Who is getting access to antiretroviral therapy? Emerging socio-demographic inequities in treatment coverage in north Tanzania

As antiretroviral therapy (ART) is scaled up in sub-Saharan Africa, the World Health Organisation (WHO) has emphasized the need for developing indicators and systems to assess equity in access to HIV testing services and ART among HIV-infected persons in need of treatment.

In the north-west of Tanzania, a population-level HIV cohort study has been monitoring the dynamics of the HIV epidemic since 1994, through multiple, linked rounds of serological, demographic and behavioural surveillance, with a separate, temporary, village-based voluntary counselling and testing (VCT) service provided during the surveys since 2000. Following the introduction of the national HIV treatment programme in 2005, data from government-run health clinics providing VCT and ART services have also been anonymously linked to the cohort dataset, providing an opportunity to analyse trends in the level of access to VCT, and subsequent clinical care for those testing HIV-positive.

The results from these analyses will be presented in the seminar, showing how the socio-demographic patterns of access to VCT and ART among the cohort participants has evolved during the first three years of the national ART programme in Tanzania. The probability of accessing an ART clinic, following an HIV diagnosis, will be compared among users of different VCT services, to assess which HIV testing model is the most efficient gateway to treatment. Estimates of ART uptake, relative to estimated need for treatment, will also be presented by age, sex and area of residence, in order to highlight emerging inequalities in ART coverage in this setting.