Trends in the uptake of voluntary counselling and testing for HIV in rural Tanzania in the context of the scale up of antiretroviral therapy

Raphael Isingo,Griter Maiseli,Julius Mngara,Doris Mbata,Ester Mwinuka,Jim Todd,Rose Manyalla,Alison Wringe,Basia Zaba,Mark Urassa,John Changalucha

doi:10.1111/j.1365-3156.2011.02877.x

Abstract

ObjectivesTo describe trends in voluntary counselling and testing (VCT) use and to assess whether high-risk and infected individuals are receiving counselling and learning their HIV status in rural Tanzania.MethodsDuring two rounds of linked serological surveys (2003–2004 and 2006–2007) with anonymous HIV testing among adults, VCT was offered to all participants. The crude and adjusted odds ratios for completing VCT in each survey were calculated to compare uptake by demographic, behavioural and clinical characteristics, stratified by sex. Repeat testing patterns were also investigated.ResultsThe proportion of participants completing VCT increased from 10% in 2003–2004 to 17% in 2006–2007, and among HIV-infected persons from 14% to 25%. A higher proportion of men than women completed VCT in both rounds, but the difference declined over time. Socio-demographic and behavioural factors associated with VCT completion were similar across rounds, including higher adjusted odds of VCT with increasing numbers of sexual partners in the past 12 months. The proportion having ever-completed VCT reached 26% among 2006–2007 attendees, with repeat testing rates highest among those aged 35–44 years. Among 3923 participants attending both rounds, VCT completion in 2006–2007 was 17% among 3702 who were HIV negative in both rounds, 19% among 124 who were HIV infected in both rounds and 22% among 96 who seroconverted between rounds.ConclusionVCT services are attracting HIV-infected and high-risk individuals. However, 2 years after the introduction of antiretroviral therapy, the overall uptake remains low. Intensive mobilisation efforts are needed to achieve regular and universal VCT use.

Highlights

In sub-Saharan Africa, where the HIV epidemic has had its most devastating impact, the expansion of voluntary HIV testing and counselling services (VCT) is seen as a key component of public health efforts to lower HIV incidence
We have previously reported socio-demographic, behavioural and clinical characteristics associated with voluntary counselling and testing (VCT) use among residents of a HIV cohort study in rural Tanzania 2003–2004, shortly before free antiretroviral treatment (ART) services (Wringe et al 2008)
Our study has shown that VCT completion in Kisesa ward was worryingly low at 10% in 2003–2004 and 17% in 2006–2007

Summary

Introduction

In sub-Saharan Africa, where the HIV epidemic has had its most devastating impact, the expansion of voluntary HIV testing and counselling services (VCT) is seen as a key component of public health efforts to lower HIV incidence. VCT aims to provide people with an opportunity to learn and accept their HIV status in a confidential environment, with counselling to encourage sexual behaviour change to prevent further infections (WHO 2005). The scaling up of VCT services could contribute towards reducing HIV transmission if counselling influenced the behaviour of HIV-positive individuals, including those who. Trends in VCT testing rates among HIV-infected individuals at the population level have rarely been reported, because there are very few settings in which an individual’s HIV status is known prior to VCT. Understanding the extent to which VCT already attracts recent seroconverters could provide useful information for the potential development of ‘treatment as prevention’ programs, which would need to identify persons with recent infection to start on ART

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