Rapid HIV testing and counseling for voluntary testing centers in Africa

Abstract

Objective: Voluntary HIV testing and counseling (VTC) has been shown to reduce the incidence of HIV in cohabiting couples who now represent the majority of new infections in many African cities. Community and client perceptions of a 1-day voluntary testing and counseling program in Lusaka, Zambia, were assessed, and a rapid HIV-testing algorithm was evaluated for VTC centers.

Methods and design: Between May 1995 and June 1996, outreach workers distributed written invitations door to door. The 1-day program was held 6 days/week including weekends. Transport, child care and lunch were provided. Community and client surveys followed in July 1996.

Results: Over 3500 couples married for a median of 4-5 years requested testing: 23% were HIV+/+, 57% were HIV-/- and 20% were discordant with one HIV+ and one HIV- partner. Sixty-eight per cent of couples surveyed had made the decision to be tested before attending the 1-day program and 80% had not previously known where to obtain HIV testing. Knowledge that couples could show discordant results rose from 29 before to 88% after pretest counseling. Clients reported high levels of satisfaction with the services and 90 out of 99 (92%) preferred to receive their results the same day. Clients at another center who waited 10 days for their results reported more fear, and 19 out of 31 (61%) would have preferred to get their results the same day. Over 99% of those who attended the program thought active promotion of voluntary HIV testing in the community was a positive thing, as did 90% of those who were invited but did not attend. Sensitivity and specificity of the rapid test algorithm were both 99.4% in this setting.

Conclusions: Active promotion of voluntary HIV testing and counseling in couples is needed to reduce the spread of HIV in high-prevalence areas. The use of rapid, on-site HIV testing allows clients to receive result-specific counseling in a single visit. Ongoing quality control of a subset of samples at an outside laboratory is essential.

PIP: Voluntary, confidential HIV testing and counseling centers (VTCs) are becoming increasingly popular in African cities with high HIV prevalence. This strategy is especially effective among HIV-discordant couples. During a 12-month period during 1995-96, community outreach workers distributed written invitations to attend a VTC in Lusaka, Zambia, in which couples would receive testing and result-specific counseling in a single visit; transportation, child care, and lunch were offered. Over 3500 couples, one-third of those invited, responded to the invitation and underwent rapid HIV testing. The Dipstick HIV-1 + 2 rapid test was used for screening and the Capillus HIV-1/HIV-2 rapid test was employed for confirmation. Both partners were HIV-positive in 23% of cases and both were HIV-negative in 57%; in the remaining 20% of couples, 1 partner was HIV-positive and the other was uninfected. 68% of participating couples had decided to seek HIV testing before receiving notice of the VTC, but 80% of them did not know where to obtain such services. Couples who attended the VTC that offered same-day test results reported substantially less fear than those who had to wait 10 days for their results. 99% of those who participated in the program thought active community promotion of VTC was desirable, as did 90% of those who were invited but did not attend. The rapid test algorithm had both a sensitivity and specificity of 99.4%. Continued retesting of a subset of samples at an outside laboratory remains essential, however. This intervention is associated with an estimated cost of US $84 per HIV infection prevented.