Promotion of couples' voluntary HIV counseling and testing: A comparison of influence networks in Rwanda and Zambia

• Type of Material: Article
• Authors: April L. Kelley, Zambia Emory HIV Research Project; Ashley K. Hagaman, Emory University; Kristin Wall, Emory University; Etienne Karita, Project San Francisco; William Kilembe, Zambia Emory HIV Research Project; Roger Bayingana, Project San Francisco; Amanda Tichacek, Emory University; Michele Kautzman, Project San Francisco; Susan Allen, Emory University
• Language: English
• Date: 2016-08-08
• Publisher: BioMed Central
• Publication Version: Final Published Version
• Copyright Statement: © 2016 The Author(s).
• License: Creative Commons Attribution 4.0 International
• Final Published Version (URL): http://dx.doi.org/10.1186/s12889-016-3424-z
• Title of Journal or Parent Work: BMC Public Health
• ISSN: 1471-2458
• Volume: 16
• Issue: 1
• Start Page: 744
• End Page: 744
• Grant/Funding Information: Additional funding sources include the Center for AIDS Research at Emory University (P30 AI050409); and the AIDS International Training and Research Program Fogarty International Center (D43 TW001042).; This study was funded by NIH R01 MH66767, HD40125, and MH95503 with additional support from the International AIDS Vaccine Initiative (IAVI) which was made possible by the generous support of the American people through the United States Agency for International Development (USAID).
• Keywords: Couple's voluntary HIV counseling and testing; Influential networks; Health service promotion; HIV/AIDS; HIV education
• Research Categories: Health Sciences, Public Health

Abstract

Background: Many African adults do not know that partners in steady or cohabiting relationships can have different HIV test results. Despite WHO recommendations for couples' voluntary counseling and testing (CVCT), fewer than 10 % of couples have been jointly tested and counseled. We examine the roles and interactions of influential network leaders (INLs) and influential network agents (INAs) in promoting CVCT in Kigali, Rwanda and Lusaka, Zambia. Methods: INLs were identified in the faith-based, non-governmental, private, and health sectors. Each INL recruited and mentored several INAs who promoted CVCT. INLs and INAs were interviewed about demographic characteristics, promotional efforts, and working relationships. We also surveyed CVCT clients about sources of CVCT information. Results: In Zambia, 53 INAs and 31 INLs were surveyed. In Rwanda, 33 INAs and 27 INLs were surveyed. Most (75 %-90 %) INAs believed that INL support was necessary for their promotional work. Zambian INLs reported being more engaged with their INAs than Rwandan INLs, with 58 % of Zambian INLs reporting that they gave a lot of support to their INAs versus 39 % in Rwanda. INAs in both Rwanda and Zambia reported promoting CVCT via group forums (77 %-97 %) and speaking to a community leader about CVCT (79 %-88 %) in the past month. More Rwandan INAs and INLs reported previous joint or individual HIV testing compared with their Zambian counterparts, of which more than half had not been tested. In Zambia and Rwanda, 1271 and 3895 CVCT clients were surveyed, respectively. Hearing about CVCT from INAs during one-on-one promotions was the most frequent source of information reported by clients in Zambia (71 %). In contrast, Rwandan couples who tested were more likely to have heard about CVCT from a previously tested couple (59 %). Conclusions: CVCT has long been endorsed for HIV prevention but few couples have been reached. Influential social networks can successfully promote evidence-based HIV prevention in Africa. Support from more senior INLs and group presentations leveraged INAs' one-on-one promotions. The INL/INA model was effective in promoting couples to seek joint HIV testing and counseling and may have broader application to other sub-Saharan African countries to sustainably increase CVCT uptake.