title: Implementation of couples' voluntary HIV counseling and testing services in Durban, South Africa.
abstract: BACKGROUND
  Couples' voluntary HIV counseling and testing (CVCT) is an evidence-based intervention that significantly reduces HIV incidence in couples. Despite the high prevalence of HIV and HIV couple serodiscordance in South Africa, there are few CVCT services.
  
  
  METHODS
  From February-June 2013, The Rwanda Zambia HIV Research Group provided support, training, and technical assistance for local counselors and promoters to pilot CVCT services in five hospital-based clinics in Durban, South Africa. Client-level data (age, gender, years cohabiting, pregnancy status, previous testing, antiretroviral treatment (ART) status, neighborhood, and test site) collected as a component of routine CVCT service operation is presented stratified by couple serostatus.
  
  
  RESULTS
  Twenty counselors and 28 promoters completed training. Of 907 couples (1,814 individuals) that underwent CVCT, prevalence of HIV was 41.8% and prevalence of HIV serodiscordance was 29.5% (19.3% M-F+, 10.3% M + F-). Most participants were 25-34 years of age, and this group had the highest prevalence. Previous individual HIV testing was low (50% for men, 63% for women). Only 4% of couples reported previous CVCT. Most (75%) HIV+ partners were not on ART, and HIV+ individuals in discordant couples were more likely to be on ART than those in concordant positive couples. Pregnancy among HIV+ women was not associated with previous HIV testing or ART use.
  
  
  CONCLUSIONS
  Implementation of standard CVCT services was found to be feasible in Durban. The burden of HIV and couple serodiscordance in Durban was extremely high. CVCT would greatly benefit couples in Durban as an HIV prevention strategy.
authors.affiliation: Rwanda Zambia HIV Research Group, Department of Pathology & Laboratory Medicine, School of Medicine, Emory University, Atlanta, GA, USA. wkilembe@rzhrg-mail.org.
authors.forename: William
authors.initials: W
authors.lastname: Kilembe
authors.affiliation: Rwanda Zambia HIV Research Group, Department of Pathology & Laboratory Medicine, School of Medicine, Emory University, Atlanta, GA, USA. kmwall@emory.edu.|Department of Epidemiology, School of Public Health, Emory University, 1518 Clifton Road NE, 4011, Atlanta, GA, 30322, USA. kmwall@emory.edu.
authors.forename: Kristin M
authors.initials: KM
authors.lastname: Wall
authors.affiliation: HIV Pathogenesis Programme, Doris Duke Medical Research Institute, University of Kwa Zulu Natal, Durban, South Africa. mammekwa@gmail.com.
authors.forename: Mammekwa
authors.initials: M
authors.lastname: Mokgoro
authors.affiliation: Rwanda Zambia HIV Research Group, Department of Pathology & Laboratory Medicine, School of Medicine, Emory University, Atlanta, GA, USA. amwaanga@rzhrg-mail.org.
authors.forename: Annie
authors.initials: A
authors.lastname: Mwaanga
authors.affiliation: Rwanda Zambia HIV Research Group, Department of Pathology & Laboratory Medicine, School of Medicine, Emory University, Atlanta, GA, USA. elisabeth.dissen@gmail.com.
authors.forename: Elisabeth
authors.initials: E
authors.lastname: Dissen
authors.affiliation: HIV Pathogenesis Programme, Doris Duke Medical Research Institute, University of Kwa Zulu Natal, Durban, South Africa. KamusokoM@ukzn.ac.za.
authors.forename: Miriam
authors.initials: M
authors.lastname: Kamusoko
authors.affiliation: Rwanda Zambia HIV Research Group, Department of Pathology & Laboratory Medicine, School of Medicine, Emory University, Atlanta, GA, USA. hphiri@rzhrg-mail.org.
authors.forename: Hilda
authors.initials: H
authors.lastname: Phiri
authors.affiliation: Rwanda Zambia HIV Research Group, Department of Pathology & Laboratory Medicine, School of Medicine, Emory University, Atlanta, GA, USA. jsakulanda@rzhrg-mail.org.
authors.forename: Jean
authors.initials: J
authors.lastname: Sakulanda
authors.affiliation: Rwanda Zambia HIV Research Group, Department of Pathology & Laboratory Medicine, School of Medicine, Emory University, Atlanta, GA, USA. jdavitte@gmail.com.
authors.forename: Jonathan
authors.initials: J
authors.lastname: Davitte
authors.affiliation: Medical Research Council, Biostatistics unit, Durban, South Africa. Tarylee.Reddy@mrc.ac.za.
authors.forename: Tarylee
authors.initials: T
authors.lastname: Reddy
authors.affiliation: Faculty of Health Sciences and Faculty of Science, Department of Molecular Biology and Biochemistry, Simon Fraser University, British Columbia, Canada. mark_brockman@sfu.ca.
authors.forename: Mark
authors.initials: M
authors.lastname: Brockman
authors.affiliation: HIV Pathogenesis Programme, Doris Duke Medical Research Institute, University of Kwa Zulu Natal, Durban, South Africa. Ndungu@ukzn.ac.za.|KwaZulu-Natal Research Institute for Tuberculosis and HIV (K-RITH), University of KwaZulu-Natal, Durban, South Africa. Ndungu@ukzn.ac.za.
authors.forename: Thumbi
authors.initials: T
authors.lastname: Ndung'u
authors.affiliation: Rwanda Zambia HIV Research Group, Department of Pathology & Laboratory Medicine, School of Medicine, Emory University, Atlanta, GA, USA. sallen5@emory.edu.|Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, GA, USA. sallen5@emory.edu.
authors.forename: Susan
authors.initials: S
authors.lastname: Allen
mesh_terms: D000163:Acquired Immunodeficiency Syndrome / Q000175:diagnosis / Q000517:prevention & control; D000328:Adult; D003376:Counseling / Q000458:organization & administration*; D005260:Female; D015658:HIV Infections / Q000175:diagnosis / Q000517:prevention & control* / Q000523:psychology; D006801:Humans; D008297:Male; D008403:Mass Screening; D012747:Sexual Partners / Q000523:psychology*; D013019:South Africa / Q000453:epidemiology; D035141:Voluntary Programs