title: Implementation and Operational Research: Evolution of Couples' Voluntary Counseling and Testing for HIV in Rwanda: From Research to Public Health Practice.
abstract: Couples' voluntary HIV counseling and testing (CVCT) is a WHO-recommended intervention for prevention of heterosexual HIV transmission which very few African couples have received. We report the successful nationwide implementation of CVCT in Rwanda.
  
  
  
  From 1988 to 1994 in Rwanda, pregnant and postpartum women were tested for HIV and requested testing for their husbands. Partner testing was associated with more condom use and lower HIV and sexually transmitted infection rates, particularly among HIV-discordant couples. After the 1994 genocide, the research team continued to refine CVCT procedures in Zambia. These were reintroduced to Rwanda in 2001 and continually tested and improved. In 2003, the Government of Rwanda (GoR) established targets for partner testing among pregnant women, with the proportion rising from 16% in 2003 to 84% in 2008 as the prevention of mother-to-child transmission program expanded to >400 clinics. In 2009, the GoR adopted joint posttest counseling procedures, and in 2010 a quarterly follow-up program for discordant couples was established in government clinics with training and technical assistance. An estimated 80%-90% of Rwandan couples have now been jointly counseled and tested resulting in prevention of >70% of new HIV infections.
  
  
  
  Rwanda is the first African country to have established CVCT as standard of care in antenatal care. More than 20 countries have sent providers to Rwanda for CVCT training. To duplicate Rwanda's success, training and technical assistance must be part of a coordinated effort to set national targets, timelines, indicators, and budgets. Governments, bilateral, and multilateral funding agencies must jointly prioritize CVCT for prevention of new HIV infections.
authors.affiliation: *Project San Francisco (PSF), Kigali, Rwanda; †Department of Pathology & Laboratory Medicine, Emory University School of Medicine, Atlanta, GA; ‡Rwanda Biomedical Center (RBC), Kigali, Rwanda; §US Centers for Disease Control and Prevention (CDC), Kigali, Rwanda; ‖Department of Epidemiology, School of Public Health, Emory University, Atlanta, GA; ¶US Centers for Disease Control and Prevention, Center for Global Health, Atlanta, GA; and #Department of Pathology & Laboratory Medicine, Emory University School of Medicine, Atlanta, GA.
authors.forename: Etienne
authors.initials: E
authors.lastname: Karita
authors.forename: Sabin
authors.initials: S
authors.lastname: Nsanzimana
authors.forename: Felix
authors.initials: F
authors.lastname: Ndagije
authors.forename: Kristin M
authors.initials: KM
authors.lastname: Wall
authors.forename: Jeannine
authors.initials: J
authors.lastname: Mukamuyango
authors.forename: Placidie
authors.initials: P
authors.lastname: Mugwaneza
authors.forename: Eric
authors.initials: E
authors.lastname: Remera
authors.forename: Pratima L
authors.initials: PL
authors.lastname: Raghunathan
authors.forename: Roger
authors.initials: R
authors.lastname: Bayingana
authors.forename: Kayitesi
authors.initials: K
authors.lastname: Kayitenkore
authors.forename: Brigitte
authors.initials: B
authors.lastname: Bekan-Homawoo
authors.forename: Amanda
authors.initials: A
authors.lastname: Tichacek
authors.forename: Susan
authors.initials: S
authors.lastname: Allen
mesh_terms: D003376:Counseling; D005191:Family Characteristics; D005260:Female; D015658:HIV Infections / Q000175:diagnosis* / Q000188:drug therapy / Q000517:prevention & control* / Q000523:psychology; D006801:Humans; D018445:Infectious Disease Transmission, Vertical / Q000517:prevention & control; D008297:Male; D009874:Operations Research; D010349:Patient Compliance / Q000523:psychology / Q000706:statistics & numerical data; D011181:Postnatal Care; D017410:Practice Guidelines as Topic; D011247:Pregnancy; D011295:Prenatal Care; D015980:Public Health Practice; D012432:Rwanda / Q000453:epidemiology; D021841:Safe Sex; D012747:Sexual Partners / Q000523:psychology*; D035141:Voluntary Programs