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
• 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.
  
  
• Subjects:
  1506 Health Services Research
• 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
• Collection(s):
  CDC Public Access
• Main Document Checksum:
  urn:sha256:747d7999395be0c1947f51ee531648417597794b7d5761f1743aea45c15979d6
• Download URL:
  https://stacks.cdc.gov/view/cdc/43623/cdc_43623_DS1.pdf
• File Type:
  [PDF - 189.62 KB ]