Cascade of care for HIV-seroconverters in rural Tanzania: a longitudinal study

ABSTRACT

We examined the HIV care cascade in a community-based cohort study in Kisesa, Magu, Tanzania. We analyzed the proportion achieving each stage of the cascade – Seroconversion, Awareness of HIV status, Enrollment in Care and Antiretroviral therapy (ART) initiation – and estimated the median and interquartile range for the time for progression to the next stage. Modified Poisson regression was used to estimate prevalence risk ratios for enrollment in care and initiation of ART. From 2006 to 2017, 175 HIV-seroconverters were identified. 140 (80%) knew their HIV status, of whom 97 (69.3%) were enrolled in HIV care, and 87 (49.7%) had initiated ART. Time from seroconversion to awareness of HIV status was 731.3 [475.5–1345.8] days. Time from awareness to enrollment was 7 [0–64] days, and from enrollment to ART initiation was 19 [3–248] days. There were no demographic differences in enrollment in care or ART initiation. Efforts have been focusing on shortening time from seroconversion to diagnosis, mostly by increasing the number of testing clinics available. We recommend increased systematic testing to reduce time from seroconversion to awareness of status, and by doing so speed up enrollment into care. Interventions that increase enrollment are likely to have the most impact in achieving UNAIDS targets.

KEYWORDS:

• HIV care continuum
• linkage to care
• testing
• ARV
• Tanzania

Acknowledgements

The authors thank the participants of the Kisesa cohort study and the study and HTC staff, without whom this analysis would not have been possible. S.C. contributed to conception, design, acquisition of data, analysis, interpretation of data and wrote the original manuscript. R.M. and B.M. contributed to design and acquisition of data and reviewed the manuscript. P.L. contributed to acquisition of data and reviewed the manuscript, W.S. contributed to the interpretation of data and reviewed the manuscript, J.B. conception, design, analysis, interpretation of data and reviewed the manuscript, J.A.D. and J.T. contributed to design and interpretation of data and wrote the original manuscript, M.U. and J.C. supervised the study, contributed to conception and interpretation of data and reviewed the manuscript. All authors have read and approved the submitted manuscript. Informed consent was obtained from all individual participants included in the study.

Disclosure statement

No potential conflict of interest was reported by the authors.

Data availability

The data that support the findings of this study are available from the corresponding author, S.C., upon reasonable request.

ORCID

Soledad Colombe http://orcid.org/0000-0003-0300-902X

Additional information

Funding

The Kisesa cohort study is funded by the Global Fund to Fight AIDS, Tuberculosis and Malaria. Kisesa CTC receives support from IeDEA (East Africa International Epidemiological Database to Evaluate AIDS) Grant (NIH) No. 5U01AI069911 (CFDA No. 93.855). Data management activities have been supported by a grant from the Wellcome Trust.