Open Access Highly Accessed Research article

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

Susan Allen12*, Etienne Karita1, Elwyn Chomba13, David L Roth4, Joseph Telfair5, Isaac Zulu1, Leslie Clark6, Nzali Kancheya1, Martha Conkling12, Rob Stephenson2, Brigitte Bekan1, Katherine Kimbrell17, Steven Dunham1, Faith Henderson12, Moses Sinkala8, Michel Carael9 and Alan Haworth1103

Author Affiliations

1 The Rwanda-Zambia HIV Research Group, 1520 Clifton Road, Emory University, Atlanta, GA 30322, USA

2 Hubert Department of Global Health, Rollins School of Public Health, Emory University, 1518 Clifton Road, Atlanta, GA 30322, USA

3 University Teaching Hospital, Lusaka, Zambia

4 Department of Biostatistics, School of Public Health, University of Alabama at Birmingham, 1530 3rd Ave S., Birmingham, AL 35294-0022, USA

5 Department of Public Health Education, University of North Carolina at Greensboro, 437 HHP Building, Greensboro, NC 27402-6170, USA

6 Department of Pediatrics, School of Medicine, University of Southern California, 4650 Sunset Blvd., CHLA MS 30, Los Angeles, CA 90027, USA

7 School of Medicine, Harvard University, 25 Shattuck Street, Boston, MA 02115, USA

8 Lusaka Urban District Health Management Team, Makishi Road, PO Box 50827, Lusaka, Zambia

9 Monitoring and Evaluation Unit, UNAIDS, 20 Avenue Appia, CH-1211 Geneva 27, Switzerland

10 Counseling Services Unit, Ministry of Health, PO Box 30205, Lusaka, Zambia

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BMC Public Health 2007, 7:349  doi:10.1186/1471-2458-7-349

Published: 11 December 2007



Most new HIV infections in Africa are acquired from cohabiting heterosexual partners. Couples' Voluntary Counselling and Testing (CVCT) is an effective prevention strategy for this group. We present our experience with a community-based program for the promotion of CVCT in Kigali, Rwanda and Lusaka, Zambia.


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.