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Trends in VCT uptake in a rural ward in Tanzania

Trends in VCT uptake in a rural ward in Tanzania. Doris Mbata, Alison Wringe, Maria Roura, Raphael Isingo, Milalu Ndege, Basia Zaba and Mark Urassa. TAZAMA / NACP seminar Dar-es-Salaam, September 19 th 2008. Overview. Background Research questions Research methods Findings

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Trends in VCT uptake in a rural ward in Tanzania

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  1. Trends in VCT uptake in a rural ward in Tanzania Doris Mbata, Alison Wringe, Maria Roura, Raphael Isingo, Milalu Ndege, Basia Zaba and Mark Urassa. TAZAMA / NACP seminar Dar-es-Salaam, September 19th 2008

  2. Overview • Background • Research questions • Research methods • Findings • Policy implications • Future research priorities

  3. Background VCT Access to VCT should be fair and efficient TREATMENT PREVENTION High ART coverage High uptake of VCT Timely ART initiation

  4. Research questions What is the profile of people who are using VCT in relation to: socio-demographic traits, HIV status and risk behaviours? How has this profile evolved as ART has become more available? What are the social and cultural factors that underlie observed patterns of VCT uptake?

  5. Methods – surveys • Every 3 years, HIV serological and sexual behaviour surveys are conducted in Kisesa ward • Surveys are conducted in temporary village-based clinics. • VCT services were available on-site in the 2004 and 2007 surveys. • VCT attendance data can be linked to demographic and serosurvey data - including separate HIV testing conducted for research purposes, without disclosure of results.

  6. Methods - analysis Univariate and multivariate logistic regression was used to identify factors associated with VCT use: • socio-demographic factors (age, sex, residence, marital status, marital change, religion, ethnic group) • clinical factors (HIV status, spouse HIV status and VCT use, BMI decrease, STI symptoms) • behavioural factors (sex with high-risk partner, # partners past 12 months, condom use past 12 months, perceived HIV risk, VCT knowledge)

  7. Methods - qualitative Qualitative data were collected during before and after introduction of ART programme: 16 sex, residence and age-specific FGDs: perceived barriers to accessing VCT (and ART) 4 sex and residence-specific FGDs and 41 IDI with HIV-positive persons: actual experiences of using VCT (and ART access)

  8. Results: VCT uptake in 2004 31% (1246 ⁄ 3980) of men expressed an interest in VCT but only 12 % completed VCT 24% (1195 ⁄ 4990) of women expressed an interest in VCT but only 7% of women completed VCT

  9. VCT uptake: men Among men: VCT uptake was higher among those: • with recent marital status change => aOR = 1.48 • from non-Sukuma tribes => aOR = 1.77 VCT completion was negatively associated with: • having no education => aOR = 0.54 • following traditional beliefs => aOR = 0.54 (aOR = adjusted Odds Ratio, a measure of how likely they are to use VCT)

  10. VCT uptake: women Among women: VCT uptake was higher among • residents of roadside villages => aOR = 1.50 • muslims => aOR = 2.14 • never married => aOR = 4.98 • separated or divorced => aOR = 6.20 • Odds of VCT completion increased with each additional level of completed education (P < 0.01; test for trend).

  11. Results: behavioural The following factors were important predictors of VCT completion among men and women: • Self-perceived risk of HIV • Prior knowledge of VCT • Previous VCT use • Sex with a high-risk partner in past yr

  12. Results: spouse factors The strongest predictor of VCT use among both sexes was spouse HIV status and VCT use: * p<0.05; ** p<0.01

  13. Results: HIV status

  14. Results – VCT trends Repeat testing in 2007 was high: 1181 persons with previous VCT => 32% re-tested 8144 never-tested persons => 15% opted for 1st VCT By 2007, men and women ~ 50% more likely to test if HIV+

  15. Results: qualitative

  16. Results: qualitative

  17. Results: qualitative

  18. Results: qualitative

  19. Conclusions • The proportion ever tested at serosurveys has increased from 12% to X% among men and from 7% to Y% among women between 2004 and 2007. • Initial discrepancies between the sexes in terms of the % of HIV+ using VCT have closed => good news for equitable access to ART • Interventions need to increase knowledge about VCT and promote access among groups with lower rates of uptake • Couple-counselling should be promoted

  20. Future research Future analyses of VCT uptake in this setting: • Continue to monitor the profile of VCT users as ART becomes locally available. • Assess the impact of VCT on behaviour change and HIV incidence • Investigate differences in VCT uptake at the village, sub-village and household level • Look at the association between ART status of household members, HIV-related mortality in household and VCT use

  21. Doris to insert KISESA picture here THANK YOU

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