title: Low rates of repeat HIV testing despite increased availability of antiretroviral therapy in rural Tanzania: findings from 2003-2010.
abstract: BACKGROUND
  HIV counselling and testing (HCT) services can play an important role in HIV prevention by encouraging safe sexual behaviours and linking HIV-infected clients to antiretroviral therapy (ART). However, regular repeat testing by high-risk HIV-negative individuals is important for timely initiation of ART as part of the 'treatment as prevention' approach.
  
  
  OBJECTIVE
  To investigate HCT use during a round of HIV serological surveillance in northwest Tanzania in 2010, and to explore rates of repeat testing between 2003 and 2010.
  
  
  METHODS
  HCT services were provided during the fourth, fifth and sixth rounds of serological surveillance in 2003-2004 (Sero-4), 2006-2007 (Sero-5) and 2010 (Sero-6). HCT services have also been available at a government-run health centre and at other clinics in the study area since 2005. Questionnaires administered during sero-surveys collected information on socio-demographic characteristics, sexual behaviour and reported previous use of HCT services.
  
  
  RESULTS
  The proportion of participants using HCT increased from 9.4% at Sero-4 to 16.6% at Sero-5 and 25.5% at Sero-6. Among participants attending all three sero-survey rounds (n = 2,010), the proportions using HCT twice or more were low, with 11.1% using the HCT service offered at sero-surveys twice or more, and 25.3% having tested twice or more if reported use of HCT outside of sero-surveys was taken into account. In multivariable analyses, individuals testing HIV-positive were less likely to repeat test than individuals testing HIV-negative (aOR 0.17, 95% CI 0.006-0.52).
  
  
  CONCLUSIONS
  Although HCT service use increased over time, it was disappointing that the proportions ever testing and ever repeat-testing were not even larger, considering the increasing availability of HCT and ART in the study area. There was some evidence that HIV-negative people with higher risk sexual behaviours were most likely to repeat test, which was encouraging in terms of the potential to pick-up those at greatest risk of HIV-infection.
authors.affiliation: Department of Population Health, London School of Hygiene and Tropical Medicine, London, United Kingdom. caoimhe.cawley@lshtm.ac.uk
authors.forename: Caoimhe
authors.initials: C
authors.lastname: Cawley
authors.forename: Alison
authors.initials: A
authors.lastname: Wringe
authors.forename: Raphael
authors.initials: R
authors.lastname: Isingo
authors.forename: Baltazar
authors.initials: B
authors.lastname: Mtenga
authors.forename: Benjamin
authors.initials: B
authors.lastname: Clark
authors.forename: Milly
authors.initials: M
authors.lastname: Marston
authors.forename: Jim
authors.initials: J
authors.lastname: Todd
authors.forename: Mark
authors.initials: M
authors.lastname: Urassa
authors.forename: Basia
authors.initials: B
authors.lastname: Zaba
mesh_terms: D003376:Counseling; D005260:Female; D015658:HIV Infections / Q000453:epidemiology* / Q000266:history / Q000517:prevention & control*; D049674:History, 21st Century; D006801:Humans; D008297:Male; D008403:Mass Screening; D016017:Odds Ratio; D062486:Public Health Surveillance; D012307:Risk Factors; D013636:Tanzania / Q000453:epidemiology