Background: Like other countries, Tanzania instituted mobile and outreach testing approaches to address low HIV\ntesting rates at health facilities and enhance linkage to care. Available evidence from hard-to-reach rural settings of\nMbeya region, Tanzania suggests that clients testing HIV+ at facility-based sites are more likely to link to care, and\nto link sooner, than those testing at mobile sites. This paper (1) describes the populations accessing HIV testing at\nmobile/outreach and facility-based testing sites, and (2) compares processes and dynamics from testing to linkage to\ncare between these two testing models from the same study context.\nMethods: An explanatory sequential mixed-method study (a) reviewed records of all clients (n = 11,773) testing at 8\nmobile and 8 facility-based testing sites over 6 months; (b), reviewed guidelines; (c) observed HIV testing sites (n = 10)\nand Care and Treatment Centers (CTCs) (n = 8); (d) applied questionnaires at 0, 3 and 6 months to a cohort of 1012 HIV\nnewly-diagnosed clients from the 16 sites; and (e) conducted focus group discussions (n = 8) and in-depth qualitative\ninterviews with cohort members (n = 10) and health care providers (n = 20).\nResults: More clients tested at mobile/outreach than facility-based sites (56% vs 44% of 11,733, p < 0.001). Mobile\nsite clients were more likely to be younger and male (p < 0.001). More clients testing at facility sites were HIV positive\n(21.5% vs. 7.9% of 11,733, p < 0.001). All sites in both testing models adhered to national HIV testing and care guidelines.\nStaff at mobile sites showed more proactive efforts to support linkage to care, and clients report favouring the\nconfidentiality of mobile sites to avoid stigma. Clients who tested at mobile/outreach sites faced longer delays and\nwaiting times at treatment sites (CTCs).\nConclusions: Rural mobile/outreach HIV testing sites reach more people than facility based sites but they reach a\ndifferent clientele which is less likely to be HIV +ve and appears to be less â??linkage-readyâ?. Despite more proactive\ncare and confidentiality at mobile sites, linkage to care is worse than for clients who tested at facility-based sites. Our\nfindings highlight a combination of (a) patient-level factors, including stigma; and (b) well-established procedures and\nroutines for each step between testing and initiation of treatment in facility-based sites. Long waiting times at treatment\nsites are a further barrier that must be addressed.
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