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)
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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