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Characteristics of HIV Voluntary Counseling and Testing Clients Before and During Care and Treatment Scale-Up in Moshi, Tanzania

Shorter, Meghan M MD*; Ostermann, Jan PhD†‡; Crump, John A MBChB*‡§‖; Tribble, Alison C MD*; Itemba, Dafrosa K BA; Mgonja, Anna; Mtalo, Antipas; Bartlett, John A MD*‡§‖; Shao, John F MD, PhD§‖; Schimana, Werner MD#; Thielman, Nathan M MD, MPH*‡

JAIDS Journal of Acquired Immune Deficiency Syndromes: December 2009 - Volume 52 - Issue 5 - p 648-654
doi: 10.1097/QAI.0b013e3181b31a6a
Epidemiology and Social Science

Objectives: 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.

From the *Department of Medicine, Duke University Medical Center, Durham, NC; †Center for Health Policy, Duke University, Durham, NC; ‡Duke Global Health Institute, Duke University, Durham, NC; §Kilimanjaro Christian Medical Centre, Moshi, Tanzania; ‖Kilimanjaro Christian Medical College, Tumaini University, Moshi, Tanzania; ¶KIWAKKUKI (Women against AIDS in Kilimanjaro), Moshi, Tanzania; and #Elizabeth Glaser Pediatric AIDS Foundation, Moshi, Tanzania.

Received for publication May 16, 2008; accepted May 6, 2009.

Supported by Roche Laboratories; National Institutes of Health: AIDS Clinical Trials Group (5U01 AI069484-02), International Studies of AIDS associated coinfections (U01 AI062563-04), (Drs. Bartlett, Crump, and Thielman), Mid-career Investigator (K24 AI-0744-01), and Center for AIDS Research (P30AI64518) (Dr. Bartlett); US Department of State Fulbright Program (Dr. Thielman); Hubert-Yeargan Center for Global Health, Duke University Medical Center (Drs. Tribble and Ms Mayhood).

Presented at 4th International AIDS Society (IAS) Conference on HIV Pathogenesis, Treatment, and Prevention, July 22-25, 2007, Sydney, Australia.

The authors report no conflict of interest.

Correspondence to: Nathan M. Thielman, MD, MPH, Box 90519, Room 109 Trent, Division of Infectious Disease and International Health, Duke Global Health Institute, Duke University Medical Center, Durham, NC 27710 (e-mail:

© 2009 Lippincott Williams & Wilkins, Inc.