Applying the Diffusion of Innovation Model to HIV Testing in Two African Cities Open Access

Abstract

Abstract

Applying the Diffusion of Innovation Model to HIV Testing in Two African
Cities
Objectives: The purpose of this study was to determine the effectiveness of the INA promotional
strategy in promoting couples' voluntary counseling and testing in Lusaka, Zambia and Kigali,
Rwanda. The INA model was based in the diffusions of innovation model. Secondary objectives
were to determine the spread of CVCT through the cities, explore the difference in decision to
test between couples with invites and those without, and the effect of other promotional
strategies.
Design: INAs were recruited from faith‐based, health, private, and community‐based
organizations. INAs were given training in CVCT methodology and given invitations to give to
potential clients.
Methods: All couples attending CVCT clinics were given in taken surveys. A subset of couples
were also given more detailed surveys. Descriptive statistics and chi‐squared tests were
calculated based on these data.
Results: In Kigali, 43% of couples attending CVCT clinics had INA invitations. Among couples with
invites, 91% decided to test compared to 84% among couples without testing (p‐value <0.001).
Previous individual HIV testing increased between 2003‐2008, from 37 to 53% in men and from
45 to 71% in women. Additionally, prior joint testing also increased from 6% in 2005 to 28% in
2008.
In Lusaka, 68% of couples attending CVCT clinics had INA invitations. Among couples with
invites, 79% decided to test compared to 88% among couples without testing (p‐value <0.001).
Prior individual HIV testing increased between 2005 and 2009, from 24 to 33% in men and from
38 to 63% in women but joint HIV testing remained the same at around 4%.
Conclusions: The INA promotional strategy was important for attracting couples to attend CVCT
clinics in both cities. In Kigali, those with INA invites were more likely to test than those without
invites while in Lusaka the reverse was true. The increase in joint testing over the years in Kigali
demonstrates the diffusion of the CVCT model through the city. The low numbers in Lusaka
demonstrate the lack of diffusion. A possible explanation is that Lusaka is a much larger and
more heterogeneous city than Kigali which makes it harder for a new idea to spread.

Table of Contents

Table of Contents
Chapter 1: Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .1
Chapter 2: Comprehensive Literature Review . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .4
Table A: Recent Articles using the Diffusion of Innovations Model . . . . . . . . . . . . . . . . . 9
Chapter 3: Manuscript . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13
Abstract . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 15
Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .16
Methods . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 18
Results . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 20
Discussion . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 22
References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .27
Tables . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .28
Chapter 4: Discussion, Conclusion, and Recommendations . . . . . . . . . . . . . . . . . . . . . . .33
References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .36

About this Master's Thesis

Rights statement

• Permission granted by the author to include this thesis or dissertation in this repository. All rights reserved by the author. Please contact the author for information regarding the reproduction and use of this thesis or dissertation.

School	Rollins School of Public Health
Department	Hubert Department of Global Health
Degree	MPH
Submission	Master's Thesis
Language	English
Research Field	Health Sciences, Public Health
Keyword	HIV Couples' Voluntary Counseling and Testing Diffusion of Innovations
Committee Chair / Thesis Advisor	Allen, Susan A, Emory University
Partnering Agencies	Emory University schools, faculty or affiliated programs

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