Differences between persons with and without disability in HIV prevalence, testing, treatment, and care cascade in Tanzania: a cross-sectional study using population-based data

BMC Public Health

Research

Sophie Mitra¹  Kofi Amekudzi²  Connie Osborne³  Olivia Keiser⁴  Janne Estill⁴  Minerva Rivas Velarde⁵  David Chipanta⁶  Silas Amo-Agyei⁷ 

[1] Fordham University, New York, USA;International Labour Organisation, Geneva, Switzerland;National HIV/AIDS/STI/TB Council, Lusaka, Zambia;University of Geneva, Geneva, Switzerland;University of Geneva, Geneva, Switzerland;Geneva School of Health Science, Geneva, Switzerland;University of Geneva, Geneva, Switzerland;Joint United Nations Programme on HIV/AIDS (UNAIDS), Geneva, Switzerland;University of Lausanne, Lausanne, Switzerland;

关键词: Persons with disability;    HIV testing, care cascade, UNAIDS 90-90-90 target;    95-95-95 target;    Leave no one behind;    Disability-inclusive-policies;   

DOI  :  10.1186/s12889-023-17013-8

 received in 2022-12-20, accepted in 2023-10-18,  发布年份 2023

来源: Springer

【 摘 要 】

BackgroundPersons with disability may have a higher HIV prevalence and be less likely than persons without disability to know their HIV-positive status, access antiretroviral therapy (ART), and suppress their HIV viral load (HIV care cascade). However, studies examining differences between persons with and without disability in HIV prevalence and the HIV care cascade are lacking. Using the Tanzania HIV Impact Survey (THIS) data collected between October 2016 and August 2017, we assessed differences in HIV prevalence and progress towards achieving the 2020 HIV care cascade target between persons with and without disability.MethodsUsing the Washington Group Short Set (WG-SS) Questions on Disability, we defined disability as having a functional difficulty in any of the six life domains (seeing, hearing, walking/climbing, remembering/ concentrating, self-care, and communicating). We classified respondents as disabled if they responded having either “Some Difficulty”, “A lot of difficulties” or “Unable to” in any of the WG-SS Questions. We presented the sample characteristics by disability status and analyzed the achievement of the cascade target by disability status, and sex. We used multivariable logistic regressions, and adjusted for age, sex, rural-urban residence, education, and wealth quintile.ResultsA total of 31,579 respondents aged 15 years and older had HIV test results. Of these 1,831 tested HIV-positive, corresponding to an estimated HIV prevalence of 4.9% (CI: 4.5 — 5.2%) among the adult population in Tanzania. The median age of respondents who tested HIV-positive was 32 years (with IQR of 21—45 years). HIV prevalence was higher (5.7%, 95% CI: 5.3—7.4%) among persons with disability than persons without disability (4.3%, 95% CI: 4.0 — 4.6%). Before adjustment, compared to women without disability, more women with disability were aware of their HIV-positive status (n = 101, 79.0%, 95% CI: 68.0—87.0% versus n = 703, 63.0%, 95% CI: 59.1—66.7%) and accessed ART more frequently (n = 98, 98.7%, 95% CI: 95.3—99.7% versus n = 661, 94.7%, 95% CI: 92.6—96.3%). After adjusting for socio-demographic characteristics, the odds of having HIV and of accessing ART did not differ between persons with and without disability. However, PLHIV with disability had higher odds of being aware of their HIV-positive status (aOR 1.69, 95% 1.05—2.71) than PLHIV without disability. Men living with HIV and with disability had lower odds (aOR = 0.23, 95% CI: 0.06—0.86) to suppress HIV viral loads than their counterparts without disability.ConclusionWe found no significant differences in the odds of having HIV and of accessing ART between persons with and without disability in Tanzania. While PLHIV and disability, were often aware of their HIV-positive status than their non-disabled counterparts, men living with HIV and with disability may have been disadvantaged in having suppressed HIV viral loads. These differences are correctable with disability-inclusive HIV programming. HIV surveys around the world should include questions on disability to measure potential differences in HIV prevalence and in attaining the 2025 HIV care cascade target between persons with and without disability.

【 授权许可】

CC BY   
© BioMed Central Ltd., part of Springer Nature 2023

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