Strategic Assessment to Define a Comprehensive Response to HIV in Iringa, Tanzania Research Brief: Linkages to Care

The reasons behind this elevated HIV prevalence are not fully understood, and the response to HIV in Iringa has thus far been insufficient to match the need. The Iringa strategic assessment was designed to inform the development of comprehensive HIV prevention interventions that respond to key factors linked to HIV-related risk in Iringa, Tanzania. The strategic assessment synthesized existing data, conducted additional analyses of representative population-based data from the Tanzania HIV/AIDS and Malaria Indicator Survey, and conducted a large number of qualitative interviews and focus groups with key informants, service delivery providers and clients, and people at heightened risk of HIV in Iringa. Together, these findings provide a better understanding of the reasons behind the high HIV prevalence in the region and help to identify and tailor an appropriate set of interventions to address it. Linkages to Care (LTC) is the process of successfully connecting people living with HIV (PLHIV) to onward treatment and care services. In Iringa, it is estimated that only 68.6% of women (26.0% in the past year) and 52.7% of men (28.2% in the past year) have ever been tested for HIV and received their results. Thus, many individuals are unaware of their HIV serostatus and miss the opportunity for linkage to services that HIV testing and counseling (HTC) provides. The continuum of HIV testing & counseling, linkages to care, and treatment is a critical component of comprehensive HIV prevention and treatment. LTC has been holistically defined as an ongoing process through which an HIV-infected individual comes to assimilate their diagnosis, understand the implications of an HIV diagnosis for self and others, opt for appropriate care and services, and commit to a regimen that enhances one's own health and protects that of others. The conceptual framework in Figure 1 models the stages and links from HTC to ART retention and adherence. It builds on Rosen and Fox's (2011) pre-ART model and includes six stages: (1) HTC; (2) access to and linkage with care; (3) clinical staging; (4) pre-ART care; (5) ART initiation; and (6) ART retention and adherence. The framework was developed to help understand and interpret the data from this strategic assessment, plan for future LTC research in Iringa, and inform the design of a comprehensive HIV prevention and treatment approach for the region. The three stages of linkages to care are access to and linkage with care, clinical staging, and pre-ART care. An individual is considered successfully linked to HIV care and treatment if he/she tests positive for HIV infection and is referred to HIV care and treatment services. Clinical staging is possible once a newly diagnosed person living with HIV has been successfully linked to care. An individual has successfully completed this stage if he/she adheres to the CDC's recommendations of seeing a medical provider, receiving full medical evaluation, and having a CD4 cell count and/or HIV viral load test conducted. Pre-ART care is the stage at which PLHIV are eligible for treatment. PLHIV are eligible for the pre-ART stage if they have a CD4 cell count below 350 cells/mm3 or are experiencing symptoms of HIV-related illness. The pre-ART stage is critical in preparing PLHIV for ART initiation and ensuring that they receive the necessary care and support to maintain their health and prevent the progression of HIV disease. The Iringa strategic assessment brief on linkages to care provides a comprehensive understanding of the LTC process and identifies key areas for improvement. The findings from this brief will inform the development of a comprehensive HIV prevention and treatment approach for the Iringa region, which will aim to improve linkages to care and increase access to HIV care and treatment services for PLHIV in the region.