Impact of a national HIV voluntary counselling and testing (VCT) campaign on VCT in a rural hospital in Tanzania

OBJECTIVE: To evaluate the impact of a national HIV voluntary counselling and testing (VCT) campaign on presentation to HIV care in a rural population in Tanzania. METHODS: Retrospective analysis of data of the VCT and of the National AIDS Control Programme registers of the St. Francis Designated District Hospital at Ifakara for the two 6-month periods before (2007) and after (2008) the National VCT Campaign. RESULTS: There were 4354 individuals presenting at St. Francis Hospital tested for HIV; 2065 (47.4%) before the VCT Campaign and 2289 (52.6%) afterwards. The overall HIV test positivity was 24.6% and higher in 2007 than in 2008 (26%vs. 23%, P = 0.034). This rate was much higher than the Tanzanian National HIV prevalence of 5.7%. Of 1069 individuals who tested HIV-positive, the proportion of married, divorced or widowed individuals and those who lived further than 10 km from the hospital increased from 2007 to 2008. In 356 HIV-infected persons with available data, the median CD4 cell count increased from 137 to 163 cells/mm(3) (P = 0.058), while the WHO clinical stage was similar in both periods. Enrolling into the National AIDS Control Programme was significantly more common in 2008 (42%vs. 30%, P < 0.001). In a multivariate analysis, the only positive predictor of testing HIV positive when presenting for care after the National VCT Campaign was being married (OR 1.61, 95%CI 1.21-2.15, P = 0.001) or divorced/widowed compared to single (OR 4.58, 95% CI 3.00-8.12, P < 0.001). CONCLUSIONS: Our results suggest that the National VCT Campaign raised awareness and readiness to test for HIV in a remote rural setting and that the HIV-positive test rate is much higher in conjunction with a specific HIV care programme.