title: Characteristics of HIV voluntary counseling and testing clients before and during care and treatment scale-up in Moshi, Tanzania.
abstract: OBJECTIVE
  We evaluated changes in characteristics of clients presenting for voluntary counseling and testing (VCT) before and during care and treatment center (CTC) scale-up activities in Moshi, Tanzania, between November 2003 and December 2007.
  
  
  METHODS
  Consecutive clients were surveyed after pretest counseling, and rapid HIV antibody testing was performed. Trend tests were used to assess changes in seroprevalence and client characteristics over time. Multivariable logistic regression models were used to estimate the contribution of changes in sociodemographic and behavioral risk characteristics, and symptoms, to changes in seroprevalence before and during CTC scale-up.
  
  
  RESULTS
  Data from 4391 first-time VCT clients were analyzed. HIV seroprevalence decreased from 26.2% to 18.9% after the availability of free antiretroviral therapy and expansion of CTCs beyond regional and referral hospitals. Seroprevalence decreased by 27 % for females (P = 0.0002) and 34% for males (P = 0.0125). Declines in seropositivity coincided with decreases in symptoms among males and females (P < 0.0001) and a more favorable distribution of sociodemographic risks among females (P = 0.002). No changes in behavioral risk characteristics were observed.
  
  
  CONCLUSIONS
  Concurrent with the scale-up of CTCs, HIV seroprevalence and rates of symptoms declined sharply at an established freestanding VCT site in Moshi, Tanzania. If more HIV-infected persons access VCT at sites where antiretrovirals are offered, freestanding VCT sites may become a less cost-effective means for HIV case finding.
authors.affiliation: Department of Medicine, Duke University Medical Center, Durham, NC 27710, USA.
authors.forename: Meghan M
authors.initials: MM
authors.lastname: Shorter
authors.forename: Jan
authors.initials: J
authors.lastname: Ostermann
authors.forename: John A
authors.initials: JA
authors.lastname: Crump
authors.forename: Alison C
authors.initials: AC
authors.lastname: Tribble
authors.forename: Dafrosa K
authors.initials: DK
authors.lastname: Itemba
authors.forename: Anna
authors.initials: A
authors.lastname: Mgonja
authors.forename: Antipas
authors.initials: A
authors.lastname: Mtalo
authors.forename: John A
authors.initials: JA
authors.lastname: Bartlett
authors.forename: John F
authors.initials: JF
authors.lastname: Shao
authors.forename: Werner
authors.initials: W
authors.lastname: Schimana
authors.forename: Nathan M
authors.initials: NM
authors.lastname: Thielman
mesh_terms: D015492:AIDS Serodiagnosis; D000328:Adult; D019380:Anti-HIV Agents / Q000627:therapeutic use; D003376:Counseling; D003906:Developing Countries; D005260:Female; D015658:HIV Infections / Q000175:diagnosis / Q000453:epidemiology* / Q000523:psychology*; D015528:HIV Seroprevalence; D006297:Health Services Accessibility; D006801:Humans; D008297:Male; D012309:Risk-Taking; D013636:Tanzania / Q000453:epidemiology
chemical_list: D019380:Anti-HIV Agents
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