From HIV diagnosis to treatment: evaluation of a referral system to promote and monitor access to antiretroviral therapy in rural Tanzania

Nsigaye, Ray; Wringe, Alison; Roura, María; Kalluvya, Samuel; Urassa, Mark; Busza, Joanna; Żaba, Basia

doi:10.1186/1758-2652-2-6

Cited by 21 publications

(31 citation statements)

References 22 publications

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“…For residents in Kisesa, ART was initially only available via a referral from the local VCT clinics to the zonal referral hospital in Mwanza City, approximately 20 km away. Several qualitative studies identified the long journey time, waiting times at the clinic and a lack of familiarity with the city and intimidation at the very large health facility as barriers to attending the ART clinic at the hospital (Nsigaye et al. 2009; Roura et al.…”

Section: Discussionmentioning

confidence: 99%

The impact of antiretroviral therapy on adult mortality in rural Tanzania

Marston

Michael

Wringe

et al. 2012

Tropical Med Int Health

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ObjectiveTo describe the impact of antiretroviral therapy (ART) on mortality rates among adults participating in an HIV community cohort study in north-west Tanzania.MethodsSerological and demographic surveillance rounds have been undertaken in a population of approximately 30 000 people since 1994. Free HIV care including ART has been available since 2005. Event history analysis was used to compare mortality rates among HIV-negative and HIV-positive adults in the 5-year period before and after the introduction of ART. Crude and adjusted hazard ratios were calculated using exponential regression models. Interaction between time period and HIV status was assessed to investigate whether there was a non-linear relationship between these two variables.ResultsMale and female mortality patterns varied over the pre- and post-ART period. In women, the crude death rate fell for both HIV negatives and HIV positives hazard rate ratio (HRR = 0.71; 95%CI 0.51–0.99 and HRR = 0.68; 95%CI: 0.46–0.99, respectively). For men, the mortality among the HIV negatives increased (HRR = 1.47; 95%CI: 1.06–2.03) while the decline in mortality among the HIV positives (HRR = 0.77; 95%CI 0.52–1.13) was not statistically significant. The largest decrease in HIV-positive mortality over the two periods was among the 30- to 44-year-old age group for women and among the 45- to 59-year-old age group for men.ConclusionThere has been a modest effect on mortality in the study population following the introduction of free ART 5 years ago. Improving access to treatment and placing greater focus on retaining individuals on treatment are essential if the full potential of treatment for reducing HIV-related mortality is to be realised.

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Section: Discussionmentioning

confidence: 99%

The impact of antiretroviral therapy on adult mortality in rural Tanzania

Marston

Michael

Wringe

et al. 2012

Tropical Med Int Health

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“…The intervention was developed based on published evidence indicating that psychosocial factors are common barriers of linkage to HIV care in SSA 13, 14, 15, 16, 17, 18, 19, 20, 21, 22, 23, and that counselling can reduce the effects of these barriers 17, 24, 25, 26, 27, 28 and may increase linkage 6, 7, 9.…”

Section: Methodsmentioning

confidence: 99%

Brief counselling after home‐based HIV counselling and testing strongly increases linkage to care: a cluster‐randomized trial in Uganda

et al. 2017

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IntroductionThe aim of this study was to determine whether counselling provided subsequent to HIV testing and referral for care increases linkage to care among HIV‐positive persons identified through home‐based HIV counselling and testing (HBHCT) in Masaka, Uganda.MethodsThe study was an open‐label cluster‐randomized trial. 28 rural communities were randomly allocated (1:1) to intervention (HBHCT, referral and counselling at one and two months) or control (HBHCT and referral only). HIV‐positive care‐naïve adults (≥18 years) were enrolled. To conceal participants’ HIV status, one HIV‐negative person was recruited for every three HIV‐positive participants. Primary outcomes were linkage to care (clinic‐verified registration for care) status at six months, and time to linkage. Primary analyses were intention‐to‐treat using random effects logistic regression or Cox regression with shared frailty, as appropriate.ResultsThree hundred and two(intervention, n = 149; control, n = 153) HIV‐positive participants were enrolled. Except for travel time to the nearest HIV clinic, baseline participant characteristics were generally balanced between trial arms. Retention was similar across trial arms (92% overall). One hundred and twenty‐seven (42.1%) participants linked to care: 76 (51.0%) in the intervention arm versus 51 (33.3%) in the control arm [odds ratio = 2.18, 95% confidence interval (CI) = 1.26–3.78; p = 0.008)]. There was evidence of interaction between trial arm and follow‐up time (p = 0.009). The probability of linkage to care, did not differ between arms in the first two months of follow‐up, but was subsequently higher in the intervention arm versus the control arm [hazard ratio = 4.87, 95% CI = 1.79–13.27, p = 0.002].ConclusionsCounselling substantially increases linkage to care among HIV‐positive adults identified through HBHCT and may enhance efforts to increase antiretroviral therapy coverage in sub‐Saharan Africa.

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“…Those who were positive in 2006–2007 were referred directly to the hospital for HIV care and treatment. Bus fares and a community volunteer were provided to escort persons to the hospital if they wished (Nsigaye et al. 2009).…”

Section: Methodsmentioning

confidence: 99%

“…VCT is also the main entry point for HIV treatment and care services (De Cock et al. 2003; Nsigaye et al. 2009).…”

Section: Introductionmentioning

confidence: 99%

Trends in the uptake of voluntary counselling and testing for HIV in rural Tanzania in the context of the scale up of antiretroviral therapy

Isingo

Wringe

Todd

et al. 2012

Tropical Med Int Health

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ObjectivesTo describe trends in voluntary counselling and testing (VCT) use and to assess whether high-risk and infected individuals are receiving counselling and learning their HIV status in rural Tanzania.MethodsDuring two rounds of linked serological surveys (2003–2004 and 2006–2007) with anonymous HIV testing among adults, VCT was offered to all participants. The crude and adjusted odds ratios for completing VCT in each survey were calculated to compare uptake by demographic, behavioural and clinical characteristics, stratified by sex. Repeat testing patterns were also investigated.ResultsThe proportion of participants completing VCT increased from 10% in 2003–2004 to 17% in 2006–2007, and among HIV-infected persons from 14% to 25%. A higher proportion of men than women completed VCT in both rounds, but the difference declined over time. Socio-demographic and behavioural factors associated with VCT completion were similar across rounds, including higher adjusted odds of VCT with increasing numbers of sexual partners in the past 12 months. The proportion having ever-completed VCT reached 26% among 2006–2007 attendees, with repeat testing rates highest among those aged 35–44 years. Among 3923 participants attending both rounds, VCT completion in 2006–2007 was 17% among 3702 who were HIV negative in both rounds, 19% among 124 who were HIV infected in both rounds and 22% among 96 who seroconverted between rounds.ConclusionVCT services are attracting HIV-infected and high-risk individuals. However, 2 years after the introduction of antiretroviral therapy, the overall uptake remains low. Intensive mobilisation efforts are needed to achieve regular and universal VCT use.

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From HIV diagnosis to treatment: evaluation of a referral system to promote and monitor access to antiretroviral therapy in rural Tanzania

Abstract: The referral system reduced delays in seeking care, and enabled the monitoring of access to HIV treatment among diagnosed persons. Similar systems to monitor referral uptake and linkages between HIV services could be readily implemented in other settings.

Cited by 21 publications

References 22 publications

The impact of antiretroviral therapy on adult mortality in rural Tanzania

The impact of antiretroviral therapy on adult mortality in rural Tanzania

Brief counselling after home‐based HIV counselling and testing strongly increases linkage to care: a cluster‐randomized trial in Uganda

Trends in the uptake of voluntary counselling and testing for HIV in rural Tanzania in the context of the scale up of antiretroviral therapy

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