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Health services research
Research
Promotion of couples’ voluntary HIV counselling and testing in Lusaka, Zambia by influence network leaders and agents
  1. Kristin M Wall1,2,4,
  2. William Kilembe1,2,3,
  3. Azhar Nizam1,2,5,
  4. Cheswa Vwalika1,2,3,
  5. Michelle Kautzman1,2,3,
  6. Elwyn Chomba1,2,3,6,
  7. Amanda Tichacek1,2,
  8. Gurkiran Sardar1,2,3,8,
  9. Deborah Casanova1,2,3,
  10. Faith Henderson1,2,3,
  11. Joseph Mulenga1,2,3,7,
  12. David Kleinbaum1,2,4,
  13. Susan Allen1,2
  1. 1Department of Pathology & Laboratory Medicine, Rwanda Zambia HIV Research Group, School of Medicine, Atlanta, Georgia, USA
  2. 2Hubert Dept of Global Health, Rollins School of Public Health, Emory University, Atlanta, Georgia, USA
  3. 3Zambia Emory HIV Research Project, Lusaka, Zambia
  4. 4Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, Georgia, USA
  5. 5Department of Biostatistics and Bioinformatics, Rollins School of Public Health, Emory University, Atlanta, Georgia, USA
  6. 6University Teaching Hospital and University of Zambia School of Medicine, Lusaka, Zambia
  7. 7Zambia National Blood Transfusion Services, Lusaka, Zambia
  8. 8College of Medicine, University of Illinois at Chicago, Chicago, Illinois, USA
  1. Correspondence to Kristin M Wall; kmwall{at}emory.edu

Abstract

Objectives Hypothesising that couples’ voluntary counselling and testing (CVCT) promotions can increase CVCT uptake, this study identified predictors of successful CVCT promotion in Lusaka, Zambia.

Design Cohort study.

Setting Lusaka, Zambia.

Participants 68 influential network leaders (INLs) identified 320 agents (INAs) who delivered 29 119 CVCT invitations to heterosexual couples.

Intervention The CVCT promotional model used INLs who identified INAs, who in turn conducted community-based promotion and distribution of CVCT invitations in two neighbourhoods over 18 months, with a mobile unit in one neighbourhood crossing over to the other mid-way through.

Primary outcome The primary outcome of interest was couple testing (yes/no) after receipt of a CVCT invitation. INA, couple and invitation characteristics predictive of couples’ testing were evaluated accounting for two-level clustering.

Results INAs delivered invitations resulting in 1727 couples testing (6% success rate). In multivariate analyses, INA characteristics significantly predictive of CVCT uptake included promoting in community-based (adjusted OR (aOR)=1.3; 95% CI 1.0 to 1.8) or health (aOR=1.5; 95% CI 1.2 to 2.0) networks versus private networks; being employed in the sales/service industry (aOR=1.5; 95% CI 1.0 to 2.1) versus unskilled manual labour; owning a home (aOR=0.7; 95% CI 0.6 to 0.9) versus not; and having tested for HIV with a partner (aOR=1.4; 95% CI 1.1 to 1.7) or alone (aOR=1.3; 95% CI 1.0 to 1.6) versus never having tested. Cohabiting couples were more likely to test (aOR=1.4; 95% CI 1.2 to 1.6) than non-cohabiting couples. Context characteristics predictive of CVCT uptake included inviting couples (aOR=1.2; 95% CI 1.0 to 1.4) versus individuals; the woman (aOR=1.6; 95% CI 1.2 to 2.2) or couple (aOR=1.4; 95% CI 1.0 to 1.8) initiating contact versus the INA; the couple being socially acquainted with the INA (aOR=1.6; 95% CI 1.4 to 1.9) versus having just met; home invitation delivery (aOR=1.3; 95% CI 1.1 to 1.5) versus elsewhere; and easy invitation delivery (aOR=1.8; 95% CI 1.4 to 2.2) versus difficult as reported by the INA.

Conclusions This study demonstrated the ability of influential people to promote CVCT and identified agent, couple and context-level factors associated with CVCT uptake in Lusaka, Zambia. We encourage the development of CVCT promotions in other sub-Saharan African countries to support sustained CVCT dissemination.

This is an open-access article distributed under the terms of the Creative Commons Attribution Non-commercial License, which permits use, distribution, and reproduction in any medium, provided the original work is properly cited, the use is non commercial and is otherwise in compliance with the license. See: http://creativecommons.org/licenses/by-nc/2.0/ and http://creativecommons.org/licenses/by-nc/2.0/legalcode.

https://doi.org/10.1136/bmjopen-2012-001171

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