Browsing by Author "Sanga, Erica Samson"

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    Linkage into care among newly diagnosed HIV-positive individuals tested through outreach and facility-based HIV testing models in Mbeya, Tanzania: a prospective mixed-method cohort study
    (BMJ Publishing Group, 2017) Sanga, Erica Samson; Lerebo, Wondwossen; Mushi, Adiel K.; Clowes, Petra; Olomi, Willyhelmina; Maboko, Leonard; Zarowsky, Christina
    OBJECTIVE: Linkage to care is the bridge between HIV testing and HIV treatment, care and support. In Tanzania, mobile testing aims to address historically low testing rates. Linkage to care was reported at 14% in 2009 and 28% in 2014. The study compares linkage to care of HIV-positive individuals tested at mobile/ outreach versus public health facility-based services within the first 6 months of HIV diagnosis. SETTING: Rural communities in four districts of Mbeya Region, Tanzania. PARTICIPANTS: A total of 1012 newly diagnosed HIVpositive adults from 16 testing facilities were enrolled into a two-armed cohort and followed for 6 months between August 2014 and July 2015. 840 (83%) participants completed the study. MAIN OUTCOME MEASURES: We compared the ratios and time variance in linkage to care using the Kaplan- Meier estimator and Log rank tests. Cox proportional hazards regression models to evaluate factors associated with time variance in linkage. RESULTS: At the end of 6 months, 78% of all respondents had linked into care, with differences across testing models. 84% (CI 81% to 87%, n=512) of individuals tested at facility-based site were linked to care compared to 69% (CI 65% to 74%, n=281) of individuals tested at mobile/outreach. The median time to linkage was 1 day (IQR: 1–7.5) for facility-based site and 6 days (IQR: 3–11) for mobile/outreach sites. Participants tested at facility-based site were 78% more likely to link than those tested at mobile/outreach when other variables were controlled (AHR=1.78; 95% CI 1.52 to 2.07). HIV status disclosure to family/relatives was significantly associated with linkage to care (AHR=2.64; 95% CI 2.05 to 3.39). CONCLUSIONS Linkage to care after testing HIV positive in rural Tanzania has increased markedly since 2014, across testing models. Individuals tested at facility-based sites linked in significantly higher proportion and modestly sooner than mobile/outreach tested individuals. Mobile/outreach testing models bring HIV testing services closer to people. Strategies to improve linkage from mobile/outreach models are needed.
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    Linkage to care after testing HIV positive: a comparative analysis of mobile versus health facility based models in rural settings, Mbeya-Tanzania.
    (University of the Western Cape, 2018) Sanga, Erica Samson; Zarowsky, Christina
    HIV testing, linkage to HIV care and continuity of care are crucial for proper management of HIV/AIDS. There is increasing interest across sub-Saharan Africa, including in Tanzania, in accessing hard-to-reach populations and remote areas with HIV testing opportunities and linkage to HIV care. Despite the efforts being made by the Tanzanian government to address some of the challenges to improving HIV testing and subsequent linkage to HIV care and treatment services, such as increasing service outlets, linkage to care in Tanzania is still low: studies published in 2009 and 2014 reported linkage rates of 14% at four months and 28% at one year. To our knowledge, there has not been any direct, prospective comparison between mobile and facility-based models of testing in countries like Tanzania, where treatment is only available in a minority of facilities. This study aimed to describe and compare rates and determinants of linkage to care in the first six months following an HIV-positive test result between mobile and facility-based models of HIV testing in Mbeya region, Tanzania.