title: Uptake of HIV voluntary counselling and testing services in rural Tanzania: implications for effective HIV prevention and equitable access to treatment.
abstract: OBJECTIVE
  To describe the associations between socio-demographic, behavioural and clinical characteristics and the use of HIV voluntary counselling and testing (VCT) services among residents in a rural ward in Tanzania.
  
  
  METHODS
  Eight thousand nine hundred and seventy participants from a community-based cohort were interviewed, provided blood for research HIV testing, and were offered VCT. Univariate and multivariate logistic regression was used to identify socio-demographic, clinical and behavioural factors associated with VCT use.
  
  
  RESULTS
  Although 31% (1246/3980) of men and 24% (1195/4990) of women expressed an interest in the service, only 12% of men and 7% of women subsequently completed VCT. Socio-demographic factors, such as marital status, area of residence, religion and ethnicity influenced VCT completion among males and females in different ways, while self-perceived risk of HIV, prior knowledge of VCT, and sex with a high-risk partner emerged as important predictors of VCT completion among both sexes. Among males only, those infected with HIV for 5 years or less tended to self-select for VCT compared to HIV-negatives (adjusted odds ratio = 1.43; 95% CI: 0.99-2.14). This contributed to a higher proportion of HIV-positive males knowing their status compared to HIV-positive females.
  
  
  CONCLUSIONS
  In this setting, a disproportionate number of HIV-positive women are failing to learn their status, which has implications for equitable access to onward referral for care and treatment services. Evidence that some high-risk behaviours may prompt VCT use is encouraging, although further interventions are required to improve knowledge about HIV risk and the benefits of VCT. Targeted interventions are also needed to promote VCT uptake among married women and rural residents.
authors.affiliation: Department of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK. Alison.Wringe@lshtm.ac.uk
authors.forename: Alison
authors.initials: A
authors.lastname: Wringe
authors.forename: Raphael
authors.initials: R
authors.lastname: Isingo
authors.forename: Mark
authors.initials: M
authors.lastname: Urassa
authors.forename: Griter
authors.initials: G
authors.lastname: Maiseli
authors.forename: Rose
authors.initials: R
authors.lastname: Manyalla
authors.forename: John
authors.initials: J
authors.lastname: Changalucha
authors.forename: Julius
authors.initials: J
authors.lastname: Mngara
authors.forename: Samuel
authors.initials: S
authors.lastname: Kalluvya
authors.forename: Basia
authors.initials: B
authors.lastname: Zaba
mesh_terms: D000293:Adolescent; D000328:Adult; D035041:Anonymous Testing / Q000706:statistics & numerical data; D015331:Cohort Studies; D003376:Counseling / Q000706:statistics & numerical data*; D005260:Female; D015658:HIV Infections / Q000175:diagnosis / Q000453:epidemiology* / Q000523:psychology; D015438:Health Behavior; D006801:Humans; D008297:Male; D008875:Middle Aged; D010342:Patient Acceptance of Health Care / Q000523:psychology / Q000706:statistics & numerical data*; D012423:Rural Health; D012737:Sex Factors; D012959:Socioeconomic Factors; D013636:Tanzania / Q000453:epidemiology