Voluntary HIV Counseling Research Articles

The seven Cs of the high acceptability of home-based VCT: Results from a mixed methods approach in Zambia

HIV testing and counselling is a critical gateway to prevention and treatment. Yet, coverage remains insufficient, few couples are tested together and gender differences in access exist. We used an embedded mixed methods approach to investigate possible explanations for the high acceptance of home-based voluntary HIV counselling and testing (HB-VCT) in a pair-matched cluster-randomized trial in Zambia. A baseline survey included 1694 individuals in 36 clusters. Adults in 18 intervention clusters were offered HB-VCT by lay counsellors. Standard testing services were available in both trial arms. After the completion of the intervention, a follow-up survey was conducted in all trial clusters. In addition, 21 in-depth interviews and one focus group discussion were conducted with home-based VCT clients in the intervention arm. Informants favoured the convenience, confidentiality and credibility of HB-VCT. Counsellors were perceived as trustworthy owing to their closeness and conduct, and the consent process was experienced as convincing. Couple testing was selected by 70% of cohabiting couples and was experienced as beneficial by both genders. Levels of first-time testing (68% vs. 29%, p < 0.0001) and re-testing (94% vs. 74%, p < 0.0001) were higher in the intervention than in the control arm. Acceptance of HIV testing and counselling is dependent on stigma, trust and gender. The confidentiality of home-based VCT was essential for overcoming stigma-related barriers, and the selection of local counsellors was important to ensure trust in the services. The high level of couple counselling within HB-VCT may contribute to closing the gender gap in HIV testing, and has benefits for both genders and potentially for prevention of HIV transmission. The study demonstrates the feasibility of achieving high test coverage with an opt-in consent approach. The embedded qualitative component confirmed the high satisfaction with HB-VCT reported in the quantitative survey and was crucial to fully understand the intervention and its consequences.

P6.041 Cost Analysis of Recruitment Strategies Used in the Partners Pre-Exposure Prophylaxis (PREP) Clinical Trial at Kisumu Site, Kenya

BackgroundRecruitment of participants into large clinical trials may be challenging and costly. Utilization of limited resources to maximise the yield is crucial. We sought to compare costs of different recruitment...

P3.108 Mobile Gynecological Clinic - Effective Tool For HIV\\STI Screening Diagnostics For Commercial Sex Workers in Lviv Region (Ukraine)

BackgroundSince October 2008 till present time, Lviv Regional AIDS Center and Charitable Salus Foundation implement project “HIV prevention by increasing access to VCT (voluntary HIV testing and counselling), sexually transmitted...

P4.063 Correlates of Voluntary HIV Testing and Collecting Test Results Among Men Who Have Sex with Men in India

BackgroundAs HIV prevention programmes in India prioritise voluntary HIV counselling and testing, among high-risk groups, hidden populations like Men Who Have Sex with Men (MSM) face barriers in accessing these...

Le conseil post-test encourage-t-il les PVVIH à partager leur statut sérologique? Pratiques et suggestions des conseillers au Burkina FasoDoes post-test counseling support PLHIV in disclosing their HIV status? Practices and propositions by counselors in Burkina Faso

Disclosure of HIV test results is discussed during post-test counseling, following norms. However, while barriers to disclosing a positive HIV result have been documented, the literature is sparse on the way guidelines are applied in the field. The aim of this article is to describe and analyze counseling practices regarding HIV disclosure to ‘significant others’ (partner, family members, friends) reported by clients and providers of HIV voluntary counseling and testing in Burkina Faso. A cross-sectional survey was conducted in urban and rural areas in 2008. A questionnaire incorporating semi-open questions was used. A total of 542 people who completed the test in 2007 and 111 service providers of HIV counseling and testing were interviewed. The data were analyzed using SPSS 12. Only 29% of those tested stated that disclosure to partner or family members was discussed with them during post-test counseling. This result is explained by providers' uncertainties and concerns regarding how to disclose, risks related to disclosure and adverse consequences of disclosure. Strategies are developed by counseling providers to support people who have been diagnosed HIV positive in disclosing to significant others, but they recognize that these actions are insufficient. Providers' suggestions are to keep fighting against the stigmatization of PLHIV, to improve counseling providers' competence in this area, and to adopt legal texts to make mandatory disclosure of the HIV result to partners. The study identified several ways to improve counseling practices regarding clients' disclosure of their HIV status in Burkina Faso. These findings could have significance for Africa as a whole.

Evaluation of the Effectiveness of HIV Voluntary Counseling and Testing Trainings for Clinicians in the Odessa Region of Ukraine

In Ukraine, only 28% of HIV-infected individuals are aware of their HIV status. Expansion of voluntary HIV counseling and testing (VCT) in primary and specialty health care settings holds promise for increasing the number of people who know their HIV status and can access care. To build capacity among health care providers to deliver VCT, we conducted two-day trainings on basic HIV knowledge and on VCT procedures in the Odessa region of Ukraine. The training programwas developed by local trainers in collaboration with faculty from the US Southeast AIDS Training and Education Center and was delivered in the clinical settings where trainees worked (n=392). We assessed training effectiveness in terms of change in knowledge among clinician trainees, comparing HIV specialists and nonspecialists and those working in urban and rural clinical settings. All else being equal, compared with their urban HIV-specialist peers, trainees who were rural nonspecialists demonstrated significantly greater increases in general HIV knowledge scores. This effort demonstrates that brief, on-site training programs support the expansion of VCT by increasing the knowledge and skills of rural nonspecialist clinicians to levels equal with urban HIV specialists.

Willingness to use couples voluntary counseling and testing services among men who have sex with men in seven countries

The willingness of male-male dyads to use couples voluntary HIV counseling and testing (CVCT) has not been previously investigated globally among men who have sex with men (MSM). Using online advertisements, data were collected from 3245 MSM in seven countries who were ≥18 years of age and had ≥1 male sex partner in the previous 12 months. The analysis examined associations between individual characteristics and willingness to utilize CVCT. The willingness to utilize CVCT was compellingly high, ranging from 79% in Australia and UK to 90% in Brazil. Older MSM and those who reported not knowing their sero-status reported lower odds of willingness to use CVCT. The relationship between being in a relationship and willingness to use CVCT varied across countries, perhaps reflecting varied local understandings of the nature and content of CVCT. Further work is required to examine willingness to use CVCT among a more heterogeneous population of MSM, and to examine how CVCT services are locally perceived in order to provide information vital for the development of locally appropriate messages to promote CVCT for MSM.

HIV and Religion in the Congo: A Mixed-Methods Study

To explore the relationship between religious affiliation and HIV infection in a war-ravaged community in sub-Saharan Africa. Mixed quantitative and qualitative methods. Individuals attending HIV voluntary counseling and testing clinics in Butembo in Eastern Democratic Republic of the Congo (DRC) completed a questionnaire and were tested for HIV infection. Risk factors for HIV seropositivity were explored, with attention to religious affiliation as a potential risk factor. Structured interviews of key informants were used to complement quantitative data. Three hundred and eighty individuals attending six clinics were enrolled. Nearly all participants (97%) self-identified as Christian (44% Catholic; 53% non-Catholic Christian). Twenty-eight patients (7.4%) tested positive for HIV. Age>30 years (adjusted OR 47 [95%CI 2.9-770, p=0.007), married status (adjusted OR 3.7 [95%CI 1.1-13, p=0.037), and Catholic religion (adjusted OR 2.7 [95%CI 1.1-6.8, p=0.030) were independent risk factors for HIV seropositivity in a multivariable logistic regression model. Rates of HIV were higher among Catholic than non-Catholic Christian participants in both single and married participants. The proportion of participants reporting condom use as a primary prevention modality did not differ significantly between religious groups; however, within both Catholic and non-Catholic Christian groups, increasing church attendance was associated with decreased use of condoms. Qualitative data highlighted divergent views toward condom use among Catholic health workers. In this cross-sectional survey in Eastern DRC, Catholic (relative to non-Catholic Christian) religious affiliation was associated with an increased risk of HIV. Increasing dialogue between biomedical practitioners and religious leaders may strengthen HIV prevention efforts in SSA.

Do Men who have Sex with Men (MSM) in the United States Understand that HIV Serodiscordance is Possible?

BackgroundLittle is currently known about the extent to which US MSM understand the possibility that a long-term sex partner can have an HIV status different than one’s own status. This information is important in the adaptation of Couples Voluntary HIV Counseling and Testing (CVCT) for US MSM.Methods428 US MSM completed an online survey using MySpace.com from March-April, 2009.ResultsOf 426 MSM with complete data, 21.1% (90) were not definitively aware that serodiscordance is possible. Factors associated with a lack of understanding that serodiscordance is possible were: never having tested for HIV (OR: 2.0; CI: 1.1, 3.8), compared to testing 0-6 months previously and having a high school education or less (OR: 2.2; CI: 1.1, 4.5), compared to men who had completed at least some college.ConclusionsA large proportion of young, internet-using MSM in the United States may not understand that HIV serodiscordance is possible within sexual partnerships. Based on these results, we recommend that CVCT provided to male couples in the United States should include education on HIV serodiscordance.

Strong effects of home-based voluntary HIV counselling and testing on acceptance and equity: A cluster randomised trial in Zambia

Home-based voluntary HIV counselling and testing (HB-VCT) has been reported to have a high uptake, but it has not been rigorously evaluated. We designed a model for HB-VCT appropriate for wider scale-up, and investigated the acceptance of home-based counselling and testing, equity in uptake and negative life events with a cluster-randomized trial. Thirty six rural clusters in southern Zambia were pair-matched based on baseline data and randomly assigned to the intervention or the control arm. Both arms had access to standard HIV testing services. Adults in the intervention clusters were offered HB-VCT by local lay counsellors. Effects were first analysed among those participating in the baseline and post-intervention surveys and then as intention-to-treat analysis. The study was registered with www.controlled-trials.com, number ISRCTN53353725. A total of 836 and 858 adults were assigned to the intervention and control clusters, respectively. In the intervention arm, counselling was accepted by 85% and 66% were tested (n = 686). Among counselled respondents who were cohabiting with the partner, 62% were counselled together with the partner. At follow-up eight months later, the proportion of adults reporting to have been tested the year prior to follow-up was 82% in the intervention arm and 52% in the control arm (Relative Risk (RR) 1.6, 95% CI 1.4–1.8), whereas the RR was 1.7 (1.4–2.0) according to the intention-to-treat analysis. At baseline the likelihood of being tested was higher for women vs. men and for more educated people. At follow-up these differences were found only in the control communities. Measured negative life events following HIV testing were similar in both groups. In conclusion, this HB-VCT model was found to be feasible, with a very high acceptance and to have important equity effects. The high couple counselling acceptance suggests that the home-based approach has a particularly high HIV prevention potential.

Intention to voluntary HIV counseling and testing (VCT) among health professionals in Jimma zone, Ethiopia: the theory of planned behavior (TPB) perspective

BackgroundVoluntary HIV Counseling and Testing (VCT) forms one of the cornerstones of HIV prevention strategies. It is imperative to understand HIV testing correlates and their theoretical underpinnings in order to promote VCT uptake. The aim of this study was to predict the intention to VCT and associated factors among health professionals in Jimma zone, Ethiopia using the theory of planned behavior.MethodsAn institution based cross-sectional quantitative study among a sample of 336 health professionals in 12 selected districts of Jimma, Ethiopia was conducted in 2012. The constructs and principles of the theory of planned behavior (TPB) were measured. Data were collected using structured questionnaire on self administered basis. A multivariable linear regression model was used to predict the role of independent variables/TPB constructs on the intention to use VCT using SPSS version 16.0.ResultsThe components of TPB independently explained the variance in intention to VCT by 30.3%. Both components of TPB and socio-demographic characteristic in the final model explained 32.7% of variance in the intention to use VCT services. Significant proportions (33.0%) of the respondents have never been tested for HIV. The respective indirect components of the TPB predicted the direct components. The strongest predictors of intention to VCT were subjective norm (β=0.39, p<0.001) and attitude (β= 0.19, p<0.001) whereas, none of the socio-demographic variables were significantly predicted the intention to use VCT. Past VCT experience did not have significant statistical association with VCT use intention.ConclusionsBehavioral intention to use VCT was a function of attitude and perceived social pressure. Demographic related social determinants were not barriers for VCT use intention. Most health workers test their blood by themselves. Strategies to empower health professionals on social pressure resistance and programs targeted at changing negative attitude on VCT use can enhance intention of health professionals to use VCT.

Effects of home-based Voluntary Counselling and Testing on HIV-related stigma: Findings from a cluster-randomized trial in Zambia

HIV-related stigma continues to be a prominent barrier to testing, treatment and care. However, few studies have investigated changes in stigma over time and the factors contributing to these changes, and there is no evidence of the impact of HIV testing and counselling on stigma. This study was nested within a pair-matched cluster-randomized trial on the acceptance of home-based voluntary HIV counselling and testing conducted in a rural district in Zambia between 2009 and 2011, and investigated changes in stigma over time and the impact of HIV testing and counselling on stigma. Data from a baseline survey (n = 1500) and a follow-up survey (n = 1107) were used to evaluate changes in stigma. There was an overall reduction of seven per cent in stigma from baseline to follow-up. This was mainly due to a reduction in individual stigmatizing attitudes but not in perceived stigma. The reduction did not differ between the trial arms (β = −0.22, p = 0.423). Being tested for HIV was associated with a reduction in stigma (β = −0.57, p = 0.030), and there was a trend towards home-based Voluntary Counselling and Testing having a larger impact on stigma than other testing approaches (β = −0.78, p = 0.080 vs. β = −0.37, p = 0.551), possibly explained by a strong focus on counselling and the safe environment of the home. The reduction observed in both arms may give reason to be optimistic as it may have consequences for disclosure, treatment access and adherence. Yet, the change in stigma may have been affected by social desirability bias, as extensive community mobilization was carried out in both arms. The study underscores the challenges in measuring and monitoring HIV-related stigma. Adjustment for social desirability bias and inclusion of qualitative methods are recommended for further studies on the impact of HIV testing on stigma.

Suicidal ideation and HIV risk behaviors among a cohort of injecting drug users in New Delhi, India

BackgroundData on mental health among injecting drug users in South Asia is scarce yet poor mental health among users has significant implications for the success of HIV prevention and treatment programmes. A cohort of 449 injecting drug users in Delhi was examined on the following issues (1) examine trends in suicidal ideation, suicide plan and suicidal attempts over a 12-month period, (2) examine association between injecting practices (receive and give used syringes) and suicidal ideation over a 12 month study period.MethodsAn observational study was conducted providing phased interventions with follow up interviews every 3 months to 449 injecting drug users (IDUs), from August 2004 to November 2005. The study was conducted in Yamuna Bazaar, a known hub of drug peddling in Delhi. Interventions included nutrition, basic medical services, needle exchange, health education, HIV voluntary counseling and testing, STI diagnosis and treatment, oral buprenorphine substitution, and detoxification, each introduced sequentially.ResultsSuicidal ideation and suicide attempts, did not significantly change over 12 months of observation, while suicide plans actually increased over the time period. Keeping other factors constant, IDUs with suicidal ideation reported more giving and receiving of used syringes in the recent past. Conclusions: Mental health services are warranted within harm reduction programmes. Special attention must be paid to suicidal IDUs given their higher risk behaviours for acquiring HIV and other blood borne infections. IDU intervention programmes should assess and address suicide risk through brief screening and enhanced counseling.

HIV voluntary counseling and testing at an abortion clinic: missed opportunities for diagnosis

BackgroundMost abortion clinics in the US do not provide opt-out HIV testing, and thus women electing abortion may not receive adequate screening for HIV. We sought to determine whether the standard practice of offering voluntary HIV counseling and testing (VCT) services to women electing abortion results in detection of undiagnosed HIV infection. Study DesignTwo thousand twenty-five women electing abortion were consecutively offered VCT at a public hospital-based, urban abortion clinic. Unlinked, anonymous HIV surveillance testing was conducted subsequent to voluntary testing without patients knowing of the surveillance study testing at the time. Multivariable analysis was used to determine factors associated with opting for VCT. ResultsOf the 13 women (0.6%) who tested positive for HIV, 8 had been previously diagnosed. Of the 5 women without previous diagnosis, only 1 opted for VCT. Overall, 530 (26%) women opted for VCT. Factors associated with opting for VCT in multivariable analysis (odds ratio, 95% confidence interval) were sex with an injection drug user (1.9, 1.1–3.2), presenting in the second trimester (1.3, 1.0–1.6), economic hardship (1.3, 1.0–1.5), partner difficulties (1.8, 1.3–2.4) and having public health insurance (1.6, 1.2–2.3). ConclusionsHIV testing via VCT did not effectively diagnose previously undiagnosed HIV infections among women seeking abortion in this clinical setting.

Increasing trends in primary NNRTI resistance among newly HIV‐1‐diagnosed individuals in Buenos Aires, Argentina

ObjectiveOur objective was to estimate primary resistance in an urban setting in a developing country characterized by high antiretroviral (ARV) coverage over the diagnosed population and also by an important proportion of undiagnosed individuals, in order to determine whether any change in primary resistance occurred in the past five years.DesignWe carried out a multi-site resistance surveillance study according to WHO HIV resistance guidelines, using a weighted sampling technique based on annual HIV case reports per site.MethodsBlood samples were collected from 197 drug-naive HIV-1-infected individuals diagnosed between March 2010 and August 2011 at 20 HIV voluntary counselling and testing centres in Buenos Aires. Clinical records of enrolled patients at the time of diagnosis were compiled. Viral load and CD4 counts were performed on all samples. The pol gene was sequenced and the resistance profile determined. Phylogenetic analysis was performed by neighbour-joining (NJ) trees and bootscanning analysis.ResultsWe found that 12 (7.9%) of the 152 successfully sequenced samples harboured primary resistance mutations, of which K103N and G190A were the most prevalent. Non-nucleoside reverse transcriptase inhibitors (NNRTI) resistance mutations were largely the most prevalent (5.9%), accounting for 75% of all primary resistance and exhibiting a significant increase (p=0.0072) in prevalence during the past 10 years as compared to our previous study performed in 1997–2000 and in 2003–2005. Nucleoside reverse transcriptase inhibitor (NRTI) and protease inhibitor primary resistance were low and similar to the one previously reported.ConclusionsLevels of primary NNRTI resistance in Buenos Aires appear to be increasing in the context of a sustained ARV coverage and a high proportion of undiagnosed HIV-positive individuals.

Who Is Going for VCT? A Case Study in Urban Burkina Faso

Introduction. Voluntary HIV counselling and testing (VCT) is a key element of treatment and is essential for prevention of vertical HIV transmission. Little information is available on the uptake of VCT in Burkina Faso. This study aims to assess the prevalence of VCT in urban Burkina Faso, where the epidemic is still highly concentrated. Methods. We conducted a two-stage clustered population-based survey among 1,694 subjects living in Ouagadougou, Burkina Faso. After informed consent was obtained, a behavioural questionnaire was administered to participants. Results. Overall, 10.2% of individuals had used VCT, while 9% were women. Among women who had a child after the launch of the programme to prevent mother-to-child transmission (PMTCT), only 10.4% have been tested for HIV. Almost all participants (99.3%) were aware of HIV/AIDS, and 65% knew the main methods of prevention. In multivariate analysis, older age and being married and better educated were independent factors associated with VCT. Conclusions. Despite high public knowledge and awareness about HIV, VCT uptake was still very low and PMTCT coverage was poor. New strategies are required to increase VCT uptake in urban areas, in particular among the youngest age.

A pilot clustered randomized control trial evaluating the efficacy of a network-based HIV peer-education intervention targeting men who have sex with men in Hong Kong, China

HIV is a serious health threat among men who have sex with men (MSM). A 2-month pilot network-based peer intervention was conducted among Chinese MSM in Hong Kong. Eight MSM peer educators were randomized into the Intervention or the Control Groups and recruited 36 and 33 peers to join the program, respectively. The educators of the Intervention Group delivered standardized and theory-based preventive messages to their peers via daily social interactions. The Control Group received education materials. Baseline between-group differences were non-significant. At post-intervention, intervened participants were more likely than controlled participants to intend to use condoms consistently during anal sex with men in the next 6 months [94.4% versus 60.6%; Relative Risk (RR): 1.56 (95% Confidence Interval (CI): 1.17, 2.08)] and to perceive behavioral control over taking up voluntary HIV testing and counseling [97.2% versus 72.7%; RR: 1.34 (95% CI: 1.08, 1.66)]. Large scale randomized trials are warranted.

HIV voluntary counselling and testing among recently initiated and traditionally circumcised men in the Eastern Cape Province of South Africa

HIV voluntary counselling and testing (VCT) is a cornerstone of the national strategic plan for HIV/AIDS treatment, care and support in South Africa. However, research shows that the utilisation of VCT services is disappointingly low, particular among males. This article focuses on the factors associated with the intention to test for HIV-infection among recently initiated and traditionally circumcised men in the rural areas of Eastern Cape Province, South Africa. Individual face-to-face interviews were conducted among 1656 sexually active men. Logistic regression analyses were used to explore the association between intention to test for HIV and psychosocial factors. Overall, 35.1% of the participants reported ever having tested for HIV. Intention to test for HIV was positively associated with perceived probability of getting an STI, positive attitudes towards gender-based violence, received general teachings about being a responsible man and highest grade passed. These findings provide specific information that can be used in the development of a focused cultural sensitive STI/HIV prevention programme aimed to increase VCT uptake among sexually active young men, which can be integrated into initiation and health education practices.

Impact evaluation of a sexually transmitted disease preventive intervention among female sex workers in Hohhot, China

The aim of this study was to evaluate the impact of HIV and sexually transmitted disease (STD) prevention interventions among female sex workers (FSWs) in the city of Hohhot in northern China. Three serial cross-sectional surveys were conducted in 2006, 2007, and 2008 among FSWs. A questionnaire was administered to the FSWs, and HIV and syphilis tests were performed for all participants. Intervention activities including condom promotion and provision, increased condom availability and accessibility, and voluntary HIV counseling and testing (VCT) were carried out among FSWs. There were 624 participants in the 2006 survey, 444 in the 2007 survey, and 451 in the 2008 survey. The United Nations General Assembly Special Session (UNGASS) indicators for FSWs increased from 13.9% in 2006 to 37.7% in 2008 (p<0.001). The average rate of consistent condom use with commercial clients in the month preceding the interview increased significantly from 39.8% in 2006 to 59.6% in 2008 (p<0.001). Not a single HIV-positive case was found among the FSWs over these 3 years, and the prevalence of syphilis decreased remarkably from 9.5% in 2006 to 1.3% in 2008. Logistic regression analysis showed that sauna or hair salon work venues, receiving services from intervention programs, and accepting HIV tests were factors associated with consistent condom use. The findings suggest that consistent condom use and awareness of HIV/AIDS prevention-related knowledge among FSWs have been improved by the intervention. Further prioritized and combined prevention programs aimed at FSWs are needed in order to prevent the HIV/AIDS epidemic spreading in the general population in China.

Khat use among HIV voluntary counselling and testing centre clients in Ethiopia

Khat (Catha edulis, a natural stimulant), has been used in Ethiopia for centuries. Over the past few decades, however, its use has dramatically increased, with recent research linking khat use to HIV status. Using qualitative methods, we explored the individual and micro-environmental characteristics of khat use and the social and physical contexts influencing type, acceptability and consequences of khat use. Among khat chewers attending an HIV voluntary counselling and testing centre in Addis Ababa, Ethiopia, we found that chewing typically starts at an early age (15–18 years). The majority of users are young (aged 18–35) and chew for pleasure, primarily in social settings. Over 25 types of khat, with varying effects were reported. Approximately half of the participants perceived khat to enhance sexual desire, while the rest claimed the effect on sexual desire to be the opposite. Alcohol use among chewers was high. Our findings suggest the need for culturally appropriate interventions that highlight the factors associated with khat use and the potential interplay between khat, alcohol and risky sexual behaviour.