 diagnosed and receiving HIV care, to de-duplicate records in a systematic manner, and to enhance our understanding of the HIV epidemic.
Three in four people diagnosed with HIV subsequently enrolled in care; with the overwhelming majority doing so the same day they tested positive, and at the facility to which they were referred. Factors most strongly associated with being linked to care were being currently pregnant, and being diagnosed positive in a dispensary facility that offers CTC services. Whereas, eight in10 pregnant women diagnosed with HIV were subsequently linked to care (highlighting there is still room for improvement within this highly important group) it is of interest that no significant association between HTC type (which includes ANC and PMTCT) and linkage to care was observed. A possible explanation for this, is that testing in ANC/PMTCT included not only women but also a sizeable number of male partners.
The association with the type of CTC services being offered at the testing facility suggests structural barriers to access of care, which can only be resolved through enhanced service planning. Other studies conducted in Tanzania have found similar associations. A study conducted in the Mbeya region found that people testing positive at a facility with a CTC, were 78% more likely to link to care compared to people testing at mobile/outreach sites (7). Another study in the Tanga region found a significant association between early entry in care and point of diagnosis, level of education and CD4 count (9). A study in the Kilimanjaro region showed that people testing in a community VCT facility were twice as likely to delay care compared to people testing in a hospital outpatient department (10).
Our finding that approximately a quarter of cases did not link to care during the pilot, is similar to the findings of other studies in Tanzania. The study in the Kilimanjaro region found that only 70% had presented to for HIV care within 6 months after receiving a positive HIV test result (10), and in the Mbeya region study, 78% linked to care within 6 months (7). Linkage to care rates vary throughout sub-Saharan Africa. In Kenya, 88% of adults linked to care within three months (20); a field assessment in Mozambique showed 67% linked to care (21); a retrospective cohort study in Cape Town, South Africa identified linkage to care as 63% (22); in Lesotho, a study found linkage to care at a facility to be 43% versus 69% if ART was initiated at home (23); and a systematic review showed linkage to care of newly diagnosed with HIV in sub-Saharan Africa ranged from 10-79% (24). As the expanded referral form includes location information it will be possible for facilities to intervene to locate and engage with persons not immediately linking to care; this important intervention was not assessed during the pilot.
Approximately 15% of people included in the pilot were found to have tested HIV positive more than once, of these 70% were previously linked to care. This finding highlights the importance of obtaining individual-level data on previous HIV test results, and potentially, a need to consider adjusting for such duplicate records in prevalence estimates based on standard aggregate reporting (wider geographically based estimates would be required to inform such an adjustment).
Introducing a form number on both parts of a two-part referral form assisted with matching a persons records between testing and care. We should note, however, that the form number does not help match cases that retest for HIV. De-duplication of these records was conducted, using additional identifiers available on the referral form. It is possible that the provision of a small stipend resulted in high variable completeness which, in turn, contributed to the ability to effectively match records. This process would be more difficult on a larger scale; an algorithm would need to be tested on a larger dataset, as is used in other countries without a national unique identifier (25)(26)(27).
The NACP already has a standard referral form and since the majority of data are already routinely collected, the work effort for facility staff to continue to complete the two-part form would be minimal. The additional cost of data entry of the referral forms could also be seen as minimal when compared to the enhanced availability and accuracy of the data. The pilot utilized field staff to gather forms from the facility on a monthly basis. This was feasible at the scale the pilot was conducted but could prove to be a human resource burden at national scale. Additionally, the pilot utilized an Access database, for implementation at national level, data entry and analysis would need to be incorporated into the existing national system. An assessment should be undertaken on alternate strategies for data collection and entry. Due to practical limitations, the pilot was conducted in only a portion of the facilities in one district. As such, linkage to care could have occurred at a facility outside of the pilot. No hospitals were included, therefore the pilot does not assess the burden the linkage system would have on a larger facility which has more cases of HIV. Despite these limitations, the pilot provides valuable information that is not available elsewhere and that can be used to determine the way forward for linking patients to HIV care and identifying potential duplicate records.
Case matching and de-duplication are of vital importance for accurately assessing the 90-90-90 targets and HIV care cascade, and for moving toward HIV case surveillance. The ability to distinguish between new and previously reported cases increases the quality of the data, and of analyses using these data. The 2017-2022 HIV Strategic Plan in Tanzania calls for strengthening linkage mechanism, and notes that a challenge to achieving this is the lack of reliable referral data (28). To utilize de-duplicated data to monitor the HIV epidemic and ensure linkage from testing to care timely manner, we recommend a two-part referral form be used for all HIV diagnoses. A new initiative by NACP to collect all HTC data in the CTC electronic database may also provide a better understanding of HTC and CTC attendance, although will require rigorous evaluation.

DATA AVAILABILITY STATEMENT
The datasets for this article contain protected health information and are not publicly available. Requests to access the datasets should be directed to Jim Todd, Jim.Todd@LSHTM.ac.uk.An event in which a person feels a fall is imminent but avoids it by compensatory action, such as grabbing a nearby object or controlling the fall. People who experience near falls may be at risk of falling and require preventive intervention to avoid potential injury.
With their wrestling lives on the line, the two seniors put on a wild, back-and-forth affair that saw several lead changes in the second period, with Pinter still looking to have enough in his gas tank, recording a three-point near fall followed with a pin at five minutes.
Tenders are invited for Constructio Of Brick Wall In Front Of Sadarpur Kothi And Near Fall At Km 24.
D'Andrea took up his new post at a moment that the US focus appeared to be shifting to Iran as the Islamic State suffered significant defeats with the near fall of Mosul in Iraq and the imminent fall of Raqqa, the group's self-declared capital in Syria.
The tension continued to build with each near fall, and it wasn't until Styles hit a Styles Clash and a Phenomenal Forearm in succession that the match finally came to an end.
However, heat two saw Danny Phillips recover from a near fall to take a win over his partner Ashley Morris in a home 5-1 taking the score to 9-3.
At another point a recipient was challenged in negotiating the thick carpet with his prosthetics; a near fall saw the Governor General once again spring into action.
History repeats itself: The rise and fall of the British pound was followed by the rise and near fall --according to Katusa--of the U.
Stenberg and Gustafson, along with fellow program members Shea Settlemyer and Delaney Van Velkinburgh, are counselors-in-training this summer for the annual Courageous Kids Camp, a four-day event at Sky Camp near Fall Creek.
Alriyadh newspaper shed lights on reports of the near fall of Alasad regime because of the recently appearing differences among its prominent figures.
Upper North Row Road, assist Leominster Police and Fire to find six youths in the woods near Fall Brook Reservoir.
I snuck off to the sumptuous Flint Oak Resort near Fall River, Kan.CHRIS Judd's extended time on the sidelines last season could help him go out with a bang in 2015, his Carlton teammate Michael Jamison says.
Judd played just one of the Blues' first 11 games last year, with pre-season Achilles tendon surgery and a badly strained hamstring in round five casting doubt over his playing future.
But after averaging 22.1 possessions, 10.7 contested possessions and 5.5 clearances a game following his return in round 13, the two-time Brownlow medallist decided to play on in 2015.
Jamison told reporters on Tuesday he thought Judd's truncated 2014 campaign had been a factor in the 31-year-old's impressive start to the pre-season.
"I think a positive to come out of him missing so many games last year is that he is feeling fresh this time of year," Jamison said at Visy Park.
"(The club is) still looking after him, (he's) still just doing a monitored load, but he's as sharp as I've seen him for a few years."
Matthew Kreuzer is another Blue returning from an injury-ravaged 2014.
Kreuzer did not play after round one last year following the recurrence of a foot injury that required surgery at the end of 2013.
The versatile tall started 2015 pre-season training on day one and his fitness and form before the Christmas break attracted rave reviews from Blues coach Mick Malthouse.
Jamison says