Technical Assistance Needs for Successful Implementation of Couples HIV Testing and Counseling (CHTC) Intervention for Male Couples at US HIV Testing Sites.

The African couples HIV testing and counseling (CHTC) model, which focuses on heterosexual couples, was adapted for same-sex male couples in the US. This paper presents the results of a follow-up survey conducted with representatives of the agencies that received CHTC training. The paper aims to understand the post-training implementation and identify critical technical assistance gaps. There are clear needs for continual learning opportunities, focused on the key skills required for CHTC, and for resources aimed at tackling agency-level concerns about service provision and integration. Central to this is the need for implementation science research that can identify the messages that are effective in encouraging couples to utilize CHTC and test models of service integration.

Universal voluntary HIV testing in antenatal care settings: a review of the contribution of provider-initiated testing & counselling.

OBJECTIVE: To assess the contribution of provider-initiated testing and counselling (PITC) to achieving universal testing of pregnant women and, from available data on components of PITC, assess whether PITC adoption adheres to pre-test information, post-test counselling procedures and linkage to treatment. METHODS: Systematic review of published literature. Findings were collated and data extracted on HIV testing uptake before and after the adoption of a PITC model. Data on pre- and post-test counselling uptake and linkage to anti-retrovirals, where available, were also extracted. RESULTS: Ten eligible studies were identified. Pre-intervention testing uptake ranged from 5.5% to 78.7%. Following PITC introduction, testing uptake increased by a range of 9.9% to 65.6%, with testing uptake ≥85% in eight studies. Where reported, pre-test information was provided to between 91.5% and 100% and post-test counselling to between 82% and 99.8% of pregnant women. Linkage to ARVs for prevention of mother to child transmission (PMTCT) was reported in five studies and ranged from 53.7% to 77.2%. Where reported, PITC was considered acceptable by ANC attendees. CONCLUSION: Our review provides evidence that the adoption of PITC within ANC can facilitate progress towards universal voluntary testing of pregnant women. This is necessary to increase the coverage of PMTCT services and facilitate access to treatment and prevention interventions. We found some evidence that PITC adoption does not undermine processes inherent to good conduct of testing, with high levels of pre-test information and post-test counselling, and two studies suggesting that PITC is acceptable to ANC attendees.

Re-Testing and Seroconversion Among HIV Testing and Counseling Clients in Lesotho.

HIV testing and counseling (HTC) is an essential component of comprehensive HIV programs. Retrospective HTC program data from 2006 to 2010 were examined to determine patterns of re-testing and seroconversion in Lesotho. Among 104,662 initially negative clients, 6,777 (6.5%) were re-testers. Predictors of re-testing included being male, age ≥ 25 years, divorced/separated, having more than a high school education, being tested as a couple, testing in the year 2006, testing in the capital city, and awareness of partner's recent testing behavior. Among re-testers who seroconverted (N = 259), predictors included being female and having less than a high school education. There is a critical need for more effectively targeting HIV retesting messages to align with WHO (2010) guidelines and identify persons at highest risk for HIV, to increase timely diagnoses and link persons to appropriate HIV prevention, care, and treatment services.

Do Men who have Sex with Men (MSM) in the United States Understand that HIV Serodiscordance is Possible?

BACKGROUND: Little is currently known about the extent to which US MSM understand the possibility that a long-term sex partner can have an HIV status different than one's own status. This information is important in the adaptation of Couples Voluntary HIV Counseling and Testing (CVCT) for US MSM. METHODS: 428 US MSM completed an online survey using MySpace.com from March-April, 2009. RESULTS: Of 426 MSM with complete data, 21.1% (90) were not definitively aware that serodiscordance is possible. Factors associated with a lack of understanding that serodiscordance is possible were: never having tested for HIV (OR: 2.0; CI: 1.1, 3.8), compared to testing 0-6 months previously and having a high school education or less (OR: 2.2; CI: 1.1, 4.5), compared to men who had completed at least some college. CONCLUSIONS: A large proportion of young, internet-using MSM in the United States may not understand that HIV serodiscordance is possible within sexual partnerships. Based on these results, we recommend that CVCT provided to male couples in the United States should include education on HIV serodiscordance.

Increasing access to HIV counseling and testing through mobile services in Kenya: strategies, utilization, and cost-effectiveness.

INTRODUCTION: This study compares client volume, demographics, testing results, and costs of 3 "mobile" HIV counseling and testing (HCT) approaches with existing "stand-alone" HCT in Kenya. A retrospective cohort of 62,173 individuals receiving HCT between May 2005 and April 2006 was analyzed. Mobile HCT approaches assessed were community-site mobile HCT, semimobile container HCT, and fully mobile truck HCT. Data were obtained from project monitoring data, project accounts, and personnel interviews. RESULTS: Mobile HCT reported a higher proportion of clients with no prior HIV test than stand-alone (88% vs. 58%). Stand-alone HCT reported a higher proportion of couples than mobile HCT (18% vs. 2%) and a higher proportion of discordant couples (12% vs. 4%). The incremental cost-effectiveness of adding mobile HCT to stand-alone services was $14.91 per client tested (vs. $26.75 for stand-alone HCT); $16.58 per previously untested client (vs. $43.69 for stand-alone HCT); and $157.21 per HIV-positive individual identified (vs. $189.14 for stand-alone HCT). CONCLUSIONS: Adding mobile HCT to existing stand-alone HCT seems to be a cost-effective approach for expanding HCT coverage for reaching different target populations, including women and young people, and for identifying persons with newly diagnosed HIV infection for referral to treatment and care.