Chronic Disease Clinic of Ifakara
The Chronic Disease Clinic in Ifakara (CDCI) is an integral part of the St. Francis Referral Hospital (SFRH) in Ifakara, Tanzania. Since 2005, CDCI delivers HIV care to patients in the large rural catchment area of the Kilombero, Ulanga and Maliyni districts according National guidelines. Initially built to support the Tanzanian National AIDS Control Programme at the peak of the HIV pandemic, the activities conducted at the CDCI have been progressively expanded to take care of all out- and inpatients with HIV including pregnant and non-pregnant adults, HIV-exposed and HIV-infected children. Care for tuberculosis and increasingly non-communicable comorbidities in HIV have been integrated. Early introduction of state-of-the-art laboratory testing in this remote setting such viral load and resistance testing have a pioneering role in Tanzania.
The CDCI is a model clinic for HIV care in rural Africa. It has grown successfully out of a collaboration between Swiss and Tanzanian institutions. These are the Swiss Tropical and Public Health Institute (Swiss TPH), the University Hospital Basel, the Ifakara Health Institute (IHI) and the St. Francis Referral Hospital (SFRH). Since the initiation of the CDCI, more than 12,000 HIV-positive individuals were enrolled into care, applying a hospital-wide testing strategy for all patients within the catchment area of the SFRH – leading to The Kilombero and Ulanga Antiretroviral Cohort (KIULARCO) allowing to analyse important research questions. Clinical services of highest standards, the establishment and maintenance of a patient cohort from the very beginning and a growing body of clinical research addressing the clinically relevant questions and interventions, together with the continuous training of medical personel have synergistically strengthened this clinical implementation platform.
Besides clinical services, the CDCI has integrated research and training. The Kilombero & Ulanga Antiretroviral Cohort (KIULARCO) has enrolled more than 11,000 PLHIV since its inception in 2005. KIULARCO aims at improving care through identification of treatment outcomes and medical needs of a rural population affected by HIV. Numerous peer-reviewed publications reflect the gained knowledge and impact made, which has informed key stakeholders, policy makers and the scientific community (publication list) at an international level. CDCI is increasingly engaged in clinical trials involving multiple international collaborations, which continues to strengthen the scientific output.
Starting treatment immediately
According to the ‘test and treat’ strategy patients are started on treatment on the same day of their HIV diagnosis, unless signs and symptoms indicate complications, requiring prior management. A professional counselling team supports patients from the first contact with information, and in coping with the diagnosis, associated stigma and medication programmes. Group sessions by HIV-positive lay counsellors are offered to patients to address challenges of living with HIV.
A dedicated team of doctors, nurses and counsellors deliver differentiated care with task shifting and extended drug refill times for stable patients. Patients under care reach high virological suppression rates of 92% (Ntamatungiro A, 2017). Patients with special needs or medical complications, often referred from other health centers are offered a diagnostic work-up by a team of medical doctors in close collaboration with the SFRH and the heart and lung disease clinic. Patients are being taken care of during hospitalization and on an out-patient basis for diagnosis and treatment of HIV-associated diseases, AIDS-defining illnesses or non-communicable co-morbidities. A specialized service (One Stop Clinic) delivers treatment and care for HIV-affected families. Management of co-morbidities is integrated into routine care, but also addressed in clinical trials, e.g. for Tuberculosis (eFASH) or arterial hypertension (CoArtHA).
Training and Capacity Building
Daily sessions on patient management, case discussions, journal clubs, state of the art lectures and quality aspects of the database allow on job training for all collaborators. Learning from attending patients and daily routine is as important as learning how to conduct research activities. All collaborators are being exposed to research through the KIULARCO as well as other new projects, and clinical trials. They learn how to design their own studies, writing proposals for grant applications and writing-up of the manuscripts. We aim to support collaborators wishing to go for Master and PhD programs or specializations. Additionally, CDCI is a recognized platform for training of doctors and students coming from abroad.