Promotion of couples' voluntary counselling and testing for HIV through influential networks in two African capital cities.
BACKGROUND
Most new HIV infections in Africa are acquired from cohabiting heterosexual partners. Couples' Voluntary Counselling and Testing (CVCT) is an effective prevention strategy for this group. We present our experience with a community-based program for the promotion of CVCT in Kigali, Rwanda and Lusaka, Zambia.


METHODS
Influence Network Agents (INAs) from the health, religious, non-governmental, and private sectors were trained to invite couples for CVCT. Predictors of successful promotion were identified using a multi-level hierarchical analysis.


RESULTS
In 4 months, 9,900 invitations were distributed by 61 INAs, with 1,411 (14.3%) couples requesting CVCT. INAs in Rwanda distributed fewer invitations (2,680 vs. 7,220) and had higher response rates (26.9% vs. 9.6%), than INAs in Zambia. Context of the invitation event, including a discreet location such as the INA's home (OR 3.3-3.4), delivery of the invitation to both partners in the couple (OR 1.6-1.7) or to someone known to the INA (OR 1.7-1.8), and use of public endorsement (OR 1.7-1.8) were stronger predictors of success than INA or couple-level characteristics.


CONCLUSIONS
Predictors of successful CVCT promotion included strategies that can be easily implemented in Africa. As new resources become available for Africans with HIV, CVCT should be broadly implemented as a point of entry for prevention, care and support.
Allen
Susan
S
The Rwanda-Zambia HIV Research Group, 1520 Clifton Road, Emory University, Atlanta, GA 30322, USA. sallen5@sph.emory.edu
Karita
Etienne
E
Chomba
Elwyn
E
Roth
David L
DL
Telfair
Joseph
J
Zulu
Isaac
I
Clark
Leslie
L
Kancheya
Nzali
N
Conkling
Martha
M
Stephenson
Rob
R
Bekan
Brigitte
B
Kimbrell
Katherine
K
Dunham
Steven
S
Henderson
Faith
F
Sinkala
Moses
M
Carael
Michel
M
Haworth
Alan
A
D000328:Adult; D003376:Counseling; D005260:Female; D015658:HIV Infections / Q000175:diagnosis / Q000517:prevention & control* / Q000523:psychology; D006293:Health Promotion / Q000379:methods*; D020010:Heterosexuality; D006801:Humans; D008297:Male; D015397:Program Evaluation; D011446:Prospective Studies; D012432:Rwanda / Q000453:epidemiology; D021841:Safe Sex; D012737:Sex Factors; D012747:Sexual Partners / Q000523:psychology*; D012944:Social Support; D014504:Urban Health; D035141:Voluntary Programs; D015024:Zambia / Q000453:epidemiology