Characteristics of HIV voluntary counseling and testing clients before and during care and treatment scale-up in Moshi, Tanzania.
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.
Shorter
Meghan M
MM
Department of Medicine, Duke University Medical Center, Durham, NC 27710, USA.
Ostermann
Jan
J
Crump
John A
JA
Tribble
Alison C
AC
Itemba
Dafrosa K
DK
Mgonja
Anna
A
Mtalo
Antipas
A
Bartlett
John A
JA
Shao
John F
JF
Schimana
Werner
W
Thielman
Nathan M
NM
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
D019380:Anti-HIV Agents
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