Comparing Couples’ and Individual Voluntary Counseling and Testing for HIV at Antenatal Clinics in Tanzania: A Randomized Trial
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Voluntary counseling and testing (VCT) for couples (CVCT) is an important HIV-prevention effort in sub-Saharan Africa where a substantial proportion of HIV transmission occurs within stable partnerships. This study aimed to determine the acceptance and effectiveness of CVCT as compared to individual VCT (IVCT). 1,521 women attending three antenatal clinics in Dar es Salaam were randomized to receive IVCT during that visit or CVCT with their husbands at a subsequent visit. The proportion of women receiving test results in the CVCT arm was significantly lower than in the IVCT arm (39 vs. 71%). HIV prevalence overall was 10%. In a subgroup analysis of HIV-positive women, those who received CVCT were more likely to use preventive measures against transmission (90 vs. 60%) and to receive nevirapine for themselves (55 vs. 24%) and their infants (55 vs. 22%) as compared to women randomized to IVCT. Uptake of CVCT is low in the antenatal clinic setting. Community mobilization and couple-friendly clinics are needed to promote CVCT.
KeywordsCouples Voluntary counseling and testing HIV Antenatal care Tanzania
This research was funded by the Center for AIDS Research of Johns Hopkins University. Analyses were supported by the Bill and Melinda Gates Institute for Population and Reproductive Health and the Hopkins Population Center, also of Johns Hopkins University. We also thank Professor Ron Gray of Johns Hopkins University, Dr. Godfrey Kigozi of the Rakai Health Sciences Program, and Dr. Jessie Mbwambo of Muhimbili University College of Health Sciences, for serving on the Data Safety and Monitoring Board for the project. We are grateful to Professor Suzanne Maman of the University of North Carolina for helpful suggestions as we designed the study. We thank the Temeke District Authority for assisting in the identification of study clinics. We extend our sincere appreciation to the counselors, interviewers, data processing staff, and laboratory staff, as well as the women and men who participated in the study.
- 5.Department of Health and Human Services (DHHS), Centers for Disease Control and Prevention (CDC). Couples HIV counseling and testing (CHCT): participants manual. DHHS and CDC. Available at: http://www.cdc.gov/globalaids/CHCTintervention/. Accessed August 11, 2009.
- 11.Voluntary HIV-1 Counseling and Testing Efficacy Study Group. Efficacy of voluntary HIV-1 counselling and testing in individuals and couples in Kenya, Tanzania, and Trinidad: a randomised trial. Lancet 2000; 356(9224):103–12.Google Scholar
- 15.Iwanowski MR. Couples VCT in ANC clinics: prevention of perinatal and heterosexual HIV transmission in Africa. Second IAS Conference on HIV Pathogenesis and Treatment. Paris, 2003 (abstract 1062).Google Scholar
- 17.U.S. Census Bureau. HIV/AIDS surveillance data base [database online]. Washington D.C.: US Census Bureau, 2001. Available at: http://www.census.gov/ipc/www/hiv3afri.xls. Accessed August 11, 2009.
- 20.WHO. Counselling for HIV/AIDS: a key to caring. Geneva: WHO/GPA/TCO/HCS/95.15; 1995.Google Scholar
- 21.U.S. Centers for Disease Control. Counseling and testing revised guidelines for HIV counseling, testing and referral. MMWR. 2001;50(RR-19):1–57.Google Scholar
- 22.Bureau of Statistics (Tanzania). Tanzania Demographic and Health Survey 1996. Calverton, Maryland: Macro International; 1997.Google Scholar
- 29.USAID. U.S. Presidents Emergency Plan for AIDS Relief: Tanzania launches national HIV/AIDS testing campaign, September, 2007. Available at http://www.pepfar.gov/press/92135.htm. Accessed August 11, 2009.
- 30.Allen S, Karita E, Chomba E, et al. Promotion of couples’ voluntary counseling and testing for HIV through influential networks in two African capital cities. BMC Public Health. 2007; 7:349.Google Scholar