Effectiveness of provider-initiated versus client-initiated HIV testing by different health facility departments in Northern Tanzania

Abstract

Background HIV prevalence in Tanzania is still high at 4.7% among adults. Regular HIV testing is consistently advocated in the country to increase the level of awareness of HIV status, thus contributing to national HIV prevention. We report findings from three years of implementation of an HIV Test and Treat project utilizing provider-initiated and client-initiated testing and counselling (PITC and CITC). This study compared the effectiveness of PITC versus CITC in HIV case detection by the different departments of health facilities. Method This retrospective cross-sectional study used health facility-based HIV testing data collected from adults aged 18 years and above between June 2017 – July 2019 in the Shinyanga region, Tanzania. Chi-square and logistic regression analysis were used to assess determinants of yield (HIV positivity). Results A total of 24,802 HIV tests were performed of which 15,814 (63.8%) were by PITC and 8,987 (36.2%) by CITC. Overall HIV positivity was 5.7%, higher among CITC at 6.6% than PITC at 5.2%. TB and IPD departments had the highest HIV positivity 11.8% and 7.8% respectively. Factors associated with a positive test were testing at a department in the facility compared to CITC, first-time test, and being or having been married compared to being single. Conclusion Success in identifying HIV + patients was highest among people visiting the clinic for HIV testing (CITC) and first-time testers. With PITC, HIV + patient detection differed between departments, suggesting divergent risk profiles of respective clients and/or divergent HIV alertness of staff. This underscores the importance of increased targeting for PITC to identify HIV + patients.

Stability in care and risk of loss to follow‐up among clients receiving community health worker‐led differentiated HIV care: Results from a prospective cohort study in northern Tanzania

“…With an increased number of PLWH on ART resulting from the "Universal Test and Treat policy" (UTT) [3] and longer survival due to ART, there is a risk that facilities become overwhelmed and are unable to provide quality services [4]. Evidence on the effectiveness of innovative HIV service provision approaches such as differentiated HIV care models (DCM) is needed, especially in sub-Saharan African where evidence is still building [5][6][7][8]. DCM includes different care packages for clients based on their needs and expectations; these packages are tailor-made based on local needs and options, consisting of several building blocks (what, where, who, when; see Table A1) [6,7,9,10].…”