Chronic Disease Clinic of Ifakara

At the peak of the HIV pandemics in 2004, the Chronic Disease Clinic in Ifakara (CDCI) has been implemented as the first rural HIV care and treatment center in rural Tanzania to support the National AIDS Control program. The CDCI is integrated in the St. Francis Referral Hospital (SFRH) in Ifakara and is a joint collaboration of the hospital, the Ifakara Health Institute (IHI), the University Hospital Basel (USB) and the Swiss Tropical and Public Health Institute.

In Tanzania, the HIV prevalence has stabilized around 4.8-5% - whereby the Morogoro region is affected with 4.2% during the last survey in 2017. Despite huge improvement, still a high proportion of patients present to care with advanced HIV (around 30%) and a high HIV-associated mortality. CDCI delivers HIV care to patients in the large rural catchment area of the Kilombero, Ulanga and Maliyni districts and also serving as the referral site for more complex patients from the valley. Besides care of currently about 4,800 people living with HIV (PLHIV), the activities conducted at the CDCI have been progressively expanded to provide services for all out- and inpatients diagnosed with HIV and/or tuberculosis including pregnant and non-pregnant adults, HIV-exposed and HIV-infected children. Integration of care for comorbidities – mostly tuberculosis but increasingly also non-communicable diseases is central in this exemplary service model – e.g., for care of families affected by HIV (One Stop Clinic). Timely introduction of advanced laboratory testing such as HIV viral load and HIV resistance testing have a pioneering role in Tanzania. Nowadays the IHI laboratory is a referral laboratory for HIV viral load testing for the whole district and works in close collaboration with other referral laboratories of the National AIDS Control program and the implementing partners. The CDCI team consists of more than 40 collaborators financed through the different partners involved - working closely together.

Besides clinical services, the CDCI integrates research and training. A patient cohort – the Kilombero & Ulanga Antiretroviral Cohort (KIULARCO) since its start in 2005 has included more than 11,000 PLHIV and serves to understand the treatment outcomes and needs of a rural population affected by HIV – aiming at improving care. Numerous publications have achieved to inform policy makers and the scientific community (publication list). Additionally, we increasingly engage in clinical trials, international collaborations to strengthen the scientific output.

At the peak of the HIV pandemics in 2004, the Chronic Disease Clinic in Ifakara (CDCI) has been implemented as the first rural HIV care and treatment center in rural Tanzania to support the National AIDS Control program. The CDCI is integrated in the St. Francis Referral Hospital (SFRH) in Ifakara and is a joint collaboration of the hospital, the Ifakara Health Institute (IHI), the University Hospital Basel (USB) and the Swiss Tropical and Public Health Institute.

In Tanzania, the HIV prevalence has stabilized around 4.8-5% - whereby the Morogoro region is affected with 4.2% during the last survey in 2017. Despite huge improvement, still a high proportion of patients present to care with advanced HIV (around 30%) and a high HIV-associated mortality. CDCI delivers HIV care to patients in the large rural catchment area of the Kilombero, Ulanga and Maliyni districts and also serving as the referral site for more complex patients from the valley. Besides care of currently about 4,800 people living with HIV (PLHIV), the activities conducted at the CDCI have been progressively expanded to provide services for all out- and inpatients diagnosed with HIV and/or tuberculosis including pregnant and non-pregnant adults, HIV-exposed and HIV-infected children. Integration of care for comorbidities – mostly tuberculosis but increasingly also non-communicable diseases is central in this exemplary service model – e.g., for care of families affected by HIV (One Stop Clinic). Timely introduction of advanced laboratory testing such as HIV viral load and HIV resistance testing have a pioneering role in Tanzania. Nowadays the IHI laboratory is a referral laboratory for HIV viral load testing for the whole district and works in close collaboration with other referral laboratories of the National AIDS Control program and the implementing partners. The CDCI team consists of more than 40 collaborators financed through the different partners involved - working closely together.

Besides clinical services, the CDCI integrates research and training. A patient cohort – the Kilombero & Ulanga Antiretroviral Cohort (KIULARCO) since its start in 2005 has included more than 11,000 PLHIV and serves to understand the treatment outcomes and needs of a rural population affected by HIV – aiming at improving care. Numerous publications have achieved to inform policy makers and the scientific community (link to publication list). Additionally, we increasingly engage in clinical trials, international collaborations to strengthen the scientific output.

Starting treatment immediately

According the WHO ‘test and treat’ strategy, patients are started on an antiretroviral treatment on the same day of diagnosis unless signs and symptoms indicate complications of HIV, which need management first. A professional counselling team sees the patient at diagnosis and supports patients accepting the diagnosis, coping with stigma and medication programmes. Group sessions by HIV-positive lay counsellors are offered to patients to address challenges of living with HIV.

 

CDCI Ifakara 2016

Quality Care

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 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 training on the job for all collaborators. Learning from patients and daily routine is as important as learning how to perform research activities. All collaborators are being exposed to research through the KIULARCO as well as in new projects and trials, and designing own studies including grant writing. 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.

CDCI Ifakara 2016
TB and HIV-treatment have been integrated into CDCI.
CDCI Ifakara 2016
Rapid diagnostic HIV-testing
CDCI Ifakara 2016
Once a year, blood samples of patients are stored in a biobank for further analyses.
The Kilombero and Ulanga Antiretroviral Cohort has recruited almost 10’000 patients.
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Selected projects at this location: