Predictors of First Follow-up HIV Testing for Couples' Voluntary HIV Counseling and Testing in Ndola, Zambia

• Type of Material: Article
• Authors: Nancy L Czaicki, Emory University; Jonathan Davitte, Emory University; Bella Siangonya, Emory University; Randee Kastner, Emory University; Nurilign Ahmed, Emory University; Naw Htee Khu, Emory University; Wan Hsuan Kuo, Emory University; Joseph Abdallah, Emory University; Kristin Wall, Emory University; Amanda Tichacek, Emory University; Mubiana Inambao, Emory University; Kakungu Simpungwe, Emory University; Ibou Thior, Program Appropriate Technology in Health; Susan Allen, Emory University
• Language: English
• Date: 2014-05-01
• Publisher: Lippincott, Williams & Wilkins
• Publication Version: Author Accepted Manuscript (After Peer Review)
• Copyright Statement: © 2013 by Lippincott Williams and Wilkins.
• Final Published Version (URL): http://dx.doi.org/10.1097/QAI.0000000000000076
• Title of Journal or Parent Work: Journal of Acquired Immune Deficiency Syndromes
• ISSN: 1525-4135
• Volume: 66
• Issue: 1
• Start Page: E1
• End Page: E7
• Grant/Funding Information: Support for this project was provided by PATH Arise Program through funding from the Canadian International Development Agency (CIDA).; Additional funding was provided by the US National Institute of Mental Health [R01 MH095503-01]; the AIDS International Training and Research Program Fogarty International Center [3D43TW001042411]; the Emory Center for AIDS Research [P30 AI050409]; The Rollins School of Public Health Global Field Experience program at Emory University; and the International AIDS Vaccine Initiative [EA040113].
• Keywords: Zambia; SEROCONVERSION; RWANDA; DISCORDANT COUPLES; INTERVENTIONS; Science & Technology; TRANSMISSION; Immunology; CVCT; concordant negative and discordant couples; HIV testing; DEVELOPING-COUNTRIES; HIV; Life Sciences & Biomedicine; AFRICA; ENROLLMENT; PREVENTION; Infectious Diseases; follow-up; SEXUAL-BEHAVIOR
• Research Categories: Health Sciences, Public Health; Health Sciences, Epidemiology; Health Sciences, Pathology

Abstract

INTRODUCTION: We describe predictors of first follow-up testing for concordant negative and discordant couples seeking joint voluntary HIV counseling and testing in Ndola, Zambia, where cohabiting couples account for an estimated two-thirds of incident HIV infections. METHODS: Demographic and serostatus data were collected from couples' voluntary HIV testing and counseling and follow-up testing services implemented in government clinics. We calculated follow-up testing rates by serostatus and compared rates before and after the introduction of a Good Health Package (GHP). RESULTS: The follow-up testing rate from May 2011 to December 2012 was 12.2% for concordant negative (M-F-) couples and 24.5% for discordant (M+F- or M-F+) couples. Significant predictors of follow-up testing in multivariate analyses included increasing age of the man [adjusted odds ratio (aOR) = 1.02 per year] and the woman (aOR = 1.02 per year), and either partner being HIV+ (aOR = 2.57 for HIV+ man, aOR = 1.89 for HIV+ woman). The man (aOR = 1.29) and the couple (aOR = 1.22) having been previously tested for HIV were predictive of follow-up testing among concordant negative couples. Introduction of a GHP increased follow-up testing among discordant (aOR = 2.93) and concordant negative (aOR = 2.06) couples. CONCLUSIONS: A low-cost GHP, including prevention, screening, and treatment for common causes of morbidity and mortality resulted in increased follow-up testing rates among HIV discordant and concordant negative couples. Overall follow-up testing rates remain low, and efforts to increase these rates are necessary to ensure linkage to combination prevention, reduce HIV transmission within couples, and identify seroconversions promptly. Further investigation of low-cost sustainable incentives and other factors influencing follow-up HIV testing for couples is needed.