of National Policy and  Guidelines that are not  Readiness for the donors  Existence of legal barriers
guidelines guiding various HIV tailored to meet the to fund targeted and political shift
ADOPT prevention approaches. needs of specific groups interventions for risk  Complacency of
PRECISION  Availability of government  Outdated size estimate for populations (GF, achievement of HIV
PREVENTION coordinating bodies high-risk populations PEPFAR) treatment target
APPROACH TO  Council-level risk stratification  Lack of evidence-based  Member of the global  Stigma and discrimination
DEVELOP analysis conducted using the interventions for some prevention collation hindering the uptake of
NATIONAL HIV UNAIDS AGYW PSE tool high-risk populations  Availability of global AIDS services
PREVENTION (during GC 7 funding request  Lack of readiness to invest Policies and guidelines  Donor dependency to
GOALS AND development); in interventions targeting highlighting deploy HIV prevention
ALIGN 2025 o Prioritization of AGYW some high-risk interventions for high- precise approaches

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10 Point Actions Strengths Weaknesses Opportunities Threats

TARGETS package of intervention populations risk populations

tailored to AGYW risk  Delays in adopting some  availability of global data
category done proven and precise HIV for size estimates for
o Geographical prioritization interventions for high- high-risk populations
to target councils with risk populations, e.g., 
moderate-high risk AGYW NSP for PWID
is also done
 Risk profiling of MHR, FHR,
PWID, fisher folks, and miners
done through IBBS surveys
 Availability of Prevention
Technical working group with
its working subcommittees
(KVP, AYAS, Condoms &
PWID) and HTS Technical
working group, and PrEP
Technical Working Groups,
VMMC Subcommittee targeted
to higher risk populations.
 Availability and accessibility of
prevention interventions in
health facilities
 Readiness to invest in
interventions targeting high-
risk population
 Decreasing level of stigma and
discrimination
 HAPCA review to accommodate
HIVST and lowering the age
for consent
Action # 3:  Good coverage of health facilities  Donor dependency of more  Private sector engagement  Political shift to other
country-wide in 184 District than 90% from bilateral for domestic resource priorities, i.e., maternal
DETERMINE councils, especially primary and multilateral donors. mobilization health and human
COUNTRY health care services support  Untapped CHWs through resources
INVESTMENT  The commitment of the  Government budget (the the formalization of the  Emerging global crises,
NEEDS FOR government to hire healthcare financial year carder including wars and
ADEQUATELY workers at all levels 2023/2024) for health is  Social protection system disease pandemics
SCALED HIV  Availability of laboratory 7.3% below the Abuja provides an opportunity  Absence of a sustainable
PREVENTION equipment and supplies to Declaration for sustainable systems, financing plan
RESPONSES AND support the provision of HIV  Limited multisectoral i.e., NHIF and health  Private sector is willing to
ENSURE prevention services. coordination on HIV insurance systems support but would wish

78
10 Point Actions Strengths Weaknesses Opportunities Threats

SUSTAINABLE  Availability of community health prevention at all levels under Social security to get ATF transparency
FINANCING workers at the community level (MDAs and schemes. and accountability and
to link with health facilities. development partners).  Existing legal framework understand why they
 Plan, strategies, and policies in  Formal recognition of and guidelines available should contribute.
place to address HIV community health to support prevention
prevention, i.e., five-year workers into the efforts, i.e., HIV
development plan III, National government health Prevention and Control
vision 2025, HIV Multisectoral system, including the Act, ELRA, construction
strategic plan, Health policy). information from the guidelines.
 Existence of well-established community.  Existing AIDS trust fund.
systems that can be linked to  Availability of several
HIV prevention and independent unlinked
sustainable financing. health information
systems.
 6. Specific HIV expenditure
is not well-tracked and
not available.
Action #4:  Existence of a strong AIDS  Roles and responsibilities  Roles and responsibilities  Frequent changes on
Commission, which also of other Ministries are of other Ministries need strategic directions due
REINFORCE HIV independent. not well clarified, to be clarified, especially to changes in political
PREVENTION  Existence of well-established HIV especially when dealing when dealing with key leadership and technical
LEADERSHIP prevention technical working with the key and and vulnerable leadership may
ENTITIES FOR groups at all levels, from the vulnerable population. population. jeopardize the continuity
MULTISECTORAL national to the ward level.  Insufficient coordination  Existence of regional of prioritized
COLLABORATION,  Position of TACAIDS at PMO for and oversight of HIV framework for HIV interventions.
OVERSIGHT AND coordination of HIV response. resources for HIV prevention. i.e., ESA's
MANAGEMENT OF prevention. commitment to gain
 Political will under the prime
PREVENTION  Slow progress towards political support.
minister’s office leadership.
RESPONSES achieving the 30-60-80  To develop cost-effective
 Presence of Technical AIDS
targets. and locally owned
Committees (TAC's) led by
 Sub-optimal accountability interventions for HIV
Permanent Secretaries for
of HIV prevention key response by tapping
Public Sector and Private
players. from existing HIV
Sector Coordination led by
prevention structures at
Association of Tanzania
all levels.
Employers (ATE).
 Use of existing resources
 Existing efforts to engage civil
for integrated HIV
society actors and other
prevention services
community-led organizations in
the HIV prevention response
(CSOs and community are well
represented in the TNCM)

79
10 Point Actions Strengths Weaknesses Opportunities Threats

Action #5:  System is inclusive of service Services are not defined by   Social, culture, and policies
delivery. the community; for are not friendly to issues
STRENGTHEN  Policy and laws are inclusive. example, the time of of KVP.
AND EXPAND getting the services.  Contradiction between
COMMUNITY-LED  Interpretation of individuals multisectoral
HIV PREVENTION on policy leads to bias. stakeholders and
SERVICES AND  Stigma and discrimination ministries.
SET UP SOCIAL hinder community  Competition of resources
CONTRACTING participation and access between national and
MECHANISMS to service. international.
 Some of the social and
cultural factors hinder
the interaction of
services to KVP.
 Adequate allocation of
funds for community-led
intervention.
 Insufficient local
organizations to receive
funds.
 Competition of resources
between local and
international
organizations.
 Unfriendly service to youth
(for example, the age of
the service provider).
Action #6:  The laws, police, and guidelines  The implementation of laws  The availability of  The laws and guidelines
regarding the provisions of is not practical. committees such as contradict one another,
REMOVE SOCIAL health services are stated very  Policy and programs are CMAC and VMAC. e.g., the issue of sex
AND LEGAL clearly. not considered gender workers and MHR are
BARRIERS TO HIV issues. criminalized while we
PREVENTION want them to access
 Pocket/exploit of society.
SERVICES FOR condoms.
 Gender-based violence.
KEY AND exists at the family and
PRIORITY societal level
POPULATIONS
Action #7:  Existence of National Policy and  Inadequate integration of  Readiness for the donors  Decrease in donor funding
guidelines that advocate national guiding to fund the Integration of for HIV prevention limits
PROMOTE THE integration somehow. documents for HIV. HIV prevention services integration plans.
INTEGRATION OF  Existence of government prevention services (GF, PEPFAR, WHO).  Preferential investment for

80
10 Point Actions Strengths Weaknesses Opportunities Threats

HIV PREVENTION coordinating bodies (e.g., MoH  Slow adoption of new  Reducing HIV prevention integration from the
INTO ESSENTIAL TACAIDS, NASHCoP) technologies (delay in service provision costs. treatment point of
RELATED  Existence of Prevention Technical registration) for HIV  Availability of global AIDS services as compared to
SERVICES TO working groups with its working prevention. Policies and guidelines. prevention.
IMPROVE HIV subcommittees (KVP, AYAS,  Inadequate integration  Initial capital/cost
 Availability of best
OUTCOMES Condoms), HTS Technical knowledge among (Investment) is the high
practices of HIV
working group, PrEP Technical service providers. prevention integration cost associated with
Working Groups, and VMMC  Limited infrastructure for services. integration, especially at
Subcommittee. the provision of the PHC level.
 Existence of an integrated supply integrated services.  Verticalization of the donor
chain system at the service  Inadequate resources and agency funding HIV
delivery point/POC (Facility). funding to integrate HIV prevention services.
prevention.
 Inadequate integration of
HIV combination
prevention services with
other HIV services.
 Inadequate monitoring
system and ownership
of integration of HIV
prevention services.
Action #8:  Existence of National Policy and  Specific guidelines for the  Readiness for the donors  Decrease in donor funding
Guidelines allowing new KVP and PrEP to fund the adoption of for HIV prevention.
SET UP technologies. framework miss the new technologies (GF,  Preferential investment in
MECHANISM FOR  Availability of government adoption of new PEPFAR, WHO). Treatment as compared
THE RAPID coordinating bodies. technologies.  Member of the global to prevention.
INTRODUCTION  Availability of government  Slow adoption of new prevention collation.  Complacency of
OF NEW HIV regulatory authorities (TMDA, technologies (delay in  Availability of global AIDS achievement of HIV
PREVENTION TBS). registration) for HIV policies and guidelines. treatment target.
TECHNOLOGIES prevention.
 Availability of Prevention  Availability of evidence-  High cost associated with
AND PROGRAM  Inadequate knowledge
Technical working group with based discovered new technologies.
INNOVATIONS its working subcommittees among the prospective technologies.
(KVP, AYAS, Condoms,) and users.
HTS Technical working group,  Inadequate capacity
PrEP Technical Working. building and technical
Groups, VMMC Subcommittee. assistance (Human
 Presence of functional supply resources, training,
chain mechanism for storage Infrastructure,
and distribution of prevention equipment).
commodities (MSD).  Poor community service
 Readiness to invest in adopting delivery mode, including

81
10 Point Actions Strengths Weaknesses Opportunities Threats

new innovations and the distribution

technologies. mechanism of services
to the community.
 Inadequate integration of
HIV combination
prevention services with
other HIV services.
 Inadequate monitoring
system of the new
technologies (lack of
tools).
 Inefficient of the
sustainable plan and
transition Road Map for
a financing mechanism
Action #9:  Existence of a unified community  All existing HIV M&E  Availability of external  Sub-optimal budget
system for all HIV prevention systems cannot provide funding for HIV allocation for HIV M&E-
ESTABLISH REAL- modules, e.g., KVP/PrEP, real-time data. programs (e.g., Global related activities.
TIME PREVENTION AGYW, CBHS, Condom  Sub-optimal data elements Fund, USG, UN  Occurrence of global
PROGRAMME programming, HIVST, VMMC to complete HIV Agencies, etc.). pandemics, e.g.,
MONITORING etc. prevention scorecards.  Availability of domestic COVID-19.
SYSTEMS WITH  Availability of priority HIV  Unrealistic KVP targets are resource mobilization  Shifting global priorities on
REGULAR prevention indicators to input attributed to the funds for HIV (ATF). the HIV agenda may
REPORTING. into HIV prevention absence of national size  Availability of potential TA affect HIV-specific
scorecards. estimates. support for HIV M&E. funding, e.g.,
 Existence of HIV M&E TWG to  Irregular HIV M&E TWG prevention.
support the coordination and meetings.
monitoring of HIV prevention
 Sub-optimal joint program
interventions.
and data reviews at
 Existence of regular National national and subnational
AIDS Spending Assessment levels to inform
(NASA) survey. prevention program.
 Existence of periodic programs
and data reviews, especially at
the regional level.
 Existence of national HIV data
management guidelines that
inform data reviews.
 Availability of competent
institutions and expertise to
develop and maintain real-time

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 10 Point Actions Strengths Weaknesses Opportunities Threats

data systems.
Action # 10:  Existing plans, strategies, and  HIV prevention system  Prioritized by global  Implementing partners
guidelines with resources. needs to be reviewed, movements, i.e., the depend on external
STRENGTHEN  Existing and operational national- i.e., TOMSHA. Global Alliance to donors exclusively for
ACCOUNTABILITY level coordination structures,  Private sector is lagging Ending AIDS, Global interventions.
OF ALL i.e., technical working groups. behind, with only 2% of Prevention Coalition.
STAKEHOLDERS  The government stakeholders are their contribution to the
FOR PROGRESS accountable for HIV prevention overall health sector
IN HIV results. budget.
PREVENTION  Low level of community
 Development partners committed
and provide technical and involvement in
financial support, and it is all addressing GBV
committed and granted. matters.
 Establishment of AIDS Trust  Low funding utilization
Fund. within the government
system delays
 Existence of Awareness creation
implementation.
through National Events
across the country, e.g., the
commemoration of AIDS day
and the National Uhuru Torch
rally.
 Existence of the HIV prevention
Policy of 2008 and 2014
guidelines at the workplace.

83
Annex 3: Unit Cost Assumptions

Unit costs
Intervention/ Priority Area Data Source
(USD)
HIV Case Finding 8.30
Linkage to Prevention, Care and
8.30
Treatment Services Lee, B., H. Pan, G. Ruhago, M. Mizinduko, D. Peter, C. Mann, and S. Forsythe.
Elimination of mother-to-child 2021. Applying Activity-based Costing and Management (ABC/M) to HIV Services
261.00
transmission (MTCT) in Tanzania. Washington, DC: Palladium, Health Policy Plus
Tanzania Condom Needs and Resource Requirement Estimation (The Condom
0.08
Condoms Tool); 2022
Lee, B., H. Pan, G. Ruhago, M. Mizinduko, D. Peter, C. Mann, and S. Forsythe.
Voluntary Medical Male 55.00 2021. Applying Activity-based Costing and Management (ABC/M) to HIV Services
circumcision (VMMC) in Tanzania. Washington, DC: Palladium, Health Policy Plus
Key and Vulnerable Populations
78.96
[KVP] Average from GOALS/RNM modelling
Vulnerable Adolescent Girls and
123.95
Young Women (vAGYWs) Average from GOALS/RNM modelling
Lee, B., H. Pan, G. Ruhago, M. Mizinduko, D. Peter, C. Mann, and S. Forsythe.
162.00 2021. Applying Activity-based Costing and Management (ABC/M) to HIV Services
Pre-Exposure Prophylaxis in Tanzania. Washington, DC: Palladium, Health Policy Plus
Post-Exposure Prophylaxis 34.27 GOALS/RNM
Sexually Transmitted Infections
16.59
(STIs) GOALS/RNM
Blood Safety and Quality 43.00 Tull ,K.(2017)
Social and Behaviour Change
3.90
Communication (SBCC) Hutchinson ,P(2014)
Gender-Based Violence (GBV)
and Violence Against Women and 21.00
Children (VAWC) Torres-Rueda, S. et al(2020)
Stigma and Discrimination 3.90 Hutchinson,P(2014)
Early Infant Circumcisions (EIMC) 55.00 Lee, B., H. Pan, G. Ruhago, M. Mizinduko, D. Peter, C. Mann, and S. Forsythe.
ART for Adult Men 236.91 2021. Applying Activity-based Costing and Management (ABC/M) to HIV Services
ART for Adult Female 236.91 in Tanzania. Washington, DC: Palladium, Health Policy Plus

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 Unit costs
Intervention/ Priority Area Data Source
(USD)
Screen HIV+ cases for TB 12.00 GOALS/RNM
HIV prevention for TB patients 1.07 GOALS/RNM
Cotrimoxazole for children -
Pediatric ART 461.00 GOALS/RNM
Diagnostics/lab costs for HIV+ in
12.00
care GOALS/RNM
Management of opportunistic
infections associated with 45.00
HIV/AIDS Stefano Bertozzi et al (2016)
Facility and Community-Based
19.00
HIV Care and Support Services GOALS/RNM
Quality of HIV Care and Viral
12.64
Suppression GOALS/RNM
TB/HIV Collaboration 11.35 GOALS/RNM

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