Predictors of Previous HIV Testing Among Couples Receiving Couples Voluntary Counseling and Testing (CVCT) in Three Regions of Zambia Open Access

Abstract

Background: Knowledge of HIV status and partner's HIV status has been shown to reduce transmission of HIV and increase protective behaviors. This analysis aims to better quantify predictors of previous testing among couples seeking CVCT services in three regions of Zambia: the northern Copperbelt region, the capital city of Lusaka, and rural Southern Province. Predictors of individual previous HIV testing and previous CVCT as a couple were examined.

Methods: 96,024 Zambian couples that sought CVCT services from ZEHRP from 2008 to 2012 were included in univariate, bivariate, and multivariate analysis of previous HIV testing predictors. Associations with previous testing were assessed using log-binomial regression and logistic regression.

Results: Overall, the prevalence of previous testing in individuals was 57.0%. In the individual previous testing analysis, living in Southern Province or the Copperbelt city of Chingola, being HIV-negative, partner being HIV-negative, being female, being pregnant or having a pregnant partner, and being age 25 to 34 were significantly associated with previous testing. In the analysis of previous CVCT indicators among couples, living in Southern Province or the Copperbelt city of Chingola, being concordant negative (both partners HIV-negative), and cohabitating for longer than 3 months were the strongest predictors of previous CVCT. Previous individual testing and previous CVCT also significantly increased over time from 2008 to 2012.

Conclusion: To address disparities in previous individual HIV testing and previous CVCT, services should be better targeted to men, the 45 and older age group, the 24 and younger age group, couples cohabitating less than 3 months, and couples living in Lusaka and the Copperbelt cities of Ndola, Kitwe, and Luanshya. In order to better understand predictors of previous testing, additional surveys could be administered to this cohort in order to determine the effect of unmeasured possible covariates such as education level, wealth, employment status, number of lifetime or current sexual partners, and condom use.

Table of Contents

CHAPTER I BACKGROUND...........................................................................................1

CHAPTER II PREDICTORS OF PREVIOUS TESTING AMONG COUPLES RECEIVING COUPLES

VOLUNTARY COUNSELING AND TESTING (CVCT) IN THREE REGIONS OF ZAMBIA.............10

Abstract..................................................................................................................10

Introduction.............................................................................................................11

Methods..................................................................................................................13

Results....................................................................................................................16

Discussion...............................................................................................................22

References...............................................................................................................27

Tables......................................................................................................................34

Table 1. Characteristics of Zambian couple cohort by region ...........................................34

Table 2. Percentage of men and women in the Zambian cohort reporting prior HIV testing

and percentage of couples in the Zambian cohort reporting prior joint testing....................35

Table 3. Unadjusted bivariate models and adjusted multivariate model of prevalence ratios (PR)

and odds ratios (OR) with 95% confidence intervals (CI) for individual analysis of predictors

of having previously been tested for HIV.......................................................................36

Table 4. Unadjusted bivariate models and adjusted multivariate models of prevalence ratios (PR)

and odds ratios (OR) with 95% confidence intervals (CI) for couple analysis of predictors of the

dichotomous outcome of having previously been tested together as a couple for HIV...........38

CHAPTER III SUMMARY, PUBLIC HEALTH IMPLICATIONS, AND FUTURE DIRECTIONS..............................................................................................................40

About this Master's Thesis

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School	Rollins School of Public Health
Department	Epidemiology
Degree	MSPH
Submission	Master's Thesis
Language	English
Research Field	Health Sciences, Epidemiology
Keyword	HIV Zambia Couples Counseling and Testing (CVCT) Previous HIV testing
Committee Chair / Thesis Advisor	Allen, Susan A, Emory University
Partnering Agencies	Emory University schools, faculty or affiliated programs

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