Voluntary HIV Testing Research Articles

Barriers and facilitators for men to attend prenatal care and obtain HIV voluntary counseling and testing in Brazil.

BackgroundProviding HIV voluntary counseling and testing (VCT) to men who attend their partner's prenatal care is an intervention with potential to reduce HIV transmission to women and infants during the vulnerable period of pregnancy. Little is known about the acceptability of this intervention in global settings outside of Africa.MethodsWe conducted in-depth qualitative interviews to evaluate potential barriers and facilitators to prenatal care attendance for HIV VCT with 20 men who did and 15 men who did not attend prenatal care with their partners at Hospital Conceiçao in Porto Alegre, Brazil. Men were recruited at the labor and delivery unit at Hospital Conceiçao via a scripted invitation while visiting their newborn infant. Interviews lasted from 35–55 minutes and were conducted in Portuguese by a local resident trained extensively in qualitative methods. All interviews were transcribed verbatim, translated, and then analyzed using Atlast.ti software. An analysis of themes was then conducted using direct quotes and statements. We applied and adapted the AIDS Risk Reduction Theoretical Model and HIV Testing Decisions Model to the qualitative data to identify themes in the 35 interviews.ResultsIf offered HIV testing during prenatal care, all men in both groups stated they would accept this intervention. Yet, individual, relationship and systemic factors were identified that affect these Brazilian men's decision to attend prenatal care, informing our final conceptual model. The men interviewed had a general understanding of the value of HIV prevention of mother to child transmission. They also described open and communicative relationships with their significant others and displayed a high level of enthusiasm towards optimizing the health of their expanding family. The major barriers to attending prenatal care included perceived stigma against HIV infected individuals, men’s lack of involvement in planning of the pregnancy as well as inconvenient scheduling of prenatal care, due to conflicting work schedules.ConclusionsBrazilian men displayed high levels of HIV-related knowledge as well as open communication about HIV testing; especially when compared to findings from African studies. Future efforts should reorient prenatal care towards providing care to the entire family with a clear focus on protecting the infant from preventable diseases. Formally inviting men to prenatal care and providing them an acceptable medical excuse from work may enhance male involvement.

High Mobility and HIV Prevalence Among Female Market Traders in East Africa in 2014.

The contribution of women's mobility to the HIV/AIDS epidemic in Africa is poorly understood, despite women's high mobility and evidence that it is associated with higher-risk sexual behavior. We sought to measure levels of mobility, HIV prevalence, and related risk behaviors among female traders in Kisumu, Kenya. We used global positioning system mapping to develop a probability-based sample and recruited 305 female market traders for participation in a survey and voluntary HIV counseling and testing in 2014. We estimated HIV prevalence and fitted logistic regression models to measure associations between mobility, risk behaviors, and HIV infection. HIV prevalence was 25.6% (95% confidence interval: 21.0 to 30.8); 11.5% had migrated (changed residence, over county, or national boundary) in the past year and 39.3% in the past 5 years. More than one-third (38.3%) spent nights away from main residence in the past month, with 11.4% spending more than a week away. Multiple partners were reported by 13.1% of women in the last year; 16% of married women reported a concurrent partnership. Mobility was not significantly associated with HIV prevalence, although recent short-term mobility was significantly correlated with higher numbers of sexual partners in the past year. Female market traders were highly mobile, and HIV prevalence among traders was higher than in the general population of women of reproductive age in Kisumu (15.3% in 2013), and Nyanza Province, Kenya (16.1% in 2012). High HIV prevalence and risk behavior among women in this study warrant accelerated attention to HIV prevention and care needs of mobile women, including market traders.

Effects of injectable progestogen contraception versus the copper intrauterine device on HIV acquisition: sub-study of a pragmatic randomised controlled trial

BackgroundEvidence from observational studies suggests an increased risk of HIV acquisition among women using depot medroxyprogesterone acetate (DMPA) contraception.MethodsWithin the context of a South African programme to increase women's access...

Incarceration and exposure to internally displaced persons camps associated with reproductive rights abuses among sex workers in northern Uganda

BackgroundWhile female sex workers (FSWs) face a high burden of violence and criminalisation, coupled with low access to safe, non-coercive care, little is known about such experiences among FSWs in...

Is 90-90-90 achievable?

By 2010, the results of observational studies had suggested that high coverage of antiretroviral therapy (ART) is associated with decreased HIV transmission at a population level. 1 Anglemyer A Rutherford GW Egger M Siegfried N Antiretroviral therapy for prevention of HIV transmission in HIV-discordant couples. Cochrane Database Syst Rev. 2011; 5 (CD009153) Google Scholar In 2011, the first reports from the randomised controlled trial HPTN 052 were published, 2 Cohen MS Chen YQ McCauley M et al. Prevention of HIV-1 infection with early antiretroviral therapy. N Engl J Med. 2011; 365: 493-505 Crossref PubMed Scopus (5409) Google Scholar which definitively showed that ART reduces the risk of sexually transmitted HIV for serodiscordant couples. Findings from HPTN 052 have been extended, 3 Cohen MS Chen YQ McCauley M et al. Antiretroviral therapy for the prevention of HIV-1 transmission. N Engl J Med. 2016; 375: 830-839 Crossref PubMed Scopus (978) Google Scholar and similarly compelling data have emerged from the TEMPRANO trial. 4 The TEMPRANO ANRS 12136 Study GroupA trial of early antiretrovirals and isoniazid preventive therapy in Africa. N Engl J Med. 2015; 373: 808-822 Crossref PubMed Scopus (860) Google Scholar On the basis of these and other data, UNAIDS in 2014, 5 UNAIDS90-90-90. An ambitious target to help end the AIDS epidemic. Joint United Nations Programme on HIV/AIDS, Geneva2014 Google Scholar and WHO in 2015, 6 WHOGuideline on when to start antiretroviral therapy and pre-exposure prophylaxis for HIV. World Health Organization, Geneva2015 Google Scholar launched aggressive new policies to diagnose and to treat all patients with HIV infection worldwide to achieve plasma viral loads of under 1000 copies per mL in at least 73%. This policy has been framed as the HIV care and treatment cascade, in which 90% of people with HIV infection worldwide are diagnosed, 90% of those diagnosed start ART, and 90% of those taking ART achieve virological suppression. 7 WHOConsolidated strategic information guidelines for HIV in the health sector. World Health Organization, Geneva2015 Google Scholar The mathematical models 8 Granich RM Gilks CF Dye C De Cock KM Williams BG Universal voluntary HIV testing with immediate antiretroviral therapy as a strategy for elimination of HIV transmission: a mathematical model. Lancet. 2009; 373: 48-57 Summary Full Text Full Text PDF PubMed Scopus (1524) Google Scholar that led to this new policy suggested that this prevalence of suppression will be associated with a fall in the basic reproductive number, R0, to below 1·0 and the gradual extinction of the HIV epidemic as a major public health problem by 2030. From HIV infection to therapeutic response: a population-based longitudinal HIV cascade-of-care study in KwaZulu-Natal, South AfricaHIV programmes should focus on linkage to care as the most important bottleneck in the cascade. Cascade estimation should be longitudinal rather than cross-sectional and start with the population stages preceding clinical care. Full-Text PDF

Risky HIV sexual behavior and utilization of voluntary counseling and HIV testing and associated factors among undergraduate students in Addis Ababa, Ethiopia

BackgroundHIV/AIDS is a major public health problem in Ethiopia. University students are often a young and sexually active group that is at risk of acquiring and transmitting HIV. We assessed risky HIV sexual behaviors and utilization of voluntary counseling and testing services among undergraduate students at Addis Ababa Science and Technology University, Ethiopia.MethodsA cross-sectional study was conducted between May and June, 2013. Standardized semi-structured self-administered questionnaire was used to collect data. Simple random sampling technique was use to select departments from each school. All students in the selected departments were the study participants. Data were entered into EPI-Info and analyzed using SPPS statistical packages. P-value < 0.05 was considered as statistically significant.ResultsOf the total 602 students selected, an overall response rate of 557 (92.6%) were registered. Among the participants 361 (60%) were males. The student ages’ were ranged from 17 up to 25 years with mean age of 20.3 ± 1.6. Around 385 (64%) of them were in the age group of 17 up to 20 years. Among the study participants, 161 (26.8%) had sexual contact and the mean age of first sexual encounter was 17.4 (SD =2.3) years. About 443 (76%) of students knew that condoms can prevent Sexually Transmitted Infections (STIs). Among sexually active students, 74 (46%) had not used condom during first time sex. Among those responded, 488 (83.4%) had heard information about VCT; however, 52% had not ever used VCT service. The overall mean score of knowledge and attitude of students towards risk perception on HIV was around 66% and 57%, respectively. Students who enrolled in health science departments had almost three time more knowledge [AOR(95%CI) = 2.83 (1.67, 4.80)] and two and half times more favorable [AOR (95% CI) = 2.55 (1.60, 4.06)] attitudes towards HIV risk reduction strategies than students in non-health related departments.ConclusionsSome students were engaged in risky sexual behaviour even though they had heard about HIV/AIDS. The perception of risk for acquisition of HIV infection and utilization of VCT were low. HIV prevention and control strategies including education in the areas of HIV/AIDS as part of university programs curriculum, specially non-health students, and strengthening health institutions to provide youth-friendly VCT services for HIV with “know your HIV status” campaigns are strongly recommended.

Couples' voluntary HIV counseling and testing provider training evaluation, Zambia.

SummaryWith the expansion of couples’ voluntary HIV counseling and testing (CVCT) in urban Zambia, there is a growing need to evaluate CVCT provider trainings to ensure that couples are receiving quality counseling and care. We evaluated provider knowledge scores, pre- and post-training and predictors of pre- and post-training test scores. Providers operating in 67 government clinics in four Copperbelt Province cities were trained from 2008 to 2013 in three domains: counseling, rapid HIV laboratory testing and data management. Trainees received pre- and post-training tests on domain-specific topics. Pre- and post-training test scores were tabulated by provider demographics and training type, and paired t-tests evaluated differences in pre- and post-training test scores. Multivariable ANCOVA determined predictors of pre- and post-training test scores. We trained 1226 providers, and average test scores increased from 68.8% pre-training to 83.8% post-training (p < 0.001). Test scores increased significantly for every demographic group and training type (p < 0.001) with one exception—test scores did not significantly increase for those receiving counseling or data management training who had less than a high school education. In multivariable analysis, higher educational level and having a medical background were predictive of a higher pre-test score; higher pre-test scores and having a medical background were predictive of higher post-test scores. Pre- and post-test assessments are critical to ensure quality services, particularly as task-shifting from medical to lay staff becomes more common. Assessments showed that our CVCT trainings are successful at increasing knowledge, and that those with lower education may benefit from repeat trainings.

Sustained effect of couples' HIV counselling and testing on risk reduction among Zambian HIV serodiscordant couples

BackgroundWe present temporal trends in self-reported and biological markers of unprotected sex and sex with concurrent partners in discordant couples receiving couples' voluntary HIV counselling and testing (CVCT).MethodsHeterosexual Zambian HIV-serodiscordant...

Seroprevalence and factors associated with Voluntary Counselling and Testing (VCT) for HIV among children in Lubumbashi, Democratic Republic of the Congo

RésuméIntroductionMalgré le dépistage du VIH proposé lors de la naissance ou au cours des consultations préscolaires, la proportion des enfants qui croissent ou décèdent sous statut sérologique au VIH inconnu est importante en République Démocratique du Congo (RDC). L’objectif de cette étude était de déterminer la séroprévalence au cours d’un dépistage volontaire et d’identifier les facteurs associés à l’acceptation du conseil et dépistage du VIH (CDV) en dehors de la maladie ou de toute exposition au VIH dans une population pédiatrique à Lubumbashi, RDC.MéthodesIl s’agissait d’une étude prospective transversale à visée analytique menée du 1er août 2006 au 31 septembre 2007. Elle avait été réalisée dans 4 centres communautaires de CDV répartis dans 4 zones de santé de la ville de Lubumbashi en RDC (Lubumbashi, Ruashi, Kampemba et de Kenya). L’étude avait consisté à faire le dépistage volontaire du VIH chez les enfants de moins de 15 ans. Les caractéristiques sociodémographiques et les paramètres relatifs au conseil et dépistage volontaire ont été étudiés. Les analyses statistiques descriptives usuelles et une régression logistique ont été réalisées.RésultatsSur 463 enfants dépistés du VIH, 41 (8,9%; IC 95%: 6,5%-11,9%) ont été testés positifs. L’acceptation du conseil et dépistage volontaire du VIH en dehors de la maladie ou de l’exposition au VIH était significativement plus élevée lorsque l’enfant était âgé de plus de 2 ans (Odds ratio ajusté (ORa) = 3,6 [IC 95%: 1,1-12,2]), lorsque le statut sérologique du VIH des parents était négatif ou inconnu (ORa = 27,4 [IC 95%: 9,4-80,0]), lorsque l’un ou l’autre ou les deux parents biologiques étaient en vie (ORa = 24,9 [IC 95%: 2,4-250,8]) et lorsque la connaissance du lieu de dépistage était fait par des moyens autres que le professionnel de santé (ORa = 2,9 [IC 95%: 1,0-7,9]).ConclusionNotre étude montre une forte prévalence du VIH chez les enfants justifiant la nécessité de réaliser le CDV qui est significativement accepté par leurs parents et tuteurs dans la ville de Lubumbashi.

Predictors of Consistent Condom and Voluntary Counselling and Testing Services Utilization Among BodaBoda Operators in Coastal Region of Kenya

Despite recent declines in global HIV/AIDS mortality, HIV/AIDS is still the leading cause of death especially in in Sub-Saharan Countries. Voluntary HIV counseling and testing (VCT) and consistent condom use among BodaBoda operators are very important in the prevention and control of the infection. This study determined the consistent condom and voluntary counseling and testing services utilization among BodaBoda operators in Coastal region of Kenya. A cross-sectional study was carried between February to December 2015. A multi-stage sampling method was applied to randomly select the BodaBoda operators. Stratification, random and systematic sampling techniques were used to identify the study participants. Interviews were conducted using structured questionnaires. Data analysis was done using statistical package for social sciences version 16. Analytical statistics were done using odds ratio to measure strength of association between Condom and VCT uptakes and independent variables. Association with p-value <0,05 was considered significant. Binary regression was used to identify predictors of condom and VCT uptakes. Of 385 participants, 98.7% were male and 1.3% female. This study revealed that the prevalence of VCT uptake and consistent condom use among BodaBoda operators in Coastal Kenya was 53.0% and 60.0% respectively. VCT uptake was found to be significantly predicted bygender (AOR=3.216, 95% CI: 1.410-9.964), visiting a VCT centre with a partner (AOR=16.39, 95%CI: 3.012-17.624), assurance of confidentially of HIV test results (AOR =4.79, 95% CI: 2.033-8.907), known VCT (AOR=0.152, 95% CI: 0.034-0.221) and fear of being seen at VCT centre (AOR=0.551, 95% CI: 0.307-0.988). Consistent condom use was significantly associated with gender (AOR=2.01, 95% CI: 1.04, 2.48), Educational status (AOR=0.80, 95% CI: 0.43, 0.85) and marital status (AOR=1.51, 95% CI: 1.07-2.15). Conclusion: The overall prevalence of VCT uptake and consistent condom use was found to be low. VCT utilization uptake among the operators was influenced by gender, assurance of confidentiality of the HIV test results, going to a VCT with a partner, fear of being seen at a VCT centre and going to a known VCT. The main predictors of consistent condom use were found to be gender, educational level and marital status. Integration of friendly VCT services would increase VCT uptake among BodaBoda operators. Support and care received after knowing the test results should be clearly communicated as it reduces stigma. Therefore, interventions targeting sex, educational status and marital status are recommended.

Assessment of Voluntary HIV Counselling and Test Utilization and Associated Factors among Youth People in Birbir Town, Gamo Gofa Zone, SNNPR, Ethiopia

Youth (15-24 years) are particularly vulnerable to HIV, because of the strong influence of peer pressure and the development of their sexual and social identities. The aim of the study was to assess voluntary counseling and testing utilization and associated factors among young people in Birbir town, Southern Ethiopia. A community based cross sectional study design was conducted from August 13-16, 2016. Simple random sampling technique was used to select 400 young’s. Semi structured questionnaire was used. The data was collected by trained Nurses. Data was entered and analyzed using SPSS version 20. Binary and Multivariable Logistic regression was performed with 95%CI, COR and AOR respectively. The finding was presented by tables, and figures. In this study a total of 378 youth were participated with response rate of 94.4%. The mean age of the participants was 20.6 years with SD (&plusmn;2.7). The majority (96%) of respondents were heard about the confidential voluntary counseling and testing service. The prevalence of voluntary counseling and testing utilization was 64.3%. The factors such as: peer encouragement [AOR=3.81, 95%CI, (2.302, 6.285)], knowing definition of voluntary counseling and testing [AOR = 13.38, 95% CI, (1.501, 119.338)], willingness to test [AOR = 10.65, 95% CI (1.268, 89.459)], health institution encouragement [AOR=1.989, 95%CI (1.076, 3.676)]and Method of testing [AOR = 0.51, 95% CI (0.289, 0.889)] were the factors associated with voluntary counseling and testing utilization. The study shows that voluntary counseling and testing utilization was 64.3%. Knowing definition of voluntary counseling and testing, methods of testing, willingness to test, health institution encouragement and peer encouragement were the factors associated with voluntary counseling and testing utilization. Health office has to work with and facilitate youth clubs to promote voluntary counseling and testing utilization and strengthen facility based testing.

Dorsal longitudinal foreskin cut is associated with reduced risk of HIV, syphilis and genital herpes in men: a cross‐sectional study in Papua New Guinea

Introduction: Various forms of penile foreskin cutting are practised in Papua New Guinea. In the context of an ecological association observed between HIV infection and the dorsal longitudinal foreskin cut, we undertook an investigation of this relationship at the individual level.Methods: We conducted a cross-sectional study among men attending voluntary confidential HIV counselling and testing clinics. Following informed consent, participants had a face-to-face interview and an examination to categorize foreskin status. HIV testing was conducted on site and relevant specimens collected for laboratory-based Herpes simplex type-2 (HSV-2), syphilis, Chlamydia trachomatis (CT), Neisseria gonorrhoeae (NG), and Trichomonas vaginalis (TV) testing.Results: Overall, 1073 men were enrolled: 646 (60.2%) were uncut; 339 (31.6%) had a full dorsal longitudinal cut; 72 (6.7%) a partial dorsal longitudinal cut; and 14 (1.3%) were circumcised. Overall, the prevalence of HIV was 12.3%; HSV-2, 33.6%; active syphilis, 12.1%; CT, 13.4%; NG, 14.1%; and TV 7.6%. Compared with uncut men, men with a full dorsal longitudinal cut were significantly less likely to have HIV (adjusted odds ratio [adjOR] 0.25, 95%CI: 0.12, 0.51); HSV-2 (adjOR 0.60, 95%CI: 0.41, 0.87); or active syphilis (adjOR 0.55, 95%CI: 0.31, 0.96). This apparent protective effect was restricted to men cut prior to sexual debut. There was no difference between cut and uncut men for CT, NG or TV.Conclusions: In this large cross-sectional study, men with a dorsal longitudinal foreskin cut were significantly less likely to have HIV, HSV-2 and syphilis compared with uncut men, despite still having a complete (albeit morphologically altered) foreskin. The protective effect of the dorsal cut suggests that the mechanism by which male circumcision works is not simply due to the removal of the inner foreskin and its more easily accessible HIV target cells. Exposure of the penile glans and inner foreskin appear to be key mechanisms by which male circumcision confers protection.Further research in this unique setting will help improve our understanding of the fundamental immunohistologic mechanisms by which male circumcision provides protection, and may lead to new biomedical prevention strategies at the mucosal level.

Factors Affecting Utilization of Voluntary HIV Counseling and Testing Services among Teachers in Awi Zone, Northwest Ethiopia.

HIV/AIDS affects the basic educational sector which is the most productive segment of the population and vital to the creation of human capital. The loss of skilled and experienced teachers due to the problem is increasingly compromising the provision of quality education in most African countries. The study was proposed to determine the magnitude of VCT utilization and assess contributing factors that affect VCT service utilization among secondary school teachers in Awi Zone. A cross-sectional study design was conducted among 588 participants in 2014. Self-administered questionnaire was used to collect data. Data was analyzed using SPSS version 16, presented as frequencies and summary statistics, and tested for presence of significant association with odds ratio at 95% CI. More than half (53.6%) of study participants were tested for HIV. Those who had sexual intercourse, had good knowledge about VCT, were divorced/widowed, were in the age group of 20–29 years, and were married utilized VCT services two, three, four, three, and two times better than their counterparts, respectively. Actions targeting unmarried status, increase of educational level, and teachers with age groups above 30 years are necessary to follow their counterparts to utilize VCT service in order to save loss of teachers.

Knowledge, attitudes, and practices related to voluntary counseling and testing (VCT) for HIV among nursing students in Zambia

Access to voluntary counseling and testing (VCT) services has become an important tool in the treatment and prevention of HIV infection. A cross-sectional knowledge, attitudes, and practices (KAP) study was conducted with 50 nursing students in Zambia. All students were aware of where to go for VCT, and 80% had reported using VCT services. However, the participants expressed concerns about privacy and confidentiality related to testing, with most students preferring to seek future VCT at a facility far from their workplace. This ongoing fear of stigma associated with HIV testing was similar to the findings of a recent KAP study conducted among young adults in Bo, Sierra Leone.

Evaluation of the integrated clinic model for HIV/AIDS services in Ho Chi Minh City, Viet Nam, 2013–2014

Setting: Ho Chi Minh City (HCMC), Viet Nam. Objective: To evaluate a new integrated service model for human immunodeficiency virus/acquired immune-deficiency syndrome (HIV/AIDS) care. Design: In HCMC, co-located services, including voluntary HIV counseling and testing (VCT), HIV treatment at out-patient clinics (OPC), and methadone maintenance therapy (MMT) for persons who inject drugs, have operated under different administrative structures. In the context of decreasing international financial support, integration of these services into one administrative structure with reduced staff occurred in seven districts in HCMC between October 2013 and June 2014. We used a pre-post study design to compare service-related outcomes from routinely collected data at health facilities 6 months before and 6 months after integration. Results: The proportion of HIV-infected persons linked from VCT to OPCs was unchanged or increased following integration. A higher percentage of patients eligible for antiretroviral therapy (ART) were started on ART. The proportion of ART patients lost to follow-up remained unchanged. The proportions of MMT patients who tested positive for heroin or other substances decreased or were unchanged. Conclusions: VCT, OPC and MMT service delivery quality remained the same or improved during the 6 months following the integration. Expansion of the integrated model should be considered for HIV-related services.

From Evidence to Health Policy Making: Pre-Exposure Prophylaxis for HIV Prevention

Pre-exposure prophylaxis (PrEP), in combination with traditional prevention strategies (such as condom use, voluntary HIV counseling and testing, and treatment for sexually transmittedinfections), has been shown to effectively prevent HIV infection. As of September 2015, the World Health Organization recommends that people at substantial risk of HIV infection should be offered PrEP as an additional prevention choice, as part of comprehensive prevention. This article introduces how to apply a systematic review using the methodology of Grading of Recommendations Assessment, Development and Evaluation (GRADE) to write clinical guidelines. With support from the Taiwan Centers for Disease Control, the Taiwan AIDS Society published clinical guidelines for oral pre-exposure prophylaxis in Taiwan. Nurses are responsible to apply evidence-based knowledge and to use their professional influence to shape health policies related to HIV prevention.

Interventions that increase the intention to seek voluntary HIV testing in young people: a review

ABSTRACTYoung people 15–24 years old represent 39% of new HIV infections globally. However, they are the least likely age demographic to seek HIV testing and the most likely to be unaware of their HIV status. The purpose of this systematic literature review was to identify interventions that increase either rates of HIV testing or intentions to seek HIV testing in young people 10–24 years old. In total, 1601 manuscripts were systematically examined and five manuscripts were included in the final review. Two common themes identified in the interventions were education and test delivery methods. Educational programs were found to be effective when delivered in classroom or entertainment-based formats. Health providers offering testing and home testing increased the rate of testing. Additional research is needed on programs aimed at young people not enrolled in schools, interventions that measure testing rates, and educating healthcare providers about offering HIV tests to young people.

Male condom use, multiple sexual partners and HIV: a prospective case-control study in Kinshasa (DRC)

ABSTRACTIn the Democratic Republic of Congo no previous studies have assessed the factors associated with different patterns of condom use and with multiple sexual partners, and the association between condom use simultaneously taking into account multiple sexual partnerships, and HIV infection. We carried out a prospective case–control study. From December 2010 until June 2012, 1630 participants aged 15–49 getting HIV Voluntary Counseling and Testing in a hospital in Kinshasa were selected. Cases were new HIV diagnosis and controls were HIV-negative participants detected along the study period. We recruited 274 cases and 1340 controls that were interviewed about HIV-related knowledge, attitudes and behaviours. Among cases there was a high prevalence of multiple lifetime and concurrent sexual partnerships (89.8% and 20.4%, respectively) and most cases never used condoms with only 1.5% using them consistently. Condom use and multiple partnerships were associated with male, single and high-educated participants. An association was found between multiple lifetime partners and ‘any condom use’ (OR = 2.99; 95%CI: 2.14–4.19) but not with consistent use. Both having two or more multiple concurrent sexual partners or not using condoms were variables similarly and highly associated to HIV risk. The association found between having two or more concurrent sexual partners and HIV was slightly higher (OR = 3.58, 95%CI:2.31–5.56) than the association found between never condom use and HIV (OR = 3.38, 95%CI:1.15–9.93). We found a high prevalence of multiple lifetime sexual partners and an extremely high prevalence of inconsistent condom use, both strongly associated with HIV seropositivity. Local programmes would benefit from comprehensive interventions targeting all behavioural and sociocultural determinants.

Implementation and Operational Research: Evolution of Couples' Voluntary Counseling and Testing for HIV in Rwanda: From Research to Public Health Practice.

Background:Couples' voluntary HIV counseling and testing (CVCT) is a WHO-recommended intervention for prevention of heterosexual HIV transmission which very few African couples have received. We report the successful nationwide implementation of CVCT in Rwanda.Methods:From 1988 to 1994 in Rwanda, pregnant and postpartum women were tested for HIV and requested testing for their husbands. Partner testing was associated with more condom use and lower HIV and sexually transmitted infection rates, particularly among HIV-discordant couples. After the 1994 genocide, the research team continued to refine CVCT procedures in Zambia. These were reintroduced to Rwanda in 2001 and continually tested and improved. In 2003, the Government of Rwanda (GoR) established targets for partner testing among pregnant women, with the proportion rising from 16% in 2003 to 84% in 2008 as the prevention of mother-to-child transmission program expanded to >400 clinics. In 2009, the GoR adopted joint posttest counseling procedures, and in 2010 a quarterly follow-up program for discordant couples was established in government clinics with training and technical assistance. An estimated 80%–90% of Rwandan couples have now been jointly counseled and tested resulting in prevention of >70% of new HIV infections.Conclusions:Rwanda is the first African country to have established CVCT as standard of care in antenatal care. More than 20 countries have sent providers to Rwanda for CVCT training. To duplicate Rwanda's success, training and technical assistance must be part of a coordinated effort to set national targets, timelines, indicators, and budgets. Governments, bilateral, and multilateral funding agencies must jointly prioritize CVCT for prevention of new HIV infections.

Promotion and Persistence of HIV Testing and HIV/AIDS Knowledge: Evidence From a Randomized Controlled Trial in Ethiopia.

We use data from a randomized controlled trial in Ethiopia and examine the causal effects of HIV/AIDS education, home-based voluntary HIV counseling and testing (VCT), and conditional cash transfers (CCT) for facility-based VCT on HIV/AIDS knowledge and demand for HIV testing. HIV/AIDS education significantly increases HIV/AIDS knowledge but has a limited effect on testing take-up. However, when HIV/AIDS education is combined with either home-based VCT or CCT for facility-based VCT, take-up increases substantially by about 63 and 57 percentage points, respectively. We also demonstrate evidence of persistence in test-taking behavior, where past HIV testing does not dampen demand for testing. Lastly, we find suggestive evidence that home-based VCT could be more effective at detecting HIV-positive cases relative to CCT for facility-based VCT. Our findings highlight the importance of geographic accessibility in the testing decision and persistence in demand for HIV testing. Copyright © 2016 John Wiley & Sons, Ltd.