Evolution of Couples Voluntary Counseling and Testing for HIV in Rwanda: From Research to Public Health Practice

September 2016 - Combination Prevention

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Karita, E., Nsanzimana, S., Nsanzimana, F., et al. Journal of Acquired Immune Deficiency Syndromes (2016), e-publication ahead of print, doi: 10.1097/QAI.0000000000001138.

This paper described the approaches Rwanda used to achieve 88–90 percent testing among married couples between ages 25–29. Over 90 percent of new infections are among couples who live together. In 1998, a research team introduced HIV testing to women, many of whom also requested it for their spouses. Follow-up data showed that HIV infection rates were twice as high among women whose partners had not been tested. Initial challenges with disclosure inspired development of procedures for couples pre- and post-test counseling. In 1999, the model was scaled up to antenatal care (ANC) clinics. Trained community leaders promoted couples testing, and 41,852 couples were tested from 2003–2008. By 2008, after a country-wide initiative for prevention of mother-to-child transmission in which community health workers promoted couples testing during home visits, 78 percent of male partners had tested at ANC clinics. In 2009, new national guidelines called for joint couples testing and counseling with shared disclosure. Initial findings indicated that counselors needed further training on joint counseling, as well as adapted data collection tools and procedures. As of 2012, more than 400 health facilities were offering couples HIV testing, with 84 percent of pregnant women’s husbands accepting testing. The authors concluded that programs should emphasize couples counseling, given its potential for risk reduction. 

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