London Sch of Hygiene and Trop Medicine

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Despite progress in delivering antiretroviral therapy (ART) in Africa, most HIV-infected persons remain undiagnosed, and many enroll in HIV clinics at an advanced stage of disease or do not regularly attend follow-up appointments. This can result in delayed initiation, or poor adherence to ART, which in turn increases mortality and the emergence of drug-resistant HIV strains.This research will enhance our understanding of how coverage with HIV services has evolved since ART became available. It will evaluate which HIV testing and treatment models encourage early access to HIV care, and investigate how long-life attendance at HIV clinics can be promoted. In particular, the research will explore the relationship between social support, family circumstances and partnership factors and access to HIV services. The research will be undertaken in rural Tanzania, where serological, demographic and behavioural surveillance has been conducted among 30,000 people since 1994, with anonymous links to HIV clinic data. This integrated system provides a unique opportunity to monitor socio-demographic inequities in HIV service coverage and gain insights into the programmatic and social factors that influence service use. The findings will lead to practical policy recommendations to encourage high levels of early, sustained and equitable access to HIV services.