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Predictors of First Follow-up HIV Testing for Couples' Voluntary HIV Counseling and Testing in Ndola, Zambia

Czaicki, Nancy L. MSPH*; Davitte, Jonathan MPH*; Siangonya, Bella MPH*; Kastner, Randee MPH*; Ahmed, Nurilign MPH*; Khu, Naw Htee MPH*; Kuo, Wan Hsuan MPH*; Abdallah, Joseph MPH*; Wall, Kristin M. PhD*,†; Tichacek, Amanda MPH*; Inambao, Mubiana MD, MPH*; Simpungwe, Kakungu MD, MPH*; Pulerwitz, Julie ScD; Thior, Ibou MD, MS; Allen, Susan MD, MPH*

JAIDS Journal of Acquired Immune Deficiency Syndromes: May 1st, 2014 - Volume 66 - Issue 1 - p e1–e7
doi: 10.1097/QAI.0000000000000076
Implementation and Operational Research: Epidemiology and Prevention
IOR articles

Introduction: We describe predictors of first follow-up testing for concordant negative and discordant couples seeking joint voluntary HIV counseling and testing in Ndola, Zambia, where cohabiting couples account for an estimated two-thirds of incident HIV infections.

Methods: Demographic and serostatus data were collected from couples' voluntary HIV testing and counseling and follow-up testing services implemented in government clinics. We calculated follow-up testing rates by serostatus and compared rates before and after the introduction of a Good Health Package (GHP).

Results: The follow-up testing rate from May 2011 to December 2012 was 12.2% for concordant negative (M−F−) couples and 24.5% for discordant (M+F− or M−F+) couples. Significant predictors of follow-up testing in multivariate analyses included increasing age of the man [adjusted odds ratio (aOR) = 1.02 per year] and the woman (aOR = 1.02 per year), and either partner being HIV+ (aOR = 2.57 for HIV+ man, aOR = 1.89 for HIV+ woman). The man (aOR = 1.29) and the couple (aOR = 1.22) having been previously tested for HIV were predictive of follow-up testing among concordant negative couples. Introduction of a GHP increased follow-up testing among discordant (aOR = 2.93) and concordant negative (aOR = 2.06) couples.

Conclusions: A low-cost GHP, including prevention, screening, and treatment for common causes of morbidity and mortality resulted in increased follow-up testing rates among HIV discordant and concordant negative couples. Overall follow-up testing rates remain low, and efforts to increase these rates are necessary to ensure linkage to combination prevention, reduce HIV transmission within couples, and identify seroconversions promptly. Further investigation of low-cost sustainable incentives and other factors influencing follow-up HIV testing for couples is needed.

*Rwanda Zambia HIV Research Group, Department of Pathology and Laboratory Medicine, School of Medicine, Emory University, Atlanta, GA;

Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA; and

HIV/AIDS Tuberculosis Global Program, Program for Appropriate Technology in Health (PATH), Washington, DC.

Correspondence to: Nancy L. Czaicki, MSPH, Rwanda Zambia HIV Research Group, Department of Pathology and Laboratory Medicine, School of Medicine, Emory University, 101 Woodruff Circle, Suite 7300, Atlanta, GA 30322 (e-mail:

Supported by PATH Arise Program through funding from the Canadian International Development Agency (CIDA). Additional funding was provided by the US National Institute of Mental Health (R01 MH095503-01), the AIDS International Training and Research Program Fogarty International Center (3D43TW001042411), the Emory Center for AIDS Research (P30 AI050409), The Rollins School of Public Health Global Field Experience program at, Emory University, and the International AIDS Vaccine Initiative (EA040113).

The authors have no conflicts of interest to disclose.

The views expressed by the authors do not necessarily reflect the views of PATH, the Canadian Government, or CIDA.

Received November 21, 2013

Accepted November 21, 2013

© 2014 by Lippincott Williams & Wilkins