The couples counseling and testing services were well received, with 3,414, couples attending in Kitwe and 4,274 in Ndola during the two -year study period. Before the centers opened, no couples counseling and testing services were available in either city.
Of the couples who came to the centers, 2,409 (71 percent) in Kitwe and 3,212 (75 percent) in Ndola decided to be tested. Only 52 (less than 1 percent) of the couples who were tested had one or both partners with an indeterminate HIV status. Staff members followed up with these couples to clarify their status, but we did not include them in any of our analyses that involved HIV status.
HIV And Syphilis Test Results
Overall, 3,513 of the couples in our study were concordant negative for HIV and 1,209 were concordant positive. The remaining 847 couples were discordant (). Kitwe couples were less likely than Ndola couples to have discordant results (p = 0.0002). And concordant Kitwe couples were more likely to have both partners test HIV-negative (p = 0.0001). The proportion of couples that were concordant positive was virtually the same in both cities (p = 0.1595).
Tested Couples’ HIV And Syphilis Results
Syphilis test results were available for 5,613 couples—the 5,569 whose HIV test results we analyzed and 44 of the 52 couples with indeterminate HIV test results. As with HIV, couples from Kitwe were more likely than couples from Ndola to be concordant negative for syphilis (p < 0.0001). Kitwe couples were also less likely to be concordant positive for syphilis (p < 0.0001). The proportion of discordant couples was nearly identical in both cities (p = 0.2).
Demographic Characteristics And The Effects Of Promotion
shows the relationship between demographic characteristics of couples and their decision to be tested. In analyses that do not control for other variables (the unadjusted odds ratios), couples with one or both partners who were older were more likely to choose to test than those who were younger. And couples who had been together longer and those who had more children were more likely to be tested than newer couples and those with fewer or no children, respectively. After adjusting for the other variables, men’s age was the only variable that was significantly associated with a decision to be tested. Exposure to different promotional strategies was not significantly associated with the decision and thus is not included in .
Demographic Characteristics Of Couples And The Decision To Be Tested
However, the most frequently reported promotion strategy was the use of influence agents, mentioned by 6,157 (80 percent) of the couples who came to the centers (). The other – strategies—including radio programs, billboards, drama group performances, and stakeholder referrals—were mentioned by 2,250 (29 percent) of the couples. On average, each of the 505 influence agents invited 67 couples for HIV testing. Of those 33,835 invited couples, 18 percent came to one of the counseling and testing centers.
Exposure To Promotional Strategies Reported By Couples Who Came To A Testing Center
Couples who were invited by influence agents but had no exposure to other promotional strategies were less likely to choose to be tested than couples who had been exposed to other strategies but were not invited by agents (p < 0.0001). Nevertheless, influence agents were responsible for the largest number of couples who received HIV testing at the centers. In addition, distinct peaks in the number of couples arriving at the centers with invitations from influence agents corresponded to the training of new agent cohorts. This suggests that each influence agent had a limited period of productivity, after which they had exhausted their sphere of influence.
The second most commonly reported promotion strategy was radio programming, cited by 24 percent of couples in Kitwe. In Ndola, radio was cited by 29 percent of couples, ranging from 10 percent after the first broadcast to over 60 percent following the program’s second airing. About 10 percent of the couples who went to the Kitwe center reported seeing a billboard about the counseling and testing program. Just 1 percent of Kitwe couples said they had learned about the program by a drama group presentation.
Demographic Characteristics And HIV Status
The relationship between couples’ demographic characteristics and HIV status is shown in . Compared to those younger in age, couples with one or both partners who were older were more likely to be concordant negative than to have one or both partners HIV-positive. Couples in which the woman was pregnant were also more likely to be concordant negative than having one or both partners HIV-positive.
Demographic Characteristics And HIV Status Of Couples
After controlling for other variables, not being pregnant remained significantly associated with both partners’ being HIV-negative. The man’s age remained significantly associated with couples’ being concordant, but not with their having one partner who was HIV-positive. Compared to couples who had been together for a shorter period of time, couples who had been together for a longer period of time were less likely to have partners with discordant HIV status than to have partners with concordant HIV status (concordant positive or concordant negative), (adjusted odds ratio 0.47 ; p < 0.001; data not shown).