Influence network effectiveness in promoting couples' HIV voluntary counseling and testing in Kigali, Rwanda.
OBJECTIVE
To identify predictors of promotion of couples' HIV voluntary counseling and testing (CVCT) in Kigali, Rwanda.


METHODS
Analysis of CVCT promotional agent [influential network leaders (INLs), influential network agents (INAs)], and couple/invitation-level predictors of CVCT uptake.


METHODS
Number of invitations and couples tested were evaluated by INL, INA, and couple/contextual factors. Multivariable logistic regression accounting for two-level clustering analyzed factors predictive of couples' testing.


RESULTS
Twenty-six INLs recruited and mentored 118 INAs who delivered 24 991 invitations. 4513 couples sought CVCT services after invitation. INAs distributed an average of 212 invitations resulting in an average of 38 couples tested/agent. Characteristics predictive of CVCT in multivariate analyses included the invitee and INA being socially acquainted [adjusted odds ratio (aOR) = 1.4; 95% confidence interval (CI) 1.2-1.6]; invitations delivered after public endorsement (aOR = 1.3; 95% CI 1.1-1.5); and presence of a mobile testing unit (aOR = 1.4; 95% CI 1.0-2.0). In stratified analyses, predictors significant among cohabiting couples included invitation delivery to the couple (aOR = 1.2; 95% CI 1.0-1.4) and in the home (aOR = 1.3; 95% CI 1.1-1.4), whereas among noncohabiting couples, predictors included invitations given by unemployed INAs (aOR = 1.7; 95% CI 1.1-2.7). Cohabiting couples with older men were more likely to test, whereas younger age was associated with testing among men in noncohabiting unions.


CONCLUSIONS
Invitations distributed by influential people were successful in prompting couples to seek joint HIV testing, particularly if the invitation was given in the home to someone known to the INA and accompanied by a public endorsement of CVCT. Mobile units also increased the number of couples tested. Country-specific strategies to promote CVCT programs are needed to reduce HIV transmission among those at highest risk for HIV in sub-Saharan Africa.
Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, Georgia 30322, USA. kmwall@emory.edu
Kristin
K
Wall
Etienne
E
Karita
Azhar
A
Nizam
Brigitte
B
Bekan
Gurkiran
G
Sardar
Deborah
D
Casanova
Davora
D
Joseph Davey
Freya
F
De Clercq
Evelyn
E
Kestelyn
Roger
R
Bayingana
Amanda
A
Tichacek
Susan
S
Allen
D000328:Adult; D016000:Cluster Analysis; D003376:Counseling / Q000379:methods; D005260:Female; D006679:HIV Seropositivity / Q000175:diagnosis* / Q000453:epidemiology / Q000523:psychology; D015497:HIV-1 / Q000302:isolation & purification*; D006293:Health Promotion / Q000379:methods; D006801:Humans; D016015:Logistic Models; D008297:Male; D008952:Mobile Health Units; D015999:Multivariate Analysis; D010865:Pilot Projects; D011237:Predictive Value of Tests; D011446:Prospective Studies; D012432:Rwanda / Q000453:epidemiology; D012747:Sexual Partners / Q000523:psychology; D012944:Social Support; D035141:Voluntary Programs