Influence network effectiveness in promoting couples' HIV voluntary counseling and testing in Kigali, Rwanda

• Type of Material: Article
• Authors: Kristin Wall, Emory University; Etienne Karita, Emory University; Azhar Nizam, Emory University; Brigitte Bekan, Emory University; Gurkiran Sardar, Emory University; Debbie Casanova, Emory University; Dvora Joseph, Emory University; Freya De Clercq, Emory University; Evelyne Kestelyn, Emory University; Roger Bayingana, Emory University; Amanda Tichacek, Emory University; Susan A Allen, Emory University
• Language: English
• Date: 2012-01-14
• Publisher: Lippincott, Williams & Wilkins
• Publication Version: Author Accepted Manuscript (After Peer Review)
• Copyright Statement: © 2012 Lippincott Williams & Wilkins, Inc.
• Final Published Version (URL): http://journals.lww.com/aidsonline/pages/articleviewer.aspx?year=2012&issue=01140&article=00011&type=abstract
• Title of Journal or Parent Work: AIDS
• ISSN: 0269-9370
• Volume: 26
• Issue: 2
• Start Page: 217
• End Page: 227
• Grant/Funding Information: This work was supported by funding from the NIMH RO1 66767, with contribution from the AIDS International Training and Research Program (AITRP) FIC D43 TW001042, the Social & Behavioral Core of the Emory Center for AIDS Research P30 AI050409, R01 AI40951, R01 AI51231, NICHD R01 40125, and the International AIDS Vaccine Initiative.
• Keywords: HIV; Community Workers; Couples’ Voluntary Counseling and Testing; Rwanda
• Research Categories: Biology, Biostatistics; Health Sciences, Public Health; Health Sciences, Pathology

Abstract

Objective To identify predictors of promotion of couples’ voluntary counseling and testing (CVCT) in Kigali, Rwanda Design Analysis of CVCT promotional agent (influential network leaders, INLs; influential network agents, INAs), and couple/invitation-level predictors of CVCT uptake. Methods Number of invitations and couples tested were evaluated by INL, INA, and couple/contextual factors. Multivariable logistic regression accounting for two-level clustering analyzed factors predictive of couples’ testing. Results 26 INLs recruited and mentored 118 INAs who delivered 24,991 invitations. 4,513 couples sought CVCT services after invitation. INAs distributed an average of 212 invitations resulting in an average of 38 couples tested/agent. Characteristics predictive of CVCT in multivariate analyses included the invitee and INA being socially acquainted (aOR=1.4;95%CI:1.2–1.6); invitations delivered after public endorsement (aOR=1.3;95%CI:1.1–1.5); and presence of a mobile testing unit (aOR=1.4;95%CI:1.0–2.0). In stratified analyses, predictors significant among cohabiting couples included invitation delivery to the couple (aOR=1.2;95%CI:1.0–1.4) in the home (aOR=1.3;95%CI:1.1–1.4), while among non-cohabiting couples predictors included invitations given by unemployed INAs (aOR=1.7;95%CI:1.1–2.7). Cohabiting couples with older men were more likely to test, while younger age was associated with testing among men in non-cohabiting unions. Conclusions Invitations distributed by influential people were successful in prompting couples to seek joint HIV testing, particularly if the invitation was given in the home to someone known to the INA, and accompanied by a public endorsement of CVCT. Mobile units also increased the number of couples tested. Country-specific strategies to promote CVCT programs are needed to reduce HIV transmission among those at highest risk for HIV in sub-Saharan Africa.