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Linkage into care among newly diagnosed HIV-positive individuals tested through outreach and facility-based HIV testing models in Mbeya, Tanzania: a prospective mixed-method cohort study
  1. Erica Samson Sanga1,2,
  2. Wondwossen Lerebo2,3,
  3. Adiel K Mushi4,
  4. Petra Clowes1,5,
  5. Willyhelmina Olomi1,
  6. Leonard Maboko1,
  7. Christina Zarowsky2,6
  1. 1NIMR-Mbeya Medical Research Centre (MMRC), Mbeya, Tanzania
  2. 2School of Public Health, University of Western Cape, Cape Town, South Africa
  3. 3School of Public Health, Mekelle University, Mekelle, Ethiopia
  4. 4National Institute for Medical Research (NIMR), Dar es Salaam, Tanzania
  5. 5Division of Infectious Diseases and Tropical Medicine, Medical Centre of the University of Munich (LMU), Munich, Germany
  6. 6University of Montreal Hospital Research Centre and School of Public Health, Université de Montréal, Montreal, Quebec, Canada
  1. Correspondence to Erica Samson Sanga; esanga{at}


Objective Linkage to care is the bridge between HIV testing and HIV treatment, care and support. In Tanzania, mobile testing aims to address historically low testing rates. Linkage to care was reported at 14% in 2009 and 28% in 2014. The study compares linkage to care of HIV-positive individuals tested at mobile/outreach versus public health facility-based services within the first 6 months of HIV diagnosis.

Setting Rural communities in four districts of Mbeya Region, Tanzania.

Participants A total of 1012 newly diagnosed HIV-positive adults from 16 testing facilities were enrolled into a two-armed cohort and followed for 6 months between August 2014 and July 2015. 840 (83%) participants completed the study.

Main outcome measures We compared the ratios and time variance in linkage to care using the Kaplan-Meier estimator and Log rank tests. Cox proportional hazards regression models to evaluate factors associated with time variance in linkage.

Results At the end of 6 months, 78% of all respondents had linked into care, with differences across testing models. 84% (CI 81% to 87%, n=512) of individuals tested at facility-based site were linked to care compared to 69% (CI 65% to 74%, n=281) of individuals tested at mobile/outreach. The median time to linkage was 1 day (IQR: 1–7.5) for facility-based site and 6 days (IQR: 3–11) for mobile/outreach sites. Participants tested at facility-based site were 78% more likely to link than those tested at mobile/outreach when other variables were controlled (AHR=1.78; 95% CI 1.52 to 2.07). HIV status disclosure to family/relatives was significantly associated with linkage to care (AHR=2.64; 95% CI 2.05 to 3.39).

Conclusions Linkage to care after testing HIV positive in rural Tanzania has increased markedly since 2014, across testing models. Individuals tested at facility-based sites linked in significantly higher proportion and modestly sooner than mobile/outreach tested individuals. Mobile/outreach testing models bring HIV testing services closer to people. Strategies to improve linkage from mobile/outreach models are needed.

  • HIV
  • Linkage to care
  • Facility-based HIV testing
  • Mobile and outreach HIV testing
  • Mbeya-Tanzania

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  • Contributors ESS designed the study, collected and assembled the data, and participated in data analysis and interpretation. ESS, PC, and LM, drafted the article. CZ, AKM and WL were study supervisors and critically revised the article. ESS and WO analyzed and interpreted the data.

  • Funding Social Innovation in Public Health Impulse (SIPHI) fellowship through the University of Western Cape (PhD writing sabbatical); NIMR-Mbeya Medical Research Centre (7500$); African Doctoral Dissertation Research Fellowship (ADDRF) award 2014, offered by the African Population and Health Research Centre (APHRC) in partnership with the International Development Research Centre (IDRC) (2014 Award).

  • Disclaimer This manuscript is published with permission from Director General, National Institute for Medical Research.

  • Competing interests None declared.

  • Patient consent Obtained.

  • Ethics approval This study was approved by the Medical Research Coordinating Committee of the National Institute for Medical Research also was approved by the Senate Research Committee of the University of Western Cape.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data sharing statement Extra data can be accessed via the Dryad data repository at with the doi:10.5061/dryad.4g0vt

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