Effective linkage from point of HIV testing to care and treatment in Tanga region, Tanzania

The research was conducted in five clinics with a high volume of clients in each of the three districts in Tanga Region. All adults aged 18 years and above at the time of CTC enrollment, between 2010 and 2014, were eligible to participate in the study. The study engaged both secondary and primary data. Mixed methods were applied in primary data collection, using a structured questionnaire, interviews with sampled CTC clients, focus group discussions with healthcare providers, and in-depth interviews with CTC clients. The qualitative data were analyzed using a thematic analysis framework, and the outcome of interest was whether a client enrolled in a CTC within three months of their first positive HIV test. A logistic regression model was used to determine factors associated with effective linkage of newly diagnosed HIV clients to CTC. A total of 16,041 adults from the three study districts were enrolled at a CTC from 2010 to 2014. The characteristics of the clients were representative of the larger group, with 72.4% being female, 52.1% married, and 59.6% having completed primary education. The median CD4 count at enrollment was 218 cells/mL, with more than half (56.3%) having CD4 counts of less than 350 cells per milliliter. Nearly all (91%) of the clients presented at a CTC within three months of receiving a positive HIV test. In a multivariate analysis, factors that remained significantly associated with early entry in CTC were level of education, CD4 count, and point of diagnosis. Participants' responses were consistent with many of the factors explained by participants to be barriers to effective linkages and referrals, such as stigma from relatives, which creates a delay in seeking treatment. The study found that despite a high rate of early entry in care and treatment services, there was a marked increase in those who waited more than three months to seek treatment. To meet the target, issues such as disclosure and stigma need to be addressed. The study highlights the importance of effective linkage systems across the HIV care continuum to ensure that individuals diagnosed with HIV are linked to and enrolled in HIV care and treatment programs in a timely manner. The study's findings have implications for future efforts to improve the client linkage and referral process to access HIV care and treatment. Systemic factors, such as inadequate training of healthcare providers, poor quality linkage or referral letters, and a lack of feedback between facilities, were identified as contributing to poorly functioning linkage systems. Client-level factors, including economic costs and preferences for certain facilities, also affected uptake to care and treatment. The study's mixed-methods approach provided an in-depth understanding of the factors influencing effective linkages to care and treatment services for PLHIV, both at the facility level and the client level.