Low Rates of Repeat HIV Testing Despite Increased Availability of Antiretroviral Therapy in Rural Tanzania: Findings from 2003–2010

Caoimhe Cawley,Mark Urassa,Milly Marston,Basia Zaba,Benjamin Clark,Raphael Isingo,Alison Wringe,Jim Todd,Baltazar Mtenga,Julian W Tang

doi:10.1371/journal.pone.0062212

Abstract

BackgroundHIV counselling and testing (HCT) services can play an important role in HIV prevention by encouraging safe sexual behaviours and linking HIV-infected clients to antiretroviral therapy (ART). However, regular repeat testing by high-risk HIV-negative individuals is important for timely initiation of ART as part of the ‘treatment as prevention’ approach.AimTo investigate HCT use during a round of HIV serological surveillance in northwest Tanzania in 2010, and to explore rates of repeat testing between 2003 and 2010.MethodsHCT services were provided during the fourth, fifth and sixth rounds of serological surveillance in 2003–2004 (Sero-4), 2006–2007 (Sero-5) and 2010 (Sero-6). HCT services have also been available at a government-run health centre and at other clinics in the study area since 2005. Questionnaires administered during sero-surveys collected information on socio-demographic characteristics, sexual behaviour and reported previous use of HCT services.ResultsThe proportion of participants using HCT increased from 9.4% at Sero-4 to 16.6% at Sero-5 and 25.5% at Sero-6. Among participants attending all three sero-survey rounds (n = 2,010), the proportions using HCT twice or more were low, with 11.1% using the HCT service offered at sero-surveys twice or more, and 25.3% having tested twice or more if reported use of HCT outside of sero-surveys was taken into account. In multivariable analyses, individuals testing HIV-positive were less likely to repeat test than individuals testing HIV-negative (aOR 0.17, 95% CI 0.006–0.52).Discussion/ConclusionsAlthough HCT service use increased over time, it was disappointing that the proportions ever testing and ever repeat-testing were not even larger, considering the increasing availability of HCT and ART in the study area. There was some evidence that HIV-negative people with higher risk sexual behaviours were most likely to repeat test, which was encouraging in terms of the potential to pick-up those at greatest risk of HIV-infection.

Highlights

HIV counselling and testing (HCT) services have recently expanded rapidly in sub-Saharan Africa in order to facilitate access to HIV treatment and care [1]
The contribution of HCT to HIV prevention may potentially acquire a further role in light of the treatment as prevention (TasP) approach, which suggests that widespread use of antiretroviral therapy (ART) could have a substantial impact in reducing rates of HIV transmission as a result of reduced viral loads in treated patients [4,5,6]
This paper reports on the uptake of HCT services during the latest round of HIV serological surveillance carried out in 2010 as part of an on-going community cohort study in Kisesa in northwest Tanzania

Summary

Introduction

HIV counselling and testing (HCT) services have recently expanded rapidly in sub-Saharan Africa in order to facilitate access to HIV treatment and care [1]. It has been widely assumed that HCT services play an important role in HIV prevention, by motivating both HIV-negative and HIV-positive individuals to reduce sexual risk taking and adopt preventive behaviours [2,3]. One modelling study suggested that regular testing for all adults aged 15 and over once per year, followed by immediate access to treatment for those testing positive, could result in the near elimination of HIV in generalised epidemic settings within 50 years [4]. This assertion has been challenged by other authors [7]. Regular repeat testing by highrisk HIV-negative individuals is important for timely initiation of ART as part of the ‘treatment as prevention’ approach

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