• Share
  • Email
  • Embed
  • Like
  • Save
  • Private Content
HIV Testing for Couples
 

HIV Testing for Couples

on

  • 1,117 views

 

Statistics

Views

Total Views
1,117
Views on SlideShare
1,117
Embed Views
0

Actions

Likes
0
Downloads
3
Comments
0

0 Embeds 0

No embeds

Accessibility

Categories

Upload Details

Uploaded via as Microsoft PowerPoint

Usage Rights

© All Rights Reserved

Report content

Flagged as inappropriate Flag as inappropriate
Flag as inappropriate

Select your reason for flagging this presentation as inappropriate.

Cancel
  • Full Name Full Name Comment goes here.
    Are you sure you want to
    Your message goes here
    Processing…
Post Comment
Edit your comment
  • most effective HIV prevention intervention for cohabitating couples in Africa, the largest group at risk for HIV infection in the world. very few couples in high-prevalence areas have been tested together. couples will come together for testing if financial and logistical obstacles are overcome. VCT is becoming increasingly available with the advent of perinatal prevention efforts and antiretroviral medication provision programs, but these programs prioritize the individual and generally do not accommodate couples
  • IN KIGALI, RWANDA, HIV TESTING FOR COUPLES FIRST BEGAN IN 1988 AS PART OF PROJET SAN FRANCISCO, A RESEARCH PROJECT EVIDENCE OF REDUCED HIV, STI, AND UNPLANNED PREGNANCY WAS PUBLISHED AS EARLY AS 1991-1993, WITH SIMILAR PUBLICATIONS FROM GROUPS IN OTHER AFRICAN COUNTRIES.
  • Stepping back, couples’ testing was successful early on, prior to availability of any PMTCT drug regimens: in both Kigali and Lusaka, our World AIDS Foundation program was able to train counselors to provide HIV testing for women during the week and with their partners on weekends. The publication detailing the findings is available, but of note on this slide are the couples with HIV+ men and HIV- women; these couples contribute to 85% of the new infections that occur in pregnant and breastfeeding women.
  • Lack of trained staff to promote and deliver couples counseling

HIV Testing for Couples HIV Testing for Couples Presentation Transcript

  • HIV testing for couples William Kilembe MD MSc Rwanda Zambia HIV Research Group 19 July 2010
  • Why test as a couple?
    • In most sub-Saharan African countries, @ 75% of adults are in a cohabiting sexual partnership (‘marriage’)
    • Most new infections are acquired in marriage
    • Joint testing reduces risk of HIV, STI, and unplanned pregnancy
    • <1% of all couples in Africa counseled and tested together
    • ANC is an opportunity for joint
    • Testing and counseling.
  • Example of Kigali, Rwanda
    • 2003-2006: 3 stand alone centers
      • 340 Influence network agents distributed 74,500 written invitations
      • 36,900 couples attended with transport reimbursed
      • 32,000 tested, 3840 discordant couples identified
    • Transition from research to practice…….
    • 2007: USAID funds PSF to train 300 counselors from Kigali government health centers
    • 40,000 couples tested at Projet San Francisco:
      • half were cohabiting couples,
      • @15% of the city’s cohabiting couples had participated
    • MOH endorsed routine testing of male partners in ANC
    • Weekend programs set up to accommodate both partners together
    By 2008 – Kigali, Rwanda
    • 2006-2008: male partners tested separately from wives in government clinics
    • 2009: CDC/NIMH/LSTM procedures adopted as National Guidelines
    • www.cdc.gov/globalaids/CHCTintervention
    • Weekend programs in clinics facilitated the transition to integrated weekday services
    Lessons learned from Kigali, Rwanda
  • Example of Lusaka, Zambia
    • 2003-2007: 3 stand alone centers operated by (ZEHRP)
      • 1600 Influence network agents distributed 144,000 written invitations
      • 18,000 couples attended
      • 13,000 tested, 2300 discordant couples identified
    • 3 fixed sites closed (NIMH funding ended)
    • 3% of Lusaka’s cohabiting couples had been tested
    • transition to weekend programs in ANC clinics; target 20% of ANC visitors to bring male partners
    • Couple transport paid, clinic promoters paid a nominal sum (not performance based)
    • Couple transport cut in half, clinic promoter pay reduced—attendance dropped >50%
    • In clinics with no couple transport, <1% of ANC visitors return with partners
    By 2008 – Lusaka, Zambia
    • Couples’ testing still not a social norm, need continued promotions and incentives
    • Sustainability will occur at a social level once enough couples have been tested (>15%)
    • Sustainability CANNOT occur if efforts are limited to ‘supply side’ without support for ‘demand side’
    Lessons learned from Lusaka, Zambia
  • Couples’ testing is possible in ANC
    • Successfully implemented in 2001 in 2 ANC clinics in Lusaka and 2 clinics in Kigali
    • No HIV testing was available at the outset, within 8 months >2000 women were tested alone during the week and >1600 women with partners on weekends
  • World AIDS Foundation HIV testing Program in antenatal clinics-2001 8 months in 2001 KIGALI LUSAKA   RWANDA ZAMBIA Singles N 193 91 HIV+ 21% 22%       Married F tested alone 791 931   14% 27%       Couples N 956 663 HIV + M / HIV + F 8% 18% HIV - M / HIV + F 5% 9% HIV + M / HIV - F 4% 8% HIV - M / HIV - F 83% 64%
  • Obstacles in CHCT Provision
    • Lack of vision and commitment among funding agencies and policymakers
    • Lack of indicators, mandates, and budgets to incentivize CVCT
    • Re-invention of the wheel with dysfunctional models (ex separate testing, no incentives).
    • Competing messages in clinics and community (e.g. malaria, HAART)
    • Lack of demand resulted in lack of CVCT supply, which in turn discourages demand
  • We need to focus on both sides SUPPLY DEMAND
    • Trained couples’ counselors
    • Accessible services, including weekend and evening
    • Stand-alone AND integrated; each plays an important role
    • Add partners to antenatal clinic, ARV screening, blood bank, existing VCT
    • Active promotion to establish social norm
    • Reach 15%-20% of a target audience to achieve ‘snowball effect’
    • Incentives for couples and promoters may be necessary in the early stages
  • Technical assistance available
    • RZHRG is a COE in CHCT with 20+ years of experience
    • Counseled couples and follow-up of >10,000 discordant couples
    • CDC funding RZHRG to provide TA
    • French and English speaking trainers
    • Didactic and practicum training for counselors, Promoters and program managers, Lab techs and Data mangers
  • Acknowledgments
    • Center for Disease Control (CDC)
    • US National Institutes of Mental Health (NIMH)
    • International AIDS Vaccine Initiative (IAVI)
    • National Institutes for Allergy and Infectious Diseases (NIAID)
    • Home office at Emory School of Public Health
    • Rwanda-Zambia HIV Research Group