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
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Date
2017
Journal Title
Journal ISSN
Volume Title
Publisher
BMJ Publishing Group
Abstract
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.
Description
Keywords
HIV testing, HIV treatment, Tanzania
Citation
Sanga, E.S. et al. (2017). 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 Open, 7:e013733.