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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dc.contributor.authorSanga, Erica Samson
dc.contributor.authorLerebo, Wondwossen
dc.contributor.authorMushi, Adiel K.
dc.contributor.authorClowes, Petra
dc.contributor.authorOlomi, Willyhelmina
dc.contributor.authorMaboko, Leonard
dc.contributor.authorZarowsky, Christina
dc.date.accessioned2018-10-18T12:56:11Z
dc.date.available2018-10-18T12:56:11Z
dc.date.issued2017
dc.description.abstractOBJECTIVE: 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.en_US
dc.identifier.citationSanga, 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.en_US
dc.identifier.issn2044-6055
dc.identifier.urihttp://dx.doi.org/10.1136/bmjopen-2016- 013733
dc.identifier.urihttp://hdl.handle.net/10566/4138
dc.language.isoen_USen_US
dc.privacy.showsubmitterFALSE
dc.publisherBMJ Publishing Groupen_US
dc.rights
dc.rightsThis is an Open Access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work noncommercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http:// creativecommons.org/licenses/by-nc/4.0/
dc.status.ispeerreviewedTRUE
dc.subjectHIV testingen_US
dc.subjectHIV treatmenten_US
dc.subjectTanzaniaen_US
dc.titleLinkage 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 studyen_US
dc.typeArticleen_US

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