Trends in HIV counseling and testing uptake among married individuals in Rakai, Uganda

Joseph Ssekasanvu,Nuala Mcgrath,Julie Denison,David Serwadda,Fredrick Makumbi,Joseph Kb Matovu,Rhoda K Wanyenze,Emilio Ovuga

doi:10.1186/1471-2458-13-618

Abstract

BackgroundDespite efforts to promote HIV counseling and testing (HCT) among couples, few couples know their own or their partners’ HIV status. We assessed trends in HCT uptake among married individuals in Rakai district, southwestern Uganda.MethodsWe analysed data for 21,798 married individuals aged 15-49 years who were enrolled into the Rakai Community Cohort Study (RCCS) between 2003 and 2009. Married individuals were interviewed separately but were retrospectively linked to their partners at analysis. All participants had serologic samples obtained for HIV testing, and had the option of receiving HCT together (couples’ HCT) or separately (individual HCT). Individuals were categorized as concordant HIV-positive if both partners had HIV; concordant HIV-negative if both did not have HIV; or HIV-discordant if only one of the partners had HIV. We used χ2 tests to assess linear trends in individual and couples’ HCT uptake in the entire sample and conducted multinomial logistic regression on a sub-sample of 10,712 individuals to assess relative risk ratios (RRR) and 95% Confidence Intervals (95% CI) associated with individual and couples’ HCT uptake. Analysis was done using STATA version 11.0.ResultsUptake of couples’ HCT was 27.2% in 2003/04, 25.1% in 2005/06, 28.5% in 2006/08 and 27.8% in 2008/09 (χ2 for trend = 2.38; P = 0.12). Uptake of individual HCT was 57.9% in 2003/04, 60.2% in 2005/06, 54.0% in 2006/08 and 54.4% in 2008/09 (χ2 for trend = 8.72; P = 0.003). The proportion of couples who had never tested increased from 14.9% in 2003/04 to 17.8% in 2008/09 (χ2 for trend = 18.16; P < 0.0001). Uptake of couples’ HCT was significantly associated with prior HCT (Adjusted [Adj.] RRR = 6.80; 95% CI: 5.44, 8.51) and being 25-34 years of age (Adj. RRR = 1.81; 95% CI: 1.32, 2.50). Uptake of individual HCT was significantly associated with prior HCT (Adj. RRR = 6.26; 95% CI: 4.24, 9.24) and the female partner being HIV-positive (Adj. RRR = 2.46; 95% CI: 1.26, 4.80).ConclusionUptake of couples’ HCT remained consistently low (below 30%) over the years, while uptake of individual HCT declined over time. These findings call for innovative strategies to increase demand for couples’ HCT, particularly among younger couples and those with no prior HCT.

Highlights

Despite efforts to promote HIV counseling and testing (HCT) among couples, few couples know their own or their partners’ HIV status
The trend analysis was conducted with data from 21,798 married individuals (52.4% female) who participated in the Rakai Community Cohort Study (RCCS) between 2003 and 2009
Predictors of HIV counseling and testing uptake among married individuals in Rakai, Uganda We conducted a sub-group analysis among 10,712 individuals (49.1% of the original sample) who participated in the RCCS for at least three study visits to assess the predictors of individual and couples’ HCT uptake

Summary

Introduction

Despite efforts to promote HIV counseling and testing (HCT) among couples, few couples know their own or their partners’ HIV status. Several studies have found that over 80% of married couples are not aware of their own or their partner’s HIV status [3,4] These findings suggest a need for interventions to increase awareness of HIV status and to promote couples’ HIV counseling and testing [5] for the purpose of reducing HIV transmission risk within married couples. A recent compartmental model to study the effect of HIV status awareness in reducing HIV incidence among married couples suggests that, among HIV-discordant couples, each percentage increase in HIV status awareness reduces HIV incidence by 0.13 and 0.32% for women and men respectively [9] These findings suggest that interventions aimed at improving couples’ awareness of each other’s HIV status, including couples’ HCT, can contribute to significant reductions in HIV incidence at the population level. Evidence from the HPTN 052 trial found that early treatment initiation, which requires timely linkage to HIV care and treatment, can reduce HIV transmission among discordant couples by 96% [11]

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Discussion

Conclusion