01 Jun Founder’s final HIV project wraps up in Tanzania

Hearing firsthand that HIV treatment clubs are effective, policymakers from rural Tanzania agreed to investigate renewed funding for them.

“It’s now the time for us to think: How can we support these clubs from our own resources?” said Dr Khamis Kulemba, regional AIDS control coordinator from the Simiyu region. Kulemba attended the final consortium meeting of the Shinyanga Test & Treat project, held in Dar es Salaam in May 2026.

This project was the last one renowned HIV scientist Prof. Joep Lange had initiated before he was killed when his flight was shot down over Ukraine. Lange founded the organisation coordinating the project, the Amsterdam Institute for Global Health and Development (AIGHD). Funding came from the pharmaceutical company Gilead.

After preparations starting in 2014, the project ran until 2021, with research continuing up to today. At the time it was proposed, universal HIV testing and treatment (where people who test positive for the virus can access antiretroviral treatment immediately) and differentiated service delivery (where people stable on antiretroviral treatment can choose to receive their medicine from a club led by community health workers instead of a clinic) were still largely untested concepts in HIV care.

The Tanzanian Shinyanga Test & Treat project set out to verify whether these ideas worked in practice.

One in Europe, one in Africa

Research coordinator Prof. Tobias Rinke de Wit from AIGHD opened the consortium meeting by taking people back to the project’s beginning.

“Joep Lange had two dreams at the end of his career,” Rinke de Wit explained. “One was to make Amsterdam the first city without any new HIV infections. But Joep was always very dedicated to Africa, and so he said that can be done only on one condition – if we do a similar project in Tanzania.”

The project’s principal investigator, Prof. Anton Pozniak, spoke to the attendees via video because he couldn’t travel to Tanzania for the meeting. Pozniak is professor in the department of clinical research at the London School of Hygiene & Tropical Medicine, among many other roles in HIV science.

“The project’s achievements have made a lasting impact on the HIV pandemic in the Shinyanga and Simiyu districts,” Pozniak said. “And it’s all thanks to the collaboration between the partners who have had the determination to make things happen.”

First clubs in the country

Following the video message, Kulemba and his counterpart from the Shinyanga region provided a picture of the HIV situation in the areas they serve.

Kulemba explained that the Simiyu region, where an estimated 40,00 people were living with HIV in 2025, had mostly reached the UNAIDS 95-95-95 targets, with 94.6% of people knowing their HIV status, 99.5% on lifelong antiretroviral treatment and 98.8% virally suppressed.

The Shinyanga region had managed to reduce HIV prevalence from 7.4% in 2003 to 5.6% in 2023, though it still sits higher than the national average of 4.4%, Dr Peter W. Mlacha shared. A main challenge is that children and adolescents are not well-identified.

The Italian non-profit Doctors with Africa CUAMM had served as the Shinyanga project’s implementation partner. CUAMM’s project implementation lead, Veronica Censi, walked attendees through their contribution.

“We were the first to set up adherence clubs in the country and established more than 70 clubs with 1,469 members,” she said. CUAMM trained nurses and community health workers to perform testing and run the clubs, and they also ensured laboratories received the equipment they needed.

Achievements include testing 338,204 people (against a target of 300,000) and successfully carrying out community awareness activities. A survey showed two-thirds of people correctly answered questions about HIV prevention measures, which was double that of an adjacent area.

3 PhD projects, 20 academic papers

Doctoral research about the Shinyanga project was structured across three components: health economics, clinical research, and social science. Altogether, it resulted in an impressive 20 academic papers.

Health economics. First to present her research was Nigerian Dr Nwanneka Okere, who graduated in March 2022 from the University of Amsterdam with a thesis titled “Differentiated service delivery in HIV care and treatment: An exploration of sustainability and impact from patients’ and providers’ perspectives”.

On the cost front, Okere found that participants in adherence clubs spend far less per year than clinic patients to receive services, incurring three times lower costs overall (US$12.40 vs $32.20).

Quality of care in clubs was comparable to clinic-based care. “What we found is that it was much more client-centred. The clients who assessed care in the DSD felt that it had a face; that it was more humane, and that they saved time as they could get around their other business,” Okere noted.

Clinical research. Next, Tanzanian Dr Ramadhani Swaibu discussed his clinical investigation. (He graduated from the University of Amsterdam in March 2026 with a thesis titled “Clinical and epidemiological assessment of a decentralised HIV test and treat care program in western Tanzania”.)

“Where and whom you test for HIV matters a lot,” Swaibu explained. Based on this finding, he recommended targeting people attending TB departments within clinics, first-time testers, and those who were formerly married for testing to improve HIV case detection.

As for feasibility, Swaibu found that the adherence clubs maintain good outcomes for stable HIV clients and can be adopted into routine care, but not as an informal add-on.

Social science. Tanzanian PhD student Tusajigwe Erio provided a social perspective on the project, detailing how it was experienced by people on the ground. She had conducted more than 80 in-depth interviews, 19 focus group discussions, and over 30 ethnographic observations during the project’s implementation phase and a year after it had ended. (Erio will defend her dissertation in the second half of 2026.)

Erio picked up on important discrepancies between policy and people’s motivations. For one, though targeting first-time testers might increase the yield of positive cases, people wanted access to repeat testing to learn about a potential diagnosis early and so protect their dignity.

And while policy dictates that patients start treatment immediately after testing positive for HIV, her findings showed people needed time to process and discuss their diagnosis.

“We know that disclosure is imperative for limiting transmission in the treat-all era,” said Erio. “However, disclosure – just like the decision to link to treatment – is not a one-time event. It is a negotiated process embedded in marital dynamics, power relations and fear of abandonment, blame, rejection, stigma and shame – especially in Shinyanga, which is a patriarchal society and where HIV is perceived differently between men and women.”

To navigate such issues, the support of community healthcare workers proved essential.

‘Whole essence of research’

The last speaker was Aman Shekalaghe, consultant laboratory specialist from Dar es Salaam, who headed up laboratory capacity-building for the project. He detailed its durable legacy – the result of new infrastructure, modern laboratory equipment, and training opportunities.

“Never before did people request to work in the lab, but now people are asking me for a job!” he shared. They even ran a WhatsApp group (“No Lab, no hospital”) where technicians could get advice on solving laboratory issues.

Though final project meetings usually involve looking back, participants discussed how the project’s gains could be sustained.

Former deputy minister and current member of parliament for Shinyanga, Patrobas Katambi, was emphatic: “I wish for the project to continue running. Shinyanga and Simiyu are ready; we are there; we are open for you to come.”

Okere later said discussing the research evidence with those who could use it was “really liberating. It was good to see the uptake of the results, and the policymakers recognising most of the results that we had to share.

“That is the whole essence of research – to find what is feasible and make policy work.”