Abstract
IntroductionMost HIV infections in Africa are acquired by married/cohabiting adults and WHO recommends couple’s voluntary HIV counseling and testing (CVCT) for prevention. The handover from NGO-sponsored weekend CVCT to government-sponsored services in routine weekday antenatal care (ANC) and individual voluntary testing and counseling (VCT) services in Zambia’s two largest cities from 2009–2015 is described.MethodsGovernment clinic counselors were trained to provide CVCT, and along with community health workers they promoted CVCT services in their clinic and surrounding areas. When client volume exceeded the capacity of on-duty staff in ANC and VCT, non-governmental organization (NGO) subsidies were offered for overtime pay.ResultsImplementation of routine CVCT services varied greatly by clinic and city. The 12 highest volume clinics were examined further, while 13 clinics had CVCT numbers that were too low to warrant further investigation. In Lusaka, the proportion of pregnant women whose partners were tested rose from 2.6% in 2009 to a peak of 26.2% in 2012 and 24.8% in 2015. Corresponding reports in Ndola were 2.0% in 2009, 17.0% in 2012 and 14.5% in 2015. Obstacles to CVCT included: limited space and staffing, competing priorities, record keeping not adapted for couples, and few resources for promotion and increasing male involvement. Conflicting training models for ‘partner testing’ with men and women separately vs. CVCT with joint post-test counseling led to confusion in reporting to district health authorities.DiscussionA focused and sustained effort will be required to reach a meaningful number of couples with CVCT to prevent heterosexual and perinatal HIV transmission. Establishing targets and timelines, funding for dedicated and appropriately trained staff, adoption of standardized data recording instruments with couple-level indicators, and expansion of community and clinic-based promotions using proven models are recommended.
Highlights
MethodsGovernment clinic counselors were trained to provide couple’s voluntary HIV counseling and testing (CVCT), and along with community health workers they promoted CVCT services in their clinic and surrounding areas
Most HIV infections in Africa are acquired by married/cohabiting adults and WHO recommends couple’s voluntary HIV counseling and testing (CVCT) for prevention
Aggregate partner testing data from antenatal care (ANC) as reported to the Lusaka District Health Management Teams (DHMT) through the HMIS system are shown in the aggregate in Fig 1 and confirm a steady increase from 2.6% of antenatal clients’ male partners tested in 2009 to 26.1% tested in 2012
Summary
Government clinic counselors were trained to provide CVCT, and along with community health workers they promoted CVCT services in their clinic and surrounding areas. Beginning in 2008, ZEHRP trained government clinic counselors and health promoters in 25 clinics in Lusaka (N = 12) and Ndola (N = 13) to promote and provide CVCT and paid overtime to off-duty clinic staff to offer these services on weekends when the clinics were not congested. Clinic nurses and counselors promoted CVCT among ANC and VCT clients. To support integration of CVCT into routine ANC and VCT in high volume clinics, ZEHRP offered to subsidize an additional off-duty clinic counselor to increase capacity to provide CVCT on weekdays if clinic staff on duty were receiving > = 5 couples/day and could not cope with the workload.
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