Sherr L, Lopman B, Kakowa M, et al. Voluntary counselling and testing: Uptake, impact on sexual behaviour, and HIV incidence in a rural Zimbabwean cohort

Department of Infectious Disease Epidemiology, Imperial College London, Londinium, England, United Kingdom
AIDS (Impact Factor: 6.56). 05/2007; 21(7):851-60. DOI: 10.1097/QAD.0b013e32805e8711
Source: PubMed

ABSTRACT To examine the determinants of uptake of voluntary counselling and testing (VCT) services, to assess changes in sexual risk behaviour following VCT, and to compare HIV incidence amongst testers and non-testers.
Prospective population-based cohort study of adult men and women in the Manicaland province of eastern Zimbabwe. Demographic, socioeconomic, sexual behaviour and VCT utilization data were collected at baseline (1998-2000) and follow-up (3 years later). HIV status was determined by HIV-1 antibody detection. In addition to services provided by the government and non-governmental organizations, a mobile VCT clinic was available at study sites.
Lifetime uptake of VCT increased from under 6% to 11% at follow-up. Age, increasing education and knowledge of HIV were associated with VCT uptake. Women who took a test were more likely to be HIV positive and to have greater HIV knowledge and fewer total lifetime partners. After controlling for demographic characteristics, sexual behaviour was not independently associated with VCT uptake. Women who tested positive reported increased consistent condom use in their regular partnerships. However, individuals who tested negative were more likely to adopt more risky behaviours in terms of numbers of partnerships in the last month, the last year and in concurrent partnerships. HIV incidence during follow-up did not differ between testers and non-testers.
Motivation for VCT uptake was driven by knowledge and education rather than sexual risk. Increased sexual risk following receipt of a negative result may be a serious unintended consequence of VCT. It should be minimized with appropriate pre- and post-test counselling.

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    • "These service-delivery models include the provider-initiated-counselling and testing (PICT), HCT at special events or campaigns, HCT at workplaces and at special places such as prisons. The quality of HIV counselling and testing is critical in ensuring the potential impact of risk reduction (Sherr et al. 2007). The current predominant counselling models such as the Egan model in South Africa and the TASO model in Uganda are seen as less structured to effect any behavioural change compared to the risk reduction model used in many other parts of the world (Van Rooyen et al. 2010). "
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    ABSTRACT: HIV counselling and testing (HCT) has become increasingly available in South Africa since the 1990s. Over 4500 public health facilities offer client and provider-initiated HIV counselling and testing. Counselling and testing remain key components of HIV/AIDS prevention as they provide an entry point into prevention, care, treatment and support services. This paper examines the quality of HIV counselling in government and Non-governmental (NGO) facilities and reviews adherence to the HCT policy guidelines during counselling sessions in 67 HIV counselling and testing (HCT) sites across 8 South African provinces.The assessment used both quantitative and qualitative methods. In total 149 structured observations of counselling sessions were conducted using a written checklist and audio recording. This assessment confirms that while counselling does occur prior and post HIV testing, the quality of counselling differs between sites and does not match the South African HCT policy guidelines. The following key aspects were not adequately discussed with clients: risk assessment and reduction, partner involvement, supportive care and treatment for those testing HIV positive. Confidentiality was also compromised by frequent interruptions during some sessions. The assessment indicated that ongoing training and mentoring of counsellors needs to be addressed, to make the HCT programme more effective.
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    • "HCT is important because it is an entry point to a comprehensive continuum of care for HIV/AIDS. In particular, it plays a pivotal role in the population's response to HIV and is also a crucial entry strategy into HIV/AIDS services such as prevention of mother-tochild transmission (PMTCT), provision of ART, management of HIV-related illnesses and provision of psychosocial support (Chersich & Temmerman 2008; Menzies, Abang, Wayenze, Nuwaha, Mugisha, Coutinho, et al. 2009; SANAC 2010; Sherr, Loopman, Kakowa, Dube, Chawira, Nyamukapa, et al. 2007). Furthermore, De Cock, Mbori-Ngacha and Marun (2002) have established that an additional benefit of HCT is that it may potentially result in a decrease in HIV-related stigma, leading to a 'normalization' of the HIV epidemic. "
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    ABSTRACT: Abstract HIV counselling and testing (HCT) is considered important because it is an entry point to a comprehensive continuum of care for HIV/AIDS. The South African Department of Health launched an HCT campaign in April 2010, and this reached 13,269,746 people by June 2011, of which 16% tested HIV positive and 400,000 of those were initiated into antiretroviral treatment. The overall objective of this project was to gain insight into the general perceptions about HIV testing in the different South African communities. Factors influencing testing in these communities were also explored. Discussions with twelve focus groups (FG) of 8-12 participants each were conducted with male and female participants recruited from both urban formal and informal communities in Cape Town and Durban. Participants included four racial groups represented by different age groups as follows: adolescents (12-17 years), youth (18-24 years) and adults (25 years and older). Data were analyzed using thematic coding. Among the key themes that emerged from the findings were the inaccurate perception of risk, fear of testing HIV positive, stigma and discrimination. Participants from both African and Indian FGs reported being less likely to do self-initiated HIV testing and counselling, while those from the FG consisting of young whites were more likely to learn about their HIV status through blood donations and campus HIV testing campaigns. Most FGs said they were likely to test if they understood the testing process better and also if the results are kept confidential. The present findings reiterate the importance of spreading positive messages and ensuring confidentiality for HIV testing in a society where there is still some stigma associated with people living with HIV/AIDS. This can partly be accomplished by the continuation of the national HCT campaign, which has been a considerable success in the fight against HIV/AIDS in South Africa during the past two years.
    SAHARA J: journal of Social Aspects of HIV/AIDS Research Alliance / SAHARA , Human Sciences Research Council 07/2014; 11(1):1-10. DOI:10.1080/17290376.2014.937355 · 0.81 Impact Factor
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    • "These have generally found greater impact among individuals testing HIV-positive compared to those testing negative [3-5]. However, some studies have found no association between VCT use and changes in sexual behaviour [6,7], while others have found increases in sexual risk taking among individuals testing HIV-negative [8]. Few studies have assessed the impact of VCT on HIV incidence, however overall, these have found no significant differences between participants who received and did not receive VCT [5]. "
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    ABSTRACT: It is widely assumed that voluntary counselling and testing (VCT) services contribute to HIV prevention by motivating clients to reduce sexual risk-taking. However, findings from sub-Saharan Africa have been mixed, particularly among HIV-negative persons. We explored associations between VCT use and changes in sexual risk behaviours and HIV incidence using data from a community HIV cohort study in northwest Tanzania. Data on VCT use, sexual behaviour and HIV status were available from three HIV serological surveillance rounds undertaken in 2003-4 (Sero4), 2006-7 (Sero5) and 2010 (Sero6). We used multinomial logistic regression to assess changes in sexual risk behaviours between rounds, and Poisson regression to estimate HIV incidence. The analyses included 3,613 participants attending Sero4 and Sero5 (3,474 HIV-negative and 139 HIV-positive at earlier round) and 2,998 attending Sero5 and Sero6 (2,858 HIV-negative and 140 HIV-positive at earlier round). Among HIV-negative individuals VCT use was associated with reductions in the number of sexual partners in the last year (aRR Seros 4-5: 1.42, 95% CI 1.07-1.88; aRR Seros 5-6: 1.68, 95% CI 1.25-2.26) and in the likelihood of having a non-cohabiting partner in the last year (aRR Seros 4-5: 1.57, 95% CI 1.10-2.25; aRR Seros 5-6: 1.48, 95% CI 1.07-2.04) or a high-risk partner in the last year (aRR Seros 5-6 1.57, 95% CI 1.06-2.31). However, VCT was also associated with stopping using condoms with non-cohabiting partners between Seros 4-5 (aRR 4.88, 95% CI 1.39-17.16). There were no statistically significant associations between VCT use and changes in HIV incidence, nor changes in sexual behaviour among HIV-positive individuals, possibly due to small sample sizes. We found moderate associations between VCT use and reductions in some sexual risk behaviours among HIV-negative participants, but no impacts among HIV-positive individuals in the context of low overall VCT uptake. Furthermore, there were no significant changes in HIV incidence associated with VCT use, although declining background incidence and small sample sizes may have prevented us from detecting this. The impact of VCT services will ultimately depend upon rates of uptake, with further research required to better understand processes of behaviour change following VCT use.
    BMC Infectious Diseases 03/2014; 14(1):159. DOI:10.1186/1471-2334-14-159 · 2.61 Impact Factor
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