Who Tests, Who Doesn't, and Why? Uptake of Mobile HIV Counseling and Testing in the Kilimanjaro Region of Tanzania

Meghan M Shorter,Dafrosa K Itemba,Antipas Mtalo,John A Crump,John A Bartlett,Elizabeth A Reddy,Nathan M Thielman,Jan Ostermann,Bernard Njau,Charles Muiruri

doi:10.1371/journal.pone.0016488

Abstract

BackgroundOptimally, expanded HIV testing programs should reduce barriers to testing while attracting new and high-risk testers. We assessed barriers to testing and HIV risk among clients participating in mobile voluntary counseling and testing (MVCT) campaigns in four rural villages in the Kilimanjaro Region of Tanzania.MethodsBetween December 2007 and April 2008, 878 MVCT participants and 506 randomly selected community residents who did not access MVCT were surveyed. Gender-specific logistic regression models were used to describe differences in socioeconomic characteristics, HIV exposure risk, testing histories, HIV related stigma, and attitudes toward testing between MVCT participants and community residents who did not access MVCT. Gender-specific logistic regression models were used to describe differences in socioeconomic characteristics, HIV exposure risk, testing histories, HIV related stigma, and attitudes toward testing, between the two groups.ResultsMVCT clients reported greater HIV exposure risk (OR 1.20 [1.04 to 1.38] for males; OR 1.11 [1.03 to 1.19] for females). Female MVCT clients were more likely to report low household expenditures (OR 1.47 [1.04 to 2.05]), male clients reported higher rates of unstable income sources (OR 1.99 [1.22 to 3.24]). First-time testers were more likely than non-testers to cite distance to testing sites as a reason for not having previously tested (OR 2.17 [1.05 to 4.48] for males; OR 5.95 [2.85 to 12.45] for females). HIV-related stigma, fears of testing or test disclosure, and not being able to leave work were strongly associated with non-participation in MVCT (ORs from 0.11 to 0.84).ConclusionsMVCT attracted clients with increased exposure risk and fewer economic resources; HIV related stigma and testing-related fears remained barriers to testing. MVCT did not disproportionately attract either first-time or frequent repeat testers. Educational campaigns to reduce stigma and fears of testing could improve the effectiveness of MVCT in attracting new and high-risk populations.

Highlights

Universal testing and immediate treatment of HIV-infected individuals could dramatically reduce or even eliminate HIV transmission [1,2]
Mobile HIV voluntary counseling and testing (MVCT) has been promoted as a means of reaching populations with limited access to HIV testing, and has been effective in attracting large numbers of new testers in countries such as Tanzania, Zimbabwe and Cameroon [7,8,9], but there are limited data describing the characteristics of community members who do not access this opportunity
While early data from a large randomized study offering in-village mobile testing demonstrated 3–13 times greater voluntary counseling and testing (VCT) uptake in intervention villages compared with control villages which had access only to nearby facility-based VCT, only 30% of residents ages 18–32 had accessed the intervention in the Tanzania sites after 24 months [4]

Summary

Introduction

Universal testing and immediate treatment of HIV-infected individuals could dramatically reduce or even eliminate HIV transmission [1,2]. Mobile HIV voluntary counseling and testing (MVCT) has been promoted as a means of reaching populations with limited access to HIV testing, and has been effective in attracting large numbers of new testers in countries such as Tanzania, Zimbabwe and Cameroon [7,8,9], but there are limited data describing the characteristics of community members who do not access this opportunity. Whether expanded HIV testing strategies reduce such barriers and successfully attract new and high risk testers, or preferentially attract lower risk repeat testers, has substantial implications for the strategies’ cost effectiveness and for the possible success of universal testing and treatment policies. We assessed barriers to testing and HIV risk among clients participating in mobile voluntary counseling and testing (MVCT) campaigns in four rural villages in the Kilimanjaro Region of Tanzania

Methods

Results

Discussion

Conclusion