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

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 (CVCT) 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 man’s (aOR=1.02 per year) and woman’s (aOR=1.02) age, the man being HIV+ (aOR=2.57), and the woman being HIV+ (aOR=1.89). 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. Conclusion 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 in order 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.

Facilitators and barriers for HIV-testing in Zambia: A systematic review of multi-level factors

“…There were three studies [ 13 , 16 , 20 ] conducted in urban areas, four [ 5 , 21 – 23 ] in rural areas, four [ 12 , 16 , 24 , 25 ] in both urban and rural areas, and one [ 26 ] in rural and peri-urban area. Eleven studies [ 4 , 18 , 19 , 27 – 34 ] were conducted in health facilities, such as hospitals, health centers, public sectors, VCT centers, and government clinics. The studies primarily investigated the populations in the following provinces ( Fig 2 ): sixteen in Lusaka [ 4 , 12 – 16 , 23 , 24 , 26 – 29 , 31 , 33 , 35 ], six in Copperbelt [ 7 , 18 – 20 , 30 , 32 ], three in Central Province (including Kapiri Mposhi district) [ 12 , 13 , 24 ], seven in Southern Province [ 15 , 16 , 21 , 22 , 34 , 36 , 37 ], and two in Luapula Province [ 30 , 32 ].…”

“…Increasing literature explores the factors that affect intentions and behaviors of taking HIV-testing, as well as the delivery and quality of HIV-testing services in Zambia. Some of them focus on demographic characteristics [ 12 , 13 ], some examine the family and social relations [ 7 , 14 ], some investigate the structural factors such as gender inequity and education attainment [ 13 , 15 , 16 ]; some highlight people’s traditional health beliefs and their perceptions on testing based on existing experiences [ 13 , 17 ], and some underline the issues regarding health infrastructure [ 14 , 18 , 19 ]. So far, there has been no systematic review to demonstrate the trend of HIV-testing studies in Zambia since the 1990s and there has been no synthesis of key socioecological factors associated with HIV-testing practices in Zambia.…”

Missed opportunities for HIV control: Gaps in HIV testing for partners of people living with HIV in Lima, Peru

“…Unaware of similar data in Latin America, our findings lag behind the 51% rate of HIV testing reported among partners of men who have sex with men (MSM) in US [ 29 ]. Our frequency of follow-up testing, though higher than the 24.5% reported by a study in sub-Saharan Africa [ 30 ], certainly points to gaps from the current global recommendation of once-a-year testing in high-risk individuals, such as partners of PLWH [ 31 ]. It should be noted that in Peru, HIV testing requires informed consent and pretest counseling, with strategies for self-testing still limited [ 32 ].…”

“…Disclosure of HIV status is a stressor for PLWH and can entail potential risks under certain circumstances. Therefore, it could be the case that health care staff postponed or adapted the emphasis on such recommendations; or that PLWH decided against doing so [ 30 , 37 ]. Indeed, problems with disclosure in our setting [ 38 ], could explain why in some cases the HIV status of IC was sometimes inaccurately reported as negative or unknown by their partners.…”

“…Indeed, problems with disclosure in our setting [ 38 ], could explain why in some cases the HIV status of IC was sometimes inaccurately reported as negative or unknown by their partners. Moreover, given that late entry into care of IC prevailed, recommendations on disclosure and HIV testing of partners could become sidetracked and/or limited to initial encounters [ 30 , 37 ].…”