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Title
Reaching men and young adults: Methods and outcomes of a 2.5 year comprehensive facility-and community-based HIV testing intervention in Bukoba Municipal Council, Tanzania, 2014-2017
Presenter
Omari Msumi
Authors
O. Msumi1, H.J. Cham2, D. Mackellar2, H. Maruyama1, O.E. Rwabiyago3, G. Kundi1, C. Steiner1, R. Weber4, J. Byrd5, E. Churi1, S. Pals2, C. Madevu-Matson6, K. Kazaura3, D. Mbilinyi7, F. Morales1, J. Justman6, A. Rwebembera8
Institutions
1ICAP at Columbia University, Dar es Salaam, Tanzania, United Republic of, 2Centers for Disease Control and Prevention, Atlanta, United States, 3Centers for Disease Control and Prevention, Dar es Salaam, Tanzania, United Republic of, 4Centers for Disease Control and Prevention, Yaounde, Cameroon, 5ICF International, Atlanta, United States, 6ICAP at Columbia University, New York, United States, 7United Nations Children's Fund, Dar es Salaam, Tanzania, United Republic of, 8National AIDS Control Program, MoHCDGEC, Dar es Salaam, Tanzania, United Republic of

Background: Few communities in sub-Saharan Africa have achieved the UNAIDS goal of diagnosing ≥90% of people with HIV, particularly for men and persons aged 15-24 years (young adults). To increase diagnostic coverage in Bukoba, Tanzania (population: ~150,000), the Bukoba Combination Prevention Evaluation (BCPE) implemented a community-wide, enhanced provider-initiated (PITC), home- (HBHTC) and venue-based (VBHTC) HIV testing and counseling (HTC) strategy. We report methods and outcomes of our three HTC models implemented from Oct 2014 through March 2017.
Description: For all models, HTC was recommended for persons who were not in HIV care or had not previously tested in the prior 90 days. PITC was implemented in outpatient clinics in all eight public and three ministry-supported private health facilities in Bukoba. In each clinic, one of two lay counselors routinely screened patients in waiting areas and referred them for testing conducted by one dedicated nurse. In all 14 urban and rural wards of Bukoba, five-six teams, each with four lay counselors and one nurse, offered HTC to persons encountered at 31,293 home visits and 79 HTC events at male- and youth-frequented clubs, workplaces, and other venues.
Lessons learned: Of 138,259 client encounters during which HTC was recommended, 133,695 tests were conducted (66% PITC, 21% HBHTC, 13% VBHTC), including 56,304 and 43,247 tests among men and young adults, respectively. Compared with other HTC models, PITC had proportionally more female testers (65%), VBHTC had proportionally more male (69%) and young-adult (42%) testers, and HBHTC had proportionally more children testers (22%) (Table). Of 5,550 (4.2%) clients who tested HIV-positive, 4,143 (3.1% of all tests) were newly diagnosed, including 1,583 (2.8%) men and 881 (2.0%) young adults. Yielding more new HIV diagnoses than HBHTC and VBHTC in all sex and age groups, PITC accounted for 79% of new diagnoses.
Conclusions/Next steps: BCPE HTC models are promising interventions to help achieve >90% diagnostic coverage for all persons with HIV, including men and young adults. In Tanzania, BCPE PITC was approved by the Ministry of Health as a new service delivery model in 2017 and is being adopted for national implementation in 2018 by three PEPFAR-supported HIV-prevention organizations.


 HIV Tests
(October 2014-March 2017)		New HIV Diagnoses
(October 2014-March 2017)
 All ModelsPITCHBHTCVBHTCAll ModelsPITCHBHTCVBHTC
Total133,69588,81327,40717,4754,1433,270499374
 n
(%)		n
(%)		n
(%)		n
(%)		n
(% of tests)		n
(% of tests)		n
(% of tests)		n
(% of tests)
Men56,304
(42)		31,329
(35)		12,917
(47)		12,058
(69)		1,583
(2.8)		1,182
(3.8)		203
(1.6)		198
(1.6)
Women77,391
(58)		57,484
(65)		14,490
(53)		5,417
(31)		2,560
(3.3)		2,088
(3.6)		296
(2.0)		176
(3.2)
<1519,204
(14)		12,785
(14)		6,146
(22)		273
(2)		137
(0.7)		119
(0.9)		16
(0.3)		2
(0.7)
15-2443,247
(32)		26,644
(30)		9,337
(34)		7,266
(42)		881
(2.0)		638
(2.4)		125
(1.3)		118
(1.6)
25-4963,435
(47)		44,122
(50)		10,257
(37)		9,056
(52)		2,824
(4.5)		2,257
(5.1)		329
(3.2)		238
(2.6)
>497,809
(6)		5,262
(6)		1,667
(6)		880
(5)		301
(3.9)		256
(4.9)		29
(1.7)		16
(1.8)
[HIV Tests and New HIV-Positive Diagnoses, Bukoba Combination Prevention Evaluation, Bukoba Municipal, Tanzania, Oct 2014-Mar 2017]

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