Knowledge and Perceptions of Couples' Voluntary Counseling and Testing in Urban Rwanda and Zambia: A Cross-Sectional Household Survey

Kelley, April L.; Karita, Etienne; Sullivan, Patrick S.; Katangulia, Francois; Chomba, Elwyn; Caraël, Michel; Telfair, Joseph; Dunham, Steve M.; Vwalika, Cheswa; Kautzman, Michele; Wall, Kristin M.; Allen, Susan

doi:10.1371/journal.pone.0019573

Cited by 43 publications

(51 citation statements)

References 42 publications

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“…Opportunity for earlier detection, early initiation of treatment and care and risk reduction strategies provided by PITC services were perceived highly by most respondents. The benefits of VCT services have been documented elsewhere by Anderson et al (2008), Shorter et al (2009), Mukolo et al (2013) and Musheke et al (2013. They have also been observed as entry points into couple counseling and increased HIV sero-status disclosure among couples (Becker et al, 2010;Kelley et al, 2011;Njau et al, 2012). This observation therefore calls for health care providers to maintain high level of confidentiality and patient care and explore the opportunity for couple counseling and promote disclosure among couples.…”

Section: Discussionmentioning

confidence: 89%

Knowledge, attitudes and acceptability to provider-initiated HIV testing and counseling: patients’ perspectives in Moshi and Rombo Districts, Tanzania

Manongi

Mahande

Njau

2014

Tanzania J Hlth Res

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Provider-initiated HIV testing and counseling (PITC) is referred to as routine testing in a clinical setting as part of a standard programme of medical services. PITC is initiated in order to avoid missed opportunities for people to get tested for HIV. While advocated as a strategy, there is dearth of information on patients' views on PITC in a number of districts in Tanzania. The objective of this study was to assess the knowledge, attitude and acceptability to PITC services among patients attending health care facilities in rural and urban settings in Kilimanjaro region A total of 12 focus group discussions (FGDs) were conducted with 99 (73 female and 26 male) patients enrolled into outpatient clinics in 8 (2 hospitals and 6 primary care centers) health facilities in Moshi Urban and Rombo districts in northern Tanzania. The study explored on knowledge, attitudes and acceptability of PITC, perceived benefits and barriers of PITC, and ethical issues related to PITC. Interviews were audio taped, transcribed, translated, and analyzed using Non-numerical Unstructured Data Indexing and Theorizing (NUDIST) software. Knowledge about PITC services was generally low. Compared to men, women had a more positive attitude towards PITC services, because of its ability to identify and treat undiagnosed HIV cases. HIV stigma was regarded as a major barrier to patients' uptake of PITC. Institutional factors such as lack of supplies and human resources were identified as barriers to successful provision of PITC. In conclusion, the findings highlight both opportunities and potential barriers in the successful uptake of PITC, and underscore the importance of informed consent, counseling and confidentiality and the need for specific strategies on advocacy for the service. _________________________________________________________________________________________

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Section: Discussionmentioning

confidence: 89%

Knowledge, attitudes and acceptability to provider-initiated HIV testing and counseling: patients’ perspectives in Moshi and Rombo Districts, Tanzania

Manongi

Mahande

Njau

2014

Tanzania J Hlth Res

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“…Knowledge of HIV discordancy is far lower in Zambia versus Rwanda, 41 and also low in South Africa. 28 As a result, many do not disclose their HIV test results to partners and husbands often assume that their wife's test result from ANC must be the same as their own.…”

Section: Discussionmentioning

confidence: 96%

“…A household survey in 2003 confirmed that though most adults wanted to be tested with their partners, many thought CVCT was available at public facilities (which was not yet the case), and only 25% knew CVCT reduced HIV transmission within marriage. 41 …”

Section: Introductionmentioning

confidence: 99%

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

Karita¹,

Nsanzimana

Ndagije

et al. 2016

JAIDS Journal of Acquired Immune Deficiency Syndromes

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Background: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.Methods: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.Conclusions: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.

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“…The implications of the local conceptions of contagious disease in rural southern Zambia on postnatal care-seeking for newborns are evident: understandings about disease transmission and treatment by clinic staff prevented or delayed HIV-infected mothers from seeking postnatal care for their newborns. Stigma attached to this particular type of disease acquisition, which includes unexposed infants becoming ill from exposure to the effects of HIV medication used by other infants, will be a challenge in the effort to increase postnatal care utilization and reduce HIV progression (Kelley et al, 2011).…”

Section: Discussionmentioning

confidence: 99%

Postnatal care utilization and local understandings of contagion among HIV-infected and uninfected women in rural, southern Zambia

et al. 2016

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Postnatal care is essential for ensuring the optimal health of newborns and necessary for the prevention of maternal-to-child human immunodeficiency virus (HIV) transmission as well as the early diagnosis and treatment of HIV-infected infants. However, coverage of postnatal care is low in many rural areas of sub-Saharan Africa. We examined women's experiences of accessing formal postnatal care for their HIV-exposed newborns, comparing reports of HIV-infected and uninfected women in an HIV-endemic area of rural southern Zambia. We conducted 24 qualitative in-depth interviews with recently delivered women in a rural region of southern Zambia, including 8 with women who were willing to disclose their HIV infection status and answer additional questions. Data were transcribed, coded and analyzed using thematic analysis techniques. HIV-infected women identified more disincentives and reported more negative experiences accessing postnatal care than HIV-uninfected women. A local notion of contagion holds that healthy infants may become sick with chibele, a fatal, febrile illness, if exposed to another infant who is taking "strong medicine", such as antiretroviral drugs. Thus, HIV-uninfected women expressed objections to sharing clinics with women and infants who were presumed to be under treatment. Additionally, women reported receiving better treatment from staff at HIV clinics compared to general pediatric clinics. Due to these tensions, HIV-infected women were less likely to visit a clinic for newborn care if the clinic or waiting area was a common space used by HIV-uninfected women and their children. When integrating programs for HIV with maternal and child health care, these nuanced tensions between groups of patients must be recognized and resolved.

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Knowledge and Perceptions of Couples' Voluntary Counseling and Testing in Urban Rwanda and Zambia: A Cross-Sectional Household Survey

Cited by 43 publications

References 42 publications

Knowledge, attitudes and acceptability to provider-initiated HIV testing and counseling: patients’ perspectives in Moshi and Rombo Districts, Tanzania

Knowledge, attitudes and acceptability to provider-initiated HIV testing and counseling: patients’ perspectives in Moshi and Rombo Districts, Tanzania

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

Postnatal care utilization and local understandings of contagion among HIV-infected and uninfected women in rural, southern Zambia

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