uptake of hiv testing in male circumcision services: the case from tanzania scaling-up male...
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Uptake of HIV Testing in Male Circumcision Services: The Case from Tanzania
Scaling-up Male Circumcision Programmesin the Eastern and Southern Africa Region:
Country Update Meeting9 June 2010
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Uptake of HIV Testing – Selected Countries
Percent of Clients Tested for HIV
Number of Individuals Served
Notes
Botswana 80% 6180
Kenya 61% 120,000
Namibia 94% 350 Those that declined were young or tested elsewhere
Swaziland 88.4% 9309
Zambia 62%/80% 29,500 62% overall, 80% of 16 and above
Zimbabwe 98% 6,070 Most who opt-out are underage
Tanzania 98%/104% 4702 Guardians and partners are testing in large numbers, too.
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Circumcisions to May 30
156 156236
333 311 296
765 1034
1450
0
200
400
600
800
1000
1200
1400
1600
Sept Oct Nov Dec Jan Feb Mar Apr May
Total: 4745 Circumcisions in Pilot Sites to Date
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Circumcised, Testing, and Testing Positive
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Why is Testing Greater than Clients Load?
Lots of guardians and some partners testing Clients are being counseled and tested several
days before surgery in some cases – which means we are seeing testing numbers for clients to be circumcised in the next month.
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Why High Testing Uptake in Tanzania?
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Hypothesis #1Clients are Young, Not Afraid of Testing HIV+
Overall 0.6% of clients testing HIV+
72.8% of MC clients are 15 or older
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Iringa Service Statistics by Age
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Voices of Our Clients
“Since I was about to undergo MC for HIV prevention I thought it will be a good idea that I establish my sero-status first and move on from there.”
“I wanted to test because I have heard of people contracting HIV infection during surgical procedure. I did not want to blame anyone if I later on got infected.”
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Hypothesis #2 Testing is Offered as Opt-out
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Voices from Our Clients
“I was offered a chance to test but I was told that it was my decision to test or decline.”
“Health care provider asked me to consent for circumcision and if I was willing I could also test for HIV.”
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Hypothesis #3Counselors are Well Trained
Counselors are previously trained in VCT or PITC
Trained in 3-day classroom/5-day practicum MC Counseling curriculum
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Voices of Our Clients
“The clinic environment is so nice and you just feel comfortable there”
“At first I was nervous about testing for HIV but after talking to the counselor I made the decision to test.”
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Hypothesis #4Treatment is Available and in Same Center
In Iringa and Mbeya in particular, where there is high HIV prevalence, some of the stigma of testing HIV+ has lessened
Clients testing HIV+ counseled, still circumcised, referred to care and treatment service
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Voices from Our Clients
“Now we know that there is plenty of ARVs and if I am found HIV positive I will be able to get ARV before it is too late”
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Hypothesis #5National HIV Testing Campaign Prepped Clients
In 2007/8 National HIV Testing Campaign was implemented
President and Mama Kikwete Test For HIV14 July 2007
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Testing Campaign Results – 4.8 Million Tanzanians Tested for HIV
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Voices of Our Clients
“I remember President Kikwete’s testing campaign. A lot of people tested in that campaign.”
“Since that campaign I have tested 4 times including this one. The previous 3 times I tested along with my wife.
“Everybody was testing and that campaign made it a normal thing to test for HIV.”
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Challenges Going Forward
Prepping/testing enough clients to feed MOVE
Pairing testing with outreach/doing it outside the facility
Developing acceptable referral mechanisms from PITC and VCT
Securing test kits in environment of shortages
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“I feel that I killed two birds with a single shot. I got MC and I know my status.”
- Client, IRH