Progress and Challenges in Integrating Couples' Voluntary Counseling and Testing into Routine Antenatal Services in Government Clinics and Predictors of 1-Month Follow-up HIV Testing for Couples' Voluntary Counseling and Testing Outside of a Research Setting in Ndola, Zambia Open Access

Czaicki, Nancy (2012)

Permanent URL: https://etd.library.emory.edu/concern/etds/2z10wq903?locale=en
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Abstract

Background: In 2008, the Ministry of Health in Zambia recommended that
HIV testing be provided to partners of antenatal clients. Herein the transition of
Couples' Voluntary HIV Counseling and Testing (CVCT) from NGO-sponsored
weekend services to integrated weekday services in government clinics in Ndola,
Zambia is examined. This examination includes a description of how CVCT data
are being recorded using individual-level data collection tools. Additionally,
predictors of follow-up HIV testing for concordant negative and discordant
couples participating in the weekend services are established.
Methods: Data were extracted from government-issued logbooks in antenatal
clinic (ANC) and voluntary counseling and testing (VCT) services in the six
largest government clinics for 2010, and in 15 clinics for the first half of 2011.
CVCT procedures were documented through observation and counselor
interviews. Follow-up data was collected from the databases of the NGO
providing weekend service and analyzed by developing a predictive logistic
regression model.
Results: In 2010, only one of the six largest clinics tested more than four
couples per week. In March-May of 2011, 11 of 15 clinics averaged less than 2.5
couples per week. 77% of couples were seen in the antenatal care (ANC)
department with the remainder tested in the voluntary HIV counseling and
testing (VCT) department. Obstacles included low participation of men, lack of
staff trained to counsel couples jointly, procurement of HIV tests for men in ANC,
and non-uniform recording of CVCT in ANC and VCT logbooks. In the follow-up
analysis, discordancy (OR = 2.50, 95% CI 1.945, 3.205) and urban clinic location
(OR = 4.27, 95% CI 2.973-6.144) were the two strongest predictors.
Conclusions: This study identified several challenges for integrating CVCT into
regular clinic services. Recommendations to address these challenges are:
implementing new data recording instruments, increasing training of counselors
and nurses in CVCT, prioritizing ANC clients attending with partners, and
expanding community sensitization using proven models. Follow-up of
discordant and concordant negative couples is an important initiative to ensure
reduced transmission of HIV between partners and to identify a seroconversion
as early as possible. Moving forward, interventions to increase follow-up rates
and streamline clinic logistics will be pursued.

Table of Contents



Table of Contents

Manuscript 1: Progress and Challenges in Integrating Couples' Voluntary
Counseling and Testing into Routine Antenatal Services in Government Clinics in
Ndola, Zambia



Title and Author...1
Abstract...2
Introduction...3
Methods...5
Results...7
Discussion...10
Conclusion...13
References...14
Figures
Figure 1...16
Figure 2...17


Manuscript 2: Predictors of 1-Month Follow-up HIV Testing for Couples'
Voluntary Counseling and Testing Outside of a Research Setting in Ndola,
Zambia



Title and Author...18
Abstract...19
Introduction...20
Methods...22
Results...25
Discussion...28
Conclusion....32
References...33
Tables
Table 1...36
Table 2...37
Table 3...38
Table 4...39
Table 5...40

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