Promotion of couples’ voluntary HIV counselling and testing in Lusaka, Zambia by influence network leaders and agents

Details

• Alternative Title:
  BMJ Open
• Personal Author:
  Wall, Kristin M ; Kilembe, William ; Nizam, Azhar ; Vwalika, Cheswa ; Kautzman, Michelle ; Chomba, Elwyn ; Tichacek, Amanda ; Sardar, Gurkiran ; Casanova, Deborah ; Henderson, Faith ; Mulenga, Joseph ; Kleinbaum, David ; Allen, Susan
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• Description:
  Objectives ; Hypothesising that couples’ voluntary counselling and testing (CVCT) promotions can increase CVCT uptake, this study identified predictors of successful CVCT promotion in Lusaka, Zambia. ; Design ; Cohort study. ; Setting ; Lusaka, Zambia. ; Participants ; 68 influential network leaders (INLs) identified 320 agents (INAs) who delivered 29 119 CVCT invitations to heterosexual couples. ; Intervention ; The CVCT promotional model used INLs who identified INAs, who in turn conducted community-based promotion and distribution of CVCT invitations in two neighbourhoods over 18 months, with a mobile unit in one neighbourhood crossing over to the other mid-way through. ; Primary outcome ; The primary outcome of interest was couple testing (yes/no) after receipt of a CVCT invitation. INA, couple and invitation characteristics predictive of couples’ testing were evaluated accounting for two-level clustering. ; Results ; INAs delivered invitations resulting in 1727 couples testing (6% success rate). In multivariate analyses, INA characteristics significantly predictive of CVCT uptake included promoting in community-based (adjusted OR (aOR)=1.3; 95% CI 1.0 to 1.8) or health (aOR=1.5; 95% CI 1.2 to 2.0) networks versus private networks; being employed in the sales/service industry (aOR=1.5; 95% CI 1.0 to 2.1) versus unskilled manual labour; owning a home (aOR=0.7; 95% CI 0.6 to 0.9) versus not; and having tested for HIV with a partner (aOR=1.4; 95% CI 1.1 to 1.7) or alone (aOR=1.3; 95% CI 1.0 to 1.6) versus never having tested. Cohabiting couples were more likely to test (aOR=1.4; 95% CI 1.2 to 1.6) than non-cohabiting couples. Context characteristics predictive of CVCT uptake included inviting couples (aOR=1.2; 95% CI 1.0 to 1.4) versus individuals; the woman (aOR=1.6; 95% CI 1.2 to 2.2) or couple (aOR=1.4; 95% CI 1.0 to 1.8) initiating contact versus the INA; the couple being socially acquainted with the INA (aOR=1.6; 95% CI 1.4 to 1.9) versus having just met; home invitation delivery (aOR=1.3; 95% CI 1.1 to 1.5) versus elsewhere; and easy invitation delivery (aOR=1.8; 95% CI 1.4 to 2.2) versus difficult as reported by the INA. ; Conclusions ; This study demonstrated the ability of influential people to promote CVCT and identified agent, couple and context-level factors associated with CVCT uptake in Lusaka, Zambia. We encourage the development of CVCT promotions in other sub-Saharan African countries to support sustained CVCT dissemination.
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• Subjects:
  • Health Services Research
  • 1506
• Source:
  BMJ Open. 2012; 2(5).
• Pubmed ID:
  22956641
• Pubmed Central ID:
  PMC3467632
• Document Type:
  Journal Article
• Funding:
  P30 AI050409/AI/NIAID NIH HHS/United States ; R01 HD040125/HD/NICHD NIH HHS/United States ; R01 AI051231/AI/NIAID NIH HHS/United States ; R37 AI051231/AI/NIAID NIH HHS/United States ; D43 TW001042/TW/FIC NIH HHS/United States ; R01 MH066767/MH/NIMH NIH HHS/United States ; U2G PS001904/PS/NCHHSTP CDC HHS/United States
• Place as Subject:
  Zambia
• Volume:
  2
• Issue:
  5
• Download URL:
  https://stacks.cdc.gov/view/cdc/43623/cdc_43623_DS1.pdf
• File Type:
  [PDF - 189.62 KB]
• Collection(s):
  CDC Public Access
• Main Document Checksum:
  urn:sha256:747d7999395be0c1947f51ee531648417597794b7d5761f1743aea45c15979d6