title: HIV incidence during a cluster-randomized trial of two strategies providing voluntary counselling and testing at the workplace, Zimbabwe.
abstract: OBJECTIVE
  To investigate HIV incidence during a trial of two voluntary counselling and testing (VCT) strategies. Counselling may promote beneficial behavioural change, although knowledge of negative status does not appear to contribute further benefit.
  
  
  METHODS
  The parent cluster-randomized trial demonstrated much greater uptake of VCT when counselling and rapid testing were available on-site (intensive VCT) than through pre-paid vouchers to an external provider (standard VCT). Anonymous HIV tests had been requested from all employees at enrolment and after 2 years intervention.
  
  
  METHODS
  The study setting was 22 businesses in Harare, Zimbabwe. Participants were 3146 HIV-negative individuals remaining in employment at the end of intervention, of whom 2966 (94.3%) consented to repeat testing. VCT linked to basic HIV care was provided and the main outcome measures were HIV incidence under each study arm, as a retrospective secondary analysis.
  
  
  RESULTS
  Mean VCT uptake in this cohort was 70.7 and 5.2%, respectively, in the intensive and standard arms. Crude HIV incidence was 1.21 per 100 person-years, with non-significantly higher rates in the intensive VCT arm [mean site incidence 1.37 and 0.95 per 100 person-years, respectively; adjusted rate ratio 1.49 (95% confidence interval 0.79-2.80).
  
  
  CONCLUSIONS
  Highly acceptable VCT did not reduce HIV incidence in this predominantly male cohort. HIV incidence was highest in the high uptake VCT arm, lending support to a US trial in which rapid testing appeared to have adverse behavioural consequences in some HIV-negative clients. Careful comparison of outcomes under different counselling and testing strategies is needed to maximize HIV prevention from global scale-up of VCT.
authors.affiliation: Department of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, UK. elc1@mweb.co.zw
authors.forename: Elizabeth L
authors.initials: EL
authors.lastname: Corbett
authors.forename: Beauty
authors.initials: B
authors.lastname: Makamure
authors.forename: Yin Bun
authors.initials: YB
authors.lastname: Cheung
authors.forename: Ethel
authors.initials: E
authors.lastname: Dauya
authors.forename: Ronnie
authors.initials: R
authors.lastname: Matambo
authors.forename: Tsitsi
authors.initials: T
authors.lastname: Bandason
authors.forename: Shungu S
authors.initials: SS
authors.lastname: Munyati
authors.forename: Peter R
authors.initials: PR
authors.lastname: Mason
authors.forename: Anthony E
authors.initials: AE
authors.lastname: Butterworth
authors.forename: Richard J
authors.initials: RJ
authors.lastname: Hayes
mesh_terms: D015492:AIDS Serodiagnosis / Q000523:psychology; D000328:Adult; D035041:Anonymous Testing; D037001:Directive Counseling; D004812:Epidemiologic Methods; D005260:Female; D015658:HIV Infections / Q000175:diagnosis / Q000453:epidemiology / Q000517:prevention & control* / Q000523:psychology; D015438:Health Behavior; D007722:Health Knowledge, Attitudes, Practice; D006297:Health Services Accessibility; D006801:Humans; D008297:Male; D008875:Middle Aged; D009786:Occupational Health Services; D010342:Patient Acceptance of Health Care; D015030:Zimbabwe / Q000453:epidemiology