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Influence network effectiveness in promoting couples HIV voluntary counseling and testing in Kigali, Rwanda

Wall, Kristina; Karita, Etienneb; Nizam, Azharc; Bekan, Brigitted; Sardar, Gurkirand; Casanova, Deborahd; Joseph Davey, Davorad; De Clercq, Freyad; Kestelyn, Evelynd; Bayingana, Rogerd; Tichacek, Amandae; Allen, Susane

doi: 10.1097/QAD.0b013e32834dc593
Epidemiology and Social

Objective: To identify predictors of promotion of couples’ HIV voluntary counseling and testing (CVCT) in Kigali, Rwanda.

Design: Analysis of CVCT promotional agent [influential network leaders (INLs), influential network agents (INAs)], and couple/invitation-level predictors of CVCT uptake.

Methods: Number of invitations and couples tested were evaluated by INL, INA, and couple/contextual factors. Multivariable logistic regression accounting for two-level clustering analyzed factors predictive of couples’ testing.

Results: Twenty-six INLs recruited and mentored 118 INAs who delivered 24 991 invitations. 4513 couples sought CVCT services after invitation. INAs distributed an average of 212 invitations resulting in an average of 38 couples tested/agent. Characteristics predictive of CVCT in multivariate analyses included the invitee and INA being socially acquainted [adjusted odds ratio (aOR) = 1.4; 95% confidence interval (CI) 1.2–1.6]; invitations delivered after public endorsement (aOR = 1.3; 95% CI 1.1–1.5); and presence of a mobile testing unit (aOR = 1.4; 95% CI 1.0–2.0). In stratified analyses, predictors significant among cohabiting couples included invitation delivery to the couple (aOR = 1.2; 95% CI 1.0–1.4) and in the home (aOR = 1.3; 95% CI 1.1–1.4), whereas among noncohabiting couples, predictors included invitations given by unemployed INAs (aOR = 1.7; 95% CI 1.1–2.7). Cohabiting couples with older men were more likely to test, whereas younger age was associated with testing among men in noncohabiting unions.

Conclusions: Invitations distributed by influential people were successful in prompting couples to seek joint HIV testing, particularly if the invitation was given in the home to someone known to the INA and accompanied by a public endorsement of CVCT. Mobile units also increased the number of couples tested. Country-specific strategies to promote CVCT programs are needed to reduce HIV transmission among those at highest risk for HIV in sub-Saharan Africa.

aDepartment of Epidemiology, Rollins School of Public Health (RSPH), Emory University, Atlanta, Georgia, USA

bProject San Francisco (PSF), Kigali, Rwanda; Rwanda Zambia HIV Research Group (RZHRG), Department of Pathology and Laboratory Medicine, School of Medicine (SOM), Emory University

cDepartment of Biostatistics and Bioinformatics, Hubert Department of Global Health, Rollins School of Public Health (RSPH), Emory University


eRZHRG, Department of Pathology & Laboratory Medicine, SOM and RZHRG, Hubert Department of Global Health, RSPH, Emory University, Atlanta, Georgia, USA.

Correspondence to Kristin M. Wall, Department of Epidemiology, Rollins School of Public Health, Emory University, 1518 Clifton Road NE, 3rd Floor, Atlanta, GA 30322, USA. Tel: +1 512 785 4779; e-mail:

Received 21 March, 2011

Revised 16 September, 2011

Accepted 3 October, 2011

© 2012 Lippincott Williams & Wilkins, Inc.