Objective(s)

We evaluated changes in characteristics of clients presenting for Voluntary Counseling and Testing (VCT) before and during Care and Treatment Center (CTC) scale-up activities in Moshi, Tanzania between November 2003 and December 2007.

Methods

Consecutive clients were surveyed following pre-test counseling, and rapid HIV antibody testing was performed. Trend tests were used to assess changes in seroprevalence and client characteristics over time. Multivariate logistic regression models were used to estimate the contribution of changes in sociodemographic and behavioral risk characteristics, and symptoms, to changes in seroprevalence before and during CTC scale-up.

Results

Data from 4391 first-time VCT clients were analyzed. HIV seroprevalence decreased from 26.2% to 18.9% following the availability of free antiretroviral therapy and expansion of CTCs beyond regional and referral hospitals. Seroprevalence decreased by 27 % for females (p=0.0002) and 34% for males (p =0.0125). Declines in seropositivity coincided with decreases in symptoms among males and females (p<0.0001), and a more favorable distribution of sociodemographic risks among females (p=0.002). No changes in behavioral risk characteristics were observed.

Conclusions

Concurrent with the scale-up of CTCs, HIV seroprevalence and rates of symptoms declined sharply at an established free-standing VCT site in Moshi, Tanzania. If more HIV-infected persons access VCT at sites where antiretrovirals are offered, free-standing VCT sites may become a less cost-effective means for HIV case-finding.