Access to, and uptake of, antiretroviral therapy among residents of a rural ward in northwest Tanzania during the first three years of the national HIV treatment programme.

Alison Wringe, London School of Hygiene and Tropical Medicine (LSHTM)
Ray Nsigaye, National Institute for Medical Research (NIMR)
Maria Roura, London School of Hygiene and Tropical Medicine (LSHTM)
Milalu Ndege, National Institute for Medical Research, Tanzania
Doris Mbata, National Institute for Medical Research (NIMR)
Milly Marston, London School of Hygiene and Tropical Medicine (LSHTM)
Benjamin D. Clark, London School of Hygiene and Tropical Medicine (LSHTM)
Joanna Busza, London School of Hygiene and Tropical Medicine (LSHTM)
Mark Urassa, National Institute for Medical Research, Tanzania

This study describes socio-demographic differentials in access to HIV services, including voluntary counselling and testing (VCT) and antiretroviral therapy (ART) among HIV-infected participants of a long-term open HIV cohort study in north-west Tanzania. Demographic, serological and sexual behaviour surveys have been conducted in Kisesa ward since 1994. VCT has been available in the ward since 2004, with referrals for free ART treatment since 2005. We used quantitative methods to estimate ART need, and to describe the uptake of VCT, referrals and ART after three years of access to the national programme. Qualitative methods were used to explore these findings. We show that socio-demographic patterns of access to HIV services are complex and rapidly evolving in this setting, with men and rural residents emerging as the most disadvantaged groups in relation to ART coverage. Various psychosocial and health systems factors explain differential use of HIV services in this setting.