Provider-initiated testing and counselling reaches persons who may not otherwise test for HIV in Zanzibar, 2010-2011

Abstract

Introduction: In 2007 Zanzibar included provider-initiated testing and counselling (PITC) in their HIV testing and counselling programme to diagnose  new infections earlier and to increase access to persons who would not otherwise get tested. Our objective was to assess the uptake of PITC and the  proportion of HIV-positive tests through PITC in Zanzibar.

Methods: Our team examined 2010-2011 programmatic data to assess how many people were tested through PITC compared to other testing approaches. We also compared the rates of HIV positivity through PITC and non-PITC programmes to assess the relative yield of case detection.

Results: From 2010 to 2011, 6.1% of tests were recorded as PITC. PITC served relatively more females (7.6%), persons aged under 15 (24.8%) and over 35  (9.1%), and widowed (12.2%) and married (8.4%) persons, and reached relatively more persons on Pemba Island (12.2%) compared to Unguja Island  (5.0%). The rate of HIV seropositivity for PITC testers was 4.1%, nearly twice the rate of non-PITC testers (2.1%, p-value<0.05). The percentage of HIV- positive tests was significantly higher for PITC compared to non-PITC for all categories of testers except clients aged 15 to 24 years compared to other  age groups (1.5% vs. 1.0%, p=0.224) and clients who were widowed compared to other marital statuses (4.9% vs. 5.8%, p=0.106).

Conclusion: Despite  challenges, PITC reaches persons who may not otherwise test for HIV. PITC may remove barriers to HIV testing for some populations and therefore result  in earlier diagnosis of HIV.