Promotion of couples’ voluntary HIV counseling and testing: a comparison of influence networks in Rwanda and Zambia

Abstract

BackgroundMany 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.MethodsINLs 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.ResultsIn 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 %).ConclusionsCVCT 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.

A Systematic Review of the Current Status of Safer Conception Strategies for HIV Affected Heterosexual Couples in Sub-Saharan Africa

“…Like our review, a recent consensus statement supporting safer conception and pregnancy for couples living with HIV found that access to SCS is limited by stigma toward HIV affected couples having children and that this stigma limits provision of safer conception services [75]. Increasing community education about SCSs via community health worker networks may help increase acceptability for previously unfamiliar conception strategies and reduce community-, provider-, or family-level stigma around pregnancy in HIV affected couples, as was accomplished with increasing community knowledge and acceptance of HIV testing [76, 77] and couples’ HIV counseling and testing [78–80]. …”

Implementation and Operational Research: Evolution of Couples' Voluntary Counseling and Testing for HIV in Rwanda: From Research to Public Health Practice

“…42–44 Social Norms Theory highlights the role of community and peer influence in changing health behaviors, and studies have shown that normalizing behaviors like HIV testing through community promotions can decrease stigma and increase uptake. 45,46 Influential network leaders (INLs) were selected from the health care, religious, nongovernmental/community-based, and private sectors.…”

Transitioning couple’s voluntary HIV counseling and testing (CVCT) from stand-alone weekend services into routine antenatal and VCT services in government clinics in Zambia’s two largest cities

“…The highest volume clinics were located in neighborhoods that had previously hosted a neighborhood randomized control trial of CVCT promotion (NIMH R0166767; 2003–2007) and/or other ZEHRP-sponsored work involving promotion and provision of CVCT from the late 1990’s onward [ 4 , 15 – 18 , 21 , 22 ].…”

“…Beginning in 2008, ZEHRP trained government clinic counselors and health promoters in 25 clinics in Lusaka (N = 12) and Ndola (N = 13) to promote and provide CVCT and paid overtime to off-duty clinic staff to offer these services on weekends when the clinics were not congested. In addition to periodic radio programs, promotions were carried out in the community by District Clinic Promoters (DCP) affiliated with the clinics, and by Influence Network agents (INA) affiliated with ZEHRP [ 5 , 21 , 22 ]. In addition, clinic nurses and counselors promoted CVCT among ANC and VCT clients.…”

“…The Zambia-Emory HIV Research Project (ZEHRP), in collaboration with the Ministry of Health (MoH) and the Ministry of Community Development, Maternal & Child Health (MCDMCH) has been implementing CVCT in the Republic of Zambia since 1994 in both stand-alone and government clinic settings [ 15 – 22 ]. In 2008, the MoH endorsed CVCT and requested that ANC departments include male partners in HIV testing.…”