Scripties UMCG - Rijksuniversiteit Groningen
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High uptake but low rates of linkage to care following home-based integrated HIV voluntary counselling and testing services and non-communicable disease screening in Ifakara, Tanzania.

(2014) Simmelink, A.M. (Anne Marieke)

In Sub-Saharan Africa, non-communicable diseases (NCDs), like cardiovascular diseases, cancer, diabetes and chronic respiratory diseases, combine with the ongoing threat of communicable diseases, creating a double burden of disease. The current health care system is not equipped to meet needs for detection and treatment. Home-based screening could provide a way of expanding access to testing, but in order to be effective, screening has to be followed by adequate and timely linkage to care. We aimed to describe disease burden and levels and correlates of successful linkage to care and/or treatment after home-based screening for chronic diseases in a semi-urban setting in Tanzania, using referral standards as they are commonly practiced in the Tanzanian health system.
In the MZIMA open adult health community cohort in Ifakara Town, Tanzania, 8,428 participants received Voluntary Counselling & Testing for HIV and were screened on tuberculosis, diabetes, hypertension, cardiac disease and cervical cancer during a home-based screening program. Participants with a screening diagnosis were referred for care and/or treatment. Registration databases of the referral clinics were checked to evaluate linkage to care and to identify factors associated with successful linkage to care.
There was a high burden of HIV, hypertension and diabetes in the screened population and most diagnosed participants were previously unaware of their condition. Linkage to care in this setting was low, ranging from 0.0% for tuberculosis to 23.1% for HIV. Participants referred for HIV or TB were 4.5 times (95% CI= 2 to 8.5 times) more likely to link into care than those referred for other diseases. Women, people with jobs generating income, known patients and persons who had used health services at least once in the past year were more likely to link into care, though these associations were not statistically significant.
The high burden of diseases and high yield of new diagnoses emphasize the need to scale-up testing for HIV and NCDs by community-based programs to extend access to screening, care and treatment. The low rates of linkage to care illustrate the necessity to improve linkage to care for all screened diseases, through application of stimulating interventions, to take advantage of early disease detection. Factors that influence linkage to care must be further explored in order to design effective programs.

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