Social network strategy (SNS) for HIV testing: a new approach for identifying individuals with undiagnosed HIV infection in Tanzania.

Social network strategy (SNS) testing uses network connections to refer individuals at high risk to HIV testing services (HTS). In Tanzania, SNS testing is offered in communities and health facilities. In communities, SNS testing targets key and vulnerable populations (KVP), while in health facilities it complements index testing by reaching unelicited index contacts. Routine data were used to assess performance and trends over time in PEPFAR-supported sites between October 2021 and March 2023. Key indicators included SNS social contacts tested, and new HIV-positives individuals identified. Descriptive and statistical analysis were conducted. Univariable and multivariable analysis were applied, and variables with P-values <0.2 at univariable analysis were considered for multivariable analysis. Overall, 121,739 SNS contacts were tested, and 7731 (6.4%) previously undiagnosed individuals living with HIV were identified. Tested contacts and identified HIV-positives were mostly aged ≥15 years (>99.7%) and females (80.6% of tests, 79.4% of HIV-positives). Most SNS contacts were tested (78,363; 64.7%) and diagnosed (6376; 82.5%) in communities. SNS tests and HIV-positives grew 11.5 and 6.1-fold respectively, from October-December 2021 to January-March 2023, with majority of clients reached in communities vs. facilities (78,763 vs. 42,976). These results indicate that SNS testing is a promising HIV case-finding approach in Tanzania.

Correction: Impact of Age and Sex on CD4+ Cell Count Trajectories following Treatment Initiation: An Analysis of the Tanzanian HIV Treatment Database.

[This corrects the article DOI: 10.1371/journal.pone.0164148.].

Impact of Age and Sex on CD4+ Cell Count Trajectories following Treatment Initiation: An Analysis of the Tanzanian HIV Treatment Database.

OBJECTIVE: New guidelines recommend that all HIV-infected individuals initiate antiretroviral treatment (ART) immediately following diagnosis. This study describes how immune reconstitution varies by gender and age to help identify poorly reconstituting subgroups and inform targeted testing initiatives. DESIGN: Longitudinal data from the outpatient monitoring system of the National AIDS Control Program in Tanzania. METHODS: An asymptotic nonlinear mixed effects model was fit to post-treatment CD4+ cell count trajectories, allowing for fixed effects of age and sex, and an age by sex interaction. RESULTS: Across 220,544 clinic visits from 32,069 HIV-infected patients, age- and sex-specific average CD4+ cell count at ART initiation ranged from 83-136 cells/mm3, long term asymptotic CD4+ cell count ranged from 301-389 cells/mm3, and time to half of maximal CD4+ reconstitution ranged from 3.57-5.68 months. CD4+ cell count at ART initiation and asymptotic CD4+ cell count were 1.28 (95% CI: 1.18-1.40) and 1.25 (95% CI: 1.20-1.31) times higher, respectively, for females compared to males in the youngest age group (19-29 years). Older patients started treatment at higher CD4+ counts but experienced slower CD4+ recovery than younger adults. Treatment initiation at greater CD4+ cell counts was correlated with greater asymptotic CD4+ cell counts within all sex and age groups. CONCLUSION: Older adults should initiate care early in disease progression because total immune reconstitution potential and rate of reconstitution appears to decrease with age. Targeted HIV testing and care linkage remains crucial for patient populations who tend to initiate treatment at lower CD4+ cell counts, including males and younger adults.

Effectiveness of prevention of mother-to-child HIV transmission programmes in Kilimanjaro region, northern Tanzania.

OBJECTIVE: To monitor the effectiveness of the prevention of mother-to-child transmission (PMTCT) components in reducing mother-to-child transmission of HIV in Kilimanjaro region, Tanzania. METHODS: We conducted a retrospective registry-based cohort study of HIV-exposed children aged 4 weeks to 18 months. Eligible children had a DNA polymerase chain reaction HIV antigen test between January 2009 and August 2012. We collected and analysed the data on the PMTCT components provided. We used logistic regression to explore factors associated with successful PMTCT usage and with infant infection. RESULTS: We studied 561 children; 283 (50.5%) were from rural areas. Breastfeeding was reported by 519 (92.5%) of mothers. In 469 (83.6%) mother-baby pairs, both received chemoprophylaxis, whereas in 9 (1.6%) pairs, neither mother nor baby received any chemoprophylaxis. Of the 522 (93.0%) infants with known outcomes at 6 months, 227 (43.5%) were alive, 258 (49.4%) were lost to follow-up, 34 (6.5%) had transferred and 3 (0.6%) had died. A total of 54 (9.6%) children were infected. Transmission rates of HIV when only the mother (adjusted odds ratio [aOR] 1.49, 95% CI: 0.47-4.77) or only the baby (aOR 1.06, 95% CI: 0.23-5.01) received chemoprophylaxis were not significantly different from transmission rates when both mother and baby received antiretroviral chemoprophylaxis. Mixed feeding practices were not associated with significantly increased risk (aOR 4.09, 95% CI: 0.58-28.76) compared with exclusive breastfeeding. CONCLUSION: This study showed that rate of MTCT of HIV was 9.6% in Tanzania between 2009 and 2012. The intrapartum and child chemoprophylaxis components of the PMTCT programme were well implemented with 84% of both mothers and their babies getting full chemoprophylaxis, and effective in reducing mother-to-child transmission.