THE UNITED REPUBLIC OF TANZANIA MINISTRY OF HEALTH AND SOCIAL WELFARE TANZANIA MAINLAND National AIDS Control Programme Surveillance of HIV and Syphilis Infections Among Antenatal Clinic Attendees 2005/06 Report Number 3. November 2006 i Table of Contents Contents ......................................................................................................................... Page Table of Contents ................................................................................................................. i Abbreviations ...................................................................................................................... ii Acknowledgements ............................................................................................................ iii Report Distribution ............................................................................................................ iv Executive Summary .............................................................................................................v 1.0 Introduction ....................................................................................................................1 2.0 Methods..........................................................................................................................3 2.1 Site selection and study population................................................................................3 2.2 Training for the surveillance protocol ...........................................................................3 2.3 Field Supervision ...........................................................................................................4 2.4 Specimen collection and Transportation .......................................................................4 2.5 Syphilis testing and Treatment .......................................................................................4 2.6 HIV testing .....................................................................................................................4 2.7 Quality Assurance ..........................................................................................................5 2.8 Ethical Consideration ....................................................................................................5 2.9 Data Entry and Analysis ................................................................................................5 3.0 Results ............................................................................................................................6 3.1 HIV prevalence ..............................................................................................................6 3.2 Syphilis prevalence ......................................................................................................12 3.3 HIV/Syphilis co-infection .............................................................................................12 3.4 Discussion ...................................................................................................................12 4.0 Comparison between Data collected in the year 2001/02 and year 2003/04 ...............14 4.1 Introduction..................................................................................................................14 4.2 Comparisons between regions, clinics sites and time periods .....................................14 3.3 Disccussion ..................................................................................................................20 5.0 Estimating and projecting HIV prevalence in Tanzania .............................................21 5.1 Background ..................................................................................................................21 5.2 Methods ........................................................................................................................12 5.3 Results ..........................................................................................................................22 Tables .................................................................................................................................23 Annexes..............................................................................................................................53 2 Abbreviations AIDS Acquired Immune Deficiency Syndrome ANC Antenatal Care AMREF Africa Medical and Research Foundation BSS Behavioural Surveillance Survey CDC US Centers for Disease Control and Prevention COSTECH Commission of Science and Technology DBS Dried blood spots ELISA Enzyme Linked Immunosorbent Assay HIV Human Immunodeficiency Virus MOH Ministry of Health MUCHS Muhimbili University College of Health Sciences NACP National AIDS Control Programme NIMR National Institute for Medical Research QA Quality Assurance RPR Rapid Plasma Reagin STD Sexually transmitted diseases STI Sexually transmitted infections UNAIDS United Nations Programme on AIDS UNDP United Nations Development Programme VDRL Venereal Disease Research Laboratory WHO World Health Organisation 3 Acknowledgements The National AIDS Control Programme (NACP) Tanzania, wishes to acknowledge with sincere gratitude all those who contributed to the production of this document. Our thanks go to all health care providers at the regional, district and health care facility levels who have given so earnestly of their time and energy. Their contributions made this report possible. We acknowledge with special gratitude the financial contributions provided by the international partners towards production of this report. These include the United States Centres for Disease Control and Prevention (CDC), Joint United Nations Programme on AIDS (UNAIDS), World Health Organisation (WHO) and United Nations Development Programme (UNDP). We specifically wish to thank the CDC for their technical collaboration. The final report was compiled by: Dr. Rowland Swai Programme Manager, NACP Dr. Geoffrey Somi Head, Epidemiology, NACP Prof. Japhet Killewo Epidemiologist, Muhimbili University College of Health Sciences (MUCHS) Prof. Eligius Lyamuya Microbiologist/Immunologist, Muhimbili University College of Health Sciences (MUCHS) Prof. Mecky Matee Microbiologist/Immunologist, Muhimbili University College of Health Sciences (MUCHS) Dr. Gideon Kwesigabo Epidemiologist, Muhimbili University College of Health Sciences (MUCHS) Dr. T. S. K. Kabalimu Commission of Science and Technology Ms. Lucy Ng’ang’a CDC-Tanzania AIDS Programme, Tanzania Mr. Raphael Isingo Statistician, National Institue for Médical Research, Mwanza Centre Mr. Joel Ndayongeje Management Information System Officer, NACP Dr. Yohana Mapala Data Manager, NACP Ms. Thabita CDC 4 Report Distribution This report is distributed to all sectors, individuals and agencies concerned with the fight against HIV/AIDS/STD in Tanzania. The following are already on the Programme’s mailing list for regular distribution: Regional Medical Officers Medical Officers In Charge of Specialised Hospitals District Medical Officers Medical Officers In Charge of hospitals Regional AIDS Control Coordinators District AIDS Control Coordinators Departments of the Ministry of Health United Nations System U.S. Centres for Disease Control and Prevention Donor Assistance Committee Members of the Sectoral Technical AIDS Committees Members of the NACP committees and sub-committees Members of the National AIDS Committees National and medical libraries Sectoral Ministries Collaborating NGOs ANC surveillance reports are disseminated by various methods including distribution of manuals to stakeholders, oral presentations in conferences and workshops and publications in scientific journals. They are also available at www.nacptz.org, which is the website of the Tanzania NACP. Single hard copies may be requested from the address below: Programme Manager, National AIDS Control Programme, Ministry of Health, P. O. Box 11857, Tel. (255) 022 211 8581 Fax (255) 022 213 8282, 022 2121624 E-mail: nacp@nacptz.org , Dar es Salaam, Tanzania 5 EXECUTIVE SUMMARY Introduction This is a report of the findings from the antenatal care clinic-based HIV and syphilis sero-surveillance conducted in Mainland Tanzania from November 2005 to February 2006. The goal of this surveillance programme is to contribute to the fight against HIV/AIDS and STIs through provision of relevant data from antenatal clinics in Tanzania. Consequently, the objective of this annual survey was to determine HIV and syphilis sero-prevalence as well as trends among antenatal clinic attendees and examine factors associated with infection. There were 92 study sites located in 15 regions namely Arusha, Dar es Salaam, Dodoma, Iringa, Kagera, Kilimanjaro, Kigoma, Lindi, Mara, Mbeya, Morogoro, Mtwara, Shinyanga and Tanga. Participating regions in these zones were selected on the basis of prior participation in ANC surveillance activities, availability of HIV prevalence data and large population densities. Participating ANC clinics were selected on the basis of serving large catchment populations. A total of 31,224 women attending antenatal clinics for the first time for any pregnancy were enrolled for the surveillance from 92 clinics that had been selected form 15 regions of Tanzania Mainland. The clinics were instructed to enroll women for a three-month period from November 2005 to February 2005. For each region except Lindi and Morogoro where seven sites were selected, six ANC were selected, two from each of three strata (urban, peri-urban and rural), making a total of 92. After training of data collectors, blood specimens were drawn from the consenting women at the clinics for syphilis RPR screening. For HIV anonymous testing, left-over blood was applied on filter paper cards and left to dry at room temperature for 24 hours. Results Of the 31,224 women, 2,546 tested HIV positive resulting in an overall HIV prevalence of 8.2% (95% CI=7.9-8.5). Regional variations in prevalence ranged between 3.5% (95% CI = 2.6% - 4.5%) in Kigoma to 18.2% (95% CI = 16.3% 20.2%) in Iringa Age-specific HIV prevalence was highest in women aged 25-34 years (9.9%) compared to those aged 15-24 years (6.8%) and 35+ years (8.1%). Single women had higher prevalence than married women (8.9% vs 8.1%). Overall, women with secondary school education or more had the highest HIV prevalence (9.3%), while women with no education had the lowest prevalence (5.5%). Prevalence varied by location of the clinic. Women attending clinics located in urban areas had significantly higher HIV prevalence (9.9%) than those attending clinics located in rural areas (4.4%). HIV prevalence did not differ with duration of residence in any of the areas surveyed. 6 In addition to HIV testing, 30,877 women attending antenatal clinics for the first time for any pregnancy were screened for syphilis infection, and 2,126 were found to be positive for syphilis resulting in an overall syphilis sero-prevalence of 6.9% (95%CI=6.6-7.1). Regional prevalence varied between 0.43% (95% CI = 0.16% – 0.9%) for Kilimanjaro and 32.1% (95% CI = 29.0%-34.4%) for Tabora region. Agespecific syphilis prevalence was highest for women aged 35 years and older(7.4%) and the lowest for the age group 15-24 years(6.5%). Conclusion In general, there is a significant downward trend in HIV infection over the three survey rounds since 2001/02. As the study population continues tyo grow and testing strategies become improved, random variation in prevalence will tend to disappear and hence any observed change will represent the true situation in the general population. In order to increase the representativeness of the selected sites for the country future surveys should include clinic sites from regions not previously studied. For the group of pregnant women to continue representing the general population in the estimation of HIV prevalence trends, efforts should be made to continuously encourage women to attend antenatal clinics and enjoy the benefits of being screened for syphilis and getting treatment if found infected, and also get access to HIV counseling and testing as an entry point to prevention of mother to child HIV transmission programmes. 7 INTRODUCTION Formed in 1964, the United Republic of Tanzania is a union between the then Tanganyika and the islands of Zanzibar. The country is divided into twenty-six regions, 21 being on the mainland and five on the isles. Physically, Tanzania is the largest country in East Africa, occupying an approximate area of 945,087 km2, and sharing borders with eight neighbouring countries that include Kenya and Uganda to the north; Rwanda, Burundi and the Democratic Republic of Congo to the west, and Zambia, Malawi and Mozambique to the South. According to the 2002 population census, the total population of Tanzania was 34,569,232 with 23% living in urban and 77% living in rural areas. The Tanzanian population structure is pyramid-like, with a significant proportion of a relatively young population at the base, 46% being in the age group of 0-14 years. The life expectancy at birth is 49 years for males and 51 years for females with an annual population growth rate of 2.9%. The first AIDS cases in Tanzania were reported in the Kagera region in 1983. In the late 1980's sentinel surveillance activities in antenatal clinics (ANC) were initiated in the Kagera region. Subsequently, in the early 1990s, basing on the assumption that pregnant women attending ANC are representative of the sexually active general population, the National AIDS Control Programme (NACP) developed a protocol for ANC HIV and syphilis sero-surveillance, and expanded activities to 11 of the then 20 regions of mainland Tanzania. This protocol was implemented until 1999, when the NACP undertook a comprehensive review that resulted in improved methods for HIV and syphilis surveillance. The second protocol review was done in 2005. During 1999 - 2002, HIV and syphilis surveillance in ANC settings was strengthened through a number of sequential core activities. The first activity comprised analysis of the existing surveillance system to uncover strengths and weaknesses. This effort resulted in a report which was used by a multidisciplinary team in a national HIV/AIDS surveillance consensus workshop to develop the document titled, “Guidelines for Monitoring and Evaluation During Mid-Term Plan III, 2000-2002.” These guidelines describe principles used in HIV/AIDS and syphilis surveillance, discuss methods of behavioural surveillance among youth, and introduce criteria for monitoring and evaluating prevention programmes. Using these and other resources, the NACP revised the protocol for ANC surveillance and came up with new methods of conducting sentinel surveillance that included the introduction of a 3-month data collection period to replace the previous system of continuous data collection, the introduction of a technology of using dried blood spots (DBS) system of filter paper cards for blood storage and the standardization of HIV testing strategies and quality assurance systems. The goal of the surveillance programme is to contribute to the fight against HIV/AIDS and STIs through provision of relevant data from antenatal clinics in Tanzania, with an objective of determining HIV and syphilis sero-prevalence among antenatal clinic attendees and examine factors associated with infection. So far three rounds of surveillance of HIV and syphilis infections among ANC attendees have been conducted. 8 The first round was conducted in 2001/2002 at 24 ANC sites in six regions of Tanzania. These regions were Dar es Salaam, Dodoma, Kagera, Kilimanjaro, Mbeya and Mtwara. The second round was conducted between October 2003 and January 2004 at 57 ANC sites located in ten regions of Tanzania. The four regions that were added to the list were Kigoma, Lindi, Morogoro and Tanga. The third round, which is the basis for this report, was conducted between November 2005 and February 2006 at 92 ANC sites in fifteen regions of Tanzania. The five newly introduced regions were Arusha, Iringa, Shinyanga, Mara and Tabora. Similar to the previous serosurveillance rounds, clinics in selected regions were stratified into three categories of urban, peri-urban and rural to allow the output to be presented according to these strata. So far, three data points are available for the 24 sites that were surveyed since 2001/2002. These data points will be used to present HIV and syphilis prevalence trends. The information generated from these surveys is vital for determining the epidemiology of HIV and syphilis in Tanzania. Since the activity is planned to continue over a long time to come, information generated will be useful for describing transmission patterns, identifying and monitoring groups at greatest risk for HIV infection and allowing projections of HIV infections thereby assisting in setting priorities, designing interventions and evaluating the impact of prevention and care programmes. 9 METHODS The third round of a series of sero-surveys among pregnant women attending ANC clinics in mainland Tanzania was conducted between November 14, 2005 and February 10, 2006. These surveys were introduced in 2001 and are meant to continue over time in an attempt to monitor HIV and syphilis infection trends in the general population. 2.1 Site selection and study population . There were a total of 92 ANC from 15 regions that participated in this ANC survey. A total of 57 sites that were included in the l ast survey round also participated in this survey. The additional 35 sites were selected to participate in this survey based on the regional population size while the specific sites in a region were selected based on the records on number of women attending ANC for the first time during a particular pregnancy. Regions with higher population densities, based on 2002 population census, were more likely to be selected. Similarly, sites with a higher number of women attending ANC for the first time during a particular pregnancy were also more likely to be selected. The regions that were selected include, Arusha, Dar es Salaam, Dodoma, Iringa, Kagera, Kilimanjaro, Kigoma, Lindi, Mara, Mbeya, Morogoro, Mtwara, Shinyanga, Tabora and Tanga. The 92 ANC sentinel sites were categorized according to their geographical location. Urban sentinel sites were clinics located within the city and in the regional headquarter town while semi-urban sites are clinics located in towns other than the regional headquarter towns. These are towns situated along major roads, district headquarter towns or border towns. Rural sites are ANC clinics which are located in the remote areas where communities either farm or keep livestock and these ANCs are not usually housed in hospital settings but in rural health centres, rural dispensaries or are stand-alone clinic. The study population consisted of all the pregnant women attending the selected ANC for the first time during a particular pregnancy during the surveillance period of three months. 2.2 Training for the surveillance protocol In January 2005, a sentinel surveillance-training workshop was held in Dar es Salaam to train those who would participate in the collection of the surveillance data. Trainees with previous experience were trained for 2 days, while new trainees were trained for 3 days. The trainees included clinic nurses and laboratory personnel of selected ANC sites, as well as Regional AIDS Control Coordinators (RACCs) and Regional Laboratory Technologists from the participating regions. The training content of the workshop included the background and aim of sentinel surveillance, its implementation, instructions on how to fill the survey instruments, laboratory testing algorithm for both HIV and syphilis, phlebotomy techniques using the vacutainer system, and the preparation, storage and shipping of DBS before testing in the 10 laboratory. Role-playing among the trainees reinforced the sequence of steps from client encounter, to collection of demographic data, blood specimens and their testing. Laboratory technologists from the Mbeya Referral Hospital, Lindi Regional Hospital and the Muhimbili University College of Health Sciences (MUCHS), and surveillance staff from NACP facilitated the workshop using the Kiswahili language to encourage interaction among the participants, maximize understanding and to minimize problems of self-expression using English as a foreign language. Since there was a long duration between the initial training and the time the survey was implemented, one day refresher training was conducted at each site before initiation of the activity. 2.3 Supportive Supervision To ensure adequate supportive supervision and quality assurance of field activities, the NACP assembled a team of laboratory and surveillance staff to monitor ANC staff and to ensure that the surveillance protocol is adhered to, the DBS preparation and storage are properly carried out and that the relevant supplies are available at all sites. During the surveys, the supervisory teams visited each site according to a regular timetable and documented the supervisory activity by completing a monitoring checklist. The teams also reviewed the stored DBS and data collection forms to confirm that collected demographic information was duly filled and available for all the stored specimens. During the data collection process, supportive supervision for record-keeping, storage of DBS, and HIV testing was provided by laboratory experts to 3 zonal centres, including Mbeya Referral Hospital (MRH), Bugando Medical Centre (BMC) and Muhimbili University College of Health Sciences. 2.4 Data collection and specimen transportation Consecutive sampling was used to select women at an ANC whose blood was tested for HIV in the HIV sentinel sero-survey. The first eligible pregnant woman and each subsequent eligible pregnant woman attending the clinic during the survey thereafter were included in the survey until the end of the 3 month survey period. At booking, a woman was routinely given a clinic card number that was also recorded in the clinic register book. This same clinic card number was put on the top margin of the surveillance data collection form, on a corresponding vacutainer tube used for blood collection, and if necessary, on a laboratory request form. The woman was interviewed and the information was recorded on the surveillance data collection form. 11 After obtaining consent from the pregnant woman at the clinic, a blood sample was taken for Rapid Plasma Reagin (RPR) testing. Between 3–5 ml of blood was collected from the woman using an EDTA-containing vacutainer tube. Plasma was drawn from the tube for the RPR test. RPR test results were recorded directly on the woman’s clinic card and on the surveillance data collection form. The remaining blood specimen was then used to prepare DBS for HIV testing. Since all identifiers were removed from the specimens, consent was not needed. ANC staff applied 100l of the blood remnant to each of five circles on a DBS card that was labeled with the surveillance number and date of preparation. The DBS cards were left to dry at room temperature, over night. The same surveillance number was also written on the surveillance data collection form (Annex 3). At this point the upper part of the surveillance data collection form that contained the woman’s clinic card number was removed and destroyed (torn up and discarded) in order to ensure de-linking of the client identifier from the respective HIV data that would be documented on the surveillance data collection form. Dried DBS cards were stacked between weighing paper and stored in zip lockable plastic bags with desiccant (drying) packets and a humidity indicator card together with their completed data collection forms. Desiccant packs were changed when humidity indicator cards changed colour from white to pink. Samples were collected continuously for 3 months between November 14, 2005 and February 10, 2006 from all sites, and data were entered onto a carbonized duplicate data collection form labeled with the client’s unique surveillance number. Study variables included age, marital status, parity, educational level, distance from residence to ANC, and duration of stay at present residence (Annex 3). ANC staff mailed completed data collection forms and DBS for HIV testing using weekly courier service from their site to their designated zonal centre. BMC received samples from Kagera, Kigoma, Mara, Shinyanga and Tabora regions; MRH received samples from Iringa, Lindi, Mbeya, Morogoro and Tanga regions; and MUCHS received samples from Arusha, Dar es Salaam, Dodoma, Kilimanjaro and Mtwara regions. Upon receipt of the samples at the zonal centres, the surveillance numbers for each sample were recorded in a log book. NACP continuously monitored the volume of DBS received by zonal centres from each site and contacted sites posting unexpected numbers for reconciliation 2.5 Syphilis Testing and Treatment In all study sites RPR test was done on the site. In the majority of rural sites, ANC nurses performed the test whereas, in most of the urban and peri-urban sites it was carried out in a laboratory by laboratory staff. Results were recorded directly on the data collection form and on the woman’s clinic card or laboratory investigation request form. No TPPA or TPHA was done on the positive RPR samples for confirmation of syphilis serology test results or for quality control. This means that, the results of syphilis testing must be interpreted with caution since the high number of false positives will produce a higher prevalence than the true one. Nevertheless women whose RPR test results were positive were offered treatment based on the National STD Treatment Guidelines1. 1 Ministry of Health Tanzania, STD Training for Clinicians; User's Manual 1 2.6 HIV testing The National HIV Reference Laboratory (NHRL) at MUCHS collaborated with the Centers for Disease Control and Prevention (CDC) on developing a DBS HIV testing protocol and algorithm. HIV testing was conducted by technologists in 3 zonal centres who had previous experience of DBS HIV testing from the previous round of sentinel survey (2003/4). At the laboratory, dried blood was eluted from the DBS card and tested using Vironostika HIV Uni-Form II Ag/Ab ELISA test (Biomerieux, The Netherlands). Specimens with negative results underwent no further testing and were considered negative. Specimens which were reactive on the first ELISA underwent a second ELISA test, Vironostika HIV Uni-Form II Plus O (Biomerieux, The Netherlands). The ELISA algorithm was independently validated by CDC in Atlanta and by the NHRL at MUCHS. Specimens that were reactive on both ELISA tests were considered HIV antibody positive. Specimens that reacted negative on the second test were considered HIV antibody negative. 2.7 Quality Assurance DBS testing laboratories randomly selected ten per cent of all samples for quality assurance (QA) testing at the AMREF laboratory in Dar es Salaam, which was designated for the activity. Every 10th sample starting from number 01 at each site was selected. 2.8 Ethical Considerations The Ministry of Health awarded ethical clearance to the National HIV Surveillance protocol during the first round of data collection in 2001-2002. Because HIV test results were not linked by name and tests were performed on residual blood from routine syphilis screening, obtaining informed consent was not warranted. All information linking the sample to the client was removed and DBS HIV testing occurred anonymously. 2.9 Data Entry and Analysis Laboratory technologists entered HIV test results in laboratory log books and delivered them to NACP for further processing. The laboratory log books had columns for surveillance number, date of specimen collection, data collection form number, test results for first ELISA, test result for second ELISA and final HIV test result. NACP data entry clerks performed double entry of data into the Epi-Info Programme. The two files were validated and incorrect entries were corrected. Data were analysed by a team of researchers from NACP, MUCHS, NIMR, COSTECH and CDC, initially during a weeklong analysis meeting, followed by several rounds of consensus gathering and review. ANC HIV and syphilis prevalence rates were calculated according to age, marital status, parity, educational level, and distance to ANC and duration of stay in residence. Prevalence was calculated with 95% confidence intervals (CI) to guide interpretation. Data were analysed using the statistical software packages EpiInfo 2002 (database and statistics software for public health professionals, July 2002) and Stata for windows Version 8.0. 2 RESULTS 3.1 HIV prevalence A total of 31,224 antenatal clinic attendees were enrolled in the ANC serosurveillance study from 90 clinics located in 15 regions of Tanzania between November 14th 2005 and February 10th 2006. The number of enrolled women regionally ranged from 1,290 in Lindi to 3,512 in Dar es Salaam. A total of 2,546 women tested HIV positive resulting in an overall HIV prevalence in this population of 8.2% (95% CI = 7.9-8.5%). HIV infection prevalence ranged from a low of 3.5% (95% CI = 2.6-4.5%) in Kigoma region to a high of 18.2% (95% CI = 16.3-20.2) in Iringa region (Figure 1). HIV prevalence is also presented at the clinic level (Table 1). Socio-demographic variables associated with HIV prevalence are reported at reginal level and are shown in Tables 7 to 22. Of the 90 ANC sites surveyed in this round, 27 (30%) were found to have a prevalence of HIV infection of 10% or more. These high prevalence sites consisted of five urban clinics in Dar es Salaam city, two urban, two semi-urban and one rural clinics in Mbeya, two urban, one semi-urban and one rural clinics in Lindi, one urban clinic in Morogoro, one urban clinic in Tanga, one urban and one rural clinics in Mara, two urban clinics in Shinyanga, two urban, two semi-urban and one rural clinics in Iringa and two urban clinics in Tabora (Table 1). The HIV prevalence differed according to residence ranging between 4.4% for rural clinics, and 9.9% for urban clinics (p<0.001) (Figure 6). 20 18.2 18 15.9 16 HIV prevalence (%) 14 12 10.9 9.4 10 8 6.1 6 4.7 4 6.1 6.1 6.4 6.5 6.8 7.2 7.2 5.0 3.5 2 Iri ng a M be ya sa la am a Li nd i ar es D Region Ta bo r Sh in ya ng a M or og or o Ta ng a M ar a Ar us ha ar a M tw m an ja ro D od om a Ki li Ka ge ra Ki go m a 0 Fig 1: Prevalence of HIV infection among ANC attendees by region, Tanzania 2005/06 3 Table 1: Prevalence of HIV and syphilis infection by ANC sites, Tanzania 2005/06 Site Dar es salaam Buguruni Kasorobo Kigamboni Oysterbay Kimara Kiwalani Total HIV % prevalen Positive ce 95% CI Total Syphilis % prevalenc e Positive 95% CI 3512 954 396 571 600 433 558 383 116 40 66 61 41 59 10.9 12.2 10.1 11.6 10.2 9.5 10.6 9.9-11.9 10.2-14.4 7.3-13.5 9.1-14.5 7.9-12.9 6.9-12.6 8.1-13.4 3510 953 396 570 600 433 558 254 3 18 4 17 92 120 7.2 0.31 4.55 0.7 2.83 21.25 21.51 6.40 0.06 2.72 0.19 1.66 17.49 18.17 8.14 0.92 7.09 1.79 4.50 25.41 25.15 Dodoma Bahi Handali Kibaigwa Makole Mpwapwa Wajenzi 1885 268 209 276 478 215 439 115 5 3 23 46 12 26 6.1 1.9 1.4 8.3 9.6 5.6 5.9 5.4-7.7 0.6-4.2 0.3-4.1 5.4-12.2 7.1-12.6 2.9-9.5 4.2-9.1 1850 258 209 274 464 210 435 221 8 55 4 30 19 105 11.95 3.1 26.32 1.46 6.47 9.05 24.14 10.50 1.35 20.48 0.40 4.40 5.54 20.19 13.51 6.02 32.84 3.70 9.10 13.77 28.44 Kagera Bukoba Katoro Kimeya Nkwenda Nyamiaga Rwamisheny e 2070 515 263 266 495 237 97 30 10 14 14 7 4.7 5.8 3.8 5.3 2.8 3.0 3.8-5.7 4.0-8.2 1.8-6.9 2.9-8.6 1.6-4.7 1.2-6.0 2060 514 263 263 491 235 168 33 39 33 25 25 8.16 6.42 14.83 12.55 5.09 10.64 7.01 4.46 10.76 8.80 3.32 7.00 9.42 8.90 19.71 17.17 7.42 15.30 294 22 7.5 4.7-11.1 294 13 4.42 2.38 7.44 Kilimanjaro Hedaru Majengo Masama Umbwe Huruma Pasua 1426 306 330 164 109 169 348 71 22 23 5 5 5 11 5.0 7.2 7.0 3.0 4.6 3 3.2 3.9-6.2 4.6-10.7 4.5-10.2 1.0-7.0 1.5-10.3 1.0-6.8 1.6-5.6 1403 306 327 155 107 166 342 6 2 0 0 2 1 1 0.43 0.65 0 0 187 0.6 0.29 0.16 0.08 0.00 0.00 0.23 0.02 0.01 0.93 2.34 Mbeya Chimala Ilembo Kiwanjampa ka Kyela Igamba Ruanda 2464 266 177 391 58 9 15.9 21.8 5.1 14.4-17.4 17.0-27.3 2.3-9.4 2463 266 177 74 11 2 3.0 4.14 1.13 2.37 2.08 0.14 3.76 7.28 4.02 675 323 202 821 96 64 36 128 14.2 19.8 17.8 15.6 11.7-17.1 15.6-24.6 12.8-23.8 13.2-18.3 674 323 202 821 18 13 6 24 2.67 4.02 2.97 2.92 1.59 2.16 1.10 1.88 4.19 6.78 6.35 4.32 4 6.59 3.31 1.62 Site Total HIV % prevalen Positive ce 95% CI Total Positive Syphilis % prevalenc e 95% CI Mtwara Ligula Mangaka Nanyamba Tandahimba Likombe Mkunya 1319 339 335 130 186 150 179 81 27 18 3 11 14 8 6.1 8.0 5.4 2.3 5.9 8.0 4.5 4.9-7.6 5.3-11.4 3.2-8.4 0.5-6.5 3.0-10.3 5.2-15.2 1.9-8.6 1302 339 332 130 182 143 176 62 17 20 8 2 7 8 4.76 5.01 6.02 6.15 1.1 5.01 4.55 3.67 2.95 3.72 2.69 0.13 1.99 1.98 6.06 7.91 9.15 11.77 3.91 9.83 8.76 Kigoma Kibondo Kiganamo Kigoma Keza Nyakitonto Ujiji 1451 223 351 272 174 171 260 50 8 4 15 6 3 14 3.5 3.6 1.1 5.5 3.5 1.8 3.5 2.6-4.5 1.6-7.0 0.3-2.9 3.1-8.9 1.3-7.4 0.4-5.0 2.9-8.9 1426 210 351 270 173 168 254 38 5 1 0 30 2 0 2.66 2.8 0.28 0 17.34 1.19 0 1.89 0.78 0.01 0.00 12.02 0.14 0.00 3.64 5.47 1.58 Lindi Chumo Mtama Liwale Nachingwea Nyangao Sokoine Town clinic 1290 128 154 331 259 165 117 136 121 1 4 38 31 11 17 19 9.38 0.8 2.6 11.5 12.0 6.7 14.5 14.0 7.8-11.1 0.01-4.2 0.7-6.5 8.3-15.4 8.3-16.6 3.4-11.6 8.7-22.2 8.7-21.0 1261 123 154 327 256 162 109 130 62 2 10 9 9 16 10 6 4.92 1.63 6.49 2.75 3.52 9.88 9.17 4.62 3.79 0.20 3.16 1.27 1.62 5.75 4.49 1.71 6.26 5.75 11.62 5.16 6.57 15.54 16.23 9.78 Morogoro Hembeti Mkuyuni Morogoro St. Francis Turiani Gairo Uhuru 2751 90 178 728 418 157 647 533 197 4 1 57 34 6 33 62 7.2 4.4 0.6 7.8 8.1 3.8 5.1 11.6 6.2-8.2 1.2-11.0 0.01-3.1 6.0-10.0 5.7-11.2 1.4-8.1 3.5-7.1 9.0-14.7 2742 88 178 723 417 157 647 532 178 14 12 22 6 3 84 37 6.49 15.91 6.74 3.04 1.44 1.91 12.98 6.95 5.60 8.98 3.53 1.92 0.53 0.40 10.49 4.94 7.48 25.25 11.48 4.57 3.11 5.48 15.82 9.46 Tanga Handeni Kwamkono Lushoto Magoma Makorola Ngamiani 2270 475 187 335 159 658 456 147 22 6 23 1 47 48 6.5 4.6 3.2 6.9 0.6 7.1 10.5 5.5-7.6 2.9-6.9 1.2-6.8 4.4-10.1 0.01-3.5 5.3-9.4 7.9-13.7 2268 475 187 335 159 656 456 64 19 2 4 6 20 13 2.82 4 1.07 1.19 3.77 3.05 2.85 2.18 2.43 0.13 0.33 1.40 1.87 1.53 3.59 6.18 3.81 3.03 8.03 4.67 4.83 Arusha 3009 183 6.1 5.3-7.0 2955 15 0.51 0.28 0.84 5 23.82 4.23 Site Ngarenaro Total HIV % prevalen Positive ce 95% CI Total Syphilis % prevalenc e Positive 95% CI 1360 825 263 225 149 89 63 8 8 12 6.5 7.6 3.1 3.6 8.1 5.3-8.0 5.9-9.7 1.3-5.9 1.5-6.9 4.2-13.6 1326 825 253 218 149 2 5 7 1 0 0.15 0.61 2.77 0.46 0 0.02 0.20 1.12 0.01 0.00 0.54 1.41 5.62 2.53 -! 187 3 1.6 0.3-4.6 184 0 0 0.00 - Mara Nyasho Bweri Tarime Mugumu Murangi Utegi 1914 430 141 563 304 296 180 122 51 6 29 9 9 18 6.4 11.9 4.3 5.2 3.0 3.0 10.0 5.3-7.6 9.0-15.3 1.6-9.0 3.5-7.3 1.4-5.5 1.4-5.6 6.0-15.3 1860 423 141 563 260 293 180 96 26 3 26 3 20 23 5.16 4.62 2.13 4.62 1.15 6.83 12.78 4.20 4.05 0.44 3.04 0.24 4.22 8.28 6.27 8.88 6.09 6.69 3.33 10.35 18.55 Shinyanga Shinyanga Kambarage Ushirombo Kahama Nkololo Nindo 2570 166 273 548 632 522 429 174 20 31 44 56 8 15 6.8 120 11.4 8.0 8.9 1.5 3.5 5.8-7.8 7.5-18.0 7.8-15.7 5.9-10.6 6.8-11.4 0.7-3.0 2.0-5.7 2544 162 267 546 622 520 427 213 7 13 23 38 102 30 8.37 4.32 4.87 4.21 6.11 19.62 7.03 7.33 1.75 2.62 2.69 4.36 16.29 4.79 9.52 8.70 8.18 6.25 8.29 23.29 9.88 Iringa Iringa Ngome Kasanga Mafinga Njombe Matamba 1610 492 201 110 352 357 98 293 90 31 19 69 76 8 18.2 18.9 15.4 17.3 19.6 21.3 8.2 16.3-20.2 15.0-22.0 10.7-21.2 10.7-25.7 15.6-24.1 17.2-25.9 3.6-15.4 1601 492 197 110 352 355 95 151 20 14 32 45 33 7 9.43 4.07 7.11 29.09 12.78 9.3 7.37 8.04 2.50 3.94 20.82 9.48 6.49 3.01 10.97 6.21 11.64 38.52 16.73 12.81 14.59 Tabora Town clinic Isevya Igunga Nzega Songambele Ilolanguru 1683 380 263 262 401 208 169 121 41 34 15 22 2 7 7.2 10.8 12.9 5.7 5.5 1.0 4.1 6.0-8.5 7.9-14.4 9.1-17.6 3.2-9.3 3.5-8.2 0.1-3.4 1.7-8.3 1632 379 235 254 392 204 168 524 157 124 70 21 77 75 32.11 41.42 52.77 27.56 5.36 37.75 44.64 29.85 36.42 46.17 22.16 3.35 31.07 36.98 34.43 46.57 59.29 33.49 8.07 44.78 52.50 31,224 2,546 8.2 7.9 – 8.5 30,87 7 2,126 6.9 6.6 7.2 Kaloleni Karatu Monduli Mbuguni Oldonyo Sambu All Regions 6 Fig 2: Prevalence of HIV and syphilis infections among ANC attendees by age group, Tanzania 2005/06 In all the 15 regions, HIV prevalence was highest among women aged 25 – 34 years (9.9%), followed by those aged 35 years and above (8.1), while the 15-24 years age group had the lowest prevalence (6.8%) Fig 3: Prevalence of HIV and syphilis infection among ANC attendees by marital status, Tanzania 2005/06 7 HIV prevalence among single women (8.9%) was higher than that of married women (8.1%) (p>0.07), However the difference was not statistically different (Figure 3). Fig 4: Prevalence of HIV and syphilis infection among ANC attendees by level of education, Tanzania 2005/06 HIV prevalence increased with level of education from 5.5% among women with no education to 8.6% among those with primary education and to 9.3% among those with secondary education or more. The difference in prevalence between those with no education and those with primary education was statistically significant. (p<0.001) (Figure 4). Fig 5: Prevalence of HIV and syphilis infections among ANC attendees by number of pregnancies, Tanzania 2005/06 8 The highest HIV prevalence (9.3%) was found in women having between 1 and 2 previous pregnancies while the lowest (5.4%) was found among those having more than five previous pregnancies. Fig 6: Prevalence of HIV and syphilis infections among ANC attendees by location of residence, Tanzania 2005/06 3.2 Syphilis prevalence A total of 30,877 ANC attendees were tested for syphilis during the study period of whom 2126 tested positive. The overall syphilis prevalence was therefore 6.9% (95% CI = 6.6-7.1), ranging from a low of 0.43% (95% CI = 0.16-0.9) in Kilimanjaro region to a high of 32.1% (95% CI = 29.0-34.4) in Tabora region. Selected sociodemographic variables associated with syphilis infection are reported by clinic, and are shown in Table 21. The prevalence of syphilis was highest among attendees from rural clinics 9.7%, than those from urban clinics 6.3% and lowest among semi-urban clinic attendees 5.9% (p < 0.001).). The age specific prevalence of syphilis were 6.5% for age group 15-24, 7.3% for age group 25-34 and 7.4% for age group 35-49. The observed differences in age-specific prevalence were not statistically significant (p > 0.05) (Figure 2). . Marital status did not appear to have a significant influence on the prevalence of syphilis (p > 0.05) (Figure 3). Prevalence increased with the number of previous pregnancies from 6.3% among those with no previous pregnancies to 9.4% among those with more than five previous pregnancies (p < 0.001) Figure 5. As in previous years, women with low education had a higher prevalence of syphilis than were women in the higher education levels (p<0.0001). Like for HIV infection, the prevalence of syphilis infection was higher among women residing within 5 Km from an ANC clinic than those residing more than 5 Km (p < 0.0001). Similarly, there was no association between syphilis infection and duration of stay at a particular residence (p > 0.05). 9 35 32.1 30 Syphilis prevalence (%) 25 20 15 12.0 10 6.5 4.8 5 2.7 0.4 4.9 7.2 8.2 8.4 9.4 5.2 3.0 2.8 0.5 Sh in ya ng a Iri ng a D od om a Ta bo ra ag er a K Li nd i M ar a M or og D ar or es o sa la am a a tw ar M be y M K ili m an ja ro A ru sh a K ig om a Ta ng a 0 Region Fig 6: Prevalence of syphilis infection among ANC attendees by region, Tanzania 2005/06 3.3 HIV and syphilis co-infection Overall, 0.74% (228/30,877 ) of clinic attendees were co-infected with syphilis and HIV. The occurrence of syphilis was strongly associated with HIV infection (p < 0.0001). 3.4 Discussion The HIV prevalence in this surveillance round that covered 15 regions of Tanzania was 8.2%, with a range of 4.7% in the region with the lowest prevalence to 18.2% in the region with the highest. This prevalence compares well with that reported in the last round (8.7%) involving ten regions, implying that the addition of five new regions in this round did not significantly affect the overall prevalence of HIV infection. This is due to the fact that four of the five new regions had a prevalence of between 6.1% and 7.2%. The prevalence of HIV infection showed strong regional variations with Iringa (18.2%), Mbeya (15.9%) and Dar es Salaam (10.9%) being the most affected. Like in the previous two reports, Kagera region continued to record the lowest prevalence of HIV infection. More than a quarter (28.9%) of the 92 sites had a prevalence of more than 10%, with most of these sites (57.7%) being in the three regions with the highest HIV prevalence. Other important findings from these data include a higher HIV 10 prevalence in women living in urban areas, aged between 25-34 years, reporting higher education level, residing within 5 Km from a particular ANC and having between 1 and 2 previous pregnancies. The prevalence of HIV infection was not associated with either marital status or duration of stay in residence. The overall prevalence of syphilis was 6.7%, with a range of 0.43% in Kilimanjaro to 32.1% in Tabora region. Notable observations from the syphilis data include a higher syphilis prevalence in women from rural than urban clinics and with high number of previous pregnancies and no formal education. However, there was no association with age, marital status or duration of stay at a particular address. As in the previous rounds, HIV and syphilis co-infections occurred in less than 1% of ANC attendees. However, the occurrence of the two infections was very strongly associated (p< 0.0001). 11 Trends in HIV prevalence between 2001 and 2006 4.1 Introduction The aim of the surveillance program is to generate HIV infection prevalence trends so as to monitor the course of the epidemic in the general population using antenatal clinic attendees as a sentinel population. To that end the surveillance programme was intensified in 1999 after realizing that the surveillance system that began in 1990 was no longer providing the required data. The first round of the intensified survey was conducted by NACP in 2001/02, the second survey was conducted in 2003/04, and the third survey in 2005/06. Data from the three survey rounds have generated three data points, which serve as initial points for describing the HIV infection trends in future. Details of the methodology adopted in the three surveys are reported in Chapter 2 of this report as well as in the previous two ANC surveillance reports (2001 - 2002 and 2003/04). The first survey round involved 24 clinic sites in 6 regions; the second involved 57 sites in 10 regions; and the third survey involved 92 sites in 15 regions. The second and third survey rounds incorporated all the 24 sites that were surveyed in the first round, making it possible to relate data of the 24 clinics collected during the three time periods. The total population enrolled for the 1st, 2nd and 3rd surveys were 7,275, 17,813 and 31,224 ANC attendees respectively. The Sociodemographic composition of the study populations of the three survey rounds is shown in Table 2. Only data from these 24 sites was used in the analyses of HIV infection trends and any differences in prevalence estimates were assessed using the Chi Square test for trend. 4.2 HIV prevalence trends among ANC attendees of all ages during 2001 to 2006 4.2.1 Comparisons between regions, clinics and time periods. Prevalence estimates were made for every round of survey and included all women who were recruited into the survey for the respective years. This means that 24 sites were included in the first, 57 in the second and 92 in the third survey rounds. Overall these estimates suggested that there is a decline in HIV prevalence, from 9.6% (95% C.I= 8.9, 10.2) in 2001/02 to 8.7% (95% C.I=8.3, 9.1) in 2003/04 to 8.2% (95% C.I. = 7.9, 8.5) in 2005/06. This finding is statistically significant, with p=0.001.(See figure 8). 12 Table 2: Socio-demographic characteristics of the study populations of the three ANC Surveys Socio-demographic 2001/ 2002 characteristics Number Percent Age group 15-24 3,924 53.9 25-34 2759 37.9 35+ 516 7.1 Previous pregnancies None 1,877 26.8 1 to 2 3,031 43.3 3 to 4 1,379 19.7 5 or more 714 10.2 Level of Education No formal 1150 15.9 Primary 5575 76.9 Secondary+ 528 7.2 Marital Status Single 969 13.3 Married 6,253 86.0 2003/2004 Number Percent 2005/2006 Number Percent 15,901 12,543 2,514 50.9 40.2 8.1 7.381 13,541 6,358 3,164 23.6 43.4 20.4 10.1 5,121 23,550 2,482 16.4 75.4 8.0 3,422 27,563 11.0 88.3 NB. Totals may not be constant in various demographic characteristics due to missing data 13 16 12 10 8 9.6 8.7 8.2 24 sites 57 sites 6 92 sites (%) HIV prevalence (%) 14 4 2 0 2001/02 2003/04 2005/06 Survey Year Fig 8: Trends of HIV Prevalence among ANC attendees of all ages (2001-2006) When the point estimates were calculated from the three rounds of surveys using only the 24 sites that had three data points, a similar trend was observed where the prevalence declined from 9.7% (95% C.I= 8.9, 10.2) in 2001/02, to 8.8% (95% C.I.= 8.1- 9.4) in 2003/02 and 8.9% (95% C.I. = 8.3- 9.5) in 2005/06. This downward trend in prevalence was statistically significant at p=0.0001. At the regional-level, there was no significant variation in HIV prevalence, between 2001 and 2006. However at the facility-level, 5 of the 6 regions each had one site that had a statistically significant difference in HIV prevalence between 2001 and 2006. Those sites were Buguruni (Dar es Salaam region), Kimeya (Kagera region), Hedaru (Kilimanjaro region), Kiwanjampuka (Mbeya) and Tandahimba (Mtwara). Of these sites, two are urban, two are semi-urban and one is rural (Table 3). 14 Table 3: Comparisons of HIV prevalence among ANC attendees by region during 2001/02, 2003/04 and 2005/06 surveys, Tanzania 2001/02 Region & Sites Total Dar es salaam Buguruni Kasorobo Kigamboni Oysterbay Positive 2003/04 Prevalence Total Positive Prevalence Total 2005/06 PrevaPositive lence pvalue 95% CI 1697 571 280 334 512 218 94 28 40 56 12.8 16.4 10 12 11 2201 884 450 389 478 236 107 43 36 50 10.7 12.1 9.6 9.3 10.5 2521 954 396 571 600 283 116 40 66 61 11.2 12.2 10.1 11.6 10.2 10.0- 12.5 10.2-14.4 7.3-13.5 9.1-14.5 7.9-12.9 0.11 0.02 0.96 0.42 0.91 Dodoma Bahi Handali Kibaigwa Makole 888 173 204 181 330 54 2 1 20 32 6.1 1.2 0.5 11 9.8 951 181 228 203 339 58 8 1 18 31 6.1 4.4 0.4 8.9 9.1 1231 268 209 276 478 77 5 3 23 46 6.3 1.9 1.4 8.3 9.6 4.6 -7.3 0.6-4.2 0.3-4.1 5.4-12.2 7.1-12.6 0.96 0.10 0.42 0.60 0.96 Kagera Bukoba Katoro Kimeya Nkwenda 1494 516 333 181 464 84 44 10 11 18 5.6 8.5 3 6.1 3.9 1348 410 245 241 452 54 39 6 2 7 4.0 9.5 2.4 0.8 1.5 1539 515 263 266 495 68 30 10 14 14 4.4 5.8 3.8 5.3 2.8 3.4- 5.6 4.0-8.2 1.8-6.9 2.9-8.6 1.6-4.7 0.10 0.08 0.67 0.00 0.09 965 294 424 133 114 61 16 32 3 10 6.3 5.5 7.6 2.3 8.8 915 221 323 268 103 47 5 22 17 3 5.1 2.3 6.8 6.3 2.9 909 306 330 164 109 55 22 23 5 5 6.1 7.2 7 3.1 4.6 4.5-7.8 4.6-10.7 4.5-10.2 1.0-7.0 1.5-10.3 0.521 0.04 0.91 0.1 0.14 1369 217 211 568 373 219 37 15 102 64 16 17.1 7.1 17.9 17.2 1486 249 188 726 323 241 38 15 137 51 16.2 15.3 8 18.9 15.8 1441 266 177 675 323 227 58 9 96 64 15.8 21.8 5.1 14.2 19.8 13.9-17.7 17.0-27.3 2.3-9.4 11.7-17.1 15.6-24.6 0.95 0.13 0.52 0.05 0.39 862 305 279 125 153 61 38 12 5 6 7.1 12.5 4.3 4 4 979 389 267 176 147 57 37 13 6 1 5.8 9.5 4.9 3.4 0.7 990 339 335 130 186 59 27 18 3 11 6.0 8.0 5.37 2.31 5.91 4.6- 7.6 5.3-11.4 3.2-8.4 0.5-6.5 3.0-10.3 0.48 0.15 0.82 0.73 0.04 Kilimanjaro Hedaru Majengo Masama Umbwe Mbeya Chimala Ilembo Kiwanjampaka Kyela Mtwara Ligula Mangaka Nanyama Tandahimba Overall, the HIV prevalence in 5 of the 6 regions was slightly higher in 2005/06, compared to 2003/04. One region, Mbeya, had HIV prevalence that was slightly lower in the third round compared to that in the second round i.e 15.8% in 2005/06 compared to 16.2% in 2003/04 . Fig 9 shows the trends in HIV Prevalence among the 6 regions. 15 18 16 12 Dar es salaam Dodoma 10 8 Kagera Kilimanjaro Mbeya Mtwara (%) Prevalence (%) 14 6 4 2 0 2001/02 2003/04 2005/06 Survey Year Fig 9: Trend in HIV Prevalence in 6 regions of Tanzania, 2001-2006 Trends at facility-level by region 24 22 20 18 16 14 12 10 8 6 4 2 0 Dar es salaam Buguruni Kasorobo Kigamboni Oysterbay (%) Prevalence (%) The following 6 charts illustrate the trends in HIV prevalence, for 24 sites that have participated in the 3 survey rounds, by region. 2001/02 2003/04 2005/06 Survey Year Fig 10: Trends in HIV prevalence in Dar es Salaam region, 2001-2006 In the Dar es Salaam region, there was less variation between the 4 sites, compared to the sites in the other 5 regions. All the sites in the Dar es Salaam region are categorized as urban sites. Figure 10 16 shows that, Buguruni has the highest prevalence and the biggest decline in HIV prevalence between 2001/02 and 2005/06, which is noted as statistically significant (p=0.02). The graph also shows that the overall HIV prevalence trend appears to follow a downward direction among the four sites, in the region. 16 12 Dodoma Bahi Handali Kibaigwa Makole 10 8 6 4 (%) Prevalence (%) 14 2 0 2001/02 2003/04 2005/06 Survey Year Fig 11: Trends in HIV Prevalence in Dodoma region, 2001-2006 Figure 11 shows that there is some variation in HIV prevalence among the sites in Dodoma region. Two rural sites have reported HIV prevalence below the regional HIV prevalence and two sites (one urban and one semi-urban) have reported HIV prevalence above the regional HIV prevalence. However no sites in the region reported any statistically significant change in HIV prevalence between 2001-2006. 16 12 Kilimanjaro Hedaru Majengo Masama Umbwe 10 8 6 4 (%) Prevalence (%) 14 2 0 2001/02 2003/04 2005/06 Survey Year 17 Fig 12: Trends in HIV Prevalence in Kilimanjaro region, 2001-2006 Kilimanjaro region shows had variation in HIV prevalence among the sites(see figure 12). Masama is the only site in the Kilimanjaro that had an increase in HIV prevalence between 2001/02 and 2003/04. However, it is the only site that had decrease in HIV prevalence between 2003/04 and 2005/06. Hedaru, a semi-urban site, had a statistically significant increase in HIV prevalence between 2001-2006 (p=0.04). 24 22 20 16 Mbeya Chimala Ilembo Kiwanjampaka Kyela 14 12 10 8 6 (%) Prevalence (%) 18 4 2 0 2001/02 2003/04 2005/06 Survey Year Fig 13: Trends in HIV prevalence in Mbeya region, 2001-2006 In the Mbeya region, Ilembo is the only site that had HIV prevalence among clinic attendees that is much lower than the other sites and the regional HIV prevalence (see figure 13). Yet it appears to have similar trend in HIV prevalence as that of Kiwanjampuka. Ilembo is a rural site and Kiwanjampuka is an urban site. 18 16 14 12 Prevalence (%) Mtwara Ligula Mangaka Nanyama Tandahimba 10 8 6 4 2 0 2001/02 2003/04 2005/06 Survey Year Fig 14: Trends in HIV prevalence in Mtwara region, 2001-2006 In the Mtwara region, there is also a significant variation between the 4 sites (see figure 14). In 2001/02 round, three sites had a very similar HIV prevalence, but all three sites had HIV prevalence less than the regional HIV prevalence. Two of the sites are semi-urban while one rural. Tandahimba had the largest increase in the HIV prevalence between 2003/04 and 2005/06, which was statistically significant (p=0.04). Ligula consistently reported an HIV prevalence that was greater than the regional HIV prevalence but declining with time. 16 12 Kagera 10 Bukoba (%) Prevalence (%) 14 8 Katoro Kimeya 6 Nkwenda 4 2 0 2001-2 2003-4 2005-6 Survey Year Fig 15: Trends in HIV Prevalence in Kagera region, 2001-2006 In the Kagera region, all the sites reported lower HIV prevalence in 2005/6 as compared to 2001/02 round. Bukoba was the only site that had HIV prevalence that was consistently higher than the regional HIV prevalence. This is the only site categorized as urban which has high volume of clients. Three of the sites reported HIV prevalence that was slightly higher in 2005/06 as compared 19 to 2003/04. Kimeya, a rural site, was the only site that had statistically significant decrease in HIV prevalence (p=0.001) between 2001-2006. Site Dar es salaam Buguruni Kasorobo Kigamboni Oysterbay Kimara Kiwalani HIV 2005-2006 % Total Positive prevalence 95% CI 3512 383 10.9 954 116 12.2 396 40 10.1 571 66 11.6 600 61 10.2 433 41 9.5 558 59 10.6 Syphilis 2005-2006 % Total Positive prevalence 3510 254 7.2 953 3 0.31 396 18 4.55 570 4 0.7 600 17 2.83 433 92 21.25 558 120 21.51 Dodoma Bahi Handali Kibaigwa Makole Mpwapwa Wajenzi 1770 268 209 276 478 215 413 115 5 3 23 46 12 26 6.1 1.9 1.4 8.3 9.6 5.6 5.9 1850 258 209 274 464 210 435 221 11.95 8 of study3.1 Year 55 26.32 4 1.46 30 6.47 19 9.05 105 24.14 Kagera Bukoba Katoro Kimeya Nkwenda Nyamiaga Rwamishenye 2070 515 263 266 495 237 294 97 30 10 14 14 7 22 4.7 5.8 3.8 5.3 2.8 3 7.5 2060 514 263 263 491 235 294 168 33 39 33 25 25 13 8.16 6.42 14.83 12.55 5.09 10.64 4.42 Kilimanjaro Hedaru 1426 306 71 22 5 7.2 1403 306 6 2 0.43 0.65 Fig 16: Comparison of HIV Prevalence among ANC attendees according to number of previous pregnancies between 2001 and 2006 Throughout the nation, there was a decline in HIV prevalence between 2001/2 and 2005/6, irrespective of the number of previous pregnancies. Generally, the highest magnitude is consistently observed between 1st and 4th pregnancy. This may be the women who are 25 years and above and are exposed to repeated risk of HIV exposure through unprotected sex 20 14 Prevalence (%) 12 Year of study 10 2001-2002 2003-2004 2005-2006 8 6 4 2 0 15-24 25-34 35+ Age group Fig 17: Comparisons of age groups specific HIV Prevalence among ANC attendees between 2001-2006 The age group 25-34 years was at the highest risk of infection for all the three round of survey. The age specific prevalence was stable for the first two rounds of survey and decreased for the last round of survey for the age group 15-24. A similar trend was observed for the age group 25-34 years. 4. 2 HIV prevalence trends among ANC attendees aged 15 - 24 years Due to wide range in prevalence estimates in various locations within a region, the median prevalence has been presented at a regional level in addition to site specific prevalence estimates. Since prevalence in the youngest age group (15 - 24 years) represents new infection and hence approximates incidence, median prevalence data presentation will concentrate on this age group, table 2. Fig 18 shows the median prevalence among ANC attendees aged 15-24 years in 6 regions. The highest median prevanlence over time in descending order is noted in Mbeya, Dar es Salaam and Kilimanjaro. Kagera was having the lowest prevalence between 2001 -2004 and replaced by Dodoma in 2005/06. No specific pattern by site is noted except in Kilimanjaro where there is a tendency of decreasing prevalence. All pattern however were not statistically significant p=0.1. 21 16.0 Median HIV prevalence % 14.0 12.0 10.0 8.0 6.0 4.0 2.0 0.0 2001/02 Mtwara Mbeya 2003/04 Year of survey Kilimanjaro Kagera 2005/06 Dodoma DSM Fig 18: Region specific trends of median HIV prevalence among ANC attendees aged 15-24 years; Tanzania 2001 - 2006 The urban population consistently had the highest median prevalence while the rural population had the lowest over time. A tendency for HIV infection to decrease in these two populations is noted over time. The Semi- urban population prevalence lies between the two without a specific pattern, implying that the Simi- urban population has chrematistic of the two population interms of risk of HIV infection. Figure 19 22 9.0 Median HIV prevalence % 8.0 7.0 6.0 5.0 4.0 3.0 2.0 1.0 0.0 2001/02 2003/04 2005/06 Year of survey Urban Rural Semi urban Fig 19: Trend of median HIV prevalence among ANC attendees aged 15-24 years by residence location; Tanzania 2001 - 2006 23 Table 4: Prevalence of HIV infection among ANC attendees aged 15-24 years by ANC sites and regions; Tanzania 2001/02 – 2005/06 Region/Site Dar es Slaam Buguruni Kigamboni MICO Kasorobo Oyesterbay Dar es Salaam median prevalence Dodoma Makole Bahi Handali Kibaigwa Dodoma median prevalence Kagera Bukoba Kimeya Nkwenda Katoro Kagera median prevalence Kilimanjaro Majengo Masama Umbwe Hedaru Kilimanjaro median prevalence Mbeya Kiwanja Mpaka Chimala Kyela Ilembo Mbeya median prevalence Mtwara Ligula Nanyamba Mangaka Tandahimba Mtwara median prevalence 2001/02 2003/04 2005/06 12.0 6.1 6.7 7.9 7.3 8.2 9.1 7.7 6.1 8.0 9.4 6.7 4.0 9.7 8.1 9.0 1.5 0.0 5.6 3.6 8.0 4.1 0.9 8.3 6.1 6.9 0.0 1.1 5.1 3.1 6.5 2.7 3.5 1.8 3.1 6.9 0.0 1.3 0.9 1.1 4.4 7.2 1.9 3.5 4.0 6.4 1.3 6.7 4.8 5.6 7.9 9.2 0.0 2.4 5.2 4.8 4.8 0.0 7.6 4.8 13.1 15.6 16.0 5.8 14.4 16.1 8.6 14.0 8.2 11.3 11.2 17.3 18.2 4.3 14.3 7.0 1.5 6.0 3.0 4.5 6.3 3.8 2.9 0.0 3.4 6.6 0.0 4.6 6.2 5.4 In order to obtain estimates of site specific HIV prevalence, crude prevalence’s were caluculated by site for the three time period. Table 4 shows prevalence estimated for the three points from the 24 participating site. Prevalence ranged from Zero percent in some parts of Dodoma to as high as 18.2 % in some parts of Mbeya. 24 Discussion Overall this analysis has revealed that there is a statistically significant (p=0.001) decline in HIV prevalence, from 9.6% (95% C.I= 8.9, 10.2) in 2001/2 to 8.7% (95% C.I=8.3, 9.1) in 2003/4 to 8.2% (95% C.I.= 7.9, 8.5) in 2005/6 in the 24 sites included surveyed consistently between 2001 to 2006. The analysis has also shown that there is no significant variation of HIV prevalence, between 20012006 at regional-level. The decline in prevalence noted in the trend analysis is therefore partly attributable to the significant changes in HIV prevalence that occurred during the period 2001-2006 in some of the facilities in the surveyed sites, including Buguruni (Dar es Salaam region), Kimeya (Kagera region), Hedaru (Kilimanjaro region), Kiwanjampuka (Mbeya) and Tandahimba (Mtwara). In addition the HIV prevalence in the 6 regions was lower during 2003/2004 compared to 2001/2002 Prevalence in the age group 15 - 24 years approximates new infection in the general population since individuals in this age group are just becoming sexually active and almost free from the disease as they enter this age group. The trend patterns in this age group are either stable or declining indicating that the rate of new infection is low. Desipe this general national overview however, some regions still show high rate of infection especially Mbeya region followed by Dar es Ssalaam and Kilimanjaro. Since the surveillance program currently does not cover the entire country there may be regions with higher prevalence prevalence estimates beyond those observed in the said 3 regions. Sinse surveillance is expanding to cover greater parts of the country this problem may be termed temporary. The surveillance program using ANC attendees reports the trend of the epidemic in the general population; specific studies are however required to illustrate the determinate of such trend. 25 ESTIMATING AND PROJECTING HIV PREVALENCE IN TANZANIA 5.1 Background The WHO, UNAIDS and its partners have developed an Estimations and Projections Package (EPP) for HIV/AIDS which was updated in 2005. This software is useful for making estimations and projections of HIV by organizing ANC prevalence data and preparing short-term projections for HIV infection. The EPP 2005 software uses ANC HIV surveillance data, which have been collected over time, fits an epidemic curve and generates estimates of HIV prevalence, number living with HIV and number of new HIV infections. The software allows for calibration of the inputted ANC surveillance data to match the overall prevalence as measured in large-scale population surveys. 5.2 Methods The survey data set from ANC clinics covering the period from 1985 to 2003/04 was combined with that from ANC clinics for 2005/2006. Following this combination, a new work set for the current estimates was created in the EPP 2005 software. Using this software a generalized epidemic state was selected and the national epidemic was defined as urban and rural sub-epidemics. The 2006 UN population estimates for adults aged 15 years and above was applied. This population was divided into urban and rural in the proportions of 77.4% for rural and 22.6% for urban areas. These rural and urban population proportions were produced by the 2002 national population census. The ANC surveillance sites were also categorized into urban and rural areas using standard national definitions of urban and rural areas. This process produced 48 urban and 53 rural antenatal clinic sites. With the combined data set it was possible to have data points from 1986 to 2006. These were then entered into the EPP 2005 urban and rural pages for the estimation. Each sub-epidemic was run independently by fitting the model to all data and on level fits. The t0, f0, r and phi were all not fixed to allow the engine to search for the best curve fit. The ANC HIV prevalence was calibrated using an average of 5.3% for rural and 10.9% for urban HIV prevalence. These averages were obtained from the 2003 Tanzania HIV Indicator Survey (THIS). 5.3 Results Urban National Rural Figure 20: Estimated trends in HIV prevalence for the period 1980-2010, Tanzania, 2003/04 26 Figure 20 depicts three HIV prevalence curves, the urban, national and rural prevalence curves representing estimates and projections for the period from 1980 to 2010. The urban HIV epidemic curve shows an increasing trend that reached its peak in 1993 and subsequently levels to a plateau. The rural curve shows a steeply increasing HIV prevalence trend until 1996 when it reached its peak that was subsequently followed by a gradually declining trend. The national HIV prevalence curve depicts a trend between the two urban and rural scenarios. The prevalence estimates shown in Table 5 complement the prevalence trends observed in Figure 20. The table also provides estimations of the number of people living with HIV and the number of new HIV infections each year. 27 Table 5: Estimated HIV infection for the period 1980 - 2010, Tanzania, 2005/06 National Year HIV prevalence Number HIV positive Urban Population 15 years and above 1980 0.0 0 12,346,938 1981 0.0 2,056 12,700,607 1982 0.0 4,465 1983 0.1 1984 HIV prevalence Number HIV positive Rural Population 15 years and above HIV prevalence 0 2,997,454 - 0.0 753 3,083,314 13,066,532 0.1 1,869 9,645 13,445,560 0.1 0.2 20,931 13,837,759 1985 0.3 45,341 1986 0.7 1987 Number HIV positive Population 15 years and above 0 9,349,484 0.0 1,303 9,617,293 3,172,148 0.0 2,596 9,894,384 4,562 3,264,157 0.1 5,084 10,181,403 0.3 11,029 3,359,345 0.1 9,902 10,478,414 14,242,595 0.8 26,176 3,457,550 0.2 19,165 10,785,045 96,457 14,660,257 1.7 59,707 3,558,733 0.3 36,749 11,101,523 1.3 195,083 15,091,567 3.4 125,734 3,662,895 0.6 69,349 11,428,672 1988 2.3 358,152 15,535,989 6.1 230,855 3,769,467 1.1 127,297 11,766,522 1989 3.6 576,817 15,992,189 9.1 353,627 3,877,351 1.8 223,190 12,114,838 1990 5.0 820,505 16,457,953 11.4 455,518 3,985,003 2.9 364,987 12,472,950 1991 6.3 1,063,172 16,930,477 12.7 519,126 4,090,880 4.2 544,046 12,839,597 1992 7.4 1,282,312 17,406,812 13.2 551,462 4,193,893 5.5 730,851 13,212,919 1993 8.1 1,455,825 17,884,367 13.2 564,963 4,293,625 6.6 890,862 13,590,742 1994 8.6 1,574,004 18,361,451 13.0 568,711 4,390,340 7.2 1,005,293 13,971,111 1995 8.7 1,642,664 18,837,695 12.7 568,217 4,484,899 7.5 1,074,446 14,352,796 1996 8.7 1,675,047 19,313,294 12.4 566,788 4,578,380 7.5 1,108,259 14,734,914 1997 8.5 1,684,416 19,787,874 12.1 566,402 4,671,643 7.4 1,118,014 15,116,232 1998 8.3 1,681,590 20,264,914 11.9 568,308 4,766,279 7.2 1,113,282 15,498,635 1999 8.1 1,674,800 20,748,445 11.8 573,238 4,863,716 6.9 1,101,562 15,884,729 2000 7.9 1,670,129 21,244,115 11.7 581,489 4,965,392 6.7 1,088,640 16,278,723 2001 7.7 1,671,714 21,753,869 11.7 592,888 5,071,440 6.5 1,078,827 16,682,429 2002 7.6 1,682,003 22,280,202 11.7 606,876 5,181,665 6.3 1,075,127 17,098,537 2003 7.5 1,702,064 22,824,243 11.8 622,650 5,295,196 6.2 1,079,414 17,529,047 2004 7.4 1,731,823 23,386,053 11.8 639,328 5,411,056 6.1 1,092,495 17,974,997 2005 7.4 1,770,383 23,965,353 11.9 656,180 5,528,945 6.0 1,114,203 18,436,409 2006 7.4 1,816,326 24,561,812 11.9 672,778 5,649,217 6.1 1,143,548 18,912,595 2007 7.4 1,867,918 25,175,048 11.9 688,962 5,772,255 6.1 1,178,956 19,402,793 2008 7.5 1,923,315 25,804,857 12.0 704,740 5,898,178 6.1 1,218,576 19,906,679 2009 7.5 1,980,796 26,451,275 12.0 720,215 6,026,920 6.2 1,260,581 20,424,355 2010 7.5 2,038,949 27,114,399 11.9 735,544 6,158,376 6.2 1,303,405 20,956,023 28 Surveillance of Transmitted HIV Drug Resistance among Women Attending Antenatal Clinics in Dar es Salaam, Tanzania Introduction It is widely acknowledged that just as is the case with other micro-organisms, exposure of HIV to antiretroviral drugs over time leads to emergence of HIV drug resistance (HIVDR). Indeed, evidence of HIVDR has been documented from studies done in developed countries where antiretroviral treatment (ART) has been in use for quite some time. HIVDR strains may be transmitted from one individual to another, posing a problem in ART in such individuals. In view of this, WHO recommends surveillance of transmitted HIVDR in resource-limited settings where ART access is being rapidly expanded. The recommended method is the so called threshold survey, in which up to 47 consecutively collected blood samples are tested for evidence of HIVDR. HIVDR prevalence is then classified as low (<5%), medium (5-15%), or high (>15%). The recommended target population is HIV-positive primagravid women under age 25 years attending antenatal clinics (ANC). The rationale of targeting this age group is that it is likely to have been “recently infected” and therefore information obtained would reflect recently transmitted HIV strains that have acquired drug resistance. The survey reported herein was conducted to assess transmitted HIVDR in Dar es Salaam where ART was first introduced in 1995 and about 11,000 patients currently receive it. Methods From 11/2005-2/2006, during the HIV ANC sentinel survey, dried blood spot (DBS) specimens were collected using remnant specimens from 47 eligible women who consecutively attended ANC for routine syphilis testing. Testing for HIVDR was done at the Centers for Disease Control and Prevention, Atlanta, GA using standard laboratory procedures. Results Among 3, 563 DBS specimens collected, 68 were from women meeting the eligibility criteria. Of these, 60 were confirmed HIV-1 positive. Forty nine of these (82%, 49/60) were positive by RT-PCR and 39 (80%, 39/49) of the RT-PCR positive samples had sequences which were used for resistance analysis. As shown in the Table 6, HIV subtypes identified from analysis of the 39 samples were A, C and D. Strains arising from recombination of different HIV subtypes (recombinants) were also identified. Table 6: HIV subtype distribution among ANC attendees in Dar es Salaam, Tanzania HIV Subtype A1 C D C/A1 CRF08/C D/CRF10 A1/D CRF15/A1 N (%) 10 (29.4) 12 (35.3) 4 (11.8) 2 (5.9) 2 (5.9) 2 (5.9) 1 (2.9) 1 (2.9) All the 39 specimens did not have drug resistance mutations-based on the WHO drug resistance surveillance mutation list. Conclusion: Results from this survey indicate that at the moment transmitted HIVDR is not a problem in Tanzania and its prevalence among recently infected pregnant women in Dar es Salaam is low (<5%). 29 Table 7a. HIV prevalence among ANC attendees, Dar es Salaam, Tanzania, 2001/02 - 2005/06 2001/2002 Characteristics No. Age group (yrs) 15-24 333 25-34 209 35-49 26 Not stated 3 Median age (yrs) 23 Marital status Single 108 Married 458 Other Not stated 5 Previous pregnancies 231 0 251 1-2 75 3-4 14 >5 Not stated Total number tested for HIV Total number HIV positive Overall HIV prevalence (%) per site HIV Preva lence (%) Buguruni (Urban) 2003/2004 No. HIV Prevalence (%) 2005/2006 No. HIV Preval ence (%) 2001-2002 No. HIV Preval ence (%) Kasorobo(Urban) 2005/2006 2003-2004 No. HIV Preva lence (%) No. HIV Prev alenc e (%) 2001-2002 No. HIV Prev alenc e (%) Kigamboni(Urban) 2005/2006 2003-2004 No. HIV Prev alenc e (%) No. HIV Prevalenc e (%) 12 23 19.2 0 513 320 36 15 23 8.2 19.1 8.3 6.7 541 366 46 1 24 9.4 16.4 10.9 0 164 97 18 1 23 6.7 15.5 11.1 0 272 136 40 2 22 7.7 14.7 5 0 202 172 21 1 24 4.0 16.3 19.0 0.0 179 125 25 5 24 6.1 19.2 20 9.1 232 129 26 2 23 9.1 9.3 11.5 0 297 233 38 3 24 6.7 17.6 13.2 0.0 13 17.2 114 769 7.9 12.7 12.7 9.2 146 301 10.3 9.3 68 328 13.2 9.5 96 224 15.6 11.2 3 0 14 0 22.2 8.6 20 50 40.0 11.2 0 9 373 5 2 5 563 1 16.4 11.9 0.0 0.0 63 217 0 55 896 1 2 3 33.3 10 18.7 26.7 21.4 341 396 114 16 17 6.2 15.4 17.5 12.5 17.6 315 492 129 15 3 7.9 14.2 14.7 13.3 0.0 3 179 75 23 150 133 103 59 5 7.3 7.5 12.5 15.3 0 151 154 61 21 2 7.3 13 8.2 0 0 194 254 92 29 2 8.8 12.6 14.1 13.8 0.0 0 7.3 16 13 107 169 98 22 6.5 10.1 14.3 13.6 117 138 55 24 6.8 12.3 20 16.7 571 884 954 280 450 396 334 389 571 93 107 116 28 43 40 40 36 66 10.1 16.4 12.1 12.2 10 9.6 12 9.3 11.6 30 Table 7a. HIV prevalence among ANC attendees, Dar es Salaam, Tanzania, 2001/02 - 2005/06 Oysterbay(Urban) Kimara(Urban) Kiwalani(Urban) Total Total Total 2005/2006 2001/2002 2003/2004 2005/2006 10.9 299 6.0 955 8.8 143 16.1 218 15.6 633 13 7.7 40 17.5 89 21 9.5 1 0.0 20 2001/2002 2003/2004 2005/2006 2003/2004 2005/2006 15-24 279 7.9 277 6.1 341 9.7 223 7.6 221 6.3 256 25-34 202 15.8 173 15.6 233 10.7 134 13.4 186 12.4 35-49 20 10 16 18.8 25 12.0 15 0 24 12.5 Not stated 11 9.1 12 25 1 0.0 12 0 2 50 Median age (yrs) 24 2003-2004 Age group (yrs) 24 24 23 24 23 24 8.2 1,901 7.6 18.8 177 3 103 5 15.6 5.7 146 8.2 5.3 64 9.4 1,408 194 9 15.0 13.9 11.1 9.6 451 12.9 11 10.6 0.0 14.3 23 Marital status Single 140 12.9 31 3.2 158 10.8 68 4.4 64 7.8 70 17.1 101 15.8 407 13.5 Married 366 10.1 446 11 440 10.0 314 10.2 368 9.8 363 11.6 457 9.4 1265 12.7 438 256 6 Other 4 25 1 0.0 4 25 5 20 Not stated 2 50 1 0.0 2 0.0 2 0 21 4.8 9 11.1 3,052 2 7 189 7.9 205 8.3 252 7.9 152 7.9 540 8.5 1,230 7.6 12.1 800 13.1 999 135 1 7.2 232 11.9 3-4 71 12.7 15.3 276 18.8 464 14.7 >5 20 25 81 18.5 125 9.6 79 15.2 1,642 522 110 8 12.4 13.6 13.6 0.0 Previous pregnancies 0 1-2 206 Not stated Total number tested for HIV Total number HIV positive Overall HIV prevalence (%) per site 41 11.7 14.6 280 56 12.1 10.7 163 38 9.2 10.5 160 196 62 9.4 8.7 9.7 202 299 107 10.4 18.7 251 85 5.4 13.1 6 0 11 9.1 6 0 14 21.4 17 5.9 19 10.5 20 15 1 0.0 25 16 1 0.0 10 20 1 0.0 512 478 600 384 433 433 558 1697 301 8 3512 56 50 61 35 41 54 59 218 325 383 11.0 10.5 10.2 9.1 9.5 12.5 10.6 12.8 10.8 10.9 31 Table 8a. HIV prevalence among ANC attendees, Dodoma, Tanzania, 2001/02 - 2005/06 Bahi (Rural) 2003-2004 2001-2002 Characteristics No. Agegroup (yrs) 15-24 68 25-34 77 35-48 22 Not stated 6 Median age (yrs) 27 Marital status Single 12 Married 159 Other Not stated 2 Previous pregnancies 1-2 44 2-3 56 3-4 39 >5 34 Not stated Total number tested for HIV 173 Total number HIV positive 2 Overall HIV prevalence (%) per site HIV Prevale nce (%) 1.5 1.3 0 0 No HIV Prevalen ce (%) 98 58 25 4.1 3.4 8 23 8.3 0.6 16 165 0 4.8 1.2 53 66 30 31 1 0 6.1 6.7 6.5 0 Handari (Rural) 2003-2004 2001-2002 No HIV Prevalen ce (%) No. HIV Prevale nce (%) 120 100 47 1 0 3 4.3 0 90 73 39 2 0 0 2.6 0 25 0 0 1.8 0 2.9 2005 - 2006 26 No. HIV Prevalen ce (%) 112 80 36 0.9 0 0 25 13 251 2 2 7.7 1.6 0 0 16 186 0 0.5 2 43 95 65 57 8 0 2.1 3.1 1.8 0 44 58 53 49 2005 2006 No HIV Prevale nce (%) No 91 76 40 2 1.1 1.3 2.5 0 107 66 7 1 26 Kibaigwa (Road side) 2003-2004 2005 HIV HIV Preva Prevalen lence ce (%) No. (%) No 2001-2002 5.6 19.7 14.3 0 120 70 13 22 0 0.5 0 0 21 188 0 0 0 1.6 0 1 18 161 5.6 11.8 0 21 203 1 3 2 0 0 0 0 2 52 80 44 52 0 1.3 0 0 39 75 52 42 1 2.6 0 3.8 0 0 47 78 34 22 4.3 9 14.7 27.3 7.1 8.6 0 0 53 86 39 21 4 11.3 8.1 10.3 4.8 0 62 127 57 28 2 1.6 11.8 10.5 3.6 0 209 181 203 8 5 1 1 3 19 18 1.4 11 23 28 244 1 3 228 0.4 5.1 14.4 6.5 0 12.5 8 204 0.5 HIV Prevale nce (%) 40 163 268 1.9 156 90 29 1 23 181 4.4 8.3 10 7.7 2006 276 23 8.9 8.3 32 Table 8b. HIV prevalence among ANC attendees, Dodoma, Tanzania, 2001/02 - 2005/06 Characteristics Agegroup (yrs) 15-24 25-34 35-48 Not stated Median age (yrs) Marital status Single Married Other Not stated Previous pregnancies 1-2 2-3 3-4 >5 Not stated Total number tested for HIV Total number HIV positive Overall HIV prevalence (%) per site Makole (Urban) 2003-2004 Mpwapwa (semi Urban) 2003-2004 2005 2006 HIV HIV Preval Prevale ence No. nce (%) No (%) Wajenzi (Urban) 2003-2004 2005 2006 HIV HIV Preval Preva ence lence No. (%) No (%) Total 2001-2002 HIV Preva lence No. (%) Total 2003-2004 HIV Prev alenc No. e (%) Total 2005- 2006 HIV Preval ence No (%) 6.9 13.1 10 0 170 117 30 2 24 5.3 7.7 0 50 110 72 25 8 24 4.5 8.3 0 12.5 207 120 23 1 23 10.1 22.5 4.3 0 237 169 30 3 24 2.1 10.1 10 33.3 453 336 87 12 24 883 581 151 6 24 6.7 10.5 3.3 16.7 962 706 201 16 3.7 9.3 5.5 12.5 166 6 48 8.3 25 12 80 2 143 2.1 11.6 396 4.8 311 0 1 11.3 0 100 270 1 5.6 0 183 0 7 4.9 0 0 271 12.2 295 0 1 7.8 0 0 258 135 8 2 3 7.1 0 0 1472 3 14 6.5 0 7.1 160 232 65 20 1 6.9 11.2 10.8 10 0 88 131 62 33 5 5.7 7.6 4.8 3 0 55 82 46 21 11 3.6 8.5 6.5 0 0 121 111 80 30 9 167 133 80 48 11 3 4.5 8.8 14.6 9.1 7.1 8.3 10.6 3.9 0 526 744 365 216 34 3.8 7.5 7.4 5.1 2.9 2001-2002 HIV Preval ence No. (%) No. 188 120 19 3 23 176 136 24 3 24 8 11.8 4.2 0 248 199 30 1 24 53 9.4 286 9.1 9 10.8 10.5 0 61 268 9.8 9.7 1 0 115 152 45 18 6.1 12.5 13.3 0 5.4 10.4 16.7 0 0 2006 No HIV Prevale nce (%) 107 774 7.5 6.1 1 6 0 0 250 344 171 123 3.6 7.8 6.4 6.2 330 339 478 319 215 351 439 888 32 31 46 19 12 49 26 54 126 9.1 9.6 5.9 5.6 14 12.6 18.8 10 0 5.3 8 4.6 0 478 637 303 181 22 162 1 9.8 111 163 48 14 3 HIV Prevale nce (%) 2005 13.9 5.9 6.1 1885 115 7.8 6.1 33 Table 8c. HIV prevalence among ANC attendees, Dodoma, Tanzania, 2001/02 - 2005/06 2001-2002 Characteristics No. HIV Prevale nce (%) Education level 65 0 No formal 105 1.9 Primary 2 0 > secondary 1 Not stated Distance from residence to clinic 135 1.5 0-5 km 36 0 More than 5 km 2 0 Not stated Duration living in residence < 6 months 161 1.2 > 6 months 12 0 Not stated Total number tested for HIV Total number HIV positive Overall HIV prevalence (%) per site Bahi (Rural) 2003-2004 No HIV Prevale nce (%) 86 95 2.3 6.3 2005 - 2006 No. HIV Prevale nce (%) 133 133 2 0 0 3.8 0 0 Handari (Rural) 2003-2004 2001-2002 HIV Prevale nce (%) 103 99 1 0 2 2005 - 2006 HIV Preval ence (%) No. HIV Prevale nce (%) 111 114 1 2 0.9 0 0 0 99 107 2 1 1 1.9 0 0 2001-2002 No 59 116 5 1 Kibaigwa (Road side) 2003-2004 HIV Prevalen ce (%) No. HIV Prevale nce (%) 5.1 12.9 40 66 133 4 177 4 3.4 50 122 127 19 2.5 1.6 0 201 1 2 0.5 0 0 228 0.4 208 0 1 1.4 0 0 141 39 1 12.1 5.1 0 7 173 1 0 4.6 0 0 266 2 0 1.9 0 23 177 4 0 0.6 0 2 224 2 0 0.4 0 5 202 2 0 1.5 0 0 177 4 11.3 0 2005 - 2006 No. HIV Prevalence (%) 10.6 8.3 0 100 174 2 0 2 10.9 100 0 138 64 1 8.7 9.4 0 212 64 0 10.8 0 0 2 201 0 9 0 275 1 0 8.4 0 173 181 268 204 228 209 181 203 276 2 8 5 1 1 3 19 18 23 1.2 4.4 1.9 0.5 0.4 1.4 11 8.9 8.3 34 Table 8d. HIV prevalence among ANC attendees, Dodoma, Tanzania, 2001/02 - 2005/06 2001-2002 HIV Prevalence (%) Characteristics No. Education level 30 10 No formal 249 9.6 Primary 50 10 > secondary 1 Not stated Distance from residence to clinic 107 9.3 0-5 km 220 10 More than 5 km 3 0 Not stated Duration living in residence 45 8.9 < 6 months 278 10.1 > 6 months 7 0 Not stated Total number tested for HIV Total number HIV positive Overall HIV prevalence (%) per site Makole (Urban) 2003-2004 No. HIV Prevalen ce (%) 23 263 53 2005 - 2006 No. HIV Prevalen ce (%) 8.7 9.5 7.5 47 352 79 0 316 22 1 9.5 4.5 0 93 245 1 8.6 9.4 0 Mpwapwa(Semi urban) 2003-2004 2005 - 2006 No. HIV Prevalen ce (%) No. HIV Prevalen ce (%) 10.6 10.2 6.3 0 89 210 20 1.1 8.6 0 51 141 16 7 193 283 2 9.8 9.5 0 226 93 8.4 0 0 478 0 0 9.6 0 25 294 16 5.1 Wajenzi (Urban) 2003-2004 2005 - 2006 No. HIV Prevalen ce (%) 2 7.8 0 0 41 278 32 164 43 8 5.5 7 0 0 206 9 0 5.8 0 Total 2001-2002 HIV Preval ence No. (%) No. HIV Prevalence (%) Total 2005 - 2006 Total 2003-2004 No. HIV Prevalen ce (%) 9.8 13.3 25 123 272 43 1 8.9 4.8 4.7 0 257 569 57 5 2.7 7.2 12.3 416 1093 110 2 4.1 8.9 10.9 0 553 1179 144 9 3.6 7.3 6.3 0 340 11 14.4 0 438 0 1 5.9 0 0 584 296 8 5.1 8.1 12.5 1425 194 2 8.2 4.6 0 1337 517 31 6.2 6.2 0 51 300 11.8 14.3 1 437 1 0 5.9 0 68 793 27 5.9 6.4 0 180 1437 4 10 7.5 0 6 1864 15 0 6.2 0 No. 330 339 478 319 215 351 439 888 1621 1885 32 31 46 19 12 49 26 54 126 115 9.8 9.1 9.6 5.9 5.6 13.9 5.9 6.1 HIV Prevalence (%) 6.1 7.8 35 Table 9a. HIV prevalence among ANC attendees, Kagera, Tanzania, 2001/02 - 2005/06 Bukoba (urban) 2003-2004 2001-2002 Characteristic s Age group (yrs) 15-24 25-34 35-48 Not stated 2005 - 2006 No. HIV Prevalence (%) No Prevalence 310 193 10 3 6.5 11.4 20 0 247 153 9 1 6.9 13.7 11.1 0 Median age (yrs) 23 Marital status 39 Single 470 Married 1 Other 6 Not stated Previous pregnancies 195 0 228 1-2 78 3-4 15 >5 195 Not stated Total number 516 tested for HIV Total number 43 HIV positive Overall HIV prevalence (%) per site 23 15.4 8.1 6.2 10.5 10.3 0 6.2 8.5 248 216 51 0 4.4 7.4 5.9 0 25 16 393 0 9.9 1 0 150 181 61 18 6 12.2 13.1 0 Katoro (Semi-urban) 2003-2004 2001-2002 No. HIV Prevalence (%) No. PrePrevalence e 165 134 29 5 1.8 5.2 0 0 115 95 33 2 0.9 3.2 6.1 0 24 25 30 484 0 1 13.3 5.4 0 0 7 321 3.1 5 143 219 89 64 0 5.6 7.3 3.4 4.7 0 23 136 92 82 23 113 115 32 3 25 0 6 233 4 2 0 2.6 0 0 8 253 0 2 4.3 2.2 3.3 3.7 4.3 41 77 65 61 1 0 2.6 3.1 3.3 0 2 94 75 84 8 410 515 333 245 263 39 30 10 6 10 9.5 5.8 3 2.5 36 Table 9b: HIV prevalence among ANC attendees, Kagera, Tanzania, 2001/02 - 2005/06 Nkwenda (Rural) 2001-2002 HIV Prevalence No. (%) Characteristics Age group (yrs) 15-24 258 25-34 165 35-48 40 Not stated 1 Median age (yrs) 24 Marital status Single 10 Married 453 Other 1 Not stated Previous pregnancies 0 104 1-2 162 3-4 106 >5 92 Not stated 104 Total number tested for HIV 464 Total number HIV positive 18 Overall HIV prevalence (%) per site 3.5 4.2 5 0 2003-2004 HIV Prevalence No. (%) 233 178 36 5 1.3 2.2 0 0 24 20 3.5 4.8 2.5 2.8 6.5 4.8 3.9 Nyamiyaga (Semi-urban) 2005 2006 259 180 49 7 1.9 4.4 2 0 24 8 443 0 1.6 1 106 141 103 99 3 2003-2004 HIV Prevalence No. (%) 2005 - 2006 89 71 15 7 105 105 24 3 2.2 1.4 0 14.3 24 2.9 3.8 0 0 24 Rwamishenye (Urban) 2005 2003-2004 2006 HIV Prevalence No. (%) Total Total Total 2001-2002 HIV Prevalen No. ce (%) 2003-2004 HIV Prevalence No. (%) 2005 - 2006 196 91 7 2 807 576 95 16 997 683 126 20 8.2 14.3 0 0 22 171 108 13 2 4.7 10.2 23.1 0 23 4.2 7.6 4.2 6.3 24 3.9 6.1 3.2 10 1021 845 187 17 3.9 5.6 4.8 5.9 24 16.7 2.7 0 0 10 168 1 3 10 1.8 0 0 12 223 0 2 0 3.1 0 0 24 272 8.3 9.9 0 6 487 0 2 14 280 0 0 0 7.9 0 0 61 1,420 2 11 14.8 5.2 0 0 70 1742 5 9 4.3 4.8 0 0 75 1984 0 11 6.7 4.6 0 0 1.9 2.8 1 0 0 96 168 118 95 18 1 3 4.2 2.1 5.6 39 64 39 35 5 5.1 3.1 0 0 0 66 77 43 45 6 1.5 3.9 4.7 0 16.7 115 127 43 6 5 7.8 11.8 4.7 16.7 40 122 120 40 7 5 8.2 5.8 10 14.3 0 349 580 323 242 349 5.2 5.7 6.2 5 5.2 502 667 372 269 16 4.6 6.7 3.5 1.5 12.5 484 761 444 341 40 5.6 5.1 4.3 2.9 5 452 495 182 237 296 294 1494 1826 7 14 4 7 29 22 83 87 1.6 2.8 2.2 3.0 9.8 7.5 5.6 2070 97 4.7 4.7 37 Table 9c: HIV prevalence among ANC attendees, Kagera, Tanzania, 2001/02 - 2005/06 Bukoba urban 2001-2002 HIV Prevale No. nce (%) Characteristics Education level 19 0 No formal 428 9.3 Primary 64 6.3 > secondary 5 0 Not stated Distance from residence to clinic 482 7.7 0-5 km More than 5 26 23.1 km 8 12.5 Not stated Duration living in residence < 6 months 513 8.6 > 6 months 3 0 Not stated Total number tested for HIV Total number HIV positive Overall HIV prevalence (%) per site 2003-2004 Katoro (Semi-urban) 2005 - 2006 Kimeya (Rural) 2001-2002 HIV Prevale No. nce (%) 2003-2004 PrePr evale No. ncee 2005 - 2006 2001-2002 HIV Preval No ence No Prevale nce 12 333 65 16.7 9.6 7.7 14 455 46 0 7.1 5.5 8.7 0 58 270 4 1 5.2 2.6 0 0 85 156 4 3.5 1.9 0 44 214 3 2 0 4.7 0 0 70 109 1 1 366 9.3 335 5.4 207 2.4 116 1.7 122 2.5 44 11.4 179 6.7 119 4.2 126 3.2 141 1 0 7 0 3 0 43 471 1 11.6 5.3 0 330 3 3 0 19 225 1 0 2.7 0 105 303 2 7.6 10.2 0 20052006 2003-2004 No. HIV Prevalence 5.7 6.4 0 0 104 135 2 1 0.7 0 121 144 1 0 7.4 3.5 0 0 177 6.2 202 0.5 207 4.8 5 2 0 38 2.6 55 7.3 0 0 2 0 1 0 4 0 1 250 12 0 4 0 1 177 3 0 6.2 0 5 232 4 0 0.9 0 6 259 1 0 5.4 0 516 410 515 333 245 263 181 241 266 43 39 30 10 6 10 11 2 14 8.5 9.5 5.8 3 2.5 3.8 6.1 0.8 5.3 38 Table 9d: HIV prevalence among ANC attendees, Kagera, Tanzania, 2001/02 - 2005/06 2001-2002 Characteristics No. No formal Primary > secondary Not stated 173 282 7 2 0-5 km More than 5 km Not stated 182 280 2 < 6 months > 6 months Not stated 1 462 1 Total number tested for HIV Total number HIV positive Overall HIV prevalence (%) per site Nkwenda (Rural) 2003-2004 Nyamiyaga (Semi-urban) 2003-2004 2005 - 2006 2005 - 2006 HIV Prevale nce (%) HIV PrevalenNo. ce (%) No. Education level 2.9 152 1.3 162 4.3 293 1.4 323 14.3 5 0 9 0 2 50 1 Distance from residence to clinic 4.4 130 2.3 243 3.6 321 1.2 243 0 1 0 9 Duration living in residence 0 28 3.6 15 3.9 421 1.4 480 0 3 0 0 HIV Prevale nce (%) No. HIV Prevalen ce (%) 2.5 3.1 0 0 57 118 7 2.9 2.9 0 0 2.9 0 Rwamishenye (Urban) 2003-2004 2005 - 2006 HIV HIV Prevale Prevalenc nce No. e (%) No. (%) Total 2001-2002 HIV Prevalence No. (%) Total 2003-2004 HIV Prevale nce No. (%) Total 2005 - 2006 No. HIV Prevale nce (%) No. HIV Prevale nce (%) 3.5 1.7 0 65 161 11 0 6.2 1.9 0 0 19 240 37 21.1 8.3 13.5 13 231 50 0 7.7 6.9 10 0 320 1,089 76 9 3.8 6.1 6.6 0 429 1275 120 2 3.3 4.9 8.3 50 419 1528 120 3 4.5 4.5 7.5 0 98 82 2 3.1 1.2 0 181 54 2 2.8 3.7 0 295 9.8 1 0 289 3 2 7.3 33.3 0 1,048 427 19 5.8 4.9 5.3 1207 611 8 6 2.5 0 1377 675 18 4.6 4.9 0 14 167 1 21.4 0.6 0 9 226 2 0 3.1 0 61 235 6.6 10.6 32 262 0 3.1 8 0 2 1,482 10 0 5.6 0 232 1583 11 6.9 4.5 0 106 1948 16 5.7 4.7 0 464 452 495 182 237 296 294 1494 1826 2070 18 7 14 4 7 29 22 83 87 97 3.9 1.6 2.8 2.2 3 9.8 7.5 5.6 4.7 4.7 39 Table 10a: HIV prevalence among ANC attendees, Mtwara, Tanzania, 2001/02 - 2005/06 Ligula (Urban) 2001-2002 Characteristics No. HIV Prevale nce (%) Mangaka (Semi-urban) 2003-2004 2005 -2006 No HIV Prevale nce (%) 208 6.3 167 6.6 146 13.7 144 8.3 30 10 26 15.4 5 20 2 0 No. HIV Prevalen ce (%) 2001-2002 No. 2003-2004 HIV Prevale nce (%) Nanyamba (Rural) 2005 -2006 HIV Prevalen ce (%) No. Prevalen ce 137 2.9 153 4.6 100 6 133 6 29 10.3 47 6.4 1 0 2 0 No. 2001-2002 No 2003-2004 HIV Prevalen ce (%) 2005 -2006 HIV Preval ence No. (%) No. HIV Prevale nce (%) 80 3.7 58 0 71 4.2 50 4 22 0 17 5.9 3 0 5 0 Age group (yrs) 158 117 28 2 15-24 25-34 35-48 Not stated Median age (yrs) 7.0 19.7 10.7 100 24 24 25 133 97 46 3 6 4.1 0 0 25 24 25 66 46 12 1 1.5 8.7 0 0 24 25 25 Marital status 58 247 Single Married 13.8 12.1 63 6.3 8 12.5 325 9.8 302 7.6 23 4.3 Other Not stated 35 243 1 100 6 33.3 1 126 3.2 116 3.4 171 11.7 157 10.2 63 11.1 45 8.9 14 21.4 14 14.3 76 93 54 56 15 20 7 14.3 14.3 2.9 31 19.4 3 0 234 3 319 5.3 3 0 0 2 0 10 5.3 6.5 3.7 0 64 1.6 97 49 51 6 25 144 8 4.2 10 1 0 63 3.2 4.1 126 5.6 10.2 81 4.9 5.9 63 7.9 9 67 32 17 11.1 3 3.1 5.9 0 2 0 12 8.3 15 0 164 3 113 2.7 0 0 2 0 Previous pregnancies 0 1-2 2-4 >5 112 124 54 15 6.3 13.7 22.2 13.3 Not stated Total number tested for HIV 305 Total number HIV positive 38 Overall HIV prevalence (%) per site 279 389 267 335 12 37 0 2 0 74 8.1 61 1.6 38 0 44 2.3 24 0 22 4.5 5 0 1 0 125 339 176 130 6 3 5 27 13 12.5 35 18 4.3 9.5 8.0 4.8 5.4 4.0 3.4 2.3 40 Table 10b: HIV prevalence among ANC attendees, Mtwara, Tanzania, 2001/02 - 2005/06 Characteristics Age group (yrs) 15-24 25-34 35-48 Not stated Median age (yrs) Marital status Single Married Other Not stated Previous pregnancies 0 1-2 2-4 >5 Not stated Total number tested for HIV Total number HIV positive Overall HIV prevalence (%) per site 2001-2002 HIV Prevale nce No. (%) 66 46 12 1 25 1.5 8.7 0 0 8 144 0 4.2 1 0 43 64 30 16 4.7 3.1 6.7 0 Tandahimba (Semi-urban) 2003-2004 2005 -2006 No. HIV Prevalen ce (%) 76 50 16 5 24 0 0 0 20 26 121 0 0.8 34 77 24 10 2 0 1.3 0 0 0 No. HIV Prevalen ce (%) Likombe (Urban) 2003-2004 2005 -2006 3 5.7 7.7 76 55 17 2 24 5.3 12.7 17.6 0 74 42 17 2 24 0 4.8 0 0 74 82 22 1 25 2.7 7.3 0 0 424 332 99 7 25 5.2 10.5 3 20 674 462 127 16 24 3.4 7.4 5.5 12.5 609 543 154 13 4.8 7.4 7.8 0 4.7 11.1 0 33.3 22 113 4.5 0.9 18 158 2 1 5.6 4.4 0 0 126 733 11.9 6.3 184 1091 7.6 4.7 3 0 4 25 105 1159 33 22 5.7 6 3 18.2 7.1 8.7 11.1 18.2 0 39 57 22 14 3 58 83 28 8 2 5.2 4.8 3.6 0 0 240 348 170 104 5.8 7.8 10 2.9 351 547 229 119 33 1.7 6.8 5.7 6.7 9.1 317 576 274 127 25 4.4 7.1 5.5 7.9 4 6.2 6.3 4 0 18 168 0 0 11.1 5.4 0 0 30 134 6.7 3.7 1 0 43 99 5 3 50 80 40 9 7 6 8.8 2.5 0 0 53 71 33 6 2 1.9 4.2 3 33.3 0 28 69 36 11 6 22 0 3.5 0 0 0 153 No. HIV Prevalen ce (%) Total 2005 -2006 99 53 13 81 79 25 1 26 No. HIV Prevalen ce (%) Total 2003-2004 HIV Prevale nce No. (%) No. No. HIV Prevalen ce (%) Total 2001-2002 HIV Prevalen ce (%) No. HIV Prevalen ce (%) Mkunya (Rural) 2003-2004 2005 -2006 HIV Prevalen ce (%) No. 862 147 186 165 150 135 179 1279 6 1319 61 1 11 7 14 2 8 66 4 81 7.1 0.7 5.9 4.2 9.3 1.5 4.5 5.1 6.1 41 Table 10c: HIV prevalence among ANC attendees, Mtwara, Tanzania, 2001/02 - 2005/06 2001-2002 HIV Prevalen No. ce (%) Characteristics Education level No formal 57 8.8 Primary 216 13.4 > secondary 32 12.5 Not stated Distance from residence to clinic 0-5 km 290 12.8 More than 5 km 14 7.1 Not stated 1 0 Duration living in residence < 6 months 56 8.9 > 6 months 248 13.3 Not stated 1 0 Total number tested for HIV Total number HIV positive Overall HIV prevalence (%) per site Ligula (Urban) 2003-2004 HIV Prevalen No ce (%) 2005 - 2006 HIV Prevalen No. ce (%) 2001-2002 HIV Prevalence No. (%) Mangaka (Semi-urban) 2003-2004 HIV Prevalen No. ce (%) No. HIV Prevalen ce (%) 2001-2002 HIV Prevalen No ce (%) Nanyamba (Rural) 2003-2004 HIV Prevalence No. (%) No. HIV Prevalen ce (%) 82 271 36 9.8 9.6 8.3 63 227 49 0 7.9 6.6 14.3 0 91 181 7 4.4 3.9 14.3 97 165 5 0 7.9 0 100 223 8 4 2 6.7 12.5 0 47 73 5 2.1 5.5 0 101 69 6 4 2.9 0 65 58 6 1 4.6 0 0 0 353 35 1 9.9 5.7 0 332 6 1 7.8 16.7 0 124 154 1 7.3 1.9 0 162 105 4.9 4.8 283 49 3 6 2 0 97 27 1 5.2 0 0 164 12 3 8.3 129 0 1 2.3 0 0 65 320 4 6.2 10.3 0 0 334 5 0 8.1 0 277 2 4.3 0 267 4.9 7 321 7 0 5.6 0 11 112 2 9.1 3.6 0 17 157 2 5.9 3.2 0 3 123 4 0 2.4 0 305 279 389 125 339 267 38 335 12 37 27 13 12.5 18 4.3 9.5 8 176 130 6 3 5 4 4.8 5.4 3.4 2.3 42 Table 10: HIV prevalence among ANC attendees, Mtwara, Tanzania, 2001/02 - 2005/06 Characteristics 2001-2002 HIV Prevale nce No. (%) Education level No formal 68 4.4 Primary 75 4 > secondary 8 0 Not stated 2 0 Distance from residence to clinic 0-5 km 128 4.7 More than 5 km 23 0 Not stated 2 0 Duration living in residence < 6 months 3 0 > 6 months 149 4 Not stated 1 0 Total number tested for HIV Total number HIV positive Overall HIV prevalence (%) per site Tandahimba (Semi-urban) 2003-2004 No. HIV Prevalen ce (%) 42 99 6 1 0 96 51 13 130 4 0 Likombe (Urban) 2003-2004 No. HIV Preval ence (%) 6 No. HIV Prevale nce (%) No. Mkunya (Rural) 2003-2004 HIV Prevale nce (%) No. HIV Prevale nce (%) No. Total 2001-2002 HIV Prevale nce (%) No. HIV Prevalence (%) Total 2003-2004 HIV Prevale nce No. (%) Total No. HIV Prevalence (%) 50 129 6 1 6.2 0 0 33 126 5 1 0 5.6 0 0 44 100 6 0 4.5 12 0 0 56 76 3 1.8 1.3 0 54 122 3 0 3.7 4.9 0 0 263 545 52 2 4.9 7.9 9.6 0 411 806 61 1 3.2 6.2 4.9 0 376 859 78 6 4.5 6.5 10.3 0 1 0 163 23 0 6.1 4.3 0 157 4 4 4.5 0 0 148 1 1 9.5 0 0 110 24 1 1.8 0 0 159 19 1 5 0 0 639 218 5 8.9 1.8 0 1042 231 6 5.6 3.5 0 1214 98 7 6.4 3.1 0 0 0.8 0 0 183 3 0 6 0 25 138 2 0 5.1 0 0 148 2 0 8.8 50 16 118 1 0 1.7 0 0 174 5 0 4.6 0 70 786 6 8.6 7 0 136 1130 13 3.7 5.4 0 10 1283 26 0 6.2 3.8 153 862 147 186 165 150 135 179 1279 6 1319 61 1 11 7 14 2 8 66 4 81 7.1 0.7 5.9 4.2 9.3 1.5 4.5 5.1 6.1 43 Table 11a: HIV prevalence among ANC attendees, Kilimanjaro, Tanzania, 2001/02 - 2005/06 2001-2002 HIV Prevalen No. ce (%) Characteristics Age group (yrs) 15-24 126 25-34 131 35-48 37 Not stated Median age (yrs) 25 Marital status Single 20 Married 274 Other Not stated Previous pregnancies 0 77 1-2 95 3-4 78 >5 44 Not stated Total number 294 tested for HIV Total number 16 HIV positive Overall HIV prevalence (%) per site 4.8 6.9 2.7 - Hedaru (Road side) 2003-2004 HIV Prevalen No ce (%) 125 79 15 2.4 2.5 0 24 10 5.1 6.5 3.2 7.7 4.5 5.5 11 210 13 109 63 33 3 0 2.4 0 3.7 1.6 0 0 2005 - 2006 HIV Prevalen No ce (%) 2001-2002 HIV Prevalen No. ce 131 142 31 2 25 7.6 8.5 0 0 235 164 19 6 24 6.4 9.8 5.3 0 25 280 0 1 4 7.5 0 0 60 364 10 7.1 23 141 97 42 3 4.3 6.4 12.4 0 0 149 203 57 15 Majengo (Urban) 2003-2004 HIV Prevalen No. ce (%) 202 109 12 7.9 4.6 8.3 23 4.7 8.9 10.5 6.7 2005 - 2006 HIV Prevalen No. ce (%) 166 140 21 3 24 4.8 10 4.8 0 3.2 7.4 0 0 5.3 6.4 11.9 7.1 0 33 287 6.1 7 1 0 31 298 0 1 138 133 36 8 8 5.1 10.5 2.8 0 0 113 140 59 14 4 2001-2002 HIV Prevale No nce 75 50 80 48 58 26 1 2005 - 2006 HIV Prevalence (%) 1.3 4 0 - 119 122 24 3 25 9.2 4.9 0 0 63 77 22 2 25 4.8 1.3 4.5 0 10 1.6 19 247 10.5 6.1 2 0 9 155 0 0 0 3.2 0 0 66 134 52 9 7 9.1 6.7 3.9 0 0 33 102 27 0 2 3 3.9 0 0 0 24 10 123 Masama (Rural) 2003-2004 HIV Prevalen No. ce (%) No. 0 3.4 3.8 0 221 306 424 323 330 133 268 164 5 22 32 22 23 3 17 5 2.3 7.2 7.6 6.8 7 2.3 6.3 3 44 Table 11a: HIV prevalence among ANC attendees, Kilimanjaro, Tanzania, 2001/02 - 2005/06: 2001-2002 Characteristics Agegroup (yrs) 15-24 25-34 35-48 Not stated Median age (yrs) Marital status Single Married Other Not stated Previous pregnancies 0 1-2 3-4 >5 Not stated Total number tested for HIV Total number HIV positive Overall HIV prevalence (%) per site No. HIV Prevalenc e (%) Umbwe (Rural) 2003-2004 2005 - 2006 HIV Prev alenc No. e (%) Pasua (Urban) 2003-2004 2005 - 2006 No. 0 6.7 0 41 46 22 0 26 0 6.5 9.1 0 196 111 11 5 23 8.7 6.3 18.2 0 176 142 27 3 24 4 2.8 0 0 69 94 25 3 27 4.4 5.3 0 0 56 71 36 6 28 1.8 5.6 0 0 481 401 76 7 24 5.2 8.5 2.6 759 560 97 13 24 6.6 5 3.1 0 633 618 159 16 4.6 6.1 2.5 0 102 863 9.8 5.9 157 1261 4 7 7 5.6 0 0 151 1269 1 5 3.3 5.2 0 0 4.3 7.3 8.3 4.1 400 612 260 111 46 6.3 6.9 4.6 0.9 2.2 271 669 338 124 24 3.3 5.4 7.1 0.8 4.2 50 1429 6.7 12.5 0 0 12 102 8.3 8.8 4 97 1 1 25 2.1 0 0 9 100 0 0 0 5 0 0 56 263 1 3 5.4 8.8 0 0 55 289 1 3 3.6 3.1 0 0 34 157 8.8 3.2 22 147 0 0 4.5 2.7 0 0 3.8 14 9.7 0 20 40 23 18 2 5 0 8.7 0 0 20 46 29 13 1 0 6.5 6.9 0 0 114 132 46 13 18 7 9.9 6.5 7.7 5.6 49 190 85 16 8 2 4.7 1.2 0 0 49 64 40 30 8 6.1 3.1 7.5 0 0 33 50 41 39 6 0 4 4.9 0 16.7 26 43 31 14 25 300 399 192 74 114 103 109 323 348 191 169 965 10 3 5 26 11 8 5 61 8.8 Total 2005 - 2006 48 45 10 45 56 12 1 27 2.9 4.6 8.1 3.2 4.2 3.0 HIV Prevalen ce (%) Total 2003-2004 HIV Preval ence No. (%) No. No. HIV Prevalen ce (%) Total 2001-2002 HIV Prevalen ce (%) No. HIV Prevalen ce (%) Huruma (semi Urban) 2003-2004 2005 - 2006 HIV HIV Prevale Prevale nce No. nce (%) No. (%) 1426 81 6.3 No. HIV Prevale nce (%) 71 5.7 5.0 45 Table 11c: HIV prevalence among ANC attendees, Kilimanjaro, Tanzania, 2001/02 - 2005/06 2001-2002 Characteristics No. HIV Prevale nce (%) Education level No formal 16 0 Primary 275 5.8 > secondary 2 0 Not stated 1 0 Distance from residence to clinic 0-5 km 203 4.9 More than 5 km 90 6.7 Not stated 1 0 Duration living in residence < 6 months 1 100 > 6 months 293 5.1 Not stated Total number tested for HIV Total number HIV positive Overall HIV prevalence (%) per site Hedaru (Road side) 2003-2004 2005 -2006 2001-2002 No Prevale nce No. HIV Prevalen ce (%) 27 188 5 1 0 2.7 0 0 44 252 10 0 4.5 7.9 0 0 5 359 60 0 113 104 4 1.8 2.9 0 214 91 1 8.4 4.4 0 1 218 2 0 2.3 0 0 301 5 0 7.3 0 2005 -2006 2001-2002 Masama (Rural) 2003-2004 No. Prevalence No. 20 7.5 6.7 13 264 46 0 15.4 6.4 3 0 5 285 39 1 0 7.4 5.1 0 0 119 14 0 0 2.5 0 0 19 227 20 2 5.3 6.2 5 1 1 146 17 0 0 3.4 0 0 361 63 6.9 11.1 295 28 0 6.4 10.7 0 3.3 27 0 7.6 0 0 131 1 1 2.3 0 0 264 3 1 6.4 0 0 161 2 1 3.1 0 0 97 325 2 7.2 7.4 50 55 268 0 10.9 6 0 0 328 2 0 7 0 6 127 16.7 1.6 3 264 1 33.3 6.1 0 0 162 2 0 2.5 50 No HIV Prevale nce No. HIV Prevale nce 2005 -2006 HIV Prevale nce No. (%) HIV Prevalen ce (%) No. HIV Prevalen ce Majengo (Urban) 2003-2004 294 221 306 424 323 330 133 268 164 5 22 32 22 23 3 17 5 16 5.5 2.3 7.2 7.6 6.8 7.0 2.3 6.3 3.1 3 46 Table 11d: HIV prevalence among ANC attendees, Kilimanjaro, Tanzania, 2001/02 - 2005/06 2001-2002 HIV Preva lence No. (%) Characteristics Education level 3 0 No formal 107 8.4 Primary 4 25 > secondary Not stated 0 Distance from residence to clinic 108 8.3 0-5 km 6 16.7 More than 5 km 0 Not stated Duration living in residence 3 0 < 6 months 111 9 > 6 months Not stated Total number tested for HIV Total number HIV positive Overall HIV prevalence (%) per site Umbwe (Rural) 2003-2004 HIV Preval ence No. (%) 2005 -2006 No. HIV Prevale nce (%) Pasua (Urban) 2003-2004 2005 -2006 HIV HIV Preval Preva ence lence No. (%) No. (%) Huruma (semi Urban) 2003-2004 2005 -2006 HIV HIV Preval Preva ence lence No. (%) No. (%) Total 2001-2002 HIV Preval ence No. (%) Total 2005 -2006 HIV Preva lence No. (%) 4 93 6 1 3.3 0 0 2 103 4 0 4.9 0 0 9 273 40 0 11.1 8.1 7.5 0 5 297 46 0 0 2.7 6.5 0 0 174 16 1 0 3.5 12.5 0 2 158 9 0 0 3.2 0 0 24 860 80 1 4.2 6.4 6.3 72 1218 133 6 5.6 5.5 6.8 16.7 59 1241 125 1 3.4 5.2 4 0 96 3.1 106 4.7 298 8.1 341 3.2 136 3.7 153 3.3 803 160 5.9 8.7 1202 5.8 1278 5.2 7 0 0 0 3 0 0 0 17 8 11.8 0 7 0 0 0 55 0 5.5 0 16 0 0 0 2 214 13 5.1 0 146 2 2.7 0 2 101 0 3 0 109 0 0 4.6 0 12 296 15 8.3 8.5 0 0 343 5 0 3.2 0 12 176 3 0 4.6 0 0 169 0 0 3 0 107 856 2 8.4 6 85 1323 21 9.4 5.5 0 0 1412 14 0 5 7.1 50 1429 1426 81 71 0 0 114 103 109 323 348 191 169 965 10 3 5 26 11 8 5 61 8.8 Total 2003-2004 HIV Preva lence No. (%) 2.9 4.6 8.1 3.2 4.2 3.0 6.3 5.0 5.7 47 Table 12a. HIV prevalence among ANC attendees, Mbeya, Tanzania, 2001/02 - 2005/06 Characteristics 2001-2002 HIV Prevalence No. (%) Agegroup (yrs) 15-24 122 25-34 74 35-48 16 Not stated 5 Median age (yrs) 23 Marital status Single 18 Married 197 Other 0 Not stated 2 Previous pregnancies 0 66 1-2 87 3-4 45 >5 19 Not stated Total number 217 tested for HIV Total number 37 HIV positive Overall HIV prevalence (%) per site Chimala (Road side) 2003-2004 2005 - 2006 HIV HIV Prevalenc Prevalence No e (%) No. (%) 2001-2002 HIV Prevalen No. ce Ilembo (Rural) 2003-2004 HIV Prevalence No. (%) 2005 - 2006 HIV Prevalenc No. e (%) 2001-2002 No HIV Prevalence Kiwanjampaka(Urban) 2003-2004 2005 - 2006 HIV HIV Prevalence Prevalence No. (%) No. (%) 15.6 23 6.3 0 116 109 23 1 25 8.6 21.1 21.7 0 104 129 31 2 26 17.3 27.9 12.9 0 103 93 12 3 25 5.9 7.5 8.3 0 110 64 10 4 23 8.3 9.4 0 0 94 72 9 2 24 4.3 4.2 22.2 0 335 199 25 9 23 13.1 24.6 24 25 422 273 26 5 23 16.1 23.1 15.4 40 366 268 39 2 24 11.2 19 10.3 0 0 18.3 0 50 22 227 0 0 22.7 15 0 0 21 241 4 0 19 22 25 0 10 197 0 4 20 6.6 0 0 11 177 0 0 18.2 7.9 0 0 6 170 1 0 16.7 4.7 0 0 71 496 1 15.5 18.1 0 38 684 1 3 13.2 19.4 0 0 78 595 0 2 15.4 14.1 0 0 13.6 20.7 20 5..3 54 108 55 28 4 1.9 20.4 21.8 14.3 0 57 114 60 32 3 12.3 27.2 26.7 6.3 66.7 4.4 11.6 8 0 56 61 49 20 2 7.1 11.5 8.2 5 0 50 70 28 25 0 4 5.7 0 12 0 12.5 20.6 24 10.5 258 311 125 23 9 13.2 23.8 21.6 13.1 0 215 328 109 14 9 11.6 18.3 9.2 7.1 0 17.1 64 69 50 28 216 233 100 19 249 266 211 188 177 568 726 675 39 58 15 16 9 102 138 96 15.7 21.8 7.1 8.5 5.1 17.9 19.0 14.2 48 Table 12b: HIV prevalence among ANC attendees, Mbeya, Tanzania, 2001/02 - 2005/06 2001-2002 Characteristics Age group (yrs) 15-24 25-34 35-48 Not stated Median age (yrs) Marital status Single Married Other Not stated Previous pregnancies 0 1-2 3-4 >5 Not stated Total number tested for HIV Total number HIV positive Overall HIV prevalence (%) per site 239 113 17 4 HIV Prevale nce (%) 16 22.1 5.9 0 22 53 308 8 4 132 180 55 6 Kyela Border) 2003-2004 No. HIV Prevale nce (%) 222 86 13 2 14 21 15.4 0 22 2005 - 2006 Igamba(Rural) 2003-2004 2005 - 2006 No. HIV Prevale nce (%) No. HIV Prevale nce (%) 198 111 12 2 18.2 22.5 25 0 139 77 9 3 9.4 13 11.1 0 23 24 No. 122 64 16 0 Ruanda (Urban) 2003-2004 2005 - 2006 HIV Prevale nce (%) No. HIV Preval ence (%) 18.9 14.1 25 0 450 238 21 19 14.2 17.7 4.8 5.3 22.5 23 No. 452 315 41 13 HIV Preva lence (%) 15.3 17.1 12.2 0 24 Total 2001-2002 HIV Prev alen ce No. (%) 799 479 70 21 13.4 20.5 12.9 11.1 23 Total 2003-2004 2005 - 2006 No. HIV Preva lence (%) 1459 847 102 34 13.6 19.6 14.7 11.8 1336 959 148 21 14.3 18.6 14.9 0 No. HIV Preval ence (%) 23 18.9 16.6 37.5 0 47 273 1 2 19.2 15.4 0 0 32 291 0 0 21.9 19.6 0 0 8 219 0 1 12.5 10.5 0 0 6 196 0 0 16.7 17.9 0 0 23 700 0 5 21.7 15.9 0 0 62 758 0 1 12.9 15.8 0 0 152 1198 9 10 15.1 15.9 33.3 10 149 2280 2 11 18.1 15.7 0 0 205 2251 5 3 16.1 15.9 20 0 12.9 21.7 12.7 16.7 125 152 34 6 6 13.6 13.8 32.4 33.3 0 97 172 45 3 6 14.4 22.7 22.2 0 16.7 52 105 43 16 12 3.9 10.5 14 12.5 25 60 76 37 21 8 21.7 15.8 18.9 14.3 12.5 294 315 94 13 12 12.9 19.1 14.9 7.7 25 264 386 125 13 33 12.5 16.8 18.4 15.4 15.2 478 569 250 72 11.7 19.9 17.6 5.6 839 152 400 106 45 11.4 18.5 18.8 12.3 13.3 743 1146 404 108 63 12.7 18.4 16.3 10.2 14.3 373 323 323 228 202 728 821 1369 2442 2464 64 51 64 24 36 116 128 218 384 391 17.2 15.8 19.8 10.5 17.8 15.9 15.6 16 15.9 15.7 49 Table 12c: HIV prevalence among ANC attendees, Mbeya, Tanzania, 2001/02 - 2005/06 Characteristics Education level No formal Primary > secondary Not stated Distance from residence to clinic 0-5 km More than 5 km Not stated Duration living in residence < 6 months > 6 months Not stated Total number tested for HIV Total number HIV positive Overall HIV prevalence (%) per site 2001-2002 HIV Prevalence No. (%) 30 173 13 1 30 15.6 0 100 Chimala (Road side) 2003-2004 No Prevale nce 61 178 10 13.1 16.9 10 2005 - 2006 HIV Prevalence No. (%) 2001-2002 HIV Prevalen No. ce 49 205 12 0 16.3 24.4 0 0 40 164 6 1 7.5 7.3 0 Ilembo (Rural) 2003-2004 2005 - 2006 HIV Prevalence No. (%) Kiwanjampaka (Urban) 2003-2004 2005 - 2006 HIV HIV HIV Prevalen Prevalen Prevalence No. ce No. ce (%) 2001-2002 No. Prevalence 29 156 3 6.9 9 0 32 144 1 0 12.5 2.8 100 0 58 449 61 13.3 18 19.7 20 577 129 10 18.5 22.5 42 540 93 0 7.1 15.7 8.6 0 0 No 113 102 2 16.8 16.7 50 120 129 249 15 16.3 15.7 222 43 1 20.7 27.9 0 125 78 8 6.4 9 0 126 60 2 10.3 5 0 145 41 1 5.5 3.2 0 404 150 14 17.8 18 14.3 719 1 6 19.2 0 0 667 6 2 14.2 16.7 0 10 207 20 16.9 15 232 2 13.3 15.5 50 20 246 0 30 21.1 0 5 200 6 0 7 16.7 11 171 6 18.2 6.4 50 7 167 3 14.3 4.8 0 64 503 1 15.6 18.1 0 23 701 2 13 19 100 1 674 0 0 14.2 0 217 249 266 211 188 177 568 726 675 39 58 15 16 9 102 138 96 37 17.1 15.7 21.8 7.1 8.5 5.1 17.9 19 14.2 50 Table 12d. HIV prevalence among ANC attendees, Mbeya, Tanzania, 2001/02 - 2005/06 Igamba(Rural) Kyela Border) 2001-2002 2003-2004 Characteristics Education level No formal Primary > secondary Not stated Distance from residence to clinic 0-5 km More than 5 km Not stated Duration living in residence < 6 months > 6 months Not stated Total number tested for HIV Total number HIV positive Overall HIV prevalence (%) per site No. HIV Prevalen ce (%) No. HIV Prevalen ce (%) 8 335 30 25 17.9 6.7 6 284 32 358 12 3 17.6 8.3 0 2 370 1 0 17..3 0 2005 - 2006 No. HIV Prevalence (%) 0 16.2 15.6 1 298 23 1 317 0 6 15.8 0 16.7 53 268 2 13.2 16.4 0 2003-2004 No. HIV Prevalence (%) 0 19.8 21.7 0 9 214 4 1 321 0 2 19.6 0 50 20 302 1 15 20.2 0 2005 - 2006 No. HIV Prevalence (%) 11.1 10.3 25 0 9 189 3 1 161 61 6 11.2 9.8 0 12 213 3 25 9.9 0 Ruanda (Urban) 2003-2004 2005 - 2006 Total 2001-2002 HIV Prev alenc No. e (%) No. HIV Prevalen ce (%) No. HIV Prevalence (%) 11.1 18.5 0 0 23 591 112 2 13 16.9 11.6 0 45 674 102 0 20 15.4 14.7 0 136 1121 110 2 186 18 0 19.6 0 0 711 11 6 15.9 18.2 1 819 1 1 15.6 0 0 12 186 4 8.3 18.8 0 16 653 6 14.5 16.1 16.7 41 79 1 12.2 15.8 0 Total 2003-2004 Total 2005 - 2006 No. HIV Prevalen ce (%) No. HIV Prevalen ce (%) 16.2 16.1 12.7 50 148 2000 290 4 10.8 16 16.9 0 178 2050 234 2 14 16.4 12.4 0 1000 342 27 16.2 15.2 11.1 2154 262 26 16.3 12.2 7.7 2358 99 7 15.9 14.1 14.3 81 1280 8 14.8 15.9 12.5 183 2238 21 14.8 15.6 33.3 101 2354 9 15.8 15.9 0 373 323 323 228 202 728 821 1369 2442 2464 64 51 64 24 36 116 128 218 384 391 17.2 15.8 19.8 10.5 17.8 15.9 15.6 16 15.7 15.9 51 Table 13a: HIV prevalence among ANC attendees, Tamga Tanzania, 2001/02 - 2005/06 Handeni Kwamkono (Rural) Lushoto (Semi-urban) (Semi-urban) 2005 - 2006 2003-2004 Characteristics No. 2005 - 2006 2003-2004 HIV Prevalence (%) No. HIV Prevalence HIV Prevalence (%) No. 2005 - 2006 2003-2004 HIV Prevalence HIV Prevalence (%) No. No Prevalence 15-24 202 5.4 209 2.4 82 6.1 71 4.2 94 3.2 127 25-34 147 9.5 212 6.1 65 4.6 88 3.4 127 6.3 167 9.6 35-48 43 14 49 8.2 19 0 27 0 23 8.7 38 10.5 Not stated 11 9.1 5 0 2 0 1 0 2 0 3 0 Median age (yrs) 24 Agegroup (yrs) 25 25 25 26 2.4 26 Marital status Single 23 4.3 12 0 19 10.5 7 0 22 9.1 12 0 Married 379 8.2 461 4.8 149 4 179 3.4 223 4.9 320 7.2 1 0 0 0 0 0 1 0 0 0 2 0 1 0 3 0 11.8 24 8.3 51 2 84 2.4 Other Not stated Previous pregnancies 0 103 8.7 102 2.9 34 1-2 143 8.4 188 5.3 51 2 54 3.7 124 3.2 149 6.7 3-4 90 5.6 125 4 46 2.2 46 0 54 11.1 82 11 >5 54 9.3 58 6.9 30 6.7 47 4.3 11 9.1 19 5.3 Not stated 13 7.7 2 0 7 0 16 0 6 16.7 1 100 Total number tested for HIV 403 Total number HIV positive 32 475 168 8 187 246 335 13 52 Overall HIV prevalence (%) per site 7.9 4.6 4.7 3.2 5.3 6.9 53 Table 13b: HIV prevalence among ANC attendees, Tanga, Tanzania, 2001/02 - 2005/06 Magoma Makolola (Rural) 2003-2004 Ngamiani (Urban) Total Total 2003-2004 2005 - 2006 (Urban) 2005 - 2006 2003-2004 No. 15-24 68 0 53 1.9 286 4.9 336 6.3 296 16.9 220 7.7 1028 8.1 25-34 75 1.3 88 0 201 9 273 7.3 213 21.6 205 12.7 828 10.9 35-48 20 5 18 0 34 8.8 42 11.9 31 9.7 24 8.3 170 8.8 Not stated 12 0 0 0 24 4.2 7 14.3 7 14.3 7 42.9 58 5.2 Median age (yrs) 25 No. HIV Prevale nce (%) 2005 - 2006 2003-2004 HIV Prevalen ce (%) Characteristics HIV Prevalen ce (%) 2005 - 2006 No. HIV Prevalen ce (%) HIV Prevalence (%) No. HIV Prevalence (%) HIV Prevalence (%) No. HIV Prevalen ce (%) Age group (yrs) 26 24 24 24 1016 1033 198 23 4.9 7.6 7.6 17.4 166 2079 0 25 7.2 6.3 0 12 482 986 549 220 33 6.4 6.4 7.8 4.1 3 25 Marital status Single 12 0 15 6.7 63 6.3 59 8.5 83 22.9 61 9.8 222 12.6 Married 162 1.2 143 0 480 6.7 597 7 461 17.6 379 10.3 1854 8.8 1 0 0 0 0 0 0 0 3 0 1 0 2 0 2 0 3 0 16 18.8 5 0 0 13 7.7 141 2.8 184 7.6 170 16.5 75 12 534 8.6 Other Not stated Previous pregnancies 0 35 1-2 69 0 44 0 267 7.5 324 4.9 281 20.3 227 11 935 10.1 3-4 47 4.3 56 0 98 10.2 118 12.7 70 17.1 122 11.5 405 8.9 >5 23 0 45 0 19 5.3 24 8.3 18 11.1 27 0 155 7.1 Not stated 1 0 1 0 20 5 8 0 8 12.5 5 0 55 7.3 Total number tested for HIV 175 159 545 658 547 456 2084 2270 Total number HIV positive 2 1 36 47 100 48 191 147 54 Overall HIV prevalence (%) per site 1.1 0.6 6.6 7.1 18.3 10.5 6.5 9.2 55 Table 13c: HIV prevalence among ANC attendees, Tanga, Tanzania, 2001/02 - 2005/06 Handeni (Semi-urban) Characteristics Kwamkono (Rural) 2005 - 2006 2003-2004 No. HIV Prevalence (%) No. HIV Prevalence (%) Lushoto (Semi-urban) 2005 - 2006 2003-2004 No. 2005 - 2006 2003-2004 HIV Prevalence (%) No. HIV Prevalence HIV Prevalence (%) No. No . Prevalence No formal 83 6 79 1.3 48 2.1 54 1.9 14 7.1 15 6.7 Primary 308 7.8 376 5.1 118 5.9 130 3.8 216 4.6 285 6.3 > secondary 12 25 20 10 2 0 3 0 16 12.5 35 11.4 0 0 0 0 0 0 Education level Not stated Distance from residence to clinic 0-5 km 258 9.7 212 6.6 137 4.4 158 3.8 205 5.9 227 8.4 More than 5 km 140 5 260 3.1 30 6.7 26 0 40 2.5 104 2.9 5 0 3 0 1 0 3 0 1 0 4 25 < 6 months 37 8.1 9 11.1 7 0 7 28.6 18 11.1 21 4.8 > 6 months 365 7.9 466 4.5 161 5 180 2.2 223 4.9 312 7.1 Not stated 1 0 0 0 0 0 5 0 2 0 Not stated Duration living in residence Total number tested for HIV 403 475 168 187 246 335 Total number HIV positive 32 22 8 6 13 23 Overall HIV prevalence (%) per site 7.9 4.6 4.7 3.2 5.3 6.9 56 57 Table 13d: HIV prevalence among ANC attendees, Tanga, Tanzania, 2001/02 - 2005/06 Magoma (Rural) 2005 - 2006 2003-2004 No. HIV Prevalen ce (%) No formal 55 1.8 33 Primary Characteristics Makolola (Urban) No. 2005 - 2006 2003-2004 HIV Prevalence (%) No. HIV Prevalence (%) 0 72 9.7 Ngamiani (Urban) HIV Prevalence (%) 30 No. 2003-2004 Total 2005 - 2006 No. HIV Prevale nce (%) No. HIV Prevale nce (%) 6.7 17 29.4 19 0 2003-2004 No. HIV Preva lence (%) 2005 - 2006 No. HIV Preval ence (%) Education level 6.9 230 2.2 9.3 7 6.7 0 116 0.9 118 0.8 437 6.2 562 7.7 475 18.1 400 11.3 289 167 0 > secondary 3 0 8 0 34 5.9 63 3.2 51 17.6 36 8.3 118 13.6 Not stated 1 0 0 0 2 0 3 0 4 0 1 0 7 0 1871 165 4 0-5 km 96 2.1 43 2.3 494 6.7 622 7.2 422 19.4 454 10.4 161 2 9.9 1716 7.7 More than 5 km 79 0 115 0 45 6.7 31 6.5 119 15.1 2 50 453 6.8 1 0 6 0 5 0 6 0 0 0 19 0 538 16 2.6 6.3 2 0 48 6.3 76 9.2 86 19.8 53 7.5 12.8 168 8.9 8.8 9.3 2094 8 6.3 0 Distance from residence to clinic Not stated Duration living in residence < 6 months > 6 months 168 1.2 154 0.6 471 6.6 580 6.9 452 17.9 402 10.9 196 184 0 Not stated 7 0 3 0 26 7.7 2 0 9 22.2 1 0 48 Total number tested for HIV 175 Total number HIV positive 2 159 1 545 658 547 456 208 4 2270 36 47 100 456 191 147 58 Overall HIV prevalence (%) per site 1.1 0.6 6.6 7.1 18.3 10.5 6.5 9.2 59 Table 14a: HIV prevalence among ANC attendees, Kigoma, Tanzania, 2001/02 - 2005/06 Kibondo (Semi urban) 2003-2004 No. HIV Prevalence (%) 15-24 116 25-34 77 35-48 Kiganamo (Semi urban) 2005 - 2006 2003-2004 No. HIV Prevalence (%) No. 0.9 103 1.9 150 4 3.3 96 5.2 136 2.2 22 9.1 23 4.3 35 5.7 Not stated 2 50 1 0 5 0 Median age (yrs) 24 Characteristics HIV Prevalence (%) Kigoma (Urban) 2005 -2006 2003-2004 2005 -2006 HIV Prevalence (%) No. HIV Prevalence (%) 184 1.1 173 6.9 135 6.7 138 0 106 6.6 118 4.2 28 3.6 21 9.5 17 5.9 1 100 1 0 2 0 No. HIV Prevalence (%) No. Age group (yrs) 25.8 25 24.9 23 24.6 Marital status Single 7 0 9 11.1 46 2.2 56 0 30 6.7 13 7.7 Married 210 3.3 214 3.3 276 3.3 291 1.4 271 7 259 5.4 Other 0 0 0 0 2 0 0 0 0 0 0 0 Not stated Previous pregnancies 0 0 0 0 2 1 4 0 0 0 0 0 0 46 1.8 51 0 85 4.7 99 1 93 8.6 79 6.3 1-2 84 1.2 78 5.1 128 3.1 131 0.8 105 7.6 103 3.9 2-3 37 8.1 49 2 54 1.9 72 1.4 65 3.1 58 6.9 >5 38 5.3 40 7.5 44 4.6 35 2.9 36 8.3 28 3.6 Not stated 2 0 5 0 15 0 14 0 2 0 4 25 No formal 45 4.4 28 0 30 0 37 2.7 67 10.5 60 5 Primary 161 3.1 174 4 272 4 288 1 204 5.4 184 6 > secondary 10 0 20 5 22 0 25 0 3 0 28 3.6 Education level 60 Table 14a: HIV prevalence among ANC attendees, Kigoma, Tanzania, 2001/02 - 2005/06 Kibondo (Semi urban) 2003-2004 Characteristics Not stated Distance from residence to clinic 0-5 km No. HIV Prevalence (%) 0 Kiganamo (Semi urban) 2005 - 2006 2003-2004 No. HIV Prevalence (%) No. HIV Prevalence (%) 0 1 0 2 0 Kigoma (Urban) 2005 -2006 2003-2004 2005 -2006 HIV Prevalence (%) No. HIV Prevalence (%) 1 0 0 0 0 0 No. HIV Prevalence (%) No. 208 3.4 204 3.9 308 3.3 351 1.1 279 6.1 259 4.6 More than 5 km 9 0 19 0 11 9.1 0 0 20 15 12 25 Not stated Duration living in residence 0 0 0 0 7 0 0 0 2 50 1 0 < 6 months 17 0 0 0 9 11.1 0 0 25 8 1 100 > 6 months 198 3.5 217 3.7 311 3.2 346 1.2 275 6.9 268 5.2 Not stated 1 0 6 0 6 0 5 0 1 0 3 0 Total number tested for HIV Total number HIV positive Overall HIV prevalence (%) per site 217 223 326 351 301 272 7 8 11 4 21 15 3.2 3.6 3.4 1.1 7 5.5 61 Table 14b: HIV prevalence among ANC attendees, Kigoma, Tanzania, 2001/02 - 2005/06 Nyakitonto (Rural) 2003-2004 Characteristics No. Ujiji (Urban) 2005 -2006 HIV No. Prevalenc e (%) 2003-2004 HIV Prevalen ce (%) No. 2005 -2006 HIV No. Prevalen ce (%) Keza Total Total 2005 -2006 2003-2004 2005 -2006 HIV Prevalence (%) No. HIV Prevalen ce (%) No. HIV No. Prevalence (%) HIV Prevalence (%) Age group (yrs) 15-24 59 5.1 94 0 201 6 157 3.8 63 3.2 699 4.9 25-34 61 3.3 58 3.4 114 9.7 89 7.9 82 3.7 494 5.3 35-48 43 2.3 19 5.3 21 4.8 13 7.7 29 3.4 142 5.6 Not stated 0 0 0 0 6 0 1 0 0 0 14 7.1 Median age (yrs) 26 25.4 23 23.5 27.6 736 581 129 5 2.9 3.8 4.7 20 98 1345 4 4 4.1 3.3 25 0 378 494 313 234 32 2.4 2.4 5.8 4.3 3.1 250 1115 84 2 4.8 3.1 3.6 0 24 Marital status Single 11 9.1 9 11.1 34 14.7 8 0 3 33.3 128 7.1 Married 149 3.4 160 1.3 307 6.7 250 5.2 171 2.9 1213 4.9 Other 3 0 2 0 0 0 2 50 0 0 5 20 Not stated 0 0 0 0 1 0 0 0 0 0 3 0 0 25 8 46 0 106 7.6 86 3.5 17 0 365 6.3 1-2 41 4.9 52 1.9 112 8.9 88 1.1 42 2.4 470 5.3 2-3 40 2.5 32 0 59 5.1 58 17.2 44 4.5 255 3.9 >5 54 1.9 37 5.4 52 5.8 26 0 68 4.4 224 4.9 Not stated 3 0 4 0 13 0 2 0 3 0 35 0 No formal 48 0 35 0 75 6.7 47 10.6 43 7 266 5.3 Primary 114 5.3 132 2.3 253 7.1 206 3.9 131 2.3 1004 5.1 > secondary 1 0 4 0 13 7.7 7 14.3 0 0 76 5.3 Not stated 0 0 0 0 1 0 0 0 0 0 3 0 Previous pregnancies Education level Distance from residence 62 Table 14b: HIV prevalence among ANC attendees, Kigoma, Tanzania, 2001/02 - 2005/06 Nyakitonto (Rural) 2003-2004 Characteristics No. Ujiji (Urban) 2005 -2006 HIV No. Prevalenc e (%) 2003-2004 HIV Prevalen ce (%) No. 2005 -2006 HIV No. Prevalen ce (%) Keza Total Total 2005 -2006 2003-2004 2005 -2006 HIV Prevalence (%) No. HIV Prevalen ce (%) No. HIV No. Prevalence (%) HIV Prevalence (%) to clinic 0-5 km 120 3.3 171 1.8 337 7.1 260 5.4 172 2.9 1252 5 More than 5 km 38 5.3 0 0 0 0 0 0 2 50 78 7.7 Not stated 5 0 0 0 5 0 0 0 0 0 19 5.3 Duration living in residence < 6 months 5 0 0 0 32 6.3 3 0 0 0 88 5.7 > 6 months 156 3.9 170 1.8 307 7.2 254 5.5 173 3.5 1248 5.1 Not stated 2 0 1 0 3 0 3 0 1 0 13 0 Total number tested for HIV Total number HIV positive Overall HIV prevalence (%) per site 163 171 342 260 174 1349 6 3 24 14 6 69 3.7 1.8 7 5.4 3.5 1417 33 1 3.2 12.1 0 4 1428 19 25 3.4 0 1451 50 5.1 3.5 63 Table 15a: HIV prevalence among ANC attendees, Lindi, Tanzania, 2001/02 - 2005/06 Chumo 2003-2004 Characteristics No Liwale (Rural) 2005 - 2006 (%)HIV No. Prevalence 2003-2004 (%)HIV Prevalence No Nachingwea (Semi-urban) 2005 - 2006 (%)HIV No. Prevalence 2003-2004 (%)HIV Prevalence No. 2005 - 2006 (%)HIV No. Prevalence (%)HIV Prevalence Age group (yrs) 15-24 71 1.4 51 0 163 1.2 170 11.2 127 6.3 132 12.9 25-34 49 4.1 55 0 99 5.1 130 12.3 82 14.6 98 12.2 35-48 21 4.8 20 5 40 2.5 29 10.3 17 11.8 26 7.7 Not stated Median age (yrs) 0 0 2 0 0 0 2 0 1 0 3 0 24 27.2 23.5 25 23 25.2 Marital status Single 37 2.7 21 0 67 0 81 13.6 39 7.7 51 7.8 Married 103 2.9 104 1 235 3.4 244 10.2 188 10.1 206 13.1 Other 0 0 0 0 0 0 0 0 0 0 1 0 Not stated Previous pregnancies 1 0 3 0 0 0 6 33.3 0 0 1 0 0 20 0 20 0 87 1.2 79 11.4 79 6.3 76 6.6 1-2 38 2.6 37 0 105 1.9 133 12.8 94 8.5 112 15.2 3-4 32 3.1 20 0 53 7.6 60 10 37 21.6 54 14.8 >5 47 4.3 50 2 56 1.8 55 10.9 15 6.7 13 0 4 0 1 0 1 0 4 0 2 0 4 25 No formal 87 3.5 82 1.2 56 1.8 117 12.8 40 12.5 67 10.4 Primary 54 1.9 45 0 233 2.6 205 11.2 176 8.5 182 12.6 > secondary 0 0 1 0 13 7.7 7 0 11 18.2 10 10 Not stated Distance from residence to clinic 0 0 0 0 0 0 2 0 0 0 0 0 0-5 km 59 3.4 69 0 179 3.4 188 10.6 178 11.8 209 11.5 More than 5 km 79 2.5 57 1.8 122 1.6 142 12 48 2.1 48 14.6 Not stated Duration living in residence 3 0 2 0 1 0 1 100 1 0 2 0 < 6 months 6 0 7 0 15 0 3 0 32 6.3 20 5 > 6 months 134 3 118 0.8 287 2.8 324 11.7 195 10.3 238 12.6 1 0 3 0 0 0 4 0 0 0 1 0 Not stated Education level Not stated 64 Total number tested for HIV Total number HIV positive Overall HIV prevalence (%) per site 141 128 4 1 2.8 0.8 302 331 227 259 8 38 22 31 2.7 11.5 9.7 12.0 65 Table 15b: HIV prevalence among ANC attendees, Lindi, Tanzania, 2001/02 - 2005/06 Nyang’ao Ntama 2005 - 2006 Characteristics 2003-2004 HIV Preva lence (%) Sokoine (Urban) 2005 - 2006 2003-2004 HIV Preva lence (%) No. HIV Preva lence (%) Town clinic (Urban) 2005 - 2006 2003-2004 HIV Prev alen ce (%) No. HIV Preva lence (%) Total 2005 - 2006 No. HIV Prevale nce (%) 15-24 69 0 115 5.2 68 2.9 69 7.3 63 9.5 62 11.3 78 10.3 607 4.8 25-34 58 3.4 86 4.7 75 10.7 39 25.7 41 19.5 38 21.1 52 17.3 393 10.4 35-48 27 7.4 32 6.3 18 5.6 9 11.1 13 23.1 10 20 6 33.3 129 7 Not stated Median age (yrs) 0 0 0 0 4 0 2 0 0 0 3 33.3 0 0 6 16.7 No. No. No. 2005 - 2006 2003-2004 HIV Prevalen ce (%) No. HIV Prevalen ce (%) HIV Prevelen ce (%) No. Age group (yrs) 26.7 26.5 23 24.7 23 24.1 631 509 139 11 8.2 10.8 10.1 0 372 904 1 13 9.1 9.4 0 15.4 335 509 240 182 24 6.9 11.8 11.3 5.5 4.2 424 777 81 8 8.5 9.9 9.9 0 24 Marital status Single 35 2.9 44 6.8 89 5.6 11 9.9 58 15.5 37 8.1 37 10.8 235 4.7 Married 119 2.5 189 4.8 75 8 108 13.9 58 13.8 76 19.7 98 15.3 899 7.7 Other 0 0 0 0 0 0 0 0 0 0 0 0 0 0 Not stated Previous pregnancies 0 0 0 0 1 0 0 0 1 0 1 0 1 0 0 36 0 69 4.4 31 9.7 40 5 38 5.3 35 5.7 55 7.3 330 3.9 1-2 62 3.2 84 6 55 5.5 54 16.7 49 24.5 57 15.8 61 14.8 432 7.8 3-4 30 6.7 49 6.1 40 7.5 13 15.4 19 10.5 10 40 17 35.3 194 11.3 >5 26 0 24 0 27 7.4 6 16.7 8 12.5 8 25 3 0 156 4.5 Not stated Education level 0 0 7 14.3 12 0 6 33.3 3 0 3 33.3 0 0 23 17.4 No formal 57 1.8 66 4.5 48 8.3 27 11.1 36 16.7 19 21.1 17 11.8 295 6.4 Primary 87 3.4 155 5.8 105 6.7 70 15.7 62 14.5 17 16.5 91 13.2 767 7.2 > secondary 10 0 12 0 7 0 22 9.1 18 11.1 15 6.7 28 17.9 73 8.2 Not stated 0 0 0 0 5 0 0 0 1 0 0 0 0 0 0 0 66 Table 15b: HIV prevalence among ANC attendees, Lindi, Tanzania, 2001/02 - 2005/06 Nyang’ao Ntama 2005 - 2006 Characteristics 2003-2004 HIV Preva lence (%) Sokoine (Urban) 2005 - 2006 2003-2004 HIV Preva lence (%) No. HIV Preva lence (%) Town clinic (Urban) 2005 - 2006 2003-2004 No. HIV Prev alen ce (%) No. HIV Preva lence (%) Total 2005 - 2006 2005 - 2006 2003-2004 No. HIV Prevale nce (%) 0-5 km More than 5 km 95 2.1 130 4.6 146 6.8 113 13.2 98 15.3 111 16.2 135 14.1 770 8.8 940 9.6 58 3.4 103 5.8 18 5.6 4 25 19 10.5 1 0 0 0 357 3.4 Not stated Duration living in residence 1 0 0 0 1 0 2 0 0 0 1 0 1 0 8 0 342 8 8.8 12.5 < 6 months 6 0 9 0 4 0 12 0 9 11.1 22 4.6 17 0 96 3.1 > 6 months 147 2.7 223 5.4 151 7.3 94 13.8 107 15 91 18.7 117 16.2 124 7.2 Not stated 1 0 1 0 10 0 13 23.1 1 0 0 0 2 0 15 20 66 1202 22 3 9.9 0 No. No. HIV Prevalen ce (%) No. HIV Prevalen ce (%) HIV Prevelen ce (%) No. Distance from residence to clinic Total number tested for HIV Total number HIV positive Overall HIV prevalence (%) per site 154 4 2.6 233 165 119 117 113 136 1135 12 11 16 17 18 19 80 5.2 6.7 13.5 14.5 15.9 14 1290 121 9.4 7.1 67 Table 16a: HIV prevalence among ANC attendees, Morogoro, Tanzania, 2001/02 - 2005/06 Gairo Characteristics Hembeti (Rural) 2005 - 2006 HIV Preva lence No. (%) 2003-2004 Mkuyuni (Rural) 2005 - 2006 No HIV Prevale nce (%) No. HIV Prevale nce (%) 2003-2004 HIV Preva lence No. (%) Morogoro RCH (Urban) 2005 - 2006 2003-2004 No. HIV Prevale nce (%) 2005 - 2006 No. HIV Prevalenc e (%) No. HIV Prevalence (%) Age group (yrs) 15-24 341 3.2 54 1.9 50 2 83 0 82 0 264 9.9 368 6 25-34 243 5.8 30 3.3 29 6.9 71 1 74 0 235 14 301 9.3 35-48 58 13.8 14 0 10 10 19 2 22 4.5 38 10.5 59 11.9 5 0 1 0 1 0 0 0 0 0 22 4.6 0 0 Not stated Median age (yrs) 24.5 24 24.6 25 25.7 25 25.1 Marital status Single 93 7.5 13 0 12 8.3 17 0 27 0 62 14.5 124 10.5 Married 544 4.6 85 2.4 78 3.8 155 1.9 151 0.7 496 10.9 604 7.3 0 0 0 0 0 0 1 0 0 0 1 100 0 0 10 10 1 0 0 0 0 0 0 0 0 0 0 0 0 112 5 22 0 14 0 37 0 24 0 176 9.1 246 5.3 1-2 252 4.8 40 5 36 5.6 65 0 70 0 262 11.5 342 9.9 2-3 149 6 15 0 20 0 47 0 45 0 92 14.1 116 7.8 >5 74 7 20 0 16 6.3 23 13 28 3.6 11 18.2 23 4.3 Not stated 60 3 2 0 4 25 1 0 1 0 18 16.7 1 0 No formal 289 2.8 38 0 34 5.9 87 2.3 70 1.4 33 18.2 64 4.7 Primary 345 7 58 3.5 56 3.6 86 1.2 107 0 451 10.4 513 8 10 10 3 0 0 0 0 0 1 0 74 13.5 151 8.6 3 0 1 0 0 0 0 0 0 0 1 100 0 0 Other Not stated Previous pregnancies Education level > secondary Not stated 68 Table 16a: HIV prevalence among ANC attendees, Morogoro, Tanzania, 2001/02 - 2005/06 Gairo Characteristics Ditance from residence to clinic 0-5 km More than 5 km Hembeti (Rural) 2005 - 2006 HIV Preva lence No. (%) 2003-2004 Mkuyuni (Rural) 2005 - 2006 No HIV Prevale nce (%) No. HIV Prevale nce (%) 2003-2004 HIV Preva lence No. (%) Morogoro RCH (Urban) 2005 - 2006 2003-2004 No. HIV Prevale nce (%) 2005 - 2006 No. HIV Prevalenc e (%) No. HIV Prevalence (%) 606 5 83 2.4 87 4.6 137 2.2 161 0.6 532 11.1 684 8.2 38 7.9 13 0 3 0 35 0 17 0 26 19.2 41 2.4 Not stated Duration living in residence 3 0 3 0 0 0 1 0 0 0 1 0 3 0 < 6 months 3 0 1 0 2 50 6 0 5 0 0 0 112 7.1 > 6 months 639 5 96 2.1 87 3.4 167 1.8 173 0.6 543 11.1 616 8 5 20 2 0 1 0 173 1.7 0 0 16 25 0 0 Not stated Total number tested for HIV Total number HIV positive Overall HIV prevalence (%) per site 647 33 5.1 99 90 173 178 559 728 2 4 3 1 64 57 2.1 4.4 1.7 0.6 11.5 7.8 69 Table 16b: HIV prevalence among ANC attendees, Morogoro, Tanzania, 2001/02 - 2005/06 St. Francis Turiani 2005 - 2006 2005 - 2006 Characteristics Uhuru (Urban) 2003-2004 No. HIV Prevalence (%) No. Total 2005 - 2006 HIV Prevalence (%) No. 2003-2004 HIV Prevalence (%) No. HIV Prevalence (%) 2005 - 2006 No. HIV Prevalence (%) Age group (yrs) 15-24 232 6.5 67 4.5 480 7.7 275 8 881 7.3 25-34 125 9.7 65 4.6 273 12.8 213 15.5 609 11.5 35-48 27 14.8 20 0 44 13.6 40 17.5 115 10.4 4 0 5 0 2 0 5 0 25 4 Not stated Median age (yrs) 24.3 25.8 23 24.8 1415 1080 236 20 52 8.8 11.9 0 447 2289 0 15 8.1 7 0 6.7 724 1217 517 207 86 5.4 8.3 7.5 6.3 5.8 584 1897 263 7 3.6 8.1 8.4 14.3 24 Marital status Single 112 4.5 12 8.3 127 11.8 67 13.4 219 11 Married 303 9.6 145 3.4 670 9.4 464 11.4 1406 8.7 Other 0 0 0 0 0 0 0 0 1 0 Not stated 3 0 0 0 2 0 2 0 4 25 0 136 6.6 30 3.3 287 5.9 152 7.2 522 6.3 1-2 187 7.5 59 8.5 365 12.6 271 12.5 732 10.7 2-3 61 11.5 46 0 102 9.8 80 17.5 256 9 >5 25 8 20 0 30 10 21 14.3 84 9.5 Not stated 9 22.2 2 0 15 13.3 9 0 36 13.9 No formal 47 2.1 25 4 99 9.1 55 9.1 257 6.6 Primary 343 8.7 123 4.1 648 9.7 410 12.4 1243 9.1 > secondary 25 8 9 0 51 11.8 67 9 127 12.6 Not stated 3 33.3 0 0 1 0 1 0 3 33.3 Previous pregnancies Education level 70 Table 16b: HIV prevalence among ANC attendees, Morogoro, Tanzania, 2001/02 - 2005/06 St. Francis Turiani 2005 - 2006 2005 - 2006 Characteristics Uhuru (Urban) No. HIV Prevalence (%) 2003-2004 No. HIV Prevalence (%) Total 2005 - 2006 2003-2004 No. HIV Prevalence (%) No. HIV Prevalence (%) 2005 - 2006 No. HIV Prevalence (%) Distance from residence to clinic 0-5 km 398 8 157 3.8 796 9.8 527 11.6 1548 9.2 More than 5 km 12 16.7 0 0 2 0 1 0 76 6.6 Not stated 8 0 0 0 1 0 5 20 6 0 < 6 months 27 3.7 0 0 0 0 11 0 7 0 > 6 months 386 8.3 155 3.9 796 9.8 516 11 1602 8.9 Not stated 5 20 2 0 3 0 6 16.7 21 9.1 2620 112 19 7.3 5.4 5.3 160 2572 19 6.3 7.2 15.8 Duration living in residence Total number tested for HIV Total number HIV positive Overall HIV prevalence (%) per site 418 157 799 533 1630 34 6 78 62 147 8.1 3.8 9.8 11.6 2751 197 7.2 9 71 Table 17: HIV prevalence among ANC attendees, Arusha,Tanzania,2005/06 Characteristics Kaloleni Karatu HC Mbuguni Monduli Ngarenaro Olsambu Total 2005/2006 2005/2006 2005/2006 2005/2006 2005/2006 2005/2006 2005/2006 Number Tested HIV Prevalen ce (%) Number Tested HIV Prevalenc e (%) Number Tested HIV Prevale nce (%) Number Tested HIV Prevale nce (%) Numb er Tested HIV Preval ence (%) 15-24 356 5.9 107 3.7 61 4.9 118 3.4 750 5.5 25-34 409 8.6 125 3.2 68 10.3 81 4.9 554 35-49 54 11.1 30 0.0 17 5.9 20 0.0 Not stated 6 16.7 1 0.0 3 33.3 6 Single 127 1.6 26 3.8 10 7.2 Married 697 8.8 237 3.0 139 20.0 HIV Prevalence (%) Number Tested HIV Prevalence (%) 97 3.1 1,489 5.1 7.6 77 0.0 1,314 7.0 55 10.9 13 0.0 189 6.9 0.0 1 0.0 17 11.8 15 13.3 118 3.4 4 25.0 300 4.0 209 2.9 1238 6.9 182 1.1 2,702 6.3 Number Tested Age group (yrs) Median age (yrs) Marital status - Other Not stated Previous pregnancies 1 0.0 0 37 5.4 1-2 514 7.0 118 3-4 203 9.9 >5 40 Not stated 31 1 0.0 4 0.0 1 0.0 7 0.0 10 0.0 63 1.6 3 0.0 58 3.4 171 2.9 3.4 65 10.8 98 6.1 901 6.1 60 1.7 1,756 6.2 83 4.8 47 8.5 28 0.0 381 7.1 46 0.0 788 7.0 12.5 58 0.0 25 4.0 28 3.6 56 10.7 16 0.0 223 5.8 0.0 4 0.0 2 0.0 8 0.0 19 5.3 0.0 1.4 72 Table 17: HIV prevalence among ANC attendees, Arusha,Tanzania,2005/06 Characteristics Kaloleni Karatu HC Mbuguni Monduli Ngarenaro Olsambu Total 2005/2006 2005/2006 2005/2006 2005/2006 2005/2006 2005/2006 2005/2006 Number Tested HIV Prevalen ce (%) Number Tested HIV Prevalenc e (%) Number Tested HIV Prevale nce (%) Number Tested HIV Prevale nce (%) Numb er Tested HIV Preval ence (%) Number Tested HIV Prevalence (%) 7 Number Tested HIV Prevalence (%) 71 Education level 32 9.4 1 0.0 3 0.0 83 2.4 32 3.1 116 0.0 267 2.2 7.0 244 3.3 144 8.3 127 3.9 1234 6.7 69 4.3 2,446 6.3 > secondary 9.8 17 0.0 2 0.0 15 6.7 92 4.3 2 0.0 292 7.2 Not stated 1 Distance from residence to clinic 778 0-5 km 45 More than 5 km 2 Not stated Duration living in residence 0.0 1 0.0 2 50.0 4 25.0 7.6 172 4.1 121 8.3 154 5.2 1314 6.8 124 2.4 2,663 6.6 8.9 90 1.1 28 7.1 68 0.0 44 0.0 63 0.0 338 2.1 0.0 1 0.0 3 0.0 2 0.0 8 0.0 1 0.0 2,971 6.1 37 8.1 No formal 628 Primary 164 < 6 months 1 0.0 814 > 6 months 7.6 262 2.7 139 7.9 219 3.7 1350 6.6 9.1 1 100.0 9 11.1 6 0.0 10 0.0 187 1.6 11 Not stated Total number tested for HIV Total number HIV positive Overall HIV prevalence (%) per site 825 263 149 225 1360 8 12 8 89 187 3,009 63 7.6 3.0 8.1 3.6 3 6.5 1.6 6.1 73 Table 18: HIV prevalence among ANC attendees, Iringa,Tanzania,2005/06 Characteristics Iringa Kasanga Mafinga Matamba Ngome Njombe Total 2005/2006 2005/2006 2005/2006 2005/2006 2005/2006 2005/2006 2005/2006 Number Tested HIV Prevalence (%) Number Tested HIV Prevalence (%) Number Tested HIV Prevalen ce (%) Number Tested HIV Prevale nce (%) Number Tested HIV Prevale nce (%) Number Tested HIV Prevalen ce (%) Number Tested HIV Prevalen ce (%) - Age group (yrs) 15-24 245 14.7 54 20.4 200 18.0 50 6.0 102 14.7 197 15.7 848 15.6 25-34 208 21.6 39 15.4 118 22.0 41 12.2 88 17.0 135 31.9 629 22.3 35-49 19 15.8 16 12.5 21 19.0 6 0.0 10 10.0 14 7.1 86 12.8 Not stated 20 30.0 1 0.0 13 23.1 1 0.0 1 0.0 11 9.1 47 21.3 Single 85 18.8 11 18.2 53 11.3 7 28.6 31 19.4 54 18.5 241 17.4 Married 407 18.2 99 17.2 296 20.6 91 6.6 170 14.7 300 22.0 1,363 18.3 2 0.0 2 50.0 1 0.0 4 0.0 Median age (yrs) Marital status Other Not stated 3 66.7 Previous pregnancies - 0 73 13.7 25 20.0 111 11.7 23 4.3 62 9.7 15 20.0 309 12.3 1-2 282 15.6 44 11.4 153 21.6 40 10.0 82 19.5 151 23.2 752 18.2 3-4 97 28.9 28 21.4 44 38.6 26 7.7 32 21.9 34 32.4 261 27.2 >5 22 13.6 11 27.3 20 20.0 8 12.5 7 0.0 6 33.3 74 17.2 Not stated 18 27.8 2 0.0 24 8.3 1 0.0 18 11.1 16.6 15.9 74 Table 18: HIV prevalence among ANC attendees, Iringa,Tanzania,2005/06 Characteristics Iringa Kasanga Mafinga Matamba Ngome Njombe Total 2005/2006 2005/2006 2005/2006 2005/2006 2005/2006 2005/2006 2005/2006 Number Tested HIV Prevalence (%) Number Tested HIV Prevalence (%) Number Tested HIV Prevalen ce (%) Number Tested HIV Prevale nce (%) Number Tested HIV Prevale nce (%) Number Tested HIV Prevalen ce (%) 151 Number Tested HIV Prevalen ce (%) 214 Education level No formal Primary > secondary 14 35.7 24 33.3 384 17.7 80 12.5 94 18.1 5 20.0 1 0.0 Not stated Distance from residence to clinic 0-5 km More than 5 km 477 18.4 93 15.1 12 16.7 15 33.3 3 0.0 2 0.0 Not stated Duration living in residence 12 302 33 5 336 11 5 4 86 7 1 16.7 21.5 6.1 0.0 96 2 19.6 9.1 5 158 36 2 25.0 7.0 14.3 0.0 195 6 7.3 50.0 > 6 months Not stated Total number tested for HIV Total number HIV positive Overall HIV prevalence (%) per site 18.3 95 17.9 1 0.0 15 13.3 492 343 9 90 8 19.5 22.2 352 110 14.6 22.2 0.0 329 26 2 15.9 0.0 40.0 1 194 6 < 6 months 491 18 300 38 1 0.0 6.7 25.0 98 27.8 21.0 21.1 0.0 21.9 15.4 0.0 0.0 340 17 15.5 16.7 201 21.5 17.6 357 77 1,310 213 10 1,526 72 12 1 1,553 56 - 27.3 17.9 17.4 0.0 18.2 18.1 16.7 0.0 18.2 17.9 1,610 90 69 19 18.3 17.3 8 19.6 31 8.2 76 15.4 293 21.3 18.2 75 Table 19: HIV prevalence among ANC attendees, Mara,Tanzania,2005/06 Characteristics Bweri Mugumu Murangi Nyasho Tarime Utegi Total 2005/2006 2005/2006 2005/2006 2005/2006 2005/2006 2005/2006 2005/2006 Number Tested HIV Prevalence (%) Number Tested HIV Prevalence (%) 15-24 72 25-34 35-49 Number Tested HIV Prevalen ce (%) 0.0 160 1.9 128 56 10.7 116 4.3 13 0.0 26 Numb er Tested HIV Prevalence (%) HIV Prevale nce (%) Number Tested HIV Prevale nce (%) Number Tested HIV Prevalence (%) 2.3 237 11.0 310 5.5 107 11.2 1,014 6.0 136 3.7 157 11.5 212 4.7 51 11.8 728 6.9 3.8 30 0.0 28 21.4 37 5.4 21 0.0 155 5.8 2 0.0 2 50.0 8 12.5 4 0.0 1 0.0 17 - 11.8 Number Tested Age group (yrs) Not stated Median age (yrs) Marital status Single 18 16.7 22 0.0 18 5.6 62 8.1 8 0.0 8 62.5 136 10.3 Married 120 2.5 278 3.2 277 2.9 362 12.4 547 5.3 164 7.9 1,748 6.1 Other 2 0.0 0 0.0 1 0.0 1 0.0 4 0.0 Not stated Previous pregnancies 1 0.0 4 0.0 7 0.0 26 3.8 0 29 0.0 56 1.8 33 6.1 83 3.6 121 5.0 29 13.8 351 4.6 1-2 52 3.8 112 5.4 98 1.0 178 17.4 180 6.1 62 8.1 682 8.2 3-4 32 12.5 67 1.5 79 5.1 107 9.3 144 5.6 38 13.2 467 6.9 >5 28 0.0 67 1.5 84 1.2 45 13.3 103 3.9 39 5.1 0.0 2 50.0 17 5.9 15 0.0 366 48 3.8 2 Not stated 6 16.7 8 0.0 - 16.7 76 8.3 Table 19: HIV prevalence among ANC attendees, Mara,Tanzania,2005/06 Characteristics Bweri Mugumu Murangi Nyasho Tarime Utegi Total 2005/2006 2005/2006 2005/2006 2005/2006 2005/2006 2005/2006 2005/2006 Number Tested HIV Prevalence (%) Number Tested HIV Prevalence (%) Number Tested HIV Prevalen ce (%) Number Tested HIV Prevale nce (%) Number Tested HIV Prevalence (%) Numb er Tested HIV Prevalence (%) Number Tested HIV Prevale nce (%) 12 33.3 167 1,603 140 4 4.2 6.3 9.3 25 10.4 17.4 0.0 1,445 460 9 6.2 7.0 0.0 Education level 8 0.0 46 4.3 120 4.2 233 2.6 13 7.7 24 4.2 1 0.0 No formal Primary > secondary Not stated Distance from residence to clinic 0-5 km 141 4.3 218 More than 5 km 84 Not stated Duration living in residence 2 < 6 months 10 0.0 9 > 6 months 131 4.6 295 13 278 5 2.8 3.6 0.0 11.1 2.7 11 368 48 3 0.0 3.2 0.0 247 48 1 3.6 0.0 0.0 336 92 2 3 293 0.0 3.1 76 353 1 Not stated Total number tested for HIV Total number HIV positive Overall HIV prevalence (%) per site 82 433 48 18.2 11.7 10.4 5.3 13.3 0.0 2.4 4.8 12.5 7 171 2 341 218 4 5.3 5.0 0.0 162 18 51 512 3.9 5.3 10 170 14.3 9.9 0.0 9.9 11.1 10.0 10 159 1,754 1 5.0 6.5 0.0 141 296 304 9 9 6 4.3 430 3.0 563 51 3.0 180 29 11.9 1,914 18 5.2 122 10.0 6.4 77 Table 20: HIV prevalence among ANC attendees, Shinyanga,Tanzania,2005/06 Characteristics Kahama Kambarage Nindo Nkololo Shinyanga Ushirombo Total 2005/2006 2005/2006 2005/2006 2005/2006 2005/2006 2005/2006 2005/2006 Number Tested HIV Prevalence (%) Number Tested HIV Prevalence (%) Number Tested HIV Prevalen ce (%) Number Tested HIV Preval ence (%) Number Tested HIV Prevalen ce (%) Number Tested HIV Prevalen ce (%) Numb er Tested HIV Prevalence (%) - Age group (yrs) 15-24 346 6.6 151 7.9 229 2.6 250 1.6 93 12.9 330 7.3 1,399 5.8 25-34 241 10.4 100 15.0 154 5.2 219 1.8 66 10.6 180 10.6 960 8.1 35-49 43 18.6 21 19.0 42 2.4 49 0.0 6 16.7 34 2.9 195 7.7 Not stated 2 0.0 1 0.0 4 0.0 4 0.0 1 0.0 4 0.0 16 0.0 Single 64 10.9 27 11.1 13 0.0 6 0.0 28 3.6 7 0.0 145 7.6 Married 561 8.7 243 11.5 416 3.6 513 1.6 136 14.0 537 8.3 2,406 6.8 Other 1 0.0 3 0.0 2 0.0 6 0.0 Not stated 6 0.0 0 165 5.5 80 6.3 87 1-2 282 9.2 118 15.3 3-4 117 11.1 55 >5 55 14.5 Not stated 13 0.0 Median age (yrs) Marital status 4 0.0 13 0.0 2.0 177 7.9 648 5.1 77 19.5 178 8.4 998 8.2 1.9 32 12.5 110 8.2 526 7.0 126 0.8 7 0.0 7.5 0.0 1 0.0 373 25 5.9 4 80 3 3 0.0 3.4 90 1.1 49 149 2.7 194 2.1 7.3 104 4.8 108 19 21.1 86 3.5 1 0.0 3 0.0 Previous pregnancies 0.0 0.0 78 Table 20: HIV prevalence among ANC attendees, Shinyanga,Tanzania,2005/06 Characteristics Kahama Kambarage Nindo Nkololo Shinyanga Ushirombo Total 2005/2006 2005/2006 2005/2006 2005/2006 2005/2006 2005/2006 2005/2006 Number Tested HIV Prevalen ce (%) HIV Preval ence (%) HIV Prevalence (%) Number Tested HIV Prevalence (%) 5.9 23 0.0 248 4.8 354 2.0 12 16.7 140 10.0 828 4.6 9.3 213 12.2 180 1.7 164 0.6 130 13.8 397 7.1 1,619 7.8 6.5 37 13.5 1 0.0 2 0.0 23 0.0 10 20.0 119 8.4 2 0.0 1 0.0 1 0.0 4 0.0 165 11.5 296 8.4 1,753 7.5 246 7.7 801 5.1 6 0.0 16 12.5 Number Tested Number Tested Number Tested HIV Prevalen ce (%) Number Tested HIV Prevalen ce (%) Numb er Tested HIV Prevalence (%) Education level 51 No formal 535 Primary 46 > secondary Not stated Distance from residence to clinic 523 0-5 km 9.2 105 More than 5 km 7.6 4 Not stated 0.0 Duration living in residence 53 < 6 months 9.4 579 > 6 months 8.8 250 11.6 324 2.5 195 1.0 22 4.5 103 6.8 325 1.8 1 100.0 2 0.0 2 0.0 1 50 10.0 11 9.1 7 0.0 33 6.1 49 8.2 203 8.4 223 11.7 418 3.3 511 1.6 132 13.6 498 8.0 2,361 6.6 4 0.0 1 0.0 1 0.0 6 0.0 Not stated Total number tested for HIV Total number HIV positive Overall HIV prevalence (%) per site 100.0 632 429 273 522 166 548 2,570 56 15 31 8.9 11.4 8 3.5 20 1.5 44 12.0 174 8.0 6.8 79 Table 22:. HIV prevalence among ANC attendees, Tabora,Tanzania,2005/06 Characteristics 1 Ilolangulu Isevya Nzega Songambele Town Clinic Total 2005/2006 2005/2006 2005/2006 2005/2006 2005/2006 2005/2006 2005/2006 Number Tested HIV Prevalence (%) Number Tested HIV Prevalence (%) Number Tested HIV Prevalence (%) Number Tested HIV Prevalence (%) Number Tested HIV Prevalence (%) 15-24 130 5.4 90 2.2 138 11.6 217 6.5 112 1.8 204 9.3 891 6.7 25-34 103 6.8 56 8.9 105 16.2 144 4.9 80 0.0 142 12.0 630 8.4 35-49 27 3.7 20 0.0 18 5.6 34 2.9 13 0.0 32 15.6 144 5.6 Not stated Median age (yrs) Marital status 2 0.0 3 0.0 2 0.0 6 0.0 3 0.0 2 0.0 Single 9 22.2 13 7.7 36 11.1 53 9.4 6 16.7 17 5.9 134 10.4 Married 251 5.2 156 3.8 225 13.3 347 4.9 199 0.5 362 11.0 1,540 6.9 Other Not stated Previous pregnancies 1 0.0 2 0.0 0.0 0.0 0.0 0.0 1 2 1 2 0 71 5.6 31 0.0 74 12.2 97 4.1 29 0.0 110 8.2 412 6.3 1-2 74 6.8 59 1.7 107 12.1 141 7.8 82 2.4 146 13.0 609 8.4 3-4 58 5.2 33 12.1 56 19.6 86 7.0 39 0.0 78 11.5 350 9.4 >5 55 5.5 42 4.8 24 4.2 43 2.3 53 0.0 42 7.1 259 3.9 Not stated 4 0.0 4 0.0 2 0.0 34 0.0 5 0.0 4 25.0 Number Tested HIV Prevalence (%) Number Tested HIV Prevalence (%) Age group (yrs) 18 3 6 53 0.0 0.0 0.0 1.9 80 Table 22:. HIV prevalence among ANC attendees, Tabora,Tanzania,2005/06 Characteristics 1 Ilolangulu Isevya Nzega Songambele Town Clinic Total 2005/2006 2005/2006 2005/2006 2005/2006 2005/2006 2005/2006 2005/2006 Number Tested HIV Prevalence (%) Number Tested HIV Prevalence (%) No formal 100 9.0 58 3.4 36 13.9 117 6.8 157 0.6 24 0.0 492 5.1 Primary > secondary Not stated 154 6 2 3.9 0.0 0.0 108 3 4.6 0.0 210 16 1 13.3 6.3 0.0 257 25 2 5.1 4.0 0.0 51 2.0 331 24 1 11.2 16.7 0.0 1,111 74 6 - 8.1 8.1 0.0 262 13.0 299 6.0 23 4.3 377 10.6 1,174 9.1 0.0 97 5 3.1 20.0 182 3 0.5 0.0 2 1 50.0 0.0 492 17 2.6 5.9 13.0 0.0 2 395 4 0.0 13.0 0.0 3 1,663 17 - 0.0 7.3 0.0 Number Tested HIV Prevalence (%) Number Tested HIV Prevalence (%) Number Tested HIV Prevalence (%) Number Tested HIV Prevalence (%) Number Tested HIV Prevalence (%) Education level Distance from residence to clinic 0-5 km More than 5 km Not stated 93 9.7 120 4.2 165 4 3.6 0.0 46 3 4.3 0.0 1 168 0.0 4.2 1 Duration living in residence < 6 months > 6 months Not stated 259 3 Total number tested for HIV 262 Total number HIV positive Overall HIV prevalence (%) per site 15 5.8 0.0 262 1 263 169 5.7 401 34 7 4.1 203 5 208 22 12.9 376 4 1.0 0.0 380 2 5.5 10.9 0.0 1,683 41 1.0 12110.8 7.2 81 Table 22: Prevalence of Syphilis by site and age group Age 25 – 34 15 – 24 # Syphilis Prevalence (%) # 35 - 49 Syphilis Prevalen ce (%) Syphilis Prevale nce (%) Not stated Number Prevela nce (%) Numb er Dar es Salaam Buguruni Kasorobo Kigamboni Kimara Kiwalani Oysterbay Total Dodoma Bahi Handali Kibaigwa Makole Mpwapwa Wajenzi Total Kagera Bukoba Katoro Kimeya Nkwenda Nyamiyaga Rwamishenye Total Kigoma Keza Kibondo Kiganamo Kigoma Nyakitonto Ujiji Total HIV Serostatus Negative Positive Syphilis Prevale nce (%) Number Syphilis Prevalen ce (%) Number No formal education Syphilis Prevale nce (%) Number Syphilis Prevalence 840 332 456 351 462 501 2942 0.4 4.5 0.4 21.1 20.8 2.6 6.9 69 24 68 59 63 67 350 0 0 0 23.7 30.2 6 10.6 0.6 5 1 21.3 20.7 4.4 7.4 366 172 233 186 218 233 1408 0 4.1 0.4 18.3 23.9 0.9 6.8 46 21 38 24 40 25 194 0 4.8 0 41.7 12.5 0 8.2 1 1 3 2 1 1 9 0 0 0 50 100 0 22.2 837 356 504 392 499 539 3127 0.2 5.1 0.6 20.9 21.4 3 7.3 116 40 66 41 59 61 383 0.9 0 1.5 24.4 22 1.6 6.8 116 91 156 243 108 236 950 3.4 28.6 1.9 6.2 13 23.7 12.4 96 76 88 191 71 166 688 1 30.3 1.1 6.3 4.2 25.3 11.9 45 40 29 29 24 30 197 6.7 12.5 0 10.3 4.2 20 9.1 1 2 1 1 7 3 15 0 50 0 0 14.3 33.3 20 253 206 251 420 198 410 1738 3.2 26.7 1.2 7.1 9.1 23.7 12.1 5 3 23 44 12 25 112 0 0 4.3 0 8.3 32 8.9 129 99 99 46 50 122 545 3.9 26.3 1 10.9 18 22.1 13.4 127 107 173 341 138 269 1155 2.4 26.2 1.7 5.6 7.2 23.8 11 2 2 2 77 15 43 141 0 50 0 7.8 0 32.6 14.9 248 113 124 255 104 171 1015 6.5 13.3 12.1 3.5 11.5 3.5 7.2 215 115 121 180 104 108 843 6.5 14.8 13.2 8.3 10.6 6.5 9.5 51 32 17 49 24 13 186 5.9 18.8 11.8 2 8.3 0 7.5 0 3 0 7 3 2 16 0 33.3 0 0 0 0 6.3 484 253 249 477 228 272 1963 6.4 14.6 12.4 5.2 10.5 2.9 7.9 30 10 14 6.7 20 14.3 14.3 18.2 16.5 2.5 7.8 15.4 9.9 454 214 141 321 160 231 1521 6.6 14.5 9.2 6.2 12.5 3.9 8.1 46 3 1 9 11 50 120 2.2 0 0 11.1 0 4 3.3 63 98 184 134 93 155 727 9.5 1 0.5 0 1.1 0 1.2 81 89 138 117 56 85 566 23.5 4.5 0 0 1.8 0 4.2 29 22 28 17 19 13 128 17.2 0 0 0 0 0 3.9 0 1 1 2 0 1 5 0 0 0 0 0 0 0 11.6 0 0 0 2.9 4.6 2.4 130 163 288 183 129 201 1094 19.2 3.1 0.3 0 0.8 0 2.9 0 19 25 28 4 7 83 0 0 0 0 0 0 0 18 2 0.3 0 0.6 0 2.6 14 7 22 97 0 14.3 22.7 12.4 14 44 121 160 64 13 416 6 8 4 15 3 13 49 0 12.5 0 0 33.3 0 4.1 43 27 37 59 35 46 247 0 7.5 4.4 17.4 15.2 0 6.5 Numbe r Numb er Syphili s Preval ence (%) 540 202 296 221 299 341 1899 167 202 347 255 165 241 1377 44 40 45 23 33 32 217 Level of Education Primary Secondary and abo 82 Kilimanjaro Hedaru Huruma Majengo Masama Pasua Umbwe Total 131 55 164 60 172 41 623 0.8 1.8 0 0 0.6 0 0.5 142 70 139 72 140 45 608 0.7 0 0 0 0 4.4 0.5 31 35 21 21 27 21 156 0 0 0 0 0 0 0 0 6 3 2 3 0 16 0 0 0 0 0 0 0 284 161 305 150 331 102 1333 0.7 0.6 0 0 0.3 2 0.5 Chumo Mtama Liwale Nachingwea Nyangao Sokoine Town Clinic Total 48 69 170 131 67 60 75 620 0 1.4 2.4 2.3 4.5 8.3 1.3 2.7 54 58 127 96 74 36 49 494 3.7 10.3 3.1 4.2 14.9 13.9 10.2 7.5 19 27 28 26 17 13 6 136 0 11.1 3.6 3.8 11.8 0 0 5.1 2 0 2 3 4 0 0 11 0 0 0 33.3 0 0 0 9.1 122 150 290 227 151 93 111 1144 0.6 6.7 3.1 3.5 7.9 7.5 5.4 4.7 Chimala Igamba Ilembo Kiwanjampaka Kyela Ruanda Total 104 122 94 366 198 452 1336 3.8 2.5 2.1 2.5 2.5 2.7 129 64 72 268 111 315 959 4.7 3.1 0 3 7.2 2.9 3.4 31 16 9 38 12 41 147 3.2 6.3 0 2.6 0 4.9 3.4 2 0 2 2 2 13 21 0 0 0 0 0 7.7 4.8 208 166 168 578 259 693 2072 Gairo Hembeti Mukuyuni Morogoro Uhuru St. Francis Turiani Total 341 50 82 365 274 231 67 1410 15.2 22.2 4.1 3.3 9.4 2.6 4.6 7.7 58 10 22 58 40 27 20 235 13.8 30 4.5 0 10 0 0 6.8 5 1 0 0 5 4 5 20 20 100 0 0 0 0 0 10 614 3.3 4.7 0.9 0 5.5 243 27 74 300 213 155 65 1077 Ligula Likombe Mangaka Mkunya Nanyamba Tandahimba 167 73 153 72 58 79 2.4 2.7 3.9 2.8 3.4 1.3 144 51 130 81 50 77 6.3 7.8 8.5 6.2 12 1.3 26 17 47 22 17 25 11.5 5.9 6.4 4.5 0 0 2 2 2 1 5 1 50 0 0 0 0 0 312 129 314 168 127 171 22 5 22 5 11 5 70 0 0 0 0 0 0 0 44 2 5 1 5 2 59 0 0 0 0 0 0 0 252 155 282 138 291 101 1219 0.8 0.6 0 0 0.3 2 0.5 10 9 39 16 46 4 124 0 0 0 0 0 0 0 1 4 37 29 11 16 19 117 0 0 0 3.4 36.4 18.8 0 6.8 78 57 115 67 46 33 15 411 2.6 3.5 1.7 7.5 4.3 12.1 0 4.1 44 87 203 179 104 58 89 764 0 6.9 3.4 2.2 12.5 6.9 5.6 5.1 1 10 7 10 7 17 26 78 0 20 0 0 0 5.9 3.8 5.1 2.9 3 0 2.2 2.3 2.6 2.3 58 36 9 96 64 128 391 8.6 2.8 22.2 5.2 10.9 4.7 6.6 49 9 32 42 1 45 178 4.1 11.1 0 4.8 0 4.4 3.9 205 189 144 539 298 674 2049 4.4 2.6 1.4 3 4 2.8 3.1 12 3 1 93 23 102 234 0 0 0 0 4.3 2.9 1.7 12.5 15.3 6.8 3.1 7 1.3 1.3 6.4 33 3 1 56 62 34 6 195 21.2 33.3 0 1.8 6.5 2.9 16.7 7.7 289 32 70 62 55 47 25 580 11.4 15.6 10 3.2 7.3 0 4 9 345 56 107 510 409 342 123 1892 13.9 16.1 4.7 2.7 7.1 1.8 1.6 6 10 0 1 151 67 25 9 263 20 0 0 4 6 0 0 4.6 4.8 3.9 5.7 4.2 5.5 1.2 27 14 18 8 3 11 7.4 14.3 11.1 12.5 33.3 0 63 43 98 54 65 49 12.7 7 3.1 1.9 6.2 0 227 94 222 119 58 226 4 4.3 6.8 5.9 6.9 0.8 49 6 8 3 6 6 0 0 25 0 0 16.7 Lindi Mbeya 2.6 Morogoro 11.1 8 9.8 85 177 667 470 383 151 2547 Mtwara 83 Total 602 2.8 533 6.8 154 5.2 13 7.7 1221 4.4 81 9.9 372 5.1 846 4.7 78 3.8 Handeni Kwamkono Lushoto Magoma Makolola Ngamiani Total 209 71 127 53 335 220 1015 3.3 1.4 0.8 5.7 3 3.2 2.9 212 88 167 88 272 205 1032 3.8 1.1 1.8 3.4 3.7 2 2.8 49 27 38 18 42 24 198 8.2 0 0 0 0 8.3 3 5 1 3 0 7 7 23 0 0 0 0 0 0 0 453 181 312 158 611 408 2123 4 1.1 1.3 3.8 2.6 2 2.5 22 6 23 1 45 48 145 4.5 0 0 0 8.9 10.4 69 79 54 15 33 30 19 230 2.5 0 6.7 0 6.7 0 2.2 376 130 285 118 561 400 1870 4.3 1.5 1.1 4.2 3 2.8 2.9 20 3 35 8 62 36 164 5 0 0 12.5 1.6 5.6 3 Ngarenaro Kaloleni Karatu Monduli Mbuguni Oldonyo Sambu total 734 356 104 116 61 97 0.1 0.3 3.8 0.9 0 0 538 409 122 76 68 74 0.2 0.5 2.5 0 0 0 53 54 26 20 17 13 0 3.7 0 0 0 0 1 6 1 6 3 0 0 0 0 0 0 0 1237 762 245 211 137 181 0.1 0.7 2 0.5 0 0 89 63 8 7 12 3 1.1 0 25 0 0 0 32 32 1 80 3 114 0 6.3 0 0 0 0 1202 628 235 123 144 68 0.2 0.3 3 0.8 0 0 90 164 17 15 2 2 0 0.6 0 0 0 0 1468 0.5 1287 0.5 183 1.1 17 0 2773 0.4 182 1.6 262 0.8 2400 0.5 290 0.3 Shinyanga Kambarage Ushirombo Kahama Nkololo Nindo total 53 149 328 344 249 228 1386 11 2.7 4 4.7 21.3 3.5 7.1 66 98 180 234 218 153 949 3 7.1 5 7.7 17.9 11.1 9.7 6 20 34 42 49 42 193 0 10 2.9 9.5 18.4 9.5 10.4 1 1 4 2 4 4 16 0 0 0 0 25 25 12.5 142 238 502 567 512 412 2373 4.9 4.2 3.8 5.5 19.7 4.2 8.3 20 29 44 55 8 15 171 0 10.3 9.1 12.7 12.5 0 8.8 12 23 139 51 353 246 824 16.7 17.4 4.3 9.8 19.5 8.1 12.9 127 208 396 526 163 180 1600 3.9 4.3 4.3 6.3 19.6 5.6 6.6 22 36 10 45 2 1 116 0 0 0 0 0 0 0 Town clinic Isevya Igunga Nzega Songambele Ilolanguru Total 204 121 125 212 109 90 861 42.2 49.6 24 5.2 33.9 44.4 30.7 141 96 102 140 80 55 614 39.7 53.1 25.3 4.3 41.3 47.3 33.9 32 17 26 34 13 20 142 46.9 76.5 15.4 11.8 38.5 45 35.2 2 1 1 6 2 3 15 0 0 0 0 100 0 13.3 338 203 239 371 202 161 1514 41.7 52.2 28 5.4 37.6 43.5 31.7 41 32 15 21 2 7 118 39 56.3 20 4.8 50 71.4 37.3 24 33 94 114 153 57 475 29.2 45.5 24.5 6.1 39.2 42 28.6 331 187 152 251 51 108 1080 41.7 55.1 30.3 4.8 33.3 45.4 33.8 23 14 6 25 0 3 71 52.2 42.9 16.7 8 0 66.7 32.4 Iringa Ngome Kasanga Mafinga Njombe Matamba total 245 99 54 200 196 47 841 3.7 7.1 83.3 14 10.2 6.4 10.1 208 87 39 118 135 41 628 4.3 6.9 28.2 11.9 8.1 9.8 8.8 19 10 16 21 14 6 86 10.5 10 18.8 14.3 7.1 0 11.6 20 1 1 13 10 1 46 0 0 0 0 10 0 2.2 402 166 91 283 279 87 1308 4 5.4 24.2 12 8.6 5.7 8.4 90 31 19 69 76 8 293 4.4 16.1 52.6 15.9 11.8 25 14 14 5 24 12 18 4 77 0 0 37.5 25 22.2 25 22.1 384 156 80 302 299 84 1305 5.2 8.3 27.5 12.6 8.7 7.1 9.6 94 34 5 33 37 6 209 0 2.9 0 9.1 8.1 0 3.3 Tanga Arusha Shinyanga Tabora Iringa 84 Mara Nyasho Bweri Tarime Mugumu Murangi Utegi total 232 72 310 140 128 107 989 5.2 2.8 5.2 0.7 6.3 14 5.5 155 56 212 97 134 51 705 4.5 1.8 4.2 1 8.2 13.7 5.1 28 13 37 22 30 21 151 7.1 0 2.7 4.5 3.3 4.8 4 8 0 4 1 1 1 15 0 0 0 0 0 0 0 372 135 534 252 285 162 1740 4.6 2.2 4.7 1.2 6.3 13.6 5.1 51 6 29 8 8 18 120 7.8 0 3.4 0 25 3.4 6.7 11 8 82 38 13 7 159 9.1 0 8.5 2.6 7.7 14.3 6.9 361 120 433 200 275 171 1560 5.3 2.5 3.9 1 6.5 12.9 5.2 48 13 48 21 5 2 137 All Total enrolees Total RPR + Syphilis Prevalence % 85 2.1 0 4.2 0 20 0 2.9 Annex 3: Data collection form for ANC sero-surveillance, Tanzania. Clinic card number ___________________________ (Remove this part after assigning surveillance number) -------------------------------------------------------------------------------------------------- MINISTRY OF HEALTH TANZANIA ANC SURVEILLANCE DATA COLLECTION FORM 1. Surveillance number __________________________________ 2. Date of specimen collection (dd/mm/yy) ________________________________ 3. Clinic Name ___________________________ District: ____________________ 4. Age of the woman (years) ____________________ 5. Marital status (circle) 1. Single 2. Married 3. Other, specify_____________________________________ 6. Number of previous pregnancies: __________________ 7. Education status of the woman (circle) 1. No formal education 2. Adult education 3. Primary 4. Secondary 5. Post secondary (e.g. collage, university) 8. Estimate distance in Kilometres from the woman’s residence to the Clinic (circle) 1. 0 to 5Km 2. More than 5 km 9. How long have you lived in that area of your residence? (years) ___________ LABORATORY TEST RESULTS L1. RPR (circle) 1. Positive L2. First Serology (circle) 1. Positive L3. Second Serology (circle) 1. Positive 2. Negative 2. Negative 2. Negative L4. Final serology result (circle) 1. Positive 2. Negative 86 Annex Table 1: Kilimanjaro region Type Name of ANC Majengo Health Centre Urban District location Moshi Municipality Pasua Health Centre Urban Moshi Municipality Umbwe Health Centre Rural Moshi Rural District Masama (Modio) Health Centre Rural Hai District Hedaru dispensary Semi-Urban (Roadside) Same District Huruma Hospital MCH Clinic Semi-urban Rombo District Table 2: Dodoma region Name of ANC Makole Urban Health Centre Type Urban District location Dodoma Municipality Wajenzi MCH Clinic Urban Dodoma Municipality Bahi Government Dispensary Rural Dodoma Rural District Handali Rural Health Centre Rural Dodoma Rural District Kibaigwa Dispensary Roadside Kongwa District Mpwapwa Hospital MCH Clinic Semi-urban Mpwapwa District Table 3: Kagera region Name of ANC Type District location Bukoba Regional Hospital Urban Bukoba Township Rwamisheni Health Centre. Urban Bukoba Township Katoro Health Centre Semi-urban Bukoba Rural District Nyamiaga Dispensary Semi-urban Ngara District Kimeya Health Centre Rural Muleba District Nkwenda Health Centre Rural Karagwe 87 Table 4: Mtwara region Name of ANC Type District location Ligula Hospital Urban Mtwara Township Likombe Dispensary Urban Mtwara Township Nanyamba Health Centre Rural Mtwara rural District Mkunya Dispensary Rural Newala Tandahimba Health Centre Semi-urban Tandahimba District Mangaka Dispensary Semi-urban Masasi District Table 5: Mbeya region Name of ANC Type District location Kiwanjampaka Health Centre Urban Mbeya Municipality Ruanda Health Centre Urban Mbeya Municipality Chimala Mission Hospital Roadside Mbarali District Ilembo Rural Health Centre Rural Mbeya Rural District Igamba Dispensary Rural Mbozi District Kyela District Hospital Border Kyela District Table 6: Dar es Salaam region Facility Type District location Kigamboni Health Centre Urban Temeke District Kasorobo MCH Clinic Urban Temeke District Buguruni Dispensary Urban Ilala District Kiwalani Dispensary Urban Ilala District Oyesterbay MCH Clinic Urban Kinondoni district Kimara Dispensary Urban Kinondoni Type Urban District location Morogoro Municipality Urban Semi-urban Morogoro Municipality Kilombero district Semi-urban Rural Rural Rural Kilosa district Morogoro rural district Mvomero district Mvomero district Table 7: Morogoro region Facility Morogoro regional hospital MCH Clinic Uhuru Health Centre St. Francis hospital MCH Clinic Gairo Health Centre Makuyuni Dispensary Hembeti Dispensary* Turiani dispensary* 88 *Two ANCs combined to make one surveillance site Table 8: Kigoma region Facility Type District location Ujiji Dispensary Urban Kigoma Town Council Kigoma Dispensary Urban Kigoma Town Council Kiganamo Health Centre Semi-urban Kasulu District Kibondo MCH Clinic Semi-urban Kibondo District Nyakitonto Health Centre Rural Kasulu District Keza Mission Dispensary Rural Kibondo District Table 9: Lindi region Name of ANC Town Clinic Sokoine MCH Liwale Rural Health Centre Nyangao MCH Nachingwea Hospital Chumo MCH Mtama Dispensary Type Urban Urban District location Lindi Urban Lindi Urban Rural Semi-urban Semi-urban Rural Rural Liwale Lindi Rural Nachingwea Kilwa Lindi rural Type Urban Urban District location Tanga Urban Tanga Urban Semi-urban Semi-urban Rural Rural Lushoto Handeni Handeni Korogwe Table 10: Tanga region Name of ANC Bombo Hospital Makorora Health Centre Lushoto Hospital Handeni MCH Kwamkono MCH Magoma MCH 89 Antenatal Clinic Type Location/District ARUSHA REGION Ngarenaro Clinic Urban Arusha Municipality Kaloleni Health Centre Urban Arusha Municipality Karatu Health Centre Semi-urban Karatu District Monduli District Hospital Semi-urban Monduli District Mbuguni Health Centre Rural Arumeru District Oldonyo Sambu Dispensary Rural Arumeru District Nyasho Health Centre Urban Musoma Urban Bweri Dispensary Urban Musoma Urban Tarime district Hospital Semi-urban Tarime District Mugumu MCH B Semi-urban Serengeti Murangi Health centre Rural Musoma Rural Utegi Dispensary Rural Tarime SHINYANGA REGION Regional Hospital Urban Shinyanga Kambarage Clinic Urban Syinyanga Ushirombo Clinic Semi Urban Bukombe District Kahama district Hospital Semi Urban Kahama District Nkololo Dispensary Rural Bariadi District Nindo Health centre Rural Kishapu district IRINGA REGION Iringa regional Hospital Urban Iringa Urban Ngome Health Centre Urban Iringa Urban Mafinga district Hospital Semi Urban Mufindi Njombe Health Centre Semi Urban Njombe Kasanga dispensary Rural Mufindi MARA REGION 90 Matamba Rural HC Rural Makete TABORA REGION Town clinic Urban Tabora Urban Isevya Dispensary Urban Tabora Urban Igunga District Hospital Semi Urban Igunga Nzega district hospital Semi urban Nzega Songambele village Rural Urambo Ilolanguru dispensary Rural UYUI 91