Integration of Couples' Voluntary HIV Counseling and Testing Into Antenatal Care Services in Lusaka, Zambia

Abstract Background The majority of new HIV infections in sub-Saharan Africa are acquired from a spouse. In Zambia, one in ten couples has different HIV results. Couples’ HIV Counseling and Testing (CHCT) decreases annual transmission rates within discordant couples by an estimated two-thirds. CVCT has particular importance for Prevention of Mother to Child Transmission of HIV programs by preventing HIV transmission from: (1) HIV+ male partners to HIV- pregnant woman (especially during pregnancy); (2) HIV+ pregnant women to HIV- male partners and; (3) HIV+ pregnant woman to newborns. While the Zambian Ministry of Health is highly supportive of integrating CVCT with antenatal care (ANC) services, less than 2% of pregnant women were tested with their partners in Lusaka and Ndola government clinics in 2010. Methods In addition to offering CVCT over the weekend at Lusaka government clinics, in April 2011, the Zambia Emory HIV Research project (ZEHRP) began implementing CVCT during the week as a service integrated with ANC in one Lusaka clinic. Through community promotion and fast tracking of clients attending ANC as a couple, this clinic established a social norm for husbands to attend the first antenatal visit with their partner. All willing couples underwent the entire HIV counseling and testing process together as a couple. Results & Conclusion From April to December 2011, 1345 pregnant women were tested with their partners at Kanyama Clinic. Of these couples, 1117 (64%) were concordant negative, 81 (7%) concordant positive, 80 (6%) discordant with the male as the index partner (M+/F-) and 59 (4%) discordant with the female as the index partner (M-/F+). CVCT in ANC has proven to be an effective strategy in identifying pregnant women at high risk of transmitting HIV to their infants, even if they are not HIV+ themselves.