title: Who tests, who doesn't, and why? Uptake of mobile HIV counseling and testing in the Kilimanjaro Region of Tanzania.
abstract: BACKGROUND
  Optimally, expanded HIV testing programs should reduce barriers to testing while attracting new and high-risk testers. We assessed barriers to testing and HIV risk among clients participating in mobile voluntary counseling and testing (MVCT) campaigns in four rural villages in the Kilimanjaro Region of Tanzania.
  
  
  METHODS
  Between December 2007 and April 2008, 878 MVCT participants and 506 randomly selected community residents who did not access MVCT were surveyed. Gender-specific logistic regression models were used to describe differences in socioeconomic characteristics, HIV exposure risk, testing histories, HIV related stigma, and attitudes toward testing between MVCT participants and community residents who did not access MVCT. Gender-specific logistic regression models were used to describe differences in socioeconomic characteristics, HIV exposure risk, testing histories, HIV related stigma, and attitudes toward testing, between the two groups.
  
  
  RESULTS
  MVCT clients reported greater HIV exposure risk (OR 1.20 [1.04 to 1.38] for males; OR 1.11 [1.03 to 1.19] for females). Female MVCT clients were more likely to report low household expenditures (OR 1.47 [1.04 to 2.05]), male clients reported higher rates of unstable income sources (OR 1.99 [1.22 to 3.24]). First-time testers were more likely than non-testers to cite distance to testing sites as a reason for not having previously tested (OR 2.17 [1.05 to 4.48] for males; OR 5.95 [2.85 to 12.45] for females). HIV-related stigma, fears of testing or test disclosure, and not being able to leave work were strongly associated with non-participation in MVCT (ORs from 0.11 to 0.84).
  
  
  CONCLUSIONS
  MVCT attracted clients with increased exposure risk and fewer economic resources; HIV related stigma and testing-related fears remained barriers to testing. MVCT did not disproportionately attract either first-time or frequent repeat testers. Educational campaigns to reduce stigma and fears of testing could improve the effectiveness of MVCT in attracting new and high-risk populations.
authors.affiliation: Duke Global Health Institute, Duke University, Durham, North Carolina, United States of America.
authors.forename: Jan
authors.initials: J
authors.lastname: Ostermann
authors.forename: Elizabeth A
authors.initials: EA
authors.lastname: Reddy
authors.forename: Meghan M
authors.initials: MM
authors.lastname: Shorter
authors.forename: Charles
authors.initials: C
authors.lastname: Muiruri
authors.forename: Antipas
authors.initials: A
authors.lastname: Mtalo
authors.forename: Dafrosa K
authors.initials: DK
authors.lastname: Itemba
authors.forename: Bernard
authors.initials: B
authors.lastname: Njau
authors.forename: John A
authors.initials: JA
authors.lastname: Bartlett
authors.forename: John A
authors.initials: JA
authors.lastname: Crump
authors.forename: Nathan M
authors.initials: NM
authors.lastname: Thielman
mesh_terms: D003376:Counseling / Q000379:methods* / Q000706:statistics & numerical data; D005260:Female; D015658:HIV Infections / Q000523:psychology*; D006801:Humans; D008297:Male; D012737:Sex Factors; D013636:Tanzania