RAPID HIV TESTING AND COUNSELING FOR VOLUNTARY TESTING CENTERS IN AFRICA

Objective: Voluntary HIV testing and counseling (VTC) has been shown t o reduce the incidence of HIV in cohabiting couples who now represent the majority of new infections in many African cities. Community and c lient perceptions of a 1-day voluntary testing and counseling program in Lusaka, Zambia, were assessed, and a rapid HIV-testing algorithm wa s evaluated for VTC centers. Methods and design: Between May 1995 and June 1996, outreach workers distributed written invitations door to do or. The 1-day program was held 6 days/week including weekends. Transpo rt, child care and lunch were provided. Community and client surveys f ollowed in July 1996. Results: Over 3500 couples married for a median of 4-5 years requested resting: 23% were HIV+/+, 57% were HIV-/- and 2 0% were discordant with one HIV+ and one HIV-partner. Sixty-eight per cent of couples surveyed had made the decision to be tested before att ending the 1-day program and 80% had not previously known where to obt ain 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%) p referred to receive their results the same day. Clients at another cen ter who waited 10 days for their results reported more fear, and 19 ou t 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 9 0% of those who were invited but did not attend. Sensitivity and speci ficity of the rapid lest algorithm were both 99.4% in this setting. Co nclusions: Active promotion of voluntary HIV testing and counseling in couples is needed to reduce the spread of HIV in high-prevalence area s. The use of rapid, on-site HIV testing allows clients to receive res ult-specific counseling in a single visit. Ongoing quality control of a subset of samples at an outside laboratory is essential.