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Meta-Analysis
. 2012 Sep 12;2012(9):CD001224.
doi: 10.1002/14651858.CD001224.pub4.

Voluntary counseling and testing (VCT) for changing HIV-related risk behavior in developing countries

Virginia A Fonner  1 , Julie Denison, Caitlin E Kennedy, Kevin O'Reilly, Michael Sweat
Affiliations
Meta-Analysis

Voluntary counseling and testing (VCT) for changing HIV-related risk behavior in developing countries

Virginia A Fonner et al. Cochrane Database Syst Rev. .

Abstract

Background: Voluntary counseling and testing (VCT) continues to play a critical role in HIV prevention, care and treatment. In recent years, different modalities of VCT have been implemented, including clinic-, mobile- and home-based testing and counseling. This review assesses the effects of all VCT types on HIV-related risk behaviors in low- and middle-income countries.

Objectives: The primary objective of this review is to systematically review the literature examining the efficacy of VCT in changing HIV-related risk behaviors in developing countries across various populations.

Search methods: Five electronic databases - PubMed, Excerpta Medica Database (EMBASE), PsycINFO, Sociological Abstracts, and the Cumulative Index to Nursing and Allied Health Literature (CINAHL) - were searched using predetermined key words and phrases. Hand-searching was conducted in four key journals including AIDS, AIDS and Behavior, AIDS Education and Prevention, and AIDS Care; the tables of contents of these four journals during the included time period were individually screened for relevant articles. The reference lists of all articles included in the review were screened to identify any additional studies; this process was iterated until no additional articles were found.

Selection criteria: To be included in the review, eligible studies had to meet the following inclusion criteria: 1) Take place in a low- or middle-income country as defined by the World Bank, 2) Published in a peer-reviewed journal between January 1, 1990 and July 6, 2010, 3) Involve client-initiated VCT, including pre-test counseling, HIV-testing, and post-test counseling, and 4) Use a pre/post or multi-arm design that compares individuals before and after receiving VCT or individuals who received VCT to those who did not, and 5) Report results pertaining to behavioral, psychological, biological, or social HIV-related outcomes.

Data collection and analysis: All citations were initially screened and all relevant citations were independently screened by two reviewers to assess eligibility. For all included studies data were extracted by two team members working independently using a standardized form. Differences were resolved through consensus or discussion with the study coordinator when necessary. Study rigor was assessed using an eight point quality score and through the Cochrane Collaboration's Risk of Bias Assessment Tool. Outcomes comparable across studies, including condom use and number of sex partners, were meta-analyzed using random effects models. With respect to both meta-analyses, data were included from multi-arm studies and from pre/post studies if adequate data were provided. Other outcomes, including HIV-incidence, STI incidence/prevalence, and positive and negative life events were synthesized qualitatively. For meta-analysis, all outcomes were converted to the standard metric of the odds ratio. If an outcome could not be converted to an odds ratio, the study was excluded from analysis.

Main results: An initial search yielded 2808 citations. After excluding studies failing to meet the inclusion criteria, 19 were deemed eligible for inclusion. Of these studies, two presented duplicate data and were removed. The remaining 17 studies were included in the qualitative synthesis and 8 studies were meta-analyzed. Twelve studies offered clinic-based VCT, 3 were employment-based, 1 involved mobile VCT, and 1 provided home-based VCT. In meta-analysis, the odds of reporting increased number of sexual partners were reduced when comparing participants who received VCT to those who did not, unadjusted random effects pooled OR= 0.69 (95% CI: 0.53-0.90, p=0.007). When stratified by serostatus, these results only remained significant for those who tested HIV-positive. There was an insignificant increase in the odds of condom use/protected sex among participants who received VCT compared to those who did not, unadjusted random effects pooled OR=1.39 (95% CI: 0.97-1.99, p=0.076). When stratified by HIV status, this effect became significant among HIV-positive participants, random effects pooled OR= 3.24 (95% CI: 2.29-4.58, p<0.001).

Authors' conclusions: These findings add to growing evidence that VCT can change HIV-related sexual risk behaviors thereby reducing HIV-related risk, and confirming its importance as an HIV prevention strategy. To maximize the effectiveness of VCT, more studies should be conducted to understand which modalities and counseling strategies produce significant reductions in risky behaviors and lead to the greatest uptake of VCT.

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Conflict of interest statement

None declared.

Figures

1
1
Study flow diagram.
2
2
Funnel Plot for Condom Use:A plot of effect estimates (log odds ratios) against their standard errors
3
3
Funnel Plot for Number of Sex Partners: A plot of effect estimates (log odds ratios) against their standard errors
4
4
Meta‐analysis: Random effects model—Condom use/protected sex
5
5
Meta‐analysis: Random effects model—Number of sexual partners
See this image and copyright information in PMC

Update of

  • doi: 10.1002/14651858.CD001224.pub3

References

References to studies included in this review

Allen 2003 {published data only}
    1. Allen, S, J. Meinzen‐Derr, et al. Sexual behavior of HIV discordant couples after HIV counseling and testing. AIDS 2003;15(5):733‐740. - PubMed
Arthur 2007 {published data only}
    1. Arthur, G, V. Nduba, et al. Behaviour change in clients of health centre‐based voluntary HIV counselling and testing services in Kenya. Sex Transm Infect 2007;83(7):541‐546. - PMC - PubMed
Bakari 2000 {published data only}
    1. Bakari, J. P, S. McKenna, et al. Rapid voluntary testing and counseling for HIV. Acceptability and feasibility in Zambian antenatal care clinics. Ann N Y Acad Sci 2000;918:64‐76. - PubMed
Chen 2007 {published data only}
    1. Chen, H. T, S. Liang, et al. HIV voluntary counseling and testing among injection drug users in south China: a study of a non‐government organization based program. AIDS Behav 2007;11(5):778‐788. - PubMed
Corbett 2007 {published data only}
    1. Corbett, E. L, B. Makamure, et al. HIV incidence during a cluster‐randomized trial of two strategies providing voluntary counselling and testing at the workplace, Zimbabwe. AIDS 2007;21(4):483‐489. - PubMed
Cremin 2010 {published data only}
    1. Cremin, I, C. Nyamukapa, et al. Patterns of self‐reported behaviour change associated with receiving voluntary counselling and testing in a longitudinal study from Manicaland, Zimbabwe. AIDS Behav 2010;14(3):708‐715. - PMC - PubMed
Grinstead 2001 {published data only}
    1. Grinstead, O. A, S. E. Gregorich, et al. Positive and negative life events after counselling and testing: The Voluntary HIV‐1 Counselling and Testing Efficacy Study. AIDS 2001;15(8):1045‐1052. - PubMed
Kawichai 2004 {published data only}
    1. Kawichai, S, C. Beyrer, et al. HIV incidence and risk behaviours after voluntary HIV counselling and testing (VCT) among adults aged 19‐35 years living in peri‐urban communities around Chiang Mai city in northern Thailand, 1999. AIDS Care 2004;16(1):21‐35. - PubMed
Machekano 1998 {published data only}
    1. Machekano, R, W. McFarland, et al. Impact of HIV counselling and testing on HIV seroconversion and reported STD incidence among male factory workers in Harare, Zimbabwe. Cent Afr J Med 1998;44(4):98‐102. - PubMed
Matambo 2006 {published data only}
    1. Matambo, R, E. Dauya, et al. Voluntary counseling and testing by nurse counselors: what is the role of routine repeated testing after a negative result?. Clin Infect Dis 2006;42(4):569‐57. - PubMed
Matovu 2005 {published data only}
    1. Matovu, J. K, R. H. Gray, et al. Voluntary HIV counseling and testing acceptance, sexual risk behavior and HIV incidence in Rakai, Uganda. AIDS 2005;19(5): 503‐511. - PubMed
Mola 2006 {published data only}
    1. Mola, O. D, M. A. Mercer, et al. Condom use after voluntary counselling and testing in central Mozambique. Trop Med Int Health 2006;11(2):176‐181. - PubMed
Muller 1995 {published data only}
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Roth 2001 {published data only}
    1. Roth, D. L, K. E. Stewart, et al. Sexual practices of HIV discordant and concordant couples in Rwanda: Effects of a testing and counselling programme for men. International Journal of STD and AIDS 2001;12(3):181‐188. - PubMed
Samayoa 2010 {published data only}
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VCT Efficacy 2000 {published data only}
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Wu 2005 {published data only}
    1. Wu, Z, K. Rou, et al. Acceptability of HIV/AIDS counseling and testing among premarital couples in China. AIDS Educ Prev 2005;17(1):12‐21. - PubMed

References to studies excluded from this review

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