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Improving on a Successful Model for Promoting Couples VCT in Two African Capitals: Mobile Couples HIV Testing Units

The Rwanda-Zambia HIV Research Group:. Rwanda ZambiaD. Joseph, MPHE. Chomba, MDE. Karita, MD MSPHS. Dunham, MAF. KatanguilaA. Haworth, MDE. Shutes, MPHI. Zulu, MD MPH US/Europe S. Allen, MD MPH M. Carael, PHD L. Clark, PhD

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Improving on a Successful Model for Promoting Couples VCT in Two African Capitals: Mobile Couples HIV Testing Units

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    1. Improving on a Successful Model for Promoting Couples’ VCT in Two African Capitals: Mobile Couples’ HIV Testing Units XV International AIDS Conference Bangkok, Thailand July 13, 2004 Dvora Joseph, MPH Projet San Francisco, Rwanda-Zambia HIV Research Group, Emory University Rollins School of Public Health Kigali, Rwanda

    2. The Rwanda-Zambia HIV Research Group: Rwanda Zambia D. Joseph, MPH E. Chomba, MD E. Karita, MD MSPH S. Dunham, MA F. Katanguila A. Haworth, MD E. Shutes, MPH I. Zulu, MD MPH US/Europe S. Allen, MD MPH M. Carael, PHD L. Clark, PhD D. Roth, PhD J. Telfair, DrPH

    3. Background: Heterosexual Transmission of HIV in Africa Over 80% of HIV+ adults live in Sub-Saharan Africa. In 2003, more than 60% of the 5 million cases of HIV occurred in Sub-Saharan Africa. Cohabiting couples in Africa represent the world’s largest risk group for HIV. In 2003, more than 60% of the 5 million new cases of HIV occurred in Sub Saharan Africa. In this region, most transmission is heterosexual, occurring predominately between cohabiting partners* - making African couples the largest risk group for HIV in the world. * AIDS Epidemic Update: WHO; 2003. ISBN 92 9173 304 0 Trask SA, et al. Molecular Epidemiology of Human Immunodeficiency Virus Type I Transmission in Heterosexual Cohort of Discordant Couples in Zambia. J Virol. 2003; 76 (1): 397-405In 2003, more than 60% of the 5 million new cases of HIV occurred in Sub Saharan Africa. In this region, most transmission is heterosexual, occurring predominately between cohabiting partners* - making African couples the largest risk group for HIV in the world. * AIDS Epidemic Update: WHO; 2003. ISBN 92 9173 304 0 Trask SA, et al. Molecular Epidemiology of Human Immunodeficiency Virus Type I Transmission in Heterosexual Cohort of Discordant Couples in Zambia. J Virol. 2003; 76 (1): 397-405

    4. Couple HIV Statistics: Rwanda In Kigali, the capital of Rwanda, 8% of couples tested in antenatal clinics were concordant positive and 9% were discordant (2002)* In our center, Projet San Francisco in Kigali, almost 2800 couples were tested in 2003. Of these couples: 18% were discordant, 14% were concordant positive * World AIDS Foundation Dr. Susan Allen founded Projet San Francisco in 1986 with her research on the natural history of HIV/AIDS in Kigali, Rwanda. The project extended its research work to Zambia in 1994. In 1988 PSF began a study of sexually active women that showed the need for and effectiveness of Couples Voluntary Counseling and Testing (CVCT). In general research has found that: §         20-45% of couples in Sub Saharan Africa have one or both partners infected with HIV [IN RWANDA:] In Kigali, the capital of Rwanda, 8% of couples tested in antenatal clinics were concordant positive and 9% were discordant (2002). In our center, Projet San Francisco in Kigali we tested almost 2800 couples in 2003. Of these couples: 18% were discordant, 14% concordant positive (+/-2%). In the first 6 months of 2004, these percentages were roughly the same[ 13.5% were discordant and 11.3% concordant + (+/-2%; n=1802).] * It should be noted that these numbers are slightly higher than in the general population of Kigali, especially for discordant couples, because outside VCT sites refer discordant couples to our study. The World AIDS Foundation study was an unselected consecutive sample that is a better representation of the general population of Kigali. Dr. Susan Allen founded Projet San Francisco in 1986 with her research on the natural history of HIV/AIDS in Kigali, Rwanda. The project extended its research work to Zambia in 1994. In 1988 PSF began a study of sexually active women that showed the need for and effectiveness of Couples Voluntary Counseling and Testing (CVCT). In general research has found that: §         20-45% of couples in Sub Saharan Africa have one or both partners infected with HIV [IN RWANDA:] In Kigali, the capital of Rwanda, 8% of couples tested in antenatal clinics were concordant positive and 9% were discordant (2002). In our center, Projet San Francisco in Kigali we tested almost 2800 couples in 2003. Of these couples: 18% were discordant, 14% concordant positive (+/-2%). In the first 6 months of 2004, these percentages were roughly the same[ 13.5% were discordant and 11.3% concordant + (+/-2%; n=1802).] * It should be noted that these numbers are slightly higher than in the general population of Kigali, especially for discordant couples, because outside VCT sites refer discordant couples to our study. The World AIDS Foundation study was an unselected consecutive sample that is a better representation of the general population of Kigali.

    5. Couple HIV Statistics: Zambia In Lusaka, the capital of Zambia, 19% of pregnant women tested with their partners in antenatal clinics were concordant positive and 17% were discordant* * World AIDS Foundation [IN ZAMBIA:] In pregnant women tested with their partners in antenatal clinics in Lusaka, the capital of Zambia, 19% of couples were concordant positive and 17% were HIV discordant. These results are similar to those reported in other couples’ voluntary counseling and testing centers and cluster sampling surveys in neighboring Kenya and Tanzania. Iwanowski MR, Rwanda Zambia HIV Research Group. Couples’ VCT in ANC clinics: prevention of perinatal and heterosexual HIV transmission in Africa. Paper presented at: The 2nd IAS Conference on HIV Pathogenesis and Treatment; July, 2003; Paris, France ** McKenna SL, et al. Rapid HIV testing and counseling for VCT centers in Africa AIDS, 1997; 11  [IN ZAMBIA:] In pregnant women tested with their partners in antenatal clinics in Lusaka, the capital of Zambia, 19% of couples were concordant positive and 17% were HIV discordant. These results are similar to those reported in other couples’ voluntary counseling and testing centers and cluster sampling surveys in neighboring Kenya and Tanzania. Iwanowski MR, Rwanda Zambia HIV Research Group. Couples’ VCT in ANC clinics: prevention of perinatal and heterosexual HIV transmission in Africa. Paper presented at: The 2nd IAS Conference on HIV Pathogenesis and Treatment; July, 2003; Paris, France ** McKenna SL, et al. Rapid HIV testing and counseling for VCT centers in Africa AIDS, 1997; 11  

    6. Response: Couples Voluntary Counseling and Testing (CVCT)

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