title: Behaviour change in clients of health centre-based voluntary HIV counselling and testing services in Kenya.
abstract: OBJECTIVE
  To explore behaviour change, baseline risk behaviour, perception of risk, HIV disclosure and life events in health centre-based voluntary counselling and testing (VCT) clients.
  
  
  METHODS
  Single-arm prospective cohort with before-after design at three (one urban and two rural) government health centres in Kenya; study duration 2 years, 1999-2001.
  
  
  METHODS
  Consecutive eligible adult clients.
  
  
  METHODS
  Numbers of sexual partners, partner type, condom use, reported symptoms of sexually transmitted infection, HIV disclosure and life events.
  
  
  RESULTS
  High rates of enrollment and follow-up provided a demographically representative sample of 401 clients with mean time to follow-up of 7.5 months. Baseline indicators showed that clients were at higher risk than the general population, but reported a poor perception of risk. Clients with multiple partners showed a significant reduction of sexual partners at follow-up (16% to 6%; p<0.001), and numbers reporting symptoms of sexually transmitted infection decreased significantly also (from 40% to 15%; p<0.001). Condom use improved from a low baseline. Low rates of disclosure (55%) were reported by HIV-positive clients. Overall, no changes in rates of life events were seen.
  
  
  CONCLUSIONS
  This study suggests that significant prevention gains can be recorded in clients receiving health centre-based VCT services in Africa. Prevention issues should be considered when refining counselling and testing policies for expanding treatment programmes.
authors.affiliation: Camden Primary Care Trust, The Mortimer Market Centre, London WC1E, UK. gilly.arthur@camdenpct.nhs.uk
authors.forename: G
authors.initials: G
authors.lastname: Arthur
authors.forename: V
authors.initials: V
authors.lastname: Nduba
authors.forename: S
authors.initials: S
authors.lastname: Forsythe
authors.forename: R
authors.initials: R
authors.lastname: Mutemi
authors.forename: J
authors.initials: J
authors.lastname: Odhiambo
authors.forename: C
authors.initials: C
authors.lastname: Gilks
mesh_terms: D000328:Adult; D015331:Cohort Studies; D003376:Counseling; D005260:Female; D015658:HIV Infections / Q000453:epidemiology / Q000523:psychology*; D006801:Humans; D007630:Kenya / Q000453:epidemiology; D008016:Life Change Events; D008297:Male; D010342:Patient Acceptance of Health Care / Q000706:statistics & numerical data; D010465:Perception; D011446:Prospective Studies; D012307:Risk Factors; D012423:Rural Health; D021841:Safe Sex; D014342:Truth Disclosure; D047568:Unsafe Sex; D014504:Urban Health