title: Promotion of couples' voluntary HIV counseling and testing: a comparison of influence networks in Rwanda and Zambia.
abstract: Many African adults do not know that partners in steady or cohabiting relationships can have different HIV test results. Despite WHO recommendations for couples' voluntary counseling and testing (CVCT), fewer than 10 % of couples have been jointly tested and counseled. We examine the roles and interactions of influential network leaders (INLs) and influential network agents (INAs) in promoting CVCT in Kigali, Rwanda and Lusaka, Zambia.
  
  
  
  INLs were identified in the faith-based, non-governmental, private, and health sectors. Each INL recruited and mentored several INAs who promoted CVCT. INLs and INAs were interviewed about demographic characteristics, promotional efforts, and working relationships. We also surveyed CVCT clients about sources of CVCT information.
  
  
  
  In Zambia, 53 INAs and 31 INLs were surveyed. In Rwanda, 33 INAs and 27 INLs were surveyed. Most (75 %-90 %) INAs believed that INL support was necessary for their promotional work. Zambian INLs reported being more engaged with their INAs than Rwandan INLs, with 58 % of Zambian INLs reporting that they gave a lot of support to their INAs versus 39 % in Rwanda. INAs in both Rwanda and Zambia reported promoting CVCT via group forums (77 %-97 %) and speaking to a community leader about CVCT (79 %-88 %) in the past month. More Rwandan INAs and INLs reported previous joint or individual HIV testing compared with their Zambian counterparts, of which more than half had not been tested. In Zambia and Rwanda, 1271 and 3895 CVCT clients were surveyed, respectively. Hearing about CVCT from INAs during one-on-one promotions was the most frequent source of information reported by clients in Zambia (71 %). In contrast, Rwandan couples who tested were more likely to have heard about CVCT from a previously tested couple (59 %).
  
  
  
  CVCT has long been endorsed for HIV prevention but few couples have been reached. Influential social networks can successfully promote evidence-based HIV prevention in Africa. Support from more senior INLs and group presentations leveraged INAs' one-on-one promotions. The INL/INA model was effective in promoting couples to seek joint HIV testing and counseling and may have broader application to other sub-Saharan African countries to sustainably increase CVCT uptake.
authors: Zambia Emory HIV Research Project (ZEHRP), Lusaka and Ndola, Zambia.
authors: April L
authors: AL
authors: Kelley
authors: Rwanda Zambia HIV Research Group (RZHRG), Department of Pathology & Laboratory Medicine, School of Medicine, Emory University, Atlanta, GA, USA.|Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, GA, USA.
authors: Ashley K
authors: AK
authors: Hagaman
authors: Rwanda Zambia HIV Research Group (RZHRG), Department of Pathology & Laboratory Medicine, School of Medicine, Emory University, Atlanta, GA, USA. kmwall@emory.edu.|Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, GA, USA. kmwall@emory.edu.|Department of Epidemiology, School of Public Health, Emory University, 1518 Clifton Road NE, GCR 458, Atlanta, GA, 30322, USA. kmwall@emory.edu.
authors: Kristin M
authors: KM
authors: Wall
authors: Project San Francisco (PSF), Kigali, Rwanda.
authors: Etienne
authors: E
authors: Karita
authors: Zambia Emory HIV Research Project (ZEHRP), Lusaka and Ndola, Zambia.
authors: William
authors: W
authors: Kilembe
authors: Project San Francisco (PSF), Kigali, Rwanda.
authors: Roger
authors: R
authors: Bayingana
authors: Rwanda Zambia HIV Research Group (RZHRG), Department of Pathology & Laboratory Medicine, School of Medicine, Emory University, Atlanta, GA, USA.|Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, GA, USA.
authors: Amanda
authors: A
authors: Tichacek
authors: Project San Francisco (PSF), Kigali, Rwanda.
authors: Michele
authors: M
authors: Kautzman
authors: Rwanda Zambia HIV Research Group (RZHRG), Department of Pathology & Laboratory Medicine, School of Medicine, Emory University, Atlanta, GA, USA.|Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, GA, USA.|Project San Francisco (PSF), Kigali, Rwanda.|Zambia Emory HIV Research Project (ZEHRP), Lusaka and Ndola, Zambia.
authors: Susan A
authors: SA
authors: Allen
mesh_terms: D000328:Adult; D003376:Counseling / Q000379:methods*; D005260:Female; D015658:HIV Infections / Q000175:diagnosis* / Q000517:prevention & control*; D058015:Health Communication / Q000379:methods*; D006293:Health Promotion / Q000379:methods*; D006801:Humans; D008297:Male; D008875:Middle Aged; D012432:Rwanda; D012747:Sexual Partners / Q000523:psychology*; D015024:Zambia
keywords: Couples’ voluntary HIV counseling and testing; HIV education; HIV/AIDS; Health service promotion; Influential networks