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

Abstract

Abstract Background Persons 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 testing, treatment, and care cascade, also known as the 90—90—90 and the 95—95—95 targets set to be achieved by 2020 and 2025, respectively). Methods 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 testing, treatment, and care cascade target between persons with and without disability. We presented the sample characteristics by disability status and analyzed the achievement of the cascade target by disability status, and sex. We used multivariate logistic regressions, and adjusted for age, sex, rural-urban-residence, education, wealth, and region. Results The sample comprised 1,831 people living with HIV (PLHIV) with a median age of 32 years (IQR 21—45). Approximately 11.8% (95% Confidence Interval [CI]: 10.2%—13.6%, n= 212) of PLHIV in Tanzania were disabled. HIV prevalence was higher (6.2%, 95% CI: 5.3%—7.4%) among persons with disability than persons without disability (4.7%, 95% CI: 4.4% — 5.1%); Women with disability were more 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%) than women without disability. After adjusting for socio-demographic characteristics, the odds of having HIV and of accessing ART were not statistically different between PLHIV 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 on ART with disability had lower odds (aOR = 0.23, 95% CI: 0.06—0.86) to suppress HIV viral loads than their counterparts without disability. Conclusion We found no differences in HIV prevalence and access to ART between persons with and without disability in Tanzania. Whereas PLHIV disability, women in particular, were advantaged in knowing their HIV-positive status, men on ART with disability may have been disadvantaged in having suppressed HIV viral loads. These differences are correctable by disability-inclusive HIV programming. HIV surveys in multiple countries sampling more persons with disability are required to measure differences in HIV prevalence better and in attaining the 2025 HIV testing and treatment cascade target for both persons with and without disability.