Influence network effectiveness in promoting couples’ HIV voluntary counseling and testing in Kigali, Rwanda

Abstract

Objective To identify predictors of promotion of couples’ voluntary counseling and testing (CVCT) in Kigali, Rwanda Design 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 26 INLs recruited and mentored 118 INAs who delivered 24,991 invitations. 4,513 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 (aOR=1.4;95%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) in the home (aOR=1.3;95%CI:1.1–1.4), while among non-cohabiting 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, while younger age was associated with testing among men in non-cohabiting 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.

Pregnant women's experiences of male partner involvement in the context of prevention of mother-to-child transmission in Khayelitsha, South Africa

“…The high reported levels of HIVrelated communication are encouraging and suggest the normalisation of HIV (Zuch & Lurie, 2012). Consistent with previous published research, we observed higher levels of MPI among participants who reported higher levels of communication with partners (Ditekemena et al, 2012;Kalembo et al, 2012;Reece et al, 2010) and stable relationship status (Ditekemena et al, 2012;Larsson et al, 2010;Morfaw et al, 2013). The high reported levels of MPI overall indicate that gender norms may be shifting, with men becoming more involved in pregnancy.…”

“…Documented barriers to MPI include poor communication within couples (Ditekemena et al, 2012;Kalembo, Yukai, Zgambo, & Jun, 2012;Reece, Hollub, Nangami, & Lane, 2010), less stable relationship status (Larsson et al, 2010;Morfaw et al, 2013) and traditional gender roles (Nkuoh et al, 2010;Reece et al, 2010;Theuring et al, 2009), including the belief that antenatal care is purely a women's responsibility.…”

Implementation and Operational Research: Evolution of Couples' Voluntary Counseling and Testing for HIV in Rwanda: From Research to Public Health Practice

“…This model was successful, particularly when invitations were distributed to the homes of individuals known personally to the INA, accompanied by an INL public endorsement, and with the availability of a mobile testing unit. 42,43 …”

The effect of HIV counselling and testing on HIV acquisition in sub-Saharan Africa: a systematic review

“…Several strategies, such as partner notification and community invitations have been effective for increasing cHCT and could have important implications if brought to scale. [39][40][41] Such efforts would have benefits on reduced HIV incidence and on reaching global HIV targets, including the 90-90-90 goals and elimination of mother-to-child transmission [42][43][44] Assessing the impact of HCT on HIV acquisition is methodologically challenging. First, all assessments of HIV acquisition require large cohorts followed for long periods with low, nondifferential loss to follow-up.…”