Promotion of couples' voluntary counselling and testing for HIV through influential networks in two African capital cities

Influence Network Agents (INAs) from the health, religious, non-governmental, and private sectors were trained to invite couples for CVCT. Predictors of successful promotion were identified using a multi-level hierarchical analysis.In 4 months, 9,900 invitations were distributed by 61 INAs, with 1,411 (14.3%) couples requesting CVCT. INAs in Rwanda distributed fewer invitations (2,680 vs. 7,220) and had higher response rates (26.9% vs. 9.6%), than INAs in Zambia. Context of the invitation event, including a discreet location such as the INA's home (OR 3.3–3.4), delivery of the invitation to both partners in the couple (OR 1.6–1.7) or to someone known to the INA (OR 1.7–1.8), and use of public endorsement (OR 1.7–1.8) were stronger predictors of success than INA or couple-level characteristics.Predictors of successful CVCT promotion included strategies that can be easily implemented in Africa. As new resources become available for Africans with HIV, CVCT should be broadly implemented as a point of entry for prevention, care and support.In 2006 more than 65% of the 4.3 million new cases of HIV occurred in Sub-Saharan Africa [1]. In this region, most transmission is heterosexual, occurring predominately between cohabiting partners [2]. Among pregnant women tested with their partners in antenatal clinics in Lusaka, the capital of Zambia, 19% of couples had two HIV+ partners ("concordant +") and 17% had one HIV+ and one HIV- partner ("discordant"). In Kigali, the capital of Rwanda, 8% of couples were concordant + and 9% were discordant [3]. These results are similar to those reported in couples' voluntary HIV counselling and testing (CVCT) centres [4-7], cluster sampling surveys [8], and to those reported for couples in neighbouring Kenya and Tanzania [9].Cohabiting couples in Africa now represent the world's largest HIV risk group [10,11]. VCT is a cost-effective method of reducing HIV transmission [12-14] and traditional clinic-based services have recently expanded to