title: Antiretroviral treatment coverage in a rural district in Tanzania--a modeling study using empirical data.
abstract: BACKGROUND
  The Tanzanian Government started scaling up its antiretroviral treatment (ART) program from referral, regional and district hospitals to primary health care facilities in October 2004. In 2010, most ART clinics were decentralized to primary health facilities. ART coverage, i.e. people living with HIV (PLHIV) on combination treatment as a proportion of those in need of treatment, provides the basis for evaluating the efficiency of ART programs at national and district level. We aimed to evaluate adult ART and pre-ART care coverage by age and sex at CD4 < 200, < 350 and all PLHIV in the Rufiji district of Tanzania from 2006 to 2010.
  
  
  METHODS
  The numbers of people on ART and pre-ART care were obtained from routinely aggregated, patient-level, cohort data from care and treatment centers in the district. We used ALPHA model to predict the number in need of pre-ART care and ART by age and sex at CD4 < 200 and < 350.
  
  
  RESULTS
  Adult ART coverage among PLHIV increased from 2.9% in 2006 to 17.6% in 2010. In 2010, coverage was 20% for women and 14.8% for men. ART coverage was 30.2% and 38.7% in 2010 with reference to CD4 criteria of 350 and 200 respectively. In 2010, ART coverage was 0 and 3.4% among young people aged 15-19 and 20-24 respectively. ART coverage among females aged 35-39 and 40-44 was 30.6 and 35% respectively in 2010. Adult pre-ART care coverage for PLHIV of CD4 < 350 increased from 5% in 2006 to 37.7% in 2010. The age-sex coverage patterns for pre-ART care were similar to ART coverage for both CD4 of 200 and 350 over the study period.
  
  
  CONCLUSIONS
  ART coverage in the Rufiji district is unevenly distributed and far from the universal coverage target of 80%, in particular among young men. The findings in 2010 are close to the most recent estimates of ART coverage in 2013. To strive for universal coverage, both the recruitment of new eligible individuals to pre-ART and ART and the successful retention of those already on ART in the program need to be prioritized.
authors.affiliation: Data Analysis Cluster, Ifakara Health Institute, Plot 463, Kiko Avenue, Mikocheni, P O Box 78378, Dar es salaam, Tanzania. flevira@ihi.or.tz.
authors.forename: Francis
authors.initials: F
authors.lastname: Levira
authors.affiliation: Department of Public Health Sciences/Global Health (IHCAR), Karolinska Institutet, Stockholm, Sweden. abela@lucme.se.
authors.forename: Abela Mpobela
authors.initials: AM
authors.lastname: Agnarson
authors.affiliation: Data Analysis Cluster, Ifakara Health Institute, Plot 463, Kiko Avenue, Mikocheni, P O Box 78378, Dar es salaam, Tanzania. hmasanja@ihi.or.tz.
authors.forename: Honorati
authors.initials: H
authors.lastname: Masanja
authors.affiliation: Department of Population Health, London School of Hygiene and Tropical Medicine, London, UK. basia.Zaba@lshtm.ac.uk.
authors.forename: Basia
authors.initials: B
authors.lastname: Zaba
authors.affiliation: Department of Public Health Sciences/Global Health (IHCAR), Karolinska Institutet, Stockholm, Sweden. anna.mia.ekstrom@ki.se.|Department of Infectious Diseases, Karolinska University Hospital, Stockholm, Sweden. anna.mia.ekstrom@ki.se.
authors.forename: Anna Mia
authors.initials: AM
authors.lastname: Ekström
authors.affiliation: Department of Public Health Sciences/Global Health (IHCAR), Karolinska Institutet, Stockholm, Sweden. anna.thorson@ki.se.|Department of Infectious Diseases, Karolinska University Hospital, Stockholm, Sweden. anna.thorson@ki.se.
authors.forename: Anna
authors.initials: A
authors.lastname: Thorson
mesh_terms: D000293:Adolescent; D000328:Adult; D044966:Anti-Retroviral Agents / Q000627:therapeutic use*; D016208:Databases, Factual; D036262:Empirical Research; D005260:Female; D015658:HIV Infections / Q000188:drug therapy*; D006268:Health Facilities; D006297:Health Services Accessibility; D006801:Humans; D008297:Male; D008875:Middle Aged; D011057:Politics; D012424:Rural Population; D013636:Tanzania; D055815:Young Adult
chemical_list: D044966:Anti-Retroviral Agents