Prevalence and predictors of failure to return for HIV-1 post-test counseling in the era of antiretroviral therapy in rural Kilimanjaro, Tanzania: challenges and opportunities

Abstract

In this era of antiretroviral therapy (ART) a limited number of population-based studies have investigated the extent of voluntary counseling and testing acceptance and completion in Africa. The aim of this study was to assess the prevalence and predictors of failure to return for HIV post-test counseling (PTC) among adults in rural Kilimanjaro, Tanzania. Following a cross-sectional survey, people aged 15–44 years living in Oria village were interviewed and offered individual HIV-1 pre-test counseling. They were asked to return for PTC two weeks after blood sample collection. HIV-1 testing was accepted by 1491 (97.6%) of participants with 98.9% expressing desire to know their results. The proportion of individuals who did not return for PTC was 50.9%. These proportions did not differ by sex. Seropositive HIV result (AOR: 2.2; 95%CI: 1.3–4.3 for women and AOR: 2.1, 95%CI: 1.2–5.7 for men), low HIV/AIDS-transmission and ART availability knowledge, perceived low risk of HIV infection, not accepting to share results (men only) and inability to self-prevent HIV infection (women only) predicted failure to return for PTC. Additionally, participants were more likely not to return for PTC if they had no-formal education or reported recent sexual-risk behaviors, for both sexes. Age, prior HIV testing or AIDS-related clinical symptoms were not associated with return for PTC in this population. These findings suggest that low returns for PTC, especially for HIV-seropositive individuals, result in a substantial missed opportunity for prevention and care. Knowledge of ART accessibility is necessary but not sufficient to promote adequate return for PTC. The high attendance for pre-test counseling should be utilized to identify potential individuals who may not return for PTC and to promote risk reduction and care.

Keywords:

• HIV infection
• post-test counseling
• antiretroviral therapy
• sexual risk behaviors
• rural Tanzania

Acknowledgements

The authors are grateful to the participants for their time. We would like to thank Hafsa Khalfan and James M. Juma for their work in coordinating delivery of results to the participants. This study was funded by a grant from the Norwegian Council for Higher Education's Programme for Development Research and Education and facilitated by the collaborating institutions: Muhimbili University College of Health Sciences, Kilimanjaro Christian Medical Centre, Centre for Education in Health Development Arusha in Tanzania, and the Universities of Oslo and Bergen, Norway. Additional financial support was provided through the Centre for Prevention of Global Infections (GLOBINF) at the University of Oslo.