Chronic Disease Clinic in Ifakara

The Kilombero and Ulanga Antiretroviral Cohort has recruited more than 8000 patients.
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Selected projects at this location:

The Chronic Disease Clinic in Ifakara (CDCI) is an integral part of the St. Francis Hospital Referral (SFRH) in Ifakara, Tanzania. It has been uninterruptedly functioning since 2005. The CDCI delivers HIV care to patients in the large catchment area of the Kilombero and Ulanga district according National guidelines. Initially built to support the Tanzanian National AIDS Control Programme, the activities conducted at the CDCI have been progressively expanded to take care of all outpatients and inpatients with HIV being visited at SFRH, including pregnant and non-pregnant adults, HIV-exposed and HIV-infected children.

The collaborative project of Swiss TPH, IHI and the St. Francis Referral Hospital so far enrolled close to 9,000 HIV-positive individuals, applying a hospital-wide testing strategy.

Integrated in CDCI is the One-Stop Clinic – a comprehensive mother and child health service, facilitating access to care for HIV-affected families. In addition, the CDCI includes now the Tuberculosis (TB) clinic of SFRH, in order to integrate services and improve the outcome of patients with TB and HIV.

Kilombero and Ulanga Antiretroviral Cohort

A research cohort, the Kilombero and Ulanga Antitretroviral Cohort KIULARCO helps to scientifically adress questions regarding treatment outcomes, adherence, resistance surveillance, co-morbidities and implementation of services can be addressed.  Teaching and training are integrated into daily routine in order to build capacity and professional carriers.

Counselling and Education

CDCI also offers voluntary counselling and testing (VCT) as well as provider initiated testing and counselling (PITC) services, supervision of other centres for care and treatment (CTC) in the Kilombero district, and educational activities to the community. The CDCI aims to be a center of excellence in the management of HIV in rural Africa.

CDCI Ifakara 2016
TB and HIV-treatment have been integrated into CDCI.
CDCI Ifakara 2016
Rapid diagnostic HIV-testing
CDCI Ifakara 2016
More than 6000 plasma samples are stored from individuals of the KIULARCO cohort.

Since May 2014 the One Stop Clinic Ifakara provides - as a part of the Chronic Disease Clinic -  a medical setting for HIV-infected mothers and their families. It aims to improve access to care and treatment for HIV-infected pregnant women, their partners and their offspring living in the Kilombero district and serve as a model clinic for other rural settings in Tanzania and sub-Saharan Africa.

Improving awareness and clinical skills

The One Stop Clinic has successfully improved the awareness and clinical skills of health workers involved in Prevention of Mother-To-Child Transmission of HIV (PMTCT) and Pediatric HIV. Over 100 health workers, distric authorities and representatives of USAID in the Morogoro Region have been reached in 2014 and 2015. The One Stop Clinic has developed tools to guide and facilitate health workers in the management of pregnant women, mothers and children living with HIV. 

Improved access and quality of care

The ‘One Stop Clinic has offered HIV testing in 2014 and 2015 to over 7,500 pregnant women in the district, and HIV care and treatment to 355 HIV-infected pregnant women. Very likely this avoided many new pediatric HIV infections. Data from Ifakara show a 2-fold increase of the number of HIV-infected women diagnosed and linked into care after the integration of services. 

Lower mother-to-child transmission of HIV

Since the One Stop Clinic was established the early Mother-To-Child Transmission of HIV is as low as 2%, reaching the WHO goal of elimination of MTCT (<5%). Since April 2014 all pregnant women living with HIV are initiated on lifelong antiretroviral treatment. Data comparing their clinical characteristics and retention in care before and after the integration of services revealed a better clinical assessment and retention in care.

Vanobberghen F et al. A decade of HIV care in rural Tanzania: trends in clinical outcomes and impact of clinic optimisation in an open, prospective cohort. PLoS One. 2017;12(7):e0180983. DOI: 10.1371/journal.pone.0180983

Letang E et al. Cohort profile: the Kilombero and Ulanga Antiretroviral Cohort (KIULARCO): a prospective HIV cohort in rural Tanzania. Swiss Med Wkly. 2017;147:w14485. DOI: 10.4414/smw.2017.14485

Muri L et al. Development of HIV drug resistance and therapeutic failure in children and adolescents in rural Tanzania - an emerging public health concern. AIDS. 2017;31(1):61-70. DOI: 10.1097/QAD.0000000000001273

Gamell A et al. Prevention of mother-to-child transmission of HIV Option B+ cascade in rural Tanzania: the one stop clinic model. PLoS One. 2017;12(7):e0181096. DOI: 10.1371/journal.pone.0181096

Gamell A et al. A case series of acquired drug resistance-associated mutations in human immunodeficiency virus-infected children: an emerging public health concern in rural Africa. Open Forum Infect Dis. 2016;3:ofv199. DOI: 10.1093/ofid/ofv199

The Positive Kids - A documentary film about HIV in Tanzania