‘It is not fashionable to suffer nowadays’: Community motivations to repeatedly participate in outreach HIV testing indicate UHC potential in Tanzania

Objective
This study examined people’s motivations for (repeatedly) utilizing HIV testing services during community-based testing events in urban and rural Shinyanga, Tanzania and potential
implications for Universal Health Coverage (UHC).

Methods
As part of a broader multidisciplinary study on the implementation of a HIV Test and Treat
model in Shinyanga Region, Tanzania, this ethnographic study focused on communitybased testing campaigns organised by the implementing partner. Between April 2018 and
December 2019, we conducted structured observations (24), short questionnaires (42) and
in-depth interviews with HIV-positive (23) and HIV-negative clients (8). Observations
focused on motivations for (re-)testing, and the counselling and testing process. Thematic
analysis based on inductive and deductive coding was completed using NVivo software.

Results
Regular HIV testing was encouraged by counsellors. Most participants in testing campaigns
were HIV-negative; 51.1% had tested more than once over their lifetimes. Testing campaigns provided an accessible way to learn one’s HIV status. Motivations for repeat testing
included: monitoring personal health to achieve (temporary) reassurance, having low levels
of trust toward sexual partners, feeling at risk, seeking proof of (ill)-health, and acting
responsibly. Repeat testers also associated testing with a desire to start treatment early to
preserve a healthy-looking body, should they prove HIV positive.