Tohara Plus

Evaluation of the acceptability and safety of the ShangRing device for male circumcision in Shinyanga, Tanzania

kmelton — Tue, 04 Jan 2022 15:15:24 +0000

Evaluation of the acceptability and safety of the ShangRing device for male circumcision in Shinyanga, Tanzania 2021 kmelton January 04, 2022

Male circumcision (MC) reduces the risk of heterosexually acquired HIV infection in men by 60%. Tanzania is among the 14 sub-Saharan African countries that is scaling up voluntary medical male circumcision (VMMC) for HIV prevention through conventional surgical circumcision. Accelerating the scale up of MC in areas with high HIV prevalence, low MC coverage, and a predominantly heterosexual epidemic is a key component in a comprehensive response for HIV epidemic control. Medical circumcision devices have the potential to speed up the roll out of MC by making the procedure quicker and easier than surgical circumcision, while remaining just as safe. The ShangRing was prequalified by the World Health Organization (WHO) in 2015 as a promising device for circumcision in adolescent and adult males 13 years and older. Based on the WHO’s framework for introducing MC devices in countries, IntraHealth International in Tanzania conducted a study to evaluate the acceptability and safety of the ShangRing MC device in Tanzania.

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Countries Tanzania

Projects Tohara Plus

Topics HIV & AIDS

Novel Approaches in Tanzania Lead to HIV Services for Over 1.3 Million Clients

kseaton — Thu, 11 Nov 2021 14:14:51 +0000

Novel Approaches in Tanzania Lead to HIV Services for Over 1.3 Million Clients kseaton November 11, 2021 November 11, 2021

More than 1.37 million clients have received high-quality voluntary medical male circumcision (VMMC) services for HIV-prevention in Tanzania over the past five years through IntraHealth International’s Tohara Plus project, one of the most successful projects of its kind.

Tohara Plus pioneered novel approaches using human-centered design to reach more clients with VMMC services, which lower a man’s risk of acquiring HIV through heterosexual sex by around 60%. Some of those approaches include:

Strategically placed services.

By engaging men where they work or spend a lot of time—such as barber shops, mines, fishing camps, agricultural plantations, motorcycle taxi stops, and cotton ginnery factories—the program reached more clients and addressed behavioral barriers that might have kept them from seeking out VMMC services. The program promotes one-on-one engagement between potential clients and community volunteer agents, popular opinion leaders, local leaders, peer networks, and satisfied VMMC clients.

Partnerships with employers.

Tohara Plus works with workplace leaders and communities to co-design VMMC programs. The program has partnered with fisherfolk, beach management units, small-scale miners, sugar plantation and ginneries owners, and boda boda (motorcycle taxi) driver associations.

Mobile clinics.

To reach remote areas of Tanzania, Tohara Plus deployed three mounted mobile clinic vans to expand “men-friendly” services for hard-to-reach adult men and high-risk mobile populations at highway truck stops and near mining and fishing communities. The vans also helped maintain services during COVID-19 by providing care in a project-controlled environment, reducing congestion at health facilities and minimizing the distance some clients must travel to access services.

The ShangRing device.

Tohara Plus registered this WHO prequalified device—a process that recognizes the safety, quality, and efficacy of a product—in Tanzania, which makes the circumcision procedure safer and easier for clients who cannot easily return to their follow-up appointments.

Real-time geostatistical data.

Tohara Plus uses granular geostatistical models and real-time data to plan and monitor VMMC services.

A VMMC client, accompanied by Dr. Sosolo, enters the mobile clinic van in the Simiyu region of Tanzania. Photo by Rashid Hamis Kindamba for IntraHealth International.

Tohara Plus reached more men with circumcision services than any other VMMC partner in Tanzania.

By using these approaches and partnering with health workers throughout seven lake zone regions northern Tanzania, Tohara Plus has achieved the following results over the past five years:

Provided VMMC services for HIV-prevention to 1,376,382 clients, reaching more men with circumcision services consecutively for the past four years than any other VMMC partner in Tanzania while maintaining high quality services.
Linked over 95% of HIV-positive clients with care and treatment services.
Achieved a 96% return rate for clients who come to their follow-up appointment within 14 days of the procedure
Introduced quality improvement measures that resulted in less than 0.1% of adverse events (well under the WHO’s standard 2%)
Established VMMC services within routine health care delivery in 104 VMMC static sites
Established five early infant male circumcision (EIMC) sites
Renovated 11 VMMC static sites
Trained 996 VMMC service providers and 2,144 community volunteer agents on the human-centered design approach
Trained 28 national VMMC/EIMC trainers
Trained 111 health workers on use of DHIS2 to manage, monitor, and apply project results to strengthen programming

The project also led a successful consortium that included two local partners—the Tanzania Youth Alliance (TAYOA) and IntraHealth’s local affiliate, Afya Plus—to create demand for and provide quality VMMC services among eligible males in the supported regions.

And when COVID-19 began to spread around the world in 2020, the project integrated COVID-19 prevention measures and vaccination awareness into VMMC routine services to ensure the safety of VMMC providers and clients and continuity of services.

“We owe our success to our partnership approach,” says Lucy Mphuru, Tanzania country director and project director of Tohara Plus. “We include stakeholders in every step of our processes to cultivate a high level of ownership and accountability. We ensured a uniquely transparent method of planning with clear roles, responsibilities, and a consensus on targets; a “moving together” through implementation approach; and side-by-side monitoring and problem solving to improve VMMC programming.”

With US President's Emergency Plan for AIDS Relief ambition funding Tohara Plus received in 2021, the project was able to identify and serve high-risk and hard-to-reach men over 24 years old, including fishermen. The proportion of males over 24 who were reached increased from 16% in 2020 to 26% in the beginning of 2021.

To read more about how Tohara Plus was affected by COVID-19 and how they quickly adapted to provide services during the pandemic, read What Does It Take to Keep HIV Services Available in Tanzania during COVID-19?, a Q&A with Lucy Mphuru, the project director.

Tohara Plus is a five-year project funded by the U.S. President's Emergency Plan for AIDS Relief (PEPFAR) through Centers for Disease Control (CDC) Tanzania to accelerate the scale up of VMMC services in seven Lake Victoria regions of Tanzania.

Tanzania HIV & AIDS Community HealthA client holds his patient card for before going into the mobile clinic van for HIV testing and the VMMC procedure. Photo by Rashid Hamis Kindamba for IntraHealth International.Tohara Plus

A Decision-to-Action Mental Journey That Increased Utilization of VMMC Services Among Fisherfolks in Lake Victoria Islands, Tanzania

kmelton — Wed, 03 Nov 2021 19:39:36 +0000

A Decision-to-Action Mental Journey That Increased Utilization of VMMC Services Among Fisherfolks in Lake Victoria Islands, Tanzania 2021 kmelton November 03, 2021 Download

Technical Briefs: Tanzania's Tohara Plus Program

Robust Monitoring, Mentoring, and Training to Optimize the Quality of Voluntary Medical Male Circumcision Services

Using Data to Improve Quality and Outcomes of Voluntary Medical Male Circumcision Services in Tanzania

Mobile Clinic Vans Make Voluntary Medical Male Circumcision Services Attractive to More Adult Men in Tanzania

A Three-Pronged Model for Stakeholder Engagement: Analysis, Transparency, and Empowerment

Tohara Journey: Integrating a Human-Centered Design Approach into a Mobile App to Enhance Uptake of Voluntary Medical Male Circumcision in Tanzania

Countries Tanzania

Projects Tohara Plus

Topics HIV & AIDS Community Health

By Msafiri Swai, Mary Goodluck Mndeme , Kija Nyalali, Lucy Mphuru, Anne Fitzgerald Vinluan

A Three-Pronged Model for Stakeholder Engagement: Analysis, Transparency, and Empowerment

kmelton — Wed, 03 Nov 2021 19:32:42 +0000

A Three-Pronged Model for Stakeholder Engagement: Analysis, Transparency, and Empowerment 2021 kmelton November 03, 2021 Download

Technical Briefs: Tanzania's Tohara Plus Program

Robust Monitoring, Mentoring, and Training to Optimize the Quality of Voluntary Medical Male Circumcision Services

Using Data to Improve Quality and Outcomes of Voluntary Medical Male Circumcision Services in Tanzania

Mobile Clinic Vans Make Voluntary Medical Male Circumcision Services Attractive to More Adult Men in Tanzania

A Decision-to-Action Mental Journey That Increased Utilization of VMMC Services Among Fisherfolks in Lake Victoria Islands, Tanzania

Tohara Journey: Integrating a Human-Centered Design Approach into a Mobile App to Enhance Uptake of Voluntary Medical Male Circumcision in Tanzania

Countries Tanzania

Projects Tohara Plus

Topics HIV & AIDS Leadership and Governance Health Workforce & Systems

By Msafiri Swai, Mary Goodluck Mndeme , Kija Nyalali, Lucy Mphuru, Anne Fitzgerald Vinluan

Mobile Clinic Vans Make Voluntary Medical Male Circumcision Services Attractive to More Adult Men in Tanzania

kmelton — Wed, 03 Nov 2021 19:29:03 +0000

Mobile Clinic Vans Make Voluntary Medical Male Circumcision Services Attractive to More Adult Men in Tanzania 2021 kmelton November 03, 2021 Download

Technical Briefs: Tanzania's Tohara Plus Program

Robust Monitoring, Mentoring, and Training to Optimize the Quality of Voluntary Medical Male Circumcision Services

Using Data to Improve Quality and Outcomes of Voluntary Medical Male Circumcision Services in Tanzania

A Three-Pronged Model for Stakeholder Engagement: Analysis, Transparency, and Empowerment

A Decision-to-Action Mental Journey That Increased Utilization of VMMC Services Among Fisherfolks in Lake Victoria Islands, Tanzania

Tohara Journey: Integrating a Human-Centered Design Approach into a Mobile App to Enhance Uptake of Voluntary Medical Male Circumcision in Tanzania

Countries Tanzania

Projects Tohara Plus

Topics HIV & AIDS Community Health

By Kija Nyalali, Lucy Mphuru, Anne Fitzgerald Vinluan

Tohara Journey: Integrating a Human-Centered Design Approach into a Mobile App to Enhance Uptake of Voluntary Medical Male Circumcision in Tanzania

kmelton — Wed, 03 Nov 2021 19:26:53 +0000

Tohara Journey: Integrating a Human-Centered Design Approach into a Mobile App to Enhance Uptake of Voluntary Medical Male Circumcision in Tanzania 2021 kmelton November 03, 2021 Download

Technical Briefs: Tanzania's Tohara Plus Program

Robust Monitoring, Mentoring, and Training to Optimize the Quality of Voluntary Medical Male Circumcision Services

Using Data to Improve Quality and Outcomes of Voluntary Medical Male Circumcision Services in Tanzania

Mobile Clinic Vans Make Voluntary Medical Male Circumcision Services Attractive to More Adult Men in Tanzania

A Three-Pronged Model for Stakeholder Engagement: Analysis, Transparency, and Empowerment

A Decision-to-Action Mental Journey That Increased Utilization of VMMC Services Among Fisherfolks in Lake Victoria Islands, Tanzania

Countries Tanzania

Projects Tohara Plus

Topics HIV & AIDS Community Health Digital Health

By Kija Nyalali, Msafiri Swai, Lucy Mphuru, Anne Fitzgerald Vinluan

Using Data to Improve Quality and Outcomes of Voluntary Medical Male Circumcision Services in Tanzania

kmelton — Wed, 03 Nov 2021 19:24:24 +0000

Using Data to Improve Quality and Outcomes of Voluntary Medical Male Circumcision Services in Tanzania 2021 kmelton November 03, 2021 Download

Technical Briefs: Tanzania's Tohara Plus Program

Robust Monitoring, Mentoring, and Training to Optimize the Quality of Voluntary Medical Male Circumcision Services

Mobile Clinic Vans Make Voluntary Medical Male Circumcision Services Attractive to More Adult Men in Tanzania

A Three-Pronged Model for Stakeholder Engagement: Analysis, Transparency, and Empowerment

A Decision-to-Action Mental Journey That Increased Utilization of VMMC Services Among Fisherfolks in Lake Victoria Islands, Tanzania

Tohara Journey: Integrating a Human-Centered Design Approach into a Mobile App to Enhance Uptake of Voluntary Medical Male Circumcision in Tanzania

Countries Tanzania

Projects Tohara Plus

Topics HIV & AIDS Measurement & Analytics Measurement and Evaluation

By Kija Nyalali, Lucy Mphuru, Anne Fitzgerald Vinluan

Robust Monitoring, Mentoring, and Training to Optimize the Quality of Voluntary Medical Male Circumcision Services

kmelton — Wed, 03 Nov 2021 14:48:24 +0000

Robust Monitoring, Mentoring, and Training to Optimize the Quality of Voluntary Medical Male Circumcision Services 2021 kmelton November 03, 2021 Download

Technical Briefs: Tanzania's Tohara Plus Program

Using Data to Improve Quality and Outcomes of Voluntary Medical Male Circumcision Services in Tanzania

Mobile Clinic Vans Make Voluntary Medical Male Circumcision Services Attractive to More Adult Men in Tanzania

A Three-Pronged Model for Stakeholder Engagement: Analysis, Transparency, and Empowerment

A Decision-to-Action Mental Journey That Increased Utilization of VMMC Services Among Fisherfolks in Lake Victoria Islands, Tanzania

Tohara Journey: Integrating a Human-Centered Design Approach into a Mobile App to Enhance Uptake of Voluntary Medical Male Circumcision in Tanzania

Countries Tanzania

Projects Tohara Plus

Topics HIV & AIDS Performance & Quality Improvement Measurement and Evaluation

By Kija Nyalali, Lucy Mphuru, Anne Fitzgerald Vinluan

What Does It Take to Keep HIV Services Available in Tanzania during COVID-19?

kseaton — Mon, 26 Jul 2021 13:50:14 +0000

What Does It Take to Keep HIV Services Available in Tanzania during COVID-19? kseaton July 26, 2021

July 26, 2021

Lucy Mphuru on how her team exceeded targets despite the pandemic.

Lucy Mphuru and her team have been providing HIV services to hundreds of thousands of clients in Tanzania for 14 years. But when COVID-19 hit the country in 2020, the pandemic threatened to halt these services.

So Lucy and her team pivoted quickly.

They developed their own creative new approaches to make sure their clients could still access high-quality health care while ensuring the safety of frontline health workers, staff, and the clients they served—and they got results. In fact, they achieved 117% of the Tohara Plus project’s target in 2020, providing over 186,000 adolescent and adult men in Tanzania’s northern regions of Mara, Mwanza, Shinyanga, and Simiyu with voluntary medical male circumcision (VMMC) services, which lower men’s risk of acquiring HIV through heterosexual sex by around 60%.

Between meetings and facility visits, Mphuru found a sliver of time to sit down with us to talk about how they did it.

Your team has seen great results in HIV prevention despite COVID-19. How did you do it?

When COVID-19 first started in March 2020, IntraHealth suspended all Tohara Plus VMMC outreach campaigns and community activities that attract big gatherings. So, with our project partners, we quickly adapted.

We focused on 29 static sites and created 42 satellite static sites in more remote locations using interactive geospatial mapping and having conversations with communities. This allowed us to prioritize the areas with high numbers of uncircumcised men and bring services closer to potential clients. We extended daily working hours and included weekend hours so clients had easier access. And we integrated COVID-19 awareness and prevention measures into routine VMMC services like facemasks, handwashing stations, and pre-booked clients and scheduled time slots for adequately spaced appointments to avoid facility congestion.

We also relied heavily on “no contact” tools such as mobile phones and apps to send SMS messages, provide toll-free hotline calls, collect data, and facilitate communication between volunteer community agents, clients, and facilities.

Another really important tool for us was our mobile clinic vans, which we started using in late 2020. They allow us to take services directly to clients, rather than the other way around. They are fully equipped with all the supplies and equipment needed to provide VMMC services at any time and location. We take them to areas with high numbers of potential clients, such as along highways to target long safari truck drivers, in mining places to target miners, along the Lake Victoria Islands to target fisherfolks, and in hard-to-reach areas.

READ: Four Ways We’re Adapting HIV Services during COVID-19 in Tanzania

Lucy Mphuru in front of a mobile clinic van. Photo by IntraHealth International.

A mobile clinic van in Tanzania. Photo by Rasheed Hamis/DDC International for IntraHealth International.

How did you adapt so quickly to COVID-19?

We already had strong relationships with the government and were part of national, regional, and district COVID-19 Rapid Response Teams. Because of that, we were well informed and aligned our implementations in accordance with the national guidance and donor requirements.

We engaged every person within the organization and worked closely with government authorities from the national to community level to adapt our implementation to the “new normal” of working.

You’re using a lot of creative new approaches to reach clients. Which ones get the best results?

First, we’ve been using formal and informal workplace-based approaches to engage employers and workers. For example, we co-designed a partnership with fisher folks, beach management units (BMU), small-scale miners, and boda boda (motorcycle taxi) drivers in Tanzania. These networks of leaders supported us to set up client-centered services, which helped increase the number of clients receiving VMMC services. With the BMUs and fisherfolk in the Lake Victoria Islands, we provided VMMC services to 1,642 males in three weeks.

We also partnered with management teams and associations at different workplaces. These include sugar and tobacco plantations, miners, and cotton ginnery factories. We built a great relationship with the ginnery management and our project team was offered space to set up a medical tent for circumcising consenting men. We were able to work with management to ensure that employees who were circumcised were granted 7-14 paid leave days for their recovery and their employment was retained so they could go back to work after healing. Thanks to those agreements, 90 clients were circumcised in two weeks.

Second, we use a human-centered design approach to address behavioral barriers and engage hard-to-reach adult men. We work with community volunteer agents, popular opinion leaders, local leaders, peer networks, and satisfied VMMC clients to reach interested new clients in the community. Most of these interactions are done through one-on-one engagement with individual men or small groups of men in places where they spend a lot of their time—barber shops, motorcycle taxi stops, among others—and mobilize them through safe and acceptable interpersonal conversation.

We conduct real-time performance monitoring daily.

Third, we are a data-driven team. We conduct real-time performance monitoring daily and have weekly service delivery surge data dashboards for each facility. This continuous quality improvement approach allows us to make real-time decisions that improve performance and maintain service quality.

At the beginning of COVID-19, IntraHealth also institutionalized the DHIS2 Touch mobile app on phones, tablets, and project laptops to facilitate remote daily data collection and live reporting by each site while promoting data quality and use. Project regional technical advisors, monitoring and evaluation officers, and facility VMMC site managers monitor clinic performances daily to troubleshoot any challenges that hinder services at static sites or pose an increased risk of COVID-19 transmission to clients or health workers.

And we invest in and rely on local partnerships. We work closely with local organizations, including Afya Plus, which is a local IntraHealth affiliate. We’ve helped them strengthen their governance, organization, and board of directors structures and systems so they can partner with the government of Tanzania, local civil society, and the private sector to improve the quality and accessibility of Tanzania’s health care system. We’ve also worked with them through our ASAP project to help build their capacity to receive direct funding from the US government and manage those funds. As part of this consortium, Afya Plus signed a sub-agreement to provide VMMC services in the Mara region, which they were able to scale up after achieving specific milestones. Now, we have a strong local partner providing VMMC services in Tanzania who we rely on and work with during COVID-19.

READ: New Afya Plus to Improve Health Care Quality and Accessibility in Tanzania

A health worker in Tanzania uploads facility data using a mobile phone. Photo by Rasheed Hamis/DDC International for IntraHealth International.

How have the PEPFAR ambition funds your team received helped?

Despite IntraHealth’s remarkable achievements since the inception of VMMC services in Tanzania, we still need to close the gap and reach more adult males who are at risk of HIV. Ambition funding was a global competitive funding opportunity from PEPFAR that we won to address this gap. The award signifies that our refined strategies and innovations—which have evolved over years—are working. The funds help us continue to achieve our targets, close the service gap, and invest in meaningful working relationships with all levels of the Tanzanian government.

As COVID-19 continues to spread, what does the future look like for Tanzania’s health workers?

The health care system in Tanzania is facing a critical shortage of health workers. They are not equitably distributed, there is limited infrastructure, and pandemic preparedness challenges remain. COVID-19 overwhelmed the health system at the beginning due to limited knowledge and technical competence to manage it.

We need to always be prepared with equitable and adequately skilled human and nonhuman resources.

Investments have now been put in place by the government of Tanzania in collaboration with other stakeholders to help the health system manage COVID-19 in an informed, systemic manner. Now, the health workforce is more knowledgeable about the disease and COVID-19 has shown how important preparedness is for the health system. We need to always be prepared with equitable and adequately skilled human and nonhuman resources, such as technology, infrastructure, funds, and tools.

This goes beyond having excellent training institutions to extend to recruitment, sustainable retention programs, a motivated workforce, meaningful data utilization, and adequate budgetary allocation to improve overall system resilience and prepare for future crises.

IntraHealth’s Tohara Plus Project leads a consortium that includes two local partners—the Tanzania Youth Alliance (TAYOA) and IntraHealth’s local affiliate, AFYA Plus. It is funded by the US Centers for Disease Control and Prevention (CDC) under the President's Emergency Plan for AIDS Relief (PEPFAR).

By Lucy Mphuru

Director of strategic information

By Katherine Seaton

Former communications manager

Tohara Plus HIV & AIDS COVID-19 Community Health Digital Health Tanzania

A health worker waits for clients in a mobile clinic van in Tanzania. Photo by Rasheed Hamis/DDC International for IntraHealth International.

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Tanzania’s Tohara Plus Exceeds HIV Service Goals Despite Pandemic

kseaton — Mon, 08 Feb 2021 15:30:05 +0000

Tanzania’s Tohara Plus Exceeds HIV Service Goals Despite Pandemic kseaton February 08, 2021 February 08, 2021

In the midst of the COVID-19 pandemic and its halting effects on health services around the world, Tanzania’s northern regions of Mara, Mwanza, Shinyanga, and Simiyu have provided crucial HIV services to over 186,000 adolescent and adult men, exceeding their target success rate by 117% through the Tohara Plus project.

The IntraHealth-led project—which is funded by the President's Emergency Plan For AIDS Relief (PEPFAR) and the US Centers for Disease Control—has provided HIV services in Tanzania since 2016 to help the country tackle its HIV epidemic sustainably while also working toward the country’s vision of an AIDS-free generation. PEPFAR has been at the forefront of achieving these HIV goals and has invested over $85 billion in the global HIV/AIDS response since 2003, saving over 18 million lives, preventing millions of HIV infections, and achieving HIV/AIDS epidemic control in more than 50 countries around the world. One of these critical services is voluntary medical male circumcision (or VMMC), a procedure that reduces a man’s risk of acquiring HIV through heterosexual intercourse by about 60%).

Tohara Plus provides VMMC services in four northern regions of Tanzania and has been exceeding targets since its inception, but in early 2020, COVID-19 threatened to halt all of the project’s VMMC activities. After temporarily stopping outreach and campaign services in the spring, the Tohara Plus team worked quickly to adapt services to follow COVID-19 safety guidelines in 71 static sites in more remote locations to sustain VMMC services.

Because of this rapid response, they met and even exceeded their adjusted 2020 targets and have continued to provide VMMC services during the pandemic. The team’s achievements include:

186,014 males provided with VMMC services, a 117% success rate based on the adjusted targets.
184,215 (99%) clients returned for a post-circumcision follow-up appointment within 14 days of their procedure.
91.6% of clients came to their second follow-up visit.

“Our team has a really strong relationship with the government—and we involve and engage them from the national level to the community level,” says Lucy Mphuru, country director and Tohara Plus project director. “We orient them on all our activities from the beginning, do joint programming to scale up solutions together, and often get ideas from them that we would never have thought of. It’s a great example of country ownership and it’s more sustainable. The model of this approach could be used in most understaffed regions to get stronger results like these in a shorter time.”

And while the project exceeded its overall target, so did each region, including Shinyanga (119%), Mara (117%), Mwanza (116%), and Simiyu (112%). Tohara Plus ensured client follow-ups were reviewed daily and if anyone missed their appointment, clients were traced through their mobile phone numbers and reminded to reschedule. By the end of the year, all sub-national units had also surpassed their annual targets while maintaining the quality and safety of VMMC services.

The project also provided technical assistance on early infant male circumcision (EIMC) through three centers of excellence—Nyamagana Hospital (Mwanza), Kahama District Hospital (Shinyanga), and Meatu District Hospital (Simiyu)—established by IntraHealth, the Tanzanian Ministry of Health and government of Tanzania in 2019 with 53 trained EIMC providers. In early 2020, 402 infants under two months old received services through these sites.

A Human-Centered Approach

Tohara Plus used the SMART (specific, measurable, attainable, relevant, time-bound) advocacy approach and human-centered design while working with local leaders, influencers, and volunteer community agents to understand and break down the barriers that keep potential clients from seeking VMMC services. Volunteer community agents and popular opinion leaders communicated one-on-one with prospective clients and shared information with and booked appointments for them in nearby static and satellite facilities. A total of 150 public opinion leaders tailored their responses, answered questions, and gave information to 13,791 prospective VMMC clients.

The project also identified specific strategies and tailored them to regions based on the challenges clients in each area faced. For example, in small mining communities without a nearby health facility, Tohara Plus provided transportation to the facilities for clients to help them access services.

To ensure high-quality services, the program continued intensive mentorship and clinical coaching, refresher trainings, and close supportive supervision to make sure health workers could recognize, categorize, manage, document, and report VMMC-related adverse events. The project also focused on data quality and conducted monthly quality checks with government partners.

New Tool for Stronger HIV-Prevention Services

To reach remote areas of Tanzania, Tohara Plus is now deploying three mounted mobile clinic vans to expand services and target hard-to-reach adult men with “men-friendly” services. The vans help to maintain services during COVID-19 by providing care in a project-controlled environment, reducing congestion at health facilities, and minimizing the distance some clients must travel to access services.

IntraHealth’s Tohara Plus Project leads a consortium that includes two local partners—the Tanzania Youth Alliance (TAYOA) and IntraHealth’s local affiliate, AFYA Plus. It is funded by the US Centers for Disease Control and Prevention under the President's Emergency Plan for AIDS Relief.

The Tohara Plus team was included as one of the 11 case studies in the World Health Organization’s Case Studies on Enhancing Uptake of Voluntary Medical Male Circumcision. You can read their case study, Triangulating Data to Direct VMMC Strategies for Reaching Uncircumcised Males in the Lake Zone Region, United Republic of Tanzania, here.

Tanzania HIV & AIDS Community HealthA male circumcision client identification card in Tanzania. Photo by Josh Estey for IntraHealth International.Tohara Plus