Changes in HIV risk behavior and seroincidence among clients presenting for repeat HIV counseling and testing in Moshi, Tanzania

Abstract

While HIV counseling and testing (HCT) has been considered an HIV preventive measure in Africa, data are limited describing behavior changes following HCT. This study evaluated behavior changes and estimated HIV seroincidence rate among returning HCT clients. Repeat and one-time testing clients receiving HCT services in Moshi, Tanzania were identified. Information about sociodemographic characteristics, HIV-related behaviors and testing reasons were collected, along with HIV serostatus. Six thousand seven hundred and twenty-seven clients presented at least once for HCT; 1235 (18.4%) were HIV seropositive, median age was 29.7 years and 3712 (55.3%) were women. 1382 repeat and 4272 one-time testers were identified. Repeat testers were more likely to be male, older, married, or widowed, and testing because of unfaithful partner or new sexual partner. One-time testers were more likely to be students and testing due to illness. At second test, repeat testers were more likely to report that partners had received HIV testing, not have concurrent partners, not suspect partners have HIV, and have partners who did not have other partners. Clients who intended to change behaviors after the first test were more likely to report having changed behaviors by remaining abstinent (OR 2.58; p<0.0001) or using condoms (OR 2.00; p=0.006) at the second test. HIV seroincidence rate was 1.49 cases/100 person-years (PY). Clients presenting for repeat HCT reported some reduction of risky behavior and improved knowledge of sexual practices and HIV serostatus of their partners. Promoting behavior change through HCT should continue to be a focus of HIV prevention efforts in sub-Saharan Africa.

Keywords:

• Tanzania
• HIV
• behavior
• incidence
• diagnosis

Acknowledgements

This study was funded in part by Roche Laboratories and by an International Studies on AIDS Associated Co-infections (ISAAC) award, a United States National Institutes of Health (NIH) funded program (U01 AI062563). Authors received support from NIH awards ISAAC (NMT, JAC); AIDS International Training and Research Program D43 PA-03-018 (NMT, JAC); the Duke Clinical Trials Unit and Clinical Research Sites U01 AI069484 (SPF, NMT, JAC), the Duke Center for AIDS Research P30 AI 64518 (NMT, JAC); the Center for HIV/AIDS Vaccine Immunology U01 AI067854 (JAC); and the US Department of State Fulbright Program (NMT); and the Hubert-Yeargan Center for Global Health at Duke University (ACT). The authors thank the study participants and the staff and volunteers of the KIWAKKUKI AIDS Information Centre, especially the many HCT counselors Rose Mosille, Awaichi Malle, Caroline Sululu, Dayness Alexander, Alice Msuya, Rosalia Nyaky, Eunice Mmbando, Catherine Puka, Fudasia Kishe, Eliakesia Shangali, Praxed Moshi, Chrisanta Shayo, Anna Mchaki, and to laboratory technician Epimack Ndanu. We acknowledge the Hubert-Yeargan Center for Global Health at Duke University for critical infrastructure support for the Kilimanjaro Christian Medical Centre-Duke University Collaboration.

Notes

Presented in part: XVI International AIDS Conference, Toronto, Canada, August 13–18, 2006. Abstract WePe0382.

Additional information

Notes on contributors

John A. Crump

Suzanne P. Fiorillo and Keren Z. Landman contributed equally to this work