Abstract
BackgroundHeterosexual couples account for 44% of new HIV infections in Kenya and there’s low awareness of self and partner HIV status. Different strategies have been employed to promote couple HIV testing and counselling (CHTC). Despite this, HIV incidence among couples continues to rise. This study sought to assess the use of a counsellor-supported disclosure (CSD) model in enhancing the uptake of CHTC and the factors that were associated with it.MethodsA pre-post quasi experimental study design with an intervention and a comparison arm was utilized. The study was conducted in Nairobi, Nakuru, Kisumu, and Homa Bay counties in Kenya. A total of 276 participants were recruited; 149 and 127 in the comparison and intervention arms, respectively. Standard HIV testing & counselling (HTC) was offered in the comparison arm whereas the counsellor-supported disclosure model was administered in the intervention arm. The model empowered index clients to invite their sexual partner for CHTC. Telephone follow-up and subsequent community health volunteer (CHV) follow-up for non-responders were embedded in the model. Semi-structured questionnaires were used to collect data at baseline and 3 months into the study. In-depth interviews were conducted with 15 participants who took up the intervention and 7 of the HTC providers who offered CSD. The quantitative and qualitative data were analyzed using STATA version 13 and NVIVO 10, respectively.ResultsUptake of CHTC was 28% in the intervention arm of the study compared to 7% in the comparison arm (p < 0.001). Participants in the intervention arm of the study had eight times higher odds of taking up CHTC compared to their counterparts. The outcome of the qualitative interviews revealed that the CSD counselling, skills on partner invitation, and follow-up for partner invitation increased the uptake of CHTC. On the other hand, unwillingness to test together with partner, lack of availability to test together as a couple, and provision of the wrong contact information by the participants reduced the uptake of CHTC.ConclusionThe CSD model improved the uptake of CHTC. This model can be integrated into the existing HTC structures to enhance the uptake of CHTC.
Highlights
Heterosexual couples account for 44% of new Human Immunodeficiency Virus (HIV) infections in Kenya and there’s low awareness of self and partner HIV status
We report on the factors that were associated with uptake of Couple HIV testing and counselling (CHTC) following the counsellor-supported disclosure (CSD) intervention from both the clients and HIV testing and counselling (HTC) service providers’ perspective
Factors that were positively associated with the uptake of CHTC included being in the study intervention, counselling on the benefits of CHTC, skills on partner invitation and follow-up for partner invitation
Summary
Heterosexual couples account for 44% of new HIV infections in Kenya and there’s low awareness of self and partner HIV status. According to the 2012 Kenya AIDS Indicator Survey (KAIS), 53% of persons found to be HIV-infected did not know that they were infected; and 40% of married/ cohabiting couples were not aware of their partner’s HIV status [5]. CHTC provides an avenue for mutual disclosure of HIV status in an environment where support can be provided by a counsellor or health worker; risk-reduction messages can be tailored to the outcome of the test results of both individuals and decisions about prevention, accessing treatment, care and support, and family planning options can be made together decreased stigma; and normalization of HIV. Despite the evidence of benefits of CHTC, the uptake of couple HIV testing and counselling in Kenya remains relatively low (31.5%) [5]
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