Aiming to Achieve 90-90-90 Targets, Tanzania Launches NIMART

PEPFAR-supported partnership collaborates with Tanzanian Government to implement nurse initiated and managed ART, better respond to HIV/AIDS through task sharing

Njombe, Tanzania, and Washington, DC, 4 October 2018 — Deputy Minister of Health, Community Development, Gender, Elderly, and Children, Dr. Faustine Ndugulile today officially launched NIMART — nurse initiated management of antiretroviral therapy — paving the way for greatly improved access to quality HIV treatment and care services for all Tanzanians, particularly those who live in remote and underserved areas.

“Nurses being empowered to initiate management of ART in Tanzania is a kind of revolution geared toward ensuring we expand access to HIV services and attain AIDS epidemic control by 2020,” Dr. Ndugulile said to stakeholders from across Tanzania who had gathered in Njombe to celebrate this important step forward.

“When practicing NIMART, I urge nurses to adhere to their ethical code of conduct and our national guidelines, and provide compassionate care to people living with HIV in a way that maintains privacy and confidentiality,” Dr. Ndugulile continued.

The Ministry officially endorsed NIMART in February 2018, fast-tracking development of a training package and mentoring package, monitoring and evaluation framework, national costed implementation plan, and the training of nurses and midwives from 12 scale-up councils with high HIV prevalence.

The National Implementation Plan for NIMART expands the scope of HIV and AIDS services that can be provided by nurses and complements other existing HIV programming in the country.

“Tanzania cannot rely on doctors alone if it is to attain HIV epidemic control by 2020,” Dr. Mpoki Ulisubisya, Permanent Secretary at the Ministry, said during a kick off technical workshop to develop the National Implementation Plan for NIMART earlier this year in Dodoma.

He urged nurses to take a leadership role in ending stigma and discrimination against people living with HIV (PLHIV), telling them, “I see NIMART as an important intervention in meeting global 90 90 90 targets, which is a crucial step toward ending the AIDS epidemic by 2030.”

In fact, NIMART is a catalyst for Tanzania’s efforts to surpass 90-90-90 and attain the 95-95-95 targets.

“As a person living with HIV for over 20 years, I know how nurses have supported people living with HIV,” said Joan Chamungu, Executive Director of the Tanzania Network of Women Living with AIDS and an important contributor to the development of the National Costed Implementation P for NIMART.

“At healthcare facilities, we often find ourselves relying on nurses for live-saving care and treatment. They are the ones who give us ART and monitor our health,” Ms. Chamungu continued, stressing the critical value of their contribution. “I wish NIMART was implemented earlier,” she said. “I have so much faith in this and I believe if it is well implemented, nurses will provide better services and we will eventually achieve the 90-90-90 targets.”

Today’s activities also included the launch of the Tanzania Nurse and Midwifery Information System (TNMIS), a national database that facilitates access to information and services regarding nursing and midwifery education, registration, licensing, and continuing professional development. It also tracks key HIV/AIDS service delivery performance indicators for nurses and midwives to help ensure quality of care.

WHY NIMART?

In 2015, the World Health Organization recommended “Test and Treat,” an approach for achieving the global
90-90-90 targets that calls for the immediate initiation of antiretroviral therapy (ART) for all people newly diagnosed with HIV. In many low-income countries, however, an inadequate number of physicians impedes efforts to take this approach to national scale at the level required to achieve epidemic control. NIMART taps into Tanzania’s largest health workforce – nurses and midwives – to overcome this challenge.

Nurses constitute the largest healthcare provider workforce in Tanzania. They are frontline caregivers providing specialized treatment and care to PLHIV, as well as broader clinical services to the entire population. With support from the U.S. President’s Emergency Plan for AIDS Relief (PEPFAR) and the U.S. Centers for Disease Control and Prevention (CDC) in Tanzania, the American International Health Alliance (AIHA) has been working to strengthen the profession and ensure an adequate supply and quality of nurses in the country since 2005 through our dynamic Tanzania Nursing Initiative (TNI). Over the years, TNI has evolved from an institutional partnership created to strengthen nursing school capacity to equip students with the knowledge and skills they need to provide quality care to a multi-pillared national project that supports improved recruitment, deployment, and retention for this critical cadre that has long been on the front lines of HIV and AIDS treatment, care, and prevention. TNI is managed through AIHA’s HIV/AIDS Twinning Center Program, which is funded by the U.S. Department of Health and Human Services, Health Resources and Services Administration (HRSA).